NARRATIVES IN ONLINE COMMUNITIES AND WOMEN'S DECISIONS ABOUT BIRTH ATTENDANTS AND BIRTH PLACE

PURPOSE: Many women use online communities to discuss their pregnancies and plans for childbirth. Stories shared within these groups may shape or reinforce opinions about birth place (home, hospital, birth center) and attendants (midwife, obstetrician, family physician, doula, no attendants). We sought to explore the relationship between online narratives and women's decisions about birth through two research questions: 1) How are different birth choices and their associated risks and benefits constructed in the narrative exchanges within different online communities? 2) Do women who make similar birthing decisions share psychosocial commonalities, such as Health Locus of Control, Behavioral Style, or Health Care System Distrust?

METHODS: We conducted: 1) a qualitative narrative analysis of forum posts in communities selected to represent a diverse range of opinions and choices and 2) an international cross-sectional online survey of 404 members of such communities, with purposeful recruitment and subsampling to ensure representation across all choices of birth place and attendants.

RESULTS: 1) Narratives describing different birth choices and experiences emphasize varying conceptions of risk and birth outcomes. In communities that reflect greater acceptance of standard medical practices, posts underscore dichotomous outcomes such as death versus health. In communities that promote out-of-hospital births and non-physician attendants, risks and benefits are discussed within a whole systems approach, incorporating factors such as morbidity, interventions, surveillance, continuous mother-baby contact, breastfeeding, physiologic pushing, and empowerment. 2) Choice of birth place yielded significant effects for Internal Health Locus of Control (HLOC-I) (F(391,3)=4.535, p=.004) and Health Care System Distrust (HCSD) (F(391,3)=3.605, p=.014). Women who chose home birth had higher HLOC-I and HCSD scores. Choice of birth attendants had significant effects for Powerful Others Health Locus of Control (HLOC-P) (F(391,4)=4.062, p=.003) and Health Care System Distrust (HCSD) (F(391,4)=2.907, p=.022). Women who planned births with obstetricians had higher HLOC-P and lower HCSD scores. Effects on Behavioral Style were not significant, nor were any interactions. Quantitative risk assessments differed significantly according to individuals' stated birth choices.

CONCLUSIONS: Online communities about pregnancy and birth promote values and choices according to the characteristics and beliefs of the membership. Pregnant women assess and evaluate the risks and benefits of childbirth practices in varying ways. Decision-making authority and knowledge are constructed differently in different communities.