Les représentations sociales du système de santé de naissances : une analyse comparative de discours en termes de choix, de lieu et d'accompagnant

Authors: Trottier, Marie-Eve
Advisor: Tremblay, Marie-ClaudeWitteman, Holly
Abstract: Although most births in Canada and the United States occur in hospitals and are attended by physicians, 1% to 5% of births are planned outside hospitals. We aimed to understand how women who make different choices regarding birth place and birth attendant represent and (dis)trust maternity care systems. We conducted secondary analyses of online survey responses from concurrent mixed-methods. Participants (n=511) were pregnant or had recently given birth in Canada or the United States, and had planned or were planning either a hospital birth with an obstetrician (n=168), hospital birth with a family physician (n=46), hospital birth with a midwife (n=48), birth centre with a midwife (n=44), home birth with a midwife (n=138), unassisted homebirth (n=67). We conducted a thematic analysis of responses to four open-ended questions and examined associations between participants’ Healthcare System Distrust Scale (HCSD) scores and their birth choices via linear regression. We triangulated key themes and HCSD by birth choices to understand whether women’s views and their distrust of healthcare systems are associated with their choices of birth place and attendant. Healthcare services organization, like costs, access or legislation was a key influence of women’s decisions and trust of the healthcare system, as were different conceptualizations of safety. Social media also guided the decision by providing sources of information and personal experiences. Mean HCSD differed by birth choice (F(5,505)=34.8). Compared to women choosing a hospital birth with an obstetrician (mean HCSD 27.4), women who chose home birth with a midwife (mean HCSD 33.2) or unassisted birth (mean HCSD 37.6) demonstrated higher distrust. To conclude, women who chose a less medicalized birth showed more distrust in the healthcare system and social representations reflected that. Women’s social representations can help us identify women’s values and some structural, social and psychological barriers to healthcare system access
Document Type: Mémoire de maîtrise
Issue Date: 2019
Open Access Date: 26 June 2019
Permalink: http://hdl.handle.net/20.500.11794/35289
Grantor: Université Laval
Collection:Thèses et mémoires

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