Experiences of Women and Other Birthing People Who Make Non-Normative Choices in Childbearing: A Constructivist Grounded Theory

Madeley, Anna-Marie (2024). Experiences of Women and Other Birthing People Who Make Non-Normative Choices in Childbearing: A Constructivist Grounded Theory. PhD thesis The Open University.


The thesis aimed to explore why and how participants construct non-normative choices in the context of pregnancy and childbearing, alongside the underlying social processes participants navigate within UK maternity systems. Non-normative choices include outside-of-guideline care, declining routinely offered care and interventions or requesting care outside sociocultural norms. Such choices represent a critical test against which claims of women-centred care and authentic informed decision-making can be tested. To date, emphasis on empirical research in this area has primarily focussed on clinician-based understandings of supporting non-normative choices and women’s experiences of more extremely positioned, mostly intrapartum choices. These have often excluded service users’ voices within more nuanced choices across the childbearing continuum, situated firmly within consent, autonomy, and agency issues. By exploring these issues, the thesis will present a constructivist grounded theory exploring the social processes experienced by and affecting women’s experience in making non-normative choices, offering a substantive theory to explain how women’s reproductive identity shapes and informs non-normative choice-making. I present how non-normative choices represent a strategy by which, in the presence of institutional and systemic identity threat, reproductive identity is expressed, reinforced, or defended through common strategies, represented in the QuEEN model of common strategies for reproductive identity reinforcement and defence.

The thesis argues that contrary to choices being seen as ‘non-normative’ within contemporary maternity care, women view their choices as normative within their unique contexts and that a paradigm shift is required to reframe how non-normative choices are viewed. Rigid, risk-based systems of care designed to categorise women throughout their pregnancy journey work directly against aspirations for personalised care planning and frameworks of choice, reinforcing the urgent ongoing need for emphasis on personalised care within the UK maternity system to achieve equitable and safe perinatal outcomes in the presence of facilitative choice and relational care models.

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