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Paradox of the institution: findings from a hospital labour ward ethnography

Newnham, Elizabeth C.; McKellar, Lois V.; Pincombe, Jan I.


Elizabeth C. Newnham

Jan I. Pincombe


Interest in the influence of culture on birth practices is on the rise, and with it comes a sense of urgency to implement practices that aid the normalisation and humanisation of birth. This groundswell is occurring despite a broader cultural milieu of escalating technology-use and medicalisation of birth across the globe. Against this background, rates of epidural analgesia use by women in labour are increasing, despite the risk of side effects. Socio-cultural norms and beliefs are likely to influence pain relief choices but there is currently scant research on this topic.

This study was undertaken to gain insight into the personal, social, cultural and institutional influences on women in deciding whether or not to use epidural analgesia in labour. The study had an ethnographic approach within a theoretical framework of Critical Medical Anthropology (CMA), Foucauldian and feminist theory. Given the nature of ethnographic research, it was assumed that using the subject of epidural analgesia to gain insight into Western birth practices could illuminate broader cultural ideals and that the epidural itself may not remain the focus of the research.

Findings from the study showed how institutional surveillance, symbolised by the Journey Board led to an institutional momentum that in its attempt to keep women safe actually introduced new areas of risk, a situation which we named the Paradox of the institution.

These findings, showing a risk/safety paradox at the centre of institutionalised birth, add a qualitative dimension to the growing number of quantitative studies asserting that acute medical settings can be detrimental to normal birth practices and outcomes.

Journal Article Type Article
Acceptance Date Dec 10, 2016
Online Publication Date Jan 3, 2017
Publication Date 2017-12
Deposit Date Sep 14, 2022
Publicly Available Date Jun 28, 2023
Journal BMC Pregnancy and Childbirth
Print ISSN 1471-2393
Publisher BMC
Peer Reviewed Peer Reviewed
Volume 17
Issue 1
Article Number 2
Public URL


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