Women’s Experiences With Maternity Care and Medical Discourse In Florence, Italy

Abstract

This dissertation is based on ethnographic research in Florence, Italy. The primary focus of this research is based on a comparison of medical discourse from Italian State documents with women’s experiences during pregnancy and childbirth in Italy. Mirroring trends throughout the developed world, Italy has maintained high rates of cesarean sections since the turn of the century. Italy’s unique political and cultural history has made Tuscany one of the best regions for maternity care within a country with significant regional variability. This dissertation looks at historical and current cultural trends to understand the ways in which women experience high-quality maternity care in Florence. This dissertation interrogates women’s experiences during pregnancy and childbirth through the theoretical lenses of political philosophy, agency and practice theory, and the medicalization of reproduction. This dissertation provides new avenues through which to draw connections between these three social theories. Medical discourse in the State documents demonstrates the ways in which women’s subjectivities and experiences are erased in an effort create a population upon which it is (theoretically) easier to enact interventions. Discourse ignores women’s agency in favor of implying that doctors and healthcare professionals are far more important actors in pregnancy and childbirth. But Italian women assert their own agency against medicalized birth through their reproductive socialities. By making connections with other mothers and midwives, women find support beyond medicalized models of maternity care. Local hospitals and healthcare clinics become sites that foster reproductive sociality. Women seek out care from healthcare professionals, primarily midwives, not due to their medical competence but due to their ability to create relationships with their patients. Midwives are part of what makes hospitals the ideal place for birth; a safe haven from the potential risk of birth. This idealization of birth, however, often gives way to less than desired care, demonstrating the fractures and inconsistencies in the way midwifery-based care is perceived. These fractures and inconsistencies are also seen in how women conceive of healthcare throughout the country. Women themselves simultaneously value and devalue their own socialities. Women’s discussion of the Italian healthcare system demonstrates how deep-seated ideologies of rationalist medical behaviors and stereotypes about the South. Women afford flexibility in departing from ideal modes of birth in their own decisions, but do not afford women the same flexibility in the South. Medicalized rhetoric seeps into deep seated beliefs about the South, demonstrating that women’s own positive experiences are not always valued as a means to achieving quality healthcare. Through analyzing the connection medical discourse and women’s reproductive sociality, I demonstrate the tenuousness with which experience is valued.