Dimensions of patient control in a free-standing birth center.

This paper explores the phenomenon of patient control in a midwife-run free-standing birth center which emphasized natural, patient controlled childbirth. Specifically, it addresses the ability of patients to translate an incipient desire for control into controlling behavior in the patient care context. It is argued that prior research has tended to conceptualize patient control in rather straightforward and simple terms and, as a consequence of focusing principally upon the formal process of information exchange in the client-provider consultative context, has glossed over the process by which patient control and the differing meanings that it carries are influenced by the cultural and political contexts in which they are embedded. It was found that the meaning that patients attributed to their controlling role was structured by two major factors. The first of these was patient ambivalence about giving birth in an alternative and innovative practice form. This was overlaid with a second factor; political conflict between the birth center and its back-up hospital. The interaction of these two factors prompted women to construe their controlling role around dimensions of individual health maintenance and 'control of self' rather than control over decision making. This occurred despite the fact that the latter type of control was often emphasized by patients when elucidating their reasons for choosing the birth center. Some implications of casting control in terms of health maintenance and 'control of self' for patient experience are discussed.