Date of Award

December 2014

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Social Sciences


Hans Buechler


Birth, Childbirth, Epidural, History of Childbirth, Medical Ethnography, Nurse-Midwifery

Subject Categories

Social and Behavioral Sciences


This dissertation is a medical ethnography of a nurse-midwifery hospital-based maternity service in an urban American hospital. The research study incorporates on-site observation, interviews, and data collection. The recent transformation of American hospital childbirth is described. Epiduralized birth has become the norm, representing a standardization of the cascade of interventions so often referred to by critics of the system of hospital birth in the United States. The routine use of the epidural has led to a Gleichschaltung of birth where the centrality of the epidural makes necessary a unitary, complex, totalistic set of interventions all of which make up an entirety of interventions that cannot be separated from each other. The policy implications for this fundamental change in American birth are discussed. The history of childbirth and midwifery in the United States is also discussed as well as the culture of the profession of nurse-midwifery. The scientific literature regarding the physiology and ecology of birth, as well as the safety of medications used in epiduralized birth (particularly bupivacaine and pitocin) is analyzed. Finally, the closure of the maternity service observed throughout this ethnographic research is discussed in light of regionalization and centralization of childbirth.


Open Access