Delivering Agency: Online Birth Stories in the US

Delivering Agency: Online Birth Stories in the US

Kathleen M. Hanlon-Lundberg, M.D.

Agency, the capacity to effect an outcome, is challenging to assess. Linguistic clues to agency may be identified by examining “loci of control”, a concept developed in social learning theory and applied to health care analysis, where perceived internal causality correlates to improved outcomes. Narrator satisfaction with birth events as reflected in positive and negative utterances in birth stories may also reflect demonstrated agency. This study examines linguistic markers of perceived loci of control, positive and negative utterances, and birth outcomes as indicators of maternal agency in labor and delivery as related through birth stories. First-person, on-line birth stories occurring between 2006 and 2016 within the US were analyzed for linguistic indicators of loci of control: the self, others (health care providers, husband, etc.) and chance (no perceived loci of control). Positive and negative emotive utterances were identified, tallied and combined, producing an emotive ratio (positive/negative) for each narrative. 30 birth stories were analyzed. All narrators indicated desire for vaginal delivery. During delivery, 17 women indicated “self” or “self with others” as loci of control, 11 indicated “others”, and 2 indicated “chance”. 15 birth stories contained positive, 4 neutral, and 11 negative emotive ratios. Positive emotive ratios were associated with “self” loci of control; negative emotive ratios were associated with “other” or “chance” loci of control. Outcomes consistent with a stated goal (vaginal delivery) support actualized agency. Overall, narrators experienced a significantly more vaginal deliveries than the US population (86.7% v 67.8%). “Self” loci of control and positive emotive ratios were associated with vaginal delivery. This suggests that women who perceive themselves as the loci of control express more positive emotive utterances and are more likely to experience vaginal delivery, enacting agency in labor and delivery. Conversely, cesarean delivery may be associated with “other” and “chance” loci of control and negative emotive ratios. Greater sample size is needed to confirm these trends.