Women's experiences of maternity care in rural Ontario: Do doctors matter?
This thesis is an investigation of maternity care in rural Ontario from the perspective of mothers. Its context is one of shrinking resources, in which physicians are frequently excluding obstetrics from their practices and rural physicians are increasingly scarce. Against this backdrop, the project set out to explore how physician scarcity, as well as the growing presence of registered midwives in Ontario, affects women's experiences of having children in rural parts of Ontario. A critical interpretive approach to research was employed, in which personal narratives are analyzed in their political contexts. Stories were gathered from 36 mothers in three case study sites. All sites offered some access to midwifery services, but differed according to the local availability of physicians delivering babies. Women's stories were supplemented and contextualized by input from 38 health care providers and community workers, as well as by health statistics. Findings are presented according to four themes. First, the importance and limitations of rurality as a determinant of health are discussed. Second, notions of expectations, satisfaction and informed choice in a rural context are explored. Third, the importance of providing relational care in maternity services is highlighted. Finally, features of a maternity care system designed with the needs of rural women in mind are outlined. This study contributes to current literature on rurality and women's health by incorporating formal and informal care into the investigation, by including midwives in the spectrum of formal maternity care providers, and by allowing women's voices and experiences to guide the analysis of rural obstetrics. It provides insights for scholars, policy makers, planners and citizens into women's health priorities, health care planning, rurality, sustainability and citizenship.