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DATE DUE DATE DUE DATE DUE Q tfigLolotéZU 6 6/01 cJCIRC/DateDuepGS-p. 15 TELLING BIRTH STORIES OF TEEN MOTHERS: DISCOURSES OF POWER, AGENCY, AND SOCIAL CHANGE By Suzanne Marie Broetje A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Sociology 2003 ABSTRACT TELLING BIRTH STORIES OF TEEN MOTHERS: DISCOURSES OF POWER, AGENCY, AND SOCIAL CHANGE By Suzanne Marie Broetje The qualitative study upon which this dissertation is based asks three major questions: (1) what are teen mothers’ experiences with childbirth and how do they differ by race/ethnicity; (2) how do the broader social, medical, and political discourses of teen childbearing in the United States shape the stories that teen mothers tell about their birth experiences; and (3) what does the way teens tell their birth stories teach us about motherhood and structures of social control and social change? This dissertation employs an actor-oriented approach to explore how norms of gender, age, and race/ethnicity shape teen mothers’ stories of childbirth. It is based on in- depth interviews with nineteen White and Hispanic teen mothers who participated in a teen parenting program in “Green County,” Oregon,” as well as eleven individuals who interacted with teen mothers in varying capacities (e.g., male partners, parents, and service providers). Story-telling provided the basic methodology for data collection. I approached stories from three points of view: as social interactions between individuals with varying degrees of power; as social processes of accommodation and resistance to master narratives; and as a means of identity formation. My role as researcher was central to this process, as I interacted with teen mothers and shaped the stories told. The findings of this study focus on three stages of the birth process: pregnancy; preparations for childbirth; and birth and the transition to parenting. In the analysis, I explore teen mothers’ accommodation and resistance to master narratives of childbirth and parenting as they struggled to prove their competence, responsibility, and identity as “good mothers.” A number of theoretical and policy implications are raised in the findings, particularly regarding research on agency, power, and identity. While many teen mothers engaged dominant discourses of “natural childbirth” in an effort to prove their own strength and competence as mothers, they rejected formal sources of information as “common sense,” challenged the care they received from healthcare providers, relied on familial support and/or their own past childcare experience, and approached labor and delivery as largely disembodied individuals. ACKNOWLEDGEMENTS A great many people deserve special acknowledgement for the support and guidance I received while working on this project over the last four years. Without each and every one of them, I fear I still would be working, and the amazing stories offered up for this dissertation would remain untold. First, I wish to thank my advisor, Rita Gallin, for her unending inspiration, support, and editing skills. She not only spent endless hours critiquing my work, but has been an invaluable source of strength, dedication, and encouragement throughout my years of exploration, backtracking, and bouncing between countries, topics, and multiple drafts. Her unwavering presence sparked my determination to finish this project, and she will always be a source of inspiration to me as both a mentor and a friend. Second, I thank all the people of “Green County,” Oregon, who collaborated with me on this project. I thank the director and caseworkers of Teen Parenting Services for generously offering their assistance to me in contacting teen mothers for participation in this study. In that vein, a very special thanks is owed to all nineteen teen mothers who opened their homes and families to me and shared personal stories of their lives. They are the heart and passion of this project, and I am forever grateful to them. I also thank the adult parents and professionals who met with me and shared their insights. Their dedication and service to young parents is both appreciated and admired. Third, I thank the Graduate School at Michigan State University for granting me an Incentive Fellowship to partially fimd this project. It came just before the birth of my smallest research assistant, Maya, and served to get this project off the ground. iv Finally, I thank my family for their multiple years of support. I thank my parents and siblings who offered words of admiration during those crucial times of self-doubt and burn-out, and who graciously blurred the lines between work and family to enable me to focus on my dissertation and “finally graduate.” I thank mi hijitas, Asha and Maya, who gave up play-time and story-time so that I could work. They tried diligently to not take it personally when I locked myself in my room with papers and the computer. Their short lives have been consumed by this project and I look forward to being more present to them, in both mind and spirit. Most of all, I thank my husband, Roger, who has been my life support and greatest advocate. He and Asha played double-time with Maya on those days when I could not be present. Patience may now be Roger’s greatest virtue afier enduring untold hours of waiting for me to finish, and of listening to me as I tried to articulate my thoughts and put them on paper. Together all of us have worked to complete this proj ect—through story-telling, listening, question-asking, inspiration, and support. I have learned a great deal during these last few years and hope that the stories told in these pages touch others as much as they have touched me. May the women whose lives are shared here grow to be strong and respected citizens of the world. And may we as readers of their life stories grow and change with them. TABLE OF CONTENTS LIST OF TABLES AND FIGURES ................................................... x CHAPTER ONE INTRODUCTION..................... ...................................................................... 1 Statement of Purpose .................................................................................. 2 Conceptual Framework .............................................................................. 4 Agency and Power ......................................................................... 5 Identity and the “Other” ................................................................. 8 Defining Childbirth ........................................................................ 12 Summary .................................................................. 14 Research Setting and Methodology ............................................................ l4 Story-Telling .................................................................................. 16 Analysis of Findings ....................................................................... 17 Outline of Dissertation ............................................................................... 19 CHAPTER TWO REVIEW OF LITERATURE ................................................................................. 21 Women’s Experiences with Pregnancy and Childbirth .............................. 22 The Medicalization of Childbirth ................................................. 23 Disembodiment of Female Sexuality ............................................ 30 Summary ............................................................... 34 Social Context of Teen Childbearing ......................................................... 36 Master Narratives of Childbirth ..................................................... 37 Medical Model ................................................................... 37 Natural Childbirth Model ................................................... 41 Old Wives’ Tales ................................................................ 42 Master Narratives of Parenting ................................................ 45 Teen Childbearing as a Moral Crisis .................................. 46 Teen Childbearing as a Culture of Poverty ........................ 51 Summary .................................................................................................... 56 CHAPTER THREE DESIGN AND METHODOLOGY ....................................................................... 58 Research Setting ......................................................................................... 58 vi Green County, Oregon ................................................... Teen Parenting Services ................................................. Sample Size and Selection ......................................................................... Teen Parents ................................................................................... Race/Ethnicity .................................................................... Age ..................................................................................... Social Class ........................................................................ Summary. . .. . ................................................................. Adults ............................................................................................. Healthcare Providers .......................................................... Social Service Providers .................................................... Parents of Teen Parents ...................................................... Consent ....................................................................................................... Data Collection ........................................................................................... Interviews with Teen Mothers ........................................................ Interviews with Teen Fathers ......................................................... Interviews with Adults ................................................................... My Role as Researcher ................................................................... Story-Telling as Methodology ................................................................... Social Interactions .......................................................................... Mater Narratives and Untold Stories ............................................. Identity Formation .......................................................................... Summary ........................................................................................ Analysis of Data: Grounded Theory .......................................................... Summary ........................................................................... CHAPTER FOUR PREGNANCY: “IT’S MY RESPONSIBILITY”....................................... .. Sociopolitical Context of Pregnancy in Green County ....................... Oregon Adolescent Pregnancy Prevention Action Agenda. . . . . Implementation of the Action Agenda in Green County ........... The Use of Birth Control ......................................................... Relationships with Parents ............................................. Relationships with Partners ............................................. Past Experience with Unprotected Sex ................................ No Reason ............................................................... Summary .................................................................. Confirming the Pregnancy ...................................................... vii 59 60 63 64 68 70 71 73 74 74 76 76 78 80 81 84 85 87 90 90 95 99 100 101 103 105 106 107 108 112 114 119 121 125 126 128 Summary ........................................................................... 211 CHAPTER SEVEN CONCLUSIONS ........................................................................... 213 Overview of the Study ............................................................ 213 Discussion of Findings ............................................................ 215 Pregnancy: “It’s My Responsibility” .................................. 215 Preparations for Childbirth: “It’s Common Sense” .................. 218 Birth and Parenting: “Reading Stories Isn’t Enough ................ 220 Generalizability .................................................................... 223 Sample Size and Selection .............................................. 223 My Role as Researcher .................................................. 225 Theoretical Implications .......................................................... 228 Master Narratives of Childbirth ........................................ 230 Master Narratives of Parenting ......................................... 231 Policy Implications ................................................................ 233 APPENDIX A: LETTERS OF INTRODUCTION TO TEEN MOTHERS ...... 236 APPENDIX B: CONSENT FORMS FOR TEEN MOTHERS ..................... 239 APPENDIX C: LETTER OF INTRODUCTION TO ADULT PARENTS ....... 241 APPENDIX D: DEMOGRAPHIC SURVEY ......................................... 243 APPENDIX E: INTERVIEW SCHEDULE FOR TEEN PARENTS .............. 244 APPENDIX F: INTERVIEW SCHEDULE FOR ADULTS ........................ 246 APPENDIX G: BIRTH STORY OF “HALEY” ....................................... 247 APPENDIX H: BIRTH STORY OF “MARIA” ....................................... 255 BIBLIOGRAPHY .......................................................................... 261 Table 3.1 3.2 3.3 4.1 5.1 5.2 6.1 Figure 6.1 LIST OF TABLES AND FIGURES Selected Characteristics of Teen Mothers in Green County by Age, 1998-2000 ........................................................................................................... 62 Selected Characteristics of Sample by Race/Ethnicity, 2001.. .......................... 69 Age of Teen Mothers by Age of Partners, 2001 ..................................... 71 Teen Mother’s Use ofBirth Control by Race/Ethnicity, 2001 . 113 Birth Plan by Race/Ethnicity ........................................................... 149 Sources ofInformation by Race/Ethnicity, 2001 . 157 Women’s Birth Outcomes by Race/Ethnicity ........................................ 184 Interpretations of Birth Outcome ................................................... 186 CHAPTER ONE INTRODUCTION Teen childbearing has been a central issue in public discourse in the United States since the 1970s (Luker 1996; Nathanson 1991).1 Many changes have taken place in American society involving sexuality, parenthood, marriage, work, gender roles, and the larger economy (Luker 1996:11). Teen mothers increasingly have been portrayed as the “nexus of most major social ills” (Kelly 1996:422), including poverty, school dropout, welfare dependency, single motherhood, child abuse and neglect, juvenile delinquency, and moral collapse (Books 1996; Irvine 1994; Luker 1996; Males 1996; Maynard 1996; Musick 1993; Rains, Davies, and McKinnon 1998). By 1985, a survey conducted by Louis Harris Associates for Planned Parenthood Federation of America reported that 84 percent of adults over age eighteen considered births to teens to be a “serious problem” (Horowitz 1995:31), a view that persists to this day. Although a wealth of literature on teen childbearing exists (see Brubaker 1999; Higginson 1998; Luker 1996; Thompson 1995), Constance Nathanson (1991 :4) contends that the focus has largely been that of “classic social problem analysis: Who does it? Why do they do it? How can we get them to stop?” This “correctional perspective” (Rains, Davies, and McKinnon 1998), which predominates in both public and social scientific discourse, frames teen childbearing as a “social problem” and focuses debates on causes, consequences, trends, and remedies. The result is a relatively limited and negative view of teen childbearing in the United States today. While many studies have emerged about ’ In 1975, Senator Edward Kennedy stated that “(1) pregnancy among adolescents is a serious and growing problem; (2) such pregnancies are a leading cause of school dropout, familial disruption and increasing dependency on welfare and other community resources” (Luker 1996:71). teen mothers, very little research has focused on the experiences of teen mothers themselves, thus reinforcing the gap between insider and outsider views (Phoenix 1991; Rains, Davies, and McKinnon 1998). Moreover, most research has focused on teen pregnancy and parenting, while almost no attention has been given to the experiences of teen mothers during childbirth (see Brubaker 1999; Low 2001; Thompson 1995). This dissertation explores how norms of gender, age, race/ethnicity, and social class shaped teen mothers’ stories of childbirth. It is based on in-depth interviews with nineteen White and Hispanic teen mothers in Oregon, as well as eleven individuals who interacted with teen mothers in varying capacities (e. g., partners, parents, and service providers). While my focus was on how teen mothers experienced childbirth, I also considered the multiple voices involved in the story-telling process and how master narratives of childbirth and parenting shaped interpretations of their experiences. Their stories varied in important ways by race/ethnicity, particularly regarding preparations for childbirth and interactions with family members and service providers. I conclude that an analysis of the birth stories of teen mothers offers important insights into relationships of power, agency, and social control. In a complex struggle of both accommodation and resistance to norms of childbirth and parenting, the teen mothers in this study presented themselves as competent and responsible. Their stories ask us to re-evaluate how children are parented in this country, regardless of age, race/ethnicity, or social class. Statement of Purpose Recognizing the limited scope of research on teen childbearing to date, the study upon which this dissertation is based asked three major questions. 1. What are teen mothers’ experiences with childbirth2 and how do they differ by race/ethnicity? 3 2. How do the broader social, medical, and political discourses of teen childbearing in the United States shape the stories that teen mothers tell about their childbirth experiences? 3. What does the way teens tell their birth stories teach us about motherhood and structures of social control and social change? Exploring the birth stories told to me by teen mothers, this dissertation offers insights into their own perspectives on childbirth—circumstances surrounding their pregnancies and preparations for childbirth as well as relationships shaping their childbirth experiences and the transition to motherhood. Throughout my analysis, I consider the ways in which teen mothers confi'onted dominant stigrnas of teen parenting in the telling of their own birth stories, particularly as they differed by race/ethnicity. Two types of master narratives are central to this study: narratives regarding dominant models of childbirth; and narratives of parenting. Together these narratives work to shape relationships, identities, behaviors, beliefs, and outcomes for birthing women. In the United States, the majority of babies are birthed according to the medical model of childbirth. Women comply with the authority of hospital policies, nurses, and doctors to assure the health of the baby because they believe that modern technologies make hospitals the safest place to give birth (Martin and Low 1999:21). Similarly, parenthood is defined in terms of age, marital status, education, and economic status. 2 I define childbirth broadly in this study, to encompass pregnancy, labor and delivery, and the transition to parenthood. See page 12 of this chapter for a more detailed discussion. Although information on age and social class was collected, these identities are not analyzed in this study. All of the teen mothers I interviewed were low-income, and their stories did not differ significantly by age. Women who are older, married, financially stable, and educated are assumed to be better mothers than those who are young, single, and poor (Luker 1996:16). Both of these master narratives imply very narrow interpretations of identities, viewing women in monolithic categories that leave little room for agency and diversity. Individuals who challenge dominant norms of childbirth and parenting—those who reject technological control and intervention, or those who are young, low-income, or poorly educated—are labeled as irresponsible, dangerous, incompetent, and/or ill-prepared to be parents (see Martin and Low 1999). Teen mothers engaged these master narratives in complex ways. Indeed, while all of the women I interviewed chose to give birth in hospitals, they criticized their treatment by doctors and nurses, interpreted many technological interventions as dangerous and/or misused, and dismissed childbirth classes as “common sense.” Moreover, while they confirmed negative stereotypes of teen mothers as immature and irresponsible, they actively differentiated themselves from “other mothers”—both teenage and adult—in an effort to expose the complexities of parenthood and prove themselves “good mothers.” It is these struggles which are discussed in the following pages as I explore how young women, differentiated by race/ethnicity, told stories about becoming and being teen mothers within specific social and political contexts. Conceptual Framework In this dissertation, I employ an actor-oriented approach to explore the ways in which teen mothers interpreted their experiences with childbirth and the transition to parenting. Much anthropological and sociological literature contains discussion of actor- oriented research—particularly phenomenology and symbolic interactionism (see Long 1992:21). The essence of an actor-oriented approach is that its concepts are grounded in the everyday life experiences of women and men (Long 1992:5). Such an approach places actors at center stage and recognizes the multiple realities and diverse social practices of various actors engaged in larger social relationships and structures. An actor-oriented approach provides a useful framework for exploring how various actors come together at one moment in time to tell stories of childbirth—teen mothers, fi'iends, family members, male partners, neighbors, politicians, media representatives, social service providers, community members, and me, the researcher. This approach highlights important concepts of agency and power, identity and social context, social control and social change, and thus creates a complex picture of how teen mothers interact in a larger social context and come to tell the stories that they do. Agency and Power Norman Long (1992:21) contends that one advantage of actor-oriented research is that it begins with an interest in explaining differential responses to similar structural circumstances, even if the conditions are relatively homogeneous. From this perspective, the differential patterns that arise are seen to be, in part, the creation of actors themselves. Individual choices, however, are continuously shaped by larger frames of meaning and action, and by the distribution of power and resources in the wider arena. Many studies (Giddens 1984; Long 1992; Scott 1985; Torres 1992) explore the central role of agency and power in the complex social processes by which actors interact with others and construct identities. In this literature, social actors are not simply seen as disembodied social categories (based on age, race, ethnicity, class, or other classificatory criteria), but active participants who process information and strategize in their dealings with other actors and outside institutions. The different patterns of social organization that emerge result fi'om the interactions, negotiations, and social struggles that take place between the several kinds of actors. Norman Long (1992222) contends that the notion of agency attributes to the individual actor the capacity to process social experience and to devise ways of coping with life, even under the most extreme forms of coercion. Actor-oriented research thus assumes that social actors are knowledgeable and capable in their attempt to solve problems, monitor continuously their own actions, and observe how others react to their behavior (see also Giddens 1984). “All forms of external intervention necessarily enter the existing life-worlds of the individuals and social groups affected, and in this way are mediated and transformed by these same actors and structures.” To the extent that larger social forces do alter the life-chances and behaviors of individuals, they can only do so by shaping the everyday life experience and perceptions of the individuals concerned (see also Scott 1985). Actors always face some alternative ways of formulating their objectives, deploying specific modes of action and giving reasons for their behavior. While some interpretations prevail over those of others, and the circumstances encountered are not simply of their own choosing, actors actively engage in the construction of their own social worlds. In this actor-oriented approach, agency cannot simply be equated with decision- making capacities. Effective agency requires organizing capacities—the ability to influence others and manipulate a network of actors who become partially enrolled in the project at hand, getting them to accept particular frames of meaning, and winning them over to particular points of view. Thus agency also implies relationships of power, in which social actors endeavor to win the struggles that take place over the attribution of specific social meanings to particular events, actions, and ideas. Power is exercised in complex ways. According to Long (1992:24), the battle to define meanings is never over since “all actors exercise some kind of ‘power,’ even those in highly subordinate positions.” Thus building on an analysis of social processes of struggle and compromise, an actor-oriented approach simultaneously reveals the “weaknesses of the powerfirl and the power of the weak, who are, whether by consent or coercion, at least part of the power relationship” (Torres 1992:110). In turn, a dynamic approach to the understanding of social change emerges—one that recognizes the central role played by human action and consciousness (Long 1992:20). In this study, I explore concepts of agency, power, and social change in two ways. First, I consider the ways in which teen mothers actively participated in the construction of their own social worlds by accommodating dominant stereotypes of teen parents while simultaneously struggling to differentiate and prove themselves “good mothers.” Second, I highlight teen mothers’ efforts to engage me, as researcher, in the re-construction of their identities by confronting negative stereotypes and seeking social change. In their birth stories, teen mothers struggled to justify their decisions and relationships and demonstrate their own agency in the birth process. Boyfi‘iends, parents, peers, and service provides figured prominently in the way that stories were told. Concepts of intentionality, competence, preparedness, and experience were highlighted in discussions of who was in control, or who or what was to blame for particular events and outcomes. My own role in the story-telling process was also central to the way in which birth stories were told. 4 As the researcher, I influenced the story-telling process, not only through the questions I asked, but through my access to power and authoritative knowledge regarding childbirth and parenting. Many of the teen mothers who participated in this study had a larger agenda in mind than just sharing their stories with me. Aware of the negative stigmas placed on teen mothers, both locally and nationally, they struggled to emphasize their own experience, responsibility, and competence as “good mothers.” They told their stories to me with the hope that I would use these stories to challenge public perceptions and negative stereotypes of teen mothers. Acknowledging their own silence and disempowerment, they told a particular version of their stories that focused on the possibilities of social change. Identity and the “Other” An actor-oriented approach also considers concepts of identity and social structure. As mentioned earlier, my study sought to highlight specific identities of race/ethnicity as they shaped teen mothers experiences with childbirth and parenting. I further considered intersecting norms of gender, age, social class, and parenting as they influenced personal and public perceptions of what it meant to be a “good mother.” Notions of agency and power, difference and solidarity, revolved around these identities and norms in complex ways as they defined specific social contexts and shaped the lives of individuals. Teen mothers engaged these dominant norms and identities in their efforts to interpret their experiences and create positive identities of themselves. ’ My role as researcher will be discussed in more detail in Chapter Three: Design and Methodology, as well in the conclusions in Chapter Seven. Like agency and power, identities of gender, age, race/ethnicity and social class are socially constructed and produced relationally (Anderson 2000; Rubin 1975). As Louise Larnphere and her colleagues (l997:4) note, “[t]hese relations are now understood to be constituted within a cultural, economic, and political system that is also historically situated.” Whether we are talking about volatile political issues like abortion, new reproductive technologies, or teen pregnancy, “notions about sex, gender, and the proper relationship between gendered/sexed and racialized individuals are all part of powerful cultural constructions that shape human interaction” (Larnphere, Ragone, and Zavella 1997z4). Actors engage these cultural constructions in the process of shaping their own identity and agency. Far fiom institutionalized and structurally determined, these identities and constructions are multiple and fluid. Recent discussions on identity (Collins 1990; Davies 1994; hooks 1984; Parpart 1993) emphasize the need to deconstruct totalizing theories that resort to linear, hierarchical, and binary ways of thinking. A “politics of difference” has emerged within sociological discourse (Torres 1991; Young 1990:307), emphasizing multiple identities, solidarities, and global diversity among women and men. Recognizing that multiple identities must be addressed from a position which seeks to integrate gender, etlmicity, social class, sexuality, and language, Lourdes Torres (1991 :283) concludes that “it is not the differences between women that separates them, but the fear of recognizing difference, naming it, and understanding that we have been programmed to respond to difference with fear and loathing.” Postmodern analyses of discourse and language explore the role of difference in the construction of knowledge and power. Maintaining that dominant meanings are often created through comparison with an “other” which then defines both itself and the dominant reality (Parpart 1993:440), discourse is considered as both an instrument and an effect of power. The notion that women have long been created and defined as “other” by men has been argued and explored by feminists for many years (Parpart 1993:443). Simone de Beauvoir (1952) was among the first to challenge male definitions of woman and conclude that women must be the subject rather than the object (other) of analysis. This initial feminist concern with woman as “other” emanated largely from White Western middle-class women and ignored the possibility of difference among women themselves. By the 19803, a number of Third World feminists accused Western scholars of creating Third World women as an undifferentiated “other,” oppressed by both gender and Third World underdevelopment (Mohanty 1991; Ong 1988). Drawing on the work of Donna Haraway (1991:183), much of this literature now contends that identities and subjectivities are a matter of local positioning, or “situated knowledges,” where knowledge is always partial but also embedded in the differing visions of active subjects. In my study, I considered the birth stories of teen mothers as “situated knowledges.” In telling their stories to me, teen mothers explored their economic, familial, and educational backgrounds; they emphasized their past experiences with childcare; and they described support systems upon which they drew in preparation for childbirth and parenting. While they explored their interactions with a variety of people during labor and delivery, they interpreted those relationships fi'om their own social location and with the end goal of proving themselves “good mothers.” In the process of collecting these birth stories, I also considered my own knowledge as partial and situated. While I shared common identities with the teen mothers in this study, we 10 differed in important ways, particularly regarding age, race/ethnicity, and social class. These shared and competing identities influenced the telling of stories in important ways, particularly in terms of the kinds of information teen mothers chose to share with me and the kinds of information that I deemed relevant. The concept of “other” was particularly salient in many of my discussions with teen mothers—how they differed fi'om other teen mothers, how they were similar to other adult mothers, how they were treated by other community members, other Hispanics, other non-parenting teens. Age and motherhood were at the heart of much of this discourse. Kristin Luker (1996: 16) argues that three major strands in the current discussions about teen pregnancy and parenting have deep roots in US. history. These have to do with (1) who is “too young” to have a baby, (2) childbearing by unmarried women, and (3) the levels of education and income that make women and men “ready" to have a baby. Mothers are defined by the convergence of these factors—“good” mothers are mature, married, educated, and financial stable. Teen mothers are stigmatized as “too young,” unmarried, uneducated, and poor. In her study with teen mothers, Joanna Higginson (1998: 135) identified a culture of “competitive parenting.” In an effort to cast off the public stigma of teen mothers as welfare-dependent, abusive, and incompetent, the teen mothers who Hi gginson interviewed worked hard to prove these images wrong through the provision of material possessions, the physical and cognitive development of their children, their knowledge of parenting, and their care and leniency in comparison with other parents (Higginson 1998: 135). I explored similar findings in my study, as teen mothers described their responsibility, preparedness, and competence as mothers, and challenged what it meant to 11 be a “good mother.” Their narratives were complicated by differences of race/ethnicity. Agency was explored in terms of how they conceptualized identity in comparison to “other mothers.” Aware of being the “other” themselves, teen mothers struggled to create identities of meaning and purpose by challenging master narratives of parenting and making their voices heard. Amira Proweller (1998) borrows the concept of “borderlands” fi'om Gloria Anzaldua (1987) to describe the “active repositioning of identities” in the context of structural dominance where discourses of race, ethnicity, gender, and social class presume an undifferentiated culture (Proweller 1998: 14). In her work with high school women, Proweller (1998: 14) found that because identities are not unitary and static, changing in relationship to the contexts in which individuals find themselves participating, individuals actively decenter class, race, and gender locations as they work at becoming somebody. Teen mothers who participated in my study reflected this process of becoming somebody in several ways. Through their stories of becoming mothers, they highlighted the complicated nature of pregnancy, childbirth, and parenting. Challenging the tendency to equate teen parenting with bad parenting, they exposed the ways in which other, older parents were similar to, or worse off than, themselves. Defining Childbirth While the focus of my study was on teen mothers’ experiences with childbirth, my definition of childbirth was broad. I drew on Robbie Davis-Floyd’s (1992) definition of childbirth because it enabled me to view childbirth as a process rather than an event— a process incorporating a whole spectrum of identities, events, choices, and outcomes. 12 In Birth as an American Rite of Passage, Davis-Floyd (1992) approaches childbirth as a year-long rite of passage for the mother, involving pregnancy, childbirth, and the transition to parenthood. In the first phase, the newly pregnant woman gradually separates herself from her former social identity and accepts her pregnancy. The second phase, “pregnancy as transformation,” lasts fi'om the woman’s final acceptance of her pregnancy until three to six weeks after her baby’s birth. During this phase the pregnant woman fully experiences the cultural overlays on her physiological process of becoming a mother. Davis-Floyd describes these overlays as occurring in five separate domains— the personal, public, medical, formally educative, and peer group (1992:23). As a woman experiences such things as physical changes, medical check-ups, childbirth classes, and baby showers, she receives symbolic messages of what it means to be a mother. In the third phase, “birth as transformation,” Davis-Floyd (1992:38) finds a narrowing of the sets of symbols and meanings that our culture offers to pregnant women for interpreting their experiences. Now the core values and essential beliefs of society are communicated, first and foremost by the medical profession. Women submit to the authoritative knowledge of doctors and are managed by technology. The fourth phase, the immediate post-partum period, is filled with a whole spectrum of new emotions— relief, triumph, bewilderment, isolation, and exhaustion. The fifth, and final, integrative phase begins and ends gradually during the newbom’s first few months of life. I use this approach in my study in two ways: first, to explore the complicated process of identity formation and change as a woman goes through the various stages of pregnancy and childbirth; and second, to highlight the multiple “domains” (social contexts) in which this process takes place. In my interviews with teen mothers, each of 13 the domains outlined above were evident—the personal, public, medical, formally educative, and peer group domains. Although the message for many teen mothers was clear—that pregnancy and parenting were choices they would have to shoulder alone— they identified various ways in which their identities, behaviors, and choices actively engaged other actors and social structures. Their stories of childbirth were as much about those interactions as they were about themselves. Summgy The conceptual framework for this study draws on an actor-oriented approach to explore the ways in which birth stories of teen mothers reflect relationships of power, agency, and social control. Teen mothers are seen as active participants in the construction of their own social worlds. To the extent that they process information and strategize in their dealings with other actors and outside institutions, teen mothers exercise power and agency in their struggles to create positives identities for themselves. By comparing themselves to “others mothers,” both teenage and adult, teen mothers accommodate important power relationships in an effort to prove themselves “good mothers.” By engaging me in the story-telling process, they further challenge norms and stereotypes and thus identify possibilities for social change. Research Setting and Methodology The research for this study was carried out in “Green County,”5 Oregon, fi'om May-December 2001. In late 1999, I gave birth to my first child, moved to Green 5 All names of places and people in this study are pseudonyms to protect the anonymity of participants. 14 County, and began attending a “new mom’s group” at the local birthing center. As part of the initiation process, I was invited to tell my own birth story, which was a welcome opportunity as I had immensely enjoyed the experiences of being pregnant and giving birth. As an advocate of un-medicated, natural homebirths, I approached birth as a potentially life-changing and empowering process. It was also a time of personal healing for me, as I moved beyond a history of sexual abuse and learned to trust my body. As new mothers continued to join the group and tell their stories of birth, I began to hear a common birth story focused on several key themes: prenatal visits and birthing classes, medical management of labor, the day, time, and drama of delivery, and the size of the baby. Although my birth experience reflected a deeper connection to my body and was quite different from women who experienced medically-managed births, I followed a similar script in narrating my experiences to them. As I looked around the room, I realized most participants shared a similar identity with me—white, middle-class, married, stay-at-home moms, with an average age of about 30 years. Although the group originally had been designed to reach teen mothers in Green County, no teen mother ever attended. I began to wonder why we told the stories we did, what our stories conveyed, and why the birth stories of teen mothers were not told in this setting. For this study, I conducted thirty face-to-face interviews, including interviews with nineteen teen mothers, two teen fathers, four parents of teen mothers, three healthcare providers, and two social service providers. All of the teen mothers were contacted anonymously through a public teen parenting program in Green County, called Teen Parenting Services. The remaining interviews comprised a convenience sample of individuals who interact with teen parents in varying capacities. 15 The teen mothers’ ages ranged from 15-22 years old at the time of the study. On average, they were sixteen years old when they got pregnant, and they were interviewed anywhere from one week to three years after the birth of their child. Roughly two-thirds (n=12) of the women identified themselves as White and one-third (n=7) as Hispanic.’5 All of the teen mothers were low-income, relying on a mixture of income sources to meet their needs, including minimum wage jobs, public assistance, and/or parental support. Nearly one half of the teen mothers were living with their boyfriends or husbands (n=9) and one-third were living with their parents (n=6). The remaining women (n=4) lived alone as single mothers (two working fulltirne to support themselves and two on welfare). Stogy-Telling Story-telling provided the basic methodology for this study. Stories are used in qualitative research in a variety of ways to elicit information about individuals, groups, and society at large. Story-telling fits well within an actor-oriented approach by enabling individuals to explore their own identities, agency, and power. Stories draw on personal experience and cultural context, and involve a range of actors in the narrative process. I approached stories from three points of view: as social interactions between producers, coaxers, and consumers with varying degrees of power (Plummer 1995:21); as social processes of accommodation and resistance to master narratives (Romero and Stewart 1999); and as means of identity formation (Chasnoff 1996). Using stories in this '5 The majority of Hispanics in Oregon are of Mexican heritage, but many subgroups exist and vary by length of residence, language(s) spoken, economic status, and education. Similar variations exist among White Oregonians as well. Where appropriate, differences within groups are noted in the findings. Two Hispanic women were recent immigrants from Mexico and many spoke English as a second language. Despite these differences within racial/ethnic groups, differences between groups were more pronounced and, thus, are the focus of this study. 16 way enabled me to explore relationships of power and social control as they influenced teen mothers’ experiences with childbirth and how they articulated those experiences to me. It also enabled me to explore my own role in the story-telling process as I interacted with participants and represented an avenue for their voices to be heard. Recognizing that stories are told in context, this study explores the meaning behind the birth stories that are told, including relationships that shape the story-telling process and why these particular stories are told to me. Analjgis of Findings I used a grounded theory approach as the basis for data analysis. A grounded theory approach is a qualitative research method that uses a systematic set of procedures to develop an inductively derived theory about a phenomenon (Strauss and Corbin 1990:24). The purpose is to generate a theory closely related to the context of the phenomena being studied. This approach was useful for the purposes of this study, as it enabled the teen mothers to guide the direction of the stories as well as the concepts and organizing themes used to generate conclusions. My research on literature related to teen childbearing highlighted a public discourse of teen mothers as welfare dependent, irresponsible, immoral, and incompetent (Higginson 1998; Kelly 1996; Rains, Davies, and McKinnon 1998). Accidental pregnancies are commonly represented as the result of ignorant and irresponsible, if not immoral, sexual activity and contraceptive practices, while intended pregnancies are portrayed as misguided and fundamentally doomed attempts to solve other life problems at the eventual expense of the child (Rains, Davies, and McKinnon 1998:308). In 17 general, teen mothers are held to be inadequate mothers, lacking the maturity, child-care experience, and education necessary to care properly for their children] As mentioned earlier, teen mothers’ motivations for telling their birth stories to me varied, as did the details of their stories and the identities upon which they drew. Common messages were clear, particularly regarding the nature of parenting and how their experiences were shaped by differences of race/ethnicity. Emphasizing their own responsibility, preparedness, and competence as mothers, they articulated a clear opposition to adoption and abortion, childbirth classes, and parenting advice. Comparing themselves to other parents, both teenage and adult, they stressed the importance of common sense and experience and their resentment of being “treated like a kid.” More specifically, three-fourths of them indicated that they met with me in order to express pride and confidence in themselves as parents, thereby challenging dominant stigmas of them as irresponsible and incompetent. One-forth (n=5) told painful stories of partner abuse, medical malpractice, and social isolation—stories that focused on victimization but also a wish to be seen as something more than a victim. Although their goal was to present a positive view of themselves as mothers, their motivations were largely born out of negative experiences during childbirth and parenting, and these experiences varied in important ways by race/ethnicity. Hispanic women were more likely to focus on negative relationships with healthcare providers and lack of social/familial support during pregnancy and childbirth; White women were more likely to focus on their interactions as young parents, including discriminatory treatment by healthcare and social service providers and abusive relationships with partners. 7 This research is outlined in more detail in Chapter Two: Review of Literature. 18 Although many of these women accommodated dominant stignas of teen parents in order to prove themselves “one of the better ones,” their narratives also suggested the stignas may be wrong as they explored lack of access to services, discriminatory treatment, and controlling relationships. Overcoming a number of difficulties in their lives—broken homes, poverty, lack of education, emotional and sexual abuse——they were optimistic about their role as parents and struggled to communicate that through their stories. Ultimately, the birth stories told by teen mothers in this study highlighted the way in which dominant stereotypes simultaneously pushed them to be better parents than other parents and placed them in confrontational relationships with those who had more power than they did. As they struggled to both accommodate and resist master narratives of childbirth and parenting, teen mothers conveyed stories that were at once optimistic and desperate, empowered and exploited. My findings suggest that while the intent of social, medical, and political discourses of teen childbearing in the United States may be about social control—to communicate and maintain dominant values regarding childbirth and parenting, punish young women who violate those values, and/or make them an example to others at risk of doing the same—teen mothers challenged those structures and discourses, demonstrated the complex nature of parenting as it intersected with norms of gender, age, and race/ ethnicity, and exposed master narratives that ignored the agency of young women as sexual partners, students, and new parents. Outline of Dissertation In Real Birth, Robin Greene (2000:iix) states that “birthing stories are stories about our children and about what really happens in childbirth, yes. But even more, they 19 are stories about ourselves, stories about becoming ourselves.” The birth stories told by teen mothers in this study were indeed stories about becoming themselves. They were told in the context of power relationships defined by inequalities of gender, age, and race/ethnicity; they were told in response to norms and stereotypes regarding who is “ready” to be a parent in the United States; and they were told with the goal of proving themselves “good mothers.” In Chapter Two, I present a review of the literature related to teen pregrancy and childbearing. Based on the research questions I outlined for this study, I explore medical and social scientific research related to childbirth, and consider the extent to which public discourse has perpetuated master narratives of childbirth that both silence the voices of teen mothers and alienate women from the childbirth process. Chapter Three explains the methodology of the study, particularly the use of story-telling and gounded theory. I outline my own role in the story-telling process—as actor, coaxer, and interpreter—and how my relationships with teen mothers shaped the stories told in this study. Chapters Four through Six present the findings of the study as they relate to the various stages of the birth story: pregnancy, preparations for childbirth, and birth and the transition to parenting. Throughout the analysis, attention is given to the ways in which teen mothers engage norms of gender, age, race/ethnicity, and social class in the telling of the birth stories. Finally, in Chapter Seven, I summarize the findings and discuss their theoretical contributions and policy implications. 20 CHAPTER TWO REVIEW OF LITERATURE Chapter One outlined the objectives of the study as threefold: one, to explore teen mothers’ childbirth experiences and how they differ by race/ethnicity; two, to consider how broader social, medical, and political discourses shape the stories teen mothers tell about their birth experiences; and three, to explore what the birth stories of teen mothers tell us about teen motherhood and larger structures of social control and social change. With these objectives in mind, I turned to sociological and anthropological literature on pregrancy and childbirth to provide a foundation on which to build my study. I looked for literature that would help elucidate the various experiences that women have had with childbirth in the United States, based on differences of gender, age, race/ethnicity, and social class. Because the majority of these studies focus on adult women, I also looked for studies that explore the specific experiences of teen women— particularly regarding issues of sexuality, pregnancy, and childbirth. In the following pages, I discuss my review of the literature in two sections: women’s experiences with pregrancy and childbirth; and the social context of teen pregnancy and childbearing in the United States. In the first section, the studies reviewed highlight how conceptualizations of the female body shape relationships of power, agency, and social control, and ultimately result in the disempowerment of women in relation to sexuality and childbirth. The second section explores in geater detail the social, medical, and political context in which teen mothers tell their birth stories—in other words, the master narratives of childbirth and parenting that shape the ways in which women interpret and narrate their 21 experiences. In this section, notions of choice and constraint are explored, again within the intersecting norms of gender, age, race/ethnicity, and social class. Women’s Experiences with Pregnancy and Childbirth A wealth of literature has emerged around women’s experiences with pregnancy and childbirth. In this section, I explore research in two specific areas: research on the medicalization of childbirth; and research on female sexuality and pregnancy. These two areas of research were chosen because they focus specifically on differences of gender, age, race/ethnicity, and social class, and consider the extent to which women are empowered or disempowered in pursuing their own needs, desires, and objectives. The first area of research focuses on the medicalization of childbirth in the United States, and the extent to which childbirth has been reduced to a “bodily function” controlled by male doctors with access to authoritative knowledge and technology (Jordan 1997:69; see also Brown et al. 1994; Davis-Floyd 1992; Harper 1994; Rothman 1989; Thompson 1995). These studies adopt a feminist perspective and critique the ways in which the dominant medical model has differently impacted women’s lives based on inequalities of gender, age, race/ethnicity, and social class (Bair and Cayleff 1993; Brown et al. 1994; Fox and Worts 1999; Lazarus 1997; Martin 1987; Oakley 1980). While these studies rarely consider the specific experiences of teen mothers, they do suggest that age intersects with race/ethnicity and social class in the disempowerment of women.. The second area of research focuses more specifically on the experiences of teen women, particularly in terms of their access to bodily knowledge and relationships with others as embodied/disembodied individuals (Fine 1988; Holland et al. 1994; Stevens- 22 Simon and Kaplan 1998; Tohnan 1994, 1991). Although these studies rarely consider teen mothers’ experiences with childbirth, they do suggest that teen women, in comparison to adult women, are further disempowered by their lack of information regarding the body and sexuality, a situation that subjects them to firrther control and manipulation by those with authoritative knowledge and power. Together, these two areas of literature emphasize issues of power and control over the female body, and provide useful insights into how young women in the United States experience childbirth as passive bodies rather than as empowered, embodied individuals. The Medicalization of Childbirth The goal of the medical model of childbirth’ is to manage birth in the most efficient means possible (Arms 1975; Davis-Floyd and Sargent 1997; Rothman 1989). Trained physicians and a range of technological interventions are relied on to address problems as they arise during labor and delivery. Birth is approached as an inherently unsafe, risky, painful event, normally requiring the use of technology, drugs, and often surgery to save the life of the mother and child. While some variation on this dominant narrative exists, particularly regarding whether the birth is attended by a doctor, midwife, and/or other family members, the setting does not change: “In the United States women give birth in the hospital” (Martin and Low 1999:20, emphasis in original). In many hospitals, 80 percent of women receive epidural anesthesia, around half of all labors are induced with an injection of Pitocin, episiotomies are performed in over ' Although the medical model of childbirth will be discussed in more detail in the following section (beginning on page 39), I begin with it here because research surrounding this model has explored women’s specific experiences as they differ by identities of race/ethnicity, social class, and, to a lesser extent, age. 23 90 percent of first-time births, almost everyone is hooked up to electronic fetal monitors, and the cesarean rate stands at 21 percent (Davis-Floyd and Sargent 1997:11). While these strategies are considered to be standard procedure, a critique of this model has been developed in a wide range of fields, including sociology (Fox and Worts 1999; Oakley 1984, 1980; Rich 1977; Rothman 1989), women’s studies (Bair and Cayleff 1993), anthropology (Davis-Floyd 1992; Jordon 1993; Lazarus 1997; Martin 1987), childbirth education (Harper 1994; Kitzinger 1984), and public health (Brown et al. 1994). These studies shed light on the assumptions of the medical approach and highlight the need to explore differences among women based on age, race/ethnicity, and social class as well as on level of social support from partners and the community. Gender inequality is a central factor defining birth experiences for women. The general critique is that the malecentric medical profession, acting on a definition of birth as hazardous, intervenes in what is essentially a natural process (Fox and Worts 1999:327). While some women need and/or actively choose medical intervention, for many women, the medical management of birth decreases their control, fails to improve the physical and emotional outcome of birth, and even alienates women fi'om a potentially empowering experience. Knowledge of the laboring woman’s body is placed in the hands of physicians who manage women through the use of technology. As a result, women are disempowered and childbirth is addressed outside the context of women’s lived experiences, knowledge, and realities. Among sociologists, Ann Oakley (1980) and Barbara Katz Rothman (1989) have contributed to a gowing feminist analysis of medicalized childbirth as disempowering for women. In Women Confined, Oakley (1980) criticizes physiological explanations of 24 postpartum depression and concludes that depression is related to the amount of medical intervention and technology used during labor and delivery. In a study with largely married, middle-class white women, Oakley (1980: 143) found that the more medical intervention a woman receives during childbirth, the more likely she is to experience depression after birth. Her findings challenge the widespread assumption that the medical management of childbirth provides the safest and most positive outcomes for both the baby and the mother. Because her study was limited to women 18-31 years of age, however, her findings tell us little about the experiences of teen mothers. Bonnie Fox and Diana Worts (1999) also offer a critique of medicalized childbirth, but they focus on the immediate social context in which women give birth, particularly the context defined by gender norms regarding childcare and housework. Interviewing 40 first-time mothers of various socioeconomic classes, Fox and Worts (1999:329) explore the types of support given to laboring women by hospital staff, the nature and quality of support women receive from loved ones during childbirth, and the prenatal and postnatal services provided by the community. Their findings (1999:344) suggest that what is problematic about medical management is not that it offers too much “care” but that it substitutes for more general social support of women in labor and after birth. Privatized responsibility for childcare and a dearth of social supports for mothering (Fox and Worts 1999:343) cause many women to rely on medical help with birth. Those women whose partners shared in the responsibility and work of the household, and promised to be active parents, were much less likely than women with less supportive partners to welcome and receive medical intervention during birth. The authors conclude (1999:344) that, if giving birth is to empower women, a variety of social resources must 25 be channeled in support of child rearing—both to facilitate partner availability and to provide alternative support when no partner is present. Although neither of these studies included teen mothers in their samples, they raise important questions regarding teen mothers’ experiences with childbirth as gendered beings. While Oakley (1980) found that the more medical intervention a woman receives during childbirth, the more likely she is to experience depression after birth, Fox and Worts (1999) suggest that levels of social support at home play an important intermediary role. Teen mothers certainly lack a number of social supports—parents are angered by their pregnancies, many partners are no longer involved, fiiends disappear, community members disapprove, school attendance is difficult to maintain, and financial support is limited. The question these studies raise thus concern their experiences with medical intervention. Are teen mothers more or less accepting of medical intervention than adult women, and do their choices reflect a lack of social support for the gendered roles they perform at home? Few studies have considered the impact of gender roles and/or lack of social support on the experiences of teen mothers during childbirth. Sarah Brubaker’s (1999) study with African American teen mothers suggests that many teens challenge medical discourses of childbirth in an attempt to maintain some autonomy and control. She concludes (1999:221) that formal and informal healthcare providers “can make positive contributions when they support teens’ autonomy and provide attention to their concerns about pain and support.” Further research is needed regarding how levels of social support influence teen mothers’ expectations and experiences with childbirth, and how relationships shape their choices regarding medical control and intervention. 26 A number of studies consider the diversity of women’s childbirth experiences with regard to differences of race/ethnicity and social class (Lazarus 1997; Davis-Floyd 1992; Martin 1987). In The Woman in the Body, Emily Martin (1987) reports far geater mortality and morbidity rates among working-class women, and among Afiican American women of all classes, than among white upper-middle-class women. She thus concludes that young African American women in a very real sense have more to resist than White women. They experience “not only a geater chance of having interventions and operations used on them, but the demeaning burden of racism instantiated in the ways they are treated” (Martin 1987:155). A gowing number of scholars have explored the experiences of women of color with health care issues in the United States (Bair and Cayleff 1993; Davis 1989; Ruzek, Clark, and Olesen 1997). Barbara Bair and Susan Cayleff (1993: 13-14) report that women of color face a range of health problems out of proportion to their numbers, including infant mortality, poor pediatric care, drug and alcohol abuse, hypertension, cardiovascular disease, high blood pressure, psychological stress, stroke, diabetes, breast cancer, and homicide. They are far less likely than White women to breastfeed and more likely to be caring for babies with a higher incidence of diarrhea, respiratory infections, and malnutrition than White babies. They have fewer options for birth control, prenatal care and abortion services, and they are more likely to be labeled as “proper” candidates for sterilization than are White women (Bair and Cayleff 1993: 14). In general, women of color are discriminated against in the health care system and have few social, political, and economic resources to ensure their needs are met. This is true for pregrancy and childbirth as well as for the treatment of other health-related problems. 27 The diversity of women’s experiences with childbirth identified here is considered in a number of studies on social class as well. While Robbie Davis-Floyd’s (1992) study of white middle-class women showed a high degee of acceptance of and satisfaction with what she termed “the technocratic model of birth” (1992:44), other studies suggest that only middle-class women desire a sense of control over what happens during birth (see Nelson 1983; Sargent and Stark 1989). For working-class women, control has a variety of meanings, fi‘om control of pain (Nelson 1983) to control of their own behavior (McIntosh 1989). Ellen Lazarus’s (1997, 1988) studies of the medical treatment of poor and working-class Puerto Rican and White women in American clinics reveal universal resentment of their rushed, impersonal, and often indifferent treatment (see also Boone 1988; McClain 1987). These women were more interested in continuity of care than in making choices that would give them more control over the birth process. These studies rarely include teen mothers in their samples, but they raise important questions regarding teen mothers’ experiences with childbirth and how their expectations and choices reflect inequalities of social class. Considering that the majority of teen mothers in the United States are low-income, research is needed to explore their birth experiences in relation to class status. In particular, are teen mothers more interested in continuity of care during childbirth than in maintaining control over themselves or the birth process? The studies outlined above explore how social context shapes women’s perceptions, expectations, and experiences of medical care during childbirth. Rather than merely reducing childbirth to a “bodily function,” inequalities of gender, age, race/ethnicity, and social class make childbirth variable and diverse. Although the experiences of teen mothers are generally excluded from these studies, the literature 28 raises issues of diversity and inequality that have important implications for teen mothers. Age intersects with other social and economic factors in complex ways to influence choice, sense of efficacy, social support, and quality of care. In Missing Voices, Stephanie Brown and her colleagues (1994) did include teen mothers in their study of pregnancy, childbirth, motherhood, and depression. The authors contend that the women most likely to be in need of sensitivity from care-givers are the least likely to have access to individualized maternity care (1994:49). In particular, they found that women who were young, without a partner, living on a low income, or irnmigants from a non-English speaking country were the most dissatisfied with their care (Brown et al. 1994:43). Although the response rate from teen mothers in this study was quite small (1.4%), the findings do suggest that teen mothers share a similar dissatisfaction with childbirth as other “socially disadvantaged” women, including single women and women of non-English speaking backgounds (Brown et al. 1994:15). Lisa Kane Low (1999) focused solely on teen mothers in her study of childbirth. Low (1999:86) contends that healthcare provided to teens during childbirth in contrast to adults is complicated by factors of age, psychosocial development, and timing of birth outside the context of adulthood. Public discourse regarding teen pregrancy and what kind of teen engages in sexual activity and becomes pregrant complicates the manner in which healthcare providers approach and care for childbearing teens. The teen mothers who Low interviewed indicated that they were perceived negatively by many healthcare providers. While a few of the teen mothers exercised agency, most of them just “shut their mouths and took it” and as a result “experienced shame, fi'ustration, disappointment, and anger within the context of their birth experience” (Low 1999:104). The findings of 29 Low’s study suggest that teen mothers do seek to exercise some control over their birth experience. Norms of age and parenting, however, influence their interactions with healthcare providers and negatively impact their experiences with childbirth and the transition to motherhood. In general, research on childbirth has drawn on the experiences of White, educated, married adult women having planned babies and has generalized findings to all women (Low 2001 :21). As such, two assumptions have been perpetuated about teen mothers: either teens share similar experiences and concerns with adults and can be treated like other “socially disadvantag ” women during childbirth (Brown et al. 1994: 15), or teens are uniquely different and need geater supervision and control than adults during childbirth (Maynard 1996:5). Either way, teen mothers are treated as a monolithic goup (Phipps and Sowers 2002), and their experiences are used to support a negative picture of birth outcomes for teen parents. Further research is needed to explore how norms of gender, age, race/ethnicity, and social class intersect in the lives of teen mothers and shape their experiences with childbirth. In particular, to what extent do teen mothers seek medical intervention during childbirth, and to what extent do they seek to maintain control over their own birth experiences? lsembodiment of F emgle Sexuilig The studies outlined above criticize the medical model of childbirth for disempowering women and igroring their diverse needs and identities. Because so few of these studies include teen mothers, I turned to another body of literature to gain more insights into how teen women access knowledge and control over their bodies. 30 Beginning with conceptualizations of female sexuality, many studies consider the ways in which young women not only have been disempowered, but also disembodied (Fine 1988; Holland et al. 1994, 1992b; Stevens-Simon and Kaplan 1998; Tohnan 1994, 1991). In an effort to control the sexuality of teenage women, dominant social structures deny young women access to important knowledge, information, and language regarding their bodies. While these studies do not directly speak to women’s experiences with childbirth, they provide important insights into how young women see their bodies, relate to others, and make decisions regarding sexuality, pregnancy, and childbirth. In particular, these studies warn of the dangers of fostering a culture of silence and passivity in young women in an effort to control their sexuality. In the United States, moral and fiscal conservatives focus on the control of female sexuality through abstinence and/or moral responsibility. Despite an extensive body of literature documenting the positive effect that sex education has on student understanding of reproductive physiology and contraception and the lack of evidence that abstinence- only education reduces teen pregnancy (Alan Guttrnacher Institute 1994; Furstenberg et al. 1997; Kirby et al. 1997; Schuster et al. 1998; Thiel and McBride 1992), abstinence remains the dominant approach. Catherine Stevens-Simon and David Kaplan (1998:1206) contend that this approach creates a social environment which forces teens to consider their sexual encounters “accidents” that “just happen.” Given this contention, the authors conclude (1998:1206) that “even young people who know how to use and have access to effective contraceptives are unable to use them because they are emotionally incapable of thinking about themselves as sexually active and do not want to appear to be too prepared for sex.” 31 Janet Holland and her colleagues (1994:23) argue that a “disembodirnent of feminine sexuality” regulates women’s bodies and reproduces conventional gender relations. Although women are able to take control of their sexuality and govern their own bodies and sensuality, they generally do not do this. The authors conducted a number of studies (1994, 1992a. 1992b) to explore the reasons behind this passivity. They conclude (1994:24) that young women are under pressure to construct their material bodies so that they fit into a particular model of femininity which is at once inscribed on the surface of their bodies (in dress, make-up, dietary regimes) and alienated from their sensuality. Women become passive bodies, rather than actively embodied, and lose control of sexual encounters to men through self-surveillance of their own bodies. An important point raised in these studies concerns the extent to which young women participate in the construction of their own bodies and relationships. In Unbearable Weight: Feminism, Western Culture, and the Body, Susan Bordo (1993) clearly demonstrates the ways in which boundaries are simultaneously policed by both internal and external forces. Contending that both genders and bodies are culturally constructed, Bordo (1993: 16) argues that the body is always mediated by constructs, associations, and images of a cultural nature. Because women are largely confined to a life centered on the body—both the beautification of one’s own body and the reproduction and maintenance of others’ bodies—culture’s grip of the body is a constant, intimate fact of everyday life (Bordo 1993:17). The female body is shaped by histories and practices of containment and control—foot-binding, corseting, rape, battering, compulsory heterosexuality, forced sterilization, unwanted pregrancy (Bordo 1993:21). 32 But power also works from below as women mold their own bodies through individual self-surveillance and self-correction to reflect dominant norms. Women’s self-surveillance of their bodies and sexuality is reinforced by silencing their desire. Deborah Tolman (1994, 1991) has written a series of articles addressing the expression of female desire in adolescence, and she echoes many of the points raised by Holland and her colleagues above. Tohnan (1994) suggests that girls’ sexuality has been deemed threatening, either to girls themselves or to society. “This culture’s story about adolescent girls and sexuality goes like this: girls do not want sex; what girls really want is intimacy and a relationship” (Tohnan 1994:250). While girls’ emotional feelings and desire for intimacy are emphasized, their sexual feelings and their bodies are silenced. Tolman (1991 :59) thus raises the following question: “If girls know about their sexual desire from their experience of their own bodies but encounter a disembodied way of speaking, hearing, and knowing about their sexuality, then...[how do girls] stay connected to their own bodily experience?” She (1991:59) answers this question by maintaining that girls’ discourse of desire is subtle, encoded in the constricted ways which the culture makes available for them to speak about an unspeakable topic, or is not expressed. Tolman (1994:251) goes on to suggest that, if both desire and danger are real forces in girls’ lives, adults’ impulse to protect girls from danger and to discount desire may in fact endanger rather than empower girls in their sexual choices. While girls are responsible for regulating their own sexual behavior and that of their partners, “choices” are to be enacted through passivity rather than agency. “By discouraging women’s sexual agency and men’s sexual responsibility, these cultural norms undermine communication and encourage coercion and violence” (Tolman and Higgens 1996:209). 33 In general, the studies reviewed here on female sexuality do not address issues of teen pregrancy or childbearing, but they do highlight a number of crucial issues related to the “teen pregnancy problem”—namely, passivity, power, and social control. Much of the research outlined above highlights the ways in which young women are alienated from their bodies and desires (Holland et al.1994; Tolman 1994; Wolf 1997). Rather . than make informed decisions about their sexual relationships, or communicate clear choices and desires to themselves or others, women are silenced and disempowered. As a result, sex and unintended pregrancies “just happen.” While women are held responsible for these outcomes, they are not given the language or power to express their needs. Although these studies have not considered women’s experiences with childbirth, their findings suggest that teen mothers may be fiirther disempowered and disembodied during pregrancy, labor, and delivery. Smnmg The studies reviewed here on medicalized childbirth and female sexuality raise important issues regarding the female body and the extent to which teen mothers possess the language and power to make informed decisions about sexuality, pregnancy, and childbirth. It is clear that women’s birth experiences are shaped in complex ways by differences of age, race/ethnicity, and social class. A number of studies (Brubaker 1999; Fox and Worts 1999; Lazarus 1999) contend that women of color and lower—class women receive more negative treatment by healthcare providers than White and middle-class women, and thus are more concerned about continuity of care during childbirth than maintaining control of themselves or the birth process. 34 The limited research that has been done with teen mothers (Low 2001) further contends that norms of age and parenting complicate experiences with childbirth and the level of control that teen mothers seek during labor and delivery. More research is needed to explore teen mothers’ experiences with power, agency, and social control. In particular, do teen mothers share similar goals, desires, and experiences as other socially and/or economically disadvantaged women, or do their relationships and social support networks create different expectations for teen mothers during pregrancy, childbirth, and the transition to parenting? While the research on childbirth explores how inequalities of gender, age, race/ethnicity and social class intersect to disempower women during childbirth, research on female sexuality further highlights the ways in which women are silenced and experience their sexuality as disembodied. Together these two areas of literature raise a number of questions related to teen mothers’ experiences with pregrancy and childbirth. If teen women lack the language and power to express their own sexuality and desires, are they further silenced and disempowered during pregrancy and childbirth? To what extent do teen mothers experience childbirth as disembodied, and thus lack the ability or desire to maintain control over the birth process? Does disembodiment influence the choices teen mothers make regarding the types of support or medical intervention they accept during childbirth? If teen mothers do seek control over the birth process, what does this contribute to the research on women’s experiences with childbirth? It is clear that teen women face a number of barriers to their firll participation in childbirth, based on inequalities of gender, age, race/ethnicity, and social class. While women are at risk of experiencing pregnancy and childbirth as both disempowered and 35 disembodied, they are not powerless in the construction of their identities and relationships with others. The studies outlined above focus specifically on literature related to the diversity of women’s experiences with sexuality, pregnancy, and childbirth. In the next section I consider more closely the complex ways in which women engage master narratives regarding childbirth and parenting. While exploring women’s experiences during pregnancy and childbirth is one thing, considering the ways in which they engage narratives to interpret those experiences is another. Struggles to accommodate and resist master narratives further highlight the complexities of power, identity, and agency in women’s lives. Social Context of Teen Childbearing Two areas of literature are explored in this section: research related to the telling of birth stories in the United States; and research on the causes and consequences of teen pregrancy and parenting. Master narratives of childbirth and parenting guide debates in these two areas, and they have much to do with the ways in which teen mothers interpret and narrate their own experiences with childbirth. In the research on childbirth, debates focus on what is considered to be the “safest” model of childbirth—the medical model or the natural childbirth model—and how much control women maintain over themselves and the birth process (Brubaker 1999; Green 2000; Jordan 1993; Martin and Low 1999). In the research on teen pregrancy and parenting, moral and economic arguments are debated as underlying causes and consequences of the “teen pregnancy problem,” as teen mothers gapple with histories of poverty, abuse, and neglect and struggle to tell their stories in a way that proves their own competence and worth as “good mothers” 36 (Higginson 1998; Irvine 1994; Kaplan 1997; Lerman 1997; Luker 1996; Males 1996; Musick 1993). At the heart of these debates lie issues of choice and constraint—what choices do/not exist, who makes choices, and who defines constraints. Master Narratives of Childbirth In Women Writing Childbirth, Tess Coslett (1994) examines literature related to the telling of birth stories in the United States. She argues (1994:4) that a woman’s story of childbirth often draws on the stories of others: the official discourses of medical experts and natural childbirth advocates; and the unofficial discourse of old wives’ tales. In the discourse of medical experts, all women are reduced to their bodily functions, while natural childbirth advocates see motherhood as the essential attribute of womanhood. Old wives’ tales challenge official discourses by voicing women’s difference and diversity. Although these three competing discourses generally do not consider the experiences of teen mothers, each of these narratives is considered here as it sheds light on the ways in which birth stories are told in the United States. Medical Model. As discussed earlier, the medical model of childbirth is predominant in the United States. Martin and Low (1999:20) argue that the master narrative of birth goes something like this: A pregrant women in her last month of pregrancy prepares a bag of things to take to the hospital when she gives birth. She has her first contractions at home but must monitor them closely so that she will arrive at the hospital at the “right” time—not too early or too late. A male partner/coach will drive her to the hospital and will be present with her throughout the birth. Nurses and doctors will monitor her progess through labor, will supply painkilling drugs if needed, will monitor the baby’s heart rate, will speed up labor if it goes too slowly, will induce labor if it does not begin, will provide for every emergency, and if necessary will perform surgery to save the life of the mother and the child. 37 This narrative stresses proper timing, progession, and monitoring. If labor does not progess according to a doctor’s expectations, interventions are used. Childbirth is approached as an inherently unsafe and painful event, normally requiring the use of technology, medications, and doctors’ expertise. In Real Birth, Robin Greene (2000) offers a collection of women’s birth stories. “Hospital Births” are the subject of her first chapter, in which she explores experiences with medicalized childbirth. In many areas of the country, the author notes, it is assumed that women want to deliver in the local hospital: “to consider alternatives is to challenge orthodox views of obstetrical care and to offend loving family members who only want ‘the best’ for mother and baby” (Green 2000: 1). Although Greene concludes (2000: 1) that many women have excellent hospital delivery experiences and feel quite satisfied with both the facility and the care they received, for some women, the institutional policies of the hospital do not allow them the birthing experience they had imagined or desired. As a result, issues of control, personal responsibility, and the lack of institutional flexibility enter into these women’s stories. Although teen mothers’ experiences with the medical model of childbirth are understudied, research suggests (Brubaker 1999; Greene 2000; Phipps and Sowers 2002) that their experiences are either subsumed under the experiences of adult women, or are overshadowed by efforts focused on teen pregnancy prevention and outcomes. Sarah Brubaker (1999:18) outlines three areas of research in medical accounts of teen childbearing: pregnancy, prenatal care, and childbirth. According to Brubaker, teen pregrancy has received the most attention, focusing on prevention and access to contraception and abortion services (see also Fennelly 1993; Steven-Simon and Kaplan 38 1998; Stewart 1993; Zabin and Hayward 1993). Research on prenatal care has also focused on access issues and individual responses to medical information and resources, often considering structural barriers or individual obstacles that prevent young women from using prenatal care (Katz et al. 1994; Lia-Hoagberg et al. 1990; Phipps and Sowers 2002). Childbirth has received the least attention from researchers of teen pregrancy, focusing more on outcomes for both mother and baby than on the birth process itself. The childbirth studies that do exist about teens tend to examine rates of maternal anemia, infant mortality, low birth weight, and preterm delivery (Phipps and Sowers 2002) as well young women’s ability to successfully assume the role of mother (Kemp, Sibley, and Pond 1990; Mercer 1986). Low (2001) reviewed only one study that addressed teen’s experiences of pain during childbirth. In that study, 33 laboring teens were asked to describe the quality and intensity of pain at three points during the labor process (see Sittner et al.1998). Although Luker (1996:1) suggests that teens are more likely than adults to experience complications during childbirth, Brubaker (1999: 19) found only one study that directly addressed that issue (see Tuimala et al. 1987). Because of her age—and assumed physical and/or emotional immaturity—a teen mother is often defined as a “high-risk” patient, firrther tying her to the medical institution. Much of the medical research on teen pregrancy and childbearing has focused on medical problems that teens and their children face as the result of early pregnancy, including anemia, toxemia, premature births, and low birth weight babies (Cooper, Leland, and Alexander 1995; Erikson 1998; Phipps and Sowers 2002). In a special Robin Hood Foundation report on teen childbearing, Rebecca Maynard (1996:5) reported that children of teen parents are more likely to be born prematurely and 50 39 percent more likely to be low birth weight babies than children of adult parents. In turn, low birth weight raises the risk of adverse conditions such as infant death, chronic respiratory problems, mental illness, cerebral palsy and hyperactivity. A theory of biological immaturity has been cited as a global explanation for the increased risk for poor birth outcomes among teen mothers (Phipps and Sowers 2002: 127), supporting the general concern raised about teens in public discourse. In a medical study by Maureen Phipps and Mary Sowers (2002), however, differences are identified between younger teen mothers and older teen mothers. Examining rates of infant mortality, very low birth weight, and very preterm delivery for women aged 12 to 23 years, the authors (2002:126) found that mothers aged 15 years and younger experienced sigrificantly worse medical outcomes than older teens and adults. Younger teens had higher rates of both inadequate prenatal care use and inadequate weight gain than older teen mothers, but they had lower rates of cesarean delivery than older teens or adults, implying that biology alone seems inadequate to account for all the associated increased risk. Pamela Erikson (1998:11) reached similar conclusions in her study with teen mothers. She found that inadequate prenatal care is common among teen parents because many do not recognize their pregnancies or conceal them, do not realize the importance and availability of prenatal care, and/or are not able to afford care. Phipps and Sowers (2002: 127) thus conclude that present progarns targeting I “teen pregrancy” may not be the most effective way to help the youngest mothers, and that a better understanding is needed of the social, biological, and medical circumstances surrounding this high-risk age goup. An important point implied by these findings is that teen mothers are diverse, and while generalizations have been made about their 40 experiences during childbirth, these generalizations are more reflective of dominant stereotypes and assumptions regarding early parenting than the actual needs and experiences of teen mothers themselves. In general, what these studies show is that, as the dominant approach, the medical model of childbirth shapes teen mothers’ experiences in fundamental ways. Teens are defined as more “at-risk” than adults, the focus on biological concerns (age) igrores important social and economic factors shaping young mothers’ lives, and concerns with outcome fail to consider the ways in which a young woman’s disempowerment during childbirth may further exacerbate her transition to motherhood. Natural Childbirth Model. The second dominant discourse on childbirth is that of natural childbirth advocates. This approach moves beyond the notion of control and explores the possibilities of “reconnection” through childbirth, including the connection of self and body, and the connection of mother and child (Arms 1975; Davis-Floyd 1992; Ehrenreich and English 1973; Harper 1994; Kitzinger 1984; Rothman 1989). Rather than viewing women’s bodies as inadequate to produce healthy babies without medical and technological assistance, advocates of the natural childbirth approach contend that focusing on the mind-body connection can facilitate a “gentle birth”—an uncomplicated, natural event in which a woman can express her power, her emotions, and her sexuality and be supported by those people she loves (Harper 1994:95). In Gentle Birth Choices, Barbara Harper (1994:7) states that a gentle birth begins “by focusing on the mother’s experience and by bringing together a woman’s emotional dimensions and her physical and spiritual needs.” The baby is recogiized as a conscious participant in his/her own birth, and it is assumed that a mother “knows how to birth her 41 child in her own time and in her own way, trusting her instincts and intuition” (Harper 1994:7). Although Harper (1994:9) views labor and birth as a time when women and their families can witness the strength and sensuality of the female body, she also notes (1994:94) that this approach remains primarily a middle-class phenomenon. Many women still lack the confidence and agency to fully participate in childbirth. Conditions such as poverty, poor nutrition, language barriers, single and young motherhood, and lack of available services create circumstances that cause women to feel that they have no choices. Giving birth in a hospital, one seventeen year-old mother in Harper’s study felt as if she were no more than a pregrant body—no one consulted her, informed her, or respected her feelings during the course of her labor. “It was as if they were punishing me for getting pregnant in the first place. They acted like I wasn’t even there and it was their job to get the baby out of me as quickly as possible” (Harper 1994:94). This quote attests to the disconnect often experienced by socially disadvantaged women, including those who are young, single, poor, or lack access to available services. Old Wives’ Tales. A third discourse identified by Coslett (1994:7) is “the old wives’ tales” whose sometimes “guesome stories are contrasted with the optimistic stories of the official discourses” outlined above. While stories of race/ethnicity and social class are largely omitted hour the official discourses, the old wives’ tales are gounded in the everyday experiences of women as they narrate their stories to one another. These stories challenge norms of womanhood and motherhood, highlight differences of race/ethnicity and social class, and explore solidarities between women that serve to undermine the official discourses in numerous ways. 42 As medical and natural childbirth experts struggle to guard the status and value of their expertise, women’s oral stories are repudiated and suppressed as “destructive and demoralizing,” “unfeminine,” and “terrifying” (Coslett 1994:110). Although women challenge official narratives through the stories they tell to one another, Coslett (1994:77) contends that women writers are always keen to ridicule the despised wives’ tales, and mark their accounts off fi'om them. This tension reflects the relative power of the official discourses to shape the ways in which birth stories are told and guard the status and value of their expertise from encroachments by lay-people (Coslett 1994:110). Old wives’ tales undercut the totalizing effect of official discourses on childbirth in a number of ways: they explore differences of race/ethnicity and social class where there is meant to be a uniform state of motherhood; they discuss highly ambivalent feelings about maternity, which is meant to be every woman’s natural destiny; and they highlight the clash between the two dorrrinant official versions of childbirth, where there is only meant to be one true version (Coslett 1994:109). In turn, these narratives affirm solidarity between types of women the official discourses would like to keep rigidly separate: mothers and “other” women who are not mothers, including sisters, midwives, nurses, barren women, and voluntarily childfree women (see Bagnold 1987; Byatt 1986). Similarly, old wives’ tales deny solidarity between women official discourses lump together as happy mothers (Coslett 1994:83) by talking about suffocatingly “good” mothers and enviable upper-class mothers as well as disgustingly lower-class mothers and deprived Black mothers (see Bowder 1983; Drabble 1966; Emecheta 1987). These “other mothers” present troubling images of what motherhood can be like, as a physical condition and as a social role (Coslett 1994:89). Social categories such as race/ethnicity 43 and social class inevitably shape their stories, as women challenge official discourses and expose a fear of motherhood, as both a bodily condition and a social role. Coslett (1994:115) finds the old wives’ tales more in harmony with the medical experts’ account of childbirth the natural childbirth discourse. Both medical experts and “old wives” admit the painfulness of childbirth and the need for interventions, although medical experts are more interested in stressing that these will work while the “old wives” are interested in the drama that ensues when it all goes wrong. Ultimately, the old wives’ tales focus on a female heroine as she struggles with the pain, drama, and agony of childbirth. “By drarnatizing it fiom the point of view of the female heroine, they inject her doubts and fears into the homogeneous official version and break them up into stories of conflict, struggle, disaster and drama” (Coslett 1994:116). Summary. The three approaches discussed above represent the variety of ways in which birth stories are told by women in the United States. In general, women follow one of the two official discourses of childbirth—the medical model or the natural childbirth model—when planning for or describing their experiences with childbirth. Coslett (1994:19) contends that, while these two approaches are philosophically opposed, they share an assumption that all women are the same. Assuming that all women are destined to be mothers, the official discourses of childbirth set up ideals of female behavior—— passivity and obedience in the medical model, and joyful, conscious achievement in the natural childbirth model. These ideals, in turn, create two kinds of mothers, failing or succeeding according to the two versions (Coslett 1994:87). Considering that natural childbirth remains largely a middle-class phenomenon, important questions emerge regarding the ways in which teen mothers experience childbirth and engage master narratives in the telling of their own birth stories. In particular, do teen mothers, defined by differences of age, race/ethnicity, and social class, make different birth choices than adult women? What are their definitions of medical and natural childbirth methods and what do those definitions tell us about structures of social control and social change? Do teen mothers choose natural methods of childbirth, and what do these choices tell us about expectations for childbirth and conceptions of their identity as mothers? Coslett’s discussion of old wives’ tales offers further insight into these questions. Norms of age, race/ethnicity, and social class intersect in dominant discourses of childbirth in ways that either assume all mothers to be the same or stigmatize teen mothers as immature and incompetent. Teen mothers’ efforts to engage dominant models of childbirth and tell their own stories of birth highlight these relationships of power, agency, and social control and complicate definitions of motherhood. Master Narratives of Parenting A second area of literature focuses on studies of teen pregnancy and parenting. This body of literature emerges from a wide range of fields, including sociology (Higginson 1998; Irvine 1994; Kaplan 1997; Males 1996), women’s studies (Luker 1996; Tohnan, 1994), social policy (Cassell 2001; Lerman 1997; Thompson 1995), and psychology (Musick 1993; Pipher 1994). Since the 19708, scholars have debated whether teen pregnancy and parenting is the result of a moral crisis or a culture of poverty in the United States. On the one hand, teen mothers are to blame for their lack of moral values and behaviors. On the other hand, economic structures are to blame for putting young 45 women in positions where they have few alternative roles. In general, this debate is shaped by master narratives of parenting in the United States——who should/not be parents, or what it means to be a “good parent.” This debate highlights the complexities of teen pregnancy and parenting, and carries specific prescriptions for how to address the teen pregnancy problem. Teen Childbearing as a Moral Crisis. The discourse on teen childbearing as a moral crisis is often reflected in the catch phrase “kids having kids” (Maynard 1996). This phrase openly communicates dominant ideologies of sex, age, and marriage in the United States, and reinforces middle-class norms and stereotypes of race, ethnicity, and social class. Some studies note that teen pregnancy is often perceived as a “black” problem (Erikson 1998; Luker 1996; Nathanson 1991), finther reinforcing traditional sexual values of the dominant community (N atlranson 1991 : 163). Moreover, teen childbearing and non-marital childbearing are typically viewed as one and the same, despite the fact that most unwed mothers are in their 20s (W etzstein 2001 :28). Constance Nathanson’s (1991) book, Dangerous Passage, provides an historical account of the social control of teen sexuality in the United States and offers insights into the emergence of teen childbearing as a moral failing. In the 19605, single parenthood among young women was not a public problem because it was largely concealed by marriage, adoption, or abortion. In contrast, the visibility of poor women’s reproductive behavior led to its definition as a “social problem” (Nathanson 1991 :35). In the 19705, adolescent pregnancy took over as the dorrrinant metaphor for women’s problematic sexual behavior, due in part to the success of birth control advocates. The definition of unwanted pregrancy as a medical problem was created by its medical “solution”——the 46 oral contraceptive pill. In turn, an underlying moral fiamework regarded nonuse or misuse of contraception as an individual moral failing. The discourse of teen childbearing as a “moral crisis” has been geatly influenced by ideologies of sex, age, and marriage in the United States. In Dubious Conceptions, Kristin Luker (1996:15-16) explores three major strands in discourse about teens and pregrancy in American history: who is considered “too young” to have a baby; how society views childbearing by unmarried women; and the extent to which education and income make women and men “ready” to have a baby. The public sentiment has been that women should wait to have children until they are in their 20s, are married, and have at least finished high school. Public discussion of early pregrancy and motherhood has placed particular emphasis on the question of what should be done to make this happen. The consensus is that teens should not have sex; if they have sex, they should use contraception; if they get pregnant despite using contraception, they should terminate the pregnancy or give up the child for adoption; and failing all of that, they should marry the father of the baby (Luker 1996: 10). Public responsibility is to use moral suasion, economic incentives, and a whole repertoire of public policy to enable and sometimes coerce teens to follow these prescriptions. Two moral issues, in particular, underlie the problem of teen childbearing: women’s sexual agency and unwed parenthood. In the 1950s, 27 percent of all girls had sexual intercourse by age eighteen; in 1988, 56 percent of girls and 73 percent of boys had sexual intercourse by age eighteen (Kimmel 2000:135). In the past three decades, out-of-wedlock births have increased 600 percent, from five percent of all births in 1960 to 30 percent in 1991 (Kimmel 2000:135). Although teens comprise only one-third of all 47 unwed mothers (Luker 1996: 1), changes in adoption patterns have made the problem more visible than in previous decades. In the 19605, 90 percent of illegitimate children born to teen mothers were relinquished for adoption. In the 19805, 96 percent of single teen mothers kept and raised their children themselves (Erikson 1998:10). Whatever may be causing such major changes in the American demogaphic profile—declines in marriage rates, increases in premarital sex, and out-of-wedlock births—Luker (1996: 160) reflects on the larger national context of the sexual and reproductive behavior of American teens. In the United States, women over twenty years of age account for most abortions, 70 percent of unmarried mothers are not teenagers, and teens make up a declining proportion of all unwed mothers (Luker 1996: 164). Thus the real question is not why teens have so much trouble managing their fertility, but why so many Americans in general have trouble doing this. For most Americans, the morality of teens remains the overriding concern. Despite the fact that teens are using contraception more often and getting pregnant less often, they remain the focus of public policy debates (Luker 1996: 10). “The double transgression of out-of-time and out-of-wedlock childbearing challenges the core values of the middle-class and becomes one of the major issues in the debate about adolescent childbearing” (Erikson 1998:10). This is fueled by the fact that the teen birthrate in the United States continues to be much higher than in most other industrialized countries, despite a steady decline in the number of babies born to 15—1 9 year-old women since 1991 (Stevens-Simon and Kaplan 1998:1205). By 2000, the teen birthrate in the United States had declined to 49 per 1,000 women, compared to rates of seven in Sweden, nine in France, 20 in Canada, and 31 in 48 Great Britain (Darroch, Singh, and Frost 2001:244). In an effort to explain why the United States continues to have rates so much higher than those in other industrialized countries, J ackqueline Darroch and her colleagues (20012249) explore two determinants—sexual activity and contraceptive use. While these authors found that the variation in sexual behavior is not an important contributor to explaining differences in levels of teen pregrancy across the five countries, they did find that teens in the United States had lower levels of contraceptive use and abortion than teens in other countries. These findings were influenced by a number of factors: societal attitudes toward teen sexual activity; teens’ attitudes toward contraceptive methods, and motivation to delay parenthood and avoid unintended pregnancy (Darrach et al. 2001:249). Catherine Stevens-Simon and David Kaplan (1998) also explore trends in the teen birthrate in the United States, and argue that the real question is not why teens are giving birth to fewer babies than previously, but why the prevalence of out-of-wedlock births and sexually transmitted diseases has risen in tandem with the prevalence of sexual activity among American teens but not among their counterparts in Europe and Japan. The authors conclude (1998:1206) that American teens are more likely to engage in unprotected sexual activity than their European counterparts due to basic differences in social values. In most industrialized countries, the goal has been to prevent sexually active teens fiom becoming the victims of sexually transmitted diseases, genital cancers, and parenthood. As a result, there is strong societal and governmental support for the use of contraceptives and abortion by teens. By contrast, in the United States the goal has been to prevent teens from having sex. “[M]oral convictions prohibiting sex before marriage created a climate in this country that made it impossible for most American 49 adults to discuss sex and contraceptives openly with teenagers. Indeed, many parents still fear that their willingress to do so will be misinterpreted as condoning or encouraging premarital sexual activity” (Stevens-Simon and Kaplan 1998:1206). This moral discourse is central to understanding master narratives of parenting and how teen mothers engage these narratives in constructing their own identities and birth stories. Brubaker’s (1999) study with teen mothers highlights the central role of “moral accounts” in shaping narratives of pregrancy, childbirth, and parenting.2 In her interviews with African American teen mothers, Brubaker notes that themes of morality were pervasive. Teen mothers “drew on larger definitions of teen pregnancy as a mistake and problem, premarital sex as irresponsible, and abortion as wrong” (1999:56). Aware of negative public stereotypes of teen mothers as incompetent and irresponsible, these young women struggled to present their behavior as more acceptable than that of other teens by narratively distancing themselves fi'om teens who became pregnant on purpose, received welfare assistance, and/or did not seek prenatal care or follow providers’ advice (Brubaker 1999:228). Further research is needed to explore the ways in which teen mothers engage these moral discourses of sexuality and parenting. Themes of morality shape decisions regarding birth control, premarital sex, abortion, adoption, and single parenthood as well as definitions of responsibility, purpose, and intent. In interpreting their experiences with pregrancy, childbirth, and parenting, how do teen mothers engage these discourses and 2 Brubaker (1999:2) explores two dominant accounts of teen pregnancy that contribute to contexts within which teens make sense of their pregnancies: rrredical accounts and moral accounts. While medical accounts emphasize the physical aspects and health problems associated with teen pregnancy, moral accounts view pregnant teens as “bad” for becoming pregnant. 50 shape their identities as mothers? What are the processes of accommodation and resistance to moral discourses of teen parenting, and what do these processes tell us about relationships of power, agency, and social control? Teen Childbearing as a Culture of Poverty. One of America’s national myths is that if teen mothers simply postponed childbearing until they were more mature, their lives would improve substantially and the costs to society of early childbearing would decline dramatically. In reality, Luker (1996:41) notes that the same social conditions that encourage teens to have babies also work to prevent them from ever being “ready” to be parents in the way that a white, middle-class public might prefer. Preexisting poverty, failure in school, a dearth of opportunities for personal and professional fulfillment, persistent divisions between the races, and traditional gender-role expectations all lead both to early pregnancy and to impoverished lives for many teens. In 1965 Daniel Patrick Moynihan advanced the “culture of poverty” thesis, arguing that poor and segegated populations develop a distinctive set of beliefs, values, and behavior patterns perpetuating their condition. Noting that more Black than White families were headed by poor women, Moynihan concluded that the structure of the Black family was deteriorating (Kaplan 1997:4). This perspective further suggested that Black teen girls’ morals were different fi'om those of mainstream society because they did not have strong values prohibiting sexual activity at an early age and before marriage. While the issue of morality is raised in Moynihan’s thesis, moral failing is blamed on social and economic inequality rather than individual choice. In Streetwise, Elijah Anderson (1990) explores in some detail the changing views on sex and family among youth in Black, urban ghettos. In the glaring absence of a strong family unit, Anderson 51 (1990: 124) describes young women who form “baby clubs” as a means of enhancing their position in the community. Due to persistent poverty, norms of ghetto culture are such that babies become a sought-after symbol of status—a passage to adulthood. Anderson (1990: 134) concludes that “the basic factors at work here are youth, ignorance, the culture’s receptiveness to babies, and the young man’s resort to proving his manhood through sexual conquests that often result in pregrancy.” The dreams of a middle-class lifestyle are thwarted by the harsh socioeconomic realities of ghetto life and so men and women alike scramble to take what they can from each other. In Not Our Kind of Girl: Unraveling the Myths of Black Teenage Motherhood, Elaine Bell Kaplan (1997) critiques the “culture of poverty” thesis and argues that this approach creates racial divisions among teens by separating poor Black teens from rrriddle-class White teens, and so-called morally corrupt Black teen mothers from all other teens. This approach also reinforces gender inequality by focusing on the sexual life of teen mothers rather than that of teen fathers. Although the culture of poverty thesis remains a powerful political theme today, Kaplan contends (1997:173) that it does not fully account for the ways women and teen mothers contribute to and are forced to create strategies that challenge the ideologies and structures that oppress them. She presents a “poverty of relationships” theory in which oppressions (most particularly race and social class) are played out in a relational framework in which young women develop intentional strategies to form and sustain relationships with their sigrificant others. Analyzing the stories of Black teen mothers in two urban neighborhoods in California, Kaplan (1997:175) concludes that teen pregrancy and parenting become strategies to deal with young women’s lack of relationships with mothers, fathers, teachers, counselors, and 52 community. Pursuing a patriarchal model of the ideal family, motherhood is accepted given the dearth of possible alternatives. Kaplan’s study demonstrates the extent to which teen mothers struggle to uphold ideals of dominant culture regarding family and parenting, despite racial and economic circumstances that deny them opportunities. Many other studies note the powerful social, cultural, and economic forces that favor teen motherhood among women of color and of low socioeconomic status (see Dodson 1998; Erikson 1998). Of the estimated one million teen pregnancies in the United States each year, approximately half result in a live birth, 40 percent end in therapeutic abortion, and the remaining pregnancies end in miscarriage (Erikson 1998:9). Erikson (199829) contends that these statistics reflect two very different realities for teens: one is unprotected sexual activity leading to pregnancy and abortion among middle- and upper-class teens; the other is unprotected intercourse leading to pregnancy and childbearing among poor, inner-city youth, many of whom welcome, or are at least ambivalent about, becoming a mother. Social interventions for teen pregrancy are often shaped by the American script for normative life events: school, work, and economic self-sufficiency (Erikson 1998215). The underlying causes of early childbearing, however, appear to be poverty and lack of access to those very resources of education and employment (Erikson 1998; Luker 1996). Lisa Dodson (1998:6) reports that, in 1998, close to 37 million people lived below the federal poverty level in the United States and the majority of these individuals were women and children. In 1993, single mothers experienced the geatest poverty, representing 60 percent of all poor families with children. While the official estimate of child poverty in 1998 was 20.5 percent for all children under the age of eighteen years, 53 some experts suggest that closer to 29 percent of American children live in relative poverty and another 11 percent in near-poverty (see Dodson 199826). Race and ethnicity are strongly associated with American poverty. In 1996, 45 percent of people considered poor were White people and 49 percent were Afiican American or Latino (Dodson 199827). Whereas public debate has focused on a “welfare culture” of dysfirnction, immorality, and individual failure, Dodson (1998:9) concludes that an increasingly stratified economy and the persistent loss of decently paid industrial employment are at the core of American family poverty. Gender also intersects with poverty in important ways. In low-income families, Dodson (1998:16) found that daughters provide necessary childcare for younger siblings, and often fill the role of mediation, advocacy, and caretaking in a family broken down by domestic violence, parental substance abuse, or physical or mental disability. Reviewing these findings with Dodson (1998:42), one respondent concluded: “It seems we bring our girls up to be strong, but that’s no news.. . .It seems though that we maybe bring them up to put other people before themselves, and that’s something to think about.” Their relationships, not their education, are emphasized at home, and this is connected to early sexual activity and early pregrancy. As Dodson (1998:45) concludes: “If she was going to be taking care of family and children anyway, why not have the baby be her own?” In general, the studies outlined above suggest that early parenting has a lot to do with the degee to which young women in poor America can imagine another life and other opportunities. “When young women choose to go through with pregnancies, the choice may be in some part about sex and love, about cultural and family tradition, but above all it is about having few alternative roles” (Dodson 1998: 104). Dodson 54 (1998:111) thus concludes that choice is not a simple yes or no to sex, pregrancy, or abortion. Young women who have no access to college or careers in the dominant economy face little loss in early childbearing. “The pull of female roles in families and in society, as well as boyfiiends’ pressures, can be resisted, but only if there are tangible alternatives” (Dodson 199821 13). Recent policy efforts have promoted increased educational and occupational aspirations for women to decrease the teen birth rate (Cassell 2002; Young et al. 2001). Exploring recent studies with teens, Carol Cassell (2002:7) reports that sophomores with low academic ability were twice as likely to become parents by their senior year as students with high academic ability, and that teen girls in the bottom 20 percent of basic reading and math skills were five times more likely to become mothers than those in the top 20 percent. Cassell (2002:11) attributes these differences to “a lack of confidence in the future, a sense of limited opportunities, and perception of a life without economic security.” Differences in race/ethnicity further exacerbate outlooks for the future. Although in absolute numbers, the majority of teen births are to Whites, proportionately more women of color have babies while they are teenagers (Erikson 1998:13). In her study with Latina teen mothers, Erikson (1998:29) concludes that “cultural norms and values surrounding reproduction are important factors in Latina teen childbearing.” The role of wife and mother is highly respected and considered the pinnacle success for women. Birth control is rarely used before the first birth, and Latina women tend to enter into marriage and childbearing at earlier ages than White women. Until recently, Erikson (1998229) notes that much of the data on Latinos masked significant subgoup 55 differences. Among Latinas, Mexican American teens have the highest birth rate and U.S.-born Latinas have almost double the birth rate of non-U.S.-born women (1998:30). Whether the causes of teen pregrancy are a question of moral failing or economic inequality, the studies reviewed in this section converge on the need for increased social, educational, and/or economic resources for young women and men as a means of pregrancy prevention and better parenting skills. Although none of the research reviewed above considers teens’ experiences with childbirth, important questions are raised conceming how young mothers cope with pregrancy and prepare themselves for childbirth and parenting. In particular, these studies provide insight into how teen mothers experience relationships of power and social control, make choices in that context, and shape their own identities as mothers. Summary The review of literature outlined in this chapter was driven by two principle questions: what are women’s experiences with childbirth; and what are the contexts shaping the stories they tell about those birth experiences? In pursuit of the first question, the research that was reviewed primary focused on conceptualizations of the female body and social control. Studies on the medicalization of childbirth in the United States argue that women are often disempowered, controlled through the use of technology, denied access to authoritative knowledge, and treated as passive bodies. Studies on female sexuality echo these findings, fiuther exploring the ways in which teen women experience their sexuality as “disembodied” and lack access to important information and language regarding their bodies and desires. Although 56 together these bodies of literature highlight important issues of diversity among women that shape their experiences with childbirth in complex ways, more research is needed with teen mothers. Studies suggest that teen women are firrther disempowered during childbirth, as they share a number of characteristics with other “socially disadvantaged” women that limit their voice and access to knowledge. But very few studies on childbirth include teen mothers in their samples. My study seeks to build on the ideas explored in this area of research by specifically considering the birth experiences of teen mothers themselves. In pursuit of the second question, research was reviewed concerning the larger context in which teen mothers tell stories of childbirth. Master narratives of childbirth and parenting shape women’s experiences and narratives in complex ways. While a number of studies highlight issues raised in these narratives—cg, medical versus natural childbirth, diversity, agency, morality, poverty, choice—only limited research has explored the ways in which teen mothers engage these narratives in interpreting and narrating their own stories of birth. My study begins with that objective in mind. In so doing, a geater understanding is sought of how teen mothers accorrrrnodate, challenge, and resist dominant ideologies and actively work to construct their own identities and experiences. 57 CHAPTER THREE DESIGN AND METHODOLOGY As stated in Chapter One, the objectives of my study were threefold: one, to explore teen mothers’ experiences with childbirth and how they differ by race/ethnicity; two, to consider how broader social, medical, and political discourses of teen childbearing shape the stories teen mothers tell about their birth experiences; and three, to explore what the birth stories of teen mothers tell us about teen motherhood and larger structures of social control and social change. Chapter Two outlined a number of studies related to these questions. While these studies highlight important relationships of power, identity, and social control, few address the specific experiences of teen mothers during childbirth. To explore questions of how teen mothers experience childbirth, and narrate those experiences to others within a larger social and political context, I developed an interview schedule to elicit their personal birth stories. The sample site was a teen parenting progarn located in “Green County,” Oregon. This site and the methodology used for sample selection, data collection, and data analysis are the subject of this chapter. Research Setting I moved to Green County, Oregon, in 1999, three weeks after the birth of my first baby. The teen mothers who participated in my study were drawn fiom the population of teen mothers who reside in Green County and were enrolled in a county-run teen parenting progam, called Teen Parenting Services (TPS).l ' I chose this county because I resided there and was acquainted with a number of programs for teens. 58 Green County, Oregon Green County offers a unique and intimate look into the lives of young women who become mothers as teens. The county is relatively small and rural, and social and healthcare services that are provided to teen parents shape experiences with pregrancy and childbirth in powerful ways. Fewer than 100,000 people reside in Green County and they are distributed among small towns and rural farmlands. Roughly one-third of the population lives in the county seat; another third is divided among the county’s other small towns; and the remaining third of the population lives in rural areas. The vast majority of the population is White non-Hispanic (87%). The fastest gowing population, however, is Hispanic (10%) (Community Assessment 2000:6). Agriculture is the principal industry of Green County, employing roughly one third of the labor force (www.census. gov). There are two major towns in Green County—which I refer to as Alton and Benton—and the majority of public services are located in these two towns. Although several of the smaller towns have their own schools, Alton and Benton each are home to a large high school that serves the majority of students in the county, and each of these schools provides in-house daycare services to parenting teens while they attend classes. A third, smaller town in Green County has an alternative school for parenting teens, and young mothers throughout the county are referred there to complete their degees. Alton and Benton each are the location for a major hospital that serves the surrounding communities and outlying areas of Green County. The vast majority of babies are born in these two hospitals. Premature births and anyone requiring more specialized services are referred to the large metro hospital in Portland. 59 As the county seat, Alton provides the majority of public services, including offices for public health and welfare assistance. Alton also offers a few alternative clinics for family planning and prenatal care, including a local branch of a health clinic devoted to serving the needs of seasonal and mi gant farm workers and others who lack access to affordable healthcare. In general, healthcare services related to pregnancy and childbirth are located in either Alton or Benton. Lack of transportation and finances make access difficult for many low-income families in the county who reside in small, rural communities 20-30 miles away. Pregnant and parenting teens, who are disproportionately poor and lack social support, are particularly limited in their access to counseling and services in the county. Teen Parenting Services My method of sample selection was influenced by the nature of services provided in Green County. Unlike more urban areas, where a number of progarns exist to serve the needs of pregrant and parenting teens, few progarns exist in Green County to target the needs of youth. Most of the services available to teens address very specific needs (e.g., pregnancy prevention, pregrancy counseling, adoption services, or parenting education). Teen Parenting Services (TPS) of the Department of Family and Youth Progarns of Green County, is one progarn that seeks a more comprehensive approach. Serving as a networking and referral agency for other progarns in the county, TPS works with service providers throughout the county, including educators, healthcare providers, counselors, and social workers. As such, TPS provided me with access to the most diverse sample of teen parents residing in the county. 60 TPS was started in 1989 to work with pregrant and parenting teens throughout Green County. Two fulltime caseworkers (one Hispanic and one White) are employed by TPS and report directly to the director of the Department of Family and Youth Progarns. Funded by a number of sources, including Adult and Family Services, county general funds, Babies First (a federal progarn that provides services to high risk babies), and a private gantor in the community, the primary objectives of TPS are the following. 0 To provide outreach to teen parents through referrals from schools, public health nurses, hospitals, healthcare providers, families, and self-referrals; 0 To provide outreach to Hispanic populations in culturally responsive ways; 0 To support staying in school; 0 To advocate for healthcare, childcare, housing, legal aid, and parenting; c To provide information/education for family planning to prevent second births; 0 To provide referral to mental health and drug and alcohol counseling; and 0 To prevent child abuse and neglect. Outcomes are recorded in numbers of contacts, numbers of referrals, and numbers of clients gaduating or completing a school pro garn. On average, TPS maintains an active caseload of approximately 100 teen mothers. Looking at the number of births to teens in Green County as a whole from 1998-2000, I estimated that TPS worked with about one-fifth of them, and thus provided me with access to a fairly representative goup of teen parents in the county. As shown in Table 3.1, Green County recorded 3,601 births from 1998-2000: the majority (87%) were to mothers twenty years of age and older; only thirteen percent of total births (n=479) were to teen mothers between the ages of ten and nineteen years. 61 Nearly three-quarters (72%) of these teen mothers were White and one-quarter (25%) were Hispanic. The majority (59%) were covered by public health insurance through the Oregon Health Plan (OHP). Table 3.1: Selected Characteristics of Mothers in Green County by Age, 1998-20002 Mother’s Age Selected Characteristics 10-19 years 20+ years Totals Race/Ethnicig # % # % # % White (non-Hispanic) 344 72% 2487 80% 2831 78.6% Hispanic 1 19 25% 548 17% 667 18.5% Native American 9 2% 29 1% 38 1% Other/unknown 7 1% 58 2% 65 2% Type of Insurance Private insurance 172 36% 2128 68% 2300 64% Public insurance 282 59% 851 27% 1133 31.5% Self-pay 17 3.5% 104 4% 121 3.4% Other/unknown 8 1.7% 39 1% 47 1.3% Totals 479 13% 3122 87% 3601 100% Teen mothers differed from adult mothers in Green County in two important ways: a higher percentage of teen mothers were Hispanic (25% vs. 17.5%) and a higher percentage of them were covered by public insurance (59% vs. 27%). These differences 2 Statistics obtained fi'om the Center for Health Statistics, www.0hd.hr.state.or.us/chs/teenp.cfin. 62 reflect similar trends nationwide. In a recent study on teen childbearing among Hispanics in the United States (NCPTP 2001), statistics show that more than one-quarter of the teen births in 2000 were to Hispanics. Hispanic teens have had the highest teen birth rate among all ethnic goups in the United States since 1994. According to preliminary data for 2000, the birth rate for Hispanics 15-19 years old was 94.4 per 1,000, nearly double the national rate of 48.7 per 1,000 (NCPTP 200122). Birth rates vary widely among Hispanic subgoups in the United States, with Mexican-Americans reporting the highest teen birth rate (101.5 per 1,000) and Cuban- Arnericans the lowest teen birth rate (27.1 per 1,000). Research also estimates that 83 percent of teen mothers are from low-income families (Evanston 1999:517), that 69 percent receive Medicaid assistance, and that 49 percent or on welfare assistance within five years of giving birth (GAO 1998). The teen mothers seeking services at TPS reflect these characteristics. Although specific numbers were not available, a high percentage of TPS clients are Hispanic and an even higher percentage are low-income and are covered by public health insurance through the Oregon Health Plan (OHP). Given the range of organizations networking with TPS, and the diverse goup of teen mothers seeking services there, I felt TPS was an appropriate resource for selecting my research sample. Sample Size and Selection Two goups of individuals were interviewed for this study: teen parents; and adults who interact with teen parents in varying capacities. The teen parents were all contacted through T PS while I contacted the adults directly. 63 Teen Parents At the time of my study, TPS had an active caseload of about 80 teen mothers. The caseworkers also maintained a list of about 100 teen mothers who were no longer “active” but were still contacted by them several times a year. The teen mothers differed by age, race/ethnicity, and sources of financial support. To elicit a diverse sample from the active caseload, I mailed letters of introduction to all 80 teen mothers to solicit volunteers for the study (see Appendix A). The caseworkers at TPS felt that teen parents on the active list would be more inclined to volunteer because their concerns were more immediate than those on the inactive list. In the letter of introduction, teen parents were encouraged to speak to their case worker if they had any questions about the study, and the caseworkers also offered to encourage their clients to volunteer. TPS mailed the letters for me to maintain confidentiality. In my letter of introduction as well as the cover letter provided by the director of the progam, teen mothers were informed that their participation was strictly voluntary. Postcards were included with the letters inviting recipients to return them directly to me with a name and phone number so that they could be contacted to schedule interviews. Because only sixteen postcards were returned (representing a 20% response rate), a second round of letters was mailed to the inactive goup of 100 teen mothers. Fourteen postcards were returned to me from this goup (representing a 14% response rate). A low response rate was expected from teen mothers due to the negative messages surrounding teen pregrancy and parenting, both locally and nationally. An even lower response rate was expected fiom the inactive goup of teen clients because of their low level of involvement with caseworkers at TPS. Although I did not have the opportunity to speak with anyone who declined to participate in this study, a fiiend who is a co-worker of a teen mother provided some insight. This teen mother had received my letter but decided not to volunteer. When my fiiend asked why, the young woman simply replied that she did not want “to relive that experience again.” For many teen mothers, the experience of being pregrant and giving birth is emotionally difficult because of the stignatization of teen parenting in this country. Thus, it is little wonder that many teen mothers neither want to revisit those memories and experiences, nor find the strength to tell their story to yet one more person after their interactions with caseworkers, doctors, and other service providers. In total, thirty teen mothers volunteered to be interviewed by me. In the process of scheduling interviews, six women moved, had their phone disconnected, or were otherwise unable to be contacted, two were unable to schedule a time with me, and three did not show up for scheduled interviews. The remaining nineteen (63%) were interviewed by me in their homes. Nine were interviewed in June 2001, one month before the birth of my second child. The remaining ten were interviewed in August and September 2001. In two cases, teen fathers also ageed to answer questions at the end of my interviews with their partners. No other teen fathers volunteered for this study. In general, the population targeted in this study was difficult to locate. They moved around frequently and had good days and bad days as they broke up with, or got back together with, partners and negotiated relationships with friends, teachers, employers, caseworkers, relatives, and others. More than once, I arrived for a scheduled interview to find a young woman emotionally drained. Interviews were rescheduled, and when started, frequently interrupted by phone calls, visitors, and crying babies. 65 Many researchers who study teen parents contact them through formal educational or other public service progams, including high schools (Chasnoff 1996; Higginson 1998; Lennan 1997), community centers (Kaplan 1997; Rains et al. 1998), GED progarns (Horowitz 1995), and health clinics (Erikson 1998). By regularly attending these progams, women are motivated participants and can easily schedule a time to be interviewed. Although a number of teen parenting classes exist in Green County, only a few of the women I interviewed participated in such classes. I sought a diverse sample of teen mothers——those in and out of school, attending and not attending progams, employed and not employed. I felt that TPS provided the widest access to such a diverse goup of women. Originally, I planned to interview both teen mothers and teen fathers. TPS works with both mothers and fathers, but I later learned that teen mothers are listed as primary clients, and teen fathers are included in their services only when they are living with their partner and show interest in participating. TPS receives referrals from school counselors, healthcare providers, family members, and others when a young woman discloses a pregrancy. As is typical in American culture, women are held responsible for pregnancies, and thus they are the principal target for health, educational, and other social service progams. Men who have fathered babies are harder to reach—they do not accept responsibility, are not teens themselves, are denied involvement by the baby’s mother, and/or are not perceived to be primary caretakers for children (Rains et al. 1998:311). Prue Rains and her colleagues (19982312) found that teen mothers play an active role in shaping their relationships with uninvolved partners, sometimes ending the relationship, sometimes refusing to accept token involvement and the claims it might justify, and 66 sometimes putting up with token involvement for the child’s sake. In any case, while a woman’s identity as mother is clear, fatherhood is contingent and variable. So why did so few teen fathers agee to participate in my study? One reason may be that teen fathers are less involved in pregrancy and childbirth (either due to their own choice or the choice of the mother) and thus have fewer stories to tell than mothers. Another reason may be that many teen mothers have unstable or temporary relationships. Just over half (58%) of the women I interviewed in this study reported that their partners were present during childbirth. At the time of the interview, only seven (3 7%) of these women were still in a relationship with the fathers of their children. The evolving nature of the status of their relationships with their partners made it more difficult to contact teen fathers and solicit their participation in this study. Another possible explanation for the low participation rate of teen fathers may be that teen fathers who do attend prenatal visits and childbirth are relegated to observer status and thus have fewer stories to tell than their partners. The two teen fathers I interviewed—one White and one Native American— felt that they had little to offer me. They described being pushed to the back of the room by relatives or being igrored by doctors during delivery. Teen mothers described similar scenarios, but in most cases, did not expect or want more than their partners’ physical presence in the room. In general, then, the birth stories told in this study are women’s stories. They are told from a female perspective and are about being/becoming a mother. As such, I decided not to contact more teen fathers for inclusion in this study. The two fathers I did interview offer unique insights into the birth stories of their partners and are presented as such in the analysis of findings. 67 In total, data from the interviews with nineteen teen mothers are the focus of this study. This sample is small, representing just over ten percent of the caseload at TPS and four percent of all teen births in Green County recorded between the years 1999-2000 (Oregon Department of Human Services 2002). Important differences of race/ethnicity, age, and social class are reflected, thus making the sample representative of the diversity of teen mothers in Green County and the United States more generally. These differences are summarized in Table 3.2 and discussed briefly in the following sections. Race/Ethnicity. As shown in Table 3.2, roughly two-thirds (63%) of the teen mothers I interviewed were White and one-third (37%) were Hispanic. Two possible explanations exist for why the response rate of White women was higher than that of Hispanic women. First, the majority of teen mothers in Green County are White. On average, statistics indicate that Hispanics comprise about 25 percent of all teen mothers in Green County, while Whites comprise about 72 percent (Oregon Department of Human Services 2002). Although one of the primary objectives of TPS is to provide outreach to Hispanic teen mothers in Green County, and their caseload thus reflects a higher percentage of Hispanic teen mothers than that reported in Green County more generally, my letter was received by more White mothers than Hispanic mothers, and I received more responses fiom White mothers who wanted to volunteer. Second, some Hispanic women face cultural and/or language barriers that may have influenced their comfort level with me and, thus, their willingness to volunteer for an interview. Although my letter of introduction was translated into Spanish and a Spanish translator was available to assist with any of the interviews I conducted, only one woman requested that a translator be provided for her. The other six Hispanic women I 68 interviewed were fluent in English and were quite comfortable talking with me about their experiences. Table 3.2: Selected Characteristics of Sample by Race/Ethnicity, 2001 Race/Ethnicity Characteristics of Teen Mothers White Hispanic Totals Age at Birth # % # % # % 13 years - - l 14% 1 5% 16 years 4 33% 2 29% 6 32% 17 years 2 17% 3 43% 5 26% 18 years 2 17% - - 2 1 1% 19 years 4 33% 1 14% 5 26% Income Source Parent(s) 4 33% 2 29% 6 32% Partner 4 33% 5 71% 9 47% Own employment 2 17% - - 2 11% Welfare 2 17% - - 2 11% Insurance Type Private insurance 2 17% 2 29% 4 21% Public insurance 10 83% 3 43% 13 68% Self-pay - - 2 29% 2 1 1% Totals 12 63% 7 37% 19 100% 69 Age. I interviewed teen mothers who were between the ages of 13 and 19 when they gave birth. On average, they were 16 when they got pregnant and 17.1 when they became mothers. The Hispanic women were roughly one year younger than the White women when they gave birth (means of 16.4 and 17.5 years, respectively). These averages are slightly below those reported for teen mothers in both county and national statistics. In Green County, teen mothers are on average 17.8 years old when they become mothers (Oregon Department of Human Services 2002). At both the county and national levels, research indicates that about two-thirds of all teen mothers are 18 or 19 years old when they give birth (GAO 1998; Luker 1996:8; Oregon Department of Human Services 2002). National studies also indicate that Hispanic mothers tend to be younger than White mothers (see Erikson 1998), a trend reflected in my sample as well. The age of the teen mothers’ partners in this study are also somewhat younger than both county and national averages (see Table 3.3). The Oregon Department of Human Services (2002) reports an average age of 21.1 years for male partners in Green County. On average, these men were 3.2 years older than their partners, and over 70 percent of them were 20 years of age or older when their partners gave birth.3 Luker (1996:2) similarly finds that about 80 percent of teen mothers in the United States have a partner who is within five years of their own age. Other studies (Lynch 2001 :95; Males 1996) report that fathers are an average of four years older than their partners, and that almost two~thirds of teen mothers have partners who are 20 years of age or older at the time of birth. 3 These statistics are compiled from the Center for Health Statistics, Oregon Department of Human Services (2002). Out of the total births reported to teen mothers (n=472) in 1999-2001, only 70 percent of the male partners provided their age. Thus, the statistics provided here are estimates. 70 In general, my sample included couples who were slightly younger and closer in age than either county or national averages: fathers were an average of two years older than their partners (19.1 and 17.1 years, respectively); and only one-third (32%) of the fathers were 20 years of age or older when their partners gave birth. Table 3.32 Age of Teen Mothers by Age of Partners, 2001 Age of Mother at Birth Age of Partner 13 16 17 18 19 Total 16 1 l 17 2 2 4 18 3 1 1 5 19 2 1 3 20 1 2 3 21 1 1 2 23 1 1 Total 1 6 5 2 5 19 Social Class. Although I did not directly ask teen mothers to classify themselves in terms of social class, I did explore their socioeconomic status by asking them to provide information on their sources of income and whether or not they received any form of public assistance (welfare, food stamps, subsidized housing, childcare assistance, public insurance). In general, information on insurance coverage was the most helpful in classifying the majority of women in this study as low-income. Two-thirds of the women 71 (n=13) were covered by public insurance through the Oregon Health Plan (OHP) when they gave birth. Two more women qualified for public insurance, although they were not enrolled in the progam at the time their children were born. These women were recent immigants from Mexico and enrolled in the OHP after being referred to caseworkers at TPS. The remaining four women (21%) were covered by private insurance when their babies were born (either through their own parents or, in one case, through prospective adoptive parents). Of these four women, one was the daughter of Hispanic farm workers and one was on welfare shortly after her twins were born. The woman who planned an adoption delivered a baby with cerebral palsy, and thus was rejected by the prospective adoptive parents. Equally disowned by her own family, this young mother relied on part time employment and public assistance to support herself and her son. Only one Hispanic woman was difficult to classify—although she lived with both her parents, was covered by their private insurance, and was attending high school, my observations of her living environment led me to classify her as low-income as well.4 As indicated in Table 3.2, enrollment in the OHP varied by ethnicity: only three Hispanic mothers (43%) indicated that they received public insurance compared to ten White mothers (83%). The lower rates of enrollment for Hispanic mothers may be due to a number of issues: language barriers, residency, access to knowledge regarding available resources. While two of the Hispanic women were covered by parents’ private insurance, the other two women were not aware of the OHP prior to giving birth. ’ This 17 year-old woman lived with her rrrother, father, and three sisters. Her older sister was also a teen mother, did not attend school or have employment, and was living at home with her boyfiiend and two daughters. The entire household relied on the father’s wages as a manager. They lived in a double-wide mobile home in an impoverished community in Green County. Everyone was home when I arrived to conduct the interview, except the young woman’s mother, who was visiting extended family in Mexico. 72 Overall, roughly two-thirds (68%) of the teen mothers I interviewed were covered by public health insurance, and the other one-third were covered either by private insurance (21%) or self-pay (11%). These percentages reflect similar statistics on teen mothers at the national level, where the General Accounting Office (GAO 1998) estimates that 69 percent of teen mothers in the United States receive Medicaid assistance while 26 percent are covered by some form of private insurance. Statistics for Green County varied slightly from these percentages—during the period 1998-2000, the Oregon Department of Human Services (2002) reported that 59 percent of all teen mothers in Green County were covered by the OHP, and 36 percent were covered by private insurance. In general, these statistics reflect the fact that a large proportion of teen mothers in Oregon, and in the United States more generally, are low-income prior to becoming pregrant and giving birth, and rely on public assistance for healthcare. Summary. The sample used in this study is fairly representative of teen mothers, both within Green County and nationally. As noted above, nearly two-thirds of teen mothers in the United States are covered by public health insurance and are eighteen years of age or older when they give birth. Moreover, half are White and one-forth are Hispanic. In my sample, the teen mothers were slightly younger and more Hispanic than those included in county and national statistics. Of the teen mothers I interviewed, only one-third were over the age of eighteen (3 7%) when they gave birth, and an equal percentage were Hispanic (37%). What the statistics presented here suggest is that teen mothers in the United States tend to be low-income, and that a sigrificant percentage of them are non-White. The sample I selected for my study reflects these statistics. Although the number is relatively 73 small (representing only 4% of all births to teen mothers in Green County in 1999-2000), it includes a diverse goup of teen mothers in Green County. Considering that Hispanics currently comprise roughly ten percent of the population, and are the fastest gowing population in Green Country, the geater number of Hispanics in my study ensures that their experiences are represented. One of the primary objectives of my study was to explore teen mothers’ birth stories and how they differ by race/ethnicity. I also collected information on age and social class in order to consider the extent to which these differences firrther shaped teen mothers’ experiences with childbirth. As discussed earlier, all of the teen mothers in my sample shared a similar socioeconomic status. Although the age at which they gave birth did vary—ranging from thirteen to nineteen years old—my findings did not reflect sigrificant differences by age in the birth stories they told. As such, the focus of this study is on race/ethnicity. AM Although my primary focus was on the birth stories told to me by teen mothers themselves, I also interviewed adults who interacted with teen mothers in varying capacities to gain further insights into teens’ experiences with pregrancy and childbirth. In total, I interviewed nine adults: three healthcare providers; two social service providers; and four parents of teen parents. These individuals comprised a convenience sample and were contacted directly by me as the research project unfolded. Healthcare Providers. The healthcare providers I interviewed consisted of a certified nurse-midwife, a labor and delivery nurse, and a family practitioner. All three 74 of these individuals were White, female, and relatively young (mid-to-late 305), and they had worked with teen mothers for a number of years. I interviewed these women in order to gain more insight into the services provided to teen mothers during pregnancy and childbirth and the types of interactions and relationships teen mothers have with healthcare providers. These three individuals were approached by me as key informants—professionals who could provide some context to the stories of teen mothers—and not as a representative sample of all healthcare providers working with teen parents in the county. In Green County, there are approximately five certified nurse-midwives and eight physicians, as well as a large staff of labor and delivery nurses, who provide services to pregnant and birthing women through the hospitals in Alton and Benton. I chose one individual from each of these three goups—a physician, a nurse-midwife, and a nurse. Each of these women was a healthcare provider whom I had met in the context of my own experiences as a new mother in Green County. I did not seek a random sample of healthcare providers, but chose to interview key informants who shared some history of working with teen mothers. In general, these three women focused on their perceptions of the social support networks available to teen mothers, the abilities of teen women to parent, and their interactions with teen mothers and their families during prenatal exams and delivery. These individuals offered important insights into the medical discourses of pregnancy and childbirth that shape how teen mothers experience childbirth and narrate those experience to others. The insights offered by these three women were so similar that I did not feel it necessary to interview more professionals in their field. 75 I did not interview any male physicians in this study, which may be a limitation. Some of the teen mothers I interviewed indicated that they had chosen a particular doctor or midwife because she was a woman; others worried they would be uncomfortable with a particular doctor because he was a man. In the end, however, the interactions and outcomes described by teen mothers did not seem to be influenced by the gender of the healthcare provider. Social Service Providers. The two social service providers I interviewed—one high school teacher and one TPS caseworker—similarly were selected by me as key informants. The two main high schools in Green County each provide teen parenting classes and daycare services for pregrant and parenting students. I chose to interview a teacher from one of these progams to gain insight into how the public school system works with teen mothers and influences their preparation for childbirth and parenting. In the social service sector more generally, professionals work with teen parents in a variety of areas, including public health, child protective services, and welfare assistance. The caseworker I interviewed fi'om TPS was an Hispanic woman who provided insights into the unique experiences of Hispanic teen mothers in Green County. In general, these two women offered firrther insight into the resources available to teen mothers to help them prepare for childbirth and parenting as well as some of the factors that may limit their access to, or use of, such public resources and services. Parents of Teen Parents. Finally, I interviewed four parents of teen parents— three mothers and one father—in order to gain some insights into their own perspectives regarding their daughters’ preparation for childbirth and parenting. Approximately one- third (32%) of the teen mothers I interviewed were still living with parents at the time of 76 the interview, although the majority (79%) of them indicated that they had been living with parents at least part of the time during their pregnancies and/or were assisted by family members during labor and delivery. The adult parents I interviewed were contacted in a number of ways. One couple wrote me a letter after receiving a letter in the mail for their daughter, who no longer lived at home, and I arranged to do an interview with them in their home. One mother wrote me a letter after receiving a consent form in the mail from me to be sigred for her daughter, and I spoke with her over the phone. Finally, one mother asked to participate in the interview I was conducting with her daughter in their home. The daughter ageed to do the interview jointly with her mother and did not seem adversely affected by her presence. Both openly shared personal information with me that other teen mothers were not necessarily as comfortable to discuss (premarital sex, birth control, physical exams). In fact, they offered assistance to one another in telling the story, providing points of clarification where they felt specific information was overlooked. In general, all four of the adult parents I interviewed were motivated to speak with me, and they actively sought me out to share their stories. Because I did not have access to the mailing list at TPS, I did not mail letters to all the parents of the teen mothers seeking services there. Nevertheless I did obtain the addresses of parents of minors, and I extended letters of invitation to them. In total, I mailed six letters to adult parents (four White and two Hispanic), soliciting their voluntary participation. Only one Hispanic mother responded to my letter, and only to inform me that her daughter was no longer living at home and she had no firrther insights to share. No one else responded to my letters and I did not pursue others means of contacting parents. 77 Hence the response rate for adult parents depended solely on the four parents who were highly motivated to speak with me—two who were very proud of their daughters’ achievements, and two who were distraught, hurting, and hoping that I would be someone who would listen. All of these parents were White, and lower-middle or working class. They explored the tensions between the ideal and reality—the ideal of teaching abstinence versus the need for safe sex—as well as the tension between parental control and individual responsibility. The fact that I did not interview any Hispanic parents is a potentially important shortcoming on my study. My interviews with teen mothers suggest that Hispanic families are central to the birth experiences of teen mothers, particularly in preparing them for childbirth and parenting. In general, the adult parents I interviewed spoke more about their own identity as parents than that of their daughters. As such, they provided some useful insights into the social norms and expectations shaping teen mothers’ narratives of childbirth. But they echoed much of what their daughters shared with me in the telling of their own birth stories. Consent Consent forms (see Appendix B) were signed by each individual prior to the interview, indicating that she/he had been informed about the objectives of the study and her/his role in the study. Six of the women (32%) I interviewed were minors between the ages of 15 and 17. I mailed additional consent forms to a parent or legal guardian of these individuals, along with a letter of introduction explaining the intent of my study (see Appendix C). In all six cases, consent forms were signed by an adult and returned. 78 The issue of requiring parental consent raised some questions regarding selection bias in this study. Many teen mothers have conflictual relationships with their parents and thus have little to no interaction with them. Because I assmned that age was an important variable to consider in the case of teen pregrancy, young women under the age of eighteen were included in this study, to the extent that they felt comfortable obtaining parental consent. In many cases, teen mothers were interviewed one to three years after the birth of their babies. As such, while almost two-thirds (63%) of those who were interviewed were under the age of eighteen at the time they gave birth, only one-third of the women in my sample still required parental consent to participate in this study. Those minors who were asked to obtain parental consent were comfortable to do so. They also were asked to sign a consent form themselves prior to conducting the interview with me. As part of written, informed consent, individuals were aware that they could withdraw from the research at any time. If an individual wished to discontinue the interview for any reason, she could withdraw from the study and have all material concerning that interview destroyed. Similarly, if an individual completed the interview but later wished to withdraw herself from the study, she was informed that all materials concerning that interview would be destroyed. Parents and guardians who signed consent forms for minors also were given the right to withdraw their daughter at any time. No one in this study requested to do so. Confidentiality was maintained throughout the study. Interviews were taped and transcribed by three individuals—myself and two local college students. I proofread all the transcriptions to ensure accuracy. Once the taped interviews were transcribed, the tapes were erased to ensure that data would not be connected with any individual. 79 Pseudonyms were used for each subject and identifying markers were changed to ensure that information contained in the interviews would not be connected with any particular person. I also sought to ensure confidentiality by not sharing personal information, such as names of people or places, with the other transcribers. Data Collection In total, thirty interviews were conducted with teen parents, healthcare providers, social service providers, and adult parents. My methods of data collection were threefold: with one exception, I conducted face-to-face interviews which each participant; an interview schedule was 1005er followed; and the questions that were posed were open-ended to allow participants as much freedom as possible to tell their stories in their own way. F ace-to-face interviews allow for geater flexibility in the gathering of data. People have different ways of narrating experiences, and open-ended questions allow for interviews to follow a range of styles—fiom a conversation to a more typical question- and-answer format. An informal interview structure also allows individuals the opportunity to offer more information where they so desire, and as the researcher, I am able to observe and record supplementary information, such as observed emotions or how physical surroundings and events affected the interview at different points. This strategy proved to be particularly useful with teen mothers who were sometimes apprehensive about doing “an interview,” often had a number of people moving in and out of the room while we talked, and sometimes used pictures, toys, or their children to jog memories, emphasize particular points, or break the ice with me. 80 Each person was interviewed only once, and the interviews generally lasted one hour. The teen mothers were given $10 as compensation for their participation in the study. With permission, all of the interviews with teen mothers were tape—recorded and transcribed as well as interviews with six of the nine adults who participated in my study. One telephone interview with a parent, one interview with a healthcare provider, one interview with a social service provider, and two interviews with teen fathers were not formally scheduled or recorded. In those cases, I recorded notes by hand after the interviews were completed, and then transcribed them. Interviews with Teen Mothers The interviews with teen mothers consisted of three parts: a demogaphic survey; the birth story; and a follow-up questionnaire. At the end of each interview, I also recorded personal notes and supplemental information regarding the interview process, our interactions, and the surrounding environment. The demogaphic survey (see Appendix D) was desigred to collect information on age, race/ethnicity, education, access to services, living arrangements and status of relationships with partners, and sources of income and support. In many cases, the survey served to break the ice with teen mothers by following a directed question-and- answer format. Some of the questions were difficult to answer, however, particularly those regarding the current status of their relationships with partners and their main sources of income and support. I quickly learned that information regarding their partners was more easily gleaned during the second part of the interview, as women narrated their stories of pregrancy and childbirth. While this information was not 81 omitted from the demogaphic survey, I limited my inquiries to living arrangements and financial support. Although most of the women I interviewed received multiple forms of public assistance—cg, food stamps, Women, Infant, and Children (WIC) supplemental nutrition services, housing assistance, cash assistance, public health insurance—in addition to support fiom partners and/or parents, there were various interpretations of what I meant by “income” or “support,” and very few of these sources were mentioned unless I specifically asked about them. The theory of competitive parenting among teen mothers (Higginson 1998) sheds some insight on this hesitancy. Joanna Higgonson (1998:139) argues that, by keeping their poverty a secret and setting forth an image that they are financially stable, teen mothers seek to cast off the criticism that they are too young to adequately provide for their children. Their desire to be independent of financial assistance, fiom both parents and the government, stands in stark contrast to the reality of most teen mothers. The teen mothers I interviewed responded similarly, unless probed more specifically about the types of support they received. Teen mothers who lived with their parents were more likely to offer information on their efforts to obtain public assistance such as public health insurance, food stamps, and welfare. Teen mothers who lived alone or with their partners were proud to say that they relied solely on their own or their partners’ income (even though three-fourths of them also received various forms of public assistance). For the second part of the interview, I put away all paperwork and turned on the tape-recorder. To elicit a running narrative of their birth experiences, I began each interview with the same statement: “I am interviewing teen parents about their 82 experiences with pregrancy and childbirth—I would like you to tell me your story now, beginning wherever you want.” The responses varied geatly—some stories were told in less than five minutes, while most provided details that carried the story for 30-40 minutes with few to no interruptions on my part. The age of the child was not connected to the length or detail of the story, nor was the type of birth. Two women preferred that I ask questions, but after a few minutes of asking them about how it felt to be pregnant, and how they prepared for childbirth, they were telling their stories comfortably. Others began detailed stories before we even sat down and I turned on the tape recorder. Once their stories were finished, I followed an interview schedule to probe for more specific information (see Appendix E). Depending on what teen mothers chose to talk about in their initial birth stories, I asked a series of open-ended questions about their experiences with pregrancy, childbirth, and parenting. Not all of the questions were asked of each individual. The most common questions focused on relationships during pregrancy and childbirth, preparations for childbirth, and the process of story telling. The following are representative of the areas about which I probed. o How did people respond when you told them about your pregrancy? o Where/what did you learn about pregnancy and childbirth? o How did others interact with you during labor and delivery? 0 How did you feel about your body during pregrancy and childbirth? o What stories of birth did you hear prior to giving birth? 0 Why did you volunteer to tell me your birth story? In general, their birth stories focused on three common themes: how and when the pregnancy was discovered; the progession of labor and delivery, and relationships 83 with others (e.g., boyfiiends, parents, healthcare providers) during pregrancy, childbirth, and the transition to parenthood. In most cases, they did not offer information about birth control, their preparations for childbirth and parenting (e.g., classes, prenatal exams, teachings fiom family and fiiends), how they felt about their bodies during pregnancy and childbirth, or what stories they had heard from others about childbirth. All of the teen mothers responded easily to my questions, but their primary focus was on presenting an image of themselves as responsible and competent parents. As such, their stories tended to focus more on their image as parents than the process of giving birth. My role in probing for information and guiding the story-telling process was central to clarifying this difference and will be discussed in more detail below. I_n_t_erviews with Teen Fathers Only two teen fathers were interviewed in this study, and both of these interviews were informal and unplanned. As explained above, after my initial letters of invitation were mailed by TPS, I discovered that only teen mothers were the recipients. Fathers were not listed as primary clients and thus they did not receive letters from me. Once I began interviewing teen mothers, invitations were extended to their partners as well. The only two men who accepted my invitation were at home when I interviewed their partners. In both cases, they cared for the children in the back room while I interviewed the women—occasionally eaves-dropping and interj ecting bits of information, opinions, and insights. Although both of these men declined invitations to be interviewed, they seemed eager to talk. Thus, after all my interview materials were put away, I presented a series of open-ended questions to them, asking them to talk about 84 their experiences during pregrancy and childbirth. I recorded the content of these conversations as soon after leaving the interview as possible. Because I was in the home primarily to interview the mother, I established a different relationship with her than I did with her partner. In both cases where the men were included, I had my newborn with me and shared a certain camaraderie with the young mother that I did not seem to share with her partner. The men primarily provided supplemental information—points that their partners forgot to mention or were not aware of during labor and delivery. They wished to emphasize their own responsibility as fathers, but would not elaborate on their feelings or experiences beyond what their partners outlined. Interviews with Adults Once all of my interviews with teen parents were complete, I interviewed healthcare providers, social service providers, and adult parents to get their unique perspectives on relationships with teen mothers. I used these interviews to help contextualize the stories of teen mothers. My intention was not to use these interviews to validate or corroborate the information provided by teen mothers. I took the stories of teen mothers as accurate and valid in their own right. Rather, the interviews with adults provided firrther insights into dominant ideologies of teen childbearing and how these shape the relationships that teen mothers have with adults who serve as their informational, service, and support network during pregnancy and childbirth. The interviews followed a general question-and-answer format (see interview schedule in Appendix F). Questions varied depending on the identity and/or profession 85 of each of the respondents, and our conversations were shaped by information I had gathered during my interviews with teen mothers. Many teen mothers complained that they were mistreated, ignored, wrongly accused, and/or judged to be incompetent by healthcare workers and social service providers. I looked for insights into these experiences by asking adults to describe the types of information they provide to teen parents and what they regard as teen parents biggest needs. In general, interviews with adults explored the kinds of information that they provided to teen parents, the nature of the relationships they established with teen parents, and the kinds of expectations they held for teen mothers and fathers during pregrancy, childbirth, and parenting. Healthcare providers offered particular insights into prenatal exams and childbirth—including factors associated with exam attendance, the use of ultrasound, and the emphasis placed on preparing teens for parenthood, as well as efforts to maintain young women’s focus during labor and delivery. Social service providers offered further insights into teen parents’ access to educational, financial, and medical resources, both before and after childbirth, and the extent to which access is differentiated by race and ethnicity. Finally, parents of teen parents provided a personal perspective on the birth process, including their own role in teaching abstinence, preparing their daughters for childbirth, and emphasizing the values of responsible parenting. Interviews with these individuals were kept informal and only loosely followed the interview schedule provided in Appendix F. I was interested in allowing these individuals to guide the direction of the conversation and the topics explored in order to gain insight into their own opinions regarding issues of teen childbearing. 86 My Role as Researcher Immediately following each interview, I recorded supplementary information about the interview, the respondent, and my relationship with her/him. The information I recorded described the context, tone, and content of each interview in order to locate my own voice in the interview process and my role in directing the focus of the conversation. In terms of the context, information was recorded about where it took place, who was present, and how the environment shaped the interaction between me and the respondent. All of the interviews with teen parents were conducted in their homes. Many of their children were present during the interviews, watching television, sleeping, playing with toys, crying, asking to be fed, playing with the tape recorder. Other individuals—friends, neighbors, family members—came and went during the interview, or called on the telephone, although the women were quick to dismiss these people and remain focused on the task at hand. My interviews with teen mothers generally followed an informal conversation style, rather than a standard question-and-answer format. Each woman was asked to tell her story, and during that time, I said very little. Once the story was complete, I asked questions about specific topics if they were not touched on in the story. The women were allowed to guide the direction of the interview as much as possible. I played an active role, however, in probing for certain kinds of information, particularly regarding their reasons for getting pregnant, their preparations for childbirth, and how they felt about their bodies, both before and after the baby was born. To the extent that their intentions were to prove themselves good mothers, information regarding preparations for childbirth were frequently dismissed as “common 87 sense,” and their relationships with others remained the focus—particularly, relationships with partners, parents, and healthcare providers. My questions about birth control, prenatal visits, childbirth classes, the body, and others’ stories of childbirth placed much more emphasis on the process of giving birth. Their answers to these questions further highlighted the way in which teen mothers struggled with dominant ideologies and stereotypes in their efforts to create a positive view of themselves. Although most of the women were comfortable answering my questions, they remained my questions and were not necessarily central to the stories women set out to tell themselves. Understanding my own role as researcher in the story-telling process stems fiom feminist methodology. One feature of feminist methodology is the use of women’s diverse lives as the primary source of data (Bloom 1998: 144). This allows women to define themselves, and in doing so, resist stereotypes and validate their own experiences (Collins 1991). Another goal of feminist methodology is to locate the researcher’s own history, values, and assumptions in the text so that she, like those researched, is open to critical scrutiny by her readers (Bloom 19982148). The real task is to engage in a critical analysis of her role as researcher with regard to social identity and positioning. My social identity no doubt influenced the findings of this research. As a White, educated, middle-class woman in my thirties, I entered into relationships with teen mothers who were younger and less privileged than I am. Although most of the teen mothers I interviewed planned to finish high school, all were low-income and only a few had plans to attend college. Where we did find common gound, however, was in our identities as new mothers. I had one toddler at home and was either pregnant or toting a newborn to each interview I completed. I also looked relatively young (those who were 88 curious estimated I was in my early twenties), a fact which seemed to help me establish rapport with them. Compared to the social workers and other service providers with whom these teen mothers interacted on a regular basis, I appeared to share their identity as a new mother and did not hold the same type of authority over them. This rapport did not exist with the two teen fathers I interviewed. Because they perceived my primary interest to be with their partners, these men maintained an emotional distance from me and only offered limited information where they wanted to. Despite my status as new mother, my position as researcher was still central to shaping my interactions with teen mothers. When I showed up at their doors, either pregnant or holding a newborn in my arms, I was always geeted warmly, if not with some curiosity. Sometimes I was asked for advice on health issues, and sometimes I was given advice on popular toys or where to shop for the best prices. But in most cases, I was met with an agenda in mind for why they volunteered to tell me their stories. At the end of each interview, I asked each woman to answer the same question: “Why did you volunteer to meet with me and tell me your story?” The answers came easily: “because I think I’m pretty responsible;” “I know what people think about teen moms;” “I like to hear others’ stories,” or because “I think you’re going to go talk to other girls about it and if I, or somebody, can help one girl, that girl can help some other girls change their lives.” These responses gant me a certain power or voice to speak, which is not necessarily something that is accessible to them as teen mothers. These women also irnply that I have the responsibility to do something with their stories that can effect some change in the world. This relationship between researched and researcher defines the heart of feminist methodology. 89 The findings of my study are presented in Chapters Four through Six of this dissertation. Where appropriate, I highlight my role in the story-telling process, although these chapters focus most closely on the voices of teen mothers themselves. In Chapter Seven, I summarize the findings and more closely analyze the ways in which I personally shaped the birth stories told in this study. Although these are the stories of teen mothers, they are based on the questions I posed, the agenda teen mothers had for telling their stories to me, and my interpretation of the stories based on my own social location as a woman, mother, sociologist, college student, and researcher. Story-Telling as Methodology As outlined above, the method of data collection used in this study was primarily that of story-telling. Stories are used in qualitative research in a variety a ways to elicit information about individuals, goups, and society at large. While research related to story-telling is large, some common themes emerge regarding the role and firnction of stories in the research process. In this study, I approach stories from three points of view: as social interactions between producers, coaxers and consumers; as processes of accommodation and resistance; and as means of identity-formation. Each of these approaches is discussed in the following pages. Socigl Intergctiorr_s_ Ken Plummer (1995) outlines most clearly a “sociology of stories” approach in Telling Sexual Stories. Working flour a symbolic interactionist approach, Plummet explores the complex social processes involved in telling stories, particularly how stories, 90 as social actions embedded in social worlds, reflect relationships of power, inequality, and social control. Plummer is less concerned with analyzing the formal structures of stories and more interested in inspecting the social role of stories—“the ways they are produced and read, the work they perform in the wider social order, how they change, and their role in the political process” (Plummer 1995:19). The focus is neither on the individual life nor on the text that is produced, but on the interaction between individuals which emerges around the process of telling stories. According to Plummer, story-telling involves a complex process of production and consumption. Three types of actors are involved in this process. Story-tellers—or producers—draw on the dominant language, discourse, and stories of others to narrate their own stories and experiences to a wider audience. Coaxers—listeners and researchers—possess the power to provoke stories from people, and can play a crucial role in shifting the nature of the stories that are told. Finally, consumers of stories interpret and make sense of stories, sometimes reading a text in relative isolation, and at other times reading it through the social worlds of class, race, gender, age, experience, or sexual orientation. Together, producers, coaxers, and consumers create the stories that are told. But because stories are “gounded in historically evolving communities of memory, [and] structured through age, class, race, gender, and sexual preference” (Plummer 1995:22), they get told and read in different ways in different contexts. The symbolic interactionist approach to story telling emphasizes the centrality of the researcher’s own experience because of the part the researcher plays in telling and retelling stories to others. In Narrative Inquiry: Experience and Story in Qualitative Research, D. Jean Clandinin and F. Michael Connelly (2000) conclude that life is filled 9l with narrative fragnents enacted in storied moments of time and space. “Once the narrative process takes hold, the narrative inquiry space pulsates with movements back and forth through time and along a continuum of personal and social considerations” (Clandinin and Connelly 2000:66). As such, there is a reflexive relationship between living a life story, telling a life story, retelling a life story, and reliving a life story. As the research begins, new stories are told and lived. Hence, as researchers, the authors conclude that we must see ourselves as always in the midst—located somewhere along the dimensions of time, place, the personal, and the social. We are also in the midst in that we are in the middle of a nested set of stories—ours and theirs (Clandinin and Connelly 2000:63). The stories that come out of our research are thus fluid and evolving. This notion of stories as social actions, as gounded in larger communities of memory and relationships, and as relationships between researcher and researched, is explored by a number of feminist writers as well (Behar 1996; Brown et al. 1994; Harding 1991). In feminist research, what is important is the relationship between the researcher and the respondent, both of whom are whole persons who have certain characteristics and experience life fi'om certain standpoints of privilege and/or marginality (Haraway 1988; Harding 1991). Rejecting the positivistic approach of distance and objectivity, the feminist paradign embraces subjectivity in research and acknowledges that how research is done is strongly shaped by who is doing the research and where that researcher is socio-culturally located. In Missing Voices: The Experience of Motherhood, Stephanie Brown and her colleagues (1994) explore methods of collecting women’s stories, relying on memory as a source of data. Typically, within the framework of positivistic science, women have 92 been primarily positioned as passive, unreflective, and uninformed sources of “raw data” (1994:5). The data developed are considered to belong to the researcher, on the gounds that only s/he has the proper qualifications to analyze it and extract its meaning. The notion that data “speak for themselves” in some impartial scientific way overlooks the part that interpreter bias can play (1994:6). In their research, Brown and her colleagues assumed that “women can be believed when they report on their lives-—that their reports have indisputable authority” (199422). Although challenged by professional journals for making such an assumption, and failing to “validate the mothers’ recall” with medical records and professionals (19943), the authors find support for this approach and validity in the stories of women. In The Vulnerable Observer, Ruth Behar (1996) explores ways in which to locate oneself in one’s own text, thus drawing deeper connections between one’s personal experience and the subject under study. This process requires a keen understanding of what aspects of the self are the most important filters through which one perceives the topic being studied. Behar contends that what happens within the observer must be made known (199626). Lila Abu-Lughod (1995) embraces this challenge in “A Tale of Two Pregrancies” by drawing connections between her own pregnancy and the research she has done on women’s reproductive strategies in Egypt. Through her own bodily experiences, she is able to re-evaluate the way in which she framed and interpreted data to pursue her own research objectives, rrrissing the subtleties of women’s experiences and relationships with one another. What she previously had not explored was the possibility that her own constructions of personal experience also would be shaped by knowledge of these women—that as her pregrancy progessed, she would draw on knowledge fi'om 93 women she knew “in the field,” as well as support fi'om “home.” Stories are told, lived, retold, and relived through her research experiences in Egypt as well as through her pregrancy at home. Telling the birth stories of teen parents is similarly infirsed with relationships of power as teen mothers, healthcare providers, social service providers, adult parents, and I, as researcher, interact in the production and consumption of these stories. Teen mothers drew on their personal knowledge and experiences, as well as the experiences of others, to narrate their stories to me. As the researcher, I raised particular questions and interpreted stories from my own point of view, based on my own knowledge and experiences as a sociologist, a woman, and a mother. Thus, in the stories they narrated to me, teen mothers discussed how and when they discovered they were pregrant, how labor and delivery progessed, and how their relationships with others influenced their experiences during pregrancy, childbirth, and the transition to parenthood. Very few of them discussed specifics of their pregrancies, feelings about their bodies, preparations for childbirth (prenatals, classes, and other sources of information), or others’ stories of childbirth. By probing for this information, I placed much more emphasis on the context and process of giving birth. In turn, I recorded stories about how teen mothers felt about their identities and responded to social norms and expectations regarding childbirth and parenting. Because these stories were a product of my relationship with the women I interviewed, they are potentially different from the stories another researcher would tell. Simply stated, I entered this research project to explore how social norms about gender, age, ethnicity, and social class shape teen mothers’ stories of childbirth and parenting, beginning from the perspectives of teen mothers themselves. Teen mothers 94 ageed to participate primarily because they perceived me to be a voice for them—either one that could articulate their fi'ustrations and insights to others, or one that could share with them the experiences of other teen parents. I did not seek to validate their narratives with “officia ” sources of information such as medical records or interviews with adults. I chose to believe the stories they told. These stories were not “truth,” but were interpretations of experiences based on the larger context within which stories are told. As both producers and consumers of stories, the larger community shapes the ways in which stories of teen childbearing can be told and heard. I interacted with teen mothers in this context, and I interpreted their stories fiom my own point of view. Master Narratives Jand Untold Stories A second related area of literature considers more directly the way in which stories are shaped and constrained within larger contexts of power and resistance, social control and social change. A number of studies explore how story tellers engage in both accommodation and resistance to master narratives of age, gender, race/ethnicity, class, and sexuality as they tell their stories to others (see Romero and Stewart 1999; Kingfisher 1996; Coslett 1994). In Women 's Untold Stories, Mary Romero and Abigail J. Stewart (19992xiv) state that master narratives are the stories we are taught and teach ourselves about who does what and why. These stories support dominant structures and act as systems of social control by blurring and erasing plot elements that do not fit. Articulating and legitimating new and untold stories sheds new light on the power structures in which gender, class, ethnicity, sexuality, and ability all define who matters and how. New 95 stories directly challenge master narratives by claiming identities denied them in master narratives and complicating our understanding of experiences. Because these new stories partially reproduce master narratives, they cannot be fully comprehended without first considering the power structures and ideologies in which they are constructed and told. Exploring this confluence of accommodation and resistance, a new understanding is gained of how women make sense of their experiences and communicate those experiences both to themselves and to others. Although stories often reflect official scripts and narratives, they also resist dominant ideologies and power relationships in important ways. In Women in the American Welfare Trap, Catherine Pélissier Kingfisher (1996) explores various forms of language as resistance. She contends that language is the primary means by which we share our lives with others. By typifying and categorizing experiences, social reality is constantly produced and reproduced (Kingfisher l996:4). Participants are not free to construct anything they want, however", dominant systems contain the power to place limits on “what is available for women to think with” (Kingfisher 1996:5). Thus, talk is both constrained and creative. “When recipients label themselves as ‘working welfare moms,’ for example, they are strategically countering prevailing notions of women on welfare as immoral and lazy” (Kingfisherl99625). They draw on ideals culturally available to them in their struggle to create their own identities. Women do not simply internalize dominant views of society, but they interpret them and create their own meanings in the context of various material constraints. In Blood Stories, Janet Lee and Jennifer Sasser-Coen (1996) explore stories of menarche in order to demonstrate how social institutions shape the knowledges and 96 practices surrounding menstruation and fiarne menarche as an important event. The authors contend that stories of menarche are stories about alienation and sexualization, lack and transformation of power, ambivalences about changing bodies, and relationships between menarche and subsequent perceptions and experiences with menstruation and menopause (Lee and Sasser-Coen 1996:5). Such stories also are about changing relationships with mothers and fathers, girlfiiends and boys, other family members, and strangers. As such, Lee and Sasser-Coen (l996:5) conclude that menarche is “a central aspect of body politics, loaded with ambivalences associated with being a woman in Western society.” Using excerpts fiom oral and written narratives, the authors explore the processes by which women internalize dominant discourses about gender and the body. They also consider women’s resistance to negative discourses through appropriation and/or integation of more positive discourses of the body as experienced in their own lives. Lee and Sasser-Coen (1996:8) conclude that “[t]elling, writing and analyzing the stories of menarche are steps toward deconstructing the negative discourses that surround menstruation, and contribute to the historical study of the patterned nature of women’s sexual and reproductive selves.” This balance between compliance and resistance highlights the complex relationship that exists between master narratives and previously untold stories. Master narratives are equally strong in the telling of birth stories, and several studies note the limited extent to which an “authentic voice” can be heard in women’s stories of childbirth (Pollock 1997; Cosslett 1994). Tess Cosslett (1994), for example, notes that childbirth, as an experience belonging to the private sphere of womanhood, has 97 long been marginalized as a subject for public representation. While she concludes that childbirth is a central life-changing event for many women and needs to be made visible, investigating women’s accounts of birth are not suddenly going to find authentic voices. These voices have been culturally constructed by prevailing discourses and cultural practices of what it means to be a woman and a mother. The consciousness of a birthing woman thus involves a process of negotiation with prevailing ideologies whose aim is power—“in terms of writing, the power to take over the story, in terms of childbirth, the power to control the experience; or in both cases, the power to protest, or celebrate, lack of control” (Cosslett 199623). In general, Cosslett (19942173) seeks to illustrate the plasticity of oral narrative, particularly with regard to the way it varies according to time, place, and audience. While certain features of both facts and feelings remain constant, women’s interpretations can change, thereby creating multiple stories. Teen parents also encounter a range of master narratives regarding childbirth and parenting, and they engage in complex processes of accommodation and resistance. As outlined in Chapter Two, birth stories generally follow one of two dominant narratives— the medical model of childbirth or the natural childbirth model. Women draw on these narratives in their own stories and interpret them to fit their own experiences. Similarly, stories about teen pregrancy and parenting are shaped by public opinions of teen parents as immoral, irresponsible, and welfare dependent. Teen mothers draw on these narratives and stereotypes as well, accommodating some of their ideologies and assumptions and challenging others. The stories that teen mothers tell in turn shed light on the assumptions of these master narratives and the power inequalities inherent in them. 98 Identity Formgtion A third approach to story telling focuses more directly on the role stories play in shaping and reshaping personal identities. Salome Chasnoff (1996) worked with teen mothers in the production of a video, “Looking at Teen Mothers: The Fantastic Moms Video.” Framing performance as a transformational activity, the teen mothers used this video to alter how they saw themselves as well as how they saw and were seen by others. Rather than authentic, isolated, and self-driven expressions, Chasnoff(l996:110) outlines the ways in which their stories were “purposefully contingent upon and in appropriation of the dominant language and its construction(s) of teen motherhood.” Replacing the dominant representation of teen motherhood with their own stories, these young women reshape the public discourse on teen motherhood and create new identities for themselves. They challenge the term “teen mother,” replacing it with multiple, often contradictory, identities, such as student worker, fiiend, artist, daughter, mother. Ultimately, they replace the dominant stereotype with something outside the known category “teen mother.” While the “pregnant teen” of dominant discourse assumes a static, monolithic identity, Chasnoff (1996:1 12) argues that teen mothers are marked by difference and diversity: “Young pregnant women, always disadvantaged by gender and age, sometimes by race, class, education, marital status, citizenship status, sometimes rejected by their own families, eventually become stignatized as ‘unwed mothers’ of ‘illigitimate children’.” According to this discourse, pregrant teens are “failed” students and teen mothers are “failed” mothers and “failed” citizens. The ultimate victim is always “society.” In confronting and altering the dominant interpretation of “teen mother,” the 99 young women in Chasnoff’s video set out, not to create positive images, but to exercise their right to position and define themselves. By presenting themselves “at the center,” and challenging domination through discursive representations, they “renarrativized the public discourse on teen motherhood and, consequently, their own private stories” (Chasnoff 199621 17). Lisa Dodson’s (1999) study, Don ’t Call Us Out of Name, locates a similar objective in the stories of poor women. Obj ecting to the terms “dysfunctional,” “welfare mothers,” or “recipients,” the women she interviewed resist being named, because “when you let them name you, everyone comes to know you that way, in a sense, you become that” (1999:180). The women in Dodson’s study insist on naming themselves, drawing on their own experiences and knowledge, and finding a version of themselves “which is your own, which has not been forced upon you by others” (1999:187). As such, they refer to themselves as “a welfare survivor,” independent, responsible, “a loud mou ,” and strong (1998:192). Summm These three approaches to story-telling—as social interactions between producers, coaxers, and consumers; as reflections of master narratives and subject narratives; and as processes of identity-formation—highlight the complex nature of story-telling, as it is influenced by power inequalities and efforts at social control. These approaches are useful for exploring the birth stories of teen mothers because of the emphasis placed on process, social interaction, and the existence of multiple voices. As teen mothers narrate their birth stories to me, the voices of others are heard as well, including those of 100 healthcare workers, social service providers, family members, fiiends, and me, as researcher. Their stories both reflect and resist dominant ideologies and stereotypes of what it means to be a teen parent, as they explore their relationships with others and demonstrate their responsibility and competence as parents. Ultimately, they struggle to prove themselves “good mothers” by resisting negative stereotypes and speaking for themselves. Analysis of Data: Grounded Theory I used gounded theory as the basis for categorizing information and formulating propositions from the stories told to me by teen mothers. A gounded theory approach is a qualitative research method that uses a systematic set of procedures to develop an inductively derived theory about a phenomenon (Strauss and Corbin 1990:24). The purpose is the development or generation of a theory closely related to the context of the phenomena being studied. Data collection and analysis are carried out simultaneously. Rather than begin with a theory, then prove it, one begins with an area of study and what is relevant to that area is allowed to emerge. This process of data analysis includes three procedures: open coding, axial coding, and selective coding. Grounded theory provides a procedure for developing categories of information (open coding), interconnecting the categories (axial coding), building a “story” that connects the categories (selective coding), and ending with a discursive set of theoretical propositions (Creswell 19982150). As I carried out my interviews with teen mothers, I followed this procedure, developing categories of information and searching for connections between these categories. 101 Open coding is the part of the analysis that pertains specifically to the naming and categorizing of phenomena through close examination of data. During open coding, I broke the interviews down into discrete parts, identified common themes and topics, and compared them for similarities and differences. These categories and sub-categories included such issues as birth control, pregrancy tests, making a decision to keep the baby, relationships with parents and healthcare providers, education, childbirth classes, prenatal exams, labor and delivery, medical interventions, others’ stories of childbirth, breastfeeding, and the transition to parenting. Axial coding puts the data back together in new ways by making connections between a category (phenomena) and its subcategories—the conditions that give rise to it, the context in which it is embedded, the action/interactional strategies by which it is handled, managed, and carried out, and the consequences of those strategies (Strauss and Corbin 1990:103). During this phase of analysis, I considered events or incidents shaping teen mothers’ experiences with childbirth, conditions influencing their actions and interactions, and broader structural conditions bearing upon their actions and interactions, including time, space, culture, economic status, age, and ethnicity. Interviews with adults were used to further clarify the connections between categories and sub-categories during this phase of analysis. Finally, in selective coding, the categories are brought together into a coherent story. Once an initial set of categories is developed, a single category is identified as the central phenomenon of interest and the interrelationships of categories are examined around this phenomenon. In this study, parenting emerged as the central phenomenon of interest as teen mothers compared themselves to other mothers, both teenage and adult, in 102 an effort to prove themselves “one of the better ones.” This phenomenon was closely linked with their experiences during pregrancy and childbirth, particularly their relationships with partners, parents, healthcare providers, and social service providers. Chapters Five and Six explore these relationships as they shape the context in which teen mothers tell their birth stories. Summary I offer this extensive review of the methodology used in this study in order to clarify my methods of sample selection, data collection, and data analysis. F ace-to-face, in-depth interviews were conducted with nineteen teen mothers, two teen fathers, and nine adults, and these interviews relied on the methodology of story-telling and open- ended questionnaires. The teen mothers who participated in my study guided the direction of the story-telling process, and they reflected important differences of race/ ethnicity. Together, their stories highlight the complex ways in which they enter into relationships with others, engage master narratives of childbirth and parenting, make decisions regarding childbirth, and struggle to prove themselves good mothers. Although the birth stories told in this study are the stories of the 19 teen mothers who volunteered to tell their stories to me, these birth stories were narrated to me within a larger context that guided the direction and focus of the stories in complex ways. In many ways, both the teen mothers and I approached this project with similar agendas— this was one opportunity for teen mothers to let their voices be heard, to challenge stereotypes of what it means to be a “teen mother,” and to prove their competence and self-worth. I was not their doctor, case worker, mother, teacher, or peer. Rather than 103 someone involved in the intimate details of their lives, they treated me as an advocate, a voice through which to communicate the more positive aspects of their lived realities and identities. My very presence in this project shaped the messages they struggled to convey, the words they used, the issues upon which they focused or which they avoided. My questions set the pace of the story-telling process by probing for certain kinds of information (e.g., use of birth control, participation in childbirth classes, birth plans, persons attending the birth) that may or may not have been shared if I had not asked. Because I was looking for uniformity and common themes across a multitude of stories, I asked these questions of everyone. Their stories may have unfolded differently under different circumstances. The following chapters present the details of the stories I collected for this study. For the sake of simplicity, the birth stories are divided into three sections, which correspond with Chapters Four through Six: pregrancy, preparations for childbirth, and birth and the transition to parenthood.5 In each chapter I explore teen mothers’ experiences and how these differ by race/ethnicity. I also consider how their interpretations and narratives are shaped in a larger context involving a range of actors with competing narratives. My own role in this process is explored in more detail in the conclusions in Chapter Seven. 5 Although the birth stories that teen mothers told to me were chronological in the sense that they moved from pregnancy, to labor and delivery, to parenting, I asked many questions at the end of their stories that caused the conversation to move back and forth in time. Thus, information about birth control was generally provided at the end of the interview, while they tended to start their stories with how they discovered they were pregnant, and then move into labor and delivery. Throughout the story, their experiences as parents are explored. 104 CHAPTER FOUR PREGNANCY: “IT’S MY RESPONSIBILITY” This chapter focuses on the beginning of the birth story, which typically began with a young woman’s discovery that she was pregnant. I focus on a teen mother’s experiences with pregrancy—why she got pregrant, how she confirmed she was pregnant, how she and others felt about the pregnancy, and what issues were considered in making the decision regarding whether or not to continue with the pregrancy. Throughout this discussion I consider the various voices involved in narrating the story— parents, teachers, doctors, peers, boyfriends, and mine, as coaxer. In this way, I explore the larger social, medical, and political narratives guiding the story-telling process, as well as relationships of power and social control shaping the processes by which young women struggled to make sense of their behaviors, relationships, and changing identities as “teen mothers.” Important differences of race/ethnicity are considered throughout the chapter as White and Hispanic women narrated their stories to me. One of the clearest messages voiced by teen mothers in this study was that pregrancy is “my responsibility.” In the next section, I discuss the sociopolitical context in which master narratives of teen sexuality and pregrancy are communicated to youth in Green County. Then I explore how these narratives shape teen mothers’ stories of their own experiences with pregrancy. In general, the public message is clear—teens are advised to abstain fiom sex; those who do not and end up pregrant have only themselves to blame. Teen mothers gappled with this message in the stories they told to me, particularly the implications raised about their intentionality and responsibility. 105 Sociopolitical Context of Pregnancy in Green County A large number of studies have reported on rates of sexual activity, contraceptive use, and pregrancy and abortion among teens in the United States (Alan Guttrnacher Institute 1994; Darroch, Singh, and Frost 2001; GAO 1998; Luker 1996; Maynard 1996; NCPTP 2001). In general, these studies find that a gowing ntunber of teens are sexually active, most do not use contraceptives consistently, the vast majority of teen pregrancies are unintentional, and both abortion and adoption rates among teens are declining. Issues of morality and responsibility shape debates over the most appropriate means of addressing these trends. The debates focus most clearly on abstinence-only education versus sex education (Cothran 2001) as a means to reduce the teen pregrancy rate. The message is that teens who do not abstain should at least practice safe sex, thereby assuming responsibility and avoiding pregrancy and the spread of sexually transmitted diseases. Accordingly, teens who are sexually active and become pregrant are deemed irresponsible, if not immoral.l These issues have been discussed in Oregon at the state level in an effort to address the issue of teen pregrancy and to identify the most appropriate means to reduce the teen pregrancy rate. In 1997, Governor John Kitzhaber released the first Oregon Adolescent Pregnancy Prevention Action Agenda (Oregon DHS 2000), which sought to mobilize local and state partners into a cohesive integated course of action. While a number of strategies and measurable outcomes were outlined in this Action Agenda, and have been updated in more recent editions, implementation has been carried out at the local level with unique implications for young women in Green County. ’ For a detailed discussion of these issues, see the review of literature in Chapter Two. 106 Oregon Adolescent Hwy Prevention A_ction Agenda The first Action Agenda, released in 1997, set the goal of reducing the teen pregrancy rate in Oregon to fifteen per 1,000 girls ages 10-17 by the year 2000. In pursuit of this goal, coalitions all over Oregon were encouraged to develop comprehensive approaches to address teen pregrancy, based on a combination of the following seven prevention strategies (Oregon DHS 2002a). 1. 7. Positive community values and norms through public awareness, adult involvement, and cooperation of stakeholders; School- and community-based life skills development, including comprehensive sex education; Abstinence education called Students Today Aren’t Ready for Sex (STARS); Contraceptive access through school-based health centers and local health departments; Male involvement and leadership in pregrancy prevention; Legal issues, including statutory rape and sexual abuse statutes, and legal paternity and child support orders; and Young parent services. A variety of indicators were identified to measure implementation of these seven strategies, including the number of coalitions formed at the county level, the percentage of students using contraceptives, receiving STARS training, or having first sexual intercourse before the age of fifteen, and the number of pregrancies reported in Oregon. In general, these indicators sought to measure changes in individual behavior— abstinence, contraceptive use, participation in STARS training—as well as changes in 107 pregnancy rates at the state and county levels. Policy makers hoped that by encouraging abstinence and/or consistent contraceptive use, teen pregrancy rates would decline statewide, thus enabling a geater number of youth “to become adults before they take on the overwhelming responsibility of parenthood” (Oregon DHS 2000: l). The goal of the Action Agenda was surpassed by the year 2000, when Oregon reported a teen pregrancy rate of fourteen per 1,000. Thus the new Action Agenda set the goal of reducing the rate to ten per 1,000 girls by the year 2010 (Oregon DHS 2002a). The same strategies continue to be implemented, and coalitions across the state have been encouraged to continue introducing them in a geater number of communities. Implementation of the Action Agenda in Green County In Green County, the “Reduce Adolescent Pregrancy Project” (RAPP) has been the primary vehicle through which efforts to reduce the teen pregnancy rate have been explored and implemented. Green County’s teen pregrancy rate has fallen more quickly than the state average: fi'om 1995 to 2000, Oregon’s teen pregnancy rate fell from 19.2 to 14.0 per 1,000 women ages 10-17; the rate in Green County fell from 20.5 to 11.2 during the same time period (Oregon DHS 2001). The rate in Green County, however, has been more sporadic, spiking in 1998 at 20.3. As such, an accurate picture of teen pregrancy and parenting rates in Green County is difficult to obtain, and RAPP members maintain that Green County continues to record one of the highest teen pregnancy rates in the state, despite temporary declines. RAPP is a local coalition of individuals representing a wide array of public service progams in Green County, including public high schools, private and county 108 health progams, alternative schools, adoption progams, and youth progams. Although this goup has been central in guiding county efforts in teen pregnancy prevention, it has done so within a political environment that does not embrace all the strategies outlined in the state Action Agenda. During the time that I was conducting my research in Green County, a number of issues were raised that clarified the complicated environment in which policies, services, and agendas were formulated and pursued. Two strategies of the Action Agenda seemed particularly contentious in Green County: the fourth strategy, emphasizing increased contraceptive access through school- based health centers; and the seventh strategy, focused on young parent services. The Director of Teen Parenting Services (TPS) in Green County explained that their progam was facing potential budget cuts fiom the Department of Youth and Family Services due to the fact that their long-term impact was questionable, despite their emphasis on preventing repeat pregnancies among teen mothers. Similarly, the two largest high schools in Green County were facing public criticism for providing daycare services to their parenting students, despite the schools’ efforts to keep teen parents in school and make them more employable in the future. The underlying fear that both programs fireled was that support to teen parents publicly condoned teen parenting and “made it too easy” for youth to have children and not assume responsibility.2 For similar reasons, Planned Parenthood was forced out of Green County in the early 19905, and only limited services for pregrancy prevention and counseling were available to women in Alton and Benton. The most recent challenge, however, has revolved around the provision of school- based health centers in Green County. In 2001, county commissioners voted to deny 2 Information obtained through personal commrmication with daycare Director. 109 pass-through funds’ to a school-based health clinic in an impoverished community in Green County. Since 1989 this center had been providing primary medical care, health education, sports physicals, prescriptions for illnesses, and other related services to low- income students who could not afford to travel to neighboring towns for health care. The commissioners stated that they were “philosophically opposed” to the services provided there because they suspected that information regarding birth control was being provided to unmarried teens. They went on to argue that “parents, and only parents, should be dealing with their children’s health care” and thus the state should not intervene.4 This stance was in direct contradiction to the strategies outlined in the state’s Action Agenda, which highlighted the importance of providing contraceptive services to teens. County residents were outraged by the commissioners’ decision and a flood of letters to the editor were published in subsequent days. Individuals condemned the decision because it discontinued the provision of necessary health care to low-income families in that community. Clinic staff further challenged the commissioners by maintaining that the clinic had never provided contraceptive information or services to students, and that their primary objective was to provide basic preventative care. The commissioners refirsed to reconsider their stance, and eventually a neighboring county ageed to manage the funds so that the clinic could remain in operation. Although RAPP members were similarly outraged by this event, they struggled to find a political strategy that would be tolerated and heard in Green County in their efforts to pursue teen pregrancy prevention strategies. Thus they focused on four strategies fiom 3 Although the clinic was not supported by county funds, it did receive funds from the state for its continued operation. County commissioners are responsible for distributed the funds to clinics in their cormty. ’ Quoted in local newspaper, August 23, 2001. 110 the Action Agenda: the first, which emphasized public awareness; the third, which stressed abstinence-based education; the fifth, which focused on male involvement in pregrancy prevention; and the sixth, which involved researching legal issues. RAPP sponsored local newspaper ads quoting statistics on teen pregrancy rates in Green County, and advocating abstinence through the statement “You can go farther when you don’t go all the way.” Motivational speakers were sponsored to present a similar message in public high schools to students, parents, and interested community members. RAPP members were also preparing to attend a local conference on how to include men in pregrancy prevention efforts.5 Abstinence-based curriculum like STARS was used in several public schools in Green County. Some teen mothers I interviewed were familiar with this curriculrun, particularly if they attended high school in Alton or Benton, and their stories reflected on the messages received there. Other teen mothers interacted with a range of adults who participated in, and/or were influenced by, the public initiatives and debates highlighted above. The dominant narratives shaping these relationships—with parents, teachers, doctors, caseworkers, and others—are explored in this chapter as they shape the ways in which teen mothers talked about circrunstances surrounding their own pregnancies and how they made decisions regarding sex, birth control, and unintended pregrancy. This review of state and county pregnancy-prevention agendas is presented here in order to highlight some of the dominant narratives of teen sexuality and pregrancy voiced in Green County during my research. Not only did these narratives provide the context in 5 This information was obtained through personal communication with members of the local Reduce Adolescent Pregnancy Project (RAPP) in Green County. RAPP sponsored the newspaper ads and the motivational speakers. lll which teen mothers told their own, but they influenced teens’ relationships with parents, healthcare and social service providers who communicated dominant norms and beliefs. In particular, adult parents explored the real conflict between the values of abstinence and the realities of safe sex , while teen mothers struggled to prove their own responsibility, particularly in regard to the use of birth control and decisions to keep the baby. Service providers entered somewhere in the middle in their efforts to provide necessary information and support to sexually active and/or pregnant teens. Ultimately, the issues outlined above demonstrate complex relationships of power and social control that shape women’s agency and identity as teen mothers. Exploring their agency in the context of pregnancy, teen mothers struggled to prove responsibility in a number of ways: for some, in their active decisions not to use birth control; or in their confirmation of the pregrancy early on; or in their commitment to keep and raise the baby themselves. Blame was further deflected in a number of ways, particularly in terms of controlling parents and uncertain relationships that made the use of birth control more complex and made the news of a pregrancy frightening. Throughout their narratives, teen mothers confionted stereotypes of what it meant to be pregrant, and they struggled to create a positive identity of themselves as responsible and competent. The Use of Birth Control Information regarding birth control was rarely volunteered during the initial birth story, but was a question I posed during the interviews because it provided some insight into women’s own views on sex, pregrancy, and the body and what factors influenced the decisions they made regarding pregrancy and whether or not to use birth control. This 112 section focuses on the reasons teen mothers gave for not using birth control. Table 4.1 provides statistics on the reported frequency of birth control use by race/ethnicity. For the seventeen women (89%) who were not using birth control at the time of conception, reasons for nonuse are listed in the table as well. Table 4.1: Teen Mother’s Use of Birth Control by Race/Ethnicity, 2001 Race/Ethnicity Birth Control Use White Hispanic Total F requencv of Us; # % # % # % Consistent 1 8% l 14% 2 1 1% Sporadic 3 25% - - 3 16% Never 8 67% 6 86% 14 74% Reason for Nonuse Parents 3 27% 1 17% 4 24% Partners 4 36% - 4 24% Experience 4 36% - 4 24% No Reason - - 5 83% 5 29% Despite the fact that the majority (89%) of pregnancies were unplanned, fourteen (74%) women reported never using birth control, three (16%) used oral contraceptives or condoms only sporadically, and only two women (11%) stated that they were using birth control at the time of conception. Birth control use varied by race/ethnicity: while 86 percent of Hispanic women reported that they never used birth control, 25 percent of 113 White women reported that they at least used birth control sporadically in the past, but not when they conceived. These ethnic differences reflected varying levels of agency and power in young women’s relationships with parents and/or male partners. Of the seventeen women who were not using birth control when they conceived, twelve women (11 White and 1 Hispanic) justified their actions by claiming that they made the most informed decision that they could. In general, they contextualized their experiences in terms of how much agency they assumed in their relationships with farme members and partners, as well as prior experience with sex and birth control. Five Hispanic women gave no explanation for why they did not use birth control. These findings highlight important ways in which race/ethnicity shaped teen women’s experiences with sexuality and birth control by explaining the way in which relationships and/or access to information and services restricted the choices they were able to make. White women were more agentic in their efforts to justify their actions than Hispanic women. The majority of Hispanic women (83%) were silent in that regard. Relationships with Parents Four women (24%) identified relationships with parents as the primary factor shaping their decisions not to use birth control. Two of these women were White, and they actively planned to get pregnant in order to get away from “dysfunctional” mothers. They felt responsible in their choice not to use birth control. Conversely, two other women (1 White and 1 Hispanic) explained that parents denied them access to information and services. Although neither of these women wanted to get pregrant, they felt that they had no other choice. 114 Jill, eighteen, with eight-month—old twins, explained that she wanted to get pregrant in order to get away from her mother, and that her partner ageed. She felt that her mother did not like her boyfiiend and tried to keep them apart. By getting pregrant, Jill gained some negotiating power over her mother to be with her boyfriend. She likes him better because we got kids and she knows that if [she and I] get in a fight she won’t be able to see us or the kids. So she tries to keep everything cool between us. I think that’s one of the reasons he wanted to have kids with me, so he could be with me, instead of my mom taking me and telling him “No, you can’t be taking her.” Jessica, eighteen, with a two-year old boy, also planned to get pregrant because of her “really dysfirnctional mom.” “I figured, oh get pregrant and then you’ll be able to leave.” Although her boyfriend planned the pregrancy with her, she said that she was “really shocked afterwards” and that her boyfriend changed his mind. “It was both of our ideas, but when it came down to it, it looked more like it was mine.” Her boyfiiend lived with her in her parents’ home for about a year after the baby was born, but he was physically abusive to her and she eventually ended the relationship. Both Jill and Jessica talked with agency and authority regarding their decisions to not use birth control. They were in steady relationships with their partners and intended to get pregrant and raise the baby on their own. Conversely, Gabriella, seventeen, with a six-month-old daughter, did not want to get pregrant. She felt disempowered and described her mother as “the strict type.” To be honest? I didn’t want to be on birth control because I was scared my mom would find anything on me. My mom is the strict type. Yeah, I wanted to get on the pill and things like that, but I was scared that she would find them on me. She explained that she knew about other forms of birth control and had considered using condoms, but never did. “When you’re at that moment, you’re not worried about 115 anything else, and it isn’t until afterwards.” She continued to have unprotected intercourse for two years, despite the fact that she did not want to get pregnant. By placing the blame on her mother for denying her access to birth control pills, Gabriella differentiated herself from other teens whom she defined as lazy and irresponsible. Some of them, I don’t think it’s so much fear of parents finding out. Because I know a lot of my fiiends that their parents go buy them protection. They will go and take them to get the pill. But I think there are just some girls, I don’t know, maybe lazy. They don’t want to go get the pill. Although Elisa was using birth control when she conceived, her story offers further insight into the parental pressures placed on young Hispanic women. Elisa suggested that many women in the Hispanic community end up leaving their parents’ home and turning to men in an effort to escape the gender roles and responsibilities they are expected to fulfill in their parents’ home. Most of the parents are really strict and don’t let their kids go out a lot, like my mom. She was really strict with me. I couldn’t like go out with my friends or have fiiends over, that kind of thing. I had to do chores because I was the oldest and a girl and I knew how to help her. I guess some kids...get tired of that and don’t get along with their moms, and don’t do that. Now they’re both mad. That’s what most of the girls say, you know. In tunr, young women move in with boyfiiends, and ultimately get pregnant, “because you know how guys are, ‘You know you can come to me’.” Although Elisa felt that she and her mom “were not getting along that bad, for me to do that,” she succumbed to similar pressures. “I just think I wasn’t thinking right at that time. I don’t know...I really didn’t have a big reason to leave, but most of my fiiends, that’s what I see happening.” Her story suggested both parental and peer pressures shaped her decisions in powerful ways. Elisa was not typical of her fiiends, in that she was actually using birth control when she got pregrant, but she felt the same pressures that other Hispanic women in her 116 community faced. She highlighted intersecting norms of gender, age, and race/ethnicity in her explanation of why young women like her get pregrant. One of my best friends, she left with her boyfiiend because of that reason, she couldn’t talk to her mom. She would always yell at her. So her boyfriend is a little bit older and he’s like “Come live with me” and I think her boyfriend wanted to have a baby with her. And so she kind of had a little pressure. I do think she had a little pressure by him. And she got pregrant, like a month later. In general, Jill, Jessica, Gabriella, and Elisa highlighted parental relationships shaping their decisions regarding sex and birth control. Whether they pointed to “dysfirnctional” mothers or “strict” gender roles and responsibilities in their parents’ home, they endeavored to prove that they had made the best choice they could. Adult parents had a different interpretation of birth control use and pregrancy as they struggled to uphold dominant norms and expectations of parenting and encourage their daughters to abstain from sex. Ms. Johnson, whose daughter became pregnant at the age of eighteen, talked about her inability to help her daughter obtain contraceptives, because to do so would be to condone premarital sex. Our family was believing in abstinence. Linda knew where she could get the birth control and all that, but I didn’t offer to take her.... So that’s a real big dilemma for parents who have teenagers—their beliefs versus the child’s. I have a fiiend that I work with right now in that same dilemma, you know if she puts her child on birth control she doesn’t want her to think that it is okay. Although Ms. Johnson refused to take her daughter to the clinic or pay for birth control, she hoped that Linda knew where to go and would do it on her own. At the same time, she acknowledged Linda’s lack of resources (financial and transportation) which made access difficult. Only when Linda suspected that she was pregrant did her mother take her to the clinic for a pregnancy test. Both mother and daughter lacked agency in this situation, and waited for the outcome to dictate their next move. ll7 Race/ethnicity further shaped information and choices regarding sex and birth control. Many studies note that unmarried Hispanic teens in the United States are at higher risk for early childbearing than White teens because of lower rates of contraceptive use (F ennelly 19932300). In particular, Katherine F ennelly (1993:302) found major barriers to contraceptive use to be ignorance about sexuality, religious and cultural proscriptions against sex and birth control, fear that parents would find out, and strong male influence. While knowledge about sex, anatomy, and the likelihood of pregnancy are not broached in traditional Hispanic families (19932303), there is the additional strain of opposing cultural values between the generations, including conflicts over chaperoning, restrictions on the social activities of girls, and parental concern with public appearances. Fennelly (1993:310) concludes that many teens thus perceive a visit to the health clinic as tantamount to public admission that they are having sex. In a local community clinic, the fear that someone they know or who knows their parents will see them there is a real possibility. Moreover, many Hispanic men reject birth control because it is “not natural,” inhibits spontaneity, or because they want to father a child (Fennelly 1993:310). Together, these pressures make it difficult for many Hispanic women to ever think or talk about using birth control. The Hispanic women in my study echoed many of these points. Neither Gabriella nor Elisa wanted to get pregrant. Both talked about “strict” parents who controlled their daughters’ movements, pressured them to stay home, and attempted to limit their relationships with men. Gabriella did not use birth control because she feared her mother’s reaction, but she did continue to have unprotected sex. Elisa did use birth control, but firrtlrer emphasized the impact that controlling parents and men have on a 118 woman’s abilities to make responsible decisions and avoid pregnancy. In the end, these women attempted to focus the blame for their pregnancies on the nature of their relationships with parents. Relationships with Pacrtners Four women (24%) discussed their decisions regarding the use of birth control in terms of the nature of their relationships with partners. All four of these women were White. Two women were not using birth control because they were in the process of breaking up with their boyfiiends when they got pregrant; one woman was never in a relationship with the father of her baby; and one woman was in a long-term relationship with her partner and did not feel birth control was necessary. In general, these women identified varying and opposing meanings for the use of birth control—either it was a means to prevent pregnancy in long-term relationships, or it was to protect themselves from sexually transmitted diseases in new relationships. Their explanations for nonuse complicated definitions of responsibility by exploring it within the context of time and the changing nature of relationships. Erika gave birth to her daughter when she was nineteen. She explained that she was not using birth control when she got pregnant because the relationship was ending. “I wasn’t planning on staying around. Things started falling apart even before we knew I was pregrant.” Amber, who gave birth to twins when she was nineteen, was in a relationship with a married man. That relationship too was ending; they did not use birth control and she discovered she was pregrant only after the relationship was over. Although both of these women acknowledged having unprotected sex, they presented 119 themselves as victims of poor timing and thus deflected blame for the unintended pregrancy away fiom themselves. Madison gave birth to twins when she was nineteen years old. Her view of birth control was somewhat different than Erika’s or Amber’s view. Madison stated that she and her partner decided not to use birth control because “we were already together.” Although she acknowledged that she did not want to get pregnant, and thus “sweated it out” every month, her story implied more than one reason for using birth control—not only to prevent pregrancy but also to protect oneself in a new relationship. Her response also suggested that neither she nor her partner regarded pregrancy as something they really wished to avoid. Recent research on teen sexuality offers firrther insight into Madison’s response regarding the use or nonuse of birth control among teens. Research finds that the spread of sexually transmitted diseases is gowing among teens in the United States (Darroch, Singh, and Frost 2001:244). The incidence of chlamydia among American teens is five times that in England and twenty times that in France. The annual incidence of gonorrhea among all teens in the United States is ten or more times the rate in other developed countries (Darroch, Singh, and Frost 2001:245). The large differences are due, in part, to a large proportion of teen women in the United States who are sexually active, and therefore at risk of pregnancy and infection. These difference also reflect different attitudes among American teen women regarding the use of contraceptives. The research concludes that teens in the United States do not consistently use birth control because to do so would imply that they recognize themselves as sexually active and thus plan ahead to have sex (N CPTP 2002). Erika and Amber suggested such 120 claims in their narratives by concluding that they did not use birth control because the relationship was already ending or was over. Madison’s story raised a different issue, however, considering that she and her partner continued to have unprotected sex for two years despite acknowledging that she was at-risk of getting pregrant. When pressed firrther by me, Madison merely concluded that birth control was “too expensive.” Either way, the threat of pregrancy was not enough to encourage her to use birth control at any point in her relationship with John. In fact, she pointed to her long-term relationship with John as proof of her ability to assume responsibility for the pregnancy. All of the women who chose not to use birth control based on the nature of their relationships with partners acknowledged the importance of birth control, and were aware of options available to them. They did not define themselves as immoral or irresponsible, however, for not using birth control and getting pregnant. Rather, the circumstances of their relationships with partners influenced the relevance of birth control, and their stories illustrated the different meanings associated with the use of birth control. Because relationships were always changing and evolving, decisions were complicated, and unintended pregnancies were sometimes regarded as out of their control. They experienced varying levels of power and agency in making appropriate decisions regarding whether or not to use birth control, and their relationships shaped the level of responsibility they assumed for having unprotected sex. Past Experience with Unprotected Sex In addition to negotiating relationships with parents and partners, four White women (24%) in this study justified their decisions not to use birth control by suggesting 121 that they were unable to get pregrant. These women were aware of the contraceptive options available to them, and two of them had used birth control in the past. Because these women had engaged in unprotected sex in the past and did not get pregnant, they concluded that they would not get pregnant and did not need to use birth control. Linda gave birth to her daughter when she was nineteen. She argued that she tried to use birth control, but the pills made her sick. She relied on luck, or “charm,” to keep her fi'om getting pregrant. I was on birth control, but then it would give me stomach aches so I got off it. I knew about condoms and everything. I don’t know why I didn’t use one. We were going to, but it happened before we put one on. Did you consider other forms of birth control? I didn’t think I was gonna get pregrant. I had sex two months before I got pregrant. So I thought, you know, the third time would be a charm. Haley, seventeen, with a three-month-old daughter, described a very similar experience. She had been living with her boyfiiend for about two years. During that time she had received two Depo Provero shots, but did not want to continue with them. Instead, she suggested that maybe she was not able to get pregrant. Like you know it’s going to happen, but you just don’t think it’s going to happen. Like I totally know it’s possible that if you have sex without protection there is a chance that you will get pregnant but I just don’t think it was. We were together for about two years before she was born. And out of that whole time, except for six months, that whole time we never used anything. I don’t lmow what I thought. Both of these women were knowledgeable about birth control, and felt they had acted responsibly in trying to use birth control. The fact that they had engaged in unprotected sex in the past without getting pregrant, however, justified their nonuse at the time they conceived. In choosing to believe they could not get pregrant, they resisted the stigna that they were irresponsible and felt justified in not using birth control. 122 Although Brooke and Angela also had unprotected sex for many months prior to getting pregnant, the stories they told implied less anxiety about the possibilities of getting pregnant. Both women denied any true intention of planning a pregrancy, but they also indicated that they wanted to have a baby. Angela, who gave birth to twins when she was eighteen, was particularly clear about her desires to be a mother. “I wanted to get pregnant since I was thirteen. I love kids and I wanted one of my own.” She said her parents tried to discourage her as long as possible. A number of negative experiences raised doubts in Angela that she would ever be able to have a baby. When Angela was sixteen years old, she was raped by a close friend. The emotional trauma of that experience caused Angela to become severely depressed. Eventually, she was admitted to the hospital and diagrosed with anorexia nervosa. Subsequently, Angela tried very hard to gain weight so that she could have a baby. She suffered a miscarriage when she was seventeen, and then conceived again and successfully carried her twins to term. Brooke gave birth to her son when she was sixteen years old. Although she was not as adamant about getting pregnant as Angela, she and her partner had unprotected sex for about a year and a half before getting pregnant. Brooke indicated that she did want to have a baby with her partner “eventually,” but was “surprised” when she did get pregnant. Why do you think you got pregnant? I wasn’t really doing it on purpose. Purposely at the time. I was actually surprised I did get pregrant when I did. So you were using birth control? 1;}; could have gotten pregnant any time during the last year and a half? Yeah, but I never did. So you weren 't thinking about that? No because after awhile, you know, I didn’t. I was like, “Okay, I’m not going to.” 123 Brooke suggested that she was infertile. As was the case with Angela, she relied on her past experience to draw that conclusion. She also deflected blame away from herself for her unintended pregrancy by pleading i grorance and acting surprised when the doctor told her the result. Other studies have found similar attitudes among teens (Brubaker 1999; Poppen 1994; Fennelly 1993). Brubaker (1999:64) interviewed four teen mothers who explained that they did not think they could or would get pregrant. Their explanations suggested that they felt invisible and that pregrancy would not happen to them. Fennelly (19932304) reached similar conclusions in her interviews with healthcare providers. Some providers suggested that teens do not plan to have sex because they do not care about the consequences of getting pregnant. Others implied that teens enjoy the risk- taking involved in unprotected intercourse. “They know it all. They know they are not going to get pregrant. They still think they can beat the little sperm. I think that’s part of their own rebellion—to take chances” (quoted in Fennelly 1993:304). Although the women I interviewed did not reflect “rebellion” in their stories, they believed quite strongly that they would not get pregrant. Cross-country studies have been conducted with teens in an effort to explain why teen pregrancy and birth rates are so much higher in the United States than in most other developed countries (Darroch, Singh, and Frost 2001). Findings suggest that American teens face more logistical, financial, and psychological barriers to obtain reproductive health services than do teens in other countries. The healthcare providers I interviewed confirmed these findings, emphasizing immaturity as a major impediment to gaining access to necessary information and services. Ms. Kogan, a certified nurse-midwife who 124 had worked with teen mothers for many years in Green County, explained the difficulty many teen mothers have admitting they are sexually active. There’s actually a huge lag between the time they actually become sexually active and when they are able to admit that to themselves and take on the responsibility and persona of being a sexually active person to the point of actually using birth control. And that average is three or four months. Her comments reflected the dominant view that teens who have unprotected intercourse are irresponsible. But she also connected this view to cultural values regarding the control of female sexuality and access to information and services that make it difficult for young women to admit they are sexually active. Drawing the conclusion that they were “rmable” to get pregnant was the easiest way for at least four women in this study to address these issues. It deflected blame away from themselves and allowed them to focus on their commitment to be responsible parents. No Reason Of the nineteen teen mothers I interviewed, five women (29%) offered no explanation for why they did not use birth control. All five of these women were Hispanic, and their stories reflected important differences of race/ethnicity in decision- making regarding birth control and pregnancy. Norma, who gave birth to her daughter when she was sixteen, merely stated that she and her partner thought “it couldn’t happen to us.” Maria, who gave birth to her son when she was thirteen, simply responded “I don’t know.” These responses were typical of the Hispanic women I met, and illustrate again the cultural limits placed on talking about sex, birth control, and pregrancy. Two of the women I interviewed were recent 125 irnrrrigants from Mexico. Neither of these women would talk about sex or birth control beyond saying the pregnancies were not planned, but that they were happy when they found out they were pregrant. Although teen pregrancy was not encouraged by their families, their narratives reflected the value placed on motherhood and the ability to assume responsibility for the pregnancy once it happened. Summm The majority (89%) of teen mothers I interviewed did not intend to get pregrant, but neither did they consistently use birth control to prevent a pregrancy from occurring. In their descriptions of how decisions were made, a number of racial/ethnic differences emerged. Only one White woman and one Hispanic woman said that they were using birth control when they got pregnant. While all of the other White woman who were not using birth control offered explanations that focused on relationships with parents, partners, and/or prior experiences with unprotected sex and infertility, only one Hispanic woman (17%) in this study offered a similar explanation. The majority of Hispanic women (86%) I interviewed did not use birth control, and they did not offer explanations for their nonuse. As mentioned above, the Hispanic community places a number of constraints on young women regarding female sexuality, and this context may have influenced the way in which young women told their stories to me. On the one hand, the Hispanic women I interviewed embraced master narratives of female sexuality that denied them the language to talk about their sexuality and disempowered them in their sexual encounters with men. Lacking both language and agency, these women were silent about their 126 experiences, intentions, and/or choices. On the other hand, some stories challenged dominant discourses and stereotypes in subtle ways by suggesting that women resisted norms and expectations and exhibited agency in their relationships with others. For example, Maria, who was thirteen when she gave birth, compared herself to other Hispanic teens in her community who were also sexually active but were still celebrated in the Hispanic community. Because when you’re fifteen, they give you a big party and stuff. A quincear'iera. I didn’t even get that and I didn’t even want it. And they were all like “You have to be a virgin and you’re not even a virgin.” And now in society, it’s like no one stays a virgin right now. Maria explained that when her uncle heard about her pregrancy, he warned her that she would not have a quinceariera. Because she felt that most girls were not virgins when they had their quincear'ieras, she resented his accusations. She also ridiculed him for assuming that his daughter was still a virgin. Although Maria offered no explanation to me for why she engaged in unprotected sex, her story suggested at least some agency and responsibility. She resisted being labeled immoral or irresponsible by her uncle, and she emphasizing the way in which she was similar to other teens in her community. Master narratives of teen childbearing were interwoven throughout the stories told in this study as they shaped expectations regarding appropriate sexual behavior and who should/not use birth control or engage in unprotected sex. While the teen mothers emphasized agency and responsibility, they also highlighted the many ways in which relationships with parents, partners, and peers restricted choices regarding sexuality and birth control. Whether immature, immoral, or irresponsible, the majority (89%) of teen mothers engaged in unprotected sex and experienced unintended pregnancies. Their 127 efforts to explain these behaviors highlight the ways in which norms of gender, age, and race/ethnicity intersect and complicate the decision-making process. Confirming the Pregnancy Despite the circumstances surrounding their pregnancies, just over half (58%) of the women in this study described themselves as taking an active role in confirming their pregnancies. The other half (42%) took a more passive approach, relying on doctors or family members to confirm the pregnancy for them. Unlike the information regarding birth control use, I did not probe for this information. Stories typically started with this topic—often with a common phrase such as “well, I found out I was pregnant when I missed my period,” or “I hid my pregrancy from my parents for as long as I could.” Again, important differences of race/ethnicity emerged in their narratives. While the majority (73%) of women who took an active approach were White, half of the women who narrated more passive experiences were Hispanic. In general, White women struggled to prove their competence and ability by emphasizing their responsibility to recogrize and confirm the pregnancy. Hispanic women were more likely to hide the pregnancy fi'om family members for fear of reprimand, or passively wait for the pregnancy to be confirmed by doctors and/or parents. The Active Approach: Taking the Test Just over half (58%) of the women I interviewed took pregrancy tests with their partners or family members early in their pregnancies. By highlighting their efforts to assume responsibility early on, they deflected accusations of blame and incompetence and 128 struggled to present a positive image of themselves as knowledgeable mothers. Five of these women were living with their partners when they got pregnant, five were living with their parents, and one was living alone. Although each of these women described turique experiences and responded differently to their pregrancies, some took a more proactive approach, while others were confused about what was happening to them and sought help fiom a variety of family members and fiiends. Through the stories they told, these women struggled with issues of intentionality and responsibility. As mentioned earlier, Jill and Jessica both planned their pregnancies to get away from “dysfunctional” mothers. Jill was pleased when her pregrancy test was positive, but Jessica was more “shocked” because her partner did not share her intentions. Conversely, while Angela and Brooke did not actively plan to get pregnant, neither were they upset by the results of their pregrancy tests. Brooke wanted to have a child with her boyfriend when she “was older.” When I asked her to talk about her experiences, she never suggested that she suspected she was, but her response implied that it was a possibility. I was having a lot of cramping in my stomach. And it was time for me to start. But it never started. And I’m like “Okay, what’s going on?” It just felt like a menstrual period. So I just thought it was going to start. But it never did. So I called the doctor and they said go out and take a home pregrancy test. And so I bought one and it came out negative, but there was a little bit positive, so I wasn’t sure. So I went to the doctor. And when I went in I was already seven weeks pregrant. I was like, “Really?” Although Brooke wanted to be pregrant, she waited for the doctor to tell her to take a pregrancy test. She did not believe the negative result and so called the doctor again because she thought it looked “a little bit positive.” When the doctor confirmed her pregnancy, however, Brooke acted surprised. In her story, her struggled between the identities of ignorance and responsibility. Although she acknowledged that she lacked 129 information regarding her body and pregrancy, and she denied a certain amount of responsibility for her actions, she was agentic in proving that she was pregrant and she hoped that her boyfiiend would stay with her and the baby once it was born. The narratives of these four women highlighted various ways in which they struggled with master narratives of teen childbearing. Although they wanted to be pregrant, they acknowledged that they were “not supposed to” be pregrant. As such, they all talked about the difficulties they experienced in breaking the news to their parents and assuming responsibility for the decisions they made. Five women were more shocked by the news that they were pregnant, although they acknowledged that they were taking a chance by continuing to have unprotected sex with their partners. Two of these women indicated that they had used birth control sporadically in the past, and the other three frequently worried that they may be pregnant. None of them, however, made any concerted efforts to either stop having sex or use birth control. Rather than blame themselves for engaging in unprotected sex, however, they focused on their pregnancies and emphasized their responsibility to confirm the pregnancy and tell their partners and family members. Linda was nineteen when she gave birth to her daughter. Her mother took her to the clinic to have a pregrancy test done. I knew right away. What happened is I had sex pretty much the day before my period so I got pregrant and it just never came. So I knew, I lmew I was pregnant. I didn’t tell my mom. I told her I thought I was, so we went to the community pregrancy place in Alton. I went and took the test and it came out positive. Madison, who gave birth to twins when she was nineteen, was living with her boyfriend when she got pregrant. We were “doing the kid’s thing—we had an apartment, 130 and we played and partied, and had a lot of firn.” Madison admitted that they continued to have unprotected sex, despite the fact that she was afiaid of getting pregnant. ...he came home in the monring and I said, “You know what? I think I might be pregrant.” And he’s all “Why?” and I’m all, “‘Cause it seems like I’m supposed to go on my period. I PMS, I have cramps, but notlring’s happening.” He’s like, “Don’t say that, don’t say that.” He’s all, “You need to take a test.” The next morning I took a pregrancy test and it was positive. Haley, who gave birth to her daughter at age seventeen, told the same story. She was living with her boyfriend and when she missed her period, she immediately told him and took a pregnancy test. I rrrissed my period and everything, and so I figured, ‘cause my period is always on the seventh of every month. And I was like, you Imow, so I knew. So we went and got a pregnancy test. And it was positive. Linda, Madison, and Haley were all White women, and they all talked with authority and knowledge about their bodies and their pregrancies. Two Hispanic women, Gabriella and Elisa, narrated similar experiences to me. Both women knew they would get pregnant eventually. On many occasions, they joked with their partners about it, or wondered if they were pregrant when a menstrual cycle was delayed. But they did not want to get pregnant. Gabriella was seventeen when she gave birth to her baby. Although she engaged in unprotected sex for two years prior to getting pregnant, she was shocked by the results of the pregrancy test. Her description of her conversation with her partner, however, suggests that she expected it to happen. When she told her partner that she was pregrant, he did not believe her because she had joked about it too many times in the past. He didn’t believe me because I used to scare him. Before that I would tell him “I think I’m pregrant, I think I’m pregrant.” So I’m thinking he used to get tired of me saying it. And finally it was true, so he didn’t believe me. 131 Gabriella’s mother, however, responded differently. She felt her mother “already brew,” and her conversation with her mother further highlighted her struggle to assert some agency and responsibility. She goes, “If you have anything to tell me, just tell me now. I don’t want to find out by other people.” And I told her and she was upset. And I go “It doesn’t matter if I’m pregrant because my sister got pregnant when she was seventeen too. . ..” So I was kind of being like, “Well, my sister did it, so I can do it too.” By comparing herself to her sister, Gabriella deflected some blame away fi'om herself while simultaneously presenting an image of herself as responsible and in control. In general, all five women brew they were at-risk of getting pregrant. Although none of them used birth control consistently, they struggled to present an image of themselves as competent and responsible by tracking their menstrual cycle, recogrizing the signs of pregrancy, taking pregrancy tests, and telling their partners and parents. Faced with the news that they were pregrant, they struggled to present a positive image of them as responsible. They talked with knowledge and agency, and thus attempted to deflect the blame for pregrancy away from themselves. The Passive Approach: Hearing the News Eight of the women (42%) I interviewed described a much more passive approach to confirming their pregnancies. Generally, pregnancy tests were performed because of other health problems—a suspected bladder infection, pain, allergies, or asthma. Three White women claimed they did not know they were pregrant; three women (one White and two Hispanic) suspected they were pregrant, but were scared to tell their parents and hid the pregrancies for as long as possible; and two Hispanic women said nothing at all 132 about their pregrancies. In general, these women chose to play the waiting game, only admitting they were pregrant after their doctors and/or parents confi‘onted them. Kris, who gave birth to her son at age sixteen, was already five months pregnant when she went to the clinic with her aunt: “I went in because I think it was a bladder infection, because I had to go pee constantly and that ended up not being right.” Kris was prescribed oral contraceptives three months earlier to regulate her period. She did not suspect a pregnancy, even though she had sexual intercourse before taking the pills. The thing that happened was I had gone to a party and I was stupid back then. I ended up getting drunk and then one thing led to another. Then the father left and so I was on my own. Because she was not in a steady relationship, and did not consider that she may be pregrant, the doctor did not perform a pregrancy test prior to prescribing birth control pills to Kris. Only after she went back in for a suspected bladder infection, and the doctor called to tell her to stop taking the pills, did she acbrowledge the situation that led to her pregrancy. Kris’s aunt answered the phone and, although she was not given any specific information, guessed Kris was pregnant. When Kris was confronted with this information, she described herself as shocked: “I just started crying my eyes out. It was like I didn’t brow what to do because I was only fifteen.” Often women were in denial and did not consider pregrancy an option until it was confirmed by a doctor. Allison, who gave birth to her son when she was eighteen, was rushed to the hospital because of cramping. I was having cramps really bad and it was so bad that I was doubled up in my bedroom. And my boyfiiend at the time said “Okay, you need to go to the hospital, we’re taking you in.” And they said, “Well, you’re pregrant.” And so I had to go out and tell him “I’m pregnant.” 133 Allison went on to explain that she stayed with her boyfriend for a short time, but eventually moved in with her mother because his place “wasn’t fit for a pregrant woman to live in.” After she moved in with her mother, she described herself as “pretty much on my own.” Much like Kris, the reality of pregrancy forced Allison to acknowledge past behaviors and decisions. Confronted with a new identity, these women relied on family members to support them and advise them about what to do. Norma, who gave birth to her daughter when she was sixteen, was totally under the authority of her parents during her pregrancy. Although Norma suspected she may be pregrant, she did not share that information with her parents. After being sick for several weeks—which she blamed on the inhaler she used to treat asthma——her parents began to suspect that something was wrong. Norma was given a pregrancy test at home; her parents looked at the results themselves, but did not share the information with her. Instead, they took her to the clinic for confirmation. I was actually scared because I’d been brought up in a very Christian home and I was very afiaid to tell my parents. Actually, I didn’t tell them any possibilities or anything. The only reason they found out that I was pregrant was because I was overdosing on my inhaler and I was getting really sick from it. And so we went to the doctor. And they said “You know part of this sicbress is she’s pregrant.” I was a month along before we brew. Although Norma knew pregnancy was a possibility, she relied on her parents to confirm it. Her parents controlled the information very carefirlly. She was kept out of school and isolated from the community while her mother slowly informed people in their church. After a week, she was allowed to speak with her boyfriend and tell him the news. Two other women, Maria and Michelle, successfully hid their pregrancies for six months from fiiends and family members because they feared reprimand fiom their 134 parents. It was only after other health problems emerged, and they were taken to a clinic for tests, that family members discovered the truth. Maria was thirteen when she gave birth to her son. Six months into her pregrancy, her parents took her to see an allergy doctor. “I was like getting stretch marks like right here by my legs and my arms, and I was scratching.” Although she brew she was pregrant, she did not tell her parents or the doctor. She was given some allergy medication and sent home. Only when the medication made her sick did her mother discover the truth. I was throwing up really bad. I didn’t sleep that much that night. Then like at five, my mom woke up because she was going to make their lunch because they were going to go to work. And so she went into my room and then she wanted to know what was going on and I was throwing up all over. . .. And my mom, she like touched me. She gabbed me and my dad is like, “Why are you gabbing her?” And my mom said, “She’s pregrant.” And then they asked me and I told them. Maria feared she would be kicked out of the house if her parents brew she was pregrant. Although they were angy, and her father did not talk to her for some time, they supported Maria throughout the pregrancy. Michelle, who gave birth to her son when she was sixteen, also hid her pregrancy for six months because her father had warned her against getting pregrant. I was told that if I was pregrant, I would be kicked out—you brow, this and that. Given the ultimatum, he said he’d rather me be in the streets, a heroin addict than be pregrant. Michelle worked in a veterinary clinic during her pregrancy and concealed her pregrancy from her employer as well. It was only when she ended up in the hospital with complications that her parents found out about the pregrancy. Shortly thereafter she delivered a baby boy, two months premature. He was born with cerebral palsy and a 135 range of other health problems. The doctors suggested that she had contracted a viral infection—perhaps fiom the veterinary clinic—during her pregrancy. Michelle thus blamed herself for her son’s condition, arguing that if she had told people about her pregnancy from the beginning, maybe she would have avoided the viral infection. Underneath her self-blame, however, she blamed her father, who was ashamed of her and disowned her from the family because of the pregnancy. Unlike the women who claimed responsibility by taking pregnancy tests early in their pregrancies, these women deferred responsibility to their parents or doctors and waited to be confronted with the news that they were pregrant. Two of these women were no longer in relationships with the father of the baby, and so they denied the possibility that they might be pregnant. Three women feared their parents’ reactions and so hid the news as long as possible. In general, the circumstances of their relationships with partners and parents made it difficult for the women to feel they could act responsibly and admit that they were pregrant. F our of the women who took a passive approach to confimring their pregrancies were Hispanic, representing over half (57%) of the Hispanic women I interviewed in this study. While Maria and Norma actively hid their pregrancies from their parents for fear of reprimand, Marta and Margarita neither hid their pregrancies nor made any effort to confirm them. They merely accepted their status and moved on. Both the “cult of virginity” and the value of motherhood apparent in the Hispanic community (F ennelly 1993) shaped these experiences. On the one hand, they were silent and passive and did not talk about their experiences or desires regarding sex and birth control; on the other hand, they readily assumed responsibility for the pregrancy and motherhood. 136 Keeping the Baby Regardless of how the pregrancies happened and/or were confirmed, the majority (89%) of teen mothers in this study were very clear in their commitment to keeping the baby, and this commitment was presented as an act of responsibility. Again, complex relationships of power and social control shaped the ways in which teen women talked about their experiences and made decisions regarding pregrancy and parenting. While two White women (11%) considered alternatives to parenthood—one considered an abortion and the other an adoption—in the end, all of the women in this study kept their babies, whether by choice or circumstance. These decisions were received in different ways by different people in the community, and teen mothers often spoke quite negatively about their interactions with others in public places. In general, public sentiment was that they were doing the wrong thing in getting pregrant and choosing to raise the babies themselves. Norms of age, race/ethnicity, and social class intersected in their narratives, firrther highlighting the ways in which master narratives of parenting shaped their identities and expectations of what it means to be a “good” parent. Haley, who gave birth to her daughter at age seventeen, felt that people were accusing her of being immoral because of her age. I can’t even say like older people. Even younger people do it. They just stare, like they are saying “You’re sinning” and we’re like the worst thing, because I’m seventeen and he’s nineteen and we just had a baby. She challenged this view by arguing that she brew people in their thirties who were not prepared to have kids. By concluding, “I don’t think it really matters how old you are,” Haley challenged people for making judgnents based solely on her age. 137 Maria experienced similar sentiments fiom the Hispanic community. She discovered she was pregnant when she was thirteen years old, and people often made comments to her about her age. The Hispanic people, they look at you and stuff and they just stare. . .. Because to them it is not okay if you get pregrant as a teenager, you brow. And so they glare at you, they stare at you and then, I don’t brow. It’s just really weird because you’ll be walking by and they’ll be staring at you really bad and everything. Did anyone ever say anything to you? They come up to you and they just ask you, “Are you pregnant?” Or, they’ll say something really rude, you brow. Like “Keep your legs closed,” in Spanish and stuff. And “You’re really young.” And then “How old are you?” Although Maria struggled to deflect these criticisms, she also noted that she dropped out of school when she was pregnant because she was “embarrassed.” By avoiding public criticism, Maria focused on the support and advise she received from family members at home. Eleven (5 8%) of the women in this study relied on the support they received from family members, particularly mothers and aunts, to get used to their new identity as mother. Although a few family members attempted to assume control over their daughters’ actions (e.g. Norma and Jessica), most families echoed dominant norms and stereotypes of parenting that placed responsibilities for parenting on the young women. Haley called her mother soon after she took the pregrancy test. Her mother was shocked, but immediately advised her on how to prepare herself for parenthood. I called her and she was like, I think she was just in shock. It was like “Oh my gosh.” And she was like, “Well you guys better get your stuff together,” cause you know we were living with other people. And so she was like “It may seem like you have a long time to get a job and get a house and whatever, but you guys don’t. You need to get it done now.” So I think her talking to me about what we needed to do. . .I brew it, but I think her actually saying, you brow, “If you don’t do this, you’re not going to be bringing her into the right kind of environment.” I think that’s kinda what made me decide to move back there with her. 138 Haley ageed with her mother that her lifestyle was not conducive to raising a child. So she moved away from her boyfriend and stayed with her mother for several months. Once her boyfriend started making some changes, they moved into an apartment together. He started a new job and Haley started parenting classes. Elisa gave birth when she was seventeen. She was also living with her boyfiiend at the time, and so called her mother on the phone to tell her she was pregnant. So I called her on the phone and I told her “Uh, I think I’m pregrant.” She’s like, “What did you say?” I don’t brow, she was like, “Well, you brow this isn’t the time, but what can we do?” She wasn’t like happy or mad or anything. But then my brother said afterwards, he didn’t think it was possible, being happy you brow. Because she didn’t really want to show it to me. Then after a while they were buying me maternity clothes. So they all helped me a lot. The general sentiment that this was the wrong time to be pregnant shaped the ways in which many of the parents responded to the news of the daughters’ pregrancies. Reflecting master narratives of parenting, adults were caught in the tension between offering support to their daughters while not condoning their behaviors. Parents were disappointed, thus reflecting master narratives of parenting that define teen parenting as wrong. By emphasizing the need to be responsible and provide the “right environment” for the baby, however, they also endeavored to make their daughters fit the mold. Although adoption and abortion were rarely mentioned by the teen mothers themselves, I asked each of them whether they had considered alternatives to keeping the baby. All but one were clearly opposed to abortion, stating “I don’t believe in abortion,” or “I could never to that.” They felt similarly about adoption. Haley said that she talked with her boyfiiend about what to do, and they jointly ageed to keep the baby. “ 139 [T]here was no doubt that we were going to keep it, cause I don’t think I could have an abortion, and I couldn’t give her away after I carried her and gave birth to her and stuff. So it was ageed that we both wanted to keep her. Madison’s partner, John, was twenty when their twins were born. He spoke very little about his experiences,6 but was clear in his commitment to raise his children. My uncle and my dad tried to talk me into telling her to have an abortion. . .. I don’t know. I felt like they’re my own. We did it, we made them. That’s your responsibility, you brow. We’re old enough that it wasn’t going to mess us up too bad, we’re done with school, for the most part. Erika, who gave birth at age nineteen, said her family was scared when they learned she was pregrant, because they did not brow if she would give the baby up for adoption or have an abortion. She was clear, however, in that she wanted to keep her baby. “I strictly don’t believe in abortion. And I wouldn’t consider adoption unless I know I can’t take care of a child. Unless the child is going to be in danger.” Some research (Dodson 1998; Kaplan 1997) suggests that socioeconomic class influences these attitudes. Thompson (1995:119) found that teen women were often unwilling to treat pregnancy as merely a choice; in their view, life was always hard, and so pregnancy was accepted as their future. Dodson (1998) similarly found that the way families raise daughters, and how young women come to brow their role and place in the world when there is no tangible path to college and career, affect how women understand the notion of choice. “Choice was not a simple yes or no to sex, pregrancy, or abortion” (Dodson 1998:111). Dodson (19982104) concludes that when young women choose to go through with pregrancies, the choice may be in some part about sex and love, about cultural and family tradition, but above all it is about having few alternative roles. 6 John was one of two teen fathers who participated in this study. I began the interview with Madison and he joined us about half-way through the interview. 140 Kaplan (1997 :xix) similarly found that for some young women, having a baby was an act of individualism and achievement. While all of the women in my study struggled to prove their worth and agency by assuming responsibility for their babies, this agency was born out of a gendered identity that presented motherhood as more of a role than a choice. Over one-third (n=7) of the teen mothers I interviewed pointed to past childcare experience as proof of their ability to be good parents—experience caring for younger siblings, cousins, and neighbors. Many argued that they had “raised” their younger siblings or cousins, and others felt prepared for anything that a new baby could offer because of previous babysitting experience in daycare settings and private homes. Their stories did not vary significantly by race/ethnicity. Both White and Hispanic women talked about their past experiences with childcare. All of these women, however, were low-income. They assumed they would be mothers someday—the question was only a matter of when. Amber and Michelle were the only two women in this study who considered alternatives to keeping the baby. Both of these women were White, and, in the end, both were denied their choice. Amber gave birth to twins when she was nineteen. When she discovered she was pregrant in her fifth month, she went to the doctor to discuss an abortion. Although she was informed that it was too late to get an abortion, she felt the doctor lied to her. I talked with my doctor and she told me that I was way too far in to have an abortion, which come to find out, I wasn’t. We found out a few weeks later that I could have had an abortion if I had gone in a few days earlier. I got lied to by my doctor, which I was pretty upset about. For one thing, she was sitting there pregnant, and she was telling me I’m having twins. And she’s pregrant. Like, “I’m having a baby, I don’t believe in that.” That’s how I felt. 141 Amber claimed that, because the doctor was pregrant herself, she was biased and browingly lied to her. As a result, she was denied the ability to make the choice on her own. And because she was uncomfortable with adoption, she made the commitment to raise the twins alone. Michelle gave birth to her son when she was sixteen. As mentioned above, Michelle actively hid her pregnancy for six months because she feared her family would disown her. Several months before she gave birth, she made arrangements to have her baby adopted. Her boyfiiend’s gandmother brew a couple from church who were trying to have a baby. “They have a house and a dog, they are very family oriented, you brow.” They ageed to adopt Michelle’s baby and were paying all the hospital bills. But when the baby was born with cereme palsy, and the doctors gave him no more than a month to live, the couple decided not to take him. Michelle was hurt but found strength within herself to raise her baby on her own. Her story firrther reflects the narratives shaping her decisions regarding parenting. The adoptive couple fit the norm of “proper parents” with their “house and dog.” Michelle felt good about trying to provide her child with this proper family environment. In the end, all nineteen women in this study kept their babies and were proud of their abilities to raise them on their own, despite the extent to which their circumstances were a product of choice or merely the best alternative. Although many of them struggled with parental and public disapproval, fear, and/or uncertainty of the firture, they regarded parenthood as an act of responsibility. Regardless of who or what was to blame for the pregnancy, they focused on the message that “it is my responsibility.” 142 Summary This chapter has explored teen mothers’ experiences with pregrancy, particularly regarding the use of birth control, the means by which they confirmed the pregnancy, their interactions with others in sharing the news that they were pregrant, and their decision to keep the baby. Throughout their stories, complex relationships of power and social control were revealed that shaped their experiences in fundamental ways and deterrrrined the choices they perceived as open to them. Intersecting norms of gender, age, race/ethnicity, and social class influenced the ways in which young women confronted dominant narratives of what it means to be sexually active, to use/not use birth control, and to be pregrant as a teen. Although their behaviors varied in terms of the choices they made, how much agency they assumed, how they interacted with others, and how they acted on their own decision or the decisions of others, in the end, they came to similar conclusions: pregnancy was their responsibility and they were acting with responsibility in choosing to have a baby and become a mother. Their stories thus raise an important issue regarding master narratives of parenting. Through the lens of age, teen mothers are defined as irresponsible and incompetent, and they constantly confi'ont these accusations throughout the stories they tell. But through the lenses of gender, race/ethnicity, and social class, these women embraced their role as mothers, only rarely considered alternatives to keeping the baby, and assumed their ability to be as competent and responsible as anyone else, regardless of their age. 143 CHAPTER FIVE PREPARATIONS FOR CHILDBIRTH: “IT’S COMMON SENSE” Typically, teen mothers’ stories of birth began with a discussion of when they discovered they were pregnant, and then quickly jumped into labor and delivery. Very few of them discussed preparations for childbirth—experiences with prenatal care, birthing classes, or options regarding the birth plan. I asked these questions of each individual in order to gain some insight into their expectations of childbirth, how they viewed their interactions with others, and how they felt about the childbirth experience. In an effort to present themselves as prepared, browledgeable, and “ready enough,” the teen mothers I interviewed tended to emphasize their own experience as well as the experience of female relatives and fiiends, and they dismissed more formal sources of information and advice as unnecessary or as “common sense.” In this chapter, I explore how master narratives of childbirth and parenting shaped teen mothers’ expectations for their own birth experiences. In Green County, the sociopolitical environment locates discussions of teen parenting in the context of gowing concerns with child poverty and the need to control the sexual behavior of teens. These concerns have a direct effect on how teen mothers interact with others and shape their own identities as parents. But they also shape women’s expectations during pregrancy, what information or advice they accept, what interventions they seek, and what sources of information or support they use in conceptualizing their own expectations for giving birth. This chapter begins with a brief overview of the sociopolitical context of parenting in Green County, and then considers the ways in which teen mothers interacted in this environment and prepared themselves for labor, delivery, and the transition to parenting. 144 Sociopolitical Context of Parenting in Green County The United States has been in a period of economic decline, and Oregon has not escaped the realities of this trend. The Census Bureau measured Oregon’s overall poverty rate for 1997-98 at 13.3 percent, compared to the national average of 11.3 percent.1 The rate is considerably higher for children, single women, and minority goup members, who struggle particularly hard to meet their basic needs for food and housing. Children under five years old have the highest poverty rate of all age goups in Oregon, with one in five living in poverty. Poverty rates are further compounded by single motherhood and minority status. Thirty percent of the households headed by single women live below the poverty level, almost twice the rate for households headed by single men. Blacks, Native Americans, and Hispanics experiencepoverty rates of 25 percent or more compared to ten percent of Whites. Hence, about 12.6 percent of Oregon households have difficulty meeting their basic needs for food, compared to a national average of 9.7 percent. Moreover, housing costs in Oregon have been pushed to some of the highest in the nation due to high population growth and low household income. These trends have fallen particularly hard on low income families in Oregon. Today, one in seven working families with children live in poverty (Thompson and Leachman 2000:46). Families in Green County have faced all the same pressures— gowing income and wage inequality, rising housing costs, a high percentage of low- paying jobs, and restricted access to public health insurance. As such, a survey conducted in 2000 with low-income families in Green County highlighted the increasing difficulties that families face in meeting their needs for childcare, housing, and food ' Except where noted, the statistics and information quoted in this section are drawn from A Portrait of Poverty in Oregon (Oregon State University Extension Service 2001 :5). 145 security (Community Assessment 2000). Based on responses from 72 families in the county, the survey reported the following results (2000:15-17). 0 Families with children in poverty averaged $10,500 in yearly household income; 0 67 percent received some form of government assistance, including food stamps (43%), energy assistance (29%), housing assistance (26%), Adult and Family Services (21%), or unemployment compensation (15%); o 61 percent listed childcare as a top concern; 0 38 percent listed housing as a top concern; 0 77 percent had health insurance, 54 percent of whom were covered under the Oregon Health Plan and 44 percent under other types of insurance; 0 5 7 percent indicated they were food-insecure, but a third did not use food stamps. Although this study did not consider the particular needs of households headed by teen parents, other sources indicate that teens comprise about thirteen percent of all parents in Green County, and that families headed by teen parents are disproportionately poor (Oregon DHS 2002b). The public cost of assisting low-income farrrilies in Green County has thus placed a particular spotlight on teen parents. The Oregon Department of Human Services (DHS) estimates that more than half of the parents of children in Services to Children and Families long-term care were teen parents at the time their first child was born (Oregon DHS 2000:2). Moreover, DHS estimates that the total annual cost for the teen parent caseload in the Adult and Family Services Division is approximately $21 million (Oregon DHS 2000:4). Efforts to reduce welfare spending thus walk hand-in-hand with efforts to reduce the teen pregrancy rate, and assistance available to teen parents continues to decline. 146 Although Teen Parenting Services (TPS) of Green County is a public progam desigred to help teen parents get on a path to self-sufficiency, it is under scrutiny by county officials for the services they provide. Public fears have been expressed that services to teen parents merely condone their behavior and do not send the proper message to other teenagers. Although the teen mothers in my study were not directly aware of these debates, they nevertheless confronted stignas and stereotypes that influenced their relationships with parents and service providers and the choices they made. Master narratives of childbirth and parenting tend to present a view of teen mothers as ignorant and immature. According to this discourse, teen mothers lack the experience and maturity to cope with labor and delivery, and thus they experience a number of poor birth outcomes, including infant mortality, low birth weight, maternal anemia, preterm delivery, and cesarean delivery (Phipps and Sowers 20022125). Efforts are made in Green County to address these concerns, particularly through prenatal exams, birthing classes, parenting classes, and other public social services, but teen mothers often resist such sources of information and instead rely on their own knowledge, experience, and “common sense” to prepare for childbirth and the transition to parenting. In the following pages, I explore the choices teen mothers made during pregrancy regarding their birth plans and the information they sought or accepted from others. In an effort to prove their own competence and worth, many teen mothers hoped to give birth “naturally.” As such, they rejected most forms of information and advice as “common sense.” In a study with teen mothers, Joanna Higginson (1998: 142) found that teens are often besieged with advice from parents, doctors, teachers, books, and magazines. By selectively accepting such advice, teen mothers demonstrated that, despite their age, no 147 one could brow better than they how best to raise their children. Although Higginson did not consider teen mothers’ preparations for childbirth, the findings of my study suggest similar conclusion. This chapter explores the ways in which teen mothers challenged relationships of power and social control by relying on their own experience and common sense, and by asserting their own agency, even at the cost of being ill-informed and under-prepared for what to expect during labor and delivery. Making the Birth Plan Many sources are available to pregnant women to assist them in developing a birth plan. Books on pregrancy and childbirth (Eisenberg, Murkoff, and Hathaway 1991; Lindsay and Brunelli 1998) provide examples of typical birth plans for women and encourage them to present a plan to their birthing coach, healthcare provider, admitting nurse, and the labor and delivery nurse prior to the day of delivery. These birth plans cover a number of issues, including medication preference, persons to be in attendance during labor and delivery, whether or not a boy should be circumcised, plans to breastfeed, and length of stay in the hospital. These plans encourage women to think and talk about their preferences early in their pregnancies so that they are able to communicate their wishes to others and have the birth experience they want. I talked to teen mothers about their birth plans. This information was generally not offered during their stories, but was a question posed by me. Although no one prepared a written plan prior to giving birth, and many of them did not even talk about preferences with their healthcare providers during prenatal exams, some of them clearly thought about the options available to them and were able to talk about the decisions they 148 made. Teen mothers who planned a natural birth offered far more information about their decisions than those who did not. In their stories, they explored relationships with family members, partners, healthcare providers, and friends that shaped their expectations and the decisions they made. Ten women (53%) in this study planned to give birth “naturally” (see Table 5.1). In general, what this decision meant was that they wanted to give birth vaginally and they did not want to receive epidural anesthesia. Table 5.12 Birth Plan by Race/Ethnicity, 2001 Race/Ethnicity Birth Plan White Hispanic Total # % # % # % Natural 5 42% 5 71% 10 53% Medicated 4 33% - - 4 21% No Plan 3 25% 2 29% 5 26% Totals 12 63% 7 37% 19 100% As women moved through their stories, it became clear that other medications, including Stadol and Pitocin, were not necessarily excluded from their plans. As such, their choice to have a “natural childbirth” was often based less on a philosophical belief in natural childbirth methods than on the fear of side effects fi'om the epidural, particularly back problems, paralysis, and/or potential harm to the baby. Teen mothers engaged master narratives of childbirth in complex ways to demonstrate their agency and 149 responsibility as parents. By exploring their browledge about various types of medical interventions, and their efforts to protect themselves and their babies fiom potential side- effects, they challenged the medical model of birth as the safest method. Drawing on the stories told to them by others, and focusing on their own efforts to give birth “naturally,” these women made decisions that enabled them to be strong and in control. Important ethnic differences were apparent in the choices women made regarding childbirth. The majority (71%) of Hispanic women planned a natural birth, compared to less than half (42%) of White women. One-tlrird (33%) of White women planned to get an epidural during labor and delivery, whereas none of the Hispanic women indicated that as an option. In general, Hispanic women drew on the advice of female relatives who encouraged them to give birth naturally so that they would be able to feel “when it was time to push.” Over half (58%) of the White women either believed that birth would be too painful, or they were advised to get an epidural because they were classified as having a “high-risk” pregrancy. Natural Childbirth In total, ten women (53%) in this study planned a “natural” childbirth. While a geater percentage of Hispanic women chose natural childbirth methods than White women (71% and 42%, respectively), they varied in the reasons they gave for doing 50. Five women chose natural childbirth because they feared the negative side-effects of an epidural, and four of these women were White. Another five women argued that they wanted to remain strong and in-control of labor, and four of these women Hispanic. These ethnic differences will be explored in more detail in the following sections. 150 Fear of the Epidural. Jessica, who gave birth at age sixteen, did not want an epidural and did not waver from that position. I didn’t want it. I didn’t want an epidural because they weren’t going to mess with my spine at all. They weren’t going to put needles back there. Once I got into it, I was like, “I don’t want a shot, just let me push.” Jessica relied on “faith and power” to get through delivery. “I believed in myself in that I could do it. That really helped.” Although she said that she was given Stadol to help with the pain early in labor, she refused everything after that and gave birth naturally. Norma, who gave birth when she was sixteen, made similar decisions. Although she refused the epidural, stating “the epidural actually really scares me,” she was given Pitocin and Stadol to manage pain during labor. Madison, who delivered twins when she was nineteen, was wonied about both the epidural and Stadol because of the harm the procedures posed for both her and her babies. I was scared because I didn’t want to take the epidural and like wind up paralyzed and having problems with my back later. And I didn’t want [the twins] to get any of the drugs, you know, into their system because I read babies have a hard time with that. One of her twins had difficulties breathing when he was born, and Madison worried that the Stadol she was given during labor may have affected him. Linda, who gave birth to her daughter at age nineteen, was also worried about potential harm to her baby. “I was worried, because they say that the medication can affect the baby. I was wonied. I brew that if I went on medication I wouldn’t be a wimp because I tried as hard as I could, but I wish I could have gone a little bit further.” In her comments, Linda suggested that she felt pressured to do the right thing, be strong, not be “a wimp,” and protect her baby. That pressure came largely from herself and her desire to be seen as a good parent. 151 Haley, who gave birth at age seventeen, talked about a sirrrilar struggle with trying to be strong and protect herself, but she also reflected a philosophical belief in methods of natural childbirth. She explained that she planned a natural birth “because I think it’s something that every woman wants to try to do. You brow, at least try.” She did accept an injection of Stadol to help with the pain during labor, and subsequently she was given Pitocin to help speed up her contractions. But Haley said there was “a definite ‘no’ on the epidural” because “I had heard things about getting the epidural and so I just wanted to be strong and do it.” Finally, she accepted the epidural because the pain was too geat. Strength and Control. The other five women who planned natural childbirths did so because they wanted to either prove they were strong or because they were advised to do so by female relatives who stressed the importance of being able to feel when it was time to push. Four of these women were Hispanic. Gabriella relied on her mother’s beliefs and advice to plan a natural childbirth. Although she did not understand the reasons behind her mother’s belief, she accepted them wholeheartedly. “They have a lot of superstition that you need to, you brow, that your back is going—I don’t brow. I’m not sure. We just don’t believe in it.” Gabriella brew that there was something dangerous about the use of the epidural, but she chose to give birth naturally, not because of these concerns, but because her mother advised her to do so. She did not need additional information—her mother’s word was enough. Maria and Elisa were also encouraged by their mothers to give birth naturally, but this advice was more clearly based on the need to maintain control during labor. Elisa, who gave birth at age seventeen said “My mom told me it’s better because then you will feel when you need to push...she told me since it was my first time to do that.” Maria’s 152 mother and godmother made similar comments and assisted her throughout labor and delivery. Two women, in particular, suggested that they planned a natural childbirth because they wished to prove their strength and ability to others. Carmen, who gave birth when she was nineteen, stated “I always thought I would be really tough. I won’t like scream or nothing. They’ll be all surprised.” Although nurses kept asking her if she wanted an epidural, she refused because she had heard that “things can happen if you have an epidural” and she did not want to lose control. Brooke, who gave birth when she was sixteen, also wanted to portray the image that she was strong and could handle childbirth without pain medication. She made few efforts to educate herself about natural childbirth, but told her fiiends about her plans, even against their advice. I didn’t talk to the doctor about it. I think she maybe asked me about it one time. That’s just what I told people, like at the school, that I was going to have it that way. And they said, “That’s what you say now.” Summary. Although half of the women in this study planned a natural birth, their reasons varied, particularly by race/ethnicity. White women tended to voice a mistrust of certain medical procedures—a mistrust that primary focused on the epidural and did not include other types of medical interventions, such as Pitocin which is used to augnent labor, or Stadol which is used as a pain reliever. Conversely, Hispanic women tended to focus on the need to maintain control during birth—to be able to feel and to brow when they needed to push as well as to be strong and demonstrate their ability to others. Their choices reflected different sources of information and support on which they drew in preparation for childbirth. These sources are discussed in more detail below. 153 Medically Managed Births Four women (21%) planned medically managed births fiom the beginning, and all of these women were White (see Table 5.1). Angela and Jill were pregrant with twins and were told by doctors to expect complications during delivery. As Angela explained, “In case there was complications with the twins, I had to be ready for a c-section and I had to have an epidural with twins.” Neither she nor Jill questioned these procedures. Kris and Erika also planned to get epidurals based on the advice they received fiom friends with childbirth experience. Kris gave birth when she was sixteen. She listened to the advice of her friend who said labor was painfirl. “Because my friend had gone through it without the epidural and she said it hurt a lot.” Although Kris described labor as “really easy,” and suggested it could have gone even faster if she had not been given an epidural, she justified her decision by suggesting that the Pitocin she received to speed up her contractions made them “worse than regular contractions” and thus they were more painful. When my contractions came, it was like being induced. Because my water had been leaking. It didn’t break though, it had just been leaking. So they had to hook me up to an IV and induce them. And by the time it had started working, my body started working with the contractions and so they were worse than regular contractions. So they ended up giving me the epidural and pain medication. Erika was far more negative about her expectations and experiences than was Kris. She described herself as “miserable” during her pregrancy, and “in so much pain” during delivery that “several epidurals” were needed. Erika recounted some of the most gaphic stories of deliveries that went wrong—umbilical cords wrapped around the babies’ necks; stillbirths; a baby’s head suctioned off by the doctor. Her story echoed these traumas in many respects and she evaluated her own birth outcome. 154 No Birth Plans Five teen mothers (26%) indicated that they made no plans for birth. Three of these women were White and two were Hispanic. All five of these women were embedded in difficult situations that prevented them fiom obtaining necessary information and advice. As such, they formulated no expectations for labor and delivery. Both Allison and Michelle gave birth two months prematurely and thus had no plans for birth. Because Michelle also actively hid her pregnancy for the first six months fiom everybody, she had few opportunities for prenatal care or to talk with anyone about what to expect during childbirth. Amber, who had considered abortion and then gave birth to twins, did not find out she was pregrant until her fifth month. As such, she did not receive prenatal care and did not have time to formulate a birth plan. The Hispanic women had equally disturbing experiences. Not only did Marta and Margarita receive inadequate prenatal care during their pregnancies, but they were disconnected from family members who could have offered them the support that other Hispanic women gleaned from their female relatives in preparation for childbirth. Margarita’s mother was seriously ill in Mexico and was unable to offer her any assistance or advice. Although Marta was the only one in this goup to begin prenatal visits early in her pregrancy, she was poorly advised by her doctor, ended up with a series of health progams, and delivered her baby two months prematurely. Sources of Information Regarding Childbirth Although half of the women (53%) in this study planned to give birth nattually, their narratives regarding preparations for childbirth reflected the tension they felt 155 between trying to be responsible and trying to appear competent. As such, they emphasized their own strength and ability, and they resisted seeking information and advice from others regarding labor and delivery. Their narratives implied that they resisted advice from others in order to prove their own competence and worth. In the end, many of them were ill-prepared for what to expect during childbirth and described very negative experiences. Roughly one-fourth of the women (26%) offered information regarding prenatal exams, classes, and other means of preparing themselves for childbirth Although I did not interrupt the flow of the stories being told to me, I did ask each woman to discuss her efforts regarding preparations for childbirth. In particular, I asked questions about where they learned about childbirth, if they took classes, or if they talked with others (healthcare providers, family members, friends) about what to expect or do during labor and delivery. Their responses highlighted the ways in which they interpreted their relationships with others—particularly healthcare providers (including doctors, midwives, and childbirth educators) and female relatives. In general, seventeen women (89%) identified one primary source of information regarding their preparations for childbirth, and two women (11%) indicated that they received no information at all prior to giving birth (see Table 5.2). Important differences of race/ethnicity emerged in the stories women told. In particular, while half (n=6) of the White women indicated that they relied on formal classes (childbirth, parenting, or high school health) to prepare themselves for childbirth, nearly half (n=3) of the Hispanic women I interviewed identified female relatives, particularly mothers and aunts, as important sources of information in preparation for their own birth experiences. 156 Table 5.2: Sources of Information by Race/Ethnicity, 2001 Race/Ethnicity Sources of Information White Hispanic Total Primgy Sources # % # % # % Childbirth Classes 3 25% 1 14% 4 21% Parenting Classes 2 17% l 14% 3 16% Health Classes 1 8% - - 1 5% Healthcare Provider - - 1 14% 1 5% Media 1 8% - - l 5% Female Relatives 2 17% 3 43% 5 26% Other Birth Stories 2 17% - - 2 l 1% None 1 8% l 14% 2 11% Secondgpy Sources Other Birth Stories 5 42% 3 43% 8 42% Healthcare Provider 2 17% - - l 5% Health Classes - - 1 14% l 5% Media 3 25% - - 4 21 % None 2 17% 3 43% 5 26% Totals 12 63% 7 37% 12 100% Of the seventeen women who did receive information on childbirth, fourteen (82%) also identified a secondary source of information. Almost half (42%) of these 157 women talked about the birth stories they heard from others, including fiiends and relatives, regarding what to expect during childbirth. Additionally, two White women talked about information provided by their rrridwives, and three White women talked about various media sources, including magazines, intemet, and television progams. Formal Classes Eight women (42%) identified formal classes as central to their preparation for childbirth: four women (21%) took childbirth classes; three women (16%) took parenting classes; and one woman (5%) took four years of child development in her high school health class. Six of these eight women (75%) were White, and their stories highlighted how preparations for childbirth were shaped by differences of race/ethnicity. Childbirth Classes. In total, four women (21%) took childbirth classes, including three White women and one Hispanic woman. While the White women took childbirth classes with their mothers as their birthing partners, the Hispanic woman attended her birthing classes with her partner. In general, all four women had very little to say about what they learned in their childbirth classes. Linda, who gave birth to her daughter at age nineteen, merely concluded “I took birthing classes, but it didn’t work.” She had hoped for a natural childbirth, but felt out of control during labor and delivery. Allison, who delivered a premature baby when she was eighteen, said she missed the last few classes and “forgot everything.” Norma was the only woman in this study to attend childbirth classes with her partner. She felt that their class was geared more toward the men than the women: “They actually tried to get those pillows for the men so they would know what it was like [to be 158 pregnant].” Nonetheless, Norma recalled being told in those classes that childbirth hurts, and she drew on that advice more than once in recounting her own birth experiences. They came out and told us “You brow we’re not going to lie to you. Childbirth hurts. We’re not going to sit here and tell you you’re going to be fine. It’s not going to hurt. You’re not going to experience any pain at all.” So they were real upfront. And I think that it prepared us pretty well. And we learned enough to at least get through it. Norma accepted this information and evaluated her own experiences similarly. Although she screamed and threw things at people in the hospital during labor, she felt that the childbirth educators were honest and had prepared her as well as they could. Healthcare providers who recommended childbirth classes to teen mothers tended to highlight the ways in which immaturity influenced women’s relationships with partners during pregrancy and childbirth. For example, Dr. Saran talked about the need to make men aware of the physical changes a woman goes through during her pregrancy. She goes from being in school, fiom usually being thin to gaining weight and not feeling as attractive as she was. There’s a lot of psycho-social stuff that goes on. I make the teen dad aware that these things are going to happen. Dr. Saran further noted that most of the teen parents she saw as clients possessed “the teenage mentality that they know everything anyway and so nothing, nobody can teach them anything.” Although she encouraged all of her teen patients to take childbirth classes, most of them refused to do so. Of the fifteen women in this study who did not take childbirth classes, seven (47%) rejected such classes as unnecessary or as “common sense.” Four of these women were White (57%) and three were Hispanic (43%). Their responses reflected similar arguments that drew on their own experiences and abilities to be good mothers, and did not vary sigrificantly by race/ethnicity. 159 Kris, sixteen, with a one-week-old son, trusted her own ability to get her through childbirth. “I think it was something I just decided not to do. I just said that I could do it.” Gabriella, seventeen, made a similar argument: “I thought I was ready. I just thought I was ready for everything.” Carmen, nineteen, considered taking childbirth classes, and was strongly encouraged by her doctor to attend them. In the end, however, she decided not to because she already brew how to breathe and did not think she would learn anything new. “They weren’t going to tell me anything that I didn’t already know. You know, the breathing and everything.” All three of these women planned to give birth naturally, and they drew on their own strength and instinct to do so. Several White women were clearly advised by fiiends and relatives against taking childbirth classes. These women relied on other sources of information to prepare themselves for childbirth. Erika, who gave birth when she was nineteen, was told that birthing classes were a waste of time. “I thought about it and then my sister said ‘No, it’s a waste of your time.’ Because my sister did it and she said it was a waste of time. I didn’t have any problems during delivery. I had her in four hours.” Although Erika suffered complications fi'om the delivery, the fact that labor was fast confirmed that she had made the right decision. Erika relied on the birth stories of others to prepare herself for childbirth Her experiences are explored in more detail below. Madison was also encouraged not to take classes. “My boyfiiend was like ‘Why do you want to spend $60 to learn how to breathe?”’ The assumption that childbirth classes primarily focused on breathing techniques was shared by many of the women in this study. Having seen similar techniques in the movies and on television, these women felt competent enough to breathe through labor and delivery on their own. 160 In general, teen mothers communicated a strong belief in their own ability, knowledge, and strength to deliver their babies without more formal browledge or advice. In so doing, they rejected childbirth classes as a waste of time and presented an image of themselves as competent and prepared. By presenting childbirth classes as nothing more than instruction on breathing techniques, they confirrned their own abilities—breathing was something they already brew how to do. As Jessica stated, “I just figured you could do all the breathing you want, but when it happens, you breathe how you want to breathe.” Hispanic mothers also drew on the experience of female relatives who offered advice throughout their pregnancies in preparation for childbirth. Although three White women relied on their mothers as birth coaches, these relationships were established within the context of formal birthing classes. Parenting Classes. Three women in this study (16%) took parenting classes while they were pregrant. One Hispanic woman was court-ordered to attend these classes as part of her drug rehabilitation progam. Two White woman also took parenting classes and drew on the advice and experience of other parents in the class. All three of these women had plans to give birth naturally. In general, master narratives of parenting played a central role in determining women’s participation in parenting classes. The public sentiment that teen parents are incompetent and ill-prepared to be parents valorized parenting classes for teens. Pregnant teens were encouraged, even court-ordered, to attend these classes in the hope that they would be better parents. Haley, seventeen, with a three-month-old daughter, took parenting classes just before her baby was born. She brew people judged her by her young age, but she was 161 proud of her efforts to learn about childbirth “fiom everywhere.” Haley identified parenting classes as her primary source of information, but she also stressed the various media sources on which she drew in preparation for childbirth. I watched movies about it. I watched like TLC on the Lifetime Channel about Baby Stories. I had like a hundred magazines, like Fit Pregnancy, and those things. And then after parenting class, I talked to people about when they were pregrant and gave birth. I tried to get as much, to surround myself with things about being pregrant, giving birth. Haley regarded the other parents in her parenting class as an important resource for information. Although she had considered taking birthing classes as well, she did not sigr up for them in time. With her focus on parenting, she did not realize that birthing classes started months in advance. She felt confident, however, about the information she gleaned from magazines and other parents. Carmen, who gave birth to her daughter when she was nineteen, also took parenting classes, but only because she was court-ordered to do so. She regarded these classes more as a source of hardship than a help. I got caught with drugs when I was eighteen and so I had to go to drug court the whole time I was pregnant and that consisted of being in classes three times a week, and I don’t have a car. I had to take a bus at six o’clock in the morning. And then I’d walk around for a couple of hours before even going to class. And this is all while I’m pregnant, and I’m working. To make time for both the classes and her job, she worked nights cleaning apartments, and continued this schedule until her baby was born. With regard to the parenting class, she challenged the relevance of many things they taught. Some of their tactics were just weird though. Like they said if you were cooking and your kid wants attention, turn off the burners and play with your child. And I was like, “You know, that’s sorta spoiling them ‘cause you can’t tell your kids that ‘Whenever you want something, I’ll just stop what I’m doing and come get you.”’ And they got mad at me for that ‘cause they said that’s what you are supposed to do. 162 Carmen openly challenged the teachers. When I asked her where she learned the most about parenting, she talked about her mother and her aunt. Her explanation highlighted the value she placed on her own browledge and experience as well as the knowledge of female relatives. Carmen did struggle, however, with some of the stories she heard fromother parents in the classes she attended. In those classes, parents told stories about losing custody of their children to Child Protective Services. Although she tried not to believe them, they caused her fear and anxiety. I remember this one lady saying that she took her kid to the doctor, the pediatrician, and they called children’s services because the kid had a piece of hair wrapped around his toe or something. You brow, I was like, I don’t think so. Because even if, the other day she had a piece of hair by her feet and I noticed it. So I was thinking you brow you would notice something like that. But I don’t think they would call because of that. So I was already worried, you brow, that what if I take her to the doctor and there’s something on her? Although Carmen doubted the stories she heard, she was afiaid that she would be unable to prove to others that she was a good parent. She worried about taking her daughter to the doctor, not only because of these stories, but because of her daughter’s birthmark. “[S]he came out with what they call a mongolian birthmark all down fiom her back down to her butt. And it looks like a bruise. So I was always worried about that.” She was comforted by the fact that her doctor was familiar with the birthmark, and assured her that it would fade with time, but the possibility of seeing a new doctor who might interpret it as a bruise still caused her fear. Summary. In total, less than half (42%) of the women in this study identified childbirth or parenting classes as their primary source of information in preparation for childbirth. The majority of these women (75%) were White and five (63%) planned to 163 give birth naturally. Although all but one of these women actively volunteered to participate in formal classes, their evaluation of the progams was fairly negative. They felt they proved their responsibility by attending the courses and trying to learn all they could in preparation for childbirth, but they ultimately concluded that the classes “didn’t work,” were “common sense,” or provided inaccurate information. Three of the women who planned natural births took parenting classes but not birthing classes, further highlighting the emphasis they placed on trying to prove themselves “good mothers.” Childcare was often substituted for childbirth in our conversations as teen mothers talked about their responsibility and competence to be good mothers. Hialthcgre Provider§ Only one Hispanic woman, Marta, identified her doctor as her primary source of information during her pregrancy. Lacking family support and advice, she was dependent on her doctor, and ended up having a very negative birth experience. Marta gave birth when she was sixteen years old. She lived with her mother but did not receive any information fi'om her. Although Marta relied on her doctor as her primary source of information, the doctor’s clinic was closed when Marta was six months pregrant because it was determined that the doctor was an alcoholic. Marta sought out a new doctor, and was quickly told that she had been given inaccurate information about her pregnancy and was suffering from a number of serious problems. “The next day I was in the hospital because I had a kidney infection and my blood pressure was high.” She stayed in the hospital for one month and then gave birth to a little boy. The baby stayed in the hospital for twelve days and then went home. After 23 days, the baby died from 164 Sudden Infant Death Syndrome (SIDS). Although Marta blamed her doctor for this outcome, she felt powerless to confiont either her or the hospital that provided her care. Two White women identified midwives as an important secondary source of information regarding childbirth. Erika, who gave birth to her daughter when she was nineteen, explained that she chose her midwife because she felt more comfortable with a woman than a man. She also felt a rrridwife would provide her with more information in preparation for labor and delivery than a physician. “They told me exactly how they were going to go, and they gave me options, to have a cesarean or to have it natural. And I liked that.” Erika also said that her midwife “told me how to breathe and things like this.” Although Erika did not take any formal childbirth or parenting classes, the information she highlighted was equated with the kind of information she assumed would have bee provided to her in such classes. As such, she felt prepared for birth. Linda, who gave birth when she was nineteen years old, also turned to her midwife for advice in addition to taking childbirth classes. She hoped to give birth naturally and felt that the midwife offered her expertise that could enable her to achieve her goal. Linda’s sister was also training to be a midwife, and Linda’s family was very supportive of her efforts to give birth naturally. Her mother attended childbirth classes with her and worked closely with the midwife while Linda was in labor. The majority (84%) of women in the study, however, did not mention healthcare providers as sources of information; neither did they discuss their experiences with prenatal exams. The healthcare providers I interviewed provided some insight into teen mothers’ reticence during prenatal exams. Dr. Saran, a family practitioner, described the teen mothers she saw as very reserved and anxious. 165 Most of them are really reserved and don’t ask a lot of questions because they have no idea what to ask. If I haven’t met them before they don’t tend to open up. They don’t want to talk to me. Often times they don’t want me to examine them. Ms. Kogan, a certified nurse-rrridwife, noted similar behaviors with the teen mothers she served. Teen parents are more sensitive to exams. In fact, half of the time, the pregnant teens that come have never had a pelvic exam before. They are not comfortable doing that. Some of them have never even had their blood drawn before. So that’s a new experience too. And too, they are still adjusting to the fact that they are pregnant. Sometimes a history of sexual abuse heightened the anxiety. Both of the healthcare providers mentioned above discussed the fact that many of their teen patients had been sexually abused in the past, which made doing the exams very difficult. Ms. Kogan recalled one patient who was abused repeatedly by an uncle for many years. When she began her prenatal visits, an ultrasound was suggested to confirm the date of conception. While the young mother wanted her current boyfriend to be the father of the baby, the uncle was also a possibility. Dr. Saran explored the commitment required of her to work with a young woman who had been sexually abused in the past. I had one in particular, who just would not let me touch her, examine her, do a pap smear, a pelvic examination, probably until mid-pregrancy. Because she didn’t feel comfortable. I brow she may have been violated initially so that made it really difficult for her to open up during an exam. This teen mother continued to come in for monthly prenatal visits and Dr. Saran continued to talk with her about her social situation. After several visits, she was able to submit to a physical exam. Research on teen pregrancy has found that anywhere fiom 43 to 62 percent of teen mothers have been sexually abused (Stock et al. 2001 :49). In their study with teen women, Jacqueline Stock and her colleagues concluded that women who had been 166 sexually abused were 3.1 times as likely as others to have been pregnant (2001 :53). For reasons such as these, healthcare providers found themselves playing more of a counseling or “mothering” role with their teen patients. Ms. Kogan stated, “A lot of our teens have very few resources, in terms of family upbringing. I do a lot of mothering in my practice.” This “mothering” consisted of instructing teen mothers about general nutrition and hygiene, as well as counseling them about their relationships with men and preparing them to make the commitment to parent their children. In general, healthcare providers felt they offered important services and advice, but teen mothers did not identify them as important sources of information. Two women mentioned that they were given books or papers to read by their physicians, but generally ' the prenatal visits were “just in and out.” One woman responded to my question by answering “my doctor” when I continued to probe about additional sources of information, but she could not give me any examples of the kinds of information provided to her. Both Dr. Saran and Ms. Kogan identified immaturity of teen mothers as a major impediment to their ability to identify themselves as parents and embrace the parenting role. Dr. Saran argued that immaturity impacted a teen mothers’ ability to draw on social and familial support. There’s who is she going to live with? Are her parents going to be accepting of what’s going on? Do her parents even know about it initially? There’s a lot of things that you have to think about in the prenatal period to anticipate problems in the postnatal period. One Hispanic mother struggled particularly hard with these questions. “It was very difficult to get her to come in once I did her initial examination. She would call me and say ‘I’m coming in, but you can’t tell my parents.’ And then she wouldn’t show up.” 167 This woman feared that the doctor would tell her mother about the pregrancy. Although Dr. Saran explained that she was bound to uphold “patient confidentiality,” the young mother did not understand and was too fiightened by the possibility of her parents discovering that she was pregrant. She successfirlly hid her pregnancy for seven months from her family. Ms. Kogan was equally concerned about the issue of immatruity. She talked about the change in prenatal care in recent years and how ultrasounds help teen parents to accept a pregrancy. In her midwifery practice, it is standard procedure to do a vaginal ultrasound early in the pregnancy to establish date of conception. Ms. Kogan explained that this was helpfirl, especially for teen parents who did not even know what month they got pregrant or were in denial about who the father was. They have been in several relationships. “Why wouldn’t the father he the guy I’m with right now, and not that guy back in January.” And so that’s how you determine. They had their period in March, they’re positive. And then you do the ultrasound, and you can say, “I’m sorry, you conceived in January.” One teen mother mentioned the impact that the ultrasound had on her. Kris found out she was pregrant in the fifth month, and the ultrasound served as a reality check: “I didn’t realize I was pregrant until the ultrasound and I started crying because I was like, ‘Oh, there’s actually a living human being.”’ Ms. Kogan mentioned that fathers need to see the ultrasound as well. “The mother is usually very much present in the moment, and the dad is often not. But that ultrasound brings them right up to speed.” They are able to see a head and legs, and they realize, “There’s a person in there.” Although the healthcare providers I interviewed emphasized the need to prepare teen mothers for parenting, and thus regarded themselves as playing a “mothering” role, teen mothers did not perceive all providers as such. Maria discovered she was pregnant 168 when she was thirteen years old. Her biggest concern about her childbirth experience stemmed from her mistreatment during prenatal exams. She described her doctor as “really rude.” She would check me and stuff—she was kind of rude, really. She was like really rough with me. She wasn’t like gentle and stuff. . .My godmother would go in with me. My mom was going to go. My godmother told her, “No, you be gentle with this girl. She’s just a girl.” So, I don’t think I would have another kid because of going through all the prenatal care and stuff. The fact that most of my discussions with teen mothers regarding prenatal care were limited and/or negative suggests that relationships with healthcare providers were more complicated than merely providing necessary information and “reality checks” to teen parents. In general, teen mothers participated in prenatal exams because they believed it was expected of them. Although the procedures performed may have been regarded as an important part of the preparation process for childbirth, teen mothers did not actively participate in these exams. Dr. Saran suggested that their limited involvement was due to the fact that they did not know what questions to ask. They may also resist asking questions because to do so would be to admit their unequal position and their lack of browledge. Hispanic women are further influenced by a culture of silence and passivity regarding issues of sex and birth control. Their interactions with healthcare were as equally negative and limited. Mgdll Only one White woman (5%) in this study indicated that she relied on various forms of media as her primary source of information. Three other White women identified the media as an important secondary source of information. All of these women read birthing books, pregrancy magazines, and informational brochures; they 169 viewed birthing videos and television progams like “A Baby Story” on the Lifetime Channel; and/or searched for information on the internet about having twins. These resources were generally free and easier to access than traveling to a class on a regular basis, and they provided some insight into what to expect during labor and delivery. Madison delivered twins when she was nineteen years old. She planned to give birth naturally, and she spent a lot of time on the internet reading about twins. On the internet, everyone puts their stories on there. I read a lot of stories about twins being born and being born real tiny and having problems with their lungs and their heart. So I was kind of worried about that. Madison did not brow anyone else with twins and she said that pregrancy books did not tell her what to expect. The only source she found to help prepare herself for childbirth was the stories that other women posted on the internet. Haley watched several episodes of “A Baby Story” on the Lifetime Channel when she was pregrant. Each half-hour episode featured the birth of a baby, following parents through pregrancy, their preparations for childbirth, labor and delivery, and the transition to parenthood. From these shows, Haley gained a glimpse into the delivery room and what childbirth may be like. I watched a few of these episodes to understand what information was being provided to viewers. In general, these were stories about middle-class, married couples who actively planned their pregnancies, were supported by a large network of family members, and gave birth in modern hospitals with high quality medical care. Their stories reflected master narratives of both childbirth and parenting—their age and social class defined them as “appropriate” parents, based on their decisions regarding prenatal care, preparations for childbirth and parenting. 170 Female Relatives Five teen mothers (26%) identified family members as their most important source of information in preparation for childbirth. Three of these five women were Hispanic. In total, 43 percent of Hispanic women identified female relatives as their primary source of information, while only 17 percent of White women did the same. These numbers reflect important differences of race/ethnicity Aunts and mothers were particularly helpful to Hispanic women in this study, often being the first farme members told about the pregrancy, and continually offering advice and information on what to expect and how to prepare for childbirth. Gabriella rejected birthing classes because she felt she could rely on the experiences of her female relatives. I kind of brew what to expect because I had seen my aunts and my mom go through labor. And to be honest with you, I don’t really believe in those kind of classes. We don’t think it’s necessary. More than once, Gabriella echoed her families’ beliefs with the comment that she did not “believe” in particular actions. When I asked about her plans for birth, she explained that she was planning to have an unmedicated birth because her family did not want her to get an epidural. “They didn’t want me to get the epidural because we don’t believe in that.” Gabriella placed geat value on the experiences and beliefs of her female relatives and based her expectations and preparations for childbirth on their advice. When probed, she could not provide a rationale. Instead, she trusted their strength, confidence, and experience as women to guide her own preparations for childbirth. Elisa, who gave birth to her daughter when she was seventeen said her mother also encouraged her to have a natural childbirth, “because then you will feel when you 171 need to push.” Elisa’s gandmother and aunt provided her with additional advice, particularly regarding how she would feel when labor started and how she would brow when it was time to go to the hospital. She spoke with confidence about her preparedness because of the support she received from other women. Kris, who delivered her son when she was sixteen, was living with her gandmother and relied on her as her primary source of information and support. She argued that, because her gandmother had five kids of her own, “She knows a lot.” Prior experience with motherhood thus gave women access to authoritative browledge that the teen mothers drew on in preparation for their own births. Qersf Birth Stories Two White women (17%) indicated that they relied on the birth stories of others as their primary sources of information regarding childbirth. Eight additional women (57%) identified birth stories as important secondary sources of information. In total, fifteen women (79%) in this study talked about the birth stories they heard fiom others as they narrated their own experiences with pregrancy and childbirth. Three women in this study recounted positive stories of birth—natural births that happened quickly and easily. These women brew fiiends or relatives who had experienced short, easy labors, and they were encouraged to believe that they could do the same. The majority (80%) of teen mothers, however, recounted a wide variety of stories that generally focused on pain, drama, death, and/or the threat of having the baby taken away by the hospital or child protective services. These women varied in their interpretations of these stories and how the stories influence their evaluation of their own 172 birth outcome. In general, seven women (47%) believed the stories they heard, and eight (53%) rejected them. These stories are outlined briefly here as well as the discussion of birth outcomes in Chapter Six. Rejecting the Stories. The most common story that was recomrted to me focused on pain and drama—difficult pregrancies, long labors, big babies, crying and yelling. In retelling these stories to me, eight teen mothers compared themselves to what they heard and highlighted the way in which they were better. They rejected these narratives and presented an image of themselves as strong and competent. Elisa gave birth to her daughter at age seventeen. She said she heard “really bad” stories about birth. One of my fiiends at school said that she was crying and yelling when she was having her baby. I didn’t really yell. I just kind of cried, but not loud or anything. Then one of my other fiiends was just like, they had been in labor for like twelve hours. The delivery took a long time. And one said they had to do a C-section or whatever you call it. Because the baby wasn’t in the right position. But I think I was pretty lucky because I think I did pretty good. Although her friends experienced long, difficult labors, Elisa did not. She attributed some of that to “luck,” but also implied that she maintained more control over the birth process. Her mother and her aunt continued to offer their support throughout labor and delivery, enabling her to stay focused and achieve the birth experience she wanted. Kris, who gave birth at age sixteen, responded to her aunt’s stories in a similar fashion. “My aunt used to try and tell me like a whole bunch of stuff, like you’re going to get really fat or it’s going to be really hard. It’s not actually that hard. It’s really fun.” Not only did she reject her aunt’s advice, but she challenged her by saying that childbirth was “fun.” Gabriella similarly refused to believe what anyone told her. “Everybody would tell you that it was painfirl, but it’s like it goes in one ear and comes out the other. 173 You don’t actually believe it until you’re actually going through it. So I never really believed it.” Haley, seventeen, with a three month-old daughter, thoroughly enjoyed her pregnancy. Although people told her pregrancy was “awful,” she disageed. For the most part, I just heard about being pregnant, that it was awful, being sick all the time, always being tired, headaches, being bitchy all the time. And that was nothing. I felt geat. I never got morning sicbress, I never got bitchy. I was happy. I was really, really, really, like extremely happy. I just felt really healthy. I just felt geat. I felt beautiful. I loved myself. I loved it when I got really big. While her fiiends listed a long line of physical complaints, Haley challenged those by describing herself as happy, healthy, and beautifirl. As she continued, Haley noted that most of the people who told her these negative things were her age. Her mother and her mother’s fiiends who had children were very supportive. They said, “It’s a piece of cake. You’ll do good.” The age difference that Haley noted suggested that efforts were being made to tell her how she should feel—or should not feel. She challenged dominant views by describing herself as happy and beautiful. In sum, Kris, Elisa, Gabriella, and Haley all rejected the negative stories they heard from others, emphasized how different they were from the stereotypes presented to them, and described their own pregnancy and/or childbirth experiences as positive, “fim,” and “happy.” Although they were confionted with stories that reflected master narratives of teen mothers as incompetent and ill-prepared, they rejected those stories and confirmed their own strength and ability to be responsible parents. Linda and Maria narrated similar stories and further highlighted the way in which such stories were intended to undermine their potential and/or confidence. Both Linda and Maria were confronted with older sisters who were jealous of the attention they 174 received. The “horror stories” they were told were intended to frighten them and undermine their efforts to have a positive birth experience. Linda, who gave birth to her daughter at age nineteen, noted that she did not hear any good birth stories. Horror stories about what it was going to feel like and be like, and afterwards. From people who already had babies... People were telling me my boobs were just going to be huge and my feet were going to swell like watermelons, you are going to gain so much weight, but I never gained weight. Mostly just stories about what’s gonna hurt. I never heard anything good. Linda acknowledged that she was very scared about what might happen during childbirth. Her sister told her that childbirth “was going to hurt like Hell” and her brother-in-law told her “It’s not gonna be firn, you are just gonna cry and it just feels like you are pooping out a rock or something.” Still, she chose a midwife and planned to have a natural birth. “I was only going to get medication if I absolutely could not stand it.” Despite what she was told, Linda chose to believe that her labor would be easy. She chose to believe that she would be strong during childbirth, that she would not cry, and that she would handle the pain. In making those plans, she rejected the messages sent to her that suggested she was incompetent or ill-prepared to be a parent. Maria, who gave birth to her son at age fifteen, also planned a natural birth, despite the stories that her sister told her. My sister tells me, “You’re not tough that much.” She is kind of jealous that I live with my parents because she ran away. And so she would tell me, “It’s not going to be fun and you’re probably going to have a c-section and stuff because you’re so young.” Since I was thirteen when I had her, she was telling me these horrible stories. I wasn’t going to be able to have him and stuff. And then like she told me that the hospital would probably keep my kid because I’m really young. Maria’s sister had also been pregrant as a teen; fearing her parents’ reaction, she ran away from home and raised her baby on her own. Maria described her sister as jealous 175 and concluded the stories were told to scare her. As such, she chose not to listen to them, but relied on the support of her mother and her gandmother during labor and delivery. She planned a natural birth and said her mother “was really helpful.” Many of the stories told by women in this section reflected themes of jealousy and fear. Sisters, in particular, tried to undermine their strength and comnritrnent to give birth naturally; fiiends similarly told stories implying that they would fail. The teen mothers I interviewed rejected these stories. Their own mothers supported them in their preparations for childbirth, enabled them to ignore the negativity, and encouraged them to give birth naturally. Believing the Stories. Seven of the women (47%) who recounted birth stories of others chose to believe the stories they heard and plan their own birth accordingly. While three of these women heard positive stories, the other four used the negative stories they heard to corroborate their own birth experiences. Erika gave birth at age nineteen, and she relied heavily on the birth stories she heard from fiiends. She said she heard many “scary stories,” including stories about the umbilical cord being wrapped around the babies neck, stillbirths, and death. I’ve also had a couple of fiiends that have had stillborn babies. Yeah, and not know it until delivery. One baby, a fiiend of mine’s baby during delivery—you brow how they use the suction cup—they suctioned the head off, the baby’s head off, the top of the head off. I don’t know the name of the doctor who did it, but it happened here. Erika’s story of her own birth was equally as traumatic as the stories she recounted from others. She described her pregnancy as “high-risk,” due to a previous back injury and problems with asthma, and she sued her midwife for malpractice. The stories she recounted from others provided the foundation for her own story. Labeling herself “high 176 risk,” Erika expected labor and delivery to be difficult, and the outcome lived up to that expectation. Amber, who gave birth to twins when she was nineteen, heard some positive birth stories, but her negative interactions with healthcare providers influenced her negative interpretations of childbirth. She heard only two kinds of stories: easy deliveries and cesareans. “Most of the women I talked to had cesareans. I never met anybody else who had twins.” These stories set the stage for how Amber interacted with healthcare providers during pregnancy and childbirth. Although she felt confident in her own abilities, and leaned heavily on her mother’s experiences and support, she continually felt defensive and falsely accused by medical staff. They were more concerned that there could be complications with the babies because I didn’t have any prenatal care. They were concerned about that. I didn’t have any of the prenatal vitamins or things like that. That was really their biggest concern. They weren’t sure I was eating well. These accusations continued into childbirth. During labor, Amber recounted that she was given sleeping pills. Later, she tested positive for “barbituates in the blood or urine because they had given me a sleeping pill but hadn’t marked it on the thing.” The nurses challenged Amber and until it was confirmed by another staff member. Although she felt competent in her ability to give birth and be a good mother, she experienced confrontational relationships during her pregnancy and expected labor to be difficult. No Informption Two women in this study (11%) reported that they received no information at all regarding pregnancy and childbirth. One woman was White and one woman was Hispanic. This lack of information was most directly influenced by the lack of family 177 involvement in their lives. For Michelle, who felt compelled to hide her pregrancy from her family for six months, her lack of information stemmed fiom the fact that her family was wholly unsupportive of her pregrancy. She explained that she did not have an opportunity to receive prenatal care or seek information about pregnancy and childbirth prior to giving birth. Margarita also lacked information because her family was not involved, although their noninvolvement had more to do with residential status than parental disapproval. Margarita described her migation back and forth across the U.S.-Mexico border during her pregrancy. Her mother, who lived in Mexico at the time and was suffering from diabetes, was unable to prepare her for childbirth or parenting. “She couldn’t talk very much. She was very sick. She couldn’t see the last time I saw her, and she couldn’t talk or walk the last mon .” Although Margarita also had two sisters nearby, they would not give her any advice. “I asked them, but they didn’t tell me anything. They don’t like to talk about it. They are shy about talking like that.” When Margarita went into labor, she was very scared because she was one month early and she thought she was suffering a miscarriage. Her father drove her back and forth fi'om the hospital. On the second trip to the hospital, she delivered a baby girl. Margarita’s story highlights the difficulties she faced because she did not have input from her mother and did not brow what to expect or look for herself. Having few alternatives to silent sisters, an unbrowledgeable father, and unhelpful doctors, she suffered alone. On the other hand, those women who did receive advice fiom their relatives were highly confident in their own abilities to be prepared for childbirth and 178 parenting. They drew on the history of women’s experiences with childbirth to justify their own preparedness and competence. This was particularly true for Hispanic women, but White women drew on their mothers’ support as well. Faced with criticism from the public (fiiends, neighbors, doctors), female relatives became a valuable support network as teen mothers struggled to meet their birth plans and maintain an image of themselves as competent and responsible. Summary This chapter has explored the ways in which teen mothers prepared themselves for childbirth, including their participation in birthing classes, parenting classes, and prenatal exams as well as their efforts to glean information fiom various media sources, family members, and others with childbirth experience. Although none of the women actively designed birth plans, most of them had clear expectations for how they wanted to experience labor and delivery. Half (53%) planned to give birth naturally; and four (21%) plarmed a medicated birth. Given that the vast majority of women in the United States choose a medically-managed delivery, their stories challenged master narratives of childbirth and parenting that stignatize teen mothers as immature and incompetent. In the context of gowing poverty and inequality in Green County, teen mothers have confronted dominant stereotypes in their interactions with healthcare providers, parents, and the public at large. In an effort to challenge these stereotypes and present a positive image of themselves as good parents, teen mothers carefully managed their interactions with others and the amount of information and advice they accepted regarding childbirth. 179 Although all but one of the women in this study received prenatal care from doctors or midwives, they did not regard their healthcare providers as important sources of information and did not talk to them about their expectations for childbirth. Moreover, the majority of women (68%) rejected birthing classes as “a waste of time” and felt “ready enough” for childbirth. My findings support Higginson’s (1998) theory of competitive parenting by suggesting that relationships of power and social control limited the relationships and information that teen mothers accepted. In an effort to appear strong and competent, they were guarded in what advice they sought, who they talked to, and what they said. Their relationships and behaviors varied by race/ethnicity. While White women were more open to formal sources of information——birthing and parenting classes, and various forms of media—Hispanic women relied much more heavily on female relatives for information regarding pregrancy and childbirth. They took the advice of mothers, aunts, and gandmothers and relied on these same women to get them through labor and delivery. These differences further shaped the ways in which they experienced labor and delivery and are discussed in more detail in Chapter Six. 180 CHAPTER SIX BIRTH AND PARENTING: “READING STORIES ISN’T ENOUGH” As teen mothers prepared for childbirth, they drew on the information they gleaned fi'om birthing and parenting classes, female relatives, and fiiends to shape plans and expectations for their own labors and deliveries. Whereas the narratives they heard were largely negative and communicated stories of pain, trauma, and complications with delivery, their own stories emphasized the desire to be strong and agentic. Although half of them planned natural births, few of them actually achieved their goals. In this chapter, I explore teen mothers’ narratives of labor and delivery, and their interpretations of birth outcomes. Occasionally, their stories explored their own lack of knowledge and preparation, but many teen mothers emphasized conflictual relationships with healthcare providers who denied them voice and control, and thus prevented them having the experience they expected. This chapter begins with a discussion of the services available to birthing women in Green County in order to outline the context in which teen mothers gave birth. Then I explore teen mothers narratives of birth, and how their relationships with healthcare providers and others shaped their interpretation of their own birth experiences. Although some of the women admitted that “reading stories isn’t enough” and that, in fact, they did not expect labor to be so difficult, more generally, their stories highlighted power inequalities between themselves and others that made it difficult to maintain control. By placing the blame on others—who were perceived to have silenced them, ignored them, and/or provided improper care—the women struggled to maintain an image of themselves as competent and responsible, even if not always in control. 181 Giving Birth in Green County There are two major hospitals in Green County—Alton Medical Center and Benton Memorial. Unless a woman plans a home birth, all births in Green County take place in these two hospitals. Alton Medical Center is one of the newest hospitals in the state, and it is widely considered to be one of the best. The Women’s Health Center at the hospital offers a number of services to women, including obstetrics, gynecology, and midwifery. The new Birthing Center offers a number of options for women during labor and delivery, including birthing suites, a Jacuzzi tub, and on-site staff supportive of a range of birthing methods. Although Alton’s Birthing Center goes a long way toward providing a space for medical and natural childbirth models to coexist, midwives in the hospital setting are still strongly supervised by physicians and expected to follow general hospital procedures that reflect the medical approach. Research and discourse on midwifery in the United States has increasingly focused on this complicated relationship between doctors and midwives. Midwifery Today, an online newsletter for research and literature related to midwifery care, explores the ways in which lines between medical and natural methods of childbirth have blurred. Master narratives of childbirth have increasingly defined hospitals as the safest place to deliver a baby; fears of malpractice strengthen relationships between doctors and certified nurse-midwives, who can only deliver babies in hospitals; and many forms of insurance will not cover services provided by lay midwives outside the hospital setting.1 ' I wanted to deliver my second baby at home in Green County, but my insurance would not cover the services for a lay midwife. Although I delivered at the Birthing Center with a certified nurse-midwife, and had an entirely natural childbirth, I was still aware that the doctor associated with my midwife was in the Center and was continually monitoring my progess. I signed a birth plan with my midwife, and submitted that to the Birthing Center, but my midwife was obligated to follow the decisions of the doctor if at any time during my labor he felt it appropriate to intervene. 182 At the Birthing Center in Alton, staff worked comfortably with certified nurse- rrridwives, who provided services in tandem with local physicians. Many nurses expressed discomfort with lay midwives who offered services to women for home births. They recounted times when they were the ones confronted with difficult situations when a woman attempting a home birth was rushed to the hospital. The general sentiment was that home births were both dangerous and irresponsible. This environment shaped the birth experiences of teen mothers in Green County in important ways. In general, the environment was such that the vast majority of women in the county chose physicians to attend their births in hospitals because it was regarded as safe and controlled (a trend shared by women throughout the country). Those who did choose midwives, however, felt comfortable to do so because all the midwives working in Green County were located in doctors offices and followed the same procedures for prenatal care, labor, and delivery as the doctors overseeing them. I did know women in Green County who planned home births and received services fiom lay midwives in more urban centers of neighboring counties. These women were generally older, White, and more educated than the teen mothers in this study. None of the teen mothers even mentioned home birth as an option. Although ten of the teen mothers (53%) I interviewed embraced the idea of a “natrual” childbirth, their definition of “natural” reflected master narratives of childbirth described more generally in Green County—in a hospital, with access to pain medications, and supported by doctors, nurses, and/or midwives. This definition carried specific implications for how they prepared themselves for childbirth, as well as the outcomes they experienced. 183 Birth Outcomes While the birth stories told in this study began with pregrancy and continued through childbirth and the transition to parenting, the central part of their stories focused on labor and delivery. It was here that contention truly emerged, as teen mothers questioned the stories they were told, their interactions with family members and partners, and the medical care provided to them. Very few of the teen mothers had deliveries that truly reflected their birth plans or expectations. Table 6.1 outlines how race/ethnicity was related to birth outcomes. Table 6.1: Women’s Birth Outcomes by Race/Ethnicity Race/Ethnicity Birth Outcome White Hispanic Total # % # % # % Natural - - 1 14% 1 5% Natural w/meds 1 8% 4 57% 5 26% Epidural ll 92% 2 29% 13 68% Total 12 63% 7 37% 19 100% Although ten women (53%) planned a natural childbirth (meaning they did not want an epidural, but were not opposed to the use of other pain medications, see Table 5.1), and two others did not exclude natural childbirth as a possibility, only six women (31%) achieved their goal, and only one woman gave birth without any type of medical intervention whatsoever (i.e., Pitocin or Stadol). The other six women received epidurals for various reasons—two had prolonged labors and ultimately delivered by cesarean; and 184 four women asked for epidurals because the pain was perceived to be unmanageable. In total, thirteen women (68%) in this study received epidurals. Although only four teen mothers planned to get epidurals from the beginning, thirteen women (68%) ultimately received them, including the four women who planned to, three who lacked a birth plan, and six who had hoped for a natural birth. Their experiences varied in important ways by race/ethnicity. All of the Hispanic women delivered vaginally, and less than one-third (29%) of them received epidural anesthesia. Conversely, all but one (92%) White woman received an epidural, and five of these women delivered by cesarean section. These differences were shaped by several factors. First, a larger proportion of Hispanic women planned a natural birth than White women (71% and 42%, respectively). Second, Hispanic women who planned natural births drew on the experience and support of female relatives throughout pregrancy and childbirth while White women relied more on “faith,” “common sense,” and formal classes. Finally, whereas all of the Hispanic women delivered singletons, four White women (33%) in this study delivered twins, and they were advised by their doctors to plan on receiving an epidural. Women’s birth outcomes were interpreted in different ways, depending on the stories teen mothers had heard from others and the types of social support they received during labor and delivery. These outcomes are summarized in Figure 6.1, which shows that most women heard negative stories of birth from others but chose not to believe them; two-thirds of the women evaluated their birth experiences negatively, and the justifications they provided for their birth outcome focused on one of three people—— themselves, their mothers, or their healthcare providers. 185 FIGURE 6.1: Interpretations of Birth Outcome Birth Outcome Others’ Stories Believe Own Birth Expect Reason Natural Jessica positive yes positive yes self Elisa negative no positive yes mother Carmen negative no negative no self Norma negative yes negative no self Margarita - - negative - care Marta - - negative - care Plans Changed Linda negative no positive no mother Gabriella negative no positive no mother Maria negative no negative yes care Brooke negative no negative no care Madison negative no negative no self Haley negative no negative no care Epidural Kris negative yes positive yes self Erika negative yes negative no care Allison - - negative - care Michelle - - negative - self Amber positive yes negative - care Jill negative yes negative yes care Angela positive yes positive yes mother Natural Childbirth In total, one-third of the women (n=6) described giving birth “naturally,” and five of these women were Hispanic (see Table 6.1). As discussed in Chapter Five, their reasons for choosing natural childbirth varied: some feared the side-effects of the epidural; others acted on the advice of friends and relatives; and two women did not form any expectations at all. Accordingly, their interpretations of birth outcomes varied. While two women (1 White and 1 Hispanic) told positive stories of birth, the other four Hispanic women were more negative about their experiences (see Figure 6.1). 186 Jessica was the only White woman in this study who gave birth naturally. Although she noted fi'om television progams that she had “always heard you scream,” she recounted fairly positive stories from her fiiends who had very short labors, and these were the stories she chose to believe. “Well, one of my fiiends, she had two little girls and her story, I wish I could relive it. Both of her daughters were born within under eleven nrinutes.” Although other fiiends told her stories that were more complicated, Jessica concluded, “What made me more confident is that they say, you know, you won’t remember the pain.” Her own experiences confirmed that to be true, “except for the head part.” But what Jessica remembered most from her birth was that she was “polite.” “I got in there, and I was being like, ‘Please, thank you, get me a drink of water.’ I was really, really, extra polite to everyone.” Jessica had planned her pregrancy in an effort to get away from a “dysfirnctional mom.” Many of her family members were present during labor and delivery, however, including her mother, father, gandmother, three aunts, and the father of her baby. Jessica originally planned to have only her partner in the room, but “kinda got stuck with all those people.” Although they were a source of stress for her, “arguing about the baby and arguing about the dad,” she was proud that she maintained control and was so “polite” to everyone. She was also thankful for the nurses who made everyone leave the hospital after the baby was born so that she could get some sleep. For Jessica, birth happened as she had planned. She believed that labor would be fast and tolerable. She wanted a natural birth because she feared side effects from the epidural. Although she was given an injection of Stadol early in her labor, she refused all subsequent interventions and birthed her baby on her own terms. Doctors and nurses 187 played a mediating role between Jessica and her family. She felt empowered and validated by the choices she made. Elisa, who gave birth at age seventeen, recounted far more negative stories of birth fiom her friends——swollen feet, crying and yelling, long labors, cesarean sections. Instead of believing these stories, Elisa relied on her mother’s advice, who emphasized the importance of feeling “when you need to push.” Similar to many other Hispanic families in this study, her mother, aunt, and partner were all present for her labor and delivery, and Elisa concluded that she “did pretty good.” Although she was induced with Pitocin at term, she was proud that she did not receive any other types of medical intervention. Despite the negative messages she received fi'om others, she demonstrated her own competence and strength to maintain control and give birth naturally. Carmen and Norma focused more directly on their own 1055 of control during childbirth, although, like Jessica, their stories highlighted conflictual relationships with family members that influenced their experiences during labor and delivery. Carmen gave birth to her daughter at age nineteen and described herself as alone and stressed during her pregrancy.” I was pretty much by myself because [my boyfiiend and I] had arguments and I didn’t want to stay with him anymore.” Although she tried to stay with an older brother, he was unhelpful. “It was just one stressful thing after another.” When she went into labor, Carmen described herself as wanting to prove that she was strong. “I always thought I would be really tough. I won’t like scream or nothing. They’ll be all surprised.” As labor progessed, however, she felt out-of-control. Oh my god, I thought I was going to die. I was just screaming, “I’m gonna die.” I was like looking out the window. I remember looking out the window thinking I was gonna die because it hurt so had. 188 Although her mother, aunt, and boyfriend were in the room with her, Carmen did not describe them as helpful. Oh my god, my mom at one time tried to made a joke and I remember screaming at her. I said, “This is not funny, I’m in labor.” And I started getting really mad, and all the nurses looked at me like I was so mean. I don’t remember what she said, but it wasn’t fimny. Carmen concluded that she was overwhelmed by the pain and just “did not expect it to be like that.” Her description of her interactions with others also suggested that conflictual relationships influenced her interpretations of outcomes. As she concluded, “I didn’t like everybody being there. I just felt so crowded because with everybody in the room, it was scary.” Her interactions with family members were’ a source of stress and anxiety, and while she wanted to be “really tough” and demonstrate her own power, she was unprepared to manage labor, and so lashed out against everyone in the room. Norma, who gave birth at age sixteen, felt she was very realistic about what she expected from her birth experience. She had been told in her birthing class that labor was painful, but she refirsed to get the epidural because she was afiaid of the side-effects. Although she felt prepared enough to “just get through it,” she described losing control during labor. “I was real mean. I wasn’t really trying to be, but I was mean to a lot of people.” She explained that she tried to punch her mom in the face, and she hither boyfriend in the process of throwing a bucket across the room. As the contractions gew stronger, she was yelling, “I’m done, I’m going home, I’m not doing this no more.” And when she noticed her father and his friend sitting in her room watching “some kind of horror movie,” she yelled, “turn off the damned TV, I’m trying to have a kid here.” I asked Norma if her birth experience was different fi'om what expected, and she ageed, but her reasons did not focus on other people. 189 Yeah, yeah. I’m real squeamish. I can’t stand to see blood or anything like that. The one cool thing is that the doctor wore glasses and when [the baby] was coming out, the way his glasses were, I actually got to see her. And I thought that it would goss me out and stuff, but I was actually like “Wow.” That moment of clarity, when she was able to see her daughter in the reflection of her doctor’s glasses, made it “all worth it” for Norma. Her description of the birth thus reflected what both she and her mother had hoped her birth experience would be. Nonna’s mother had delivered all her children by cesarean section and so she could not offer advice to Norma on how to prepare herself for childbirth. Norma talked at some length about that and just hoped “to give actual birth.” All of these women shared similar experiences——they planned natural births because they believed they could do it, they wanted to remain in control and be “strong” during labor and delivery, and they wanted to make responsible decisions, such as avoiding negative side-effects of an epidural. Healthcare providers were not heard in these stories, except to provide necessary support, intervention, and mediation where needed. Family members, on the other hand, figured prominently, offering advice and assistance (whether wanted or unwanted). For these young women, in the process of assuming a new identity as mother, their decisions and behaviors were their best efforts to assert some independence and authority over their own lives. “Natural” childbirth epitomized that desire. Consumed by family involvement, intervention, and stress, some of the teen mothers were able to achieve their goals, while others described themselves as “fieaking out” or lashing out at those around them. Marta and Margarita, who went into labor and delivery without any expectations whatsoever, lacked family involvement altogether. This lack of familial support, coupled with very negative interactions with healthcare providers during labor 190 and delivery, left the two women feeling unprepared, disempowered, and silenced. Their stories further highlighted the role played by families—total non-involvement meant that they neither brew what to expect nor had anyone to turn to for advice. In sum, much of the experiences (both positive and negative) described by the women who gave birth naturally was shaped by their relationships with family members. Five (83%) of these women were Hispanic, and their stories illustrated the central role played by family members during labor and delivery. While Marta and Margarita were wholly uninformed and passive during childbirth, Carmen and Norma felt crowded and overwhelmed by family members and lashed out at them during labor and delivery. All of these women struggled with the central role played by Hispanic families in the lives of young women. Only Elisa drew heavily on the advice and support of female relatives during pregnancy and childbirth. Trusting her relatives’ prior experience and advise, she planned her own birth accordingly, was positively supported by them, and spoke about her experiences with agency and authority. The Plans Changed Six of the ten women in this study who planned to give birth naturally ended up receiving epidural anesthesia. Four of these women were White and two were Hispanic. Their reasons varied for why plans changed, as did their interpretations of their experiences. In particular, three women indicated that the pain was more than they could bear. Strongly supported by their mothers and/or other female relatives throughout the birth process, these women eventually asked for an epidural to help manage the pain, and they felt very positive about their decisions. The other three women in this section were 191 also overwhelmed by the pain. Labor was much more intense than they expected, and they ultimately accepted various forms of pain medication. All three of these women felt that the medications were stronger than they could handle; they therefore lost control over the birth process and were very disappointed by the outcome. Linda, who gave birth at age nineteen, recounted “horror stories” told to her by her sister, brother-in-law, and friends who already had babies. Although she was scared by these stories, she wanted to give birth naturally because she had heard that “the medication can affect the baby.” She attended Lamaze classes with her mother and chose a midwife as her care provider. She chose not to believe the stories of others, but to protect the health of her baby and focus on her own strength to “just deal with the pain.” When back labor: started to overwhelm her, however, she asked for “some pain medication.” After it started to wear off, she asked for an epidural, which “helped a lot.” “Finally, I could just lay there and watch TV and not feel nothing at all. I liked that.” Although Linda went against her original plan, she felt in control and was positive about the decisions she made. “In my head I was thinking I am just going to do it for as long as I could. And I did. I did it for as long as I could.” When it was time to deliver the baby, she was very aware of what she was feeling and still felt in control. A couple of minutes later [my midwife] comes up and is like “Pus ” and I was just “Okay.” So I was pushing and pushing, she said “Just wait for the contractions to push,” but I didn’t want to wait. I wanted her out of there. So forty minutes of pushing and she was out. My face while I was pushing, my eyes would be tingling, my cars would be ringing. I would just hold my breath for so long. I wouldn’t wait for the next contraction, I was getting light headed. I just wanted to get through the contractions. I wanted her out of there. Linda received a lot of support from both her midwife and her mother and was confident that she had done the best she could. Although she was disappointed that she ended up 192 getting an epidural and could not endure the pain any longer, she concluded that she had chosen the best option. Linda was one of the few women in my study who actively decided to take birthing classes in support of her goal for a natural childbirth. According to her, however, those classes “didn’t work.” When the “fast labor kicked in,” she was overwhehned and asked for help. Gabriella, who gave birth at age seventeen, told a similar story. Although she recounted negative stories she had heard from others, she dismissed those stories and chose to rely on the advice of her mother and aunts who encouraged her to give birth naturally. Gabriella believed that childbirth ‘firvas going to be simple” and that she was “ready for everything.” When she went into labor, however, she was “shocked.” “I started crying because my boyfiiend wasn’t there because we weren’t together at the time. And I was just thinking about a whole bunch of different things, like ‘what am I going to do?”’ During her pregrancy, Gabriella described herself as “emotions ” and “always depressed.” “During the whole time, I had problems with my boyfiiend because he would always cheat on me.... I was always crying throughout my whole pregnancy. I was stressing on everything.” Despite this stress, she was not anxious about giving birth. “I just wanted to hurry up and get it over and done with to see what it was actually like, because I didn’t think it was going to be bad.” Ultimately, the pain was geater than Gabriella expected and she asked for an epidural. She had little more to say about it then “it helped.” She conveyed an image of herself as browledgeable and in control. Maria was scared when she found out she was pregrant at age thirteen. Although she hid her pregrancy for six months, once the news was made public, she received a lot 193 of support and advice fiom her mother and godmother. As was true for Gabriella, this support enabled Maria to feel confident about her abilities to give birth naturally, despite the “horrible stories” told to her by her sister. During labor and delivery, her mother and godmother continued to offer their support and guidance. Although Maria did not take childbirth classes during her pregrancy, and had very negative experiences with her doctor during prenatal exams, this familial support enabled her to feel confident and prepared for labor and delivery. Maria experienced a number of difficulties during labor and delivery, and these problems were blamed on unhelpfirl nurses. Maria was gratefirl that her mother and godmother were there to intervene. Did you feel prepared for childbirth? Yeah... Because when I was having her, the nurses didn’t help. I couldn’t like breathe in, breathe out or anything. It was really hard for me. But my godmother, she’s like really tall. My mom and my godmother, they made me like sit up, and the nurses, they had me like laying down and I couldn’t do it. So they made me sit up and then I like pushed and would breathe in and then breathe out, and everything. And then that’s how it happened. Sitting up. Finally, “at the very last minute,” Maria ageed to an epidural because she “was shaking really bad.” She felt confident in her decision and her abilities to handle childbirth. While Linda, Gabriella, and Maria drew on the support of female relatives and felt positive about their decisions to get an epidural, three other women spoke more negatively about their interactions with medical staff, particularly concerns that medications had been administered incorrectly, causing them to lose control during labor and delivery. All three of these women were White and had plarmed to give birth naturally because they wanted to be strong and because they wanted to protect themselves and their babies from potentially harmful medications. The circumstances 194 varied geatly for why these women were unable to achieve their goals, but all of them ageed that the medications caused them to lose their focus and thus their agency to determine the outcomes of their own birth experiences. Brooke, who delivered her baby by “emergency c-section” at age sixteen, planned to give birth naturally, although she did not talk to her doctor about her plans. “No, I didn’t talk to the doctor about it. I think she maybe asked me about it one time. That’s just what I told people, like at the school, that I was going to have it that way.” Brooke’s decision was thus more influenced by a desire to appear strong than by any deeper understanding of what natural childbirth meant. Despite the stories Brooke heard about childbirth, she felt she brew “the facts” and did not expect to feel a lot of pain. As labor progessed, however, she changed her mind. “Then I was thinking, when I was dilated to like four, I was like ‘That’s it.’ I was in too much pain. I couldn’t do it.” So she made the decision to get an epidural. Brooke’s description of her experiences changed at that point. She felt she “passed out for like half the time,” and did not remember much of what happened to her. “All I remember is waking up and I was in so much pain. They were asking me if I wanted a c-section.” Brooke felt that the epidural had been administered incorrectly and was causing her to lose focus and to shake “uncontrollably.” When asked to sign a release form for the cesarean, she had difficulty doing so. “They drugged me up so much, I was just shaking from the drugs, to where like I wasn’t comprehending anything that was going on.” Brooke’s only reason for choosing a “natural” birth was to prove that she was strong. Rather than explore her own lack of preparedness, however, Brooke blamed the healthcare providers for her loss of control and for the outcomes of her birth. 195 Madison, who gave birth to twins at age nineteen, also noted that she did not expect the drugs to be so strong. She described herself as “hallucinating” during labor, and felt that she did not remember things very clearly. Haley, who gave birth at age seventeen, echoed similar complaints. She felt that after she was given Stadol, “the whole birth was kind of firzzy" and she lost control over herself and her experiences. Events escalated to the point that she was given Pitocin to help speed up the contractions, and then she was given an epidural to help manage the contractions. Rather than talk to her about her progess, Haley felt the nurses and doctors took over. And so they gave me the Pitocin and I don’t brow how long it was. I don’t brow how long I was pushing or anything. But she was in there face up, and they said they are usually face down. And so when I was finally dilated and everything, run, the doctor came in. But I don’t remember, you brow, them being “Okay, you’re dilated. You brow, “It’s time, we can start pushing.” In general, Haley felt that the doctor made the decisions for her. “He was kind of like, you brow, let’s get it over with.” Once the baby was born, the doctor cut the umbilical cord, despite the fact that they had discussed letting Haley’s boyfriend do it. “He didn’t give us a chance to say what we wanted to do. And I was upset.” Haley partly blamed herself for not sticking to her birth plan. I don’t think I really handled it that geat. I think I would have handled it a lot better if I never would have had the epidural. Of course, it would have been more painfirl and everything, but at least I would have been more in control, more, you brow, I would have been pushing better, been taking what everyone else was saying better. Because I don’t really know how long I was pushing, but I brow it was for a couple of hours. Once Haley ageed to the epidural, she relied on the nurses to tell her what to do. She could not feel the contractions as well, or feel when it was time to push. Although Haley thus assumed some of the blame, she felt the doctor ultimately disempowered her—he did not explain options to her and he did not listen to her. Haley’s mother 196 suggested that other actions could have been taken to avoid the epidural. Rather than talk with Haley about those options, the doctor walked into the room when it was time to deliver the baby and did everything himself. I really do not like him at all. He didn’t explain to me anything. He didn’t ask me what I wanted done. My mom told me that usually they can go in there and turn the baby. And that would have made it a lot easier for pushing. And she got mad because of the way he was handling things. I think I was just too out of it for me to really notice to that extent. Haley remembered the doctor saying that he was in a hurry and needed to be somewhere. “I was like, ‘Then why don’t you get someone else to come in that has the time.’ That just really upset me.” Haley did not make this comment directly to the doctor, but did think it and convey her feelings to her partner, Brian, in the days following the birth. Haley relied on Brian for many of the details of the birth. At the time, she felt “too out of it” to take any action. Haley was the most enthusiastic of all the mothers I met about the invitation to be interviewed. My initial conversation with her on the phone was very animated, and her mother also conveyed Haley’s enthusiasm to me when I sought her parental consent for Haley’s participation. Haley was very articulate about her desires for a natural birth. She took classes, talked with other parents, and read “everything” in preparation for her own birth experience. Her mother, sister, and boyfiiend were with her during labor and delivery, and were very supportive and encouraging. When the delivery began to deviate dramatically fiom her expectations, she was hurt and frustrated, primarily because of how she was treated by her doctor. My study gave Haley the opportunity to voice her pain, to convey her browledge, competence, and preparedness, and to challenge her treatment in the hospital. Of all the 197 women who participating in this study, she came closest to articulating the philosophies of the natural childbirth model. She also highlighted the ways in which her experiences were complicated by norms of age and parenting—norms that defined her as too young to be competent and responsible. “I brow people who are not prepared when they are your age and they have kids.” Comparing herself to me, Haley challenged the doctor for assuming he brew anything about her based on her age and denying her control. In sum, this goup of six women explored various circumstances surrounding their decisions to accept medical intervention. Although all of them originally planned a natural birth, their reasons varied, firrther influencing their experiences during labor and delivery and their interpretations of why their plans changed. For half of these women, labor and delivery proved to be more difficult than they expected, and epidurals offered them relief from the pain so that they could maintain control and still have a positive birth experience. For the other women, the epidural represented an important turning point in their stories. They described “hallucinating,” passing out, feeling “firzzy,” and “shaking uncontrollably.” Suggesting that “too much” had been given to them, they blamed their loss of control on healthcare providers who undermined their control and would not listen to them. They thus challenged the medical model of birth that deemed such interventions safe and effective. Two of these women who planned natural births and subsequently changed their minds were Hispanic. Both of these women were accompanied by female relatives throughout labor and delivery and drew on their support when making the decision to get an epidural. Despite the fact that Maria evaluated her birth negatively because of her poor treatment by healthcare providers, she felt positive about her decision. Again, the 198 support that Hispanic families provided young women during pregnancy and childbirth was a central factor in the evaluations that were made. The Epidural Four White women in this study (21%) actively made the decision early in their pregnancies to get an epidural—Kris and Erika followed the advice of fiiends who said that childbirth was painful and that epidurals were beneficial; Jill and Angela were pregrant with twins and were advised by their doctors that it would be their only option if they wanted to give birth vaginally. All four of these women fully embraced the medical model of childbirth, although they had very different interpretations regarding their experiences with labor and delivery. Three other White women received epidurals during childbirth, although they did not formulate birth plans and had no expectations for labor and delivery. Allison and Michelle went into labor prematurely and delivered by cesarean section, and Amber was pregrant with twins and had pursued the option of getting an abortion. This section explores the stories told by these seven women. Their stories differed in important ways from the stories told in the previous two sections. Although two women, Kris and Angela, told positive stories of birth, the other women told very negative stories about premature deliveries, medical malpractice, and/or mistreatment by healthcare providers. What makes these stories particularly different from the stories told above is the extent to which they felt healthcare providers discriminated against them during childbirth and the transition to parenting due to their young age and/or marital status. 199 Kris was sixteen when she gave birth to her son. Although she was told that childbirth was hard and that it was going to “hurt really bad,” she was positive about her own experiences. At first, I was scared. I just wanted to get it done and over with. And then during, it was neat, because I was actually giving birth. Just as soon as he came out and they laid him on top of me, it was just, I had the biggest smile on my face. I didn’t remember any of the pain at all. Kris was advised by several of her friends to get an epidural. She took their advice, got the epidural, and was happy with her experiences. She was strongly supported by her midwife, gandmother, and boyfiiend in making her decisions, and these relationships made all the difference for her. As a new parent, she continued to rely on their support, living with her gandmother and making plans to marry her boyfiiend. Erika, who gave birth at age nineteen, had the opposite experience. Long separated fi'om the father of her baby, and receiving only limited support from her mother, Erika lived alone and heard horrible stories of childbirth fiom her fiiends and neighbors. Although she chose a midwife to provide her prenatal care and deliver her baby, she planned a medically-managed delivery. She expected childbirth to be painful and traumatic, and her story confirmed it as such. From the beginning, Erika described her interactions with nurses at the hospital as confrontational. After being refused admittance three times because she was “not dilated enough,” Erika demanded that they admit here and begin administering pain medications. Her midwife was out of town, so another midwife was called in. Erika described this midwife as “pushy,”and she suggested that the midwife forced ideals of childbirth on her that she did not agee with—ideals that reflected a more natural approach to labor and delivery than Erika was prepared to deal with. 200 As labor progessed, Erika raised huge issues regarding the administration of the epidural—whether it had been done incorrectly, whether or not it had been done at all. Her interpretation of events changed as her story progressed and she struggled to find reasons for why her experiences were so negative. At first, she suggested the nurses were lying to her and questioned whether or not the epidural had been given to her. I never felt anything hour it. I mean I didn’t feel my contractions for about half an hour, then all of a sudden I was like, “what happened here?” They probably didn’t even give it to me....It was bad. It was really hard. It hurt really bad. They were like, “How can you tell, we just gave you an epidural?” I go “I can feel everything you are doing. It doesn’t even feel like I have any pain medication in my body.” Later in her story, Erika contradicted herself by acknowledging that she had been given an epidural, but suggested that it had been administered incorrectly, creating a hole in her spine and causing persistent back pain. I was also having back problems. My back was just killing. And it has been killing me since I had her. I can’t sit up straight. I can’t sit all the way up without it killing me. In the end, Erika sued her midwife for malpractice because she felt that she was allowed to hemorrhage to the point of ahnost dying. She wasn’t listening to me, she wasn’t listening to the nurses, she was listening to nothing. I hemorrhaged really bad with her. And she said that how much blood I was losing was normal. And it wasn’t. I had a different doctor come in, that was my other doctor, on Monday. She said, “This is ridiculous. [She] should have done something about this.” She didn’t put me on any kind of medicine or nothing. Erika went into the birth experience expecting it to be bad, and she had very negative interactions with healthcare providers. She challenged the authority of both nurses and midwives who provided care to her, and blamed them for her poor outcomes. In particular, she challenged the midwife because she suspected she was not following 201 standard medical procedures but instead was forcing Erika to follow natural, low- interventionist methods with which Erika did not agee. Michelle delivered her son two months prematurely. Born with cerebral palsy and a host of other health problems, the doctors gave him little hope for survival. Michelle felt very disempowered by their diagnosis. Basically my story about him is that the doctors, they should not tell you that this kid, this is just another story. This is just another case of this and that, we see it all the time, they’ll live maybe six months, maybe a year at the most. And do what you can for them, but take him home and let him die basically. Although the doctors gave her no hope for her son’s survival, Michelle relied on faith, her mother’s support, and her commitment to her son to keep him alive. Three years later, when I met Michelle, he had surpassed all expectations that the doctors could give, and continued to gow and interact in new ways. She concluded that her life had changed for the better because of her experience. “If I had had a normal child, I wouldn’t have learned all the things I have, and I wouldn’t be the person I am today.” She ageed to tell her story in the hope that doctors would listen and not be so quick to judge a child with disabilities. She also blamed herself for son’s health problems because she hid her pregnancy for six months and did not receive any prenatal care. Angela, Jill, and Amber all delivered twins. While their experiences varied widely, all three of these women struggled with healthcare providers to prove their competence and responsibility as parents. Although a medically-managed birth was assumed with twins, these women challenged the care they received and the ways in which doctors and nurses interacted with them during childbirth. Although Angela was positive about the outcome of her experiences, Jill and Amber were far more negative, and they concluded that doctors treated them “like kids,” 202 Jill, who delivered twins at age seventeen, accused her doctor of medical malpractice. She delivered by cesarean section and now believes that she will never be able to give birth vaginally. They told me if I got pregrant again, they would just cut me back open. Because there might be complications fi'om when they put everything back in. Cause they had to like move everything. So it wasn’t probably placed in the right spot. I wouldn’t have it natural. In general, the seven women discussed in this section experienced medically- managed births. Five of these women were considered “high-risk”—three delivered twins and two delivered their babies two months prematurely. The other two women, Kris and Erika, planned a medically-managed birth fi'om the beginning because they were advised to do so by fiiends with birth experience. Summm Regardless of their birth plans and outcomes, over two-thirds (n=13) of the teen mothers in this study spoke negatively about their birth experiences. Their reasons varied—fiom their own lack of preparedness and level of family involvement, to the type of care they received fiom healthcare providers. Although ten women desired to be strong and to give birth naturally, power struggles ensued as teen mothers interacted with family members and healthcare providers and endeavored to make their voices heard and remain in control. Many women held an innate trust in themselves to give birth, but they lacked information and experience, and they were often overwhelmed by the realities of giving birth. Many studies have looked at women’s varied experiences with childbirth, based on norms of gender, age, ethnicity, and social class (Fox and Worts 1999; Lazarus 1997; 203 Brown et al. 1994; Sargent and Stark 1989). These studies suggest that socially disadvantaged women accept medical interventions differently from White, middle-class women during childbirth. In particular, Lazarus (1997) suggests that poor and working- class women are much more interested in continuity of care than in making choices that would give them more control over the birth process. Similarly, Brown and her colleagues (1994:43) found that women who were young, without a partner, living on a low income, or had irnmigated fiom a non-English speaking country were the most dissatisfied with their care. Fox and Worts (1999:344) conclude that what is problematic about medical management is not that it offers too much “care” but that it substitutes for more general social support of women in labor and after the birth. My study supports these findings in a number of ways, identifying ethnic differences in the types of interventions used for women during delivery, as well as differing opinions fi'om the teen mothers themselves regarding the level of intervention and support they expected or sought. While clearly some teen mothers were more concerned about continuity of care than having control over the birth process, my findings suggest that many of them were primarily concerned about having the power to make their own decisions and be perceived as strong and in control. Many teen mothers received more medical interventions then they originally planned to receive, and others complained that they were “treated like kids” during postnatal exams with their children. Through their stories, these women challenged the ways in which master narratives of childbirth and parenting shape their relationships with healthcare providers. These narratives also shape their relationships with others, particularly family members and male partners. 204 Involvement of Male Partners One final issue raised in the birth stories of teen mothers concerned their interactions with male partners. Over half (53%) of the teen mothers I interviewed were accompanied by the father of the baby during labor and delivery, and one woman was accompanied by her new boyfiiend, who planned to assume the role of father. It was important to these women that their partners be present, but often the young fathers played very marginal roles, taking a backseat to other family members in the room. Three of the eleven women (27%) who were accompanied by their partners regarded them as ill-prepared to offer support. Thus stories were narrated with humor and a certain expectation that the young man’s incompetence was normal. In so doing, these women further emphasized their own competence and ability. Although they embraced master narratives of teen parenting, they actively differentiated themselves from “other” teen parents in an effort to prove their worth. Kris’s boyfriend was not the father of her baby, but she was proud of his comnritrnent to being a father and his efforts to be involved in the birth. She laughed as she recounted his efforts to help her during labor. My boyfiiend tried to help me breathe through my contractions. It was kind of funny how he was trying to help me. He’s like hoo-hoo-hoo. My midwife was like trying to help him, have him help me breath. She was trying to teach him, but he couldn’t quite get it down. Madison gave birth twins when she was nineteen years old. Her boyfiiend, John, was present during our interview, and together they talked to me about his role during labor and delivery. So how did you prepare yourself for labor? [John]: I didn’t do nothing. Did you know what you were supposed to do when you got there? [John]: Yeah. Kind of. I just went in there and acted like... I don’t brow. 205 [Madison]: When I had really bad contractions, the nurse was telling him how to coach me to breathe. He would keep messing up the rhythm. So I was trying to stay with the rhythm. His grandma was right there, she was all “John, John.” It was pretty funny. This was a common attitude among teen fathers, as described by their partners during our interviews. Occasionally the fathers attended prenatal visits with their partners—to hear the heartbeat, see the ultrasound, and occasionally ask questions—but generally they stood by silently as various women and healthcare providers in the room assumed control. Carmen, who gave birth at age nineteen, had been living with her boyfiiend, Tomas, when she got pregrant. Although Tomas attended some prenatal exams with her and was present for the birth of their daughter, he was described as a silent observer. “I remember when they said “Who wants to cut the umbilical cord?” And my mom did that. I guess later on my boyfiiend said he wanted to, but he didn’t speak up.” Carmen was not surprised by Tomas’s passivity in the delivery room. During prenatal exams, he was often uncomfortable with what the doctor was doing. Ultimately, he decided to stay in the waiting room. Did he go to any of the prenatal visits with you. Oh yeah. He went to one, but when she went up there with her hand, you know, her finger, he didn’t want to go again. He wanted to wait out in the waiting room after that. So after that, he waited in the waiting room. [laughing]. He was like, “No, don’t like that.” During childbirth, he displayed the same uneasiness, refusing to look when the baby was passing through the birth canal. I just kept pushing harder and harder so she would come out. And then my aunt’s like “Look I see hair.”‘ Well, she’s not even out yet, and she’s laughing, and my boyfiiend, my boyfiiend’s like, “I don’t want to see” [laughing]. 206 Throughout her narrative, Carmen laughed at her boyfriend’s behavior and general incompetence. “He didn’t brow nothing. He just sat there He was rubbing my head, like going like this, while I was screaming. Other than that, that was it.” She did not expect him to be more involved, and thus dismissed his interest in cutting the umbilical cord when the baby was born. Instead, Carmen’s mother and aunt were central figures during labor and delivery, playing an active and supportive role to Carmen and further marginalizing Tomas’s involvement. Tomas’s lack of involvement did not stop with childbirth, but extended into parenting as well, and Carmen was very negative about their relationship. Although she wanted to leave him, she felt bound to him because he was the father of her baby. I’m just trying to hold it together. I try all the time to make everything okay, but I brow it’s not okay. Actually I left him on Friday and I came back yesterday. I leave him all the time. And I just need to be strong enough to leave him for good. But I probably won’t. And it’s partly because of her. I just want him to be around her. And I don’t know. I just brow that everything would be, I don’t brow, I just think my life would be a lot better if I was by myself. Why? Because I wouldn’t be under a rrricroscope all the time. I swear he’s like “Who called?” and “What did you get in the mail?” “What’s in the mail?” And I’m like, “God, just shut up.” Three women (27%) felt that their partners were marginalized by other family members and/or by healthcare providers who do not recognized them as important actors in the childbirth process. Haley worked harder than most teen mothers in this study to prepare herself and her boyfiiend for childbirth. They had a birth plan with clear expectations for what they wanted to happen during labor and delivery. In particular, they discussed who would cut the umbilical cord before the baby was born. While Brian decided that he wanted to do it, the doctor denied them the opportunity. 207 I don’t know if it’s because I wanted him to, or if it’s because he actually changed his mind, but he did want to [cut the umbilical cord]. And so I wrote that down, and [the doctor] just did it. And you brow, he didn’t give us a chance to say what we wanted to do. And I was upset. Norma and George shared similar experiences, although family members figured much more prominently in their story. As discussed earlier, Norma felt most comfortable with George and preferred to have only him in the room. They were the only couple in this study to attend birthing classes together, and George planned to cut the umbilical cord after the baby was born. As it turned out, however, they were overwhelmed by family members and George was “pushed to the back comer by the bathroom, ten feet from the bed.” Norma lost control and was yelling at everyone in the room, but George felt powerless to intervene. Many of the teen mothers in this study had much more tenuous relationships with their partners than Norma, Haley, or Madison. Although their partners attended the births, and continued to live with them, they were described much more negatively, both during delivery and afterwards. In particular, their stories emphasized the pressures they felt to maintain relationships with the fathers of the babies——pressures from parents, friends, and themselves. Master narratives of parenting entered their stories in many ways as they struggled to prove themselves good parents by demonstrating their comnritrnent to provide two parents for their child. These pressures influenced how they talked about their experiences during childbirth and the transition to parenting. Jessica, who gave birth at age sixteen, had even more family members in the room during the birth of her baby than Carmen or Norma Although Jessica purposely got pregrant in order to escape her “dysfirnctional mom,” and her father left the family for some time after hearing that his daughter was pregnant, both of her parents were present 208 at the birth, as well as other extended family members and her boyfiiend, David. In narrating her experiences with childbirth, Jessica described her father as a central figure. My dad actually got to cut the umbilical cord. He was really happy about that. Did you talk about that before hand? Well, actually, my dad is really sensitive to me being in pain so he was really angy at the time. He pushed the father out of the way at the time, so he kinda sat in the corner. Although David was pushed to the back of room and not allowed to be an active participant during delivery, soon after the birth, he was invited to live with Jessica in her parents’ home and be a father to his son. Over the course of a year, he started abusing alcohol and battering Jessica. When he finally beat her in front of their son, she kicked him out of the house and ended the relationship. Finally when [our son] turned about a year and a couple of months old he actually witnessed it. That was one of the worst times it had ever happened. I think that has made a big impact on his life. After that, he moved out and he really hasn’t had much to do with us at all. Jessica was encouraged to have her son’s father in his life. She endured an abusive relationship in an effort to live up to that responsibility. One of Jessica’s biggest concerns now is trying to parent her son and help him with anger management issues, which she feels stem fiom their experiences with David. She enrolled her son in special anger management classes and works very carefully to control the environment in which he lives. Although she was in a new relationship when I met her, she was very guarded about making plans for the firture. She felt her new boyfiiend was a positive influence, but stressed that her son’s stability was her biggest priority. Allison told a similar story. Although she had been living with her boyfiiend, Jared, when she got pregnant at age eighteen, and he was the only one with her during the birth, she did not speak positively of his involvement or their relationship. He refused to 209 get up in the middle of the night to care for the baby, and he refused to go out and find a job to pay for the bills. Allison wanted the relationship to work because he was the father of her child. So when the baby was three months old, she found employment and left Jared in charge of babysitting. After several months, she discovered that he had physically abused the baby repeatedly. I came home from work one day and my son was lethargic. And everybody was just like “Oh, he’s better now. He’ll be okay.” Okay, well.... Who said that? Well, my mom was there and my boyfriend’s aunt, which is who we were living with. They were there. And I said, “Okay, fine.” He looked okay. He was doing better. The next couple of days he was doing better and then he just started to get sick. And he started to throw up and throw up a lot and he got dehydrated, and we took him to the hospital. And this was three days later. When I took him to the hospital, he had six broken ribs, a broken left shoulder bone, and two brain hemorrhages in his head. And his dad did it to him. And so he went to prison and my son went to a foster home and I got sent to classes. Allison was reunited with her son two years later, but was still under the watchful eye of Family and Child Services. She assumed full responsibility for what happened and spoke positively about the future. With a new husband and a new baby, Allison was intent on making her son feel secure and loved. All of the teen mothers were asked the question “Do you think you were treated any differently as a teen parent?” Although responses were quite varied, several women challenged stereotypes of them by emphasizing the fact that they were in steady relationships with the father of their child. For example, Madison justified her actions, and her ability to be a good parent, through her relationship with her boyfiiend. The twin’s gandma was a little bit mad at first when she found out that we were pregnant. She wanted us to wait, you know. It would have been better, but all right, it happened. But all in all, I think everybody was really excited. I do have a boyfriend that was involved and is still involved, I think everybody was really cool about it. 210 Haley and John responded very sirrrilarly to suggestions that they were too young to be good parents. Haley emphasized the value of having the involvement of two committed parents, regardless of age. I can’t say that we were as ready as we should be, but we were ready enough. You brow, she has both of her parents. We can feed her and clothe her. We spend all of our time with her. Although Kris was never in a relationship with the father of her baby, her new boyfiiend was very involved and fully supported by her family. They quickly accepted him as the father, even to the point of believing that the newborn looked like him. [I]t’s really hard for everyone to believe that he’s not the real father. Which is kind of hard for me to believe too, because he looks exactly like my boyfriend, exactly. And my boyfiiend and I had never done anything all through both of the times we went out before. We’ve never done anything. He looks exactly like him, the hair, the eyes, the skin, everything. And when he was a baby? We look at him and his pictures and then when he was a baby, his pictures, and they look exactly alike too, which is really weird. Kris spoke for some time about this resemblance and even pulled out pictures of her boyfriend to show to me after the interview was over. Having a father for her child was very important to her and obviously encouraged by her family. Again, master narratives of parenting were evident in the stories teen mothers told. The status of their relationships with men was scrutinized and central to their efforts to claim positive identities for themselves and prove themselves “good mothers.” Summary The women discussed in this chapter highlighted a number of factors that influenced their expectations regarding labor and delivery, as well as their interpretations of birth outcomes. Both healthcare providers, family members, and male partners figured 211 prominently in their stories. Rather than question their own preparedness or competence, many of the teen mothers criticized the care they received, and half of them argued that they felt crowded and stressed by so many family members in the room. Although many of them also discussed the importance of having their male partners involved, these men generally played a very passive role during labor and delivery, and were sometimes dismissed as incompetent. Important ethnic differences were apparent in their stories. While White women received more medical interventions and spoke more negatively about those interventions and their interactions with doctors and nurses, Hispanic women received more advice and assistance fi'om family members (both wanted and unwanted), and interpreted their experiences in terms of that involvement. My findings highlight the complex relationships shaping the ways in which teen mothers experienced childbirth, as well as the factors influencing how teen mothers interpreted their own behaviors and decisions. Struggling to present an image of themselves as good mothers, they explored unequal relationship of power and authority, their access to knowledge and decision-making, and their relationships with male partners. 212 CHAPTER SEVEN CONCLUSIONS In this dissertation, I have explored the birth stories told to me by teen mothers, focusing on their own perceptions of pregrancy and childbirth, and how their experiences were shaped by larger social, medical, and political discourses of teen childbearing in the United States. By focusing on the voices of teen mothers themselves, I endeavored to understand their relationships with parents, peers, partners, healthcare providers, caseworkers, and others during pregnancy, childbirth, and the transition to parenting. I also considered the ways in which these relationships reflected master narratives of childbirth and parenting and influenced teen mothers’ interpretations of their own experiences based on norms of gender, age, and race/ethnicity. In this final chapter, I summarize the theoretical and methodological approaches used in my study, key findings, theoretical contributions, and policy implications. Overview of the Study The conceptual framework for this study drew on an actor-oriented approach and concepts of agency, identity, power, and social control. Teen mothers were not simply seen as disembodied social categories——based on age, gender, race/ethnicity, or social class—but as active participants who process information and strategize in their dealings with other actors and outside institutions. As such, I explored agency and power in two ways: as teen mothers actively participated in the construction of their own social worlds, simultaneously accommodating dominant stereotypes of teen mothers as irresponsible and immature and struggling to prove their own responsibility and 213 competence; and as teen mothers engaged me, as researcher, in the re-construction of their identities as “good mothers.” My research was carried out in Green County, Oregon, from May—December 2001. I conducted thirty face-to-face interviews, including nineteen teen mothers, two teen fathers, four parents of teen mothers, three healthcare providers, and two social service providers. All of the teen mothers were contacted anonymously through Teen Parenting Services (TPS) of Green County, and represented just over ten percent of the total population of teen mothers seeking services at TPS during 2001. Two-thirds (n=12) of the women were White, and one-third (n=7) were Hispanic; on average, they gave birth when they were seventeen years old; and all nineteen women were low-income. Story-telling provided the basic methodology for the study. I approached stories from three points of view: as social interactions between producers, coaxers, and consumers with varying degees of power; as social processes of accommodation and resistance to master narratives; and as a means of identity formation. Using stories in this way enabled me to explore relationships of power and social control as they influenced teen mothers’ experiences with childbirth and how they articulated those experiences to me. It also enabled me to explore my own role in the story-telling process as I interacted with participants and represented an avenue for their voices to be heard. My study drew on Davis-Floyd’s (1992) definition of childbirth, approaching childbirth as a year-long rite of passage. The stories I collected spanned women’s experiences fiom sex and pregrancy to childbirth and the transition to parenting. I began each interview with the same statement: “I am interviewing teen parents about their experiences with pregrancy and childbirth—I would like you to tell me your story now, 214 beginning wherever you want.” Depending on what teen mothers covered in their narratives, I probed for further information regarding pregrancy and childbirth by following a series of open-ended questions. The most common questions I pursued focused on women’s relationships during pregrancy and childbirth, their preparations for childbirth, and the birth stories they had heard fiom others. As interviews were conducted and transcribed, I employed the methodology of gounded theory to analyze data and shape the direction of subsequent interviews. Discussion of Findings Chapters Four through Six presented the findings of my study as they related to three major stages of childbirth: pregrancy, preparations for childbirth, and birth and the transition to parenting. Throughout my analysis, an actor-oriented approach highlighted relationships of power and social control as well as teen mothers’ own agency in engaging master narratives and constructing positive identities of themselves as “good mothers.” My findings explore the ways in which teen mothers both accommodated and resisted negative stereotypes of teen mothers in an effort to prove their own competence and responsibility. Their stories revealed important differences of race/ethnicity as teen mothers described relationships shaping the choices they made regarding sex, birth control, pregnancy, prenatal care, birth plans, labor and delivery, and parenting. Pregpancv: “It’s My Resmnsibilitjfi’ Teen mothers’ stories regarding sex, birth control, and pregrancy emphasized themes of responsibility. They explored relationships of power and social control that 215 shaped their own conceptualizations of agency and intentionality. Confronting stignas of teen mothers as immoral and irresponsible, they argued that lack of information, misconceptions about birth control, and/or limited access to necessary services led to unintended pregrancies for the majority (89%) of them. Important ethnic differences emerged in the level of intentionality or blame they assumed, as they described a variety of relationships and circumstances leading to their unintended pregrancies. In general, White women were much more agentic than Hispanic women in their explanations for unintended pregrancies. Hispanic women were less likely to use birth control than White women, and they were also less likely to offer explanations for their nonuse. While two-thirds of the White mothers (67%) reported that they never used birth control, the majority of Hispanic mothers (86%) reported the same. All but one White woman (91%) offered explanations for their nonuse, including the changing nature of their relationships with partners, health issues, and the extent to which unprotected sex in the past led them to believe that they would not get pregrant. In their view, these reasons proved their responsibility and competence. Only one Hispanic woman (14%) talked about the reason for her failure to use birth control, which was based more on the fear of her parents discovering the truth than on her own determination that birth control was not necessary. The majority of Hispanic women (71%) were silent about their feelings regarding birth control use or nonuse. When probed, they typically responded, “We just didn’t think about it,” or “I don’t brow.” The reticence I observed among Hispanic women was influenced by several factors: the value placed on virginity in the Hispanic community, which makes sex and birth control taboo subjects, and thus embarrassing to talk about; the machismo culture 216 that constricts young women’s voices; and the age and cultural differences between the participants and myself, which may have heightened their discomfort with talking to me. Although these same women were quite animated in their discussions regarding childbirth and parenting, they were more embarrassed by intimate topics than the White women I interviewed. Many of the studies I reviewed on teen sexuality and pregrancy in Chapter Two (Fine 1988; Holland et al. 1994, 1992b; Stevens-Simon and Kaplan 1998; Tolman 1994, 1991) offer insights into the findings and observations noted above. In particular, research on Hispanic women (F ennelly 1993) highlights the ways in which norms of gender and age intersect with race/etlmicity to disempower women. Katherine Fennelly (1993) found that, while Hispanic communities oppose premarital sex and value girls’ virginity, those beliefs do not deter girls fiom engaging in sex when pressured by partners to prove their love and/or femininity (i.e., ability to bear children). Although young Hispanic women may be deterred from talking about their desires and experiences, or seeking access to necessary information and services, their actions highlight the complicated nature of balancing dominant norms of female virginity and male virility. Whatever the circumstances surrounding their pregnancies, once the young women in this study confirmed that they were pregrant, they struggled to present an identity of themselves as competent and responsible and, in so doing, engaged master narratives of parenting that defined them as immoral and incompetent. Over two-thirds (68%) of the women I interviewed readily acbrowledged their pregrancies and took tests within the first few weeks to confirm that they were pregnant. Their narratives and experiences did not vary significantly by race/ethnicity. Through the stories they told to 217 me, these young women struggled to deflect blame and construct positive identities of themselves as good parents. Although often afraid to share the news with parents and other relatives, they spoke with confidence and resilience regarding their decision to go through with the pregrancy. Their unwavering decision to raise a baby on their own was offered as further proof of their responsibility and moral comnritrnent to parenting. Prgparations for Childbirth: “It’s Common Sense” Preparations for childbirth reflected similar themes of responsibility and competence as teen mothers described their birth plans and the various sources of information on which they drew in preparation for labor and delivery. In general, the women did not volunteer this information to me, although they were willing to talk about it when probed further. Rather, their stories focused on circumstances surrounding their pregnancies and/or on how others interacted with them as parents. To that end, dominant discourses on teen childbearing were evident in their narratives, emphasizing the causes and consequences of teen childbearing rather than their actual experiences with childbirth. They were clearly prepared to provide rationales for why they got pregrant, or for why they believed they were “good mothers.” They were less forthcoming, until asked by me, about their personal expectations and plans for labor and delivery, or how they prepared themselves to have the birth experience they wanted. Only two White women in this study (11%) offered such information in their initial birth stories. At least two possible explanations are evident for why the teen mothers I interviewed volunteered little information on their expectations and preparations for childbirth. On the one hand, I was generally the first person to invite them to tell their 218 birth stories. Only one woman in my study indicated that she had been invited to share her story with a class of high school students. On the other hand, confronting the stigma of themselves as incompetent and ill-prepared, they relied on their own strength and “common sense” to get through childbirth, rather than the advice of healthcare providers, childbirth educators, or others. As such, they chose to believe that they would “just brow what to do when the time came” rather than admit their lack of knowledge by seeking outside assistance and advice. When probed by me, the women in this study did talk about a number of issues regarding their preparations for childbirth that highlighted relationships of power and social control as well as differences of race/ethnicity. In general, Hispanic women were more likely to plan natural births than White women (71% and 42%, respectively), and to draw on the experiences and support of female relatives in preparation for childbirth. White women focused more heavily on their own browledge and experiences, gleaning some information fiom magazines, videos, and birthing or parenting classes. Teen mothers’ narratives of childbirth implied powerful conceptualizations of the “other” (see Parpart 1993; Torres 1991; Young 1990) as they explored their own identities in relation to those around them, particularly “other teenagers” and “other mothers,” both teenage and adult. Struggling to prove their own competence and preparedness, the teen mothers in this study challenged much of the information and advice offered them regarding preparations for childbirth. Of the eight women who took formal classes, five (63%) questioned the relevance of the information they received and/or concluded that the classes “didn’t work.” Of the fourteen women who formulated birth plans, only four (29%) discussed such plans with their healthcare providers. 219 My findings support Higginson’s (1998) thesis of “competitive parenting,” which suggests that, in an effort to prove their knowledge of parenting, teen mothers reject the advice of others, including parents and healthcare providers. Higginson (1998:142) found that, “In selectively accepting advice, the teen mothers demonstrated that, despite their age, no one could know better than they how to best raise their children.” Directly challenging master narratives of parenting, and related norms of age, marital status, and economic status (see Luker 1996), the teen mothers I interviewed struggled to prove that age was not a determining factor in their ability to be good parents. My findings further suggest that the choices teen mothers make prior to giving birth are influenced by race/ethnicity. While all of the women I interviewed consistently challenged and/or rejected information offered by healthcare providers, educators, and peers, Hispanic women typically relied on the knowledge and experiences of female relatives to prepare for and get through the natural childbirth experience. In particular, mothers, aunts, and gandmothers were revered for their birthing experiences, and those who could rely on their relatives had more positive expectations for their own births. Birth and Parenting: “Ream Stories Is_n’t Enougm Narratives of teen mothers’ birth experiences further explored themes of power and social control as they reflected on their relationships with healthcare providers and family members during labor and delivery. Although the majority (74%) of women I interviewed formulated birth plans prior to giving birth, and had positive expectations for labor and delivery, thirteen women (68%) expressed feelings of anger, disappointment, and/or confusion regarding birth outcomes. Interactions with healthcare providers and 220 family members were cited as primary reasons for their negative experiences, leading to feelings of disempowerment and/or medical nristreatrnent. Despite their limited efforts to prepare themselves for childbirth, only four women (31%) blamed their negative birth outcomes on their own lack of browledge and preparedness. Although half (53%) of the women I interviewed planned to give birth “naturally,” only one Hispanic woman (5%) gave birth without medical intervention. Five other women (26%) described their birth experiences as “natural,” although they received injections of either Pitocin or Stadol to help manage their contractions during labor and delivery. The majority of women (68%) received an epidural, including those who delivered vaginally (n=8) and those who delivered by cesarean section (n=5). These birth outcomes varied by race/ethnicity. While five of the six women (83%) who gave birth “naturally” were Hispanic, eleven of the thirteen women (85%) who received an epidural were White. My findings support research with adult women that concludes that birth outcomes are shaped by race/ethnicity (Boone 1988; Lazarus 1997). Although more Hispanic women in my study planned a natural childbirth than White women (71% and 42%, respectively), the percentage of Hispanic women who actually experienced a natural birth far outweighed that of White women (71% and 8%, respectively). In general, White women received more medical intervention than Hispanic women. But dissatisfaction with the birth experience was shared equally by both goups, suggesting that multiple factors influenced their evaluation of the birth experience. Although the teen mothers I interviewed evaluated their birth outcomes in a number of ways, the majority (69%) were critical of the information and/or care they 221 received, and they expressed these concerns in the context of norms of age and parenting. In particular, the women felt ignored and/or disempowered by healthcare workers who assumed control and refused to listen to their needs. Two White mothers suggested that they were treated “like kids,” and would have been treated better if they had been older or married. Both White and Hispanic mothers felt that doctors silenced them and/or gave them inaccurate information about the status of their pregnancies, the progession of labor and delivery, and/or the health of their babies. Conversely, of the six women (32%) who evaluated their birth experiences positively, four (2 White and 2 Hispanic) indicated that their mothers were their primary support. These adult women attended birthing classes with their daughters, shared about their own pregrancy and childbirth experiences, and assisted their daughters throughout labor and delivery. Family members, however, were not always supportive or welcomed. Three women (16%) indicated that they were “overwhelmed” by the number of family members in the room who assumed too much control or argued with one another about the father of the baby. Two other Hispanic women largely attributed their negative birth outcomes on the fact that their mothers were not present during labor and delivery. Lacking familial support, they did not understand what was happening, and lacked the power to question the authoritative browledge of healthcare providers. In general, norms of age and parenting shaped the ways in which teen mothers interacted with healthcare providers and family members during labor and delivery. The more that adults subscribed to the dominant view that teen parents are irresponsible or ill- prepared, the more negatively teen mothers evaluated their birth experiences. The value placed on motherhood in the Hispanic culture cushioned many of the women who drew 222 on the advice, experience, and strength of their female relatives; those who lacked such support described more negative birth outcomes. While White women also drew on the support of female relatives, their relationships with healthcare providers more directly shaped their evaluations of birth outcomes. Ultimately, they attempted to assert agency by rejecting medical advice and/or interventions. This strategy enabled teen mothers to highlight their own experiences, strength, and decision-making power, but left many of them unprepared and overwhelmed during labor and delivery. Generalizability A number of factors influence the extent to which the findings of this study can be generalized to a larger population of teen parents in Oregon, or in the United States more generally. In this section, I discuss the strengths and limitations of the sample size and selection process as well as my own role as researcher in the story-telling process. Sample Size and Selection The findings of this study were largely based on interviews with nineteen teen mothers who were enrolled in Teen Parenting Services (TPS) of Green County, Oregon, in 2001. These women represented roughly ten percent of the TPS caseload, and four percent of the entire population of teen mothers in Green County. The sample was not randomly selected, but was comprised of those who chose to respond to my letter of invitation which was mailed to the entire TPS caseload in June 2001. As such, the sample used in this study represents only those teen mothers who sought services through TPS at that time and who took the initiative to volunteer for an interview. 223 Although my sample was diverse, reflecting both local and national averages for age and ethnic backgound of teen mothers, a number of factors limit the generalizability of findings to larger populations of teen mothers in Oregon or in the United States as a whole. In particular, all of the participants in this study were low-income; all of them delivered their babies in hospitals; all but one were fluent in English; and all of them took the initiative to contact me for an interview. I only interviewed two teen fathers, and I did not interview teen mothers who shared more diverse class backgounds, who experienced an abortion or adoption, or who were educated in methods of childbirth outside the hospital setting. Future research could build on the findings of this study by targeting more diverse goups of teen mothers, including those who come from middle- and upper-class backgounds; those who planned and experienced homebirths; those who participated in a range of childbirth classes; and those who chose to either abort or give their babies up for adoption. Such studies would further explore how social class intersects with gender, age, and race/ethnicity, and thus highlight the extent to which the findings of my study were a product of their low social class versus other variables. Moreover, longitudinal studies could tap into valuable insights and feedback fi‘om the teen mothers themselves, thus highlighting the ways in which my role as researcher shaped the story-telling process. I interviewed teen mothers at one point in time——I gathered their stories, interpreted and organized the concepts, and presented the findings fiom my own perspective. Further insights would be gained if teen mothers were interviewed more than once and allowed to respond to the findings in different venues (i.e., during follow-up personal interviews or in focus goup discussions). These 224 strategies would raise a number of interesting questions: Do teen mothers identify different themes and concepts in the birth stories that are told? Would the “story” evolve and change with subsequent interviews and opportunities for reflection? A more random sample of teen mothers would also address the issue of motivation, including those motivated to tell their birth stories as well as those interested in leaving painful experiences in the past. The women who volunteered to be interviewed by me shared an agenda—to prove their responsibility and self-worth as parents. I presented them with an opportunity to make their voices heard. As such, their stories focused on presenting an identity of themselves as “good mothers.” Those with more painful stories did not volunteer to meet with me. It remains unclear how their experiences would engage the birth story told in this study. Finally, comparative studies would firrther hi glrli ght intersecting norms of gender, age, race/ethnicity, and social class as they shape the story-telling process, including studies with teen fathers, adult mothers and fathers, and/or teens who chose abortion or adoption rather than parenting. Do teen fathers focus on similar themes of responsibility and experience in telling their stories of childbirth? Do adult mothers and fathers offer more information on their preparations for childbirth or bodily experiences with labor and delivery? Do their experiences overlap with those of teen parents who share similar identities of race/ethnicity or social class? My Role as Researcher My own role in the story-telling process further shaped the data collected in this study and the generalizability of findings. Although I remained fairly quiet during the 225 interview process and encouraged women to tell their stories fiom their own point of view, I played a central role as “coaxer.” As such, the stories told in this study were a product of multiple voices—including teen mothers, male partners, parents, healthcare providers, peers, caseworkers, neighbors, teachers, and me—and the various assumptions, stereotypes, and experiences we each brought to the table. They were but one version of the true story; a different researcher would likely tell a different story of childbirth and have different interactions with the same goup of participants. In general, teen mothers told me stories that focused on how they were publicly received and/or treated as mothers. They typically began with the day they learned they were pregnant and explored how people responded to them and the decisions they made. Then they jumped to experiences with labor and delivery, and how they were treated by healthcare providers and others who were present in the room when the baby was born. Their stories ended with lengthy discussions of their parenting experiences, particularly their treatment by healthcare providers, parents, partners, and the general public. Throughout their stories, teen mothers endeavored to prove their own experience and competence and to challenge public stereotypes of them as ill-prepared to be “good mothers” (for example, see the birth stories included in Appendices G and H.) The story that this dissertation tells starts with those stories as its foundation, but my questions and underlying objectives expanded the story in particular directions. As such, the story is ultimately told by me. I asked teen mothers to elaborate on a number of issues—why they got pregnant, whether or not they used birth control, if they considered alternatives such as adoption or abortion, how they prepared themselves for labor and delivery, what role their partners played in the birth process, and who was present in the 226 room when the baby was born. Their responses to these questions reflected the ways in which they engaged master narratives of childbirth and parenting, as well as norms of gender, age, and race/ethnicity. While I asked questions that reflected dominant stereotypes of teen mothers as irresponsible and/or ill-prepared, they confionted those discourses by consistently struggling to prove their own strength and ability as parents. As the researcher, I possessed more power than the teen mothers I interviewed, and the stories they told to me were shaped by that relationship. I was more educated, I had a wealth of browledge regarding the philosophies of natural childbirth, and my identity as mother was not publicly criticized or challenged. For many of the teen mothers in this study, however, I was the first adult who asked them to tell their stories. These young women embraced the opportunity and used it to make their voices heard. As such, they were not powerless in the story-telling process——they shaped the direction of the story in important ways and had an agenda in mind for the particular kind of story they wanted to tell. They told painful stories of abuse and neglect, mistrust, and misunderstanding. Continually challenged by healthcare providers, parents, caseworkers, and others, they emphasized their own strengths and comrrritrnents and endeavored to be the best parents they could be. Because I was either pregrant or accompanied by a newborn during all of my interviews with teen mothers, my identity as a new mother set the stage for my interactions with them. I was not a caseworker asking them to justify their actions, and I was not a parent reprimanding them for their behavior. One mother to another, we talked about our children and I asked them to tell their stories to me. They believed that I not only understood their stories but had the voice to make their stories heard. Based on my 227 own experiences with pregrancy and childbirth, I guided their stories and probed for information that I was interested in pursuing. During our brief encounter, they shared pictures of their children, criticized their case workers and meddlesome relatives, and offered advice to me about the best places to shop for toys and other supplies. Ultimately, this dissertation seeks a balance between their voices and my own. While I endeavored to tell their stories as they were told to me, my interpretations were shaped by my own assumptions, browledge, and experiences. Not only was I a new mother myself, but I went into this project well educated in theories of female sexuality, empowerment, and childbirth. As a proponent of natural childbirth, I looked for ways in which childbirth influenced young women’s knowledge of the body and provided them with opportunities for empowerment and embodiment. I was not expecting their stories to engage master narratives of parenting so strongly, or for parenting to overshadow their experiences with sexuality, the body, and childbirth. Theoretical Implications This study was based on an actor-oriented approach, using theories of agency and power to explore the ways in which teen mothers talked about their experiences with pregrancy, preparations for childbirth, and birth and the transition to parenting. A number of theoretical implications are raised in the findings of this study, particularly regarding the ways in which teen mothers engaged master narratives of childbirth and parenting in an effort to assert their own agency and identity as “good mothers.” As the birth stories unfolded, agency was articulated as multiple and relational, involving a range of actors and voices in the story-telling process. 228 Seeking to prove their competence, responsibility, and agency, many of the women I interviewed embraced ideals of natural childbirth without understanding its philosophical underpinnings related to the power and browledge of the female body and sexuality. They rejected information and advice fi'om healthcare providers and educators in an effort to emphasize their own experience, strength, and common sense. Finally, they pointed to the incompetence of “other teen parents” in order to prove their own responsibility and commitment to parenting. In so doing, teen mothers engaged in a complex dance of accommodation and resistance to stereotypes which simultaneously defined and constricted their own agency and power. Ultimately, the birth stories told by teen mothers in this study expose the complicated nature of agency and social change by highlighting the power relationships and multiplicity of agency. Agency involves both accommodation and resistance to norms, and, as such, it is relational—it is not about one individual, and cannot be expressed out of context of relationships with others. The stories told in this study expose the multiple voices involved in the story telling process, and thus the relational nature of agency. Even when someone seems to comply with master narratives or norms, she may be achieving her goals. Her agency is at once constrained and empowered as she struggles to shape her identity in relation to others. The findings of this study illustrate the multiplicity of agency on two gounds—as teen mothers engaged master narratives of childbirth and master narratives of parenting. Although they struggled to present an image of themselves as “good mothers,” the stories women told highlighted their lack of browledge, information, and agency and the extent to which their agency was contingent on norms and experiences of others. 229 Master Narratives of Chilm In Chapter Two of this dissertation, I highlighted how conceptualizations of the female body in the United States shape relationships of power, agency, and social control, and ultimately result in the disempowerment of women during childbirth. I also explored research related to the larger medical, social, and political contexts in which teen mothers tell their birth stories—including the medicalization of childbirth, the disembodiment of female sexuality, and the “moral crisis” of teen parenting in the United States. My literature review highlighted important gaps related to teen childbearing, and the extent to which agency, identity, power, and social control shape the choices that teen mothers make during labor and delivery. In particular, a number of questions were raised: if teen women lack the language and power to express their own sexuality and desires, are they further silenced and disempowered during childbirth? To what extent do teen mothers experience childbirth as disembodied, and thus lack the ability or desire to maintain control over the birth process? Ifteen mothers seek control during labor and delivery, what does this contribute to the research on childbirth? These questions highlight important intersections between agency, power, and social control as teen mothers engage ideologies of female sexuality and childbirth in their relationships with healthcare providers, parents, partners, and peers. The findings of my study suggest that, in their attempt to assert an identity of themselves as responsible and competent, teen mothers accommodated many norms and stereotypes that ultimately served to firrther disempower them during pregnancy and childbirth. Although half of the women embraced the natural childbirth model, they rarely articulated the philosophical underpinnings of natural childbirth. For these teen mothers, 230 giving birth “naturally” was about proving to others (parents, healthcare providers, partners, peers) that they were strong and competent. In choosing natural childbirth as a symbol of their maturity and responsibility, they resisted formal sources of information and advice (such as healthcare providers and childbirth classes), rejected the epidural as dangerous, and relied on their own common sense and past childcare experience to get them through labor and delivery. They did not challenge norms of female sexuality reinforcing their silence and passivity, but trusted that they would “just know what to do when they time came.” As such, many of the teen mothers in this study set themselves up for difficult births. They described themselves as “freaking out” during labor and delivery, fighting with parents and/or healthcare workers, or feeling out of control. Although their plans for natural childbirth performed an important function—communicating to others that they were strong and competent—those ideals also prevented them fiom seeking advice from others and sufficiently preparing themselves for labor and delivery. In the end, most of the women in this study evaluated their birth experiences negatively, and their stories confirmed the stereotype that teen mothers are immature and ill-prepared for childbirth. Master Narratives of Pgrentifl Throughout the stories told in this study, teen mothers engaged master narratives of parenting on many levels. In the United States, these narratives draw on norms of age, education, and social class to define teen mothers as irresponsible and incompetent. They thus shape the relationships that teen mothers have with healthcare providers, parents, caseworkers, and others who interact with them during pregrancy and childbirth. 231 The primary reason that teen mothers gave for volunteering to tell their stories to me was to confront master narratives of parenting and construct an identity of themselves as “good mothers.” In so doing, they simultaneously confionted and confirmed negative stereotypes by comparing themselves to others who they deemed stereotypically irresponsible or incompetent. They acted with agency and power as they described their experiences, relationships, and the choices they made during pregnancy, childbirth, and the transition to parenting. The price of doing so, however, was the accommodation of negative stignas and stereotypes, and limited browledge regarding the actual childbirth experience. The majority of women told me stories of teen parents who were irresponsible— they had access to birth control, but laziness prevented them fiom using it; they repeatedly left their babies with their parents so that they could “go partying”; they dropped out of school; and they were no longer involved with the father of the baby. By telling these stories to me, the women sought to demonstrate their own competence and ability as parents. They recognized and confirmed norms of parenting that challenged their identity as “good mothers,” but they also struggled to prove the ways in which they were different and better than other parents. Parenting skills were further demonstrated through their description of male partners who were often described as incompetent during labor and delivery. Just over half(58%) of both Hispanic and White mothers were attended by their partners during childbirth. While it was important that they be present, often the young fathers played only marginal roles and the women laughed at their discomfort and incompetence. In so doing, the young women accomplished an important goal: by accommodating master 232 narratives of teen parents as incompetent, they compared themselves to their partners and emphasized their own strengths and abilities. In general, master narratives of parenting were infused throughout their discussions of pregnancy, childbirth, and the transition to parenting. Stignas and stereotypes limited their relationships with others by constricting the types of information and advice they would accept, and by consistently focusing their efforts on identity construction and maintenance. They accepted responsibility for the pregnancy, sought prenatal care, struggled to keep their partners involved, prepared themselves for labor and delivery, stayed home with the baby rather than “go partying” with friends, and stayed in school. As such, they defended their identity as “good mothers” and rejected public stignas and relationships that limited their ability to act responsibly. Policy Implications In conclusion, the findings of this study highlight a number of policy implications related to education, parenting norms, and the provision of healthcare. Although many of the teen mothers I interviewed talked with agency and responsibility regarding their childbirth and parenting experiences, they lacked important information about sexuality and birth control and were unprepared for what to expect during labor and delivery. As such, the majority of women (89%) experienced unintended pregnancies, either because they lacked access to birth control or because they convinced themselves that they could not get pre grant. Subsequently, the majority of them (68%) were unprepared for what to expect during labor and delivery, and they negatively evaluated their experiences and interactions with healthcare providers. 233 High schools in Green County present their students with abstinence-based curriculum in an effort to promote pregrancy prevention. Teachers distribute “Think it Over Baby” dolls to students to demonstrate the difficulties of caring for infants. Several of the women I interviewed indicated that these scare tactics did not work, and that more information was needed regarding safe sex and birth control. Likewise, a number of childbirth and parenting classes are offered in Green County, yet the majority of teen mothers in my study rejected those classes as a “waste of time.” Rather than talk to their healthcare providers in preparation for labor and delivery, these women relied on the birth stories of others, “faith,” or “common sense” to get them through childbirth. Although half of the women I interviewed planned to give birth naturally, they were unprepared and lashed out at healthcare providers. As Madison concluded, “reading stories isn’t enough.” They needed other educational resources to prepare themselves for labor and delivery so that they could remain in control. Further education is needed to increase teens understanding and awareness of issues related to the body, sexuality, pregnancy, and childbirth. Sensitivity to cultural diversity is essential, as White and Hispanic teen mothers relate to sexuality differently. Ultimately, teen women need to be firrther empowered to make informed choices about their bodies, have geater access to birth control, and choose fiom a range of options for learning about pregrancy and childbirth. Currently, teen mothers experience pregnancy and childbirth as ill-informed and disempowered individuals. Norms and stereotypes shaping parenting also need to be re-evaluated. Many of the teen mothers who participated in this study reflected a common theme in their stories—despite the circumstances surrounding their pregnancies, they struggled to prove 234 themselves “good mothers” by emphasizing their experience, competence, and responsibility. They compared themselves to “other” parents, who they described as “dysfirnctional” and neglectfirl, and they pointed out the ways in which they differed from both teenage and adult parents. Through their narratives, they suggested that parenting was not a factor of age alone and that they were better parents than many of the parents they saw around them. Ultimately, their stories ask us to re-evaluate how children are parented in this country, regardless of age, race/ethnicity, or social class. Norms of parenting also directly impact teen mothers’ experiences with childbirth. In particular, their narratives suggest that the belief that teen mothers do not make “good parents” shapes poor birth outcomes for many young women. Ethnic differences were apparent in the stories told by the women I interviewed. Hispanic women tended to place more value on family advice and support; those who received positive family support reported more positive birth experiences. In contrast, White women relied on personal strength and experience, rejecting much of the advice and technological intervention available to them by healthcare providers. Together, the findings of this study offer two implications for the provision of healthcare: first, healthcare provided to Hispanic women during pregrancy and childbirth must emphasize better ways to include female relatives and facilitate communication between them and the teen mothers; second, healthcare providers need to be more sensitive to the needs of teen mothers who are confionted with negative expectations of their parenting skills, lack necessary information about the body, and resist asking questions or seeking support. 235 APPENDIX A LETTER OF INTRODUCTION TO TEEN PARENTS Dear Parent: I am a sociology student at Michigan State University and am currently doing a study with teen parents in Oregon. This letter is a request for your voluntary participation in my study. The study is entitled "Telling Birth Stories of Teen Mothers and Fathers: Discourses of Age, Ethnicity, and Power.” I am interested in your birth story to understand more about how teens experience pregnancy, childbirth, and becoming a new parent. I will ask you questions about prenatal care, kinds of support received during pregrancy and childbirth, birth choices, and how you felt about yourself and the birth of your baby. As a participant in this study, you will be asked to meet with me for about 1-2 hours. The day, time, and place will be arranged by phone. To assist us further, you have the option of having a Spanish translator attend the interview. Ifyou are under 18, we will also need sigred consent from a parent or guardian before arranging the interview. I will tape- record your story and our conversation. At any time during or after the interview, you may choose to end your participation and not have any part of your story included in my study. You may also choose to not answer certain questions. At all times, your privacy will be protected to the maximum extent allowable by law. I am doing this study for my Ph.D. at Michigan State University and will be presenting my findings there. As a permanent resident of Oregon, I will also use this research to help organizations understand the experiences and needs of teen parents in Oregon. By participating in this study, you will be helping such organizations to meet the needs of others like yourself. You will receive a $10 gift to thank you for your time. I would also be happy to share the results of this study with you once preliminary findings have been prepared. If you have any questions or concerns about this study and/or would be willing to participate, please write your name and phone number on the enclosed postcard and drop it in the mail. When I receive the postcard, I will call you to answer any questions you may have and/or to arrange a time to meet. Thank you for your consideration. Sincerely, Suzanne M. Broetje 236 LETTER OF INTRODUCTION TO TEEN PARENTS (Spanish translation) Estimado Padre: Hola! Soy un estudiante en sociologia en la Universidad del Estado de Michigan y estoy envuelta a1 momento en un estudio con padres adolescentes en Oregon. Esta carta es una solicitud para su participacion voluntario en mi estudio. El estudio se entitula “Relatando Historias de Partos de Padres Adolescentes: Discursos de Edad, Etrricidad, y Poder.” Estoy interesada en su historia de parto para entender mas sobre como adolescentes ponen por experencia e1 embarazo, el parto, y hallandose padres nuevos. Le preguntaré sobre cuidado pre-natal, tipos de apoyo recibido durante el embarazo y parto, elecciones de parto, y, en fin, como se siente de si mismo/a y del nacirrriento de su bebé. Como participante de éste estudio, 1e voy a pedir que se reune connrigo dc 1-2 horas. El dia, hora y lugar se arreglara por telefono. Para asisitirle mas, tenra la opcion de tener un traductor de habla-Espailol presente durante la entrevista. Si es menor, se requiere e1 permiso de un padre o tutor antes de hacer arreglos para la entrevista. Grabaré su historia y nuestra conversacion en cinta. A cualquier momento durante o despues de la entrevista, puede escoger ha terrninar su participacion. Podra tambien escoger a no contestar ciertas preguntas. A todo momento su privacidad sera protejida al extento maximo permitido por ley. Estoy haciendo este estudio para mi Doctoria en la Universidad del Estado de Michigan y presentaré mi estudio alli. Como residente permanente de Oregon, utilizaré este estudio para asisitir a organizaciones entender las experencias y necesidades de padres adolescentes en Oregon. En participando en este estudio, estara tambien asistiendo a tales organizaciones a cumplir semej antes necesidades como las suyas. Recibira una donacion de $10 dolares por agadecer su participacion en el estudio. Puedo compartir los resultados del estudio con usted tan pronto esten listo. Si tiene algunas preguntas o preocupaciones del estudio y/o esta disponible a participar, por favor regese la tarjeta adj unta con su nombre y numero de telefono. Lo/a contacto por telefono para contestar alguna pregunta que tendra y/o para hacer arreglos para unimos. Gracias por su consideracion. Atentarnente, Suzanne M. Broetje 237 LETTER OF INTRODUCTION (round 2) Dear Parent: This letter is an invitation for you to participate in a study about teen parents that is being done by Suzanne Broetje. She is interested in talking to you about your birth stories, including your experiences with pregnancy, childbirth, and becoming a new parent. Very simply, you are being asked to do the following: > Meet with Suzanne for 1-2 hours (in your home or other place of your choice) > Tell your story about being pregnant and giving birth to your child > Receive $10 for your time This is very informal, completely voluntary, and fun. While Suzanne has a few specific questions to ask, you can tell your own story however you choose to tell it. Suzanne is a Sociology student at Michigan State University, as well as a new mother. She lives in McMinnville now, but does not work for Family and Youth Programs. She will be the only person to see the personal information you share with her. Afier all the interviews are completed, this study will be used for her degree at MSU, as well as to raise awareness here about the needs of teen parents like you. Ifyou would like to be interviewed, or have more questions, please return the self- addressed, stamped postcard to Suzanne with your name and phone number and she will call you. Or she can be reached at xxx-xxx-xxxx. Thank you for your consideration, and hope to hear from you soon. 238 APPENDIX B CONSENT FORM FOR TEEN PARENTS Summary of research In this study, I am asking teen mothers and fathers to tell their birth stories. In addition to interviewing you, I am interviewing service providers and family members who interact with teen parents. In particular, I am interested in your birth story to understand more about how teens experience pregnancy, childbirth, and becoming a new parent. I will ask you questions about prenatal care, kinds of support received during pregnancy and childbirth, birth choices, and how you felt about yourself and the birth of your baby. Voluntary participation and confidentiality The interview will take about 1-2 hours. Your participation in this research is strictly voluntary. At any time during the interview, you may choose to end your participation. You may also choose to not answer certain questions. To assist us further, you have the option of having a Spanish translator attend the interview. As we talk, the interview will be tape recorded. Once your words have been transcribed on paper, the tape will be destroyed to ensure that no one can connect your responses to you. The data collected will be kept confidential—information about you will not be shared with anyone, and your name will not be used in any reports. At all times, your privacy will be protected to the maximum extent allowable by law. You will receive a $ 10 gift to thank you for your participation in this study. I would also be happy to share the results of this study with you once preliminary findings have been prepared. Contact Information If at any time you have questions about this study, or wish to remove yourself fi‘om the study, you may contact me at xxx-xxx-xxxx. Additionally, if you have any questions about your role and rights as a subject of research in this study, you may contact David Wright, chair of the University Committee on Research Involving Human Subjects, Michigan State University, 517-355-2180. By signing below, you agree to participate in this study. signature date print 239 CONSENTIMIENTO DE PADRES ADOLESCENT ES Resumen del Estudio En este estudio, les estoy preguntando a madres y padres que relaten sus historias de parto. Aparte de entrevistandote, estoy entrevistando a los que proporcionan servicios, parientes, y iguales quienes relacionan con padres adolescentes. En particular, estoy interesada en su historia de parto para mas entender como adolescentes ponen por experencia el embarazo, el parto, y hallandose padres nuevos. Le preguntaré sobre cuidado pre-natal, tipos de apoyo recibido durante e1 embarazo y parto, elecciones de parto, y, en fin, como se siente de si mismo/a y del nacimiento de su bebé. Participacibn Voluntaria y Confidencial La entrevista tomara de 1-2 horas. Su participacion en este estudio es estrictamente voluntario. A cualquier momento de la entrevista, podra escoger a terrninar su participacion y no tiene ninguna parte de su historia incluido en el estudio. Podra tambien escoger a no contestar ciertas preguntas. Para asistirle mas, tendra la opcion de tener un traductor de habla-Espafiol presente durante la entrevista, cual sera grabada. Al ser sus palabras puestas por escrito, la cinta sera destruido para asegurar que nadie puede atribuir sus respuestas a usted. Los datos reunidos seran mantenidos confidencialmente— infonnacion suya no sera compartida con nadien, y su nombre no sera usado en ningun informe. A todo momento, su privacidad sera protejida a1 extento maximo permitido por ley. Recibira una donacion dc $10.00 dolares por agradecer su participacion en el estudio. Puedo compartir los resultados del estudio con usted tan pronto esten preparados. Informacion Como Contactarme Si tiene algunas preguntas sobre este estudio, o desea quitarse de participar en el estudio, podra contactarme a1 telefono 503-434-7274. Adicionahnente, si tiene algunas preguntas sobre su rol de participante y derechos como parte de este estudio, podra contactar a1 Sr. David Wright, catedra del Comité de la Universidad de Estudios Envolviendo Ser Humanos, Universidad del Estado de Michigan, 517-355-2180. Firmando aqui abajo, esta de acuerdo ha participar en este estudio. F irma Fecha Nombre en Molde 240 APPENDIX C LETTER OF INTRODUCTION TO PARENT/LEGAL GUARDIAN OF MINORS Dear I am a sociology student at Michigan State University and am currently doing a study with teen parents in Oregon. has volunteered to participate in my study. As she/he is a minor, I am seeking permission from you to allow her/him to be interviewed by me. The study is entitled “Telling Birth Stories of Teen Parents: Discourses of Age, Ethnicity, and Power.” In addition to interviewing teen parents, I will interview service providers and family members who interact with teen parents. In particular, I am interested in the birth stories of teen parents to understand more about how they experience pregnancy, childbirth, and becoming a new parent. I will ask questions about prenatal care, kinds of support received during pregnancy and childbirth, birth choices, and how they felt about themselves and the birth of their babies. As a participant in this study, your daughter/son will be asked to meet with me for about 1-2 hours. The day, time, and place will be arranged by phone. Participation in this study is strictly voluntary, and can be withdrawn at any time during or after the interview. The data collected will be kept confidential—personal information will not be shared with anyone, and names will not be used in any reports. I would be happy to share the results of this study once preliminary findings have been prepared. I am doing this study for my PhD at Michigan State University and will be presenting my findings there. As a permanent resident of Oregon, I will also use this research to help organizations understand the experiences and needs of teen parents in Oregon. By participating in this study, your daughter/son will be helping such organizations to meet the needs of others like her/himself. If you have any questions or concerns about this study you can contact me at xxx-xxx- xxxx. Ifyou would be willing to allow your daughter/son to be interviewed, please sign, date, and return the consent form to me in the enclosed, self-addressed, stamped envelope. Once I receive the consent form, I will contact your daughter/son by phone to arrange a time to meet. Thank you for your consideration. Sincerely, Suzanne M. Broetje 241 CONSENT FORM TO BE SIGNED BY PARENT/LEGAL GUARDIAN Summary of research In this study, I am asking teen mothers and fathers to tell their birth stories. In addition to interviewing your daughter/son, I am interviewing service providers and family members who interact with teen parents. In particular, I am interested in the birth stories of teen parents to understand more about how they experience pregnancy, childbirth, and becoming a new parent. I will ask questions about prenatal care, kinds of support received during pregnancy and childbirth, birth choices, and how they felt about themselves and the birth of their babies. Voluntary participation and confidentiality The interview with your daughter/son will take about 1-2 hours. Participation in this research is strictly voluntary. At any time during the interview, your daughter/son may choose to end participation, or to not answer certain questions. Ifrequested, a Spanish translator can also assist us during the interview. As we talk, the interview will be tape recorded. Once it has been transcribed on paper, the tape will be destroyed to ensure that no one can connect responses to any particular individual. The data collected will remain confidential, and I will not use names in any reports. At all times, the privacy of your daughter/son will be protected to the maximum extent allowable by law. She/he will receive a $10 gifi for participation in this study. I would also be happy to share the results of this study once preliminary findings have been prepared. Contact Information If at any time you have questions about this study, or wish to remove your daughter/son from the study, you may contact me at xxx-xxx-xxxx. Additionally, if you have any questions about your daughter’ s/son’s role and rights as a subject of research in this study, you may contact David Wright, chair of the University Committee on Research Involving Human Subjects, Michigan State University, 517-355- 21 80. By signing below, you agree to allow to participate in this study. signature date print 242 APPENDIX D DEMOGRAPHIC SURVEY Age Ethnicity Self Partner Child Service provider/insurance: Connection to Teen Parenting Services Living arrangements, work, sources of income/support: Siblings, parents’ age, occupation: Relationship with partner now/ future: 243 Education APPENDIX E INTERVIEW SCHEDULE FOR TEEN PARENTS Birth Story I am interviewing teen parents about their experiences with pregnancy and childbirth. I would like you to tell me your story now, beginning wherever you want to. Experiences with pregnancy Why do you think you got pregnant using birth control: why or why not planned or not How did you feel about being pregnant consider options who did you tell and why; what were their reactions Describe your relationship with your partner, family, friends during pregnancy how did you feel about your body during pregnancy How were you treated by others, supported/not supported, during pregnancy Where/what did you learn about the body, pregnancy, childbirth Prenatal care Childbirth classes Family Friends Media What was the effect of this information on you—did you feel prepared? How did you choose your doctor/midwife Experiences with childbirth Who attended the birth of your child How did others interact with you during birth? doctors, nurses family, partner friends, others Who made decisions during birth. . .what and why What did you want/expect from birth Did you have a birth plan—why did you plan a natural birth Describe yourself (thoughts, feelings, actions) during childbirth How did you feel about your body [your partner’s body] when giving birth Was the baby breastfed? Why or why not In general, how did you feel about the birth of your baby/how it happened Did these birth experiences change you in any way Is there anything you wish had been done differently regarding pregnancy or birth Do you feel you were treated differently because of your age 244 INTERVIEW SCHEDULE (cont) Telling birth stories What stories of birth did you hear before giving birth Family Friends Media Other What effect did these stories have on you Is your birth story similar/different from those you have heard? Have you told your birth story to anyone who, why/why not what did you talk about Do you think you tell your story differently in different contexts (time, place, people) How do you feel about telling your birth story to me now Parenthood How do you feel about being a parent. . .what influences these feelings most Where/what did you learn about parenting Do you think your experiences during preg/birth influence how you are as a parent now How do you feel about your body now Do you think of yourself as a “teen parent”: why or why not How are you treated as a parent—by whom What do you think about teen parents in general Why did you volunteer to meet with me and tell me your story 245 APPENDIX F INTERVIEW SCHEDULE FOR ADULTS Background Occupation/title Relationship to teen parents Access to information Where/what do teens learn about the body, pregnancy, childbirth Media School Parents, peers What information do you provide to teen parents What information do teens need about the body, pregnancy, childbirth Do needs differ by gender, age, ethnicity, class Agency and decision-making I am asking teen parents about their experiences with pregnancy and birth. what do you think is a “typical” birth story for a teen parent What birth stories have you heard from teen parents How have you interacted with teen parents during pregnancy and childbirth Who makes what decisions regarding birth What do you expect fiom the teen mother during pregnancy and childbirth What do you expect from the teen father during pregnancy and childbirth How are others involved in the birth process with teen parents Teen parenting What are important issues that teen parents deal with during pregnancy, birth, parenting What information have you provided to teens about parenting How do you view the lives, motivations, abilities of teen parents 246 APPENDIX G BIRTH STORY OF HALEY Haley is a seventeen year-old White mother of a three-month old daughter. She lives with Brian, who is nineteen and the father of her baby. Brian works full-time as a manual laborer in Alton. Me and him were living here and we were staying with some people. He wasn’t working. I wasn’t working. We weren’t really doing anything you know. And then, um, I missed my period and everything, and so I figured, cause my period is always on the seventh of every month. And I was like, you know, so I knew. So we went and got a pregnancy test. And it was positive. And so, I don’t lmow. I was scared, it was kind of, I don’t know. It was really scary because I knew that it’s not something we should be doing so young, you know. But, also it was kind of exciting and something new. And so there was no doubt that we were going to keep it, cause I don’t think I could have an abortion, and I couldn’t give her away after I carried her and gave birth to her and stuff. So it was agreed that we both wanted to keep her. And so, uh, I don’t really remember why, but I ended up moving back to [my mom’s] for like two months. I think it was because I told him that, cause he was smoking weed and stuff, that you know I was gonna, you know we were having a baby, and if you don’t want to stop, and go to school and get a job, and, you know, stop hanging out with the people you hang outwith, then you know I won’t come back until then. And so he did that and I came back and we stayed with his sister when he first got that job in October, and then we finally got enough money where we could make a down payment here, and then we moved in here. I don’t know, I wasn’t, it didn’t really hit me that I was pregnant until I started showing. I knew I was, but it wasn’t that real to me yet. Cause when I lived down there with his sister, I didn’t really start showing until I was six months pregnant, but I felt her moving and stuff. So we moved in here and I was so happy. I really liked being pregnant after we had everything together. I heard all these stories about people, you know, who felt sick all the time, but I never got morning sickness. I felt totally healthy the whole time. I felt probably better than I did before I was pregnant. I don’t know, I liked being pregnant. And, um, I took, I was probably about five months when I took my parenting classes. I took those in [Alton]. And throughout my pregnancy, I read all the magazines and stuff they have, and so I pretty much knew all the facts about what they talk about in the parenting class. But like, people were there that had already had kids too, so I would hear about, you know, the things they were going through with their kids. It was like, it kind of, I don’t know, prepared me a little bit for what really happens when you have a kid. The whole fantasy about, you know, having the perfect baby who’s going to sleep and not, you know, not wake up in the middle of the night. But, um, I liked parenting class a lot. 247 I wasn’t really scared about it. I heard about people who were scared the whole time they were pregnant about giving birth. But I don’t think I was up until the actual time that I freaked out. I was. . .like, I woke up, urn, on the 18th. I had contractions for like 14 hours before. They were five minutes apart. Like five minutes apart exactly. They didn’t really hurt. But I figured that this isn’t that hard. So I called my mom and my sister and they came down. And they stayed with me here, cause we went to the hospital and um, they uh, I don’t know what it was, but she checked to see if my water had broken and she put monitors on my stomach and stuff. And I was all excited cause I thought, you know, it was time, and everything. Cause I had thought that it had broken a little bit, cause I had heard about that. Cause I was leaking. And it was clear and everything. But it wasn’t a lot. And so that, and the contractions being every five minutes. And so they were like “come back when your contractions are like two minutes apart or your water breaks.” And I was like, very very anxious the whole time. We had to come home and we were here for, um, it was probably for only like four hours because then they were all downstairs and he was in the shower and I was laying in the bed. And I was laying there, and all of a sudden my water broke. I was like, “oh my gosh.” It was the weirdest feeling. I think it was just weird. And I got up and it was gushing everywhere and I ran into the bathroom and yelled “my water broke,” and Brian was like, “ahhhh.” And so like he was all rushing to get out of the shower and my mom heard me upstairs, and so she was like “Well, why don’t you jump in the shower really quick,” you know. So I got in the shower. And then like everyone was all excited. We all piled into the car and drove down there. And then, oh, that’s when the contractions started hurting. And so, and the whole time I was pregnant, I was like I’m going to do it naturally, cause I think it’s something that every woman wants to try to do. You brow, at least try. But, I didn’t do it (laughs). It was a lot harder than I thought it was going to be. A lot, lot harder. And there was like a definite “no” on the epidural. It was not something that I wanted. So they gave me Staydol. And I did not like that at all. It didn’t help with the pain, it just made me feel all weird. And made me really, really, really sleepy. (baby hissing). And so, urn. . ...where was 1? Oh yeah. I keep losing my train of thought. And so after maybe, it was 1:30 when my water broke. Um, probably at about five o’clock in the morning, I decided to get an epidural because the pain was just, I couldn’t do it. It was a lot harder than I thought it was going to be. And he said that, you brow, I know I was disappointed because you know I wanted to do it natural. I had heard things about getting the epidural. And so I just wanted to be strong and do it. But uh, the guy said, “In half an hour it should start working and you should feel your feet getting kind of tingly and start to get kind of numb.” And I was like “okay.” But like an hour later, you know, nothing. And so he gave me more. And then I think it just took a little bit longer to kick in because I was numb clear up to my. . .my checks were getting numb and stuff. But after that, the pain... I didn’t feel anything. And so I was able to sleep. Um, I don’t really remember a lot of it. I think it’s because of the first Staydol that they gave me. But 248 um, I wasn’t (baby crying).... I wasn’t, um. .. (making hand motions). Dilated? Yeah (laughs). Thank you. I wasn’t dilating very fast at all. When I got, for like two, maybe three weeks before I was in labor, I was dilated like three. And so, but then, they had to give me some Pitocin to, you know, speed that up. And so, uh, I don’t brow when (baby crying)... I was like, I don’t brow, the whole birth was kind of fuzzy just because of the first thing they gave me and probably because I was so tired. Um, and so they gave me the Pitocin and I don’t know how long it was. I don’t brow how long I was pushing or anything. But she was in there face up, and they said they are usually face down. And so when I was finally dilated and everything, um, [the doctor] came in. But I don't remember, you brow, them being “Okay, you’re dilated.” You brow, “It’s time, we can start pushing.” The whole process was kind of like that. Like, he didn’t really explain anything to me at all. He was just kind of like, you brow, “Let’s get it over with.” But the nurses, they were really nice. They made sure I was comfortable and asked questions and answered mine. But I don’t brow. I didn’t like [the doctor]. He was fine for my visits and stuff. He made me feel really comfortable. Just, I think it was he was just honest about everything. Um, but, so I remember pushing. I think it took forever. I think it took quite a long time. And I was still, I wasn’t as numb, but I was still numb. So I couldn’t really feel whether or not I was pushing. And you brow, he kept saying “You need to push harder” and stuff like that. And I was like trying my hardest. We had to get this bar that like hooked on the bed, so I could like pull on that and then like, I don’t brow. Finally, I don’t brow how, but finally it happened. Uh. . .it was 4:22 when she was born. But I had to get a, I don’t brow how to say it.... Episiotomy? Yeah, episiotomy. And uh, which I was really scared of when I was pregnant. I didn’t really get that. But they said if, you brow, he didn’t give me one she wouldn’t come out, so I was like, “Okay, (laughs) give me one.” And so I remember just seeing him reach down and grab the scissors and I was like “Oh my god.” But I brew I wasn’t going to feel it. But it was still scary. And the next thing I know I just saw her come out. And I was like, it was one of the weirdest... but, it was amazing, and like my mom and my sister, and our friends that were there were crying and I was crying and it was like “Oh my gosh.” Brian didn’t cry though, which was weird to me, cause I figured he would. But he didn’t. But I don’t know. They took her and they suctioned her mouth out and then uh, Brian says that they put her on my stomach to do all that, but I don’t remember that. Right after her being born, I don’t remember her, but I guess they cut the cord and everything on my stomach. But I don’t remember. Which is another thing that upset me because on my birth plan that we wrote, both me and Brian wanted him to. Well at first he didn’t want to cut the cord. He was like “No, I’m not going to do that.” He thought it was disgusting. We watched this movie about, you know, it showed all of it and everything, and he saw this guy like cut the cord, and he just thought it looked so disgusting. He was not going to do it. I was like “come on.” And so eventually he, you brow, I don’t brow if it’s because I wanted 249 him to, or if it’s because he actually changed his mind, but he did want to. And so I wrote that down, and [the doctor] just did it. And you brow, he didn’t give us a chance to say what we wanted to do. And I was upset. But. . ..let’s see. And after, I guess, after they did all that stuff on my stomach, they took her and did stuff to her. It’s really firzzy to me, a lot of it. I remember um, the first thing I remember after that, she was all wrapped up in a little blanket and she looked so small, and she had, her head was so cone-shaped, and I was like “Oh my god” (laughs). She had this hat on, and her head just looked like two feet long. But she was so tiny. It was. . .an amazing feeling you brow, to have, to be able to hold her and stuff after all that time. And then they handed her to me all wrapped up and stuff. And I was breastfeeding her and stuff. And I don’t know. I loved that feeling of her just being so new. And by that time everyone had gone and me and Brian were sleeping with her at the hospital. And run, I stayed for a day, only a day. I wanted to go home. Brian was going to have to work the next day and I didn’t want to be alone. But we just stayed there. And it was so cute. He slept with her on a little couch. We just relaxed and spent the time with her, and talking about everything. All the nurses were like “she’s so cute.” And then, uh, at that time we didn’t have a car, and so we had one of our friend’s moms drive us here with her. And that was weird, I was nervous being with her in the car. Like actually going home with her. It felt weird. Like I’m not supposed to take her. It just felt very weird. And we got home and um, I think the house was pretty messy, and I felt like, the house is never spotless, but I feel like everything feels really hectic. Like I just can’t not think about that. But um. . ..so we got home, and it was... (baby fussy). I think it was kinda like, what now? It was a really weird feeling. Was your mom still here? No, I wanted her to stay for a couple of weeks, or a couple of days at the very least, but right away Brian... I think he stayed at the hospital and then we came home the next day so that we could have the day together here, and so the next day he had to work. So you were at home all by yourself? Yeah, and that was weird. But for the first probably two or three weeks, all she did was sleep. And I had to keep her awake to feed her and stuff and she would sleep all the time. And so, and I was still breastfeeding her, since that was one of the things I wanted to do was breastfeed her until you brow she was a year. Cause that’s how long I wanted to stay at home for a year, and then go to school. So I wanted to breastfeed her the whole time. But uh, and so it was really weird being at home with her. You brow just me and her. But it was nice to have the time, you know, to get to brow each other and stuff. Brian would come home fiom work and we would just play with her, but when she was that young, she didn’t really play [laughs]. I think we just annoyed her cause like we wanted to play. I think we both expected a little bit more, not so much sleeping and eating. But, bringing her home and actually having her was a lot different fiom what I 250 actually pictured, you brow. I didn’t picture everything to be you brow, like movie type, all perfect. But I think she was maybe 3 weeks old and my mom and my sister were here visiting. They stayed for about a week. And I was feeding her on the couch and my mom was sitting there. And I was feeding her and she started crying like she wasn’t getting anything and I tried to get milk and there was nothing there. And I was like, you brow, I didn’t want to face up to the fact that she wasn’t getting anything. Because this is what I wanted to do. I wanted to breastfeed her. And I ended up having to give her a bottle. And I just cried and cried. . .. I think that was the hardest thing so far, to have to feed her from a bottle. I mean, you brow millions of people do it, and they’re pretty healthy, but I don’t brow. And with bottle feeding came a whole bunch of problems. Because before she pooped fine. Now she’s like constipated and stuff like that. I think a lot of time it seems she has an upset stomach which with the formula, or the milk, my milk, you know it was perfect for her. So that’s been the hardest thing. I like spending time with her. I love it. I love being a mom. I think it’s awesome. I love it. I love being with her. I love having her. It’s a whole different kind of feeling. I don’t think that I could like have this much love for anyone but my own child. Well I have some other questions. First I want to go back to when you were pregnant. How did others interact with you? I got a lot of support fiom Brian, and my mom, and sister, and friends. A lot. I think I first told my mom. I didn’t know until I was a month and a half along and then I called her like two days after I found out. Cause I was never scared to tell her anything. I brew it’s not that she’d jump up and be all happy that I was pregnant but I brew she’d be there. So I called her and she was like, I think she was just in shock. It was like, “Oh my gosh.” And she was like “Well you guys better get your stuff together” cause you brow we were living with other people. And so she was like “It may seem like you have a long time to get a job and get a house and whatever, but you guys don’t. You need to get it done now.” So I think her talking to me about what we needed to do...I brew it, but I think her actually saying, you know, “If you don’t do this, you’re not going to be bringing her into the right kind of environment.” I think that’s kinda what made me decide to move back there with her. Because I brew that if I didn’t give him like, you brow, an ultimatum like that...he had a really hard time with me. He used to get social security and he would spend all his money. Like $800 a month. Gone. So that was just really important... Where did you learn about being pregnant and changes that your body would go though? I think I got it fi'om everywhere. Because I was so excited. I watched movies about it. I watched like TLC on the Lifetime channel about Baby Stories. I had like a hundred magazines, like Fit Pregnancy, and those things. And then after the parenting class, I talked to people about when they were pregnant and gave birth. I tried to get as much, to surround myself with things about being pregnant, giving birth. 251 How was everyone interacting with you during the birth? It was so awesome. Like my family, Brian, and some of the nurses. They'd like, if I was having any contractions, Barbara, she'd like rub my back and stufi‘. They just talked to me, they'd be like “How are you doing?” I think Brian would more try to get my mind off of it, before I actually got the epidural. And like while I was pushing, they would hold my legs and be like "You're doing good.” They were just really supportive, really compassionate. And I think the females more [laughs], like my mom and Barbara brew what I was going though. My mom wanted me to do it natural too. I‘m not sure. She did it naturally. But it was great. And the nurses were very supportive. There was one in particular. She came in all the time to check on me. And she would explain a little bit about what they were going to do. About every half hour. So who made most of the decisions. Who had control? Um, I think, up until it was time to push and everything, I was the one who was saying what my needs were and what I wanted. And then it was really after [the doctor] came in. I really do not like him at all. He didn't explain to me anything. He didn't ask me what I wanted done. My mom told me that usually they can go in there and turn the baby. And that would have made it a lot easier for pushing. And she got mad because of the way he was handling things. I think I was just too out of it for me to really notice to that extent. And I remember him saying like he was in a hurry. He had to be somewhere you brow. And I was like, “Then why don't you get someone else to come in that has the time.” That just really upset me. In general, how did you feel about your body when you gave birth? I don't think I really handled it that great. I think I would have handled it a lot better if I never would have had the epidural. Of course, it would have been more painful and everything, but at least I would have been more in control, more, you brow, I would have been pushing better, been taking what everyone else was saying better. Because I don't really brow how long I was pushing, but I brow it was for a couple of hours. They were just about ready to give me a c-section. So I wasn't really.... After, you brow, I was very excited but I was also kinda disappointed about the way that everything went. Thinking back, what kinds of stories did you hear before giving birth? Well, for the most part, I just heard about being pregnant, that it was awful, being sick all the time, always being tired, headaches, being bitchy all the time. And that was nothing at all. I felt great. I never got morning sicbress, I never got bitchy. I was happy. I was really, really, really, like extremely happy. I just felt really healthy. I just felt great. I felt beautiful. I loved myself. I loved it when I got really big. I don't brow, for the most part, that's what I heard from people. But also, I don't know if it had anything to do with it, but most of the girls I talked to were girls. You brow, they were young like me. So I don't brow. But like my mom and her fiiends who had kids were like “It's a piece of cake. You'll do good.” They were supportive. They didn't say, you know, “It's a piece of cake.” But they were realistic about it. I think older women were more... 252 I was 8% months pregnant and I went down there to visit my mom and sister and stuff. And my mom and I were in Wal-Mart looking around in the baby section and I'd seen this girl that I'd had a class with in high school. And she had a baby. And I was like “Oh my god.” I saw her and she was like “You're pregnant” and I was like “You had a baby.” And she was like “Yeah.” And she was like “It was so hard. Giving birth is so hard.” I think her son was like two months old. Um, she told me how hard it was and how awful it was. And my mom was like “Don't let people like that... I'm sure for some people it is really hard, but if you just listen to all the negative things that people are going to say then you are just going to get yourself worked up and scared.” That’s weird though. I didn't even think about that until now. It was mostly young people who were very negative. So how do you think your story is similar or difl'erent? I think for me, the actual pregnancy part is different because I didn't go though what I guess most women do. But the birth part....I'm not sure if it was a worse time for me than most of what I heard. I think it probably was. Because I don't think most people here had [my doctor]. And because of the choice I made to have the epidural. I should have made my mind up like I had in the beginning and stuck to it. So you were pretty well educated about the epidural. Yeah. And I brow that usually they give it to you in enough time to where it will wear off when you're ready. But I was still numb up to here [chest] probably by the time I was ready. And I think [the doctor], he's been doing that for years and years. And it's become like any other job. Do you think your experiences have influenced how you are as a parent now? I think so. I think mostly just watching other people. The way they are as parents. I think, I don't really see anything significant that I would do any different from others would do. I know that a lot of kids in the parenting class were like mandatory. They had to go there for some reason. So they just weren't ready. And I can't say that we were as ready as we should be, but we were ready enough. You brow. It's not like, you brow, she has both of her parents. We can feed her and clothe her. We spend all of our time with her. I brow a lot of young parents, I don't understand. You have a baby, and if you're not ready, then you need to give the child to someone that will take care of it. So many people just pawn their kids off on their own parents. I could never do that. I saw a lot of that in parenting class. How do you think you are treated as a parent now? I think it varies a lot. I think it depends on the people that I brow and are friends with, or the people we just see in the grocery store. You brow those people are like “Oh, how's the baby doing?” I can't even say like older people. Even younger people do it. They just stare, like they are saying “You're sinning” and we're like the worst thing, because I'm seventeen and he's nineteen and we just had a baby. I know people who are not prepared when they are your age and they have kids. So I don't think it really matters how old you are. What do you think of teen parents in general? I don't brow. Just because I've met and talked to some that totally have it together. They brow it's not just them. They've brought 253 another child into the world. You brow, it's not like children ask to be born. If your not ready, they're the ones who are going to suffer. And so I think the people who understand that and also want to be parents, I think they are the ones that spend the time, and actually their kids grow up browing that their parents are always there. But then I've met some that just, I don't brow. Some teen parents. I've met some that... A lot of them, they'll make excuses, or leave their kids with other people all the time and go partying with their fiiends. Honestly. I did drink alcohol, but I've had close to two years now clean and sober, but if I was to ever do that, I think it would be really hard. But I think I would have enough love for her to just, if I can't stop and can let other people take care of her. I read this summer that kids don't ask to be born. Unless you plan for it, you still made the choice by not using protection. You are going to take care of your child. Or if you're not, let other people do it. So did you not use protection? I was on the shot for like six months. I had taken it twice. But when I moved out here, I just didn't. And you didn 't think about getting pregnant. I just don't think... Like you brow it's going to happen, but you just don't think it's going to happen. Like I totally know it's possible that if you have sex without protection there is a chance that you will get pregnant but I just don't think it was. We were together for about two years before she was born. And out of that whole time, except for six months, that whole time we never used anything. I don't know what I thought. 254 APPENDIX B BIRTH STORY OF MARIA Maria is a fifteen year-old Hispanic mother of a sixteen month-old son. She attends high school and lives with her parents, who are fieldworkers in a local vineyard. Well, it was probably February, late February. I was at my mom and dad’s house. And then I was like getting stretch marks like right here by my legs and my arms, and I was scratching. They took me to the doctor. The doctor sent me to some allergy lady that tested me. And then we went there like the next week and I wasn’t going to school or anything. Did you know you were pregnant when you went to the allergy doctor? Yes, I did. Yeah, I didn’t tell no one. And so after that, we went there and then we came home and she gave me, the doctor gave me like some...she put some stuff up my nose and I was like throwing up. But after like I had this stuff coming down my nose and then I bled and stuff. And so...and then I was throwing up really bad. I didn’t sleep that much that night. Then like at five, my mom woke up because she was going to make their lunch because they were going to go to work. And so she went into my room and then she wanted to brow what was going on and I was throwing up all over. And so she came out of my room and then she went into my dad’s room and my dad was sleeping and she wakes up my dad and she went like “She’s really sick.” And so my dad gets up. He goes, “What’s wrong?” And I’m like, “I’m sick.” And my mom, she like touched me, and she like grabbed me and my dad is like, “Why are you grabbing her?” And my mom said, “She’s pregnant.” And then they asked me and I told them. Then my mom started saying why didn’t I tell them like before I went to get allergy tested and stuff. And so I tell them, “I’m really scared” and that I didn’t want to tell no one. And so he started talking to me and because he didn’t expect it from me and he was turning really angry...but nothing happened. He went to work and right before he went to work he goes, “We’re going to talk about this later.” And so that day I went to school and everything and then I wasn’t going to come home because I thought they were going to like kick me out. So I didn’t come home. And then one of my best fiiends, that lives up the street, she brew about it and I told her my parents found out, and then like I came home and everything and my parents got home, and I talked to them. My dad just said, “Who is the father?” And I told him. And then, because I was trying not to cover him up, but I didn’t want to tell him like, who the dad was, so my dad got really mad and he said, why didn’t I tell him like before he left? Because he would like come over a lot and he would just come over and he would 1ike...we were not really dating at 255 the time. We were just friends. He told me that he was going to tell my parents. And so he would always come to my house but he like didn’t want to say anything. And so he would just come for me, he would come and say, “I’m going to leave.” And he found out my parents were like kind of angry. My dad didn’t talk to me like for a week, I think. And my mom, she didn’t say much. She just went by and said that if anything happens, she’s going to be there and stuff. And then I went to get prenatal care and everything. Went to the bathroom and did a pregnancy test and everything. So then I went to the doctor for prenatal care. When I would go to my prenatal care, my mom would go with me every time, or most of the time. And my godmother, she really helped and she would take me and she would give me rides and stuff. I think I quit school like the next week, like three weeks later, when my parents found out. I quit school because I wasn’t going to stay there. I was really embarrassed to go to school, you brow, middle school. And so I quit school and I stayed home and stuff. And so then I would go to my prenatal care and I would come home and I would tell my dad everything and my mom, what they would tell me. And my dad, he would always tell my mom that he was never going to be there, at the hospital. He was just going to like drop us off and everything, and he wasn’t going to be there. And he was going “I’m not even going to help you guys out and you guys have to do it on your own.” And then I went to my prenatal care, it was on a Friday. I went to my prenatal care and the lady, my doctor, she checked me and everything. And I was like overdue. My due date was April 26'“. So I went and she said that, if I wanted to go, I could have him that same day. She would like break my water and I could just go down to the hospital. And she could break my water. And I was like, “Well wait, because I have to go tell my dad.” And so afterwards, I came home and then that same day my parents were going to get a loan and I was doing a lot of that. So I came home, it was like after I came home. I ate right before and then I came home and I was getting really bad. I had backaches and stuff. And so I still went to the bank, came home, and I went to the store. I came home and we rearranged our living room and about everything was done like at eleven at night. I ate and you’re not supposed to eat. And I ate, and then I slept for a little while, but I couldn’t sleep, and then I got up and I came to the living room. My brother was watching TV. This was around 12:30. I didn’t sleep that much. And so my mom came out of her room and she asked if I wanted to go to the hospital and I said, “Yes.” And then my mom asked my brother if he could take us. And my brother was like “Go tell dad. Ifhe doesn’t want to take you guys out, I’ll take you or we can call a taxi.” And so my mom went and told my dad. So he came out with me and asked me “Are you ready? How do you feel?” And I told him, and I called the hospital. Well, my dad got up and took a shower... and he took, it took like until 1:30 to get to the hospital. It took an hour. I was waiting and waiting. I got to the hospital and they checked me and everything. And then like around six or seven, my mom called my godmother because she wanted to be there and she was there through the whole thing. She got there like around eight or nine. 256 Around seven, the doctor came in to break my water and I guess when she broke it, he like pooped in me. So they broke my water and everything and they found out that he had just pooped and everything. And then at 11:40 I had him. And my dad was there the whole time. My mom was like really mad because she was like “You said you weren’t going to be here, so leave.” And so he wasn’t there for like, he was there until like seven in the morning, but he wasn’t there when he was born. Like he got there like five minutes later because we called. My mom called him and told him that he was born. Before that day he went to the store and got him like a whole bunch of clothing and stuff. So he got there and he came back. And he was gone for a while. He came back home and then Sunday, they went back because Saturday night my mom came home and I was there the whole night alone. Then Sunday morning they went back and Sunday afternoon I came home. And after I came home, it was like I got home and his uncle from his dad’s side brought him like a big bag of clothing and his aunt came. Like a whole bunch of people came to our house. And then afterwards, like two weeks more, like when I came home there were people here at my house. My dad had like his uncle and his uncle’s sister and everything. They were here and then my dad was like they were working on something outside and so I came home and I was eating tortillas and then like the next day, I think it was the next week, on a Friday, I think it was, I was up vacuuming and cleaning and everything. And then like two or three weeks later, I got really sick and I was in bed like for a week. And I was like, I had pain and everything. I was really sick and I had a lot of fever. I went to the doctor and she gave me some medicine. It didn’t help me until my mom took me to some lady. She like, she’s an herb lady. And she like took care of me, and than I came back and, I don’t brow.... Did you plan to get pregnant? Did you want to be pregnant? No. My wishes weren’t to get pregnant. My goal right now, since I was ten years, since I was little, was to be a probation officer. And so it was one of my goals. So I wasn’t even planning on getting pregnant. And I have an older sister, she got pregnant when she was fifteen. I didn’t want to get pregnant. And I saw how she and her husband, her boyfriend, they fight and stuff. And they don’t get along and the little kids have to go through all of that and everything. And I wasn’t planning on getting pregnant. So what happened? You just didn ’t use birth control at that time? No. Why? I don’t brow. You didn ’t think about it? Yeah. So how did your boyfriend feel when you told him? Well, he didn’t find out until like I was probably like eight months, eight or nine months. He didn’t find out. Because his brothers, they would like ask. My dad didn’t want to say anything, you brow? But his brother came up once. His brother called me and he said, "You’d better tell your dad that if it’s my brother, you’d better tell him that its him.” But I didn’t want to say anything and I’m like “Don’t worry about it.” And then he was like “Why does your dad not 257 know?” But my dad knew that it was his brother. And so I told him that when he came home and everything. And he found out by his brother. That’s how he found out. He would call and he would change his name, he wanted to talk to me and he would change his name and stuff. My dad didn’t want him to talk to us. And so he changed his name and stuff and it got me in trouble more. And so that’s how he found out He came like, I think he was like eight months old, when he came the first time. I think he was a little bit younger and then he came around. Maybe he was five months when he came the first time. And then he came again right before he turned one. He didn’t show up at the house because we had company over from California visiting us and so he didn’t come. He just drove by, but he didn’t come. He hasn’t called or anything. But the thing is his uncle, my son’s uncle, comes and like before he turned one, he gave us like, he gave my dad like an envelope full of money. I think the envelope had like $1500. And he said it was for the kid and so my parents thought it was like his dad sending the money, but told his brother. So my dad talked to his brother and everything and I guess it was fiom his uncle, but it wasn’t from his dad. And so they like gave my dad money, but my dad has the thought that it isn’t his uncle’s money, it’s his dad’s. But he hasn’t come to talk or anything. Did you feel prepared for childbirth? Yeah. Because like my mom.... Because when I was having her, the nurses, they didn’t...I couldn’t like breath in, breath out or anything. It was really hard for me. But my godmother, she’s like really tall, and they made me, my mom and my godmother, they made me like sit up and the nurses they had me like laying down and I couldn’t do it. So they made me sit up and then I like pushed and would breathe in and then breathe out, and everything. And then that’s how it happened. Sitting up. But I couldn’t, they wanted me to just be like laying down and I couldn’t. It was really hard. Did you have any medication during this time? Yeah, I had a something that they... Epidural? Yeah, I had an epidural. At the very last minute because I couldn’t. I was shaking really bad and everything. How did you feel about the birth? The only thing that I didn’t like was going to the prenatal care. I did not like that. Because my doctor, she was like really rude. She would check me and stuff—she was kind of rude, really. She was like really rough with me. She wasn’t like gentle and stuff. My godmother would go in with me and everything. My mom was going to go, my godmother told her, “No, you be gentle with this girl. She’s just a girl.” So. . .I don’t think I would have another kid cause going through all the prenatal care and stuff. How was the doctor during the birth? She was alright during the birth, but I just didn’t like the prenatal care. She was really rude. Did she talk to you at all about what to expect? Not really. Not really. She didn’t say that much. 258 What type of things do you remember hearing, other stories that you were told about childbirth before he was born? My sister tells me, “You’re not tough that much.” She is kind of j ealous that I live with my parents because she ran away. And so she would tell me, “It’s not going to be fun and you’re probably going to have a c-section and stuff because you’re so young.” Since I was thirteen when I had her. She told me, she was telling me like these horrible stories. I wasn’t going to be able to have him and stuff. And then like she told me something about, she told me that the hospital would probably keep my kid because I’m really young. But my mom, she was really helpful. She would tell me, “When we go, they are probably going to make you like push in, push out, breath in, breath out” And so she told me about like how she had me and everything. My aunts weren’t really helpful. One of my aunts, she got really mad. And so I didn’t have no one. We had just our secretary for our business. She’s the one that would tell me stories and stuff and how she had her little girl. She had a midwife and she had her little baby at her house. She told me her story and everything. But like my aunts, they didn’t tell me nothing. My mom was the only one. Do you feel like you were treated any differently by like the doctor or nurses because you were so young? Just the doctor. Because the nurses at the hospital, they were just really nice and everything. And my dad was even telling me you brow, how they treated me because like they gave me so many bags of stuff and they gave me clothing and everything. And it was like, they gave me like several bags of clothing and blankets, and stuff. I mean, one of the nurses brought me like a great big bag firll of clothing and stuff, and diapers and stuff. And then like the hospital gave me a pump. They just helped me out a lot. And then I guess my dad said like, because we’ve seen some other Hispanic people who come down fiom Mexico, we see them, you brow. And they don’t treat them like that. And my dad said that they were just like treating me really good and everything. So how did you feel about your body when you were pregnant? Oh, I got a lot of stretch marks. So that’s the only thing that I didn’t like either. I have a whole bunch of stretch marks. I felt okay, you brow, just like the glares and stuff. The Hispanic people, they look at you and stuff and they just stare. The Hispanic people treated you dififerently than others? Yeah. Because like if you’re Hispanic and you’re from Mexico...? Because to them it is not okay if you get pregnant as a teenager, you brow. And so they glare at you, they stare at you and then, I don’t brow. It’s just really weird because you’ll be walking by and they’ll be staring at you really bad and everything. They’ll be glaring at you. And you can like feel something that they’re glaring and everything. Did anyone ever say anything to you? I was told, I mean my uncle lives in California, so I would go to California and all the people, they’re all glaring at you. And they come up to you and they just ask you, “Are you pregnant?” Or, they’ll say something really rude, you brow. Like, “Keep your legs closed,” in Spanish and stuff. And “You’re really young.” And then “How old are you?” and everything. 259 Is it still the same now? Now, they don’t really. IfI go, you brow, they don’t think he’s my son or anything. Like some cousins and aunts that didn’t brow I was pregnant. We go to parties and everything, you brow, family parties. And they think he’s my mom’s and everything. And so when I go places they don’t. Even like guys, they don’t. Like some friends fiom when I was in the gang, they haven’t seen me and so they see me now and they’re all like, “Is that your mom’s baby?” And I say, “No, it’s my baby.” How long were you in a gang? I was probably like a year or two, or three. I was really bad. My life changed. Right before, just like when I met his dad, my life changed a lot. Why? Because he wasn’t into the gang hanging and stuff, and so my life changed a lot. He helped me out a lot because I would want to go party and go to dances and go get drugs and stuff and he changed me, practically. He like told me, you brow, that drugs were wrong. And my parents would always tell me, but it was like, I wouldn’t change for my parents. And so he told me “You had better change or you’re going to.” Because I wasn’t like involved with my family or anything. I was just living here and I would come and then. I would leave. And like my parents would try to keep me home, you brow. And they were telling me to go to school and come home. How do you feel about your body now? I feel okay. I don’t feel weird or anything. Like my aunts and uncles were all like, “Oh, you’re...” Because when you’re fifteen, they give you, they make a big party and stuff. A quinceafiera. I didn’t even get that and I didn’t even want it. And they were all like “You have to be a virgin and you’re not even a virgin.” And now in society, it’s like no one stays a virgin right now. So you think there are a lot of girls that have a quincean'era, they ’re not virgins either? No. I would say most of them—they’re not virgins. 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