There has been a call within the medical anthropology literature to not merely describe health inequities, but to also reveal and combat their underlying causes. The application of practice theory to birth systems has been one promising area of work in this regard, revealing universal patterns to otherwise unique experiences of change. I further this anthropological endeavor through an analysis of an understudied dynamic within U.S. birth systems-the experiences of Amish, Mennonite, and Brethren parents and their care providers. This dissertation highlights how interpersonal relationships affect change on the individual and group level within healthcare systems and I attempt to answer how these relationships can be structured to address inequities in health experiences.This dissertation is a multi-sited praxiography of birth systems across the states of Indiana and Michigan. Chaos theory and anthropological research on liminality were sources of inspiration for questions about praxis in these contexts and served as key frameworks in data analysis. Data on praxis was collected primarily through 41 interviews with providers, parents, and knowledgeable community members with the goal of understanding the power dynamics that change praxis at the individual and system level. Within this sample were former and current members of Brethren churches and several care providers with extensive experience with birth care in Amish, Mennonite, and Brethren communities. Archival research, auto-praxiographic reflections, attendance at public events, and the collection of relevant praxis documents were also important sources of data. Rather than detailing any one praxis system in depth, this dataset was intended to capture the complex interactions that occur between several praxis systems to affect change.Data analysis revealed limits on both parents' and providers' power to control the birth process that are not adequately predicted by either obstetric or midwifery systems. Through analysis of experiences of vulnerability and examples of resilience in various birth systems, I illustrate the need for diverse relationships within and between systems while also advancing anthropological theories that further illuminate these concepts. I also outline how religious exemptions can be a source of unpredictable chaos that may simultaneously reduce health inequities for some and increase health inequities for others. I propose that examples such as birth in Amish, Mennonite, and Brethren communities demonstrate that exemptions for alternative praxis should not be restricted based on religion. Instead, I argue for the decriminalization of individual birth praxis, the facilitation of praxis change, and integrated yet autonomous health system designs.℗ Across three data chapters I critically compare the quality and design of U.S. birth systems and their unique answers to what is the right time, place, and care needed for a successful transition. The exploration of change at the individual and system level in two different transitional contexts-experiences with counter-culture systems and experiences with the birth process-challenges existing anthropological frameworks for change. By taking an interdisciplinary approach that borrows concepts from chaos theory, this dissertation also expands those frameworks. I conclude that birth is a chaotic, unpredictable process where there is no universal answer for the right time, place, and care for birth. For a birth system to be robust it should thus adapt to this diversity in praxis as opposed to attempting to control it.℗
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