Holly Witteman*, University of Toronto, Toronto, Canada Sarah Whyte, University of Waterloo, Kitchener-Waterloo, Canada Jacqueline Bender*, University of Toronto, Toronto, Canada Michelle Janutka, University of Toronto, Toronto, Canada Erica Sutton, University of Toronto, Toronto, Canada Laura O'grady, University Health Network, Toronto, Canada Kate Sellen, University of Toronto, Toronto, Canada Morgan Von Tunzelmann, University of Waterloo, Kitchener-Waterloo, Canada Carolynn Prior, Sages Femmes Rouge Valley Midwives, Scarborough, Canada Murray Enkin, McMaster University, Hamilton, Canada Kirstin Borgerson, Dalhousie University, Halifax, Canada Nadine Wathen, University of Western Ontario, London, Canada Track: Research Presentation Topic: Consumer empowerment, patient-physician relationship, and sociotechnical issues Presentation Type: Oral presentation Submission Type: Single Presentation Building: MaRS Centre, 101 College Street, Toronto, Canada Room: CR3 Date: 2009-09-18 09:00 AM – 10:30 AM Last modified: 2009-08-14

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Background: Many women use online communities to discuss their pregnancies and plans for childbirth. Knowledge shared and created within these groups may shape or reinforce opinions about birth place (home, hospital, birth center) and attendants (midwife, obstetrician, family physician, unassisted birth) within the broader social context of contested birth philosophies.

Objective: In this study, we sought to explore the relationship between apomediation in online pregnancy communities and women's choices of birth place and attendants.

Methods: We conducted: (1) content and narrative analyses of forum posts in established online communities based in Canada, the United States and Australia and (2) a cross-sectional online survey members of such communities. Communities were selected to represent a diverse range of opinions and comparable frequencies of different birth choices. The survey contained both closed- and open-ended questions and used purposeful recruitment and subsampling to ensure adequate sample size across all birth choices of interest in this study.

Results: (1) Narratives describing different birth choices and experiences emphasize varying conceptions of risk and birth outcomes as well as varying levels of acceptance or rejection of medicalized birth. In communities that reflect greater acceptance of common medical practices, posts underscore dichotomous outcomes such as death versus health. In communities that promote out-of-hospital births and non-physician attendants, risks and benefits are discussed within a whole systems approach, incorporating factors such as morbidity, interventions, surveillance, continuous mother-baby contact, breastfeeding, physiologic pushing, and empowerment. Participants in all of these online communities establish, engage with, situate themselves within, and challenge norms and values within the online community and external systems. (2) Significant differences were observed between women's self-assessments of whether or not their opinions of various birth choices were influenced by their participation in online communities: Chi^2(5, N = 577) = 53.31, p < .001. Women who chose less medicalized options such as midwife-attended or unassisted birth were more likely to indicate that participation in these communities influenced their opinions. Responses to open-ended questions indicated that these communities offer increased awareness of alternative options, provide knowledge and practical skills for negotiating birth and postpartum experiences in different contexts, and help to normalize birth choices that are outside the statistical norm.

Conclusions: Pregnant women assess and evaluate the risks and benefits of childbirth and postpartum practices in varying ways. Online communities about pregnancy and birth promote values and choices according to the characteristics and beliefs of the membership. Decision-making authority and knowledge are constructed differently in different communities. This exploratory study suggests that apomediation may play a role in the birth choices of subgroups of women who participate in these online communities.