(Re)Making Choice and Autonomy in Publicly Provided Maternity Healthcare

This article is concerned with healthcare institutions’ principles of choice and autonomy in the care practices of maternity healthcare provided by the Nordic welfare state. The issue is explored through analysis of institutional ethnographic material collected at four different maternity healthcare clinics in one large city in Finland. The analysis shows that nurses remake the medical institutions’ demands for choice and autonomy in healthcare. In the nurses’ experience-based knowledge of pregnancy, choice is not just a static activity but something that is achieved through a process of coming to know one’s choices. Choice as a process involves experiencing pregnancy, and the nurses’ respect for this process can be understood as enabling motherhood. The nurses encourage the women to be self-reliant and autonomous. This increasing demand for choice and autonomy may also be interpreted as a demand of consumer capitalism. The welfare service response has been to treat women to an extent as neoliberal reflexive individuals, in effect, responsible for their own motherhood. These nursing approaches to providing choice and autonomy for pregnant women both potentially enable and control motherhood.