Problematising public and private work spaces: Midwives' work in hospitals and in homes (original) (raw)
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Midwifery, 2012
Aim: to ascribe meaning to the everyday experiences of midwives during their first year of practice as they interact with their social environment. Design: a qualitative, ethnographic study. Setting: a major maternity department located in the West Country, UK. Participants: seven newly qualified midwives working in the chosen setting. Measurements: as befits an ethnographic approach, observant participation and interviews in the field were the selected data collection tools. Reflexivity was at the hub of the research process. A field diary was kept in order to ensure that the researcher took into account both her own perceptions and the interactions with participants and significant others. This paper draws on data that illustrates some of the predispositions that may constitute the midwifery habitus. Findings: the main themes that emerged from the data were in relation to the culture of midwifery, fitting into the culture and determining what type of midwife the neophytes wanted to be ('what is a midwife?'). To enhance transparency, the latter theme is focused upon in this paper using a model that is a synthesis of some of the findings and Bourdieu's notion of habitus. Key conclusions and implications for practice: this research provides insight into the professional and cultural experiences of newly qualified midwives, especially how cultural interactions, education and expectations may shape the midwifery habitus. It would seem that midwives who take a critical and reflective approach to practice are key players in the cultural recreation of midwifery. Accordingly, to enable the aforementioned approach to practice, it is important that reflective and reflexive practices are an integral part of midwifery education. Nevertheless, the implications for practice are not merely one-dimensional. Observations in the field suggest the importance of making the quality of midwives' working lives a priority by facilitating a more supportive working environment. Moreover, midwives should not be marginalised for preferring to work in the community, the birth centre or the high-risk environment. Future planning of the maternity services needs to consider how a 'being with the woman' approach can be facilitated for all women, balancing the virtues of both the medical and midwifery models of care. & 2011 Elsevier Ltd. All rights reserved. also required a detailed exploration of the literature related to the nature of midwifery and its cultural framework. Transition literature The literature suggests three phases of transition: the rite of separation, social limbo (neither one thing nor another) and the rite of incorporation (Glaser and Strauss, 1971; Turner, 1982). In relation to the first phase, Godinez et al. (1999) discovered that real nursing work was quite different from what nurses had been schooled for, and identified this phenomenon as 'reality shock'. Kramer (1974) first used this term to make the point that many ideals and values espoused during nurses' professional education are not operational and go unrewarded in the work setting. More recently, in a survey sent to a group of newly graduated certified Contents lists available at ScienceDirect
Health:, 2009
a b s t r a c t Worldwide, increasing percentages of women are giving birth in centralized hospitals in the belief that this maximizes safety for themselves and their babies. In parallel, there is international recognition that the number of birth interventions used in the routine care of labouring women is rising. This is fuelling concern about iatrogenesis, and, particularly, maternal and infant morbidity and mortality. It also has an adverse impact on the economics of health care. National and international policy characterizes midwives as the guardians of normal childbirth. This guardianship appears to be failing. The objective of this metasynthesis is to explore midwives' perceptions of hospital midwifery with a focus on labour ward practice to examine professional discourses around midwifery work in the current modernist, risk averse and consumerist childbirth context. Based on an iterative search strategy, 14 studies were selected for the metasynthesis. Three overarching themes were identifi ed: 'power and control'; 'compliance with cultural norms'; and 'attempting to normalize birth'. Most midwives aimed to provide what they characterized as 'real midwifery' but this intention was often overwhelmed with heavy workloads and the normative pressure to provide equitable care to all women. This raises questions of authenticity, both in terms of midwives living out their beliefs, and in terms of acknowledgement of the power to resist. The theoretical insights generated by the metasynthesis could have resonance for other professional and occupational groups who wish to offer autonomous individualized services in an increasingly risk-averse target driven global society. k e y w o r d s authenticity; bad faith; hospital birth; metasynthesis; midwives; real midwifery; resistance a d d r e s s
Objective: To explore the relationship between the birth environment and midwifery practice using the theoretical approach of critical realism. Background: Midwifery practice has significant influence on the experiences and health outcomes of childbearing women. In the developed world most midwifery practice takes place in hospitals. The design and aesthetics of the hospital birth environment impact on midwives and inevitably play a role in shaping their practice. Despite this, we understand little about how midwives’ own thoughts and feelings about hospital birth environments may influence their behaviours and activities when caring for childbearing women. Methods: An exploratory descriptive methodology was used and 16 face-to-face photo-elicitation interviews were conducted with practising midwives. Interviews were audio recorded and transcribed verbatim. Thematic analysis informed by the theoretical framework of critical realism was undertaken. Results: Midwives clearly identified cognitive and emotional responses to varied birth environments and were able to describe the way in which these responses influenced their practice. The overarching theme ‘messages from space’ was developed along with the three sub-themes of ‘messages’, ‘feelings’ and ‘behaviours’. Midwives’ responses aligned with the three domains of a critical realist world-view and indicated that a relationship existed between the birth environment and midwifery practice. Conclusions: The design of hospital birth rooms may shape midwifery practice by generating unseen cognitive and emotional responses, which influence the activities and behaviours of individual midwives.
Cogniţie, Creier, Comportament / Cognition, Brain, Behavior , 2007
This paper deals with maternity care in the Czech Republic. It concentrates on midwives as significant providers of maternity and birth care. The main aim of this paper is to show how the culture of midwives shapes the care they provide. Building on the ethnographic research in two small maternity hospitals in the Czech Republic, I focus on three domains that are organized around three types of views: 1) the views of the participating midwives on their own role, work, and occupational identity; 2) the participants’ views on their colleagues – the midwife “professionalizers”; and 3) the views on their key clients – the women giving birth. I show that all the three domains of the midwife culture are strongly determined by the medical model of childbirth, though this has been significantly challenged by those who promote alternative births.
International Journal of Qualitative Studies on Health and Well-being
Purpose: There is a need to deepen knowledge about midwives' care in obstetric-led labour wards in which midwives are responsible for normal births. This ethnographic study explores the content and meaning of midwives' care of women in a hospital-based labour ward in Sweden prior to the introduction of a theoretical midwifery model of care. Methods: Data were gathered through participant observation, analysed through interpretation grounded in reflexivity discussions and are presented in the form of ethnographic descriptions. Results: The midwives' care was provided in a field of tension in which they had to balance contrasting models of care, described in the themes: The birthing rooms and the office-Different rooms of care, Women giving birth or being delivered-Midwives' expectations and relationships with women, Old and new caring roles of the midwife-Women giving birth in a "new age", Being and doing-Different approaches to caring, and Holistic and reductionist care-Guided by contrasting models and guidelines. The midwives' freedom to act as autonomous professionals was hindered by medical and institutional models of care and this led to uncertainty regarding their roles as midwives. Conclusions: Midwives having to balance their activities in a field of tension require midwifery models that can guide their practice.
The professional socialisation of midwives: Balancing art and science
Sociology of Health & Illness, 1989
Mastery of esoteric knowledge is one of the central features assigned by sociologists to fully professionalised service occupations, together with an orientation towards public service. There are, nevertheless, different views about the best way in which this education and socialisation can be provided for new recruits for practitioner roles. Some maintain that the university provides an ideal training ground. Critics of this view, however, call for a rejection of 'university diploma mills' and a retum to the type of apprenticeship socialisation common during the premodern era. This paper tests the usefulness of these perspectives in understanding the occupational socialisation of Newfoundland and Labrador midwives. Three major styles of training -traditional apprenticeship, vocational schooling and university education -can be discerned. In comparison to both apprenticeship and academic styles of occupational socialisation, only vocational training nicely blended the art and science of midwifery to produce competent and committed professionals.
Medicine as discursive resource: legitimation in the work narratives of midwives
Sociology of health & illness, 2003
This article examines the work narratives of midwives practicing in the United States, specifically in the State of Florida. We focus analytic attention on how the discourse of medicine is used as a resource in constructing a sense of legitimation for midwifery. Data are drawn from in-depth interviews with 26 direct-entry, licensed midwives and certified nurse-midwives.
Choice, continuity and control: changing midwifery, towards a sociological perspective
Midwifery, 1995
In this paper sociological theories of the professions and the organisation of work are drawn on to explain current developments in the organisation of maternity care. Utilising the literature on the sociology of the professions and general trends in health policy and labour markets, possible reasons for the current renaissance in midwifery and some implications for midwives are discussed. Thus, whilst some women and midwives may be building a paradigm of 'womancentred' practice based on an equal partnership, for other midwives, the result may be a divided workforce consisting of an elite core and casualised periphery based on the ability to give a full-time flexible commitment to work. The implications of excluding those midwives who are unable to combine fulltime work with their own domestic commitments are discussed.
Midwives, Marginality, and Public Identity Work
Symbolic Interaction, 2005
Because midwifery in the United States is an occupation at the margins of medicine, midwives must frequently negotiate competing identity claims. This article examines the public identity work of a group of midwives by focusing on two important tools they use to accomplish this work: boundary negotiation and impression management. Drawing on data from indepth interviews with twenty-six licensed, nurse, and empirical midwives in the state of Florida, this article illustrates the ways in which midwives frame their identities in relation to history and media representations and manage public identities through boundary negotiation and impression management. I argue that the marginality of this occupation lends itself to competing categories of identity that midwives must negotiate. These categories become salient when midwives confront historical and media representations of childbirth and midwifery as well as the perceptions of the general public, consumers, lawmakers, and medical professionals.