Standards and stories: the interactional work of informed choice in Ontario midwifery care (original) (raw)
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Canadian Journal for Studies in Discourse and Writing/Rédactologie
Midwifery in Ontario, Canada exists at the intersection of mainstream healthcare ideology and an alternative, woman-centred ideology of care. As a result, midwifery interaction is characterized by discursive hybridity. We trace this hybridity in the conversational stories co-narrated by midwives and clients during clinic visits. We show how conversational storytelling performs a complex shifting and blending of rhetorical forms and functions integral to the clinical interaction. Conversational stories conform to the structural requirements of the clinic visit and unfold in different ways and perform different functions at different times. Stories may be told, evaluated, and received as institutionally relevant for both clinical and social purposes. Clinical stories perform relational functions, and stories that appear to be fully social orient to the clinical agenda. Hybridity is accomplished through two forms of linguistic borrowing: the blending of professional-institutional and m...
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Communication during labour is consequential for women's experience yet analyses of situated labour-ward interaction are rare. This study demonstrates the value of explicating the interactional practices used to initiate 'decisions' during labour. Interactions between 26 labouring women, their birth partners and HCPs were transcribed from the British television programme, One Born Every Minute. Conversation analysis was used to examine how decisions were initiated and accomplished in interaction. HCPs initiate decision-making using interactional practices that vary the 'optionality' afforded labouring women in the responsive turn. Our focus here is on the minimisation of optionality through 'assertions'. An 'assertive' turn-design (e.g. 'we need to…') conveys strong expectation of agreement. HCPs assert decisions in contexts of risk but also in contexts of routine activities. Labouring women tend to acquiesce to assertions. The expectation...
Storytelling in midwifery: is it time to value our oral tradition?
British Journal of Midwifery, 2017
Historically, midwifery has been an oral culture, where the generation of knowledge occurs through narrative or 'storytelling' rather than through scientific data. In recent years, however, the prevalence of scientific knowledge has dominated midwifery. The gold standard of scientific research is the randomised controlled trial, which is arguably a poor fit for normal midwifery practice because, in its purest form, midwifery is about supporting and enabling physiology with minimal intervention. A number of practices in midwifery have seen widespread adoption before there were published scientific data to support them. These include non-suturing of perineal tears in the 1990s, the use of water and, more recently, the use of hypnosis techniques for labour and birth. It seems possible that the narrative tradition of knowledge-sharing in midwifery may have contributed to these phenomena. Midwives should be encouraged to value this 'way of knowing' more highly, and research in the context of UK midwifery practice should be undertaken to develop the knowledge base. Keywords Midwifery | Storytelling | Narrative | Research | Evidence base T he generation of knowledge in midwifery arguably occurs through a kind of 'storytelling' rather than through scientific facts, but the prevalence of scientific know ledge has come to dominate midwifery practice. However, the gold standard of scientific research, the randomised controlled trial (which, in general terms, measures the effect of treatments or interventions) is a poor fit for normal midwifery practice, which is about supporting and enabling physiology with minimal intervention. This paper seeks to explore the value of storytelling in midwifery, presenting it as a legitimate and relevant form of knowledge for the profession.
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The purpose of this paper is to examine patient-provider narrative co-construction of symptoms, diagnosis and treatment in the medical consultation. Narrative scholarship has demonstrated that conversational narratives, including those that take place in medical consultations, are typically co-constructed by all participants within the conversation. In the context of the medical consultation, this means that patient narratives are co-constructed with providers, and that at times, provider contributions to the patient narrative can hide patient contributions. The inherent power asymmetry that exists between patient and provider facilitates the possibility for provider contributions to obscure those of the patient. Based on audio-recorded data from medical consultations between two different nurse practitioners and one patient,findings from this study demonstrate that such narrative co-construction leads to differential information regarding the patient's symptoms, diagnosis and t...