Shona Dove1, Eimear Muir-Cochrane2. 1. University of South Australia, City East Campus, North Tce, Adelaide, SA 5000, Australia. Electronic address: shona.dove@unisa.edu.au. 2. Flinders University, GPO Box 2100, Adelaide 5001, SA, Australia. Electronic address: eimear.muircochrane@flinders.edu.au.
Abstract
OBJECTIVE: To examine how midwives and women within a continuity of care midwifery programme in Australia conceptualised childbirth risk and the influences of these conceptualisations on women's choices and midwives' practice. DESIGN AND SETTING: A critical ethnography within a community-based continuity of midwifery care programme, including semi-structured interviews and the observation of sequential antenatal appointments. PARTICIPANTS: Eight midwives, an obstetrician and 17 women. FINDINGS: The midwives assumed a risk-negotiator role in order to mediate relationships between women and hospital-based maternity staff. The role of risk-negotiator relied profoundly on the trust engendered in their relationships with women. Trust within the mother-midwife relationship furthermore acted as a catalyst for complex processes of identity work which, in turn, allowed midwives to manipulate existing obstetric risk hierarchies and effectively re-order risk conceptualisations. In establishing and maintaining identities of 'safe practitioner' and 'safe mother', greater scope for the negotiation of normal within a context of obstetric risk was achieved. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The effects of obstetric risk practices can be mitigated when trust within the mother-midwife relationship acts as a catalyst for identity work and supports the midwife's role as a risk-negotiator. The achievement of mutual identity-work through the midwives' role as risk-negotiator can contribute to improved outcomes for women receiving continuity of care. However, midwives needed to perform the role of risk-negotiator while simultaneously negotiating their professional credibility in a setting that construed their practice as risky. Crown
OBJECTIVE: To examine how midwives and women within a continuity of care midwifery programme in Australia conceptualised childbirth risk and the influences of these conceptualisations on women's choices and midwives' practice. DESIGN AND SETTING: A critical ethnography within a community-based continuity of midwifery care programme, including semi-structured interviews and the observation of sequential antenatal appointments. PARTICIPANTS: Eight midwives, an obstetrician and 17 women. FINDINGS: The midwives assumed a risk-negotiator role in order to mediate relationships between women and hospital-based maternity staff. The role of risk-negotiator relied profoundly on the trust engendered in their relationships with women. Trust within the mother-midwife relationship furthermore acted as a catalyst for complex processes of identity work which, in turn, allowed midwives to manipulate existing obstetric risk hierarchies and effectively re-order risk conceptualisations. In establishing and maintaining identities of 'safe practitioner' and 'safe mother', greater scope for the negotiation of normal within a context of obstetric risk was achieved. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The effects of obstetric risk practices can be mitigated when trust within the mother-midwife relationship acts as a catalyst for identity work and supports the midwife's role as a risk-negotiator. The achievement of mutual identity-work through the midwives' role as risk-negotiator can contribute to improved outcomes for women receiving continuity of care. However, midwives needed to perform the role of risk-negotiator while simultaneously negotiating their professional credibility in a setting that construed their practice as risky. Crown
Authors: Celia P Grigg; Sally K Tracy; Virginia Schmied; Amy Monk; Mark B Tracy Journal: BMC Pregnancy Childbirth Date: 2015-12-18 Impact factor: 3.007