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Book part
Publication date: 30 June 2004

Lara Foley

This chapter is concerned with the varied legitimizing discourses used by midwives to frame their identities in relation to their work. This sociological issue is…

Abstract

This chapter is concerned with the varied legitimizing discourses used by midwives to frame their identities in relation to their work. This sociological issue is particularly important in the context of an occupation, such as this one, that exists at the border of competing service claims. Drawing on 26 in-depth interviews, I use narrative analysis to examine the stories that midwives tell about their work. Through these women’s work narratives, I show the complex intersection of narrative, culture, institution, and biography (Chase, 1995, 2001; DeVault, 1999).

Details

Gendered Perspectives on Reproduction and Sexuality
Type: Book
ISBN: 978-0-76231-088-3

Book part
Publication date: 25 November 2019

Melodie Cardin

This research studied the integration of Ontario midwives into the hospital system, through analysis of 15 semi-structured interviews with midwives throughout the Canadian…

Abstract

This research studied the integration of Ontario midwives into the hospital system, through analysis of 15 semi-structured interviews with midwives throughout the Canadian province. In 1994, following activism from parents and families who wanted “alternative” choices for childbearing, Ontario became the first Canadian province to legislate and publicly fund midwives. This followed nearly a century in which midwifery had all but disappeared in Canada, in part due to deliberate campaigns to discredit woman-centered health care and knowledge. The findings from this research were considered through the lens of Foucault’s concept of power/knowledge, to identify the ways in which medicalized norms have been privileged in Ontario birth care, and to demonstrate how pregnant people1 and midwives have struggled against the power/knowledge of hospital environments. This research looked at the ways that midwifery, as a social movement born of feminist and countercultural activism, offers possibilities for resisting disciplinary power. Midwives in Ontario offer an alternative to medicalized childbirth which recognizes that a birth caregiver’s role is not only the physical care of parents and babies, but guidance for families during a liminal experience – the birth of a new child, which changes a family permanently and profoundly.

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Childbearing and the Changing Nature of Parenthood: The Contexts, Actors, and Experiences of Having Children
Type: Book
ISBN: 978-1-83867-067-2

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Article
Publication date: 1 December 1994

D. Wayne Taylor and Faith Nesdoly

Using several frameworks for public policy analysis, documents howmidwifery in Ontario evolved from being illegal in 1982 to being aself‐regulated health profession in…

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Abstract

Using several frameworks for public policy analysis, documents how midwifery in Ontario evolved from being illegal in 1982 to being a self‐regulated health profession in 1990. In 1985, the Ontario Government agreed that midwifery should be “legalized”; but how to do it was the question. The lobbying efforts of two coalitions armed with research‐based evidence influenced the policy decision process. Coalition A favoured midwifery becoming a self‐regulated health profession based on their beliefs that: (1) childbirth should be “de‐medicalized” and (2) the parents have a right to choose. Coalition B favoured the medical model and believed that “treatment was better”; it opposed home births, in general, and midwifery being self‐regulated, in particular. Also examines future implications of the Midwife Act.

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Health Manpower Management, vol. 20 no. 5
Type: Research Article
ISSN: 0955-2065

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Article
Publication date: 1 May 2007

Rowena Doughty, Tina Harris and Moira McLean

The School of Nursing and Midwifery at De Montfort University has been consistently successful in producing student midwives who are, by the end of their chosen programme…

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Abstract

Purpose

The School of Nursing and Midwifery at De Montfort University has been consistently successful in producing student midwives who are, by the end of their chosen programme, fit for practice, purpose and award according to the DMU. This paper aims to investigate this claim.

Design/methodology/approach

The paper looks at De Montfort University where an innovative tripartite assessment process has been developed to support midwifery students in practice. This involves the student, his/her personal tutor and his/her clinical midwife mentor. All three are involved in the planning of appropriate learning experiences to facilitate the student in meeting the clinical learning outcomes, utilising a personal professional portfolio.

Findings

The paper finds that the close working relationships between the placement providers and the university have improved the assessment of practice and enhanced the student experience. Clinical midwife mentors have commented on how well the tripartite approach works and they appreciate the clear lines of communication that this relationship provides. The personal tutor role is well established in the School of Nursing and Midwifery and the midwifery team have developed this role to include the assessment of students within the tripartite structure. This is beneficial from a quality perspective; while clinical midwife mentors will obviously change due to differing student placements, the personal tutor is the variable that is the constant through the student's progression on the programme.

Originality/value

The tripartite approach to the practice assessment of pre‐registration midwifery education investigated in this paper has proved to be a robust approach to ensuring students are fit for practice, purpose and award at the point of qualification and eligible to register as a midwife with the Nursing and Midwifery Council.

Details

Education + Training, vol. 49 no. 3
Type: Research Article
ISSN: 0040-0912

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Article
Publication date: 5 March 2018

Melissa Cora Cardinal

The purpose of this paper is to advocate for improved service delivery of maternal-newborn care in northern Indigenous communities. This is done through critical…

Abstract

Purpose

The purpose of this paper is to advocate for improved service delivery of maternal-newborn care in northern Indigenous communities. This is done through critical examination of the loss of pregnancy and birthing knowledge and practice in these communities, from both a historical and contemporary lens. Supporting the return of traditional midwifery practices to the communities is the recommended solution.

Design/methodology/approach

The paper is a general review of the available literature regarding Indigenous birthing practices, historical and contemporary Canadian maternal health service provision, and midwifery.

Findings

Current maternal health care practice in these northern communities is not resolving service delivery and human resource inadequacies, highlighting the need for a community-based and midwifery-driven primary health care approach. Potential recommendations include implementing a comprehensive birthing initiative, innovative midwifery training, and promotion and support of the role of the community midwife.

Originality/value

“Lost births” is a largely unrecognized issue in Canadian public health literature. The value of this paper lies in its potential to stimulate discourse and advocacy.

Details

International Journal of Health Governance, vol. 23 no. 1
Type: Research Article
ISSN: 2059-4631

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Article
Publication date: 1 January 1997

Lesley A. Page

Important shifts in policy and practice, the shift to woman‐centred services, the recognition that midwives should be lead clinician in a number of cases, and the idea of…

Abstract

Important shifts in policy and practice, the shift to woman‐centred services, the recognition that midwives should be lead clinician in a number of cases, and the idea of effective care, are leading to fundamental change in the maternity services. For many years, midwives have shown interest in the idea of evidence‐based or effective care. There are a number of good reasons for the interest in evidence‐based care. However, unless the political reality of the difficulties of the change are faced, the changes will remain rhetorical, virtual rather than real. Midwifery holds the potential for using evidence in practice, and for improving health outcomes for mothers and babies. If the status quo is not challenged, an important opportunity will have been missed.

Details

Journal of Clinical Effectiveness, vol. 2 no. 1
Type: Research Article
ISSN: 1361-5874

Article
Publication date: 5 March 2018

Joy Kemp, Elizabeth M. Bannon, Mercy Muwema Mwanja and Deusdedit Tebuseeke

The purpose of this paper is to describe the development of a national standard for midwifery mentorship in Uganda, part of a wider project which aimed to develop a model…

Abstract

Purpose

The purpose of this paper is to describe the development of a national standard for midwifery mentorship in Uganda, part of a wider project which aimed to develop a model of mentorship for Ugandan midwifery using the principles of action research. It aims to stimulate debate about strengthening the capacity of a health regulatory body, midwifery twinning partnerships and the use of international health volunteer placements.

Design/methodology/approach

Model of mentorship for Ugandan midwifery was a 20-month project implemented by the Royal College of Midwives UK and the Uganda Private Midwives Association. Following a situational analysis, the project was structured around three action reflection cycles, participatory workshops, individual twinning relationships between UK and Ugandan midwives and peer exchange visits. The capacity of the Ugandan Nurses and Midwives Council (UNMC) to develop a standard for midwifery mentorship was assessed. A capacity building programme was then designed and implemented to develop the standard for midwifery mentorship.

Findings

The capacity of UNMC was increased and the standard was developed though has yet to be validated and adopted. However, this intervention may not be replicable as a stand-alone intervention because its success was inextricably linked to the wider programme activities and support structures.

Originality/value

This is the first paper describing midwifery twinning to strengthen the capacity of a regulatory body to develop practice standards.

Book part
Publication date: 22 November 2019

Lauren A. Diamond-Brown

Unassisted childbirth, also known as “freebirth,” is when a person intentionally gives birth at home with no professional birth attendant. The limited research on…

Abstract

Unassisted childbirth, also known as “freebirth,” is when a person intentionally gives birth at home with no professional birth attendant. The limited research on unassisted birth in the United States focuses on women’s reasons for making this choice. Studies suggest women are committed to birthing without a professional and that this choice is rooted in religious or natural-family belief systems. These studies do not adequately account for the ways a framework of “choice” obscures the role structural barriers play in decision-making processes. International research on unassisted childbirth finds that it is not always a first choice and may be a last resort for women who have had negative experiences with maternity care. More research on unassisted birth in the United States is needed to better understand if people face similar structural barriers. In this paper I examine how structural limitations of the US healthcare system intersect with values in decision-making processes about childbirth. Drawing on in-depth interviews with nine women who gave birth unassisted in the United States, I examine the women’s shared ideological commitments, negative experiences with health care, and barriers faced seeking care. I discovered that unassisted birth may not be a first, or even positive choice, but rather a compromise informed by ideological commitments and constrained choices. Structural barriers in the US healthcare system prevented women from having a professional birth attendant who they felt was acceptable, available, and accessible. I conclude by discussing the implications of these findings for debates about birth justice and health policy.

Details

Reproduction, Health, and Medicine
Type: Book
ISBN: 978-1-78756-172-4

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Article
Publication date: 12 August 2014

Colm O'Boyle

The purpose of this paper is to describe what it is like to be a midwife in the professionally isolated and marginalised arena of home birth in Ireland and to explore…

Abstract

Purpose

The purpose of this paper is to describe what it is like to be a midwife in the professionally isolated and marginalised arena of home birth in Ireland and to explore whether the organisation of home birth services and professional discourse might be undermining the autonomy of home birth midwives.

Design/methodology/approach

This paper is drawn from auto-ethnographic field work, with 18 of the 21 self-employed community midwives (SECMs) offering home birth support to women in Ireland from 2006 to 2009. The data presented are derived from field notes of participant observations and from interviews digitally recorded in the field.

Findings

Home birth midwives must navigate isolated professional practice and negotiate when and how to interface with mainstream hospital services. The midwives talk of the dilemma of competing discourses about birth. Decisions to transfer to hospital in labour is fraught with concerns about the woman's and the midwife's autonomy. Hospital transfers crystallise midwives’ sense of professional vulnerability.

Practical implications

Maternity services organisation in Ireland commits virtually no resources to community midwifery. Home birth is almost entirely dependent upon a small number of SECMs. Although there is a “national home birth service”, it is not universally and equitably available, even to those deemed eligible. Furthermore, restrictions to the professional indemnification of home birth midwives, effectively criminalises midwives who would attend certain women. Home birth, already a marginal practice, is at real risk of becoming regulated out of existence.

Originality/value

This paper brings new insight into the experiences of midwives practicing at the contested boundaries of contemporary maternity services. It reveals the inappropriateness of a narrowly professional paradigm for midwifery. Disciplinary control of individuals by professions may countermand claimed “service” ideologies.

Details

Journal of Organizational Ethnography, vol. 3 no. 2
Type: Research Article
ISSN: 2046-6749

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Article
Publication date: 9 July 2018

Angele Pieters, Kim E. van Oorschot, Henk A. Akkermans and Sally C. Brailsford

The purpose of this paper is to investigate inter-organizational designs for care–cure conditions in which low-risk patients are cared for in specialized care…

Abstract

Purpose

The purpose of this paper is to investigate inter-organizational designs for care–cure conditions in which low-risk patients are cared for in specialized care organizations and high-risk patients are cared for in specialized cure organizations. Performance impacts of increasing levels of integration between these organizations are analyzed.

Design/methodology/approach

Mixed methods were used in Dutch perinatal care: analysis of archival data, clinical research and system dynamics simulation modeling.

Findings

Inter-organizational design has an effect on inter-organizational dynamics such as collaboration and trust, and also on the operational aspects such as patient flows through the system. Solutions are found in integrating care and cure organizations. However, not all levels of integrated designs perform better than a design based on organizational separation of care and cure.

Practical implications

A clear split between midwifery practices (care) and obstetric departments (cure) will not work since all pregnant women need both care and cure. Having midwifery practices only works well when there are high levels of collaboration and trust with obstetric departments in hospitals. Integrated care designs are likely to exhibit superior performance. However, these designs will have an adverse effect on organizations that are not part of this integration, since integrating only a subset of organizations will feed distrust, low collaboration and hence low performance.

Originality/value

The originality of this research is derived from its multi-method approach. Archival data and clinical research revealed the dynamic relations between organizations. The caveat of some integrated care models was found through simulation.

Details

Journal of Integrated Care, vol. 26 no. 4
Type: Research Article
ISSN: 1476-9018

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