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Examines issues raised by Changing Childbirth. Summarizes an IMS/RCM report and is based on research in maternity units at different stages in the adoption of various approaches to developing continuity of care. It is concerned with the effect on midwives′ working lives and explores issues of grading, responsibility, working hours, career progression and job satisfaction.

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).

Since the 1990s, public health agencies as well as nutrition and child health experts have recognized breastfeeding as the most appropriate infant-feeding mode for optimal health and psycho-emotional development. Consequently, breastfeeding has become a standard of good mothering, internalized by mothers, who implement a demanding self-discipline to perform breastfeeding. This dedication reflects the delegation of biopolitics to individuals in modern neoliberal societies: authoritative experts inform new parents, who then bear the responsibility of their children's health risk management. They are expected to choose appropriate practices as part of a collective strategy of risk management and anticipation of the future by changing current behaviours, aiming at the emergence of a ‘healthy body and mind’ society. Among these practices, breastfeeding holds a central place due to medical consensus about its benefits. In my ethnography of postpartum consultations by independent midwives in Switzerland, I studied the breastfeeding practices and experiences of home birth parents as part of the ‘holistic care’ provided by these midwives. Shadowing midwives during their postpartum visits between 2014 and 2017, I witnessed parents committing to the body and emotional work required to carry out their ‘breastfeeding project’, designed in continuity with their out-of-hospital birth choice. During their follow-ups, midwives engage with parents in a shared construction of meanings around breastfeeding, anchoring parenting identities in the body. I explore in this chapter the issues raised by the production of lactating maternal bodies and how women engage in body and emotional work to achieve it.

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.

Language is a fundamental and yet extraordinarily powerful medium. Language is more than the primary feature distinguishing humans from other species. As our principle means of communication, language links us to culture, and in so doing, shapes our perceptions and determines the way in which we think (Clark, Eschholz & Rosa, 1981; Thorne, Kramarae & Henley, 1983). Language is inseparable from social life. Through language, individuals learn cultural patterns and political and social values (Mueller, 1973). Language also reflects the prejudices of society, with assumptions about relative status, power or appropriate behavior often built into the words we use to talk about different groups of people. As Frank and Anshen (1983) note, ageism, racism, and most importantly for this discussion, sexism, are all perpetuated by our language, even among those who consciously reject those prejudices.

Within maternity hospitals midwives are expected to follow the protocol‐driven culture and orders issued by senior staff. Simultaneously, midwives are expected to follow social policy documents and the Midwives Rules and Standards that advocate choice provision for childbearing women. Quality assurors and auditors of clinical practice need to be aware that these two directives sometimes clash. Allegiance to a hierarchical system driven by protocols and orders from the top down, at the same time as providing “woman‐centred” care is often unattainable. In order for a midwife to action the woman's choice, resourceful thinking may be required. This paper aims to examine this issue.

A descriptive interview study set out to discover strategies which midwives use to resolve conflict produced from competing directives. An appraisal of 20 midwives' views were gained from semi‐structured interviews conducted in seven maternity units in the UK. Taking a post‐positivist approach, inductive thematic analysis was used to interpret the data.

Three main categories represented resourceful ways of pleasing both authority and the childbearing woman. Midwives occasionally: are economical with the truth; circumvent face‐to‐face confrontation with senior staff; and persuade women to refuse what they perceive are unnecessary and invasive interventions.

This paper offers unique insights into methods that midwives use to resolve conflicts in direction issued by management. It is important that auditors are aware that midwives sometimes struggle to support the preferences of healthy childbearing women. This reduces job satisfaction, delivery of care and consequently requires address.

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.

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.

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.

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.

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.

Using a health belief model (HBM), this study aims to assess the knowledge, attitudes and practices of Iranian midwives in relation to HIV/AIDS protection behavior and to determine the needs of interventional programs for promotion of the behavior among midwives of maternity care units.

This was a cross‐sectional study in five selected hospitals in Isfahan. All 58 midwifery personnel of maternity wards of these hospitals participated in the study. Tools for data collection were a checklist to assess midwives' practice and a questionnaire to assess knowledge, attitude, and the HBM of midwives about HIV/AIDS‐protection methods.

A total of 58 midwifery personnel with average working experience of 10.92±7.98 years were assessed in the study and with a high knowledge, positive attitude and moderate practice about HIV/AIDS protection methods. The midwives perceived two main barriers, which impacted on their self‐efficacy and their protection behavior. These barriers were the emergency conditions of the work and the low availability of protective equipment.

HIV/AIDS protection behavior and HBM of midwives can be promoted by overcoming management barriers such as inadequate midwifery personnel in emergency conditions and insufficient protective equipment. The behavior also needs to be promoted by educational interventions which focus on improving midwives' perceived risk of HIV/AIDS infection.

Women with little-to-no English continue to have poor birth outcomes and low service user satisfaction. When language support services are used it enhances the relationship between the midwife and the woman, improves outcomes and ensures safer practice. However, this study has shown a reluctance to use professional interpreter services by midwives. This study aims to understand the experiences of midwives using language support services.

A maximum variation purposive sampling strategy was used to recruit midwives (N = 12) to a qualitative, semi-structured interview study. Data were analysed using thematic analysis.

Four themes were generated from the data analysis with a central organising concept of “Navigating Care Without Language”. These themes were: “Continuity as Key”, “Facilitating Tools”, “Networks of Support” and “Innovative Planning”. Each of these themes had between three and four sub-themes. It was found midwives are keen to support women with language barriers. However, support can be difficult due to the unavailability of equipment and resources; lack of continuity (of interpreter and midwife); inability to plan for the acute care of women who require interpreter services; and the system not being accessible enough to women who require language support services, thus causing them to fall through the net.

Continuity of carer appears to be a protective factor due to the flexibility, relationship and continuum of support. This study will aid the development of education for undergraduate, post-graduate and practising midwives. It will also inform policymakers working to improve the service offered to women who speak little-to-no English.

Many practising midwives feel neither confident nor competent to answer the nutritional concerns of pregnant women in their care. This study was designed to develop and evaluate a nutrition open‐learning pack for practising midwives. A statistically significant increase (p < 0.001) in midwives’ nutrition knowledge scores was demonstrated following study of the nutrition open‐learning materials. Evaluation of the nutrition open‐learning materials was positive with constructive comments and suggestions being made for further development. Open learning is a time‐consuming activity that requires support from managers in terms of study time. As a strategy, open‐learning materials can be developed for whatever the topic and academic level required, which could encompass pre‐registration midwifery education, post‐graduate study and continuing professional development (CPD).