Relative professional roles in antenatal care: results of a survey in Scottish rural general practice

How midwives' discursive practices contribute to the maintenance of the status quo in English maternity care

BACKGROUND

poor relationships between maternity care professionals still contribute to poor outcomes for childbearing women, although issues concerning power, gender, professionalism and the medicalisation of birth have been identified and discussed as germane to this situation for nearly three decades. Although power relationships and communication issues are known to affect the way maternity care professionals in the UK work together, there has been no study of the interplay between these factors, or of how semiotic aspects of professionals' communication relate to it.

AIM

to explore how National Health Service midwives' discursive practices relate to the status quo; that is, how they contribute either to maintaining or challenging traditional discourses concerning power, gender, professionalism and the medicalisation of birth.

METHOD

in a qualitative study within a critical discourse analysis framework, data were collected from maternity care professionals and women within one English maternity unit, through semi-structured interviews and observation of physical behaviour and naturally occurring conversation.

FINDINGS

midwives in the unit revealed an inconsistent professional identity, sometimes challenging established hierarchies and power relationships, but often reinforcing traditional notions of gender, professionalism and the medicalisation of birth through their discursive practices.

CONCLUSIONS

given the known effect of wider social factors on maternity care, it is not surprising that the status quo persists, and that problems linked to these factors are still commonplace. This situation is compounded by the conflicting obligations under which UK midwives are forced to practice. These findings may have implications for midwives' capacity to respond to current challenges facing the profession.

Groups or teams in health care: finding the best fit

RATIONALE

In the evolution of the team concept, clear distinctions between 'groups' and 'teams' were made. In this paper we argue that these distinctions were not made explicit in the translation of team structures to health care. Even though teams are appropriate for many health care settings, this paper explores the notion that when teams may not be working, it is the concept of team that may not be appropriate, not the functioning of the team itself.

METHODS

This paper reviews the differences between teams and groups, and identifies how these differences are expressed in health care settings using urban and rural examples from the UK and Australia.

RESULTS

Some suggestions about matching structures to suit the unique nature of health care provision, particularly in community health settings, are made.

DISCUSSION

Instead of concentrating on improving the process of teams, the focus could be better directed to ensure that whatever structure is utilized best facilitates the necessary outcomes in the most effective way. The team approach may not always be the best approach, and sometimes referring to a number of people working together as a group is sufficient.