Continuity of Midwifery Care in England: A New Professional Project?

Abstract

Over the last decade, an increasing amount of research has examined the relationship between gender and professionalization using female professional projects to illustrate how the generic notion of a profession has been a gendered one. This paper develops Witz's (1990) theory of professional strategies in female‐dominated occupations particularly regarding midwives in Britain in the twentieth century and suggests that an important dimension that also needs to be critically examined in midwifery history is the interaction of gender and social class within midwifery. Furthermore it documents the traditional emphasis in midwifery on the single woman's career path. This historical analysis has resonance today as midwifery in Britain is undergoing a renaissance. The role of the midwife and the current organization of the maternity services are being reviewed with the intention of providing increased choice and control over the reproductive process for women and increased continuity of care with a midwife. These changes are viewed as midwives' new professional project and the implications for midwives and women discussed. The aim of this paper is to explore the explanatory power of these approaches to current developments in maternity care and by drawing historical parallels, consider the impact that this professionalizing strategy may have for those who are excluded from this process of ‘dual closure’. Furthermore, this paper asks whether this new way of working empowers midwives, women, both or neither?

Born in the USA: Exceptionalism in Maternity Care Organisation among High-Income Countries

“…During the first decades of the twentieth century, midwifery in the US rapidly became a low status occupation. By way of contrast, in the UK, Finland, and the Netherlands the midwifery elite were reinventing the profession as an occupation for aspiring middle-class young women as they moved into the workplace (Heagerty 1997, Wrede 2001, Sandall 1996). Wiedenbach (1960:256) pointed out the negative connotation acquired by the term midwife in the US, although in the same period (first half twentieth century) there is some evidence of decline in the status of midwifery the UK (Heagerty 1997).…”

Understanding the social organisation of maternity care systems: midwifery as a touchstone

“…The main consumer organisations concerned with maternity care – the National Childbirth Trust, Association for Improvements in Maternity Care, and Maternity Alliance – began to challenge such medical dominance. In the 1980s research evidence also began to play an important role in legitimising these concerns, resulting in an alliance between consumers, the Royal College of Midwives (RCM) and the interest groups identified above (Sandall 1996). This coalescence created a ‘window of opportunity’ to introduce policy change (Kingdon 1995).…”

“Being with” while retaining and asserting professional midwifery power and authority in home birth

“…There is not room here for exploration of the power of risk and risk theory in society (Beck, 1992(Beck, , 1999 or even in childbirth (Murphy-Lawless, 1998). Nor is there room for discussion of how obstetrics and midwifery use definitions of normality in childbirth as a jurisdictional boundary and professionalizing strategy (Sandall, 1996;Witz, 1992). Nonetheless it can be seen that underpinning medical professional authority is the power to define health and normality and the claim to control and alleviate sickness; even to an extent, to prevent or postpone death.…”