Medicine as discursive resource: legitimation in the work narratives of midwives

Abstract

This article examines the work narratives of midwives practicing in the United States, specifically in the State of Florida. We focus analytic attention on how the discourse of medicine is used as a resource in constructing a sense of legitimation for midwifery. Data are drawn from in-depth interviews with 26 direct-entry, licensed midwives and certified nurse-midwives. Historically, social scientific literature on midwifery has placed a midwifery, or a holistic, model of childbirth in polar opposition to a technocratic or medical model. In practical work, however, midwives demonstrate knowledge of, and make use of, a discourse of medicine to serve their purpose-at-hand. In these 'narratives of legitimation', the medical model does not emerge as an entity definable as separate and necessarily at odds with the midwifery model. Rather, the medical model is a resource through which midwives work narratively to construct the validity of their profession.The midwives interviewed use the discourse of medicine in three specific ways. First, they draw upon it as a contrast device, setting themselves and their work apart from the medical establishment. Second, midwives use the medical model to communicate necessary daily aspects of their work. Finally, they construct a story of medical collaboration to equate their work with that of physicians.

Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the ‘modernization’ of the medical workforce

“…From this study, the intra-professional boundary seems every bit as entrenched as interprofessional boundaries, between medicine and related professions, studied elsewhere (Norris, 2001;Foley & Faircloth, 2003;Hibbert et al, 2003;Mizrachi & Shuval, 2005). Indeed, geneticists tended to include a different profession-genetic counsellors-within their epistemic community where they explicitly excluded GPSIs.…”

“…Hibbert et al, 2003;Mclaughlin & Webster, 1998), and the need for immersion in day-to-day clinical-genetics work to achieve sufficient expertise to practise safely. In this way, geneticists" conceptions of the legitimacy of the existing jurisdictional boundary went to the very heart of their professional project, by locating expertise in lengthy professional training and ongoing interaction with other experts-defined relationally (Foley & Faircloth, 2003) through comparison with the "go-it-alone" model of general practice. This arose less from the esoteric nature of theoretical genetics knowledge than from the indeterminacy of applied clinical judgement, which relied in part on accumulated collective knowledge and learning by "osmosis," as the geneticist in Site D put it.…”

“…There is a considerable literature offering rich insights into strategies deployed by professions in legitimating their jurisdictional boundaries (e.g. Norris, 2001;Foley & Faircloth, 2003;Hibbert, Hanratty, May, Mair, Litva & Capewell, 2003;Mizrachi & Shuval, 2005), but relatively little of this studies these legitimatory strategies in relation to specific pressures of technology, policy or managerialism (Lupton, 1997;Sanders & Harrison, 2008). Rarer still are studies examining the reconstruction of professional boundaries by actors on the ground in the face of technological, managerial or policy changes which disrupt the existing division of jurisdictional responsibility (recent exceptions include Mclaughlin & Webster, 1998;Charles-Jones, Latimer & May, 2003;McDonald, Harrison, Checkland, Campbell & Roland, 2007).…”

‘Stars’ or ‘professionals’: the imagined vocation and exclusive knowledge of translators in Israel

“…These findings show that, by and large, the interviewees consent to, rather than renounce, the status hierarchy imposed by the discourse of elite translators and accept its underlying value-scale, albeit with ambivalence. Their ambivalence emerges from the complex ways they waver between embracing and rejecting elements of this elitist canonical discourse, thereby exhibiting a resourceful negotiation of their own occupational status and self-esteem (for other examples of such discursive identity and status negotiations see, e.g., Snow & Anderson 1987, Foley & Faircloth 2003, Sela-Sheffy 2006b. Let me examine a few examples of these self-imaging negotiations.…”

Women׳s views on partnership working with midwives during pregnancy and childbirth

“…In addition, health insurance only covers payment for a midwife licensed as a Certified Professional Midwife (CPM) in eleven American states (Carter, 2010). CPM's usually practice within the home or birth centres and are similar to independent midwives and community midwives in the UK whereas Certified Nurse Midwives (CNM's) are more commonly hospital based, working alongside doctors (Foley et al, 2003). Midwifery was legalised in some Canadian provinces from the early 1990s, and in 2002 between 3-5% of women were cared for by midwives (Benoit et al, 2010;Canadian Institute for Health Information, 2004 (ACOG, 2011, p.1) The power of language when using a medical discourse, with the emphasis on risk, reduces choice and further excludes woman from the decision making process (Williams, 1997).…”