Space and place in the construction and performance of gendered nursing identities

Halford, Susan; Leonard, Pauline

doi:10.1046/j.1365-2648.2003.02601.x

Cited by 99 publications

(98 citation statements)

References 13 publications

(13 reference statements)

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“…One reason given for this feeling of control is that the woman has the higher status of 'resident' at home and the midwife is constructed as a 'visitor', whereas in hospital these roles are reversed. 37 Following this, Gilmour 38 argued that transforming hospital spaces so they are more home-like challenges the dominance of biomedical values, a claim disputed by Fannin,39 who argued that it is presumptive to assume that making a hospital space more like a home will in itself fend off the controlling influence of biomedicine. Others have also been critical of the assumptions that underlie the discourses of pro-home birth academics and activists.…”

Section: Development Of Birth Centresmentioning

confidence: 99%

An ethnographic organisational study of alongside midwifery units: a follow-on study from the Birthplace in England programme

McCourt

Rayment

Rance

et al. 2014

Health Services and Delivery Research

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BackgroundAlongside midwifery units (AMUs) were identified as a novel hybrid organisational form in the Birthplace in England Research Programme, to which this is a follow-on study. The number of such units (also known as hospital birth centres) has increased greatly in the UK since 2007. They provide midwife-led care to low-risk women adjacent to maternity units run by obstetricians, aiming to provide a homely environment to support normal childbirth. Women are transferred to the obstetric unit (OU) if they want an epidural or if complications occur.AimsThis study aimed to investigate the ways that AMUs in England are organised, staffed and managed. It also aimed to look at the experiences of women receiving maternity care in an AMU and the views and experiences of maternity staff, including both those who work in an AMU and those in the adjacent OU.MethodsAn organisational ethnography approach was used, incorporating case studies of four AMUs, selected for maximum variation on the basis of geographical context, length of establishment of an AMU, size of unit, management, leadership and physical design. Interviews were conducted between December 2011 and October 2012 with service managers and key stakeholders (n = 35), with professionals working within and in relation to AMUs (n = 54) and with postnatal women and birth partners (n = 47). Observations were conducted of key decision-making points in the service (n = 20) and relevant service documents and guidelines were collected and reviewed.FindingsWomen and their families valued AMU care highly for its relaxed and comfortable environment, in which they felt cared for and valued, and for its support for normal birth. However, key points of transition for women could pose threats to equity of access and quality of their care, such as information and preparation for AMU care, and gaining admission in labour and transfer out of the unit. Midwives working in AMUs highly valued the environment, approach and the opportunity to exercise greater professional autonomy, but relations between units could also be experienced as problematic and as threats to professional autonomy as well as to quality and safety of care. We identified key themes that pose potential challenges for the quality, safety and sustainability of AMU care: boundary work and management, professional issues, staffing models and relationships, skills and confidence, and information and access for women.ConclusionsAMUs have a role to play in contributing to service quality and safety. They provide care that is satisfying for women, their partners and families and for health professionals, and they facilitate appropriate care pathways and professional roles and skills. There is a potential for AMUs to provide equitable access to midwife-led care when midwifery unit care is the default option (opt-out) for all healthy women. The Birthplace in England study indicated that AMUs provide safe and cost-effective care. However, the opportunity to plan to birth in an AMU is not yet available to all eligible women, and is often an opt-in service, which may limit access. The alignment of physical, philosophical and professional boundaries is inherent in the rationale for AMU provision, but poses challenges for managing the service to ensure key safety features of quality and safety are maintained. We discuss some key issues that may be relevant to managers in seeking to respond to such challenges, including professional education, inter- and intraprofessional communication, relationships and teamwork, integrated models of midwifery and women’s care pathways. Further work is recommended to examine approaches to scaling up of midwifery unit provision, including staffing and support models. Research is also recommended on how to support women effectively in early labour and on provision of evidence-based and supportive information for women.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Development Of Birth Centresmentioning

confidence: 99%

An ethnographic organisational study of alongside midwifery units: a follow-on study from the Birthplace in England programme

McCourt

Rayment

Rance

et al. 2014

Health Services and Delivery Research

View full text Add to dashboard Cite

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“…Health care practitioners also, wittingly or otherwise, discourage interactions and requests for help from patients through their body language (Halford and Leonard 2003). Practitioners of complementary and alternative medical (CAM) usually articulate a more equalitarian view of practitioner-patient relations than those in allopathic medicine (Oerton 2004, Sointu 2006), but it is not by chance that their health care practices do not generally require the infliction of pain or the immobilization of the patient, so that the micropolitics of their interactions rarely challenge the equalitarian ethos.…”

Section: The Power Relations Of Body Workmentioning

confidence: 99%

Conceptualising Body Work in Health and Social Care

Twigg

Wolkowitz

Cohen

et al. 2011

Body Work in Health and Social Care

193

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Body work is a central activity in the practice of many workers in the field of health and social care. This article provides an introduction to the concept of body work -paid work on the bodies of others -and demonstrates its importance for understanding the activities of health and social care workers. Providing an overview of existing research on body work, it shows the manifold ways in which this can inform the sociology of health and illness -whether through a micro-social focus on the inter-corporeal aspects of work in health and social care, or through elucidating our understanding of the times and spaces of work, or through highlighting the relationship between mundane body work and the increasingly global movements of bodies, workers and those worked-upon. The article shows how understanding work undertaken on the bodies of others as 'body work' provides a mechanism for relating work in the sphere of health and social care to that in other sectors, opening up new avenues for research.

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“…Shaw and Kitzinger (2005) and Davis-Floyd and Davis (1996) are among a number of writers who have suggested that women feel more in control of their birth at home or in home-like settings such as free-standing birth centres. One reason given for this feeling of control is that the woman has the higher status of 'resident' at home and the midwife is constructed as a 'visitor', whereas in hospital these roles are reversed (Halford and Leonard 2003). This writing also echoed the critical literature on residential care, where those in need of care attempt to live 'private lives in public places' (Willcocks et al 1986).…”

Section: The Literature On Place and Therapeutic Spacesmentioning

confidence: 99%

Place of Birth and Concepts of Wellbeing

McCourt¹,

Rayment²,

Rance

et al. 2016

Anthropology in Action

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Unit -FMU). Midwifery units have been designed and intended specifically as locations of wellbeing and although the meaning of the term is used very loosely in public discourse, this claim is supported by a large epidemiological study, which found that they provide safe care for babies while reducing use of medical interventions and with better health outcomes for the women. Our research indicated that midwifery units function as a protected space, one which uses domestic features as metaphors of home in order to promote a sense of wellbeing and to re-normalise concepts of birth, which had become inhabited by medical models and a preoccupation with risk. However, we argue that this protected space has a function for midwives as well as for birthing women. Midwifery units are intended to support midwives' wellbeing following decades of professional struggles to maintain autonomy, midwife-led care 2 and a professional identity founded on supporting normal, healthy birth. This development, which is focused on place of birth rather than other aspects of maternity care such as continuity, shows potential for restoring wellbeing on individual, professional and 2 community levels, through improving rates of normal physiological birth and improving experiences of providing and receiving care. Nevertheless, this very focus also poses challenges for health service providers attempting to provide a 'social model of care' within an institutional context. Permanent repository link

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Space and place in the construction and performance of gendered nursing identities

Cited by 99 publications

References 13 publications

An ethnographic organisational study of alongside midwifery units: a follow-on study from the Birthplace in England programme

An ethnographic organisational study of alongside midwifery units: a follow-on study from the Birthplace in England programme

Conceptualising Body Work in Health and Social Care

Place of Birth and Concepts of Wellbeing

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