Examining the social construction of childbirth in Australia : the politics of power

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Background: In 2008, a national review of maternity services was commissioned by the Australian Government. A number of significant reforms to the funding, organisation and delivery of maternity services were proposed with the stated intention of improving women’s access to high quality, safe maternity services. A community consultation process was undertaken as part of The Review, inviting interested parties to comment on the proposed reforms. Over 900 individuals and professional organisations responded. Aim: The aim of this study was to uncover the perceptions, beliefs and meanings associated with childbirth held by the key stakeholders in Australian maternity care. Methods: Discourse analysis was chosen as the methodology for this project as it enabled examination of the unspoken or hidden messages in the data, paying particular attention to the construction of childbirth and the manifestation of power relations. The data set comprised of 11 submissions from peak professional and consumer bodies to the National Maternity Services Review (MSR). Findings: The expression of, or desire for, power and control was found to be the major discourse underpinning all of the submissions analysed. In the context of maternity service reform, this discourse confirmed the existence of fundamentally different constructions of childbirth by the key stakeholders. This resulted in diverse opinions on how maternity services should be managed and operationalised. A discourse of risk and safety was used by the peak medical bodies to argue against the majority of proposed reforms. In contrast, peak nursing, midwifery and consumer groups used language that constructed childbirth as a normal life event. As such, submissions from midwifery, nursing and consumer groups demonstrated strong support for the Government’s reform agenda, arguing for a new vision for the future of maternity care that placed the childbearing woman at the centre of care. Discussion: A clash of ideologies was evident amongst the key stakeholders in Australian maternity care. The fundamentally different constructions of childbirth possessed by obstetricians and midwives (supported by nurses and consumers) support the notion of ‘turf wars’ in the maternity care system. Whilst midwives and obstetricians already work together collaboratively, it appears that their interactions are often underpinned by the ‘politics of power’. The findings of this research raise important issues around power and control in childbearing. They raise questions about women’s right to have control over their bodies in childbirth – including decisions about their most suitable care provider, model of care and intended place of birth. As long as the struggle for power underlines the actions of care providers, women will not truly be at the centre of maternity care. Conclusion: Understanding the different ideologies inherent in the professional and public discourses of childbirth provides insight into how each party can work together more effectively to ensure the delivery of high quality maternity services for Australian women. The encouragement of professional courtesy in practice would go some way in ameliorating the ‘politics of power’ that underpin maternity care providers’ interactions. Changes to the way medical and midwifery students are educated, including greater exposure to normal birth, is required. Further research into the socio-cultural meanings associated with birth is warranted as developing greater awareness of the different constructions of childbirth supports harmonious relationships between maternity care providers.
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