The politics of practice : case-loading midwifery practice in New Zealand

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In their daily work case-loading midwives traverse place. They visit childbearing women or attend childbirth in women’s homes and they may spend time in clinics or a variety of birthing facilities including smaller primary birthing units or larger obstetric hospitals. They spend their days engaging with childbearing women, their family or supporters and with obstetric, other professional or midwifery colleagues. As they move across place and between people, they traverse a variety of physical places and discursive spaces. Midwives journey into the intimate space of the childbearing woman attempting to understand their subjective experience and the way that this pregnancy and childbirth is situated within the landscape of their life world. They travel with this understanding as they negotiate other spaces; the biomedical space of the maternity context and obstetric hospital and the spaces of their own constructions of childbirth. This movement points to the complexity of midwifery practice. As midwives traverse a variety of discursive frameworks they must negotiate multiple and sometimes competing meanings and interests. The obstetric hospital setting provides midwives with particular challenges as they work to create, maintain and protect the birthing space of the women in their care. Ultimately midwives work to create a space for birthing that is perhaps unique to each midwife/woman pairing. Using a poststructural feminist approach, this thesis explores the discursive construction of case-loading midwifery in New Zealand. Midwives are often described as “guardians of normal birth” and this thesis argues that this is a constructed, strategic position rather than an ontological given. The practice of case-loading midwives within the obstetric hospital provides a focus, exposing the contested nature of maternity care and illustrating the way that midwives negotiate this contested terrain.
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