Independent midwifery practice : a critical social approach : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University

Abstract

This study commenced three years after the passing of the. Nurses Amendment Act 1990 which gave midwives legal authority to practise without medical supervision. It explored the social and political contexts of the work-lives of four independent midwives in New Zealand. A critical social approach was used to examine how midwives manage and negotiate their practice in an environment in which a dominant medical discourse prevail. In-depth individual case studies were used for data collection and reporting. The research process provided an opportunity for participants to examine their takenfor- granted work environments and consider those personal actions and hegemonic structures which exist to constrain their practice. The participants surfaced those actions which could be described as counter-hegemonic and resistant to the dominant medical discourse. The study also illuminated those cognitive and physical actions which demonstrated compliance with medicalised childbirth and thus maintained the status quo. Midwives in this study used strategies of responsible subversion, the generation of midwifery language and the presentation of an alternative midwifery model of childbirth to contest medicalised childbirth. Within a context of assumed authority by doctors over the midwives the dominance of medical discourse prevailed. The participants were aware of the vulnerability of midwifery knowledge when it was made visible. It ran the risk of being dismissed as unscientific by medicine, or being incorporated into the dominant medical discourse on a superficial level. Conversely, midwifery knowledge that was not made visible was likely to remain marginalised and unrecognised.