Critical Medical Anthropology in Midwifery Research

Newnham, Elizabeth; Pincombe, Jan; McKellar, Lois

doi:10.1177/2333393616675029

Cited by 12 publications

(6 citation statements)

References 15 publications

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“…Data, therefore, were analysed using Geertz’ concept of ‘thick description’, as well as an analytic framework adapted from Baer, Singer and Johnsen’s Levels of Health Care Systems model that frames data analysis according to four system-levels, from the macro to the individual perspective [16, 24]. Using this analytic method, underpinned by the triad of chosen theory, we identified ways in which the experience of birth have been shaped by hegemonic discourses, with a view to recognizing how these understandings have been embodied or resisted by women and midwives.…”

Section: Methodsmentioning

confidence: 99%

“…In this article, we use an intermediate social level of analysis to describe the dynamics of the hospital [16]. After a brief overview whereby we position the institution from the perspective of a critical methodology (CMA), we outline Foucault’s identification of the medical gaze, and depict how institutional surveillance, the Organisational technology , was symbolised by the Journey Board .…”

Section: Introductionmentioning

confidence: 99%

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Paradox of the institution: findings from a hospital labour ward ethnography

Newnham

McKellar

Pincombe

2017

BMC Pregnancy Childbirth

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BackgroundInterest in the influence of culture on birth practices is on the rise, and with it comes a sense of urgency to implement practices that aid the normalisation and humanisation of birth. This groundswell is occurring despite a broader cultural milieu of escalating technology-use and medicalisation of birth across the globe. Against this background, rates of epidural analgesia use by women in labour are increasing, despite the risk of side effects. Socio-cultural norms and beliefs are likely to influence pain relief choices but there is currently scant research on this topic.MethodsThis study was undertaken to gain insight into the personal, social, cultural and institutional influences on women in deciding whether or not to use epidural analgesia in labour. The study had an ethnographic approach within a theoretical framework of Critical Medical Anthropology (CMA), Foucauldian and feminist theory. Given the nature of ethnographic research, it was assumed that using the subject of epidural analgesia to gain insight into Western birth practices could illuminate broader cultural ideals and that the epidural itself may not remain the focus of the research.ResultsFindings from the study showed how institutional surveillance, symbolised by the Journey Board led to an institutional momentum that in its attempt to keep women safe actually introduced new areas of risk, a situation which we named the Paradox of the institution.ConclusionsThese findings, showing a risk/safety paradox at the centre of institutionalised birth, add a qualitative dimension to the growing number of quantitative studies asserting that acute medical settings can be detrimental to normal birth practices and outcomes.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Paradox of the institution: findings from a hospital labour ward ethnography

Newnham

McKellar

Pincombe

2017

BMC Pregnancy Childbirth

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“…Having previously articulated a macro-social level of analysis (see Newnham et al, 2016b), looking at the way that epidural analgesia is presented in medical discourse (Newnham et al, 2016a) and the intermediate-and micro-social analysis by looking at the influence of institutional culture and policy on midwifery practice (Newnham et al, 2015;Newnham et al, 2017), and now the information given to and received by women, we have been able to illustrate the way in which these discourses were operationalised at the micro-level of the informed consent process as well as the influence of these discourses on the individual-level-how they affect women's experience of labour and birth.…”

Section: Discussionmentioning

confidence: 99%

“…Where this intersects with CMA, is in the identification of the influence of hegemonic discourse on the institution, and the ensuing influence of the institution on practice, including how practitioners interact with, and speak to clients (Newnham et al, 2015;Lazarus, 1988;Singer and Baer, 1995;Baer et al, 1986). Our intention here is to explain the 'intermediate-social' level of interaction (see Newnham et al, 2016b) between the midwives and women and show how this was influenced by hospital policy and practice expectations as well as how it affected women's experience.…”

Section: Introductionmentioning

confidence: 99%

‘It's your body, but…’ Mixed messages in childbirth education: Findings from a hospital ethnography

2017

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Objective: to investigate the personal, social, cultural and institutional influences on women making decisions about using epidural analgesia in labour. In this article we discuss the findings that describe practices around the gaining of consent for an epidural in labour, which we juxtapose with similar processes relating to use of water for labour and/or birth.Design: ethnography.Setting: tertiary hospital in Australian city. Participants: sequential interviews were conducted with 16 women; hospital staff (primarily midwives and doctors) participated during six months of participatory observation fieldwork.Findings: women were not given full disclosure of either practice and midwives tailored the information they gave according to the institutional policies rather than evidence.Key conclusions: informed consent is an oft-cited human right in health care, yet in maternity care the micropolitics of how informed consent is gained is difficult to ascertain, leading to a situation whereby the concept of informed consent is more robust than the reality of practice; an illusion of informed consent exists, yet information is often biased towards medicalised birth practices.Implications for practice: as primary maternity care-givers, midwives have a role in providing unbiased information to women; however it appears that hospital culture and policy affect the way that this information is presented. It is arguable whether women in such instances are giving true informed consent, and for this reason, the ethics of these hidden practices are questioned.

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“…Despite common critiques of ethnography as being unscientific and too limited to allow generalization ( Herbert, 2000 ), in recent years, there has been a growing interest in the use of ethnography in healthcare research ( Bunce et al, 2014 ; Eccles et al, 2012 ; Greenhalgh, 2018 ; Greenhalgh & Swinglehurst, 2011 ), including maternity care. Ethnography is a methodology used in maternity settings that can promote creativity, rigor, and reveal complex phenomena with a capacity to formulate understanding ( Newnham et al, 2016 , 2021 ), hence this setting was chosen for this study. In addition, maternity was selected as the setting for this study as the authors of this paper are part of an academic research group whose remit is maternity care, and the second author is a midwifery academic.…”

Section: Introductionmentioning

confidence: 99%

The Use of Ethnography in Maternity Care

Coates

Catling

2021

Global Qualitative Nursing Research

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While the value of ethnography in health research is recognized, the extent to which it is used is unclear. The aim of this review was to map the use of ethnography in maternity care, and identify the extent to which the key principles of ethnographies were used or reported. We systematically searched the literature over a 10-year period. Following exclusions we analyzed 39 studies. Results showed the level of detail between studies varied greatly, highlighting the inconsistencies, and poor reporting of ethnographies in maternity care. Over half provided no justification as to why ethnography was used. Only one study described the ethnographic approach used in detail, and covered the key features of ethnography. Only three studies made reference to the underpinning theoretical framework of ethnography as seeking to understand and capture social meanings. There is a need to develop reporting guidelines to guide researchers undertaking and reporting on ethnographic research.

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Critical Medical Anthropology in Midwifery Research

Cited by 12 publications

References 15 publications

Paradox of the institution: findings from a hospital labour ward ethnography

Paradox of the institution: findings from a hospital labour ward ethnography

‘It's your body, but…’ Mixed messages in childbirth education: Findings from a hospital ethnography

The Use of Ethnography in Maternity Care

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