The plasticity of professional boundaries: A case study of collaborative care in maternity services

Being safe practitioners and safe mothers: A critical ethnography of continuity of care midwifery in Australia

“…Lupton (1999 p 66) argues this resulted in the assumption that if childbearing women know about their risks, they will (and should) take precautions to avoid them. Such assumptions have shaped maternity services policy worldwide and, despite being safer than ever in the developed west, birth is an event for which risks must be identified, calculated and managed (Lane 2006;Tracy 2006). Edwards and Murphy-Lawless (2006) argue that medical control of childbirth was inevitable once doctors offered guarantees of safety, and such assurances remain the foundation on which medical dominance of childbirth rests (Skinner 2003;Symon 2006;Reiger 2006;MacKenzie Bryers & van Teijlingen 2010).…”

Primary maternity care reform: Whose influence is driving the change?

“…The discourse 'managerialism' in corporate governance came with changes in authority and accountability in the management of maternity services with managers functioning as independent arbitrators in service delivery. In this process the monopoly of medical authority in maternity care has been challenged by evidence that other maternity care professions such as general medical practitioners (GPs) in rural practice and midwives could perform equally well with substantial cost efficiencies (Lane, 2006). The discourse serves to undermine the strongly held power base of obstetric medicine exemplified in the fear based messages:…”

“…In a similar experience to other countries who have adopted a corporate governance approach the Australian health services management context has undergone significant change. The discourses; 'marketisation', 'managerialism' and 'consumerism' are central to corporate governance (Lane, 2006) and when applied to maternity services posed challenges to existing boundaries, which have traditionally supported elite professionals such as obstetricians (Lane, 2006). Challenges have arisen in response to the need for cost constraint in order to halt escalating costs associated with maternity services, changes to authority in the management of maternity services and the rise in consumer influence.…”

“…Implementation of the primary maternity care model will bring Australian maternity services in line with developments in New Zealand, Canada and the UK (Downe et al, 2010;Martin and Kasperski, 2010;Skinner and Foureur, 2010). The reform will see healthy pregnant women, formerly included into obstetric load, being re-categorised to non-obstetric based services (Lane, 2006). The reform requires maternity care professionals including general medical practitioners with procedural obstetric qualifications (GPO), midwives and obstetrics to work collaboratively in a multidisciplinary team providing continuity of care (Commonwealth of Australia, 2008;Commonwealth of Australia, 2009).…”

The future role of pharmacists in primary care

“…Sociologists speculate that this erosion of the traditional boundaries of professions is driven by diverse social pressures, such as globalisation, marketisation, managerialism, and consumerism. 7 Since pharmacists have acquired the capacity to recommend or prescribe more medicines without reference to a doctor and have taken on these new roles, their effectiveness has come under some scrutiny. 8 Thus, Davis et al in this month's BJGP assess the impact of the availability of over-the-counter topical chloramphenicol on the appropriateness of its use.…”