The struggle for contested boundaries in the move to collaborative care teams in Australian maternity care

McIntyre, Meredith; Francis, Karen; Chapman, Ysanne

doi:10.1016/j.midw.2011.04.004

Cited by 23 publications

(12 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recent social scientific studies confirm that these ideological and professional differences persist (McIntyre et al . , Pollard , Reiger and Lane ). For example, an organisational case study found Australian midwives and doctors had significantly different attitudes to childbirth and differing professional cultures.…”

Section: Midwifery and Medicinementioning

confidence: 98%

Renegotiating inter‐professional boundaries in maternity care: implementing a clinical pathway for normal labour

Hunter

Segrott

2014

Sociology Health & Illness

View full text Add to dashboard Cite

This article presents findings from a study of a clinical pathway for normal labour (Normal Labour Pathway) implemented in Wales, UK. The study was conducted between 2004 and 2006. The pathway aimed to support normal childbirth and reduce unnecessary childbirth interventions by promoting midwife-led care. This article focuses on how the pathway influenced the inter-professional relationships and boundaries between midwives and doctors. Data are drawn from semi-participant observation, focus groups and semi-structured interviews with 41 midwives, and semi-structured interviews with five midwifery managers and six doctors, working in two research sites. Whereas some studies have shown how clinical pathways may act as ‘boundary objects’, dissolving professional boundaries, promoting interdisciplinary care and de-differentiating professional identities, the ‘normal labour pathway’ was employed by midwives as an object of demarcation, which legitimised a midwifery model of care, clarified professional boundaries and accentuated differences in professional identities and approaches to childbirth. The pathway represented key characteristics of a professional project: achieving occupational autonomy and closure. Stricter delineation of the boundary between midwifery and obstetric work increased the confidence and professional visibility of midwives but left doctors feeling excluded and undervalued, and paradoxically reduced the scope of midwifery practice through redefining what counted as normal.

show abstract

Section: Midwifery and Medicinementioning

confidence: 98%

Renegotiating inter‐professional boundaries in maternity care: implementing a clinical pathway for normal labour

Hunter

Segrott

2014

Sociology Health & Illness

View full text Add to dashboard Cite

show abstract

“…[35] Our study findings related to inter-professional collaboration between midwives and physicians concur with previous study results examining the collaboration between midwives, nurses and physicians in maternity services. [36,37] Simpson et al [38] found that nurse-midwives and physicians in maternity services had a common objective of improving maternal and neonatal outcomes; however, they did not always come to an understanding on how to achieve that shared objective. [38] Education programs for health professionals would benefit by focusing on inter-professional collaboration.…”

Section: Discussionmentioning

confidence: 99%

Midwives’ experience of participating in the Advanced Life Support in Obstetrics® educational program in Rwanda

Uwajeneza

Babenko-Mould

Evans

et al. 2015

JNEP

View full text Add to dashboard Cite

High maternal and newborn mortality rates remain a global health issue. Ninety-nine percent of maternal deaths occur in low and middle income countries and many could be prevented by having more qualified health providers. In 2013, 62% of maternal deaths took place in Sub-Saharan Africa. The Advanced Life Support in Obstetrics (ALSO R ) Educational Program is an internationally recognized continuous professional development course aimed at increasing the knowledge, skills, competence, and confidence of health professionals to manage obstetric emergencies. The purpose of this qualitative descriptive study was to explore midwives' experiences of translating the knowledge and skills acquired from participating in the ALSO R program into their professional practice in Rwanda. A purposive sample of nine midwives participated in one-to-one interviews directed at understanding their experience of implementing their new knowledge and skills into practice. All interviews were audio-recorded and transcribed verbatim. Content analysis was used to illuminate five themes: 1) Improved midwifery practice, 2) Availability of resources, 3) Inter-professional collaboration, 4) Job (dis)satisfaction, and 5) Autonomy for midwifery practice. The findings revealed that although midwives reported increased knowledge, skills and confidence in management of obstetric emergencies, their ability to change practice was often hampered by non-conducive work environments, a shortage of health care providers, and insufficient equipment and materials. These findings can serve to inform ALSO R course module development, midwifery education development, and health human resources policy that can address obstetrical and newborn education needs and health service delivery in Rwanda.

show abstract

“…Evidence that midwives have the skills necessary to perform as well as their medical peers in delivering equivalent outcomes in healthy women with substantial cost‐efficiencies 19 has focused attention on the economic benefits to be gained by efficiently functioning collaborative care teams. Discourses implicit in the struggle for contested boundaries of practice in maternity care involving the midwifery and obstetric professions are strongly present in the text 25 . The silent voice associated with consumers satisfied with obstetric care in the consultation process has inadvertently contributed to a consensus of opinion in support of the reforms in the absence of the counter viewpoint.…”

Section: Methodsmentioning

confidence: 99%

“…Discourses implicit in the struggle for contested boundaries of practice in maternity care involving the midwifery and obstetric professions are strongly present in the text. 25 The silent voice associated with consumers satisfied with obstetric care in the consultation process has inadvertently contributed to a consensus of opinion in support of the reforms in the absence of the counter viewpoint. Silence from this group of consumers represents the transitory nature of involvement with the service.…”

Section: Sociocultural Levelmentioning

confidence: 99%

Critical discourse analysis: Understanding change in maternity services

McIntyre

Francis

Chapman

2012

Int J of Nursing Practice

Self Cite

View full text Add to dashboard Cite

This paper provides an example of the use of critical discourse analysis (CDA) in the area of maternity care policy and describes the process of CDA as an effective research method for understanding the influences of change in the context of Australian maternity services. CDA is a methodological approach that examines how discourse is formed and given power, as a result of how power is used, who uses it and the context within which this usage takes place. The application of CDA is described in this study for the purpose of examining key-stakeholder use of knowledge and power for the purpose of influencing the direction of the maternity services reform. The CDA theoretical framework guided discourse identification and analysis of the purpose behind the discourse through examination of power relationships between key stakeholders. The use of a theoretical lens in the form of neoliberalism to supplement the theoretical framework facilitated the exposure of forces intrinsic to the maternity care context driving change.

show abstract

The struggle for contested boundaries in the move to collaborative care teams in Australian maternity care

Cited by 23 publications

References 33 publications

Renegotiating inter‐professional boundaries in maternity care: implementing a clinical pathway for normal labour

Renegotiating inter‐professional boundaries in maternity care: implementing a clinical pathway for normal labour

Midwives’ experience of participating in the Advanced Life Support in Obstetrics® educational program in Rwanda

Critical discourse analysis: Understanding change in maternity services

Contact Info

Product

Resources

About