‘So either you have a foetal monitor or you have your waters broken, basically is it?’: Articulating maternity care policy at a midwives’ ante-natal clinic

摘要

Maternity care in Ireland has been described as a ‘testament to the strength and influence of the medical profession' (Mc Kee 1986: 192). A review of maternity and gynaecology services in the Dublin area in 2004 revealed that ‘no participant…thought that the maternity services were women centred at the time' (Women's Health Council, 2007, Review of the gynaecology and maternity services in the greater Dublin area). Meanwhile, current Department of Heath policy aims to deliver ‘woman centred' maternity care as a means to ensuring the well being of Irish women (Department of Justice, Equality and Law Reform 2007, National women’s strategy 2007–2016. Dublin: Stationery Office). This paper deploys Frame Analysis in order to show how maternity policy is articulated in the face-to-face interaction of a midwives' ante-natal clinic. Drawing on the interactive notion of frames and knowledge schemas (Goffman 1967, Interaction ritual: Essays on face to face behaviour. New York: Pantheon; 1981, Tannen and Wallat 1993), the analysis shows how current maternity policy is articulated linguistically in the context of a midwives' ante-natal clinic. Several frames are intertwined in the talk: examination frame, reporting frame, socio-relational frame. The frames can be identified with reference to question- answer- commentext question exchange structures, and a conversational register. Frame switches are accomplished by both the women and the midwives. The medical model of pregnancy and birth prevails in the interactions. The analysis also shows how women attempt to articulate their perspectives on pregnancy and birth through the alignments they take up in the talk that occurs and through their ability to frame switch gracefully.Resistance to current policy occurs occasionally and fleetingly, instigated by women's introduction of a birth plan or by recommendations of the midwife. Resistance is a delicate undertaking and ultimately the medical perspective that prevails in the face-to-face interaction while alternative perspectives are heard as whispers that are easily silenced. Close analysis of how policy is enacted and resisted in face-to-face interaction in this health care context is important for enabling change to take place.