Crafting the Midwife: learning to care in the margins of biomedicine

Overview of the research

Aim: explore the consequences of the current organisational priorities of maternity services in the UK, examining the ways in which contemporary midwifery practice impacts upon maternal health. In the UK, the relational approach to childbirth exists largely in contrast to organisational arrangements that prioritise systems and professional adherence to guidelines emphasising a standardised view of childbearing processes (Flynn, 2002). McCourt et al (2009) argue that this underlying standardisation reifies a hegemonic biomedical conceptualisation of childbirth at the expense of other forms of knowledge.

The proposed research will consider the role of the midwife in the reproduction of and resistance to the contemporary organisational structure of maternity services in the UK. Inspired by research in medical anthropology (Prentice, 2013; Mol, 2002; Martin, 2001) and the anthropology of learning and education (Evans, 2006; Lave and Wenger, 1993; Toren, 1990), this research will investigate the political and social organisation of midwifery training and practice. It will situate midwifery practices in relation to the historical contingencies that have led to the current form of practice in the UK today, and examine the possibilities for midwives who advocate a social and female-centred approach to birth.

Current anthropological literature reveals that a significant proportion of contemporary midwifery activity reflects a renegotiation of what is assumed to be standard practice (Downe and Dykes, 2009; Scamell and Stewart, 2014). The proposed research, focusing on the ways in which midwives' communities of practice (Lave and Wenger, 1991) function, offers the promise of insight into the everyday enactment of midwifery as a relational and embodied skill.

Positioning of the research

This research will make visible the complex structural conditions and social processes of learning that produce midwives as practitioners with a particular ethical disposition. Such an approach emerges from new trends in the anthropology of learning that emphasise human beings as biologically determined to understand the world through others. This research will lend itself to a critical contribution to the debate about midwifery not only in the UK (NHS England, 2016), but also globally as governments and international health organisations (WHO, 2016) seek to reduce inequalities in maternal health provision.

Research design and methodology

The proposed research is ethnographic, with a significant period of fieldwork focusing on the training and education of midwives. The researcher is a practising midwife, which will facilitate access to relevant field sites and provide common ground with participants.

This research will observe student midwives who are approaching the end of their third year of training - and progressing into the first six months of their status as qualified midwives. As well as observing the training and interactions of student midwives in the educational setting, it will also observe their social interactions with one another outside of the formal setting. This is important for exploring learning within an anthropological framework. The project will conduct ethnographic interviews with teachers, and students as they transition to qualified midwifery status. Conducting ethnographic interviews with practising midwives at varying stages of their career will allow me to capture an in depth understanding of midwives' changing experience of the political, economic and social transformation that has led to a medicalisation of their profession. It will also interview those doctors working in obstetrics who work alongside midwives and who are also caught between their reliance on midwives' particular skill and the expertise that a medicalised model of birthing lends to them as facilitators of government-imposed standards and regulations for safe child birth.