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Midwives’ emotion and body work in two hospital settings : personal strategies and professional projects
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Rayment, Juliet (2011) Midwives’ emotion and body work in two hospital settings : personal strategies and professional projects. PhD thesis, University of Warwick.
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Official URL: http://webcat.warwick.ac.uk/record=b2521739~S15
Abstract
Much has been written in recent years of a ‘crisis’ in the recruitment and retention of
midwives in the NHS. The crisis has been attributed variously to burnout, a lack of
professional autonomy, a bullying culture, and an ideological conflict between the
way in which midwives wish to practise and the way they are required to practise
within large bureaucratic institutions, such as NHS Trusts. Negotiating these
experiences requires a significant amount of emotional labour by midwives, which
they may find intolerable. This thesis explores the strategies NHS midwives deploy
in order to continue working in NHS maternity services when many of their
colleagues are leaving. It examines the extent to which working in a midwife-led
service rather than a consultant-led service helps or hinders midwives’ capacity to
manage the emotional and ideological demands of their practice.
Ethnographic fieldwork was carried out in a consultant unit and an Alongside
Midwife-led Unit (AMU) in two NHS Trusts in England. The findings from
negotiated interactive observation and in-depth unstructured interviews with eighteen
midwives were analysed using inductive ethnographic principles.
In order to ameliorate the emotional distress they experienced, the midwives used
coping strategies to organise the people and spaces around them. These strategies of
organisation and control were part of a personal and professional project which they
found almost impossible to articulate because it ran contrary to the ideals of the
midwifery discourse. Midwives explained these coping strategies as firstly, necessary
in order to deal with institutional constraints and regulations; secondly, out of their
control and thirdly, destructive and bad for midwifery. In practice it appeared that the
midwives played a role in sustaining these strategies because they formed part of a
wider professional project to promote their personal and professional autonomy.
These coping strategies were very similar in the Consultant Unit and the Midwifery
Unit. A midwife-led service provided the midwives with a space within which to
nurture their philosophy of practice. This provided some significant benefits for their
emotional wellbeing, but it also polarised them against the neighbouring Delivery
Suite. The resulting poor relationships profoundly affected their capacity to provide a
service congruent with their professional ideals. This suggests that whilst Alongside
Midwife-led Units may attempt to promote a midwifery model of care and a good
working environment for midwives, their proximity to consultant-led services
compounds the ideological conflict the midwives experience. The strength of their
philosophy may have the unintended consequence of silencing open discussion about
the negative influence on women of the strategies the midwives use to compensate
for ideological conflict and a lack of institutional and professional support.
Item Type: | Thesis (PhD) | ||||
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Subjects: | R Medicine > RG Gynecology and obstetrics | ||||
Library of Congress Subject Headings (LCSH): | Midwives -- Great Britain, Great Britain. National Health Service, Job stress | ||||
Official Date: | May 2011 | ||||
Dates: |
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Institution: | University of Warwick | ||||
Theses Department: | Department of Sociology | ||||
Thesis Type: | PhD | ||||
Publication Status: | Unpublished | ||||
Supervisor(s)/Advisor: | Wolkowitz, Carol ; Bradby, Hannah, 1966- | ||||
Sponsors: | Economic and Social Research Council (Great Britain) (ESRC) (PTA−031−2006−00332) | ||||
Extent: | 358 leaves : ill. | ||||
Language: | eng |
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