Being safe practitioners and safe mothers: a critical ethnography of continuity of care midwifery in Australia.
OBJECTIVE
To examine how midwives and women within a continuity of care midwifery programme in Australia conceptualised childbirth risk and the influences of these conceptualisations on women's choices and midwives' practice.


METHODS
A critical ethnography within a community-based continuity of midwifery care programme, including semi-structured interviews and the observation of sequential antenatal appointments.


METHODS
Eight midwives, an obstetrician and 17 women.


RESULTS
The midwives assumed a risk-negotiator role in order to mediate relationships between women and hospital-based maternity staff. The role of risk-negotiator relied profoundly on the trust engendered in their relationships with women. Trust within the mother-midwife relationship furthermore acted as a catalyst for complex processes of identity work which, in turn, allowed midwives to manipulate existing obstetric risk hierarchies and effectively re-order risk conceptualisations. In establishing and maintaining identities of 'safe practitioner' and 'safe mother', greater scope for the negotiation of normal within a context of obstetric risk was achieved.


CONCLUSIONS
The effects of obstetric risk practices can be mitigated when trust within the mother-midwife relationship acts as a catalyst for identity work and supports the midwife's role as a risk-negotiator. The achievement of mutual identity-work through the midwives' role as risk-negotiator can contribute to improved outcomes for women receiving continuity of care. However, midwives needed to perform the role of risk-negotiator while simultaneously negotiating their professional credibility in a setting that construed their practice as risky.
University of South Australia, City East Campus, North Tce, Adelaide, SA 5000, Australia. Electronic address: shona.dove@unisa.edu.au.
Shona
S
Dove
Flinders University, GPO Box 2100, Adelaide 5001, SA, Australia. Electronic address: eimear.muircochrane@flinders.edu.au.
Eimear
E
Muir-Cochrane
D000884:Anthropology, Cultural; D001315:Australia / Q000453:epidemiology; D003266:Continuity of Patient Care / Q000592:standards* / Q000639:trends; D005260:Female; D006801:Humans; D008880:Midwifery / Q000379:methods / Q000592:standards*; D009035:Mothers; D011247:Pregnancy
Childbirth risk; Continuity of care; Identity; Midwifery; Mother–midwife relationship