An analysis of the language used in the documents created by midwifery professional bodies to describe the scope of practice of midwifery has shown that many of these definitions of scope of practice reveal a continuing orientation to a medical model of pregnancy and birth and a synonymisation of midwife-led care with woman centred care.
In a paper published in the December 2016 edition of Midwifery, O’Malley-Keighran and Lohan (2016) sampled data contained in documents produced by nine midwifery professional bodies from New Zealand, Ireland, Canada, Malaysia, the USA, Sweden and the International Confederation of Midwives (ICM).
Their paper offers a fascinating analysis of elements of the text of these documents, for example in looking at who is deemed to have agency within each statement. In other words, what does the text of documents imply about who (or what) is in control and at the centre of decision-making? Although we might think one thing, close analysis of what we are saying or doing can show that we – or our words – are (either deliberately or inadvertantly) suggesting or implying otherwise.
This is such an important idea, and O’Malley-Keighran and Lohan (2016) summarise their findings in relation to what they found about agency:
Three general types of definitions of scope of practice were identified; a formal type which focused on midwifery practice in which the midwife and woman were largely absent as agents, a second, less formal type which focused on the midwife as agent, from which the woman was largely absent as an active participant and one exception to the pattern which featured the woman as agent. The main type of verb used in the definitions was Doing Processes such as monitor, diagnose. Saying (advise), Sensing (identify), and Being (be able to) processes were much less frequent in the data. The definitions of scope of practice explored in this study (with one exception) revealed a general lack of woman-centeredness and more of a focus on an orientation to birth as a medically managed event.
I can’t say that I’m completely surprised to read these findings, as disappointing as they are, because they reflect the reality that a number of midwives and women feel disappointed by the reluctance of some midwifery professional bodies to support a truly woman-centred approach to pregnancy, birth and midwifery practice. But, as the authors suggest in their conclusion, “by analysing statements of scope of practice by professional bodies and the contexts in which they are produced, we can continue to reveal the underlying social, political, and historical forces that influence midwifery practice.” Perhaps this timely research will encourage us to pay more attention to what is contained within our words and documents.