Knowledge, power and resistance in midwifery practice and maternity care

Theoretical perspective In this presentation, we will draw on concepts from Michel Foucault to critically examine how power is distributed and exercised in maternity systems and  language and practices of health... [ view full abstract ]

Theoretical perspective

In this presentation, we will draw on concepts from Michel Foucault to critically examine how power is distributed and exercised in maternity systems and  language and practices of health professionals and organisational culture influence the implementation of evidence into practice.

Argument

Research in the fields of implementation science and knowledge translation report resistance to policy and practice change and emphasise the need for multidisciplinary approaches to address the challenges of implementing evidence into practice. In our research into maternity care, we have employed discourse analysis to examine practice, to understand how organisational culture and individual professional practice influence experiences and outcomes of the women who use maternity services in New South Wales, Australia. 

In this paper, we draw on three of our studies to examine the implementation of evidence based practice in midwifery services. These three studies examined: 1) the implementation of routine psychosocial assessment and depression screening in the perinatal period; 2) the facilitators and barriers to physiological birth positioning and 3) the implementation of principles and strategies to support the initiation and establishment of breastfeeding.

Discussion

An ethnographic approach with observations of practice and discourse analysis allowed us to take a ‘micro-perspective’ or a close-up view of ‘the Institution’ and how it works including an understanding of the cultures and how players act and feel in this context, and where the contradictions and areas of social conflict lie. In these studies we noticed a difference between what midwives say they do, or what they recognise as best practice, and what they actually do when observed in the practice setting. We were also able to observe and critique what professionals do in practice and to explore the impact of the environment on practice.

Conclusion

An innovation gap was observed across these different practice contexts. By applying key concepts from the work of Foucault, we propose this gap is influenced by the way in which guidelines are ‘imposed’ upon health practitioners (and consequently women) through a range of targets and performance measures.