‘You don’t know what’s going on in there’: a discursive analysis of midwifery hospital consultations

Abstract

In contemporary Western society, the concept of risk is mostly linked related to negative or undesirable outcomes and used to explain unusual or abnormal events that have harmful consequences. Working in a poststructuralist framework, in this article we examine how risk shapes interactions between midwives and pregnant women in the context of public hospitals in Australia. We draw on data from an observational study of clinical encounters in three Australian hospitals between October 2014 and July 2015. The research teams recorded 83 health encounters and in this paper we draw on data from the recordings of 10 clinical consultations between 8 midwives and 10 pregnant women at various stages of gestation. We used these data to explore how a discourse of risk was mobilised through rhetorical strategies and practices of ‘hunting’ for the abnormal and attempts to control the body. Our findings demonstrate how a discourse of pregnancy and birth as risky operates within public hospital midwifery consultations. We found that in the midwifery consultations we recorded, pregnancy was constructed as a period of vulnerability and unpredictability. It was normalised through discursive practices of hunting for the abnormal and rhetorical strategies of attempting to control the body. Within this discourse, midwives occupied conflicting positions. They asserted that women, with the right support, were capable of spontaneous and intervention-free (pregnancy and) birth. Yet, they acted to enable medical professionals to assess a woman’s ability to give birth (un)assisted, or the potential for an adverse event. The women, while positioned as passive within the public health system, were positioned as active in surveilling themselves and responsible for taking steps to mitigate against adverse events.

Keywords:

• risk
• pregnancy and birth
• discourse
• health

Acknowledgements

We would like acknowledge and thank the people and organisations who were involved in and contributed to the development on this project and the preparation of this manuscript. We would also like to thank the patients and health professionals who participated in this project.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Australian Research Council: [grant number DP130104164], awarded to Renata F.I. Meuter, Cindy Gallois, Norman Segalowitz and Andrew G. Ryder.