More Than a Question: A Conversation Analysis of Midwives' Approaches to Addressing Violence in Antenatal Care.

Abstract

Antenatal care consultations provide a critical opportunity to enquire about experiences of violence, yet midwives often face structural and practical barriers. Although several countries have implemented guidelines recommending routine enquiry, limited research has examined how midwives introduce this sensitive topic during consultations. This study uses conversation analysis (CA) to examine how midwives introduce questions about violence in 35 antenatal care consultations recorded in Norway, where the topic was raised in 21 cases. In all but one instance, midwives engaged in some form of interactional preparation before asking the question. Our findings identify two main approaches for introducing the topic: a task-oriented approach and a conversational approach. The task-oriented approach is characterised by its routine framing of the enquiry, accomplished through procedural pre-sequences and explicit references to institutional mandates. In contrast, the conversational approach is characterised by a gradual, sequential progression into the topic, achieved through the incorporation of related proxy topics or by responding to troubles-talk. Although each approach has distinct advantages and limitations, our analysis reveals that midwives address enquiries about violence with profound interactional sensitivity. These findings demonstrate how preparatory work functions as an interactional display of delicacy in managing sensitive topics, with implications for training and policy.