‘Any lumps or bumps up top?’ The discourse of midwifery

Traditionally, studies of interaction in medical settings have tended to focus almost exclusively on doctor-patient interaction with the activities and perspective of the medical professionals receiving the lion’s share of attention. As a result, the conversational activity of the patient or service-user has been obscured, and their role in the interaction left, with a few exceptions, largely undefined (Davis 1988, Metrustry 1993). This paper examines the interaction that takes place at a midwives’ antenatal clinic in a busy, urban Irish maternity hospital from the perspective of both participants. The visits of 22 women to this clinic were recorded over a five-month period. The women ranged in age from 18-39 years and from 16 weeks pregnant to 40 weeks and 10 days pregnant. Five midwives were involved in the study. Seventy-one visits to the clinic were recorded. Using an adaptation of Mishler’s (1984) approach to the analysis of medical discourse, the content of participants’ models for pregnancy and birth as revealed in the discourse are described. Key elements of the women’s model of pregnancy and birth include: their view of these events as integrated into their life as a whole, their subjective experience of these events, their orientation to the midwifery frame of reference, and their ability to challenge dominant cultural assumptions about birth in contemporary Irish society. Midwives were found to use a template of pregnancy and to compare the women they encounter at the clinic to this template. They have sets of expectations for women at different stages of gestation, for women who are pregnant for the first time, for women with experience of pregnancy, and for developments known as minor disorders of pregnancy. The attempts to make women to conform to the expectations set out by the model are visible in the discourse and frequently made explicit by the midwives. Both midwives and women are successful at introducing their model for pregnancy and birth. Ultimately, however, it is the midwifery model that prevails as the midwives, by virtue of their role as professionals in the interaction and the location of the interaction in an institutional context, can steer the conversation back into the world of midwifery. This results in the silencing of women’s perspective on pregnancy and birth and also results in preventing of a plurality of voices from emerging in the discourse.