Social Work - Theses

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Start date: 2000 × End date: 2009 × Subject: Victoria × Subject: health ×

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    Professional aspirations and consumer expectations: nurses, midwives, and women's health
    GREHAN, MADONNA MAY ( 2009)
    This thesis undertakes a history of midwifery's present in the arena of Victoria, Australia. It asks: what lies behind midwifery's aspiration to differentiate itself as a profession, separate and distinct from nursing? The thesis applies contemporary and historical inquiry in two parts. In Part I, the contemporary arm, a review of discourses and policies was combined with individual (n=22) and group interviews (n=4) to discover the perspectives of nurses, midwives, consumers, and others, on midwifery's separation from nursing via its professionalising process. In the larger arm, Part II, midwifery's and nursing's historical and professional trajectories in Victoria were mapped from European settlement in the 1840s through to the present. This was achieved by detailed examination of a range of primary sources, including records of the Melbourne Women's Hospital, the Victorian parliament and its delegated authorities, and professional associations. The Foucauldian concept of government frames this interpretation of women's health care history. Government encompasses the themes of regulation and expertise, both of which are key elements in claiming status as a profession, and are argued here to be central in nursing's and midwifery's history. Because tensions over the status of pregnancy and birth as health states or potential illness states are longstanding, the concepts of health and illness also inform this inquiry. Midwifery's history is shown to be a contingent and complex history, intricately intertwined with that of nursing since the earliest days of settler society. Throughout 170 years of history following European settlement in Victoria, two themes dominate the provision of care to women, and the roles of midwives and nurses in that care. The primary theme is the safety of women. An interconnected theme is the politics of women's health, that is, the politics of delivering safety. Stemming from concerns about women's safety and how to achieve it, the arena of women's health care and the roles of midwives and nurses within it is characterised by a perennial cycle of seemingly intractable issues. These issues include: questions about who should practice midwifery/maternity care, under what conditions, what education and training is required for the role, perceived disparities between city and rural services, consumer choice, autonomy, and the cost of services. While the context in which these perennial problems are played out has changed considerably over time, and while the meaning of safety has shifted over time, the issues, themselves, have remained consistent. These intractable issues are a permanent feature of the women's health care arena. Over the 170 years of history examined here, they have not been resolved by the formation or reframing of professional identities, by the reconfiguration of education pathways, or by new models of care. Thus, the promise of a reformed maternity care service for the betterment of all women may not be achieved by midwifery's separation from nursing. In the Victorian setting, midwifery has had, and continues to have, much in common with nursing. A grasp of these historically-enduring commonalities confirms that there may be a lot to lose by midwifery's separation from nursing.