Abstract:
Change was a constant companion for New Zealand midwives during the
1990's. The Nurses Amendment Act 1990, that restored midwifery autonomy
was only one of a constellation of changes that saw significant restructuring of
the health services in small communities. The purpose of this study was to look
at the issues for a group of midwives in rural South Otago who took the
opportunity to work independently and offer local women a choice of maternity
care during this time.
In this study, five rural midwives were interviewed and met subsequently in a
focus group. The transcripts were analyzed using discourse analysis informed
by a postmodern/feminist theoretical framework. In addition the local
newspapers covering the years 1990-1999 were read with a particular focus on
the reports of health changes. These texts were also subjected to a discourse
analysis using Lyotard's (1997) notion of language games, and bell hook's
(1990) ideas around strategic positioning for the marginalised.
To practise autonomously, the midwives in this study perform an intricate
dance, balancing the contradictions of competing discourses. Their positioning
and place of difference is tensioned primarily by a deep sense of community
commitment and entanglement, and also by a feeling of physical and perceptual
distance from their urban midwifery colleagues. This is underpinned by a
staunch belief in women's ability to birth safely in their local area.
The findings of this study suggest that the continuation of a comprehensive
rural midwifery service is challenged by changes in the arrangement and
funding of rural health, plus the increasing use of medical and technological
intervention in childbirth. For rural midwifery to survive, this study shows that midwives need to remain flexible and alert while continuing to align themselves
with women who are their primary source of support and inspiration. At the
same time, they need to forge strategic linkages and alliances, both local and
national that will allow them to move and reposition in order to continue their
work and provide a realistic childbirth choice for rural women.
