Midwifery: a model of sustainable healthcare practice?
Degree GrantorUniversity of Canterbury
Degree NameDoctor of Philosophy
The global discourse around sustainability in healthcare has increased exponentially in the recent years. Sustainable healthcare has been defined as the long-term maintenance of health and wellbeing of the human population. However, there is a paucity of research around midwifery as a sustainable practice.
Using a qualitative research approach, I set out to establish what ‘sustainability’, in its broadest sense, meant to three groups of midwives practicing in the South Island of New Zealand. My aim was to define the term in relation to midwifery practice within the context of a caseload model and to determine whether sustainability was embraced as a concept of value in their work.
Within a series of focus groups, over a fourteen month period, using participatory action research as my methodological framework, I worked with purposefully selected midwives who represented a broad range of practice experience. Actor Network Theory (ANT) was used as a theoretical framework and analytical tool that enabled access to the networks via historical sources and from the data generated from the study.
Analysis of the data indicated that the midwives had an understanding of the tenets of environmental, economic and social sustainability and were able to relate the significance of these elements to their practice. However, their primary focus was on sustainability within the context of professionalism. Further analysis using ANT revealed a number of barriers that the midwives perceived as challenges to the sustainability of their professional identity and prohibited them from engaging with the broader tenets of sustainability within midwifery practice. It transpired that the hegemony of neoliberalism was instrumental in undermining the values of sustainability within the NZ midwifery context.
Neoliberalism makes its presence felt in multiple ways within the network, for instance in the concept of consumerism, in the materiality status of technology, in the semiotic nature of the nostalgia expressed by the midwives, and in the professional issues identified. These elements demonstrate that the barriers that impact on the professional identity of the midwives generate a ‘siege’ mentality, and it can be concluded that they prevent the midwives from engaging with the concept of sustainability in their practice.