From changing childbirth to better births: a critical discourse analysis of maternity policies in the NHS

Recent high-profile investigations into maternity care, by Ockendon (2022) and Kirkup (2023) have highlighted the concerns with the quality of maternity care in the NHS. The role of midwives is not immune from this and the wider discourse that now surrounds practice suggests that change is needed. However, missing from the wider debate about midwives is a discussion of how the midwifery profession is constructed. This paper uses a Policy-as-discourse stance to analyse how the role of the midwife is brought into being through policy discourse. ‘Policy documents’ were defined as written proposals emanating from the Department of Health or the NHS Executive which have had a significant impact on the development of midwifery practice in the UK. To identify documents for the discourse analysis selection criteria were that the policies appeared to have been implemented in the NHS, been publicly available since 1992 and focus on midwifery services and midwives.
Two policies were selected, Changing Childbirth (1993) and Better Births (2015) and analysed from the ‘policy as discourse’ perspective with an underlying Foucauldian approach. A Foucauldian approach facilitates a detailed investigation of the structural and linguistic features of texts in relation to other social processes, in particular how power shapes and constrains agency. The policy as a discourse perspective examines how policy constructs and position subjects, their identities and their roles within society. Analysis of the policies shows developing neoliberal discourses with strong discourses of responsibilisation, evident in the increasing rhetoric of choice and control in maternity services. Discourses of normal childbirth and the concept of continuity care develop alongside these neoliberal discourses, which position midwives as the lead professional for pregnancy as childbirth as way of increasing both quality and choice of services. As the remit of midwives, promoting continuity of care and normal childbirth furthers the professional position of midwives. These findings suggest that neoliberal discourse and the concepts of normality and continuity in policies shape professional midwifery identity. Future policy should consider the occupational boundaries that are drawn from the normal childbirth discourse and the rhetoric which embeds the current power dynamic within maternity care.