From changing childbirth to better births: a critical discourse analysis of the influence of policy on professional identity

Midwifery practice and the professional identity of midwives are influenced by policy and the discourses located both within the policy and wider society. Recent high-profile investigations into maternity care have highlighted the concerns with the quality of maternity care in the NHS and its long-term sustainability. This research sought to understand the views of those responsible for creating and implementing this policy. This paper discusses the findings of semi-structured interviews with policy actors about the influence of policy on midwifery identity.
‘Policy actors’ were defined as individuals involved in the creation or implementation of maternity policy, recognising that there are multiple potential actors concerned with the collective issue a policy address. Participants were located using purposeful sampling technique based on their engagement in and understanding of, recent and current policy that affects UK midwifery, as this enabled selection of appropriate participants to provide data in line with the research question posed.
Individual interviews were conducted using a topic guide developed following a policy analysis of two midwifery policy documents, Changing Childbirth (1993) and Better Births (2015). A ‘semi-structured’ approach to the interviews was used explore the participants experiences of policy in maternity services as well as developing and implementing policy and how this influences the midwifery profession. Interviews were conducted over Microsoft teams, recorded and then transcribed to facilitate the analysis.
Critical discourse analysis was used to analyse the date. The criteria set out by Parker (2002) for distinguishing discourses, which considers ten points with which to interrogate the text, was adopted to analyse the data. These criteria provide prompts to consider the historical context of discourses and how discourses support institutions, reproduce power relations and ideology.
Analysis of the interviews demonstrate discourses that influence the professional identity and roles of midwives, including neoliberal discourses, discourses of normality and risk, as well as questions around the sustainability around models of practice and implementation of policy recommendations.