Achieving Publicly Funded Midwifery in Alberta: A Case Study of the Changing Nature of Midwifery Work
Creators: name: Field, Diane
Publisher: name: Arts
Year: 2018
Subjects: subject: midwives
subject: work practices
subject: Alberta
subject: public funding of midwifery
subject: Education--Health
subject: Education--Social Sciences
subject: Education--Sociology of
subject: Sociology
subject: FOS: Sociology

description: From 1994 to 2008, Alberta midwives were in the unique position among the provinces of Canada of being provincially regulated but unable to obtain public funding for their care work. With the achievement of government funding for midwifery services in 2009, midwifery’s place as an equal but autonomous health care profession within this province’s health care system was secured. My dissertation investigates how and why Alberta midwives undertake particular work practices to mediate the effects of public funding on their daily work lives. I also interrogate the midwives’ ability to maintain their work practices within the core principles of the midwifery model of care, in ways that are distinct from the influence of public funding. In this pursuit, I undertake a case study in a midwifery clinic in southern Alberta that includes: observation of midwife-client appointments over an 8-month period; in-depth, semi-structured interviews with both midwives and clients; and gathering of documents pertaining to both the work of the clinic midwives and the broader political-economic and institutional contexts. My contributions to an understanding of midwives’ work practices include: • Although the daily work of Alberta midwives rests primarily on the enactment of the core principles of the Canadian midwifery model of care, I find midwives are confronted with a paradoxical struggle to maintain their core principles in light of the diverse nature of clients, as a direct consequence of public funding. • I argue that midwives employ strategies that reflect an initial “gatekeeping” to determine the suitability of clients for their care that intermittently results in tensions between their philosophical foundations and their day-to-day work practices. • I contend that midwives establish caring connections in individual appointments with their clients by, initially, creating conditions that support the building up of these relationships and, later, by consolidating and fortifying these relationships through an increased emphasis on partnership aspects of care. • With the achievement of public funding and the substantial increase in the number of women seeking their care, I document how these midwives develop alternative group approaches to individual appointments that go some way to alleviate increased tensions and work stresses. As well, I conclude this style of care has the potential to continue to foster intimate and trusting relationships. • I assert that midwives’ work involved in promoting and facilitating breastfeeding is effective due to the continued strengthening of deep and intimate relationships between themselves and their clients, although they occasionally adopt but also struggle to resist the role of “expert” if clients choose other methods of feeding.