Reconcilable differences? Portuguese obstetricians’ and midwives’ contrasting perspectives on childbirth, and women’s birthing experiences

Abstract

Based on recent ethnographic research in Portugal, this paper examines contrasting perspectives of doctors and midwives regarding their roles in childbirth, the institutional contexts in which these divergent perspectives are enacted and sustained, and the inter-related experiences of birthing women. It was found that obstetricians’ rhetoric around birth focused on potential risk; interventions were often explicated through a perception of childbirth as a risk-laden, and potential emergency, situation. Within this discourse, hospital-based birth was presented as a triumph of progress. Technical measures were justified using institutional rationales, such as the use of anaesthetic pain relief during labour to ensure tranquillity within the maternity units and the induction of labour to guarantee “throughput” and free up hospital beds. Midwives, contrastingly, described their philosophy of care as one focused on offering women presence, guidance, and a range of informed choices in the management of birth, and professed their commitment to an ideal model of normal birth founded on minimal intervention, except in cases of clinical necessity. Both professional groups expressed mutual respect for each other´s skills and respective roles. However, the co-existence of different professional rationales within the same hospital setting, they admitted, resulted in tensions. These were found to be exacerbated by historical power dynamics and the present spatial and organisational separation of the two groups. Selected extracts from Portuguese women´s birth narratives from the same study are utilised to elucidate the variegated experiences of women, and the modes by which authoritative knowledge is reproduced. The potential ramifications of the current situation for the provision of effective maternity care are discussed, and the conceptualisation of women as autonomous consumers of services is challenged.