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Birth centres: A success story
In the UK most births take place in obstetric led units (ONS, 2004). The main purpose of this small study was to describe midwives' experiences of supporting normal birth in two different obstetric led units. Six semi-structured interviews were undertaken with midwives currently working on labour ward. The main findings were that labour ward midwives used a range of strategies to support clinical autonomy and facilitate normal birth. Some midwives who used traditional or non-scientific approaches in their practice were seen as different, being described as ‘mad’ or ‘bolshie’ by fellow midwives and doctors. The ability to support normal birth skills in obstetric units is problematic and appears to be governed by midwives’ faith in normal birth, the birthing environment and personal level of empowerment.
Health professionals have often been described as if they were in conflict with the new managerialist spirit in health care. However, because of their distributed and mobile sites of intervention, the work of community teams presents particular problems for traditional notions of management. In this UK study we identify how mental health team members are regulated by means of a subtle 'deep management'. Team members point to a lack of management direction from senior colleagues, even though some of them participate in the management process themselves. However, the lack of overt management leads them to prioritise clients and foreground professional identities in performing their duties and much additional administrative work besides. This also meant that the organisational structure-the team-was defined in subjective terms. Participants had become self-regulating 'deep managed' subjects under a largely hands-off management regime.