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Standards and Stories: The Interactional Work of Informed Choice in Ontario Midwifery Care
Healthcare Policy
  • Phillippa Spoel
  • Pamela J. McKenzie, University of Western Ontario
  • Susan James
  • Jessica Hobberlin
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This paper uses a discourse-rhetorical approach to analyze how Ontario midwives and their clients interactionally accomplish the healthcare communicative process of "informed choice." Working with four excerpts from recorded visits between Ontario midwives and women, the analysis focuses on the discursive rendering during informed choice conversations of two contrasting kinds of evidence – professional standards and story-telling – related to potential interventions during labour. We draw on the concepts of discursive hybridity (Sarangi and Roberts 1999) and recontextualization (Linell 1998; Sarangi 1998) to trace the complex and creative ways in which the conversational participants reconstruct the meanings of these evidentiary sources to address their particular care contexts. This analysis shows how, though very different in their forms, both modes of evidence function as hybrid and flexible discursive resources that perform both instrumental and social-relational healthcare work.

This paper examines how ontario midwives and their clients interactionally accomplish "informed choice" in clinic visits by calling on and negotiating two contrasting kinds of evidence: (a) authoritative guidelines articulated in professional standards and community protocols and (b) social stories told by midwives as they talked with women about healthcare options. How do participants recontextualize the meanings of these different evidentiary sources to address their particular care contexts? Our analysis indicates that participants invoke evidence in ways that combine instrumental and social talk to perform both clinical and relational functions. The interaction thus enacts a hybrid discourse, simultaneously reflecting and reproducing midwifery's relational-feminist goals and the requirements of regulated healthcare.


Cet article emprunte une démarche rhétorique pour analyser la façon dont les sages-femmes et leurs clientes en Ontario accomplissent de façon interactive les processus de communication en santé pour faire des « choix éclairés ». À l'aide de quatre extraits enregistrés lors de rencontres entre sages-femmes et femmes en Ontario, l'analyse se penche sur le rendu discursif de deux types distincts de données – les normes professionnelles et la narration d'anecdotes– au cours de conversations portant sur un choix éclairé au sujet d'une possible intervention pendant le travail. Nous employons les concepts de l'hybridité discursive (Sarangi et Roberts 1999) et de la recontextualisation (Linell 1998; Sarangi 1998) pour retracer les chemins complexes et créatifs qu'empruntent les participantes pour reconstruire la signification des sources de données afin d'aborder leur propre cas. Cette analyse montre comment, bien que sous des formes différentes, les deux modes de données fonctionnent comme des ressources discursives hybrides et flexibles qui agissent tant au niveau instrumental que socio-relationnel.

Citation Information
Phillippa Spoel, Pamela J. McKenzie, Susan James and Jessica Hobberlin. "Standards and Stories: The Interactional Work of Informed Choice in Ontario Midwifery Care" Healthcare Policy Vol. 9 (2013) p. 71 - 85
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