Kerreen Reiger

In the context of debates on personal identity and social relationships in late modern societies, this article explores several narratives through which the Australian Generations Oral History Project's interviewees make sense of themselves. As they ‘re-member’ family connections formed in specific time and place—and often recalled through emotionally significant material objects—some tell life stories marked by stability, others by contingency, while others construct so-called ‘do-it-yourself’ biographies. I conclude that the complexity of these lives, and of their telling, reveals the ways in which a sense of generational location mediates other dimensions of identity and shapes responses to broad structural and cultural developments.

Recent quality and safety discourse stresses locating “human errors and mistakes” within an institutional framework. I go further to contend that, in spite of well-meaning individual practitioners, aspects of a powerful, self-interested obstetric professional culture pose a major barrier to quality childbirth care. Using my analysis, I contrast the profession's “knightly” self-image with critical scholarship, and it examine evidence given to public inquiries into obstetric misdemeanors and mistakes in Australia, England, and Ireland. Policy incentives to reform maternity care need to go beyond technical auditing measures to foster collaboration, social as well as institutional accountability, and critical self-reflection within the obstetric profession.

While collaborative, multidisciplinary teamwork is widely espoused as the goal of contemporary hospitals, it is hard to achieve. In maternity care especially, professional rivalries and deep-seated philosophical differences over childbirth generate significant tensions. This article draws on qualitative research in several Victorian public maternity units to consider the challenges to inter-professional collaboration. It reports what doctors and midwives looked for in colleagues they liked to work with ? the attributes of a ?good doctor? or a ?good midwife?. Although their ideals did not entirely match, both groups respected skill and hard work and sought mutual trust, respect and accountability. Yet effective working together is limited both by tensions over role boundaries and power and by incivility that is intensified by increasing workloads and a fragmented labour force. The skills and qualities that form the basis of ?professional courtesy? need to be recognised as essential to good collaborative practice.

Drawing on research into cultural and organizational change in the Victorian Maternal and Child Health Service during the 1990s, this paper examines implications for the nursing leadership provided by service coordinators. The project included a quantitative survey of nurses and semistructured interviews with managers and coordinators. Under a strongly neoliberal state government in Victoria, Australia, services were fundamentally restructured through tendering processes. A competitive, productivist culture was introduced that challenged the professional ethos of nurses and a primary health orientation to the care of mothers and infants. This paper focuses on the pressures that the entrepreneurial environment presented to maternal and child health nurses\u27 identity and collegial relations and to the coordination role. It argues that coordinators emerged as a Significant nursing management group at the interface of administrative change and the management of professional practice. Although many nurses skilfully negotiated tensions with peers and management, their leadership role needs further clarification and support.<br /

The recent international resurgence of midwifery has involved the profession’s seeking to gain greater independence and the lessening of medical dominance. In such a context, issues currently facing Australian midwives are significant. This paper outlines the development of research questions with regard to midwives professional consciousness, and considers the structural context of maternity services. It then explores changing political consciousness and dilemmas. In particular, the emergence of an autonomous professional identity for midwives as articulated by the Australian College of Midwives Incorporated (ACMI), has not been straightforward. Unevenness of educational preparation and a projected shortage of midwives together with growing frustration at inadequate recognition of midwives’ distinctive knowledge and skills all pose challenges to policy moves to encourage a greater midwifery role in maternity car

In the interest of increased accountability and quality in health care in recent decades, policy makers, professionals, and consumers have sought to standardize service provision. Yet in maternity care in particular, the resulting spread of evidence-based clinical guidelines and care protocols remains at odds with an alternative humanistic discourse stressing the importance of individualizing women’s care. This article uses an approach from critical discourse studies and medical humanities to analyze the underlying premises of what each of these visions posits as desirable. Interpreting these as “discursive imaginaries,” we argue that neither discourse alone offers an adequate policy and practice agenda. The way forward lies in extending their shared commitment to high quality care in light of emerging complexity perspectives and the humanistic principles of the person-centered health care movement.