The power of language: a secondary analysis of a qualitative study exploring English midwives’ support of mother's baby-feeding practice
Introduction
Effective communication is central to developing a trusting relationship in professional interactions (Zoppi and Epstein, 2002; McCabe and Timmins, 2006). During the childbearing process, effective communication with health professionals is essential in facilitating an encounter that is emotionally satisfying, and has a safe outcome for mother and baby (Dickson, 1997; O’Driscoll, 1997). The midwife is usually the main caregiver to childbearing women in developed countries [World Health Organization (WHO), 2000], and in global, and national, definitions of the midwife's role communication is fundamental to midwifery practice [WHO, 2000; Nursing Midwifery Council, 2004a, Nursing Midwifery Council, 2004b, Nursing Midwifery Council, 2007; International Confederation of Midwives, 2005]. Furthermore, Nicholls and Webb (2006) identified ‘good communication skills’ as the greatest attribute of a ‘good midwife’ in a systematic search of the literature.
Communication is a complex skill (McCabe and Timmins, 2006). Social communication requires little conscious effort, but communication that satisfies women's needs during childbearing requires engagement at a deeper level (Murray et al., 2006). Successful communication involves a mix of interpersonal skills including: effective listening; appropriate body language; proficient language use; and observation, interpretation and appropriate response making to the interpersonal skills with people with whom one is conversing (O’Driscoll, 1997; McCabe and Timmins, 2006). However, reviews of women's experiences of maternity care in England have reported mixed accounts of women's satisfaction with communication with the health professionals providing care (Redshaw et al., 2007). A metasynthesis of qualitative breast-feeding studies indicates that breast-feeding mothers have explicitly expressed discontentment with the communication styles used by health professionals supporting them (Nelson, 2006; McInnes and Chambers, 2008). Hoddinott and Pill (2000) described health professionals displaying an authoritarian attitude where communication was one sided, and lacked a facilitating and partnership approach. This is disappointing as partnership working and empowerment are key principles of care provision in English maternity services [Department of Health (DoH), 2004].
Few research studies have explicitly explored the use of language during health professional–patient interactions in health care; however, Hewison (1995) observed nurses during day-to-day interactions with their patients and suggested that language was used as a tool to exert power and control over patients.
This paper reports on the language used by midwives describing their actions when supporting mothers with baby feeding. The term ‘baby feeding’ was used to relate to English midwives’ specific remit to support mothers with feeding during the postnatal period (NMC, 2004a). The findings reported here are a secondary analysis of the data collected in a study exploring midwives’ views of baby feeding (Furber, 2004). The initial study was developed after the authors were concerned that midwives were not implementing evidence-based guidelines related to baby feeding. After the original study was reported, the findings revealed patterns in the language used by the midwives that were not always congruent with personalised, woman-centred care. As such, the authors decided to analyse the interviews again to explore the use of language by the midwives in reporting their experiences of baby-feeding practice.
Section snippets
Method
In the initial study, a qualitative approach was used and data collected and analysed using grounded theory principles (Glaser, 2001). The relevant ethics and research governance committees granted approval for the study in the autumn of 1999. Thirty midwives were recruited from two consultant-led maternity services in the north of England. Midwives who cared for mothers who had given birth to healthy babies were included. Data were collected using audiotaped, in-depth interviews by CF between
Secondary analysis of the data
The secondary analysis involved the content analysis method (Morse and Field, 1996; Burns, 2000). The interviews were read through systematically again to identify patterns related to the new aim. The data were coded again according to the patterns that emerged. These patterns were then evaluated by exploring data that fitted with the emerging patterns, and data that disconfirmed these (Burns, 2000). The search facilities of NUD*IST were used to seek individual words such as ‘girls’ and
Participants
Nineteen of the participants were from one maternity service, and 11 were from the other. All were female and their midwifery experience varied from 8 months to 31 years. Twenty-two midwives only worked in hospitals, six were community midwives, and two worked in midwifery teams covering hospital and community.
Summary of findings of the initial study
The core category that emerged from the data suggests that these midwives were ‘surviving baby feeding’. Supporting mothers with baby feeding was not easy for these midwives; they were
Discussion
This secondary analysis has illustrated how language may be used as a tool by midwives in directing mothers towards the preferred decision of the midwife.
However, these midwives were not observed in practice so we cannot be certain that these words were used in face-to-face encounters with mothers. Effective communication includes interpretation of body language (McCabe and Timmins, 2006), and mothers were not asked their opinion of the encounters with these midwives either. Observation of
Implications for practice and conclusions
The findings from this study indicate that language can be used to undermine women. Others have stated that language influences power differentials during social interactions (Lanceley, 1985; Shirley and Mander, 1996). In maternity care, language is used to dominate (Hastie, 2005), and involves power, control and access to choices (Shapiro et al., 1983; Shirley and Mander, 1996). Language communicates ideas and beliefs (Reibel, 2004); therefore, information provided by authority figures, such
Acknowledgements
This study was funded by the School of Nursing, Midwifery & Social Work of the University of Manchester.
The authors would like to thank the midwives for participating in this study. Thanks are also extended to the anonymous reviewers of previous drafts of this paper.
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