The discourse of midwives and the strategies of politicians

This paper examines the way that midwives have responded to and attempted to shape the redesign of maternity services in remote areas of Scotland. From a longitudinal study of midwifery units, data were collected on the lived experience of midwives and the significance of context and forms of involvement on individual and group attitudes and perceptions. Our focus is on the ways in which midwives seek to accommodate their own and community needs whilst also relating to the expectations and demands of central policy. From drawing on findings from a study of six health care sites in remote and rural Scotland, we demonstrate how the orchestration of narratives of change are not conducted by a single and remote political arm but are variously composed and reconfigured by the strategies of politicians, the financial narratives of central policy and the local sense-making and stories of midwifery groups. We illustrate how a different types of change narrative can emerge from midwives, managers, local communities, politicians, policy documents and the media, and how these can shift in meaning and emotionality over time. Multiple stories are 'voiced' that compliment and compete in the alignment, misalignment and realignment of a movement between two emerging 'dominant' change narratives.