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Standardizing or Individualizing? A Critical Analysis of the "Discursive Imaginaries" Shaping Maternity Care Reform

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Abstract:

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.

Keywords: CRITICAL DISCOURSE ANALYSIS; EVIDENCE-BASED MATERNITY CARE; HEALTH CARE STANDARDIZATION; HUMANISTIC BIRTH; NORMAL BIRTH; PERSON-CENTERED CARE

Document Type: Research Article

DOI: https://doi.org/10.1891/2156-5287.2.3.173

Publication date: 2012-09-01

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  • The International Journal of Childbirth is a peer-reviewed, quarterly journal publishing original research, reviews, and case studies concerned with the practice of midwifery, women's health, prenatal care, and the birth process. The journal encourages the exploration of the complex and contextual issues surrounding childbirth provision and outcomes and invites manuscripts from a wide range of clinical, theoretical, political, methodological, psychological, public health, policy, and multicultural and interdisciplinary perspectives.
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