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Great expectations: Legitimacy and emotions among out of hospital midwives

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Abstract

In this article we examine the process by which a group of marginal health-care professionals portray the legitimacy of their skills and services to potential clients. While extensive attention has been devoted to this construal of legitimacy through such affinitive alignments, much less attention has been given to elucidating the factors shaping how marginal social groups construct alternative professional legitimacy frameworks with which to contest dominant competitors. Drawing on qualitative content analysis of direct entry midwives’ (DEMs) online descriptions of their practices and in-depth interviews, we explain how DEMs construe professional legitimacy through alternative cultural understandings of maternity care and experience. Our study highlights three key components of DEMs’ professional legitimation: midwives’ alignment with professional associations and scientific research, the creation of new understandings of care relationships and space, and the role of emotions in defining the optimal birth experience. We argue that the positive emotions associated with direct entry midwifery care become critical mechanisms for redefining both professionalism and the experience of birth within the boundaries of alternative practice.

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Notes

  1. This represents an increase from 5 per cent of births attended by midwives in 1993 and 3 per cent attended by midwives in 1989 as well as an increase of 5 per cent of out-of-hospital births from 2004 (Hamilton et al, 2004).

  2. Because of the precarious legal positioning of midwives in at least one state in which we interviewed, we wish to protect the anonymity of respondents and therefore do not include any further identifying information about them.

  3. Interestingly, even throughout this more personable biography, all institutional affiliations are active links by which potential consumers may directly access professional organizations’ webpages.

  4. In interviews we find that midwives working in birth centers still utilize formal ‘informed consent’ procedures as per insurance and hospital guidelines, but generally work to develop relationships and understandings of a birth plan beyond the strictures of what they consider a limited and superficial evidence of women's autonomy.

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Acknowledgements

The authors would like to thank Karen Hegtvedt, Ellen Idler, Cathryn Johnson, Richard Levinson, and three anonymous reviewers for their many helpful comments on previous drafts.

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  1. Sociology Department, Emory University, 1555 Dickey Drive, Atlanta, 30322, GA, USA

    Selina Gallo-Cruz

  2. Sociology Department, Wellesley College, 106 Central St., Wellesley, 02481, MA, USA

    Markella Rutherford

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  1. Selina Gallo-Cruz
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  2. Markella Rutherford
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Correspondence to Selina Gallo-Cruz.

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Gallo-Cruz, S., Rutherford, M. Great expectations: Legitimacy and emotions among out of hospital midwives. Soc Theory Health 9, 275–301 (2011). https://doi.org/10.1057/sth.2011.8

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