Off the Beaten Track: a Postmodern Feminist Analysis of Rural Midwifery and Rural Media Health Discourses

Change was a constant companion for New Zealand midwives during the 1990's. The Nurses Amendment Act 1990, that restored midwifery autonomy was only one of a constellation of changes that saw significant restructuring of the health services in small communities. The purpose of this study was to look at the issues for a group of midwives in rural South Otago who took the opportunity to work independently and offer local women a choice of maternity care during this time. In this study, five rural midwives were interviewed and met subsequently in a focus group. The transcripts were analyzed using discourse analysis informed by a postmodern/feminist theoretical framework. In addition the local newspapers covering the years 1990-1999 were read with a particular focus on the reports of health changes. These texts were also subjected to a discourse analysis using Lyotard's (1997) notion of language games, and bell hook's (1990) ideas around strategic positioning for the marginalised. To practise autonomously, the midwives in this study perform an intricate dance, balancing the contradictions of competing discourses. Their positioning and place of difference is tensioned primarily by a deep sense of community commitment and entanglement, and also by a feeling of physical and perceptual distance from their urban midwifery colleagues. This is underpinned by a staunch belief in women's ability to birth safely in their local area. The findings of this study suggest that the continuation of a comprehensive rural midwifery service is challenged by changes in the arrangement and funding of rural health, plus the increasing use of medical and technological intervention in childbirth. For rural midwifery to survive, this study shows that midwives need to remain flexible and alert while continuing to align themselves with women who are their primary source of support and inspiration. At the same time, they need to forge strategic linkages and alliances, both local and national that will allow them to move and reposition in order to continue their work and provide a realistic childbirth choice for rural women.