How midwives' discursive practices contribute to the maintenance of the status quo in English maternity care.

Background: poor relationships between maternity care professionals still contribute to poor outcomes for childbearing women, although issues concerning power, gender, professionalism and the medicalisation of birth have been identified and discussed as germane to this situation for nearly three decades. Although power relationships and communication issues are known to affect the way maternity care professionals in the UK work together, there has been no study of the interplay between these factors, or of how semiotic aspects of professionals' communication relate to it.

Aim: to explore how National Health Service midwives' discursive practices relate to the status quo; that is, how they contribute either to maintaining or challenging traditional discourses concerning power, gender, professionalism and the medicalisation of birth.

Method: in a qualitative study within a critical discourse analysis framework, data were collected from maternity care professionals and women within one English maternity unit, through semi-structured interviews and observation of physical behaviour and naturally occurring conversation.

Findings: midwives in the unit revealed an inconsistent professional identity, sometimes challenging established hierarchies and power relationships, but often reinforcing traditional notions of gender, professionalism and the medicalisation of birth through their discursive practices.

Conclusions: given the known effect of wider social factors on maternity care, it is not surprising that the status quo persists, and that problems linked to these factors are still commonplace. This situation is compounded by the conflicting obligations under which UK midwives are forced to practice. These findings may have implications for midwives' capacity to respond to current challenges facing the profession.