Beyond the silo effect : the challenges of collaboration

Women entering the maternity arena in Australia and other Western regimes have suffered incidentally from what is known as the\u27 silo effect\u27. This refers to a clash between the training regimes of the \u27old\u27 professionalism and the \u27new\u27 professionalism. Under the \u27old\u27 professionalism, hierarchies were erected between medicine and the so-called semi-professions such as nursing and social work (Tully and Mortlock 2004) resulting in what Degeling et al (1998; 2000) have documented as oppositional modes of decision-making, styles of working, roles and accountabilities. Within the last decade, a \u27new professionalism\u27 has emerged in many Western regimes, including Canada, NZ, the UK and The Netherlands. (Romanow Report 2002; Street, Gannon and Holt 1991; Victorian Department of Human Services, Australia 2004) depicted by a flatter more egalitarian structure of multidisciplinarity .. An example in Australia is the Future Directions in Maternity Care document released in mid 2004 by the Bracks Victorian Labor government. In Australia, the move towards the \u27new professionalism\u27 can be attributed to a confluence of macro economic factors including the swing away from hospital-based training and towards university-based training for nurses and midwives, the ripple effects of three decades of feminism, the professionalisation of midwifery, the attrition of midwives from the workforce, the rise of health consumerism from the late 1980s and the crippling costs of professional indemnity health insurance for obstetricians leading to a crisis in recruitment.<br /

Difficult birth for power sharing

There is meant to be collaboration between doctors and midwives in maternity care but this is being hindered by unequal and disrespectful cultures and practices

When is collaboration not collaboration? When it\u27s militarized

In adopting the medical lobby&rsquo;s preferred definition of collaboration where midwives are legally compelled to seek endorsement for their care plan from an obstetrician, Determination 2010 connotes a form of militarized collaboration and thus negates all that genuine collaboration stands for&ndash;&mdash;equality, mutual trust and reciprocal respect. Using Critical Discourse Analysis, the first half of this paper analyses the submissions from medical, midwifery and consumer peak organisations to the Maternity Services Review and Senate reviews held between 2008 and 2010 showing that Determination 2010 privileges the medical lobby worldview in adopting a vertical definition of collaboration. The second half of the paper responds to the principal assumption of Determination 2010&ndash;&mdash;that midwives do not voluntarily collaborate. It argues by reference to a qualitative inquiry conducted into select caseload maternity units in South Australia, Victoria and New South Wales during 2009&mdash;2010 that this presupposition is erroneous. The evidence shows that genuine collaboration is possible without legislative force but it requires a coalition of the willing among senior midwives and obstetricians to institute regular interdisciplinary meetings and clinical reviews and to model respectful behaviour to new entrants.<br /

Creating ambiguity, creating social change

Current government policy in Victoria, as elsewhere, is seeking to change the provision of maternity care from an obstetric-led system to a flatter, more collaborative system that brings midwives to the front line as primary carers, at least in the public sector.However, dominant medical discourses continue to exert a sedimentary effect on contesting claims from midwives that deny the high-risk nature of the majority of births and which valorise the competence of the female body. Although there have been modifications in maternity arrangements (and the incumbent government is currently considering more), medical discourses continue to legitimate obstetric power via legal and professional structures, fortify the obstetric &lsquo;habitus&rsquo;, infect mainstream popular consciousness and undermine autonomous midwifery practice. Drawing from research material gleaned from in-depth interviews with nine obstetricians and thirty midwives conducted in 2004 and 2005, I argue that alternative discourses may strategically undermine obstetric dominance. Specifically, reversing stereotypes; inverting the binary opposition and privileging the subordinate term (or substituting the negative for positive); and defamiliarizing what is perceived to be fixed and given, all play on the ambiguities of representation and present social activists (midwives, childbirth educators and women) with valuable opportunities to challenge fundamentalist medical orthodoxies.<br /

Not-the-Troubles : disinterring the marginalised stories of the ordinary and the everyday

Urban studies of Belfast, Northern Ireland, thoroughly explore the contested or post-conflict city. However, these ‘grand narratives’ do not necessarily accord with people’s day-to-day experiences. Although the ordinary and the everyday are the lifeblood of anthropological inquiry, the mundane in Belfast dwells on the narratorial margin, as academic and political loci predominantly align to the Troubles: to the protagonists, the causes or the peace-building aftermath. Ten by Nine (Tenx9) is a monthly, public storytelling night showcasing ordinary people and their true, personal, everyday stories, juxtaposing the funny, poignant and educational, and celebrating the quotidian. Retelling Belfast at Tenx9 challenges hegemonic discourse by moving the mundane from the margin to the centre, opening up a space for small ‘t’ troubles to be shared. The communitas at Tenx9 promotes a sense of belonging in the city outwith Troubled narratives and storytelling, an ancient Irish oral culture, becomes a new form of symbolic practice.PostprintPeer reviewe

Canine connections : fieldwork with a dog as research assistant

My research seeks out muted narratives that struggle to be heard in the contested city of Belfast. My dog is one of my ethnographic methods: dog-walking is rarely a direct journey from A to B and she can ‘authenticate’ my lingering presence in unfamiliar places; she is a gateway to dog-focused communal activities; and her categorisation of people is based on smell, not politics, religion or country of origin. When encountering random strangers with an attractive and friendly dog, her role is obvious: introduction enacted, anthropologist takes over. But does she simply mediate the encounter or does she shape what happens? The relationship between dog and person is reciprocal and the extent to which each actor responds to the other prolongs and moulds the encounter. Can she elicit stories that may not otherwise be told, do more than ‘only connect’? This paper draws on actor-network theory and cosmopolitanism.PostprintPeer reviewe

Childhood Developmental Trends in Executive Function as Measured by The Delis-Kaplan Executive Function System: An Exploration of Gender Differences.

The purpose of this study is to examine the development of Executive Function (EF). Specifically, this study investigates whether there are consistent increases in EF performance on the Delis-Kaplan Executive Function System (D-KEFS) from the age of 8 years to 15 years. Gender differences in the development of EF are also examined. To this end, the standardization data for eight of the D-KEFS tests were analyzed, comparing performance across age groups (8- year-olds, 9-year-olds, etc.) and gender groups. Significant age effects were found for all tests overall. However, significant change between consecutive age groups was found only for some age groups, on some tests. Gender effects were significant for two D-KEFS tests. However, age and gender interaction effects were not significant for any test. The results suggest that EF is developing, in irregular patterns, between the ages of 8 years and 15 years. There is not evidence for significant gender differences in the developmental course ofEF as measured by the D-KEFS