Borrowed voices -- conversational storytelling in midwifery healthcare visits.

Midwifery in Ontario, Canada exists at the intersection of mainstream healthcare ideology and an alternative, woman-centred ideology of care. As a result, midwifery interaction is characterized by discursive hybridity. We trace this hybridity in the conversational stories co-narrated by midwives and clients during clinic visits. We show how conversational storytelling performs a complex shifting and blending of rhetorical forms and functions integral to the clinical interaction. Conversational stories conform to the structural requirements of the clinic visit and unfold in different ways and perform different functions at different times. Stories may be told, evaluated, and received as institutionally relevant for both clinical and social purposes. Clinical stories perform relational functions, and stories that appear to be fully social orient to the clinical agenda. Hybridity is accomplished through two forms of linguistic borrowing: the blending of professional-institutional and more casual-conversational modes, and interactional features such as shared narration and recontextualization

Standards and Stories: The Interactional Work of Informed Choice in Ontario Midwifery Care

Abstract This paper uses a discourse-rhetorical approach to analyze how Ontario midwives and their clients interactionally accomplish the healthcare communicative process of informed choice. Working with four excerpts from recorded visits between Ontario midwives and women, the analysis focuses on the discursive rendering during informed choice conversations of two contrasting kinds of evidence – professional standards and story-telling – related to potential interventions during labour. We draw on the concepts of discursive hybridity (Sarangi and Roberts 1999) and recontextualization (Linell 1998; Sarangi 1998) to trace the complex and creative ways in which the conversational participants reconstruct the meanings of these evidentiary sources to address their particular care contexts. This analysis shows how, though very different in their forms, both modes of evidence function as hybrid and flexible discursive resources that perform both instrumental and social-relational healthcare work. This paper examines how ontario midwives and their clients interactionally accomplish informed choice in clinic visits by calling on and negotiating two contrasting kinds of evidence: (a) authoritative guidelines articulated in professional standards and community protocols and (b) social stories told by midwives as they talked with women about healthcare options. How do participants recontextualize the meanings of these different evidentiary sources to address their particular care contexts? Our analysis indicates that participants invoke evidence in ways that combine instrumental and social talk to perform both clinical and relational functions. The interaction thus enacts a hybrid discourse, simultaneously reflecting and reproducing midwifery\u27s relational-feminist goals and the requirements of regulated healthcare. Résumé Cet article emprunte une démarche rhétorique pour analyser la façon dont les sages-femmes et leurs clientes en Ontario accomplissent de façon interactive les processus de communication en santé pour faire des « choix éclairés ». À l\u27aide de quatre extraits enregistrés lors de rencontres entre sages-femmes et femmes en Ontario, l\u27analyse se penche sur le rendu discursif de deux types distincts de données – les normes professionnelles et la narration d\u27anecdotes– au cours de conversations portant sur un choix éclairé au sujet d\u27une possible intervention pendant le travail. Nous employons les concepts de l\u27hybridité discursive (Sarangi et Roberts 1999) et de la recontextualisation (Linell 1998; Sarangi 1998) pour retracer les chemins complexes et créatifs qu\u27empruntent les participantes pour reconstruire la signification des sources de données afin d\u27aborder leur propre cas. Cette analyse montre comment, bien que sous des formes différentes, les deux modes de données fonctionnent comme des ressources discursives hybrides et flexibles qui agissent tant au niveau instrumental que socio-relationnel