Abstract
This paper focuses on eight National Health Service (NHS) community midwives' experience of linear time during the third phase of a 3-year action research study. Drawing on the words of the midwives, the paper seeks to compare and contrast the ways in which they experienced this temporal framework, individually and organizationally, in their clinical practice. Midwifery work was mostly described as being bound by a ‘technical administrative rationality’ that controlled the organization of paid employment, although this contradicted a cyclical, ‘nurturing rationality’ that was rooted in relational time. The midwives struggled with, and at times resisted, a more relational approach to working when the introduction of a supportive process called clinical supervision was introduced. This approach to working contested their existing temporal boundaries and imposed its own temporal framework. Despite all the midwives commenting on the importance of making time to meet as a group, clinical supervision was experienced as creating more work. There is, therefore, justification for acknowledging that in times of turbulent change and acute staffing crises, NHS community midwives preferred to prioritize work through assembly line production rather than investing time in nurturing, supportive client and colleague relationships.
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Notes
Primary Care Trusts (PCTs) cover all parts of England and receive budgets directly from the Department of Health. Since April 2002, PCTs have taken control of local health care while strategic Health Authorities monitor performance and standards.
According to Lipsky ‘street-level bureaucrats respond to the individual needs or characteristics of the people they serve or confront. In practice, they must deal with clients on a mass basis, since work requirements prohibit individualized service….At best, street level bureaucrats invent benign modes of mass processing that more or less permit them to deal with the public fairly, appropriately, and successfully. At worst, they give in to favouritism, stereotyping, and routinizing – all of which serve private or agency purposes’ (Lipsky, 1980, p. xii).
Caseloading involves midwives being responsible for, and providing care for, women throughout pregnancy, birth and the postnatal period. Rather than being attached to clinical locations their work is with women (McCourt et al., 2006).
References
Adam B (1990). Time & Social Theory. Polity Press in association with Blackwell Publishers: London.
Adam B (1995). Timewatch, The Social Analysis of Time. Blackwell Publishers: Oxford.
Adam B (2004). Time. Polity Press: Cambridge.
Alvesson M (2002). Postmodernism and Social Research. Open University Press: Buckingham.
Arney WR (1982). Power and the Profession of Obstetrics. The University of Chicago Press: London.
Ball L, Curtis P, Kirkham M (2002). Why do Midwives Leave? The Royal College of Midwives: London.
Bond M, Holland S (1998). Skills of Clinical Supervision for Nurses: A Practical Guide for Supervisees, Clinical supervisors and Managers. Open University Press: Buckingham.
Bone D (2002). Dilemmas of emotion work in nursing under market-driven health care. The International Journal of Public Sector Management 15: 140–150.
Bryson V (2007). Gender and the Politics of Time, Feminist Theory and Contemporary Debates. The Policy Press, University of Bristol.
Butterworth T, Faugier J (1998). Supervision for life. In: Butterworth T, Faugier J, Burnard P (eds). Clinical Supervision and Mentorship in Nursing, 2nd edn. Nelson Thornes Ltd: Cheltenham.
Coser LA (1974). Greedy Institutions, Patterns of Undivided Commitment. Macmillan Publishers: London.
Curtis P, Ball L, Kirkham M (2006). Why do midwives leave? (Not) being the kind of midwife you want to be. British Journal of Midwifery 14: 27–31.
Dadds M (2002). Taking curiosity seriously: the role of awe and Wanda in research-based professionalism. Educational Action Research 10: 9–26.
Davies K (1990). Women, Time and the Weaving of the Strands of Everyday Life. Gower Publishing Company Limited: Aldershot.
Davies K (1994). The Tensions between process time and clock time in care-work, the example of day nurseries. Time & Society 3: 277–303.
Deery R (2003). Engaging with clinical supervision in a community midwifery setting: an action research study. Unpublished PhD thesis, University of Sheffield, UK.
Deery R (2005). An action research study exploring midwives' support needs and the effect of group clinical supervision. Midwifery 21: 161–176.
Deery R, Kirkham M (2000). Moving from hierarchy to collaboration: the birth of an action research project. The Practising Midwife 3: 25–28.
Deery R, Kirkham M (2006). Supporting midwives to support women. In: Page LA, McCandlish R (eds). The New Midwifery, 2nd edn. Science and Sensitivity in Practice Elsevier Limited: London.
Deery R, Kirkham M (2007). Drained and dumped on: the generation and accumulation of emotional toxic waste in community midwifery. In: Kirkham M (ed). Exploring the Dirty Side of Women's Health. Routledge: London.
Derbyshire F (2000). Clinical supervision within midwifery. In: Kirkham M (ed). Developments in the Supervision of Midwives. Books for Midwives: Manchester.
DOH (1993). Changing Childbirth, Part 1 (Report of the Expert Maternity Group), HMSO, London.
DOH (2004). Improving Working Lives in Midwifery, a Guide for Midwives and Managers. Department of Health: London.
DOH (2006a). Modernising Maternity Care. Department of Health: London.
DOH (2006b). Our Health, Our Care, Our Say: A New Direction for Community Services. Department of Health: London.
Dykes F (2005). ‘Supply’ and ‘demand’: breastfeeding as labour. Social Science & Medicine 60: 2283–2293.
Dykes F (2006). Breastfeeding in Hospital. Routledge: London.
Ely M, Anzul M, Friedman T, Garner D, Steinmetz AM (1991). Doing Qualitative Research: Circles Within Circles. The Falmer Press Teachers Library: London.
Everingham C (2002). Engendering time: gender equity and discourses of workplace flexibility. Time and Society 11: 335–351.
Flint C, Poulengeris P, Grant A (1989). The “Know Your Midwife Scheme” – a randomised trial of continuity of care by a team of midwives. Midwifery 5: 11–16.
Fox M (1989). Unreliable allies: subjective and objective time in childbirth. In: Forman FJ, Sowton C (eds). Taking Our Time, Feminist Perspectives on Temporality. Pergamon Press: Oxford.
Frankenburg R (1992). ‘Your Time or Mine’: temporal contradictions of biomedical practice. In: Frankenburg R (ed). Time, Health & Medicine. Sage Publications: London.
Gee H, Glynn M (1997). The physiology and clinical management of labour. In: Henderson C, Jones K (eds). Essential Midwifery. Mosby: London.
Gibson D (1994). Time for clients: temporal aspects of community psychiatric nursing. Journal of Advanced Nursing 20: 110–116.
Goffman E (1974). Frame Analysis: An Essay on the Organization of Experience. Northeastern University Press: Boston.
Hall ET (1989). The Dance of Life, The Other Dimension of Time. Anchor Books Editions: New York.
Hassard J (1989). Time and organization. In: Blyton P, Hassard J, Hill S, Starkey K (eds). Time, Work and Organization. Routledge: London.
Helman C (2007). Culture, Health and Illness, 5th edn, Hodder Arnold: London.
Hochschild A (1983). The Managed Heart Commercialisation of Human Feeling. University of California Press: Berkeley, California.
Hochschild A (2003). The Commercialization of Intimate Life, Notes from Home and Work. University of California Press Ltd: London.
Hunter B, Deery R (2005). Building our knowledge about emotion work in midwifery: combining and comparing findings from two different research studies. Evidence Based Midwifery 3: 10–15.
Hunter B, Deery R (eds) (2008). Emotions in Midwifery and Reproduction. Palgrave Macmillan: London.
Jones AR (2001). Time to think: temporal considerations in nursing practice and research. Journal of Advanced Nursing 33: 150–158.
Kahn RP (1989). Women and time in childbirth and during lactation. In: Forman FJ, Sowton C (eds). Taking our time. Feminist Perspectives on Temporality. Pergamon Press: Oxford.
Kirkham M (2003). Midwifery in the NHS. Midwifery Matters 96 (Spring): 2–3.
Kirkham M (2004). Choice and Bureaucracy. In: Kirkham M (ed). Informed Choice in Maternity Care. Palgrave Macmillan: Hampshire.
Kirkham M (2007). Women out of place. In: Kirkham M (ed). Exploring the Dirty Side of Women's Health. Routledge: Oxon.
Kirkham M, Morgan RK, Davies C (2006). Why Do Midwives Stay? Department of Health via Bedfordshire & Hertfordshire Workforce Development Confederation, Department of Health.
Kirkham M, Stapleton H (2000). Midwives' support needs as childbirth changes. Journal of Advanced Nursing 32: 465–472.
Lavender T, Chapple J (2004). An exploration of midwives' views of the current system of maternity care in England. Midwifery 20: 324–334.
Lawton J (2000). The Dying Process. Routledge: London.
Lipsky M (1980). Street-Level Bureaucracy. Dilemmas of the Individual in Public Services. Russell Sage Foundation: New York.
Martin E (1987). The Woman in the Body – A Cultural Analysis of Reproduction. Milton Keynes: Open University Press.
Mason M (2000). Incurably Human. Working Press: London.
Mauthner N, Doucet A (1998). Reflections on a voice-centred relational method. analysing maternal and domestic voices. In: Ribbens J, Edwards R (eds). Feminist Dilemmas in Qualitative Research, Public Knowledge and Private Lives. Sage Publications: London.
McCourt C, Stevens T, Sandall J, Brodie P (2006). Working with women: developing continuity of care in practice. In: Page LA, McCandlish R (eds). The New Midwifery, Science and Sensitivity in Practice, 2nd edn. Elsevier Limited: London.
McCrea H, Wright M, Murphy-Black T (1998). Differences in midwives' approaches to pain relief in labour. Midwifery 14: 74–180.
McKnight J (1995). The Careless Society, Community and its Counterfeits. Basic Books: New York.
McNiff J, Whitehead J (2006). All You Need To Know About Action Research. Sage Publications Ltd: London.
Page LA (2000). The New Midwifery, Science and Sensitivity in Practice. Churchill Livingstone: London.
Polkinghorne D (2004). Practice and the Human Sciences. State University of New York Press: Albany, USA.
Sandall J (1998). Occupational burnout in midwives: new ways of working and the relationship between organisational factors and psychological health and well being. Risk Decision and Policy 3: 213–232.
Sennett R (1998). The Corrosion of Character, The Personal Consequences of Work in the New Capitalism. W.W. Norton & Company: London.
Silverman D (2006). Interpreting Qualitative Data, 3rd edn. Sage Publications: London.
Simonds W (2002). Watching the clock: keeping time during pregnancy, birth, and postpartum experiences. Social Science & Medicine 55: 559–570.
Simpson J (2004). Negotiating elective caesarean section: an obstetric team perspective. In: Kirkham M (ed). Informed Choice in Maternity Care. Palgrave Macmillan: Hampshire.
Stein M (2007). Toxicity and the unconscious experience of the body at the employee–customer interface. Organization Studies 28: 1223–1241.
Walker L, Avant K (1995). Strategies for Theory Construction in Nursing, 3rd edn, Appleton & Lang: Norwalk.
Walsh D, Downe S (2004). Outcomes of free-standing, midwife-led birth centres: a structured review. Birth 31: 222–229.
Walsh K (1997). Encounters, endings and temporality in psychiatric nursing. Journal of Advanced Nursing 25: 485–491.
Waterman H, Tillen D, Dickson R, de Koning K (2001). Action research: a systematic review and guidance for assessment. NHS R&D HTA Programme.
Waterworth S (2003). Temporal reference frameworks and nurses' work organization. Time & Society 12: 41–54.
Waterworth S, May C, Luker K (1999). Clinical ‘effectiveness’ and ‘interrupted’ work. Clinical Effectiveness in Nursing 3: 163–169.
Wilkins P (1998). Clinical supervision and community psychiatric nursing. In: Butterworth T, Faugier J, Burnard P, (eds). Clinical Supervision and Mentorship in Nursing, 2nd edn. Nelson Thornes Ltd: Cheltenham.
Zerubavel E (1979). Patterns of Time in Hospital Life. University of Chicago: Chicago.
Zerubavel E (1981). Hidden Rhythms, Schedules and Calendars in Social Life. University of California Press: Berkeley.
Acknowledgements
I thank all those who participated in this study as well as Professor Mavis Kirkham, Professor Chris Cowton, Dr Sharon Wray and Deborah Hughes for helpful comments and discussion during the writing of the paper. The research was also partly funded by a grant from the West Yorkshire Workforce Development Confederation.
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Deery, R. The Tyranny of Time: Tensions between Relational and Clock Time in Community-Based Midwifery. Soc Theory Health 6, 342–363 (2008). https://doi.org/10.1057/sth.2008.13
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DOI: https://doi.org/10.1057/sth.2008.13