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The Tyranny of Time: Tensions between Relational and Clock Time in Community-Based Midwifery

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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

  1. 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.

  2. 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).

  3. 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).

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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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  1. Division of Midwifery, The University of Huddersfield, Ramsden Building, Queensgate, Huddersfield, HD1 3DH, UK

    Ruth Deery

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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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