Reconcilable differences?: Portuguese obstetricians’ and midwives’ contrasting perspectives on childbirth, and women’s birthing experiences

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This paper examines the contrasting perspectives of doctors and midwives in Portugal regarding their roles in childbirth, the institutional contexts in which these divergent perspectives are enacted and sustained, and the inter-related experiences of birthing women. The ethnographic research presented found obstetricians’ rhetoric to focus on potential risk; interventions were often explicated through a perception of childbirth as a risk-laden, and potential emergency, situation. Within this discourse, hospital-based birth was presented as a triumph of progress. Technical measures were justified using institutional rationales, such as the use of anaesthetic pain relief during labour ensuring tranquillity within maternity units, and labour induction guaranteeing “throughput” and freeing up hospital beds. Midwives, contrastingly, described a philosophy of care focused on offering women presence, guidance, and informed choices during birthing, professing their commitment to minimal intervention, except in cases of clinical necessity. Both professional groups expressed mutual respect for each other’s skills and respective roles. Yet the co-existence of different professional rationales within the same hospital setting resulted in tensions which were exacerbated by historical power dynamics and the present spatial and organisational separation of the two groups. The ramifications of the current situation for the provision of effective maternity care are discussed, and the conceptualisation of women as autonomous consumers of services is challenged. Extracts from Portuguese women’s birth narratives from the same study are utilised to elucidate the highly variegated experiences of women.