FROM TENDER CARE TO TENDERED CARE: THE CASE OF THE VICTORIAN MATERNAL AND CHILD HEALTH SERVICE

Restructuring the public sector along market principles has been a major policy development of the late twentieth century in most western countries. This paper examines the impact of recent political and administrative change on a Victorian universal primary health program, the Maternal and Child Health Service (MCHS). The first section establishes the development of the service in the years when an interventionist state provided bureaucratic support for the expansion of public health activities. In the next significant period of organisational change, the 1980s‐early 1990s, key interest groups articulated their positions in view of the administrative imperatives of corporate managerialism. Dramatic ‘marketisation ’ of the service then occurred with the impact of compulsory competitive tendering (CCT) in the mid‐1990s. The paper argues that attention to the complex processes of change shows the interplay of interest groups, discursive positions and administrative regimes, with new strategies emerging to counter the contracting state.     

‘How can we go on caring when nobody here cares about us?’ Australian public maternity units as contested care sites

BackgroundProvision of personalised, continuous care focused on ‘well women’ is now central to midwifery identity and work ideals, but it remains difficult in hospital contexts shaped by increased demand and by neoliberal policies. Previous accounts of occupational and work-family conflicts in midwifery and nursing have pointed to the ‘moral distress’ associated with managing conflicting expectations in health workplaces.QuestionThis paper examines these issues in the Australian context and considers further the ethical implications of midwives not feeling ‘cared for’ themselves in health care organisations.MethodsQualitative research in several Victorian maternity units included use of interviews and observational methods to explore staff experiences of organisational and professional change. Data were coded and analysed using NVivo.FindingsMidwives reported frequent contestation as they sought to practice their ideal of themselves as caregivers in what they reported as often ‘uncaring’ workplaces. To interpret this data, we argue for seeing midwifery caring as embodied social practice taking place within ‘organisation carescapes’.ConclusionTheoretical analysis of the moral and ethical dimensions of the contemporary organisational structure of maternity care suggests that a practice-based and dialogical ethic should form the core principle of care both for women in childbirth and for their carers.