Grounded theory analysis of hospital-based Chinese midwives’ professional identity construction
Background: The professional development of midwifery in China has been challenged by its marginalised professional status and the medical dominance within midwifery practice in the contemporary maternity care system. There has been growing confusion about, ‘Who the midwife is and what does the midwife do?’ within and outside the profession. The sense of identity crisis for the profession has become particularly salient when Chinese midwifery becomes a sub-branch of the nursing profession during the contemporary period. If, however, we consider the International Confederation of Midwives (ICM) Mission Statement (2008: 32) that midwives are the ‘most appropriate professionals for childbearing women in keeping childbirth normal’, then the focus on a greater understanding of midwives is needed. It is the aim of this research to facilitate this understanding by exploring how hospital-based Chinese midwives construct their professional identity in the contemporary maternity care system and the factors that significantly influence the process. Design and Method: A Constructivist Grounded Theory (CGT) study was conducted to achieve the research aim. A sample of 15 midwives and 5 women participants was recruited between October 2010 and May 2011 from a capital city in one province of China. The accounts from the participants in the form of in-depth individual interviews were digitally recorded and three work journals from midwife participants were also included to facilitate the exploration of the study subject. NVivo 8 was used to assist with data management for the analysis. Findings: Six principle categories were identified: ‘institutional position’; ‘organisational management’; ‘professional discourse’; ‘compromising strategies’; ‘engaging strategies’; and ‘hybrid identity’. The integration of the principle categories has developed the theoretical model ‘navigating the self in maternity care’, which suggests that professional identity construction in midwives is a dynamic process, involving a constant structural and attitudinal interplay between the external (‘obstetric nurse’) and internal (‘professional midwife’) definitions of the midwife. The model indicates that the midwives’ professional identity construction was contextualised in their ‘institutional position’ in the contemporary maternity care system. In everyday practice, midwives experienced identity dissonance in relation to two competing identities: the ‘obstetric nurse’, bound up to the ‘organisational management’ in hospital settings; and the ‘professional midwife’, associated with the ‘professional discourse’ in the midwifery profession. Two types of strategies were identified to reduce the identity dissonance – ‘compromising strategies’ and ‘engaging strategies’ – which resulted in a ‘hybrid identity’, as the construction of professional identity in individual midwives is navigating along an identity continuum with ‘obstetric nurse’ and ‘professional midwife’ at opposing ends. This thesis has expanded on the current theoretical knowledge of identity work by elaborating on the discursive practices professionals employ to legitimate their professional identity and the various strategies individuals use to negotiate their identities at work. It has also extended attention to the influence of institutional forces on professional identity construction. With specific regard to Chinese midwifery, this emerging theoretical model provides a number of possible implications for midwifery practice, education and policy which would facilitate the exploration of effective operational processes for midwives in China to develop professionally.