"Knights" or "knaves"? Public policy, professional power, and reforming maternity services.

Recent quality and safety discourse stresses locating "human errors and mistakes" within an institutional framework. I go further to contend that, in spite of well-meaning individual practitioners, aspects of a powerful, self-interested obstetric professional culture pose a major barrier to quality childbirth care. Using my analysis, I contrast the profession's "knightly" self-image with critical scholarship, and it examine evidence given to public inquiries into obstetric misdemeanors and mistakes in Australia, England, and Ireland. Policy incentives to reform maternity care need to go beyond technical auditing measures to foster collaboration, social as well as institutional accountability, and critical self-reflection within the obstetric profession.