Department of Sociology, Siena College, Loudonville, NY, USA.
Brigham and Women's Hospital, Division of General Internal Medicine, Boston, MA, USA.
Soc Sci Med. 2021 Sep;285:114296. doi: 10.1016/j.socscimed.2021.114296. Epub 2021 Aug 4.
How do health professionals with fundamentally different philosophies toward health, and different status levels, manage power in their work relationships? This paper argues that taking a negotiated order interactionist approach, which contends that the social order shapes behavior but is continuously negotiated through social interactions, and synthesizing it with a countervailing powers perspective can yield insight into the power dynamics between health professionals. It focuses on the birth field, with attention to the relationship between two very different types of birth professionals: obstetricians and doulas. Unlike doctors, who maintain a dominant place in health care and subscribe to a biomedical perspective of birth, doulas hold a low-status position and take a holistic approach toward birth, which may cause conflict in the labor room. In-depth interviews with 43 birth doulas based in the US (May-July 2018) found that the doula-doctor relationship is a complex story of power, deference, and countervailing responses. Doulas reported that doctors are more receptive to them now than in the past but that this is an outcome of creative countervailing responses involving deferential maneuvers and direct challenges to physician authority. Doulas' strategic management of their relationships with health professionals has allowed them entry to the hospital, permitting them to represent a holistic voice in the labor room. A minority of doulas have begun to develop relationships with doctors that constitute a collaborative approach toward birth care, indicating that changes in standard care are possible. By revealing how a subordinate actor can challenge physicians and effect change in care, this study contributes to scholarship seeking to understand the nature of unequal relationships between health professionals in a context of biomedical dominance.
健康专业人员对健康有着截然不同的理念和不同的地位层次，他们如何在工作关系中管理权力？本文认为，采取协商秩序互动主义的方法，即社会秩序塑造行为，但通过社会互动不断协商，并将其与抗衡权力的观点相结合，可以深入了解健康专业人员之间的权力动态。本文关注的是生育领域，关注两种截然不同类型的生育专业人员之间的关系：产科医生和导乐。与医生不同，他们在医疗保健中保持主导地位，并接受生物医学的生育观，导乐则处于低地位，并采取整体的生育方法，这可能会在产房引起冲突。对美国 43 名导乐的深入访谈（2018 年 5 月至 7 月）发现，导乐与医生的关系是一个复杂的权力、尊重和抗衡反应的故事。导乐报告说，医生现在比过去更愿意接受他们，但这是一个创造性抗衡反应的结果，包括尊重的策略和对医生权威的直接挑战。导乐对与健康专业人员关系的战略管理使她们能够进入医院，允许她们在产房中代表整体的声音。少数导乐已经开始与医生建立关系，形成一种合作的生育护理方法，表明标准护理的变化是可能的。通过揭示从属行为者如何挑战医生并对护理产生影响，本研究有助于理解在生物医学主导的背景下健康专业人员之间不平等关系的性质的学术研究。
