Toward a semiotics of midwifery: Multimodal communication's effects on accessibility, equity, and power dynamics.

According to semiotics, we live in a world of signs, where almost anything can act as a signifier and convey meaning. But what of the semiotic landscape of midwifery? What signs are present within a client's multi-sensory experience of their midwifery care? How are these signs functioning to increase equity and accessibility? Or worse, how might certain aspects of the client's experience communicate unjust power dynamics? Semiotics allows us to examine a wide communicative and educational environment. By paying particular attention to the multivalent meanings of different signs-be they written, visual, oral, or even physical-we can start to see how multimodal communication plays a vital role in a client's perception of equity and power. One way to improve client experience is by approaching education and semiotic experience from the same place as trauma-informed care. A more health-literate sensitive approach viewed through the lens of semiotics assumes all clients have little previous knowledge or comfort within a care setting. This hyperawareness and criticality of the semiotic environment would allow midwives to acknowledge various sensory and communicative biases and intentionally redesign the entire client experience. The semiotic landscape is then curated to meet the needs of the most important audience-those marginalized and discriminated against whether that is because of education, finances, race, gender, or any other intersectional identity. We must acknowledge the fact that all sign systems can either reinforce abusive power relations or work to improve them. For what is at stake here is not just a client's overall comfort, but their full understanding of the care they are receiving, the options they have, and their autonomy within their entire perinatal experience.