Problematising public and private work spaces: midwives' work in hospitals and in homes.

OBJECTIVES: as the boundaries between public and private spaces become increasingly fluid, interest is growing in exploring how those spaces are used as work environments, how professionals both construct and convey themselves in those spaces, and how the lines dividing spaces traditionally along public and private lines are blurred. This paper draws on literature from critical geography, organisational studies, and feminist sociology to interpret the work experiences of midwives in Ontario, Canada who provide maternity care both in hospitals and in clients' homes. DESIGN: qualitative design involving in-depth semi-structured interviews content coded thematically. SETTING: Ontario, Canada. PARTICIPANTS: community midwives who practice at home and in hospital. FINDINGS: the accounts of practicing midwives illustrate the ways in which hospital and home work spaces are sites of both compromise and resistance. With the intention of making birthing women feel more `at home', midwives describe how they attempt to recreate the woman's home in the hospital. Similarly, midwives also reorient women's homes to a certain degree into a more standardised work space for home birth attendance. Many midwives also described how they like `guests' in both settings. KEY CONCLUSIONS: there seems to be a conscious or unconscious convergence of midwifery work spaces to accommodate Ontario midwives' unique model of practice. IMPLICATIONS FOR PRACTICE: we link these findings of midwives' place of work on their experiences as workers to professional work experiences in both public and private spaces and offer suggestions for further exploration of the concept of professionals as guests in their places of work.

The psychosocial and socioeconomic consequences of bovine spongiform encephalopathy (BSE): a community impact study.

The detection of the first indigenous case of bovine spongiform encephalopathy (BSE) in Canada on May 20, 2003, had significant consequences for the livestock industry. As a result, borders were closed by several trade partners, particularly the United States. The outbreak led to direct and indirect economic impacts to the "cattle" industry exceeding $6 billion. As a consequence of a number of risk management interventions implemented by the Canadian Food Inspection Agency (CFIA) and provincial agencies, the BSE outbreak appears to have been largely contained. The initial results from our study of the socioeconomic and psychosocial impact of BSE on the health and well-being of rural and farm families living in Canada, a topic that remains largely unexamined are presented. Our analysis of the outbreak raises a number of questions concerning the resulting consequences for farmers, their families, and their communities, including considerations from a social determinants' of health perspective. In particular, our preliminary findings reveal that 5 years following the detection of the first indigenous case of BSE in Canada, ongoing uncertainty and stress resulting from unrecoverable financial losses continue to weigh heavily on the health and well-being of farmers, their families, and survival and sustainability of agricultural communities.

Accessing maternity care in rural Canada: there's more to the story than distance to a doctor.

Drawing upon a comparative, qualitative study of the experiences of rural women accessing maternity care in two Canadian provinces, we demonstrate that availability of services, having economic and informational resources to access the services offered, and the appropriateness of those services in terms of gender, continuity of care, confidentiality, quality of care, and cultural fit are key to an accurate understanding of health care access. We explore the implications of living rurally on each of these dimensions, thereby revealing both gaps in and solutions to rural maternity care access that narrower, proximity-based definitions miss.

Adding women's voices to the call for sustainable rural maternity care.

The shortage of maternity care providers in Canada has been documented largely from the perspective of physicians. Women in rural communities, however, have much to contribute to this discussion. Exploratory research in 3 rural communities in south central Ontario eliciting the perspectives of 36 birthing women has affirmed the need for integrated models of maternity care. Rural women seek care that is local and "relational," characterized by time spent with care providers, continuity and personalized care. They also seek care that is based on fully informed choice. Collaborative models of care, including rural physicians, nurses and midwives, have the potential to create the sustainability and collegiality required to achieve these qualities.