Careful and Creative Craftwork: How CNMs Legitimize Risk and Responsibility Talk with Pregnant People with a BMI of 30 or Higher: A Critical Discourse Analysis
2021-05
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Careful and Creative Craftwork: How CNMs Legitimize Risk and Responsibility Talk with Pregnant People with a BMI of 30 or Higher: A Critical Discourse Analysis
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2021-05
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Background: Society has placed an enormous amount of the responsibility for reducing risk during pregnancy on the pregnant people themselves. This neoliberal view of individual responsibility especially has affected pregnant people with a BMI of 30 or higher. They have endured many consequences from this, such as emotional distress, loss of autonomy, stigmatization, marginalization, and are blamed for the increased risk to the baby from their body size. Aims: I sought to learn how CNMs legitimize their talk about risk and to gain a critical understanding of how CNMs are reproducing and/or resisting societal discourses of risk and responsibility with pregnant people with BMIs of 30 or higher. Methods: Van Leeuwen’s categories of legitimation (authorization, moral evaluation, and rationalization) provided the theoretical framework. In an outpatient clinic, I recorded and transcribed verbatim twelve prenatal appointments where CNMs were implementing a new risk-reduction guideline for patients with a BMI of 30 or higher in pregnancy. Using a critical discourse analysis approach influenced by van Leeuwen, Fairclough, and Gee, the transcripts were coded for van Leeuwen’s categories and subcategories of legitimation and then analyzed. Findings: CNMs predominantly used authorization to legitimize the introduction of the BMI guideline in the appointments. When the CNM would give the weight gain, diet, or exercise recommendations, the CNM would follow a similar sequence in their conversation to the other CNMs in the study. The sequence began with CNM stating the recommendation and then assessing for compliance. If the pregnant person was in compliance, there would be explicit praise. If not, either the pregnant person or the CNM would offer an explanation. Then, CNM would validate the explanation. When the CNMs discussed the risks or reducing the risks of having a BMI of 30 or higher, the CNM would most often use the legitimation category rationalization. Conclusions:. CNMs were both reproducing and resisting ideas of risk and responsibility when discussing the BMI guideline. The CNMs appeared aware of the moral weight of the conversation but did not stray from the guideline’s recommendations. CNMs carefully crafted their language to meet both the needs of their patients and the needs of the organization.
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University of Minnesota Ph.D. dissertation. May 2021. Major: Nursing. Advisor: Joan Liaschenko. 1 computer file (PDF); xi, 237 pages.
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Martin, Katherine. (2021). Careful and Creative Craftwork: How CNMs Legitimize Risk and Responsibility Talk with Pregnant People with a BMI of 30 or Higher: A Critical Discourse Analysis. Retrieved from the University Digital Conservancy, https://hdl.handle.net/11299/257102.
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