Organizing change: the hospital management of childbirth as practice

Abstract

This work aims to understand the maintenance-change process of hospital childbirth management. We used the Schatzki’s practice onto-epistemology, and we conducted a Practice Based Study in a public maternity hospital. Data were gathered from observations, interviews, and documentary research. Rather than a medical-hospital event, hospital childbirth management is a socialmaterial practice that overlapped other practices (maternal, medical and health management practices) and is constructed by the interactions between humans and no humans. We argue that the maintenance-change of hospital childbirth management is interdependent: there is the dissolution of certain activities and material arrangements, while other organizational elements remain unchanged. Our contribution is the analysis of the “maintenance-change” of practices as a single, simultaneous and recursive process. This evidence that practices are dynamic, and that change is a constitutive element of organizational/social life. In practical terms, this work can contribute to the formulation of public health policies and to a hospital childbirth management organized around a new logic (beyond medical technique). This has the potential to reduce the rate of unnecessary cesarean sections and, consequently, the costs of maternity hospitals and health system, and to advance the debate about hospital management, its actors and practices.