ABSTRACT
This chapter addresses new and “old” social actors interacting in Russian maternity care, and in particular, their negotiations around “good care.” The multifaceted notions of “good care” include State-determined standards and requirements; new market and consumer demands; and different emotional styles of communication. The current neoliberal policies create new spaces for some professional groups to enter the field of maternity care services provision (though sometimes forming their own illegal or semi-legal markets): these are independent midwives, doulas, consultants, etc. At the same time, hospital care providers have to accomplish multiple roles in order to meet new patient expectations: they act as clinicians, service providers, and State bureaucrats. Maternity care providers routinely cope with challenges and conflicting requirements by applying “manual management” - that is, personal informal coordination via constant negotiations. They also are to do emotional labor in order to cope with various patients’ demands and discontents and to prevent complaints that would be followed up by State sanctions. As the result, professional groups of obstetricians, neonatologists, midwives and nurses, who are socially considered to be in a powerful position, find themselves under overall control and are indeed limited in their possibilities to provide “good care,” which is so different and inconsistent in the interpretations of different actors. In this chapter, we present our empirical findings on how care providers negotiate “good care” and try to cope with multiple institutional challenges in order to provide it. We ask and answer the questions of what kind of maternity care practitioners work in this field, how they provide care they consider to be “good,” and why they are limited in their possibilities to accomplish it.
