Standardizing or Individualizing? A Critical Analysis of the “Discursive Imaginaries” Shaping Maternity Care Reform

In the interest of increased accountability and quality in health care in recent decades, policy makers, professionals, and consumers have sought to standardize service provision. Yet in maternity care in particular, the resulting spread of evidence-based clinical guidelines and care protocols remains at odds with an alternative humanistic discourse stressing the importance of individualizing women’s care. This article uses an approach from critical discourse studies and medical humanities to analyze the underlying premises of what each of these visions posits as desirable. Interpreting these as “discursive imaginaries,” we argue that neither discourse alone offers an adequate policy and practice agenda. The way forward lies in extending their shared commitment to high quality care in light of emerging complexity perspectives and the humanistic principles of the person-centered health care movement.