Informing choice: The organization of institutional interaction in clinical midwifery care

Researchers in LIS have called for the study of the social practices out of which informing is achieved. This article analyzes the informed choice discussion (ICD) between midwives and childbearing women as a form of institutional interaction that accomplishes informing. The ICD institutionally presumes a woman to have information needs that must be met before she can make a decision. Conversation analysis, a method commonly used to study practitioner–client interaction but little used in LIS, is employed to identify the unique “fingerprint” of the ICD. Analysis shows how participants develop a joint sense of the interactional tasks of informing and deciding. As an ideal, informed choice divides the cognitive labor: informing is midwife-led and deciding is client-led. In practice, however, informing and deciding are intertwined to such an extent that their resolution is neither automatic nor straightforward but must be negotiated. To be accepted as adequate, a decision must also be deemed adequately informed. Difficulties in negotiating transitions can result in one speaker treating a decision as resolved while another treats it as still open. Analyzing the fingerprints of institutional informing interactions can provide a starting point for analyzing the interactional accomplishment of informing in other settings.