Giving instruction on self-care during midwifery consultations in Japan

This study focuses on instructional talk during prenatal visits in Japan. In order to prepare an upcoming delivery, a midwife often engages in instructional talk about the patient’s self-care at home. Yet, giving instruction is an interactionally challenging task, even in the medical setting. For example, a recipient may not accept advice easily, since this may reveal a recipient’s lack of knowledge and incompetence. By using conversation analysis, I find some interactional steps through which a midwife establishes interactional relevance of instruction. These steps include (1) assuring readiness of a recipient, (2) unpacking instruction and (3) contextualizing the instruction to a recipient’s everyday life. In each step, a patient’s claim for her competency and concern is used as a resource for developing the instructions. For example, a midwife gives advice to a patient about self-care in order to address the patient concerns. Instead of simply teaching what is generally considered necessary to self-care for delivery, a midwife designs her advice according to what an individual patient has expressed as a concern and what can be anticipated for her situation given her social category. This allows a more individualized presentation manner, which may encourage a patient’s active participation in her self-care.