Negotiating medical and cultural scales in Nigerian pre-labour midwife-patient interaction

In Nigerian maternity care studies, culture and medicine are often presented as unrelated binary, with the dichotomy ignoring the ways in which biomedical, socio-religious, and cultural practices interact in everyday life. Our study therefore investigates that divide by means of a multimodal interactional study of 25 pre-labour encounters from Akachukwu Hospital and Maternity’s social media archives. We integrate Interactional Sociolinguistics with Blommaert’s Sociolinguistic Scale Theory to re-evaluate how biomedical, religious, and cultural meanings are interactionally negotiated during pre-labour communication and how participants navigate different scales of authority through contextualisation cues and scale shifts. Our analysis sees these pre-labour sessions as scale-shifting, hybrid events in which interaction move fluidly between institutional directives, cultural and religious norms, family voices, embodied actions, personal narratives, and light-hearted conversations such as banter. Our study thus reframes interactional research in health settings by treating culture as an interactional resource rather than as a static backdrop. Through an interactional sociolinguistic and scale-sensitive analysis, we show that cultural, bodily, and institutional scales are not hierarchical categories but fluid orientations that participants shift between within single interactions. These shifts are accomplished through contextualisation cues, including language choice, gaze, gesture, touch, humour, and directive practices, through which participants negotiate authority, empathy, and cooperation during pre-labour care. Finally, we recommend that midwifery training and supervision should explicitly address how communication can be adapted to local cultural beliefs and social norms to foster safer childbirth.