Friday, March 14, 2008

My ePortfolio: Thinking about my midwifery philosophy

I have done very little work to my ePortfolio in the last couple of weeks. However, I have just finished writing out my midwifery philosophy.

I first articulated this philosophy in the early 1990s. It hasn't changed much over the years. But I would confess that my scope of practice does not extend like it did a few years ago. By this I mean that I do not stretch the boundaries of the care I provide in a way that I used to eg I would not consider a breech (baby coming bottom first) birth at home, whereas years ago I would have.

There are a couple of reasons for this. Firstly, I do not do much clinical work these days because of my other roles of teacher and researcher, so I am probably not so confident as when I was practicing as a midwife full time. The second reason is my concern about litigation. I have written about this before and constantly challenge myself to ensure that I am not a fearful midwife. But it can be hard at times.

Please feel free to have a look at my midwifery philosophy and give me feedback. What aspects would you agree with and in what areas would your beliefs differ?

Image: 'Grin'


Anonymous said...

like it - it is same as mine pretty much.

Sarah Stewart said...

What about attaining partnership with women - do you think that is truly possible? Do women want it?

Anonymous said...

I do actually. I think its highly possible. Not sure the attaining it thing is necessarily relevant or the objective.
I think there has been a tendency among critics of the partnership framework to over-fixate and obsess with the notion of "attaining" it - and too little focus on the process of trying to achieve it - and the benefits to each partner of engaging in the process of trying to "be" in partnership. What really matters to me is that midwives facilitate a relationship with women which is interactive and inclusive, an exchange where women (and midwives) are respected as competent contributers - as opposed to being treated as vacant vessels as they have been in a medical framework.
When people talk about "attaining it" - I often find they are not really clear about what they mean by that.
I see a partnership as a fluid thing anyway - at times there may be road blocks or challenges - in a partnership - you work through those - so at what point would critics who need to pin point having "attained it" - do so? I just think that is fitting criteria for a partnership. Bit like a square peg in a round hole criteria...
I am happy that the partnership framework provides a process to use to achieve workable midwife-woman relationships.

Sarah Stewart said...

Thank you very much for that, Rae.

Anonymous said...

Do women want it? Its a partnership - ask them. Thats the beautiful thing about partnership I think.
Interesting idea - did anyone ever ask women if they wanted to be medicalised and ignored?

What I like about partnerships is that as you live them - they are diverse and responsive to individual women and dynamic. Its exhausting sometimes but also unpredictable and stops it being bland.

Anonymous said...

I totally agree with your comments about informed choice being used to wipe our hands of responsibility. I think facilitating informed choice is a skill in its own right and something that is yet to be explored adequately. When do we learn that skill. We have some emphasis on it within our program but only really because individual staff are committed to it - it lacks a profile all of its own - I think?

Dot said...

'Midwifery is a profession of women supporting women...' I've never met a male midwife, but there are some, aren't there? But the man in the room tends to be the father or the obstetrician.

I wouldn't argue that gender equality requires that there be more male midwives. But I am rather interested in what happens to feminist ideologies around childbirth, and especially to debates about gender essentialism/ gender as completely constructed. On the one hand, bodily difference seems irreducible and overwhelming in childbirth and the profound experiences of giving birth and breastfeeding a child really are inaccessible to the most sensitive and caring man. But, on the other hand, one can't take the birthing body out of a cultural context and reduce it to a wholly 'natural' function; a homebirth is a culturally meaningful choice just as a hospital birth is, and one's bodily experience is mixed up with all the talk of pain, pain relief, power, relaxation, danger, (im)modesty, woman as primal force/biological bombsite etc etc

Anyway, I'd be interested to read any thoughts you have on gender and midwifery.

Anonymous said...

I think as women we have a lived history of oppression by male hierarchy - and it would be difficult for a male to address this adequately to be "with women" ad to share power.

Sarah Stewart said...

Thanks for the question, dot. This will end up in a blog post one day. Short answer: I have met and worked with some lovely male midwives so on one level I am not against the idea of male midwives. They do tend to go up the managerial ladder much quicker than women, and you have to question this considering the maternity services are about women, both as users and workers.

Nevertheless, since I have worked in a caseload situation with women, ie working with women from conception to after the baby is born, I just cannot see how a man can develop the same relationship with a birthing woman as a female midwife does. It is not about the personal tasks like vaginal examinations, it is more about the long term relationship stuff. I am just not sure a man can do it in the same way a woman can

Kay Hardie said...

Reading these comments with interest as about to revisit my philosophy of care on my website. Am finding myself looking up definitions of words in my concise Oxford dictionary - words that I am pretty sure what they mean but sometimes I am surprised. 'Partner -a person who takes part in an undertaking with another or others, especially in a business or firm with shared risks and profits' It seems to me therefore that midwifery can be nothing else but a partnership including the sharing of 'risks' And I most definitely believe that women want it too. I also agree with your comments about male midwives Sarah - whilst male midwives too will have partnerships with women I cannot see how it could be a deeply emotional and intimate as one with a female