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Ways of knowing in midwifery
Abstract
Scientific ways of knowing dominate our society today and this has major ramifications for midwifery. This article outlines the historical development and cultural understanding of ways of knowing in our society today. It is suggested that the patriarchal societies in which our ways of knowing have developed have emphasised scientific ways of knowing while other ways such as intuition and embodied knowledge received little acknowledgement. This article then goes on to explore these other ways of knowing, discusses their implications for midwifery care and suggests that to embrace many and varied ways of knowing is to more fully realise our abilities and potential as midwives.
... En fait, il a été fondu dans l'idéologie technomédicale, ce qui lui a fait perdre son souffle et son potentiel et peut-être même être devenu un facteur inhibiteur de l'autonomie des sages-femmes (Davis-Floyd & Mather 2002). Les sages-femmes ont quand même lutté (et luttent encore) pour poursuivre et raffiner un corpus de connaissances unique et congruent avec leur propre profession et leurs communautés épistémologiques (Cragin 2004, Davis 1995, Church & Raynor 2000. D'autres vont jusqu'à proposer une reconstruction des savoirs autour de la naissance (Downe & McCourt, 2004). ...
... Les modes de connaissances sont donc importants à nommer et à valoriser. L'enjeu n'est pas banal car le mode de connaissance dominant dans notre société actuelle est la méthode scientifique, (Davis 1995) ce qui a eu une influence majeure sur les sages-femmes car d'autres modes de connaissance n'ont pas été clairement reconnus alors qu'ils sont utilisés traditionnellement par les sages-femmes. ...
... Si les sages-femmes affirment qu'elles ont une pratique holistique, il serait logique et surtout cohérent qu'elles valorisent et qu'elles utilisent divers modes de connaissance et divers savoirs dans leur pratique. Pour Davis (1995): "to embrace many and varied ways of knowing is to more fully realise our abilities and potential as midwives » (p.31). ...
How midwifery as discipline can reclaim specific knowledges, language, ways of knowing, clinical reasoning and decision making? The importance of critical thinking in formation and cultivate the ability of reflective practice
... There is extensive discussion in the literature relating to the art and science of midwifery practice (Carper, 1978;Hagell, 1989;Davis, 1995;Gilkison, 2013;Power, 2015). It is the scientific ways of knowing that have come to dominate our society (Davis, 1995;DavisFloyd and Davis, 1996;Barnes, 1999;Shallow, 2001;Yuill, 2012). ...
... There is extensive discussion in the literature relating to the art and science of midwifery practice (Carper, 1978;Hagell, 1989;Davis, 1995;Gilkison, 2013;Power, 2015). It is the scientific ways of knowing that have come to dominate our society (Davis, 1995;DavisFloyd and Davis, 1996;Barnes, 1999;Shallow, 2001;Yuill, 2012). This has had profound implications for the art of midwifery practice. ...
Historically, midwifery has been an oral culture, where the generation of knowledge occurs through narrative or 'storytelling' rather than through scientific data. In recent years, however, the prevalence of scientific knowledge has dominated midwifery. The gold standard of scientific research is the randomised controlled trial, which is arguably a poor fit for normal midwifery practice because, in its purest form, midwifery is about supporting and enabling physiology with minimal intervention. A number of practices in midwifery have seen widespread adoption before there were published scientific data to support them. These include non-suturing of perineal tears in the 1990s, the use of water and, more recently, the use of hypnosis techniques for labour and birth. It seems possible that the narrative tradition of knowledge-sharing in midwifery may have contributed to these phenomena. Midwives should be encouraged to value this 'way of knowing' more highly, and research in the context of UK midwifery practice should be undertaken to develop the knowledge base.
... Midwives' ability to be 'with woman' during labour and birth is enhanced by the knowing and trust that comes out of the relationship developed in the antenatal period [45]. The various embodiments of 'knowing' in midwifery practices have been written about in midwifery literature globally [46][47][48], the importance of the 'knowing' that comes from relationship is confirmed in our findings as highlighted visually in the word cloud generated from the interview transcripts (Fig. 2). Because the relationship is developed in the antenatal period, being 'with woman' during labour and birth commences during pregnancy when relationships are being built. ...
... Midwives' ability to be 'with woman' during labour and birth is enhanced by the knowing and trust that comes out of the relationship developed in the antenatal period [45]. The various embodiments of 'knowing' in midwifery practices have been written about in midwifery literature globally [46][47][48], the importance of the 'knowing' that comes from relationship is confirmed in our findings as highlighted visually in the word cloud generated from the interview transcripts (Fig. 2). Because the relationship is developed in the antenatal period, being 'with woman' during labour and birth commences during pregnancy when relationships are being built. ...
Background
The phenomenon of being ‘with woman’ is fundamental to midwifery as it underpins its philosophy, relationships and practices. There is an identified gap in knowledge around the ‘with woman’ phenomenon from the perspective of midwives providing care in a variety of contexts. As such, the aim of this study was to explore the experiences of being ‘with woman’ during labour and birth from the perspective of midwives’ working in a model where care is provided by a known midwife.
Methods
A descriptive phenomenological design was employed with ten midwives working in a ‘known midwife’ model who described their experiences of being ‘with woman’ during labour and birth. The method was informed by Husserlian philosophy which seeks to explore the same phenomenon through rich descriptions by individuals revealing commonalities of the experience.
Results
Five themes emerged 1) Building relationships; 2) Woman centred care; 3) Impact on the midwife; 4) Impact on the woman; and 5) Challenges in the Known Midwife model. Midwives emphasised the importance of trusting relationships while being ‘with woman’, confirming that this relationship extends beyond the woman – midwife relationship to include the woman’s support people and family. Being ‘with woman’ during labour and birth in the context of the relationship facilitates woman-centred care. Being ‘with woman’ influences midwives, and, it is noted, the women that midwives are working with. Finally, challenges that impact being ‘with woman’ in the known midwife model are shared by midwives.
Conclusions
Findings offer valuable insight into midwives’ experiences of being ‘with woman’ in the context of models that provide care by a known midwife. In this model, the trusting relationship is the conduit for being ‘with woman’ which influences the midwife, the profession of midwifery, as well as women and their families. Descriptions of challenges to being ‘with woman’ provide opportunities for professional development and service review. Rich descriptions from the unique voice of midwives, provided insight into the applied practices of being ‘with woman’ in a known midwife model which adds important knowledge concerning a phenomenon so deeply embedded in the philosophy and practices of the profession of midwifery.
... In this section I will focus on the second of these definitions: 'body work as labour', which most closely represents the work of midwives, although other kinds of body work, for example 'body-making through work', e.g. the process of gaining embodied knowledge are also relevant (Davis 1995;Davis-Floyd and Davis 1996;Sternberg and Horvath 1999;Stewart 2005a). I will situate midwives within the existing debates on some key themes in the literature on body work: the concept of 'dirty work', touch and sexuality. ...
... Limited research exists on how the artistry of midwifery, such as intuition and embodied knowledge, is used and transferred in the care midwives provide for women (Kennedy, 2000;Davis-Floyd and Davis, 1996). However, Davis (1995) and Siddiqui (2005) suggest that the relationship between women and midwives is a key element in intuitive knowing. Women have been reported to believe that midwives 'just know' and that midwives believe in and use intuitive knowledge during the birth process (Kennedy, 2000). ...
Abstract
Aim: This research sought to explore how the skills of non-verbal communication are taught, learnt and assessed on a labour ward.
Method: An ethnographic approach was used to explore the relationship between mentors and students in a labour ward setting during focus group discussions across a number of trusts. The object was to ascertain, through discussion, how students learn and mentors assess the skills of empathy, intuition and sensitivity in being “with woman” in a labour ward setting. An etic view of relationships between mentor and student in a labour ward culture was explored through the facilitation of focus group discussion. Ethical approval was obtained from Integrated Research Application System and the University of Surrey Ethics Committee.
Sample: A total of fifty-six participants across eight sites took part in the project including mentors and third year students on midwifery programmes.
Findings: Three main themes from the data analysis were identified: being “with woman”, teaching and learning strategies, and assessment.
Implications: The findings implied that most participants agreed on a definition of being “with woman” and used role modelling to teach and learn these skills. Mentors, however, implied that assessing such skills was difficult and concluded that continuous assessment of communication skills and the “soft skills” of empathy, sensitivity and intuition were required.
Key words: (10): Teaching & learning, skills assessment, labour ward, “soft skills” of empathy, sensitivity & intuition, “being with women” mentors and student midwives, evidence based midwifery.
... Women are closely connected to the body, emotion and irrationality while men are connected with the mind, control and reason. The body, bodily sensations and experiences are discounted as sources of knowledge, and women are discounted as 'knowers' (Davis, 1995). ...
The body is of central concern to midwifery yet, as a profession, we have largely failed to grapple with the corpus of feminist and other literature that deals with the body. This article provides an overview of the ways in which the body has been theorised, from the essential and biological through to postmodern theories of the body. We draw attention to the limitations of some of these approaches, suggesting that Elizabeth Grosz's schema of the Möbius strip (representing the inter-relationships between the inside and outside, culture and nature) provides a useful framework for thinking about the body; one that avoids a biological materialism that disregards the effect of culture, and a cultural determinism that neglects the corporeal body. Recognising the multiplicity and fluidity of women's experiences of pregnancy, their body and childbearing emancipates us from the limitations imposed by the masculinist Western philosophical traditions that we have inherited.
... Evidence of midwifery as a profession has been documented since the beginning of recorded history and can be found in Genesis and Exodus (The Holy Bible, 1962). However, midwifery has struggled to pursue and refine a body of knowledge unique to and congruent with its own profession and epistemological communities (Davis, 1995; Church and Raynor, 2000; Cragin, 2004). Expert midwifery ARTICLE IN PRESS knowledge operationally defined as clinical competence has been extensively researched because it is scientific and it is easily measured (Raisler, 2000). ...
to explore the ways of knowing used by the midwife while attending women during childbirth through textual analysis of poems written by American midwives.
a hermeneutic phenomenology and human science research method inspired by van Manen was used. Midwifery ways of knowing during childbirth were thematically derived from 10 poems written by midwives about attending childbirth or the experience of being a midwife. Textual analysis included examination of the poems as a whole, via verse and metaphor, and via individual lines of prose.
10 American midwives wrote the poems used in this study. The poems were discovered through online searches of many databases using the key words 'poetry, poems, midwifery and childbirth' and through a national call for poetry by the researcher over a period of 4 years (1996-2000), undertaken in order to publish an anthology of poetry written by midwives.
three authoritative ways of knowing that guided the care given by the midwife to women during childbirth were discovered. They were self-knowledge from the belief system of the individual midwife, grounded knowledge from the midwife's personal lived experience with childbirth, and informed knowledge from objective and scholarly sources.
midwives must continue to develop their own body of knowledge in order to move the profession forward. Multiple ways of knowing including the use of experiential/contextual and intuitive knowledge is legitimate and humane, if provision of care is holistic. Care of women during childbirth can be enhanced with the use of multiple knowers and multiple ways of knowing. This study captured a unique and fresh interpretation of the lived experience of midwifery knowledge. Midwifery educational programmes should offer opportunities for students to explore the artistry as well as the science of midwifery practice.
Hintergrund: Die Intuition der Hebamme ist ein bislang im deutschsprachigen Raum noch unbeachtetes Forschungsfeld. Angesichts der Akademisierung des Hebammenberufes soll die Bedeutung dieser Wissensform für die Geburtsarbeit herausgestellt werden. Ohne wissenschaftliche Anerkennung ist eine gezielte Förderung dieser Kompetenz unmöglich. Methode: Vier außerklinische geburtshilflich erfahrene Hebammen wurden nach einem Methodenmix interviewt. Die Auswertung erfolgte zweiphasig im Rahmen eines zirkulären Dekonstruierens und in Anlehnung an die Tiefenhermeneutik.
Ergebnisse: Die Hebammen wenden vertrauensvoll ihre - durch Erfahrung gewonnene - Intuition unter der Voraussetzung einer Verbindung zu sich selbst und zum Mutter-Kind-System an. Sie ist für ein kundiges Urteil im Geburtsgeschehen unerlässlich und macht Geburtshilfe als Alarm und Anker sicherer. Eine Grafik zum „dynamisch-periodischen Geschehen der intuitiven Erkenntnis“ fasst alle Ergebnisse zusammen.
Schlussfolgerung: Die Intuition ist ein unverzichtbares Element der Kernkompetenzen einer Hebamme und bedarf als solche der Sensibilisierung und Förderung. Als Quelle praxisleitenden Wissens dient sie der Hebamme maßgeblich dazu, die richtigen Schlüsse im Geburtsgeschehen zu ziehen, um handlungsfähig zu bleiben.
Schlüsselwörter: Intuition, Hebammenkunst, implizites Wissen, kundiges Urteil, Verbundenheit
Abstract
Background: The intuition of the midwife is a research field that has so far been ignored in German-speaking countries. In view of the academization of the midwifery profession, the importance of this form of knowledge for labor should be emphasized. Targeted promotion of this competence is impossible without scientific recognition.
Method: Four out-of-hospital midwives with experience in obstetrics were interviewed according to a method mix. The evaluation was carried out in two phases as part of a circular deconstruction and based on depth hermeneutics.
Results: The midwives confidently apply their intuition - gained through experience - provided they are connected to themselves and to the mother-child system. It is essential for an informed judgment in the birth process and makes obstetrics as an alarm and anchor safer. A graphic for "the dynamic-periodic occurrence of the intuitive knowledge" summarizes all results.
Conclusion: Intuition is an indispensable element of the core competencies of a midwife and as such needs to be sensitized and encouraged. As a source of practical knowledge, it serves the midwife significantly to draw the right conclusions in the birth process in order to remain capable of acting.
Keywords: intuition, midwifery, implicit knowledge, expert judgment, connectedness
Aim: This research sought to explore how the skills of non-verbal communication are taught, learnt and assessed on a labour ward. Method: An ethnographic approach was used to explore the relationship between mentors and students during focus group discussions across a number of trusts. The object was to ascertain, through discussion, how students learn and mentors assess the skills of empathy, intuition and sensitivity in being 'with woman' in a labour ward setting. An etic view of relationships between the mentor and the student in a labour ward culture was explored through the facilitation of focus group discussion. Ethical approval was obtained from Integrated Research Application System and the University of Surrey Ethics Committee. Sample: A total of 56 participants across eight sites took part in the project including mentors and third-year students on midwifery programmes. Findings: Three main themes were identified from the data analysis: being 'with woman', teaching and learning strategies, and assessment. Implications: The findings implied that most participants agreed on a definition of being 'with woman' and used role modelling to teach and learn these skills. Mentors however implied that assessing such skills was difficult and concluded that continuous assessment of communication skills and the 'soft skills' of empathy, sensitivity and intuition were required.
Wal-Mart entered into the Korean market in 1997 after regulations governing foreign retailers were completely lifted. Since Wal-Mart began its retailing operations in Korea, it made every effort to incorporate the principles of supply chain integration in Korea. Currently, many supply chain integration attempts made in Korea have made some contributions to the development of the Korean distribution system, even though the results are not completely satisfactory. Two reasons might be cited. First, there is no noticeable competitive supply chain infrastructure in Korea to support the principles of supply chain integration. Highly competitive and aggressive supply chain strategies that Wal-Mart has been accustomed to using in the United States are directly in conflict with the existing distribution channels in Korea. Second, a relationship building process among supply chain partners (internal as well as external) has been painfully slow at best and in many instances non-existent. However, there is an opportunity in Korea for many foreign retailers to reduce the supply chain cost if it is properly implemented. This paper closely examines some of the reasons why the supply chain integration process for foreign retailers in Korea has been slow, and the attempts to provide possible solutions.
to explore midwives' views in relation to the provision of systematic postpartum care.
qualitative focus group study using grounded theory approach.
Dar es Salaam, Tanzania.
49 nurse/midwives in five focus group discussions, each having 9-11 participants.
eight categories were identified: 'reflecting', 'getting ready', 'defining abilities', 'networking', 'integrating', 'balancing', 'dealing with reality', and 'caring'. The identified core category that integrated and encapsulated all other categories was 'becoming a good resource and support person for postpartum woman'. The mediating factors found to have potential for influencing how a midwife can function in order to become a good resource and support person were: a) the structure and approach in maternal and child health services, b) midwives' knowledge, attitude and skills, c) informal sources of knowledge to parents, and d) cultural beliefs and practices.
the findings of this study provide an understanding of the way midwives feel and think about the provision of postpartum care. The findings demonstrate that midwives need support in their efforts to achieve what they consider necessary for postpartum care. Interventions for educating and supporting midwives should be targeted at enabling them to deal with all the factors that influence their role and help them to identify and use better strategies to provide quality care.
To conduct a metasynthesis of six qualitative studies of midwifery care and process; identify common themes and metaphors among the six studies for further exploration and theory development; and create a framework for further metasynthesis of qualitative studies of midwifery practice in the USA.
A qualitative metasynthesis to analyse, synthesise, and interpret six qualitative studies on the process and practice of midwifery care.
Hospital, birth centre, and home birth settings were represented across all of the studies. Participants included nurse- and direct-entry midwives who provided both childbearing and gynaecological care. Recipients of midwifery care also received both childbearing and gynaecological care.
Four overarching themes were identified: the midwife as an 'instrument' of care; the woman as a 'partner' in care; an 'alliance' between the woman and midwife; and the 'environment' of care. These were interpretively and conceptually arrayed into a helix model of midwifery care.
The findings from this exploratory metasynthesis clearly indicate that the practice of midwifery is a dynamic partnership between the midwife and the woman, and reflects an environmental perspective. In a country that has a standard of highly technical childbirth care, perhaps the most outstanding concept of this model is that of the midwife as an 'instrument' of care. The significance of the findings will be determined by their ability to guide further research efforts to support a standard of midwifery care for all women in the USA.
This model offers a benchmark and a structure for considering the dynamic elements of midwifery practice and key roles that the midwife plays in the health care of women and babies.
This book examines the relationships between caring, stress and coping, and health, and claims that caring is primary. . . . This work extends the thesis begun in "From Novice to Expert: Excellence and Power in Clinical Nursing Practice" (Benner, 1984), the thesis that caring is central to human expertise, to curing, and to healing.
One of the aims of the book is to distinguish the nursing perspective from purely psychological, physiological, or biomedical views. The nursing perspective offered is based upon the notion of good inherent in the practice and the knowledge embedded in the expert practice of nursing. Herein lies the premise of the book: An articulation of alternative approaches to health promotion, restoration, and even curing practices based upon the primacy of caring.
This book shares the phenomenological and feminist goal of making visible the hidden, significant work of nursing as a caring practice. Phenomenology and feminism have influenced the work, but expert nursing practice illuminates all the theoretical points. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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