PERCEPTIONS OF THE MIDWIFE’S ROLE: WHAT HAS INFLUENCED WOMEN’S AND MIDWIVES’
2.2 SECTION 1: BACKGROUND 1 INTRODUCTION
2.2.7 HOLISTIC BIRTH
The description of birth culture is traditionally about knowing birth intuitively, incorporating social and emotional needs. Before the seventeenth century birth knowledge was handed down through generations of women from observation and feelings, where birth was known about intuitively. Davis-Floyd (1992) identifies this as a holistic model of birth, through her anthropological findings. The body and mind are viewed as one self, as a whole, whereas the technocratic model divides the body into parts, separated from the mind and soul.
Kitzinger (2005) describes the spirituality of birth and how this is evident throughout time, especially within other non-western cultures through sculptures and carvings showing messages of spirituality being at the heart of physiological birth. Here she describes birth scenes in ancient drawings that have been salvaged:
“Usually they show a mother giving birth in an upright position, attended by one or two women, supporting her from behind or kneeling in front----Dutch scenes show a comfortable and prosperous domestic setting, and focus on the social nature of the birth”
(Kitzinger 2005:24).
Hall and Taylor (2004) discuss spiritual birth as the ability to become wide open in the emotional and spiritual sense, as well as physically:
“To be totally vulnerable, a woman requires a place of safety. It means she needs to feel safe within her physical environment”
(Hall and Taylor 2004:10).
Due to the wave of medicalisation that engulfed childbirth through history ensuring the birthplace was within a controlled environment, spirituality of birth has been suppressed within our westernised process of birth. To help understand why this happens, Jordan (1993) discusses authoritative knowledge and how it can be characterised through its dominance and authority:
“To legitimize one way of knowing as authoritative devalues, often totally dismisses, all other ways of knowing. Those who espouse alternative knowledge systems tend to be seen as backward, ignorant or naïve troublemakers…the constitution of authoritative knowledge is an ongoing social process that both builds and reflects power relationships within a community of practice. It does so in such a way that all participants come to see the current social order as a natural order, i.e. as the way things (obviously) are”
(Jordan 1993:152).
Davis-Floyd (2001) suggests that the aim of giving holistic care may be too great a challenge in institutions that are technologically orientated due to the authoritative knowledge suppressing other ways of knowing. Therefore, women have less opportunity to experience spirituality and believe in the physiological nature of birth because this way of knowing is being suppressed by the authoritative knowledge of the institution and its organisational culture.
Jordan’s (1997) study of birth in an American hospital found that: the woman and her partner are never spoken to directly by the doctor; the messages are
relayed through the midwife; the midwife has to wait for the doctor to make the decisions; the midwife implies that even if she did perform a vaginal examination the doctor would not consider her findings as a true interpretation and he would perform another anyway.
Jordan (1997) gives some excellent examples of the authoritative knowledge being held with the doctor. The midwife and woman are viewed as not having the knowledge to make any decisions. There appears to be a hierarchy here, where the doctor is at the top, the midwife is next, the woman and the partner at the bottom. The woman’s knowledge about her own body is dismissed as invalid by the doctor. The medicalised discourse controls the relationships within the institution and therefore, has the authoritative knowledge.
Polanyi’s (1963) theory explains how beliefs rather than evidence become a true fact and become authoritative knowledge. Polanyi argued that scientific knowledge is:
“Steadfastly committed to established beliefs and dogmas within the scientific community. It is the social scientific community, not a rational scientific method, that is the determining condition of scientific knowledge”
(Polanyi 1963:375).
Downe and McCourt (2004) give a detailed exploration of the history of scientific thought and the limitations of applying theories of certainty viewed from a technocratic birth paradigm. Generally these results are viewed as authoritative knowledge and applied to the whole of the population when childbirth is about complexity and chaos and does not reflect all childbirth experiences. Beliefs, for example, that caesarean section is safer and has reduced perinatal mortality and morbidity, when it has not made any significant difference and has increased morbidity (Kings Fund 2008)11 have become viewed as fact.
Evidence of how knowledge is constructed by midwives can be found in Hunter’s (2008) work. She used poems written by ten American midwives to draw out three authoritative ways of knowing that guided their care given to women during childbirth. 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. Their beliefs are constructed into fact, which forms their knowledge base and will be passed onto others.
2.2.8 CONCLUSION
I have discussed in detail the current political position of maternity services and the definition of the midwife’s role. The historical factors of midwifery and how it has been influenced by medicalisation and technocratic birth have given an insight into the factors affecting maternity services today. Traditional holistic factors and the dominance of authoritative knowledge from obstetric practices have been explored. My chosen definition of technocratic birth and holistic birth throughout this thesis is Davis- Floyd’s (1992), discussed within this chapter.12
The information gained from this part of my thesis will assist understanding of how knowledge bases have been formed and how women’s and midwives perceptions found in this study have been constructed. I will now discuss the second part of this chapter, where I have reviewed the literature.
12 See figure 2.1.