WHAT A MIDWIFE DOES: WOMEN’S AND MIDWIVES’ ‘SITUATED KNOWLEDGES’
6.3 WOMEN’S THEMES: DISCOVERING WOMEN’S ‘SITUATED KNOWLEDGES’
6.3.3 Technology is Necessary/ Needed in Childbirth Basic themes feeding into this are:
•
Technology is an important part of the midwife’s role.•
Hospital is safer than home to give birth.•
Expect environment to be technological.•
Influence of television programmes (show technological birth).Significant value was placed on technology during pregnancy, labour and birth. This emerged from interactions with midwives that shaped their views of the midwife’s role. In particular, the use of technology for monitoring by the midwives, as discussed earlier in this section. On further investigation this theme ran through their experience, from the first to the final interview. This example from Jenny shows how she interprets the midwife’s reliance on technology within her role and how Jenny felt safe being attached to the monitor:
Jenny (6wks following the birth): “when I was in labour there was a midwife and two others to check to see if the baby was okay on the monitor, they were so good, they were lovely. About every five or ten minutes she kept going out and coming in and going out and coming in. Then checking the heart monitor first, then checking the pains on the monitor and asking me if I wanted more pain relief. She was really nice. I felt okay when she wasn’t in there, I was with my mum and my boyfriend, I felt fine and she was in every five minutes and I had the alarm if I needed her I only had to press it”
(Transcript 28,p4).
This demonstrates how technology is used by the midwife to replace her or as a babyminder.47
The midwives are working within this technocratic medicalised birth culture and must conform to be accepted, this ensures they keep their employed status within the institution. Encouragingly, all of the women in this study perceived that a midwife was needed throughout their childbirth experience. An interesting aspect to these results, found at the initial interview, was that most of the women perceived that the midwife would be with them all of the way through their childbirth experience. Through the woman’s experience their ‘situatedness’ would change and their situated knowledge developed. Where they were ‘situated’ was different for each individual woman. Some women were disappointed that they did not experience continuity from the same midwife in the interviews following the birth of their baby. Some women expressed that
they did expect continuity during their pregnancy, but following the birth said that they had not expected this to occur, which was a contradiction to their previous response. A few of the women did not think continuity was important throughout their childbirth experience, but did only expect to see a few rather than many midwives, therefore still valuing some level of continuity. These findings seem to reflect the importance of this for women.
All of the women throughout their experience, valued the support of family/ partner through their childbearing experience. They felt this gave them support and advocacy. An important finding in relation to this is that about half of the women described being without their family/partner through their experience as being on their own. As a midwife the role should be primarily to support women and to be their advocate, this function was not perceived as being part of the midwife’s role.
Providing an appropriate environment for birth was perceived as part of the midwife’s role. Only a few of the women described wanting to have a calm, comfortable environment; the other descriptions are of clinical high technological environments being provided for birth. Some of the descriptions are barbaric in nature and are full of visions of fear and pain.48 The most
interesting perception is that of having machinery with them in the room, as this is an accepted vision and it appears to be a wish that technology is there. This correlates with the perception of the midwife needing to use technology to function in her role. The women expect the midwife to use a mixture of technology and sharp instruments in labour and birth as part of her role. Here are some examples of the expectation of what will be in the labour room:
Danni (36wks): “a drip, the machines to monitor me, a doctor, the midwife and my husband”
(Transcript 10,p2).
Mel (36wks): “me and my husband, a bed and lots of machines I suppose and those silver trolleys with knives and scissors and things on them” (Transcript 30,p2).
How childbirth is portrayed within the media appears to have an effect on women’s views of the role of the midwife. Television programmes had a
considerable influence on perceptions of the midwife’s role in this study. Most of the women at 20 weeks or 36 weeks of their pregnancy interpreted television as influencing their perception. Celebrity stories of childbirth also had an impact on this. Here are some examples from the women’s interviews of the responses when I asked if they knew what midwives did before they were pregnant:
Yvonne (20wks): “just from magazines and television programmes really I suppose. You tend to get celebrities talking about pregnancy and labour and things now. They always look so glamorous afterwards don’t they? I hope I’m like that. Posh had her toenails painted when she had one of hers I think, do you think they would do that for me? (laughing)”
(Transcript 33, p1).
Terri (20wks): “ only from family and the telly. On the telly it’s usually about when you are in labour, it just looks technical and scary”
(Transcript 1, p1).
6.4
MIDWIVES’
THEMES:
MIDWIVES’
KNOWLEDGE
CONSTRUCTION
This section provides an overview of the main global theme, three organisational themes and related basic themes identified from interviews with the midwives who were present either in labour or/and at the birth of each of the women’s baby’s. Ten interviews were performed, within four weeks of birth. The midwives are identified as each woman’s midwife, throughout the text.
The three organisational themes identified were:
•
Focus on midwives ‘doing’ rather than ‘being’.•
Medicalised culture constrains practice of midwives supporting normal physiological process, which is influenced by dominant medical discourse.•
Significant value placed on technology during pregnancy, labour and birth.This provided an overarching global theme, which is similar to the one identified in relation to women’s themes: the focus of maternity care within the institution is medically led and technological, which has resulted in devaluation of the normal physiological birth process.
The global theme is central to the web of organisational themes and their related basic themes, which is shown diagrammatically in Figure 6.4.
The basic themes are discussed within each organisational theme in the next part of this section. It may be beneficial to refer to Figure 6.4 whilst reading the next part of this section.
Figure 6.4 Midwives Themes
Doctors Midwife Guidelines ‘free to roam’ Co-ordinators
Medicalised culture constrains practice of midwives
practice in fear of Normality belief Midwives value Midwives think women litigation destroyed technology value technology
Technology is needed /necessary for childbirth
Machines used as
replacement midwife/ babyminder
Focus of maternity care within institution = medical led technological
normal birth process not valued
Women do not understand Physiological birth Models providing continuity of care
not evident
Focus on midwives ‘doing’ rather than ‘being’
Expectation of women that midwives two types of midwives No midwifery led should be ‘doing’ environment
Midwives will be ‘situated’ differently depending on their own individual experiences of life, including those of being a woman and as a midwife. Their ‘situated knowledges’ are individual, but do relate to some identifying themes to colleagues working within the same model of care and environment. Grouping themes together can result in loosing some of the midwife’s ‘situatedness’, although I have attempted to retain this.
6.4.1 Focus is on Midwives ‘Doing’ Rather Than ‘Being’