Chapter 2 Literature review
2.5 Theme 3 Intuition based on connective ways of knowing, emotion and
Mok and Stevens (2005, p.30) describe intuition within midwifery practice as the notion of connectiveness; an “awareness creating relationship” or “tuning in” to the woman. Ólafsdóttir (2009, p. 192) similarly in her narrative ethnographic study of Icelandic midwives asserted that midwives would “connect” with women which enabled them to elucidate the woman’s needs. Ólafsdóttir (2009, p. 201) suggested
that this development of connective knowing was often related to emotional situations that could support or restrict the midwives’ knowing depending on the context. Winter (2002) in her grounded theory study of independent midwives’ ways of assessing progress in labour similarly found that if a relationship broke down with a woman or her partner during labour this would restrict and disrupt the midwives’ knowing. Midwives’ knowing could also be disrupted if the woman was transferred from home to hospital as the midwives believed their relational intuitive knowing was not valued in the hospital settings where medical science and technology are revered (Bone 2009).
Davis-Floyd (2004) has also attributed the relationship between the woman and the midwife as a key point in intuition, asserting that the relationship between the woman and the midwife enabled the midwife to ‘tune in’ psychically and spiritually to subtle clues and qualitative changes during care. Davis-Floyd and Davis (1997) describe this concept in their narrative study researching a cohort of homebirth midwives from the USA and their experiences of intuition. It is acknowledged however that they do not define what is meant by ‘spirituality’. The homebirth midwives interviewed described their intuition as emotional, physical, psychic and spiritual. This intuitive connection with the woman and her baby was dependent on the degree they connected to their own thoughts and feelings (Davis-Floyd and Sargent 1996).
In Davis-Floyd and Davis’ (1997) study, the midwives interviewed linked intuition to their “higher selves”; however because of this spiritual connection they were unwilling to accept that intuition could be wrong (Davis-Floyd and Davis 1997, p. 159). Once again Davis-Floyd and Davis (1997 p. 159) do not define their described terms of “spiritual” and “psychic”. Belenky et al. (1997, p. 54) contest the idea of
intuition or ‘subjective knowledge’, always being correct asserting that this leads to absolutism and can negate legitimate answers from the outside world. The participants, however, in Davis Floyd and Davis’(1997) study would justify their intuition, even if proved incorrect, mitigating that it was not intuition in the first place but use of their “rational minds” (Davis-Floyd and Davis 1997, p. 159).
Other researchers have identified the relationship between the midwife and the woman as being important to intuition and have similarly identified a spiritual or psychic relationship (Ólafsdóttir 2009; Hall and Taylor 2004). Ólafsdóttir (2009, p. 192) asserted that this spiritual relationship enabled the midwives to develop a form of “inner knowing” or “intuitive knowledge”. In Ólafsdóttir’s (2009) narrative study of Icelandic midwives, stories were related of sensing “something behind me”. As Ólafsdóttir (2009, p.149) describes the Icelandic midwives in her study: “seemed to have contact to the spiritual world”. This would include narratives that described how:
“women or transcendent people had told them who was behind them from the other side”
(Ólafsdóttir 2009, p.149).
This notion of spirituality however enters into the arena of ‘mystical’ knowledge which sits firmly outside the realm of rational thinking and professional practice (Wickham 2004). Benner (1984) asserted that intuition should not be confused with mysticism, as she maintained it is only available in situations where a deep background or knowledge of the situation exists. Defining spirituality is also difficult and there may be a danger of restricting the full and composite meaning, particularly when relating it to practice situations (McSherry 2006; White 2006). Hall (2001) has
however identified features of spirituality from other health care disciplines including transcendence, searching for meaning and purpose, relational aspects and creativity and applied these to midwifery and childbirth. Intuition however is not included. There was also a dearth of research or theoretical papers across all health disciplines in the area of spirituality and intuition.
Other researchers and philosophers have asserted the importance of emotion in relation to intuition and tacit knowledge. These include nursing theorists Herbig et al., and the philosophers Polkinghorne and Gendlin, their concepts will now be discussed.
Herbig et al. (2001, p. 694) have identified that there are emotional aspects involved in tacit knowledge and have demonstrated that the information provided by tacit knowledge was important. In their nursing research they identified that nurses’ tacit knowledge was more likely to be effective if they attended to their emotions. In the following excerpt the results are discussed in terms of groups of nurses that were ’successful’ or ‘not successful’ in a simulated critical incident:
“Although both groups reported feelings as essential aspects in the situation, successful nurses seemed to be able to use these feelings as action-related information while unsuccessful nurses seemed to perceive feelings as obtrusive and irritating. “
Similarly, Polkinghorne (2004, p.110), a philosopher and psychotherapist, presents a convincing case for the use of emotion in deliberations, as it serves as sources of information for “right actions”. Polkinghorne (2004) asserts that it is frequently an emotional response to a situation rather than a detached rational thought that serves as a guide to appropriate action. Polkinghorne (2004) deliberates that
emotion can focus attention to reveal aspects of a situation that may otherwise remain hidden. This is cited as intuitive knowledge and associated with a relational connection:
“One often feels a friend’s needs intuitively before coming cognitively aware of them”
(Polkinghorne 2004, p. 110). Polkinghorne (2004, p.130) calls for ‘embodied’ knowledge which involves the individual drawing on not only emotion but values and feelings. This is linked to the psychotherapist and philosopher, Gendlin’s (1962, p. 138) philosophy of experiencing:
“Experiencing is our interaction with life situations and the visceral meanings these situations have for us”.
Gendlin (1962) asserted that experiencing was beyond thought and conceptualised it as “bodily felt meaning” or embodied knowledge. He explicated this as an unconscious awareness that guided individual actions. Polkinghorne (2004) conceptualises embodied knowing as an implicit process and a combination of emotions, memories and the felt presence of others. He asserts that this knowing functions “below the level of conscious awareness” and is concerned with the integration of multiple values and particular needs (Polkinghorne 2004, p. 140).This notion of the unconscious concurs with the psychological theories presented, however the ‘felt’ presence of others is suggestive of utilising the senses.
This section has considered intuition as a connective form of emotional, psychic and spiritual knowing. This connection has embraced both the link between the midwife and the woman, and between the midwife and her ‘higher self’. Polkinghorne
(2004) has however further developed this concept of intuition as a form of embodied knowledge. This emphasises the importance of relationships but also acknowledges patterning and addresses the concerns of mysticism explaining the spiritual and psychic as emotions and felt presence. Polkinghorne (2004) has called for a judgment based practice to utilise embodied knowledge. This concept is now continued in the concluding part of the review which considers intuition in the context of decision making and professional judgment.