Dear Ans, Jo Anne and everyone
I think the concept of 'caritas' is a good one here: that is, loving care as a kind of gift. Denis Walsh has written about this in the context of birth centre care. I am particularly interested in the importance of Aristotelian values - courage, love, trust - in the exercise of maternity care, and I think that positive/salutogenic/optimal maternity care does end up being a synthesis between Khunian normal science and a values based maternity care. This is not a simple or easy course of just being kind and nice - I have put courage first in the list of virtues because I think that we cannot do normal physiological salutogenic birth without being deeply courageous. Midwives (and doctors) who manage to support such birthing regularly in very difficult contexts are often risking their reputation, and their livelihood, - they should be our heros, and we really need to recognise them, and tell them how much they mean to us in keeping this vision of caritas and wisdom in maternity care alive. I also think that this only becomes truly optimal when it is shared by all professional who are interacting with women, so that the care given is seamless between and across professional groups and boundaries, and that this is supported by mutual trust and belief in womens capacity to give birth, and in the expertise and essential goodwill of others with whom we interact. This is very often not easy - but I do think we do the best for women and babies if we can manage to make it happen. I have seen this in operation in some places. We need to learn from those places and individuals as much as we can.
More specifically, Robbie Davis-Floyd has written about 'post-modern' midwives, who successfully practically and philosophically cross home and hospital birth boundaries, and a colleague of mine, Louise Simpson, has recently finished some work around midwifery expertise that notes the capacity of the expert to operate between and across these kind of boundaries, and, crucially, to influence positive change within and between environments of care.
On the specific question of the Cartesian divide Ans - there is some debate as to whether Descartes every really meant for the mind and body to be separated out - he did identify them as different spheres, but he also talks about how they are interrelated. While I agree that technocratic consumerist ways of doing childbirth have forced an industrial model on to maternity care ( hence the machine metaphor - Emily Martins book, 'The woman in the body' is good on this), I wonder if it is Descartes comments on how the mind and body are interconnected which have more to say for us now - specifically in the debate we are having about intermittent auscultation. I am really fascinated to hear qualitative accounts of how expert midwives construct and carry out intermittent auscultation, and what they 'hear' when they listen to the FH - I guess it is a bit like Chinese medicine, where the nature of the pulse tells the expert practitioner much more than the count that is made - Im really looking forward to what people find out!
all the very best
Soo
Professor Soo Downe
Director
Midwifery Studies Research Unit
University of Central Lancashire
Preston PR1 2HE
Lancashire
England
+44 (0) 1772 893815
tel: 01772 893815
>>> Jo Anne P Davis <[log in to unmask]> 07/14/07 5:59 pm >>>
Interesting thoughts, Ans. In my dissertation on defining US midwives' concept of normalcy during childbirth,
there emerged (not surprisingly) a dichotomy between 'routine' care and 'individualized' care. Routine care was
perceived by the midwives as overarching surveillance and intervention understood in the medical model as
necessary to good care. The midwives walked a fine line between the dominant model demands for routine
surveillance and intervention, and their preference for individualizing each woman's care to her unique needs and
expectations. Not unexpectedly, the midwives also demonstrated the significant emotional management
demands of this balancing act.
I agree that the need for true caring has been subsumed and greatly diminished into medical care, and the
midwives in my study (and many other colleagues) relate struggles to sustain caring in the midst of the demands
of medical care. The notion of 'relational' practice (which I see as encompassing this kind of 'female' or social
caring) as an essential component of midwifery/maternity care practice came through quite strongly. Referring
to this as 'female' caring, of course, feels like stepping out on very thin ice, as it hearkens back to the 19th
century debates on what women stereotypically bring to the healthcare occupations, particularly medicine (see
Emily and Elizabeth Blackwell). Perhaps in midwifery's occupational project, distancing somewhat from
'sentimental caring' in favor of being 'scientific' was a necessary stance to gain standing. Just thoughts...
Jo Anne Davis
Jo Anne P. Davis, CNM, PhD
Midwifery Faculty
New York University College of Nursing
----- Original Message -----
From: Ans Luyben <[log in to unmask]>
Date: Saturday, July 14, 2007 8:32 am
Subject: Re: SV: intermittent auscultation
To: [log in to unmask]
> Hi Kathy,
>
> I really like this discussion and fits my study on "routine" antenatal
> care.
> As my study aims to study its effectiveness, I would even like to argue
> stronger- that "routine" care are not effective to meet most women's needs
> ( it is only more explicit in different ethnic or deprived social groups).
>
> I would say however, that we need to "care" during the normal passage
> to
> motherhood ( this used to be a characteristic of female society), but
> in a
> different way as it has been defined now ( as in "medical care"). ( Which
> might question the definition of "normal obstetrics").
>
> Maybe Soo Downe would agree with me, that "routine" is a result of the
> development of Cartesian thought... and supports the functioning of the
> "well- oiled machinery of the system". Doubtful however whether this should
> be the focus of midwifery.
>
> best wishes,
>
> ans
>
> -----Oorspronkelijk bericht-----
> Van: A forum for discussion on midwifery and reproductive health
> research. [
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