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It might be worthwhile to look at more theoretical the case study work conducted by Dutch midwife and sociologist Leonie van der Hulst. Hulst van der, L.A.M. (1999a) 'Dutch midwives: relational care and birth location', Health and Social Care in the Community, 7: 242-47 Leonie divides midwifery into four theoretical care themes: A. Obstetric-technical B. Risk selection C. Social environment of the client D. Relational care This sounds vaguely similar to "The main processes for therapeutics were supporting "normalcy" and "vigilance." While they may seem very different, they actually are intricately related and have much to do with "being with" woman." As outlined by the previous contribution to this debate. Edwin R. van Teijlingen Department of Public Health & Dugald Baird Centre for Research on Women's Health University of Aberdeen Aberdeen AB25 2ZD Tel. +(44)-1224-552491 Fax. +(44)-1224-662994 E-mail address: [log in to unmask] Web address http://www.abdn.ac.uk/public_health/phstaff/phevt.htmi -----Original Message----- From: [log in to unmask] [mailto:[log in to unmask]]On Behalf Of Holly Powell Kennedy Sent: 15 March 2000 15:18 To: [log in to unmask] Subject: RE: Introduction and request Dr. Fahy, Thank you for sharing this article. I agree with many of your premises about how we approach being midwives, as well as how we teach them midwifery. I would be interested in getting the reference for this article if it is in print or press. My own research is geared toward understanding the process of exemplary midwives. I recently published a Delphi study done with exemplary midwives and women for whom they had cared. The results were fascinating and aligned in three dimensions: therapeutics, caring, and the profession. The main processes for therapeutics were supporting "normalcy" and "vigilance." While they may seem very different, they actually are intricately related and have much to do with "being with" woman. We actually called it "the art of doing nothing well" from one of the midwive's quotes. I can't email it to you but it is in the Jan/Feb 2000 Journal of Midwifery & Women's Health (formerly the Journal of Nurse-Midwifery), 45(1), pp 4-19. I think it is a start in documenting, via research, the process of our care that can account for our differences and our outcomes. The ACNM has incorporated "hallmarks" of midwifery into their core competencies which we believe capture the essence of midwifery competency more clearly. They include recognition of normalcy of pregnancy and women's reproductive systems, empowerment, therapeutic value of human presence, cultural competency, among others. Those were written in 1997 and can be found on the ACNM web site (midwife.org). Again, think you for sharing this article with us! At 09:45 AM 3/15/2000 +1000, you wrote: >Dear Susan, > >I see the word diagnosis as part of the scientific, techno-rational paradigm >of assess, diagnose, plan, implement and evaluate. This paradigm works well >if you have a problem or if you want to treat everything as a potential >problem. Such a paradigm guides thinking and perception. The midwifery >paradigm, I think, is quite different. I have written on this for the >Australian College of Midwives Journal; Being a Midwife and Doing Midwifery. >You may find it interesting so I am attaching a copy of that article from my >files. > >Dr. Kathleen Fahy >Associate Professor >Midwifery Co-ordinator >University Southern Queensland >07 46312377 >[log in to unmask] > > >-----Original Message----- >From: Susan Burvill [mailto:[log in to unmask]] >Sent: Wednesday, March 15, 2000 3:43 >To: [log in to unmask] >Subject: Re: Introduction and request > > >Dear Kathreen >Thank you for your input. I read with interest your comments. I do agree >with you that diagnosis is a biomedical slant but I am interested in the >'midwifery diagnosis' not the medical diagnosis. It may become more apparent >when I start to do my indepth interviews that the paradigm of 'diagnosis' >does not apply to midwifery, which is part of what I wish to establish or >not establish. I have observed that midwives make diagnosis although not >termed diagnosis. For example, 'a woman is in 2nd stage of labour' - is >surely a diagnosis? Not wanting to get too involved in the semantics at this >stage, I find midwifery decision making fascinating and a foundation to >understanding how our approach differs to our obstetric colleagues. >Kind regards >Susan >----- Original Message ----- >From: Kathleen Fahy <[log in to unmask]> >To: <[log in to unmask]> >Sent: Saturday, March 11, 2000 6:11 AM >Subject: RE: Introduction and request > > >> Dear Susan, >> >> I don't have much to specifically add to your topic but I do have a >> suggestion for changing your words. >> >> If your aim is to move away from biomedical discourse then a word like >> 'diagnosis' keeps you locked in. Maybe there isn't a 'start' to labour. >> Maybe it creeps up slowly. Maybe that is one of the big differences >between >> midwifery and obstetrics; midwives don't have to put things in tight >boxes. >> We can accept the continuity of branxton hicks, early labour, established >> labour etc. Why do you want to answer this question? >> >> >> Dr. Kathleen Fahy >> Associate Professor >> Midwifery Co-ordinator >> University Southern Queensland >> 07 46312377 >> [log in to unmask] >> >> -----Original Message----- >> From: Susan Burvill [mailto:[log in to unmask]] >> Sent: Saturday, March 11, 2000 8:23 >> To: [log in to unmask] >> Subject: Introduction and request >> >> >> Dear Colleagues >> I have been on the list for many months but not actually introduced myself >> I am Susan Burvill, I practice as an Independent midwife in South London >and >> at present I am doing an MSc at Surrey University in Advanced Clinical >> Practice (Midwifery). >> My particular interests surround the re-discovery and develpment of a >clear >> midwifery discourse which is distinctly separate from the biomedical >> discourse now so ubiquitous in women's health and childbirth. For my final >> MSc dissertation I am focussing on the midwifery diagnosis of labour >onset. >> In order to tease out and explore the 'midwifery expertise' I will conduct >> serial indepth interviews with two experienced midwives along the lines of >> Firlej and Hellens 'Knowledge Elicitation' process. >> Has anyone read or heard of this approach used to explore midwifery >> knowledge? I have found none so far. >> I would also be interested on any refs pertaining to labour onset >diagnosis, >> there appears surprisingly little in the data bases and journals that I >have >> reviewed. >> I look forward to any leads >> Thanks in advance >> Susan >> >> > > >Attachment Converted: "c:\eudora\attach\3MIDWIFE.DOC" > Holly Powell Kennedy, PhD, CNM Director, Graduate Program in Nurse-Midwifery University of Rhode Island 2 Heathman Road Kingston, RI 02881 USA (O) 401-874-5328 (F) 401-874-2061 %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%