- Email: [email protected]
A midwifery course case study — Research in progress
AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED
A MIDWIFERY
COURSE CASE STUDY - RESEARCH
IN PROGRESS
Margaret Barnes R~, RM, B.Ed., MA (Sociology) Developments in midwifery have emphasised the importance of choice and shared responsibility in the provision of care for women, but has failed to make explicit the processes which may make this happen. While structural changes may have taken place, the fundamental issues related to power, control and the oppression of w o m e n remain unchallenged. This research project involves a case study of a tertiary midwifery course, an exemplar, from which to examine broader issues in midwifery and midwifery education. It is being undertaken as a doctoral study. The theoretical framework for the study draws on feminist and poststructuralist theory and aims to represent multiple perspectives. Childbirth, midwifery and midwifery education have been influenced socially and historically by predominantly male medical systems, which have sought to medicalise childbirth. While it can not be denied that advances in maternity care have improved outcomes for mothers and babies, childbirth has been problematised, with solutions sought in increasing (and at times unjustified) use of technology and intervention. The technocratic approach to birth has become dominant in a complex power, control and profit relationship. In this relationship, tensions are evident between medicine, midwifery and the childbearing woman, despite a seemingly c o m m o n goal, healthy childbirth. Taking a feminist approach this research project aims to analyse these relationships and to acknowledge the tenet of feminist research "that w o m e n ' s lives are i m p o r t a n t " ( R e i n h a r z 1992:241). Doering (1992) claims that the two philosophies of feminism and poststructuralism have relevance to nursing (midwifery) because they incorporate the concepts of power and women's experience. She suggests that these concepts "reflect the historical, social, and political dynamics in which the discipline of nursing operates." Weedon describes feminist poststructuralism as "a m o d e of knowledge production which uses poststructuralist theories of language, subjectivity, social processes and institutions to u n d e r s t a n d existing p o w e r relations and to identify areas and strategies for change" (1987: 40,41). PAGE 30
The relationship between k n o w l e d g e / p o w e r is central to poststructuralism. Doering (1992) relates the Foucauldian representation of power as "a strategic situation in a given society" and that p o w e r relations in society have a purpose to maintain social hierarchy through the day to day practices of individuals. Power and knowledge are intertwined in that p o w e r limits what is acceptable to be k n o w n and knowledge develops in r e s p o n s e to or r e s i s t a n c e to p o w e r relationships. "Knowledge and power are viewed as mutually generative, that is knowledge initiates power and power generates knowledge" (Dickson 1990: 22). When considering the historical, social and political dimensions of midwifery and childbearing the theoretical framework provided by feminism and poststructuralism, with the e m p h a s i s o n r e l a t i o n s h i p s of p o w e r and k n o w l e d g e is r e l e v a n t for this r e s e a r c h . Considering the above issues which concern midwifery, education of midwives and the issues for childbearing w o m e n which are implicit, the research project focuses on the following concerns: 1.
The processes in the course which facilitate or impede student learning and development.
2.
The extent to which a w o m a n centred curriculum might influence student attitudes and practices within the midwifery context.
3.
The extent to which a shift in educational paradigm and a woman-centred focus in the curriculum may facilitate change in childbirth and midwifery in the long term.
Within a poststructural framework, "language is the c o m m o n f a c t o r in the analysis o f social organisation, social m e a n i n g s , p o w e r and individual consciousness." (Weedon 1987 in Dickson, 1992:23). It is then the analysis of texts which can provide access to such language and subsequent analysis of social organisation and power relations. A representation of multiple voices or perspectives is important within this framework, and consistent with this text has been sought from a number of sources, student interview and journals, teacher reflections, course documents and published accreditation criteria and standards.
ACMI JOURNAL
SEPTEMBER 199(9
AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED
What began as an implementation and evaluation study of a midwifery course has evolved into an analysis of the much broader issues facing midwifery. Student concerns reflect what remain as issues for the midwifery community. Issues such as advocacy, conflicting interests, the influence of medical domination and the often disempowering nature of the birth experience.
Birth Without Borders
As this research is in progress I would welcome comments, questions and feedback.
F e b r u a r y 2 8 , M a r c h 1 & 2, 1 9 9 7 Chiang Mai, Thailand
References
1st A S E A N I n t e r n a t i o n a l C o n f e r e n c e
Dlckson, G. (1990) A feminist poststructurahst analysis of the knowledge of menopause. Adv Nurs Sci 12(3) 15-31 Doering, L. (1992) Power and knowledge in nursing A fennnlst poststructurahst view. Adv Nurs Soci. 14(4) 24 33 Reinharz, S. (1992) Feminist Methods in Social Research New York. Oxford UniversityPress Weedon, C. (1987) Feminist Practice and Poststructurahst Theory. Oxford. Basl~ Blackwell Press. Contact
Margaret Barnes School of Nursing Griffith University, Nathan, Qld. 4111 07 3875 5214 or 074 456 192 email: [email protected]
DISTANCE LEARNING PROGRAM The Australian College of Midwives Inc. in conjunction with Southern Cross University, Lismore NSW offers the followmg UNITS of STUDY that you may undertake as continuing education or as credits towards a Master degree. Members of the ACMI receive a reduction in fee for each unit undertaken • • • • •
C h i l d b i r t h in the 90's Learn h o w you can personally benefit from the latest international research relating to pregnancy, birth and post-natal periods. Meet the leading specialists. Dr. Wirapong C h a t a r a n o n (Thailand), Elizabeth Davis (U.S.A.), Dr. Tanit Habanananada (Thailand), Dr. Yehudi G o r d o n (UK), Doris Haire (U.S.A.), Prof. Marshall Kalus (U.S.A.), Phyllis Klaus (U.S.A.), Dr. Michel Odent (France), J o s e p h Chilton Pearce (U.S.A.), A n d r e a Robertson (Australia), Dr. Toshiyasu Shimizu (Japan), Dr. Marsden Manager (Denmark). For Conference Brochure contact:
B.W.B. Coordinators: Dr. Tanit Habanananda, Maelanie Habanananda, Julia Jus Tel~Fax. (66-53) 271-590 P.O. Box 111, Phra Singh, Chiang Mai 50200, Thailand
CHILDBIRTH EDUCATION & PARENTCRAFT THE MIDWIFE AS A PRIMARY HEALTH CARE PROVIDER & ADVOCATE MATERNAL ASSESSMENT CARE OF THE PERINEUM & PERINEAL SUTURING
ACMI Pens $5.00 each (includes postage)
ACMI Address Books $6.00 each (includes postage)
NEONATAL RESUSCITATION
Available from: ACMI Office
For further information on the Distance Learning Program contact:
Suite 23, 431 St Kilda Road
Australian College of Midwives Inc. Suite 23, 431 St Kilda Road MELBOURNE VIC 3004
Melbourne Vic 3004 Make cheque payable to ACMI
Tel: (03) 9804 5071
SEPTEMBER 1096
ACbll JOURNAL
PAGE 31
AUSTRALIAN COLLEGE O F MIDWIVES INCORPORATED
THE ROYAL HOSPITAL FOR W O M E N PADDINGTON
FINAL GRADUATION FROM THE MIDWIFERY SCHOOL (AFTER 119 YEARS OF MIDWIFERY EDUCATION) ALL PAST GRADUATES, STAFF AND FRIENDS OF THE 'ROYAL' ARE INVITED TO ATI'END.
TENTATIVE DATE 11 OCTOBER 1 9 9 6 TO BE FOLLOWED B Y A D I N N E R DANCE FOR FURTHER INFORMATION PLEASE PHONE: (02) 9339 4278 (MIDWIFERY SCHOOL) R S V P R E Q U I R E D BY."
13 SEPTEMBER 1 9 9 6
P R O P O S E D SUMMIT MEETING Organised by the Committee of Presidents of Nursing and Midwifery Colleges Date
31 January 1997
Venue
Melbourne
Aim
To identify issues within nursing and midwifery healthcare environments in Australia culminating in the development o f a strategic plan f o r the nursing and midwifery profession f o r resolution.
Proposed speakers f r o m the Federal Health Department NH&MRC Nursing and Midwifery professions For further information contact: Executive Officer - ACMI Suite 23 431 St Kilda Road Melbourne Vic 3004
PAGE 32
ACMI JOURNAL
SEPTEMBER 1996
A MIDWIFERY
COURSE CASE STUDY - RESEARCH
IN PROGRESS
Margaret Barnes R~, RM, B.Ed., MA (Sociology) Developments in midwifery have emphasised the importance of choice and shared responsibility in the provision of care for women, but has failed to make explicit the processes which may make this happen. While structural changes may have taken place, the fundamental issues related to power, control and the oppression of w o m e n remain unchallenged. This research project involves a case study of a tertiary midwifery course, an exemplar, from which to examine broader issues in midwifery and midwifery education. It is being undertaken as a doctoral study. The theoretical framework for the study draws on feminist and poststructuralist theory and aims to represent multiple perspectives. Childbirth, midwifery and midwifery education have been influenced socially and historically by predominantly male medical systems, which have sought to medicalise childbirth. While it can not be denied that advances in maternity care have improved outcomes for mothers and babies, childbirth has been problematised, with solutions sought in increasing (and at times unjustified) use of technology and intervention. The technocratic approach to birth has become dominant in a complex power, control and profit relationship. In this relationship, tensions are evident between medicine, midwifery and the childbearing woman, despite a seemingly c o m m o n goal, healthy childbirth. Taking a feminist approach this research project aims to analyse these relationships and to acknowledge the tenet of feminist research "that w o m e n ' s lives are i m p o r t a n t " ( R e i n h a r z 1992:241). Doering (1992) claims that the two philosophies of feminism and poststructuralism have relevance to nursing (midwifery) because they incorporate the concepts of power and women's experience. She suggests that these concepts "reflect the historical, social, and political dynamics in which the discipline of nursing operates." Weedon describes feminist poststructuralism as "a m o d e of knowledge production which uses poststructuralist theories of language, subjectivity, social processes and institutions to u n d e r s t a n d existing p o w e r relations and to identify areas and strategies for change" (1987: 40,41). PAGE 30
The relationship between k n o w l e d g e / p o w e r is central to poststructuralism. Doering (1992) relates the Foucauldian representation of power as "a strategic situation in a given society" and that p o w e r relations in society have a purpose to maintain social hierarchy through the day to day practices of individuals. Power and knowledge are intertwined in that p o w e r limits what is acceptable to be k n o w n and knowledge develops in r e s p o n s e to or r e s i s t a n c e to p o w e r relationships. "Knowledge and power are viewed as mutually generative, that is knowledge initiates power and power generates knowledge" (Dickson 1990: 22). When considering the historical, social and political dimensions of midwifery and childbearing the theoretical framework provided by feminism and poststructuralism, with the e m p h a s i s o n r e l a t i o n s h i p s of p o w e r and k n o w l e d g e is r e l e v a n t for this r e s e a r c h . Considering the above issues which concern midwifery, education of midwives and the issues for childbearing w o m e n which are implicit, the research project focuses on the following concerns: 1.
The processes in the course which facilitate or impede student learning and development.
2.
The extent to which a w o m a n centred curriculum might influence student attitudes and practices within the midwifery context.
3.
The extent to which a shift in educational paradigm and a woman-centred focus in the curriculum may facilitate change in childbirth and midwifery in the long term.
Within a poststructural framework, "language is the c o m m o n f a c t o r in the analysis o f social organisation, social m e a n i n g s , p o w e r and individual consciousness." (Weedon 1987 in Dickson, 1992:23). It is then the analysis of texts which can provide access to such language and subsequent analysis of social organisation and power relations. A representation of multiple voices or perspectives is important within this framework, and consistent with this text has been sought from a number of sources, student interview and journals, teacher reflections, course documents and published accreditation criteria and standards.
ACMI JOURNAL
SEPTEMBER 199(9
AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED
What began as an implementation and evaluation study of a midwifery course has evolved into an analysis of the much broader issues facing midwifery. Student concerns reflect what remain as issues for the midwifery community. Issues such as advocacy, conflicting interests, the influence of medical domination and the often disempowering nature of the birth experience.
Birth Without Borders
As this research is in progress I would welcome comments, questions and feedback.
F e b r u a r y 2 8 , M a r c h 1 & 2, 1 9 9 7 Chiang Mai, Thailand
References
1st A S E A N I n t e r n a t i o n a l C o n f e r e n c e
Dlckson, G. (1990) A feminist poststructurahst analysis of the knowledge of menopause. Adv Nurs Sci 12(3) 15-31 Doering, L. (1992) Power and knowledge in nursing A fennnlst poststructurahst view. Adv Nurs Soci. 14(4) 24 33 Reinharz, S. (1992) Feminist Methods in Social Research New York. Oxford UniversityPress Weedon, C. (1987) Feminist Practice and Poststructurahst Theory. Oxford. Basl~ Blackwell Press. Contact
Margaret Barnes School of Nursing Griffith University, Nathan, Qld. 4111 07 3875 5214 or 074 456 192 email: [email protected]
DISTANCE LEARNING PROGRAM The Australian College of Midwives Inc. in conjunction with Southern Cross University, Lismore NSW offers the followmg UNITS of STUDY that you may undertake as continuing education or as credits towards a Master degree. Members of the ACMI receive a reduction in fee for each unit undertaken • • • • •
C h i l d b i r t h in the 90's Learn h o w you can personally benefit from the latest international research relating to pregnancy, birth and post-natal periods. Meet the leading specialists. Dr. Wirapong C h a t a r a n o n (Thailand), Elizabeth Davis (U.S.A.), Dr. Tanit Habanananada (Thailand), Dr. Yehudi G o r d o n (UK), Doris Haire (U.S.A.), Prof. Marshall Kalus (U.S.A.), Phyllis Klaus (U.S.A.), Dr. Michel Odent (France), J o s e p h Chilton Pearce (U.S.A.), A n d r e a Robertson (Australia), Dr. Toshiyasu Shimizu (Japan), Dr. Marsden Manager (Denmark). For Conference Brochure contact:
B.W.B. Coordinators: Dr. Tanit Habanananda, Maelanie Habanananda, Julia Jus Tel~Fax. (66-53) 271-590 P.O. Box 111, Phra Singh, Chiang Mai 50200, Thailand
CHILDBIRTH EDUCATION & PARENTCRAFT THE MIDWIFE AS A PRIMARY HEALTH CARE PROVIDER & ADVOCATE MATERNAL ASSESSMENT CARE OF THE PERINEUM & PERINEAL SUTURING
ACMI Pens $5.00 each (includes postage)
ACMI Address Books $6.00 each (includes postage)
NEONATAL RESUSCITATION
Available from: ACMI Office
For further information on the Distance Learning Program contact:
Suite 23, 431 St Kilda Road
Australian College of Midwives Inc. Suite 23, 431 St Kilda Road MELBOURNE VIC 3004
Melbourne Vic 3004 Make cheque payable to ACMI
Tel: (03) 9804 5071
SEPTEMBER 1096
ACbll JOURNAL
PAGE 31
AUSTRALIAN COLLEGE O F MIDWIVES INCORPORATED
THE ROYAL HOSPITAL FOR W O M E N PADDINGTON
FINAL GRADUATION FROM THE MIDWIFERY SCHOOL (AFTER 119 YEARS OF MIDWIFERY EDUCATION) ALL PAST GRADUATES, STAFF AND FRIENDS OF THE 'ROYAL' ARE INVITED TO ATI'END.
TENTATIVE DATE 11 OCTOBER 1 9 9 6 TO BE FOLLOWED B Y A D I N N E R DANCE FOR FURTHER INFORMATION PLEASE PHONE: (02) 9339 4278 (MIDWIFERY SCHOOL) R S V P R E Q U I R E D BY."
13 SEPTEMBER 1 9 9 6
P R O P O S E D SUMMIT MEETING Organised by the Committee of Presidents of Nursing and Midwifery Colleges Date
31 January 1997
Venue
Melbourne
Aim
To identify issues within nursing and midwifery healthcare environments in Australia culminating in the development o f a strategic plan f o r the nursing and midwifery profession f o r resolution.
Proposed speakers f r o m the Federal Health Department NH&MRC Nursing and Midwifery professions For further information contact: Executive Officer - ACMI Suite 23 431 St Kilda Road Melbourne Vic 3004
PAGE 32
ACMI JOURNAL
SEPTEMBER 1996