- Email: [email protected]
Research in midwifery — The relevance of a feminist theoretical framework
AUSTRALIANCOLLEGEOF MIDWIVES INCORPORATED
RESEARCH IN MIDWIFERY - THE RELEVANCE OF A FEMINIST THEORETICAL F R A M E W O R K Margaret Barnes
RN, Midwife, B E d (Nurs), MA(Sociology)
Lecturer, School of Nursing, Queensland University of Technology Victoria Park Road, Kelvin Grove Qld 4059 Phone: 07 3864 3903 email: [email protected] (Reprint request to MB) ABSTRACT As midwifery develops as a discipline and n e w models of care are introduced within maternity services, research activity and inquiry into practice and professional issues will be required. This paper suggests that an appropriate theoretical nnderpinning for research in midwifery is one that is based on feminist theory. It is argued that by adopting this approach, midwifery practice will focus on the needs of w o m e n and change in the provision of services for childbearing w o m e n will be in response to w o m e n ' s e v a l u a t i o n o f existing services. By addressing the needs of w o m e n it is argued that the profession will also benefit, as the role of midwifery in the health care of childbearing w o m e n will be defined. Key words: Feminism, research, women-centred midwifery practice INTRODUCTION As midwifery moves toward n e w models of care and an increasing focus on w o m e n centred practice a framework for research in midwifery will assist in providing a theoretical underpinning to research activity in midwifery. In this paper I suggest that a feminist theoretical framework is appropriate to the study of childbearing and midwifery as feminism seeks to address and overcome the oppression of w o m e n and in so doing provides an appropriate framework within w h i c h to examine issues and practices which influence the fives and experience of women.
to make connections between changes in childbirth and the position of w o m e n in society (for example, Oakley 1976). In her work Wisewoman and Medicine
Man: Changes in the Management of Childbirth, Oakley traces the historical changes in childbirth, specifically those w h i c h led to male control of reproductive health, and relates these changes to the position of w o m e n in society. In this early work Oakley suggests that the opposing definitions of childbirth as 'natural' or 'medicalised' is more than opposing professional views. Rather, she suggests that there is a sex difference in the structure of control, that is, that over the last century the social and medical management of childbirth In industrialised cultures has shifted from a community of untrained women, to one based on a profession of formally trained men. These claims are further expanded in her w o r k Women ConFmedwhere Oakley (1980) explores the experience of childbirth from women's perspective. A significant finding in this work was the identification of the connection between the construction of the 'medical maternity case' and the subsequent control of reproductive health and childbearing w o m e n by medicine.
The Relevance o f a Feminist A p p r o a c h to The Study o f Childbearing and Midwifery
Oakley's work was followed by that of other writers and a questioning of the position of women in society generally was demonstrated through a feminist critique of the e x p e r i e n c e o f childbearing and motherhood (for example, Wearing 1984; Rich 1986). This interest in a feminist analysis of the position of childbearing w o m e n occurred at a time when the p o s i t i o n of w o m e n w i t h i n society was being examined more generally through the processes and activism of the w o m e n s liberation m o v e m e n t (Sheridan 1990).
The r e l e v a n c e of a feminist a p p r o a c h to the examination of issues related to childbearing became apparent with the work of feminist writers who began
This analysis was reflected in the views of w o m e n t h e m s e l v e s w h o w e r e b e c o m i n g increasingly dissatisfied with maternity care. Oakley and Houd
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AUSTRALIAN COLLEGE OF MIDWIV~ INCORPORATED
(1990) suggest that the growing consumer movement of the time stemmed from the growing discontent with maternity services and a recognition that many solutions for health problems lie outside the reach of medical science and technology. Subsequent research indicates a continuing dissatisfaction with the care provided for w o m e n during pregnancy and childbirth (for example, Brown and Lumley 1994; Green et al 1990) findings w h i c h have led to proposals for significant changes in provision of maternity services (NHMRC 1996).
Development of Woman-Centred Midwifery Practice. There is a growing recognition that midwives have a significant contribution to make to the health and welfare of women, babies and their families (Page 1995). Midwives are considered integral to the implementation of the Safe Motherhood Initiative an initiative which aims to reduce maternal deaths due to pregnancy, childbirth or abortion (Hernes 1996). However, this contribution is limited in countries where there is increasing interest and use of technology, where pregnancy and birth have been medicalised and where the role of the midwife is eroded (Page 1995). Despite this, there are vigorous attempts to revitalise midwifery, the heart of which is a refocussing of midwifery philosophy, theory and practice to place the w o m a n and her family at the centre of their care. This refocussing is lead by w o m e n w h o have been increasingly dissatisfied with the birthing services and from the profession that is dissatisfied with the diminished role of the midwife in providing care for w o m e n ha normal pregnancy and birth. The notion of 'women-centred' midwifery care has developed in recent years through the w o r k of midwives such as Caroline Flint (1993) and Lesley Page (1995) in the United Kingdom and Karen GuiUiland and Sally Pairman (1994) in New Zealand who have articulated the meaning of contemporary midwifery and the 'with-women' role. While the term 'midwife' has traditionally been defined as 'withwoman', adoption of the essence of this traditional meaning has been varied over time. The current discourse that describes women-centred midwifery practice aims to articulate the possibilities for contemporary practice and to emphasise this central feature of midwifery. JUNE 1999
This interest in m i d w i f e r y c o i n c i d e d w i t h an increasing interest in the quality of maternity services. In Australia a number of birthing services reviews have been conducted which highlighted women's dissatisfaction with care and services available (Young 1995). In the United Kingdom the House of Commons Report on the Maternity Services (1992) emphasised the need to provide choice, control and continuity of care for childbearing women. This report led to the establishment of an expert maternity group to review maternity services, the result of which has been recommendations to fundamentally change m a t e r n i t y services in Britain. The p r i n c i p l e s underlying the recommendations include the centring of services around the individual needs of w o m e n and their families, giving w o m e n choice about their care, place of birth and caregiver and to involve w o m e n in decision making at all levels (Page 1995). The principles and recommendations of the expert panel are published in Changing Childbirth (1993), a d o c u m e n t w h i c h has significantly influenced thinking and practice in midwifery since its release, not only in Britain but internationally. These developments in the birthing services and midwifery have led to a questioning of approaches to midwifery, in particular the relationship between midwife and w o m e n during the childbearing period. This aspect of midwifery care is developed by GuiUiland and Pairman (1994) in the monograph The Midwifery Partnership A Model for Practice. In this w o r k , the a u t h o r s d e v e l o p a t h e o r e t i c a l framework for the practice of midwifery based on the partnership between the woman and the midwife. The basis for this partnership is derived from the following assumptions: 9 Pregnancy and birth are normal life events 9 Midwifery's professional role is with w o m e n during pregnancy and childbirth 9 Midwifery provides w o m e n with continuity of caregiver throughout the experience 9 Midwifery is w o m e n - c e n t r e d (Guilliand and Pairman 1995). In support of this position Couves (1995:119) suggests that it is the woman and her family w h o are central to excellence in midwifery and that w o m e n have the right to be equals in the relationship that develops between them and the midwife.
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T o w a r d Woman-Centred Practice I n c o r p o r a t i n g F e m i n i s m into R e s e a r c h Methods If the relationship between woman and midwife is central to midwifery practice, feminism can provide an appropriate theoretical framework for research in midwifery. Feminism enables the examination of issues and practices that influence the lives and e x p e r i e n c e s of w o m e n and i m p o r t a n t l y acknowledges w o m e n as partners in the research process. Having said this, I acknowledge the many other approaches to research which aim to improve health care for w o m e n and that the perspective discussed in this paper is one way of many to enrich the production of midwifery knowledge. There are m a n y schools of feminist thought, but for the purposes of this paper general principles which apply to feminist approaches generally will be discussed. Early feminist research writing concentrated on the critique of male dominated modes of knowledge production rather than the development of alternative w o m e n - c e n t r e d m o d e s ( D u f f y 1984). D e s p i t e d e v e l o p m e n t s and further articulation of w h a t feminist research might be, the main principles remain the same. Lather (1991:71), for example, suggests that "to do feminist research is to put the social construction of gender at the centre of one's inquiry", or as Harding (1987) points out, feminist research is for women. The goal of the feminist perspective is to re-place w o m e n ' s experience in the development of knowledge and to make gender issues a legitimate field of inquiry. Feminism provides principles and a perspective from which to work rather than a specific method or methodology. Stanley and Wise (1990) suggest that 'feminism' should be present in positive ways throughout the research process, as feminist principles underpinning both epistemology and analysis. This immersion of feminism in research m e t h o d s is supported by Reinharz (1992), w h o suggests that feminism provides the perspective for research and the particular discipline provides the method. Reinharz suggests that feminist research is guided by feminist theory, aims to create social change and strives to represent human diversity (1992:240). Feminist A p p r o a c h e s to Research in Nursing and Midwifery Development of feminist perspectives on research and scholarly inquiry is most evident within the social PAGE 8
sciences. However, the appropriateness of adopting feminist approaches to nursing research is also apparent in the literature (for example, Webb 1984, 1993, Chhm and Wheeler 1985, Speedy 1991, Parker and McFarlane 1991, Sohier 1992, DeMarco, Campbell, and Wuest 1993). In the nursing literature a feminist approach is suggested as a strategy to investigate nursing in a different way (Sigworth 1995). Webb (1993:422) contributes to the discussion through analysis of research processes and their relevance to nursing, and suggests that methods are used in ways which attempt to reduce power inequalities within research relationships, to report women's experiences in their own terms whilst also a t t e m p t i n g a structural analysis of the conditions of their lives, and to include the within the analysis the role and influence of researchers themselves. Speedy (1987) acknowledges the relevance of a feminist p o s i t i o n w h e n d i s c u s s i n g the professionalization of nursing, in that, a feminist analysis a c k n o w l e d g e s the position of w o m e n (nurses) in a profession historically dominated by physicians and administrators (p23). Speedy claims that it is difficult for w o m e n to be positioned in maleo r i e n t e d p r o f e s s i o n a l systems that are o f t e n incompatible with women's family responsibilities (p21). Valentine (1992) and Chinn and Wheeler (1985) discuss the place of nursing in the w o m e n ' s movement and emphasise the oppression of nurses as a reason to consider feminist process more closely. Sohier (1992) extends the debate in suggesting that attention to issues of power, oppression and rejection of patriarchal structures of knowledge and power will enable creative solutions to be sought for major health problems. Sohier's argument is based on beliefs that nursing can draw on the potential of nursing knowledge to influence nursing and health. Therefore, a feminist approach to midwifery research can provide an analytical strategy to examine the position of midwives within the profession and to critique structures of knowledge and p o w e r in practice. In addition, feminist a p p r o a c h e s to midwifery research provide a theoretical framework for the development of theory and practice which places w o m e n at the centre of midwifery activity and inquiry. An approach which may provide an
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a p p r o p r i a t e f r a m e w o r k to e x a m i n e w o m e n ' s dissatisfaction with maternity care and to analyse the p o t e n t i a l for m i d w i f e r y to address s u c h dissatisfaction and meet the needs of women. Feminist Praxis - Possibilities for M i d w i f e r y Research
Two principles tmderlying feminist approaches are important to the conduct of midwifery research. The first principle is that research is conducted for the benefit of women, either directly or indirectly. This principle is grounded in the feminist notion that research and inquiry aim at improving the situation for women, rather than promoting the interests of others. The second principle is that research is seen as a means of social change. If midwives are to acknowledge w o m e n ' s evaluation of maternity services and in so doing aim to more adequately meet their needs, change within the practice of midwifery and the organisation and culture of maternity services is necessary. For s u c h c h a n g e to be effective, it is m o s t appropriately directed by the w o m e n themselves, an approach which would see a strengthening of the relationship between midwives and women. In strengthening this relationship, the needs of w o m e n become the central focus of midwifery practice. In addition, it allows for a rethinking of the position of midwives in the professions and enables a reshaping of the profession that acknowledges the contribution m i d w i v e s can make to t h e h e a l t h n e e d s o f childbearing women. Combining these two principles leads to a feminist praxis approach to research that seeks to develop emancipatory knowledge. For Lather (1986) praxis refers to the "dialectical tension, the interactive, reciprocal shaping of theory and practice" seen as the centre of emancipatory social science. A feminist praxis approach considers w o m e n as central to the research process in that the research aims to benefit women, and also that the w o m e n t h e m s e l v e s c o n t r i b u t e to the g e n e r a t i o n o f knowledge. As Bortin et al (1994) suggest midwives need to study women, not as objects of scientific interest but rather as participants whose experiences are validated. For midwifery, this approach provides a framework to examine the developing womenc e n t r e d m o d e s of m i d w i f e r y p r a c t i c e and underpinning philosophies. Within this framework, JUNE 1999
particular political, social or cultural factors which influence the practice of midwifery and experience of childbearing, are acknowledged. Fahy (1996:55) suggests that praxis is essentially about "living and acting in a fully aware and responsible way" by thinking and acting for the benefit of clients and ourselves. A praxis a p p r o a c h to midwifery research would mean that we are working for the benefit of w o m e n and improving the situation for midwives t h r o u g h the p r o c e s s e s o f thinking, reflecting, acting and theorising. A praxis approach m a k e s the r e s e a r c h p r o c e s s t r a n s p a r e n t and cooperative rather than objective and distanced. CONCLUSION
In t_hispaper I have outlined the relevance of feminist approach to midwifery research in order to address contemporary issues in midwifery and to improve care for childbearing women. In suggesting a feminist approach, the needs of women will become the focus of midwifery activity and inquiry. Such a development has the potential to lead to change in the maternity services and to strengthen the relationship between w o m e n and midwives, a development which may enhance the reshaping of midwifery practice to meet both the health needs of w o m e n and the professional needs of nlidwives,
References:
Bortin, S, Alzugaray, M., Dowd, J. And Kalman, J. (1994) A Feminist perspective on the Study of Home Birth. Application of a Midwifery Care Framework. Journal of Nurse-Midwifery, vol. 39, no. 3, pp.142-149. Brown, S. And Lumley, J. (1994) Satisfaction with care in labour and birth: A survey of 760 Australian Women, Birth vol. 21, no. 1, pp 4-13. Chinn, P and Wheeler, C. (1985) Feminism and Nursing. Can nursing afford to remain aloof from the women's movement? Nursing Outlook, vol. 33, no.2, pp. 74-77. Couves, J. (1995) Working in Practice. In Page, L. (Ed) Effective Group Practice in Midwifery. Working with Women. Oxford: Blackwell Science. DeMarco, R. Campbell, J. And Wuest, J. (1993) Feminist critique: Searching for meaning in research, Advances in Nursing Science, vol. 16, no. 2, pp. 26-38.
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Department of Health (1993) Changing Childbirth. Report of the Expert Maternity Group, London: HMSO. Duffy, M. (1985) A critique of research: A feminist perspective, Health Care for Women International, no. 6 pp. 341-352. Flint, C. (1993) Midwifery Teams and Caseloads, Oxford: Butterworth-Heinematm Green, J., Couplend, V. And Kitzinger, J. (1990) Expectations, Experiences and Psychological Outcomes of Childbirth: A prospective study of 825 women, Birth, vol. 17, no. 1, pp 15-23. Guiliiand, K. And Pairman, S. (1994) The MidwiferY Partnership. A model for practice, Wellington: Victoria University. Guilliand, K. And Palrman, S. (1995) The Midwifery Partnership. A model for practice, NZ CoUege of Midwives Journal, October, pp 5-9. Harding, S. (1987) Is there a feminist method? In Harding S. (Ed) Feminism and methodology. Indiana: Indiana University Press and O p e n University Press. Hernes, G. (1996) The politics of health of women and children, Midwifery, Vol 12, pp 109-112. House of Commons Health Committee (1992) Second Report: Maternity Services, London: HMSO. Lather, P. (1991) Getting Smart. Feminist Research and Pedagogy within/in the Postmodern, New York: Routledge. National Health and Medical Research Council (1996) Options for effective care in childbirth. Canberra: AGPS. Oakley A. (1976) Wisewoman and Medicine Man: Changes in the Management of Childbirth. In Mitchell, J and Oakley, A. (Eds) The Rights and Wrongs of Women, Penguin Books. Oakley, A (1980) Women Confined, Oxford: Martin Robertson. Oakley, A and Houd, S. (1990) Helpers in Childbirth. Midwifery Today, Hemisphere Publishing: USA. Page, L. (1995) Change and Power in Midwifery, Birth, vol.22, no.4, pp.227-231. Parker, B. And McFarlane, J. (1991) Feminist theory and nursing: An e m p o w e r m e n t m o d e l for research, Advances in Nursing Science, vol. 13, no. 3, pp. 59-67. Reinharz, S. (1992) Feminist Methods in Social Research, New York; Oxford University Press Rich, A. (1977) Of Woman Born. Motherhood as Experience and Institution, London: Virago. PAGE 10
Sheridan, S. (1990) Feminist Knowledge, Women's Liberation, and Women's Studies. In Gunew, S (ed) Feminist Knowledge Critique and Construct, London: Routledge. Sigsworth, J. (1995) Feminist research: its relevance to nursing, Journal of Advanced Nursing, no. 22, pp. 896-899. Sohier, R. (1992) Feminism and Nursing Knowledge: The p o w e r of the weak, Nursing Outlook, vol. 40, no.2, pp. 62-66. Speedy, S. (1987) Feminism and the professionalisation of nursing, The Australian Journal of Advanced Nursing, vol. 4, no. 2, pp. 20-27. Stanley, L and Wise, S. (1990) Method, methodology and epistemology in feminist research processes. In Stanley, L. (Ed) Feminist Praxis Research, Theory and Epistemology in Feminist Sociology, London: Routledge. Valentine, P. (1992) Feminism a four letter word, The Canadian Nurse, December, pp. 20-23. Wearing, A. (1984) The Ideology of Motherhood, Sydney: George Allen and Unwin. Webb, C. (1993) Feminist research: definitions, methodology, methods and evaluation, Journal of Advanced Nursing, no. 18, pp. 416-423. Webb, C. (1984) Feminist methodology in nursing research, Journal of Advanced Nursing, no. 9, pp. 249-256. Yotmg, D. (1994) Using research plus community action to change Maternal Health, Birth, vol. 21, no.l, pp. 2-3
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RESEARCH IN MIDWIFERY - THE RELEVANCE OF A FEMINIST THEORETICAL F R A M E W O R K Margaret Barnes
RN, Midwife, B E d (Nurs), MA(Sociology)
Lecturer, School of Nursing, Queensland University of Technology Victoria Park Road, Kelvin Grove Qld 4059 Phone: 07 3864 3903 email: [email protected] (Reprint request to MB) ABSTRACT As midwifery develops as a discipline and n e w models of care are introduced within maternity services, research activity and inquiry into practice and professional issues will be required. This paper suggests that an appropriate theoretical nnderpinning for research in midwifery is one that is based on feminist theory. It is argued that by adopting this approach, midwifery practice will focus on the needs of w o m e n and change in the provision of services for childbearing w o m e n will be in response to w o m e n ' s e v a l u a t i o n o f existing services. By addressing the needs of w o m e n it is argued that the profession will also benefit, as the role of midwifery in the health care of childbearing w o m e n will be defined. Key words: Feminism, research, women-centred midwifery practice INTRODUCTION As midwifery moves toward n e w models of care and an increasing focus on w o m e n centred practice a framework for research in midwifery will assist in providing a theoretical underpinning to research activity in midwifery. In this paper I suggest that a feminist theoretical framework is appropriate to the study of childbearing and midwifery as feminism seeks to address and overcome the oppression of w o m e n and in so doing provides an appropriate framework within w h i c h to examine issues and practices which influence the fives and experience of women.
to make connections between changes in childbirth and the position of w o m e n in society (for example, Oakley 1976). In her work Wisewoman and Medicine
Man: Changes in the Management of Childbirth, Oakley traces the historical changes in childbirth, specifically those w h i c h led to male control of reproductive health, and relates these changes to the position of w o m e n in society. In this early work Oakley suggests that the opposing definitions of childbirth as 'natural' or 'medicalised' is more than opposing professional views. Rather, she suggests that there is a sex difference in the structure of control, that is, that over the last century the social and medical management of childbirth In industrialised cultures has shifted from a community of untrained women, to one based on a profession of formally trained men. These claims are further expanded in her w o r k Women ConFmedwhere Oakley (1980) explores the experience of childbirth from women's perspective. A significant finding in this work was the identification of the connection between the construction of the 'medical maternity case' and the subsequent control of reproductive health and childbearing w o m e n by medicine.
The Relevance o f a Feminist A p p r o a c h to The Study o f Childbearing and Midwifery
Oakley's work was followed by that of other writers and a questioning of the position of women in society generally was demonstrated through a feminist critique of the e x p e r i e n c e o f childbearing and motherhood (for example, Wearing 1984; Rich 1986). This interest in a feminist analysis of the position of childbearing w o m e n occurred at a time when the p o s i t i o n of w o m e n w i t h i n society was being examined more generally through the processes and activism of the w o m e n s liberation m o v e m e n t (Sheridan 1990).
The r e l e v a n c e of a feminist a p p r o a c h to the examination of issues related to childbearing became apparent with the work of feminist writers who began
This analysis was reflected in the views of w o m e n t h e m s e l v e s w h o w e r e b e c o m i n g increasingly dissatisfied with maternity care. Oakley and Houd
PAGE6
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AUSTRALIAN COLLEGE OF MIDWIV~ INCORPORATED
(1990) suggest that the growing consumer movement of the time stemmed from the growing discontent with maternity services and a recognition that many solutions for health problems lie outside the reach of medical science and technology. Subsequent research indicates a continuing dissatisfaction with the care provided for w o m e n during pregnancy and childbirth (for example, Brown and Lumley 1994; Green et al 1990) findings w h i c h have led to proposals for significant changes in provision of maternity services (NHMRC 1996).
Development of Woman-Centred Midwifery Practice. There is a growing recognition that midwives have a significant contribution to make to the health and welfare of women, babies and their families (Page 1995). Midwives are considered integral to the implementation of the Safe Motherhood Initiative an initiative which aims to reduce maternal deaths due to pregnancy, childbirth or abortion (Hernes 1996). However, this contribution is limited in countries where there is increasing interest and use of technology, where pregnancy and birth have been medicalised and where the role of the midwife is eroded (Page 1995). Despite this, there are vigorous attempts to revitalise midwifery, the heart of which is a refocussing of midwifery philosophy, theory and practice to place the w o m a n and her family at the centre of their care. This refocussing is lead by w o m e n w h o have been increasingly dissatisfied with the birthing services and from the profession that is dissatisfied with the diminished role of the midwife in providing care for w o m e n ha normal pregnancy and birth. The notion of 'women-centred' midwifery care has developed in recent years through the w o r k of midwives such as Caroline Flint (1993) and Lesley Page (1995) in the United Kingdom and Karen GuiUiland and Sally Pairman (1994) in New Zealand who have articulated the meaning of contemporary midwifery and the 'with-women' role. While the term 'midwife' has traditionally been defined as 'withwoman', adoption of the essence of this traditional meaning has been varied over time. The current discourse that describes women-centred midwifery practice aims to articulate the possibilities for contemporary practice and to emphasise this central feature of midwifery. JUNE 1999
This interest in m i d w i f e r y c o i n c i d e d w i t h an increasing interest in the quality of maternity services. In Australia a number of birthing services reviews have been conducted which highlighted women's dissatisfaction with care and services available (Young 1995). In the United Kingdom the House of Commons Report on the Maternity Services (1992) emphasised the need to provide choice, control and continuity of care for childbearing women. This report led to the establishment of an expert maternity group to review maternity services, the result of which has been recommendations to fundamentally change m a t e r n i t y services in Britain. The p r i n c i p l e s underlying the recommendations include the centring of services around the individual needs of w o m e n and their families, giving w o m e n choice about their care, place of birth and caregiver and to involve w o m e n in decision making at all levels (Page 1995). The principles and recommendations of the expert panel are published in Changing Childbirth (1993), a d o c u m e n t w h i c h has significantly influenced thinking and practice in midwifery since its release, not only in Britain but internationally. These developments in the birthing services and midwifery have led to a questioning of approaches to midwifery, in particular the relationship between midwife and w o m e n during the childbearing period. This aspect of midwifery care is developed by GuiUiland and Pairman (1994) in the monograph The Midwifery Partnership A Model for Practice. In this w o r k , the a u t h o r s d e v e l o p a t h e o r e t i c a l framework for the practice of midwifery based on the partnership between the woman and the midwife. The basis for this partnership is derived from the following assumptions: 9 Pregnancy and birth are normal life events 9 Midwifery's professional role is with w o m e n during pregnancy and childbirth 9 Midwifery provides w o m e n with continuity of caregiver throughout the experience 9 Midwifery is w o m e n - c e n t r e d (Guilliand and Pairman 1995). In support of this position Couves (1995:119) suggests that it is the woman and her family w h o are central to excellence in midwifery and that w o m e n have the right to be equals in the relationship that develops between them and the midwife.
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T o w a r d Woman-Centred Practice I n c o r p o r a t i n g F e m i n i s m into R e s e a r c h Methods If the relationship between woman and midwife is central to midwifery practice, feminism can provide an appropriate theoretical framework for research in midwifery. Feminism enables the examination of issues and practices that influence the lives and e x p e r i e n c e s of w o m e n and i m p o r t a n t l y acknowledges w o m e n as partners in the research process. Having said this, I acknowledge the many other approaches to research which aim to improve health care for w o m e n and that the perspective discussed in this paper is one way of many to enrich the production of midwifery knowledge. There are m a n y schools of feminist thought, but for the purposes of this paper general principles which apply to feminist approaches generally will be discussed. Early feminist research writing concentrated on the critique of male dominated modes of knowledge production rather than the development of alternative w o m e n - c e n t r e d m o d e s ( D u f f y 1984). D e s p i t e d e v e l o p m e n t s and further articulation of w h a t feminist research might be, the main principles remain the same. Lather (1991:71), for example, suggests that "to do feminist research is to put the social construction of gender at the centre of one's inquiry", or as Harding (1987) points out, feminist research is for women. The goal of the feminist perspective is to re-place w o m e n ' s experience in the development of knowledge and to make gender issues a legitimate field of inquiry. Feminism provides principles and a perspective from which to work rather than a specific method or methodology. Stanley and Wise (1990) suggest that 'feminism' should be present in positive ways throughout the research process, as feminist principles underpinning both epistemology and analysis. This immersion of feminism in research m e t h o d s is supported by Reinharz (1992), w h o suggests that feminism provides the perspective for research and the particular discipline provides the method. Reinharz suggests that feminist research is guided by feminist theory, aims to create social change and strives to represent human diversity (1992:240). Feminist A p p r o a c h e s to Research in Nursing and Midwifery Development of feminist perspectives on research and scholarly inquiry is most evident within the social PAGE 8
sciences. However, the appropriateness of adopting feminist approaches to nursing research is also apparent in the literature (for example, Webb 1984, 1993, Chhm and Wheeler 1985, Speedy 1991, Parker and McFarlane 1991, Sohier 1992, DeMarco, Campbell, and Wuest 1993). In the nursing literature a feminist approach is suggested as a strategy to investigate nursing in a different way (Sigworth 1995). Webb (1993:422) contributes to the discussion through analysis of research processes and their relevance to nursing, and suggests that methods are used in ways which attempt to reduce power inequalities within research relationships, to report women's experiences in their own terms whilst also a t t e m p t i n g a structural analysis of the conditions of their lives, and to include the within the analysis the role and influence of researchers themselves. Speedy (1987) acknowledges the relevance of a feminist p o s i t i o n w h e n d i s c u s s i n g the professionalization of nursing, in that, a feminist analysis a c k n o w l e d g e s the position of w o m e n (nurses) in a profession historically dominated by physicians and administrators (p23). Speedy claims that it is difficult for w o m e n to be positioned in maleo r i e n t e d p r o f e s s i o n a l systems that are o f t e n incompatible with women's family responsibilities (p21). Valentine (1992) and Chinn and Wheeler (1985) discuss the place of nursing in the w o m e n ' s movement and emphasise the oppression of nurses as a reason to consider feminist process more closely. Sohier (1992) extends the debate in suggesting that attention to issues of power, oppression and rejection of patriarchal structures of knowledge and power will enable creative solutions to be sought for major health problems. Sohier's argument is based on beliefs that nursing can draw on the potential of nursing knowledge to influence nursing and health. Therefore, a feminist approach to midwifery research can provide an analytical strategy to examine the position of midwives within the profession and to critique structures of knowledge and p o w e r in practice. In addition, feminist a p p r o a c h e s to midwifery research provide a theoretical framework for the development of theory and practice which places w o m e n at the centre of midwifery activity and inquiry. An approach which may provide an
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a p p r o p r i a t e f r a m e w o r k to e x a m i n e w o m e n ' s dissatisfaction with maternity care and to analyse the p o t e n t i a l for m i d w i f e r y to address s u c h dissatisfaction and meet the needs of women. Feminist Praxis - Possibilities for M i d w i f e r y Research
Two principles tmderlying feminist approaches are important to the conduct of midwifery research. The first principle is that research is conducted for the benefit of women, either directly or indirectly. This principle is grounded in the feminist notion that research and inquiry aim at improving the situation for women, rather than promoting the interests of others. The second principle is that research is seen as a means of social change. If midwives are to acknowledge w o m e n ' s evaluation of maternity services and in so doing aim to more adequately meet their needs, change within the practice of midwifery and the organisation and culture of maternity services is necessary. For s u c h c h a n g e to be effective, it is m o s t appropriately directed by the w o m e n themselves, an approach which would see a strengthening of the relationship between midwives and women. In strengthening this relationship, the needs of w o m e n become the central focus of midwifery practice. In addition, it allows for a rethinking of the position of midwives in the professions and enables a reshaping of the profession that acknowledges the contribution m i d w i v e s can make to t h e h e a l t h n e e d s o f childbearing women. Combining these two principles leads to a feminist praxis approach to research that seeks to develop emancipatory knowledge. For Lather (1986) praxis refers to the "dialectical tension, the interactive, reciprocal shaping of theory and practice" seen as the centre of emancipatory social science. A feminist praxis approach considers w o m e n as central to the research process in that the research aims to benefit women, and also that the w o m e n t h e m s e l v e s c o n t r i b u t e to the g e n e r a t i o n o f knowledge. As Bortin et al (1994) suggest midwives need to study women, not as objects of scientific interest but rather as participants whose experiences are validated. For midwifery, this approach provides a framework to examine the developing womenc e n t r e d m o d e s of m i d w i f e r y p r a c t i c e and underpinning philosophies. Within this framework, JUNE 1999
particular political, social or cultural factors which influence the practice of midwifery and experience of childbearing, are acknowledged. Fahy (1996:55) suggests that praxis is essentially about "living and acting in a fully aware and responsible way" by thinking and acting for the benefit of clients and ourselves. A praxis a p p r o a c h to midwifery research would mean that we are working for the benefit of w o m e n and improving the situation for midwives t h r o u g h the p r o c e s s e s o f thinking, reflecting, acting and theorising. A praxis approach m a k e s the r e s e a r c h p r o c e s s t r a n s p a r e n t and cooperative rather than objective and distanced. CONCLUSION
In t_hispaper I have outlined the relevance of feminist approach to midwifery research in order to address contemporary issues in midwifery and to improve care for childbearing women. In suggesting a feminist approach, the needs of women will become the focus of midwifery activity and inquiry. Such a development has the potential to lead to change in the maternity services and to strengthen the relationship between w o m e n and midwives, a development which may enhance the reshaping of midwifery practice to meet both the health needs of w o m e n and the professional needs of nlidwives,
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