Friday, June 22, 2007

Do midwives overvalue the role of midwives?

The article that I wrote about in a previous post, 'With woman' philosophy: examining the evidence, answering the questions, by Carolan and Hodnett also asks some hard questions about the role of midwives. Recognizing that an intimate midwife-woman relationship is the cornerstone of midwifery philosophy, they ask : Is an intimate midwife-woman relationship what most women want or need?

First Carolan and Hodnett review the midwifery philosophy of the relationship between midwives and women:
Today, the midwife–woman relationship is seen as the cornerstone of 'woman-centred' care, which in turn is seen as satisfying for women. Within midwifery writings, the 'with woman' aspect of this relationship receives considerable attention, and the partnership between the midwife and woman is seen as crucial... Throughout, an emphasis on intimacy, woman empowerment and individually tailored, engaged care prevails ...

[T]he midwife–woman relationship is portrayed as going beyond more usual professional relationships in terms of importance, intimacy and intensity... Walsh, discusses the midwife as a 'friend' ... James ... suggests that 'midwives and women experience birth together'...
Is this what women want, or is this what midwives want?
Fleming ... has discussed the woman–midwifery partnership as problematic, suggesting that the values central to midwifery practice may not hold much sway for birthing women. In this 3-year project, set in New Zealand, Fleming researched the relationship from both midwives' and women's points of views. She found that, although midwives felt they were providing care that was different from medical services, in terms of supporting and empowering women, many women, in fact, chose midwifery care for the convenience of having a midwife visit them at home... [M]any did not feel they needed emotional support from the midwife, although midwives felt the provision of support was important...
Many women simply do not share the midwives' view of childbirth.
Although 'with woman' care, with the midwife–woman relationship as central, is prominently advised in contemporary midwifery texts. the evidence suggests that what women particularly want is an opportunity to participate in decision-making, and care that is consistent, respectful and informative...
Moreover:
... [T]here is a danger that the midwife–woman relationship, by virtue of its feminine complicity and views of birth as 'women's business', may exclude the woman's male partner. For example, the very term 'woman centred' is quite different to its antecedent 'family-centred' care and seems to suggest that the woman's partner is of lesser importance...
The irony here is that it seems that midwives, in their very philosophy, are guilty of precisely what they accused doctors of doing: overvaluing their own importance in childbirth. Midwives accused doctors of believing that their medical skills are needed when they are not. It is distinctly possible that midwives believe that their emotional support and their philosophy of childbirth is needed when they are not. Midwives run the risk of making themselves the center of childbirth when they are, in fact, viewed by women as providing the exact same services as doctors, no more.

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