Two recent phenomena are causing me considerable concern. Firstly, some midwives are being critic... more Two recent phenomena are causing me considerable concern. Firstly, some midwives are being criticised or disciplined for not carrying out particular clinical observations on women in labour. At the same time, increasing numbers of women seek support from doulas or others because they see midwives as too busy to support them in labour, or they see support as not part of the midwives' role. The tension between these two phenomena leads me to seek to stimulate a debate on the role of the midwife during labour. While debate is better undertaken in person, I hope this article will raise some issues of concern.
Midwives Coping with Loss and Grief , Midwives Coping with Loss and Grief , کتابخانه دیجیتال جندی... more Midwives Coping with Loss and Grief , Midwives Coping with Loss and Grief , کتابخانه دیجیتال جندی شاپور اهواز
When asked to write on midwifery and sustainability, I was struck by the fact that such a request... more When asked to write on midwifery and sustainability, I was struck by the fact that such a request could only be a very modern one. Until recently no one could see such a basic practice as midwifery as anything other than sustainable in itself and contributing fundamentally to sustaining society. Birth is about relationships. It was, and in many contexts still is, something done by mothers who are supported by midwives and families. Changes over recent years have seen birth move from the home to the hospital and become surrounded by increasingly complex technology and organization. Birth is also the entry to society and how we manage that entry demonstrates our values as a society. We thus have tensions between supportive relationships around birth and our organizations that embody values of hierarchy, efficiency, technology and expert authority. These tensions can create frustration for midwives and mothers; but behind this shines the knowledge of what birth can be
Foreword Acknowledgements Glossary of terms and context of analysis Glossary of terms Context of ... more Foreword Acknowledgements Glossary of terms and context of analysis Glossary of terms Context of the analysis Introduction References CHAPTER 1: The need for a midwifery ethic of practice The metaphor Looking for the pool of ethics: a personal journey Ways of seeing: ways of acting The social construction of our world The nature of 'practice' References CHAPTER 2: On the sealed highway - mainstream ethics, medicalisation and midwifery The nature of midwifery practice The influence of moral philosophy, and nursing ethics Moral philosophy and mainstream ethical frameworks available to midwives Why midwives would be turning to mainstream ethical frameworks Summary References CHAPTER 3: The false trail - a critique of bioethics and the problem-solving approach for midwifery ethics Bioethics - its development and critics (the pool of ethics) Casuistry and context Quandary or dilemma-based ethics Contextualism A critique of the normative, dilemmic/problem-solving approach of bioethics for midwifery When the situation is stripped of context When the subject is depersonalised The abstract nature of principles What is ethically 'good'? Prior ethical practice , character, virtues and relationships Summary References CHAPTER 4: Midwifery's detour through nursing ethics - a critique of professional codes and influences that shape the midwifery ethics discourse Traditions of a professional practice, institutionalisation, and application of a code a critique of ethical codes Perceived strengths of codes Perceived weaknesses of codes How ethical discourse in midwifery is shaped Educational curricula and their ethical orientation The workplace setting and institutional influence Text books, journals and conference presentations: their ethical orientation CHAPTER 5: Off the beaten track - feminist virtue ethics and midwifery Values and assumptions of feminist theory - epistemology and ontology A feminist approach to ethics in midwifery Virtue Ethics - context, character and relationship Narratives, identity and traditions The public and private Privilege Difference Normal/Abnormal - The impact of linguistics Metaphors in childbirth reveal practice orientation Summary References CHAPTER 6: A conducted tour or independent travel? examining underlying assumptions and values Owners of the original knowledge Profiles of those women telling their experiences The informant-researcher relationship Constructing consensual meanings Mothers' and midwives' shared values Power in relationships Power 'over' - exploitative, manipulative Power 'for' - nutritive Power 'with' - integrative Summary References CHAPTER 7: Facing obstacles along the way - mothers' and midwives' narratives of unethical childbirth practices Institutional dominance Paternalism Lack of self-determination Fear, Safety, Mortality-Morbidity (negativity of attitude) Unsupportive of the woman Procedure-oriented approach 'system workers' Values conflict Workplace/service provider versus personal/professional midwifery ethics Not valuing individuals Emotions/feelings Summary References CHAPTER 8: Going to a comfortable place - the ethical voice of mothers and midwives 'Being with' woman Values-Virtues Supporting the woman Knowing the woman Woman's comfort: security, 'safe' for the woman Ways of seeing Metaphors used by mothers and midwives Personal transformation Summary References CHAPTER 9: Checking our course - values and philosophical foundations of the midwifery profession The philosophy and theory behind midwifery practice Ways of knowing: midwifery's epistemology Ethical theories and principles 'incorporated' Ways of seeing and construction: orientation Practitioner definitions of midwifery practice Practitioner identified philosophy of midwifery practice: values and beliefs Summary References CHAPTER 10: Plotting our practice - values and philosophical foundations of the birthing environment The power of language Birth language A concept analysis of normal labour Practice decisions and conflict between work place and personal/professional ethics The midwifery relationship Summary References CHAPTER 11: The discourse of other travellers - literature on women's experiences The birth: women's experiences The midwife's approach: women's experiences Summary References CHAPTER 12: Mapping a new ethic for midwives - from 'practice estate' to the pool and back, now a return journey travelled in tandem The ethic of engagement - a midwifery ethic The nature of engagement in ethical responses and relationships The centrality of concepts which emerged from real life experience and literature, in an ethic of midwifery Implications for practice and recommendations References Conclusion
The basic skills of research, i.e. listening and observation, are also the basic skills of midwif... more The basic skills of research, i.e. listening and observation, are also the basic skills of midwifery. Midwives need to embrace research skills as well as research findings if their practice is to become research based.
ABSTRACT To examine the use of evidence based leaflets on informed choice in maternity services. ... more ABSTRACT To examine the use of evidence based leaflets on informed choice in maternity services. Non-participant observation of 886 antenatal consultations. 383 in depth interviews with women using maternity services and health professionals providing antenatal care. Women's homes; antenatal and ultrasound clinics in 13 maternity units in Wales. Childbearing women and health professionals who provide antenatal care. Intervention: Provision of 10 pairs of Informed Choice leaflets for service users and staff and a training session in their use. Participants' views and commonly observed responses during consultations and interviews. Health professionals were positive about the leaflets and their potential to assist women in making informed choices, but competing demands within the clinical environment undermined their effective use. Time pressures limited discussion, and choice was often not available in practice. A widespread belief that technological intervention would be viewed positively in the event of litigation reinforced notions of "right" and "wrong" choices rather than "informed" choices. Hierarchical power structures resulted in obstetricians defining the norms of clinical practice and hence which choices were possible. Women's trust in health professionals ensured their compliance with professionally defined choices, and only rarely were they observed asking questions or making alternative requests. Midwives rarely discussed the contents of the leaflets or distinguished them from other literature related to pregnancy. The visibility and potential of the leaflets as evidence based decision aids was thus greatly reduced. The way in which the leaflets were disseminated affected promotion of informed choice in maternity care. The culture into which the leaflets were introduced supported existing normative patterns of care and this ensured informed compliance rather than informed choice.
Page 1. SURVIVORS OF CHILDHOOD SEXUAL ABUSE AND MIDWIFERY PRACTICE CSA, BIRTH AND POWERLESSNESS L... more Page 1. SURVIVORS OF CHILDHOOD SEXUAL ABUSE AND MIDWIFERY PRACTICE CSA, BIRTH AND POWERLESSNESS Lis Garratt Foreword by Mavis Kirkham Page 2. Survivors of Childhood Sexual Abuse and Midwifery Practice Page 3. Page 4. ...
Research and audit: Evaluation of supervision of midwives Audit of supervision of midwives Implic... more Research and audit: Evaluation of supervision of midwives Audit of supervision of midwives Implications of current supervision Changes in practice: Research implementation The new LSA arrangements in practice Supervision in a midwife managed birth centre Clinical supervision within midwifery Anonymised case studies of supervisory practice Education for supervisors: Development of the new open learning programme Supervision at masters level Index.
Two recent phenomena are causing me considerable concern. Firstly, some midwives are being critic... more Two recent phenomena are causing me considerable concern. Firstly, some midwives are being criticised or disciplined for not carrying out particular clinical observations on women in labour. At the same time, increasing numbers of women seek support from doulas or others because they see midwives as too busy to support them in labour, or they see support as not part of the midwives' role. The tension between these two phenomena leads me to seek to stimulate a debate on the role of the midwife during labour. While debate is better undertaken in person, I hope this article will raise some issues of concern.
Midwives Coping with Loss and Grief , Midwives Coping with Loss and Grief , کتابخانه دیجیتال جندی... more Midwives Coping with Loss and Grief , Midwives Coping with Loss and Grief , کتابخانه دیجیتال جندی شاپور اهواز
When asked to write on midwifery and sustainability, I was struck by the fact that such a request... more When asked to write on midwifery and sustainability, I was struck by the fact that such a request could only be a very modern one. Until recently no one could see such a basic practice as midwifery as anything other than sustainable in itself and contributing fundamentally to sustaining society. Birth is about relationships. It was, and in many contexts still is, something done by mothers who are supported by midwives and families. Changes over recent years have seen birth move from the home to the hospital and become surrounded by increasingly complex technology and organization. Birth is also the entry to society and how we manage that entry demonstrates our values as a society. We thus have tensions between supportive relationships around birth and our organizations that embody values of hierarchy, efficiency, technology and expert authority. These tensions can create frustration for midwives and mothers; but behind this shines the knowledge of what birth can be
Foreword Acknowledgements Glossary of terms and context of analysis Glossary of terms Context of ... more Foreword Acknowledgements Glossary of terms and context of analysis Glossary of terms Context of the analysis Introduction References CHAPTER 1: The need for a midwifery ethic of practice The metaphor Looking for the pool of ethics: a personal journey Ways of seeing: ways of acting The social construction of our world The nature of 'practice' References CHAPTER 2: On the sealed highway - mainstream ethics, medicalisation and midwifery The nature of midwifery practice The influence of moral philosophy, and nursing ethics Moral philosophy and mainstream ethical frameworks available to midwives Why midwives would be turning to mainstream ethical frameworks Summary References CHAPTER 3: The false trail - a critique of bioethics and the problem-solving approach for midwifery ethics Bioethics - its development and critics (the pool of ethics) Casuistry and context Quandary or dilemma-based ethics Contextualism A critique of the normative, dilemmic/problem-solving approach of bioethics for midwifery When the situation is stripped of context When the subject is depersonalised The abstract nature of principles What is ethically 'good'? Prior ethical practice , character, virtues and relationships Summary References CHAPTER 4: Midwifery's detour through nursing ethics - a critique of professional codes and influences that shape the midwifery ethics discourse Traditions of a professional practice, institutionalisation, and application of a code a critique of ethical codes Perceived strengths of codes Perceived weaknesses of codes How ethical discourse in midwifery is shaped Educational curricula and their ethical orientation The workplace setting and institutional influence Text books, journals and conference presentations: their ethical orientation CHAPTER 5: Off the beaten track - feminist virtue ethics and midwifery Values and assumptions of feminist theory - epistemology and ontology A feminist approach to ethics in midwifery Virtue Ethics - context, character and relationship Narratives, identity and traditions The public and private Privilege Difference Normal/Abnormal - The impact of linguistics Metaphors in childbirth reveal practice orientation Summary References CHAPTER 6: A conducted tour or independent travel? examining underlying assumptions and values Owners of the original knowledge Profiles of those women telling their experiences The informant-researcher relationship Constructing consensual meanings Mothers' and midwives' shared values Power in relationships Power 'over' - exploitative, manipulative Power 'for' - nutritive Power 'with' - integrative Summary References CHAPTER 7: Facing obstacles along the way - mothers' and midwives' narratives of unethical childbirth practices Institutional dominance Paternalism Lack of self-determination Fear, Safety, Mortality-Morbidity (negativity of attitude) Unsupportive of the woman Procedure-oriented approach 'system workers' Values conflict Workplace/service provider versus personal/professional midwifery ethics Not valuing individuals Emotions/feelings Summary References CHAPTER 8: Going to a comfortable place - the ethical voice of mothers and midwives 'Being with' woman Values-Virtues Supporting the woman Knowing the woman Woman's comfort: security, 'safe' for the woman Ways of seeing Metaphors used by mothers and midwives Personal transformation Summary References CHAPTER 9: Checking our course - values and philosophical foundations of the midwifery profession The philosophy and theory behind midwifery practice Ways of knowing: midwifery's epistemology Ethical theories and principles 'incorporated' Ways of seeing and construction: orientation Practitioner definitions of midwifery practice Practitioner identified philosophy of midwifery practice: values and beliefs Summary References CHAPTER 10: Plotting our practice - values and philosophical foundations of the birthing environment The power of language Birth language A concept analysis of normal labour Practice decisions and conflict between work place and personal/professional ethics The midwifery relationship Summary References CHAPTER 11: The discourse of other travellers - literature on women's experiences The birth: women's experiences The midwife's approach: women's experiences Summary References CHAPTER 12: Mapping a new ethic for midwives - from 'practice estate' to the pool and back, now a return journey travelled in tandem The ethic of engagement - a midwifery ethic The nature of engagement in ethical responses and relationships The centrality of concepts which emerged from real life experience and literature, in an ethic of midwifery Implications for practice and recommendations References Conclusion
The basic skills of research, i.e. listening and observation, are also the basic skills of midwif... more The basic skills of research, i.e. listening and observation, are also the basic skills of midwifery. Midwives need to embrace research skills as well as research findings if their practice is to become research based.
ABSTRACT To examine the use of evidence based leaflets on informed choice in maternity services. ... more ABSTRACT To examine the use of evidence based leaflets on informed choice in maternity services. Non-participant observation of 886 antenatal consultations. 383 in depth interviews with women using maternity services and health professionals providing antenatal care. Women's homes; antenatal and ultrasound clinics in 13 maternity units in Wales. Childbearing women and health professionals who provide antenatal care. Intervention: Provision of 10 pairs of Informed Choice leaflets for service users and staff and a training session in their use. Participants' views and commonly observed responses during consultations and interviews. Health professionals were positive about the leaflets and their potential to assist women in making informed choices, but competing demands within the clinical environment undermined their effective use. Time pressures limited discussion, and choice was often not available in practice. A widespread belief that technological intervention would be viewed positively in the event of litigation reinforced notions of "right" and "wrong" choices rather than "informed" choices. Hierarchical power structures resulted in obstetricians defining the norms of clinical practice and hence which choices were possible. Women's trust in health professionals ensured their compliance with professionally defined choices, and only rarely were they observed asking questions or making alternative requests. Midwives rarely discussed the contents of the leaflets or distinguished them from other literature related to pregnancy. The visibility and potential of the leaflets as evidence based decision aids was thus greatly reduced. The way in which the leaflets were disseminated affected promotion of informed choice in maternity care. The culture into which the leaflets were introduced supported existing normative patterns of care and this ensured informed compliance rather than informed choice.
Page 1. SURVIVORS OF CHILDHOOD SEXUAL ABUSE AND MIDWIFERY PRACTICE CSA, BIRTH AND POWERLESSNESS L... more Page 1. SURVIVORS OF CHILDHOOD SEXUAL ABUSE AND MIDWIFERY PRACTICE CSA, BIRTH AND POWERLESSNESS Lis Garratt Foreword by Mavis Kirkham Page 2. Survivors of Childhood Sexual Abuse and Midwifery Practice Page 3. Page 4. ...
Research and audit: Evaluation of supervision of midwives Audit of supervision of midwives Implic... more Research and audit: Evaluation of supervision of midwives Audit of supervision of midwives Implications of current supervision Changes in practice: Research implementation The new LSA arrangements in practice Supervision in a midwife managed birth centre Clinical supervision within midwifery Anonymised case studies of supervisory practice Education for supervisors: Development of the new open learning programme Supervision at masters level Index.
This paper addresses the educational implications of a study of midwives and senior student midwi... more This paper addresses the educational implications of a study of midwives and senior student midwives knowledge of haemoglobinopathies. Knowledge was assessed from 850 multiple choice questionnaires.
Respondents who had received training on the haemoglobinopathies scored significantly higher, especially on the genetics questions. Training from a haemoglobinopathies counsellor appeared most effective in raising knowledge levels in clinically relevant areas. Many midwives, however, had received no relevant education or found what they had received to be inadequate.
Higher levels of haemoglobinopathy awareness were found in midwives who had received a theoretical education relatively recently and had this reinforced by clinical practice.
In order to provide women centred care for all ethnic groups education around haemoglobinopathies needs to be prioritised especially for qualified midwives. This need must be addressed in ways most appropriate for the midwives concerned and using the specialist knowledge of those whose teaching is most effective.
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Respondents who had received training on the haemoglobinopathies scored significantly higher, especially on the genetics questions. Training from a haemoglobinopathies counsellor appeared most effective in raising knowledge levels in clinically relevant areas. Many midwives, however, had received no relevant education or found what they had received to be inadequate.
Higher levels of haemoglobinopathy awareness were found in midwives who had received a theoretical education relatively recently and had this reinforced by clinical practice.
In order to provide women centred care for all ethnic groups education around haemoglobinopathies needs to be prioritised especially for qualified midwives. This need must be addressed in ways most appropriate for the midwives concerned and using the specialist knowledge of those whose teaching is most effective.