"Conceptions of midwifery" A study of forms of knowledge and values foundational for midwifery

Abstract

Knowledge acquisition and the values inherent in midwifery form the major focus of this study. Particular emphasis is placed upon the value of experience in clinical practice to provide a sound methodological framework for knowledge acquisition. The concept of intuition is explored in relation to knowledge gained through experience. Professional values such as autonomy and advocacy are examined in relation to the central focus of respect for persons in the provision of health care.
The author takes a phenomenological approach in exploring the subjective issues of knowledge acquisition and professional values. The main instrument used in the research is Semi-structured interviews with 20 health professionals - 5 doctors and 15 midwives.
Doctors are included in this study not as a comparative group, but because they are an integral part of the maternity services and historically have significantly influenced and shaped midwifery. Therefore a medical perspective is important and provides the opportunity to explore the medical position in relation to the current government recommendations and the promotion of the midwife as the 'lead professional' in maternity care (FIMSO 1993). A Semantic Differential Rating Scale is used merely to clari!' language constructs and provide direction for the in-depth interviews that followed. A detailed theoretical review is undertaken prior to the research and the findings from the study are related to the theory.
The findings from this study highlight that autonomy and knowledge are perceived to have more authority within the medical profession, even though the doctors interviewed did not perceive themselves to be any more autonomous or knowledgeable than midwives. This variance in perception is important and may contribute to a self-fulfilling prophecy which continues to undermine the status of the midwifery profession. Experience and intuition were acknowledged to be important aspects of professional practice and midwives commented that they valued the knowledge gained from other experienced midwives
above knowledge gained from their medical colleagues. There was a shared value to the 'duty ethic' amongst doctors and midwives and respect for persons was shared by both groups of professionals. Midwives were concerned with empowering women and their role as client advocate was seen as very important. Midwives were committed to continuing and advancing their education but research was seen as less important. This qualitative study provided a rich source of data, much more than could be encompassed within the hypotheses. Therefore a number of themes emerged that provide opportunity for wider discussion and further research.