feminist perceptions of midwifery practice

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PARTNESRHIPP,O WERA ND POLIITCS:
FEMINSITP ERCETPIONSO FM IDWIFERPYR ACTICE
VA LERIEE.M .F LEMIGN
·
A thepsriess enitnfe udfl ilmeonftt h er euqiremefnottrs h ed egroefe
Dotcoorf P hiolsophy
MASSYE UNIVERSITY
NEW ZEALAND
SEPTEMBER 1994
11
ABSTRACT
Thist hespirso vidaensi netrpretactriivtei oqfut eh ep artnersohfai p
groupo fi ndependmeindtw iveasn dt heicrl ienitnsu rbanN ew
ZealanAd t.h eoretbiacsaiglsro undeidnt hep rinciopflf eesm inibsumt
inocrporataisnpgce tso fc ritiscoacli sacli enacned p ostmoedrnism
underpibnost thh em ethodloogicaaplp roaacnhd a nalsyiosf d ataT.h e
majocro ncepotfss u bjecittiypv,o we/rk nowledagnedp raxhiasv bee en
utiliasse dt ofoolras n alyosfid sa tap,r imarciollyl ected tshermoiu­gh
structuirneetrdv iews.
Resulotfts h isst udy shotwheawdth ilteh ep artnerosfhm iipd wifaen d
client beicnacmree asiinngtleyna ssee acphr eganncyp rogressaendd,
particisp arnetporttehda itt w asi mportatnhta ctl iesn tknetwh eir
midwiveprsi or to fleaebloiuonrfg,i s n timaacnydt rusotn leym erged
durinagn da ftelra bourM.i dwiveisnt hisst udwye rea waroef t he
,·
p
p�wert hehya da ndt hep otentfioaral b usoef t hiso werd espitthee
�
no ioofnp artnsehrip.
Iti sa rguetdh atth er eflexpirvoec esisnevso lvweidt h trheisse arhcahv e
motivattehdep articiptaobn etcso maew arteh atth eikrn owledge and
actionasr es haped by aosfpt ehcedt osm inansto cioarld erW.h ile
colclteivpeo litiaccatli obny midwiveas ndc lienwtist ha viewt o
overcomitnhgi wsa s notf ully demonsitnrt ahtiessdt udyi,t i s
suggesttehda bty engagiinn gt hirse seartchhe rmea y beo ngoing
emancaitporeyff ectfso rt hep artiacnitpasn do themri dwives.
iii
ACKNOW LEDGEMENTS
Theraer em anyp eoplweh oh avea ssisatnedds uppormteed
throughtohutet i mIeh avbee eunn dertatkhiiwnsog r kT.o e acohf
themI wistho e xpremsys d eepa ppreciaantdih oenat rfetlhta nks.
�
Whilieti s nosibtlone a mee veryohneer teh,e arrete h osweh om
Ie speciwailstlhoy m ention.
Toa ltlh pea rtainctiispnt hisst udy, ftorha agnerkesi ntgoj oimne o n
thijso urnYeoyu.cr o mmitmweanstw ondrefualn dI h opteh ayto u
haveen joytehdpe r oceosfss h aritnhgo ugahntdsi deaassm ucha sI
havdeo ne.
Myp artnEedrn,Ra o she,a s gimvete hnse p ace tainmtdeou ndearkte
thirse searFcohrt. h iasn df olri stetnomi ent gh roughtohupetr ocess
my hearttfhealntk s. stOiumrui nlgad tiscussainoddn esb atoens
midwifhearvye haellspome edf ocumsy thougahntdsi deas.
Tom ys upeirsvoJrusl,i e BSoadnddySr,pa e eadnydJ udiCtlha trhea nks
fory ourp atienacned a cademgiuci danacnedc hallengmees to
throhuogutth pee riooftd h isst udy.
Theraer ea lsmoa nyf riendsc oalngldue eabso tihn t h_ew orlodf
midwifaenrdiy n o thdeir scipsluicnhen sua rss ianngdm edicwihnoe
havceh allengeendc oaunrdam geae td vartiiomuaessst hitsh eswiass
unfoldTione ga.c ohfy oug oemsy t hanks.
FinatlhlTeyr ,a vGerla natn dA cademWiocm enA'wsa rfdr oMma ssey
Univerasriaetc yk nowlewdigteahdp preciation.
--.
iv
PREFACE
Thitsh esiisws r itteennt irienlt yh ef irpsetr soInn.i titahliflsey l t
somewhuantc omfortaasab claed,e mwirci trearrse ulsyet hpee rsonal
prono"uInf" o rre asoonfms a intaionbijniegvc ittHyo.w evearsn, o ted
byR easo(n18 91t)h ec onceopfto bjectbievciotmyer se dundaanst
researcmhoevrefs r oam controlploistniigot no t haotf a facilitator.
Sandelo(w91s9k3ia) l spoo inotustt hatth leo sosfo bjevcittniye endo t
meant hleo sosfr igour.
Feminist ressuecahrD cuhfef(ry9s1 8 5a)n dW ebb( 9192h)a vfeu rther
as
develotpheied d eapsr oposbeyRd e ason haanvdse u ggesttheatdth e
useo ft hteh ipredr siosni nappropirnfi eamtien riesste airncw hh ich
reflexbievtiwteyte hner esearacnhdep ra rticiipsaa nktesyc oncept.
Sucrhe flexiispv airttyi cualpaprrloyp riinta htisest udwyh icfho cuses
ons ubejctivaintdir eesl ationships.
Iti sa lseoq ualalpyp roprtihaattthe ep artici·ap raean ctksnowledged
anda lthoufgorhre asoonfcs o nfidaelniitttiiy s n otp ossitboln aem e
these participantasp,p rposvbeeyude d aocnhry,am tsht ehra inn itials
orc odehsa vbee euns edT.h ihse lptsom aintatihnpe e rsonhood of
eacpha rticainpdai nsit nk eepiwnigt fhe mintihosutg ht.
V
TABLEO F CONTENTS
ABSTRAC.T. . . .. . . .. . . . . . ... . . . . . . . . .. . . . . . . . . . . . . . . .i.i
ACKNOWLEDGEMENT.S . . . . . . . . . ii.i . . . . . . . . . . . . . . . . . . . .
PREFACE . . .
. . . . . .. .. . . . . . . . . . . .. . . . . . . . . . . . .0 .• • • • • I V
CHAPTEORN E:I ntroduacntdiO ovne rview. . 1
. . . . . . . . .. . . . ..
Outlining the problem 1
. . . . . . . . .. . . . .0 • • • •0 • • • •0 0 • • • •
Aimso ft hset udy . 4
. . . . . . . . . . . . . . . . .0 • • • • •0 o 0 • • • • •0
Overvioeftw h set udy 5
. . . . . . .. . . . . . . .0 • • • • •• • 0 • • • ••
CHAPTETRW O:M idwifienrN ye wZ ealand . 7
. . . . . . . . . . . . . .. .
Thec onteoxftt h e1 990a mendmetnott h Neu rseAsc t
(9177) . . . . 7
. . . . . . . . . . . . . . . . . . . . . . . . . . 0. 0 • • • •
0
Legislation. .. 7
. . . . . . . . . .0 • • • • • • •: • • 0 •0 • • 0 • 0 •0 • • • •
Specrieaplo rts 10
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 •
Thec onsurmm eovement 12
. 0 • • • •0 • • •0 0 0• • •• • • • • • • •0 •
HomebirAtshs ociation 13
. . . . .. . . . .0 • • • •0 • • • •0 • •
Savteh Mei dwivAesss ociation . 16
. . . . . . . . . . . . .0 0 •
Midwifienriyt iativ.es. . 17
. . . . . . . . . . . . . .. . . . . . .0 0 • • •
TheN ewZ ealaCnodl leogfMe i dwives 19
. . . . . .0 • • •
Changiensm idwifperrayc tsiicnec1 e99 0 21
. . .0 • • • • • •0 • 0 0
Indepenmdiednwti fperrayc tice . 22
. . .. . . . . . . 0 • • 0
Hospimtiadlw ifery . 25
. . . . . . . . . . . . .. . . . . .0 • • • ••
Theb acklaagsahi nisntd epenmdiednwti fery 27
. . . . . .
Midwifperrayc tiinctee rnationally 30
. . . . . .. . . .. . . .. . . . .
Conclusion 32
. . . . . . .. . . . . . . . .. . . . . . . . .. 0 • • • • • • • • • •
CHAPTETRH REEL:i teraRteuvriee w . . 33
. . . . . . . . . . . . . . . .. . .0
vi
Earlhyi stoofrm yi dwifery . . . 34
. . . . .. . . . . . . . . . . . .. . . .
Thea scendeonfoc bys tetri.c i.a n.s .. .. .. ..3 6. . .. .. .. . .
Critiqoufte hsme edicmaold eolf b irth 39
. . . . . . . . . . . .... .
Feminist ocfrti htmeie qduiecm aold eolf
chilidrbt.h . . . . . . . .3 9. . . . . . . . . . . . . . . . . . .
Further corfit thimeqe udeiscm aold eolf b irth 43
. . . . .
Midwifleirtye ra.tu.r..e... . . .. ...... .. .. .. ..4..7. . .
Continoufic tayra en dp artnerisnmh iidpw ifery5 0
. . .
Midwifreersye a.rc.h . . . 52
. . . . . . . . . . . . . . . . . . . . . . . . . .
Clinipcraolc edures. . . 56
. . . . . . . . . . . . . . . . .. . . . . .
Thee ssenocfme i dweirfpy ractice. . 59
. . . . . . . . . . . .
Conclusion 62
. . .. . . . .. . . .. . . . . . . .. . . .. . . . . . . . . .. . .
CHAPTERF OUR:T heoretPiocsailt i.o n.. .. . . . .6 3. . . . . . . . . . .
.
Femintihseto r.y . . . . . . . . . 6.3 . . . . . . . . . . . . . . . . . . . . . .
.
Liberal fe.m in.i s.m . . . . . .6 4 . . . . . . . . . . . . . . . . . .
.
Marxifsetm inis.m . . . . . . . 6.6 . . . . . . . . . . . . . . . . .
.
Radicfaelm ini.s m . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Sociafleimsitn is.m . . . . . . . 7.1 . . . . . . . . . . . . . . . . .
.
Limitatoifgo rnasn fde mintihseto .r. y . . . . .7 2. . . . . . . . . . .
Thes ituaotfit nhgir se search. . . 74
. . . . . . . . . . . .. . . . . . . .
Prax.is . . . . . . 75
. . . . . . . . .. . . .. . . . . . . . . . . . . . . .
Subject.iv.i.t.y . . . . . 77
. . . . . . . . . . . .. . . . . . . . . . .
Powe/rK nowled.g e . . . . . . . 79. . . . . . . . . . . . . . . . .
.
Conclus.io.n. . . .. ,. . . ...............82. .
. . . . . . . . .
CHAPTERF IVEM:e thod.s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Thep articip.an.ts. . . . 84
. . . . . . . . . . . . . . . . . . .. . . . ... . .
Se_lectainodnb ackgrooufpn adr tici.p .a n.t s . . . . . . 84
Them idiwve.s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Thec lient:s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
. .
Ther esearc.he r. . . . . . . . . . . . . . . . . . . . . . . . . . . 88
.
vii
Ethiccoanlis derat.io.n.s . ... . 88
. . . . . . . . . . . .. . . . . . . . .
Reflievxiitnyt her elatioonfst hhierp e searacnhde r
thpea rtici.p a.n .t s. . . . . . .8 9. . . . . . . . . . . . . .
Ther ight tion ffourlmla t.i o.n .. . . . .9 2. . . . . . . . . . .
Negoattiitnhgpe a rtner.s.hip. . 92
. . . . . . . . . . . . . . .
Condfeinti�i.cy . . . .9 3
. . . . . . . . . . . . . . . . . .. . . . . .
Issuoefrs e albiilaintdvy a lidity . . . . 93
. . . .. . . . . . . . . . . . .
DatCao lclteio.n . . . . . . . . . . . .9 .5 . . . . . . . . . . . . . . . . . . .
.
Thep relimimneaertyi n.g s. . . . . . .9 .5 . . . . . . . . . . .
Interwsv ie. . . 96
. . . . . . . .. . . . . . . . . . . . . . . . . . . . . .
Journalalnidcn lgi nnioctael.s . . . 98
. . . . .. . . . . . .. .
Videtoapes. . . . . . . . . . . .9 .8 . . . . . . . . . . . . . . . . . .
.
Thep roceosfds a tcao llec.t i.o n. . . . . 9.8 . . . . . . . . . .
Dataan alysis 99
. . . . .. . . . . . . .. . . . . .. . . . . . .. . . . .. . . . .
Conclusion .... 101
. . . . . . . . . . . . . . . .. . .. . . .. . . . .. . . .
INTRODUCTOIN TOT HED ATA 102
CHAPTERS IX: SeMeikdiwnigf Cearrye 103
Pasetx perieKnncoewsl:e dfgoer future decision
making . . . .. . . 103
. . . . . . . . . . .. . . . . . . . . . .
Poor expewriiteshnt caensd haorsdp itcaalr e 104
Womena rneo tl istetnoe .d . . . . . .1 0.5 . . . . . . . . . .
.
Framgentecda raen dc onfliacdtviincge . . ..1 07
. . . . .
Tasakp proacthome isd wifperrayc tice. 114
. . . . . . . . .
Invsiibiolfiw toym enw ithtihne medical
system. . . . . . 116
. . . . . . . . . . . . . . . . . . . . . . .
Accetsosm idiwfecrayr e. . . . . . . . . .1 2.1 . . . . . . . . . . . . . .
Midwiveasl ternaptriavcet nietris.o . . . 1.2 8. . . . .
as .
-
Conclus.i.o.n . . .. ... 132
. . . . . . . . .. . . . . . . . .. . . . . . . .
CHAPTERS EVEN: DevetlhoMepi idnwgi fPearryet rnshi.p 133
. . . .
viii
Partnerasmhoinpg msitd wives 133
Rivalarmyo ngmsitd wive.s .. ............1 38
. . . . . . . . .
Partnerosfmh iidpw iafned c lient. . . . .....1.4 4
. . . . . . . . .
Definitnhgbe o undaroifte hsre e lation.s.h.i..p1 45
.
Clienstese kirnega ssurfarnocmte h e
researcher. . ....... .....1.5.1
. . . . . . . . . .
Conclusion 153
CHAPTEERI GHTF:e minPirsatx Wiosr:k iTnogg eth.e.r. ....1 55
.
Midwifkenroyw dlgee. . . . . . . . . . . 1.5 5. . . . . . . . . . . . . . . .
Poweirn t hmei dwicflei/e pnatr tne.rs..h.i.p. .......1 64
.
Reciproacnidrt eyf lexiinvt ihmteiy d wicflei/e nt
partner.s h.i p. . . . . . . . . . .1 7.3 . . . . . . . . . . . . . . . . .
Concu lsi on . . . . . . . . . . . . . .1 .7 8. . . . . . . . . . . . . . . . . . . .
.
CHAPTER NINET:h eP artnerEsvhailpu at.e.d . . .1 80
. . . . . . . . . .
Expectaotfil oanbso u.r. ........ . . . .1.81
. . . . . . .. . . . . .
Reviewtihnbegi retxhp erie.n.c..e.. .. ..·. . . .: . . .0 • 0 188
Midwi/fc eliesnutp pofrotr eoatchhe. r. .. 194
. . . 0 • • • •0 0 •
Dissoltvhipena gr tner.s.h.i.p 198
0 • • • • • • •0 0 0 0 •• •0 0 0 0 •
Conclus.i.o.n. ......... . 201
. . 0 • • 0 • 0 0 • 0 0 • •• •0 •0 0 • 0
CHAPTER TDEiNs:c ussRieocno,m mendatCioonncsl,u sion2 02
Revisitthiaeni gm osf t hset udy . . ... 202
. . . . . . . .0 0 • •0 • 0
Froms ubjecttioiv nitteyr subjectivity2 03
0 • 0 0 0 • 0 • 0 • 0
Powe/rKn owledg.e. .... 206
. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Praxis 209
. . . 0 0 • • •0 • • 0 0 . 0 • • 0 . 0 0 0 0 0• •0 •0 0 0 0 0 0 0
Implicaftoimroi ndsw ifperrayc t.i.c.e. ..... 210
0 0 0 0 • 0 • 0 0
Implicafto!mr<i mdsw ifeedruyc at.io.n 213
. 0 0 0• • •0 • 0 0 0 0 0
Limitatoifto hnissst ud.y. ... 213
. 0 • • 0 • 0 • 0 0 0 • 0 0 0 • 0 0 0 • 0
Implicaftoifrou ntsu rrees ear.c.h 216
. . .0 • • 0 0 • •0 • 0 0 0 0 • 0
Concludsitnagt ement. ..... 218
. . . . . . 0 • 0• • 0 • • •0 0 0 0 0 0 0
lX
APPENDIOXN E:D efiniotfai m oind iwf.e .... . . . . . 2.1.9. . . . . .
APPENDITWXO : Lettferro amp artici.p a.n t. . . 2.2 0. . . . . . . . . .
APPENDITXHR EE:I nformaftoiPror no specPtairvitepi acnt.s.2 2 1
Clieinntf orma.t.i.on. . .......... . . ...2.21. . . . . . .
. . .
Midwifien forma.t.i.o...n. ...... . . .........2 .2.2.. .
REFERENCE.S. ... . . . ........................ . .2.23.
. . .