With the exception of the midwifery led care postnatal group, when asked about what women think a doctor does, all of the women felt that the doctor was the decision maker and the midwives carried out his instructions:
“I think the midwives need the doctor to make the decisions. The midwife is constantly waiting for the doctor to decide on the results she has”
Susan (CLC, A/N, Primip: Transcript 3A,p4).
“The midwives do the monitoring on a regular basis, but it is definitely the consultant that is the one who makes the decisions”
Shona (CLC, A/N, Multip: Transcript 2A,p4).
The assumption that I made earlier in section 5.3.3 in relation to women waiting for the midwife to tell her if everything was fine from the results via the technology is dispelled here. The women see the midwife giving the results to the doctor; therefore she perceives it as the doctor’s role to inform her if the pregnancy, labour or birth is progressing normally, not the midwife. The women view the doctor as the powerful decision maker and the midwife as his handmaiden. The way in which midwives conduct their role leads to women interpreting what they see. The women view the doctor as having the authoritative knowledge, which she has ‘come to know’ (Kingdon 1997) by viewing interactions between midwives and doctors. She interprets the work of this type of ‘modest witness’, one that appears to be supporting the technocratic birth culture, rather than the normality of birth. How midwives have come to practice within technocratic environments in this way has been discussed in Chapter 241 and Chapter 342. Witz (1992) explains how the power of the
medical profession to set limits on midwifery practice was related to its position as a male dominated institution and its relationship to the state. By setting limits within the NHS hierarchical structure this inhibits the midwife making the decisions, due to guidelines and rules set down by the medical profession within the institution. One of the most interesting aspects of the data collected was from the women receiving consultant led care regarding their choice of health professional:
41 See chapter 2, section 2.2.5.6 The Emergence of Technocratic Birth 42 See chapter 4, section 4.2 Feminist Theory and the Role of the Midwife
“ Well I had to have a consultant because of my problems. I am under Mr D, he’s had all of mine”
Shona (CLC, A/N, Multip: Transcript 2A,p4).
This comment is extremely interesting as the doctor could be mistaken for the woman’s partner. I am undecided if this is related to the culture within the institutional environment or perhaps related to trust in the doctor by her. She appears to situate herself as owned by Mr D. This also correlates with Carol’s response:
“I am a diabetic, so I am always under Mr B, they always look at me as if to say why aren’t you under Mrs C, but I’ve never had a problem with Mr B, I’ve had three children with him, so if there is not a problem why fix it, I’ve had three with him and every time they ask why I’m not with Mrs C, he’s never caused any complications. He takes good care and he allows his midwives to take quite a bit of care. He allows them to do all of the monitoring, he will fix me if need be”
Carol (CLC, A/N, Multip: Transcript 2A,p4).
Carol’s comments correspond with Shona’s in relation to her identifying her children as Mr B’s, placing trust in Mr B to take care of her through this experience or perhaps she is also an oncomouse, but with Mr B’s trademark, instead of Mr D’s. Carol views herself as disembodied; she views Mr B as her body fixer. Carol perceives the midwife as being under the control of Mr B, that the midwife is his handmaiden. She perceives the technology used for monitoring by the midwife as blurring into the main focus of her role through what she has witnessed, which is her situated knowledge.
The women experiencing midwifery led postnatal care were asked what they thought the doctor did, which was in contrast to what has been found above:
“I haven’t seen a doctor at all through my pregnancy; I have never felt I have needed to”
Louise (MLC, P/N, Primip: Transcript 1A,p4).
“I was happy with having midwifery led care, I was happy with that decision; I didn’t need to see a doctor”
Sarah (MLC, P/N, Primip: Transcript 1A,p4).
“Doctors are supposed to be more educated, but the midwife explains everything to you. The Doctor said my baby was breech, I didn’t worry, I just asked my midwife to check, she felt is as being head down and she explained what she was feeling where. She was right it was head down”.
The midwifery led women appear to question the doctor’s decisions, the need to see a doctor and ownership of their bodies. There appears to be a distinction between how the women’ experiencing consultant led care and those receiving midwifery led care have come to know about the role of the midwife and about childbirth.
5.4 CONCLUSION
The first phase has suggested contrast between the ‘situated embodied knowledges’ of the women experiencing midwifery led care and those receiving consultant led care. Using Haraway (1988, 1991,1997) to interpret the findings of this phase has assisted my understanding of the women’s current located knowledge.
The empowerment belief of women created by midwives provides a really interesting aspect, which only presented within the ‘situated knowledges’ of women experiencing midwifery led care. The influence of media appeared to be strong, especially within the midwifery led women’s experiences, along with experiences of friends. Women who experienced consultant led care, were influenced by their family or previous childbirth experiences, if it was their first baby they were also influenced by the media. Women experiencing consultant led care appeared to come to know what a midwife did through their relationship with technology and monitoring, which was in contrast to the midwife’s influence on women’s empowerment, which was found within the ‘situated knowledges’ of the midwifery led women. The women’s perception of the doctor’s role in relation to the role of the midwife informed us of differences in the situated knowledges of women experiencing care led by different health care professionals. The women experiencing consultant led care perceived that the doctor is the decision maker within the relationship with her and the midwife. She views herself as disembodied. She sees the midwife as a handmaiden to the doctor, who integrates with technology to test her body and then reports the results to the doctor who makes the decisions about what interventions are needed to ensure her body functions in a timely manner. She is not connecting from the interactions from her body or baby from the inside, but coming to know about her body and baby from other factors around her, from the outside;
machines, midwives and doctors. Her experiences and observations have led her to her personal ‘situated knowledges’.
The themes identified have provided useful information to guide this study into the next phase. In this chapter I have provided a partial perspective of women’s perceptions of the role of the midwife. Further investigation is required to provide a deeper understanding. There has been an increasing body of evidence created more recently of women experiencing midwifery led care (Flint et al 1989, Page 1999, Sandall et al 2001,Walsh 2007a). Views from women experiencing consultant led care are not frequently investigated in comparison. The second phase of this research study concentrates on the situated knowledges of women receiving consultant led care. This is reflected with the midwife’s views of how they think women perceive their role. This will provide the information needed to explore perceptions of the midwife’s role further. In chapter 6 the findings from the second phase of this study will be discussed, and will provide a deeper insight into perceptions of the midwife’s role. In chapter 7, I discuss the findings from both this and the second phase. Figure 5.1 tracks my research journey so far.
Figure 5.1 Research Journey
Perceptions of a Midwife’s Role
Traditional Midwifery Skills
Male Influence on Birth Plurality of Existing Definitions of a Midwife’s Role
Dominance of Medicalisation Medicalisation of Birth
Role Defined Through a Medical Lens
Current Midwifery Policy
Evidence of Midwives, Women’s and Partner’s Views
Influence of knowledge of feminism research design of first phase
Liberal First Wave ………
Marist Liberal Radical Second Wave findings from first phase of study Postmodernism Psychoanalytic
Technoscience Cyberfeminism Third Wave
Midwife’s influence on women’s empowerment
Influence of family, friends and media
Technology and monitoring Influence of doctors.
The overarching theme was that women experiencing midwifery led care have a different view of the midwife’s role compared to women experiencing consultant led care
Identification of Haraway (1991, 1997) as research design of second phase Chosen theoretical perspective
Liberal First Wave ……… Marist Liberal Radical Second Wave ………... Postmodernism Psychoanalytic