PRUEBAS DE CHI-CUADRADO DE PEARSON

Mā te rongo, ka mōhio; Mā te mōhio, ka mārama. Mā te mārama, ka mātauranga, Mā te mātauranga, ka waiora.

(Through resonance comes awareness; through awareness comes understanding; through understanding comes knowledge, through knowledge comes life and wellness)

It is rather a method that at the outset of inquiry creates the space for an absent subject and an absent experience that is to be filled with the presence and spoken experiences of actual women (Smith, 1987, p. 107).

Introduction

This chapter presents a comprehensive overview of the development and theoretical underpinnings of Te whakamāramatanga; the research methodology/ model developed and trialled within the doctoral research project and presented within this thesis. Narratives and the value of narrative research as a mode of inquiry within multicultural contexts are discussed. A partnership framework for the research methodology is showcased and the methodology/model’s relational links to kaupapa Māori research and Māori centred research are established. Core Māori theoretical concepts and principles are identified, and explanations are provided regarding their conceptual relevance to the research design. Midwifery theoretical concepts are also outlined and recommendations for their integration within the methodology are stated. Theoretical approaches to narrative analysis are discussed, specifically the application of Arthur Frank’s and Margaret Somer’s narrative research ideas and the social theories of Michel Foucault, Bruno Latour, Pierre Bourdieu, Bronwyn Davies, and Rom Harre are also considered in regards to their analytical relevance. Te

whakamāramatanga is promoted as a culturally and contextually relevant response to Midwifery professional governance requirements. It is proposed that through implementing the methodology within research, the development of multicultural research partnerships may be facilitated.

Constituting Narratives and Stories

Within academia, there is considerable debate regarding the elements and organisational schema that may constitute a narrative (Frank, 2000a; Garro & Mattingly, 2000; Labov & Waletzkey, 1967; Linde, 1993; Plummer, 1995; Polkinghorne, 1988; Riessman, 1993, 2008). Historically, disciplinary conceptualisations of narrative have largely been drawn from the field of literary criticism; specifically from literature on narratology 14 _{(Bahktin, 1981; Frank, 2002;}

Maines, 2005; Mishler, 1986; Page, 2006; Sarbin, 1986). Definitions have also arisen from the field of sociolinguistics (De Fina, 2003; Gee, 1991; Thornborrow & Coates, 2005); where narrative tends to be characterised as a class of discourse, and the term story is reserved for an archetypal form.

Narratives are variously described as reports of temporally sequenced events (Bruner, 1991; Elliott, 2005; Paley & Eva, 2005), personal accounts (Robinson, 2005) sources of subjective truth (Riessman, 1993), ways of giving meaning to experience (Garro & Mattingly, 2000), modes of explanation (Bruner, 1986, 1987), and organizational schema expressed in story form (Polkinghorne, 1988). Within research, these multiple characterisations of narrative have resulted in the categorisation and structuring of narratives (Labov & Waletzkey, 1967) based on their form and content.

Health researchers frequently employ the terms ‘narrative’ and ‘story’ interchangeably (Greenhalgh & Hurwitz, 1999), inferring a degree of synonymy. Researchers (Barton, 2004; Paley, & Eva, 2005; Riessman, 1993) who consider this practice to be problematic have attempted to distinguish stories from narratives. Stories have primarily been constructed as subjective accounts that contain interwoven plots and characters, and are designed to elicit a particular response from listeners; whereas narratives are perceived to be objective reports of causally connected and temporally sequenced events.

14 _{Narratology refers to the theory, and study of narrative structure and the ways in which narratives}

influence individual and collective perceptions of selves and experiences. The literary study of narrative form emerged in the 4th _{century BC with Aristotle’s Poetics. However, modern narratology has developed}

The absence of disciplinary consensus regarding the constitution, classification and structuring of ‘health research narratives’ is perhaps due in part to a perception amongst researchers that stories of illness or disease may be tales of power and morality (Crossley, 1999; Frank, 1998). Denzin ( 1989) remarks that due to the element of plight and/or tragedy commonly found in such stories, they may contain “interactional moments and experiences which leave marks on peoples lives” where “character is manifested” (p. 70). Illness narratives are therefore individualized and not really generalisable as ‘data’ (Frank, 1993). Denzin (1989) and Frank (1993, 1998) suggest that illness narratives are moral tales of the ‘self’ and infer that researchers are subject to a moral mandate to honour the narrative voices of research participants when re-telling participants’ stories.

Original storyteller’s narrative constructions are on occasion displaced or discounted by researchers (Labov & Waletzkey, 1967; Riessman, 1993) who constitute such accounts as narratives based on their conformity to a specific arrangement of narrative elements. Due to the ethical tenets associated with research some health researchers (Bishop, 1996; Frank, 2005; Garro & Mattingly, 2000) have opposed the imposition of such classifications on narratives. Researchers (Bishop, 1996; Frank, 2005) have also viewed the use of analytical frameworks for, as Riessman (2008) suggests, constructing (suitable) narratives for inquiry; as contributing to the de-contextualisation of narratives. In his critique of narrative inquiry methods Barthes’ (1974) suggests the reconstruction and reshaping of narratives by researchers, facilities the homogenization of narratives. He perceives researchers’ construction of the “grand narrative structure” as self aggrandizement and the imposition of structure “as exhausting….as it is ultimately undesirable, for the text thereby loses its difference” (p. 3). Following Barthes, Polkinghorne (1988) de-problematizes the delineation of narrative from story by constituting narrative as broadly inclusive; encompassing “any spoken or written presentation” (p. 13), which by default may include stories. More recently, Phibbs (2008), drawing on Plummer (1995, pp. 17-20), has viewed narrative through a broad but alternative lens and suggested that narratives may be perceived as “stories and action” in relation to “times, selves and settings” (p. 47).

In this thesis, the debate within health research regarding what elements and/or format constitute a health narrative is regarded as irrelevant, because such practices attempt to settle on paper that which is not settled in reality (Latour, 1999). As Frank (2000b) suggests “[P]eople do not tell narratives they tell stories: let me tell you a narrative sounds strange” (p. 354). In choosing to whom, where, when and how, we

tell stories and in the act of storytelling we create and enable un-finalised and dynamic relationships. “One person may be speaking but stories are told with - not only to listeners who are part of the storytelling” (Frank, 2000b, p. 354). Telling a story is therefore a “relational act” (Linde, 1993, p. 112) that implicates a narrator’s audience. Ochs and Capps (2001) theorise everyday storytelling relationships as conversations, that facilitate acknowledgement of, as well as exploration of our responses to, and the meanings associated with, identities and experiences. It is suggested that the researcher as listener and co-constructor of the ‘interview’ story, has a responsibility to ensure that participants’ narrative ‘voices’ and ‘storied’ meanings are heard and respected (Frank, 2000a; Ochs & Capps, 2001).

History of Midwives, Women and Māori: The Role of Narrative

We live in a storied world. Women share stories, and in doing so, disclose to each other, their identities, experiences, beliefs, secrets, and deepest desires. Through the telling and retelling of stories, women nurture, create, accept, rationalise, adjust, invest in, and re-invent their identities and lives, in order to develop, refine and maintain, social networks and social worlds. As Frank (2000a) proposes, there are no places outside stories.

It is therefore unsurprising that whenever midwives meet, reciprocal storytelling is unconsciously initiated, because the commonality of narrative habitus15 _{(Frank, 2005)}

forms bonds between midwifery practitioners and facilitates the building of trust and respect. The storytelling exchange frequently involves reflecting on events in professional practice, and is used as a way to both safely self evaluate professional performance, and identify the philosophical and professional beliefs of peers. This reciprocity in storytelling and hearing also occurs within the midwife/woman/family relationship with childbearing women. Midwives disclose to women who they are as women and health care practitioners via their stories, and assess women’s wellbeing via, and care for women’s needs in response to, women’s stories (Leap & Hunter, 1993; McHugh, 2004; Wickham, 2004a). Midwives may also collect stories of pregnancy and child birth and as Mol (2008) suggests “pass them on from one person to the next” (p. 17), potentially shaping professional practice, clinical research and health policy (Steiner, 2005).

15 _{Frank draws on the concept of habitus as conceptualised by Pierre Bourdieu (1977) Bourdieu defines}

habitus as the body made social through “systems of durable, transposable dispositions” (p. 72), or in other words habitual, or a predisposition to particular ways of being.

The oral tradition of passing down mātauranga Māori (traditional knowledge) and tikanga (cultural traditions) via he kōrero kanohi ki te kanohi (face to face communication) is a highly valued aspect of Māori culture (Binney, 1987). Researchers (Bishop & Glynn, 1992; Cram, 2001; Cram, Phillips, Tipene-Matua, Parsons & Taupo, 2004; Irwin, 1994; Mead, 1996; Royal, 1998; Smith 1999b) suggest that research involving Māori knowledge and people needs to be conducted in culturally appropriate ways and in keeping with Māori cultural preferences. In this instance the taonga of women’s narratives may best be served by respecting the narratives in their entirety. The narrative analysis may be collaboratively constructed by research participant and researcher, and can disrupt the power relationship of who within the research process is known and who is the knower. Drawing on a post- colonial paradigm, this form of narrative analysis is concerned with the collaborative ‘We’ (interviewer and interviewee) not the individualistic ‘I’ (researcher) and may promote the whakamana (empowerment) and tino rangatiratanga (self determination) of both Māori and non-Māori women.

Development of Te Whakamāramatanga

Midwifery practitioners in Aotearoa, New Zealand regardless of their sphere of employment are required to embrace the philosophical underpinnings, theoretical concepts and ethical requirements that inform, and provide the basis for professional practice (New Zealand College of Midwives, 2005). Consequently, this qualitative research methodology has been developed and trialled, within a partnership framework that is woman and whānau (family) centred. The research process has encompassed the midwifery ethical concepts of negotiation equality, empowerment, respect, trust, shared responsibility, informed choice and consent.

In accordance with the stipulated performance criteria for the first professional competency of midwifery practice and ethical responsibilities to the wider community, midwives must demonstrate that they recognise Māori as tangata whenua, and practice in accordance with the principles of protection, partnership and participation as an affirmation of the Treaty of Waitangi.

In order for midwives to acknowledge a Māori world view, it is essential that relevant cultural concepts/processes, particularly whakapapa (genealogy) and whakawhanaungatanga (building and maintaining relationships), are encompassed within the creation of midwifery research and care provision frameworks. Such

concepts may have cross-cultural significance and accordingly, have been incorporated into the development of the methodology ‘Te Whakamāramatanga’.

I demonstrate throughout the thesis that this framework has been perceived by Māori and European research participants as providing a contextually relevant and safe process for participants to share their stories and co-constitute new narratives of midwifery knowledge. I also propose that the methodology/model provides a framework that may be adapted for application to clinical midwifery practice, and that it has the potential to facilitate change in the field of health care.

Te Whakamāramatanga

The title of this partnership model ‘Te Whakamāramatanga’ (Figure 3, p. 53) draws from the Māori whakatauki (proverb) I te kore, ki te po, ki te ao Mārama (From darkness through the night into the world of light) which acts as a metphor for both the creation of humanity and childbirth. Within the thesis the title of the methodology reflects the spiritual call to us as human beings to embrace our part in the movement of the universe and move from darkness into the light of knowledge and relational connection as human beings. As such this model has the potential to be adapted and applied as a framework for healing and new growth in a variety of settings.

Within the research paradigm the term ‘Te Whakamāramatanga’ encompasses all aspects associated with research design. Definition16 _{of that which needs to be}

identified, examined. Elucidation of the complexities associated with the research process and Enlightenment through the gifting of knowledge within the research partnership. Interpretation of reciprocal knowledge to uncover the deepest embedded

Meanings, and recognising their intrinsic value. Seeking and at the conclusion of the research process, crafting Solutions to the questions and problems identified. The following section outlines the key ideas within the research model ‘Te Whakamāramatanga’ through considering the philosophical underpinnings of ‘he pikorua’ and the theoretical concepts that make up the model.

16 _Ngā _{kupu me Te Reo M}ā_{ori (M}ā_{ori language terms) are frequently associated with more than one}

meaning depending on context. In this chapter italics are used to indicate English translations of possible contextual interpretations of Māori terms. For example, within Te Ao Māori (the Māori world) ‘Te whakamāramatanga’ may be interpreted as meaning Definition, Elucidation, Enlightenment, Interpretation, Meanings and Solutions.

Philosophical Underpinnings

Te Pikorua (Entwined Pikopiko Ferns)

I have visually represented ‘Te Whakamāramatanga’ with he pikorua pounamu. Taonga crafted in pounamu are highly valued by all Māori. Stories from my childhood attest to the life force of pounamu, and the protective and creative influences it has enacted on individuals; keeping them safe on their journeys and/or spiritually changing them from within.

Te pikorua is commonly explained as two autonomous pikopiko ferns that are continuously entwined with no beginning and no end. As such they are a representation of an infinite partnership. The triple twisted pikorua more frequently refers to the interconnectedness of two cultures or two peoples and their challenges and reconciliations over time. In Greymouth this interpretation of he pikorua was applied to the conceptualisation, and actuality, of a partnership that was co- constructed by Tangata whenua, health professionals and District Health Board employees from Grey Base Hospital. This partnership was formed with the intent of developing and conducting workshops for community members and health care providers. The workshops focused on supporting the continuity of cross-cultural knowledge and respect, within the field of health care provision (West Coast District Health Board, 2004). The pikorua may therefore be applicable for symbolising the creation of the research partnership and the continuity of that research partnership maintained over time, and throughout the research process.

For the purposes of ‘Te Whakamāramatanga’, the pikopiko ferns represent multiple

partnerships (Māori/Europeans, research participants/researchers,

women/midwives), and may appear as various combinations within those partnerships, such as Māori midwifery researcher/European woman research participant.

The pikopiko ferns may also represent interpersonal communication; an integral element within the research process, particularly within narrative research. The elements of creativity and protection traditionally attributed to the pikorua enhance a cultural framework that may facilitate the development of intimacy, and encourage reciprocity between researchers, research participants, women and midwives. The continuity of korero may therefore be considered inherent within the pikorua, at both macro (societal, community), and micro (individual/whānau) levels.

Nga Kete o te Wananga (Baskets of Knowledge)

Women’s and midwives’ narratives contain nga kete o te wananga (the baskets of knowledge); the gifts of Tāne Mahuta. This is the knowledge that guides the research process, the knowledge that is uncovered within the research process, and the knowledge that will be created by the research partnership. Such knowledge may be summarised as knowledge of the physical senses (te kete aronui), knowledge that is beyond the physical senses (te kete tuauri), and knowledge that is born from the sense of oneness that develops amongst members of the partnership (te kete tuatea).

Knowledge of the physical senses contains all the knowledge of the natural world that we see, hear, smell, taste, and touch. For the purposes of this study, such knowledge is created from women’s embodied experience of childbearing, loss, and caring for that loss, as expressed in the stories that are shared by all participants in the research process.

The knowledge that is beyond the physical senses encompasses theoretical knowledge, comprehends, discloses and explains the reality behind what is experienced in the natural world, and for the purposes of this thesis, helps explain and inform the research process. Such knowledge may be described as sense perception; and is frequently difficult to grasp, and/or may even be hidden. Midwifery knowledge of the normality of pregnancy is hidden knowledge based on midwives’ ability to identify the patterns of changes, and rhythms of energy, associated with pregnancy, without the benefit of, or recourse to, medical technology. Pelvin terms this “midwifery’s art of knowing” (1996, p. 14).

Childbearing women also have personal, private ways of ‘knowing’ in relation to their pregnancies; their embodied knowledge of each pregnancy, and the physical intimacy they experience with their individual bodies. Women collectively may refer to this knowledge as intuition. For women who miscarry and the midwives who care for them, knowledge of a problem may become evident in the co-recognition of the subtly changing patterns associated with a pregnancy. Changes may be benign on an individual basis, but collectively they tell a different story. This knowledge is therefore embedded in women’s and midwives’ narratives.

The knowledge that is born from a sense of whakaaro kotahi (unity) develops gradually amongst members of the research partnership. The reciprocity of ritual story sharing between researcher and research participant creates knowledge that is beyond

time and space; that is deeply spiritual in nature, and informed by forbears, history and culture. Such spiritual knowledge, co-created by the whanaungatanga of researcher and research participant, facilitates the building of mutual trust and respect. Revelation of spiritual knowledge during the research process, and within the research findings may be proportional to the levels of intimacy and trust that are achieved within the research partnership.

In the next section of the chapter a visual representation of the model is presented, followed by a discussion of the theoretical processes and concepts of ‘Te Whakamāramatanga’. The theoretical processes are Whakamātautau (examination) and Whakataunga (conclusions, findings, implications). The theoretical concepts are Whakapapa (genealogies), Whakawhanaungatanga (building relationships), Whakarurutanga (safety), Whakaaetanga (acceptance, approval, agreement), Whakiritenga (negotiation), Whakangungu (protection, advocacy), Whakawhirinaki (building trust), Whakamana (empowerment), Ōritetanga (equity) and Mana Motuhake (autonomy, self determination).