A hermeneutic analysis of the rise of midwifery scholarship in New Zealand.Abstract
In the past 25 years there has been a significant rise of scholarly activity, meaning university-based postgraduate education
Postgraduate education (often known in North America as graduate education, and sometimes described as quaternary education and research, amongst New Zealand New Zealand (zē`lənd), island country (2005 est. pop. 4,035,000), 104,454 sq mi (270,534 sq km), in the S Pacific Ocean, over 1,000 mi (1,600 km) SE of Australia. The capital is Wellington; the largest city and leading port is Auckland. midwives. This paper records stories of that change, accessed through a hermeneutic her·me·neu·tic also her·me·neu·ti·cal
[Greek herm research study. The analysis is through the viewpoint of the author, Liz Smythe, who was one of the first New Zealand midwives to gain a PhD supervised su·per·vise
tr.v. su·per·vised, su·per·vis·ing, su·per·vis·es
To have the charge and direction of; superintend.
[Middle English *supervisen, from Medieval Latin by midwives, about midwifery midwifery (mĭd`wī'fərē), art of assisting at childbirth. The term midwife for centuries referred to a woman who was an overseer during the process of delivery. In ancient Greece and Rome, these women had some formal training. . She uses her own story as a scaffold scaffold
Temporary platform used to elevate and support workers and materials during work on a structure or machine. It consists of one or more wooden planks and is supported by either a timber or a tubular steel or aluminum frame; bamboo is used in parts of Asia. to view the stories of her peers. Five other midwives participate in this study, with data drawn from interviews and written reflections. The purpose of the study was to capture stories pertaining per·tain
intr.v. per·tained, per·tain·ing, per·tains
1. To have reference; relate: evidence that pertains to the accident.
2. to scholarship to reveal the manner in which a variety of individuals, each choosing her own pathway pathway /path·way/ (path´wa)
1. a course usually followed.
2. the nerve structures through which an impulse passes between groups of nerve cells or between the central nervous system and an organ or muscle. , came to establish an early wave of New Zealand midwifery research-based scholarship. It is a snapshot (1) A saved copy of memory including the contents of all memory bytes, hardware registers and status indicators. It is periodically taken in order to restore the system in the event of failure.
(2) A saved copy of a file before it is updated. of history that offers insight into the play between profession, practice, and scholarship. Some of the key leaders, notably Joan Donley, had minimal involvement with university life. Karen Guilliland and Sally Pairman addressed the professional/practice issues from outside university and later turned to university-based scholarship to document the insights. Others, such as Liz herself, attained tertiary tertiary (tûr`shēârē), in the Roman Catholic Church, member of a third order. The third orders are chiefly supplements of the friars—Franciscans (the most numerous), Dominicans, and Carmelites. qualifications and were ready for the new era of degree level training. Some doctorally prepared midwives came from overseas to share the leadership of postgraduate education and research. A strong theme emerging from the study is the huge commitment the scholarly leaders made in the development and reshaping of midwifery. Questions are raised about the future of midwifery scholarship in a climate of fierce competition for research funds. It is argued that scholarship is vital to underpin and guide the midwifery profession, but at what cost to the individuals involved? What strategies are needed to ensure scholarship remains strong and responsive? These questions need to be addressed by the profession.
Hermeneutics hermeneutics, the theory and practice of interpretation. During the Reformation hermeneutics came into being as a special discipline concerned with biblical criticism. is about life-experience and belongs to it. Hermeneutics is the lived experience of lived experience (Crowe, 2006, p.26).
This paper is written to articulate the lived experience of the rise of midwifery scholarship in New Zealand. By 'scholarship' I mean involvement in university study, and, for this research, those midwives beginning postgraduate postgraduate
after first degree graduation, the registerable degree in veterinary science.
may be a research degree, e.g. PhD, or a course-work masterate with a vocational bias, or any combination of these. study in the era of the 1980s when midwifery was in transition from hospital-based training to polytechnic education. This pioneer group of midwives went on to do masters and doctoral research 'in midwifery'. I draw from the philosophy of hermeneutics, which recognises that one can only understand the experience of others through the lens of one's own historical being-in-the-world. Thus as author I acknowledge the interpretations as my own. My own story is the scaffold on which this bigger story is told. I share it to enable readers to discern dis·cern
v. dis·cerned, dis·cern·ing, dis·cerns
1. To perceive with the eyes or intellect; detect.
2. To recognize or comprehend mentally.
3. the standpoint from which I interpret, and because the insights of 'my story' so strongly colour my passion and commitment to scholarship. I do not seek to track the historical milestones of the transition to a university-based structure of postgraduate education, but rather to tell stories. Harman (2007, p.28) says life is always 'thisly': this life, in this time, with these people, doing this thing. Stories hold the 'thisness' helping us resist the temptation to reduce life to theoretical constructs. Throughout the paper I use the word 'us' to refer to my perception of what the community of midwives I was a part of, at the time, was thinking. This is of course an assumption, yet from the perspective of hermeneutics we become "swept in a further tendency of life" (Crowe, 2006, p.81) by something bigger than 'my own view'. I am not saying each and every person believed the interpretations I offer. Rather, this was my sense of what 'we' thought. Is this paper therefore 'research', or a personal account of my own scholarly journey? From a hermeneutic perspective, it is both. It is a scholarly, research based analysis of the lived experience of a small cohort cohort /co·hort/ (ko´hort)
1. in epidemiology, a group of individuals sharing a common characteristic and observed over time in the group.
2. of midwives who were at the forefront of postgraduate university based midwifery education, interpreted from the horizon of my own experience. It is the lived experience of lived experience (ibid).
The word 'hermeneutics' emerged in the seventeenth century to mean the "science or art of interpretation" (Grondin, 1991, p.1) although its roots can be traced back to the writings of the ancient Greeks This an alphabetical list of ancient Greeks. These include ethnic Greeks and Greek language speakers from Greece and the Mediterranean world up to about 200 AD.
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A . Gadamer, a key writer on philosophical hermeneutics, is clear that prejudices or pre-understandings are the very conditions by which we understand. The challenge is not to set them aside but rather to work with them in the quest towards understanding. We come to understand through the history into which we were born and now live. "It is history that determines the background of our values, cognitions, and even our critical judgement. 'That is why,' says Gadamer, 'the prejudices of the individual, far more than his judgements, constitute the historical reality of his being'" (ibid, p.114). My own prejudices arise from beginning hospital-based nurse training in 1971, doing midwifery training through a 6 month course at a St Helens St Helens may refer to:
midmost of practice 'learning' was a daily challenge of trying to cope with new, complex, stressful situations where life and death could sway in the balance.
Understanding is always a dialogue between self and other (other being text, person or artefact See artifact. ). "In this dialogue there are no statements, only questions and answers that call forth new questions in turn" (ibid, p. 119). Understanding is therefore always a quest, always on-the-way, always personal. The journey never ends for, as the context ever changes, so too does understanding need to realign re·a·lign
tr.v. re·a·ligned, re·a·lign·ing, re·a·ligns
1. To put back into proper order or alignment.
2. To make new groupings of or working arrangements between. itself with the unfolding stories. It is as though our being exists in a kaleidoscope kaleidoscope (kəlī`dəskōp), optical instrument that uses mirrors to produce changing symmetrical patterns. Invented by the Scottish physicist Sir David Brewster in 1816, the device is usually a hand-held tube, a few inches to as much that can never return to a previous pattern, yet over the generations the understanding of what it means to be in the midst of such patterning is known and shared.
Ethics approval for this study was gained through Auckland University of Technology Not to be confused with the University of Auckland.
The Auckland University of Technology (AUT) (Māori: Te Wananga Aronui o Tāmaki Makau Rau) is the newest university in New Zealand. Ethics Committee ethics committee A multidisciplinary hospital body composed of a broad spectrum of personnel–eg, physicians, nurses, social workers, priests, and others, which addresses the moral and ethical issues within the hospital. See DNR, Institutional review board. . The choice of participants was my own, based on my personal network. One responded to an open invitation to offer written reflections, and the other four were interviewed. Karen Guilliland and Sally Pairman figure prominently, for I believe much of the current health and strength of midwifery in New Zealand is owed to their huge commitment and tenacity. Gillian White, who trained in England as England A refers to England's developmental national teams in several sports. Players on these teams often "graduate" to slots on the appropriate senior national team. The phrase may refer to:
2. A midwife is required to perform the business she undertakes with proper skill, and if she be guilty of any mala praxis, (q.v. , talks of her early recognition that midwives needed to be doing their own research. Cheryl Benn and Maralyn Foureur (previously Rowley) are included as midwives who arrived in New Zealand with nearly completed doctoral qualifications to enable New Zealand midwives to do research under midwifery guidance. My own story was gathered by a written reflection and a tape-recorded interview. All participants were engaged in postgraduate study in the 1980s and 90s, and beyond. Karen has been Chief Executive Officer of the New Zealand College New Zealand College (known as NZC) is an English language college in Newmarket, Auckland, New Zealand. School Information
The interview sought to elicit e·lic·it
tr.v. e·lic·it·ed, e·lic·it·ing, e·lic·its
a. To bring or draw out (something latent); educe.
b. To arrive at (a truth, for example) by logic.
2. each person's story. I began with questions about pre-registration midwifery education and encouraged each person to keep telling the story, keeping the focus on 'scholarship' but recognising the journeys 'towards' and 'through' were all unique. Interviews were transcribed and transcripts were read and re-read. Stories were taken from the transcripts and crafted to reveal 'meaning' more distinctly (Caelli, 2001). I wrote and re-wrote interpretations of the stories to try to reveal scholarship as it showed itself in the context of that person's experience, recognising the 'with-world' relationships, 'with-people' relationships, 'with-self ' relationship revealing mood and concern, all of which are experienced in 'time' (Schmidt, 2006). The process of such interpretation is described by van Manen (1990) as dwelling dwelling
an abnormality of gait in a horse in which there is a momentary hesitation before the foot is placed on the ground. with text, intuiting intuiting,
v to use impression, insight, or premonition to gain information about a client. meaning, writing and re-writing. The trustworthiness trustworthiness Ethics A principle in which a person both deserves the trust of others and does not violate that trust of this study does not lie in whether my interpretations are 'true' for they can only ever be 'as I understand' but whether I have enabled the readers to share in their own interpretive in·ter·pre·tive also in·ter·pre·ta·tive
Relating to or marked by interpretation; explanatory.
in·terpre·tive·ly adv. process and arrive at their own insights. The crafted stories were returned to participants prior to inclusion to ensure their right to withdraw or restate re·state
tr.v. re·stat·ed, re·stat·ing, re·states
To state again or in a new form. See Synonyms at repeat.
re·state data. They are 'their' stories yet interpretation comes with prejudice of the researcher (Gadamer, 1982; Smythe, 2007).
Stepping into University Study
I begin with my own story of leaving my job as a charge midwife in Delivery Suite to go to university:
In 1985 that I should be going to University sent shock waves through my community of midwives and doctors. There was one paediatrician who I remember shaking his head saying 'but why?' He kept saying to everyone 'why would a midwife go to university?' Colleagues in Delivery Suite all wanted to know 'what are you learning?' I remember writing back saying for the first time ever in my education I am learning how to think. I did an essay in English Literature critiquing an essay written by Cardinal Newman. I wrote about his beautiful transition from one paragraph to the next etc, saying how excellent I thought it was. The tutor who marked it said "but his argument was rubbish". I thought 'goodness they expect me to have an opinion of my own!' That was mind-blowing. I'd assumed because the teacher had given it to us, it was good. Just that learning to critique, learning to bring my own voice (author).
We currently assume that it is fitting for midwives to attend a university to advance their learning. In 1985 it was considered odd and unnecessary. I quickly came to see the impact of being asked to 'think'. When one has been schooled in obedience OBEDIENCE. The performance of a command.
2. Officers who obey the command of their superiors, having jurisdiction of the subject-matter, are not responsible for their acts. and 'right' answers it was a huge leap to suddenly challenge and voice a contrary opinion. For me, university study, in the era of feminism feminism, movement for the political, social, and educational equality of women with men; the movement has occurred mainly in Europe and the United States. It has its roots in the humanism of the 18th cent. and in the Industrial Revolution. , and the Cartwright Inquiry The Cartwright Inquiry was a Committee of Inquiry held in New Zealand in 1988. It was commissioned by the then Minister of Health, Michael Bassett to investigate the alleged malpractice of Associate Professor Herb Green, a gynaecology and obstetrics specialist. (Coney coney or cony (both: kō`nē), name used for the rabbit (Oryctolagus) and for its fur; more often, for the pika, a small rodent found at high altitudes in both hemispheres; and for the hyrax, a small herbivorous, , 1988), with Marxist theory permeating per·me·ate
v. per·me·at·ed, per·me·at·ing, per·me·ates
1. To spread or flow throughout; pervade: "Our thinking is permeated by our historical myths" academic thinking, encouraged a strong critique of the status quo [Latin, The existing state of things at any given date.] Status quo ante bellum means the state of things before the war. The status quo to be preserved by a preliminary injunction is the last actual, peaceable, uncontested status which preceded the pending controversy. . Yet within New Zealand midwifery such thinking was also happening beyond the walls of university:
While I was burying myself in the scholarship of academia Joan Donley was hard at work publishing 'Save the Midwife' (1986) drawn from her own self-taught insights. When I came back to Auckland for my mid year break midwives gathered at Massey University and started talking 'autonomy'. I was in the ivory tower while midwifery was quietly getting on with its renaissance (author).
The rise of 'thinking' in New Zealand midwifery was strongly influenced by Joan Donley. Her book challenged midwives on all fronts and called for a rethink re·think
tr. & intr.v. re·thought , re·think·ing, re·thinks
To reconsider (something) or to involve oneself in reconsideration.
re . She wrote that the midwife had been: "upgraded and refurbished to become a nurse-midwife, a hybrid, a medically-oriented handmaiden hand·maid also hand·maid·en
1. A woman attendant or servant.
2. often handmaiden Something that accompanies or is attendant on another: , while the real midwife is an endangered species endangered species, any plant or animal species whose ability to survive and reproduce has been jeopardized by human activities. In 1999 the U.S. government, in accordance with the U.S. " (1986, p.11). In the spirit of Joan's embodied em·bod·y
tr.v. em·bod·ied, em·bod·y·ing, em·bod·ies
1. To give a bodily form to; incarnate.
2. To represent in bodily or material form: feminist perspective, she helped us to see that the emancipation Ask a Lawyer
Country: United States of America
I am 17 years old and would like to know if I would be able to file for minor emancipation. of midwifery required political action. Her own midwifery experience fuelled her passion:
As a midwife in the controversial domiciliary field for 12 years, my knowledge of the subject is more than merely academic. Personal involvement in the political battle to keep the home birth option open has provided insights for analysis I could never have gained from a seat outside the ring. In fighting this battle I had to go back--to research the historical background. Therefore, this book was written to clarify these issues and to provide an understanding of the historical/ political developments without which no battle can be successfully fought. (Donley, 1986, p.12)
Joan led the way for those of us who had become politically awakened a·wak·en
tr. & intr.v. a·wak·ened, a·wak·en·ing, a·wak·ens
To awake; waken. See Usage Note at wake1.
[Middle English awakenen, from Old English in showing that 'what mattered most' came from the understandings of experience. Her metaphor is of 'fighting the battle'. The tactics of warfare were required by both academia and politics.
Gillian White voiced her experience of those times in the mid to late 80s:
Imagine teaching in a course to educate midwives as a profession subsumed by nursing [Advanced Diploma of Nursing] ... It was not a sustainable position for me ... the battles we had were with politicians, the medical profession, NZNA, nurses and often with midwives themselves. Wellington midwives did not always agree with Auckland midwives and the South did not always agree with the North. (Gillian White)
Challenging the status quo and identifying strategies for change meant disrupting vested interests vested interest
1. Law A right or title, as to present or future possession of an estate, that can be conveyed to another.
2. A fixed right granted to an employee under a pension plan.
3. , removing comfort and control, and challenging what until then had been considered 'how it should be'. There were battles on all fronts with the ground of education in the midst of it all, for decisions around who controls education set the pedagogy, philosophy and possibilities for the next generation (Pairman, 2006). I remember these tensions. Heidegger talks of inauthenticity and authenticity The correct attribution of origin such as the authorship of an e-mail message or the correct description of information such as a data field that is properly named. Authenticity is one of the six fundamental components of information security (see Parkerian Hexad). : "One is characterized char·ac·ter·ize
tr.v. character·ized, character·iz·ing, character·iz·es
1. To describe the qualities or peculiarities of: characterized the warden as ruthless.
2. by complacency com·pla·cen·cy
1. A feeling of contentment or self-satisfaction, especially when coupled with an unawareness of danger, trouble, or controversy.
2. An instance of contented self-satisfaction. , distraction Distraction
Divination (See OMEN.)
a “person from Porlock” interrupted Coleridge while he was recollecting the dream on which he based “Kubla Khan”. [Br. Lit.: Poems of Coleridge in Magill IV, 756] , and self-concealment, while the other is marked by commitment, struggle, and sober responsibility for oneself. One kind of life is, ultimately, a failure to "own-up" to oneself, while the other is a life of profound honesty" (Crowe, 2006, p.70). This was an era of New Zealand midwives boldly trying to regain the authentic heart of midwifery practice. In the struggle, responsibility to take on battles with those who had vested interests in the status quo required courage and tenacity. Amongst midwives in those early days of change there were many content to stay with familiar ways and not disturb their comfortable world.
Making universities more accessible to midwives
In 1989 the New Zealand College of Midwives was formed. The first undergraduate direct entry midwifery degree programme was established at Otago Polytechnic Otago Polytech, or "TekOtago" focuses on skills based, technical education and occupational training, offering a range of New Zealand accredited degrees, diplomas and certificates in many areas of interest http://www.otagopolytechnic.ac.nz/programmes/areas-of-interest.html. in 1992, led by Sally who had a degree in English literature English literature, literature written in English since c.1450 by the inhabitants of the British Isles; it was during the 15th cent. that the English language acquired much of its modern form. done prior to her nursing and midwifery training (Pairman, 2006). Auckland Institute of Technology, where I was teaching midwifery, started with a direct-entry diploma DIPLOMA. An instrument of writing, executed by, a corporation or society, certifying that a certain person therein named is entitled to a certain distinction therein mentioned.
2. programme in 1992 (Gunn, 1992), which became a degree in 1994. By that stage I had my BA (Social Science) majoring in 'nursing' even though every assignment I had done was related to midwifery. Huge changes were afoot in the shaping of midwifery as a profession. The postgraduate focus followed closely behind:
We started a campaign with the universities that midwives should be able to go straight into Masters ... I think we did a campaign where we wrote to all the universities saying it's time things changed. (Karen Guilliland)
My road to scholarship was the equivalent of a full three-year undergraduate degree “First degree” redirects here. For the BBC television series, see First Degree.
An undergraduate degree (sometimes called a first degree or simply a degree before I could enter a masters programme. Later midwives had some reduction of papers in recognition of their professional qualification, gaining what was seen as the equivalent entry standard to postgraduate programmes. The College of Midwives however did not think this was good enough. Karen forged the way by proving her own capability of achieving at masters level without an undergraduate degree. She was accepted into the Victoria University Masters programme with an Advanced Diploma Qualification.
Scholarship following in support
A key feature of the rise of scholarship in New Zealand is that in many ways the political action came first and the formal scholarship followed behind. This is clearly seen in the stories of Karen and Sally:
We [Sally Pairman and I] worked really well together. She's the 'detail' and I'm the 'big picture'. We said, 'why don't we model what we keep saying about how midwives and women work together? We want to do something in partnership'. So Jill White [Victoria University] had to do all sorts of things in the university to allow us to use the one thing as a special topic for both of us. The model of partnership that we published from that may look tiny and simple but it took 10 drafts of the bloody thing to make it that tiny and simple. (Karen Guilliland) The idea to work on articulating our philosophy of midwifery came out of our experiences of trying to bring about change, and my experiences of working as a home birth provider, and the experience of the politics of getting College established. We just felt as though midwives needed something to kind of hang to, to frame up their work, to help them see what it was that this partnership actually meant. We had already adopted it as a College. We had it in our standards, we had it in the philosophy. We hadn't defined it, and it was like, "What is it?" And we had that experience of actually working in partnership, both from a political and the practice level. So it was trying to write about that. (Sally Pairman)
Karen and Sally were both key players in the establishment of the College of Midwives, winning autonomy and articulating the philosophy of practice that moved from creating dependency to building partnership. They had travelled the country talking with groups of midwives but knew that was not enough. Scholarship provided the vehicle to both firm up their thinking and disseminate dis·sem·i·nate
v. dis·sem·i·nat·ed, dis·sem·i·nat·ing, dis·sem·i·nates
1. To scatter widely, as in sowing seed.
2. it as the focus for New Zealand midwives. While political action created change, scholarship needed to follow closely behind to give structure, stability and credence. Further their monograph mon·o·graph
A scholarly piece of writing of essay or book length on a specific, often limited subject.
tr.v. mon·o·graphed, mon·o·graph·ing, mon·o·graphs
To write a monograph on. The Midwifery Partnership: A model for practice (Guilliland & Pairman, 1995) became an example of scholarly capability and possibility.
In the same year Valerie Fleming Valerie Fleming (born December 18, 1976) is an American bobsledder who has competed since 2003. At the 2006 Winter Olympics in Turin, she won a silver in the two-woman event with teammate Shauna Rohbock. graduated with New Zealand's first doctorate in midwifery. Her thesis was entitled en·ti·tle
tr.v. en·ti·tled, en·ti·tling, en·ti·tles
1. To give a name or title to.
2. To furnish with a right or claim to something: 'Partnership, power and politics: feminist perceptions of midwifery practice' (Fleming, 1995). Gilkison wrote: "This is New Zealand's first major piece of research on a midwifery topic ... In order to establish and declare midwifery as a profession in its own right and to create our own body of language, this kind of research is extremely important." (Gilkison, 1995, p.11). Looking back one wonders whether the impact of the research itself was as significant as the fact that we now had a homegrown home·grown
1. Raised or grown at home.
2. Originating in or characteristic of a locality: "Rock is homegrown music in the United States, evolved from blues and country and Tin Pan Alley" doctoral qualification.
Bringing in academic expertise
With pre-registration midwifery education as a degree programme, a growing number of midwives were stepping into masters study as the next step of their education. On the principle that educators should have at least one degree higher than the level of their students, there was a need to attract doctorally prepared midwives to New Zealand. Valerie Fleming, one of my PhD supervisors, moved back to Scotland. At that time there would have been no other midwife able to supervise me if Cheryl Benn had not moved to New Zealand:
We lived in an area [of South Africa] where down the road there were batteries of gunshots every night. We always lay in bed listening how far is it coming up the road? We decided we had to look for better options. My sister-in-law who was in Finland at the time knew that we were looking. She emailed us and said, "There's a job going at Massey University". (Dr Cheryl Benn)
People need incentive to leave one country and move to another. The rising danger of South Africa South Africa, Afrikaans Suid-Afrika, officially Republic of South Africa, republic (2005 est. pop. 44,344,000), 471,442 sq mi (1,221,037 sq km), S Africa. gave Cheryl that incentive. A chance 'find' via Finland opened the door for her to come to New Zealand where she took over the supervision of my PhD. Without Cheryl I would have had no choice but accept guidance from a non-midwife. I tell this story to show the challenge of growing 'scholarship' when there are so few to lead the way. For Cheryl it was not only a culture change of country but also of research methodology:
When I did my PhD in South Africa, quantitative methodology was very predominant ... When I came there weren't many people doing any quantitative work at all at Massey. My growth in qualitative was enormous over those first years. (Cheryl Benn)
Cheryl bought an expertise in quantitative research Quantitative research
Use of advanced econometric and mathematical valuation models to identify the firms with the best possible prospectives. Antithesis of qualitative research. methodology to face a nursing and midwifery community who had embraced qualitative approaches. My supervision was a wonderful experience of partnership where Cheryl freely offered me all her scholarly wisdom and together we tried to understand the nature of my phenomenological journey, exploring the meaning of 'being safe' in childbirth childbirth: see birth.
Childlessness (See BARRENNESS.)
(Rom. Diana) goddess of childbirth. [Gk. Myth. (Smythe, 1998, 2000, 2001, 2003). Visiting scholars A visiting scholar, in the world of academia, is a scholar from an institution who visits a receiving university that hosts him where he or she is projected to teach (visiting professor), lecture (visiting lecturer), or perform research (visiting researcher such as Professors Nancy and John Diekelmann taught us both. It was a learning community where we all supported and encouraged each other.
I met Maralyn Foureur in the back of the shuttle bus going to the College of Midwives Conference in Christchurch in 1996. She had come from Australia with her very nearly finished PhD to (ultimately) take on a Joint Chair of Midwifery with Victorian University and Wellington Women's Hospital Women's Hospital of Greensboro (part of Moses Cone Health System)
As the state's first free-standing hospital dedicated to women, the Women's Hospital of Greensboro is a 134-bed hospital is dedicated to providing state-of-the-art, compassionate and personalized care to women . I remember the sense of awe I had for such a practice-focused scholar. She talks about why she came to New Zealand:
The midwives in Australia currently are unable to get professional indemnity insurance unless they are employed by a hospital ... So the numbers of midwives in independent midwifery practice is limited. One of the reasons that I came to New Zealand was because of the midwifery-led maternity care that is here. I wanted to see how it was working and for me that was a big shock. All of my research and my reading had said low intervention is the consequence of midwifery-led maternity care--and it's not. The intervention rates are going up and up here (as elsewhere), so from a research perspective, it is very interesting to try to work out what might be happening. So now I explore and write about the complexity of maternity care and the power relations that impact on women and midwives. (Maralyn Foureur)
Maralyn had a scholarly interest/passion in midwifery led maternity MATERNITY. The state or condition of a mother.
2. It is either legitimate or natural. The former is the condition of the mother who has given birth to legitimate children, while the latter is the condition of her who has given birth to illegitimate children. care. New Zealand midwifery offered itself as a huge case study. How would outcomes of birth change within this 'experiment' of giving midwives autonomy to make decisions with-women rather than always with-doctors? Maralyn has moved back to Australia 10 years later, a decade that has seen a global increase in intervention in childbirth, pondering pon·der
v. pon·dered, pon·der·ing, pon·ders
To weigh in the mind with thoroughness and care.
To reflect or consider with thoroughness and care. the complex power relations that hold sway and somehow undermine the belief and courage that birth with minimal intervention is not only possible but desirable. Her scholarship seeks to unravel and offer insights. Meanwhile, in the time she was in New Zealand her scholarship has guided other New Zealand midwives, including Joan Skinner's doctoral study 'Love and fear: risk and the midwife' (Skinner Skin·ner , B(urrhus) F(rederick) 1904-1990.
American psychologist. A leading behaviorist, Skinner influenced the fields of psychology and education with his theories of stimulus-response behavior. , 2005).
How does scholarship show itself?
What difference has scholarship made to the practice of midwifery? Was my perplexed per·plexed
1. Filled with confusion or bewilderment; puzzled.
2. Full of complications or difficulty; involved.
[Middle English, from perplex, confused paediatrician right in thinking it was rather a waste of time and money? Gillian talks of how she came to see the need for scholarship:
I returned to clinical practice ... I watched as nursing/midwifery practice appeared to be at the whim of each individual ... I saw nurses and midwives attempt to defend their practice against 'evidence based medical practice'. I was always unconvinced of the quality of the evidence but the doctors were in a more powerful position and undertook 'research' ... I decided that the best way I could serve midwifery was to gain research skills and defend midwifery practice from a research base. (Gillian White)
I remember sitting around Joan Donley's kitchen table in the late 1980s writing submissions to win midwifery autonomy and hearing Joan say "but we need the evidence". Passion and belief are in themselves not sufficient to convince those who not only hold power but also have vested interests in maintaining that hold. Gillian recognised that midwives needed to gain research skills that would enable midwives to decide what needed to be researched, to determine how that would be done and then to have control over the dissemination dissemination Medtalk The spread of a pernicious process–eg, CA, acute infection Oncology Metastasis, see there of findings. Only in that way could their practice wisdom be offered as evidence. Her masters thesis followed her interest of midwifery education (White, 1990).
Karen tells her story of also seeing the need for establishing evidence:
For my masters thesis I set up a midwifery database that became the New Zealand College of Midwives database. I went to ICM [International Congress of Midwives], I met up with the Canadians who had a database and the American College of Nurse Midwives database people. I had the obstetric notes that the Ministry had here. I just put all those things together and came up with a new database. I really don't know how I did it. I sort of nutted my way through it and got it out. I didn't own a computer, I couldn't work one and I was doing a database! (Karen Guilliland)
This story shows the pioneering spirit of those times. Karen set about the task of establishing a database by taking an investigative tour of world. She then had to learn the related skills of technology. She found the 'know how' along the way. The database of the New Zealand College of Midwives was thus established early in its history to collect, collate col·late
tr.v. col·lat·ed, col·lat·ing, col·lates
1. To examine and compare carefully in order to note points of disagreement.
2. To assemble in proper numerical or logical sequence.
3. and analyse an·a·lyse
v. Chiefly British
Variant of analyze.
analyse or US -lyze
[-lysing, -lysed] or -lyzing, evidence.
Sally, needing a doctoral qualification to advance her educational career, looked back to all that she and others have achieved as part of the commitment to shaping a robust midwifery profession in New Zealand. It was story that needed to be documented:
What I've done in my doctorate is identified four strategies that I think have led to the professionalisation of midwifery in New Zealand. I've looked at the partnership model and the impact that that has had in New Zealand and internationally. I've looked at midwifery education, and how we've developed the midwifery profession through what we've done with education. I've looked at the College of Midwives and its role in meeting professional standards. And I've looked at the Midwifery Council, and the regulation. Those four strands integrated to create this profession that we've got, and bring it about. Over the years I've worked in each of those strands, so it really helped me to be able to see that the work that I've done on these things, has actually had some impact on where we are now. (Sally Pairman)
When I meet the new generation of student midwives, it is with shock I realise they do not know a time before the College of Midwives. They take for granted that there is a Midwifery Council. They naturally accept that they are in a degree level programme and that they do not need to have a nursing qualification to get into the programme. The partnership model is assumed to be that way midwifery has always been practiced. Sally's scholarship (Pairman, 2005, 2006) stands as a reminder of what was before and documents the huge commitment, political strategising and professional growth that have brought New Zealand midwifery to its current place. At the same time it reminds us of the contextual, ever changing nature of what it means to be a midwife.
Maralyn signals the impact a strong piece of work can have on global midwifery:
The original paper I published from my PhD gets cited about a hundred times a year. (Maralyn Foureur)
When there is research that presents evidence, in this example that midwifery-led care makes a difference to childbirth outcomes, midwives and others from around the world seize it to fight their own battles (Rowley [aka Foureur], Hensley, Brinsmead, & Wlodarcyzk, 1995).
In 1988 there was a midwifery conference in Auckland at which Caroline Flint Caroline Louise Flint (born 20 September 1961 in Twickenham, England) is a British Labour politician. She is the Member of Parliament for Don Valley in Northern England, the Minister of State for Employment and Welfare Reform in the Department for Work and Pensions and the , author of 'Sensitive Midwifery' (Flint flint, mineral
flint, variety of quartz that commonly occurs in rounded nodules and whose crystal structure is not visible to the naked eye. Flint is dark gray, smoky brown, or black in color; pale gray flint is called chert. , 1986), galvanised New Zealand midwives. Joan Donley laid down the challenge: Today we must decide whether we become moas (1) or midwives" (Donley, 1988, p.6), and argued that the only way for us to survive was to break away as a group from the professional body of nursing, and form a College of Midwives. I remember how courageous and exciting that moment felt as individually we stepped forward to make that commitment by paying a membership fee. Ever since, the touchstone touchstone
Black, silica-containing stone used in assaying to determine the purity of gold and silver. The metal to be assayed is rubbed on the touchstone, and then a sample of metal of known purity is rubbed on the stone right next to it. of the past two decades has been the biennial biennial, plant requiring two years to complete its life cycle, as distinguished from an annual or a perennial. In the first year a biennial usually produces a rosette of leaves (e.g., the cabbage) and a fleshy root, which acts as a food reserve over the winter. College of Midwives Conference. Sally states:
I must have spoken at every midwifery conference since the College of Midwives began. I think to start with there weren't that many people there who were prepared to actually get up and speak, so we ended up doing it because we'd overcome our anxiety, to some extent anyway.... I'm really delighted to see so many of the younger ones coming through. And now we've got so many more midwives who are doing research, who are doing scholarly activities and want to talk, and it's fantastic. (Sally Pairman)
I remember Sally presenting at the 1988 conference and being in awe of her scholarship, just as I now cringe cringe
intr.v. cringed, cring·ing, cring·es
1. To shrink back, as in fear; cower.
2. To behave in a servile way; fawn.
An act or instance of cringing. at the naivety na·ive·ty or na·ïve·ty
Artlessness or credulity; naiveté.
naivety or naïveté
the state or quality of being naive
Noun 1. of my own. We were all new at this, learning from each other, and inspired by international keynote speakers. In 2006 abstracts from would-be presenters were being turned away because of the excess. Midwifery research is flourishing. Our own scholars are invited to be keynote speakers, for example: Judith McAra Couper who is about to complete her PhD on the rise of intervention in childbirth, and: Carolyn Young who is interviewing independent midwives who self-identify has having 'burnt-out'. I am their supervisor. My experience is being reinvested back into the profession. As Sally says, to watch the emerging scholars is fantastic.
The huge commitment
New Zealand midwives have come a very long way over the past two decades, but not without a huge commitment. Sally describes a time in her life:
I had this new baby, and I had Oscar who was at kindergarten, and a borrowed computer. I was really struggling with writing. I was the president of the College of Midwives, so I was still traveling, and taking Felix with me around the country to be looked after by midwives everywhere. It was a fairly full-on year. In some ways I sort of regret that I was doing as much as I did that year of having a new baby. (Sally Pairman)
All midwife participants who had done a masters degree are likely to describe it as needing to be squeezed into an already busy life. Sally did her's alongside both a commitment to a new baby and to the new, fledgling College of Midwives (Pairman, 1998). Maralyn describes a similar sense of huge commitment:
I think I neglected my children heaps. They got used to me working on the computer all the time. It was not having enough time and space to focus on the study which was probably one of the major things that caused me to have a marriage breakdown. My partner got more and more resistant to me wanting to put another room on the house so I could study in peace, and so I did it all on the kitchen table, and would clear away every night to put the tea out and get it all out again the next day. Um, how did I juggle it? I don't know. By the time I was doing the randomised control trial I'd actually also taken on a job at the hospital as the clinical midwifery consultant ... that was my job as well as independent midwifery as well as trying to manage the home. (Maralyn Foureur)
Maralyn juggled research with husband, children, a position of responsibility and a caseload case·load
The number of cases handled in a given period, as by an attorney or by a clinic or social services agency.
Noun of midwifery clients. My impression is that people like Maralyn, Karen and Sally had such a passion for making midwifery care better for women that they gave every last ounce of time and commitment to the quest, sometimes at deep cost to themselves and their families. Cheryl similarly carried a huge load:
James was born, and he went back to work with me after seven weeks. It was the norm for me. That was pretty tough. I was trying to breastfeed a baby, I'd put him in the childcare centre at the hospital, go and work with the students, run back to feed him, back to the students, teach at the university, you know back and forth. It was pretty exhausting but we survived that and coped reasonably well. About a year after he was born I had this "oh I need to study again". Because you're working academically you're expected to do a masters degree and then go on to a doctorate. (Cheryl Benn)
Cheryl's commitment was as an educator. She felt the pressure to enrol in her PhD, and had the passion to want to do that. Her life was already so busy that it simply meant continuing the pace of 'pretty exhausting'.
My question is: do New Zealand midwives, as a profession, expect the same level of overwhelming commitment from future scholars? If not, where are the scholarships, the funded PhD opportunities that are prevalent in the more established professions to make scholarship a viable career pathway for midwives?
Research and Politics
Maralyn reminds us research is political
Research has to have practical applicability. For me as a midwife, that's fundamental. It's a political activity and you have to be making a difference to childbirth for women. So, how do you teach research--you start with politics, the 'so what', why are you doing this and what contribution are you trying to make to the world and, in our business, to women in particular. (Maralyn Foureur)
Recognising that the amount of midwifery research that will get done in this country is always going to be limited, Maralyn challenges us to remember to think strategically about the questions we ask, and the purpose for which we engage in a process that is costly in time and money. She draws us back to the quest that has been such a powerful driver of the last two decades: to make a difference to the childbirth experience for women. At the same time she shares something of her own battle:
I've applied for several external grants and been unsuccessful. It's very difficult to get funding. I've applied to the Health Research Council on three separate occasions for grants for projects to do with maternity care. The feedback we get are things like 'this is a beginning researcher who does not have a big enough track record'. (Maralyn Foureur)
Maralyn is a leading midwifery researcher/scholar yet she is decreed a 'beginning researcher' by those who allocate research funds. Our scholarship is so new when competing against medicine, science and a host of other well established disciplines. Yet, without winning large research grants it is very hard to establish the kind of track record funders have come to expect. Further, the favoured randomised Adj. 1. randomised - set up or distributed in a deliberately random way
irregular - contrary to rule or accepted order or general practice; "irregular hiring practices" controlled trial controlled trial Clinical research A clinical study in which one group of participants receives an experimental drug while the other receives either a placebo or an approved–'gold standard' therapy. See Blinding, Double-blinded. research method enrolling large numbers of subjects and then introducing an intervention to the experimental group often does not sit comfortably with the partnership model of midwifery practice. Until we win such grants we will not have the funds to offer scholarships to PhD students. In this highly competitive environment the message is to work with an inter-disciplinary team drawing on the expertise of other disciplines. Such strategies, while offering valuable support, also present the danger that the research priorities midwives bring may be sidelined by the interests of the more experienced researchers from other disciplines.
Having reflected with these participants I believe none of us could have sustained our journey through scholarship if we had not had a passion for the nature of the learning:
I did a Bachelor of Arts degree majoring in Psychology and Sociology and in the first year did Fine Arts and History. It was the most wonderful course. I loved it to the 'nth' degree and that is very much still part of what I like to do, delving into the history of art and architecture. I have an abiding interest in history; and so when I first moved here, I looked at the history of St Helens Hospital here in Wellington. I found a whole cupboard of archives, all of the birth records from 1907 to 1980 were stuffed in a cupboard and people were going to throw them out. And I thought ooh. (Maralyn Foureur)
When this pioneering generation went to university there were few papers (if any) directly related to midwifery. We therefore found ourselves exploring knowledge from a wide variety of other disciplines and bringing those insights back to midwifery. Maralyn has skills in historical analysis that today's students are less likely to acquire. As a profession we need to recognise the value of scholars exploring outside of the domain of midwifery so they can challenge, expand and grow our own knowledge base. When there is passion, scholarship flourishes.
Sally talks about the nature of her experience:
There's been exhilarating moments; total exhilaration when we got the 1990 amendment. When I think about what we've achieved in New Zealand, I think that's incredible; amazing. I was really, really happy when I handed in my doctorate. For me it's always we, what we've done. Each thing is not just one person. I think that Karen is an individual person that none of this could have happened without. I don't particularly feel like that about me. I mean, I think we've all helped the process along the way, but it has been us. (Sally Pairman)
Scholarship and the shaping of New Zealand midwifery have been so closely intertwined for people like Karen and Sally that you cannot talk about one without the other. As a witness to the past two decades I stand in awe of the leadership of Karen and Sally, both have offered extraordinary gifts of 'self ' without which New Zealand midwifery would not be where it is today. But Sally is right; they could not have lead without the commitment and support of New Zealand midwives. Her doctorate tells the story of 'us'. It has been an exhilarating ex·hil·a·rat·ing
Causing exhilaration; invigorating.
ex·hila·rat , amazing a·maze
v. a·mazed, a·maz·ing, a·maz·es
1. To affect with great wonder; astonish. See Synonyms at surprise.
2. Obsolete To bewilder; perplex.
v.intr. story. Scholarship now holds it as history, telling the story to enable future generations to understand the commitment, struggle and gains of this era of New Zealand midwifery.
But what next? Who will be the scholars of the future?
I don't see the next generation of leaders coming through and that worries me ... People get very, very involved in their own lives, their own practice, their own environments, their own sort of analysis of 'this obstetrician' and 'that hospital dynamic'. They can't lift up another level and think 'how does all this work in a bigger picture context?' We don't seem to be developing that ability in people ... They're turning their minds to practice. They're not turning their minds to politics. I think that's a challenge for us as a profession, is how we actually get them involved. (Sally Pairman)
As I read Carolyn Young's data of independent midwives who have valiantly struggled to maintain a 24-hour a day, seven day a week caseload I am not surprised that they have no energy for anything more than their practice. The commitment of being an autonomous practitioner who works within the partnership model is huge. It seems the next layer of scholars, such as Carolyn, will bring challenge to the model of practice that emerged from the 1990 winning of independence. As the new tensions emerge that midwives become passionate about, so they too will recognise scholarship as a powerful tool to provide evidence. Perhaps now that scholarship is more established the route to change will find its beginnings in the university and then be translated into political action. Or perhaps those two will always walk hand in hand.
Midwifery scholarship in terms of university qualifications is in its infancy infancy, stage of human development lasting from birth to approximately two years of age. The hallmarks of infancy are physical growth, motor development, vocal development, and cognitive and social development. . We have a very short list of midwives with PhDs, research grants, or significant international peer-reviewed publications. Yet consider the commitment, passion and capability of a group of women who had to find their own way, forge a midwifery pathway, support each other and at the same time carry the leadership of the profession in political, practice and education domains. Scholarship has brought credibility by establishing evidence and articulating the knowing. It has equipped midwives with valuable skills of critique and given them the confidence to publish. It has opened doors to new insights. For undergraduate students who sigh sigh (sī),
n an audible and prolonged inspiration followed by a shortened expiration.
sigh at the scholarly expectations of their education, I remind them of the battles that were fought to ensure they had the opportunity to be regarded as competent scholars able to contribute to the establishment of their own knowledge base as opposed to borrowing knowledge from others.
The rise of midwifery scholarship has been phenomenal over the past two decades. We have proved ourselves more than capable. We have kept closely linked to practice. We have recognised the politically contested nature of knowledge and developed research skills to enable us to produce our own evidence. We have come a long way, but the journey is far from over. It is for the next generation to stand on the shoulders of those who have gone before and reach higher. In a climate where scholars, who are often in education, hold the tension of needing to teach, practise prac·tise
v. & n. Chiefly British
Variant of practice.
practis·er n. and research, the Midwifery Council needs to re-consider the expectations related to competency-based practising certificates. In my view a small proportion of the profession needs to be permitted and supported to make scholarship their priority. History shows that the knowledge that surrounds birth will always be contested. Midwives must be poised to add their voice to each new debate over what counts as truth. It is scholarship that builds a strong foundation for women-focused, politically attuned at·tune
tr.v. at·tuned, at·tun·ing, at·tunes
1. To bring into a harmonious or responsive relationship: an industry that is not attuned to market demands.
2. , midwifery practice. Joan Donley proved that you do not need to be within a university setting to be scholarly, yet for most of us it is the university that equips and lends credibility to outputs. Let us invest time, money, support and encouragement in the scholars of the future, helping them to access the resources that enable scholarship.
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Variant of interpretive.
in·terpre·ta examination of the referral for obstetric ob·stet·ric or ob·stet·ri·cal
Of or relating to the profession of obstetrics or the care of women during and after pregnancy.
pertaining to or emanating from obstetrics. consultation practices and attitudes of New Zealand midwives. Unpublished doctoral thesis, Victoria University of Wellington
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(1) A moa is a large bird once prevalent in New Zealand, now extinct.
Liz Smythe RGON RM PhD
Auckland University of Technology
Liz has a background in midwifery. She supervises a wide range of postgraduate students who choose to use hermeneutic methodology.
Contact for correspondence: email@example.com