 THE MIDWIFE-MOTHER RELATIONSHIP
Mavis Kirkham (editor)
Reviewed by Jane Fisher
In this book Mavis Kirkham, Professor of Midwifery at the University of Sheffield in England, has drawn together a series of essays examining the relationship between childbearing women and midwives. All the authors are either practising midwives or academics teaching and conducting research in this field. Their essays have a range of styles: some reporting research findings, some describing particular aspects of practice and some opinion or personal accounts derived from experience and observation. Professor Kirkham provides a summary introduction and concludes the work with a chapter reviewing the complexities of this relationship and therefore the highly refined skills required to operate within it.
Most of the papers describe research or practice in Britain. However, there are two chapters describing the history of changes to legislation regarding independent midwifery practice in New Zealand and research that has examined the subsequent impact.
In broad terms this book takes the view that the relationships between women who are pregnant or giving birth and midwives are different from those that develop between women and other health care professionals. It is proposed that the optimal midwife-mother relationship is an intense, intimate attachment between women with common values and goals, in which differences in power are minimised and mutuality is encouraged. It argues further that established organisational structures serve to obstruct the formation of these relationships and that they develop best in settings freed from institutional requirements and protocols. The complexities of this endeavour are reflected in the divergence of views about how the relationship is best characterised. In detailed arguments, Nicky Leap proposes a companionship between women; Mary Cronk that a midwife is a professional servant; Valerie Fleming that the relationship is a partnership and Sally Pairman
that it is a professional friendship.
There is a clear theme that midwives are much more than technologists and that their sensitive support, capacity to foster trust and promote choice and personal autonomy are central to the successful facilitation of a mother's adaptation to a major life event. Many of the papers acknowledge the potential for the relationship to be highly intense and that a dependent attachment formed at a time of heightened vulnerability places considerable demands on a midwife's clinical and interpersonal skills. There is acknowledgement that her [all the papers refer to midwives as women] own psychological needs must be well understood. Jean Davies and Margaret Chesney explore the frustrations and challenges in attempting to provide optimal midwifery care in circumstances of poverty and social adversity either in the home country or in a developing one. There are also thoughtful explorations of some of the potential obstructions to the formation of an optimal
relationship, including Chris Bewley's essay about the midwife's own parental status and Margaret Chesney's about language and cultural barriers.
I think there are a number of limitations to this book. First, it takes a position that is strongly opposed to an evidence base to midwifery practice and argues that alternative sources of authoritative knowledge including clinical and personal experience are equally valid. Ruth Wilkins (p 35) describing this as the "putative superiority of scientific over other sorts of knowledge". There is a consistent view that the relevant aspects of mother-midwife relationships are not able to be measured and are only able to be investigated through qualitative investigations. Despite the limits to generalisation that these methods impose, most of the research reports describe great psychological benefits to women from midwifery care and there is limited engagement with the potential for risk or harm. Only Nadine Edwards' and Tricia Anderson's papers acknowledge that as in all relationships, this one can be imperfect and cause tension, mistrust or
dissatisfaction. Many of the authors argue for the psychological benefits of a relationship in which the midwife self-discloses, spends time socialising with the woman in her care and conducts clinical practice in the woman's home. However, there was no reference to the psychological literature regarding professional boundaries and the harm associated with boundary transgression.
The second is that apart from Valerie Fleming's paper outlining New Zealand's situation, the book lacks a description of the health service structures to which reference is made. It would be helpful for international readers to have a description of National Health Service models of midwifery and obstetric care, including funding, medico-legal responsibility and professional indemnity arrangements. Without this there are limits to its applicability in other countries, including Australia where there are relatively few midwives in independent practice, and most work in multidisciplinary teams even when the midwife is the primary care professional. There is no discussion of the relevant health economics involved in providing midwifery services of the kind promoted here. However, in seeking to act on the recommendations this book contains, some review of the funding mechanisms either public or fee for service is essential.
Finally, none of the papers consider the midwife mother relationship during operative delivery, yet in this country as in other in the developed world, between a third and a half of mothers experience these procedures.
Despite these limitations, this book contains much that will stimulate discussion and critical review. In this way it would prove a useful adjunct text in the training of midwives and other health professionals.
Jane Fisher PhD
Senior Lecturer
Key Centre for Women's Health in Society
University of Melbourne
Available from CAPERS - buy
this book now
Back to Reviews
|
