Abstract:
Risk is a dominant discourse in current formations of Western society. This thesis
examines how risk is expressed in New Zealand midwifery by investigating both
midwives’ actions and midwives’ attitudes. Risk is a complex concept and theoretical
approaches to it come from a variety of perspectives. The techno rational approach
stresses the quantifiable and probabilistic nature of risk; the social and cultural
approaches are varied and stress the cultural embeddedness and valueladen
nature of
risk and its expression. Midwives must deal with risk from multiple and sometimes
conflicting perspectives.
The philosophical approach of critical realism, which proposes that knowledge should
be explored through multiple lenses and that knowledge is both fallible and
emancipatory, provides the ontological and methodological support for the study. A
national survey of midwives’ practices and attitudes was undertaken in 2001,
followed by six focus group discussions with midwives in a variety of settings.
The findings of the research reveal that midwives are both constrained by and act in
resistance to risk. A model of midwifery is developed which illustrates the findings.
The model is a threelegged
birth stool, a birth stool for the midwife to sit on, rather
than for the mother. The seat of the stool is called ‘being with women’. This concept
is central for New Zealand midwives, as they do not exclude women with risk factors
from their care. They continue to provide care when risk is identified and when
obstetricians need to be involved. The relationship they have with women is pivotal.
The legs of the birth stool, which help give support to ‘being with women’, are:
‘being a professional’, ‘working the system’ and ‘working with complexity’. The
struts of the stool are ‘storytelling’, which help to keep the stool secure and stable.
Midwives can use the stool as a tool to reflect on practice and to keep them connected
to women. The stool can assist them in putting risk and its management into action
and into perspective. Educators can use the stool to develop integrated and competent
new midwives; managers can use it to provide systems that support the midwife;
researchers can attend to areas of the birth stool that are less well understood.
