Dear Deirdre,
Please don't denigrate someone's opinion as a joke. It was a considered
response. I need to ask some critical questions.
>I hope Irene that your letter is a joke because if what you are saying is
>what you feel then surely you are taking as ostrich approach to consumer
>involvement in Maternity Services. You will never get it right until you
>not only have consumer imput but have equal imput at all levels of your
>training and through out your service.
1. how is 'equal' input possible given all the power differentials inherent
in the midwife/woman relationship? When we identify these differentials
what do we do with them? How do we work with them?
At present midwives are accountable
>only to Midwives and maybe the medical profession at large but as maternity
>services exist now midwives are not accountable to the one group they
>should be Mothers (Consumers)
2. all midwives are accountable on many levels and to many quarters for
their own actions. Ask any tribunal veteran. They are most certainly
accountable to the woman both singly through a duty of care and in the
context of their social contract, and collectively through registering
practices, and their competencies, etc. Where do you get the impression
they are not?
>If anything you need to take a much closer look at exactly how NZ got their
>autonomy and you will realize that many many consumer groups came together
>in support. The Government is not going to listen to a bunch of Midwives
>when the have Ob's in their ears. The Government will only change it's
>mind when it's sees enough people pushing as to affect the VOTE!
3. has anyone advocating the NZ approach really looked at it critically?
Do all midwives in NZ practice in partnership and in a professionally
autonomous way? What are the barriers and facilitators to this, and what
are the continuing problems they experience? How well does the model apply
to the Australian context?
4. do you all realise what you already have that is very wonderful indeed
in this country? Look around and count at least a few blessings. Other
countries look to us, but that doesn't mean we can't strive for more. It
does mean we should idnetify our strengths to counter our anguish.
>Don't be fooled thinking that you can gain or maintain any sort of autonomy
>in this society with out the full support of your "BIRTHING SISTERS" you
>have no hope.
5. as to birthing sisters....I hesitate to collectivise ourselves in such a
way. Helen and Irene raise some interesting questions, and I raised the
cautions earlier (as has Carol Thorogood in other contexts) of running away
with seductive ideas without subjecting them to serious critique. There
are differing agendas for women and midwives, just as there are common
ones, and Marina articulated this well in her post last week, that perhaps
women don't want to have a say in everything we do, just in that which most
affects them. In this we need to ally with them. We then need their
say...help me to help you...could be the motto, on issues where our threats
threaten what they want from us. Examples include erosion of midwifery
models of care and expansion of alternatives in place of birth. Do the
women really care whether we educate ourselves in one way or another? Or
whether we work internationally? How we are constituted as a professional
body? What alliances we form for our own strategic positioning as long as
these don't affect their concerns?
I Will be the first to
>admit that constantly being under the watchful eye of a group of consumers
>even hand picked ones can be sometimes quite harrowing especially if they
>understand they have the right to openly evaluate the care you give, the
>service you provide but if a midwife can't stand up to this kind of
>evaluation then I can only wonder what it is she has to hide.
As to partnerships. If partnerships between midwives and women are to be
equal in such a way as having the midwife always under the watchful eye of
the 'consumer', especially in the atmosphere of intense scrutiny as your
language suggests, where is the trust? Where is the return accountability
of the consumer to the midwife?
Finally, to Robin. Midwives do resist bad practices everyday, and many
burnout, many despair and some even suicide or succumb to mental breakdowns
becuase of the incessant battle to protect the women's experience or to
fight injustice. They too are (mostly) women in a patriarchal world, and
so are perhaps not the best ones to always be the advocate. Women need
(all of them, not just a few) to educate themselves to make the choices
they need to. In every context. Midwives can help, but they can't do it
for you. Together - indomitable.
And last -- without trying to teach my granny to suck eggs - Kathleen, what
about a reconception of what it means to be a profession along feminist
lines, taking what is best from the old models of a profession, and
applying the critique and wisdom of some of the feminist (almost don't dare
say it) nursing literature. Midwifery discourse is full of it already, but
doesn't talk it as well as nursing does. Reconstructed profession of
midwifery would work on power with, close nexus between midwife, woman and
community for justice in birthing, excellence in education and research,
principles of power sharing and mutual empowerment, recognition of each
other as expert knowers, etc. The bones are already there in the
definition of a midwife, in midiwfery curricula, in what women are asking
of us and prepared to give in return. And it's clearly articulated in
Guilliland & Pairman as well.
Enough! (I've jsut finished an inspiring tutorial with my third year
nursing students on what might professional mean. From the mouths of babes
really!).
Cheers, now. Trish
end note
. I wonder how many midwives out there not
>only provide but encourage honest evaluation of the service they have
>provided. How many midwives would actually change they way they practice
>based on the written feed back of consumers. How many of you who practice
>in either private practice or caseload situations have consumers that you
>are directly accountable to on regular occassions .
I do and have, and also know of many other instances and ways in which this
occurs. Quality improvement (global initiatives of a service) right
through to intensely personal and individual methods of both peer and woman
evaluation. Do we now subject the consumer movement to the same test of
altruism in relation to performance? If you really want equality, this is
what you will get. How has the consumer helped midwifery so far? Fair
question. And I'm not being deliberatel provocative, becuase of course
they have.
Really the end now. Off to take some days off to prepare for the conference.
--
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