Jo Gould
University of Brighton
I have been a midwife for eighteen years. During this time I have worked in clinical practice, education and more recently as an academic. My research interests are feminism and the politics of birth, the promotion of physiological birth, birth space and midwifery education.
Aim:
This paper seeks to explore the value of storytelling in midwifery as a legitimate form of knowledge which enhances practice.
Background:
A recent experience of sharing practice at a midwifery storytelling circle, illuminated the value of sharing stories with colleagues. A positional intervention used in a prolonged labour to encourage the baby to rotate and be born at home immediately after, was shared with the midwives present. Shortly after, a midwife from the storytelling circle reported that the intervention had been used at the birth centre to correct a persistent posterior position, a spontaneous birth quckly followed. Although the technique seemed to have been successful, I questioned whether it was the effect of the intervention in both cases, or whether the babies turned spontaneously, as there was no ‘scientific’ evidence support it.
Rolfe (2000) suggests that midwifery is historically an oral culture, where the generation of knowledge occurs through narrative or ‘storytelling’ rather than through scientific papers or ‘facts’. Scientific knowledge involves the transmission of facts from one who knows to one who does not; narrative can accommodate much broader epistemology and involves the passing on of more diverse knowledge, as in the storytelling circle. Several practices in midwifery have seen widespread adoption prior to there being published data to support them. These include non-suturing of perineal tears during the 1990s, use of water for labour and birth during the same period and more recently the use of birth hypnosis. The narrative tradition of knowledge sharing in midwifery may have contributed to this phenomena.
Belenky (1986) describes how current dominant ways of knowing (rational, masculine, technological, scientific) disadvantage women’s ways of knowing, which tend to be more emotional, intuitive and personalized. Women have accumulated knowledge about childbirth over many centuries; yet much of this knowledge is disregarded and devalued by the current dominant scientific discourses (Stewart, 2010). In addition, Schon (1983) suggests that professional education undermines knowledge gained from practical experiences and reflection; valuing intellectual, scientific knowledge forms more highly. It is evident that this was the case when I had reflected on the value of storytelling and its impact on practice. Although biomedical knowledge is critical to high quality midwifery practice, narrative traditions of sharing stories and reflecting on practice are equally critical in developing knowledge specific to the profession. Evidence suggests storytelling may enhance and develop insight, empathy, connectedness and intuition (Davis-Floyd 1996, Fry 2007, Hunter 2008), skills at the heart of excellent, woman-centred midwifery practice.
Reccomendations:
Midwifery is a relatively new profession and has borrowed heavily from medicine and other health professions in constructing its own knowledge base (Hunter 2008). The time may have come to recognize the limitations of the RCT on midwifery practice, which in its purest form is about enabling physiology. Qualities such as insight, empathy and intuition may be developed via sharing of stories and practice. Is it time to recognize and give equal value to these alternative ways of knowing in order to develop the right skills for midwifery practice?
Social and cultural precursors and consequences of optimal childbirth , Educational aspects , Philosophical and theoretical critiques and debates
