By Nessa McHugh
GET A GROUP OF MIDWIVES together and they start to share stories. They share their experiences, their humour, their frustrations and, most of all, they share their knowledge.
If you ask those same midwives to communicate their knowledge in a more formal way or formally to identify how 'they know what they know', the chances are that they will back away. It is possible to argue that there is a dangerous threat to modern midwifery. This is the risk of becoming second rate obstetricians, we would only be able to 'advance' our practice in ways that support the obstetric model of childbirth, not in ways that move beyond it. We only have to look at all the failing midwifery schemes around the country to know that midwives have the ideas but there is not always the back up there to support us. We are only allowed to operate within the same systems of knowledge and the same systems of care.
Yet when we share our stories, we share our knowledge; a very different knowledge that springs from a different source and has a different focus. Belenky et al (1997) argue that accepted concepts of knowledge and truth have been shaped by a culture dominated by masculine knowledge - women's ways of knowing do not fit into this system and are consequently of no value.
Medical knowledge is steeped in a technocratic western belief system which places women's knowledge as stereotypically emotional, personalized and intuitive. As midwives struggling to maintain a professional identity in a culture of birth that is forever encroached upon by misuse of technology and masculine patterns of thought, are we too in danger of valuing the scientifically objective over the unquantifiably subjective?
Davis-Floyd (1994) writes that in western societies technology-dominated culture functions as a powerful control agent which shapes our values and beliefs. We are engaged in a struggle to hold legitimate knowledge, but is legitimate and authoritative midwifery knowledge the same as scientifically objective knowledge? When we talk about evidence-based practice, whose evidence are we referring to? The midwives getting together and sharing stories? The knowledge gained from woman to woman interconnection?
As a student and as a midwife I continue to learn from scientific frameworks, but the deep knowledge that is the essence of midwifery knowledge comes from interconnection: interconnection with the women I work with and the women who are midwives and friends.
Messer-Davidow (1985) writes that all women are the teachers and the taught, no-one comes empty handed with nothing to share.
Get a group of midwives together and we share our diverse knowledge. It seems that the strength of midwifery knowledge is interconnection and, through that, the trust of intuition. To trust our intuitive knowledge we have to connect with ourselves as knowing individuals with voices and values worth hearing. Throughout our history, our voices and knowledge have been repressed so, for many of us, taking the step to recognise ourselves as sources of valuable and authoritative knowledge demands a great leap of self confidence.
Yet as midwives we tell our stories, share our experiences and speak out. When we connect together to share our concepts of holistic birth we break away from what Blenky (1997) refers to as silent knowledge, where women experience themselves as voiceless and subject to the whims of an external authority. The midwives that I meet and share stories with are using their knowledge authoritatively. They construct knowledge in a way that incorporates many strategies for knowing not least their own intuitions.
We place a premium on how much we see, not of objects, but of ourselves and others as Knowers, with feelings, ideas and values. Messer-Davidow (1985)
Here's to the value of women's stories.
Nessa McHugh, Midwife
Belenky Field M, Clinchy McVicker B, Goldberger Rule N and Muttuck Tarule J (1997). Women's Ways of Knowing. The development of self, voice and mind. 2nd edn 1997 (1st edition 1986). Basic Books, New York.
Davis - Floyd R (1994). 'The technocratic body : American childbirth as cultural expression', Social Science and Medicine, 38, 8,1125-1140.
Messer-Davidow E (1985). 'Knowers, knowing and knowledge: Feminist theory and education', Journal of Thought, 20, 8-23.
AH updated 27 September 1999