Abstract

The word midwife, meaning "wfth woman" conveys the relational sense of the work of midwifery. Midwives are with woman through the physical and emotional care they provide throughout a woman's pregnancy, birth and early mothering experiences and on a more philosophical level, strongly believing in women's capability to grow, birth and nourish a child and to make decisions about her experiences. The women too, are with woman; most Canadian midwives are women.

The research question, what is ft like to be with woman? reflects a desire to develop an in-depth understanding of the experience of being with woman as a midwife and as a woman receiving midwifery care. Hermeneutic phenomenology was selected as the research method best suited to the purpose of the study. Data were collected through conversational interviews with women and midwives, observations of situations such as prenatal visits, prenatal classes, births, and homevisits, and aesthetic forms such as art, literature, and movies. Data were analyzed through writing and re-writing.

The analysis revealed five themes. A theme is a particular way of viewing the whole of the experience. The first theme, setting the tone for the relationship contributes understanding to the overall approach the midwife and woman take in initiating and developing their relationship. The second theme, trust reveals the primacy of trust within the midwifery relation. The third theme, having a birth expedence explores how the midwife and woman experience birth together. The fourth theme, fri ends, sisters, mothers, and angels discusses the ways in which the relation is experienced by women and midwives. The fifth theme, awakening to our women-selves reveals the nature of women's work as experienced in the midwifery relation.

While the purpose of phenomenology is not to generate theories, the knowledge attained may be useful to midwives and to other healthcare professionals. Midwifery in Alberta is undergoing a period of intense transition as midwives enter the healthcare system as regulated professionals. The final chapter includes a brief analysis of the potential influences, both positive and negative, that regulation may have on the midwifery relation.

Table of Contents

Chapter 1: What Does it Really Mean to be With Woman? 1

The Question I

First Steps to Understanding 4

Relation - Coming to an Understanding of the Concept 5

The Midwifery Relation - Mutual Embodiment 7

Monique's Story - Searching for Trust 8

The Midwifery Relation - Situating the Experience 10

Diane's Story - Love is Really Important 10

The Essence of Midwifery 11

The Midwifery Relation - More Than "Getting to Know You" 16

The Method 20

Hermeneutic Phenomenology 20

Can a Feminist do This? 25

Conducting the Research 28

Data Collection 28

Settings 30

Observation 30

Conversational Interviews 30

Group Discussions 31

Written and Taped Narratives 31

Personal Journal 31

Etymological Sources 32

Literature, Art, and Film 32

Data Analysis 33

The Use of Narratives or Stories 34

Considerations of Rigor 34

Ethical Considerations 36

Summary 38

Chapter 2: Fuelling the Midwifery Fires 40

Midwifery Practice in Alberta 40

Finishing Ellie's story - Fuelling the fires 56

Chapter 3: Setting the Tone for the Relation 58

Cynthia - Making our own decisions 58

Tone: a woman centred approach 60

The invitation 61

Really hearing 64

Mutual self reflection 67

Tone: being "at home" 70

Tone: the "illusion" of enough time 73

Tone: attention to the lived body 75

Setting the Tone for Trust, Friendship, Birth Experience and Awakening 77

Chapter4: Trust 79

Re-Placing Trust 80

Janet - I'm talking about me here 80

Re-placing the professional expert 82

Re-placing risk 85

Re-placing knowledge 87

Trusting in the Body - Trusting with the Body 93

Blind Trust 93

Gut instincts 95

Mutual Trust 97

Aiden - Shared Decision Making 97

Patience 99

Kathleen - Appropriate patience 102

Chapter 5: Having 2 Birth Experience 105

Chantal-Ilovedmybirth 105

Claire - What I got was a birth experience 106

Birth at home - at home with birth 111

Meg - Home as a familiar birthplace 114

Chantal - A bank of memories 116

Camille - An alien world 117

Home as a safe birthplace 120

Whose birth is this? 124

InHerownTime 125

Aiden - I never felt rushed 125

The Birthing Body - Childbirth "Naturally" 128

Laurel - Ground yourself 132

An intimate touch 133

Body with baby - one becomes two 136

A Family "birth experience" 137

Camille - You're doing such a good lob mommy 137

Continuity of Family 138

Being known 141

Inviting is a gift 142

Birth-day as celebration 143

Chapter 6: Friends, Sisters, Mothers and Angels 145

Elise - The matriarch 151

Kathleen - Doing it on her own 152

Elise - The stalker 154

Friendship - a dangerous relation? 157

Andrea-Pushingbuttons 161

Making Time, Taking Time 163

A Mother's Touch 167

Part of the family 169

Kathleen - One of the family 170

Angels in the house 171

Chapter 7: Awakening to Our Women-Selves 173

Elizabeth - Common Ground 174

Brett - The essence of womanhood 177

Baubo's gift to Demeter - the power of the woman's body 178

Biological determinism? 181

In the company of women 183

Elizabeth - Celebrating womanhood 185

Camille - Terry experienced something natural 187

Women as Nurturers 187

Heather - A touch that heals 189

Connection to All Women 189

Chapter 8: Completing the Circle 192

Limitations 188

Application to practice 189

Seeking Legitimacy 192

Challenge: Mandatory Consultation 195

Challenge: Healthcare Reform 200

Challenge: Formal Midwifery Education 203

Meeting the Challenges 204

A Beginning 205

References 209

Appendix A: Interview Schedule 224

Appendix B: Sample Recruitment Letters and Advertising 225

Appendix C: Sample Consent 227

© Max van Manen, 2002
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