Risk and the Midwife: a Descriptive and Interpretive Examination of the Referral for Obstetric Consultation Practices and Attitudes of New Zealand Midwives

Risk is a dominant discourse in current formations of Western society. This thesisexamines how risk is expressed in New Zealand midwifery by investigating bothmidwives’ actions and midwives’ attitudes. Risk is a complex concept and theoreticalapproaches to it come from a variety of perspectives. The techno rational approachstresses the quantifiable and probabilistic nature of risk; the social and culturalapproaches are varied and stress the cultural embeddedness and valueladennature ofrisk and its expression. Midwives must deal with risk from multiple and sometimesconflicting perspectives.

The philosophical approach of critical realism, which proposes that knowledge shouldbe explored through multiple lenses and that knowledge is both fallible andemancipatory, provides the ontological and methodological support for the study. Anational 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 inresistance to risk. A model of midwifery is developed which illustrates the findings.

The model is a threeleggedbirth stool, a birth stool for the midwife to sit on, ratherthan for the mother. The seat of the stool is called ‘being with women’. This conceptis central for New Zealand midwives, as they do not exclude women with risk factorsfrom their care. They continue to provide care when risk is identified and whenobstetricians 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’. Thestruts 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 connectedto women. The stool can assist them in putting risk and its management into actionand into perspective. Educators can use the stool to develop integrated and competentnew 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.