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 thesis examines how risk is expressed in New Zealand midwifery by investigating both midwives’ actions and midwives’ attitudes. Risk is a complex concept and theoretical approaches to it come from a variety of perspectives. The techno rational approach stresses the quantifiable and probabilistic nature of risk; the social and cultural approaches are varied and stress the cultural embeddedness and valueladen nature of risk and its expression. Midwives must deal with risk from multiple and sometimes conflicting perspectives. The philosophical approach of critical realism, which proposes that knowledge should be explored through multiple lenses and that knowledge is both fallible and emancipatory, provides the ontological and methodological support for the study. A national 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 in resistance to risk. A model of midwifery is developed which illustrates the findings. The model is a threelegged birth stool, a birth stool for the midwife to sit on, rather than for the mother. The seat of the stool is called ‘being with women’. This concept is central for New Zealand midwives, as they do not exclude women with risk factors from their care. They continue to provide care when risk is identified and when obstetricians 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’. The struts 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 connected to women. The stool can assist them in putting risk and its management into action and into perspective. Educators can use the stool to develop integrated and competent new 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