The midwifery partnership: an exploration of the midwife/woman relationship

Abstract

This study is designed to explore both the nature of the relationship midwives and women have together during pregnancy, labour and birth and the postnatal period and the understanding women and midwives have of this relationship. The outcomes of this study are then used to refine the theoretical model of midwifery as a partnership (Guilliland & Pairman, 1995). The design for this qualitative exploratory study is underpinned by a feminist philosophy. In particular, it draws upon the work of Patti Lather (1986, 1991) by integrating her notions of reciprocity and dialogical theory-building in the methodology of the study, thus allowing the theoretical model (Guilliland & Pairman, 1995) to provide the 'a priori' theoretical framework for the study without pre-determining the outcome. Six independent midwives and six of their clients explore their experiences of the midwife/woman relationship through individual semi-structured interviews and then through two focus group meetings of participants. Participants are actively involved in analysis of the data and identification of the emerging themes. On completion of this process the model of midwifery practice previously developed (Guilliland & Pairman, 1995) is shared with the participants who collectively explore areas for refinement in light of the findings of this study. The data which emerge through this research provide richness and depth to discussion of the midwife/woman relationship. The midwife and the woman contribute equally to the relationship and value what each brings to the relationship. The woman, with her knowledge of self and family, also brings an expectation of trust, equality, respect and openness of the professional care she seeks from the midwife. The woman brings a willingness to actively participate in her care, sharing responsibility for her decisions and assuming control over her experience. The midwife, from her foundation of professional standards and ethics, brings her ability to be 'with woman'. In this she utilises her knowledge, skills and 'self in practice, and is accessible and supportive to the woman. The midwife also brings her ability to practise independently and to develop practice wisdom. Both the woman and the midwife bring themselves as women to the relationship and the shared experience of being female contributes to the nature of the relationship. The midwife and the woman work together in a particular way, which integrates the notions of 'being equal', 'sharing common interests', 'involving the family', 'building trust', 'reciprocity', 'taking time' and 'sharing power and control'. Through the relationship both the midwife and the woman are empowered in their own lives. The relationship also has emancipatory outcomes as new knowledge of childbirth and midwifery are generated. This new kind of professional relationship challenges the dominant medical model of childbirth. This study teases out 'midwifery partnership' to mean 'professional friendship' and will contribute to midwifery's understanding of the practice of partnership. This study advances understanding of the relationship midwives and women have together, including its significance at a personal, professional and political level.