the value of academic skills in midwifery - european midwives€¦ · how are virtues related to...
TRANSCRIPT
THE VALUE OF ACADEMIC SKILLS
IN MIDWIFERY
Raymond de Vries
Academie Verloskunde Maastricht/Zuyd
Universiteit Maastricht
University of Michigan
@agoodbirth
To puncture or not to puncture?
The value of academic skills
in midwifery
Academic skills Midwifery
Academic skills The 3 R’s
Critical reasoning
•observation,
• interpretation,
•analysis,
• inference,
•evaluation,
•explanation,
•metacognition (thinking about thinking).
midwife
verloskundige
sage-femme
jordemoder
hebamme
bidan
kätilö
Defining midwifery
A midwife is a person who, having been regularly
admitted to a midwifery educational program that is
duly recognized in the country in which it is located,
has successfully completed the prescribed course
of studies in midwifery and has acquired the
requisite qualifications to be registered and/or
legally licensed to practice midwifery.
WHAT MAKES MIDWIFERY
UNIQUE AMONG
PROFESSIONS?
Key midwifery concepts that define
the unique role of midwives:
partnership with women to promote self-care and the health
of mothers, infants, and families;
respect for human dignity and for women as persons with
full human rights;
advocacy for women so that their voices are heard;
cultural sensitivity, including working with women and
health care providers to overcome those cultural practices
that harm women and babies;
a focus on health promotion and disease prevention that
views pregnancy as a normal life event.
An “in-between” profession
An “in-between” profession
An independent profession with its own
expertise, but sometimes:
• working as the “verlengd arm” of an
obstetrician
• with regulations created by non-midwives
• and facing competition from nurses
Which diminishes the value of midwifery
as an independent practice
A threat: losing what is distinct to midwifery
An opportunity: to discover new ways to work in
health systems of the 21st century
What midwifery skills are required to provide
good caregiving?
What midwifery skills are required to provide
quality/virtuous caregiving?
What are the skills of a midwife?
An internet adventure
Technical
• Clinical knowledge and skills: the “how-to”
But we are more than technicians
Psychological
• Caring for the needs of women struggling with
stress, sadness, depression, PTSD,
But psychological states are produced within social
structures and cultural systems
Social
Understanding and responding to:
• women’s needs in relation to their position in
social, economic, and cultural systems and
• The factors that promote and hinder the
practice of midwifery.
But study of social structures and cultural systems
cannot tell you what is “right”
Good caregiving requires:
good clinical technique,
an understanding of a woman’s
psychological state,
as embedded in social and cultural
systems.
Quality/virtuous caregiving requires:
good clinical technique,
an understanding of a woman’s
psychological state,
as embedded in social and cultural
systems.
When?
How?
Moral
Who can find a virtuous woman?
Who can find a virtuous woman? Her price is far above rubies. She
worketh willingly with her hands…She is like the merchants' ships;
she bringeth her food from afar; She riseth also while it is yet
night…She girdeth her loins with strength, and strengtheneth her
arms…She stretcheth out her hand to the poor; yea, she reacheth
forth her hands to the needy…Strength and honour are her clothing;
and she shall rejoice in time to come… She openeth her mouth with
wisdom; and in her tongue is the law of kindness...she eateth not the
bread of idleness…Favour is deceitful, and beauty is vain: but a
woman that feareth the LORD, she shall be praised. Give her of the
fruit of her hands; and let her own works praise her in the gates.
Proverbs 31 (KJV)
Who can find a virtuous midwife?
Who can find a virtuous midwife? Her price is far above rubies. She
worketh willingly with her hands… She riseth also while it is yet
night…She girdeth her loins with strength, and strengtheneth her
arms…She stretcheth out her hand to the poor; yea, she reacheth
forth her hands to the needy…Strength and honour are her clothing;
and she shall rejoice in time to come… She openeth her mouth with
wisdom; and in her tongue is the law of kindness...she eateth not the
bread of idleness…Favour is deceitful, and beauty is vain: but a
midwife that feareth the LORD, she shall be praised. Give her of the
fruit of her hands; and let her own works praise her in the gates.
Proverbs 31 (KJV)
What are the
characteristics of
a
“virtuous
midwife”?
MacIntyre’s Definition of a “Practice”
“By a practice I am going to mean any coherent and complex form of
socially established cooperative human activity through which goods
internal to that form of activity are realized in the course of trying to
achieve those standards of excellence which are appropriate to, and
partially definitive of, that form of activity, with the result that human
powers to achieve excellence, and human conceptions of the ends and
goods involved, are systematically extended.”
Alasdair MacIntyre, After Virtue, 3d ed. (Notre Dame, IN: University of Notre Dame Press, 2007), 187.
Practices are:
• Coherent and complex
• Socially Established human activity (through which)
• Goods internal to that form of activity (are realized)
• In the course of trying to achieve those standards of excellence (appropriate to and partially definitive of those powers with the result that)
• Human powers to achieve excellence and human conceptions of ends and goods are systematically extended.
Practices are:
• Coherent and complex
• Socially Established human activity (through which)
• Goods internal to that form of activity (are realized)
• In the course of trying to achieve those standards of excellence (appropriate to and partially definitive of those powers with the result that)
• Human powers to achieve excellence and human conceptions of ends and goods are systematically extended.
Midwifery is a distinct and complex activity,
Created by experience, research, and education,
That continues to refine and perfect its work,
In an effort to provide even better care to women
and families,
Thereby promoting human welfare.
Features of Practices
• Practices are not simply sets of technical skills.
• No fixed end—we strive to continuously improve
midwifery.
• Practices are not to be confused with their
institutional settings.
• Practices require institutions (schools, hospitals,
professional organizations, etc), but are not
identical with them.
Internal and External Goods
• Internal Goods
• Found only within
practices
• Can be identified
only by those within
practices
• Not scarce–hence
not objects of
competition
• External Goods
• Scarce
• Available outside
practices
• Examples:
• Prestige
• Status
• Money
What is a Virtue?
“A virtue is an acquired human quality the possession and exercise of
which tends to enable us to achieve those goods which are internal
to practices and the lack of which effectively prevents us from
achieving any such goods.”
Alasdair MacIntyre, After Virtue, 3d ed. (Notre Dame, IN: University of Notre Dame Press, 2007), 191.
How Are Virtues Related to Practices?
• 1) Virtues define our relation to others in practices.
• 2) Virtues define our relation to past participants in
practices.
• 3) Virtues allow us to resist the corruption of practices by
institutions.
Can these virtues be taught?
They certainly can be learned
but
perhaps they can not be taught
A virtuous midwife must have critical
reasoning skills and the ability to find and
process information from outside her
specific area of expertise
To know when and how to exercise her skills
To know how to protect and promote
her profession
To recognize the distinctive nature of her practice
Netherlands as a model
• Autonomous midwifery here is an
inspiration to others
• Why?
• Not just because Dutch midwives are
excellent technicians, but because they
work in a system that values and protects
their work.
Netherlands as a model
• But the system is changing, and if midwives
are simply good technicians, they will be
unable to provide “good care”. Midwives
here are just learning needs to be done to
protect and promote good midwifery care.
Is academization of midwifery education a
‘good thing’?
Yes: it is necessary to compete in the
medical marketplace,
But: not if it alters the ‘practice of midwifery’
such that midwives lose the ‘internal goods’
of their profession.
You must teach the skills necessary to
respond to :
• Technical aspects of reproduction, pregnancy, birth, infant
care and parenting,
• The psychological dimensions of all of the above,
• The social situation of the women seeking care and the
system in which midwives work.
• But do not forget:
A virtuous midwife is more than all these!
To puncture or not to puncture?
Who can find a virtuous midwife?
It is our duty to create the
next generation of virtuous midwives