The value of academic skills in midwifery - European Midwives€¦ · How Are Virtues Related to Practices? •1) Virtues define our relation to others in practices. •2) Virtues

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

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sage-femme

jordemoder

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bidan

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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