Monday, 2 January 2012

Bystanding Behaviour in Midwifery

I was alerted by a friend on facebook, to this article Bystanding Behaviour in Midwifery, about the way midwives don't stand up for women and how midwifery students are acculturated and desensitised to unkind behaviour. The article, written in 2008, is by Margaret Jowitt, who did her masters in Keele in 1998 on Mothers' Experience of Birth at Home and in Hospital. The book "Childbirth Unmasked" was written as a result of her reseach. Margaret is a lay member of the Association of Radical Midwives UK and a columnist for the Huffington Post.

Margaret wrote:
"I HAVE LONG WANTED to write an article on ‘Woman's inhumanity to woman' but have shied away until now for fear of being seen as attacking midwives and failing to acknowledge all they have achieved over the years in the care they give to women, often under very difficult and alien circumstances when they are based in hospitals".
I'm very glad she found a way to move through her fear and publish this article on Bystanding Behaviour in Midwifery and good to see it online as the issues are still alive and well today and not just in the UK.  Distressing as it is to think such articles are necessary, we need to examine and digest the ideas presented in this piece and discover what we can do to change or do better. I shared the article on facebook and twitter, thinking it would be useful for midwifery students.  However, I was prompted to put this post up to explore the ideas further following a reply 'tweet' to the article on Twitter.
I was a bystander recently and it traumatized me , worse was my colleagues saying it was normal and I was being dramatic. 
How many of us have had our feelings about and discomfort with the way women have been treated minimised or dismissed?
What happens to us when abuse is normalised?

When there is a disconnect between what we know is right and what is happening, between what is taught and what is practice, there is cognitive and emotional dissonance and a sense of not knowing what to do next...

How do you deal with that?

Is this your experience?


KQ said...

I have been interested in this topic since one of my Masters lecturers brought the Stanford Prison Bystander Experiement to the attention of our class.

The article you linked to is one of those pieces of writing which is worth reading every now and then as it hits the nail on the head in some many ways!

Carolyn Hastie said...

Thanks for your comment KQ. The Stamford experiment by Zimbado and the Milgram study are powerful examples of the way power can corrupt and our willingness to do vile things if told to by someone in 'authority'. Both studies showed how critical the environment is to human behaviour. I really appreciated the link you provided, I hadn't realised that Zimbardo defended someone from the Abu Ghraib horror. That example too shows how easily corrupted we humans are. Zimbardo maintains that we are all capable of evil. That seems to be correct. What's interesting is those who choose not to look the other way or become involved, like the woman who became his wife, and the 24-year-old reservist Joe Darby who told people what was happening at Abu Ghraib. What makes those people different? I'm really interested in the renegades, the deviants, those who defy. Zimbardo says those people have empathy - the question is why do they have it and not others. I believe with all my heart that education is the path to freedom and free thinking; to stimulate the capacity to think for oneself. Freire talks about such education as "conscientisation" - the development of critical consciousness through a process of reflection and action. We need more of that.

KQ said...

Yes, interestingly my lecturer prefaced the workshop about Christina Maslach's (his wife) work with an explanation of the experiement and the influential role that she had played by speaking up. Made quite an impression. :-) A long way to introduce the topic of work burn out but got my attention for the morning!

Carolyn Hastie said...

Very clever of your lecturer by the sounds of it! So what do you think we can do, as a profession, about this problem we have?

KQ said...

Not sure I feel up to addressing a question about an entire profession! :-)

I guess the simple answer is for people to speak up and not be bystanders to normalised violence in droves. Easy to type.

Paul Watson (captain of the sea shepherd) comments in the documentary SharkWater something like: not everyone has to be radical but it does help to have a couple of people standing up and living their values and beliefs to an extreme extent so that others have the courage to do the same.

KQ said...

This is the direct quote from Paul Watson that I found from the doco, it isn't exactly the one I wanted but still works.

We're now in the midst of a 3rd World War, but this time the enemy is ourselves, and the objective is to save the planet FROM ourselves.. There's no hope for masses of humanity to do anything - they never have, they never will. All social change comes from the passion and intervention of individuals or small groups of individuals. Slavery wasn't ended by any government or any institution. Women got the right to vote not because of any government. The civil rights movement, the same thing. India with Mahatma Gandhi, South Africa with Nelson Mandela. Again, it's always individuals. You need those individuals with the passion and the energy to get involved. In fact, I don't know of any government or any institutions that are doing anything to solve any of these problems. All over the world, all I am seeing is individuals and non-government organizations that are passionately involved in protecting ecosystems and species, and that's where I see some optimism. That's where I see results are happening.

Carolyn Hastie said...

A brilliant quote. Not everyone needs to be the radical, that's true, but we do need a critical mass, enough to create the field of change. Do you know about the book Power vs Force by David Hawkins? He talks about mindfulness and tipping points (but in different words) Both writers are explaining concepts that are neatly illustrated by the 100th monkey phenomenon.

KQ said...

Lovely. Will check it out. Thanks!

Anonymous said...

I have been digesting this article for several days now - I plan to re-read often during my nursing degree, graduate year and midwifery training.

The hard truth for me is that change usually only comes from those who have a problem with the status quo... or within the 'system', from those who can be critical of orthodoxy and accept a history of harm associated with their own practice/beliefs (and not just someone elses!).

As a neophyte, these are my thoughts: qualitative study may hold some of the answers to the problem of abuse and midwives being disempowered bystanders. So too could the development of criteria for quantitative study that no longer makes women invisible, separates the mother-baby dyad and distorts the physiology of birth. This may pose great burdens on academia, but aren't we worth it?

Developing a 'broader' evidence base that is woman-baby-centred may be a start in producing systems that enable safe, woman-centred care (mother/midwife). In my own self-directed study, a lot of the literature I've read so far contains practitioner-led rituals, RCTs with no physiological control and conclusions that defy basic common sense...therefore, I ask how can knowledge, practice and policy built on these foundations result in genuine woman-centred care - which does not risk interference and iatrogenic injury to mother and/or baby and a culture of dissatisfaction and bullying?

Carolyn Hastie said...

Yes, we are certainly worth it Anonymous! Totally worth it. It is only with people like you, with fresh eyes and therefore clarity about what you see who are able to help those of us who are deeply enculturated with the system to open our eyes and minds to see differently. I'm grateful that you are doing the thinking and analysing you are doing! Keep writing, keep challenging and keep learning - that's how things change for the better. Things might look bad now, but they used to be much worse. We have come a long way in the last forty years. The fields of neuroscience and various forms of physiology are providing a solid science informed foundation for midwifery care that is truly wholesome, participatory and woman centred.

Kate said...

Thanks Carolyn, I certainly agree with you that many things have improved significantly. These are the positives I look to as I start my nursing/midwifery studies and hope one day to contribute to.

I admit to being incredibly inspired by midwives and researchers like you, your colleagues - and Reed, Walsh, Downe, Wickham, name just a few!

(I didn't mean to post anonymously the first time, sorry about that.)

Lmr1985 said...

I too can identify with the tweet of being a helpless bystander then when asking why the situation ended in the way it did being told, "that's just the way it is here".

There seems to be no room for advocating for the women when you are a student. The institution is a hierarchy and you must know your place.

However the faces of the women with pleading eyes to speak for her will haunt me forever. It makes me so sad that I became part the operation, rather than part of the woman.

I have to live with myself and these faces forever. I do know that it has shaped my practice for the future and I take comfort in knowing that after qualification I will not be merely a bystander.

Carolyn Hastie said...

Very difficult position to be in lmr1985 The 'system' and medical power are sometimes insurmountable. I worked in a place where the obstetrician was known as 'the Caesar King' and women would go to him, knowing that reputation. I saw that women thought "at least he is good at them, if I need one" - not aware of the programming power of that kind of thought pattern. His ability to use weasel words to undermine women's sense of self was/is breathtaking and all pervasive. Striking fear into a woman's heart at the height of vulnerability is all too easy and these unethical types do it and get paid well for it.