Practice: a battlefield where the natural versus the technological

Abstract

In 1999, I introduced my doctoral research with a statementabout modern childbirth taking place in a veil of tension betweenthe technocratic and natural models of childbirth. Technocratic– where events and midwives’ reactions may be largelyguided by electronic and other devices, and a natural model inwhich the midwives’ role is to provide security and support forthe mother as she births according to her own body’s timetable.The literature provided a key to understanding the diversity ofpublic perception of technology, with the scientific philosopherEllul (1963: 83) stating: ‘Technology produces values of unimpeachablemerit, whilst simultaneously destroying values no lessimportant – impossible to state that technology brings about absoluteprogress or regress.’Habermas (1984) proposed the silent infiltration of technologyinto society and argued that purposive rationality had becomethe ‘dominant belief system due to society valuing anddemanding technical efficiency’. The revelatory power of technologywas embodied when ‘…user and recipient of technologybecome integrated with the machinery to form an interpretativeand transparent relationship and the human body experience becomeshermeneutically transparent in that it can be interpretedin a similar way as a text’ (Ihde, 1990: 90).The literature was not without critics like Reynolds (1991),who warned about the abuse of technology allowing humanityto destroy natural cycles on one hand while building fabricationsof it on the other. Healthcare literature provided a similar patternof oppositional views with Donnison (1977) proposing thattechnology enables men to dominate the processes of childbirth.Oakley (1987) said expert technological knowledge enables themedical profession to control childbirth. However, other writerssuch as Wajcman (1991) perceived technology to be empowering,giving women control over their childbirth experience ,whileDoyal (1995) perceived the ‘technologisation’ of childbirth to bea demonstration of patriarchy, male domination of women andthe medicalisation of childbirth by male obstetricians. This viewwas supported by Dover and Gauge (1995), who reported thattechnology de-skills midwives and undermines their professionalexpertise, and midwives were being accused of ‘trusting the technologytoo much’ (Hemminki and Merilainen, 1996).This controversial background formed the context of my researchinvolving an observation programme, comprising 17 casestudies conducted across midwifery units in Northern Ireland– a postal survey targeted all practising midwives (1086 with a60% response rate). Complementary fieldwork involved the surveyof computer competence among new entrants to midwifery/nursing courses (731 with a 100% response rate) and in-depthinterviews with midwifery managers (10).The observation studies confirmed the midwife as in a key positionin relation to exercising judgement and assuming responsibilityfor a woman and her baby’s welfare when technology isused – the technology did not undermine the midwife’s position,rather it appeared to focus and strengthen it. Women and theirpartners used the cardiotocography machine as an electronicwindow to provide them with evidence of their babies wellbeingand it aided them in the processes of delivery. Midwives’ willingnessto use technology was affected by their level of training,perceived competence, and confidence.Often students perceive technology to be an important aspectof their work and are motivated to use it. Those with no trainingin computers scored significantly lower on confidence (p<0.001)and motivation (p<0.001). Midwifery managers considered midwivesought to be assessed for technical competence as part oftheir undergraduate education. There was a belief that those whowere very proficient in technology usage would enable labouringwomen to be more independent and less dependent on the midwifeas ‘truly competent midwives use machines as tools and alliesto support and enhance decision-making skills’ (Sinclair, 1999).The role of the midwife in the modern labour ward demandsspecialist skills in technology. Midwives need to be highly competentin the use of induction technologies ‘hardware’, as well asthe ‘software’ required to support women in natural childbirth.These skills need to be clearly identified and appropriately addressedthrough curriculum development.Ten years later, the battle continues and entrenchment has becomepart of the fabric of practice, with some holding fast toman-managed labour in a consultant-led environment or woman-led labour in a midwife-led unit.