Decision-making in the woman-midwife dyad : a relational undertaking : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Midwifery at Massey University, Manawatu, New Zealand
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2013
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Massey University
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Abstract
Within midwifery in both Canada and New Zealand informed choice and decisionmaking
is a strong tenet of the profession’s philosophy and ethics. Through
discussions and conversations, decision-making was explored in the womanmidwife
dyad with birth of the placenta as the vehicle. Using various
epistemological, theoretical principles and philosophical paradigms, as well as
acknowledging the research journey itself, this thesis develops not only a model
that increases the understanding of decision-making but a new relational research
methodology that is fitting for midwifery and other health disciplines in which longterm
relationships are established.
The evolving methodology developed from the challenges of the research journey
and the steps undertaken to address the challenges. These steps involved
consultation, professional networks, building relationships and adapting to
circumstances. Participants were recruited through professional networks and
involved 14 woman-midwife relationships. In total 14 women, 5 support persons,
and 18 midwives were involved from New Zealand and Ontario, Canada. The
stories, experiences, and thoughts of each woman, her support person, and the
midwives in the childbearing relationship were gathered through recording of the
decision-making discussions and conversational interviews. The resulting
methodology, which is presented in the first substantive chapter, recognises the
complexity of influences on the researcher and participants and their involvement
together, in constructing knowledge.
Influenced by Granovettor’s (1985) concepts of embeddedness and Sherwin’s
(1998) broader definition of relationality, the findings identify how identity projects,
philosophies, socio-political, and locational events influence decision-making within
the woman/family-midwife partnership. Participant’s talk as a whole and in part
were analysed using social theories of identity, including narrative identity,
positioning, location, professional projects, and power. The central finding in this
research is that decision-making in the woman/family-midwife partnership is
relational in nature, influenced by social networks and the historical, social,
political, and economic contexts and locations in which they are embedded.
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Keywords
Midwifery, Decision-making