Cyd Ropp, Ph.D.
As part of the naturalized ideological
superstructure of Western thought, rationalism is held to be the ideal standard
of reason. Both the law and Western
medicine strongly identify with the values of science and the larger
philosophical agenda of rationalism. Fortunately,
midwives were never admitted to the academy in the first place, and so midwifery
has remained insulated as an exclusively female prudential endeavor. As English midwife Jane Sharp penned in 1671:
It is not hard words
that perform the work, as if none understood the Art that cannot understand
Greek. Words are but the shell. . . . It
is commendable for men to employ their spare time in some things of deeper
Speculation than is required of the female sex; but the art of Midwifery
chiefly concerns us. (Donegan 28)
The privileging of obstetric
protocols and normative standards over midwifery's responsiveness to the
particular case can be seen as a variation of the two thousand-year-old
struggle between prudential reasoning and Aristotelian philosophy's penchant
for rationalistic systemization.
Midwifery may thus be counted alongside the ancient philosophy of sophism
as one of the prudential arts displaced by rule-based rationalism. The
art of traditional midwifery stems from an ancient worldview that privileges practical
wisdom and intuitive knowledge over scientific methodology and technology-based
authoritative knowledge. Because
traditional midwifery makes no attempt to demarcate itself as a medical or
scientific profession, midwives are free to speak to the laboring woman's
emotional, social, and spiritual needs in addition to her physical needs. Traditional
midwifery is an ancient art that not only predates Western scientism, it has
been excluded and therefore insulated from Western scientism throughout history. Because of its insular existence as an
exclusively female endeavor, midwifery continues to actively employ the ancient
form of reasoning known as prudence. To
seek acceptance within the conventional academic community by adopting their
standards of thought and reason is to admit the superiority of patriarchal
scientism over traditional female ways.
My studies have
found that the midwifery model encourages the use of prudential reasoning,
while the medical model encourages reliance on rationalism. By rationalism, I refer to the employment of
formal logical proofs, rules of objective evidence, and normative standards of
care.
The midwifery
model relies far less upon formalistic standards and in many instances seems to
violate rationalism. For example,
midwifery's reliance upon subjective intuition as a source of knowledge, as
well as the midwife's holistic integration of mind/body and mother/fetus,
violates rationalist principles of objectivity.
Irrationality, as I use the term, refers to using non-rational means to
discern the demands of an exigency.
Using intuition, emotion, and body-knowledge to discern information, as
well as acting-without-thinking--or its opposite,
patiently-watching-and-waiting --are examples of non-rational modalities at work.
By the standards of conventional
medicine, the irrationalism of the midwifery model amounts to an "anything
goes" model of care, entirely without standards. Midwifery’s counter to this charge is that,
far from "anything goes," midwifery provides the most appropriate
care by responding to the particular case.
Undiluted
irrationalism, then, is not to be confused with prudential reasoning. The midwifery model traditionally employs
prudence in the management of birth.
Prudence does not confine midwifery's critical process to the irrational
polarity of rationality. Rather,
prudential wisdom is the ability to range freely between rationality and
irrationality in the pursuit of the best course of action to resolve the
exigency at hand. The midwifery model
tends to develop and encourage irrational modalities of experience in pursuit
of this goal, while the medical model tends to discount them. It is possible that, in practice, the medical
model actually employs both irrationality and prudential wisdom to a greater
degree than they care to admit.
Rules and
normative standards on the one hand, emerging exigency and timely resolution on
the other. Prudence involves shuttling
back and forth between these positions in pursuit of the best response to the particular
case. A prudent person, therefore, lets
the emerging exigency drive the application of appropriate rational norms. The prudent person knows, usually by benefit
of experience, if/when/and to what extent rationality applies to the
situation. An exclusively rational
person, on the other hand, upholds normative standards and formalistic rules as
the highest standard of care, and will apply those standards irrespective the
suitability of their application to the particularities of the exigency.
The ability to employ both modes of
thought, when required, is the hallmark of prudence. In Court, juries may be instructed to hold the
midwife to the "reasonable person" standard. For the prosecution, that reasonable person
standard is rationalism. For the midwife,
that reasonable person standard should be recognized as prudence. Whereas conventional medicine claims there are
no standards in the absence of rationalism, midwives actually employ an
alternative standard to rationalism: prudence.
In
addition, the medical model and midwifery model radically differ in their approaches
to the issue of standard protocols of care.
Medical experts are able to authoritatively declare, and usually
quantify, which events shall be considered normal and which are considered
abnormal at every stage of labor and delivery.
This practice of
holding patients to predetermined time standards ensures that physicians only
deal with standardized norms; deviations from the norm are simply not allowed,
which serves to further reinforce the artificially-mandated "norms"
of the medical model. By this reasoning,
labor that progresses more rapidly or slowly than average comes to be regarded,
under the medical model, as abnormal and therefore pathological. This manner of defining pathology as any
deviation from normative standards reflects what feminist Nona Lyons has
identified as a more typically masculine orientation to caring--one that
invokes impartial rules, standards, and principles.
There are no hard
and fast normative standards under the traditional midwifery model. The midwifery model reflects Lyons'
identification of a more typically feminine approach to caring that promotes
the welfare of others on their own terms rather than through application of
impartial universal standards of care.
Hospital-based midwifery care uses medical guidelines and time frames
because of malpractice issues that require midwives to quite tightly follow
medical protocols. In the homebirth arena, care is based on emerging exigencies
rather than a predetermined "laundry list."
While CNMs are
allowed to attend homebirths, the standardized protocols they are legally
required to uphold place primary agency with the absent physician and allow the
midwife to operate as a secondary agent in his stead. If the homebirth RN violates the Board of
Nursing's standards by ceding agency to the birthmother rather than the absent
supervising physician, her nursing license could be subject to revocation. RNs who practice traditional, non-medicalized
midwifery, in other words, necessarily lose their legal sanction to practice.
California has recently loosened the supervising physician stricture for
midwives, due to unavailability of backup obstetricians.
Midwives’
descriptions of the artistic aspect of traditional midwifery emphasize the
manner by which a midwife intuitively responds to the unique exigencies of the
particular case--by deviating from textbook recommendations through a process
of "non-linear," non-rational thought. This ability is developed through
"experience" and "practice," and often results in
unexpected-but-efficacious responses. This
is an excellent definition of the process of prudential wisdom.
The medical model
equates the absence of fixed universal standards to having "no real
standard" at all. There is no room
for the "fluid," "amorphous" response to the particular
case typical of prudential rather than rationalistic reasoning. Traditional midwifery's detractors reason
that the absence of fixed standards is merely a camouflage for incompetence.
Faith Gibson, speaking
in Court in 1998 as an expert witness on behalf of the traditional midwifery
model, countered the charge of camouflage by insisting that, "Births vary
from situation to situation. And what's
appropriate is to respond to the specific situation." Gibson equated fixed
standards with an inability to respond to exigencies on a case-by-case
basis. Gibson clearly believes that the enforcement
of universal standards leaves no room for prudential wisdom--the ability to
judge the best course of action for the given case at hand (Ropp).
Conclusion
This whole-hearted
recognition of midwifery's reliance upon prudence provides a contemporary site
for practical reasoning and counters the prevailing belief that irrationalism
and anarchistic behavior are what remain when the rationalism and protocols of
medicine are not necessarily followed.
It is no accident that midwifery relies upon prudential reasoning, for
historically women were excluded from formal academic training, and the entire
field of midwifery, as an exclusively female endeavor, was cut off from the
revolution that advanced the field of obstetrics as a medical science. To reduce midwifery at this late date to a
systematic, instrumental approach and conventional educational structure in the
name of recognition and respectability not only diminishes the scope of the art
of the midwife, it creates a kind of instrumental monster devoid of the
capacity for prudence. Capitulating to
the dominant culture’s educational standards and methods is not the way to
promote traditional midwifery and other feminine arts. Is it?
End Table:
Foundational
Philosophical Distinctions
_____________________________________________________
Aristotelian, philosophic, tendency.....Isocratean,
oratorical, tendency
tame
and bloodless phraseology.....powerful, elegant language
scientific
rule.....opinion and likelihood
systematized
medical skills.....a midwife who can acutely divine
the birthmother’s thoughts,feelings,and hopes
systematic,
rule-based preparation..... here-and-now invention
generic
pedagogy.....paradigmatic/imitative pedagogy
instrumental
view of medicine.....childbirth as empowered feminine
rational,
logical.....emotional, empathic
literal
exactitude.....colorful, tropological speech, including humor
rule-based
procedure.....prudential wisdom-based procedure
discrete
disciplinary classifications.....holistic approach to knowledge
evidentiary
proofs.....evidence via elegant, copious speech
abstracted
topical premises.....culturally embedded; situationally responsive
fixed,
precise standards of judgment.....judged by peer review
Works Cited
Cicero. On
Oratory and Orators, J. S. Watson (ed.).
Carbondale: Southern Illinois University Press, 1970.
Donegan,
Jane B. Women and Men Midwives:
Medicine, Morality, and Misogyny in Early America. Westport: Greenwood, 1978.
Garver,
Eugene. Aristotle's Rhetoric: An Art
of Character. Chicago: Chicago UP,
1994.
Lay,
Mary M. The Rhetoric of Midwifery:
Gender, Knowledge, and Power. New
Brunswick: Rutgers UP, 2000.
Leff,
Michael. "Cicero's Pro Murena and the Strong Case for
Rhetoric." Rhetoric & Public Affairs, 1: 1 (1998), 61-88.
Leff,
Michael. "Genre and Paradigm in the
Second Book of De Oratore." The
Southern Speech Communication Journal, 51 (Summer, 1986), 308-325.
Lyons,
Nona Plessner. "Two Perspectives:
On Self, Relationships, and Morality."
Harvard Educational Review, 53 (1983): 125-145.
Ropp,
Cyd C. The Rhetoric of Childbirth. Dissertation: U of Memphis, 2001.
Turkel,
Kathleen Douherty. "Midwifery and
the Medical Model." Women's
Studies in Transition: The Pursuit of Interdisciplinarity. Eds:
Kate Conway-Turner et al. Newark:
U of Delaware P, 1998. 218-235.
Warren,
Virginia L. "Feminist Directions in
Medical Ethics." Feminist
Perspectives in Medical Ethics. Eds.
Helen Bequaert Holmes and Laura M. Purdy.
Bloomington: Indiana UP, 1992.
32-45.
p.s.
what does learning to type up a Works Cited page have to do with learning to
facilitate births?
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