Midwifery research: dumb and dumber


Recent midwifery research runs the gamut from horrifying to horrifyingly stupid.


Midwives’ clinical reasoning during 2nd stage labour: Report on an interpretive study by Jefford and Fahy

Clinical reasoning was once thought to be the exclusive domain of medicine – setting it apart from ‘non-scientific’ occupations like midwifery. Poor assessment, clinical reasoning and decision-making skills are well known contributors to adverse outcomes in maternity care. Midwifery decision-making models share a common deficit: they are insufficiently detailed to guide reasoning processes for midwives in practice. For these reasons we wanted to explore if midwives actively engaged in clinical reasoning processes within their clinical practice and if so to what extent’. The study was conducted using post structural, feminist methodology…


Over half of the participants demonstrated the ability to use clinical reasoning skills. Less than half of the midwives demonstrated clinical reasoning as their way of making decisions. The new model of Midwifery Clinical Reasoning includes ‘intuition’ as a valued way of knowing. Using intuition, however, should not replace clinical reasoning which promotes through decision-making can be made transparent and be consensually validated.

Factors affecting midwives׳ confidence in intrapartum care: A phenomenological study by Bedwell et al.

[M]idwives are frequently the lead providers of care for women throughout labour and birth. In order to perform their role effectively and provide women with the choices they require midwives need to be confident in their practice. This study explores factors which may affect midwives׳ confidence in their practice…


[T]he principal factor affecting workplace confidence, both positively and negatively, was the influence of colleagues. Perceived autonomy and a sense of familiarity could also enhance confidence. However, conflict in the workplace was a critical factor in reducing midwives׳ confidence. Confidence was an important, but fragile, phenomenon to midwives and they used a variety of coping strategies, emotional intelligence and presentation management to maintain it.

Conclusion and implications

[T]his is the first study to highlight both the factors influencing midwives׳ workplace confidence and the strategies midwives employed to maintain their confidence. Confidence is important in maintaining well-being and workplace culture may play a role in explaining the current low morale within the midwifery workforce. This may have implications for women׳s choices and care. Support, effective leadership and education may help midwives develop and sustain a positive sense of confidence.

Passing yarns forward: unravelling the dimensions of knitting and birth by midwife Sarah Wickham

To the best of my knowledge and that of the MIDIRS Reference Database, it was a male surgeon, Michel Odent (1996, 2004) who first made the very practical art of knitting a topic for debate within the midwifery literature. Perhaps it was such an unremarkable, everyday activity to the midwives who were doing it that it didn’t warrant special mention or consideration…

In this first article, entitled Knitting needles, cameras and electronic fetal monitors, Odent (1996) focused on Gisele’s knowledge of physiology and on the importance of privacy and darkness. In simple terms, a woman may feel less observed by a midwife whose attention appears to be focused on knitting …

Later, Odent (2004) returned to this topic in print and cited further research showing that repetitive tasks are an effective means of reducing tension. He has also proposed that, from the perspective of a birthing woman, the knowledge (which can be gained through the audible clicking of the needles, even if she doesn’t actually watch her midwife) that her midwife is knitting can be reassuring (Odent 2008, personal correspondence). If the midwife is knitting, then she or he cannot be too worried about what is happening. Knitting helps keep midwives’ adrenaline levels low, ensuring a sense of security all round.

These three papers cover disparate areas, but are united by several characteristics that are depressingly common in midwifery research. First, the focus is not on patients and not on outcomes, but on midwives themselves. Second, they are not quantitative, merely descriptive. Finally, their conclusions are alarming. Apparently, a substantial proportion of midwives don’t use, and don’t know how to use, clinical judgment, midwives’ confidence is not based on performance, but rather the opinions of colleagues, and there is no limit to the stupidity of certain practicing midwives.

If this is what passes for research among midwives, and if these are their conclusions, they shouldn’t be allowed to care for houseplants, let alone patients.