Interview with Elizabeth Newnham, lecturer in Midwifery at Griffith University, Australia.
Since January this year, I have been working as a lecturer in midwifery at Griffith University. I currently teach in the Masters in Primary Maternity Care – a postgraduate programme that implements the ‘Framework for Quality Maternal and Newborn Care’ from the Lancet series on midwifery and supports the development of maternity care leaders who can design, implement, and evaluate leading-edge primary maternity care models. Before this I was at Trinity College Dublin for two years, which was also a wonderful experience.
I am only at the beginning of my exploration into care ethics. During my doctoral research, which was an ethnographic study of epidural analgesia use within a hospital labour ward setting, I really started to think deeply about the idea of informed consent, an idea which is completely embedded into health care practice and based on the bioethical principle of autonomy.
What I saw in practice, in my research, and around the world within the maternity context, is that when we follow the principle of autonomy to its endpoint – when women are wanting to make decisions about their bodies, but outside of medical recommendations, then they appear neither to have autonomy nor the opportunity to give informed consent.
There are cases all over the world of women being bullied, coerced, threatened or forced into decisions about their bodies that they disagree with—this is not only unethical, it is dehumanised care. This is something I now want to explore further using a care ethical framework.
As I was thinking about this problem, I came across an article by Jennifer MacLellan1) proposing that midwifery look to care ethics as a solution to some of these issues. This interested me, so I then read Joan Tronto’s Moral Boundaries2) and also looked at Carol Gilligan’s In a different voice and started to explore articles on the topic. However, I was particularly drawn to the way that Tronto brought the political into care ethics.
As a midwife who also has degree in Politics, I see care ethics as a politicised ethics. Drawing on Tronto’s care ethics argument, it is important that power relationships are made visible when we are talking about care, ethics and all things in between, such as bodily autonomy and decision-making.
There is also an emphasis on relationality—attentiveness arises between people, rather than passed from one person to another as are autonomy and consent—and on the recognition of the asymmetry of these relationships. People are not necessarily equal, especially at the time of care-giving and care-receiving, as to require care is to have some level of vulnerability.
The way that Tronto makes care central to human life is also a great shift in how we think about care. Which has traditionally been relegated to the private/female sphere, and has often been unpaid, unrecognised and undervalued, while generating wealth, goods or power has typically been hyper-valued. This is one of the most important aspects of care ethics – that care is actually central to who we are as a species and to our survival and therefore deserves attention.
I am still at the early stages of learning, but I suppose at this moment the most important thing has been that the concept of autonomy, so central (and for the most part unquestioned) to my teachings in midwifery, can be unpacked to reveal assumptions about individualism, agency and equality that are not apparently obvious, and which actually recreate power relationships.
I am lucky to have found several brilliant and supportive teachers/mentors over the years. But, specific to ethics, I must mention Mavis Kirkham, with whom I co-authored a recent article on care ethics3).
I remember reading her work as a midwifery student – the results of an ethnographic study that demonstrated how the institution could effectively come between the midwife-mother relationship. And that really struck me. It provided an explanation, and perhaps a solution, to the discord that I was feeling in practice. It is, of course, an ethical dilemma – to be in a profession that is at its foundation woman-centred and yet midwives find themselves everyday having to support the needs of the institution over the needs of the woman.
I am also enjoying some correspondence with Inge van Nistelrooij, and some of her colleagues at the University of Humanistic Studies, Utrecht. They have extensive experience and publications in the field of care ethics, and with whom I share a common interest of care ethics in maternity. We have begun some interesting discussions and hope to work on some projects together in the future.
I look forward to collaborating with my new colleagues in the midwifery team at Griffith University. If we consider the university (and academia) as an institution with its own power relationships, Midwifery@Griffith embodies a kind of ‘care ethics’ in the practice of a collaborative collegiality that is also founded on relationality and mutual support, is student-centred, with a transformative education philosophy and commitment to improving maternity care systems in Australia.
Again, I am quite new to this, but I really favour Tronto’s thesis in Moral Boundaries. I have read some of Elisabeth Conradi’s work on attentiveness within institutions and the simplicity yet importance of this in practice also strikes a chord. I look forward to exploring more publications on care ethics, both seminal and emerging.
The most obvious would be Mavis Kirkham and my recent article on the topic of care ethics in midwifery:
My PhD Thesis was published as a book in 2018 by Palgrave Macmillan and is called Towards the humanisation of birth: A study of epidural analgesia and hospital birth culture. Although not about care ethics, ethical practice and informed consent do come into it. It might also be of interest to anyone looking into hospital birth culture, midwifery practice, the experience of childbirth, maternity policy or ethnography.
Articles published from this doctoral research include:
I think care ethics, by Tronto’s definition, as ‘a species activity that includes everything we do to maintain, continue, and repair our ‘world’ so that we can live in it as well as possible.’ (Tronto 1993, p. 103) is actually crucial to our future survival. The emphasis on care as a practice is a message that could help with numerous current global problems, the most obvious being the environment.
Care ethics provides an ethical grounding for promoting social justice. It does this by inserting an understanding and recognition of power into ethical thinking, by placing increased value on relationality, by recognising vulnerability and embodiment as central principles of existence, by emphasising the need for a dialectical ethics that moves between practice and theory, and in doing all of this, exposing the falsehood that late capitalism and neoliberalism perpetuate – that the pursuit of profit and power, status or material possessions are to be valued over humanity, care and equity.
I think care is talked about a lot, especially in the health sector – but is not always understood in the same way by different groups. I know of no current Australian research in which care is central – but as I hope to begin work in this area I am sure I will find out if/where these may be.
No recommendations as such. I think this consortium is a really good starting point, because connection, especially between disciplines, is needed to keep ideas growing and developing. The CERC conference would be great way to create connections and new networks, and I look forward to attending one. There is something about having dedicated time and space to discuss concepts, current research and new ideas with other interested people – an embodied relationality perhaps – that can be deeply inspiring.