Including the nonrational is sensible midwifery

Abstract

Since the subordination of midwifery by medicine and nursing in the 19th and 20th centuries the standard approach to childbirth has been dominated by rationality. This approach proceeds by creating dichotomies and then prioritising one half of the dichotomy whilst rejecting the opposite term. Rationality itself is prioritised, for example, by contrasting it with the rejected opposite: irrationality. Expert clinical practice is, however, increasingly identified as being inclusive of more than merely rational ways of knowing and behaving. This paper is based on a post-structural study concerning changes to women's embodied sense of self during childbearing. We expose the limitations of pure rationality in the context of childbirth and use the concept of safety to exemplify the limitations that pure rationality imposes. The paper draws on philosophical and spiritual theory to present an analysis of ideas about mind, body, soul and spirit. The standard rational/irrational dichotomy is critiqued and contrasted with the embodied reality of nonrational experiences that are individual, contextual and 'in-the-moment'. Nonrational experiences are identified to be inclusive of power and knowledge that are both rational and nonrational. This revised conceptualisation provides a theoretical basis that allows for and promotes more possibilities and thus more holistic ways of knowing in midwifery. Our thesis is that midwives and women need to take conscious account of nonrational knowledge and power during the childbearing year. We argue that pure rational thinking limits possibilities by excluding the midwife's embodied ways of knowing along with the ways of knowing embodied by the woman. The inclusion of women's and midwives'nonrational ways of knowing in childbearing situations opens us up to knowledge and power that provides for a more complete, and therefore a more optimal, decision-making process.