art and birth
putting the 'art' into the art and science of
midwifery!
tricia anderson and lorna davies
This article was originally published in
The Practising Midwife, July / August 2004.
Republished with permission.
Children are naturally creative beings. We are born with an ability to use many different forms of self expression. If you offer a three year old a selection of poster paints and a piece of paper, they will proudly present you with their masterpiece without a modicum of self consciousness. If you offer an adult the same tools in higher education the majority will feel at best challenged and at worst, patronised.
Our mainstream educational system continues to elevate the status of the scientific and undermines the value of the aesthetic during our developmental years. Literacy and numeracy are the core features within the national curriculum. Although primary school children may be 'allowed' to spend time using art, this time becomes increasingly rationed throughout the school years. By the time they are fourteen, the vast majority of children have chosen to 'drop' art, unless of course they have 'talent', have opted for a 'specialist' art based programme in order to pursue a career in an arts based area.
Midwifery is a profession which combines both art and science, yet it is currently more 'science' than 'art'. Midwives know this phenomenon firsthand as the 'super-valuation' of the scientific and technocratic: the supremacy of the rational, medical model (Davis-Floyd, 1993). There is a lot of talk amongst midwives about challenging this medical model and humanising birth. But if we are to challenge the supremacy of the scientific, - and don't forget that most of us have been educated within this scientific, medical model - we need to give value, space and time to exploring alternatives ways of expression, thinking and being.
In our lives prior to our entry into midwifery, we both studied for degrees in arts-related subjects. We believe that midwifery education has failed to capitalise on the power, energy and sheer fun of the arts to enable midwives to explore their emotions, passion and experiences of being involved in the extraordinary world of birth. The power and beauty of a woman giving birth under her own steam can be breath-taking; the sight of a woman strapped up in lithotomy stirrups can be devastating: yet how often do we encourage midwives and students to explore their emotions in bearing witness to these things?
The scientific, medicalised component is well-established within midwifery education; however, little emphasis is put on providing appropriate education for student midwives in the more sensitive, caring side of midwifery. Students need to develop appropriate attitudes, empathy and understanding, and the depth of articulate emotional responses required of a skilled, sensitive midwife. This area is more subtle and complex then technical skills and is harder to teach and assess.
Yet it is for their humanising gifts that woman value midwives: skilled communication, support and empathy are values which constantly arise as characteristics which women seek in their midwives. Little attention is paid in contemporary midwifery education to how to develop and strengthen these skills. The first step must be to help students open their hearts to the experiences of women, babies and new families, and artistic expression is one way to facilitate this. The arts can also contribute to education as a learning activity, helping students to acquire skills such as communication and interpersonal skills, emotional literacy, team skills, problem-solving, lateral thinking, flexibility and adaptability. These are the very skills we now recognise as essential for today's midwives: skills that will help to develop the critically thinking, autonomous midwife required for current and future practice. Grant (1998), a pioneer in this approach to education who is leading its development at South Bank University in London, suggests that the main purpose of studying the arts is to enable healthcare professionals to take better care of their patients and better care of themselves.
“Imagination is more important than knowledge: knowledge is limited. Imagination encircles the world." (Albert Einstein)
Art has the power to confront and challenge dogma and ideology. The arts can also be used for empowering self and others as catalysts for change. Through art, the neglected imagination is watered and flourishes. In our opinion, it is a wasted opportunity for midwives who are privileged enough to be involved in birth, the ultimate act of creation, not to be given the opportunity to explore and unleash their own creative potential.
When invited to participate in artistic activity, be it painting, singing, dancing or theatre work, most midwives and students alike will generally proclaim “But I'm not creative” However, create a permissive and safe space for them to do so, and, to use a stateside expression, “Wow, do they rock!!”
We co-facilitate a weekend residential workshop called “Sex, Birth and Rock and Roll”, where we use the power of the arts to convey a more holistic view of midwifery practice. At a point during the weekend, the participants are invited to take some paints and paper and to sit for an hour or so and create an image that represents childbearing for them. It is not art therapy, but simply a space for women to engage in a form of self expression that may have been denied to them for some considerable time. The results, as you can see, are amazing.
"Art is a marriage of the conscious and the unconscious." (Jean Cocteau)
What the painting seems to do is to give the participants the confidence to move beyond the cognitive, into less tangible areas of their being. In 'Birthing from Within', Pam England describes how she uses painting to encourage the parents in her classes to move into their right brains, the less rational, more primal brain space. Rogers (1983) talks about the concept of 'whole-person' learning, in which both hemispheres of the brain engage. The left hemisphere is logical, linear and deals in ideas that are clear-cut and defined. The right hemisphere functions in a different way, grasping the essence before it understands the details and can make creative leaps. It operates in metaphors, and can take in what Rogers called the whole gestalt, the total configuration. To help students become skilled reflective practitioners able to use professional artistry in their decision-making, the right hemisphere needs to be stimulated as much as the left. Using art is a direct route into this 'whole-brain' thinking.
Learning needs to take place in both the affective (emotional) and the cognitive (rational) domains. Bloom (1965), a cognitive theorist, draws a clear distinction between the two, both of which need to develop in a parallel pattern of growth to facilitate the highest possible level of genuine learning. Too often in institutionalised education the emphasis remains firmly on the cognitive. Bloom's taxonomy incorporates in the affective domain at its base level the notion of 'receiving' - paying attention to stimuli, observing and developing awareness. This is followed by 'responding' in which students are encouraged to formulate a response to the stimuli. Working with art helps students develop this skill of first observing and then articulating a personalised response. Unlike cognitive approaches, there is little opportunity for surface learning; students engage with the material on a deeply personal level.
"Life beats down and crushes the soul; art reminds you that you have one." (Stella Adler)
We talk a great deal about holism in midwifery practice but what does it really mean? The Concise Oxford English Dictionary (2002) defines holism as “the tendency in nature to form wholes that are greater than the sum of the parts through creative evolution”. However, in midwifery the word appears to have taken on a vague, nebulous characteristic and smacks of empty rhetoric, because the 'physical' takes precedence at every step of the way. How can we care for a woman's emotional and spiritual well-being if we are not emotionally literate ourselves? Something is missing: perhaps the rejection of the arts in midwifery education could be this missing link.
We need to seriously debate the greater inclusion of arts subjects in our curricula. In New South Wales, Australia, they have recently introduced a core theme in the midwifery curriculum entitled Creative Arts and Midwifery (Jackson & Sullivan, 1999). The aims are that students will demonstrate an understanding of midwifery as art; develop an understanding of the artistic and scientific components of clinical practice; examine images of concepts such as pain, suffering, parenting and caring through a variety of artistic media; and to show sensitivity to the intricacies of human relationships through exploration of what it is to be human.
The work submitted by the students includes poetry, prose, collage, sketches, photographic essays, needlework and quilting and is of high quality. Students appreciate being able to look at the wider issues of midwifery and explore their own ideas and feelings in a creative way. Through creating artwork and then telling its story, they are able to make meaning out of previously irreconcilable events and develop a deeper understanding of the context of midwifery, including such concepts as 'love', 'pain' and 'loss'. Jackson & Sullivan state that on completion of the course, students are able to conceptualise pregnancy and birth in a more holistic way. They recommend this approach as a way to help students develop insights and understanding into a range of human conditions and experiences to which they may previously have had little exposure (Jackson & Sullivan 1999).
At Bournemouth University there is now a similar option unit for pre-registration students entitled “Using the humanities to learn about birth” which explores existing birth art and poetry and encourages students to produce their own. At APU, there are several modules which serve to promote the arts in midwifery such as 'Images of Women and Childbirth'. Additionally an 'arts thread' is woven into the fabric of the curriculum, and is used primarily to support personal growth and development.
The value of storytelling is now gaining credence in academia, (Fairburn 2002) but why not poetry, dance, music and, of course, painting? We need to set aside our prejudices, feel the fear and do it anyway. By doing so we may be offering access to a window to the soul that midwives have long been denied; it could potentially alter the meaning of midwifery care beyond recognition.
For further details about "Sex. Birth, Rock and Roll", email withwomanuk@yahoo.co.uk
References
Bloom BS (1965), Taxonomy of educational objectives. Longman, London.
England P & Horowitz R (1998) Birthing from Within. Partera Press, Albuquerque
Fairburn GJ (2002) Ethics, Empathy and Storytelling in Professional Development: Leaning in Health and Social Care, vol.1 no.1. March 2002
Grant J (1998). Different ways of knowing. Practising Midwife 1:11; 41.
Jackson D & Sullivan JR. Integrating the creative arts into a midwifery curriculum: a teaching innovation report. Nurse Education Today (1999), 19, pp527-532.
Rogers C (1983) Freedom to learn for the 80s. Charles E. Merrill Publishing Co, Bell & Howell, Colombus, Ohio.
The Concise Oxford English Dictionary (2002) Oxford University Press. Oxford
Quotations from www.quotationreference.com