Thursday, November 25, 2010

Midwifery exam, 1973

click to enlarge

I found this exam paper when going through an old file.
I read through the questions, and this is what I noticed:

  • Questions on breech presentation: diagnosis, ECV, indications for Caesarean section, and foetal risks associated with [vaginal] breech delivery.
  • A question on [vaginal] delivery of the second twin.
  • Questions on anaemia, fundus not equal to dates, varicose veins, onset of second stage, increasing parity, indications for forceps, polyhydramnios, placenta succenturiata, inversion of the uterus, and infants with sticky eyes, thrush, physiological jaundice, and cephalhaematoma.

Each of these questions could be asked today, to students who would like to be awarded the midwife qualification.

The new graduate midwife in 1973 was expected to be able to attend women with breeches and twins.  There was no reliance on ultrasound or continuous electronic fetal monitoring.  When we suspected twins or breech, the mothers were either sent by a doctor for X-ray (knowing that this may expose the mother and baby to harmful radiation), or told to 'wait and see'.

Today we do not avoid mention of the woman's vagina, as is apparent in this exam paper. Today midwives tend to use the word 'birth' rather than 'delivery', although at times that sort of political correctness is carried a bit too far. If a baby is born surgically, 'delivery' is a more realistic description of the event than 'giving birth'.
You may be surprised that there are no questions about 'evidence'. Midwifery in 1973 was seen as a body of knowledge that was passed in a didactic fashion from teacher to pupil.  Medicalisation of the whole maternity episode was well under way.  The midwife in 1973 was often called the maternity nurse.  The doctor was secure at the top of the care pyramid, and care of 'normal' birth was delegated to midwives and student doctors.   The thought that actions or interferences by the providers of care might in fact interrupt delicately balanced natural processes and even cause harm to the mother or baby was not discussed.

There were no questions about informed decision making by the mother, or any other matter that might approach an understanding of a woman's autonomy over her own body.  Childbirth was a condition, which needed to be managed and treated strictly in a medical way. 

If you are a midwifery student, please take time to review the questions on this exam paper.  The time allowed in 1973 was three hours, so don't rush.  I would love to know how you think you would perform with this set of questions.  Joy

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