THE CARING DILEMMA IN MIDWIFERY
Bibliographic record
Abstract
The caring dilemma, first described by Reverby in 1987, denotes the tension caused by being obliged to provide care without the right to determine how that care is to be provided. Such a dilemma is salient in the practice of midwifery based on a continuity of care model that has recently emerged or been implemented in various jurisdictions. Briefly, this model involves the provision of care by a single midwife or pair of midwives to a woman throughout her pregnancy, birth and post-natal period. Continuity of care necessitates that midwives be on call for significant lengths of time to ensure attendance at the woman's birth. It is the on-call nature of this form of midwifery work that most significantly poses a caring dilemma for midwives. In this paper, we trace both the structural and experiential aspects of the caring dilemma through an examination of midwifery in the Canadian province of Ontario. Our analysis reveals that despite being a salient feature of midwifery practice, some work structures can be created to mediate the caring dilemma experienced by midwives. Le dilemme de la prise en charge, que Reverby a évoqué la première fois en 1987, dénote la tension que cause le fait d’être tenu d'offrir une prise en charge sans avoir le droit d’établir de quelle manière l'offrir. L'exemple des sages-femmes, dont la pratique repose sur un type de soin continu qui est récemment apparu ou qu'on vient de mettre sur pied dans diverses administrations, illustre très clairement ce dilemme. Pour résumer, ce modèle veut qu'une femme enceinte soit prise en charge pendant sa grossesse, à son accouchement et durant sa période postnatale par une ou deux sages-femmes. La continuité de la prise en charge oblige les sages-femmes à être sur appel durant des périodes prolongées pour que la femme qui accouche bénéficie de leur présence. Pour les sages-femmes, c'est la nature même de leur travail effectué sur appel qui engendre, de façon cruciale, le dilemme de la prise en charge. Dans cet article, nous abordons les aspects structurels et expérimentaux que représente le dilemme de la prise en charge par le biais d'une étude sur la pratique du métier de sage-femme dans la province canadienne de l'Ontario. Notre analyse révèle que, si le dilemme de la prise en charge est inhérent à la profession de sage-femme, il n'empêche que des structures professionnelles peuvent être mises en place pour en atténuer les aspects négatifs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.025 | 0.057 |
| Scholarly communication | 0.009 | 0.004 |
| Open science | 0.002 | 0.008 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".