Contemporary midwifery practice: Art, science or both?

This article will consider the debate as to whether contemporary midwifery care should be based on policies and guidelines underpinned by systematic review (positivism), or based on evidence derived from experiential knowledge and intuition (constructivism). A critical review of current literature in relation to epistemology (the theory of knowledge) in a health-care setting has discovered a dearth of midwifery-specific papers; rather the focus has been on the acquisition of knowledge in a nursing environment. Comparisons can be made between the role of the midwife and advanced nurse practitioner in terms of autonomous practice, advanced critical reasoning and expert decision-making in time-critical situations; as a consequence, this article will use nursing literature in addition to midwifery-specific literature to underpin the discussion where appropriate.

Carper's (1978) taxonomy of knowledge offers four fundamental patterns of knowing in nursing:

Siddiqui (2005) applies this paradigm to midwifery knowledge using the terms theory, practice, research and the midwife's personal belief system, all of which come into play in clinical practice: underpinning theory and research via taught sessions within the university setting during training, complemented by practice both as a student and then as a registered midwife by building a library of knowledge through experiences in practice. This follows Bloom's (1956) taxonomy of a hierarchy of levels of thinking from being provided with information to comprehension, application, analysis, and synthesis, culminating with evaluation of knowledge in order to apply it appropriately in decision-making.