SECTION 2: MIDWIFERY PRAXIS The word praxis means the exercise or practice of knowledge, skill, or art. It is the practical application Of theory, mak- ing a logical segue from the theoretical basis for midwifery practice. Elheory does not translate directly to practice, but rather it informs practice; practice illuminates questions and debates that in turn further clarify or revise theory. Praxis is knowing how. It is a transcendence of theoreti- cal rules given meaning and context by active service at the point of care—being with woman. Competence in clinical practice is developed through experience over time. Reflec- tion on practice processes and outcomes leads the midwife back to the theory base and knowledge acquisition to ready oneself for similar encounters in the future. Clinical exper- Lise is developed after years Of practice, resulting in fluid, flexible, proficient practice (Benner, 1982). Subtle cues, such as the sights, sounds, smells, and feel of the laboring woman, arc quickly perceived and grasped by the expert midwife. Beginning midwives apprehend the salient features separately until they arrive at qualitative distinctions. New clinicians must build body memory during the performance of skills, create mental catalogs of experiences, and establish checklists of assessments and therapies to support their clin- ical decision making. For midwives of all levels of experience
and expertise, midwifery care is distinguished by adherence to midwifery philosophy (see Box l- I model of care, and hallmarks of care. The midwifery profession codifies the deeply held philosophical convictions through thc Hallmarks of Midwifery Care, which outlines the core beliefs, values, and characteristics of midwifery practice. These hallmarks place each woman's health and optimal outcome as a care priority (see Box 1-3). For apart from inquiry, apart from the praxis, individu- als cannot be truly human. Knowledge emerges only through invention and re•invention, through the restless, impatient, continuing, hopeful inquiry human beings pursue in the world, with the world, and with each other. Paulo Freire, Pedagogy of the Oppressed physicians or other interdisciplinary care providers. Each discipline has distinct and different services to offer, although overlap can occur. Midwives and the care they providc arc integral to an effective women's hcalthcarc system (Van Lerberghe et al., 2014). Discussions of the parameters of midwifery practice within the practice location(s) and nationally defined scope are guided by collaborative relationships and may be expressed through clinical practice agreements and delineation of privileges. These clcmcnts of clinical midwifery carc (including privi- leges and practice descriptions) are useful tools in evaluat- ing whether a particular midwifery practice is appropriate for an individual woman. Midwifery care is provided to one woman at a time in
pursue in the world, with the world, and with each other. Paulo Freire, Pedagogy of the Oppressed Possibilities and Probabilities The role of the midwife is to listen to women, validate their experience, clarify their needs, and facilitate meeting those needs in a caring and nonjudgmental manner. A key element to providing woman-oriented care is ensuring access to care by connecting women with appropriate services. Services include mainstream medical and health care, alternative or integrative therapies, and services addressing other needs, such as psychosocial and financial supports. The founda- tional philosophy and hallmarks of midwifery guide the care that midwives provide (see Boxes I-I and 1-3). Interprofessional practice describes an effective work- tor an individual woman. Midwifery care is provided to one woman at a time in the context of her specific life situation and is expressed in terms of hopeful possibilities. Scientific evidence is developed with clearly defined populations of patients in narrowly focused areas and is expressed in terms Of nu- merical probabilities. The term evidence-based practice has become a widely claimed basis for clinical decisions; however, it is not the only element to consider when working with women and their families. Instead midwives can view current evidence through the lens of education, knowledge, and experience to provide evidenced-informed practice, which results in a synthesis Of traditional and empiric practices with current evidence and recommenda- tions for best practice. Care is then applied in practice to each individual woman, based on her self-identified needs
and expertise, midwifery care is distinguished by adherence to midwifery philosophy (see Box l- I model of care, and hallmarks of care. The midwifery profession codifies the deeply held philosophical convictions through thc Hallmarks of Midwifery Care, which outlines the core beliefs, values, and characteristics of midwifery practice. These hallmarks place each woman's health and optimal outcome as a care priority (see Box 1-3). For apart from inquiry, apart from the praxis, individu- als cannot be truly human. Knowledge emerges only through invention and re•invention, through the restless, impatient, continuing, hopeful inquiry human beings pursue in the world, with the world, and with each other. Paulo Freire, Pedagogy of the Oppressed physicians or other interdisciplinary care providers. Each discipline has distinct and different services to offer, although overlap can occur. Midwives and the care they providc arc integral to an effective women's hcalthcarc system (Van Lerberghe et al., 2014). Discussions of the parameters of midwifery practice within the practice location(s) and nationally defined scope are guided by collaborative relationships and may be expressed through clinical practice agreements and delineation of privileges. These clcmcnts of clinical midwifery carc (including privi- leges and practice descriptions) are useful tools in evaluat- ing whether a particular midwifery practice is appropriate for an individual woman. Midwifery care is provided to one woman at a time in
pursue in the world, with the world, and with each other. Paulo Freire, Pedagogy of the Oppressed Possibilities and Probabilities The role of the midwife is to listen to women, validate their experience, clarify their needs, and facilitate meeting those needs in a caring and nonjudgmental manner. A key element to providing woman-oriented care is ensuring access to care by connecting women with appropriate services. Services include mainstream medical and health care, alternative or integrative therapies, and services addressing other needs, such as psychosocial and financial supports. The founda- tional philosophy and hallmarks of midwifery guide the care that midwives provide (see Boxes I-I and 1-3). Interprofessional practice describes an effective work- tor an individual woman. Midwifery care is provided to one woman at a time in the context of her specific life situation and is expressed in terms of hopeful possibilities. Scientific evidence is developed with clearly defined populations of patients in narrowly focused areas and is expressed in terms Of nu- merical probabilities. The term evidence-based practice has become a widely claimed basis for clinical decisions; however, it is not the only element to consider when working with women and their families. Instead midwives can view current evidence through the lens of education, knowledge, and experience to provide evidenced-informed practice, which results in a synthesis Of traditional and empiric practices with current evidence and recommenda- tions for best practice. Care is then applied in practice to each individual woman, based on her self-identified needs
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