'Then we forget to sit on our hands': how epistemic injustice impedes midwives' and students' capacities to humanize birth

Abstract

The ubiquity of negative childbirth experiences, and their repercussions, are gaining increased global attention. 'Humanizing birth' principles, developed by social science and midwifery scholars, promote relationship-based care tailored to women/birthing people's needs. Midwives play a vital role in birth experiences, but little is known about how they form their perspectives on and capacities to facilitate humanized birth. To address this gap, this study analyses Australian midwives' and students' views of a good birth, a good midwife, and the factors assisting or preventing them facilitating humanized birth experiences. Focus groups and semi-structured interviews elicited participants' (n = 23) perspectives. Participants consistently articulate a specialized midwifery approach and knowledge base aligning strongly with humanizing birth principles. However, they describe having their expertise dismissed within the hospital-based birth system, thus prevented from practicing according to these principles and the evidence base. We argue this constitutes epistemic injustice, with testimonial injustice occurring when midwives'/students' knowledge is wrongly overridden by others with higher status in the professional hierarchy, and hermeneutical injustice perpetuated by epistemic assumptions built into the healthcare system itself. Unable to deploy their expertise, midwives experience epistemic stress and are driven to leave the mainstream birth system, further diminishing the possibilities of humanizing birth.