The Meaning of ‘Being Responsible’ for Safe Care in Childbirth

Abstract
This paper offers a hermeneutic analysis of the meaning of ‘being responsible’ for safe care in childbirth. It examines historical text related to New Zealand experience and it shows how in colonial times it is unlikely that responsibility was even considered. In retrospect, it is clear that the family held full responsibility, for often there was no one else. The notion of responsibility grew with the rise of professions and maternity hospitals. It was taken from the women and owned by the health professionals. Responsibility, however, did not necessarily enact safe care. Consumer movements in the 1950’s began the fight to win back the right of parents to be responsible for shared decision making within maternity care. Midwifery autonomy, legislated in 1990, heralded a new model of partnership with the intent of responsibility being shared with the woman. The paper concludes that ‘responsibility’ needs to be brought to question rather than assumed. 

Keywords
Responsibility, childbirth, safety   

Introduction
A hermeneutic approach to the question ‘what is the meaning of ‘being responsible’ for safe care in childbirth?’ prompts us to remember that “we always stand within tradition ... it is always part of us” (Gadamer, 1960/1982, p.250). Heidegger similarly tells us that the past does not trail along behind, but is “something which already goes ahead” (1927/1962, p.41). Therefore to understand the notion of responsibility for safety in childbirth it is important to explore our traditions, to see afresh the expectations, values and practices that went before and which, largely, determine our response to the moment of now (Smythe, 1998). This paper, drawn from a hermeneutic doctoral study that explored the meaning of ‘being safe’ in childbirth (Smythe, 1998), seeks to bring to question some of the meanings of ‘responsibility’ in relation to the safety of childbirth as they have shown themselves over the past two centuries in New Zealand. In particular it asks ‘who owns responsibility’?