 And now I have the pleasure of introducing Saline LeMay from Quebec, Canada. And Saline has been a midwife for over 30 years in Quebec. She was actively engaged for legalization of midwifery practice. She's the past president of the Quebec Midwives Association and is a member of the board of the Orre des Sages-Fammes du Québec. She is a baccalaureate in nursing and MA in anthropology and a doctorate in applied human sciences from the Université de Montréal. She's teaching as a senior lecturer in the BAC en pratique des Sages-Fammes for 10 years at the Université de Québec à Trois-Rivières in Quebec. She has three children, three grandchildren. Please excuse my French accent and I'm going to turn it over to Saline as she talks with us about sharing storage, constructing knowledge, language and meanings. So hello everybody, I hope you hear me well and that talking too loud. Thank you for inviting me to be there and share with you some of thoughts I have. Happy Midwives Day for everybody. So this presentation began with my doctoral research findings. It was about midwifery practice before its legalization in Quebec, Canada in 1999. So it was about midwives who were practicing outside the legal and institution mostly home birds. So one of the themes of my thesis was learning and understanding together. And it was about sharing stories. The midwives were meeting each week together and sharing stories about the bird they were immersed in. And they were discussing a lot of things. And the fact is that after the legalization there was institutionalization and bureaucratization of practice and now it's more management values oriented. So we are talking about efficiency, the management of time. And when the midwives are meeting now they have more standards, narrative rules like they have, you know, not they have to but they use to use the biomedical language. Birds is about description of the bird. You know, it's like a report what happened, when, and it's more a ritualization of bird stories. And often it's focusing on transfers and complications. So because they don't have time to share the normal stories. You know, what do we say about it? It was normal. Everything went fine. So there's nothing much to say about that. So and the authorities now are questioning even the need for team meetings each week because it's for them. It's like what is the big deal about, you know, doing those meetings? It's like losing time. So what is the context now from the 80s to now it's the authoritative knowledge is very biomedical. We are in an era of science, you know, which the values of neutrality, objectivity, what counts is facts, numbers. It's the instrumental reason. It's still very much the, you know, body-mind duality. And from the research, you know, it's like knowledge from nowhere. You know, it's so objective that it's not situated. We are still using the biomedical paradigm. So it's the dominance of biology and technology and pathology oriented and resolve oriented. So and we are also in the area of scientism, which means that the scientific knowledge is bringing like the truth. And it's really the only real knowledge. And with the evidence-based paradigm is more and more like that. So what is the problem? The biomedical language is continuously carrying the medical metaphors about the woman's bodies. You know, it's like a machine. It's still very strong. And it's the continuous background music of fear because we're talking about the good case, you know, which has complications and many horror stories. And it's a silencing, a traditional and honored way of woman ways of knowing, which is telling stories. We don't have time to tell stories like anecdote. So where's the specificity of midway free? You know, what is different? Are we a kind of nurse or a kind of doctor? I want to remind you that in Quebec, the midwives were legalized as a profession, this thing, from medicine and from nursing. So it's a quest to find what is special for us. And with stories, it can do something about that. What is sharing stories? You know, it's sharing a lived experience. And it's different from the description of facts and measures and results. It's really an embodied and experiential knowledge because a story is about a unique event and situation. And there's two meanings of the situation. It can be a material meaning, which is objectivity. You know, it's a case. It's a biomedical knowledge. You have numbers and the facts. Everything is measured. But it can have another meaning, which is existential meaning. So a situation is a moment in the unfolding of an existence. You know, we're talking about subjectivity and singularity. We're talking about the multiplicity of knowledge and the evidence of persons, not of numbers. So a story is considered as a whole. Usually we have the normal and pathological in the way we're working, but we forget about the existential. And sharing stories can help us to go through that. So why sharing stories? First, you know, it's acknowledging a human impulse to tell tales. It's for a lot of different society and cultures. It's oral traditions. You know, it's not written. So what people know is from stories and legend and all that myths. And traditionally for midwives, the knowledge were transmitted orally. So it's a historical, traditional way for us to know things but to transmit. And it's a valued way of knowing. And sharing stories, it brings an integrative knowledge because in a story you have emotion, you can have clinical reasoning, you can know about mechanism and spirituality. So it's many things together. Sharing stories having access to multi-levels of reality and in a way it's learning about complexity. We have a tendency to see the childbirth in mechanism, which we want to facilitate, but it's still in a mechanic way of thinking. So in sharing stories, having access to profound knowing and so in going beyond the mind. And it can be accessed to new knowledge. And sharing stories have an epistemological value and it's considered like that with philosophers and in sociology and in anthropology. And we're using language when we tell a story that value connectedness in one event. So in the medical terminology, when you use that, we reinforce the technical rationality. So why sharing stories? The stories can tell us about the process versus the results, which are all statistic. And the numbers we use in obstetric, it's about the results. And we know that with midwives, the process is as important as the results. So and it's also exploring the values implicit in the story. And it's about, you know, it's a hermeneutic process. When we share a story, tell a story, we also create meanings. We are able to name the values. And sometimes and often it can have a therapeutic aspect of narratives. It can be beneficial for the storyteller, sometimes cathartic. And it's about mind and art opening. And for the one who are listening, you know, we can develop an ethics of listening. How we listen just with the ears or with the mind, the heart, the soul. So why sharing stories? It has the potential to develop a reflective practice, you know, having discussion, having reflection of a lot of things. And it's really not easy when we work in a very institutional context to have time and take time to develop a reflective practice. Stories can be informative. They can be formative. And sometimes they can be transformative. We all know some stories and we live things that, you know, transform ourselves, mindblower. And then in each story it can have the potential to find big things in small details. It's the treasure of understanding and consciousness raising. So in sharing stories we can find what are the gifts in the story. I will tell you about the story are not just the good stories. It's all about Albert, everywhere with everybody, you know. So we can learn how to find what is the story within the story. And in a way it's, you know, a way of acknowledging the invisible of the reality, which is not the paradigm of the biomedical culture. So why sharing stories? You know, it's learning and having bringing new knowledge about different things like life, death, love, mothering ourselves, birth, the body, the newborn, father, the art of presence, midway free as an art, compassion, confidence, intuition, transformation, sacredness, vigilance, et cetera. We all can add something on that list. So why sharing stories? It's all also to honor the dignity of power and powers of women. You know, birth is something that women can do. And physiologically speaking, we forget that the woman is not giving birth because we're there. We are there because she's giving birth. You know, we forget that. So, and it gives the value of a shared live experience. So it's not about me that lived that, but sharing that, you know, create a kind of shared live experience. So it can have an affirmation that childbirth without numbers is possible. Yay! What are the issues about that? You know, we can having a sense, different concept of time, you know, the clock time versus the process time. We knew about the care of time. So when we tell stories, we can develop a sense, different sense about time. And it's, we can use different language. And Lavel, it's an author who says the creation of language is like the creation of the world. So we have not just the words, but the way we tell things is telling things about birth and about midway free too. And it values the different ways of knowing. And it values thing, that learning from each other and learning from women. They are the one we, you know, we can learn from. And the issue is knowing and understanding the normality, the variety, and the concept of unique normality too. So, and it's putting childbirth in a complexity vision versus, you know, mechanistic vision. So we have time to add details and telling about the context. So we can, one of the issue is the distinction between technical care, which needs this distanciation versus relational care. You know, we're used to learn that being a good professional is being kind of distance. Creating from the patient. But this objectification of the patient is a risk of alienation for the patient and for the carer. You know, one of the author and the philosophy said that objectification, taking the woman as an object of care is a way, is a kind of violence. You know, and this was strong, but it's, I think it's true. So the woman is not an object of care. She is situation. She has a name. And she can do, you know, with the, so we are talking about, you know, the powers of stories. But we can have stories of power. And I want to distinguish here that it's not the power over. It's the power from within, which is not the same at all. So one of the issue is also creating a sense of wisdom, you know, because sash farm. I am a sash farm, which is a wise woman. And it's, I'm privileged to have the wisdom in my professional identity. So because talking about birth is also talking about life. You know, and when we consider the dance of childbirth is our relation with uncertainty. And it's a result and it's weaving the things. There's a place for the unknown there and a place for the possibilities and miracles and a lot of different things. And we can as a teacher, consider the narrative competencies, information for midwives, because it can be really an educational strategy for students learning to tell stories. In a way, when we tell stories, it creates also resistance to the reductionism in healthcare. So it's the richness of childbirth. We have to speak for that. So sharing stories is not just about physiological birth or home birth or water birth. It's about sharing all about birth, the miracle, the tragic, the joy, suffering, sorrows. It can be anywhere. And a difficult birth has a lot of things to teach us as well as a miracle birth. And sharing stories is a commitment to learn and understanding and making meaning and going beyond facts. There's a Buddhist nun, Pema Children. I don't know if I pronounce this well. She said, when you are ready to listen and to learn, even the stones speak. So it's a commitment just to stay open in our mind and heart and really ready to learn. So when sharing stories can honor the importance of questioning and reflection, there's a lot of potential in sharing stories. It is a potential for a cellatogenic perspective on birth versus seeing birth as a problem. Some women are courageous, resilient, and sometimes we thought that it will never end. It will go with the section or whatever the results. And finally, she made it. And you know, so there's something as a potential there for the woman. And sharing stories is also a potential of putting weight on normality and resisting to the weight of our stories. They can last for many years, some very difficult or tragic things. But then we have to, I think it's an occasion to share different levels as, you know, the difficulties but also the miracle. There's an emancipatory potential for midwives because it values the clinical reasoning versus just applying protocols. So and it's an occasion to create a midwifery language, you know, to talk about the things that are invisible, the spirit, spirituality, and the energy and all that, which is not really recognized in obstetric. And it can have the fundamental contribution to the midwifery paradigm. Is there a midwife's gaze? What is our unique or special way to, can we see the glass as full and not always as empty, you know? And the sharing stories as a potential of creating and strengthening our professional identity and culture. And generated by shared stories in which beliefs, identities, values, and relationships are linked to the narrative. So I want to share with you one of the past president of the SOGC in Canada that said one day, you know, restore the wonder. Birth is so precious. So it's not just about facts. We are privileged to be part of a childbirth and birth of babies on mothers and families. So we should honor that and acknowledge that. And this author said that the universe is made of stories and not atoms. And this is what I had to share. I wanted to share with you. So thank you. Thank you very much. So it's up to you to share a story or asking some questions. Yes, I think it would be wonderful if someone would like to share a story, short story. And I'll keep an eye on the window in case you need the microphone. Perhaps rather than stories, does anyone have any questions? Perhaps maybe questions about how to incorporate more narrative. Oh, there we go. Good one, Anna. I'll turn it over to you. Celine, yes. I think that, you know, we have in French in Quebec a book about all different births. But you know what? I was thinking about that. And I read recently a book. It's in English. And the title is Transform by Postpartum Depression. And there are stories of those women who, you know, they didn't expect that at all. It was not at risk, but they had a bad postpartum depression. And they are talking about their story and finding finally how, because of that, they were transformed. So it's not about just the good and the miracle and the powerful. And it's important. But everything can be part of learning about life and love. Even a story which is difficult, it's not about the facts. It's about what we learn about that and what makes us different in our relation to the world. Celine, can you hear me? Absolutely. Celia Jevitt from the United States. I teach in a midwifery program where I'm reviewing the evaluations of our midwifery faculty members. And many times over the last few years, the students have said in their evaluations to us, we don't want to hear your old stories. We don't want to hear your old cases. We want the evidence. Just tell us the evidence. Have you ever heard that from midwives who are learning? Yes, absolutely. Especially with our era of evidence. And this is scientism. It's so strong that it's the real knowledge we have to know. It's about scientific facts. I don't know how to... It's not old stories. But what about, let's say in our university when the students are coming for the first time in birthing centers and in Quebec, 90% of the midwifery practice is outside hospital. It's in birthing centers and at home. The hospital is not something that women want with midwives for now. But one of the first things that they have to do when they go in a clinical practice, when they have their first birth, they have to do an homework on that and tell the story and tell how they felt and express what they learned from that. So it's the first things to do, but I don't know if there's still all four years during that time a place to tell not what happened to them, but what they learn from what happened to them. I don't know. It's up to the program to value the storytelling. You have given me an idea. We do have weekly clinical conferences with the students. And I'm going to change my vocabulary a little bit to ask them to tell their stories. Thanks so much, Celine. That's really helpful. So I was interested, Celine, in what you were saying about how people do not want to have clinical conferences. Any more, did I understand you correctly that people felt they weren't valuable anymore? I was still thinking that the opportunity to have a clinical conference that involves the story of the woman herself, her prenatal course, her plans for the birth, the family members who's going to have with her the setting that she's in, it could be construed as a wonderful opportunity for midwives and for doctors also to think of the narrative of the woman and the birth even though you're in a technical sense doing a chart review or a clinical conference. So I can see that as being valuable in addition to an education, but also in practice. Thank you, Catherine, to talk about the doctors. Because I was a consultant as a midwife two years ago in a small hospital in Quebec and there was this doctor was telling me that at one point a woman that was not progressing at all and he was thinking about having a c-section and then he asked the woman to be in different position and try this and finally it went well and it was for him like a miracle. And I was telling him you should tell this story to your colleagues and to the nurses because then everybody can know that when you're changing position it can make a difference and the woman can have results. So he was happy about that and take time and make an appointment with all the team to tell. Absolutely. I think Cherie has a question. Well, Susanna in the chat room says that she as a student appreciates the professor's stories. That's good to know. Thank you, Susanna. All right. Would anyone else like to share their perspective or their experiences? Raise your hand if you want me to enable your mic for you so that you can talk. Oh, Tova. Let's see. Where are we? Tova. Tova. If she raises her hand she'll be right at the top. Okay. I just enabled your mic. Are you able to talk now? Okay. So you have a microphone, Tova. Is it green up at the top? We can see that you have the mic. Is it white or green? Click on the arrow and connect your microphone. Is it? No? Yeah. Maybe no. Can you hear me now? Yes. Uh-huh. Okay. I'm a midwife, too. Like all my friends here. I think it's very, for me, it's very important to let the stories emerge in the birth situation. I have just my last birth. I work just now. I work in very little town in Greenland. But it doesn't make any difference because I have always been very aware of letting the stories emerge. I can tell you an example from the recent birth I've had. The baby was posterior and we have used a lot of time to try to turn it around and such things. And it was a young girl, her first child. And she was about 8 centimeters and then she suddenly began to push. And I told her, this is not possible. You cannot give birth like this. Nobody can do that. Then she just went on pushing. And then suddenly I saw the baby was about to come. I could see some of a little bit here. And then I just told her, now you're doing, now you're about to do what is impossible to do. And she was really, really proud. She gave birth and it was wonderful. But I think it's so important for, in any birth situation that you show, you give the birthing woman and her family the chance to see the stories in the situation. And now she's so proud and she knows she's a really special person because she did what's not possible to do. And all the family, they are proud of her. I think it's really an example of the art of midwifery, which we never talk so much about. Never talk about. That was just what I would say. Now that's a very valuable reminder. I think it's really a possibility for us to empower the women we work with. Not to tell them what to be proud of, but to let them understand it in the situation. Let them see it themselves. Yes, but that was my story. I'm going to turn off your mic now. Anyone else? We've got a couple more minutes before we have to wrap up the session and give the room over to the next speaker. So, Atove, do you see in the chat room, you were fading in and out a little bit. And Olga Alishin would like you just to summarize the end. And Gemma from Australia also points out how important storytelling is to midwifery students and even in the desire to become a midwife. Mike is enabled if you want to share something with the group. Rita, you have to unmute the mic. You ready? Go ahead. Your microphone looks like it's ready. Oh, it just got muted. Now it's open. Can you go ahead and now it's muted again. Can you unmute it and then go ahead and see if we can hear you? Okay. Rita is typing. Just type your comment then, okay, Rita? While you are typing, I know it's hard to tell it on the keyboard, but we just want to thank Celine very much for sharing her thoughts with us. I mean, it's been a very engaging session and I'm sure it's brought to mind a lot of stories for practicing midwives and midwives-to-be applause, yes. And I'm going to turn off the recording at this point.