We’ve always done it that way (part 1)

Aren’t habit, custom and tradition marvellously labour-saving devices?! It doesn’t matter how rational we might seek to be when making a decision that we have time to ponder; during the course of a day, we each have to make hundreds of decisions about small things. Because we lead busy lives, it is inevitable that we will make some of these decisions without thinking about them at all, thus making use of some of the behavioural shortcuts that are an essential and useful aspect of human nature. As the first of three articles (first published in The Practising Midwife journal in 2008 and now shared here for a wider audience) that seek to explore a few of the issues around what some midwives call the WADI (‘we’ve always done it that way’), syndrome, this one looks at some of the advantages and disadvantages of traditions, customs and habits.

Habits

Let’s start by defining a habit as a behaviour pattern which has become repeated so frequently that it has become nearly or completely involuntary. In other words, a habit is something we do without thinking about it. Habits can include anything from the way someone might flick her head to adjust her hair to the three sentences that we say each time we give a particular leaflet out to a pregnant woman. Many of the hand skills that we use frequently become habitual; when is the last time you stopped to think about how to do something that you do regularly, like chopping a carrot, driving round a corner or rubbing a labouring woman’s sacrum?

Once we have learned a habit, we often continue to do it the same way until we encounter the presence of an external factor, such as a student who needs to know what we are doing step-by-step or, perhaps, the desire to change our practice in a particular area because we have discovered another way which we perceive to be better. Even then, habits can be hard to break, for the very reason that they are frequently used and almost involuntary behaviours.

One of the best things about habits is the way that they allow us to efficiently multi-task; you only need to compare the fluidity with which a first-year student midwife and an experienced phlebotomist can converse (or not) with a woman while taking blood in order to see the advantage of developing patterns of behaviour. The potential downside, of course, is that the behaviour that has become a habit may be less than best practice, either because we learned ‘bad’ habits straight off, or because new information has come to light yet we have not adapted our patterns accordingly. The judgement of what makes a habit ‘good’ or ‘bad’, of course, is completely relative; one of the top five bugbears amongst many student midwives is that they have to learn a new way to lay out a delivery pack with each new mentor, yet some midwives find it very useful to arrange things in a certain way because they can then find and pick up exactly what they need without having to look away at the crucial moment!

Customs and Traditions

A custom, then, could be defined as a habit or practice that is common to several people within a group, and a custom may be so important within the group that it is considered to be an unwritten law. Customs common to groups of midwives include the practice of writing down telephone messages or birth records in a particular way in a special book, or the order and form of a shift handover. Although there may be wide variation in how these things are done between different geographical areas, there often exist customs within areas of practice that are carried out for years.

As customs are handed down to new members of a group over time, often by word of mouth or by example rather than as written rules, they become traditions. One of the nicest midwifery-related traditions I ever encountered was in a hospital where the midwives who had worked overnight would make a large pot of tea and coffee each morning and greet each of the arriving midwives with a freshly poured cup of their favourite brew. I quickly learned to get into the habit of putting the kettle on at 6.45am!

Just as with habits, some customs and traditions – perhaps like the morning tea example – are hard to fault, while others are, upon analysis, arguably less beneficial to one or more groups. As Robbie Davis-Floyd proposed (1992), a number of traditions within maternity care have become rituals and we have seen a significant movement to challenge some of the obstetric interventions that have become routine, such as episiotomy, ARM and electronic fetal monitoring. These are important things to challenge, and we need to continue to challenge them, but should we also think about the smaller and less obvious habits, customs and traditions that we have developed?

Read part two of this article here…

Davis-Floyd, R E (1992) Birth as an American Rite of Passage. University of California Press, Berkeley.

 

This article was first published in 2008 and should be cited as Wickham S (2008). We’ve always done it that way: part 1. TPM 11(3):45.
photo credit: Lemoox teapot via photopin (license)

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