Midwives’ care on a labour ward prior to the introduction of a midwifery model of care: a field of tension

Abstract

Purpose: There is a need to deepen knowledge about midwives' care in obstetric-led labour wards in which midwives are responsible for normal births. This ethnographic study explores the content and meaning of midwives' care of women in a hospital-based labour ward in Sweden prior to the introduction of a theoretical midwifery model of care. Methods: Data were gathered through participant observation, analysed through interpretation grounded in reflexivity discussions and are presented in the form of ethnographic descriptions. Results: The midwives' care was provided in a field of tension in which they had to balance contrasting models of care, described in the themes: The birthing rooms and the office-Different rooms of care, Women giving birth or being delivered-Midwives' expectations and relationships with women, Old and new caring roles of the midwife-Women giving birth in a "new age", Being and doing-Different approaches to caring, and Holistic and reductionist care-Guided by contrasting models and guidelines. The midwives' freedom to act as autonomous professionals was hindered by medical and institutional models of care and this led to uncertainty regarding their roles as midwives. Conclusions: Midwives having to balance their activities in a field of tension require midwifery models that can guide their practice.

The birthing room and its influence on the promotion of a normal physiological childbirth - a qualitative interview study with midwives in Sweden

“…Mothers´ lack of influence and participation in decisions became evident in our study in the midwives´ descriptions about how they were torn between the birthing room and the office, and often had to leave the mother to join "the rounds" in the office outside. These findings are similar to what were found in an ethnographic study in Sweden; that many of the decisions important for the birthing women are made in the office, which also serve as a breathing space for midwives who, while chatting with their colleagues, can observe the CTG on the monitors (Nilsson et al, 2019).…”

“…Obstetric hospital settings in New Zealand have been found to make midwives fearful, which led them to adopt a medical care approach (Davis & Walker, 2010 ). In an ethnographic study using observation in birthing rooms at a hospital labour ward in Sweden, the midwives were seen to work in a “field of tension” in which they were caught between midwifery, medicine and the institutional bureaucracy, which in the end led them to doubt their own knowledge and also to lose their freedom to act as autonomous professionals (Nilsson et al, 2019 ).…”

Job satisfaction in midwives and its association with organisational and psychosocial factors at work: a nation-wide, cross-sectional study

“…An integrated review showed that high job satisfaction increased intention to stay in the midwifery profession [ 10 ]. Midwives in the Nordic countries have an autonomous professional responsibility and handle uncomplicated pregnancies and births independently [ 11 ] in a context where almost all births are carried out at obstetric-led hospitals [ 12 ]. This autonomy could be expected to improve job satisfaction, but few studies exist on midwives’ job satisfaction in the Nordic countries.…”

Exploring the uses of virtues in woman‐centred care: A quest, synthesis and reflection

“…The simplicity of womancentred care is therefore probably best captured by Fleming (1998), who describes woman-centred care as being with women through a relationship centred in 'being'. This has been described as the 'being approach' rather than the 'doing approach' during birth, which means just being present, minimizing examination, palpation, auscultation or checking maternal vital signs (Fleming, 1998;Nilsson et al, 2019). 'Such is the simple person: a real individual, reduced to his simplest expression' (Comte-Sponville, 2002, p. 149).…”