Self-concept Factor Influencing Antenatal Provider Selection: A Qualitative Study from Indonesian Midwives

Abstract

Background: The different philosophies of care between midwives and obstetricians influence maternal health services. Midwives deliver a holistic physiological approach, while obstetricians implement a medical approach and a technocratic model. Different perspectives in interpreting professional philosophies may impact the choices of antenatal providers for midwives, themselves. This study aims to determine the self-concept of Indonesian midwives in interpreting professional philosophy regarding the decision-making of the antenatal provider during pregnancies.
 Materials and Methods: A qualitative descriptive with a phenomenological approach was carried out. It used a purposive sampling method. This study involves 15 midwives who are still active in providing services in private midwifery practices, primary health centers, and hospitals that had experienced pregnancy. The variable was the perspective of midwives in choosing ANC providers considering the self-concept. Data obtained by in-depth interview technique for 60-90 minutes duration and is analyzed using thematic analysis techniques.
 Results: As the results, the selection of ANC providers has been shaped by the self-concept factor. Most perspectives are influenced by (1) knowledge of the physiological and high-risk of pregnancy concept (2) previous experiences in pregnancy/ childbirth/ after birth (3) role in families when addressing reproductive health decisions. Conversely, education level and work experiences did not affect the option to have antenatal care.
 Conclusion: Self-concept influences midwives’ perspective of making decisions about ANC providers. This study shows there is a limited understanding of the philosophy of midwifery care which reflects on the decision-making of the midwives in regard to the care received during the pregnancy.