The experiences of midwives in integrated maternity care: A qualitative metasynthesis

Promoting positive interactions between midwives and obstetricians at the primary/secondary interface

“…Factors promoting effective communication included flat hierarchies and greater midwifery autonomy (Barker et al, 2019;Beasley et al, 2012;Downe et al, 2010;Skinner & Foureur, 2010), clear role definitions and boundaries (Munro et al, 2013;Norris, 2017), trust and respect (Chang Pecci et al, 2012;Downe et al, 2010;Lane, 2012), regular interprofessional interaction and use of structured communication tools (Marshall et al, 2009;Norris, 2017;Romijn et al, 2018), robust conflict resolution processes (Chang Pecci et al, 2012), shared education, (Meffe et al, 2012;Murray-Davis et al, 2014) and effective communication systems (Psaila et al, 2015;Schmied et al, 2015;Shaw et al, 2013). Some studies described predominantly unsatisfactory relationships between obstetricians and midwives (Barker et al, 2019;Behruzi et al, 2017;Downe et al, 2010;Lane, 2012;McFarland et al, 2019;Psaila et al, 2015;Ratti et al, 2014;Reiger, 2011;Schmied et al, 2015;Shaw et al, 2013;Watson et al, 2016). Factors leading to unsatisfactory relationships were historical interprofessional animosity and doctors' mistrust of midwifery education (Downe et al, 2010;Ratti et al, 2014;Watson et al, 2016), power imbalance favouring medical discourses (Barker et al, 2019;Lane, 2012;McFarland et al, 2019;…”

“…Some studies described predominantly unsatisfactory relationships between obstetricians and midwives (Barker et al, 2019;Behruzi et al, 2017;Downe et al, 2010;Lane, 2012;McFarland et al, 2019;Psaila et al, 2015;Ratti et al, 2014;Reiger, 2011;Schmied et al, 2015;Shaw et al, 2013;Watson et al, 2016). Factors leading to unsatisfactory relationships were historical interprofessional animosity and doctors' mistrust of midwifery education (Downe et al, 2010;Ratti et al, 2014;Watson et al, 2016), power imbalance favouring medical discourses (Barker et al, 2019;Lane, 2012;McFarland et al, 2019;Ratti et al, 2014;Reiger & Lane, 2009;Watson et al, 2016), differing philosophies and poor information systems and transfer processes Schmied et al, 2015;Shaw et al, 2013).…”

Current Resources for Evidence-Based Practice, November 2020

“…However, after reading the McFarland et al ( 2020) article, I think this issue is more complicated. McFarland et al (2020) reported numerous circumstances under which newly trained midwives suffered more than their more experienced colleagues, and these circumstances were mostly related to the fact that midwifery training remains idealized. Once in practice, however, midwives discover a large disconnect between what they learned in training and the realities of practicing in a risk-based, medicalized model.…”

“…The finding that caseload midwifery was associated with lower rates of burnout persisted even when controlling for hours worked or 24-hour availability shift requirements. Perhaps this is related to the extensive findings by McFarland et al (2020) about midwives in integrated practices being forced to conform to non-midwifery models of care, and midwives prefer more the increased autonomy found within caseload models. Alternatively, perhaps it has more to do with the fact that midwives in a caseload model are responsible for fewer patients overall.…”

“…We must consider that most of the research summarized by Sulieman-Martos et al (2020) and McFarland et al (2020) was not conducted in the United States. With our much lower reliance on midwives, these results may not be generalizable to our circumstances.…”