An exploration of the role and experiences of the postnatal domiciliary midwife in Victoria, Australia

Abstract

This study aimed to explore the current professional lives, roles and experiences of homecare midwives providing postnatal domiciliary care. The changing environment of maternity care in Australia, with limited resources, has resulted in a continual decrease in postnatal hospital length of stay. Early discharge has resulted in an increased number of clients requiring home visits and domiciliary midwives are attending to mothers and babies who are experiencing increased acuity. A literature review revealed there is a paucity of research pertaining to postnatal care in the home and postnatal care is marginalised in terms of the broader context of midwifery care. There were no available studies that specifically addressed domiciliary midwives’ experiences of care in the home environment. The research design for the study was critical ethnography. There were four ethnographic methods utilised: participant observation, critical conversations, field notes and reflective journalling. Seven domiciliary midwives participated in the study. Data analysis was comprised of three aspects: qualitative content analysis—summative, deep data immersion and qualitative thematic analysis—conventional. The results revealed the role of domiciliary midwives was embedded in their experiences and participants were expert practitioners. Seven themes exemplified their role: relating with intention, autonomy, assessment, prediction, management, education and advocacy. The experiences were characterised by three themes: role complexity and negotiation, personal validation and satisfaction, and professional undervaluing. This study has contributed to the existing body of knowledge by exposing the juxtaposed position of expert practitioners who are personally satisfied yet professionally undervalued. Domiciliary midwives are dedicated to excellent service provision, operating with a vast array of knowledge, skill and experience. Despite limited resources and a changing healthcare context the safety, health and well-being of mothers and babies was not compromised.