Conflicting ideologies as a source of emotion work in midwifery

Abstract

Objective: to explore how a range of midwives experienced and managed emotion in their work. Design: a qualitative study using an ethnographic approach. Data were collected in three phases using focus groups, observations and interviews. Setting: South Wales, UK. Participants: Phase One: self-selected convenience sample of 27 student midwives in first and final years of 18-month (postnursing qualification) and 3-year (direct entry) programmes. Phase Two: opportunistic sample of 11 qualified midwives representing a range of clinical locations and clinical grades. Phase Three: purposive sample of 29 midwives working within one NHS Trust, representing a range of clinical locations, length of clinical experience and clinical grades. Findings: community and hospital environments presented midwives with fundamentally different work settings that had diverse values and perspectives. The result was two primary occupational identities and ideologies that were in conflict. Hospital midwifery was dominated by meeting service needs, via a universalistic and medicalised approach to care; the ideology was, by necessity, ‘with institution’. Community-based midwifery was more able to support an individualised, natural model of childbirth reflecting a ‘with woman’ ideology. This ideology was officially supported, both professionally and academically. When midwives were able to work according to the ‘with woman’ ideal, they experienced their work as emotionally rewarding. Conversely, when this was not possible, they experienced work as emotionally difficult and requiring regulation of emotion, i.e. ‘emotion work’. Key conclusions: unlike findings from other studies, that have located emotion work primarily within worker/client relationships, the key source of emotion work for participants was conflicting ideologies of midwifery practice. These conflicts were particularly evident in the accounts of novice midwives (i.e. students and those who had been qualified for less than 1 year) and integrated team midwives. Both groups held a strong commitment to a ‘with woman’ ideology. Implications for practice: understanding the dilemmas created by conflicting occupational ideologies is important in order to improve the quality of midwives’ working lives and hence the care they give to women and families. In the short term, strategies involving education and supervision may be of assistance in enabling midwives to reconcile these conflicting perspectives. However, in the long term more radical solutions may be required to address the underpinning contradictions.