Abstract
ABSTRACTPurpose: 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.
Highlights
Midwives’ care of women during childbirth is provided in a cultural and situational context
Childbirth care is primarily provided in hospital labour wards and the centralization of maternity services has created a culture of industrial models of care in which the institution constitutes a more significant social unit than the care of the individual or the family (Davis-Floyd, 1992, 2003; Newnham, McKellar, & Pincombe, 2017; Walsh, ElNemer, & Downe, 2008)
The midwives moved constantly between different rooms and perspectives of how childbirth care should be performed, with an ambivalent relationship between midwifery, medicine and the institutional organization. These circumstances obstructed the midwives’ freedom to act as autonomous professionals and created doubt and uncertainty regarding their own knowledge, regarding their caring role, and whether they were aware of the genuine needs of a woman during childbirth. These findings demonstrate the significant impact of the workplace culture on midwives’ care of birthing women, in birthing cultures dominated by reductionist paradigms such as medical and institutional models of care
Summary
Midwives’ care of women during childbirth is provided in a cultural and situational context. Enabling meaningful relationships between midwives and women and their families is central in midwifery models of care (Hunter, Berg, Lundgren, Ólafsdóttir, & Kirkham, 2008; ICM, 2005). An evidence-informed framework for Quality Maternal and New-born Care (QMNC) has recently been developed (Renfrew et al, 2014). This framework comprizes health systems required by all childbearing women and their families and midwifery is considered a fundamental component of this framework (Renfrew et al, 2014). Various studies into midwives’ practice show that midwives feel that their work takes place between different “belief systems”(Blaaka & Schauer Eri, 2008), based on “conflicting models of care” (Olafsdottir, 2006/2011), in which the midwives’ approaches vary between being “with the woman” or being “with the institution” (Hunter, 2004) in workplace cultures in which they feel they are being monitored, as well as being controlled by clinical guidelines (Davis & Homer, 2016)
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