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Meyer H, Lee N, George K, Kearney L. Factors influencing midwives' intentions to facilitate normal physiological birth: A qualitative study. Women Birth 2024; 37:101617. [PMID: 38701683 DOI: 10.1016/j.wombi.2024.101617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 04/08/2024] [Accepted: 04/14/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Whilst most women desire to birth vaginally, research highlights reducing rates of normal physiological birth worldwide. Previous studies have focussed largely on clinical practices associated with vaginal birth however health care professionals' intentions are also known to effect behaviour; a factor not well understood within the context of midwifery and normal physiological birth. QUESTION/AIM To explore factors influencing midwives' intentions to facilitate normal physiological birth. METHODS A qualitative study using individual interviews was conducted. The Theory of Planned Behaviour was used to develop a semi-structured interview guide to gather perceptions, thoughts, knowledge, and experience of normal physiological birth from participants. Data were analysed thematically within the theoretical constructs: attitudes, subjective norms, and perceived behavioural control. FINDINGS Fourteen midwives from various practice settings, models, and locations in Australia were interviewed. Major factors influencing midwives' intentions to facilitate normal physiological birth were influenced by workplace culture, values and influence of leaders, the need to prioritise collaborative interdisciplinary relationships and support autonomy in midwifery. DISCUSSION Factors influencing the midwives' intentions of facilitating normal physiological birth were multifaceted. Some influences are more obvious and observable through practice, while others were rooted in underlying beliefs and attitudes that were hidden in the subconscious of those involved. However, all contributing influences ultimately shape midwives' intentions and the way in which they facilitate normal physiological birth. CONCLUSIONS Midwives intend to support normal physiological birth; however multiple factors influence their intentions over time. Prioritising collaborative interdisciplinary relationships and supporting autonomy in midwifery could address known barriers.
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Affiliation(s)
- Holly Meyer
- School of Nursing, Midwifery and Social Work, University of Queensland, Australia; School of Health, University of the Sunshine Coast, Australia.
| | - Nigel Lee
- School of Nursing, Midwifery and Social Work, University of Queensland, Australia
| | - Kendall George
- Women's and Newborn Services, Townsville Hospital and Health Service, Australia
| | - Lauren Kearney
- School of Nursing, Midwifery and Social Work, University of Queensland, Australia; Women's and Newborn Services, Royal Brisbane and Women's Hospital, Metro North Health, Australia
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Shorey S, Ng ED. Midwives' perceptions of and experiences with normal physiologic birth: A qualitative systematic review. Birth 2023; 50:749-763. [PMID: 37712184 DOI: 10.1111/birt.12763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 03/06/2023] [Accepted: 08/01/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Normal physiologic birth has been shown to result in optimal maternal-infant outcomes, but the concept of physiologic birth is continually evolving. Midwives play an important role in advocating for normal physiologic birth; however, their perceptions of what this approach entails have not been systematically appraised. OBJECTIVE In this qualitative review, we aimed to examine midwives' perceived meanings of "normal physiologic birth" and to describe their experiences facilitating such births. METHODS Five electronic databases were searched, and 26 qualitative papers were included, representing a total of 433 midwives from different backgrounds (i.e., independent, home-based, community-based, and hospital-based). Eligible papers were assessed for quality, and then data were coded and synthesized thematically. RESULTS Four highly connected themes were generated: (1) the midwife: fundamental beliefs; (2) the woman: empowerment and advocacy; (3) the environment: ambience and culture; and (4) the team: need for institutional support and recognition. The fundamental beliefs of midwives, such as their perceived role and definition of normal physiologic birth and their self-confidence, influence practice styles and contribute to personal and professional development. Midwives often advocate for a person-centered approach that encouraged women's and other birthing person's autonomy and involvement in shared decision-making. The midwife-client relationship is also central. Most importantly, a conducive birthing environment and an inclusive workplace culture that encourages interprofessional support, collaboration, and recognizes midwifery practices were identified as crucial in providing optimal conditions for the facilitation of physiologic birth. CONCLUSIONS This review provides healthcare policymakers and institutions fresh impetus to evaluate and revise as needed current workplace policies to be more inclusive and supportive of midwifery practices and physiologic birth.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Esperanza Debby Ng
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
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Stone NI, Thomson G, Tegethoff D. Skills and knowledge of midwives at free-standing birth centres and home birth: A meta-ethnography. Women Birth 2023; 36:e481-e494. [PMID: 37037696 DOI: 10.1016/j.wombi.2023.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/03/2023] [Accepted: 03/30/2023] [Indexed: 04/12/2023]
Abstract
PROBLEM When midwives offer birth assistance at home birth and free-standing birth centres, they must adapt their skill set. Currently, there are no comprehensive insights on the skills and knowledge that midwives need to work in those settings. BACKGROUND Midwifery care at home birth and in free-standing birth centres requires context specific skills, including the ability to offer low-intervention care for women who choose physiological birth in these settings. AIM To synthesise existing qualitative research that describes the skills and knowledge of certified midwives at home births and free-standing birth centres. STUDY DESIGN We conducted a systematic review that included searches on 5 databases, author runs, citation tracking, journal searches, and reference checking. Meta-ethnographic techniques of reciprocal translation were used to interpret the data set, and a line of argument synthesis was developed. RESULTS The search identified 13 papers, twelve papers from seven countries, and one paper that included five Nordic countries. Three overarching themes and seven sub-themes were developed: 'Building trustworthy connections,' 'Midwife as instrument,' and 'Creating an environment conducive to birth.' CONCLUSION The findings highlight that midwives integrated their sensorial experiences with their clinical knowledge of anatomy and physiology to care for women at home birth and in free-standing birth centres. The interactive relationship between midwives and women is at the core of creating an environment that supports physiological birth while integrating the lived experience of labouring women. Further research is needed to elicit how midwives develop these proficiencies.
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Affiliation(s)
- Nancy Iris Stone
- Evangelische Hochschule Berlin, Department of Midwifery Sciences, Teltower Damm 118-122, 14167 Berlin, Germany.
| | - Gill Thomson
- School of Community Health & Midwifery, University of Central Lancashire, Preston PR1 2HE, Germany
| | - Dorothea Tegethoff
- Universitätsmedizin Rostock, Ernst-Heydemann-Straße 8, 18057 Rostock, Germany
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Liepinaitienė A, Cilinskaitė E, Galkontas A, Dėdelė A. Lithuanian midwives' attitudes and actions during low-risk birth. Eur J Midwifery 2023; 7:13. [PMID: 37388809 PMCID: PMC10302214 DOI: 10.18332/ejm/166294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/17/2023] [Accepted: 06/02/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION This study sheds light on the attitudes and practices of Lithuanian midwives during low-risk births. The aim is to reveal how autonomous work is incorporated into daily routines, how care is oriented towards the mother, and how care is delivered before and during interventions. It highlights midwives' views on both their own and their colleagues' actions during labor, what is aimed for and what outcome is expected. METHODS A qualitative research method was chosen. Midwives were interviewed individually in February and April 2022 by random sampling and semi-structured interviews, after the purpose of the survey was explained and their consent was given to use the information only for scientific work purposes. Midwives were recruited through social networks, sharing information about the study and its nature. All data were coded and analyzed in aggregate form. Ten midwives working in the labor ward participated in the study. RESULTS From the midwives' point of view, every birth and its experience are unique. Midwives work together with mothers to achieve the common goal of a positive birth experience. Communication with the mother and her family, good rapport, clear information and informed decision-making are key aspects for midwives during labor. The midwife's actions must be reasonable and purposeful, with a preference for non-medicated methods of pain and stress relief. CONCLUSIONS A low-risk birth that is within the competence of midwives is one in which there is a low likelihood of medical interventions. Midwives are encouraged to minimize the use of interventions and to provide high quality delivery care.
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Affiliation(s)
- Alina Liepinaitienė
- Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, Kaunas, Lithuania
- Faculty of Medicine, Kauno Kolegija Higher Education Institution, Kaunas, Lithuania
| | - Ema Cilinskaitė
- Public Institution Kaunas City Polyclinic, Kaunas, Lithuania
| | - Aurimas Galkontas
- Faculty of Medicine, Kauno Kolegija Higher Education Institution, Kaunas, Lithuania
- Faculty of Public Health, Medical Academy, Lithuania University of Health Sciences, Kaunas, Lithuania
| | - Audrius Dėdelė
- Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, Kaunas, Lithuania
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Galera-Barbero TM, Aguilera-Manrique G, Correia TIG, Fernandes HJ. Adaptation and validation of the Portuguese version of the provider attitudes towards planned home birth (PAPHB) Scale. Midwifery 2023; 119:103609. [PMID: 36804674 DOI: 10.1016/j.midw.2023.103609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
Maternity health care professionals' attitudes on the option of home birth can influence the choices and decisions women and their partners make about place of birth. Midwives are particularly influential in this space. The study outlined in this paper aimed to translate and validate the Provider Attitudes towards Planned Home Birth (PAPHB) scale questionnaire for use in the Portuguese maternity context. METHODS A total of 118 Portuguese midwives were selected through intentional sampling. The procedure was divided into two phases. In the first phase, a triple translation from the original language into Portuguese and a cross-cultural adaptation of the Provider Attitudes towards Planned Home Birth (PAPHB) scale were carried out, obtaining three versions of the same questionnaire. The second phase consisted of the validation of the questionnaire, for which the Provider Attitudes towards Planned Home Birth (PAPHB) scale was submitted to a panel of 20 experts and to a pilot test. Subsequently, the reliability and statistical validity of the scale were evaluated. RESULTS After content analysis, the results confirmed a four-dimensional structure with a Cronbach's α value of 0.933 for the Provider Attitudes towards Planned Home Birth (PAPHB) scale as a whole, showing good internal consistency. Finally, a bivariate analysis was carried out identifying associations between variables and midwives' attitudes towards home birth. Positive attitudes towards homebirth were strongly influenced by previous clinical experience and exposure to home birth during midwives' academic education. CONCLUSION The 18-item scale is a reliable and valid tool to quantify attitudes towards planned home births in Portugal as the results obtained in the study showed very good internal consistency.
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Affiliation(s)
- Trinidad María Galera-Barbero
- Midwife of the Spanish National Health, Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain.
| | | | - Teresa Isaltina Gomes Correia
- Midwife, Research Group for Health Sciences, UICISA:E, Professor of the Polytechnic Institute of Bragança, 5300-146 Bragança, Portugal
| | - Hélder Jaime Fernandes
- Research Group for Health Sciences, UICISA:E, Professor of the Polytechnic Institute of Bragança, 5300-146 Bragança, Portugal
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Deliktas Demirci A, Kabukcuoglu K, Haugan G, Aune I. Turkish midwives' experiences and opinions in promoting normal births: A grounded theory study. Midwifery 2021; 99:103006. [PMID: 33910158 DOI: 10.1016/j.midw.2021.103006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 02/05/2021] [Accepted: 04/06/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Worldwide, the biomedical model of maternity care has been dominant, with the overuse of interventions. AIM This study aimed to gain a deeper understanding of the experiences and opinions of Turkish midwives regarding the promotion of normal births. METHODS In-depth interviews were conducted with 12 midwives; data were analysed using grounded theory. The data were analysed according to the constant comparative method. FINDINGS The study generated a core category (We want to promote normal births, but have no power to do it), which means all participants wanted to promote normal births. However, they have been disempowered by the medicalised systems of care. There were also three main categories (different ideologies in the labour ward, the midwives have no power, unempowered women). The participants reported that different ideologies in the labour ward were a challenge to promoting normal births. Their working conditions and education level were not enough to support normal birth. The pregnant women were described as unempowered due to a lack of antenatal education and having a fear of childbirth. CONCLUSION AND IMPLICATIONS FOR PRACTICE Normal birth could be promoted by enhancing the power and responsibilities of midwives. The women need antenatal education to have a normal birth. The normal birth may promote the enhanced readiness of women and midwives.
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Affiliation(s)
- Ayse Deliktas Demirci
- Akdeniz University, Faculty of Nursing, Department of Obstetrics & Gynaecological Nursing, Antalya, Turkey.
| | - Kamile Kabukcuoglu
- Akdeniz University, Faculty of Nursing, Department of Obstetrics & Gynaecological Nursing, Antalya, Turkey
| | - Gorill Haugan
- Norwegian University of Science and Technology (NTNU), Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, Trondheim, Norway; Nord University, Faculty of Nursing and Health Science
| | - Ingvild Aune
- Norwegian University of Science and Technology (NTNU), Faculty of Medicine and Health Sciences, Faculty of Medicine and Health Sciences, Department of Clinical and Molecular Medicine, Midwifery Education, Trondheim, Norway
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Skrondal TF, Bache-Gabrielsen T, Aune I. All that I need exists within me: A qualitative study of nulliparous Norwegian women's experiences with planned home birth. Midwifery 2020; 86:102705. [DOI: 10.1016/j.midw.2020.102705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/19/2020] [Accepted: 03/11/2020] [Indexed: 11/29/2022]
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MacLellan J. Vulnerability in birth: A negative capability. J Clin Nurs 2020; 29:3565-3574. [PMID: 32045047 DOI: 10.1111/jocn.15205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/11/2019] [Accepted: 02/03/2020] [Indexed: 11/28/2022]
Abstract
AIM This article explores the literature on women's expectations for birth, the sociocultural context from which these expectations originate and their impact on the interpretation of birth experience. BACKGROUND Childbirth is associated with specific expectations from women with the potential for dissatisfaction if these expectations are not met. DESIGN This paper presents a systematic analysis of the concept of vulnerability in childbirth. FINDINGS A framework was extracted from the literature that linked the themes of a discourse of control, construction of inadequacy and shame of exposure to explain the sociocultural origin of dominant childbirth expectations in the literature. The experience of vulnerability unique to the birthing event is suggested as exposing the woman to this underlying contextual framework and impacting the interpretation of her birth. CONCLUSION This synthesis has exposed the transient experience of vulnerability during birth as a significant contributor to the birthing woman's interpretation of the birth and her place within it. RELEVANCE TO CLINICAL PRACTICE An explanatory framework is offered to clinicians that could increase their awareness of sociocultural and historical factors impacting a woman's expectations for birth. Appreciation of the woman's vulnerability in birth, exposing her to the influence of this framework, can assist clinicians to facilitate a quality birth experience for women. Furthermore, supporting women and midwives to accept this experience of birth vulnerability as a "negative capability," can facilitate an empowering birth experience.
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Bringedal H, Aune I. Able to choose? Women's thoughts and experiences regarding informed choices during birth. Midwifery 2019; 77:123-129. [PMID: 31323487 DOI: 10.1016/j.midw.2019.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 06/30/2019] [Accepted: 07/08/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To gain a deeper understanding of women's thoughts and experiences regarding informed choices during childbirth. DESIGN/SETTING A qualitative approach with individual in-depth interviews was chosen for data collection. Ten women were interviewed three to four weeks after the birth of their first child. The transcribed interviews were analysed using systematic text condensation. FINDINGS Two main themes emerged based on the analysis: "women's resources and coping abilities" and "women's abilities to make informed choices during birth". Women's resources and coping abilities influenced how they retrieved information and made their own choices. Their abilities to make informed choices during birth were influenced by the course of the birth process and the fact that they were patients and submitted to the hospitals' routines. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Instead of using the term "informed choice", women in this study discussed involvement, participation and being heard and seen as individuals. How receptive women are to information during birth varies, and midwives play an important role during pregnancy in informing and encouraging them. The relationship between women and midwives influences women's abilities to make informed choices during birth. Women need individual care and should be encouraged to have realistic expectations and to gain knowledge and confidence in their ability to give birth. A model of care in which women experience greater continuity will have an impact on their expectations, decision-making and experience of birth.
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Affiliation(s)
- Hilde Bringedal
- Women and Children Center, St.Olavs Hospital, Olav Kyrres gate 11, 7006 Trondheim, Norway.
| | - Ingvild Aune
- Midwifery Education, Faculty of Medicine and Health Sciences, Department of Public health and Nursing, NTNU - Norwegian University of Science and Technology, Mauritz Hansens gt. 2, 7004 Trondheim, Norway
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Abstract
Building on insights from science and technology studies-inspired anthropological research on reproduction, this paper uses a praxiographic approach to analyze homebirth midwifery practices in Germany. I show that such practices are syncretic, and that techniques of routinizing and multiplying obstetrical interventions are combined in more or less coherent ways to configure pregnancies and births as physical, emotional, and social becomings. In the process of attending, homebirth bodies learn to co-respond to each other, to the midwifery techniques, and to the homebirth environment. Understanding how and with which aims midwives and women invest in those longterm engagements specific to homebirth surroundings may inform clinical practices.
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Hunter M, Smythe E, Spence D. Confidence: Fundamental to midwives providing labour care in freestanding midwifery-led units. Midwifery 2018; 66:176-181. [DOI: 10.1016/j.midw.2018.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 12/17/2022]
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