Challenges to midwives' scope of practice in providing women's birthing care in an Australian hospital setting: A grounded theory study

How do professional connections and relationships impact midwives' well-being and career sustainability? A Grounded Theory study protocol

Significant attrition and projected workforce shortages within the midwifery profession are global issues. Extensive research has identified that high levels of workplace adversity, chronic stress, and increasing rates of vicarious trauma and moral injury experienced by midwives, underpin this situation. Researchers have explored midwives' intention to stay in the midwifery workforce and identified ways to support students' transition to professional practice. Supportive collegial relationships have been reported to be protective for new and early career midwives' well-being and resilience. However, there is a gap in knowledge and understanding of the impact and significance of professional connections and relationships for midwives across their careers. This article describes a protocol for a study designed to explore and understand how professional connections and relationships impact midwives' well-being and career sustainability. Glaserian Grounded Theory (GT) methodology will be used to conduct the study. Constant comparison will be used to analyze data collected from in-depth interviews with midwives at various stages in their professional careers, with the aim of understanding the significance of professional connections and relationships on their well-being and career sustainability, and in understanding the potential protections and benefits. It is anticipated that the findings and theory generated from this study will have national and international implications and provide evidence about the impacts, including benefits and any potential disadvantages, of professional relationships in sustaining midwifery careers. This will be of significant value to, as well as inform, the development of midwife retention strategies.

Midwives' perceptions of and experiences with normal physiologic birth: A qualitative systematic review

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.

How can scope of practice be described and conceptualised in medical and health professions? A systematic review for scoping and content analysis

BACKGROUND

The term scope of practice (SOP) refers to the limits of a health professional's knowledge, skills and experience and reflects all tasks and activities they undertake within the context of their professional role. Inconsistency in definitions of SOP contributes to uncertainty and confusion regarding professional practice boundaries and potentially impacts societal access to safe, effective and efficient healthcare options. The aim of this paper is to understand the conceptual diversity that may exist in terminology used to describe medical, nursing/midwifery and allied health SOP within an Australian practice context exemplar.

METHODS

A systematic review for scoping and content analysis of SOP definitions and concepts, involving inductive thematic analysis and synthesis of published and grey literature.

RESULTS

The initial search strategy yielded 11,863 hits, of which 379 were suitable for inclusion. Data coding identified various SOP terms and definitions and the emergence of six, conceptual elements underpinning the theoretical construct. These were subsequently proposed as a preliminary conceptual model ('Solar') to explain how the six conceptual elements may be applied across various professions, clinical settings and jurisdictions to better understand and address current and evolving SOP issues.

CONCLUSION

The findings of this study highlight limited consistency in SOP definitions and terminology within a single jurisdiction, and the conceptual complexity of the underlying theoretical construct. Further research is required to build on the proposed 'Solar' conceptual model and create a universal SOP definition across jurisdictions, to enhance understanding of the importance of SOP to workforce policy, clinical governance, service models and patient outcomes.

The Good Life: From Birth to Death

Nurses are almost always present at birth and at death. The aim was to describe the similarities in nursing care between birthing and end-of-life patients under a humanistic and holistic caring perspective, focusing on pain management, anxiety and stress reduction, self-care and empowerment, and emotional and family support.

Subversive acts and everyday midwifery: Feminism in content and context

BACKGROUND

Midwives are often at the forefront of political campaigns for women's empowerment, overtly advocating for women's rights and reproductive justice. However, midwives can also be found engaging in inadvertent activism on a daily basis within routine care. When casting a feminist lens over both the content and context of midwifery practice in Australia, subversive acts and opportunities for feminist reform can be found.

AIM

To interrogate the significance of feminism in midwifery practice, identifying feminist successes and further opportunities for implementation including: analysis of the Midwifery Standards for Practice; the primary tenets of woman-centred care; the content versus context of midwifery in Australia; and feminist opportunities for enhanced practice. This paper will discuss the importance of feminism in midwifery practice and its significance in informing optimal midwifery care.

DISCUSSION

Incorporating women's voice and respecting women's bodies and agency in the delivery of care is a fundamental component of midwifery practice. However, while the content of midwifery practice is innately feminist in its emphasis on woman-centred care, it will be argued that the context of birthing in Australia is not. The resultant effect is the emergence of victim blaming in maternity care and the construction of an archetypal 'good birthing woman'.

IMPLICATIONS AND RECOMMENDATIONS

Moving away from the myth of the 'good birthing woman' and the act of victim blaming, midwifery could instead direct its focus towards challenging the rigid systems and structures within which midwives implement care. By further embracing feminist principles midwives will ensure a truly woman-centred future.

"I love being a midwife; it's who I am": A Glaserian Grounded Theory Study of why midwives stay in midwifery

Aims and objectives

To understand why Western Australian (WA) midwives choose to remain in the profession.

Background

Midwifery shortages and the inability to retain midwives in the midwifery profession is a global problem. The need for effective midwifery staff retention strategies to be implemented is therefore urgent, as is the need for evidence to inform those strategies.

Design

Glaserian grounded theory (GT) methodology was used with constant comparative analysis.

Methods

Fourteen midwives currently working clinically area were interviewed about why they remain in the profession. The GT process of constant comparative analysis resulted in an overarching core category emerging. The study is reported in accordance with Tong and associates’ (2007) Consolidated Criteria for Reporting Qualitative Research (COREQ).

Results

The core category derived from the data was labelled—“I love being a midwife; it's who I am.” The three major categories that underpin the core category are labelled as follows: “The people I work with make all the difference”; “I want to be ‘with woman’ so I can make a difference”; and “I feel a responsibility to pass on my skills, knowledge and wisdom to the next generation.”

Conclusion

It emerged from the data that midwives’ ability to be “with woman” and the difference they feel they make to them, the people they work with and the opportunity to “grow” the next generation together underpin a compelling new middle‐range theory of the phenomenon of interest.

Relevance to clinical practice

The theory that emerged and the insights it provides will be of interest to healthcare leaders, who may wish to use it to help develop midwifery workforce policy and practice, and by extension to optimise midwives’ job satisfaction, and facilitate the retention of midwives both locally and across Australia.