Enhancing the midwife-woman relationship through shared decision making and clinical guidelines

Understanding the barriers and facilitators related to birthing pool use from organisational and multi-professional perspectives: a mixed-methods systematic review

AIMS

To identify and synthesize the evidence regarding the facilitators and barriers relating to birthing pool use from organizational and multi-professional perspectives.

DESIGN

A systematic integrated mixed methods review was conducted.

DATA SOURCES

MEDLINE, CINAHL, PsychINFO, EMCARE, PROQUEST and Web of Science databases were searched in April 2021, March 2022 and April 2024. We cross-referenced with Google Scholar and undertook reference list searches.

REVIEW METHODS

Data were extracted from studies meeting the inclusion criteria. Barriers and facilitators to birthing pool use were mapped and integrated into descriptive statements further synthesized to develop overarching themes.

RESULTS

Thirty seven articles (29 studies) were included-quantitative (12), qualitative (8), mixed methods (7), and audits (2), from 12 countries. These included the views of 9,082 multi-professionals (midwives, nurses, obstetricians, neonatologists, students, physicians, maternity support workers, doulas and childbirth educators). Additionally, 285 institutional policies or guidelines were included over 9 papers and 1 economic evaluation. Five themes were generated: The paradox of prescriptiveness, The experienced but elusive practitioner, Advocacy and tensions, Trust or Trepidation and It's your choice, but only if it is a choice. These revealed when personal, contextual, and infrastructural factors were aligned and directed towards the support of birth pool use, birthing pool use was a genuine option. Conversely, the more barriers that women and midwives experienced, the less likely it was a viable option, reducing choice and access to safe analgesia.

CONCLUSION

The findings demonstrated a paradoxical reality of water immersion with each of the five themes detailing how the "swing" within these factors directly affected whether birthing pool use was facilitated or inhibited.

A qualitative study of factors that influence midwives' practice in relation to low-risk women's oral intake in labour in Australia

BACKGROUND

Restriction of food and fluids during labour increases women's discomfort, anxiety and stress which are associated with obstruction of the normal process of labour. Whilst research evidence and clinical guidelines recommend that normal uncomplicated labouring women should not be limited in their oral intake during labour, some midwives continue to restrict or discourage women's oral intake. To promote best practice, it is important to understand the influencing factors which affect midwives' decision-making processes.

OBJECTIVE

This study aimed to investigate the influences that affect midwifery practice regarding oral food and fluid intake for low-risk labouring women.

DESIGN

An interpretive descriptive approach employed 12 semi-structured interviews with registered midwives with current labour and birthing experience in Australia. Data was analysed using thematic analysis.

FINDINGS

Three themes were identified: midwives' knowledge and beliefs; work environment and women's expectations of care. Midwives' practice was affected by their knowledge and values developed from professional and personal experiences of labour, their context of practice and work environment, the clinical guidelines, policies and obstetric control, and women's choice and comfort.

CONCLUSION

This study indicates that midwives' decision-making in relation to women's oral nutrition during labour is multifaceted and influenced by complicated environments, models of care, and power relations between doctors and midwives, more so than clinical guidelines. It is important for midwives to be aware of factors negatively influencing their decision-making processes to enable autonomy and empowerment in the provision of evidence-based care of labouring women.

Midwives' perceptions of being 'with woman': a phenomenological study

BACKGROUND

Being 'with woman' is a central construct of the midwifery profession however, minimal research has been undertaken to explore the phenomenon from the perspective of midwives. The aim of this study was to describe Western Australian midwives' perceptions of the phenomenon of being 'with woman' during the intrapartum period.

METHODS

Descriptive phenomenology was selected as the methodology for this study. Thirty one midwives working across a variety of care models participated in individual interviews. Giorgi's four stage phenomenological approach was employed to analyse data.

RESULTS

Three themes were extracted 1) Essential to professional identity; 2) Partnership with women; and 3) Woman-Centred Practice. Midwives described the importance of being 'with woman' to the work and identification of midwifery practice. Developing a connection with the woman and providing woman-centred care inclusive of the woman's support people was highlighted.

CONCLUSIONS

For the first time, we are able to offer evidence of how midwives understand and perceive the phenomenon of being 'with woman' which has theoretical and practical utility. Findings from this study provide evidence that supports expert commentary and confirms that midwives conceptualise the phenomenon of being 'with woman' as essential to the identity and practice of the profession. Some previously identified 'good midwifery practices' were revealed as practical manifestations of the phenomenon. This new knowledge facilitates clarity and provides evidence to support statements of professional identity, which is useful for the development of educational curricula as well as supporting graduate and professional midwives. The findings emphasise the importance of the development of language around this important philosophical construct which permeates midwifery practice, enhances professional agency and supports the continued emphasis of being 'with woman' with new understanding of its applied practices in a variety of care models.

Informing the development midwifery standards for practice: A literature review for policy development

AIM

To critically appraise and synthesise the literature regarding the role and scope of midwifery practice, specifically to inform the evidence based development of standards for practice for all midwives in Australia.

DESIGN

A structured scoping review of the literature DATA SOURCES: CINAHL Complete, MEDLINE Complete and Cochrane Libraries databases, online and grey literature databases REVIEW METHODS: Comprehensive searches of databases used key words and controlled vocabulary for each database to search for publications 2006-2016. Studies were not restricted by research method.

FINDINGS

There is no substantive body of literature on midwifery competency standards or standards for practice. From 1648 papers screened, twenty-eight papers were identified to inform this review. Eight studies including systematic reviews were annotated with three research papers further assessed as having direct application to this review. To inform the development of Midwife standards for practice, the comprehensive role of the midwife across multiple settings was seen to include: woman centred and primary health care; safe supportive and collaborative practice; clinical knowledge and skills with interpersonal and cultural competence.

KEY CONCLUSIONS

Midwifery practice is not restricted to the provision of direct clinical care and extends to any role where the midwife uses midwifery skills and knowledge. This practice includes working in clinical and non-clinical relationships with the woman and other clients as well as working in management, administration, education, research, advisory, regulatory, and policy development roles.

IMPLICATIONS FOR PRACTICE

This review articulates the definition, role and scope of midwifery practice to inform the development of contemporary standards for practice for the Australian midwife.

Women’s Decision-Making About Birthplace Choices: Booking for Birth Center, Hospital, or Home Birth in the North of England

Aim:

This article presents findings from an interpretive phenomenological study that illuminates unique characteristics of the different social representations of antenatal primigravida and multigravida women who book to birth their babies in a birth center, hospital, or at home.

Methods:

Semi-structured interviews were conducted with 19 women and analyzed by interpretive phenomenological analysis.

Findings:

Analysis revealed different social representations independent of each other that illustrate how these social groups, determined by women’s collective voices, are uniquely characterized by group views, beliefs, misinterpretations, and preconceptions that establish what influences women in decision-making about choice of birthplace.

Conclusion:

Women make decisions about what they want for themselves in this birthing experience. These decisions are made long before this impending experience. Recognizing the different social representations of women in pregnancy reveals deeper insight into the complexities of women’s decision-making about birth choices and highlights why some women might opt for certain choices. Knowing that some women may make decisions based on little or misrepresented information confirms midwives are best placed in their interactions with women to provide positive influences, empowering them to make decisions based upon what they want for themselves. This affirms the woman and her midwife should remain partners in the decision-making process.

Decision-making in Swiss home-like childbirth: A grounded theory study

BACKGROUND

Decision-making in midwifery, including a claim for shared decision-making between midwives and women, is of major significance for the health of mother and child. Midwives have little information about how to share decision-making responsibilities with women, especially when complications arise during birth.

AIM

To increase understanding of decision-making in complex home-like birth settings by exploring midwives' and women's perspectives and to develop a dynamic model integrating participatory processes for making shared decisions.

METHODS

The study, based on grounded theory methodology, analysed 20 interviews of midwives and 20 women who had experienced complications in home-like births.

FINDINGS

The central phenomenon that arose from the data was "defining/redefining decision as a joint commitment to healthy childbirth". The sub-indicators that make up this phenomenon were safety, responsibility, mutual and personal commitments. These sub-indicators were also identified to influence temporal conditions of decision-making and to apply different strategies for shared decision-making. Women adopted strategies such as delegating a decision, making the midwife's decision her own, challenging a decision or taking a decision driven by the dynamics of childbirth. Midwives employed strategies such as remaining indecisive, approving a woman's decision, making an informed decision or taking the necessary decision.

DISCUSSION AND CONCLUSION

To respond to recommendations for shared responsibility for care, midwives need to strengthen their shared decision-making skills. The visual model of decision-making in childbirth derived from the data provides a framework for transferring clinical reasoning into practice.

Giving birth: the voices of Australian women

BACKGROUND AND SIGNIFICANCE

Women's perceptions of childbirth are defined within sociocultural context. Listening to the voices of women is essential to increase nurses' sensitivity to the needs of childbearing women and help nurses provide culturally competent healthcare.

PURPOSE

The purpose of this qualitative descriptive study was to identify Australian women's perceptions of giving birth.

METHOD

Seventeen Australian women who had given birth in the past 12 months participated in audiotaped interviews. Trustworthiness of the findings was ensured. Themes were generated on the basis of rich narrative data.

RESULTS

Themes included focusing on the moment of birth, being empowered by giving birth, defining the spiritual dimension of giving birth, having a diminished or traumatic birth, feeling concern for the child, coming to know the child, and receiving care: nurses making a difference.

IMPLICATIONS FOR CLINICAL PRACTICE

Results confirm the findings of other studies suggesting that provision of educational resources and individualized nursing care creates a climate of confidence in childbearing women.