Midwives 'with woman' in the private obstetric model: Where divergent philosophies meet

Midwives' adaptation of their practice, role, and scope to ensure access to sexual and reproductive services during humanitarian crises: A scoping review

PROBLEM

Limited research has examined and synthesized the adaptation of midwives and midwife-led interventions during crises.

BACKGROUND

Evidence suggests that midwives are essential to respond to sexual and reproductive health care needs during disruptive times, and that they adapt to continue to provide their services during those circumstances.

AIM

To map the adaptations of midwives when providing care during crises globally. Secondary objectives include identifying which midwives adapted, what services were adapted and how, and the demographic receiving care.

STUDY METHODS

Scoping review using Levac's modifications of Arksey and O'Malley's methods. Publications and grey literature, in English and Spanish, with no limitations based on study design or date were included. Data was extracted and mapped using Wheaton and Maciver's Adaptation framework.

FINDINGS

We identified 3329 records, of which forty-two were included. Midwives' prior training impacted adaptation. Midwives adapted to the COVID-19 pandemic, epidemics, natural disasters, and World War II. They adapted in hospital and community settings around the provision of antenatal, labor and birth, postpartum, and contraceptive care. However, no specific data identified population demographics. Midwifery adaptations related to their practice, role, and scope of practice.

CONCLUSION

The limited available evidence identified the challenges, creativity, and mutual aid activities midwives have undertaken to ensure the provision of their services. Evidence is highly concentrated around maternal health services. Further high-quality research is needed to provide a deeper understanding of how midwifery-led care can adapt to guide sustainable responses to ensure access to sexual and reproductive health services during crises.

Labouring women perspectives on mistreatment during childbirth: a qualitative study

BACKGROUND

Respectful care during labour and childbirth, which has recently received a great deal of attention around the world, is vital for providing high-quality maternity care. However, this area has been underexplored in developing countries including Iran.

RESEARCH AIM

This study aimed to assess postpartum women's views regarding disrespect and abuse during labour and childbirth in Iran.

METHODS

A qualitative study that involved a purposive sample of 21 postpartum women was conducted in Tehran, Iran, between 2019 and 2020. Following the semi-structured individual interviews, a conventional content analysis was performed.

ETHICAL CONSIDERATIONS

This research approved by Shahid Beheshti University of Medical Sciences in Tehran, Iran, with the ethical approval number 1396.810. Following explanation of the study's objectives, eligible women consented to participate in the study. The confidentiality of the participants' information and the anonymity of the analysis were maintained at all stage of the study. All data was stored on the password protected file in the researcher computer The findings were only disseminated in summary form, with no identifying of individual participants.

RESULTS

Analysis of the data resulted in two main themes: 'inappropriate interaction' and 'inadequate quality care'. The 'inappropriate interaction' theme includes 'lack of empathy' and 'verbal abuse'. The second theme includes five sub-themes 'lack of participation in decision-making', 'lack of privacy', 'ignorance of women's pain and medical needs', 'rushed labour and painful procedures', and "unsatisfying facilities'.

CONCLUSION

Providing supportive care, respectful communication, adequate participation in decision-making, maintaining privacy, attending to women's labour pain and medical needs, and improving the quality of the physical birth environment are all examples of what labouring women consider to be respectful maternity care. To minimise disrespect and maltreatment of women during childbirth, an all-inclusive strategy engaging women, communities, healthcare professionals, managers, and educators is required.

"It's no ordinary job": Factors that influence learning and working for midwifery students placed in continuity models of care

BACKGROUND

Maternity policy and guidelines increasingly recommend or stipulate the increased provision of midwifery continuity of carer as a priority model of care. The scale up and sustainability of this model will require that student midwives are competent to provide continuity of carer at the point of qualification. Guidance relating to how to optimally prepare student midwives to work within continuity models is lacking.

AIM

To explore perspectives and experiences of working within and learning from student placement within continuity models of care.

METHODS

An online mixed methods survey aimed at midwifery students and qualified midwives with experience of working within or providing education relating to continuity models. Quantitative results were analysed through descriptive statistics while free text responses were brought together in themes.

FINDINGS

Benefits and challenges to placement within continuity models were identified. These provide recommendations that will enhance learning from and skill development within continuity models of care.

CONCLUSION

There is a need for continuity of mentorship and strong relationships between education and practice, and the provision of flexible curriculum content around this to enable students to prioritise appointments with women in their care. System level evaluation and support is needed to guide the optimal provision of continuity models, so that they are effective in improving outcomes and experiences. Foregrounding woman centred care as foundational to education and facilitating the critical deconstruction of dominant discourses that conflict with, and may prevent this form of practice, will promote the provision of care that is integral to these models.

Creative arts intervention in support of women experiencing a high-risk pregnancy: A qualitative descriptive thematic analysis

BACKGROUND

Mental illness can have negative effects on both the pregnant woman and her unborn child. Studies that use the creative arts as interventions have proven to be beneficial to women's antenatal mental health and wellbeing, however, these studies are limited and emergent. Music, drawing and narrative (MDN) is an established music therapy intervention, stemming from guided imagery and music (GIM), that has the potential to support positive mental health and wellbeing. Yet, to date, there have been limited studies on the use of this form of therapy with inpatient antenatal women.

AIM

To describe antenatal inpatient women's experiences of participating in a MDN session.

METHODS

Qualitative data were collected from a sample of 12 inpatient pregnant women who participated in MDN group sessions of drawing to music. Post intervention interviews explored the mental and emotional health of participants. A thematic analysis of the transcribed interview data was performed.

FINDINGS

Through reflection women were supported to acknowledge both the positives and difficulties of pregnancy as well as establish meaningful connections through shared experience. These thematic findings highlighted that MDN enabled this group of pregnant women to better communicate their feelings, validate emotions, engage in positive distractions, develop greater connections, improve optimism, experience calmness, and learn from others.

CONCLUSION

This project demonstrates that MDN may offer a viable method for supporting women experiencing high risk pregnancies.

The Parturient Women's Privacy Preservation in the Delivery Rooms: A Qualitative Study

Introduction: Parturient women's privacy preservation and respectful maternity care (RMC) in delivery room is an important principle in the high quality of midwifery care to achieve maternal satisfaction and positive childbirth experience. Hence, it is essential to make natural vaginal delivery (NVD) a positive experience and increase the mothers' satisfaction. This study aimed to investigate the privacy preservation of parturient women's in the delivery room. Methods: Using conventional content analysis, this qualitative study was conducted from June 2018 to December 2020 at two hospitals and three health centers in Shahroud, Iran. Purposeful sampling was employed and it was continued till data saturation through in-depth interviews with 37 participants. Results: The results of interviews with 21 women with NVD experience and 16 maternity health service providers resulted in the extraction of four themes including physical, spiritual-mental, informational, and social privacy. Conclusion: Various mechanisms were found to promote the privacy and satisfaction of parturient women in the delivery room. They included the necessity continuous education, monitoring about mother's privacy preservation and intervention to improve effective communication skills among staff in delivery rooms.

An integrative review of supportive relationships between child-bearing women and midwives

AIMS

To review and evaluate the literature on the factors related to developing supportive relationships between women and midwives, including facilitators and barriers.

DESIGN

An integrative review.

METHOD

The search used CINAHL, MEDLINE, Embase, EMcare, Maternity and Infant Care, PsycINFO, and Google Scholar from January 2009-June 2020. Two reviewers screened the eligible studies, and 2,399 records were identified. Quality was assessed with the mixed methods appraisal tool, and 14 articles were included.

RESULTS

The findings highlight that successful relationships require therapeutic communication, trust, respect, partnership, and shared decision-making. Supportive relationships improve women's satisfaction and birth outcomes, and continuity of care model is an enabling factor. Further research is required to understand supportive relationships in non-continuity of care models and when different cultural backgrounds exist.

Midwives' knowledge and practice of Respectful Maternity Care: a survey from Iran

BACKGROUND

In the past decade, countries worldwide aimed to evaluate the quality of childbirth care and reduce the high rates of disrespect and abuse during childbirth. Few studies have attempted to identify providers' characteristics associated with respectful maternity care quantitatively. This study aims to evaluate midwives' knowledge and practice of respectful maternity care (RMC).

METHODS

A cross-sectional study was carried out in 15 teaching and non-teaching hospitals in Tehran, Iran. The hospitals were selected by using a cluster sampling design. Midwives' Knowledge and Practice of Respectful Maternity Care scale (MKP-RMC) was administered to 250 midwives working in maternity units at study hospitals. The data were analysed by statistics package for social science (SPSS, version 21.0, Chicago, IL).

RESULTS

Findings demonstrated that the mean score for knowledge and practice of midwives were 20.96 ± 3.54 and 101.64 ± 11.49, respectively. Also, in both knowledge and practice scales, midwives had the highest score in "providing safe care' domain and the lowest score in "preventing mistreatment" domain.

CONCLUSION

Our findings showed that for Iranian midwives, providing care to preserve mothers' and their babies' wellbeing is more critical than preventing maternal mistreatment, resulting from the importance of the care provision in the Iranian healthcare system. Promoting midwives' knowledge and practice through developing a tailored educational program to prevent mistreatment and providing emotional support alongside physical care is recommended.

Maternity research priorities in country Western Australia: a Delphi study

Objective Health research priorities are commonly identified and resourced by strategic leaders. The importance of recognising the expertise of clinician-researchers is being prioritised by a national funding shift towards applied research. There is a dearth of evidence regarding research priorities for maternity care in rural and remote health in Australia. This study aimed to develop an evidence-based consensus of maternity research priorities in regional, rural, and remote areas of Australia's largest rural health service (by land area) in Western Australia. Methods A three-phased Delphi method was selected to achieve an interdisciplinary, evidence-based consensus on maternity research priorities within Western Australian Country Health Service. Results Across three study phases, 432 participants responded. Representation was from seven regions and all stakeholder roles within the regions. Phase 1 included 173 responses yielding 53 concepts categorised under five domains. Phase 2 involved 161 participants who prioritised concepts under domains of (i) workforce and education; (ii) health equity; (iii) Aboriginal health; (iv) logistics and health systems; and (v) clinical. Phase 3 included 96 participants revealing 15 maternity research priorities with the top four ranked concepts: 'recruitment and retention of staff'; 'care for women and families with vulnerabilities', 'models of care offering continuity' and 'systems efficiencies'. Conclusions The novel evidence provided in this study, in conjunction with a strong consensus on research priorities and an interdisciplinary approach, strengthens the findings of this study and amplifies the mandate of action without delay.

The concept, importance and values of support during childbearing and breastfeeding - A discourse paper

BACKGROUND

Professional support in childbearing has beneficial effects on childbirth experience, interactions within the family, breastfeeding and medical outcomes. However, more knowledge is needed about prerequisites for professional support to be valuable and satisfactory during childbearing.

AIM

The aim of this discourse paper is to describe and explore prerequisites for professional support that are of value for women and their families during childbearing as well as how healthcare organizations can be formed to facilitate these prerequisites.

DESIGN

Discourse paper.

METHODS

This discourse paper is based on our own experiences and is supported by literature and theory.

RESULTS

Well-functioning structures and processes facilitate professional support that leads to safe, secure, calm and prepared parents with the ability to handle the challenges of childbearing and parenting. When organizing care in childbearing, prerequisites for support needs must also be considered.

Iranian midwives' awareness and performance of respectful maternity care during labor and childbirth

INTRODUCTION

Midwives' perceptions of Respectful Maternity Care (RMC) play an important role in promoting quality of care. This study aimed to explore the awareness and performance of Iranian midwives of RMC during childbirth.

METHODS

A cross-sectional study was carried out from November to December 2020 to evaluate 130 midwives' awareness and performance of RMC during childbirth at four public hospitals in Urmia province, Iran. Participants were midwives who were working in the labor unit and had at least one year of work experience. The Midwives' Knowledge and Practice Scale on Respectful Maternity Care was used to assess midwives' awareness and performance. The quality assessment of questionnaires was based on the mean for each item. A multivariate linear regression approach was developed to evaluate the relationship between midwives' age, academic education level plus occupational information and their awareness and performance of RMC.

RESULTS

This study revealed that Iranian midwives had good awareness but fair performance of RMC. The mean scores of the overall awareness and performance of RMC were 36.07±10.13 and 75.47±35.4, respectively. Midwives' performance on two domains was fair including 'Giving emotional support' and 'Providing safe care'. The results of multivariate linear regression analysis showed a significant negative relationship between job satisfaction and midwives' performance on RMC. Also work experience plus a Master's degree in midwifery had positive significant effects on midwives' awareness along with performance on RMC (p<0.05).

CONCLUSIONS

Promoting respectful maternity care requires essential interpersonal and communication skills and supportive attitudes from midwives.

Affecting Factors of Parturient Women's Privacy Preservation in The Maternity Ward: A Qualitative Study

Objective: Different factors have an important role in the positive and negative childbirth experiences of the mothers. The parturient mother's privacy preservation is one of the factors for increasing the mothers' satisfaction consistent with natural childbirth. Hence, this study aimed to investigate the factors affecting the parturient mother's privacy preservation. Materials and methods: Content analysis was used in this qualitative study that is based on the semi structured individual interviews with women who had experienced natural vaginal delivery, midwives, and the specialist in a maternity ward from 2018 to 2021 in Shahroud, Iran. The collected data were analyzed simultaneously with the sampling procedure using a five-step qualitative content analysis method. To ensure the robustness of the data, Lincoln and Guba's four criteria (credibility, dependability, confirmability, and transferability) were used. Results: The findings of the study with 40 participants resulted in the extraction of 28 codes, 9 subcategories, and 2 main categories entitled extra-and intra personal factors affecting the mother's privacy. Conclusion: To foster the mother's awareness of her rights and privacy during pregnancy and delivery, continuous education, monitoring, and evaluating both the students and the staff to respect preserving the mother's privacy is necessary to develop an instrument to measure the preservation of the mother's privacy in the maternity ward.

Lay and healthcare providers' experiences to inform future of respectful maternal and newborn care in Tanzania and Malawi: an Appreciative Inquiry

OBJECTIVES

Disrespectful care, which remains prevalent in low and middle-income countries (LMICs), acts as a barrier to women accessing skilled birth attendance, compromising care when services are available. Building on what was positive in facilities, we aimed to explore lay and healthcare providers' experience of respectful care to inform future interventions.

SETTING

Five maternity facilities in Mwanza Tanzania and Lilongwe Malawi.

PARTICIPANTS

94 participants in Malawi (N=46) and Tanzania (N=48) including 24 women birthing live baby within the previous 12 months; 22 family members and 48 healthcare providers who regularly provided maternity care in the included facilities DESIGN: The study was guided by Appreciative Inquiry (AI). Semistructured, one-to-one interviews were conducted between January and December 2019. Interviews were audio-recorded, translated where necessary, transcribed verbatim, and analysed using the framework approach.

RESULTS

Four main themes describing participants positive experience and their vision of respectful care were identified: (1) empathic healthcare provider-woman interactions including friendly welcome and courteous language, well-timed appropriate care and information sharing, (2) an enabling environment, characterised by improvement of physical environment, the use of screens, curtains and wall partitions for privacy, availability of equipment and provision of incentives to staff, (3) supportive leadership demonstrated by the commitment of the government and facility leaders to provision of respectful care, ensuring availability of guidelines and policies, supportive supervision, reflective discussion and paying staff salaries timely, (4) providers' attitudes and behaviours characterised by professional values through readiness, compassionate communication and commitment.

CONCLUSION

The positive experiences of service users, families and healthcare providers provided insight into key drivers of respectful care in facilities in Tanzania and Malawi. Interventions targeting improved environment and privacy, healthcare provider communication and developing positive leadership structures in facilities could provide the basis for sustained improvement in respectful and dignified maternal and newborn care in LMICs.

"We can't just have a casual conversation": An institutional ethnography-informed study of work in labour and birth

Labour and delivery units often become contested workplaces with tensions between obstetrics, nursing, and midwifery practices. These tensions can impede communication and raise concerns about provider wellness and patient safety. Remedying such tensions requires inquiry into the drivers of recurrent problems in interprofessional practice. We engaged in change-oriented inquiry informed by institutional ethnography (IE) within an academic hospital in Toronto, Canada (2017-2019). Clinicians identified critical incident analysis reports used to document recurrent issues for transfers of care (TOC) and consultations between professionals. We then mapped the everyday/everynight work of midwives, nurses, and obstetricians by observing (75 h) and interviewing them (n = 15). We also traced work processes to local (forms and hospital policies) and external (national policies and evidence-based guidelines) texts. Our IE-informed analysis made visible the otherwise hidden links between the everyday work of practitioners and its social organization. Three intrapartum work processes involving midwives consulting with obstetricians were identified: induction of labour with TOC back to midwife once labour was "active", consultation without TOC, and TOC for various indications. Three points of disjuncture complicated these processes: (i) a local "3 consult rule", linked to medico-legal governance and remuneration structures; (ii) subjective interpretations of the "4-cm dilation rule", a policy meant to standardize practice; and (iii) regulations delaying the timing of consultations. The Electronic Fetal Monitoring system served as a powerful text, materializing issues of professional scope and autonomy for midwives, and medicolegal accountability for obstetricians. Our study extends extant evidence that medicine-driven governance of midwifery practices can perpetuate interprofessional challenges. While practitioners spoke of the three disjunctures as 'laws', most also viewed them as ostensibly modifiable. Interprofessional tensions may be addressed by considering how social organization, materialized in texts detailing medico-legal liability and remuneration, can constrain possible practices through regulatory protocols, local ruling policies, and cultural expectations (e.g., documentation practices).

Parturescence: A theorisation of women's transformation through childbirth

PROBLEM

The potential for positive transformation through giving birth is under-acknowledged and poorly understood.

AIM AND METHOD

By drawing on theories of new feminist materialism to open up ways of thinking about childbirth and maternity care, we discuss how aspects of the process of matrescence, a woman's 'mother-becoming', pertain to women's opportunities in childbirth. We introduce the term, 'parturescence', as a moniker for the opportunity for 'becoming', and therefore transformation, offered in birth giving.

RESULTS AND DISCUSSION

Using Davies' interpretation of Bergson's lines of descent and ascent we suggest the conditions of a woman's parturescence (whether birth giving will result in a positive or negative transformation) is enabled by 'with woman' midwifery care. The intra-action between this care, and the materiality of birth - the pain and exhaustion women experience in labour and birth, results in a rematerialisation of who and what women are and the opportunity for women's transformation.

CONCLUSION

The development of this theory of parturescence unifies disparate aspects of maternity care and birth literature, provides insight into the potential mechanisms and conditions that impact women's parturescence, and suggests that birth, including the challenging and destabilising parts, is not just for the production of a baby, but also a site of women's 'becoming'.

Towards a conceptualisation of woman centred care - A global review of professional standards

BACKGROUND

Woman centred care is purported to underpin Midwifery philosophy. However, the evidence and focus of this concept within midwifery professional standards has yet to be verified. Further to this, woman centred care is, at this time, mostly depicted as a way of assisting, supporting and interacting with a woman and her family. It is however, without a substantive universally accepted definition.

OBJECTIVE

This study aimed to review midwifery standards documents. An organised and targeted methodology was conducted to identify the approaches to woman centred care that currently underpin midwifery governance.

METHODS

A comprehensive and specific search for 'woman centred care' was conducted across a global collection of midwifery standards. A professional document was included if it represented either or all of the underpinnings of midwifery education, contained statements related to standards of practice, overall governance or any equivalence. Individual documents were initially searched for the words 'woman centred care', followed by 'women centred care', 'patient/person centred care' and 'client centred care'.

FINDINGS

An extensive review of 142 documents was undertaken. These included: thirty independent nations, thirty represented by the European Midwives Association and a further twenty-one identified through the International Confederation of Midwives (ICM). The World Health Organisation (WHO), yielded midwifery information from a further sixty-one nations. The phrase 'woman centred care' was located within 3.5% of the documents reviewed. Overall, five examples were found that directly referred to the actual phrase 'woman centred care' and one to the use of 'person centred care'. Therefore, it was established, that at the time of this review, there was limited formal depiction of the concept of woman centred care.

How is organisational fit addressed in Australian entry level midwifery job advertisements

Background

Midwifery job retention is an ongoing global issue. Prior research has recognised that considering an individual’s attributes in relation to their work environment may assist in improving job satisfaction among midwives, leading to improved long-term job retention in the midwifery profession. The aim of this study was to evaluate whether, and how organisational fit is addressed in current entry level midwifery job advertisements within Australia.

Methods

Midwifery jobs were searched for within 12 search engines, using the search term ‘midwife’, including Seek.com, Indeed.com, government employment websites for all Australian states and territories, and private health organisation websites. Data were extracted from eligible job advertisements by three independent researchers. Extracted data encompassed elements addressing person-job fit and person-organisation fit. Content analysis involving chi-square and Fischer exact tests were completed on extracted data.

Results

Key findings demonstrate private health care organisations (29.2%) are more likely than public health care organisations (8.8%) to ask potential candidates to have additional qualifications, however, public health care organisations (34.1% vs. 16.7%) are more likely to ask for dual registration as a midwife and nurse. This is further supported by private health care organisations being more likely to refer to the candidate as a midwife (72.9% vs. 48.4%) than as a nurse. Private health care organisations more often noted access to support for employees and were more likely to mention access to employee assistance programs (41.7% vs. 13.2%), orientations (16.7% vs. 0%) and included benefits (72.9% vs. 42.9%). Clinical skills and personality traits were more frequently addressed in public health organisation advertisements; these included a requirement of employees to be accountable (49.5% vs. 6.3%), innovative (28.6% vs. 0%), have teamwork (69.2% vs. 52.1%) and conflict resolution skills (36.3% vs. 8.3%), and have knowledge of legislation (44.0% vs. 25.0%) and contemporary midwifery issues (28.6% vs. 4.2%).

Conclusion

This study highlights that organisations employing midwives may be unwittingly contributing to the problem of midwife attrition through inattention to factors that endear midwives to workplaces in job advertisements. Further work developing employee selection and recruitment processes that are informed by the concept of person-job-organisation fit, is necessary.

Development and psychometric properties of Midwives' Knowledge and Practice Scale on Respectful Maternity Care (MKP-RMC)

Objective

To develop a scale for evaluating knowledge and practice of midwives on Respectful Maternity Care (RMC).

Methods

An exploratory sequential mixed method study was conducted from January 2018 to July 2019 in two non-teaching public hospitals in Tehran, Iran. In the first part of the study, a literature review and qualitative study were carried out in order to develop the preliminary item pool. Then face, content and construct validity and reliability (internal consistency and test-retest) were assessed.

Results

The MKP-RMC scale has 23-item in knowledge and 23-item in practice section that loaded in three factors: Giving emotional support, providing safe care and preventing mistreatment. Exploratory factor analysis accounted for 43.47% and 58.62% of observed variance in knowledge and practice sections, respectively. The internal consistency and internal correlation coefficient of both section of MKP-RMC indicated acceptable reliability.

Conclusion

The MKP-RMC is a valid and reliable tool for measuring midwives' knowledge and practice of respectful care during labor and childbirth. The MKP-RMC could be used in maternity services to evaluate and improve quality of childbirth care through development of educational interventions for effective behavioral change. Confirmation of validity and reliability of translated version of the scale in other maternity care providers and different contexts is recommended.

Graduating midwifery students' preferred model of practice and first job decisions: A qualitative study

OBJECTIVES

To explore and describe the preferred model of practice and first job decisions of final stage midwifery students from three Western Australian universities.

DESIGN

Qualitative descriptive.

SETTING

Three Western Australian (WA) universities offering courses leading to registration as a midwife.

PARTICIPANTS

Twenty-seven midwifery students from undergraduate and postgraduate (pre-registration) courses.

METHODS

Data were collected from recorded interviews and focus groups. Thematic analysis of interview transcripts was used to identify commonalities. Data saturation guided when recruitment ceased and final sample size was achieved.

FINDINGS

Participants' preferred model of maternity care was influenced by learning about and witnessing both autonomous midwifery practice and collaborative care during their studies. The greatest influence was clinical experience, with most preferring a continuity of midwifery model (CoM) but first consolidating their practice in a public hospital. Most students reported that they would not choose a private hospital as their first option. Work/life balance was also considered, with some accepting that family commitments and a need to work close to home may prevent them from choosing a CoM model.

CONCLUSION AND IMPLICATIONS

Although many Australian midwifery students start their midwifery course with preconceived ideology of their eventual workplace, the influences of their educators, clinical placement environment, preceptors and continuity of care experience relationships with women helped determine their final direction. To provide students with the experiences to become woman-centred autonomous practitioners it is important for universities and all maternity care providers to carefully consider their responsibility in how they influence midwifery students in education and practice.

Midwives' perspectives of respectful maternity care during childbirth: A qualitative study

The adoption of respectful maternity care during labor and birth is a complex process which needs both scientific and interpersonal skills of providers. In this regard, identifying the potential barriers and applying effective strategies for implementing respectful maternity care are essential. This study aimed to explore the perceptions of Iranian midwives regarding respectful maternity care during labor and childbirth. This was a qualitative study which was conducted from September-December 2018 in two non-teaching public hospitals in Tehran, Iran. Twenty-four semi-structured interviews were conducted with midwives, who had more than one year work experience in labor and childbirth units, through a purposive sampling method. A content analysis approach was used to analyze the data and identify themes. Three themes were extracted including “showing empathy”, “women-centered care” and “protecting rights”. Showing empathy reflects that “establishing a friendly relationship” and “being with women”. Women-centered care encompassed “keeping women safe” and “participating in decision making”. Protecting rights reflected a need for “safeguarding dignity” as well as “giving equal care” and “preparing appropriate environment”. Iranian midwives considered respectful maternity care a broader concept than just preventing mistreatment. Providing supportive care through friendly interaction with women was the first step for providing respectful maternity care. Respectful care is also promoted by providing safe care, implementing evidence-based care and involving women in their care as well as by providing an appropriate environment for women, families and caregivers.

'They follow the wants and needs of an institution': Midwives' views of water immersion

BACKGROUND

A midwife's ability to fully support women's autonomy and self-determination with respect to midwifery care is often challenging. This is particularly true of water immersion for labour and birth. However, the woman's agency over what happens to her body and that of her unborn baby should be key considerations for maternity care provision.

OBJECTIVES

A three phased mixed-methods study was undertaken to examine how water immersion policies and guidelines are informed. Phase three of this study captured the knowledge and experiences of Australian midwives, their support for water immersion and their experiences of using policies and guidelines to inform and facilitate the practice.

METHODS

Critical, post structural, interpretive interactionism was used to examine more than 300 responses to three open-ended questions included in a survey of 233 midwives. Comment data were analysed to provide further insight, context and meaning to previously reported results.

FINDINGS

Findings demonstrated a complex, multidimensional interplay of factors that impacted on both the midwife's ability to offer and the woman's decision to use water immersion under the themes 'the reality of the system', 'the authoritative 'others'' and 'the pseudo decision-makers'. Multiple scaffolded levels were identified, each influenced by the wider macro-socio-political landscape of Australian midwifery care.

CONCLUSIONS

The insight gained from examining midwives' views and opinions of water for labour and birth, has aided in contextualising previously reported results. Such insight highlights the importance of qualitative research in challenging the status quo and working towards woman-centred practice and policy.

Midwives' experiences of learning and teaching being 'with woman': A descriptive phenomenological study

Being 'with woman' is a fundamental concept of midwifery philosophy. Minimal evidence explicates ways this important construct is learned or taught. This paper reflects one part of a larger study and explored midwives' experiences of learning and teaching related to the phenomenon of being 'with woman'. Using a descriptive phenomenological approach, 31 midwives working in a variety of models in Western Australia were interviewed to explore the phenomenon of being 'with woman'. Rich descriptions of how midwives learned and taught others to be 'with woman' were obtained. Descriptive phenomenology is useful in revealing features of the phenomenon through description of lived experiences of purposively sampled participants. Giorgi's method was used to analyse data from the two main interview questions. The themes for learning to be 'with woman' were observing midwives; inspirational leaders; learning from the women; a variety of experiences enhances learning; and, develops over time. The themes for teaching being 'with woman' were, approaches for teaching; teaching is implicit; reliance on observation, comprehension and assimilation. Insights into the learning and teaching of practices supported by professional philosophy offer educators and leaders new knowledge and ways to enhance the transfer of knowledge and skills of being 'with woman'.

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.

"It's what midwifery is all about": Western Australian midwives' experiences of being 'with woman' during labour and birth in the known midwife model

Background

The phenomenon of being ‘with woman’ is fundamental to midwifery as it underpins its philosophy, relationships and practices. There is an identified gap in knowledge around the ‘with woman’ phenomenon from the perspective of midwives providing care in a variety of contexts. As such, the aim of this study was to explore the experiences of being ‘with woman’ during labour and birth from the perspective of midwives’ working in a model where care is provided by a known midwife.

Methods

A descriptive phenomenological design was employed with ten midwives working in a ‘known midwife’ model who described their experiences of being ‘with woman’ during labour and birth. The method was informed by Husserlian philosophy which seeks to explore the same phenomenon through rich descriptions by individuals revealing commonalities of the experience.

Results

Five themes emerged 1) Building relationships; 2) Woman centred care; 3) Impact on the midwife; 4) Impact on the woman; and 5) Challenges in the Known Midwife model. Midwives emphasised the importance of trusting relationships while being ‘with woman’, confirming that this relationship extends beyond the woman – midwife relationship to include the woman’s support people and family. Being ‘with woman’ during labour and birth in the context of the relationship facilitates woman-centred care. Being ‘with woman’ influences midwives, and, it is noted, the women that midwives are working with. Finally, challenges that impact being ‘with woman’ in the known midwife model are shared by midwives.

Conclusions

Findings offer valuable insight into midwives’ experiences of being ‘with woman’ in the context of models that provide care by a known midwife. In this model, the trusting relationship is the conduit for being ‘with woman’ which influences the midwife, the profession of midwifery, as well as women and their families. Descriptions of challenges to being ‘with woman’ provide opportunities for professional development and service review. Rich descriptions from the unique voice of midwives, provided insight into the applied practices of being ‘with woman’ in a known midwife model which adds important knowledge concerning a phenomenon so deeply embedded in the philosophy and practices of the profession of midwifery.