All you need is a dark space and a good midwife: an exploration of the enactment of the defining attributes of midwifery led care in midwifery led intrapartum settings

Caine, Deborah (2021) All you need is a dark space and a good midwife: an exploration of the enactment of the defining attributes of midwifery led care in midwifery led intrapartum settings. Doctoral thesis, University of East Anglia.

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Background: There is sound evidence that UK maternity services should be based on the model of midwifery led care in situations where pregnancy and birth are expected to be straightforward, a view underpinned by evidence from systematic review and other research (Hollowell et al., 2011, Sandal et al., 2016) and government recommendation (NICE, 2014; NHS England, 2016). The idea of midwives occupying professional leadership positions within maternity services is not a new one, and first found formal recognition in the Changing Childbirth report (1993) which, as government policy, became a major influence on thinking about how services should be organised. The implication was that midwifery led care was the appropriate choice for women regarded as being at low risk of complications. Despite the wealth of more contemporary literature supporting the model it is not entirely clear what defines and makes it an effective pathway i.e., the strategies and techniques are used by midwives to interact with women, particularly in intrapartum care, and the impact on practice of midwifery led birthing environments. Though such matters have been explored by looking at qualities and outcomes of midwifery led care separately, a comprehensive in-depth exploration and analysis is lacking.

Methodology: The study uses a qualitative case study approach to examine the strategies, techniques, and practices used by midwives to enact the attributes of midwifery led care, thereby increasing our understanding of the model. Four defining attribute themes of midwifery led care were ascertained through a process of concept analysis. An Alongside Midwifery Unit (AMU) and a Freestanding Midwifery Unit (FMU) were recruited as the 'cases'. The study received Ethics Committee and Research Governance Committee approval. Direct non participant observation of midwifery intrapartum care, follow-up interviews with the midwives, and document analysis, were data collection methods. Framework analysis was used to analyse the data across the two cases. The Framework method is an example of thematic analysis or qualitative content analysis used in qualitative research that allows for comparing and contrasting data across and within cases. Data collection for case 1 (AMU) took place from March to August 2016. During this period 1 birth was observed and 9 midwife interviews took place. A number of documents were collected for review relating to different aspects of the AMU's service. Data collection for case 2 (FMU) took place from March 2017 to October 2017. Two births were observed and 7 midwife interviews were recorded.

The four defining attributes of midwifery led care were overall themes of the study. Data collected was organised in relation to the themes. Data analysis resulted in each theme containing several related sub themes. For example, the first of the defining attribute themes, ‘the midwife is the lead professional and acts as an autonomous practitioner’ gave rise to the sub themes: leading care through expertise, advocating for women, and problematic autonomy. Open coding revealed 2 additional themes: preserving self and working together.

Findings: Research participants identified with and verified the relevance of the defining attributes of midwifery led care. It has been possible to assemble a picture of how the attributes are enacted in midwifery led settings. Some of the findings represent features of this model of care which have hitherto not received comprehensive attention in contemporary literature. A conceptual model for the enactment of the defining attributes of midwifery led care in midwifery led intrapartum settings has been developed as a result of this research.

Conclusion: The findings address the need to deepen knowledge of midwifery led care in environments where midwives are the responsible professionals for labour and birth, at a time of great upheaval of maternity services and the development of midwifery led continuity of care models. This research study contributes to the background picture of midwifery led care and provides novel perspectives that can be taken into consideration when developing maternity services.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
Depositing User: Chris White
Date Deposited: 01 Dec 2021 10:52
Last Modified: 01 Dec 2021 11:01


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