Influences on Midwifery Practice for the Management of Women in Labour

Abstract

The research comprises a series of three studies to explore the practice of midwives ascertain what factors influenced midwives' decision making during the management of labour, and the partnership relationship between the midwife and the woman. A cross sectional design was employed using the predominant methods of interview, questionnaires and thinking aloud tape recordings as triangulation of data. Sample size comprised 104 independent, team and hospital based midwives who were providing labour care to 100 low obstetric risk nulliparous women in the Auckland metropolitan area, New Zealand. Results of this research identified that numerous factors both intrinsically and extrinsically had the potential to influence midwifery practice. The practice of the midwives in providing the labour care was found to be relatively homogenous despite the style of care provided (independent, team, or hospital based). On the other hand, the setting in which the majority of midwives practised (mainly large obstetric hospitals) identified practice influenced by the medical model of care. The influence of technology and the medical model of care, however, did not impact on the women working in partnership with the midwives. This was found to have occurred because the midwives adopted a humanistic approach to care, utilising technology alongside relationship-centred care. In determining what influenced midwives working in partnership with women, it was found that little emphasis was placed on the need for the midwives and the women to have equal status in decision making. Also, it was not deemed essential to have continuity of carer to achieve a relationship of partnership. Birth plans were found to be a beneficial tool for the sharing of information and structuring discussion. However, to assist women to express their preferences and be involved in the decision making process it is proposed that this could be achieved through a conceptual model of shared decision making. This shared decision making model meets the core objectives outlined in Changing Childbirth of continuity, choice, and control, and provides a partnership framework for midwives and women to recognise and utilise differences in their experience and knowledge to achieve their aims.