Exploring midwives' interactions with mothers when labour begins: A study using participatory action research.

OBJECTIVE

to explore the interactions between mothers and midwives when labour begins with a focus on midwives and unexpected birth out of hospital.

DESIGN

participatory action research (PAR) that sought to understand and improve interactions between mothers and midwives through interviews, focus groups and a joint workshop.

SETTING

maternity services in the north of England, in a district general hospital with one obstetric unit and two birth centres, across two sites and where there was a birth rate of 6000.

PARTICIPANTS

a total of 72 participants took part in the study. Thirteen mothers and five midwives were interviewed. Seven mothers were interviewed who had contacted a midwife in labour and subsequently given birth unexpectedly out of hospital. Thirty-one mothers and twenty-three midwives took part in a series of ten focus groups.

KEY FINDINGS

three major themes were identified from the midwives' data: 'Formulaic discourse as self-protection', 'One to one or one to everyone' and 'Interactions and time'. The latter theme is discussed in this paper showing that when midwifery activity was high and they did not have enough time, midwives experienced a high degree of conflicting emotions such as fear, helplessness and frustration, which stretched their personal and professional integrity and triggered changes in their thinking and behaviour.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

current maternity services appear constrained by a reduced midwifery workforce that is expected to meet excessive organisational demands whilst coping with reduced bed capacity. These pressures can promote changes in midwives' behaviour and thinking which disconnects them from mothers rather than focussing on their needs. Safety depends on a high degree of midwife to mother continuity. However, a business model approach, prioritising throughput and process promotes fragmented care and can potentially threaten the safety of mothers and babies. In this study, there appears to be a link between disconnected interactions when labour begins and mothers giving birth unexpectedly out of hospital.