Jefford Elaine, Jomeen Julie, Wallin Margie
Southern Cross University, Australia.
University of Hull, Hull, UK.
Eur J Midwifery. 2018 Jun 27;2:6. doi: 10.18332/ejm/92529. eCollection 2018.
In this review we explore the concept of Midwifery Abdication and whether it is acknowledged or discussed within the midwifery literature.
A modified Whittemore and Knafl integrative review framework of 2005 enabled consideration of quantitative and qualitative literature. A total of 1508 papers were located. Duplicate records were removed, leaving 1197 records. All titles, abstracts, or case facts were reviewed using a framework derived from the definition of . Three qualitative studies were selected for analysis; the NICE Quality Appraisal Checklist was used to determine study quality.
Abdication occurs, as reported within the wider midwifery literature, and indicated in three studies from different countries. However, the original constructs need to be widened to include: 'external perceptions of midwifery practice' and 'how can reflection facilitate change'. The extent of philosophy in these environments leads to the adoption of midwifery philosophy failure. Such an environment impacts on a midwife's ability to fully exercise autonomy, and to advocate for normality and women. This renders almost inevitable or at least very difficult to prevent. A midwife's professional identity, environmental hierarchy and associated culture of social obedience, acceptance and finding one's place, all act as influencing factors in abdication.
Midwifery education needs to ensure that midwives are prepared and able to embrace their professional status as independent practitioners. Promotion of reflexive practice to facilitate personal and professional change is warranted. Practice policies that are not supportive of a midwife's professional autonomy and scope of practice reinforce the technocratic work environment.
在本综述中，我们探讨了助产士放弃职责的概念，以及这一概念在助产士文献中是否得到承认或讨论。
采用2005年修改后的惠特莫尔和克纳夫综合综述框架，对定量和定性文献进行考量。共找到1508篇论文。去除重复记录后，剩余1197条记录。使用从……定义衍生而来的框架对所有标题、摘要或案例事实进行审查。选择了三项定性研究进行分析；使用英国国家卫生与临床优化研究所（NICE）质量评估清单来确定研究质量。
正如更广泛的助产士文献中所报道的那样，放弃职责的情况确实存在，并且在来自不同国家的三项研究中有所体现。然而，最初的构想需要拓宽，以纳入：“对助产实践的外部认知”以及“反思如何促进变革”。这些环境中的理念程度导致助产理念的采用失败。这样的环境会影响助产士充分行使自主权以及倡导正常分娩和维护女性权益的能力。这使得放弃职责几乎不可避免，或者至少极难预防。助产士的职业身份、环境等级制度以及与之相关的社会服从、接受和找到自身位置的文化，都是导致放弃职责的影响因素。
助产士教育需要确保助产士做好准备并能够接受其作为独立从业者的职业地位。促进反思性实践以推动个人和职业变革是有必要的。不支持助产士职业自主权和执业范围的实践政策强化了技术官僚的工作环境。
