Midwives’ care on a labour ward prior to the introduction of a midwifery model of care: a field of tension

ABSTRACT

Purpose: There is a need to deepen knowledge about midwives’ care in obstetric-led labour wards in which midwives are responsible for normal births. This ethnographic study explores the content and meaning of midwives’ care of women in a hospital-based labour ward in Sweden prior to the introduction of a theoretical midwifery model of care. Methods: Data were gathered through participant observation, analysed through interpretation grounded in reflexivity discussions and are presented in the form of ethnographic descriptions. Results: The midwives’ care was provided in a field of tension in which they had to balance contrasting models of care, described in the themes: The birthing rooms and the office—Different rooms of care, Women giving birth or being delivered—Midwives’ expectations and relationships with women, Old and new caring roles of the midwife—Women giving birth in a “new age”, Being and doing—Different approaches to caring, and Holistic and reductionist care—Guided by contrasting models and guidelines. The midwives’ freedom to act as autonomous professionals was hindered by medical and institutional models of care and this led to uncertainty regarding their roles as midwives. Conclusions: Midwives having to balance their activities in a field of tension require midwifery models that can guide their practice.

KEYWORDS:

• Midwifery
• women
• models of care
• experiences
• childbirth
• ethnography
• culture
• woman-centred
• work place

Acknowledgments

We thank the midwives and the women with their partners and birth companions who so generously shared their birth experiences.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to restrictions, e.g., their containing information that could compromise the privacy of research participants.

Additional information

Notes on contributors

Christina Nilsson

Christina Nilsson, RN, RM, PhD, has extensive experience as a midwife in labour wards with normal and complicated childbirth. She currently holds a position as Senior Lecturer in Sexual and Reproductive Health at the University of Borås, Faculty of Caring Science, Work Life and Social Welfare. She also works as a midwife and manager for the non-governmental organization Inter-Cultural Doulas in Gothenburg. This organization provides support to non-Swedish speaking women during pregnancy and childbirth. Her research is focused on women’s fear of childbirth and related areas such as experiences and outcomes of labour and birth, vaginal birth after caesarean (VBAC), care and the birthing room environment.

Olof Asta Olafsdottir

Olof-Asta Olofsdottir, RM, RN, PhD, graduated as a midwife in 1978 and since 1995 has been a leading developer of midwifery curricula and education at the University of Iceland. She is currently Professor of Midwifery at the Faculty of Nursing, School of Health Care Sciences. Her main research interests are in the field of midwifery, curriculum and educational development, models, and outcomes of childbearing care with a focus on place of birth and cultural contexts.

Ingela Lundgren

Ingela Lundgren, RN, RM, MNursSci, MPH, PhD, holds a position as Professor in Reproductive and Perinatal Health/Midwifery Science at the University of Gothenburg, Sahlgrenska Academy, Institute of Health and Care Sciences, and as university hospital senior midwife at Sahlgrenska University Hospital, Gothenburg, Sweden. Lundgren has worked as a midwife since 1986, primarily with childbirth in standard delivery wards, Birth Centre care, and homebirths. Her research focuses on the meaning of childbirth in a woman’s life, women’s experiences of giving birth both at the time of birth and from a long-term perspective, support during childbirth by professionals and non-professionals, and the organization of maternity care.

Marie Berg

Marie Berg, RN, RM, MNursSci, MPH, PhD, holds a position as Professor in Health Care Sciences specialising in Reproductive and Perinatal Health/Midwifery Science at the University of Gothenburg, Sahlgrenska Academy, Institute of Health and Care Sciences, and as a clinical consultant hospital midwife at Sahlgrenska University Hospital, Gothenburg, Sweden. Berg has worked as a midwife since 1980, both in Sweden and in the Democratic Republic of Congo and therefore has experience in a diversity of clinical settings and challenges. A main part of her research concerns labour and birth aimed at supporting normal physiological births with healthy outcomes.

Lisen Dellenborg

Lisen Dellenborg holds a doctorate in social anthropology and is employed as a University Lecturer and researcher at the University of Gothenburg, Sahlgrenska Academy, Institute of Health and Care Sciences. Dellenborg has extensive experience of ethnographic research in Senegal and Sweden. Dellenborg’s areas of expertise are anthropology, hospital ethnography, transcultural healthcare, inter-professional communication and relations within Swedish health care, and she specialises in female genital cutting, gender, sexuality, ethnicity and religion.