'Bringing forth' skills and knowledge of newly qualified midwives in free-standing birth centres: A hermeneutic phenomenological study

AIM

To understand and interpret the lived experience of newly qualified midwives (NQMs) as they acquire skills to work in free-standing birth centres (FSBCs), as well as the lived experience of experienced midwives in FSBCs in Germany who work with NQMs.

BACKGROUND

In many high-, middle- and low-income countries, the scope of practice of midwives includes autonomous care of labouring women in all settings, including hospitals, home and FSBCs. There has been to date no research detailing the skills acquired when midwives who have trained in hospitals offer care in out-of-hospital settings.

METHODS

This study was underpinned by hermeneutic phenomenology. Fifteen NQMs in their orientation period in a FSBC were interviewed three times in their first year. In addition to this, focus groups were conducted in 13 FSBCs. Data were collected between 2021 and 2023.

FINDINGS

Using Heidegger's theory of technology as the philosophical underpinning, the results illustrate that the NQMs were facilitated to bring forth competencies to interpret women's unique variations of physiological labour, comprehending when they could enact intervention-free care, when the women necessitated a gentle intervention, and when acceleration of labour or transfer to hospital was necessary.

CONCLUSION

NQMs learned to effectively integrate medical knowledge with midwifery skills and knowledge, creating a bridge between the medical and midwifery approaches to care.

IMPLICATIONS

This paper showed the positive effects that an orientation and familiarization period with an experienced team of midwives have on the skill development of novice practitioners in FSBCs.

IMPACT

The findings of this study will have an impact on training and orientation for nurse-midwives and direct-entry midwives when they begin to practice in out-of-hospital settings after training and working in hospital labour wards.

PATIENT AND PUBLIC CONTRIBUTION

This research study has four cooperating partners: MotherHood, Network of Birth Centres, the Association for Quality at Out-of-Hospital Birth and the German Association of Midwifery Science. The cooperating partners met six times in a period of 2 ½ years to hear reports on the preliminary research findings and discuss these from the point of view of each organization. In addition, at each meeting, three midwives from various FSBCs were present to discuss the results and implications. The cooperating partners also helped disseminate study information that facilitated recruitment.

Women's experience of early labour in a free-standing birth centre: Midwifing embodied labour

ISSUE

Women who present at hospital labour wards in early labour must often meet measurable diagnostic criteria before admission.

BACKGROUND

Early labour is a phase of neurohormonal, emotional, and physical changes that are often not measurable. When admission to birthplace is based on results of diagnostic procedures, women's embodied knowledge may be disregarded.

AIM

To describe the early labour experience of women with spontaneous onset of labour in a free-standing birth centre, as well as midwifery care when women arrived in labour.

METHODOLOGY

An ethnographic study was conducted in 2015 in a free-standing birth centre after receiving ethics approval. The findings for this article were drawn from a secondary analysis of the data, which included interview data with women and detailed field notes of midwives' activities related to early labour.

FINDINGS

The women in this study were instrumental in the decision-making process to stay at the birth centre. Observational data showed that vaginal exams were rarely conducted when women arrived at the birth centre and were not a deciding factor in admission.

DISCUSSION

The women and midwives co-constructed early labour based on the lived experience of women and the meaning that this experience held for both.

CONCLUSION

Given the growing concern about the need for respectful maternity care, this study provides examples of good practice in listening to women, as well as an illustration of the consequences of not doing so.

Skills and knowledge of midwives at free-standing birth centres and home birth: A meta-ethnography

PROBLEM

When midwives offer birth assistance at home birth and free-standing birth centres, they must adapt their skill set. Currently, there are no comprehensive insights on the skills and knowledge that midwives need to work in those settings.

BACKGROUND

Midwifery care at home birth and in free-standing birth centres requires context specific skills, including the ability to offer low-intervention care for women who choose physiological birth in these settings.

AIM

To synthesise existing qualitative research that describes the skills and knowledge of certified midwives at home births and free-standing birth centres.

STUDY DESIGN

We conducted a systematic review that included searches on 5 databases, author runs, citation tracking, journal searches, and reference checking. Meta-ethnographic techniques of reciprocal translation were used to interpret the data set, and a line of argument synthesis was developed.

RESULTS

The search identified 13 papers, twelve papers from seven countries, and one paper that included five Nordic countries. Three overarching themes and seven sub-themes were developed: 'Building trustworthy connections,' 'Midwife as instrument,' and 'Creating an environment conducive to birth.'

CONCLUSION

The findings highlight that midwives integrated their sensorial experiences with their clinical knowledge of anatomy and physiology to care for women at home birth and in free-standing birth centres. The interactive relationship between midwives and women is at the core of creating an environment that supports physiological birth while integrating the lived experience of labouring women. Further research is needed to elicit how midwives develop these proficiencies.

"Putting the baby back in the body": The re-embodiment of pregnancy to enhance safety in a free-standing birth center

The general discourse in most countries is that technological surveillance during pregnancy and childbirth is synonymous with safety, while women's individual experiences are less likely regarded as critical. The aim of this ethnographic study at a birth center in Germany was to describe how midwives and their clients construct risk and safety. The data collection methods included participant observation and semi-structured interviews. 'Putting the baby back in the body' was the major theme that emerged, supported by three sub-themes. The women in this study relied on scans at the beginning of pregnancy to make their baby real to them, but became more confident in their capacity to sense their baby after experiencing the first fetal movements. The midwives fostered this confidence by using interactive palpation of the abdomen with the women, thus supporting their individual sensory experience, and, in the midwives' view, enhancing overall safety during pregnancy and at birth.