Mapping the emotional terrain of midwifery: what can we see and what lies ahead?

Greater understanding of midwives' emotion work could potentially improve practitioner/client and collegial relationships, and inform future organisation and delivery of maternity care. However, midwives' emotion work remains relatively unrecognised and under-investigated. Drawing on a previous paper (Hunter, 2001), I contrast previous and current knowledge in the field. Four key areas appear significant: impact of work context and organisation; midwife-woman relationships; collegial relationships; emotion work as coercion or gift? More research is needed into how midwives manage emotions and learn emotion management skills. Trends towards ''high tech but low care solutions'' (Kirkham, 2009, p.237) have implications for future emotion work study

Relationships between working conditions and emotional wellbeing in midwives

Background Emotional distress in midwives contributes to high attrition. To safeguard midwives’ wellbeing, there is a need to identify the impact of workplace variables. Aim To review the existing evidence on the relationships between working conditions and emotional wellbeing in midwives, and construct an analytic framework for understanding these relationships. Methods Systematic search and selection procedures using a range of databases. Results of included studies were synthesised into a thematic literature review of qualitative and quantitative research. Findings Various types of poor emotional wellbeing in midwives correlate with a variety of interrelated working conditions, including low staffing/high workload, low support from colleagues, lack of continuity of carer, challenging clinical situations and low clinical autonomy. Staffing levels seem to be able to modify the effects of many other variables, and the impact of challenging clinical situations is affected by several other variables. Discussion These workplace variables can be categorised as modifiable and non-modifiable risk indicators. Conclusion While certain conditions that correlate with midwives’ wellbeing are non-modifiable, several crucial variables, such as staffing levels and continuity of carer, are within the control of organisational leadership. Future research and interventions should focus on these modifiable risks. Research design should maximise the chance of establishing causation, while any innovations in this area should anticipate the interrelatedness of these risk factors to avoid unintended negative consequences

Renegotiating inter-professional boundaries in maternity care: implementing a clinical pathway for normal labour

This article presents findings from a study of a clinical pathway for normal labour (Normal Labour Pathway) implemented in Wales, UK. The study was conducted between 2004 and 2006. The pathway aimed to support normal childbirth and reduce unnecessary childbirth interventions by promoting midwife-led care. This article focuses on how the pathway influenced the inter-professional relationships and boundaries between midwives and doctors. Data are drawn from semi-participant observation, focus groups and semi-structured interviews with 41 midwives, and semi-structured interviews with five midwifery managers and six doctors, working in two research sites. Whereas some studies have shown how clinical pathways may act as ‘boundary objects’, dissolving professional boundaries, promoting interdisciplinary care and de-differentiating professional identities, the ‘normal labour pathway’ was employed by midwives as an object of demarcation, which legitimised a midwifery model of care, clarified professional boundaries and accentuated differences in professional identities and approaches to childbirth. The pathway represented key characteristics of a professional project: achieving occupational autonomy and closure. Stricter delineation of the boundary between midwifery and obstetric work increased the confidence and professional visibility of midwives but left doctors feeling excluded and undervalued, and paradoxically reduced the scope of midwifery practice through redefining what counted as normal

Resilience in UK midwifery: the importance of self-awareness and professional identity

Background: Midwifery is widely acknowledged as emotionally challenging work. Many midwives work in situations of adversity, with negative effects on wellbeing, morale and retention. However, not all midwives respond negatively to adversity. Some describe continued passion for their work, demonstrating resilience: the ability to respond positively and consistently to adversity. Aim: To explore UK midwives’ understanding and experience of resilience and identify factors involved in developing midwifery resiliency. This is the first study to focus directly on midwifery resilience. Method: A self-selected sample of midwives was recruited via the UK Royal College of Midwives (RCM) journal. Inclusion criteria were: participants in clinical practice for 15 or more years and self-identifying as ‘resilient’. A closed online discussion group was conducted between October- November 2012, facilitated by the research team. Eleven midwives actively participated in the discussions. Qualitative data were analysed thematically using NVIVO. Study rigour was enhanced by independent cross-checking of coding, and an Expert Group consultation assisted data interpretation and concept modelling. Ethical approval was obtained from School Research Ethics Committee at Cardiff University. Participation was voluntary. Participants received study information prior to consent and were guaranteed anonymity throughout. Key findings: Four major themes were identified: Challenges to resilience; Managing and coping; Self-awareness and self-identity; Building resiliency. This paper focuses on Self-awareness and Self-identity, which featured strongly in the data. Participants perceived that resilience could be developed over time; key factors in building resiliency were ‘knowing oneself’ and having well-integrated professional and personal identities. Implications: Insights from ‘resilient’ midwives indicate that it may be possible to develop educational and practice-based strategies to facilitate resiliency. This in turn should help midwives to manage the emotional demands of their work and may improve workforce retention. This has potential benefits for midwifery internationally

Addressing social inequity through improving relational care: A social–ecological model based on the experiences of migrant women and midwives in South Wales

Background: Migrant and ethnic inequalities in maternal and perinatal mortality persist across high-income countries. Addressing social adversity and inequities across the childbirth trajectory cannot be left to chance and the good intentions of practitioners. Robust, evidence-based tools designed to address inequity by enhancing both the quality of provision and the experience of care are needed. Methods: An inductive modelling approach was used to develop a new evidence-based conceptual model of woman–midwife relationships, drawing on data from an ethnographic study of relationships between migrant Pakistani women and midwives, conducted between 2013 and 2016 in South Wales, UK. Key analytic themes from early data were translated into social–ecological concepts, and a model was developed to represent how these key themes interacted to influence the woman–midwife relationship. Results: Three key concepts influencing the woman–midwife relationship were developed from the three major themes of the underpinning research: (1) Healthcare System; (2) Culture and Religion; and (3) Family Relationships. Two additional weaving concepts appeared to act as a link between these three key concepts: (1) Authoritative Knowledge and (2) Communication of Information. Social and political factors were also considered as contextual factors within the model. A visual representation of this model was developed and presented. Conclusions: The model presented in this paper, along with future work to further test and refine it in other contexts, has the potential to impact on inequalities by facilitating future discussion on cultural issues, encouraging collaborative learning and knowledge production and providing a framework for future global midwifery practice, education and research. Patient or Public Contribution: At the outset of the underpinning research, a project involvement group was created to contribute to study design and conduct. This group consisted of the three authors, an Advocacy Officer at Race Equality First and an NHS Consultant Midwife. This group met regularly throughout the research process, and members were involved in discussions regarding ethical/cultural/social issues, recruitment methods, the creation of participant information materials, interpretation of data and the dissemination strategy. Ideas for the underpinning research were also discussed with members of the Pakistani community during community events and at meetings with staff from minority ethnic and migrant support charities (BAWSO, Race Equality First, The Mentor Ring). Local midwives contributed to study design through conversations during informal observations of antenatal appointments for asylum seekers and refugees

Eat Well Keep Active: Qualitative findings from a feasibility and acceptability study of a brief midwife led intervention to facilitate healthful dietary and physical activity behaviours in pregnant women

Pregnant women often find it difficult to follow recommendations for a healthy lifestyle and some women refer back to pregnancy as being the start of their problems with obesity. This paper reports the findings of a study designed to test the feasibility and acceptability of a brief, novel, midwifery led intervention to encourage healthy lifestyle in pregnancy. The intervention was theoretically driven, based on Self Determination Theory and utilised Motivational Interviewing to facilitate motivation to pursue a healthy lifestyle. This paper reports the qualitative finding from semi-structured interviews with a sample of 20 pregnant women. The findings suggest that the three psychological needs of Self Determination Theory are supported, the intervention was received well by participants who also reported positive change in lifestyle behaviours. Theoretically driven interventions for pregnant women, such as the novel intervention reported here are scarce. The Eat Well Keep Active has the potential to make a difference to women before, during and after pregnancy in motivating healthy lifestyle behaviour