Western Australian Midwives’ Perceptions and Experiences of Being ‘With Woman’ During Labour and Birth

Being ‘with woman’ is an important construct of the midwifery profession and is included in philosophy statements of leading midwifery organisations globally. Despite its centrality, little research has been conducted to offer evidence around this phenomenon. A phenomenological approach was undertaken to explore Western Australian midwives’ perceptions and experiences of being ‘with woman’ in a variety of models. Findings revealed that while midwives perceived the phenomenon similarly, experiences were distinct to the model worked in

Midwives' perceptions of being 'with woman': A phenomenological study

© 2019 The Author(s). Background: Being 'with woman' is a central construct of the midwifery profession however, minimal research has been undertaken to explore the phenomenon from the perspective of midwives. The aim of this study was to describe Western Australian midwives' perceptions of the phenomenon of being 'with woman' during the intrapartum period. Methods: Descriptive phenomenology was selected as the methodology for this study. Thirty one midwives working across a variety of care models participated in individual interviews. Giorgi's four stage phenomenological approach was employed to analyse data. Results: Three themes were extracted 1) Essential to professional identity; 2) Partnership with women; and 3) Woman-Centred Practice. Midwives described the importance of being 'with woman' to the work and identification of midwifery practice. Developing a connection with the woman and providing woman-centred care inclusive of the woman's support people was highlighted. Conclusions: For the first time, we are able to offer evidence of how midwives understand and perceive the phenomenon of being 'with woman' which has theoretical and practical utility. Findings from this study provide evidence that supports expert commentary and confirms that midwives conceptualise the phenomenon of being 'with woman' as essential to the identity and practice of the profession. Some previously identified 'good midwifery practices' were revealed as practical manifestations of the phenomenon. This new knowledge facilitates clarity and provides evidence to support statements of professional identity, which is useful for the development of educational curricula as well as supporting graduate and professional midwives. The findings emphasise the importance of the development of language around this important philosophical construct which permeates midwifery practice, enhances professional agency and supports the continued emphasis of being 'with woman' with new understanding of its applied practices in a variety of care models

The MidPIC study : midwives’ knowledge, perspectives and learning needs regarding preconception and interconception care

Preconception and interconception care improves health outcomes of women and communities. Little is known about how prepared and willing Australian midwives are to provide preconception and interconception care. The aim of this study was to explore midwives’ knowledge, perspectives and learning needs, and barriers and enablers to delivering preconception and interconception care. We conducted a cross-sectional exploratory study of midwives working in any Australian maternity setting. An online survey measured midwives’ self-rated knowledge; education needs and preferences; attitudes towards pre and interconception care; and views on barriers, enablers; and, future service and workforce planning. Quantitative data were analysed descriptively and demographic characteristics (e.g., years of experience, model of care) associated with knowledge and attitudes regarding pre- and interconception care were examined using univariate logistic regression analysis. Qualitative data were captured through open-ended questions and analysed using inductive content analysis. We collected responses from (n = 338) midwives working across all models of care (full survey completion rate 96%). Most participants (n = 290; 85%) rated their overall knowledge about pre and interconception health as excellent, above average or average. Participants with over 11 years of experience were more likely to report above average to excellent knowledge (OR 3.11; 95% CI 1.09, 8.85). Online e-learning was the most preferred format for education on this topic (n = 244; 72%). Most (n = 257; 76%) reported interest in providing pre and interconception care more regularly and that this is within the midwifery scope of practice (n = 292; 87%). Low prioritisation in service planning was the most frequently selected barrier to providing preconception and interconception care, whereas continuity models and hybrid child health settings were reported as enablers of pre and interconception care provision. Findings revealed that midwives are prepared and willing to provide preconception and interconception care. Pre and post registration professional development; service and funding reform; and policy development are critical to enable Australian midwives’ provision of pre and interconception care

"It's what midwifery is all about": Western Australian midwives' experiences of being 'with woman' during labour and birth in the known midwife model

Background: The phenomenon of being 'with woman' is fundamental to midwifery as it underpins its philosophy, relationships and practices. There is an identified gap in knowledge around the 'with woman' phenomenon from the perspective of midwives providing care in a variety of contexts. As such, the aim of this study was to explore the experiences of being 'with woman' during labour and birth from the perspective of midwives' working in a model where care is provided by a known midwife. Methods: A descriptive phenomenological design was employed with ten midwives working in a 'known midwife' model who described their experiences of being 'with woman' during labour and birth. The method was informed by Husserlian philosophy which seeks to explore the same phenomenon through rich descriptions by individuals revealing commonalities of the experience. Results: Five themes emerged 1) Building relationships; 2) Woman centred care; 3) Impact on the midwife; 4) Impact on the woman; and 5) Challenges in the Known Midwife model. Midwives emphasised the importance of trusting relationships while being 'with woman', confirming that this relationship extends beyond the woman - midwife relationship to include the woman's support people and family. Being 'with woman' during labour and birth in the context of the relationship facilitates woman-centred care. Being 'with woman' influences midwives, and, it is noted, the women that midwives are working with. Finally, challenges that impact being 'with woman' in the known midwife model are shared by midwives. Conclusions: Findings offer valuable insight into midwives' experiences of being 'with woman' in the context of models that provide care by a known midwife. In this model, the trusting relationship is the conduit for being 'with woman' which influences the midwife, the profession of midwifery, as well as women and their families. Descriptions of challenges to being 'with woman' provide opportunities for professional development and service review. Rich descriptions from the unique voice of midwives, provided insight into the applied practices of being 'with woman' in a known midwife model which adds important knowledge concerning a phenomenon so deeply embedded in the philosophy and practices of the profession of midwifery

Women's experiences with breastfeeding in public: An integrative review

© 2020 Australian College of Midwives Background: Much evidence around public breastfeeding does not reflect experiences of the key stakeholder, the breastfeeding woman, and focuses upon the audience. Selective evidence has explored breastfeeding experiences revealing challenges with public breastfeeding as a serendipitous finding. Although women's experiences have been explored in specific contexts, insight into commonalities reflective of an international perspective is unknown. Objective: to explore, review and synthesise published literature on women's experience with public breastfeeding. Methods: An integrative review allows inclusion of findings beyond empirical evidence. Whittemore and Knafl's approach was used to capture and analyse evidence from varied sources to provide understanding of a phenomenon from diverse methodologies. PubMed, Medline, Ovid emBase, Scopus, Science Direct, the Cumulative Index of Nursing and Allied Health Literature and PsychINFO were searched. Inclusion criteria included publications in English after 2005 offering descriptions of women's experiences. Data evaluation included assessment of literature quality. A constant comparison approach involved comparing, analysing and drawing similar concepts into themes. Findings: Integration of women's experience with public breastfeeding from 27 publications covering 12 countries revealed two key themes, what women shared as ‘enhancing’ and ‘challenging’. Challenges included four subthemes: ‘drawing attention’, ‘sexualisation of breasts’, ‘awareness of others’ discomfort’, and ‘efforts not to be seen’. Enhancing incorporated subthemes: ‘supportive audience’ and ‘confidence’. Conclusion: Challenges confirm an international commonality that women encounter during public breastfeeding suggesting a multilayered approach addressing community and societal behaviours is required. Insight to enhance public breastfeeding experiences offers direction to improve support

"In the shape that she needs me": The 'with woman' relationship in three different practice contexts

Background: Being ‘with woman’ is central to midwifery philosophy, cited in statements by professional midwifery organisations around the world. Despite its asserted importance, very little research has been undertaken to describe or understand the phenomenon of being ‘with woman’. Aim: The aim of this study was to explore Western Australian midwives’ experiences of being ‘with woman’ during labour and birth in a variety of contexts. Method: Descriptive phenomenology was chosen as the methodology for this study as it useful for revealing constituents of the same phenomena as it is experienced by different individuals. A total of 31 midwives participated in in-depth interviews. Midwives worked in one of three different models where labour and birth care was provided by known midwives, unknown midwives; or unknown midwives and known obstetricians. Findings: Midwives described experiences of being ‘with woman’ in the context of three models which were unique and distinct in each. Relationship with the woman was inherent to being ‘with woman’ but expressed and experienced differently in each model. Midwives in continuity models emphasised how their trusting relationship built over time enhanced being ‘with woman’ and sustained their passion for midwifery practice in this context. Building a connection, for midwives who were not known to the woman in a public hospital model required highly developed skills to build a rapid rapport with a woman they had not met before. A unique triad relationship between woman, obstetrician and midwife occurred in the private obstetric model which both enabled and challenged being ‘with woman’. Implications: The innovative findings provide insight into how the phenomenon of being ‘with woman’ is experienced within the context of the different models. Insights gained are useful to facilitate the teaching and learning of ‘with woman’ and to appreciate the unique features and role of the woman-midwife relationships built in each setting

Midwives and registered nurses' role and scope of practice in acute early pregnancy care services in Australia: a scoping review protocol.

OBJECTIVE: The objective of this review is to review and synthesize what is documented on the role and scope of practice of midwives and registered nurses working in acute early pregnancy care settings in Australia. INTRODUCTION: Women experiencing complications before 20 weeks of pregnancy may need to attend an acute care service, often a hospital emergency department. Both midwives and registered nurses provide care for women with early pregnancy complications, and it is important that their role and scope of practice is documented. This review will explore the literature relating to acute early pregnancy care in Australia to better understand how midwives' and registered nurses' roles and scope are currently described in this setting. INCLUSION CRITERIA: Any literature that explores the role and scope of practice of midwives and registered nurses who care for women who present to acute care services in Australia with early pregnancy complications will be considered for inclusion in the review. METHODS: A 3-step review process will involve a preliminary search of MEDLINE and ProQuest, followed by a more detailed search of a larger selection of databases, using identified keywords and phrases from the initial search. Reference lists of retrieved literature will then be examined for relevant citations. Literature in English will be considered, including relevant gray literature. Search results will be imported into reference and review support software. Data that align with the inclusion criteria will be organized into tabulated and narrative formats for presentation. SYSTEMATIC REVIEW REGISTRATION NUMBER: Open Science Framework osf.io/5bnqz

Online portfolio for midwifery student assessment and recording of clinical experiences

Introduction: Across Australia, the healthcare industry is moving to paperless modes of documentation. The introduction of a paperless portfolio for midwifery students follows this directive and prepares students for working in a moving technological environment. Aim: Midwifery students at Curtin University have historically recorded compulsory clinical experiences (over 300) using paper templates in a written portfolio. Records were easily lost, feedback from facilitators inconsistent and the mode of documentation outdated. Innovation: The School of Nursing, Midwifery and Paramedicine purchased an online digital personalised tutoring platform for healthcare (PebblePad) in 2016. The program has been implemented to replace the written portfolio for all new-to-course students and existing students on an elective basis. The PebblePad ‘Midwifery Practice Record’ (MPR) has been specifically designed by the midwifery teaching team, so that it contains all templates for all clinical experiences, Nursing and Midwifery Board of Australia (NMBA) registration specific competencies and reflections. Students can be formatively and summatively assessed, as both preceptors and lecturers have secure access and signature capabilities. Discussion: Implementation of an online portfolio has meant sweeping changes for the students, preceptors, clinicians and industry partners. Policies and user guides have smoothed the transition. Anecdotal student feedback suggests that the MPR is accessible and easy to use, and students participate in peer teaching of subsequent cohorts. Students are also able to keep their account at no cost, for ongoing recording of professional development, which supports lifelong learning. Industry response has been positive as it matches their demands of moving to a paperless system. The online portfolio has not only meets industry demand but also allows real-time feedback, which is particularly beneficial to remote students. Conclusions and implications for practice: The development and implementation of this new technology was a steep learning curve for students, staff and industry but has resulted in positive feedback regarding formative and summative assessment and portability

The power of identity: Midwives 'with woman'

Background: Being ‘with woman’ is a fundamental construct of the midwifery profession, inherent in professional standards and philosophy statements around the world. Despite its centrality, very little research has been undertaken to explore the phenomenon. Aim: The aim of this study was to explore Western Australian midwives’ perceptions of the phenomenon of being ‘with woman’. Method: Descriptive phenomenology was selected as the methodology for this study; known for its usefulness in facilitating understanding by revealing perspectives and lived experiences of phenomena. Thirty one midwives working in a variety of practice contexts participated in in-depth interviews. Giorgi's four-stage phenomenological method was used for data analysis. Findings: Three main themes were revealed (1) essential to professional identity; (2) partnership with women; and (3) woman centred practice. Discussion: For the first time, we are able to offer an understanding of how midwives themselves conceptualise the phenomenon of being ‘with woman’. Midwives have also revealed how broader ‘woman-centred’ practices articulate into the phenomenon of being ‘with woman’ which is significant. Findings support the professional commentary of midwifery leaders and emphasise the asserted importance of being ‘with woman’ to the profession of midwifery. Implications: The innovative findings of this study offer a conceptualisation of a phenomenon so central to the profession of midwifery which offers both theoretical and practical utility. New evidence provided in this study delivers clarity and empirical support to statements of professional identity which will be useful for the development of future strategic professional documents, educational curricula and in supporting graduate and professional midwives. The development of a framework of language around this important philosophical construct which permeates midwifery practice, enhances professional agency and supports the continued emphasis of being ‘with woman’ with a fresh perspective of its applied practices in a variety of contexts