Research Article| Volume 33, ISSUE 5, e455-e463, September 2020

Download started.


A qualitative study of factors that influence midwives’ practice in relation to low-risk women’s oral intake in labour in Australia

Published:November 30, 2019DOI:



      Restriction of food and fluids during labour increases women’s discomfort, anxiety and stress which are associated with obstruction of the normal process of labour. Whilst research evidence and clinical guidelines recommend that normal uncomplicated labouring women should not be limited in their oral intake during labour, some midwives continue to restrict or discourage women’s oral intake. To promote best practice, it is important to understand the influencing factors which affect midwives’ decision-making processes.


      This study aimed to investigate the influences that affect midwifery practice regarding oral food and fluid intake for low-risk labouring women.


      An interpretive descriptive approach employed 12 semi-structured interviews with registered midwives with current labour and birthing experience in Australia. Data was analysed using thematic analysis.


      Three themes were identified: midwives’ knowledge and beliefs; work environment and women’s expectations of care. Midwives’ practice was affected by their knowledge and values developed from professional and personal experiences of labour, their context of practice and work environment, the clinical guidelines, policies and obstetric control, and women’s choice and comfort.


      This study indicates that midwives’ decision-making in relation to women’s oral nutrition during labour is multifaceted and influenced by complicated environments, models of care, and power relations between doctors and midwives, more so than clinical guidelines. It is important for midwives to be aware of factors negatively influencing their decision-making processes to enable autonomy and empowerment in the provision of evidence-based care of labouring women.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Nursing and Midwifery Board of Australia
        Midwife Standards for Practice.
        • King R.
        • Glover P.
        • Byrt K.
        • Porter-Nocella L.
        Oral nutrition in labour: ‘whose choice is it anyway?’ a review of the literature.
        Midwifery. 2011; 27: 674-686
        • The Royal College of Midwives
        Evidence Based Guidelines for Midwifery-Led care in Labour, Nutrition in Labour.
        2012 (Accessed 23/5/18)
        • Hunt L.
        Literature review: eating and drinking in labour.
        Br. J. Midwifery. 2013; 21: 499-502
        • Singata M.
        • Tranmer J.
        • Gyte G.M.L.
        Restricting oral fluid and food intake during labour (review).
        Cochrane Collab. 2013; 8: 1-104
        • Australian Institute of Health and Welfare
        Maternal Deaths in Australia in 2006-2010.
        • World Health Organization (WHO) and UNICEF
        Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for Essential Practice.
        2015 (Accessed 26/8/17)
        • Tillett J.
        • Hill C.
        Eating and drinking in labour.
        J. Perinat. Neonatal Nurs. 2016; 30: 85-87
        • Parsons M.
        A midwifery practice dichotomy on oral intake in labour.
        Midwifery. 2004; 20: 72-81
        • Sarts-Hopko N.
        Oral intake during labor: a review of the evidence.
        Am. J. Matern. Child Nurs. 2010; 35: 197-203
        • Everly C.
        Facilitators and barriers of independent decisions by midwives during labor and birth.
        J. Midwifery Womens Health. 2012; 57: 49-54
        • Cheyne H.
        • Dowding D.
        • Hundley V.
        Making the diagnosis of labour: midwives’ diagnostic judgement and management decisions.
        J. Adv. Nurs. 2006; 53: 625-635
        • Blix-Lindström S.
        • Johansson E.
        • Christensson K.
        Midwives’ navigation and perceived power during decision-making related to augmentation of labour.
        Midwifery. 2008; 24: 190-198
        • Toohill J.
        • Sidebotham M.
        • Gamble J.
        • Fenwick J.
        • Creedy D.K.
        Factors influencing midwives’ use of an evidenced based normal birth guideline.
        Women Birth. 2017; 30: 415-423
        • Freeman L.M.
        • Adair V.
        • Timperley H.
        • West S.
        The influence of the birthplace and models of care on midwifery practice for the management of women in labour.
        Women Birth. 2006; 19: 97-105
        • Martin C.H.
        • Bull P.
        Measuring social influence of a senior midwife on decision‐making in maternity care: an experimental study.
        J. Commun. Appl. Soc. Psychol. 2005; 15: 120-126
        • Noseworthy D.
        • Phibbs S.R.
        • Benn C.A.
        Towards a relational model of decision-making in midwifery care.
        Midwifery. 2013; 29: 42-48
        • Schneider Z.
        • Whitehead D.
        • LoBiondo-Wood G.
        • Haber J.
        Nursing and Midwifery Research: Methods and Appraisal for Evidence-Based Practice.
        5th ed. Mosby Elsevier, Sydney2016
        • Thorne S.
        Interpretive Description: Qualitative Research for Applied Practice.
        2nd ed. Routledge, New York2016
        • Guest G.
        • Bunce A.
        • Johnson L.
        How many interviews are enough?: an experiment with data saturation and variability.
        Field Methods. 2006; 18: 59-82
        • Braun V.
        • Clarke V.
        Thematic analysis.
        in: Cooper H. Camic P.M. Long D.L. Panter A.T. Rindskopf D. Sher K.J. APA Handbook of Research Methods in Psychology, Vol 2: Research Designs: Quantitative, Qualitative, Neuropsychological, and Biological. American Psychological Association, Washington2012: 57-71
        • Dahlen H.G.
        • Tracy S.
        • Tracy M.
        • Bisits A.
        • Brown C.
        • Thornton C.
        Rates of obstetric intervention among low-risk women giving birth in private and public hospitals in NSW: a population-based descriptive study.
        BMJ Open. 2017; 2: 1-9
        • Hegney D.
        Practice nursing in rural Australia.
        Contemp. Nurse. 2007; 26: 74-82
        • Kruske S.
        • Young K.
        • Jenkinson B.
        • Catchlove A.
        Maternity care providers’ perceptions of women’s autonomy and the law.
        BMC Pregnancy Childbirth. 2013; 13: 84-88
        • Considine J.
        • Botti M.
        • Thomas S.
        Do knowledge and experience have specific roles in triage decision-making?.
        Acad. Emerg. Med. 2007; 1: 722-726
        • Australian Nursing and Midwifery Council
        Code of Professional Conduct for Nurses.
        • Jefford E.
        • Fahy K.
        • Sundin D.
        Decision-Making Theories and their usefulness to the midwifery profession both in terms of midwifery practice and the education of midwives.
        Int. J. Nurs. Pract. 2011; 17: 246-253
        • Hunter B.
        Emotion work and boundary maintenance in hospital-based midwifery.
        Midwifery. 2005; 21: 253-266
        • Reiger K.M.
        • Lane K.L.
        Working together: collaboration between midwives and doctors in public hospitals.
        Aust. Health Rev. 2009; 33: 315-324
        • Freeman L.M.
        • Griew K.
        Enhancing the midwife–woman relationship through shared decision making and clinical guidelines.
        Women Birth. 2007; 20: 11-15
        • Parsons M.
        • Griffiths R.
        The effect of professional socialisation on midwives’ practice.
        Women Birth. 2007; 20: 31-34
        • Larkin P.
        • Begley C.M.
        • Devane D.
        Women’s experiences of labour and birth: an evolutionary concept analysis.
        Midwifery. 2009; 25: e49-e59
        • Lyndon A.
        • Zlatnik M.G.
        • Wachter R.M.
        Effective physician-nurse communication: a patient safety essential for labor and delivery.
        Am. J. Obstet. Gynecol. 2011; 205: 91-96