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Midwives must, obstetricians may: An ethnographic exploration of how policy documents organise intrapartum fetal monitoring practice

  • Kirsten A. Small
    Correspondence
    Corresponding author:
    Affiliations
    Transforming Maternity Care Collaborative

    School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, 4131, Qld, Australia

    Grafton Base Hospital, Northern NSW Local Health District, Arthur Street, Grafton, 2460, NSW, Australia
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  • Mary Sidebotham
    Affiliations
    Transforming Maternity Care Collaborative

    School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, 4131, Qld, Australia
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  • Jennifer Fenwick
    Affiliations
    Transforming Maternity Care Collaborative

    School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, 4131, Qld, Australia

    Gosford Hospital, Central Coast NSW Local Health District, Gosford, 2250, NSW, Australia
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  • Jenny Gamble
    Affiliations
    Transforming Maternity Care Collaborative

    School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, 4131, Qld, Australia
    Search for articles by this author

      Abstract

      Background

      The capacity for midwifery to improve maternity care is under-utilised. Midwives have expressed limits on their autonomy to provide quality care in relation to intrapartum fetal heart rate monitoring.

      Aim

      To explore how the work of midwives and obstetricians was textually structured by policy documents related to intrapartum fetal heart rate monitoring.

      Methods

      Institutional Ethnography, a critical qualitative approach was used. Data were collected in an Australian hospital with a central fetal monitoring system. Midwives (n = 34) and obstetricians (n = 16) with experience working with the central fetal monitoring system were interviewed and observed. Policy documents were collected and analysed.

      Findings

      Midwives’ work was strongly structured by policy documents that required escalation of care for any CTG abnormality. Prior to being able to escalate care, midwives were often interrupted by other clinicians uninvited entry into the room in response to the CTG seen at the central monitoring station. While the same collection of documents guided the work of both obstetricians and midwives, they generated the expectation that midwives must perform certain tasks while obstetricians may perform others. Midwifery work was textually invisible.

      Discussion and conclusion

      Our findings provide a concrete example of the way policy documents both reflect and generate power imbalances in maternity care. Obstetric ways of knowing and doing are reinforced within these documents and continue to diminish the visibility and autonomy of midwifery. Midwifery organisations are well placed to co-lead policy development and reform in collaboration with maternity consumer and obstetric organisations.

      Keywords

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