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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Article info
Publication history
Published online: May 23, 2021
Accepted:
May 16,
2021
Received in revised form:
May 13,
2021
Received:
February 10,
2021
Identification
Copyright
© 2021 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
