Abstract
Problem
Women’s autonomous choices in pursuit of physiological childbirth are sometimes limited
by the midwife’s willingness to support those choices, particularly when those choices
are contrary to recommendations or outside of guidelines.
Background
Women’s reasons for making such choices have received some research attention, however
there is a paucity of research examining this phenomenon from the perspective of caseloading
midwives’ and their perception of personal/professional risk in such situations.
Aim
To synthesise qualitative research which includes the voices of midwives working in
a continuity of carer model who perceive any kind of risk to themselves when caring
for women who decline current established recommendations.
Methods
Systematic literature search and meta-synthesis were carried out following a pre-determined
search strategy. The search was executed in April 2021 and updated in July 2021. Studies
were assessed for quality using JBI Critical Appraisal Checklist for Qualitative Research.
Data extraction was assisted by JBI QARI Data Extraction Tool for Qualitative Research.
GRADE-CERQual was applied to the findings.
Findings
Eight studies qualified for inclusion. Five main themes were synthesised as third
order constructs and were incorporated into a line of argument: Women’s rights to
bodily autonomy and choice in childbearing are violated, and their ability to access
safe midwifery care in pursuit of physiological birth is restricted, when midwives
practise within a maternity system which is adversarial towards midwives who provide
the care which women require. Midwives who provide such care place themselves at risk
of damaged reputation, collegial conflict, intimidating disciplinary processes, tensions
of ‘being torn’, and a heavy psychological load. Despite these personal and professional
risks, midwives who provide this care do so because it is the ethical and moral thing
to do, because they recognise that women need them to, because it can be very rewarding,
and because they are able to.
Conclusion
Maternity systems and colleagues can be key risk factors for caseloading midwives
who facilitate women’s right to decline recommendations. These identified risks can
make it unsustainable for midwives to continue providing woman-centred care and contribute
to workforce attrition, reducing options/choices for women which paradoxically increases
risk to women and babies.
Keywords
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Article Info
Publication History
Published online: July 19, 2022
Accepted:
June 28,
2022
Received in revised form:
May 19,
2022
Received:
January 18,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
