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
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 accessOne-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:
Subscribe to Women and BirthAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
McLean S. Autonomy, consent and the law: RoutledgeCavendish 2009.
White Ribbon Alliance. Respectful maternity care: The universal rights of women & newborns 2019. 〈https://www.whiteribbonalliance.org/wp-content/uploads/2019/10/WRA_RMC_Charter_FINAL.pdf?eType=EmailBlastContent&eId=44444444–4444-4444–4444-444444444444〉.
- The experiences of privately practising midwives in Australia who have been reported to the Australian health practitioner regulation agency: a qualitative study.Women Birth. 2021; 34: e23-e31
- We are just obsessed with risk’: healthcare providers’ views on choice of place of birth for women.Br. J. Midwifery. 2019; 27: 633-641
- Why do women choose homebirth in Australia? a national survey.Women Birth. 2021; 34: 396-404
International Childbirth Initiative. 12 steps to safe and respectful MotherBaby-Family. 2018. 〈http://www.internationalchildbirth.com〉.
Beech B. Am I allowed? What every woman needs to know before she gives birth: Birth Practice and Politics Forum; 2021.
- Caring for women making unconventional birth choices: a meta-ethnography exploring the views, attitudes, and experiences of midwives.Midwifery. 2019; 72: 50-59
- Women refusing standard obstetric care: Maternal fetal conflict or doctor-patient conflict?.J. Pregnancy Child Health. 2016; 3: 2-6
Patterson J. A time of travelling hopefully: A mixed methods study of decision making by women and midwives about maternity transfers in rural Aotearoa, New Zealand [PhD]: Victoria University; 2009.
Skinner J. Risk and the midwife: A descriptive and interpretive examination of the referral for obstetric consultation practice and attitudes of New Zealand midwives [PhD]: Victoria University of Wellington; 2005.
Young C. The experience of burnout in case loading midwives: An interpretive phenomenological study [PhD]: Auckland University of Technology; 2011.
- Midwifery continuity of care.Elsevier,, 2019
- Ways of providing midwifery continuity of care.in: Homer C. Leap N. Brodie P. Sandall J. Midwifery Continuity of Care 2 ed. Elsevier, Chatswood, Australia2019: 53-74
- Midwife-led continuity models versus other models of care for childbearing women.Cochrane Database Syst. Rev. 2016; : 4
- Operationalising caseload midwifery in the Australian public maternity system: findings from a national cross-sectional survey of maternity managers.Women Birth. 2018; 31: 194-201
- An interactive decision-making framework (i-DMF) to scale up maternity continuity of carer models.J. Res. Nurs. 2020; 25: 561-576
- Outing the researcher: the provenance, process, and practice of reflexivity.Qual. Health Res. 2002; 12: 531-545
Ford P., Crowther S., Waller N. Midwives’ experience of personal/professional risk when providing continuity of care to women who decline recommendations: A meta-synthesis of qualitative studies. 2021.
- Meta-Ethnography: Synthesizing Qualitative Studies.Sage, 1988
- A methodological systematic review of meta-ethnography conduct to articulate the complex analytical phases.BMC Med. Res. Methodol. 2019; 19: 1-18
- Qualitative metasynthesis: issues and techniques.Res Nurs. Health. 1997; 20: 365-371
Department of Health. Report of the Expert Maternity Group: Changing childbirth (Cumberlege Report). HMSO, London; 1993.
- Attitudes of midwives in Sweden toward a woman’s refusal of an emergency caesarean section or a caesarean section on request.Birth. 2011; 38: 71-79
- Kildea S. Women’s, midwives’ and obstetricians’ experiences of a structured process to document refusal of recommended maternity care.Women Birth. 2016; 29: 531-541
- Against the grain: midwives’ experiences of facilitating home birth outside of guidelines.Br. J. Midwifery. 2020; 28: 370-376
- Midwives’ experiences of caring for women whose requests are not within clinical policies and guidelines.Br. J. Midwifery. 2013; 21: 564-570
- Meta-synthesis method for qualitative research: a literature review.J. Adv. Nurs. 2005; (50{Walsh, 2005 #1163}(2)): 204-211
- Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series.Implement. Sci. 2018; 13: 2
- An interpretative phenomenological study of midwives supporting home birth for women with complex needs.Br. J. Midwifery. 2019; 27: 625-632
- Examining autonomy’s boundaries: a follow-up review of perinatal mortality cases in UK independent midwifery.Birth. 2010; 37: 280-287
- Conducting a meta-ethnography of qualitative literature: lessons learnt.BMC Med. Res. Methodol. 2008; 8: 1-10
- A mixed-methods pilot study exploring midwives’ job satisfaction: is being of service to women the key?.Eur. J. Midwifery. 2022; 6: 1-8
- Building confident ways of working together around higher-risk birth choices.Essent. MIDIRS. 2014; 5: 13-16
Baranowska B., Węgrzynowska M., Tataj-Puzyna U., Crowther S. “I knew there has to be a better way”: Women’s pathways to freebirth in Poland. Women & Birth (in press) 2021.
- Why do women choose homebirth in Australia? a national survey.Women Birth. 2021; 34: 396-404
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.
