UK midwives' perspective on the practice of intrapartum midwifery-led care within the hospital setting: a qualitative study

By Student at Kings College London, Rachel Housego on 11 May 2022

Background  

Women and children who would have previously died in childbirth are now alive due to advancements in obstetrics. Data, however, shows increased epidural rates (CQC, 2020), planned caesarean rates, and decreased vaginal birth rates. There are, however, clear arguments as to the negative effects of medical input in maternity care, not least the complications associated with obstetric procedures.  

Complications from caesarean section or operative deliveries include increased risk of haemorrhage, DVT and infection, whilst caesarean section also impacts future pregnancy due to an increased risk of uterine rupture (NHS, 2019). Balancing the risks and benefits of normal birth versus high risk procedures is a complex issue, but evidence suggests midwives are finding it increasingly difficult to advocate normal childbirth due to medical domination (Hadjigeorgio and Coxon, 2014; Hopkins 2000; Bosch 1998).  

A ‘blame culture’ mentality is also rife in maternity care (Lintern, 2021) and indicates a rationale for increased and potentially unnecessary intervention. Between 2009 and 2020 the number of compensation claims relating to maternity has almost doubled (Lintern, 2021). Furthermore, studies have shown midwives are leaving the profession due to the blame culture (Ford, 2020). In the context of the increasing rate of intervention, this study answers a call from Wong et al (2017) to analyse midwives’ perceptions of physiological birth. It is crucial that we understand the social factors that impact a midwives’ ability to provide midwife-led care to promote psychological birth in cases where this is most appropriate. ICEA defines “physiological birth as a birth where the baby is birthed vaginally following a labour which has not been modified by medical interventions”. 

Aim

The aim of this study is to identify the barriers and facilitators to midwives practicing midwifery-led care, within the hospital setting, during the intrapartum period.

The objectives of the study are: 

  • To analyse midwives’ perceptions of physiological intrapartum care 
  • To understand the extent to which midwives feel they can promote physiological labour and birth 
  • To identify barriers and facilitators to midwives providing midwifery-led care and physiological labour and birth 

Participants 

If you are a qualified midwife with a minimum of 6 months experience working on a midwifery-led birth centre or obstetric-led delivery unit, you are invited to take part in the focus groups (which will be conducted online via Microsoft Teams)

How to take part 

Please contact Rachel.housego@kcl.ac.uk to express your interest in taking part in the study.

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