Introduction:
Childbirth is viewed as a major life event for women
and their families. For the majority of
women this is a normal process. While
midwives have traditionally been seen as guardians of normal birth this
paradigm is beginning to change as are the needs of women becoming
pregnant. Women are now embarking on the
pregnancy journey with more complex health issues and co-morbidities. Such
issues may predispose women to an increased risk of critical illness, which the
midwife must respond to. Limited
published literature exists in relation to the midwife’s experience of
providing such care.
Aim:
The aim of this study was to explore midwives perceptions
of caring for women with critical care needs in the labour ward setting.
Methodology:
A qualitative descriptive design was utilised and a
purposive sample of ten midwives (n=10) from a stand-alone maternity unit in
the Republic of Ireland were interviewed. Ethical approval was granted from the
Ethics Committee at the study site and access to the site was then negotiated
through midwifery management. All of the midwives interviewed had at least one
year’s experience of midwifery practice on a labour ward. Participants length of experience as a midwife varied from three to twenty years.
Results:
Following thematic analysis using Braun and Clarke’s
framework (2013) four themes emerged: provision of safe care, support,
education and psychological impact. The
findings of this study highlighted that midwives generally learn how to care
for women with critical care needs through experience gained in practice. Support in practice was considered essential
in the provision of safe patient care with midwives noting the support of the
multidisciplinary team as particularly important. Barriers to support midwives in practice
included the infrastructure of the organisation and the power struggle that
existed between doctors and midwives.
Irrespective of support and experience all midwives expressed a need for
specialist training and education to care for this cohort of women. Midwives
noted too how critical illness can have a psychological impact on women and
themselves.
Conclusion:
There is a significant need for education and
training in this area of practice. This could include a theory component
accompanied by competence assessment.
Psychological supports too need to be put in place for women in receipt
of such care and for midwives delivering this care including an emphasis on
building resilience in the workplace for midwives.
Reference
Braun V, and Clarke V (2013) Successful qualitative research London: Sage