From worry to hope : an ethnography of midwife - woman interactions in the antenatal appointment

Abstract

Better outcomes for mother and baby observed in 'midwifery continuity of carer' programmes are attributed to positive midwife-woman relationships formed within these models, but this effect is not fully understood. Like midwife-led care, continuity of midwifery carer in Australia continues not to be seen as mainstream. To advocate for and better understand this continuity of carer model, this study used video ethnography framed by feminism and a critical approach. Midwife-woman interactions in a number of late pregnancy antenatal appointments were observed and filmed. These were at two Sydney hospitals with either the midwifery continuity of carer programme or in standard maternity care. Focus groups and interviews were undertaken. Thematic and content analysis techniques were used. Worry was a common feature of the antenatal appointment. It reflects the worry pregnant women report: worry about pregnancy, their baby, uncertainty about birth and transition to motherhood. 'Dysfunctional' or 'iatrogenic' worry occurred with system-focused midwives invested in standardised/medicalised tasks, whereas 'functional' worry occurred with woman-centred midwives invested in the woman. Hope creation was also seen, although less frequently. It occurred when worry was moderated and linked with adaptation of standardised and medicalised appointment factors, including environment, time, and midwife investment (how she interacted with the woman). Regardless of where they worked, some midwives were 'adaptive experts', but in most instances the midwives in continuity had greater opportunity to adapt. This adaptation resulted in midwife-woman interactions being bidirectional and shared, with discussing and storytelling taking place, rather than one-way midwife telling. These shared interactions created connection, or reflected the connection created by continuity of carer. This study showed the benefit of the midwifery continuity of carer programme. It provided opportunity for midwives to adapt, worry was moderated, and women appeared more hopeful. Being more hopeful may enable women to better manage their labours and parenting, creating these improved outcomes.

Date of Award	2018
Original language	English