Midwives’ experiences of normalizing childbirth in Malta

Abstract

The concept of normality and its impact during childbirth, is a highly debated topic between healthcare professionals in the maternity setting worldwide. Despite this, little is known about the experiences of midwives locally, on normalizing childbirth. The aim of this qualitative study was to explore midwives’ experiences of normalising childbirth. The objectives of the study were to identify midwives’ perspectives of factors which promote normality in childbirth and to determine midwives’ views of factors which hinder normality in childbirth. To accomplish these objectives, a qualitative approach was adopted, and one-time, semi-structured, face-to-face interviews were conducted with a purposive sample of eight midwives using an interview schedule which was selfdesigned by the researcher. All the midwives who met the inclusion criteria for participation and were approached, participated voluntarily. The interviews were audiotaped and transcribed verbatim. The transcripts were analysed using thematic analysis as described by Braun and Clarke (2006). Findings of this study indicate that midwives’ understanding of normality in labour varies greatly, although their main aim being the optimum health outcomes of the mother and infant is similar. Moreover, the participants’ experiences around the concept of normalisation during childbirth locally are affected greatly by more hindering factors, as opposed to promoting factors of normality. Findings also revealed that although a lot of efforts are made by the midwives to promote normality during childbirth, however there are too many barriers that hinder their efforts. The barriers mentioned include: the lack of midwifery-led model of care, absence of midwife-mother rapport, medicalised environment, omitted information about natural alternatives during birth and the medicalisation of childbirth. The main conclusions and implications are that the barriers are suppressing the promoting factors of normality during childbirth locally, and that improvements are needed to increase the normalization of childbirth. In view of these findings, recommendations for practice, education and research were proposed. Recommendations for practise and education included the introduction of midwifery-led care, the provision of continuity of care with the midwives, the encouragement of midwives to take further courses in alternative therapies and to educate and empower mothers and their partners on their right to an informed choice thereby enabling the couple to feel more involved in the decision-making during childbirth. A recommendation for further research is to conduct similar qualitative research with different participants, such as the mothers in labour.