Working in an obstetric-led unit : exploring the influence of the birth environment on the provision of midwifery care

Abstract

This qualitative study explores the influence of the obstetric-led birth environment on midwifery practice. Being aware of the components making up the birth environment as well as powerful medical discourse sheds light on how space and place may influence midwifery practice. Throughout the years, the concept of childbirth transitioned from a normal physiological process to a potentially pathological process requiring constant monitoring and surveillance. This ideology intensified through the hospitalization of childbirth and the ever-increasing reliance on technology, deeming midwives’ role to support physiological childbirth, within a hospital controlled by obstetricians, as challenging. The physical environment is shown to leave an impact not solely on mothers but also on midwives’ practice. A qualitative research method was used to gather data from eight participants using indepth semi-structured interviews with the incorporation of visual elicitations. Midwives presented their own experiences of working at the main local hospital. Similarities were evident, especially on how they feel caught up in a paradoxical role wanting to support physiological childbirth yet surrounded by birth paraphernalia and being constantly watched by obstetricians, who are mostly able to see childbirth as normal in retrospect. The power of the obstetricians and their involvement, even in the care of low-risk pregnancies, restricts midwives whilst coerces mothers to submit to the idea that childbirth is safest within hospital. The medicalization of childbirth led to what midwives describe as a ‘baby factory’, where timeframes and excessive interventions rule the process of childbirth. Some midwives admittingly express how the concept of medicalization of childbirth may have carried them away, leading to an escalation of unnecessary interventions. The hospital-looking birth rooms heavily surrounded by technology and the constant ward rounds by obstetricians were identified by midwives as having the most influence on their practice. Midwives expressed how working in a calmer ambience, mimicking the home environment, without unnecessary interventions would be optimal.