Transcript midwives working for midwives – their experiences and challenges

MIDWIVES WORKING FOR
MIDWIVES – THEIR
EXPERIENCES AND
CHALLENGES
Dr. Diana du Plessis
In Association with Philips Avent
2012
Philosophy of Woman-centered
care
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Gives priority to the wishes and needs of
the user.
Embraces the midwifery-led care of
women with a normal pregnancy, labour
and post-natal period.
Confidence in the body’s natural abilities
Woman-centered care:
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Childbirth: a normal life experience
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Most pregnant women have the potential to
have a normal and safe pregnancy and to
give birth without medical intervention
Midwives are private primary
care givers
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Work in close collaboration with medical
practitioners who share the same
philosophy of childbirth
Private maternity obstetric unit
in Johannesburg
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Private midwives and
MOU midwives work
collaboratively
Provide intrapartum
and postpartum care
Low-technology care
Homely and relaxed
atmosphere.
The private midwife
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Has to apply for “birthing rights”
Must provide proof of obstetric back-up
Self-employed practitioner or in partnership
Provides antenatal care,
Progress the client intrapartum and
Provide some post partum care
Work independently and in close collaboration
with the midwives appointed by the MOU
MOU midwife
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Assists the private midwife during labour
and birth and
nurses the client post-natally
Problem statement
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Numerous studies on the effectiveness of birth
centers but minimal research was found on the
experiences of midwives and private midwives
working together in an MOU in collaborative
partnership.
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From personal observation, it appears that the
relationship between the private midwife and
MOU midwife changes when these two sets of
practitioners provide “split-services”
Research questions
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What are the experiences of midwives
working for private midwives during
labour, birth and the postpartum period
in a private Midwife Obstetric Unit in
Gauteng?
How can the midwives be assisted to
deliver collaborative maternity care?
Results: Theme 1. Positive
experience
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Identify with the values and aims of the
MOU
Felt supported in their efforts to treat the
laboring women with dignity and respect
Practiced as peers and colleagues
Had the opportunity to improve their
knowledge and skills
“I agree with the ethos of this place;
we should not interfere with labour
and birth”.
Positive continue
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Expanded on the reasons why they left the
traditional hospital systems:
Not treated with dignity and respect;
“I just could not fight the system”.
“I left government, because they treated the
women so badly”
“I left them (the private hospital group)
because the women are all conned into
caesareans, and I had to stand there and
defend the doctor”.
Positive continue
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Felt appreciated if their opinions were sought by the
private midwife.
“It [working in collaboration] makes it easier to work
together as a united group”
“Better than working for a doctor”.
They valued the opportunity to share ideas and
experiences with one another.
Theme 2: Staff midwives
expressed negative sentiments
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Role conflict
2.1 Role conflict and
accountability
“……Midwife X called for obstetric
back-up too late…….. I was called in as
to provide an explanation and to write a
detailed incident report. I already felt
bad that [the incident] happened, all of
a sudden I felt it was my fault.”
2.2 Role conflict:
responsibilities
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Staff midwives felt being taken advantage of
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“We are supposed to be a team, to help and support each
other but I know that midwife A induces clients in her
consulting room. By the time the client arrives in full
labour, the midwife pretends that the client went into
normal labour. By withholding information, she puts me
at risk” “By the way, is an induction part of the private
midwife’s scope of practice?”
“When I complain about this issue, my concerns are
ignored”.
Role conflict: staffing
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Frustration when agency places an
inexperienced or disinterested staff
member.
“We were so busy and then I had to
work with an inexperienced agency
staff member, it was really difficult. But
if I complained …. She will just take her
bag and go”
2.3 Role conflict and the private
midwife
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“[She] acted like a gyne and only pitches
way later. I’m required to progress a
woman I have never even seen before.
How is this different from government?
…. She gets the money for the delivery,
yet I have to do the progressing!”
2.3.1 Lack of Professional
Conduct
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The private midwives were not necessarily
seen as leaders or experts
Late arrival
“I had two fresh c/sections, and the rooms
were all full. When the lady arrived without
calling her midwife, I had to stop everything
and progress her.”
Role conflict continue
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Felt not valued:
“I gave her some advice when the woman
was pushing for a long time, but she said
afterwards I was interfering and overruling
her authority. I thought we were colleagues
and was merely trying to help … I mean, I am
not inexperienced!”
“I have the impression that there is a gap
between us; my opinion just does not count”.
Role conflict continue
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Quality of the relationship with the private midwives:
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Entry to the room restricted
But then requested to suture a tear
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“I refused to do that, it’s her responsibility and I told her to
phone the back-up gyne if she is not up to it.”
“I also take responsibility if I suture…. Why can’t she do it
herself? I’m not good enough to be present during the
birth, why do I have to do the dirty work? How do I know
what happened?”
2.4 Role conflict: Undermining
the ethos of the MOU
Interference in the normal process of labour
 Inductions;
 medicalization in stead of nonpharmacological methods;
 ROM
 IV infusion (short line) inserted regularly,
especially when the labour is progressing
slowly.
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“push the boundaries and got away with it…..
2.5 Role conflict & client
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No relationship with the client
Had to remain in the background
Felt left out
“…I felt unwelcome and disappointed”
and “I didn’t know if she noticed I was
actually there”
Role conflict continue
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Reluctant to report “….we are evaluated
by the private midwife…. I don’t want to
be seen as a negative person”
2.6 Communication barriers
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The private midwife’s professional notes were
often not available, written or accessible.
No antenatal records.
Incomplete private midwife’s records
Staff midwives had to “find” the relevant
information and complete the patient files.
“Why must I guess the amount of blood loss
during the second stage or complete her
partogram? It remains her responsibility!”
Theme 2.7: Workplace boredom
Workplace boredom
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Provide help and support during the second stage of
labour and nurse the woman in the post partum period.
Some liked being absorbed into the system
Others: Stagnating and their skills were eroding.
Expressed the need to start an own private practice or to
travel internationally to gain more experience.
“I really miss being the actual midwife, but I don’t want to
be in private practice either. What do I do?”
The End
Partnership
Mutually beneficial
Quality Maternity Care