Understanding how midwives employed by the National Health Service facilitate women's alternative birthing choices: Findings from a feminist pragmatist study

• Published in: PloS one 2020-11, Vol.15 (11), p.e0242508
• Main Authors: Feeley, Claire, Thomson, Gill, Downe, Soo
• Format: Article
• Language: English
• Subjects: Adult; Autonomy; Biology and Life Sciences; Birth; Birth rate; Birthing centers; Birthing Centers - statistics & numerical data; Childbirth & labor; Clinical decision making; Decision Making; Delivery (Childbirth); Delivery of Health Care - statistics & numerical data; Delivery, Obstetric - statistics & numerical data; Ethics; Female; Feminism; Government policy; Health Knowledge, Attitudes, Practice; Health risks; Health services; Home Childbirth - statistics & numerical data; Humans; Knowledge; Laws, regulations and rules; Legislation; Maternal child nursing; Maternal health services; Medical care decision making authority (Law); Medicine and Health Sciences; Methods; Middle Aged; Midwifery; Midwives; Natural Childbirth - statistics & numerical data; Natural language processing; Norms; Nurse Midwives - psychology; Obstetrics; Ontology; Patient Care Planning - statistics & numerical data; Pediatrics; People and Places; Physiology; Practice; Pragmatism; Pregnancy; Professionals; Public policy; Reflexivity; Research methodology; Social aspects; Social Sciences; Surveys; Surveys and Questionnaires; United Kingdom; Vagina; Women's rights; Womens health; Womens rights; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0242508

UK legislation and government policy favour women's rights to bodily autonomy and active involvement in childbirth decision-making including the right to decline recommendations of care/treatment. However, evidence suggests that both women and maternity professionals can face challenges enacting decisions outside of sociocultural norms. This study explored how NHS midwives facilitated women's alternative physiological birthing choices-defined in this study as 'birth choices that go outside of local/national maternity guidelines or when women decline recommended treatment of care, in the pursuit of a physiological birth'. The study was underpinned by a feminist pragmatist theoretical framework and narrative methodology was used to collect professional stories of practice via self-written narratives and interviews. Through purposive and snowball sampling, a diverse sample in terms of age, years of experience, workplace settings and model of care they operated within, 45 NHS midwives from across the UK were recruited. Data were analysed using narrative thematic that generated four themes that described midwives' processes of facilitating women's alternative physiological births: 1. Relationship building, 2. Processes of support and facilitation, 3. Behind the scenes, 4. Birth facilitation. Collectively, the midwives were involved in a wide range of alternative birth choices across all birth settings. Fundamental to their practice was the development of mutually trusting relationships with the women which were strongly asserted a key component of safe care. The participants highlighted a wide range of personal and advanced clinical skills which was framed within an inherent desire to meet the women's needs. Capturing what has been successfully achieved within institutionalised settings, specifically how, maternity providers may benefit from the findings of this study.