The woman, partner and midwife: An integration of three perspectives of labour when intrapartum transfer from a birth centre to a tertiary obstetric unit occurs.

BACKGROUND: When transfer in labour takes place from a birth centre to a tertiary maternity hospital the woman, her partner and the midwife (the triad) are involved, representing three different perspectives. The purpose of this paper is to explore the integration of these intrapartum transfer experiences for the birth triad. METHODS: Giorgi's descriptive phenomenological method of analysis was used to explore the 'lived' experiences of Western Australian women, their partners and midwives across the birth journey. Forty-five interviews were conducted. FINDINGS: Findings revealed that experiences of intrapartum transfer were unique to each member of the triad (woman, partner and midwife) and yet there were also shared experiences. All three had three themes in common: 'The same journey through three different lenses'; 'In my own world' and 'Talking about the birth'. The woman and partner shared two themes: 'Lost birth dream' and 'Grateful to return to a familiar environment'. The woman and midwife both had: 'Gratitude for continuity of care model' and the partner and midwife both found they were: 'Struggling to adapt to a changing care model' and their 'Inside knowledge was not appreciated'. CONCLUSION: Insight into the unique integrated experiences during a birth centre intrapartum transfer can inform midwives, empowering them to better support parents through antenatal education before and by offering discussion about the birth and transfer after. Translation of findings to practice also reinforces how midwives can support their colleagues by recognising the accompanying midwife's role and knowledge of the woman.

Midwives' experiences of transfer in labour from a Western Australian birth centre to a tertiary maternity hospital.

BACKGROUND: When transfer in labour takes place from a woman-centred, midwifery led centre to a tertiary maternity hospital it is accepted that women are negatively affected, however the midwife's role is unevaluated, there is no published literature exploring their experience. This study aimed to describe these experiences. METHODS: Giorgi's descriptive phenomenological method of analysis was used to explore the 'lived' experiences of the midwives. Seventeen interviews of transferring midwives took place and data saturation was achieved. FINDINGS: The overall findings suggest that midwives find transfer in labour challenging, both emotionally and practically. Five main themes emerged: (1) 'The midwife's internal conversation' with subtheme: 'Feeling under pressure', (2) 'Challenged to find a role in changing circumstances' with subtheme: 'Varying degrees of support', (3) 'Feeling out of place' with subtheme: 'Caught in the middle of different models of care, (4) 'A constant support for the parents across the labour and birth process' with subthemes: 'Acknowledging the parents' loss of their desired birth' and (5) 'The midwives' need for debrief'. CONCLUSION: Midwives acknowledged the challenge of finding the balance between fulfilling parents' birth plan wishes with hospital protocol and maintaining safety. Transfer for fetal or maternal compromise caused anxiety and concern. The benefits of providing continuity of care were acknowledged by the midwife's knowledge of the woman and her history but these were not always recognised by the receiving team. Discussing the transfer story afterwards helped midwives review their practice. Effective communication between all stakeholders is essential throughout the transfer process.

The relationship is everything: Women׳s reasons for choosing a privately practising midwife in Western Australia.

OBJECTIVE: the purpose of this study was to describe women׳s reasons for choosing to birth with a privately practising midwife. DESIGN: a modified grounded theory methodology was used. PARTICIPANTS AND SETTING: the sample comprised 14 Western Australian women who had received maternity care from a privately practising midwife within the previous five years. FINDINGS: data analysis revealed three categories: the first was conceptualised as 'I knew what I wanted from my caregiver', which included sub-categories of: I wanted continuity of care; I wanted a relationship with my care provider; and I wanted a care provider with the same childbirth philosophy as me. The second encapsulated 'I knew what I wanted from my pregnancy and birth experience,' with two sub-categories, I wanted a natural, active, intervention free pregnancy and birth and I wanted my partner and family to be included. The final category was labelled 'I was willing to get the research to get what I wanted' and incorporated two sub-categories, I researched my care options and I researched my care provider options and the evidence around pregnancy and birth to be actively involved. KEY CONCLUSIONS: findings offer insight around women׳s reasons for choosing this model of midwifery care and highlight that women know exactly what they want from their caregiver. Women valued working with their midwife towards a shared goal of an intervention-free, normal birth, researched their options and found mainstream services restrictive and focused on medical risk status rather than on the individual woman. IMPLICATIONS FOR PRACTICE: findings will be of interest to maternity care practitioners and policy makers, as they highlight why some women prefer a social model of midwifery care that reflects a family centred, individualised and holistic approach. This insight can inform the development of maternity health care practices to recognise and accommodate the needs and values of all childbearing women.