Midwifery in Abu Dhabi: A descriptive survey of midwives.

BACKGROUND: Midwives of international standards may save lives on a scale unmatched by any other intervention. There are limited trained midwives in Abu Dhabi. Midwifery may be eroded or diminished if there is attrition and/ or no succession of trained midwives (Bharj et al., 2016). Therefore, high quality midwifery education is needed. AIM: This study aimed to describe midwifery in Abu Dhabi to inform the development of a new midwifery education degree program. METHODS: In 2022, midwives working in Abu Dhabi were invited to an anonymous online questionnaire. Data collected included characteristics such as age, qualification, duration of practice, practice setting, and skills used. Excel was used to perform descriptive statistics. FINDINGS: Seventeen midwives participated (N = 17). The majority (58.8%, n = 10) work in Labour Ward, four midwives rotated to antenatal, labour, and postnatal areas (23.5%, n = 4). Midwives came from many countries, but there were no midwives of Emirati nationality. Seventy per cent held Undergraduate (70.5%, n = 12) and almost a third held Postgraduate (29.5%, n = 5) midwifery degrees. Skills commonly used included parentcraft (47.0%, n = 8), promoting physiologic labour and birth encouraging freedom of movement (93.8%, n = 15), facilitating safe spontaneous vaginal births (88.2%, n = 15), perineal and vaginal suturing (68.8%, n = 11) and immediate care of the newborn (100.0%, n = 17). Midwives less commonly led antenatal assessments (37.5%, n = 6) and worked in postnatal areas (31.3%, n = 4). CONCLUSION: Understanding midwives' characteristics, where they work, and skills used may inform Midwifery education. Having more midwives will strengthen midwifery and increase women's choice for respectful, safe maternity care.

The experiences of midwives and women during intrapartum transfer from one-to-one midwife-led birth environments to obstetric-led units.

OBJECTIVE: To explore the transition from midwifery one-to-one support in labour within a midwife-led birth environment to an obstetric-led unit from the perspectives of midwives and women. DESIGN: Ethnographic study. Data was collected from eleven transfers to an obstetric-led unit. The transfer process was observed for four women. Semi-structured interviews were completed following the births with eleven women and eleven midwives. Nine maternity records were also analysed. SETTING: An alongside midwife-led unit, freestanding midwife-led unit, women's homes in England. FINDINGS: Territorial behaviour was the main theme experienced by midwives when transferring women to obstetric-led units. Territorial behaviour manifested itself as a feeling of 'us versus them' behaviours, 'feeling under scrutiny' and being aware of 'conflicting ideologies'. For women there were four themes that had an impact on their experiences of transfer obstetric-led units including: (1) their midwife continuing the care on the labour ward, (2) having time to adjust to their new situation, (3) all staff introducing themselves and (4) not being separated from their baby for long periods of time. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Transfer from a midwife-led birth environment to an obstetric-led unit is a stressful situation for midwives and women. This paper highlights how territorial behaviours impacted negatively for midwives during transfer to an obstetric-led unit. More research is required to understand territorial behaviours within the maternity services and how more respectful compassionate working relationships can be created. Additionally, from the perspective of women this paper highlights four aspects of care that positively impacted on the experiences of women and even helped them to build resilience to cope with the change of location, situation, medical interventions and new carers when transferring to an obstetric-led unit.

Midwifery one-to-one support in labour: More than a ratio.

OBJECTIVE: To explore midwifery one-to-one support in labour in a real world context of midwife-led birth environments. DESIGN: Ethnographic study. Data was collected from 30 observations inside and outside the birth environments in three different birth settings. Semi-structured interviews were completed following the births with 29 low-risk women and 30 midwives with at least one year labour support experience to gain their perspectives. Twenty-seven maternity records were also analysed. SETTING: An alongside midwife-led unit, freestanding midwife-led unit and women's homes in England. FINDINGS: Six components of care were identified that required balance inside midwife-led birth environments: (1) presence, (2) midwife-woman relationships, (3) coping strategies, (4) labour progress, (5) birthing partners and (6) midwifery support. Midwives used their knowledge, experience and intuitive skills to synchronise their care for the six components to work in balance. Balancing of the six components have been translated into continuums representing the labour care and requirements. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Midwifery one-to-one support in labour is more than a ratio when translated into clinical practice. When the balance of the six components were tuned into the needs of women, women were satisfied with their labour and birth experience, even when it did not go to plan. A one midwife to one woman ratio should be available for all women in labour.

What is meant by one-to-one support in labour: analysing the concept.

BACKGROUND: the term one-to-one support in labour is used in a range of research reports and policy documents internationally without a clear consensus on definition. AIM: the aim of this paper is to examine the variety of meanings and to clarify the concept of one-to-one support in labour. METHOD: Walker and Avant provide a useful guide for the analysis of concepts and this has been used as a starting point from which to build our discussion. We systematically examined the literature to answer the 'who, what, when, where, and how' for providing one-to-one support in labour. FINDINGS: our paper examines the evidence for one-to-one support in the light of the range of meanings that have been attributed to the concept. Multiple meanings for the concept have created confusion and there is a need for greater clarity, which may be used in directing research, practice, and policy. CONCLUSIONS: in spite of strong evidence for the benefits of one-to-one support in labour, the utility of the evidence base is limited by the failure to specify what is meant by one-to-one support leading to a lack of comparability/applicability. There is a need for research that focuses more clearly on articulating what happens during labour between the woman and the range of people who support her, in services that are deemed to offer one-to-one support.