‘Bringing forth’ skills and knowledge of newly qualified midwives in free‐standing birth centres: A hermeneutic phenomenological study

Abstract

Aim

To understand and interpret the lived experience of newly qualified midwives (NQMs) as they acquire skills to work in free-standing birth centres (FSBCs), as well as the lived experience of experienced midwives in FSBCs in Germany who work with NQMs.

Background

In many high-, middle- and low-income countries, the scope of practice of midwives includes autonomous care of labouring women in all settings, including hospitals, home and FSBCs. There has been to date no research detailing the skills acquired when midwives who have trained in hospitals offer care in out-of-hospital settings.

Methods

This study was underpinned by hermeneutic phenomenology. Fifteen NQMs in their orientation period in a FSBC were interviewed three times in their first year. In addition to this, focus groups were conducted in 13 FSBCs. Data were collected between 2021 and 2023.

Findings

Using Heidegger's theory of technology as the philosophical underpinning, the results illustrate that the NQMs were facilitated to bring forth competencies to interpret women's unique variations of physiological labour, comprehending when they could enact intervention-free care, when the women necessitated a gentle intervention, and when acceleration of labour or transfer to hospital was necessary.

Conclusion

NQMs learned to effectively integrate medical knowledge with midwifery skills and knowledge, creating a bridge between the medical and midwifery approaches to care.

Implications

This paper showed the positive effects that an orientation and familiarization period with an experienced team of midwives have on the skill development of novice practitioners in FSBCs.

Impact

The findings of this study will have an impact on training and orientation for nurse-midwives and direct-entry midwives when they begin to practice in out-of-hospital settings after training and working in hospital labour wards.

Patient and Public Contribution

This research study has four cooperating partners: MotherHood, Network of Birth Centres, the Association for Quality at Out-of-Hospital Birth and the German Association of Midwifery Science. The cooperating partners met six times in a period of 2 ½ years to hear reports on the preliminary research findings and discuss these from the point of view of each organization. In addition, at each meeting, three midwives from various FSBCs were present to discuss the results and implications. The cooperating partners also helped disseminate study information that facilitated recruitment.

Impact of parenting resources on breastfeeding, parenting confidence and relationships

Women's contact with health services during pregnancy and the postnatal period offer important opportunities to promote and support maternal wellbeing, breastfeeding and positive parenting practices. Breastfeeding supports the short and long-term health of both baby and mother (Victora et al., 2016). However, the decision to breastfeed is influenced by multiple complex factors at the individual, family, health system, and societal level (Dyson et al., 2009). Several studies have identified breastfeeding self-efficacy, defined as a mother's confidence in her ability to breastfeed her new infant, as an important factor in breastfeeding outcomes including duration and exclusivity (Blyth et al., 2008; Dennis, 2006).