Key indicators influencing management of prolonged second stage labour by midwives in freestanding birth centres: Results from an ethnographic interview study |
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| Institution: | 1. Department of Health Promotion and Development, University of Pittsburgh, School of Nursing, 440 Victoria Building, 3600 Victoria Street, Pittsburgh, PA 15261, USA;2. University of Pittsburgh Medical Center;1. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia;2. Department of Rural Health, The University of South Australia, Adelaide, Australia;1. Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia;2. Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia;1. Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Australia;2. School of Health and Social Development, Deakin University, Melbourne, Australia;1. School of Nursing, York University, Canada;2. School of Nursing and Midwifery, Monash University, Australia;3. Department of Obstetrics, Affiliated Hospital of Xuzhou Medical University, PR China;4. Department of Obstetrics, Sir Run Run Hospital of Nanjing Medical University, PR China;5. Department of Nursing, Sir Run Run Hospital of Nanjing Medical University, PR China |
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| Abstract: | ProblemsComplications for newborns and postpartum clients in the hospital are more frequent after a prolonged second stage of labour. Midwives in community settings have little research to guide management in their settings.AimWe explored how US birth centre midwives identify onset of second stage of labour and determine when to transfer clients to the hospital for prolonged second stage.MethodsEthnographic interviews of midwives with at least 2 years’ experience in birth centres and participant observation of birth centre care.FindingsWe interviewed 21 midwives (18 CNMs, 3 CPMs/equivalent) from 18 birth centres in 11 US states, 45% with hospital practice privileges. Midwives relied on and engaged in embodied practice in evaluating each labour and making decisions concerning management of labour. Midwives considered time a useful but limited measure as a guiding factor in management. Though ideas of time and progress do play an important role in the decision-making process of midwives, their usefulness is limited due to the continual, multifactorial, and multisensory nature of the assessment. Relationship with the transfer hospital structured midwives’ decision-making about transfers.Discussion & conclusionThese findings can inform future robust multivariate evaluation of factors, including but not limited to time, in guidelines for management of second stage of labour. Optimal management may require formal consideration of more than just time and parity. Our findings also suggest the need for evaluation of how structural issues involving hospital privileges for midwives and relationships between birth centre and hospital staff affect the well-being of childbearing families. |
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| Keywords: | Labour Second stage of labour Birth centres/birthing centres Community birth Midwives |
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