Midwives must,obstetricians may: An ethnographic exploration of how policy documents organise intrapartum fetal monitoring practice |
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| Institution: | 1. Transforming Maternity Care Collaborative;2. School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, 4131, Qld, Australia;3. Grafton Base Hospital, Northern NSW Local Health District, Arthur Street, Grafton, 2460, NSW, Australia;4. Gosford Hospital, Central Coast NSW Local Health District, Gosford, 2250, NSW, Australia;1. La Trobe University, Melbourne, Australia;2. Australian Catholic University, Melbourne, Australia;3. Western Health, Melbourne, Australia;1. NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute — The University of Queensland (MRI-UQ), South Brisbane, Australia;2. Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia;3. Institute for Social Science Research, The University of Queensland, Brisbane, Australia;4. Griffith University, School of Medicine and Gold Coast University Hospital, Gold Coast, QLD, Australia;5. SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia;6. University of Auckland and Counties Manukau Health, Auckland, New Zealand;1. Faculty of Health, School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, QLD 4556, Australia;2. Faculty of Arts, Business and Law, Engage Research Lab, University of Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, QLD 4556, Australia;1. Perinatal and Women’s Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood, NSW 2134, Australia;2. School of Psychiatry, UNSW Medicine, Sydney 2052, NSW, Australia;3. Royal Hospital for Women, Sydney, Barker St, Randwick, NSW 2031, Australia;4. Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, NSW 2522, Australia;5. Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling Street, Surry Hills, NSW 2010, Australia;6. Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW 2006, Australia;7. School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Sydney 2052, Australia;8. Faculty of Nursing, University of Calgary, 2500 University Drive, NW, Calgary, AB T2N 1N4, Canada;1. College of Medicine and Public Health, Flinders University, Australia;2. School of Nursing and Midwifery, Deakin University, Australia;3. Centre for Quality and Patient Safety Research, Western Health Partnership, Australia;1. National Perinatal Epidemiology and Statistics Unit (NPESU), Centre for Big Data Research in Health and School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, 2052 Australia;2. Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, NSW 2522, Australia;3. Perinatal and Women’s Mental Health Unit, St John of God Health Care, 23 Grantham St, Burwood NSW 2134, Australia;4. School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia;5. Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling Street, Surry Hills, NSW 2010, Australia;6. Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW 2006, Australia;7. School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Sydney 2052, Australia;8. Faculty of Nursing, University of Calgary, 2500 University Drive, NW, University of Calgary, Calgary, AB T2N 1N4, Canada;9. Royal Hospital for Women, Sydney, Barker Street, Randwick, NSW 2031, Australia |
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| Abstract: | BackgroundThe capacity for midwifery to improve maternity care is under-utilised. Midwives have expressed limits on their autonomy to provide quality care in relation to intrapartum fetal heart rate monitoring.AimTo explore how the work of midwives and obstetricians was textually structured by policy documents related to intrapartum fetal heart rate monitoring.MethodsInstitutional Ethnography, a critical qualitative approach was used. Data were collected in an Australian hospital with a central fetal monitoring system. Midwives (n = 34) and obstetricians (n = 16) with experience working with the central fetal monitoring system were interviewed and observed. Policy documents were collected and analysed.FindingsMidwives’ work was strongly structured by policy documents that required escalation of care for any CTG abnormality. Prior to being able to escalate care, midwives were often interrupted by other clinicians uninvited entry into the room in response to the CTG seen at the central monitoring station. While the same collection of documents guided the work of both obstetricians and midwives, they generated the expectation that midwives must perform certain tasks while obstetricians may perform others. Midwifery work was textually invisible.Discussion and conclusionOur findings provide a concrete example of the way policy documents both reflect and generate power imbalances in maternity care. Obstetric ways of knowing and doing are reinforced within these documents and continue to diminish the visibility and autonomy of midwifery. Midwifery organisations are well placed to co-lead policy development and reform in collaboration with maternity consumer and obstetric organisations. |
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| Keywords: | Midwifery fetal monitoring power obstetrics guidelines ethnography |
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