Intrapartum uncertainty: A feature of normal birth, as experienced by midwives in Scotland.

Objective: to explore midwives' perceptions of intrapartum uncertainty when caring for women in low risk labour. Design: a grounded theory approach was used to capture the experiences of midwives practising in Scotland. Data were generated through unstructured in-depth one-to-one interviews and focu...

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Publicado en:Midwifery Vol. 30; no. 1; pp. 28 - 36
Autores principales: Page, Miranda, Mander, Rosemary
Formato: research tables/charts Journal Article
Publicado: Elsevier B.V. 2014
Acceso en línea:Ver este registro en EBSCOhost
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      pub: Elsevier B.V.
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        10.1016/j.midw.2013.01.012
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        atl: Intrapartum uncertainty: A feature of normal birth, as experienced by midwives in Scotland.
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        au:
          Page, Miranda
          Mander, Rosemary
        affil: NMAHP Research Unit, Iris Murdoch Building, University of Stirling, Stirling, FK9 4LA, UK
      sug:
        subj:
          Uncertainty
          Intrapartum Care
          Midwives
          Childbirth
          Management of Labor
          Human
          Scotland
          Pregnancy
          Female
          Grounded Theory
          Interviews
          Focus Groups
          Thematic Analysis
          Female
      ab: Objective: to explore midwives' perceptions of intrapartum uncertainty when caring for women in low risk labour. Design: a grounded theory approach was used to capture the experiences of midwives practising in Scotland. Data were generated through unstructured in-depth one-to-one interviews and focus groups. Setting: four Health Boards in Scotland. Participants: 19 midwives, practising in a range of maternity settings, participated in the study. The maternity settings included; obstetric led labour wards, along-side maternity units, stand-alone community maternity units, and community and independent practice. They also had a mixture of clinical experience, ranging from one to 20 years in practice. Findings: Three categories emerged from the analysis, intrapartum uncertainty, the normality boundary and threshold pressures. Recognising the point at which a labour deviates away from normal constitutes 'intrapartum uncertainty'. In these situations midwives develop a normality boundary that shape their clinical judgements and decisions. The boundary becomes the limit, edge or border of what they accept as normal in a labour. Therefore if midwives tolerate intrapartum uncertainty they are more likely to construct labours as normal, than midwives with a lower tolerance of uncertainty. This can be mediated by threshold pressures that expand or contract their definitions of normality. So that supportive environments and good relationships with women enable midwives to tolerate uncertainty and thus maintain normality. Implications for practice: the reemphasise on midwifery practice as a means of supporting normal birth has been promoted as a way of 'demedicalising' birth for low risk women. However to maintain normality midwives need to understand the impact uncertainty has on their decision making. Supporting midwives to tolerate uncertainty, either at unit or national level, will expand definitions of normality so that birth can remain natural and dynamic.
      pubtype: Academic Journal
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    language: English
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