Subtheme: More than a job

This sub-theme represented the emotional connection the midwives experienced in their role (Table 10). Words used to describe this connection to their profession which the midwives felt were, ‘special’ (McCourt and Stevens 2006), and ‘vocation’ (Cox and Smythe 2011) symbolising their feeling that this was more than a job for them. The midwives’ identification with midwifery was described in an emotive way, that they felt passionate and committed to their role and the significance they associated with their own identity and the importance of midwifery practice.

Evocative descriptions from the ten studies highlighted an emotional connection of the participants to midwifery and their role as a continuity midwife. The midwives often referred to their role as a continuity midwife in relation to their previous roles in fragmented and institutionally focused models, favouring their experiences in MCoCer roles (Newton et al. 2016; Rawnson 2011; Moore 2009). Professional autonomy, meaningful relationships and flexible working were highlighted as reasons for the midwives preferring to work in this way (Jepsen et al. 2016; Newton et al. 2016; Gray et al.2013; Cox and Smythe 2011).

The continuity role was described as being all encompassing and absorbing. While this was perceived as a positive aspect of MCoCer in some of the studies (Jepsen et al. 2016; Newton et al. 2016; Cummins et al. 2015; McAra-Couper et al. 2014; Gray et al. 2013; Cox and Smythe 2011; Rawnson 2011; Moore 2009), several of the studies discuss the challenge that this posed to their ability to separate their professional and personal lives (McCourt and Stevens 2006; Moore 2009; Rawnson 2011).

There is something romantic about people becoming everything to other people, becoming an important part of their lives. (Engel et al. 2003:13)

The seeming paradox highlighted by the findings is that while joy for midwifery is the key reason why midwives wish to work in MCoCer models, the personal/professional boundary must be negotiated to ensure balance for midwives and prevent burn-out. These findings reflect the conclusions of McAra-Couper et al. 2014 about what sustains midwives in MCoCer practice. The theme ‘Counting the Personal Costs’ further outlines the challenges which midwives experienced working in MCoCer models, while the theme ‘Strategies to Sustain’ identifies the ways midwives negotiated these challenges to create sustainable practice.

Table 10: Thematic Framework for Joy of Practice: More than a Job

STUDY NO.

STUDY AUTHOR THEME THEME DESCRIPTION SUPPORTING DATA

2 COX AND SMYTHE Passion and commitment

Although the LMCs had left their practice they still looked back on their experiences of caseloading practice as positive and fulfilling.

And I looked and thought I love midwifery…the demand I had when I was doing it was my satisfaction. (p.18) ‘vocation’ (p.19)

3 CUMMINS ET AL. Finding satisfaction with continuity

Working in continuity of care was reported as satisfying and rewarding.

…get tingles every time I see a woman starting her mothering journey (p.441)

They [the women] were always happy to have me there. (p.441)

The relationship with the group: Prepared to work in continuity of

midwifery care

The midwives described their feelings about continuity of carer with emotive language,

highlighting the importance of this model for them.

We learnt about the benefits of it [continuity] and it all just makes sense. (p.442)

…I developed a passion for group practice’ (p.442)

6 ENGEL ET AL. Job satisfaction Several of the midwives described a ‘love’ for midwifery along with a reluctance to relinquish that relationship when they have put so much of themselves into that women’s care.

I think the job can be quite idealised. There is something romantic about people becoming everything to other people, becoming an important part of their lives. (p.13)

9 GRAY ET AL. ‘it is something more meaningful, something different’

The follow through experience provided an

opportunity that was very different from any other in the midwifery course.

You connect- and it is something more meaningful, something different. (p.402)

11 JEPSEN ET AL. Working in an obligating but rewarding job

A sense of honour and pride in the feedback women gave them for the effort of providing them with continuity and women centred care.

When they say they are so happy to see me, you really put your heart and soul into it. (p.66)

13 MCCOURT AND STEVENS

Being there Our studies suggested that midwives and women valued ‘being there’ very highly and that being with women is about more that a physical presence. The midwives felt a sense of getting something back from the women, on a personal and professional level.

We like to think they want us and are upset if we are not there, but it isn't true. Now it is us that wants to be there, that's why you put yourself on call so much, you don't want to miss the end – it's the icing on the cake (p.17) Described as ‘special’ (p.18)

14 MOORE Emotive expressions The emotional investment of the midwives

throughout the MGP program indicated the passion and joy they experienced through their midwifery role.

It’s been really good, really good, as much as I want to go home I don’t because this, it’s just magical… (p.93)

15 NEWTON ET AL. Perceptions of ‘real’ midwifery: Satisfaction

The combination of meaningful relationships with women and practising autonomously gave satisfaction and was described emotively by the midwives.

. . . essentially working like this has been the pinnacle of my midwifery career, there’s nothing would ever beat this way of working. (p.228)

16 RAWNSON Learning partnerships The overwhelming desire and concern to meet and facilitate women’s expectations was experienced by the students. The emotion which the students reported recognition for their input, from women conveyed the deep-seated nature of being ‘needed’ and ‘valued’.

With your caseload ladies you sort of want to go out for them 110%, you really do (p.789)