Author Findings Methodology Strengths and Weaknesses CASP
Healthcare Commission 2008 UK
Women’s satisfaction on care received from maternity services.
High satisfaction associated with: -Shorter duration of labour.
-Receiving the pain relief they wanted - A straightforward vaginal birth
-Cared for by fewer midwives, who they have met before.
-Spoken to in a way they could understand -Treated with kindness
-Confidence and trust in staff
-Given information and explanations they needed
26,325 women responded to survey from 149 acute hospital trusts and 2 primary care trusts in England
Good sample size but based on a survey- therefore only a baseline view of the issues.
Extensive sample size. Mixed methods would have added greater clarity to the findings.
Walsh 2007a UK
Ethnographic study of a Birth Centre. Midwives felt able to practice autonomously.
Midwife’s demonstrated social as well as clinical support to women.
Demonstrated social capital between themselves as a group.
Had good job satisfaction
Observation of women and midwives’ interactions (20 visits) and interviews with both women (30, 3 months postnatal period) and staff (15) in a standalone birth centre.
Good methodology- interviews with women and midwives plus observation. Based on Birth Centre environment only.
Complies. Study design gives a 360-degree perspective of the subject studied. Based on one site, therefore findings may only be applicable to this site, which the researcher acknowledges.
Davis and Iredale
2006 UK
Explored midwives perceptions of their role.
Focus groups included midwives working in midwifery led and consultant led environments.
Felt safe outcomes for mother and baby were paramount along with building trusting supportive relationships.
Concerned medical staff Interfere with normal childbirth
7 focus groups. 48 midwives from maternity units in mid and south Wales.
Valuable study in terms of midwives views, although follow up interviews would have been useful to explore in more depth.
Did not look at women’s views of the role.
A good sample size was generated. Only one type of method was used, the addition of other methods may have provided increased the richness of the data.
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Mead and
Kornbrot 2004 UK
In higher levels of intervention environments midwives perceived risk as higher than those working in low intervention units.
Those in higher interventionist units overestimated the value of technological interventions and underestimated women’s ability to progress normally.
A survey of midwives’ views
(120) in 11 maternity units. The findings are valuable but were based on a survey, therefore were only a baseline view.
Further investigation through other methods would have been useful to investigate the findings further.
Ball et al 2002 UK
Based on reasons of why midwives leave the profession.
Reasons were:
Unwillingness to continue practicing the type of midwifery demanded of them. Dissatisfied with requirements to rotate through all shifts and areas of practice- felt unable to sustain relationships with women and colleagues.
4 focus groups consisting of 6-10 midwives in each group.
Looked specifically at why midwives leave, not on how they perceived their role.
Complies. Addition of other methods within the design may have given more information regarding some of the findings.
Hunter 2005a UK
Similar to Downe and McFarlane (1999). Description of midwives working in community as working in a ‘with woman’ model of care and those in the hospital as ‘working with institution’. The ‘with institution’ model was based on a medical approach to childbirth- managing the process. The ‘with woman’ model was based on individual woman’s needs and a holistic view.
The ‘with woman’ model matched the ideal role many of them believed their role to be.
Therefore, those working in this way had increased job satisfaction.
4 focus groups, separated by location and setting of midwifery practice (hospital or community).
Observational data of 6 working in a community setting and 6 hospital based midwives.
Valuable piece of work in terms of the findings, as this gives an exceptional overview of how working in different environments and models can change how care is delivered.
Was specifically about how midwives viewed their role. It did not include women’s perceptions of the midwife’s role.
Mixed methods of data collection provide depth to the subject. The study was based on one site, therefore may only be applicable to this geographical area.
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Kirkham and Stapleton 2000 UK
Midwives felt constrained within current culture of the NHS, which inhibited them to have support needs met and acted as an obstacle to progress in developing midwifery practice.
Interviews with 168 midwives at 6 different sites in England.
Did not look at women’s views of the role.
Complies with CASP, another method may have added richness to the data. Heres et al
2000 Netherlands
Looked at length of labour of women having spontaneous labour and birth by 2 groups of care givers- obstetrician and midwife.
Labour was 5-6hrs longer for primigravid women and 3-4hrs longer for multigravid women if cared for by an obstetrician.
57,871 women receiving care from midwives. 31,999 women receiving care from obstetricians.
Descriptive study comparing the circadian pattern of the hour of birth.
There were more women in the midwives group; therefore there may have been some bias.
The study did not investigate the reasons for the findings
This study did not contain any qualitative data and therefore cannot be measured against this tool.
Downe and McFarlane 1999 UK
Midwives working in hospital held completely different concept of midwifery to those working in the community.
Longitudinal case control survey. 2 formal control groups, in total 16 midwives: 11 community based midwives, 5 working in acute hospital labour ward setting.
Related to midwives training needs by self-assessment, not specifically about their role and how they think they are perceived.
This survey would have benefited from another method of investigation to clarify the points made. Van der Hulst
1999 Netherlands
Differences of midwives’ behaviour depending on the environment they provided care in.
Midwives were more relaxed when providing care at home, take on an informal approach and interaction with the woman became easier.
Random sample survey of 150 independently practicing midwives.
Limitations to the data collection as based on a survey.
Another method of data collection would have strengthened the findings.