A Qualitative Study of Midwifery Practices During the Second Stage of Labour

Abstract

This qualitative study explores midwifery practice during the second stage of labour focusing specifically on whether midwives adopt a directed or physiological approach to maternal pushing. It was undertaken against the backdrop of research findings suggesting that there is no proven benefit to directing a woman’s pushing efforts but anecdotal evidence suggests that this remains a routine and accepted part of midwifery practice in the United Kingdom (UK). Semi- structured interviews were undertaken with ten midwives who had recent experience of caring for women during the second stage of labour, ten women who had recently given birth and four obstetricians. A form of thematic analysis was undertaken. Findings were viewed through a lens of critical social theory (CST) and drew on feminist principles to provide a deeper understanding of the emergent themes. Findings indicated that a directed approach to second stage pushing was the norm in this UK Maternity Unit and was deeply embedded within the cultural context of what it meant to be a midwife that involved ‘ doing’ rather than ‘being’. Reasons explaining why midwives continue to use directed pushing were grouped into themes; ‘ time passing and watching the clock’ ‘different worlds’ , ‘different women’, ‘midwives take charge’, ‘growth of confidence and changing practice’ and ‘conflict’. When viewed from a CST perspective midwives undertaking directed pushing is seen as an example of institutionalised oppressive behaviour symbolising the way in which knowledge and rationality are disregarded in favour of a risk averse practice that is paradoxically the opposite of what evidence recommends. Midwives are identified as being oppressed by the dominant biomedical model to the extent that they do not view directed pushing as an intervention. In order to promote a more physiological approach with its’ associated benefits, a return to a social model of midwifery with a focus on salutogenesis rather than pathogenesis is called for. Recommendations for midwifery education, practice and research are provided in order to support the transformational shift in midwifery culture that is needed if such a change is to become a reality.