What factors influence midwives’ practice in relation to women’s oral intake during labour?

Author: Mika Tadaumi

Tadaumi, Mika, 2018 What factors influence midwives’ practice in relation to women’s oral intake during labour?, Flinders University, College of Nursing and Health Sciences

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Abstract

The study explores what factors influence midwives’ practice in relation to women’s oral intake during labour. Labouring women’s food and fluids consumption is a controversial topic worldwide since Mendelson’s Syndrome was identified in 1946. For this reason, restriction of women’s oral nutrition in labour has become a common practice universally. However, improvements in anaesthetic techniques and pharmacological management have decreased maternal mortality related to Mendelson’s Syndrome dramatically. A large number of current studies report that women’s oral intake during labour does not influence any maternal and neonatal birth outcomes. Furthermore, women’s birth experiences impact on their parenthood and lives significantly. Starvation during labour leads to women’s discomfort, anxiety and stress which are associated with obstruction of the normal process of labour. Even though clinical guidelines state that normal uncomplicated labouring women should not be limited in their oral intake during labour, midwives still make decisions to reduce or discourage women’s oral nutrition in labour. Accordingly, this study investigates the influences which affect midwives’ decision-making in relation to women’s oral intake in labour. The findings may help to understand evidenced based woman-centred care and enhance women’s birth experiences. The literature review focuses on the broad context of midwives’ decision-making, and explores what factors influence midwives’ decision-making regarding labour management. Institutional and human environment, midwives’ professional autonomy, knowledge of practice and values and beliefs, and women’s desires and behaviours during labour and their culture, were identified as factors which influence midwives’ decision-making in regards to management of labour. However, factors which influence midwives’ decision-making regarding women’s oral intake during labour have not been identified specifically.

A qualitative design using interpretative descriptive approach (Thorne 2008) was chosen as the best methodology to gain an in-depth understanding of midwives’ experiences and thoughts of their practice regarding women’s oral nutrition in labour. Purposive sampling and snowball sampling were used to recruit a variety of participants into this study. Twelve registered midwives who currently provide labour and birth care in Australia participated in semi-structured interviews which lasted 30 to 50 minutes. Audio recording were transcribed and the thematic analysis (Braun and Clark 2012) was undertaken for data analysis with the assistance of NVivo version 11 software.

As a result of the analytic process, four themes were identified. The participants understood that women’s food and fluids intake during labour should not be restricted, but four competing factors influenced their practice of supporting or inhibiting women’s oral intake in labour. Midwives’ practice was affected by their knowledge and values developed from professional and personal experiences of labour, their context of practice and work environment such as, public or private systems, and models of care, the clinical guidelines and policies, and obstetric control, and women’s choice and comfort. These factors that influence midwives’ decision-making when managing women’s oral intake during labour create tension and are all interrelated. The study provides an understanding of factors which influence midwives’ decision-making regarding women’s oral intake during labour. Therefore, the study suggests that awareness of these four factors and their inter-relation to practice are significant for midwives to provide woman-centred care and support women’s positive birth experiences.

Keywords: Midwives' practice, oral intake, labour

Subject: Midwifery thesis

Thesis type: Masters
Completed: 2018
School: College of Nursing and Health Sciences
Supervisor: Linda Sweet