Midwives assessing progress in labour : working and learning

Sookhoo, Maureen (2004) Midwives assessing progress in labour : working and learning. Doctoral thesis, University of Northumbria at Newcastle.

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Abstract

This Thesis is based upon a project researching midwives confidence and capability in holistic assessment for 'normal labour' and the development of these attributes as a response to learning to care for women. The project was an exploratory qualitative study uSing interview, ethnography and questionnaires to collect data from three sites in the UK. Qualitative data analysis was adopted to build theory and this resulted in the development of a project model (Figure 6.1: Midwives Assessing Intrapartum
Progress) that represents the findings of the study.
Results identify a range of diagnostic information that midwives can consider when judging labour progress and identifies differences when assessing lowrisk cases between those using an active management style of assessment and those using an expectant management style in the extent of making use of internal or external indicators of progress respectively. Differences in interpreting information and
judgements about using procedures reflect a focus on childbirth and care, learning from experience and influences within the midwifery team and organisation.
Differences in understanding and in philosophical position towards childbirth interact with capability resulting from experience, and this interaction is expressed in the degree of discretion to practice holistic assessment, negotiated within the structures and processes of the work place. To adopt an expectant management style of assessment for normal labour midwives must sustain motivation. Motivation is dependant upon understanding and capability, both learned in practice, but not well developed in many of the respondents in the study.
Active management creates an illusion of accuracy and certainty and this is not safe or effective for midwifery diagnosis. It has also restricted midwives tolerance for uncertainty and decreased the credibility of less technical information that is important. A holistic approach to assessment based on observation and complemented by technology when required is a more effective diagnostic approach when midwives spend sustained periods with women without on-site medical cover.

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