An exploration of midwives' experiences and practice in relation to the assessment of maternal postnatal genital tract health

Larkin, Valerie (2012) An exploration of midwives' experiences and practice in relation to the assessment of maternal postnatal genital tract health. Doctoral thesis, Northumbria University.

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Abstract

Over the past 15 years the focus of postnatal care has changed. Contemporary professional guidance no longer directs midwives to undertake specific assessment tasks in relation to women’s genital tract, but advocates an holistic and individualised approach. However more recently some concern has been expressed within the professional literature that women’s physical needs may be overlooked. It is unclear how midwives decide upon their approach to maternal genital tract assessment, the involvement of women in this process, what assessment methods they use and the factors that influence this clinical reasoning process.

A constructionist grounded theory methodology was employed to guide the research design and processes, including analysis of the data, the use of theoretical sampling to evolve the emerging research categories and the construction of a grounded theory. Ethical approval was gained from the regional research ethics committee and the research and development committee at the data collection site. Sampling was purposeful and data was collected using narrative style in depth interviews involving fourteen midwives and observations of fifteen postnatal assessments involving five midwives and fifteen postnatal women.

Three themes were identified from the data and form the framework of the constructed grounded theory; they are Methods, Motivators and Modifiers. Within each theme are a number of categories and focused codes. The Methods theme summarises a range of assessment methods used by the midwives, including risk assessment, questioning and clinical observations. The Motivators theme incorporates factors which motivated how, when and why the midwives undertook genital tract assessment and includes verification, personal preferences and sensitive care. The Modifiers theme consists of factors and contexts, which facilitated or inhibited the midwives’ ability to negotiate an appropriate approach to assessment and includes the categories therapeutic relationship, care in context and evolving midwifery knowledge.

The findings of this study suggest that the midwives are aware of a range of assessment methods, however there was less articulation or demonstration of methods pertaining to assessment of uterine health. The motivating and modifying factors highlight midwife, woman and contextual factors, which may enhance and inhibit the midwives clinical reasoning process. The complexity of contemporary midwifery practice is illuminated as these factors conflict and create practice tensions and contradictions for the midwives. There was limited evidence that the midwives involved women in deciding the approach to genital tract assessment. Implications include the need to ensure midwives have the knowledge regarding uterine health and the skills and affective abilities to engage women in health assessments and practice effectively within the complexity of contemporary practice.

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