Towards a professional value-driven midwifery care : a cooperative inquiry research approach

Abstract

Introduction: Midwifery is a highly ethical profession and often referred to as one of the oldest professions. Midwives are at all times expected to observe and apply professional care in their interaction with women during childbirth. Despite this, there is a growing belief that there is generally low ethics and care is deteriorating in midwifery around the globe. Midwifery is a highly specialised value-driven clinical field performed by skilful individuals, the midwives. It is a unique science (Jiménez-Lopez, Roales-Nieto, Seco and Preciado, 2014:79) and the art of nurturing which is composed of scientific acts or procedures which relate to the care of the woman and the expected baby in the course of pregnancy, labour and the postnatal period (International Confederation of midwives, 2011). Objective: The objective of the study was to develop strategies to empower midwives regarding professional value-driven midwifery care and to engage, enhance and equip midwives with necessary skills to implement the value-driven care during childbirth. Methodology: A Cooperative Inquiry (CI) approach was conducted in a maternity ward of one public hospital in Mpumalanga province. The CI intended to promote collaboration, democratic participation, partnerships, mutualism, joint-decision making and sharing among the participants. Purposive sampling was used to recruit the midwives and to encourage their participation. Midwives played a dual role as participants-researchers of an existing problem that required their active participation to solve a problem in order to improve service delivery in their own setting. Midwives became the only category which was actively involved in the Planning, Action, Observation and the post-cycle Reflection of the phases except for the pre-cycle Introductory phase of the study only. The study was conducted in four phases namely the Introductory, Creation, Implementation and the Evaluation phases which were further subdivided as follows: Phase 1: The Introductory phase This phase was threefold and was subdivided into: The Preparatory phase, stage 1, which involved gatekeeping into the setting, the Reflection phase, stage 2, wherein the 1st Reflection took place as the Hand Diagram image exercise and the Reflection phase, stage 3, which occurred as the 2nd Reflection phase in which a Nominal group technique (NGT) was conducted Phase 2: The Creation phase which comprised of the Planning phase was achieved by conducting three focus group discussions. Phase 3: The Implementation phase took place as the Action phase and that is where the actual strategies were developed. The final phase was Phase 4: The Observation phase which led to the development of an audit tool for respectful midwifery care towards the admitted women. Findings: Five themes emerged from the study as: ‘providing quality midwifery care to the women during childbirth’, ‘preserving the holistic well-being of the women who undergo childbirth’, ‘upholding professional practice to improve midwifery care’, ‘maintaining ethical midwifery care and ‘outlining barriers towards professional value-driven midwifery care’. The integration of these themes was used as a source of information to develop strategies which promote value-driven midwifery care. Conclusion: The study gave the midwives an opportunity to become change agents, develop new skills and tools which they will continue to use post the study to ensure that value-driven midwifery care is implemented and sustained. The study will also benefit the women and the expected babies, their families and the community at large as care will improve. The study will also extend the notion of value-driven care in health care with specific attention to midwifery. Recommendations for service delivery improvement and the implications for midwifery practice, DoH and Nursing Education were brought forward.