Woman-centred care in the Enculturation of Midwives - a focused ethnography

Maree Anne Crepinsek

doi:10.25918/thesis.537

Woman-centred care is a foundational philosophy in midwifery practice, influencing how care is provided during pregnancy, birth, and postpartum. Despite its recognised importance, there is limited research examining the meaning, definition, and practical application of woman-centred care, demonstrating a need for further conceptual development. A focused ethnographic design was constructed, whereby woman-centred care was investigated through an enculturation lens. A point-in-time review of the application of “woman/women-centred care” within current governance, education, and practice documents was conducted. Additionally, utilising interviews and thematic analysis with birthing women, leaders in midwifery, practising midwives, educators, and students, all contributed their perceptions about their lived experience of woman-centred care. Across global documents, the concept was depicted in only 3.5% of midwifery governance documents. Further investigation revealed that other words and phraseology that implied woman-centred care were also being applied. Within service provision guiding documents, woman-centred care was described in 10.81% of documents reviewed. This limited number of instances was further investigated for meaning, with content analysis revealing the themes of “woman”, “collaboration”, “care”, “culture”, “ensure”, “communication”, “informed”, “evidence” and “communities”. A review of 247 midwifery service promotional materials revealed 8% presenting a focus on woman-centred care. Following a qualitative analysis of the interviews, 10 themes emerged from the interview data. Highlighting the importance of flexible thinking, experiential learning, and cultural influences in midwifery, as well as how experience and wisdom are ‘passed on’ in practice, was described as integral to being woman-centred. The concept was described as being deeply influenced by midwifery culture, where differences were noted across the sector. Emphasised were the variations in approach between education and midwifery practice. The complexities of enacting woman-centred care were found to include the influence of models of care, the lack of a “midwifery voice”, the impact of hierarchical power, and fears about litigation. The array of tasks required and the influences of policies and procedures were also described as impacting the provision of woman-centred care. Recommendations from this research include: the application of consistency in teaching and learning across the sector; the strengthening of the role of midwifery across all models of care; and the development of a research-based, globally accepted definition of woman-centred care. Further research could focus on developing a consistent approach to incorporating woman-centred care across education and practice. Further research is needed to establish a universally accepted definition of woman-centred care and to guide its consistent application in both education and practice.

Woman-centred care in the Enculturation of Midwives - a focused ethnography

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Woman-centred care in the Enculturation of Midwives - a focused ethnography

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