Elsevier

Women and Birth

Volume 30, Issue 2, April 2017, Pages e125-e131
Women and Birth

Original Research - Qualitative
The woman, partner and midwife: An integration of three perspectives of labour when intrapartum transfer from a birth centre to a tertiary obstetric unit occurs

https://doi.org/10.1016/j.wombi.2016.10.008Get rights and content

Abstract

Background

When transfer in labour takes place from a birth centre to a tertiary maternity hospital the woman, her partner and the midwife (the triad) are involved, representing three different perspectives. The purpose of this paper is to explore the integration of these intrapartum transfer experiences for the birth triad.

Methods

Giorgi’s descriptive phenomenological method of analysis was used to explore the ‘lived’ experiences of Western Australian women, their partners and midwives across the birth journey. Forty-five interviews were conducted.

Findings

Findings revealed that experiences of intrapartum transfer were unique to each member of the triad (woman, partner and midwife) and yet there were also shared experiences. All three had three themes in common: ‘The same journey through three different lenses’; ‘In my own world’ and ‘Talking about the birth’. The woman and partner shared two themes: ‘Lost birth dream’ and ‘Grateful to return to a familiar environment’. The woman and midwife both had: ‘Gratitude for continuity of care model’ and the partner and midwife both found they were: ‘Struggling to adapt to a changing care model’ and their ‘Inside knowledge was not appreciated’.

Conclusion

Insight into the unique integrated experiences during a birth centre intrapartum transfer can inform midwives, empowering them to better support parents through antenatal education before and by offering discussion about the birth and transfer after. Translation of findings to practice also reinforces how midwives can support their colleagues by recognising the accompanying midwife’s role and knowledge of the woman.

Introduction

The birth of a baby is a pivotal day in a woman’s life with women stating they remember the highs and lows, the exhaustion, the despair and the exhilaration.1 The overall experience changes if her birth plan is not realised due to problems occurring during labour.2, 3, 4 Women who plan to birth in a low risk centre but are required to transfer to a tertiary referral unit experience a range of emotions including concern, fear and disappointment.5, 6 However, the woman’s recollection and memory of this event is one perspective. Within the birthing room there are usually at least three people; the woman, her life partner and the midwife; the birth triad. Each of these participants approaches the birth journey independently and lives the experience in a different way. They are influenced by a variety of factors such as hormones, expectations, hopes, policies and legal requirements.7, 8, 9, 10 The three perspectives mean that the birth journey is viewed through lenses with individualised foci, however, because each participant is so immersed in their own journey they may have limited insight into the experiences of others.

The findings of this paper are part of a larger qualitative study in which the overall experiences of women, partners and midwives were independently examined when transfer took place in labour from a low risk birth centre to a tertiary obstetric unit.7, 10, 11 The purpose of this unique paper is to explore the integration of the lived experiences of an intrapartum transfer within the labour journey for the birth triad (the woman, her partner and the midwife).

Section snippets

Literature review

Childbirth choices for women in Western Australia are divided into private or public care, within a variety of options. Women can birth in a private hospital with care being provided by a private obstetrician or a public hospital under a public hospital consultant, with care provided by the medical and midwifery team. Alternatively, women can select a birth centre or home birth with care provided by a midwife, either through a government funded program or independent practice together with

Participants and methods

The study was conducted at a birth centre in Western Australia, on the grounds of a tertiary obstetric hospital, which provided woman-centred, midwifery-led care for low risk women. The outcomes in the birth centre reflected existing evidence whereby women have lower rates of intervention, operative birth and pharmacological analgesia.22, 23, 24, 25 The purpose of this paper is to describe the integration of the ‘lived’ experiences of an intrapartum transfer within the labour journey for the

Findings

Data collection was in the form of interviews with a total of 45 individual interviews took place, making a total of 15 triads (women, partners and midwives) which, according to Giorgi forms sufficiency of data.31 It was considered that sufficiency was reached when the narratives appeared to have revealed full and comprehensive interpretations of events with as much variation as possible and also beginnings of repetition were being heard. Eleven primiparous and four multiparous women

Integration of the journeys of the woman, partner and midwife

Asking about the whole labour and birth journey allowed each participant to describe their own individual pathway giving rise to different views or perceptions of the same experience. Analysis took place as described above by comparing the 3 node groups from 3 sets of qualitative data against each other, revealing integration of similar experiences. Fig. 1 illustrates how the experiences of triad members are pulled together whilst they simultaneously have a singular unique view. The three

Integrated themes between two parties

As well as the integrated themes between all members of the triad there were overarching themes made up of shared experiences between the other member pairs: the woman and partner, the woman and midwife and the partner and midwife.

Integration of woman and midwife

The emerging subtheme from both the women and midwives’ perspective was an appreciation of the continuity of care model.

Integration of partner and midwife

The subthemes shared by the partner and midwife were ‘Struggling to adapt to a changing model of care’ and feelings of ‘Inside knowledge not appreciated’.

Integration of woman and partner

The subthemes shared by women and their partners were that they were ‘Grateful to return to the familiar environment’ of the birth centre after the birth and secondly the importance of reflecting on their ‘Lost birth dream’.

Discussion

Our findings suggest that when intrapartum transfer occurred from a birth centre to a tertiary obstetric unit there were commonalities and differences in the labour and birth journey for the woman, her partner and accompanying midwife. The normal path of labour was disturbed which impacted them all, but in different ways. It has been suggested that disturbances during labour and birth can change birth moods and cause tension34 and in this WA study the disturbance was in the form of moving from

Conclusion

When intrapartum transfer takes place from a low risk birth centre to a tertiary obstetric unit the experience is shared by three parties who see the journey through their own lenses. Each is absorbed in their own world, with the woman ‘in the zone’, the partner in a heightened sense of awareness and the midwife responsible for ensuring a safe outcome. Shared perceptions must be appreciated including the opportunity to talk about the birth and have their experience acknowledged whilst

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