'Lending the space': midwives' perceptions of birth space and clinical risk management

Abstract

Objectives: to explore and describe midwives perceptions of birth space and clinical risk management and their impact on practice both before and after a move to a new facility.

Design: an exploratory descriptive study utilising a modified participatory approach and observation and focus groups for data collection.

Setting: a major metropolitan maternity hospital in Victoria, Australia.

Participants: 18 midwives, including graduate year midwives, caseload midwives and hospital midwives working normal shifts, employed within a hospital.

Findings: the major themes identified were perceptions of birth space, perceptions of risk management, influence of birth space and risk management on practice and moving but not changing: geographical space and practice. Midwives desire to create the ideal birth space was hampered by a prevailing biomedical discourse which emphasised risk. Midwives in all three groups saw themselves as the gatekeepers, 'holding the space' or 'providing a bridge' for women, often in the face of a hierarchical hospital structure with obstetricians governing practice. This situation did not differ significantly after the relocation to the new hospital. Despite a warmer, more spacious and private birth space midwives felt the care was still influenced by the old hierarchical hospital culture. Caseload midwives felt they had the best opportunity to make a difference to women's experience because they were able, through continuity of care, to build trusting relationships with women during the antenatal period.

Key conclusions and implications for practice: although the physical environment can make a marginal contribution to an optimal birth space, it has little effect on clinical risk management practices within a major public hospital and the way in which this impacts midwives' practice. The importance of place and people are the key to providing an optimal birth space, as are women centred midwifery models of care and reasonable workloads.