Midwives working in standard maternity settings: an exploration of their views on maternity reform

Over the past two decades, Australian maternity services have been the subject of a number of state and federal inquiries, reviews and reports. As a result, midwifery practice throughout Australia has acknowledged that maternity care must change to meet the needs of women and families (Commonwealth of Australia, 1996; 1998; 1999; 2008; Hirst, 2005). As such, the Australian Health Ministers in November 2010 endorsed the National Maternity Services Plan (NMSP), which specifies four key priorities for Australian midwives (CoA, 2011). The objective of the NMSP is to provide a framework within the Australian health care system to guide the delivery of high quality, woman centred maternity care within a five-year period of 2010 to 2015. Implementation of the key priorities in the National Maternity Services Plan are critical to contemporary midwifery practice and for strengthening and expanding women centred care. Therefore, research into exploring the views of midwives during a period of reform was viewed as essential. Consequently, case study methodology was employed to discover the level of knowledge midwives had regarding the NMSP priorities and, the perceived impact of the reforms on the way midwives provide care. Additionally, midwives included in this study were asked to explain how they perceived they would transition into providing more autonomous care to pregnant and birthing women. Semi structured interviews were utilised to collect rich data for analysis. The results highlighted significant differences and deficiencies in participants’ knowledge of the NMSP and its implications on midwifery practice. In particular, the participants who were employed in a private maternity facility had significantly less awareness of the NMSP than midwives employed in public hospitals. However, a limitation of this qualitative study was that the findings from seven midwives cannot be generalised for the national population of midwives. Findings revealed that the reforms were perceived as an obstacle whereby the midwives claimed they would be burdened with additional responsibilities to enhance their practice. Therefore, this study concluded that registered midwives need significant, well-planned professional development to enable the transition process to autonomous, woman centred, contemporary practice.