The Lived Experience of Midwives Caring for Women Facing Termination of Pregnancy in the Late Second and Third Trimester

Termination of pregnancy (TOP), in the late second and third trimester, is planned fetal loss that is medically and socially complex, and has lasting consequences for women. In New Zealand TOP after 20 weeks gestation may be performed to save a woman’s life or to preserve her physical or mental health, which might be at risk of permanent damage due to fetal abnormality or severe intrauterine growth restriction. Core midwives in New Zealand are the main caregivers for women who face this procedure after 20 weeks gestation. A small number of international studies have demonstrated the ethical, moral and professional challenges midwives face when providing TOP care; however, the New Zealand maternity system, as well as its legal framework, cannot be compared to countries overseas. This hermeneutic phenomenological study aims to uncover the lifeworld of New Zealand midwives in the context of TOP and seeks to establish what enables midwives in their role, the effects of TOP care, if any, and the shortcomings in support networks that midwives would benefit from. Eight midwives from two District Health Boards in the North Island of New Zealand were interviewed about their experiences of caring for women who underwent TOP in the late second and third trimester. Data from the interviews were analysed using Max van Manen’s methodological framework. The midwives’ experience is described in three themes that emerged through reflection and writing: ‘a different kind of midwife’; ‘staying true to oneself’; and ‘melting an iceberg’. The findings of this thesis suggest that TOP care is a different, specialised role within midwifery. Midwives facilitate death within the space of birth, not daily, yet on a regular basis. Addressing the mother-baby dyad the midwives support women in their decision, provide a positive childbirth experience, and address women’s complex needs by meeting them in their emotional space. Midwives enable memory making, honour the life and death of the baby, and provide the baby with dignity. Yet, the findings suggest that midwives are unprepared for this role and its effects. Feeling unsupported and unacknowledged they are left trying to sustain themselves as support structures are missing. A growing iceberg of unprocessed emotions ensues that midwives are not equipped to negotiate. This research study recognises the value of midwifery care in the context of TOP; yet, also the complexity of this specific role. The beneficiaries of this study will be the general midwifery community, managers, midwives who provide TOP care, students, and education providers