Searching for autonomy

Objective: to gain an understanding of what midwives understand by the term 'autonomy', and to discover whether they consider themselves and their colleagues to be autonomous in practice. Participants: a snowball sample of 27 midwives working in five National Health Service (NHS) trusts within the south west of England, based in both hospitals and in the community. Method: within a qualitative research design, semi-structured interviews with participants were tape-recorded and transcribed verbatim, and analysed using thematic content analysis. Findings: most participants did not fully understand the implications of professional autonomy, particularly in terms of interprofessional collaboration and control of their own practice. There were mixed views among respondents about whether they practised autonomously. Although good relationships with medical personnel were found to facilitate midwifery autonomy, the ongoing dominance of the medical profession was still perceived as a major barrier to autonomy. Many participants did not feel that their midwifery education had equipped them for professional autonomy, although midwives educated by the direct-entry route were perceived to be more capable of exercising autonomy in practice than were nurse-trained midwives. Some participants expressed doubts about the possibility of genuine midwifery autonomy within the present system, while others felt that many midwives do not support their own or other midwives' professional autonomy. Implications for practice: midwives need to initiate major change at a collective level, or to consider the creation of obstetric nursing posts, both to afford women the choice of genuinely autonomous midwifery care and to alleviate the stresses of practising within a system that requires the accountability and responsibility of midwifery autonomy, yet neither recognises nor supports it. © 2003 Elsevier Science Ltd. All rights reserved