The kaleidoscopic midwife: a conceptual metaphor illustrating first-time mothers' perspectives of a good midwife: a grounded theory study

BACKGROUND The literature review reveals information about what makes a good midwife from several perspectives. However, there is a dearth of knowledge around women’s perceptions of a good midwife in different birthplaces. AIM. The aim of the study was to explore and explain first-time mothers’ expectations and experiences of a good midwife during childbirth in the context of different places of birth. METHODS A qualitative grounded theory methodology was undertaken. Fourteen first-time mothers planning to birth in different settings in England (Home, Freestanding Midwifery Unit, Obstetric Unit) were recruited. Data were collected through two semi-structured interviews for each participant (before and after birth). Data analysis included the processes of coding and conceptualising data, with constant comparison between data, literature and memos. Ethical approval was gained. Informed consent was obtained from participants and women were free to decline participation or to withdraw at any time. Confidentiality was guaranteed. FINDINGS The model named ‘The kaleidoscopic midwife: a conceptual metaphor illustrating first-time mothers’ perspectives of a good midwife’ was developed. The model is dynamic and woman-centred, operationalised as the midwife’s characteristics that should adapt to each woman’s individual needs in the context of each specific labour, irrespective of the birth setting. Four pillars of care are encompassed in the care provided by a good midwife in the labour continuum: promoting individuality; supporting embodied limbo; helping to go with the flow; providing information and guidance. As a kaleidoscopic figure, a good midwife should be multi-coloured and ever changing in the light of the woman’s individual needs, expectations and labour journey (e.g. stage of labour and events occurring during childbirth), in order to create an environment that enables her to move forward despite the uncertainty and the expectations-experiences gap. The following elements are harmonised by the kaleidoscopic midwife: relationship-mediated being; knowledgeable doing; physical presence; immediately available presence. CONCLUSION The model presented has relevance to contemporary debates about quality of care and place of birth and can be used by midwives to pursue excellence in caring for labouring mothers. Independently from the place of birth, when the woman is cared for by a midwife demonstrating the above characteristics, she is more likely to have an optimum experience of birth