Kjekt, komplekst og krevjande. Jordmorrolla ved normale fødslar i differensiert fødselsomsorg

SUMMARY Background. In 2001 the Norwegian Parliament decided that maternity care in Norway should be differentiated. The purpose was twofold. Firstly, to preserve the de-centralized maternity care already provided - and secondly, to differentiate care between low- and high risk pregnancies in tertiary care hospitals. Tertiary care hospitals are the highest level of maternity care hospitals in Norway and provide care to both low- and high risk woman. Approximately 70 % of births take place in these institutions. Some tertiary care hospitals have separate birthing units for low- and high risk births, in others, both low and high risk births take place within the same unit. Focus. The focus of this study is to gather knowledge from midwives regarding their feelings of responsibility to maintain low-risk births “normal” in hospitals that do not have separate low risk birthing units. By focusing on these challenges I hope to contribute to a constructive debate concerning the organization of maternity care and midwives working conditions, in such a way that is beneficial to both birthing women/-families and midwives. Method. Qualitative method with semi-structured interviews, ten midwives, with a range of 2 to 36 years working experience have been interviewed. The informants work at a tertiary care hospital birthing unit with approximately 1400 births yearly. Both low- and high risk births are attended in the same localities. The data is analyzed with thematic analysis. Three main topics are discussed: midwifery practice, the relationship to the birthing woman/-family and influences of the medical discourse. Results. The results show that midwives wish to practice the midwife model of care attending normal births based on the principals of autonomous midwifery; closeness, holistic care and continual presence. Differing cultural and structural factors combine to make this approach difficult and their work often becomes routine based. The reasons for not always being able to follow the midwife model of care are complex. The midwives focus on strict national obstetric guidelines, fear of negative feedback and differing expectations of the midwife role. Midwives experience both intra- and inter role conflicts in the practice of their profession. Intra role conflicts, because both birthing women/-families and doctors have other expectations to normal birth than midwives themselves. Inter role conflicts, when they have responsibility for both low and high risk births at the same time. All the informants meant that there is a need for more midwives and better localities to keep low risk births normal. They also call for the opportunity for more continuity in their work and to have met the birthing woman/-couple before attending their labor and birth. Several of the midwives expressed the wish for a separate unit for low risk births. Key words: Role of midwife; Normal birth; Tertiary care hospital; Differentiated maternity car