Midwifery one-to-one support in labour: ethnographic study of midwife-led birth environments

Background: This research is about midwifery one-to-one support in labour. One-to-one support in labour is associated with improved birth outcomes. However, uncertainty exists as to what it is that produces such positive birth outcomes. UK publications advocate the midwife to provide one-to-one support in labour, but research findings question their ability to focus entirely on women due to their medical, technological and documentation responsibilities. All of these studies were based within hospital environments and none were completed in the UK. This indicates a gap in knowledge concerning how midwifery one-to-one support translates into practice in the UK and within midwife–led environments. Methods: The aim of this research was to explore midwifery one-to-one support in labour in a real world context of midwife-led care. An ethnographic approach was completed over three case study sites (Alongside midwife-led unit, freestanding midwife-led unit and women’s homes) each including ten labouring women receiving midwifery one-to-one support in labour. Findings: Two main themes: Balancing the needs of the woman and balancing the needs of the NHS organisation. Inside the birth environment midwives used their knowledge, experience, intuition and motivation to balance six components. These included presence, midwife-woman relationships, coping strategies, labour progress, birthing partners and midwifery support. Outside the birth environment midwives experienced surveillance and territorial behaviours which were heightened during transfer from a midwife-led birth environment to the labour ward. Conclusion: When a ratio of one midwife to one woman was achieved, midwives were 100% available for a woman in their care. This enabled midwives to be constantly present when required and provide total focus to tune into the needs of women and synchronise their care. Although midwives balanced the needs of the NHS organisation this did not impact on midwives capability to be present with women in labour