“Midwifery Abdication”: A Finding From an Interpretive Study

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BACKGROUND: Good clinical reasoning in midwifery is essential for the safety and quality of the care for women and babies. Midwives, as autonomous practitioners, are held legally and professionally accountable for their clinical reasoning, decisions, and the care they provide. Yet there is contested space between being accountable to the woman (and her birth experience) and being accountable to legal and professional frameworks and regulations. This places the midwife in a vulnerable position. This vulnerability is explored in this article.

METHODOLOGY: The narratives of 6 midwives who were interviewed as part of a larger study were subjected to an inductive thematic analysis. Trustworthiness and rigor of the study was assured by careful monitoring of the research process and data checking.

RESULTS: Although potentially unpalatable to the midwifery profession, we feel it is important to acknowledge that a concept called Midwifery Abdication does perhaps exist. Our assertion is underpinned by 3 key themes: “internalized perceptions of midwifery practice,” “knowing but failing to act,” and “prioritization of the woman's needs.” Although this may be an unconscious act, it may be part of a conscious thought process which is influenced by internal and external factors. The result is loss of one's professional voice. Midwifery Abdication introduces a level of risk, in changing clinical situations, which require a reconsideration and potential renegotiation of maternal choices and decisions.

CONCLUSION: Some midwives appear to abdicate their professional decision-making role. Midwives must practice within their country's legislative framework, which is complemented by their regulatory authority codes of professional conduct, standards, and ethics. Midwifery Abdication undermines the safety and efficacy of midwifery practice and thus destabilizes our right to claim professional autonomy.

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