Empowering and 'endorphic': analysis of free-text survey responses in the M@NGO trial of caseload midwifery

Background: One of the mechanisms behind the measureable benefits of caseload midwifery is the midwife-woman relationship. The midwife’s personal attributes and philosophical commitments affect the quality of this... [ view full abstract ]

Background: One of the mechanisms behind the measureable benefits of caseload midwifery is the midwife-woman relationship. The midwife’s personal attributes and philosophical commitments affect the quality of this relationship. Some have hypothesised that midwives working in caseload models might have different attributes to those electing shiftwork. To explore this question we qualitatively analysed the free-text responses provided on postnatal surveys in the M@NGO study of caseload midwifery.

Method: M@NGO was the largest randomised controlled trial of caseload midwifery to include woman of any risk status (n=1748). The trial recruited women of all obstetric risk: ≥ 18 years, <24 week’s gestation, singleton pregnancy, planning a vaginal birth, and not already booked with a care provider. Participants were randomised to caseload midwifery (antenatal, intrapartum and postnatal care from a primary or ‘back-up’ midwife) or standard care (a general practitioner and/or rostered midwives and obstetric doctors). Midwives in both models used the hospital protocols and followed national consultation and referral guidelines. Six weeks after birth women responded to a survey about their experiences of care including five open-ended questions. The researchers used qualitative software, NVIVO version 10, to code, organise and analyse the free-text survey data thematically using a five-step deductive approach.

Results: The response rate was 52% (n=901). Respondents from both groups characterised midwives as Informative, Competent and Kind. Participants in the caseload group perceived midwives as Empowering and ‘Endorphic’. Women in caseload care described how the midwife helped them feel: relaxed, reassured, loved, nurtured, and safe. We generated the term ‘Endorphic’ to describe the midwife’s ability to elicit these feelings (and associated hormones like endorphins and oxytocin) in pregnant and birthing women. 

Discussion: Caseload midwifery attracts, motivates and enables midwives to go Above and Beyond in the practise of midwifery. The concepts of an Empowering and ‘Endorphic’ midwife enhances understanding of how the complex intervention of caseload midwifery influences normal birth rates and experiences.

Conclusion: Caseload models motivate and enable midwifery care to go Above and Beyond such that women feel empowered, nurtured and safe during pregnancy, labour and birth.