Background, including element of originality
The Barkantine Birth Centre, opened in 2008, is the first purpose built urban Freestanding Midwifery Unit (FMU) in London. It consistently achieves about 89% of spontaneous vaginal births and a similar percentage of normal births. High rates of normal birth within FMUs have also been reported nationally by the Birthplace in England Research Programme.
A knowledge gap has been identified regarding key elements of philosophy, knowledge and practice which may potentially affect the care outcomes in FMUs as well as staff wellbeing and job satisfaction. This ethnographic study aimed at contributing to knowledge and theory-generation in the arena of midwifery-led birth settings and particularly midwifery units.
Method
This is a post-critical ethnographic study carried out by an insider researcher. Fieldwork was conducted at the FMU from April 2011 to June 2012. A total of 82 participants were recruited including staff, service users and stakeholders. The fieldwork included participant observation, semi-structured interviews, analysis of local operational procedures and guidelines. Audio recordings were transcribed verbatim and anonymised to maintain confidentiality. Analysis was conducted alongside data collection using a modified constructionist Grounded Theory approach.
Results
The analysis generated 152 codes, which were organised into categories and subcategories. The identified categories contributed to the creation of three models which included the key characteristics of well-functioning FMUs from the view point of the midwives, women and organisation. This presentation focuses on the professional dimension of the midwives and the key concept of mindfulness.
Midwives described how, having time to dedicate to the women, and being able to be in the room with the labouring woman, allowed them to be ‘fully present’ and grasp clues about progress in labour. The opportunity of ‘being there’ allowed the midwives to ascertain what the needs of the woman were and to offer care tailored around unspoken needs. Midwives also described how mindfulness helped predicting complications.
Discussion
Brown and Ryan defined mindfulness as an enhanced awareness and attention of the present reality or current activity. The origin of the concept of mindfulness has its roots in Buddhist and other contemplative traditions. The stress-reductive effect of mindfulness practice is well- established and mindfulness meditation-based interventions have been introduced with positive impact for their therapeutic efficacy in reducing distress.
The concept mindfulness builds on the work by authors such as Leap, Kennedy and Olafsdottir, who describe concepts such as 'the art of doing nothing well’, ‘enduring presence’, ‘the less we do the more we give’ and ‘being with’. They all highlighted the importance of a quiet presence, which allows the midwife to connect with her ‘conscious and sub-conscious knowing’.
In contrast ‘mindlessness’ was described as the relative absence of mindfulness by dividing attention with multiple tasks, being worried, distracted or by refusing to acknowledge a thought, emotion or motivation.
Conclusion
The accounts of the midwives suggested that there was a direct link between being able to offer one- to-one care, mindfulness and safety.
Studies of and contributions to practice and/or service organisation , Studies of collaboration to improve maternal, infant, family, and maternity staff wellbein , Examinations of building design and of the physical and psychosocial environment of birth , Social and cultural precursors and consequences of optimal childbirth , Emotional and spiritual aspects of labour and birthing , Educational aspects , Philosophical and theoretical critiques and debates
