Reason: Restricted by author. A copy can be supplied under Section 51(2) of the Australian Copyright Act 1968 by submitting a document delivery request through your library or by emailing firstname.lastname@example.org
Midwives and complementary and alternative medicine: a grounded theory study.
In order to distinguish essays and pre-prints from academic theses, we have a separate category. These are often much longer text based documents than a paper.
posted on 14.02.2017by Hall, Helen Grace
The use of Complementary and Alternative Medicine (CAM) during pregnancy is
becoming increasingly popular in Australia and midwives are often enthusiastic advocates.
Some believe the therapies are congruent with professional ideology and provide useful
options to reduce the medicalisation of childbearing. However, currently there are limited
educational opportunities, a lack of clinical evidence and few specific guidelines to assist
midwives make informed CAM decisions. How midwives navigate between the
fundamentally different assertions held by CAM and conventional medicine, and the
challenges they encounter when considering its use in an environment dominated by
biomedicine, is largely unknown.
The purpose of this study was to generate theory about the processes midwives
engage in when considering the use of CAM in clinical practice. The research also aimed to
identify and explain the factors that mediate midwives’ utilization of these processes. The
findings of the study contribute towards a body of knowledge that will result in better
educational and practice guidelines for midwives.
Grounded theory, underpinned by the theoretical framework of symbolic
interactionism was employed for this study. Twenty five midwives who worked in four
hospitals and associated community clinics in Victoria, Australia, participated. Data were
collected from 25 semi-structured interviews and non-participant observation of a subgroup
of nine midwives as they interacted with women during 39 antenatal appointments and nine
hours of childbirth classes.
The central problem participants experienced is described as ‘Integrating diverse
perspectives; considering the use of CAM in a hospital environment.’ The basic social
process (BSP) midwives utilised to deal with this problem is conceptualised as, ‘Navigating a
safe path together.’ The BSP is at the heart of the theory and although it embraces a range of
responses, the process is common to all participants. It elucidates how midwives moved
through three transitional phases of individualising pregnancy care, encountering diverse
perspectives and expectations, and minimising the risks associated with childbearing, when
confronted with the central problem.
Four interrelated categories represent the various strategies participants engaged. The
first, communicating about CAM, encompasses the key strategies that midwives employed
when exchanging information with women. The second category, determining the role of
CAM, explicates the strategies they used when considering the place of the therapies in
contemporary maternity practice. The third category, influencing CAM use, highlights the
processes utilized to encourage women to make safe therapeutic choices. The final category,
managing the conflicts, reveals how midwives responded when confronted by divergent
approaches to maternity care.
Contextual conditions were found to have a significant influence on midwives’
behaviour towards CAM in clinical practice. Three broad mediating factors were identified.
The context of professional work encompasses an expansive set of workplace and
occupational conditions that exert a significant effect. The individual midwife’s beliefs and
knowledge and the woman’s expectation and health, also moderate participants’ behaviour.
Navigating a safe path together offers a possible explanation of midwives’ responses
to the use of CAM by childbearing women. The theory explicates how midwives’ system of
meaning around safe childbearing and their professional role directs their actions. Midwives
engage a process where they work in partnership with women in a pragmatic quest to
individualise the childbearing experience while prioritising safety. The theory demonstrates
that many struggle to reconcile the professional discourse of facilitating women informed
choices with the realities of daily practice.