The work-life balance of the case-loading midwife: a cooperative inquiry

Donald, Heather Lorraine
Smythe, Liz
McAra-Couper, Judith
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Doctor of Health Science
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Auckland University of Technology

Case-loading midwives have a demanding role with an unpredictable workday in which they juggle their professional, social, and personal demands. They often work long hours at a time and may choose to stay on-call without taking regular and frequent time off. These midwives are now the majority of Lead Maternity Carers (LMC) in the New Zealand maternity service contracted by the Ministry of Health to provide continuity of maternity care. The New Zealand College of Midwives’ philosophy and standards of practice uphold a continuity of care ethic that is enhanced by midwives working in partnership with women. Cooperative inquiry, an action research approach, was selected as the best fit to investigate the concern some case-loading midwives had about the affect this on-call lifestyle had on their well-being. The tension between their professional and personal commitments was at times hard to control. Many suffered from guilt if they could not be there for the women in their care. They had an overwhelming commitment to always be there. Over 18 months 15 case-loading midwives investigated their practice in four cycles of reflection and action to make their work-life balance better. The participants became co-researchers and co-participants through collaboration and dialogue. The findings gave a range of practical ways of how they achieved change.

An influence of appreciative inquiry added a positive focus on what was good as participants envisioned and created a better future. To bring a deeper understanding to the change process the ‘thinking tools’ of the French social philosopher Pierre Bourdieu [1930-2002] were introduced. The important concepts of field, capital and habitus were used during the analysis and discussion of the findings. This had a core framework of reflexivity that illuminated the complex relationships between culture and power that confronts midwives in contemporary society. It was identified that the provision of continuity of care had come with personal, emotional and physical cost with a threat of burnout. To succeed in creating new or innovative ways to practice the participants needed to change their assumptions about how they provided care. This required an empowering approach to care focussed on the women’s ability to cope rather than a dependency on the relationship between the woman and the midwife. An innovative tool to enable midwives to self-monitor their well-being was developed from this study. The study concludes with recommendations for leaders and educators on how to be change agents in promoting case-loading midwives self-care towards ensuring sustainable, safe midwifery practice, while still honouring the principles of continuity of care for the women they serve.

Case-loading , Midwife , On-call , Work-life balance , Personal well-being , Action research , Cooperative inquiry , Appreciative inquiry , Pierre Bourdieu , Culture , Power , Reflexivity , Continuity of care and empowerment
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