TENSIONS AND BARRIERS IN IMPROVING MATERNITY CARE
the story of a birth centre
2010136 pages Paperback
ISBN-10 1846194253
ISBN-13 9781846194252
Ruth Deery, Deborah Hughes and Mavis Kirkham, respectively Reader in Midwifery, University of Huddersfield, Centre for Health & Social Care Research; Community Midwifery Team Leader, Bradford Teaching Hospitals NHS Foundation Trust; Emeritus Professor of Midwifery, Sheffield Hallam University
Foreword by Sheila Kitzinger, Writer on pregnancy, childbirth and midwifery, and social anthropologist of birth.
Description
'We have written this book because the story it tells warrants a wide audience. We see the purpose of this book as informing discussion and decision-making around reconfigurations of maternity care, so that planning, communication, management and recruitment can be improved and shared vision articulated and understood.'
Throughout the world, women-centred care is gaining prominence in providing maternity care. Many birth centres open each year to meet this need – but at the same time, many close or are shelved. So why should the turnover in organisations that deliver such a vital service to women be so high, thwarting many midwives from practising as they would wish?
This carefully researched and passionate book tells the story of a birth centre that did fail, and the painful but valuable lessons it presents for others. Many of the issues and behaviours illustrated – lack of leadership, support, vision and plain-dealing, and tensions between bureaucracy and women-centred care – will find resonance in maternity services and midwifery experiences in the UK and throughout the world.
Tensions and Barriers in Improving Maternity Care is a vital and challenging resource for all midwives, managers and policy makers and shapers with an interest in maternity and women-centred care.
'A remarkably detailed analysis of the politics of a birth centre trapped in a medicalised system that threatened and rapidly destroyed it. It is a vivid example of how autonomous midwifery is undermined by an organisational structure in which management focuses exclusively on one model of care.'
From the Foreword by Sheila Kitzinger
 Birth Centres Background to the study Background and context The Research Story Aims of the research Anonymisation of the research site Negotiating ethical hoops Methodology The Story of the Birth Centre The early days Recruiting the midwives Widening cracks The road to closure Birth Centre figures The dream job: niche practice in midwifery Autonomy and freedom Shared philosophies The dream job – niche practice Niche practice versus the organization Opposition to the Birth Centre Alliance of the Unwilling Midwifery opposition General Practitioner opposition Obstetric consultant opposition Managerial opposition The role of midwifery managers Professional dissonance in midwifery management The experience of the Birth Centre midwives Working in a fragile service Recruiting from ‘outside’ Isolation and frustration: pain and powerlessness at work Battle by attrition: the operationalisation of non-support Spiralling downwards: interventions in the Birth Centre Integrating the Birth Centre Staffing by community midwives: overload, fragmentation and burnout Closure by stealth: reducing continuity of care Closure by stealth: the loss of the 24-hour service Closure by stealth: the curtailment of postnatal care Closure by stealth: falling birth numbers The Writing on the Wall Doomed from the outset? A political and financial exercise? The impact of constant change of senior managers The political impediments to closure: pawns in a game The Birth Centre: ideals, models and tensions The ideal service: the midwives’ vision * Why birth centres? A social model for maternity care Place and territory The social role of the birth centre Uniforms – symbol of the tensions around the Birth Centre Power, authority and management Conclusion Recommendations
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