Understanding how NHS midwives facilitate women’s alternative birthing choices: Findings from a feminist pragmatist study

UK legislation and government policy favour women’s rights to bodily autonomy and active involvement in childbirth decision-making including the right to decline recommendations of care/treatment. However, evidence suggests that both women and maternity professionals can face challenges when supporting women’s decisions that go outside of sociocultural norms and/or maternity guidelines. This study explored NHS midwives practice of facilitating women’s alternative physiological birthing choices –defined in this study as ‘birth choices that go outside of local/national maternity guidelines or when women decline recommended treatment of care, in the pursuit of a physiological birth’. This paper reports the findings related to ‘how do NHS midwives self-defining as facilitative of women’s alternative birthing choices achieve their delivery of care (the what, how and why for their chosen actions)?’ The study was underpinned by a feminist pragmatist theoretical framework and narrative methodology was used to collect professional stories of practice via self-written narratives and interviews. Through purposive and snowball sampling, a diverse sample of 45 NHS midwives from across the UK was recruited. Data were analysed using narrative thematic that generated four themes that described midwives’ processes of facilitating women’s alternative physiological births: 1. Relationship building, 2. Processes of support and facilitation, 3. Behind the scenes, 4. Birth facilitation. Collectively, the midwives were involved in a wide range of alternative birth choices across all birth settings. Fundamental to their practice was the development of mutually trusting relationships with the women which were strongly asserted a key component of safe care. The participants highlighted a wide range of personal and advanced clinical skills which was framed within an inherent desire to meet the women’s needs. Capturing what has been successfully achieved within institutionalised settings, specifically how, maternity providers may benefit from the findings of this study.