Autonomy in Midwifery Practice: Challenges and Themes

MWF30004: assignment 2
Introduction
This essay will critically analyses the themes identified from a qualitative interview with a
registered midwife about a main challenge she identified that impacts her midwifery practice
and philosophy. During the the interview the midwife identified ‘Autonomy’ as the main
challenge affecting her practice.
The World Health organisation defines “Autonomy” a concept central to the definition of a
midwife: “the midwife is an autonomous practitioner of midwifery, accountable for the care
she or he provides” (WHO 1992,) consequently is practicing accountable for making
decisions in relation to maternity care within the context of normality (NMC, 2004).
The definition og Women-centred care” is a term is also used in the essay which describes “a
philosophy of maternity care aiming to promote a holistic approach by recognizing each
woman’s social, emotional, physical, spiritual and cultural needs” ((RCM, 2018)
Further key themes derived from the data were medicalisation of birth “Doctors”, Power
between Midwives and Doctors, concluding with Midwives Autonomy in workplace. The
themes critically analyzed in this essay included sub-themes such as medicalisation of
childbirth and the fear of litigation, defensive medicine, fading skills, women choice, woman
centre care relating to the impact this has in autonomy and desocio making in midwifery
practice in which will be defined along with each of themes
The themes will be analysed in relation to current midwifery literature, supporting the key
findings identified.

, and explain that any limitations will be acknowledged to ensure a 'critical analysis'
In spite of the considerable debates and research for several years, the concept of
“normality” in labour and childbirth is not universal or standardized for all woman.
(WHO,2018).

Theme 1 “Medicalisation of birth”
The term “Doctors”- is represented several times in the data analysis, hence the
medicalization of birth is summarized as follows.
‘Medicalisation of childbirth’ is defined as the application of a variety of practices to initiate,
accelerate, control or monitor the physiological course of labor, with the purpose of
improving the outcome for women and babies. (WHO,2018). Despite the fact the main goal
of interventions is keeping the woman safe, these interventions are not always justified.
(World Health Organisation,2018), (Women Childbirth Rights, 2017). The impact
medicalization of childbirth has in midwifery practice limits the midwife to provide women
centered care and practice autonomously.
During the interview process the interviewee (Midwife B) expressed her views on the
medicalization of birth stating that woman even in a low-risk model of care, doctors are
willing to be fully involved with the woman in labour. For instance, (Midwife B) described
her feelings by stating that:
“The fact that we got doctors 24/7 even when women are low risk... doctors still want
to be involved, wanting to know what's going and I don't think they need to be because it is
low risk.... having a doctor wanting to be inside the room and knocking at the door changes
the dynamic of the birth...and when they come in it just gets turned upside down and the
beginning of the cascade of events commenced” (Midwife B, 2018).
The literature supports (Midwife B) statement cited in Newnham, 2014; arguing the concept
of Medicalisation of birth has become a global concern over the past decades’ where the
increase of Obstetrics interventions is becoming a normal pattern for western societies. This
argument is maintained by Johansen, Newburn, & Macfarlane, (2002) stating this

medicalised culture has increasingly taken over “normal” where doctors relaying in
technology and interventions instead. Doctors perceive childbirth as an illness and see
woman’s body as a “machine” instead of a physiological process; subjecting healthy pregnant
women to unnecessary medical interventions when the machine (body) has failed. In
Australia (96.9%) women give birth in the fragmented model of care in which the numbers of
interventions are amongst one of the highest in the world. (Rigg, Schmied, Peters & Dahlen,
2017). To do any different would go against standardisation of normal birth and possibly
place the unborn child at risk, is the mainstay of the obstetric argument and discussion of
dominance relating to childbirth and several explanations have been discussed to justify the
medicalisation of childbirth. (Johansen, Newburn, & Macfarlane, 2002). This Medicalisation
of childbirth influence women finding themselves trapped in a system preventing freedom of
choice (WHO,2018) (The Royal College of Midwives, RCM-2012). Cooks (2012) suggest an
increased availability of midwifery care is an important approach to ensuring that women
have not only a healthy birth experience but also a highlight choice and control. Morgan
(2015) further states midwifery care embraces the fundamental concept in midwifery,
spanning both the biomedical model and feminist health care goals. These findings suggest
that midwives are in a sole position to identify and and develop theories availability of
midwifery care is an important approach to ensuring that women have not only a healthy
birth experience but also one that is positive,
In contrast, Earle, (2005) states that defensive medical practice is used by obstetricians to
avoid litigation which could be one of the possible reasons for the rise in medicalization
nowadays. Furthermore, the alarming increase in litigation within the medical model in the
United Kingdom shows that 70% of these cases comprises of obstetric cases only.
(Pienaar,2017). In Australia 80% of medical claims are made against obstrics doctors. Similar
data is also supported by (Asher et al.... stating that the fear of litigation along with the legal