Analisi Articulo De Revista

From Journal of Midwifery & Women's Health
Creating a Collaborative Culture in Maternity Care
Soo Downe, RM, MSc, PhD; Kenny Finlayson, BSc; Anita Fleming, RM, RN, MA
Authors and Disclosures
Posted: 06/07/2010; J Midwifery Womens Health. 2010;55(3):250-254. © 2010 Elsevier Science, Inc.
* |   |
* Abstract and Introduction
* Collaboration in a Maternity Context
* Discussion* Conclusion
* References
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* Collaboration in a Maternity Context
* Discussion
* Conclusion
* References
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Collaboration in a Maternity Context
The Current Situation
Rates of routine intervention for healthy women and babies in normal childbirth have reached epidemic proportions in some settings in both resource-rich and resource-poorcountries. This is not a benign occurrence. Recent studies have indicated that above a certain level, high rates of intervention may be harmful for both women and babies.[1–4] In this context, the term "medicalisation of childbirth" is taken for granted as a description of modern maternity care that does not need to be challenged or problematised. This phrase is not neutral. Anecdotally, its usetends to be associated with the assumption that the overtreatment of some women in pregnancy and childbirth is a consequence of unnecessarily extreme risk aversion, with a consequent polarisation of professional positions into those who resist this move (usually midwives) and those who embrace it (usually obstetricians).
Studies conducted with childbearing women in different birth settings suggestthat some women are drawn into this polarity of views and beliefs. For example, in her ethnographic study of a midwife-led birth centre in the United Kingdom, Annandale[5] found that women who chose to receive care in the birth centre became highly allegiant to the philosophy and beliefs of the birth centre midwives—sometimes in opposition to the views and attitudes of friends and family. On theother side of the equation, Machin and Scamell[6] observed what they termed the "irresistible biomedical metaphor" at work. In their study, women who attended National Childbirth Trust classes and had the intention of giving birth normally changed their allegiance and accepted the use of intervention once they entered a hospital setting for birth.
To date, few studies have sought to illuminate thesubject of interprofessional relations within a maternity setting, but those that have tend to support the view that there are fundamental clinical and professional differences between midwives and physicians with regard to maternity care. A qualitative evaluation of the relationship between physicians and nurse-midwives at a large maternity hospital in the United States revealed clinical,professional, and personal differences between the two disciplines in relation to specific procedures, particularly around the use of oxytocin to induce and augment labour and the use of routine fetal monitoring.[7] However, although there were profound attitudinal differences around tools and techniques in labour, the core motivation for both groups was actually the same. As the authors concluded:"Nurses and physicians shared the common goal of a healthy mother and baby but did not always agree on methods to achieve that goal…."[7]
This situation of professional groups bypassing each other—rather than working with each other—is mirrored by an article reporting on the views of junior physicians working in maternity care in northeast England.[8] The physicians were sent a survey asking them...