2.3 Bases Teóricas
2.3.2 Calidad del Servicio Educativo
While within individual rooms the midwife worked alone, this was in the midst of a unit where 20-30 births or more occurred each day. Where possible the principle of one to one care was maintained throughout this period. This was evident from all the interviews and confirmed by the midwife managers I met. If there was a shortage of midwives, a student midwife might be given the care of a suitable woman in labour; the midwife in charge would take responsibility for the woman and would be in and out. Alternatively, student midwives replaced midwives for their breaks and assisted in the transfers to the postnatal wards.
The hospital had a range of evidence based guidelines for obstetric and neonatal care, and the midwives made efforts to provide best care and also follow hospital protocols. While the midwives criticised the high level of labour inductions, they worked closely with obstetricians, anaesthetists and neonatologists and valued the multi-disciplinary nature of their work. Barbara acknowledged the ideals of the new unit and explained what she perceived this to be:
Well (the workload) continues but who is going to say that you are not going to get maximum care and best of practice, I mean that is what your unit aims to do. The guidelines are there, all the reports are there, there are so many reports looking at communication, consultation with your staff. And I know there is a lot written about midwives in conflict with obstetricians but it has to be multi-disciplinary, it has to be, and there has to be that level of respect.
Barbara (15, 25-30)
The shared goals of midwives and doctors, and the requirements for best practice meant that, as far as Barbara was concerned, each had to respect each other’s skills and expertise. This trust between midwives and obstetricians was not reflected in the earlier interviews.
As was evident from the previous chapter, the midwives now worked well together and again, in contrast to the experiences of the midwives interviewed previously, there was greater acceptance of different ways of working:
adaptable . . . I suppose the more you work with people the more you do get to know their idiosyncrasies and they get to know mine as much.
Susan (1, 32-37)
Working together referred to being present at a birth or when dealing with an emergency. These were the only times that the midwives now worked together. As will be seen, midwives now used various positions for birth and variations in practice were now accepted. Though some midwives referred to hospital policies, there no longer seemed to be the consensus of care which had been evident before the move. This will be explored further in later chapters but as Margaret explained:
. . . .there are still issues, but overall I think people gel as a team, as a group of midwives, some people might disagree but overall I think so.
Margaret (1, 9-11)
One year after the opening, the midwives had adapted to new ways of working and had settled into their new maternity hospital.
Conclusion
This chapter has provided an account of how the labour ward midwives had adapted to the different ways of working in this new labour ward. It has described how they managed and organised their work and how they dealt with issues that were of concern to all. The number of women coming for induction each day was a problem as it led to pressure to vacate rooms quickly following a birth. They complained about this and expressed frustration that nothing was being done.
Because of the number of women coming for induction each day, the midwives had been under pressure to open the Induction Room, yet the Home from Home Room had been converted into a conventional labour room, and at the time of the interviews, there was little enthusiasm for the Pool Room to be opened.
Unlike the midwives interviewed previously, the midwives now complained about the issues of concern to them such as the number of ‘inductions’ and not getting their meal breaks. While they felt that, nothing was being done (p. 126), previously, in Hospital A, midwives did not raise their concerns. How the midwives experienced
practice within the individual labour rooms will be explored in the next two chapters. This chapter considered the challenges for the midwives working in this large maternity unit. The sub-themes identified here were ‘going with the flow’, ‘never ending swell, ‘the epidural question’, ‘contested priorities’ and ‘clearing the decks’. The everydayness of these data resonates with Lipsky’s street level bureaucracy and highlights that, as with other public sector workers, the midwives had to adapt to their environment and provide ‘best care’ with little control over their working conditions and the number of women who would come to the labour ward each day. The issues of power and control, and consensus of care, which had been very evident in the earlier interviews, were not now apparent in the dialogue of these midwives. There was little diversity in this aspect of midwives’ description of this world. The stresses and difficulties were shared and the findings from this chapter will be discussed further in Chapter 14.