Diseño Pre test

The thirteen studies listed above identified the importance for the midwives to know the women in their care and to be known by them (Table 9). Continuity with women enabled midwives to provide responsive (Gray et al 2013; McCourt and Stevens 2006) and individually tailored woman centred care (Moore 2009).This element constituted the ‘knowing’ and provided the foundation of woman centred care as described by Jepsen et al. 2016; Cummins et al. 2015; Browne et al. 2014; Edmondson and Walker 2014; Gray et al. 2013; Moore 2009. The ability to provide woman centred care in partnership with women was made possible through the development of mutual relationships. This was described as ‘cohesiveness’, ‘togetherness’, (Jepsen et al. 2016) ‘holistic’ and ‘personalised care’ (Newton et al. 2016).

The development of meaningful relationships with women was a key component for the midwives’ job satisfaction which was made possible through the continuity of carer models they were working in. This incorporated both the ‘knowing’ described by studies Jepsen et al. 2016; Cummins et al. 2015; Edmondson and Walker 2014; Cox and Smythe 2011; McCourt and Stevens 2006; Engel 2003; Sandall 1997) and the ‘being known’ by women was highlighted by three of the studies (Jepsen et al. 2016; McAra-Couper et al. 2014; Rawnson 2011). This indicated a reciprocal relationship of mutual respect (McCourt and Stevens 2006), and recognition of the needs of the midwife as well as the

Table 9: Thematic Framework for Joy of Practice: Knowing and being known

STUDY NO.

STUDY AUTHOR THEME THEME DESCRIPTION SUPPORTING DATA

1 BROWNE ET AL. Woman centred care The continuity experience provided student midwives with an appreciation of the benefits of continuity models of care and facilitated a woman-centred focus.

I think for me, continuity has brought home woman-centred care…because you’ve got the relationship with this woman... (p.575)

2 COX AND SMYTHE

Passion and commitment

The midwives’ experiences and relationships with women, particularly during labour and birth, had been incredibly special to them.

I love midwifery, I love working with mother and babies (p.16)

3 CUMMINS ET AL. The relationship with the woman

The relationship with the woman was valued in so many aspects of the care provided by the participants.

I loved the satisfaction that women got…also the satisfaction I got and the midwives would get from seeing them from the beginning to end (p.441). ‘I really love the relationship’ (p.440)

5 EDMONDSON AND WALKER

Continuity of care Participants believed continuity of care enhanced the construction of the birth centre midwife role through the development of meaningful and trusting relationships with the women.

I get to meet them early in their pregnancy and we develop that relationship so that by the time they come to birth it’s just like having a friend around.’ (p.35)

6 ENGEL Job Satisfaction The meaningful relationship with the woman

seems to be at the heart of job satisfaction for the midwife and yet the most difficult to pull back from.

…the actual continuity and satisfaction…and having women coming back baby after baby is lovely. (p13)

9 GRAY ET AL. ‘You really get to know what makes her tick’

This notion of ‘really knowing the woman’ was a strong theme. Each woman was recognised as being unique and students felt that by forming a relationship with her, they were able to learn about more than just her pregnancy.

You really get to know what makes her tick’ (p401) …that connection, that continuity that you get with women… (p.402)

11 JEPSEN ET AL. Cohesiveness through knowing

To know each other was the glue of the model and created cohesiveness.

When I am in my car driving to the hospital-I know who I will meet. I think of a specific woman, who has a face, who I know, and can relate to. (p.66)

Being a personalised professional

The midwives used ‘an affair’ to illustrate the intense but short relationship demanding a professional midwife's willingness to show herself as a person, because an affair is a two-way relationship and demands intimacy. The midwives’ comments revealed the interconnections between them and women as being ‘known’.

They are very attentive to my needs, too. A much greater recognition … that I am also a human being (p.65)

Having a high degree of job satisfaction

The midwives felt that they were doing a good job and this feeling led to high engagement which again led to a meaningful relationship – a positive circle developed.

I get a high degree of job satisfaction…I feel that it means something that we know each other. (p.65)

12 MCARA-COUPER ET AL.

Working in partnership with women

Midwives in this research identified the primary factor that sustains them is the joy experienced in the reciprocal relationship formed when LMC midwives work in partnership with women and their families/whanau, increasing job satisfaction and reducing stress- echoing McCourt and Stevens (2006).

Women turn up at my practice and I’ve thought, ‘well, this is why I’m here.’ They’ve given me so much back. So that’s been so rewarding

and that’s what you do it for is the clients. (p.30)

13 MCCOURT AND STEVENS

Relationship and Reciprocity

This theme captures an aspect if the midwife-woman relationship, which emerged as a central characteristic of a caseload practice. The relationship was valued highly be the woman and the midwives. It was more reciprocal than generally found in traditional professional-client relations.

Knowing women who I provide care for makes the job fulfilling and meaningful. (p.16)

14 MOORE Women and midwives together

All the midwives described how the MGP model enabled them to work together with the women across the continuum.

The women feel empowered because they feel they’ve had so much involvement in their own birth and they have felt in control. (p.110)

15 NEWTON ET AL. Working with women Forming relationships with women was the focus of the caseload model, and thus provided an opportunity for midwives to engage with women in a way that many had not previously experienced.

As far as the actual working as a midwife, it’s probably the most rewarding thing I’ve done. I’ve been a midwife for twenty-five years. . .[it’s] because of the relationship you build up with the women. (p.228)

16 RAWNSON ‘Making it good’ The ‘Caseloading Bloom’ described in the pictorial representation of their experience symbolised the development of the students through meaningful learning relationships with women.

She invited me into her family, I felt kind of like part of the whole family…(p.790)