Birth Territory: A theory for midwifery practice

A Qualitative Analysis of Women's Short Accounts of Labour and Birth in a Western Australian Public Tertiary Hospital

“…Waldenstrom et al 45 also identified that respectful relationships, especially with midwives, had a strong mediating effect on womens' childbirth experiences. The findings echo those of Fahy and Parratt 46 who found that where childbearing women felt allied with midwives, they were far more likely to feel stronger, more confident and empowered. Recent work undertaken in Western Australia also clearly demonstrated that the attitudes and behaviours of caregivers had a significant impact on how women reflected on their birth experience, 47 which is consistent with the findings of Hodnett's systematic review.…”

Exploring the strategies that midwives in British Columbia use to promote normal birth

“…Fahy and Parratt [36] refer to the ideal birthing environment as the “sanctum”—a homely, private environment where the woman feels at ease and comfortable. The environment is familiar and feels private and safe, and has easy access to a bath, toilet and the outdoors.…”

‘Tough love’: The experiences of midwives giving women sterile water injections for the relief of back pain in labour

“…Although there is no precise definition in the midwifery/obstetric literature regarding what constitutes an intervention during labour, in this study the term is used to refer to a treatment that is either clinically justified or one instigated for convenience, clinician's choice or to achieve efficiency. The term has also be used to describe aspects of care that are not seen to sit comfortably within the concept of woman centred care (Maputle & Donavon, 2013 Fahy & Parratt, 2006;Rooks, 1999). Determining what constitutes an intervention can thus also reflect the flow of power and decision making between care providers and pregnant/labouring women.…”

“…Kirstie described a woman's prerogative to use the analgesia of her choice and her obstetrician's contrary view: Fahy and Parratt (2006, p. 46) discuss the theory of "birth territory" and an individual's use of power, referred to as "jurisdiction". Power may be integrative, where all persons within the birth territory share power to support the birthing woman in her choices; conversely, and as described in the above quote, power may be disintegrative, where one person (the obstetrician) exerts an ego-driven dominance over others (in this case, both the woman and her midwife) (K. Fahy & Parratt, 2006). Collaboration between professionals requires mutual trust and respect for each other's skills and knowledge (Heatley & Kruske, 2011) and the use of language that conveys these sentiments (Reiger & Lane, 2009 Kirstie's sense of frustration with the obstetrician's attitude may also reflect differences in approaches to research evidence, and different perceptions of the relevance and legitimacy of that evidence.…”

“…The term is also associated with paternalism and control, as illustrated in a political context by neoliberal policies aimed at austerity, but which act to control already disadvantaged groups such as Indigenous persons and young single mothers (Mendes, 2009). As such, the metaphor of tough love does not sit well with the notion of relationships between labouring women and midwives being based on mutual trust and shared power (Kirkham, 2011), nor that of midwifery guardianship (K. Fahy & Parratt, 2006). Alexandra's reference to a "level of goodness" suggests that the acceptability of the procedure may be challenged by the pain midwives inflict through the injections.…”