Setting the stage for health: Salutogenesis in midwifery professional knowledge in three European countries

Abstract

There is a lack of systematic evidence concerning health orientation in maternity practice in the current climate of risk avoidance. The midwifery professional project is orientated toward the preservation of normal physiological processes during the maternity episode. This study investigates accounts of midwives who were working in health-orientated birth settings, to examine if and how they frame a health orientation in professional practice. Twenty-seven narrative interviews were conducted with midwives working in pre-, peri-, and postnatal care in different maternity care settings in Switzerland, Austria, and Germany. In-depth and comparative pattern data analyses were conducted. The distinct practice orientation of the participants was revealed in three main concepts, underpinned by a common framework mirroring the three parameters of the Sense of Coherence (comprehensibility, manageability, and meaningfulness) described in Aaron Antonovsky's salutogenic theory. The midwives’ implicit salutogenic knowledge shaped their reported actions in supporting mothers, fathers, and families to have health-promoting experiences in maternity care. These results suggest that an implicit health orientation in maternity care practice can be prefered through examination of the practice reports of midwives working in settings that have a health-promoting philosophy. Implications for midwifery practice and research are discussed. Consideration is given to the relevance of the results for debates about avoiding overtreatment and for the operationalization of salutogenic theory in health care practice.

“Just a little help”: A qualitative inquiry into the persistent use of uterine fundal pressure in the second stage of labor in Spain

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“…In order to avoid new knowledge being tacit, we need to conduct research in order to explore and verbalize such new understanding and to add this to midwifery knowledge. Recent studies on tacit knowledge of midwives' care when working in health-oriented birth settings (i.e., normal birth settings in hospitals, birth centres and homebirths) clearly demonstrate how midwives' praxis links to the concept of Sense Of Coherence (SOC) and salutogenesis (Magistretti, Downe, Lindstrøm, Berg, & Schwarz, 2016). This raises the question of whether the midwives in our study who experience contrasting models of care (Blaaka & Schauer Eri, 2008;Bryar & Sinclair, 2011;Hunter, 2004;Olafsdottir, 2006Olafsdottir, /2011 are in a field of tension because they experience obstacles towards salutogenic views and a promotion of pathology, thus preventing them from working as autonomous professionals based on their own knowledge.…”

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