The culture of midwifery in the National Health Service in England

Abstract

The culture of midwifery in the National Health Service was examined in order to foster understanding of the context of midwifery practice. In-depth interviews were conducted with midwives in five, very different, sites across England. The culture which emerged was one of service and sacrifice where midwives lacked the rights as women which they were required to offer to their clients. There was a lack of mutual support and of positive role models of support with considerable pressure to conform. Guilt and self-blame were common as was learned helplessness and muting. The dilemmas of this culture are considered and the resistance which it offered to change in relationships. Change was either resisted, brought about by stealth or strategically planned to equip midwives to change their culture.

Transformational Leadership and Midwifery: A Nested Narrative Review

“…The topic has been the subject of comment from distinguished writers from both nursing and midwifery backgrounds (Rafferty 1993;Barker 1994;Page 1995;Kirkham 1996;Hurst 1997;Kirkham & Perkins 1997;Pashley 1998;Fisher & Davidhizar 1998;Kirkham 1999;Ralston 2005).…”

Access or Egress? Questioning the “Ethics” of Ethics Committee Review for an Ethnographic Doctoral Research Study in a Childbirth Setting

“…The valuing of relationships over tasks, and the structural and temporal freedoms described in Walsh's (2006) study benefited both the women and the midwives. Kirkham's (1999) ethnography of midwifery practice in the United Kingdom identified a divergence in cultural norms whereby midwives support women through their pregnancy and birth process, encouraging autonomy and control, but have little access to similar support, autonomy and control themselves. Equally, while promoting trusting relationships between midwives and women, there was a decided lack of trust within institutionalised midwifery, with midwives identifying a culture that emphasises self-sacrifice, guilt and blame, leading to a lack of solidarity between colleagues and a resulting horizontal violence.…”

“…Midwives wanting to make changes felt they had to do so secretly for fear of being targeted as a misfit or deviant. Kirkham (1999) noted that this kind of behaviour, associated with feelings of powerlessness, is symptomatic of oppressed groups, therefore any attempt to make changes in the maternity system, she argued, needs to first address culture.…”

Professionalism and person-centredness: developing a practice-based approach to leadership within NHS maternity services in the UK

“…Person-centredness is far less likely to emerge in professional contexts characterised by patriarchal tradition and technical capacity (Hunt & Symonds, 1995;Kirkham, 1999;Sandall et al, 2009). Indeed, person-centred care is contingent on relationships which are fundamentally democratic and respectful of all parties.…”