A Grounded Theory on Constructing Relationships In Midwifery-led Units

Introduction: Community midwifery postnatal services are not routinely practised in Ireland. The public health nurse provides one visit following birth, which is the norm in the established consultant-led model. Two midwifery-led units in Ireland provide a family-centred model of maternity care including a postnatal community midwifery service. This is the first study to investigate the provision of a postnatal community midwifery service as part of a midwifery-led philosophy of care. The study was justified as no studies exist to examine midwifery led postnatal care from an Irish perspective, even though this service has been operating since 2004. The National Maternity Strategy (DOH, 2016) has set out recommendations that support the development of community midwifery models of care, which incorporate postnatal services. Objective: To explore midwives’ perceptions and experiences of providing a postnatal midwifery service in a community setting following birth in a midwifery-led unit in Ireland. It is hoped that valuable lessons may be learned from midwives’ experiences and stories. Methodology: A Glaserian grounded theory design was employed to address the research objective. Nineteen purposively sampled midwives working in two midwifery-led community services were interviewed. Data were collected through semi-structured interviews theoretical sampling and memoing and analysed using constant comparative analysis. Data collection was undertaken during the Coronavirus pandemic (Feb 2020-Jan 2022) and the HSE cyber-attack (May 2021-Sept 2021). Findings: The indings identified a substantive grounded theory of ‘A place for you and us,’ a core category consisting of three sub-core categories which emerged to support the substantive theory. Sub-core categories identified were visualising midwifery-led philosophies, directioning; solution building for modern midwifery challenges and evolving; future community midwifery services. These findings may guide the provision of community maternity services in Ireland as advocated by the Maternity Strategy (DOH, 2016) as unique features from midwifery perspectives and maternity services are revealed. Conclusions: Findings from this study indicate that the advantages of woman centred models of care are relevant only if these models are available for midwives to experience. The importance of trusting and respecting midwifery expertise by others enabled conflicts and solution building through meaningful collaborative and collegial working to be resolved. Foundations were strengthened when cohesive woman centred management coincided with respectful, equity driven partnerships with MDTs working in primary and hospital jurisdictions. Building relationships and effective inter-relational working strategies sustained, strengthened and evolved community services through enhanced collaboration within maternity disciplines and shared ownership and investment in community services. Implications for practice: Women centred evidence based models and knowledge while widely available can only become relevant and valuable once midwives are exposed and have opportunities to relate and identify with them. Despite policy recommending the expansion of postnatal services, there remains a paucity of empirical evidence and experiences of postnatal perspectives from community midwives. There is a need to report on Irish community services, and identify policy and guideline recommendations to address gaps in current empirical research.