Midwives' attitudes towards supporting normal labour and birth – A cross-sectional study in South Germany. (August 2016)

• Record Type: Journal Article
• Authors: Zinsser, Laura A.; Stoll, Kathrin; Gross, Mechthild M.
• Is Part Of: Midwifery. Volume 39(2016)
• Page Start: 98
• Page End: 102
• Publication Date: 2016-08
• Subjects: Self-efficacy -- Normal physiologic birth -- Support -- Midwife -- Birth setting -- Out of hospital birth; Midwifery -- Periodicals; Midwifery -- Periodicals; Sages-femmes -- Périodiques; Midwifery; Periodicals; Electronic journals; 618.2005
• DOI: 10.1016/j.midw.2016.05.006
• Languages: English
• ISSNs: 0266-6138

Abstract

Abstract: Objective: supporting healthy and normal physiological birth is part of the global maternity care agenda. Rising rates of interventions have been attributed to several factors, including characteristics, attitudes and preferences of childbearing women and their care providers. In this paper, the application of a scale that measures midwives' attitudes towards supporting normal labour and birth is described as well as factors that are associated with favourable attitudes, such as general self-efficacy, years in midwifery practice, and primary practice setting. Design: in this cross-sectional study an online questionnaire was sent out via e-mail to midwives in two regions of South Germany. The questionnaire contained a validated general self-efficacy scale, a 38-item instrument that measures attitudes towards supporting normal birth among German midwives and questions about midwives' practice experiences and educational preparation. Findings: on average, participants ( n =188) were 39 years old (SD=10.3), and had 12 years of experience caring for women during labour and birth (SD=9.6). Multivariate modelling revealed that higher general self-efficacy, working primarily in out-of-hospital settings and having provided intrapartum care for fewer years were significantly associated with midwives' favourable attitudes towards supporting physiological birth (variance explained R 2 =29.0%, n =184). General self-efficacy (1.4%) and years of work experience (3.3%) contributed less of the variance in the outcome than work setting (24.5%). Sources of knowledge about normal birth were not significantly associated with the outcome and reduced the overall variance explained by 0.2%. Conclusions: the study has shown that, compared to work setting, the general self-efficacy of German midwives, years providing intrapartum care and sources of knowledge about normal birth had comparatively little impact on their attitude towards supporting normal physiologic birth. Increasing exposure to out-of-hospital birth among German midwives throughout education and practice and fostering the skills and confidence necessary to support normal birth in hospital settings are important strategies to decrease unnecessary obstetric interventions. Highlights: Midwives who practiced in birth centres or at home scored significantly higher on a scale that measures attitudes towards supporting normal birth. Work setting explained nearly 25% of the variance in scale scores. Midwives with higher general self-efficacy scores and midwives with fewer years of experience caring for childbearing women scored significantly, but these variables explained very little variance in scores. The findings have implications for expanding practice options for midwives, as one strategy to increase the numbers of normal births in Germany.