Skills and Knowledge of Midwives at Free-Standing Birth Centres and Home Birth: A metaethnography

Abstract

Problem: When midwives offer birth assistance at home birth and free-standing birth centres, they must adapt their skill set. Currently, there are no comprehensive insights on the
skills and knowledge that midwives need to work in those settings. Background: Midwifery care at home birth and in free-standing birth centres requires context specific skills, including the ability to offer low-intervention care for women who choose physiological birth in these settings.

Aim: To synthesise existing qualitative research that describes the skills and knowledge of certified midwives at home births and free-standing birth centres.

Study design: We conducted a systematic review that included searches on 5 databases, author runs, citation tracking, journal searches, and reference checking. Meta-ethnographic techniques of reciprocal translation were used to interpret the data set, and a line of argument synthesis was developed.

Results: The search identified 13 papers, twelve papers from seven countries, and one paper that included five Nordic countries. Three overarching themes and seven sub-themes were developed: ‘Building trustworthy connections,’ ‘Midwife as instrument,’ and ‘Creating an environment conducive to birth.’

Conclusion: The findings highlight that midwives integrated their sensorial experiences with their clinical knowledge of anatomy and physiology to care for women at home birth and in free-standing birth centres. The interactive relationship between midwives and women is at the core of creating an environment that supports physiological birth while integrating the lived experience of labouring women. Further research is needed to elicit how midwives develop these proficiencies.