Pioneering a new model of midwifery care: A phenomenological study of a midwifery group practice

This study explores the essence of the experience of midwives working within a new midwifery model of care: A Midwifery Group Practice (MGP) and is one component in a quality assurance project to evaluate the new service. In March 2005 the Re-Birthing Report was released in Queensland. This report reviewed maternity services in Queensland and contained key recommendations and guiding principles which were subsequently endorsed by the Queensland Government. The Re-Birthing Report clearly articulates that maternity care in Queensland must change to meet the needs of women and families birthing in Queensland in the 21st Century (Hirst, 2005). Consequently this report was the catalyst for the metropolitan hospital in Queensland where this study was conducted, to implement a Midwifery Group Practice (MGP) model of care. A recently published Federal Government Review of Maternity Services in Australia has also made recommendations that will potentially enable midwifery models of care to be implemented throughout Australia (2009). An extensive review of the literature outlined relevant key issues including significant gaps in Australian research relating to case-load midwifery practice. No Australian research was found to specifically explore the midwives' experiences when pioneering new midwifery models of care, such as a MGP. The philosophical approach adopted for this study is Hermeneutics (interpretive) phenomenology. Hermeneutics is considered most relevant to this research as it is grounded on the ontological view that the interpretive process is the experience. Therefore, through phenomenology this study interpreted the essence of the experience of midwives pioneering a new model of midwifery care (the phenomena). Purposeful sampling was employed for this study as each participant was 'selected' purposefully for the contribution he or she could make towards the emerging theory.;The study received ethical clearance and approval by the Health Service Human Research Ethics Committee and the Australian Catholic University Human Research Ethics Committee. Semi-structured interviews were conducted, recorded and the information deidentified when transcribed, providing a rich source of data for analysis. The chosen method of data analysis employed was guided by Gadamer's theoretical model. This model is underpinned by the hermeneutic circle of understanding as proposed by Heidegger, which is viewed as one between pre-understanding of the phenomena and understanding. The hermeneutical circle is a circle of interpretation that moves forward and then backward beginning at the present and it is never closed or complete. Through this process of rigorous understanding and interaction the phenomenon under study was uncovered. The researcher became immersed in the data whereupon after transcribing the data further reflected and identified categories and themes. This process allowed a highly fluid process until a point of data saturation was reached. Essential elements which emerge from the midwives' experiences are revealed in this study and these will potentially impact on the sustainability of new MGP services. These essential elements are: work/life balance, shared group philosophy, group antenatal care, peer support/ case management, and organisational support. Notably and fundamental to all the elements that emerged from the midwives' experiences, was a Cultural of Trust.