The grounded theory of Coalescence of Perceptions, Practice and Power : An understanding of governance in midwifery practice

Journal article


Ferguson, Bridget, Baldwin, Adele, Henderson, Amanda and Harvey, Clare. (2022). The grounded theory of Coalescence of Perceptions, Practice and Power : An understanding of governance in midwifery practice. Journal of Nursing Management. 30(8), pp. 4587-4594. https://doi.org/10.1111/jonm.13892
AuthorsFerguson, Bridget, Baldwin, Adele, Henderson, Amanda and Harvey, Clare
Abstract

Aims
This study aimed to understand midwifery care during labour, particularly decision-making processes, within Australian health systems.

Background
Midwifery, founded on a wellness model of motherhood, is at risk of being medicalized. Whilst medical intervention is lifesaving, it requires judicious use. Governance provides oversight to care. Exploring decision-making contributes to understanding governance of practices.

Method
Straussian grounded theory using semi-structured interviews. Eighteen Australian registered midwives were interviewed about their practice when caring for women during labour.

Results
Midwives were caught between divergent positions; birth as natural versus birth as risk. Experienced midwives discussed focussing on the woman, yet less experienced were preoccupied with mandatory protocols like early warning tools. Practice was governed by midwives approach within context of labour. The final theory: The Coalescence of Perceptions, Practice and Power, comprising three categories: perceptions and behaviour, shifting practice and power within practice, emerged.

Conclusions
Coalescence Theory elucidates how professional decision making by midwives during care provision is subject to power within practice, thereby governed by tensions, competing priorities and organizational mandates.

Implications for Midwifery Managers
Midwifery managers are well positioned to negotiate the nuanced space that envelopes birthing processes, namely, expert knowledge, policy mandates and staffing capability and resources, for effective collaborative governance. In this way, managers sustain good governance.

Keywordsearly warning tool; governance; intrapartum; midwifery or midwife; midwifery practice; risk aversion
Year2022
JournalJournal of Nursing Management
Journal citation30 (8), pp. 4587-4594
PublisherJohn Wiley & Sons Ltd
ISSN0966-0429
Digital Object Identifier (DOI)https://doi.org/10.1111/jonm.13892
PubMed ID36325759
Scopus EID2-s2.0-85142229489
PubMed Central IDPMC10099921
Open accessPublished as ‘gold’ (paid) open access
Page range4587-4594
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online18 Nov 2022
Publication process dates
Accepted27 Oct 2022
Deposited07 May 2025
Additional information

© 2022 The Authors. Journal of Nursing Management published by John Wiley & Sons Ltd.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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