Faculty of Nursing
Normal birth and issues of safety and risk: midwives perceptions in an Icelandic context
Masters student: Valgerur Lísa Sigurardóttir Advisor: lf sta lafsdóttir Masters committee: Hildur Kristjánsdóttir and Marianne Mead
Theses submitted for a Master of Science Degree in Nursing (60 ECTS)
Printed in Iceland of Pixel prentjónusta Reykjavík 2008
Normal birth and issues of safety and risk: midwives perceptions in an Icelandic context ________________________________________________________________________________
Abstract
Wellbeing and safety of mother and child is a guiding light in midwifery care. For the last decades medicalisation has increased in childbirth practice and more risk thinking is dominant in the childbirth environment. Physiological births have decreased and this has been of concerns in midwifery internationally where the concepts of safety and risk in relation to normal births, have been up for the debate. The aim of this study was to explore how midwives perceive the issues of safety and risk in an Icelandic context. A qualitative study about how midwives make decisions, describe and perceive safety and risk in normal birth was conducted. Data was collected by a convenience sample of eighteen midwives with different background in two focus group interviews, all of them practicing in two birth units in Landspitali-University Hospital. Data was analysed in themes and underthemes within an ethnographical tradition. The findings suggest that place of birth and risk mindset had influence on midwives confidence and inner knowledge and how they define normal birth. Being able to be present with the woman during birth is important in order to form a reciprocal relationship, built on trust. That kind of relationship created a sense of safety and an opportunity to use clinical skills and inner knowledge to decide about the best care for the women. If this kind of relationship was not created it could result in lack of safety. Procedure policies which are paradoxical to their knowledge and work based on conflicting models of care also created a lack of safety, which could be described as a feeling of being watched. This affected midwives and womens autonomy for decisionmaking. Yet, the midwives described how they sometimes step out of frameworks and make an autonomous decision built on midwifery knowledge, clinical assessment and the womans choice. In that way they provided evidence based care.

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