LAUSR

Objectives Unconventional birth choices can be characterised as birth choices that go outside of national guidelines and/or when women decline recommended are. The aim of this study was to explore the views and experiences of midwives who self-define as facilitators of women’s unconventional birth choices, whilst working within the NHS. By use of professional accounts, this study sought to understand what the midwives did, why, and how they performed evidence-based midwifery practice to fulfil the birth choices of the women in their care. Method This study employed a narrative inquiry qualitative study design. 45 NHS midwives were recruited from across the UK during January–July 2017. Participants worked within a range of posts Band 5–8 and across all maternity settings i.e. community, birth centres and hospital. Participants had two options; to provide a self-written narrative followed by an interview (n=22) or just standalone interview (n=23). Either data collection method asked the participants to describe a detailed account of a clinical occasion where they facilitated a woman’s unconventional birth choice. Prompt questions were used to explore the initial clinical situation to explore what, how and why the midwives acted in the way they described, which also led to numerous other clinical situations that were explored during the interview. A pluralistic narrative data analysis strategy was employed to capture the complexities associated with the midwives clinical practice. Results Data analysis is currently ongoing (tbc May 2018), however, a key finding is the midwives’ use of complex multi-modal evidence gathering techniques to inform clinical practice. Birth choices made by women varied e.g. VBAC at home, homebirth no midwives allowed inside birthing room, declining vaginal examinations during labour, declining transfer to hospital following prolonged third stage. Midwives demonstrated using ‘mindlines’ for clinical situations that were ‘in-the-moment’. Where there was time, during the antenatal period, midwives actively sourced and integrated a wide range of formal information to guide care planning. Where there was little or no evidence to inform clinical practice, midwives drew upon the basic sciences, physiology, simulated practice and clinical expertise to apply such knowledge to clinical situations. Drawing upon notions of novice to expertise, the participants demonstrated high levels of skill and competency to achieve evidence-informed practice where the women’s personal preferences were central to the clinical care. Conclusions There is an increased onus upon maternity professionals to respect women’s autonomous decision making and to provide individualised care. Arguably, neither EBM or guidelines could not ever account for every maternal choice possible, therefore the findings of this study offers insights to how midwives can provide evidence-informed clinical care despite such challenges. The large sample set which recruited midwives from a range of maternity settings and who held a wide range of positions suggests transferability of the findings to other similar maternity settings.