When the Midwife-woman partnership breaks down - principles for ending the relationship

Abstract

New Zealand’s unique Lead Maternity Carer (LMC) midwifery model of practice is a privilege for both women and midwives. Underpinning this model of practice is the concept of partnership. The midwife-woman relationship has been identified as the key sustaining element of one-onone midwifery care. However practice experience reveals the potential for this key relationship to break down. This becomes a particularly complex and conflicting challenge when the midwife recognises that for her own professional safety she needs to unilaterally end the midwife-woman relationship. Of paramount importance to a healthy functional partnership is mutual trust, respect and reciprocity. There is a taken for granted assumption that trust can be established and maintained, that there is willingness for sharing on both sides and a reciprocal respect. When trust is eroded or irretrievably breaks down, the health and survival of the relationship are threatened, and the alliance has the potential to become unstable and unsafe. Consequently the midwife may decide to end the relationship. A framework, to help navigate and support the midwife who is experiencing this distressing challenge, does not exist. A case study, explored through descriptive interpretive analysis, is used to present one of the author's experience of a breakdown in the trust relationship. Analysis of the experience reveals the intuitive process this midwife utilised, to ensure she upheld her professional responsibility as well as maintaining her self-worth and integrity. Implications for practice arose from the discussion and principles were distilled. These may provide an appropriate and professional process for midwives on the rare occasion they need to end the partnership