Normal birth, magical birth: the role of the 36-week birth talk in caseload midwifery practice

Abstract

Objective: to obtain a detailed description of the 36-week birth talk, and how it is delivered to and perceived by women and their birth partners. Design and method: two qualitative methods: ethnography and interpretative phenomenological analysis. Non-participant observation of five birth talks and in-depth semi-structured interviews with midwives, women and their birth partners. Setting: two caseload midwifery practices in an inner city area of England, and women's homes. Sample: five birth talks, five case-loading midwives, five childbearing women and five birth partners. Findings: a rich description of the content and conduct of the birth talk emerged from the data. In addition, three master themes were identified: a new philosophy for birth ('don't forget the magic'); the construction of authoritative midwifery knowledge ('they make you believe that you can have what you want'); and achieving a sense of coherence ('making sense of the birth'). Implications for practice, policy, education and research: the majority of data from this study suggest that the effectiveness of a birth talk cannot be separated from the philosophy and continuity associated with caseload midwifery practice. The birth talk is therefore probably not transferable per se into different models of care in order to achieve higher rates of normal birth. Further evaluation of the effectiveness of the birth talk in clinical practice, and further research into alternative birth philosophies in different settings is now required. Caseload midwifery practice has been shown to benefit women and midwives. This study would seem to concur with these previous findings. The sense of coherence concept could prove to be a useful tool to measure outcomes in future midwifery research. © 2008 Elsevier Ltd. All rights reserved.