gms | German Medical Science

Background: The practical training in midwifery education in Germany takes place predominantly in hospital delivery rooms, where intravenous infusions, augmentation with oxytocin, administration of analgesics, and cesarean deliveries are the norm. The result of this is that midwifery students have accompanied very few women who have given birth physiologically, without invasive interventions. Learning an occupation does not only mean learning to carry out tasks, it is also a process of socialization into a professional circle (Benoit, 1989). According to Benoit et al. (2001, p. 139): Midwifery education “refers to the formal requirements and organization of the midwife training program,” while socialization “signifies the informal process... by which a midwife acquires the shared culture of midwifery.” Ivan Illich (1973 in Benoit et al., 2001, p. 139) called this “hidden curriculum”. Historical examples show us that, even in the 18th century, women who had had a home birth gave accounts of inadequate care by midwives who had been trained in the clinic.

Methods: In the framework of my master’s thesis, I carried out a qualitative study in a birth center in Berlin. The study included 5 semi-structured expert interviews lasting one hour with each of the midwives at the birth center, as well as approximately 50 hours of participant observation at births. After receiving my master’s degree, in the framework of information gathering on birth in France, I interviewed 4 independent home birth midwives practicing in France (semi-structured interviews, inclusion criteria were: full-time work as an independent midwife, more than 4 births per month). The interviews lasted from 45 minutes to 1½ hours. All interviews were recorded on a hand-held recording device, transcribed and analyzed according to Grounded Theory (open, axial and selective coding to generate categories) (Charmaz, 2009).

Results: The categories that emerged from the coding were:

1) Seeing to learn – learning to see: The midwives all described the process that they went through when beginning work in an out-of-hospital setting in a similar way. The observation of births in their new setting was an integral part of the learning process.

2) From thinking pathologically to honoring individuality: The monitoring and care of women at birth in out-of-hospital settings is oriented on the birth process and individual rhythms of birth, and not on the standards that were practiced in training and in experience gathered in clinical settings.

3) Negotiating normality: Normality, or that which is thought to be normal, takes on a different meaning at out-of-hospital settings than it had in the clinic setting.

Recommendations: The ability to monitor and provide care at a birth without or with only minimal invasive interventions must be learned. If one has the goal to reduce the use of interventions, including reducing the rate of cesarean deliveries, then midwives must have the opportunity to see and accompany birth without interventions in their training.