gms | German Medical Science

Background: Midwives in German clinical settings care for several women at different stages of birth at the same time, trying to meet the wishes of the women giving birth. Routines and internalized actions, the so-called implicit knowledge, often help in this complex performance. However, the support provided by midwives strongly depends on the clinical framework conditions.

The randomised controlled multicenter study “Be-Up: Geburt aktiv”, conducted in different German cities between 2018–2021 studied the influence of a newly designed alternative birthing room on birth mode and the wellbeing of labouring women. At the same time, research into the care and support of the medical staff in this setting was a concern of the study.

Aim/Research question: This qualitative work (aiming at the doctoral degree of the first author) wants to reconstruct the influence of the birthing room and its design on midwives` orientation patterns. Another aim of the presented study is to explore possible differences between orientation patterns in differently designed birthing rooms. Thus, the Research question is: Which orientation patterns do midwives show while attending a birth in a usual birthing room compared to their orientation patterns in the alternatively designed birthing room of hospitals taking part in the study “Be-Up: Geburt aktiv”?

Methods: Investigating tacit knowledge asks for special scientific methods with the Documentary Method being especially appropriate for exploring tacit and practical knowledge. This exploration is possible by defined steps in the scientific process that aim at deeper areas of knowledge that are besides argumentative knowledge.

To reconstruct the practical knowledge and orientation patterns, 12 narrative topic-centered individual interviews have been conducted to date in both locations (usual and alternatively designed birthing space). The aim was to achieve theoretical saturation in order to capture the action-guiding orientations comprehensively and in detail. In a circular procedure, interviews, transcription and evaluation were carried out in parallel.

Results: In this paper, findings from the eight evaluated interviews on the usual birthing room will first be presented with regard to the dimensions guiding the midwives’ actions there. These dimensions concern the four aspects of the woman being cared for, the clinical setting, the midwives’ own person and their ideas about the midwifery profession. In an individual way, these four dimensions proved to be action-guiding for the daily work in the delivery room for each of the midwives interviewed.

Relevancy: This qualitative doctoral study contributes to a deeper understanding of professional habits in midwives working in different clinical birth settings. Additionally, further investigation of orientation patterns in the alternatively designed birthing room will help in exploring the complexity of midwives` practical knowledge.

Recommendations/Conclusion: Midwives play a major role in the course of births, which they attend. This role in turn underlies external and internal influences, that cannot always be influenced by the midwives themselves. Exploration of those influences may help in getting back in the center of interest in midwives’ work what should be there – the orientation towards the woman.

Ethics and conflicts of interest: A vote on ethics was obtained. The research was supported by external funding. There are no conflicts of interest.