104 Chapter 4 I certainly feared upright births in my early years. After the baby was born, the blood clattered down and I wanted to administer oxytocin right away. After a while, you get used to the noise and you can estimate the blood loss better, and you hold off administering oxytocin. (Midwife 14) However, more often, midwives talked about the emotions they felt after an obstetric emergency such as a postpartum hemorrhage or fetal distress. They described feeling helpless and afraid when these situations happened, and feeling uncertain and unsafe during subsequent births. The described feelings were mostly related to childbirth and rarely to a situation occurring in pregnancy, such as fetal growth restriction. After that case [neonate with asphyxia], when I noticed a little dip in the fetal heartbeat, I immediately thought “oh no, not again”. (Midwife 3) It appeared that midwives could react in two ways to these stressful experiences. One group became more defensive and felt they needed to do more interventions, and also performed more interventions than they had in previous pregnancies or births. This group practiced the check and control approach to feel more certain and safe. The other group of midwives reflected on having feelings of uncertainty and fear that an obstetric emergency or complication would reoccur. They suggested that they needed to regain confidence, but were aware of this response and the impact it might have on the use of interventions. As described in the following quote, these midwives were conscious not to perform more interventions in later situations. Afterwards, all midwives in my practice wanted to check blood when a woman had a little itching [after a fetal death caused by cholestasis]. But it was just one case, and we cannot implement a new treatment based on one case. (Midwife 11) Besides fear for complications, perinatal mortality or morbidity, midwives spoke about their fear for a legal complaint or claim. Woman-centeredness Most midwives in our study talked about woman-centered care in relation to their attitude towards the use of interventions. They talked about how woman-centered care was part of their daily practice and about the difficulties they encountered in providing this care. They highly valued the wishes of the woman, and strived to meet these wishes as best as possible. When the woman had other preferences than her midwife concerning the obstetric management, midwives with a more wait and see approach told us they would support the woman in her choice. Other midwives expressed difficulties supporting the woman’s care wishes when these wishes differed from their own preferred management. They expressed their dilemma between values as
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