107 Experiences, beliefs, and values influencing midwives’ attitude Discussion Midwives’ attitude towards interventions presented itself in an attitude oriented towards wait and see and an attitude orientated towards check and control. Coping with experiences of complications or complaints, and values on collaboration with women or health care providers in obstetrician-led care influenced midwives’ attitude. It appears that midwives with a wait and see attitude have a more restricted approach to interventions compared to midwives with a check and control attitude. The care of midwives based on a wait and see attitude suggested a more supportive style of behavior, where care based on a check and control attitude suggested a more directive style of behavior. Two paradigms The wait and see and check and control attitudes match the sociological framework of the social and medical model of care (26). In practice, a whole range of combinations of the two ways of operating can be seen (26). In accordance with the social model, midwives with a wait and see attitude focus on normality of childbirth, social support, and an active involvement of the individual woman. In accordance with the paradigm of trust (27), these midwives build a relationship with the woman through open communication and equality. The midwife-woman relationship is the vehicle through which trust is built, personalized care is provided, and contributes to a woman’s feeling of empowerment. In contrast, the medical model of care focuses on risk and ways for risk reduction, whereby women are less involved in their care (26). Midwives with a check and control attitude also believe that normal childbirth requires medical control to guarantee safety and apply interventions at the earliest sign of pathology, like in the medical model. This attitude is more influenced by the paradigm of risk (28). In the last century, midwifery care has become more technologically oriented and the number of hospital births has grown, creating an increasing reliance on standardized procedures and a prominent place for risk management (26,29,30). As such, the standardization of care by guidelines, and audits of healthcare provision have brought about a shift in focus, away from the trust in the normality of childbirth and professional autonomy (30,31). Perinatal care in the United States of America is more influenced by the paradigm of risk, resulting in a care system that more strongly believes birth is an event with a high potential of pathology (32). Most midwives work in a hospital setting, where the autonomy of a midwife differs greatly between hospitals. In the Netherlands, primary care midwives work in collaboration with hospitals but can make autonomous decisions about certain, nationally regulated childbirth interventions, eg, external version of a breech (10,14,15). On the other hand, certain interventions, such as an epidural, are only 4
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