Protocols, policy directives and choice provision: UK midwives' views

Within maternity hospitals midwives are expected to follow the protocol-driven culture and orders issued by senior staff. Simultaneously, midwives are expected to follow social policy documents and the Midwives Rules and Standards that advocate choice provision for childbearing women. Quality assurors and auditors of clinical practice need to be aware that these two directives sometimes clash. Allegiance to a hierarchical system driven by protocols and orders from the top down, at the same time as providing "woman-centred" care is often unattainable. In order for a midwife to action the woman's choice, resourceful thinking may be required. This paper aims to examine this issue. DESIGN/ METHODOLOGY/APPROACH: A descriptive interview study set out to discover strategies which midwives use to resolve conflict produced from competing directives. An appraisal of 20 midwives' views were gained from semi-structured interviews conducted in seven maternity units in the UK. Taking a post-positivist approach, inductive thematic analysis was used to interpret the data.

Three main categories represented resourceful ways of pleasing both authority and the childbearing woman. Midwives occasionally: are economical with the truth; circumvent face-to-face confrontation with senior staff; and persuade women to refuse what they perceive are unnecessary and invasive interventions.

This paper offers unique insights into methods that midwives use to resolve conflicts in direction issued by management. It is important that auditors are aware that midwives sometimes struggle to support the preferences of healthy childbearing women. This reduces job satisfaction, delivery of care and consequently requires address.