Affective care: rhetoric or reality

Midwives say they are "with women", and philosophies of midwifery espouse "holistic care". A study into the counselling role of midwives revealed that midwives are "physically with women", and adopt a reductionist model of midwifery care. A combination of quantitative and qualitative research methods was used to explore the counselling attitudes, intention, and behaviour of midwives practising in a large Melbourne metropolitan obstetric and midwifery teaching hospital. This sample of midwives revealed positive attitudes towards the counselling of childbearing women and a high counselling behavioural intention. Reflection on their midwifery practice and support of propositions relating to the affective role of the midwife, highlighted further their claims of attending to the psychosocial needs of childbearing women. However, when observed in practice, the midwives engaged in minimal communication with the women and demonstrated few counselling behaviours. In fact, the focus of midwife care was clearly physical and task oriented, with an emphasis on the giving of practical advice and a lack of attention to the affective needs of their midwifery clients. It is argued that a number of factors are responsible for the discrepancy between midwives' intention and practice. Firstly, midwives adopt self-defence techniques in response to the requirement to deal with the psychosocial needs of childbearing women. Secondly, this mode of self-protection is precipitated by feelings of uncertainty in not knowing what to do, compounded by inadequate role preparation through nursing and midwifery education. Finally, socialisation of midwives within the work culture is a powerful determinant of the model of care they adopt.