Stop the turf wars

In the Lancet framework for optimal maternal and newborn care that we explored last week, we saw the importance of establishing effective collaborative practices between all providers of maternity care. This is fundamental to the provision of safe maternity care.

Last week we also saw how a lack of collaboration between midwives and doctors negatively affects women. There are coroners reports and large-scale enquiries from countries around the globe identifying how this lack of respect, trust and collaboration between midwives and doctors has negatively contributed: not just to the woman’s perceived experience of her maternity care, but to the actual outcomes. The so-called ‘turf wars’ of birth may limit opportunities to move forward and establish maternity models that make the woman the focus of care.

Barriers to midwife-doctor relationships

In any maternity care system, women will sometimes need access to specialist medical support and it’s absolutely imperative that midwives can be in relationship with, and work with, doctors and other specialists. However, significant barriers emerge to positive working relationships between doctors and midwives. These can include:

• potential for vastly different philosophies about pregnancy and birth
• a lack of understanding of and trust in the scope of practice and training of midwives
• concerns that more midwives in continuity models will mean less work (and income) for doctors
• ingrained historical animosity between the two groups (the ‘turf wars’)
• dysfunctional communication patterns.

Over 20 years ago, Joanne Harcombe wrote in ‘Power and political power positions in maternity care’ that “the challenge is now for women, midwives and obstetricians to re-examine power positions, abandon the power struggle and to work together in creating a positive climate for change.” (Harcombe, 1999, p.78). Unfortunately, this advice still stands, as the power struggle is as alive now as it was then. In order to address this struggle and stop the detrimental effects on women, we need to focus on the relationships involved, and identify ways to bring people together to focus first and foremost on the woman’s needs.

What works well

There are some remarkable instances of midwives and doctors putting aside any philosophical differences in service of the shared goal of safe, empowered, and supported birth care for women and babies. For this to work well, there needs to be acceptance of each other’s scope of practice and high levels of mutual trust and respect. There also needs to be a high degree of clarity in who is responsible for which aspect of care, and clear agreement around when and how consultation or referral in both directions is needed.

This level of collaboration requires respectful, timely communication within a relationship based on mutual trust.

Over to you

We know we have to address the power struggle between doctors and midwives in order to provide the best care for women and babies – but how do you think this can be done?

What is one key way that the ‘turf wars’ over childbirth can be overcome? Share your thoughts with the group.

References

1. Harcombe, J. 1999. Power and political power positions in maternity care. British Journal of Midwifery. 7:2, 78-82