Midwives' experiences of working in an obstetric high dependency unit: A qualitative study

- Midwives were experienced in providing maternity care to well women.
- Midwives felt overwhelmed about working in an obstetric high dependency unit.
- Pre-registration midwifery education does not equip midwives to deliver high dependency care.
- Midwives require additional skills and knowledge for obstetric high dependency care.
- An obstetric high dependency unit can promote keeping mother and infant together.

Objectivesto understand the challenges experienced by midwives providing obstetric high dependency care and identify the training they perceive is needed for work in an obstetric high dependency unit.Designsixteen midwives who worked in the obstetric high dependency unit participated in one of three focus groups. Focus groups lasted 60-90 minutes and were conducted in the workplace and facilitated by author (IE). Data were digitally recorded, transcribed and analysed manually by author (IE), specifically using a 'codebook' model to generate codes, categories and themes.Settinga purpose built, two-bed obstetric high dependency unit located in the delivery suite of a large, urban tertiary teaching hospital in New Zealand.Findingsfive themes were conceptualised: Theme 1: 'high dependency care is not our bread and butter'; the midwives felt that working in the obstetric high dependency work did not constitute 'normal' midwifery work. Theme 2: 'we are family… embracing the baby and partner in HDU'; the midwives recognised that an obstetric high dependency unit enabled the mother and infant to be cared for together, was beneficial for maternal psychosocial wellbeing, and supported mother-infant bonding and breastfeeding. Theme 3: 'primum non nocere; First, do no harm'; the midwives voiced concern that they lacked the skills and training to provide obstetric high dependency care and considered this a potential risk to sick women in their care. Theme 4: 'graceful swans and headless chickens'; the midwives reported feelings of stress, anxiety, fear and of being overwhelmed by the demands of obstetric high dependency care. The more experienced midwives were able to portray calmness and poise despite lots going on beneath the surface. This was in contrast to other, often less experienced midwives, who appeared confused and less organised. Theme 5: 'please sir, can I have some more training?'; the midwives unanimously sought training in the provision of obstetric high dependency care and saw facilitation of training to be a responsibility of the hospital.Key conclusionsmidwives who are competent in obstetric high dependency care are well placed to provide holistic care to sick women within an obstetric high dependency unit. Midwives found this work challenging and identified the need for specific knowledge and skills beyond those required in the provision of care to well women. The midwives sought post-registration training in obstetric high dependency care. These findings are consistent with other studies reported in the literature.Implications for practicepost-registration training must be made available to midwives providing high dependency care to sick women to ensure they have the specialised skills and knowledge for practice. Responsibility to facilitate training rests with hospitals providing this service.