Midwives accompanying women in labour during transport: a qualitative study

Abstract Background Centralisation of maternity care is linked to prolonged travel distances between home and labour facilities and to born before arrival (BBA) births. Norwegian official guidelines recommend transport by ambulance with an accompanying midwife or GP for women travelling more than 90 min. BBA-births are associated with adverse pregnancy outcomes, and women experience BBA-births as chaotic and dramatic. Ambulance personnel describe feeling unqualified to handle these emergencies. Less is known about the experiences of accompanying midwives in emergency situations. This study aims to explore the experiences of midwives involved in accompaniment services for pregnant women in Norway. Methods Individual, semi-structured interviews were conducted in the autumn of 2022 with eight midwives experienced in accompaniment transport services in Norway. The data were analysed using systematic text condensation as described by Malterud. Results The analysis resulted in the following four main findings: (1) Decision-making in isolation: Midwives often felt alone in emergency situations, (2) Strong professional identity: Midwives saw themselves as essential in providing qualified care, (3) Practical and organisational concerns: The uncertainty of what might happen during a shift was experienced as stressful and constraining. The midwives questioned whether policymakers understand the impact of centralisation, and (4) Challenging yet empowering experiences: While all midwives acknowledged the risk associated with BBA-births, uncomplicated BBA-births could be empowering experiences. Conclusions This study highlights midwives’ experiences accompanying women in labour during transport. Some midwives recounted roadside births as empowering and unique experiences but also described demanding situations and feelings of isolation. Our study suggests that the accompaniment services require cross-professional collaboration and strong and easily accessible support systems.