The Landscape of Caring for Women: A Narrative Study of Midwifery Practice

Authors

  • Holly Powell Kennedy CNM, PhD,

    Corresponding author
      Holly Powell Kennedy, CNM, PhD, University of California, San Francisco, 2 Koret Way, Department of FHCN, Box 0606, Room N411Y, San Francisco, CA 94143. E-mail: holly.kennedy@nursing.ucsf.edu
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    • Holly Powell Kennedy, CNM, PhD, FACNM, is an Assistant Professor in the Department of Family Health Care Nursing at the University of California, San Francisco, CA. She codirects the UCSF/SFGH Interdepartmental Nurse-Midwifery Education Program and conducts research on the midwifery model of care. She is the Chair of the American College of Nurse-Midwives Division of Research and Co-Chair of the International Confederation of Midwives Research Standing Committee.

  • Maureen T. Shannon CNM, FNP, MS,

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    • Maureen Shannon, CNM, FNP, MS, is an Associate Clinical Professor and a doctoral student in the Department of Family Care Nursing at the University of California, San Francisco, CA. She provides perinatal and primary care to HIV-infected women as a member of the UCSF Women's Specialty Practice and Perinatal HIV Program and has been involved in numerous research studies investigating strategies to interrupt perinatal HIV transmission.

  • Usa Chuahorm RN, MSN, PhD(c),

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    • Usa Chuahorm, RN, MS, is an Assistant Professor at Burapha University and a doctoral candidate at Chiang Mai University, Thailand. She is an experienced midwife and educator and recently spent a year as a special studies student at the University of California, San Francisco, CA.

  • M. Kathryn Kravetz CNM, MS

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    • M. Kathryn Kravetz, CNM, MS, is a recent graduate of the UCSF/SFGH Interdepartmental Nurse-Midwifery Education Program at the University of California, San Francisco, CA, where she worked as a research assistant with Dr. Kennedy and was a student member of the ACNM Political Action and the Political and Economical Affairs Committees. She is currently working as a Policy Intern for the American College of Nurse-Midwives.


Holly Powell Kennedy, CNM, PhD, University of California, San Francisco, 2 Koret Way, Department of FHCN, Box 0606, Room N411Y, San Francisco, CA 94143. E-mail: holly.kennedy@nursing.ucsf.edu

Abstract

Our purpose was to expand knowledge on the process and outcomes of midwifery care. Narrative analysis was used to interpret stories provided by midwives to illustrate their practice and recipients of midwifery care about their experience. A purposive sample of 14 midwives and four recipients of midwifery care was recruited as a subsample from a prior Delphi study on midwifery practice. Three broad themes were identified: 1) the midwife in relationship with the woman, 2) orchestration of an environment of care, and 3) the outcomes of care, called “life journeys” for the woman and the midwife. The findings are discussed from the perspectives of therapeutic landscapes described in cultural geography and prior research on midwifery practice. The challenge is to confirm the associations between the processes of care identified in these narratives with both short- and long-term outcomes in the health of women and their families. These appear to go well beyond the usual perinatal measures currently used in health care research and hold implications for how care is delivered, measured, and evaluated.

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