Collegial midwifery assistance during the active second stage of labour

Abstract: AbstractSevere perineal trauma (SPT) is a serious complication following vaginal birth. To reduce its incidence rate, various preventive strategies have been implemented in Swedish obstetric units. Collegial midwifery assistance (CMA), involving an additional midwife being present during the active second stage of labour, is a clinical practice that was evaluated in the Oneplus trial, which proved a 30% reduction in SPT. The primary aim of this thesis was to investigate midwives’ and women’s experiences of collegial assistance during the active second stage of labour. The secondary aim was to obtain an improved understanding of the learning embedded within this clinical practice. The four papers included in this thesis are part of the Oneplus trial. Paper I has a qualitative design, using reflexive thematic analysis based on five focus group interviews with midwives (n=37). Papers II, III, and IV have quantitative designs using data from the Oneplus trial. In Papers II and IV, data was collected from clinical registration forms (CRFs) completed by the primary and second midwife after each birth (n=1430) and local databases. Paper III is a cohort study based on data from a questionnaire completed by women one-month postpartum, local databases, and CRFs (n=1050). For Papers II, III, and IV, we performed descriptive statistics as well as univariable and multivariable logistic regression analyses. In Paper I, four key themes were constructed: (i) challenging the professional role, (ii) a balancing act between different roles, (iii) not just why and how - but who, (iv) a potential arena for learning. In Paper II, the majority of the midwives fully agreed on items related to perceived confidence and considered having a colleague present to be a positive experience (61% and 56% respectively). Midwives with less than two years of work experience were more likely to fully agree on feeling confident (aOR 9.18, 95% CI 6.28-13.41) and experiencing the presence of a colleague as positive (aOR 4.04 % CI 2.83-5.78). Paper III showed that the clinical practice was well received by women, with 36% strongly agreeing that they felt safe and 43% expressing willingness to have CMA in the event of a subsequent birth. Women who experienced fear of birth, who had a lower level of education, and who did not have Swedish as their mother tongue showed higher levels of satisfaction with CMA. Midwives with less than two years of work experience reported new learning in three out of four births (76%) and those with over 20 years of work experience reported learning in one out of five births (22%). The importance of various factors influencing learning differed for primary and second midwives and were also influenced by the level of work experience. Our findings indicated that the CMA intervention was a well-accepted clinical practice among both midwives and women giving birth. CMA was found to provide valuable support and professional learning, which was especially pronounced among early career midwives. Experiences were complex and influenced by various factors, and the findings can be used to facilitate implementation and guide future practice.