Facilitators and barriers to the implementation of a physiological approach during labour and birth: A systematic review and thematic synthesis
Abstract
OBJECTIVES: To explore facilitators and barriers to the implementation of a physiological approach to care during labour and birth in obstetric settings. To explore how facilitators and barriers located at three levels: organisation, professional groups (midwives and obstetricians) and women, interact to influence the implementation of a physiological approach.
METHOD: A systematic review of the literature, identified 32 eligible studies from four databases reporting relevant qualitative data. Findings from these studies were thematically synthesised in three phases: line by line coding of findings from primary studies, development of descriptive themes and analytical themes. This review is reported in line with PRISMA guidelines.
FINDINGS: At an organisational level, centralisation of care in obstetric units limited time for labouring and professional care to support a physiological labour and birth. Risk management strategies ostensibly designed to promote safety sustained a risk-based approach. At a professional level, important barriers include hierarchical decision-making led by obstetricians, midwifery acquiescence, obstetric and midwifery risk preoccupation, rationalisation of the routine use of clinical intervention and an erosion of midwifery skills and knowledge. At the level of the woman, barriers include a lack of knowledge and reliance on professional decision-making. Facilitators include collaborative working by midwives and obstetricians, a valuing of…
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