A critical ethnographic approach to facilitating cultural shift in midwifery

Objective: to improve understanding of local midwifery morale, inform development and reorganisation of a maternity unit, and enhance midwifery involvement in strategic planning.

Participants: a randomised stratified sample of 20 midwives working in a UK National Health Service (NHS) hospital and its surrounding community area.

Method: within a critical ethnographic framework, focus groups were tape-recorded and transcribed, and analysed using a thematic content analysis approach.

Findings: key areas affecting midwifery morale were identified, in particular staffing levels, working relationships and organisational issues. One year later, despite many changes having taken place, midwifery morale was still low but participants were more politically analytical of, and actively involved in changing their situation. The findings of the study indicate that there are complex and long-standing cultural inhibitions to the effective development of midwifery care but, if these are made explicit through a planned collaborative process, such as in this study, a process of cultural shift can be seen to begin.

Implications for practice: focus groups can be a useful tool in moving midwifery culture forward within a local context.