Midwife’s experiences of using intuition as a motivating element in conveying assurance and care

doi:10.4236/health.2011.37075

Paper Menu >>

Journal Menu >>

Vol.3, No.7, 453-461 (2011)

doi:10.4236/health.2011.37075

Health

Midwife’s experiences of using intuition as a motivating

element in conveying assurance and care

Agnet a Olsson, Annsofie Adolfsson*

School of Life Sciences, University of Skövde, Skövde, Sweden; *Corresponding Author: Annsofie.adolfsson@his.se

Received 14 April 2011; revised 30 May 2011; accepted 11 June 2011.

ABSTRACT

The expectations of a successful outcome dur-

ing childbirth are high for all of the parties

concerned. The overall objective of pre natal care

and birth care is that midwives contribute to

create the most positive experience for the ex-

pectant pare nts co ncer nin g their p regn ancy , t he

actual childbirth and the child’s infancy. During

the past thirty years, there has been a signifi-

cant increase in Caesarean section frequency

both in Sweden and in the rest of the Western

World. More parents feel an overall insecurity

when it comes to the labor phase leading up to

childbirth. The purpose of this study was to

describe how midwives experience their work of

creating a sense of security and providing good

nursing care when meeting with the expectant

parents. A phenomenological approach was

implemented using eleven qualitative interviews

and these were analyzed with Giorgis’ method

of analysis. The results of this analysis revealed

three themes: organizational-professional con-

ditions, the communicative ability of the mid-

wives and their reflective-emotional compe-

tence. The ability of the midwives to trust their

inner sensibility and intuition was something

that was characteristic of all the interviews and

consequently this was the essence of the re-

sults. Managements’ organization of the work-

load and how management utilized competent

and experienced midwives affected the mid-

wives’ ability to contribu te to a sense of security

and provide competent nursing care for expec-

tant parents. When the communication was

based on sensibility and compassion, the mid-

wives’ were enabled to create a sound and

trusting relationship between themselves, the

MVC and with the expectant parents. The emo-

tional involvement on the part of the midwives

was an essential requirement for carrying out

the work in a satisfactory manner. Perhaps a

question for future research is how inner

knowledge based on practical experience can

benefit new personnel and how the or ganization

and the education of healthcare providers can

utilize the intuitive knowledge of midwives.

Keywords: Fear of Childbirth; Midwife Encounter;

Support Midwife; Security in Childbirth

1. INTRODUCTION

This study is about using the experience of midwives

to contribute and provide proper nursing care for expec-

tant mothers by helping them to develop a sense of secu-

rity with consistent and competent care for the women

during their pregnancy and through the delivery of the

baby. The expectations for a successful delivery are high

for all concerned. Therefore, the demands are high

within the Maternity Health Care system (MVC) and the

delivery ward to offer the expectant parents the best care

possible [1]. The healthcare in Sweden for pregnant

women is managed from a national base program with

guidelines to identify possible complications and their

reasons. The role of the midwife is to contribute to a

meaningful and positive experience of the pregnancy,

delivery of the baby and the infancy.

The professional role of the midwife has changed

during the last couple of decades. Healthcare today for

pregnancy and child delivery has a large focus on the

symptoms of possible psychological issues and dysfunc-

tion which are often due to fears associated with preg-

nancy, the delivery and even child raising. Pregnancy and

delivery healthcare has become more of a medical matter

since women have moved from delivering babies at the

home, to the delivering their babies in the ho spital. As a

result, the care is focused on the complications, the risks

and the outcome o f the delivery than it is on the women’s

experiences of the pregnancy and the delivery [2].

In the last thirty years, the number of Caesarean sec-

tion deliveries has increased in Sweden from approxi-

A. Olsson et al. / Health 3 (2011) 453-461

454

mately six percent to nineteen percent and the percent-

age is slightly higher in the larger cities. This phenome-

non is not unique for Sweden when compared with the

rest of the Western World [3].

When the author of this study began working as a

midwife, the birthrate in Sweden was high and conse-

quently the workload for midwives was high. The final

training for a midwife student at the time was to manage

the care of two or three women who were in labor at the

same time. In spite of these conditions, the feeling in

general was that most women and couples were not

overly concerned or insecure before the delivery. The

questions that women and couples ask in the MVC no-

wadays have changed in character and the questions re-

flect a common insecurity in connection with the actual

delivery.

The aim of this article is to study and reflect upon the

experience of midwives in order to use their experience

to create a sense of security and provide good nursing

care to the expectant parents during their pregnancy and

through the delivery of their baby.

2. METHOD

When researching this phenomena in the context of

living situations in the real wo rld th e goal was to detect,

analyze and clarify the contents in terms of the issue and

the essence of the studied subject. An important aspect

of the interviews to be understood with regard to the

phenomena of intuition on the part of midwives, was that

the subject was discussed and described in explicit and

implicit terms [4,5]. The interviewer must be skilled and

knowledgeable in order to listen carefully to the inter-

viewee to decipher when she is expressing herself in

implicit terms. When the implicit content of the inter-

view was clearly understood and clarified we got a more

complete picture of the studied phenomena, which was

the midwives live world experience of caring for preg-

nant women throughout their pregnancy term [6].

Phenomenology is a con scious philosophy th at is used

through languag e to describe people as subjects of a r eal

world and their experiences as real events [4,7,8]. The

ancient Greek philosopher Aristotle [9] theorized that

thoughts did not exist until one of the senses had ex-

perienced it.

2.1. Data Collection

The object of the data collection was to compile a da-

tabase, which reflected and represented the variety and

depth of the midwives experiences in working with ex-

pectant parents as closely as possible. There were two

sources of data included in this stud y. In ord er to recruit

participants for the study, an interest questionnaire was

sent out in the mail to the midwives in the Skaraborg

district MVC that is located in the Midwest of Sweden.

A verbal presentation was also conducted at a working

staff meeting in a delivery ward, in the same area, with

the same goal of recruiting participants for the study.

The researcher excluded those people who were previ-

ous or present colleagues of theirs from being potential

participants in the study.

There were eight midwives from the MVC and seven

midwives from the delivery clinic who responded that

they were interested in participating in the study. Of these,

the first ten who responded were chosen to participate in

the study. Five of these selected participants were from

the MVC and five were from the delivery clinic. The age

of the selected interviewees ranged from thirty-seven to

sixty-three years old. Their work experience varied in

length of time from ten to thirty-seven years.

In order to test the interview guide and verify the in-

terview technique a test interview was carried out under

the supervision of an overseer with an eleventh partici-

pant. The results of this interview were also used in the

study. The interviews of the ten selected participants

were performed at each individual’s workplace between

September and October of the year 2008. The in terviews

lasted between thirty and sixty minutes each. The ques-

tions in the interview guide were as follows:

How do midwives define the concept of security?

How do midwives define the concept of good nursing

care? What experiences could the midwives recall that

created a feeling of security and a good nursin g situation?

What are the prerequisites for creating security and good

nursing care when meeting with the prospective parents?

How did the education of the midwives contribute to

their ability to create security and good nursing care?

2.2. Data Analysis

The above analysis method was performed in four

steps [4,6-9]:

　The interview material was read through a number of

times to get a feeling for the text of the transcripts as a

whole and to understand how the phenomena of creating

security and good nursing care for expectant paren ts was

accomplished by the midwives.

　The interview material was divided into parts where

meaning bearing units were identified so that the mate-

rial was more manageable.

　The themes of the interview material were developed

from the meaning bearing units. Three central themes

were developed:

1) Organizat ional and Prof essional prerequi sites.

2) The Abilit y to Communicat e on the part of the Mid-

wives.

3) The Reflective and Emotional Competence of the

A. Olsson et al. / Health 3 (2011) 453-461

455

Midwives.

The relationship of the concepts from each of the

three themes gives us the essence of the interviews. The

essence of the interviews reflected how the midwives

actually utilized their intuitive inner feelings and how

this enables them to provide and create security in order

to give good nursing care for the expectant parents.

2.3. Ethical Aspects

All of the participants were given o ral and written ad-

vice regarding the objectives and design of the study.

They acknowledged that they were participating of their

own free will and all signed a confidentiality statement.

3. RESULTS

3.1. The Function of the Organization and

Professional Prerequisites

The interviewees expressed in their interv iews that the

knowledge obtained from education is a prerequisite to

perform the work of a midwife. The midwives with more

experience reported that they have had a lot of exercis-

ing and drilling on th is sort of practical knowledge an d it

should enhance their ability t o prov ide security and good

nursing care for their patients. The interviewees ex-

pressed that the educational element of their training

confirmed much of the practical nature of caring for

pregnant women up to the point of their delivery. When

it came time for the delivery, they felt that they were

truly on their own without their mentors to guide them.

Newly credentialed midwives are focused on making

medical judgments by the manual and reacting to condi-

tions that they perceive to be outside of the normal.

The combination of work experience prior to their

midwife education and their experiences of different

situations during on the job training was a common

thread among the midwives that en abled them to possess

the inner confidence to provide the security needed by

the expecting couple. This demonstrates that these ex-

periences create something valuable in the midwives

intuition that the formal education does not.

Formal education was a catastrophe in the sense that

it did little to educate me in group dynamics and psy-

chology…when leading a group of expectant parents one

should only be doing and reacting to real life situations

without having to consult the manual…in the end I did

not feel prepared for this type of situation with regards

to my formal train ing. (Interview #3)

A large responsibility in preparing th e next generation

of midwives for their craft is that mentoring midwives

bestow upon them their real life experience as well their

practical knowledge. In the final phase of a midwives

education, a period of twenty weeks is spent on training

for the labor phase of the pregnancy and for the actual

delivery of the baby in the delivery ward. During this

period it is the responsibility of the mentoring midwife

to transfer as much of her inner knowledge and experi-

ence to the apprentices as possible. This is very de-

manding on the mentors’ energy. This is an important

phase in the development of inner security and confi-

dence in apprentices that is such an essential part of be-

ing a midwife.

According to the interviewees, the presence and sup-

port of their colleagues once they are on their own in the

capacity of a midwife is a very important source of

knowledge that is both formal and informal. In order to

provide good nur sing care and create the ne cessary secu-

rity in expecting parents it is important to combine the

theoretical and practical healthcare knowledge together

with the psychological factors in volved in order to iden-

tify their needs from a holistic perspective. The midwife

must appreciate the woman as a unique individual and

the woman must understand that what she relates to her

midwife will be the basis for determining a specific

course of action with regard to her care based on her

individual needs. This is an important aspect of the rela-

tionship between the midwife and the woman and it is

accomplished with the midwife’s ability to be competent,

keen and sensitive to the woman on an individual basis.

The results of the interviews show that the physical

and emotional needs of women in terms of their nursing

care vary from woman to woman. Some women desire

to have more physical contact in the form of massage

and perhaps some demonstration of physical closeness

such as an arm around the shoulder or a supporting em-

brace while others are satisfied to feel at peace with their

selves and take some physical presence as needed. In

terms of emotional presence, midwives must be infor-

mative to the women with regard to their present situa-

tion and at the same time be a gu ide for the future possi-

bilities. The midwife must attentively listen to the co up le

to decipher what it is exactly that they want to be in-

formed about.

The education of a midwife also consists in coming to

an understanding of what the limits of her responsibility

are and realizing that there are situations where there is

the need for other professional services and caring that

she cannot provide. Accessibility to these services and

resources can have an important bearing on the course of

action in these situations. The interviewees acknowl-

edged that the organization and leadership contribute to

the efficiency of how their organization works and they

feel that they must be provided with sufficient resources

in order to perform their function to the best of their

ability. From a perspective of time, they felt that a high

A. Olsson et al. / Health 3 (2011) 453-461

456

work load combined with understaffing contributed to

the feeling that the midwives could not manage good

nursing care for the women. With unreasonable time

constraints, the midwife cannot attentively pay attention

to the needs of the women.

There are times when there just is not enough time to

give the patients what they need…and it is frustrating…I

cannot put the blame on myself and therefore I must

assign that blame outside of myself and chalk it up to

inefficiency within the organiza tion. (Interview #9)

How work is organized and if the po ssibility exists for

further educatio n and tr ain ing on behalf of the midwives,

has a significant influence on the perception of how

work is managed and experienced in the organization.

Professional guidance for the midwives combined with

an adequate time to reflect upon and discuss the nursing

care that is being provided to patients should be the

norm of the organization’s service as opposed to the

exception to the rule.

Through the support of colleagues and with guidance

counseling, a midwife gets the opportunity to test their

inner feelings about different situations and this enables

them to determine their boundaries regarding the re-

sponsibilities that they assume as a midwife. Healthcare

work can be more effectively organized when the avail-

able personnel are utilized as efficiently as possible. For

example, assistant nurses and the midwives colleagues

are an important part of the organization and they can be

effectively utilized in order for the expectant couple to

manage their pregnancy and make the delivery as routine

as possible. Midwives felt more confident when they had

the obstetrician that they trusted the most on duty when

they were performing their work. Conversely, when

midwives felt they were on a different page than the

working obstetrician it would create less than comfort-

able conditions in certain caring situations. As in any

organization, it is very important to have the proper lead-

ership in place so that personnel are in their most effec-

tive position and the interviewees were quick to under-

stand this.

…to me it is important who the doctor is that is man-

aging things…and this has an influence on how secure I

feel in certain situations…is he listening to what I have

to say about my observations with regard to the wom-

an…this is significant about my feelings of security with

my patient. Sometimes I am not so confident in the sup-

port and I feel as if I am taking too much responsibility

in certain situations. (Interview #6)

3.2. The Ability to Communicate

The first meeting between the midwife and the woman

or with the couple may well determine how the relation-

ship between the parties will develop. Therefore, it is

important to take as much time as needed and to invest

some extra energy into this meeting so that the relation-

ship takes root in a positive manner. Midwives need to

be attentive and listen carefully to the woman by show-

ing a genuine engagement with them in order to create a

trusting and secure relationship.

…I must be into her…it is the personal contact that

counts…the eye to eye con tact…if there is no connection

between us it is going to be difficult if conditions become

tough…it won’t work. These are basic conditions for

effective communication. (Interview #9)

The ability to communicate also includ es the ability to

interpret the verbal and nonverbal language. This re-

quires the midwife to listen closely in order to hear what

the woman is saying and to understand what is behind

her words. In this way, she is studying the woman and

learning her mannerisms in order to take what she has to

say seriously and responsibly. Body language between

the patient and the midwife is significant to the nonver-

bal communication between the two and it describes

information mutually tog ether. Th e patien ts are watching

the midwife closely as well, to discover the meaning in

their body language. To be honest and open in their

communication with the couples helps to facilitate the

sharing of knowledge and information. This gives both

the midwife and the couple the necessary security to

encourage the woman to develop and use her own

strength and resources.

…but I cannot carry her…the care is about giving her

the answers to her questions in order to enable her to

take as much control of her situation as possible. (Inter-

view #3)

Body contact in the form of the examination of the

pregnant abdomen through palpitation helps to give the

woman a clearer conception of her pregnancy and helps

her to identify with the little body within her. The goal

of the examination is to help the woman to feel that be-

ing pregnant is normal and to clarify and focus on the

healthy aspects of it. In this way, it enables the woman

to feel secure and create a safe feeling about her preg-

nant cond ition.

…I am not afraid to put enough pressure on the

pregnant abdomen in order to clarify the position of the

baby’s body to the mother…I think that is important. The

mother becomes more curious about her baby and her

abdomen, which is h ealth y and streng th ens them…no w it

is a baby and not just a bi g stom ach. (Interview #2)

Midwives shou ld take a position in th eir conv ersations

with the expectant couples that encourages them to know

themselves in order that they pursue their own solutions

and make their own decisions. If the expectant parents

have the ambition to make themselves knowledgeable

and confident enough to make their own decisions it

A. Olsson et al. / Health 3 (2011) 453-461

457

gives them a stronger sense of control and a feeling that

they can influence their situation. Even in the situation

where the midwife has a medical responsibility to react,

the goal of the midwife is through communication to

encourage the woman and the couple to feel as if they

are participating in the decision process.

The man also has an important ro le in this process and

the interviewees noted that a man who felt secure in

himself was a source of support that enabled the woman

to feel secure. The communication process should en-

courage the man to participate in all that is happening

and occurring. The interviewees observed that it was

frustrating when they were not able to reach the couples

in their conversations and realized that these couples

were the ones who needed the verbal contact. It can be

a difficult situation to manage when the communication

between the couple does not seem to be working.

…when you have a patient that is not open for any

communication at all…it could be a very frightened pa-

tient who has just quit on themselves…I think that is

difficult…maybe the couple is not even communicating

with each other…this is no t easy. (Interview #4)

The interviewees felt that the well prepared parents

were the ones that were communicating well with each

other, as well as communicating effectively with the

midwife. They felt that this made the nursing care more

managable and enabled the midwife to not feel alone

when the couple was participating in the process of cre-

ating a positive experience of both the pregnancy an d the

childbirth. It appeared to the interviewees that the num-

ber of women who were lacking in confidence to manage

their own birth of their child was increasing. A conse-

quence of this lack of confidence in women is that they

feel more afraid and insecure, which makes it more dif-

ficult for the midwife to create an atmosphere of security.

3.3. The Reflective-Emotional Competence

The reflective-emotional competence is the experi-

ence based silent knowledge that is acquired after work-

ing in a field such as midwifery for a long period of time.

This knowledge enables a midw ife to see each expectant

couple as a unique set of circumstances and actually feel

their emotional, physical and spiritual needs. From this

knowledge, the midwife is able to create an overall vi-

sion for their expectations and design an environment

that will provide both security and good overall nursing

care. This vision should create a sense of teamwork be-

tween all of the parties with the midwife using herself as

a tool and taking the responsibility to establish the roles

of all those participating. One interv iewee describes that

when she feels the sensation of establishing the prereq-

uisite chemistry for the situation, she views this as an

invitation from the couple and this gives her an emo-

tional confidence to securely manage their pregnancy

and delivery. The midwife must get herself in a position

where she has a definite feeling about where the couple

is in their emotional state before she can provide the

total nursing care strategy required for the delivery of

the baby.

...I don’t come into a situation with all o f the solution s

in my pocket…first, I must land in their situation and

observe all of the necessary details and make order of

it…where are they in their emotions and feelings? For

example…I think this is what creates security for th em…

if it is not anything urgent I recommend that there is

nothing to be in a great hurry for… this usually gives

them the confidence to relax fairly quickly. (Interview #9)

When the woman is in the actual labor phase of her

pregnancy, she is hypersensitive to everything that is

going on in the room around her. She is acutely aw are of

both her partner and the midwife and about their emo-

tional state without verbal communication. The midwife

has been studying the couple throughout the pregnancy

and enabling them to develop their own set of resources.

She is aware of if the couple is in need of extra support

and at the same time she is ready to provide that support

in order to create the necessary level of security that the

situation demands. When she does this, she is fulfilling

her obligation to provide good nursing care to them. To

have a special love for people and to have a love and

passion for her job is a real motivating force for the

midwife to create this bond between all of those partici-

pating in the pregnancy. Th is gives the couple a positive

experience in conn ection with their child bearing.

…ah yes…I had a couple who…in other words I think

it is really funny with first time parents…when I took

over it seemed really tough and the decision had been

made for a Caesarean section…and then I felt just

that…no!...now we shall continue…work on…and the

father became such a pillar of strength, who so strongly

took on his role supernaturally…positively…and

coached her…we can do this!...so, I just pulled a b it and

stayed out of the way…when I saw what I saw I just en-

couraged them to keep working and got her to deliver on

her knees…she was able to take out the baby on her

own…ahhh…the three of them became one…baby,

mother, father…I thought about doing the navel string

test but then I thought to myself forget about doing

that…it was such a long delivery, a first born at that…it

felt like such a victory…with such a simple remedy, by

encouraging them it accomplished everything…it went

so well…oh yes…happiness!...what a feeling!...it made

me shiver…they had so much strength in them-

selves…they amazed me…I did that and I didn’t really

do all that much…but it got them to do it for them-

selves…in the end, it makes me wonder about what it is

A. Olsson et al. / Health 3 (2011) 453-461

458

that a couple needs from the midwife and perhaps per-

form some sort of analysis…it seems that this couple

needed maturity and insigh t from me. (Interview #7)

Midwives develop much of their nursing care strategy

for the women and the couple on the basis of their indi-

vidual emotional and psychosocial needs instead of

purely on the basis of the usual and customary controls

and procedures that are mandated by the ministry of

health. Midwives manage the balance of purely medical

standpoints and the other practical aspects of healthcare

proceedings based on individual needs. These practical

aspects may include simple things such as encouraging

someone to join a prospective parent group, an appoint-

ment with a psychologist or perhaps encouraging contact

that is more frequent with the midwife. Interviewees felt

that the reflective and emotional counseling throughout

the pregnancy and up to the delivery was the more time

demanding and complicated aspect of the midwives du-

ties. One interviewee describes both the hard and the soft

variables. The hard variables are the ones that are meas-

urable such as blood pressure, external measurements

such as the size of the abdomen, the baby’s heartbeat

and other routine tests. The soft variables are the wom-

an’s emotional wellbeing and her ability to manage her

pregnancy. Often an appointment with the midwife is a

routine meeting in the beginning with respect to the hard

variables. Dealing with the soft variables was more

complicated because the emotional issues seemed to

come up at the conclusion of the meeting, which could

lead to exceeding the time constraints.

…I usually begin with the controlled measurements

immediately…many of the women come with their con-

cerns and questions at the end of the meeting…they do

not seem to be comfortable taking them up directly at the

beginning of the meeting…I need to read the women

better. (Interview #11)

According to the interviewees, the midwives need to

feel secure in order that they convey their security to th e

women and the couples. This creates a secure atmos-

phere, which enables both security and good healthcare

to be established. One midwife explained in her inter-

view that one of her professors in the midwife education

said that the number one contradiction in the actual de-

livery itself was to have an emotionally incompetent

midwife in the de livery room. This served as a reminder

to this midwife, that even in situations where she would

feel stress levels growing in her, it was absolutely nec-

essary to remain outwardly calm and in control of her-

self in order to not alarm her patient.

3.4. The Essence

The participants in th e interviews, generally speaking,

acknowledged that they had learned to trust and depend

upon their inner feeling and intuition in their work as

midwives. Using this intuition as an important tool and

motivating force in their craft enabled them to trust

themselves and their competence in order to analyze a

situation, make a decision and formulate a solution.

Even with their abundance of experience, the interview-

ees still feel a fascination and awe with this feeling of

intuition as it enables them to know what every parent

and couple feels and what they need to know with regard

to their experience of their pregnancy and deliver y. They

relate that in most cases their inner feelings and intuition

were confirmed in the successful delivery of the baby.

The more experienced midwives felt that their reliance

upon this inner knowledge was directly proportional to

their level of experience and they believe that the more

experience they received, the more they trusted their

intuition to help them make important decisions in the

birthing of babies. The midwives expressed a deep sense

of satisfaction when their colleagues gave their approval

and acknowledged their intuition during a situation but

at the same time, they felt that it was frustrating when

the same colleagues did not share their in tuitio n in other

situations. The sense of intuitive knowing also enables

the midwives to combine all of their theoretical knowl-

edge with their practical experience that they have ac-

cumulated over the years, which gives them a more

complete and comprehensive knowledge system to han-

dle all of the possible situations and outcomes related to

pregnancy and delivery.

4. DISCUSSION

All of the interviewees described this sense of intui-

tive knowledge and it ran like a red thread through all of

the themes that they discussed. Th e interviewees pointed

out that the level of this intuitive knowledge and the

ability to use it in a given situation was directly propor-

tional to the level of th eir exp erience. It stands to reason

that the more healthcare situations that a midwife had

participated in, the more experienced she was in the pos-

sible outcomes to any given situation which enabled her

to use her intuition in order to give the women and cou-

ples a sense of security in delivering their babies. Intui-

tive knowledge was found to be a valuable tool to be

used in acute and emergency situations as well as those

situations that were not of an emergency nature.

Olafsdottir [10] describes in her dissertation how mid-

wives use this intuition on a deeper lev el, as if there is a

sixth sense, to care for their mothers to be. Berg,

Lundgren, Hermansson and Wahlberg [11] describe this

sixth sense as a reciprocal communicative process be-

tween the midwife and the parents to be. They describe

the phenomena of the mothers anticipating the midwives

thoughts and actions from their perspective without the

A. Olsson et al. / Health 3 (2011) 453-461

459

spoken word.

According to the Educational Referenc e Book [13 ] the

word intuition means to have an immediate understand-

ing about a thing or condition withou t logical grounds in

fact. When healthcare workers work for a number of

years and acquire the necessary experience they find

themselves confident enough to make crucial decisions

that they cannot explain afterwards, but upon later in-

spection find themselves to be entirely correct. This

phenomenon is further confirmed by Benners theory [14]

about the differ ent levels of appr enticeship that the nur se

goes through, from the novice to the highest level of

healthcare related skills that consist of intuitive under-

standing of every situation an d the ability to act immedi-

ately with skill and confid ence.

This brings us to the question as to whether intuition

can be taught. Young [15] found in their study that intui-

tive feeling cannot be taught withou t actually having the

experiences necessary to provoke these feelings. She

found that nurses can, however, be trained to know their

own subjective facts and to make their decisions based

upon this knowledge. Rew [16] concludes that students

can develop their intuition through different practical

experiences. From an organizational perspective contri-

butions to the development of an individual’s intuitive

ability to know things may be the result of management

organizing the work so that more experienced midwives

are able to share their experience with less experienced

workers.

When communicating with the women and the cou-

ples, the midwives are using themselves as a tool to

build a confidential relationship with the parents to be.

Since the midwives are also being observed from the

perspective of the women and the couples, their body

language must confirm to them that the information

given to them is trustworthy and reliable. Interviewees

feel that their value to the expectant mothers and couples

is to give them a sense of confidence in themselves and

to help them develop a positive attitude about the birth

and delivery of their baby. They felt that an important

factor in this development was their ability t o communi-

cate by giving and receiving information with compe-

tence. When the interviewees had difficulty in establish-

ing a good communication with their expectant couples,

they found that both parties were in turn frustrated by

this and this was confirmed in studies by Halldorsdottir

[17], Nilsson, and Waldermarsson [18]. Consequently,

the interviewees felt that it would be very helpful to re-

ceive more education in the area of communicatio n skills.

Education in motivation interview technique is a high

priority for these midwives in order to motivate the

women and couples to help contribute to their own solu-

tions and caring according to Barth and Näsholm [19].

Practical knowledge and many experiences contribute

to the foundation of the ability of the midwife to see

each expectant mother and couple as a unique set of cir-

cumstances on an individual basis. The midwives de-

scribe their engagement with the women and couples as

an emotional interplay that requires keen listening skills

regarding the expectant parent’s needs. There is a recip-

rocal nature in the relationship between the midwife and

the women as well, because when the midwife feels se-

cure in herself this feeling of security is transferred and

has a calming effect on the woman. According to Nor-

berg [20], healthcare philosophy comes from a Christian

Humanist point of view. She maintains that healthcare

management can create an artwork that expresses an

attitude about life and this attitude can reflect a deeper

engagement in healthcare philosophy.

The interviewees express in the study that the meeting

with the prospective parents is not just about their formal

competence and practical skill. The meeting is largely

about their attitudes and feelings regarding people, in

combination together with their moral and ethical ma-

keup. The midwife profession demands a special love

for people in order that they can feel secure in emotion-

ally engaging with them on a matter that is so imp ortant

as childbearing. According to Benner [21], the ability to

be emotionally competent and to listen keenly to your

patient cannot be a forced ability, but it must come from

within if one is truly an expert in the area of healthcare.

In other words, one must have a personal presence.

I have reached the conclusion that as nurses and mid-

wives, we have an enormous power to influence how

people experience their very first and their last hours of

their lives. As midwives, we routinely encou nter women

in different situatio ns who are in a position of weakness,

therefore it is imperative that we are conscious as pro-

fessionals of this power and how we app ly it in their care.

During the course of my twenty years as a midwife, I

have been present to many conversations and discus-

sions with prospective parents that spoke of their ex-

periences surrounding their pregnancies and childbear-

ing. They seem to be, overall, content and satisfied with

their experiences. When the mid wife shares in their hap-

piness or sadness it strengthens their experience and

gives them warmth, a feeling of security and even an

inner strength that they carry with them further in their

lives. It seems that when their experience is not per-

ceived in a positive manner it is often dependent on the

failure of the midwife to create a relationship that is

based on her ability to communicate and establish the

couple in security and confidence. This can create an

unbalance in the perception of control of the couple’s

destiny in their prospective childbearing. This provokes

the question as to how can we conduct this relationship

A. Olsson et al. / Health 3 (2011) 453-461

460

between our expectant parents so that we can reach the

goal of a positive experience of the pregnancy, delivery

and the child’s birth to all couples.

Further Re search

According to Benner’s [21], nurses and healthcare

personnel go from the novice to the expert in their field

of work through an accumulation of experience that th ey

attain from their work experience. One question that

comes to mind is how the organization can adjust the

management of the workload in the system to the level

of the cumulative experience of the staff. How can the

experience related inner knowledge that leads to intui-

tion, be effectively transferred to new personnel? How

can the organization and the education process best util-

ize the expert knowledge of the more experienced mid-

wives? Finally, we might ask, how can the intuition and

inner knowledge of the most experienced midwives be

utilized in the education of the expectant parents? Can

we use this inner knowledge to further develop and im-

prove the parent groups that focus on the ability and the

strength of the parents to contribute to a more positive

experience in the pregnancy and delivery of their child?

5. CONCLUSIONS

If intuition is a difficult concept to define or under-

stand, perhaps it is even more difficult to measure the

effects of its use in midwives’ working to create security

and good nursing care with expecting parents. The inter-

viewees in the study discussed how their inner feelings

motivated them in their work. For midwives to feel that

they can perform their work in a satisfactory manner, the

nursing care profession and the healthcare organization

must provide them with a secure workplace and envi-

ronment. According to the interviewees, expectant par-

ents want and expect the security that goes with compe-

tent nursing care, in order that they will feel confirma-

tion and respect in the treatment that they receive. Their

feelings regarding their security and treatment were

largely dependent upon the emotional engagement that

was created between the midwife and the couple.

Expecting parents are often meeting with midwives in

their first major change of life period within the health-

care network. Since many times these couples are rela-

tively young and inexperienced, they are dependent on

the midwife to be competent and have rather well de-

veloped communication skills. This is why it is so im-

portant that these skills are emphasized and are a focus

of the midwife’s development and education. A practice-

ing midwife is expected to be able to make difficult de-

cisions in different healthcare situations. The support of

colleagues and their counsel helps to encourage an en-

gaged relationship between the midwife and the expec-

tant parents. There are going to be times when a midwife

will be required to manag e difficult emotions on the part

of the expecting parents, such as suffering and grief and

this is when the support of their colleagues is so impor-

tant. It helps the midwife to manage their own emotional

stress in order that they can remain open and flexible

during difficult circumst anc es.

REFERENCES

[1] Hildingsson, I. and Häggström, T. (1999) Midwives’

lived experience of being supportive to prospective mo-

thers/parents during pregnancy. Midwifery, 15, 82-91.

doi:10.1016/S0266-6138(99)90003-7

[2] Lundgren, I. (2004) Releasing and relieving encounters:

experiences of pregnancy and childbirth. Scandinavian.

Journal Caring Science, 18, 368-375.

doi:1 0.1111/j.1471-6712.2004.00300.x

[3] Fischer, C., Hauck, Y. and Fenwick, J. (2006) How social

context impacts on womens fears of childbirth: A West-

ern Australian example. Social Science & Medicine, 63,

64-75. doi:10.1016/j.socscimed.2005.11.065

[4] Giorgi, A. (1997) The theory, practice and evaluation of

the phenomenological method as a qualitative research

procedure. Journal of Phenomenological Psychology, 28,

235-260. doi:10.1163/156916297X00103

[5] Söderlund, M. (2003) Tre kvalitativa forskningsansatser

med relevans för vårdvetenskap. Vård i Norden, 23, 9-15.

[6] Dahlberg, K. (1997) Kvalitativa metoder för vårdvetare.

Studentlitteratur, Lund.

[7] Englander, M. and Robinson, P. (2008) Appliceringen av

den deskriptiva fenomenologiska humanvetenskapliga

metoden. Vård i Norden, 28, 49-51.

[8] Englander, M. and Robinson, P. (2007) Den deskriptiva

fenomenologiska metoden. Vård i Norden, 27, 57-59.

[9] Stensmo, C. (1994) Pedagogisk filosofi. Studentlitteratur,

Lund.

[10] Swanson, K.M. and Wojnar, D.M. (2007) Phenomenol-

ogy: An exploration. Journal of Holistic Nursing. 25,

172- 180. doi:10.1177/0898010106295172

[11] Olafsdottir, O.A. (2006) An icelandic midwifery saga,

coming to light, with woman and connective ways of

knowing. Ph.D. Thesis, Thames Valley University, Rey-

kjavik Island.

[12] Berg, M., Lundgren, I., Hermansson, E. and Wahlberg, V.

(1996) Women’s experience of the encounter with the

midwife during childbirth. Midwifery, 12, 11-15.

doi:10.1016/S0266-6138(96)90033-9

[13] Educational Reference Book (Pedagogisk Uppslagsbok)

(1996) Från A till Ö utan pekpinnar. Fälts tryckeri,

Värnamo.

[14] Benner, P. (1993) Från novis till expert – mästerskap och

talang i omvårdnadsarbetet. Studentlitteratur, Lund.

[15] Young, C.E. (1987) Intuition and the nursing process.

Holistic Nursing Practise, 1, 55-62.

[16] Rew, L. (1990) Intuition in critical care nursing practise.

Dimensions of Critical Care Nursing, 9, 30-37.

doi:10.1097/00003465-199001000-00011

[17] Halldorsdottir, S. and Karlsdottir, S. (1996) Empower-

ment or discouragement: women´s experience of caring

A. Olsson et al. / Health 3 (2011) 453-461

461

and uncaring encounters during childbirth. Health Care

for Women Interna tional, 17, 361-379.

doi:10.1080/07399339609516251

[18] Nilsson, B. and Waldemarsson, A.-K. (1995) Kommuni-

kation. Samspel mellan människor. Studentlitteratur,

Lund.

[19] Barth, T. and Näsholm, C. (2006) Motiverande samtal –

MI. Att hjälpa en människa tillförändring på sina egna

villkor. Studentlitteratur, Lund.

[20] Norberg, A. and Nilsson, K. (1997) Omvårdnadens mo-

saik: En modell. Lib er, Göteb o rg.

[21] Benner, P., Tanner, C. and Chesla, C. (1999) Expertkun-

nande i omvårdnad, omsorg, kliniskbedömning och etik.

Studentlitteratur, Lund.