Vol.3, No.7, 453-461 (2011)
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/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.
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
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
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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
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.
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-
3) The Reflective and Emotional Competence of the
A. Olsson et al. / Health 3 (2011) 453-461
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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.
3.1. 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
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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
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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 dont 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
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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.
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
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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
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
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
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?
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.
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