Midwives' perceptions of their role in mode of birth decisions

Midwives play an important role in the journey of women in labour, from conception to birth and beyond. It is acknowledged globally that midwives are critical care providers of pregnant women and are the main professionals on birth wards, providing healthcare education and information to mothers- and fathers-to-be (Gunnervik et al, 2010). As a result, one study in the UK emphasised that midwives and other health professionals should be conscious of how ‘their own bias influences women's choices' (Houghton, 2008). Furthermore, Green (2015) cited a number of sources indicating that women perceived the influence of midwives as a critical factor regarding their birth position choices. In another UK study, it was argued that women in high-income countries, contrary to expectations, did not necessarily have the freedom to choose when it came to birth place (Coxon et al, 2014). This situation is similar to middle-income countries, as confirmed by a recent study exploring the birth stories of South African women (Hastings-Tolsma et al, 2018). Hence, the role of the midwife in improving women's birth choices, such as their choice of mode of birth, needs to be further explored, especially in the context of women-centred care (Sengane, 2013). It has been argued that the lack of midwife involvement in such choices is a possible reason for the high number of caesarean section births (James et al, 2012), and that midwifery-led care leads to a greater possibility of mothers choosing a spontaneous vaginal birth (Soltani and Sandall, 2012). In terms of safety outcomes, there is evidence demonstrating that there is less likelihood of interventions when midwives are in charge of maternity care (Sandall et al, 2009). This study therefore sought to explore and describe how midwives saw their role in women's chosen mode of birth at South African public sector birthing units.