title: Making physiological birth possible: birth at a free-standing birth centre in Berlin.
abstract: BACKGROUND
  the practical training in midwifery education in Germany takes place predominantly in hospital delivery wards, where high rates of intervention and caesarean section prevail. When midwives practice birth assistance at free-standing birth centres, they have to make adjustments to what they learned in the clinic to support women without the interventions common to hospital birth.
  
  
  OBJECTIVE
  the primary aim of this study was to investigate and describe the approach of midwives practicing birth assistance at a free-standing birth centre.
  
  
  METHODS
  a qualitative approach to data collection and analysis with grounded theory was used which included semi-structured expert interviews and participant observation. Five midwives were interviewed and nine births observed in the research period. The setting was a free-standing birth centre in a large German city with approximately 115 births per year.
  
  
  RESULTS
  the midwives all had to re-learn birth assistance when commencing work outside of the hospital. However, having been trained predominantly in hospital maternity wards, they have retained many aspects characteristic of their training. The midwives use technology, although minimal, and medical discourse in combination with 1:1, woman-centred care. The birthing woman and midwife share authority at birth. The fetus is treated as an ally of the mother, suited for birth and cooperative. Through use of objective and subjective criteria, the midwives have their own approach to making physiological birth possible.
  
  
  CONCLUSIONS
  to prepare midwives to support low-intervention birth, it is necessary to include training in birth assistance with women who birth physiologically, without interventions common to hospital birth. The results of this study would also suggest that the rate of interventions in hospital could be reduced if midwives gain more experience with women birthing without the above-mentioned interventions.
authors.affiliation: Geburtshaus Kreuzberg, Müllenhoffstr. 17, 10967 Berlin, Germany. nancyiris21@gmail.com
authors.forename: Nancy I
authors.initials: NI
authors.lastname: Stone
mesh_terms: D000328:Adult; D016550:Birthing Centers / Q000458:organization & administration*; D003266:Continuity of Patient Care / Q000458:organization & administration*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D006801:Humans; D007400:Interprofessional Relations; D008875:Middle Aged; D008880:Midwifery / Q000458:organization & administration*; D009035:Mothers / Q000706:statistics & numerical data; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D049590:Postpartum Period; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology