title: Glancing beyond or being confined to routines: labour ward midwives' responses to change as a result of action research.
abstract: OBJECTIVE
  to examine midwives' responses to a changed approach in the initial encounters with women and their partners in the labour ward.
  
  
  METHODS
  as part of a local project to improve hospital based childbirth care, Action Research (AR) was undertaken with midwives. To establish their beliefs, practices, and responses to change during the first cycle, 37 out of 57 midwives were interviewed. Data analysis was guided by interpretative description.
  
  
  METHODS
  a labour ward in western Sweden.
  
  
  RESULTS
  two themes emerged: 'Glancing beyond routines' describes how the changed care approach enabled 'valuing the idea' and 'acquiring extended space to create a lingering presence'. The theme 'being confined to inherent routines' expresses 'resistance to the need for change' and a 'feeling of pressure to change'.
  
  
  CONCLUSIONS
  the AR study design enabled the midwives to reflect on their routines and to transform tacit use-in-action to reflection-in-action. Midwives who persisted in being confined to inherent routines felt pressured by the change process. Others felt that the AR process granted them official licence to create chronological and emotional space in which they could 'be' and not just 'do'.
  
  
  CONCLUSIONS
  to a greater or lesser extent, midwives in this setting had integrated relatively impersonal system-wide technocratic norms of childbirth into their belief systems and behaviours. The data suggest that a whole-system shift is necessary to enable caring, behaviours based on the formation of positive relationships to become the key driver of the first encounter on the labour ward.
authors.affiliation: NÄL-Hospital, Larketorpsvagen 5, 461 85 Trollhattan, Sweden. viola.nyman@vgregion.se
authors.forename: Viola
authors.initials: V
authors.lastname: Nyman
authors.forename: Terese
authors.initials: T
authors.lastname: Bondas
authors.forename: Soo
authors.initials: S
authors.lastname: Downe
authors.forename: Marie
authors.initials: M
authors.lastname: Berg
mesh_terms: D003696:Delivery Rooms / Q000458:organization & administration*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008880:Midwifery / Q000379:methods; D009721:Nurse Midwives / Q000523:psychology*; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D009936:Organizational Innovation; D036801:Parturition / Q000523:psychology; D018743:Perinatal Care / Q000379:methods / Q000592:standards; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D058996:Quality Improvement; D018454:Spouses / Q000523:psychology; D013548:Sweden