title: Midwives' experiences of the factors that facilitate normal birth among low risk women at a public hospital in Australia.
abstract: BACKGROUND
  normal birth has major advantages for mothers and infants. Nonetheless, in the developed world, rates of normal birth have declined significantly over the past 20 years, and many women currently have caesarean section births for unclear reasons. Midwives are interested in ameliorating this trend and aim to facilitate women to have meaningful birth experiences and to achieve the best possible birth.
  
  
  OBJECTIVE
  this project aimed to explore midwives' experiences and views of the factors that facilitate or impede normal birth.
  
  
  METHODS
  one maternity setting in Melbourne, Australia.
  
  
  METHODS
  a purposive sample of 22 midwives, all with recent birthing experience, participated in in-depth interviews.
  
  
  METHODS
  a qualitative study using an Interpretative Phenomenological approach. Interviews were audio-recorded and transcribed verbatim. Analysis was guided by Smith and Osborn's (2008) approach.
  
  
  RESULTS
  midwives identified a number of factors that complicated their task of facilitating normal birth. Barriers included: (1) time pressures; (2) a risk adverse culture, and; (3) women's expectations. Factors facilitating normal birth included: (1) a supporting environment, and (2) midwifery attributes and a desire to promote normal birth.
  
  
  CONCLUSIONS
  in Australia, most births take place in obstetric models of care, in which the majority of midwives are employed. The birth environment, in these units, is often risk-adverse with high rates of intervention and caesarean section. Midwives, wishing to promote normal birth in obstetric led units, face a number of challenges and often feel unsupported by senior colleagues. This situation causes conflict and gives rise to stress and unmet support needs.
authors.affiliation: School of Nursing and Midwifery, St Alban׳s Campus, Victoria University, PO Box 14228, Melbourne 8001, Australia. Electronic address: Mary.carolan@vu.edu.au.
authors.forename: Mary
authors.initials: M
authors.lastname: Carolan-Olah
authors.affiliation: School of Nursing and Midwifery, St Alban׳s Campus, Victoria University, PO Box 14228, Melbourne 8001, Australia. Electronic address: gina.kruger@vu.edu.au.
authors.forename: Gina
authors.initials: G
authors.lastname: Kruger
authors.affiliation: Sunshine Hospital, Western Health, Women׳s & Children׳s Division, 176 Furlong Rd, St Albans, VIC 3021, Australia. Electronic address: annette.garveygraham@wh.org.au.
authors.forename: Annette
authors.initials: A
authors.lastname: Garvey-Graham
mesh_terms: D000328:Adult; D001315:Australia; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D009035:Mothers; D009721:Nurse Midwives / Q000523:psychology*; D024802:Nurse's Role / Q000523:psychology*; D036801:Parturition / Q000523:psychology*; D011247:Pregnancy; D036301:Qualitative Research; D012309:Risk-Taking; D012944:Social Support
keywords: Midwifery-led; Midwives; Normal birth; Obstetric-led