title: Factors affecting midwives' confidence in intrapartum care: a phenomenological study.
abstract: BACKGROUND
  midwives are frequently the lead providers of care for women throughout labour and birth. In order to perform their role effectively and provide women with the choices they require midwives need to be confident in their practice. This study explores factors which may affect midwives' confidence in their practice.
  
  
  METHODS
  hermeneutic phenomenology formed the theoretical basis for the study. Prospective longitudinal data collection was completed using diaries and semi-structured interviews. Twelve midwives providing intrapartum care in a variety of settings were recruited to ensure a variety of experiences in different contexts were captured.
  
  
  RESULTS
  the principal factor affecting workplace confidence, both positively and negatively, was the influence of colleagues. Perceived autonomy and a sense of familiarity could also enhance confidence. However, conflict in the workplace was a critical factor in reducing midwives' confidence. Confidence was an important, but fragile, phenomenon to midwives and they used a variety of coping strategies, emotional intelligence and presentation management to maintain it.
  
  
  CONCLUSIONS
  this is the first study to highlight both the factors influencing midwives' workplace confidence and the strategies midwives employed to maintain their confidence. Confidence is important in maintaining well-being and workplace culture may play a role in explaining the current low morale within the midwifery workforce. This may have implications for women's choices and care. Support, effective leadership and education may help midwives develop and sustain a positive sense of confidence.
authors.affiliation: University of Manchester, Oxford Road, Manchester M13 9PL, UK. Electronic address: carol.bedwell@manchester.ac.uk.
authors.forename: Carol
authors.initials: C
authors.lastname: Bedwell
authors.affiliation: Baines Wing, School of Healthcare, University of Leeds, Leeds LS2 9JT, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: McGowan
authors.affiliation: University of Manchester, Oxford Road, Manchester M13 9PL, UK.
authors.forename: Tina
authors.initials: T
authors.lastname: Lavender
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards*; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008137:Longitudinal Studies; D008875:Middle Aged; D009721:Nurse Midwives / Q000523:psychology*; D009723:Nurse-Patient Relations; D011247:Pregnancy; D011446:Prospective Studies; D036301:Qualitative Research; D020377:Self Efficacy
keywords: Confidence; Intrapartum care; Midwives; Self-efficacy