title: Midwives' perceptions of their role within the context of maternity service reform: An Appreciative Inquiry.
abstract: BACKGROUND
  In 2010 Australian Government reform of maternity services enabled midwives to access Medicare. This significant change provides midwives with new opportunities to engage in patterns of working that provide continuity of care to childbearing women. There remains limited evidence, however, on midwives perceptions of how the reforms impact them both personally and professionally.
  
  
  OBJECTIVE
  This research examined midwives' perceptions of their role and how, in light of the reform agenda, they might conceptualise a change in working patterns and environment to provide greater levels of continuity of care.
  
  
  METHODS
  A qualitative descriptive approach was employed using the four-stage Appreciative Inquiry model. Twenty-three midwives from three maternity units within south-east Queensland participated in one of six focus groups. Thematic iterative analysis was employed to identify empirical codes and examine relationships within and across the data.
  
  
  RESULTS
  Midwives endorsed the reforms and considered the concept of continuity of midwifery care as fundamental to achieving a woman centred maternity system. Most participants, however, found it difficult to conceptualise how they might contribute to any level of system change. In addition the majority passively accepted the status quo of their employing organisation and believed they were powerless to effect change.
  
  
  CONCLUSIONS
  In order to promote the growth of evidence based continuity of care models midwives need to work to their full scope of practice. Strong midwifery leadership is required to enable midwives to re-conceptualise roles and work patterns and identify how they can engage with and contribute to reform of maternity services.
authors.affiliation: Associate Professor of Midwifery, School of Nursing and Midwifery, Maternity and Family Unit, Centre for Health Practice Innovation (HPI), Griffith Health Institute, Griffith University, University Drive, Meadowbrook, Queensland 4131, Australia. Electronic address: m.sidebotham@griffith.edu.au.
authors.forename: Mary
authors.initials: M
authors.lastname: Sidebotham
authors.affiliation: Professor of Midwifery, School of Nursing and Midwifery, Maternity and Family Unit, Centre for Health Practice Innovation (HPI), Griffith Health Institute, Griffith University, University Drive, Meadowbrook, Queensland 4131, Australia; Clinical Chair Gold Coast University Hospital, Parklands, Queensland, Australia. Electronic address: j.fenwick@griffith.edu.au.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fenwick
authors.affiliation: Nursing & Midwifery Director, Nursing & Midwifery Practice Development Unit, Logan Bayside Health Network, Metro South Hospital & Health Service, Logan Hospital, Meadowbrook, Queensland 4129, Australia. Electronic address: susan.rath@health.qld.gov.au.
authors.forename: Susan
authors.initials: S
authors.lastname: Rath
authors.affiliation: Associate Professor of Midwifery, School of Nursing and Midwifery, Maternity and Family Unit, Centre for Health Practice Innovation (HPI), Griffith Health Institute, Griffith University, University Drive, Meadowbrook, Queensland 4131, Australia. Electronic address: j.gamble@griffith.edu.au.
authors.forename: Jenny
authors.initials: J
authors.lastname: Gamble
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D003266:Continuity of Patient Care; D005260:Female; D017144:Focus Groups; D018166:Health Care Reform; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008427:Maternal Health Services / Q000458:organization & administration*; D008875:Middle Aged; D008880:Midwifery; D009721:Nurse Midwives; D009723:Nurse-Patient Relations; D010465:Perception; D011247:Pregnancy; D017009:Professional Autonomy; D036301:Qualitative Research
keywords: Appreciative; Continuity; Inquiry; Midwives; Workforce