title: Midwives' experiences of transfer in labour from a Western Australian birth centre to a tertiary maternity hospital.
abstract: BACKGROUND
  When transfer in labour takes place from a woman-centred, midwifery led centre to a tertiary maternity hospital it is accepted that women are negatively affected, however the midwife's role is unevaluated, there is no published literature exploring their experience. This study aimed to describe these experiences.
  
  
  METHODS
  Giorgi's descriptive phenomenological method of analysis was used to explore the 'lived' experiences of the midwives. Seventeen interviews of transferring midwives took place and data saturation was achieved.
  
  
  RESULTS
  The overall findings suggest that midwives find transfer in labour challenging, both emotionally and practically. Five main themes emerged: (1) 'The midwife's internal conversation' with subtheme: 'Feeling under pressure', (2) 'Challenged to find a role in changing circumstances' with subtheme: 'Varying degrees of support', (3) 'Feeling out of place' with subtheme: 'Caught in the middle of different models of care, (4) 'A constant support for the parents across the labour and birth process' with subthemes: 'Acknowledging the parents' loss of their desired birth' and (5) 'The midwives' need for debrief'.
  
  
  CONCLUSIONS
  Midwives acknowledged the challenge of finding the balance between fulfilling parents' birth plan wishes with hospital protocol and maintaining safety. Transfer for fetal or maternal compromise caused anxiety and concern. The benefits of providing continuity of care were acknowledged by the midwife's knowledge of the woman and her history but these were not always recognised by the receiving team. Discussing the transfer story afterwards helped midwives review their practice. Effective communication between all stakeholders is essential throughout the transfer process.
authors.affiliation: School of Nursing and Midwifery, Curtin University, GPO Box U1987, Perth, Western Australia, Australia; Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, PO Box 134, Subiaco, Western Australia 6904, Australia. Electronic address: lesley@kuliukas.com.
authors.forename: Lesley J
authors.initials: LJ
authors.lastname: Kuliukas
authors.affiliation: School of Nursing and Midwifery, Curtin University, GPO Box U1987, Perth, Western Australia, Australia; Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, PO Box 134, Subiaco, Western Australia 6904, Australia. Electronic address: lucy.lewis@curtin.edu.au.
authors.forename: Lucy
authors.initials: L
authors.lastname: Lewis
authors.affiliation: School of Nursing and Midwifery, Curtin University, GPO Box U1987, Perth, Western Australia, Australia; Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, PO Box 134, Subiaco, Western Australia 6904, Australia. Electronic address: y.hauck@curtin.edu.au.
authors.forename: Yvonne L
authors.initials: YL
authors.lastname: Hauck
authors.affiliation: School of Nursing and Midwifery, Curtin University, GPO Box U1987, Perth, Western Australia, Australia. Electronic address: r.duggan@curtin.edu.au.
authors.forename: Ravani
authors.initials: R
authors.lastname: Duggan
mesh_terms: D001315:Australia; D016550:Birthing Centers; D003142:Communication; D003266:Continuity of Patient Care; D005260:Female; D006771:Hospitals, Maternity; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric / Q000523:psychology; D008880:Midwifery / Q000379:methods; D007744:Obstetric Labor Complications / Q000523:psychology*; D009774:Obstetrics; D036801:Parturition; D010360:Patient Transfer; D011247:Pregnancy; D036301:Qualitative Research
keywords: Birth centre; Continuity; Intrapartum; Midwife; Transfer