title: Perceptions of labour pain management of Dutch primary care midwives: a focus group study.
abstract: BACKGROUND
  Labour pain is a major concern for women, their partners and maternity health care professionals. However, little is known about Dutch midwives' perceptions of working with women experiencing labour pain. The aim of this study was to explore midwives' perceptions of supporting women in dealing with pain during labour.
  
  
  METHODS
  We conducted a qualitative focus group study with four focus groups, including a total of 23 midwives from 23 midwifery practices across the country. Purposive sampling was used to select the practices. The constant comparison method of Glaser and Straus (1967, ren. 1995) was used to gain an understanding of midwives' perceptions regarding labour pain management.
  
  
  RESULTS
  We found two main themes. The first theme concerned the midwives' experienced professional role conflict, which was reflected in their approach of labour pain management along a spectrum from "working with pain" to a "pain relief" approach. The second theme identified situational factors, including time constraints; discontinuity of care; role of the partner; and various cultural influences, that altered the context in which care was provided and how midwives saw their professional role.
  
  
  CONCLUSIONS
  Midwives felt challenged by the need to balance their professional attitude towards normal birth and labour pain, which favours working with pain, with the shift in society towards a wider acceptance of pharmacological pain management during labour. This shift compelled them to redefine their professional identity.
authors.affiliation: Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081, BT, Amsterdam, The Netherlands. g.klomp@vumc.nl.
authors.forename: Trudy
authors.initials: T
authors.lastname: Klomp
authors.affiliation: Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081, BT, Amsterdam, The Netherlands.
authors.forename: Ank
authors.initials: A
authors.lastname: de Jonge
authors.affiliation: Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081, BT, Amsterdam, The Netherlands.|Midwifery Education Program, McMaster University Hamilton, Hamilton, ON, Canada.
authors.forename: Eileen K
authors.initials: EK
authors.lastname: Hutton
authors.affiliation: Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081, BT, Amsterdam, The Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Hers
authors.affiliation: Department of Primary Care and Community Care, Women's Studies Medicine, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
authors.forename: Antoine L M
authors.initials: AL
authors.lastname: Lagro-Janssen
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003469:Culture; D005260:Female; D017144:Focus Groups; D006801:Humans; D048949:Labor Pain / Q000451:nursing* / Q000523:psychology; D008875:Middle Aged; D008880:Midwifery / Q000379:methods; D009426:Netherlands; D009721:Nurse Midwives / Q000523:psychology*; D024802:Nurse's Role / Q000523:psychology; D059408:Pain Management / Q000379:methods / Q000451:nursing* / Q000523:psychology; D010465:Perception; D011247:Pregnancy; D011320:Primary Health Care / Q000379:methods; D036301:Qualitative Research; D055815:Young Adult