Midwifery abdication – is it acknowledged or discussed within the midwifery literature: An integrative review

INTRODUCTION: In this review we explore the concept of Midwifery Abdication and whether it is acknowledged or discussed within the midwifery literature. METHODS: A modified Whittemore and Knafl integrative review framework of 2005 enabled consideration of quantitative and qualitative literature. A total of 1508 papers were located. Duplicate records were removed, leaving 1197 records. All titles, abstracts, or case facts were reviewed using a framework derived from the definition of Midwifery Abdication. Three qualitative studies were selected for analysis; the NICE Quality Appraisal Checklist was used to determine study quality. RESULTS: Midwifery Abdication occurs, as reported within the wider midwifery literature, and indicated in three studies from different countries. However, the original constructs need to be widened to include: ‘external perceptions of midwifery practice’ and ‘how can reflection facilitate change’. The extent of philosophy in these environments leads to the adoption of midwifery philosophy failure. Such an environment impacts on a midwife’s ability to fully exercise autonomy, and to advocate for normality and women. This renders Midwifery Abdication almost inevitable or at least very difficult to prevent. A midwife’s professional identity, environmental hierarchy and associated culture of social obedience, acceptance and finding one’s place, all act as influencing factors in abdication. CONCLUSIONS: Midwifery education needs to ensure that midwives are prepared and able to embrace their professional status as independent practitioners. Promotion of reflexive practice to facilitate personal and professional change is warranted. Practice policies that are not supportive of a midwife’s professional autonomy and scope of practice reinforce the technocratic work environment.