Conference Contribution Details
Mandatory Fields
O'Connell, R; Downe, S, Dykes, F
12th Annual Conference. Transforming Health Care through Education and Reseaarch
The Size Paradox Enabling Authentic Midwifery to Emerge
School of Nursing and Midwifery Trinity College Dublin
Peer Reviewed Abstract
Optional Fields


Midwives purport to be the guardians of normal birth yet this is often considered to be a rare event in hospital environments.


To explore midwives’ experience of midwifery as they moved to a new large maternity hospital. 


Hermeneutic phenomenology based on the work of Heidegger and Gadamer with Van Manen used for analysis.  17 midwives were interviewed about their experience in the new unit and the impact that this had on their practice.  Ethical approval was obtained.

Findings and implications

The midwives worked in an environment dominated by a biomedical approach to childbirth.  The workload required midwives to manage the throughput of women and be flexible and responsive in relation to service needs.  Street level bureaucracy was apparent in their practice.  A paradox occurred whereby, due to the increased workload of all staff, the labour ward midwives escaped from the Panopticon of obstetric (and midwifery) surveillance.  This enabled nascent midwifery practices to emerge.  In providing uninterrupted one to one care, authentic relationships were formed with women leading to midwives to sharing in the beauty of birth, particularly when an ‘optimal’ birth was achieved.  Midwives had greater opportunities to enact ‘real midwifery’ and normalise birth for women.  The paradox of this mega maternity unit enabled authentic midwifery to emerge.