Compassionate care or acting on routine - a video-ethnographic study of midwives' and midwifery students' support during the second stage of labour

Background: There is a lack of knowledge regarding how midwifery preceptors provide support during the second stage of labour while teaching. The aim of this study was to explore how midwives support women when they are precepting students, and to describe what types of support preceptors and midwifery students provide to women during the second stage. Methods: A video-reflexive ethnography methodology utilising video recordings and interviews was conducted at two labour wards in Sweden. Four women were filmed and cared for by five preceptor-student pairs. The data was collected during 2019-2020 and was analysed inductively. A framework analysis approach was conducted using the Royal College of Midwives (RCM) guidance on support during childbirth, and the observed support dimensions found were quantified into minutes. Findings: Two overarching themes were found: Support provided with compassion and Support provided in a routine manner. Of the RCM support dimensions Emotional support, Physical support, Information and advice were observed. The fourth support dimension Advocacy was lacking, and there were several instances of non- consented care. Discussion: Support provided on routine and the absence of Advocacy, could be related to the fragmented care system, where midwives do not provide continuity of care to women. Despite midwives and midwifery students providing emotional and physical support, instances of disrespectful care were observed, which students also participated in. Conclusion: There was evidence of disrespectful care that was normalised and accepted in the births that were filmed. This may further amplify students' internalisation and reproduction of acts and behaviors that are disrespectful.