Disconnection: Exploring transfer from midwifery-led to consultant-led care a phenomenological study of women's views

Background: Understanding womens feelings during the transfer process can illuminate womens perspectives thus minimising the risk for postnatal psychological and emotional morbidity, and inform midwifery practice. Aim: To explore the meaning women ascribe to their feelings when transferred from an environment emphasising a social model of pregnancy and birth in a Midwifery Led Unit, to a contrasting, more medicalised setting of a Consultant Led Unit. Methods: The study adopted an idiographic focus, by conducting semi-structured interviews with new mothers. A purposive sample of eleven women was recruited via participating midwifery led units and their Facebook page. An interpretative phenomenological approach was selected to explore mothers individual perceptions of experiences. Findings: Participants described feeling a strong sense of community in the midwifery led unit, where they enjoyed a sense of belonging, safety, and support. The overarching theme of disconnection signified feelings of muted agency when transferred to a different environment. Women used adaptive processes to reconcile themselves to a medicalised ideology. The impact of the transfer also resulted in a sense of alienation and not belonging. Conclusion: Adjustment to a different model of care meant women needed to rapidly amend their notions of normality and agency, at the same time as entering motherhood. Raising awareness about the possible psychological adjustments women have to make during at this time could provide reassurance to other women. It also highlights the need for support during and after transfer. Strengthening continuity of care could help facilitate the adjustment process. (C) 2018 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.