A qualitative study of how caseload midwifery is constituted and experienced by Danish midwives

Objective: the aim of this study is to advance knowledge about the working and living conditions of midwives in caseload midwifery and how this model of care is embedded in a standard maternity unit. This led to two research questions: 1) What constitutes caseload midwifery from the perspectives of the midwives? 2) How do midwives experience working in caseload midwifery? Design and setting: phenomenology of practice was the analytical approach to this qualitative study of caseload midwifery in Northern Denmark. The methodology was inspired by ethnography, and applied methods were field observations followed by interviews. Participants: thirteen midwives working in caseloads were observed during one or two days in the antenatal clinic and were interviewed at a later occasion. Findings: being recognised and the feeling of doing high quality care generate high job satisfaction. The obligation and pressure to perform well and the disadvantages to the midwives' personal lives are counterbalanced by the feeling of doing a meaningful and important job. Working in caseload midwifery creates a feeling of working in a self-governing model within the public hospital, without losing the technological benefits of a modern birth unit. Midwives in caseload midwifery worked on welcoming and including all pregnant women allocated to their care; even women/families where relationships with the midwives were challenging were recognised and respected. Key conclusions: caseload midwifery is a work-form with an embedded and inevitable commitment and obligation that brings forward the midwife's desire to do her utmost and in return receive appreciation, social recognition and a meaningful job with great job satisfaction. There is a balance between the advantages of a meaningful job and the disadvantages for the personal life of the midwife, but benefits were found to outweigh disadvantages. Implications for practice: In expanding caseload midwifery, it is necessary to understand that the midwives' personal lives need to be prepared for this work-form. The number of women per full time midwife has to be surveilled as job-satisfaction is dependent on the midwives' ability of fulfilling expectations of being present at women's births. (C) 2016 Elsevier Ltd. All rights reserved.