PhD in Nursing Science Program

Midwives and Normalcy, Experience and Meaning: A Hermeneutical-Phenomenological Study of Midwives' Concept of Normalcy in Childbirth

Dissertation under the direction of Professors Kathleen A. Dwyer and Dean Colleen Conway-Welch 

Belief in the normalcy of labor and birth is a core philosophical value for the US midwifery profession, yet it remains largely unexplored. The purpose of this study was to describe and define the concept of normalcy, as a critical characteristic defining the midwifery model of care as experienced and operationalized by US midwives. This phenomenological-hermeneutical study was structured utilizing the Barcott-Schwartz & Kim hybrid concept development model. Midwifery practice directors in hospital, freestanding birth center and home birth practices nominated midwives who demonstrated a strong commitment to normalcy in clinical practice. Nominated midwives were interviewed individually; interviews were transcribed verbatim.

Analyses resulted in generation of a description of the concept, attributed meanings, and descriptions of midwives' construction and enactment of the concept. Five empiric referents for normalcy during labor and birth were identified: spontaneous onset of labor, spontaneous progress, spontaneous birth, the woman's effective coping, and the woman's freedom and capacity to enact effectively her labor and birth. Dynamics shaping these empiric referents included the environment, the midwife's 'knowing,' and midwifery's therapeutic lens. Meanings included empowerment of women, optimal outcomes of maternity care, and benefits to the profession. Notable was the degree of distress that midwives, particularly in hospital and home birth practice settings, experienced in settings where the concept of normalcy was not the effectual value driving implementation of care.

Midwives construct the concept of normalcy during labor and birth as unique to each woman, observable in empiric referents, and highly responsive to contextual dynamics. Enactment of care driven by a belief in normalcy involves a decision-making process strongly influenced by the trustworthiness of the woman's capabilities for labor and birth, and the degree of role autonomy the midwife possesses in the practice setting. Midwives attached broad implications for women, importance to the midwifery profession, and passion to the concept of normalcy.

These findings contribute to further understanding of this theoretical construct, its influence on midwives' clinical decision-making, and possible linkages between the midwifery model of care and clinical outcomes.