Passing through but needing to be heard‡ban ethnographic study of women's perspectives of their care on the postnatal ward.

Abstract

Background. There is a wealth of literature demonstrating that women are critical of their care on the postnatal ward, but little information as to why. This ethnographic study therefore explored the context of care on the postnatal ward and women's views of that care. Method. The study was undertaken in one Acute NHS maternity unit in the South of England. Non-participant observation was undertaken to explore activities and interactions between the care-givers and women within the ward environment. This was followed by in-depth interviews with twelve women between two and five weeks postnatally about that experience. Findings. Analysis revealed the impact of the hierarchical structure within the organisation which pervaded through and rendered the care of women marginalised. Midwives maintained efficiency in their interaction with the women and their main focus was on 'processing' the women through the ward. Care was articulated through the procedural language of 'checks' and 'work' illustrating an ethos of 'task-based' contacts between midwives and women. The midwives felt ambivalent and physically withdrew from the women upon completion of set 'tasks'. comprising primarily physical care. Women, as passive recipients, were not able to make themselves heard and therefore individual care needs were not always met. This 'functional relationship', valued and supported by the organisation, offered an 'unconnected presence' to the women. Women sought a 'connected presence' from the midwife in recognition of their needs. In the absence of emotional or physical support, some women sought support from the other women or 'opted out' by transferring home earlier that originally intended to receive support from their immediate family and their community midwife. Conclusions. A formal definition of 'care' which encompasses physical and emotional aspects appears lacking. Midwives must reconsider how individualised care, desired by the women, can best be provided.