HomePsychology and Education: A Multidisciplinary Journalvol. 48 no. 7 (2025)

The Lived Experiences of Midwives in Private Birthing Home Practice

Ed Raphael Espinoza | Frenee Lyn Aradanas

Discipline: others in psychology

 

Abstract:

Midwives in private practice at birthing homes are independent professionals who operate their own businesses or are employed in these settings, in contrast to those employed in conventional settings, such as hospitals and rural health facilities. The purpose of this novel type of study is to explore the lived experiences of midwives working in a birthing home in private practice. The majority of them are employed in unfavorable conditions that harm their career growth. Five themes emerged from the study: challenges, coping mechanisms, desires, fears, and realizations. The study employed a qualitative research method, using an unstructured interview anchored in the theory of Perceived Organizational Support. Purposive sampling was used to select participants based on predefined criteria established by the researchers. The study had 27 participants, of whom 2 were from La Union and the rest from Pangasinan. The analysis of their responses was conducted using hermeneutic phenomenology, specifically the Ricœur approach. The findings suggest that numerous obstacles are encountered when working as a privately practicing midwife. Their working environment is filled with numerous negatives rather than positives. Regarding their viewpoints, the adverse experiences had a significant impact on their perceptions of their occupation. Private practice may not be a highly profitable career, but insights from personal experience can reveal necessary changes within the profession. This research suggests that additional studies should be conducted to better confirm the concerns expressed by these midwives and to investigate private birthing centers in other regions of the country. With backing from both government and private sectors, particularly from multiple midwifery organizations, along with fair compensation and excellent working conditions, these midwives will have a bright future in their careers.



References:

  1. Agwu MO (2013). Impact of fair reward system on employees job performance in Nigerian Agip Oil Company Limited Port-Harcourt. Br J Educ Soc Behav Sci. 3(1): 47-64.doi.org/10.97- 34/BJESBS/2013/2529.
  2. Akbarbegloo M, Valizadeh L. Occupational tension and coping strategies in nurses in psychological ward of Tabriz Razi hospital. Modern Care. 2011;8(1):45–51. Retrieved from https://www.researchgate.net/publication/233755659_OCCUPATIONAL_TENSION_AND_COPING_STRATEGIES_IN_NURSES_IN_PSYCHOLOGICAL_WARD-RAZI_HOSPITAL_TABRIZ
  3. Alliman, J., Stapleton, S., Wright, J., Bauer, K., Slider, K., & Jolles, D. (2019). Strong Start in birth centers: Sociodemographic characteristics, care processes, and outcomes for mothers and newborns. Birth, 46(2), 234–243. 10.1111/birt.12433
  4. Anastasi E, Borchert M, Campbell OMR, Sondorp E, Kaducu F, Hill O, Okeng D, Odong VN, Lange IL. Losing women along the path to safe motherhood: why is there such a gap between women’s use of antenatal care and skilled birth attendance? A mixed methods study in northern Uganda. BMC Pregnancy Childbirth. 2015. https://doi.org/10.1186/s12884-015-0695-9
  5. Andrews H, Perron L, Plaetse BV, Taylor DJ. Strengthening the organizational capacity of health professional associations: The FIGO LOGIC Toolkit. Int J Gynaecol Obstet. 2013;122(3):190-191. doi:10.1016/j.ijgo.2013.06.002
  6. Baird MB, Smith CM, DeBacco KM. Perspectives of northern Ugandan health providers about the effects of cultural beliefs and practices on birth outcomes. Health Care Women Int. 2015. https://doi.org/10.1080/07399332.2014.942907
  7. Baljoon RA, Banjar HE, Banakhar MA (2018). Nurses’ work motivation and the factors affecting it: A scoping review. Int J Nurs Clin Pract. 5: 277. doi: https://doi.org/10.15344/2394-4978/2018/277 
  8. Bedwell C, McGowan L, Lavender T. Factors affecting midwives׳ confidence in intrapartum care: A phenomenological study. Midwifery. 2015;31(1):170-176. doi:10.1016/j.midw.2014.08.004
  9. Beheshtifar M, Ali-Nezhad H, Nekoie-Moghadam M (2012). Investigation of perceived organizational support on employees’ positive attitudes toward work. Interdiscipl J Contemp Res Bus. 2012(4): 432-442. http://dx.doi.org/-10.3233/WOR-62327   
  10. Bloxsome D, Ireson D, Doleman G, Bayes S. Factors associated with midwives’ job satisfaction and intention to stay in the profession: An integrative review. J Clin Nurs. 2019;28(3-4):386–399. doi: 10.1111/jocn.14651.
  11. Brookins, M. (2017) Consequences of Nepotism, bizfluent.com/info-12115748-consequences-of-nepotism Retrieved from https://bizfluent.com/info-12115748-consequences-of-nepotism
  12. Cadée F, Perdok H, Sam B, Geus M, Kweekel L. Twin2twin an innovative method of empowering midwives to strengthen their professional midwifery organizations. Midwifery. 2013;29(10):1145-1150. doi:10.1016/j.midw.2013.07.002
  13. Canila, C. C., & Hipolito, J. H. (2018). Assessing the state of professional practice of midwifery in the Philippines. Philippine Journal of Health Research and Development, 22(2), 1–11. Retrieved from https://herdin.ph with HERDIN ID 108948-19061819245917
  14. Catling C, Rossiter C. Midwifery workplace culture in Australia: A national survey of midwives. Women Birth. 2020;33(5):464-472. doi:10.1016/j.wombi.2019.09.008
  15. Catling, C. J., Reid, F., and Hunter, B. (2017) ‘Australian Midwives’ Experiences of Their Workplace Culture’, Women and Birth, 30/2: 137–45. https://doi.org/10.1016/j.wombi.2016.10.001
  16. Clements, V., Davis, D. & Fenwick, J. 2013. ‘Continuity of care: Supporting new graduates  to grow into confident practitioners’, International Journal of Childbirth [Online], vol. 3, no.  1, pp. 3-12, Retrieved: 8 March, 2016. http://dx.doi.org/10.1891/2156-5287.3.1.3
  17. Clinton, C., & Oula. (2022). Supporting midwifery is the answer to the wicked problems in maternal health. The Lancet Global Health, 10(6), e823–e824. https://doi.org/10.1016/S2214-109X(22)00183-8
  18. Cramer E, Hunter B. Relationships between working conditions and emotional well-being in midwives. Women Birth. 2019;32(6):521-532. doi:10.1016/j.wombi.2018.11.010
  19. Cronie D, Perdok H, Verhoeven C, et al. Are midwives in the Netherlands satisfied with their jobs? A systematic examination of satisfaction levels among hospital and primary-care midwives in the Netherlands. BMC Health Serv Res. 2019;19(1):832. doi:10.1186/s12913-019-4454
  20. Cummins, A. M., Denney-Wilson, E. & Homer, C. S. E. 2015. ‘The experiences of new graduate midwives working in midwifery continuity of care models in Australia’, Midwifery [Online], vol. 31, pp. 438-444. Retrieved: Retrieved 1 September, 2016, from Sciencedirect.  http://dx.doi.org/10.1016/j.midw.2014.12.013
  21. Daemers DOA, van Limbeek EBM, Wijnen HAA, Nieuwenhuijze MJ, de Vries RG. Factors influencing the clinical decision-making of midwives: a qualitative study. BMC Pregnancy Childbirth. 2017;17(1):345. doi: 10.1186/s12884-017-1511-5.
  22. Dahlen HG, Caplice S. What do midwives fear? Women Birth. 2014;27(4):266–270. doi: 10.1016/j.wombi.2014.06.008.
  23. Department of Health. (2021). Administrative Order No. 2021-0034: National policy on essential intrapartum care at primary level non-specialist birthing centers. https://law.upd.edu.ph/wp-content/uploads/2022/03/DOH-Administrative-Order-2019-0034.pdf  Retrieved from https://law.upd.edu.ph/wp-content/uploads/2022/03/DOH-Administrative-Order-2019-0034.pdf
  24. Donnolly N, Butler-Henderson K, Chapman M, Sullivan E. The development of a classification system for maternity models of care. Health Inf. Manag. J. 2016; 45: 64-70 https://doi.org/10.1177/1833358316639454
  25. Doron, S. C. (2017). Compliance of private lying-in clinics as perceived by midwives. University of Bohol Multidisciplinary Research Journal, 5, 48–60. https://doi.org/10.15631/ubmrj.v5i0.51
  26. Dreyer, P. S., & Pedersen, B. D. (2009). Distanciation in Ricoeur’s theory of interpretation: Narrations in a study of life experiences of living with chronic illness and home mechanical ventilation. Nursing Inquiry, 16(1), 64–73. https://doi.org/10.1111/j.1440-1800.2009.00433.x
  27. Esia-Donkoh, K., D. Yelkpieri and K. Esia-Donkoh, 2011. Coping with stress: Strategies adopted by students at the winneba campus of University of education. US-China Education Review, 1(2): 290–299 Retrieved from ERIC: https://eric.ed.gov/?id=ED528318
  28. Galletta M, Portoghese I, Pili S, Piazza MF, Campagna M (2016). The effect of work motivation on a sample of nurses in an Italian healthcare setting. Work. 54(2): 451-460. doi: 10.3233/- WOR-162327
  29. Garcia de Frutos, M. (2020) ‘Delivering Next Generations’, British Journal of Midwifery, 28/8: 504–08. Retrieved from https://www.britishjournalofmidwifery.com/content/comment/delivering-next-generations
  30. Geraghty, S., Speelman, C., and Bayes, S. (2019) ‘Fighting a Losing Battle: Midwives Experiences of Workplace Stress’, Women and Birth, 32/3: e297–306. https://doi.org/10.1016/j.wombi.2018.07.012
  31. González-Timoneda, A., Hernández Hernández, V., Pardo Moya, S., and Alfaro Blazquez, R. (2021) ‘Experiences and Attitudes of Midwives During the Birth of a Pregnant Woman with COVID-19 Infection: A Qualitative Study’, Women and Birth, 34/5: 465–72. https://doi.org/10.1016/j.wombi.2020.12.001
  32. Gray, L., Smith, J., & Brown, K. (2019). Midwives’ transition to practice: Expectations and experiences. Midwifery, 70, 1–8. https://doi.org/10.1016/j.midw.2018.11.008
  33. Grzybowski, S., Stoll, K., & Kornelsen, J. (2011). Distance matters: A population-based study examining access to maternity services for rural women. BMC Health Services Research, 11, 147. https://doi.org/10.1186/1472-6963-11-147
  34. Jarosova D, Gurkova E, Palese A, et al. Job satisfaction and leaving intentions of midwives: analysis of a multinational cross-sectional survey. J Nurs Manag. 2016;24(1):70-79. doi:10.1111/jonm.12273
  35. Jolles, D. R., Langford, R., Stapleton, S., Cesario, S., Koci, A., & Alliman, J. (2017). Outcomes of childbearing Medicaid beneficiaries engaged in care at strong start birth center sites between 2012 and 2014. Birth., 44(4), 298–305. https://doi.org/10.1111/birt.12302
  36. Katy B. Kozhimannil, PhD, MPA Impossible Math: Financing a Freestanding Birth Center and Supporting Health Equity February 19, 2019 Retrieved from https://www.ajmc.com/view/impossible-math-financing-a-freestanding-birth-center-and-supporting-health-equity
  37. Kemp, J., Maclean, G.D, and Moyo, N. (2021) Global Midwifery: Principles, Policy and Practice. Swansea, UK: Springer. https://doi.org/10.1007/978-3-030-46765-4
  38. Kerkman T, Dijksman LM, Baas MAM, Evers R, van Pampus MG, Stramrood CAI. Traumatic Experiences and the Midwifery Profession: A Cross-Sectional Study Among Dutch Midwives. J Midwifery Womens Health. 2019;64(4):435–442. doi: 10.1111/jmwh.12946.
  39. Lewis, L., Barnes, C., Roberts, L., McLeod, L., Elliott, A., and Hauck, Y. L. (2020) ‘The Practice Reality of Ward Based Midwifery Care: An Exploration of Aspirations and Restrictions’, Women & Birth, 33/4: 352–59. https://doi.org/10.1016/j.wombi.2019.08.010
  40. Lyon B. Stress, coping, and health: a conceptual overview. In: Rice VH, editor. Handbook of stress, coping, and health: implications for nursing research, theory, and practice. 2nd ed. Thousand Oaks: SAGE Publications, Inc.; 2012. p. 2–20 Retrieved from https://us.sagepub.com/en-us/nam/handbook-of-stress-coping-and-health/book234165
  41. Manacsa, R & Tan, A 2012, ‘Strong republic sidetracked: Oligarch dynamics, democratization, and economic development in the Philippines’, Korea Observer, vol. 43, no. 1, pp. 47-87. Retrieved from https://www.researchgate.net/publication/262123704_Economic_Policy_in_a_Democratic_Polity
  42. Martin, J., Hamilton, B., Osterman, M., & Driscoll, A. (2021). Births: Final data for 2019. National Vital Statistics Reports, Vol. 70, No. 2. National Center for Health Statistics. https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-02-508.pdf   https://doi.org/10.15620/cdc:100472
  43. Matthews R, Hyde R, Llewelyn F, Shafiei T, Newton M, Forster DA. Factors associated with midwives’ job satisfaction and experience of work: a cross-sectional survey of midwives in a tertiary maternity hospital in Melbourne, Australia. Women Birth. 2022;35(2):e153-e162. doi:10.1016/j.wombi.2021.03.012
  44. Mayhew M, Hansen PM, Peters DH, et al. Determinants of skilled birth attendant utilization in Afghanistan: a cross-sectional study, American Journal of Public Health, 2008, vol. 98 (pg. 1849-56) https://doi.org/10.2105/AJPH.2007.123471
  45. Mharapara, T. L, Staniland, N., Stadler, M., Clemons, J. H., and Dixon, L. (2022) ‘Drivers of Job Satisfaction in Midwifery—A Work Design Approach’, Women and Birth, 35/4: e348–55. https://doi.org/10.1016/j.wombi.2021.07.004
  46. Nasrollahpour Shirvani D, Ashrafian Amiri H, Motlagh ME, Kabir MJ, Maleki MR, Shabestani Monfared A. et al. Evaluation of the function of referral system in family physician program in northern provinces of Iran. Journal of Babol University of Medical Sciences. 2008;11(6):46–52. Persian.
  47. Nepotism. (2013). Dictionary.com. Retrieved from https://www.dictionary.com/browse/nepotism
  48. Nielsen, K., Nielsen, M. B., Ogbonnaya, C., Känsälä, M., Saari, E., & Isaksson, K. (2017). Workplace resources to improve both employee well-being and performance: A systematic review and meta-analysis. Work & Stress. https://doi.org/10.1080/02678373.2017.1304463
  49. Ombanda, P. (2018). Nepotism and Job Performance in the Private and Public Organizations in Kenya. International Journal of Scientific and Research Publications (IJSRP), 8(5). https://doi.org/10.29322/IJSRP.8.5.2018.p7762
  50. Pedersen, B. D. (2005). Sygeplejepraksis: Sprog & erkendelse [Nursing practice: Language and cognition] (Doctoral thesis). The Faculty of Health Science, University of Aarhus.
  51. Phil. Health Circular No. 0033 s. Deferment of License to Operate (LTO) Requirement for Renewal of Accreditation of Birthing Homes/Lying-in / Maternity Clinics. (2013). Retrieved 11 January 2017
  52. Phil.Health Circular No.15  Guidelines for Accreditation of Out -patient Clinics, Philhealth circular No. 25-2015 Social Health Insurance Coverage and Benefits for Women About to Give Birth Revision 1 https://www.philhealth.gov.ph/circulars/2015/circ015-2015.pdf
  53. Pomeroy, A., Koblinsky, M., & Alva, S. (2014). Who gives birth in private facilities in Asia? A look at six countries. Health Policy and Planning, 29(Suppl 1), i38–i47. https://doi.org/10.1093/heapol/czt103
  54. Pour AY, Nekoei MH, Torki S (2016). The relationship between quality of work life and performance of railway headquarter employees in Hormozgan province. Glob J Sci Res. 4(4):63-68. Retrievead from: www.gjsr.blue-ap.org
  55. Professional Regulation Commission. (n.d.). Board of Midwifery: Continuing education. https://www.prc.gov.ph/uploaded/documents/Board%20of%20Midwifery-CE.pdf
  56. Rasoulynejad SA. Patient Views for Self-Referral to Specialists. Iranian Journal of Public Health. 2007;36(1):62–7. Persian. Retrieved from https://ijph.tums.ac.ir/index.php/ijph/article/view/2136
  57. Reckon News. (2023, March). Birth centers have never been more popular but struggle to remain viable: How some midwives are changing the system. https://www.reckon.news/news/2023/03/birth-centers-have-never-been-more-popular-but-struggle-to-remain-viable-how-some-midwives-are-changing-the-system.html
  58. Ricoeur, P. (1976). Interpretation theory: Discourse and the surplus of meaning. Texas Christian University Press.
  59. Rutaremwa G, Wandera SO, Jhamba T, Akiror E, Kiconco A. Determinants of maternal health services utilization in Uganda. BMC Health Serv Res. 2015. https://doi.org/10.1186/s12913-015-0943-8
  60. Say L, Raine R. A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context, Bulletin of the World Health Organization, 2007, vol. 85 (pg. 812-9) https://doi.org/10.2471/BLT.06.035659
  61. Shiffman J. Can poor countries surmount high maternal mortality? Stud Fam Plan. 2000;31(4):274–89. https://doi.org/10.1111/j.1728-4465.2000.00274.x
  62. Shinohara Y. Factors influencing job satisfaction in hospital-based midwives in the mid-career or later stages. Article in Japanese. Journal of the Japan Maternal and Infant Care Association. 2020;13:15-24. doi:10.11477/mf.7011200090.
  63. Siyam, A., Zurn, P., Rø, O. C., Gedik, G., Ronquillo, K., Co, C. J., Vaillancourt-Laflamme, C., Dela Rosa, J., Perfilieva, G., & Dal Poz, M. R. (2013). Monitoring the implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel. Bulletin of the World Health Organization, 91(11), 816–823. https://doi.org/10.2471/BLT.13.118778
  64. United Nations Population Fund, International Confederation of Midwives, & World Health Organization. (2021). The State of the World’s Midwifery 2021: Delivering health, saving lives. United Nations Population Fund. https://www.unfpa.org/sites/default/files/pub-pdf/21-038-UNFPA-SoWMy2021-Report-ENv4302.pdf Retrieved from https://www.unfpa.org/sites/default/files/pub-pdf/21-038-UNFPA-SoWMy2021-Report-ENv4302.pdf
  65. World Health Organization (2021) Global Strategic Directions for Nursing and Midwifery 2021-2025. Geneva: World Health Organization. Retrieved from https://www.who.int/publications/i/item/9789240033863 (who.int)