The Virgin Midwives: A Phenomenological Study about the

Experience of Midwives on their First Encounter with Women during

Child Birth

By: John Theo Gutierrez. John Rendon Oaa. Jon Axl Poblete.

Carlajean Escolar. Maria Sophia Rondolo. Mikaela Rose Sevilla. Rica Mae Tomalon

ABSTRACT

INTRODUCTION

The most precious moment in a womans existence is the delivery of her first baby

(Darvill et al., 2010 in Guitter et al., 2014). In order to fulfil her dream, there are the midwives

that frequently provide the care for women throughout the labour and birth (Bedwell et al.,

2015). It is defined by the WHO (1992) in Simpson, (2007, p.4) that a midwife is a person who,

having been admitted to an educational programme, duly recognized in the country in which it is

located, has successfully completed the prescribed course of studies in midwifery and has

acquired the requisite qualifications to be registered and/or legally licensed to practice

midwifery. She must be able to give the necessary supervision, care and advice to women

during pregnancy, labour and the postpartum period, to conduct deliveries on her own

responsibility and to care for the new born and the infant Likewise, Thompson (2004) in

Simpson (2005, p. 5) proposes that being the wardens of the natural child bearing are midwives

all about.

In addition, one of the most important aspects of the total birth experience is the support

received from the midwife (Lavender, 2002). Moreover, Maillefer et al. (2015) explains that

women more likely need maternity care that can give them continuity of care, and

recognize the significance of having a good communication between them. Similarly, it is

identified that the particular attention must be given to any women in the maternity

pathway. Besides, Dickson (2010) in the study of Dahlberg and Aure (2012) entitled The

womens birth experiences: The effect of interpersonal relationships and continuity for care,

emphasized that the effective technique for a woman to undergo successful operation and her

midwife to have the existence of communication skills, knowledge and understanding which are

vital ports is by taking care in midwifery services. Hence, the whole feature of midwifery service

is in the strong connection between the midwife and the woman (Hunter et al., 2008 in Dahlberg

& Aure, 2012). Another, Rider (1998), in the study of Ariarte et. Al. (2001, p. 14), characterizing

a midwife as a person that has the ability to listen carefully, has goals, has the energy, has the

courage to move forward, and has the ability to understand the patients on its own way reflects

the true nature of midwifery.

After all, midwifery is not an easy profession since midwives also have struggles, just

like other health care practitioners. Midwives are facing huge obstacles and challenges every

day to finish their job successfully.

First, stimulating the patients state of mind is to become a mother, wherein her

capability must not exceed the limits of her capacity, was a trial for the midwives (Lundgren &

Dahlberg, 2014). Also, according to Lundgren and Dahlberg (2014), the midwifes role is to

accompany the woman with being anchored, which means to be anchored is to respect the

womans ability limits. Thus, it is a problem if the connection between the two is disturbed.

According to Brudal (2000), the woman is in the special state of mind during childbirth.

Second, the midwives another challenge is to handle the situation as sincerely and

naturally in giving the attention to women at high risk in order to raise the child birth to a normal

(Berg, 2005). Pregnant women at risk want to be treated as normal (Harvey, 2001). Pregnant

women labeled as high risk are exposed and vulnerable (Lindmark et al., 2003). According to
Dahlberg (2007), in Berg (2005), the midwives are being persuaded to guide every patient

having a natural gift in promoting the normal process. High risk is defined as a women with any

kind of complicated childbirth (Downe, 2003)

Hence, the midwives are now dealing with problem in the maternity and neonatal

mortality ratios. For the past 20 years, the mortality rate has increased (WHO, 2002). According

to the UNFPA, of the 73 countries that make up 92% of all maternal and new-born deaths in the

world, only 4 have a midwifery workforce sufficient to meet the universal needs for reproductive,

sexual, maternal, and new-born health.

Nevertheless, all the problems now have the solution for it. Being professional as they

seem is the greatest art of all. Despite of the struggles, the midwives come out with the

strategies to figure out the difficulties they are facing with.

First, the midwives use the coping strategies in order to face the problems (Spiby et al.,

2000). Also, it makes them to be encouraged with the help of the relaxation phase via the

breathing process. This will make their companion establish the trust to them.

Another thing is that using the coping strategies is very important. The concept of coping

as cognitive and behavioural efforts is defined as taking over threatening situations (Sarafino,

2002). According to Brannon et al. (2009), coping behaviours include the problem oriented

process, in which the person is faced with the reason for his/her disturbance, and the emotional

oriented process, based on which the person tries to adjust his/her emotional responses.

Lastly, to prevent the increase in maternity and neonatal mortality rate is by using the

antenatal and postpartum care (Koblinsky, 2008). Also, Koblinsky (2008) stated that midwives

must address the vulnerability at the time of the postpartum care and the increase in antenatal

care that makes the mortality to be avoided.

 Thus, the literature reviews for this phenomenon only exist on the western countries in

which there is no study that has been conducted on the Philippines. Experiences of the

midwives and with regard to the patient and how they interact positively towards them will be

emphasized.

With this, the present study aims to evaluate the experience of midwives during their first

encounter with women during childbirth. Specifically, this study will be the answer to the

following questions:

1. What are the struggles of the midwives during their first encounter with

women giving birth?

2. How do the midwives cope-up with the difficulties during their first encounter

with women giving birth

 METHODOLOGY

The study is a qualitative research design using a phenomenological method since it

aims to describe a phenomenon about midwives who encounter their first child birth with a

woman. Phenomenology studies focus on experiences, events and occurrences with disregard

or minimum regard for the external and physical reality" (Dudovskiy, 2011).

This study includes the population of midwives. Out of the population, the sample of

midwives in their first encounter with women during child birth was selected and the technique

was the non probability sampling using the snowball sampling type since one of the sample was

took the researchers to other sample that also had an experience to the alleged phenomena.

According to Andale (2016), snowball sampling is where researchers recruit other participants

for a test study.

To answer the specific research questions, the researchers conducted an interview

among the participants. The interview questions include the experiences in the struggles of the

midwives during their first encounter with the women giving birth and the strategies in coping

with the difficulties of it.

Since the participants have been identified, the researchers proceeded to the data

gathering. The researchers would sent an appointment with the participant for an interview at

their convenient date and time. One-on-one interview with the participant was conducted. An

audio tape recorder was provided in collecting data. The first day of the interview occurred on

February 25, 2016 in Trece Martires City wherein the researchers interviewed 3 participants that

took 2 hours to finish. Each of the interview does not exceed within 15 minutes. On the next day,

the researchers continued on interviewing the last 2 participants since it was their convenient

time. It took 1 hour to finish the data gathering among the participants throughout the day.
 The non-numerical data will be analyzed by using the Thematic Analysis of Braune &
Clark (2006). According to Braune & Clark (2006), thematic analysis is a qualitative analytic
method for establishing, examining and describing themes within data wherein it organizes and
characterizes the data set in details.
 RESULTS AND DISCUSSION

A thorough and rigorous reading and analysis of the transcripts of the interviews with the

participants resulted in several themes which are presented in this section under three cardinal

categories, namely Struggles of the Midwives, Coping Strategies and First Experience of the

Midwives during Child Birth.

Research Question No. 1. Struggles of the Midwives

The Table 1 shows the struggles of the midwives on their first encounter with women

during child birth.

Table 1

Themes for Struggles of the Midwives

Themes Definition / description Sample Quote

Adapting the Field This is the adjustment done by the
participant to be fit in the
profession.
Noong una medyo mahirap
kase nag-aadjust ka. Noong
una hahawakan mong
trabaho, yung health ng
mother at baby kase 9
months na pagbubuntis ng
nanay

Dealing with the The commitment done by the
Patients participants in order to take care
the mother and the childs life.
Siyempre challenging ang
trabaho ng midwife kase una,
hawak mo nga ang buhay ng
nanay at baby. Medyo
kailangang maingat ka rin sa
unang una sa panganganak
ng nanay

... kasi siyempre sabi ko nga


Saving Lives The complications that participants
face in providing the needs of
women and babies which includes
being high risk, being stress,
bleeding, increase in blood
pressure, and out of oxygen.
As shown in Table 1, adapting to the field is one of the struggles of the midwives on their
first encounter with women during child birth. This claim supports the idea of Van der Putten
buhay ang hawak mo ,
macha-challenge ka
siyempre, kung okay ba sila
pareho
Yung pag may pasyenteng
dinudugo, pag may mga
emergency cases talagang
kakabahan ka pag may
pasyenteng dinudugo tapos
tumataas yung BP, yung
baby nai-istress...
...kung okay ba sila pareho
yung nanay hindi siya
duduguin Yung baby
naman Dapat pag labas
nya umiiyak o aktibo sya
dapat maganda yung kulay
nya, dapat mabigay lahat
nang pangangailangan nya
tulad ng medesina pareho
sila para sa nanay at sa
baby.
Kapag hindi marunong umiri
ang nanay or di kaya high
risk
Kunware paglabas ni baby
eh di agad siya umiyak,
kumbaga kailangan mo
siyang paiyakin tapos kung
kulang paglabas niya, kulang
si baby kailangan mo siyang
i-oxygen agad, parang hirap
na hirap siya...
(2008) that the midwives often struggled to adapt to their new role because of the increased

responsibility and awareness of accountability which often led to anxiety. According to Skirton et

al., (2012), the newly qualified midwives tends to often experience a lack of confidence in their

own abilities to make decisions based on their clinical assessments. However, within a year of

practicing, the confidence level of the midwives will arouse modestly (Davis et al., 2011).

Moreover, dealing with the patients on the first exposure is one of the challenges that

midwives encounter since the life of the mother and the baby is depending on them. As stated

by Page et. Al. (n.d), in Sehhatie et Al. (2014), that midwife's functions and actions during the

critical stage of woman life may lead to different outcomes ranging from life to death and from

heath to physical injuries, with significant effects on the mental and emotional health of mother

and child.

In addition to, the midwives have the difficulties with the emergencies that may harm

both the mother and the child. Saving their lives is one of the priority of the midwives. As

proposed by Berg (2005), child bearing women at high risk live in an extremely vulnerable

situation which become a crucial part that midwifery and medical care exist on equal terms for

the woman's sake. According to the participants, it is difficult to handle a women giving birth with

complications making their profession hard.

Research Question No. 2. Coping Strategies of the Midwives

The Table 2 shows the coping strategies of the midwives on their first encounter with

women during child birth.

Table 2.

Themes for Coping Strategies of the Midwives

 Themes Definition / description
Seeking for Guidance The solemn request done by the
participants in order to ease the
nervousness and to guide them in
their profession.
Referring to the Experts The practice made by the
participants in case of emergency
by sending the patients to a
medical specialist like obstetrician
and pediatrician and to a hospital.
Sample Quote
Siyempre, unang una,
magdadasal ka din na
tulungan ka tas kailangan
alam mo yung mga dapat
mong gawin
Siyempre pag may
pasyenteng dadating tapos
ikaw mismo yung magha-
handle pag may
manganganak, dasal ka
lang.
Kapag ang pasyente ay high
risk inirerefer ko yun sa aking
OB, pag naman baby ang
high risk nirerefer ko sa aking
pediatrician.
Dapat ang midwife ay
marunong mag identify ng
mga high risk para sa ganon,
di aabutan dito sa clinic yung
may mga komplikasyon.
Refer dapat agad.
Yung pag may pasyenteng
dinudugo, pag may mga
emergency cases talagang
kakabahan ka pag may
pasyenteng dinudugo tapos
tumataas yung BP, yung
baby nai-istress so,
tumatawag pa kami sa
referred hospital.
Applying Medical A standard method of completing a
Routines procedure by the participants to
make an uncertain situation stable.
kulang si baby kailangan
mo siyang i-oxygen agad,
parang hirap na hirap siya
kailangan mo syang i-suction
ganun. Agad, mga routine,
kailagan kasi umiyak si baby,
ok yung color niya, ok yung
heart, heartbeat niya tsaka
yung paghinga niya.

As shown in the table 2, the first thing that the midwives do in order to ease their fear

and insecurities is by seeking for guidance. The participants ask for guidance by praying before

filling in the operations. Spirituality is the main element of care and should not be neglected in

the field of nursing and midwifery (Crowther & Hall, 2015). Also, women intensify their prayers

to God for protection, safe delivery and blessings during their pregnancy (Jesse et Al., 2007).

Furthermore, the midwives stated that referring to an expert and a hospital is the best

way as they encounter emergencies that they cannot handle because of their limited skill. There

is a difference between a midwife and an obstetrician. According to the Northside Womens

Specialists, midwives are the ones responsible for the obstetrical care and they cannot perform

a caesarean sections in which they can only perform normal birth giving while the obstetrician

can perform caesarean sections and any other necessary surgical procedure during your

pregnancy and delivery.

Additionally, the midwives apply the medical routine when facing uncertain situation. This

supports the statement of Koblinsky (2008) that it is a must a midwives initiate a postpartum

care and antenatal care to decrease the mortality rate.

Main Research Question. First Experience of the Midwives during Child Birth
The Table 3 shows the experience of the midwives about their first encounter with
women during child birth.
Table 3.
Themes for First Experience of the Midwives during Child Birth
Themes Definition / description
Feeling Nervous The state of being anxious by the
participants since it was their first
time even though they had proper
training.
Difficulties The participants make a hard time
on looking for the patients during
their first experience.
Sample Quote
Ano, nakakakaba na
nakakatakot siyempre, kung
kaya mo bang magpaanak
tas isa ka lang, isa lang ako
nun ehh
Siyempre medyo
ninenerbyos ka kase hindi
naman basta yung...lalo
pagmidwife, pag
nanganganak, hindi naman
basta parang ano lang yun
eh. Kailangan alam mo yung
gagawin mo .
Noong una medyo mahirap.
Kailangan sa center kase
ang midwife, siya yung nag-
bibigay ng advise sa nanay
about sa kanilang kalusugan
para yung pagbubuntis niya
eh maging safe. Ma-advice
ang mother para safe sa
pagbubuntis
Nako mahirap. Kasi
dalawang buhay hawak mo,
 buhay nang nanay at buhay
ng baby.

Mahirap kasi maraming

problema

As shown in the table 3, the midwives experience nervousness on their first encounter

with women during child birth. The particapants lacking in the confidence since it was their first

time in their profession with a lack of experience. Also, the participants experience difficulties

since they are facing a big responsibility in child birth.