Expert intrapartum maternity care: a meta-synthesis

Aim. This paper reports a meta-synthesis exploring the accounts of intrapartum midwifery skills, practices, beliefs and philosophies given by practitioners working in the field of intrapartum maternity care who are termed expert, exemplary, excellent or experienced. Background. Expertise in nursing and medicine has been widely debated and researched. However, there appear to be few studies of practitioners' accounts of expertise in the context of maternity care. Given current international debates on the need to promote safe motherhood, and, simultaneously, on the need to reverse an examination of the nature of rising rates of routine intrapartum intervention, maternity care expertise is timely. Method. A systematic review and meta-synthesis were undertaken. Twelve databases and 50 relevant health and social science journals were searched by hand or electronically for papers published in English between 1970 and June 2006, using predefined search terms, inclusion, exclusion and quality criteria. Findings. Seven papers met the criteria for this review. Five of these included qualified and licensed midwives, and two included labour ward nurses. Five studies were undertaken in the USA and two in Sweden. The quality of the included studies was good. Ten themes were identified by consensus. After discussion, three intersecting concepts were identified. These were: wisdom, skilled practice and enacted vocation. Conclusion. The derived concepts provide a possible first step in developing a theory of expert intrapartum non-physician maternity care. They may also offer more general insights into aspects of clinical expertise across healthcare groups. Maternity systems that limit the capacity of expert practitioners to perform within the domains identified may not deliver optimal care. If further empirical studies verify that the identified domains maximize effective intrapartum maternity care, education and maternity care systems will need to be designed to accommodate them.