How do midwives and obstetricians communicate at the primary/secondary interface?

Rachel Cassie
13 December 2019


Cassie, R.V. (2019). How do midwives and obstetricians communicate at the primary/secondary interface? (A thesis submitted in fulfilment of the degree of Master of Midwifery at Otago Polytechnic, Dunedin, New Zealand.) [PDF 1.67MB]


Interprofessional communication is a critical component of safe maternity care. The literature reports circumstances in New Zealand and overseas when interprofessional collaboration works well between midwives and obstetricians as well as descriptions of unsatisfactory communication between the two professions.

This qualitative research focused on communication between community based LMC (lead maternity carer) midwives and public hospital obstetricians/registrars at a New Zealand District Health Board. The objectives were to define effective collaboration from research participants’ perspective, to identify barriers and challenges to good communication, to generate proposals to foster positive collaboration, and to explore participants’ understanding and use of the Guidelines for Consultation with Obstetric and Related Medical Services (Referral Guidelines).

Eight primary care midwives, three obstetricians and two obstetric registrars were interviewed about their interactions at the primary secondary interface and their understanding of and use of the Referral Guidelines. The theoretical perspective was Appreciative Inquiry and data was analysed using thematic analysis. Results indicated usually positive interprofessional interactions. Participants valued the Referral Guidelines but also reported some limitations to their applicability.

Dominant themes that emerged were the need to negotiate differing philosophies, to clarify blurred boundaries that sometimes led to lack of clear lines of responsibility, and the importance of three-way conversations. When three-way communication between midwife, obstetrician/registrar and woman occurred effectively, communication was usually optimal. Three-way communication was pivotal in negotiating philosophical difference and clarifying blurred boundaries. The research findings lead to recommendations on promotion of optimal communication.

Rachel Cassie's thesis was supervised by Jean Patterson, Christine Griffiths and George Parker. 



This thesis is available under a Creative Commons Attribution-NonCommercial-NoDerivatives licence CC BY-NC-ND 4.0 International.

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