TY - JOUR
T1 - Kairos care in a Chronos world
T2 - Midwifery care as model of resistance and accountability in public health settings
AU - Niles, Paulomi Mimi
AU - Vedam, Saraswathi
AU - Witkoski Stimpfel, Amy
AU - Squires, Allison
N1 - Funding Information:
We thank the midwives who participated for offering their time, insight, and their dedication to caring for women and families. We also acknowledge Dr Deborah Padgett, Dr Victoria Vaughn Dickson, Dr Rayna Rapp, Dr Annie Gibeau, and Dr Audrey Lyndon who provided thoughtful expertise and guidance through the research and writing process. The study was approved by the NYU Institutional Review Board (IRB FY2018-1741).
Publisher Copyright:
© 2021 Wiley Periodicals LLC
PY - 2021/12
Y1 - 2021/12
N2 - Background: In the United States (US), pregnancy-related mortality is 2–4 times higher for Black and Indigenous women irrespective of income and education. The integration of midwifery as a fundamental component of standard maternity services has been shown to improve health outcomes and service user satisfaction, including among underserved and minoritized groups. Nonetheless, there remains limited uptake of this model in the United States. In this study, we examine a series of interdependent factors that shape how midwifery care operates in historically disenfranchised communities within the Unites States. Methods: Using data collected from in-depth, semi-structured interviews, the purpose of this study was to examine the ways midwives recount, describe, and understand the relationships that drive their work in a publicly funded urban health care setting serving minoritized communities. Using a qualitative exploratory research design, guided by critical feminist theory, twenty full-scope midwives working in a large public health care network participated. Data were thematically analyzed using Braun & Clarke's inductive thematic analysis to interpret data and inductively identify patterns in participants’ experiences. Findings: The overarching theme “Kairos care in a Chronos World” captures the process of providing health-promoting, individualized care in a system that centers measurement, efficiency, and pathology. Five subthemes support the central theme: (1) the politics of progress, (2) normalizing pathologies, (3) cherished connections, (4) protecting the experience, and (5) caring for the social body. Midwives used relationships to sustain their unique care model, despite the conflicting demands of dominant (and dominating) medical models. Conclusion: This study offers important insight into how midwives use a Kairos approach to maternity care to enhance quality and safety. In order to realize equitable access to optimal outcomes, health systems seeking to provide robust services to historically disenfranchised communities should consider integration of relationship-based strategies, including midwifery care.
AB - Background: In the United States (US), pregnancy-related mortality is 2–4 times higher for Black and Indigenous women irrespective of income and education. The integration of midwifery as a fundamental component of standard maternity services has been shown to improve health outcomes and service user satisfaction, including among underserved and minoritized groups. Nonetheless, there remains limited uptake of this model in the United States. In this study, we examine a series of interdependent factors that shape how midwifery care operates in historically disenfranchised communities within the Unites States. Methods: Using data collected from in-depth, semi-structured interviews, the purpose of this study was to examine the ways midwives recount, describe, and understand the relationships that drive their work in a publicly funded urban health care setting serving minoritized communities. Using a qualitative exploratory research design, guided by critical feminist theory, twenty full-scope midwives working in a large public health care network participated. Data were thematically analyzed using Braun & Clarke's inductive thematic analysis to interpret data and inductively identify patterns in participants’ experiences. Findings: The overarching theme “Kairos care in a Chronos World” captures the process of providing health-promoting, individualized care in a system that centers measurement, efficiency, and pathology. Five subthemes support the central theme: (1) the politics of progress, (2) normalizing pathologies, (3) cherished connections, (4) protecting the experience, and (5) caring for the social body. Midwives used relationships to sustain their unique care model, despite the conflicting demands of dominant (and dominating) medical models. Conclusion: This study offers important insight into how midwives use a Kairos approach to maternity care to enhance quality and safety. In order to realize equitable access to optimal outcomes, health systems seeking to provide robust services to historically disenfranchised communities should consider integration of relationship-based strategies, including midwifery care.
KW - health systems
KW - individualized care
KW - midwifery
KW - relationship-based model
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U2 - 10.1111/birt.12565
DO - 10.1111/birt.12565
M3 - Article
C2 - 34137073
AN - SCOPUS:85108092342
SN - 0730-7659
VL - 48
SP - 480
EP - 492
JO - Birth
JF - Birth
IS - 4
ER -