"That's a task which takes time": a realist evaluation of how context affect midwives' perception of time in a Danish antenatal psycho-social screening program.

Background: midwives by virtue of being in close contact with expecting parents during pregnancy plays an essential role for providing psycho-social care including early identification of vulnerability and referral to supportive interventions. Woman-centeredness is recommended in maternity care. However, midwives are confronted with institutional demands which may cause organization-centered care. The objective of this study was to explore how organizational context influence midwives’ perception of time by examine how this affects professional approach when providing care for expecting parents in vulnerable positions.

Method and Material: a concurrent realist evaluation of a dialogue-based psycho-social screening program in a Danish region. 15 interviews with midwives and 16 observations during screening was conducted.

Findings: time determines whether midwives are able and confident to meet and communicate with expecting parents with compassion, thus it influences their ability to provide woman-centered care and ultimately reaching a trustful midwife-woman and couple relationship. Hereby, organizational opportunities for flexibility serves as a significant context by empowering midwives with enhanced autonomy and resilience to meet the need of women and couples. However, most midwives had experienced that pressure of time due to heavy workload was increased when organizational support was lacking, by which dialogue within screening changed by becoming more distant and less present.

Conclusion: preliminary findings demonstrates that pressure of time is caused by institutional demands and triggers feelings of being compelled to meet the needs of organization instead of the woman and couple. Hereby, the approach and communication and thus the midwife-woman and couple relationship is directly affected by organizational contextual conditions. Hence, organizational prioritization of flexibility and thus midwives’ autonomy is crucial for midwives’ ability and confidence to assess and meet the needs of women and couples in vulnerable positions.