Providing care under stress : creating risk : 12 midwives experience of horizontal violence and the effects on the provision of midwifery care : a thesis presented in partial fulfillment of the requirements for the degree of Master of Arts in Midwifery at Massey University, Palmerston North, New Zealand

Abstract

Bullying, harassment, horizontal violence, whatever the name used, this behaviour is a problem for the midwifery profession. While the problem has been acknowledged in New Zealand there is a paucity of research that is relevant to the New Zealand situation and to midwifery internationally. The experience of horizontal violence, and the effects of that experience on the provision of midwifery care have been explored using a qualitative approach for data collection, and thematic analysis to analyze the data. Twelve midwives from a variety of practice settings and modes, for example self-employed, employed midwives and midwives working in team practices participated in in-depth semi-structured interviews that were audio taped. Each participant provided their personal understanding of the term horizontal violence, and common characteristics of their understanding are presented, as is a short explanation of their experience of horizontal violence. As a number of the midwives referred to being bullied in their understanding and experience of horizontal violence the use of the term bullying appeared to be used interchangeably by the midwives in the study. Categories from analysis of the data are separated into the expenence of horizontal violence and the effects on the provision of midwifery care. Key categories from the experience are 'fractured relationships' and 'hanging on: surviving the experience'. 'Providing care under stress: creating risk is the key category in relation to the effects on the provision of midwifery care. Midwives who took part in this study were personally and professionally affected by the experience of horizontal violence and consequent bullying behaviour. Relationships between midwives, and midwives and women suffered and affected the midwifery care that midwives were able to provide. Where midwives practiced in isolation the potential for risk for women was greatly increased. Themes that support the main category of 'providing care under stress: creating risk' and which illustrate the effect on the provision of care are centered on the issues of risk, isolation in practice, surviving the experience and feelings of guilt. Recommendations arising from this study include: • The development of policies and protocols that address the issue of horizontal violence and workplace bullying in facilities in which midwives work and women give birth. • Midwives working in group practices need to document a commitment to zero tolerance ofhorizontal violence. • Communication skills and assertiveness training must be included within any midwifery education syllabus. • A study that is more representative of the New Zealand midwifery workforce is necessary to determine accurately the true situation within the profession in respect of the effects ofhorizontal violence on practice.