Midwifery in Lithuania: Addressing the Barriers to Realization of Midwives’ Competence in Midwifery Care
BACKGROUND. Despite the recent important developments of midwifery practice in Lithuania, maternity care is still operating under the medical paradigm and with a biomedical model of care. This study was part of a national project on the analysis of the health care workforce and focused on professional rights, duties, responsibilities, competence, functions, and work load of midwives in order to investigate midwifery practice and propose recommendations to the Ministry of Health of the Republic of Lithuania. The purpose of this paper was to report on findings from the focus group discussion on midwives’ competence and extent of its realization in midwifery care in Lithuania. MATERIAL AND METHODS. A multiprofessional focus group discussion was conducted for this study. The group consisted of official representatives from professional associations and higher educational institutions, health care funding, midwives and obstetricians/gynecologists. Three preliminary assumptions on the topic were made by the researchers and 4 leading questions matching those assumptions were announced for the group to structure the discussion. Key CONCLUSIONS. Participants of a focus group discussion identified a series of key elements that impedes the implementation of competence acquired by midwives and limit the work to full extent of their capacity and education. These included the following: the domination of medicine and weak authority of the midwife in decision-making, a lack of opportunity to practice across the full spectrum of maternity care in all levels of health care, the invisibility of the midwifery service in regulation of payment and scientific research, the lack of clear vision about what midwifery is and what it is midwives must do on their own within the community, low motivation of midwives themselves to function according to their competence and the full potential of their role. These issues must be addressed and embraced if the midwives in Lithuania are willing to fulfill their role in practice according to their education and legally regulated scope of practice. The balanced work load for midwives at the hospital also would help overcome existing barriers and increase physical capacity and professional motivation of midwives as well.
Correspondence to O. Riklikienė Department of Nursing and Care, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus 9, Kaunas 44307, Lithuania. firstname.lastname@example.org