Antecedents and consequences of emotional work in midwifery: A prospective field study

Background: Given the effort made in today's birthing rooms to increase women's childbirth satisfaction, special attention is directed to midwives' expressions of authenticity (namely to display emotions that he/she actually experience) in birth encounters. Objectives: To explore antecedents and consequences of emotional work strategies expressed in a specific birth encounter, to (1) understand the specific factors in a midwife birthing woman encounter, namely parity (whether or not it is a first birth), use of epidural analgesia, induction of labor, and instrumental birth that stimulate the use of deep or surface acting; (2) test the link between emotional work strategies and birthing experience, and (3) assess whether associations between the midwife's choice of strategy (deep acting or surface acting), and the woman's childbirth experience is moderated by the birthing woman's perception of the midwife's emotional work strategies. Design: A prospective-correlational field study. Participants: 104 births, selected by a convenience sampling method including 24 midwives and 104 birthing women, in one birthing room in Israel. Methods: Data were collected by validated questionnaires at two time points: immediately after labor and 48 h after labor. Results: Linear mixed model analyses revealed that of the antecedents to emotional work strategies, epidural analgesia was negatively associated with surface acting (beta = -.301, p < .05); primigravida was significantly associated with deep acting (beta = 611, p < .01) and negatively associated with surface acting (beta = -.433, p < .01); induction of birth was not associated with deep or surface acting (p > .05), and instrumental birth was significantly associated with deep acting (beta = -.590, p < .05) and positively associated with surface acting (beta = .444, p < .05). Regarding consequences of emotional work strategies, the midwife's engagement with surface acting was negatively related to the woman's birthing experience (beta = -.155, p < .05), whereas the relationship between midwife's engagement in deep acting and the woman's satisfaction also depended on the latter's perception that the midwife had engaged in deep acting (beta = -.096, p < .05). Conclusions: The midwife-birthing woman encounter is becoming globally significant for improving childbirth outcomes. Therefore, these findings offer empirical support for the importance of the midwife's expression of authenticity toward the birthing woman in improving her childbirth experience, especially when the woman perceives the midwife's emotional work strategy accurately. Also noteworthy are the aforementioned conditions that shape the midwife's engagement in deep acting or surface acting, with important recommendations to improve women's childbirth experiences. (C) 2016 Elsevier Ltd. All rights reserved.