The Art of Doing “Nothing” Well: What Makes Midwives Different. Results of a Delphi study by Holly Powell Kennedy, CNM, PhD, FACNM

In the January/February 2000 Journal of Midwifery and Women’s Health, Holly Powell Kennedy reports on the results of her study of “exemplary” midwives and their patients to try and learn what is unique and exemplary about the midwifery model of care. That is, what is different about the way that midwives provide care from the way that physicians provide care? The critical difference that emerged from this study was the midwives’ art of doing “nothing” well; that is, being there with the woman, being vigilant to assure that things were going well, but not intervening or using technology unless it was necessary. One woman summed it up by saying, “A large part of her providing the kind of care we wanted is what she didn’t do… she didn’t rush anything … she said to me your body knows what to do so just let it do it.” Some of the qualities that were strongly identified by women with midwifery care were belief in the normalcy of birth, exceptional clinical skills and judgment, and commitment to the health of women and families. The following terms were also strongly identified by women with the midwives who cared for them: calm, patient, confident, decisive, intelligent, mature, persistent, honest, compassionate, trustworthy, flexible, understanding and supportive, warm, nonjudgmental, gentle, nurturing, not focused on self, realistic, reassuring and soothing, possessing a generous and loving spirit, possessing a sense of homor, and being personable.

Why is it important to try to identify what it is that midwives do differently and do well? Midwifery care has been shown to be safe, effective, and satisfying for women, but there has been little research on why this is so, that is, on the process of midwifery care. If women are to continue to have access to midwifery care in the future, midwives must be able to describe our philosophy and process of care and link these attributes to our outcomes. Holly Kennedy’s landmark study is a significant contribution to this effort. (Kennedy HP (2000). A model of exemplary midwifery practice: results of a Delphi study. J Midwifery & Women’s Health, Volume 45, No. 1, pp. 4-19.)