Analisi del pensiero delle ostetriche per la riorganizzazione dell'assistenza finalizzata all'applicazione dei quarto passo dell'iniziativa ospedale amico del bambino nella Clinica L. Mangiagalli di Milano

Introduction: The BFHI Step 4 is not applied in the Obstetric and Ginaecological Clinic Mangiagalli of Milan (Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico). Aim: The aim of this qualitative study is to understand why midwives don’t apply the BFHI Step 4, although several studies demonstrate many important psycophisical benefits for mother and newborn through the skin to skin contact at birth. Methods: Sixteen midwives were interviewed between 25-05-2012 and 6-06-2012. After being recorded the interviews were transcribed and analyzed: the sentences were listed and then grouped in Labels, Cathegories and Themes. Results: Four great thematic areas were identified and grouped in two main parts: braking forces and driving forces. The braking forces are formed by the resistances to change, like mental organization, habits, rules, fear of losing control, thoughts of impossibility and difficulty, personal beliefs, organizational mode and a negative relationship with colleagues; while the driving forces are made up of midwives’ proposals and suggestions for the implementation of the organizational change and the creation of a unified and cohesive group of professionals. Conclusions: The organizational model, midwives habits, frame of mind and personal beliefs hinder the implementation of the BFHI Step 4, and make the host mode of the newborn contrary to the best practice. A review of the organizational mode is required, in order to let midwives and the University Clinic regain their original function of mothers and newborns’ health promotion. Research implications: In the Obstetric and Ginaecological Clinic Mangiagalli of Milan (Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico) an organizational change starting from a context analysis is required, in order to identify all the braking forces that oppose to the desirable change, to restrain and direct them in the right direction. This change should clearly define the general and specific objectives to be achieved, involve and motive midwives, creating conditions to feel them part of a united professionals’ team and active protagonists of change, that will improve their evidence based work, focused on mother baby’s pair