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PubMed2003

The first breastfeed: a content analysis of midwifery textbooks.

This paper reviews content related to the first breastfeed in textbooks commonly used in midwifery education programs in Australia. Few scholars have critically examined the adequacy of such information for evidence-based midwifery practice. Five midwifery textbooks were chosen for content analysis specifically related to: skin-to-skin contact for newborn adaptation; orientation and coordination; suckling for effective breastfeeding; instructions to facilitate breastfeeding initiation; breast structure and function; and breastfeeding promotion. A score was calculated with the maximum possible total of 105. The content analysis scores ranged from 35 to 54, with two texts (Lowdermilk, Perry & Bobak 2000; Sweet 1997) scoring 54. Skin-to-skin contact to facilitate breastfeeding initiation is not well promoted in popular midwifery textbooks. Further research to promote midwives access to evidence-based research for effective midwifery practice in relation to breastfeeding initiation is required.

Adult↗
PubMed2006

The challenge of improving perinatal care in settings with limited resources. Observations of midwifery practices in Mozambique.

The aim of this study was to observe and analyse midwifery care routines related to asphyxia and hypothermia during the perinatal period and to investigate the effect of an in-service education program. A direct non-participant pre- and post-intervention observation study of midwifery a performance during childbirth was conducted at a labour ward in Maputo. The observed groups consisted of 702 and 616 midwifery-attended deliveries. Examination was also conducted of the partographs (702 vs. 616). The quality of midwifery care related to prevention and early detection of asphyxia and hypothermia was found to be inadequate and the intervention had no significant effect upon the midwives' performances. This could be attributed to the quality of the intervention itself or to failure of implementing managerial decisions such as transfer of partograph documentation from obstetricians to midwives. Change in professional performance does not automatically follow awareness of evidence-based midwifery practices, but requires behavioural change, which may be more difficult to achieve.

Adolescent↗
PubMed1994

Midwifery defined by physicians, nurses and midwives: the birth of a consensus?

OBJECTIVE: To describe the form of midwifery practice preferred by physicians practising obstetrics, nurses providing maternity care and midwives. DESIGN: Mail survey conducted in 1991. SETTING: Province of Quebec. PARTICIPANTS: A systematic random sample of 844 physicians, 808 nurses and 92 midwives; 597, 723 and 92 respectively completed the questionnaire, for an overall response rate of 80%. MAIN OUTCOME MEASURES: Midwife training options, range of responsibilities, location of midwifery care, relationship to other maternity care providers and degree of autonomy. RESULTS: Most of the physicians, nurses and midwives surveyed agreed that if midwifery was legalized, midwives should have a university degree, provide basic care to women with normal pregnancy and delivery, provide prenatal and postnatal care in hospitals and community health centres, perform delivery in hospitals and work in close collaboration with the other maternity care professionals. Disagreement existed concerning the level of university training required, the need for training in nursing first, the scope of medical intervention performed by midwives, out-of-hospital delivery, the autonomy of midwives and control over their practice. CONCLUSION: Some consensus on midwifery practice exists between physicians, nurses and midwives. In jurisdictions where opposition to midwives is strong, such consensus could serve as the starting point for the introduction of midwifery.

Attitude of Health Personnel↗
PubMedDate not supplied

Feminism and nurse-midwifery. Historical overview and current issues.

Despite the fact that the profession of nurse-midwifery and feminism are both disciplines concerned with women and issues affecting women's lives, there has been little investigation or acknowledgement of relationships between their two paradigms. The work presented here is an attempt to discover both similarities and differences between nurse-midwifery and feminist thought. Using a historical approach, it is shown that despite the common goal of improving and maintaining women's status in the world, whether in general or more specifically with regard to health, feminist theorists and nurse-midwives, to a large degree, have worked separately from each other, rarely acknowledging in any formal way the importance of the other discipline. Current issues that have an effect on the practice of nurse-midwifery today--lay midwifery, the profession of nursing, and nurse-midwifery research--are presented in relation to contemporary feminist thought.

Female↗
PubMedDate not supplied

Trends in nurse-midwifery. Results of the 1988 ACNM Division of Research Mini-Survey.

The purpose of the 1988 Mini-Survey was the collection of up-to-date data from the ACNM membership, focusing on nurse-midwifery income. These were the last data collected about CNMs for the 1980 decade. The final survey sample included 1,735 CNMs and 67 SNMs; 70.6% of the CNMs were in clinical practice. The demographic, employment, and income findings are presented for all CNM respondents by ACNM region of residence and for CNMs in full-scope clinical nurse-midwifery practice. Additional income findings for CNMs working full time and part time are also presented by ACNM region of residence, as well as by selected individual states. Nurse-midwifery income is compared with nursing income during the same time period. Demographic and/or employment characteristics are presented for CNMs doing home births, for student nurse-midwives, for nurse-midwifery faculty, and for nurse-midwives with doctorates. In surveys done from 1984 to 1988, the mean full-time CNM annual income increased by +10,000. The 1988 Survey data are now approximately two years old and the impact of the recent nursing shortage on both nursing and nurse-midwifery salaries was not necessarily reflected in these data.

Certification↗
PubMedDate not supplied

The Yolo County Midwifery Service. A descriptive study of 496 singleton birth outcomes, 1990.

The Yolo County Midwifery Service was begun in January 1989 to serve pregnant low-income women who were denied care by local obstetricians. In 1990, 58% of women served were Latina and 33% were Anglo-white. Their mean age was 24.5 +/- 5.5 years, and their mean level of education was 9.9 +/- 3.5 years. Thirty-seven percent were nulliparous. All deliveries were at the only hospital in the county with a maternity service. To evaluate the effectiveness of nurse-midwifery care in this sample, a prospective study of the service's 496 singleton birth outcomes during 1990 was undertaken. Although the cesarean rate in 1990 for the obstetricians not associated with the midwifery service at this hospital was 20.6%, the midwifery clients experienced a primary cesarean birth rate of 3.7% and a total rate of 6.7%. Instrument-assisted deliveries took place for 1.0% of births. The success rate for women attempting vaginal birth after cesarean was 87.2%. Delivery over an intact perineum occurred for 51.8%. Preterm birth was experienced by only 1.0% of the women. A newborn birth weight of < 2,500 g occurred in 2.4% of births. Occult cord prolapse preceded a single neonatal death, resulting in a perinatal and neonatal death rate of two per 1,000. These data add to the growing body of information about nurse-midwifery in which that care is found to be a safe, well-accepted, and cost-effective adjunct to existing obstetric care services.

Adult↗
PubMedDate not supplied

Criteria for accreditation of direct-entry midwifery education.

The American College of Nurse-Midwives' Division of Accreditation criteria for accreditating direct-entry midwifery education call for programs to require baccalaureate degrees for entry or award them at conclusion of the program and require faculty to be midwives certified by the ACNM Certification Council. Neither criteria can be met by any existing direct-entry program. The authors argue against these criteria, based in part on familiarity with the Seattle Midwifery School. The paper describes the development of the Seattle Midwifery School, summarizes reasons for and against requiring degrees for midwifery education, argues against excluding faculty of existing direct-entry schools who are not certified by the ACNM Certification Council, notes other efforts to develop credentials for direct-entry midwives, and concludes that professional direct-entry midwifery must be based on widely respected, rigorous national standards.

Accreditation↗
PubMed2001

Nutrition education in health professions programs: a survey of dental, physician assistant, nurse practitioner, and nurse midwifery programs.

OBJECTIVE: This study determined the perceived needs and curriculum recommendations for nutrition education, and expected competencies in nutrition of graduates, of predoctoral dental, physician assistant, nurse practitioner, and midwifery programs. SUBJECTS: Surveys were mailed to all dental schools (n = 54) and physician assistant (n = 95), nurse practitioner (n = 150), and certified nurse midwifery programs (n = 42) in the United States. Surveys were addressed to the program directors of physician assistant, nurse practitioner, and certified nurse midwifery programs and the associate or assistant dean of academic affairs of dental schools. DESIGN: A 4-page survey was designed and pilot-tested. The survey included questions on respondents perceptions of and recommendations for their programs in nutrition education and expected nutrition competence level of their graduates. A reminder postcard was mailed 2 weeks after the initial mailing to nonrespondents; a second survey was mailed to nonrespondents 1 month after the postcard mailing. STATISTICAL ANALYSES: Data were analyzed using JMP-IN software. Frequencies, and chi 2 analyses, Wilcoxon rank sum test, Pearson chi 2 test. RESULTS: The overall response rate was 80.7% (n = 276). Perceived needs for competence in nutrition varied by respondents. Most of the physician assistant nurse midwifery, and nurse practitioner program directors had similar perceptions of graduates' competence in nutrition. Dental school academic administrators differed significantly from the program directors about the perceived need for knowing how to counsel on a modified diet and how and when to refer to a registered dietitian. Time was the most important factor that would enhance provision of nutrition education in the programs. Computer-based programs were the most frequently requested education tool to enhance nutrition education. APPLICATIONS/CONCLUSIONS: The disciplines agreed that graduates of dental schools and physician assistant, nurse practitioner, and nurse midwifery programs need some level of competence in nutrition relative to their discipline. Registered dietitians involved in health professions education can play an active role in developing practice-based, time-sensitive, and flexible strategies for nutrition education of these health professions groups.

Chi-Square Distribution↗
PubMed2006

[Midwifery education: apprentice or student?].

The article focuses on the history of midwifery education in Northern Germany and the changes male surgeons and doctors have brought up with their presence in the teaching of midwives. Before the academic doctors Georg David Bössel (born 1704) and Johann Georg Nessler (died 1804) started midwifery schools in Flensburg and Altona (1765) a woman was a trainee of a midwife, when she wanted to learn the profession. As early as 1731 Jacob Leonard Vogel (1694-1781) in Luebeck gave some theoretical lessons as an addition to the apprenticeship. When Christian Carstens (1781-1814) became midwifery teacher in 1805 he succeeded within short time to exchange the "old" midwives of Luebeck with younger midwives who only had learned practical obstetrics in a delivery ward. Of course the new pupils learned less as the apprentice in former times as they only delivered very few women and didn't experienced the conditions under which women gave birth to their child in their own home and with their own birth setting. Nevertheless the state officials accepted this new method of teaching as a norm and established a new midwifery school in 1805 attached to the University of Kiel.

Female↗
PubMed1991

A corporate college of nursing and midwifery philosophy: a strategy for managing change.

This paper is an account of the process of identifying a college of nursing and midwifery corporate philosophy. This process represents one component of a change strategy for managing an amalgamation between three schools of nursing to form one college of nursing and midwifery. The paper is divided into four sections: Literature review, Methodological approach, Lessons learned and Managing change: a way forward. The literature review draws on what is described, in general education, as the school/college 'effectiveness literature'. This literature emphasises why the building of corporate norms is so important and that real change in the organization of a college cannot occur without the college redefining its commitments. A methodological approach embedded in grounded theory is described. This approach facilitated the discovery of colleagues' views from their perspective, and within their working context. It also enabled all the staff to take part in the process of identifying a corporate philosophy, which would subsequently underpin the college's educational policy and practice. This process was therefore conceptualised as an attempt to provide 'ownership' for a working corporate philosophy. In the final section it is suggested that many of the theories of change nurse and midwifery educators draw upon are conceptually and practically inadequate, as a basis for action in the socio-political climate of the 1990s. Effective approaches to the management of multiple changes calls for combining and balancing factors that do not apparently go together--in essence a dialectical approach to the management of change in nurse and midwifery education.

Data Collection↗
PubMedDate not supplied

Web-based data collection in midwifery clinical education.

A Web-based computerized database for clinical data collection use by midwifery and nurse practitioner students was developed and revised over 2 years. The database provided insight into the number and diversity of clients seen as well as the student's level of autonomy. Students documented a selected set of data elements sensitive to nursing and midwifery care for all client encounters. Analysis of the clinical encounter data entered by nurse-midwifery students in the Antepartum Care course during two winter semesters included 1,417 client encounters. Results of the analyses are presented as well as educational and clinical issues involved in the development and maintenance of the database. Future work includes refining the current database, expanding the data set to include the ACNM nurse-midwifery clinical data sets for antepartum and intrapartum care, and pilot testing the Web-based version in Fall 2003 by using wireless, handheld technology.

Competency-Based Education↗
PubMedDate not supplied

The theoretical basis for nurse-midwifery practice in the United States: a critical analysis of three theories.

The relatively recent effort of midwifery scholars has resulted in the development of three middle-range midwifery theories in the United States. This article examines the three theoretical models that have been developed to describe the essential components of midwifery practice. The three theorists demonstrate remarkable consistency in the identification of concepts important to the discipline, which includes the following essential characteristics of the midwifery paradigm of care: 1) acknowledgment of connections between the mind and body and the person to the person's life and world; 2) assuming the perspective of the woman to investigate meaning and her experience of symptoms or conditions, so that a plan of care is developed by midwife and woman together; and 3) protection and nurturance of the "normal" in processes related to women's health, implying a judicious use of technology and intervention.

Adult↗
PubMedDate not supplied

Midwifery's research heritage: A Delphi survey of midwife scholars.

A Delphi survey was conducted with midwife scholars to determine the top 10 midwifery studies worthy of recognition in 2005, the 50th anniversary of the American College of Nurse-Midwives (ACNM). This survey was undertaken by students of Philadelphia University's Graduate Midwifery Program as a service-learning project on behalf of the ACNM Division of Research. Selected midwife scholars participated in 2 or 3 rounds of response and feedback to achieve consensus about research deemed historically or currently important to midwifery practice. The top 10 studies, as determined by the 19 participating midwife scholars, are presented here. These results are offered as reflection on research that has helped to shape and define the discipline of midwifery in the United States.

Delphi Technique↗
PubMedDate not supplied

Midwifery as a discipline.

Recent developments within midwifery necessitate an examination of whether midwifery qualifies as a discipline as well as a profession. A discipline is a formalized branch of knowledge and is different from, although related to, a profession of the same name. The author contends that the discipline of midwifery is undeveloped at present but that the time is right for explicit discussion about what defines the discipline of midwifery.

Certification↗
PubMedDate not supplied

Curriculum trends in nurse-midwifery education. Views of program directors.

The purpose of this study was to determine the extent to which nurse-midwifery education programs are addressing the practice competencies that have been recommended by the Pew Health Professions Commission and others as essential for effective practice in the 21st century. This study was part of a larger survey of eleven health professions education programs. The 56 nurse-midwifery program directors whose names and addresses were provided by the American College of Nurse-Midwives were surveyed by mailed questionnaire, with a response rate of 59% (n = 33). The study sought to identify current and ideal emphasis placed on 33 broad topics, most important curriculum topics, and barriers to curriculum change as perceived by respondents. Findings revealed that nurse-midwifery program directors would like to see greater emphasis placed on every topic except one (tertiary/quaternary care). Desired increases ranged from .04 to 1.36. The overall mean rating for all topics was 3.51 for current emphasis (5-point scale) and 4.18 for ideal emphasis, both of which were higher than any other survey group. The greatest desired increases (> 1.00) were for "primary care," "managed care," "use of electronic information systems," and "business management of practice." Respondents identified "primary care," "health promotion/disease prevention," and "accountability for cost-effectiveness and patient outcomes" as the most important topics. The top three barriers to curriculum change were identified as "already crowded curriculum," "inadequate funding," and "limited availability of clinical learning sites," the last being statistically significant compared with other survey groups. Findings indicate that nurse-midwifery program directors perceived that they are adequately addressing most of the curriculum topics, while continuing to focus on the need for curriculum change as the health care environment changes.

Curriculum↗
PubMedDate not supplied

The use of complementary therapies in midwifery in the UK.

Midwives in the United Kingdom (UK) are autonomous, independent practitioners and the lead professionals in normal pregnancy and childbirth. Changing Childbirth, a government report, gave a recommendation that women should have continuity of care. Midwives have recognized the ability to implement complementary therapies in health care and have succeeded in forming the Complementary Therapies in Maternity Care National Forum (May 1988). The National Health Service Confederation identified midwives as the highest users of complementary therapies in the health care services. Midwives are in a position to incorporate complementary therapies into their practice in conjunction with the rules and guidelines promulgated by the UK Central Council for Nursing, Midwifery, and Health Visiting. Highlighting the Complementary Therapies in Maternity Care National Forum underscores the increased use of therapies by midwives in the UK. Documentation of complementary therapies used in midwifery practice has resulted in some evidence-based practice for reference. Caseload midwifery (the progressive approach of smaller teams of midwives, who are community-based) and education can play key roles in integrating complementary therapies into midwifery, providing women with more choice, and achieving greater client satisfaction from the childbirth experience. Success is also dependent on government commitment and involvement.

Complementary Therapies↗
PubMed2002

Addressing the barriers to midwifery--Australian midwives speaking out.

This research gives a voice to midwives in identifying the barriers and current problems in the organisation of maternity care in Australia. Using a critical feminist research approach, data was collected from a cross section of midwives nationally. Through standard qualitative research methods, themes were identified that enabled analysis of significant issues affecting the current status of midwifery. The system of maternity care was identified as being dominated by medicine, not evidence based and restricting of women's choices, with midwifery autonomy not recognised or supported. The invisibility of midwifery within the community was identified as a significant barrier which, in conjunction with the occupational imperialism of obstetrics, ensures ongoing strategic control of maternity services and a denial of the rights of consumers to access midwifery care.

Attitude of Health Personnel↗
PubMed2003

Nurturing the future of midwifery through mentoring.

Mentoring has become a popular approach for providing support in developing knowledge and practice across a variety of disciplines. Midwives often provide mentoring for midwifery mentees and newly graduated midwives without formal recognition or predetermined outcomes. Little literature exists within midwifery practice outlining how its use may be of value. This paper presents literature around the topic of mentoring, discussing possible benefits and suggesting ways in which mentoring may be utilised within midwifery to promote personal and professional development. Finally, it presents some of the limited examples of mentoring emerging from the midwifery literature.

Attitude of Health Personnel↗