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PubMedDate not supplied

Nurse-midwives' use of and attitudes toward epidural analgesia.

The use of epidural analgesia for labor and birth has risen dramatically in the United States, and nurse-midwives are caring for increasingly greater numbers of women who deliver under epidural analgesia. The authors of this investigation undertook a national survey by mailed questionnaire to explore the use of and attitudes toward epidural analgesia among certified nurse-midwives. A stratified, random sample of one-half of American College of Nurse-Midwives members was polled, and 1,605 (60.7%) questionnaires were returned. A slight majority of certified nurse-midwives (CNMs) (53%) reported a negative attitude toward the increased use of epidurals in CNM practice, and 64% reported concern over the increased number of their clients who desire epidural anesthesia. CNMs were almost evenly split on the issue of whether nurse-midwives should discourage the use of epidurals in nurse-midwifery practice. For those CNMs with epidural analgesia available at their primary birth site (87% of the sample), the mean CNM epidural rate was 26%. Various reasons for the increased use of epidural analgesia in CNM practice are explored, as are the possible implications of such increased use in contemporary nurse-midwifery practice. Suggestions for further research are offered.

Adult↗
PubMed1997

Community midwives' and general practitioners' perspectives, of antenatal care in the community.

OBJECTIVE: to ascertain who was providing antenatal care in the community in a defined geographical area in the north of England, and whether the care could achieve the government objectives presented in Changing Childbirth (DoH 1993). DESIGN: a questionnaire was used to obtain demographic information and semi-structured interviews were held with care providers in order to assess the perspective of those providing care. PARTICIPANTS: a purposive sample of nine community midwives and six general practitioners (GPs). FINDINGS: the midwife was the professional undertaking most of the antenatal care although in most instances there was a GP available on site if required. GPs saw the midwife as the main provider of care with themselves as 'back up'. Conflict over responsibility for care was an issue in some instances. Whilst changes in antenatal care provision had been, or were about to be made, only one midwife expressed a clear positive feeling towards midwife-led care. Giving women the opportunity for choice provoked an overwhelming feeling of helplessness for midwives. Midwives and GPs believed their education adequately prepared them to provide antenatal care in the community, however, GPs did not attend regular updating sessions. IMPLICATIONS FOR PRACTICE: whilst it was recognised that midwives are taking increasing responsibility for antenatal care, GPs still believe that overall responsibility lies with them; therefore, there is a need to clarify roles. The majority of midwives expressed reservations about midwife-led care.

Adult↗
PubMed1997

Care of the perineum in the second stage of labour: a study of views and practices of Australian midwives.

OBJECTIVES: to seek the views of midwives on the practices related to the perineum in the second stage of labour; to identify predictors of their practices and to identify their actual practices in the second stage of labour, prior to a randomised trial of second stage perineal massage. PARTICIPANTS AND SETTING: independent midwives in South Australia and 194 midwives working in the delivery suites and birth centres of seven public hospitals in four states of Australia. DESIGN: midwives were surveyed using a questionnaire which sought their views on, and practices relating to, second stage perineal massage, delivery of the head and reasons for cutting an episiotomy. FINDINGS: one third of the respondents 'never' practised perineal massage in the second stage of labour, 43% were 'undecided' as to its value and 19% disagreed with the practice. Over half agreed that its use should be decided by the woman and her partner. When invited to select the five statements they most agreed with, and the five they most disagreed with, out of a possible 24, equal numbers (26%) were for and against the statement referring to such massage as helping to stretch the perineum and prevent tearing. More than half (55%) disagreed with the statement which predicted they would find the practice distasteful, while only 1.6% agreed with this statement. During delivery of the head, 71% of respondents attempted some form of flexion. There was 100% agreement that fetal distress almost always or frequently was an indication for cutting an episiotomy. CONCLUSIONS: there is little evidence from randomised trials to support many of the second stage practices, and further research will clarify those which are most effective. This sample of midwives demonstrated considerable variation in their views on, and practices in, the second stage of labour. Although one-fifth disagreed with the practice of second stage perineal massage, and 40% agreed that the midwife should decide, more than half (57%) believed it was a matter of choice for the woman and her partner. All were supportive of episiotomy use for fetal distress.

Female↗
PubMed1998

Differences in midwives' approaches to pain relief in labour.

OBJECTIVE: To examine the influence of midwives' approaches on the care given to women for pain relief during labour. DESIGN: Non-participant observation was used to collect data on midwives' behaviours during interactions with women in labour. SETTING: A large teaching hospital in Northern Ireland. PARTICIPANTS: Observations focused on interactions that were related to pain relief and involved 11 midwives caring for 15 women throughout the first stage of labour. KEY FINDINGS: Midwives' approaches to pain relief differed; at one extreme the midwife acted as 'a cold professional' whilst at the other extreme she was observed to be 'a disorganised carer'. In the middle of these two extremes was the 'warm professional'; her approach had a positive influence on the women's experience of labour pain. IMPLICATION FOR RESEARCH: Further research is needed to develop a profile of the factors that 'make' for a warm professional. The information gained could be used to teach midwives the skills of being 'a warm professional', in particular, the value of effective communication for sensitive care such as pain relief in labour.

Adult↗
PubMed1999

Midwives' lived experiences of being supportive to prospective mothers/parents during pregnancy.

OBJECTIVE: To elucidate midwives' narrated experiences of being supportive to prospective mothers or parents during pregnancy. DESIGN: Phenomenological hermeneutic analysis of transcribed text from seven tape-recorded interviews. SETTING: Midwifery clinics in five health centres in the context of Swedish primary health care. PARTICIPANTS: Seven midwives working in antenatal care. FINDINGS: The interpretation of the text showed that through perception and intuition the midwives seemed to become aware that some women needed increased support. The situations of these prospective mothers were often characterised by difficult social problems or fears. The prospective fathers were mostly absent in the narratives. The midwives acted on both a personal and a professional level with ethical perspectives in mind, when they were advocating their clients' rights to receive proper care. The comprehensive understanding of the interpretation revealed that the midwife sometimes perceived herself as being metaphorically 'The Good Mother'. KEY CONCLUSIONS: Having the role of 'The Good Mother' could be understood as a way for the midwife to establish a fruitful relationship with prospective mothers/parents. IMPLICATIONS FOR PRACTICE: The findings provide a basis for reflection on the mothering and supportive function of midwives when providing antenatal care.

Adult↗
PubMed2000

They were different and few: an Australian study of midwives' attitudes to research and computerised research findings.

This study sought to determine factors influencing the utilisation of research findings by Australian midwives before and after exposure to an on-line research database within their practice setting. The setting was a large maternity hospital in South Australia and data were collected via pre and post intervention questionnaires. 14 midwives from the Delivery Suite and Birth Centre of this hospital participated in the study. Midwives showed an increased receptivity to the concept of computerised research findings after exposure to the database. They rated research as highly important to providing quality midwifery care and for the midwifery profession, and saw midwives as the key players in maternity care research. These findings are not in keeping with previous research--largely accounted for, we believe, by the particular, and small number of, midwives who volunteered to participate in the study (24% of those invited).

Adult↗
PubMed1999

To see or not to see? Midwives' perceptions of reduced antenatal attendances for 'low-risk' women.

OBJECTIVE: To explore the views of midwives towards traditional and flexible schedules of antenatal attendance for women at low risk. DESIGN: A qualitative approach using focus groups. SETTING: Three NHS Trusts providing maternity care in and around Bristol. SAMPLE: 14 midwives who had provided antenatal care to women participating in the Bristol Antenatal Care Study. FINDINGS: Midwives generally expressed support for a move away from the traditional schedule of antenatal attendances, suggesting that this represented a move towards the acceptance of pregnancy as a normal life event. They recognised that some women would prefer flexible care and the possibility of a reduction in the number of antenatal attendances. However, they suggested that some women would require additional information in order to feel confident in these circumstances. The midwives also recognised that both they and pregnant women have reservations about reducing contact during the antenatal period. Central to these reservations is a concern that women's psychosocial as well as physical needs may go unmet if antenatal contact is reduced. IMPLICATIONS FOR PRACTICE: Although in principle supporting a move away from the traditional schedule of antenatal attendances, the reservations felt by midwives towards a reduction in antenatal attendances are reflected in their practice. These concerns currently impede any radical move away from the traditional schedule of antenatal check-ups and will need to be addressed by midwifery managers prior to the implementation of a more flexible schedule of antenatal attendances, if any such change is to be sustainable.

Appointments and Schedules↗
PubMed1999

Aspects of the preparation of student midwives for autonomous practice.

OBJECTIVE: To investigate aspects of the preparation of student midwives for autonomous practice, within the context of the relationship between the student and her supervising midwife. DESIGN: A qualitative research design was used and responses from in-depth interviews were analysed utilising the principles of grounded theory. SETTING: Interactions between the student and supervising midwife in the clinical setting were used to explore preparation for autonomous practice including issues in socialisation, role of the midwife, variations in placements and practice. SUBJECTS: Seven student midwives and their seven identified midwife 'supporters' and four midwives working on night duty. Initially purposeful in nature, the sample developed towards a theoretical sample. FINDINGS: Analysis revealed nine related categories common to this relationship presented within the themes of Recognition, Incorporation and Facilitation. KEY CONCLUSIONS: The findings suggest that students exhibited a fear of independent action through non-assertive behaviour, passive learning and subsequent compliance. Students were observing role conflict as the midwives in the hospital environment aimed to provide women-centred care whilst juggling with the restrictions on their practice, a situation which may be accepted or, at times, challenged by the student. IMPLICATIONS FOR PRACTICE: Midwives need to be aware of factors which influence their ability to be autonomous practitioners and how this relates to educational preparation in midwifery.

Education, Nursing, Graduate↗
PubMed1994

State practice environments and the supply of physician assistants, nurse practitioners, and certified nurse-midwives.

BACKGROUND: Most proposals to increase access to primary care in the United States emphasize increasing the proportion of generalist physicians. Another approach is to increase the number of physician assistants, nurse practitioners, and certified nurse-midwives. METHODS: We analyzed variations in the regulation of nurse practitioners, physician assistants, and certified nurse-midwives in all 50 states and the District of Columbia. Using a 100-point scoring system, we assigned numerical values to specific characteristics of the practice environment in each state for each group of practitioners, awarding a maximum of 20 points for legal status, 40 points for reimbursement for services, and 40 points for the authority to write prescriptions. We calculated coefficients for the correlation of summary measures of these values within states with estimates of the supply of practitioners per 100,000 population. RESULTS: There was wide variation among states in both practice-environment scores and practitioner-to-population ratios for all three groups of practitioners. We found positive correlations within states between the supply of physician assistants, nurse practitioners, and certified nurse-midwives and the practice-environment score for the state (Spearman rank-correlation coefficients, 0.63 [P < 0.001], 0.41 [P = 0.003], and 0.51 [P < 0.001], respectively). Positive associations were also found in the states between the supply of generalist physicians and the supply of physician assistants (r = 0.54, P < 0.001) and nurse practitioners (r = 0.35, P = 0.014). Nevertheless, in the 17 states with the greatest shortages of primary care physicians, favorable practice-environment scores were still associated with higher practitioner-to-population ratios for physician assistants (r = 0.68, P = 0.003), nurse practitioners (r = 0.54, P = 0.026), and certified nurse-midwives (r = 0.42, P = 0.09). CONCLUSIONS: State regulation of physician assistants, nurse practitioners, and certified nurse-midwives varies widely. Favorable practice environments are strongly associated with a larger supply of these practitioners.

Health Services Accessibility↗
PubMed2006

Mozambican midwives' views on barriers to quality perinatal care.

Our purpose in this study was to explore the midwives' perception of factors obstructing or facilitating their ability to provide quality perinatal care at a central labor ward in Maputo. In-depth interviews were undertaken with 16 midwives and were analyzed according to grounded theory technique. Barriers to provision of quality perinatal care were identified as follows: (i) the unsupportive environment, (ii) nonempowering and limited interaction with women in labor, (iii) a sense of professional inadequacy and inferiority, and (iv) nonappliance of best caring practices. A model based on the midwives' reflections on barriers to quality perinatal care and responses to these were developed. Actions aimed at overcoming the barriers were improvising and identifying areas in need of change. Identified evading actions were holding others accountable and yielding to dysfunction and structural control. In order to improve perinatal care, the midwives need to see themselves as change agents and not as victims of external and internal causal relationships over which they have no influence. It is moreover essential that the midwives chose actions aiming at overcoming barriers to quality perinatal care instead of choosing evading actions, which might jeopardize the health of the unborn and newborn infant. We suggest that local as well as national education programs need to correspond with existing reality, even if they provide knowledge that surpasses the present possibilities in practice. Quality of intrapartum and the immediate newborn care requires a supportive environment, however, which in the context of this study presented such serious obstacles that they need to be addressed on the national level. Structural and administrative changes are difficult to target as these depend on national organization of maternal health care (MHC) services and national health expenditures.

Adult↗
PubMed1992

Testing for HIV in the antenatal clinic: the views of midwives.

Self administered questionnaires were given to 34 midwives, who regularly counsel parturient women about the HIV antibody test, to investigate their attitudes to the test being offered in the antenatal clinic. Most of the midwives felt that testing should not be compulsory and that the test should be offered to all pregnant women who ask for it, not only those in recognized risk groups. Most also felt that women should be told the results of the test and that it should not be the midwives aim to increase the number of women having the test. Most felt that all midwives should counsel about the test but would like health advisers, GPs and obstetricians to be involved also. They also felt that they did not have sufficient knowledge in some areas to counsel particularly with regard to the practical and psychological implications of being HIV positive. This has implications in terms of the provision of adequate pre-test counselling for all pregnant women as an improvement in counselling services requires an allocation of finances, e.g. for training of midwives, which may be seen as unnecessary in areas of low seroprevalence. Further discussion and debate of these issues is required.

AIDS Serodiagnosis↗
PubMed1988

Use of a computer to take booking histories in a hospital antenatal clinic. Acceptability to midwives and patients and effects on the midwife-patient interaction.

An interactive computer system was used by midwives to acquire a full patient history at the first antenatal visit. The clinical efficacy of the system had been previously established. The present evaluation examined the effects of computer use on the interview process and on midwife-patient communications, and its acceptability to midwives and patients. Data included video recordings of 32 conventional interviews and of 63 interviews in which the computer was used, each with associated questionnaires assessing patients' reactions. Midwives' views were obtained through a structured discussion session. Computer use had no effects on patients' reactions to the interview, and midwives were enthusiastic. Detailed analysis of the video recordings using established quantitative techniques did not reveal any negative psychologic effects that would preclude the use of nurse-patient interactive computers. However, midwives were inclined to give less information to patients, especially when they were new to the computer, and to use more closed questions and leading questions. The findings have important implications for the future use of similar computer systems. These are presented in the form of guidelines for future systems design and implementation.

Adult↗
PubMed2004

Midwives' attitudes to and knowledge about a newly introduced foetal screening method.

A number of screening procedures are offered by midwives during pregnancy and the number is increasing rapidly. The measurement of nuchal translucency is a fairly new ultrasound method for antenatal screening, primarily for Down syndrome. The results give a better risk calculation than maternal age alone and can mean a decrease in the number of invasive procedures needed to identify this syndrome prenatally. The aim of this study was to gain insight into the midwives' point of view concerning the introduction of the method in two different hospitals. In one hospital it had been introduced as part of a research project while in the other it had been integrated as an offer in the antenatal care programme. A questionnaire was sent to the 80 midwives working in the antenatal clinics serving these two hospitals. A total of 79% of the questionnaires were answered. The results indicate that in both districts, the similarities are greater than the differences with regard to the midwives' education, knowledge and their own opinions of their ability to inform pregnant women about the method. Although most of the respondents were positive to it, a number of midwives felt that, in general, information about foetal diagnosis was a difficult part of their work, mentioning both ethical and practical aspects. This highlights the need for continuing education, standardized policy and an ongoing ethical debate.

Attitude of Health Personnel↗
PubMedDate not supplied

Integration of midwives into the Quebec health care system. L'Equipe d'Evaluation des Projets-Pilotes Sages-Femmes.

This paper reports on one aspect of the evaluation of the midwifery pilot projects in Quebec: the identification of the professional and organizational factors, as well as the mode of integrating midwives into the maternity care system, that would promote the best outcomes and the autonomy of midwives. The research strategy involved a multiple-case study, in which each midwifery pilot project represented a case. Based on a qualitative approach, the study employed various sources of data: individual interviews and focus groups with key informants, site observations and analyses of written documents. Results show that midwives were poorly integrated into the health care system during the evaluation. Four main reasons were identified: lack of knowledge about the practice of midwifery on the part of other health care providers; deficiencies in the legal and organizational structure of the pilot projects; competition over professional territories; and gaps between the midwives' and other providers' professional cultures. Recommendations are provided to facilitate the integration of midwives into the health care system.

Attitude of Health Personnel↗
PubMed2003

Birth outcomes: utility values that postnatal women, midwives and medical staff express.

OBJECTIVE: To determine if and to what extent postnatal women's preferences for birth outcomes differ from those of midwives and medical staff, and whether any variations in utility scores are associated with demographic variables. DESIGN: Cross sectional cohort study. SETTING: The Women's and Children's Hospital, Adelaide. POPULATION: A total of 180 participants which included 90 postnatal women, 59 midwives and 31 medical staff. METHODS: Preferences (utility scores) were measured by direct interviews using utility techniques: the visual analogue scale and the standard gamble. MAIN OUTCOMES MEASURES: Preferences (utility scores) for eight birth outcomes. RESULTS: Women assigned higher utility scores for the five birth outcomes of jaundice requiring phototherapy, admission to neonatal nursery, shoulder dystocia, nerve palsy and transient neurological symptoms than midwives, which suggested that women regarded these outcomes as less severe (P < 0.01). Utility scores for the women and medical staff were similar. The majority of postnatal women, midwives and medical staff preferred permanent neurological sequelae to perinatal death. Eighty-nine percent of postnatal women preferred permanent neurological sequelae to perinatal death compared with 71% of midwives (P < 0.01), and 68% of medical staff (P < 0.01). CONCLUSION: Utility values for important birth outcomes varied between women who had recently given birth and health professionals. Clinical practice should recognise and respect the preferences of women, with appropriate balance between their preferences, those of health professionals and the known benefits of care.

Adult↗
PubMedDate not supplied

[How Italian midwives contribute to breastfeeding promotion: a national experience of "cascade" training].

Social changes of the last century have increasingly transformed maternity and newborn care into a medical act and have greatly reduced the number of breastfeeding women. In Italy, the explicit aim of the Ministry of Health concerning mother and child health (Progetto-Obiettivo Materno-Infantile) is to bring this process back to a more natural activity. The prevalence of women who breastfed after the third month of life has been set as an indicator of the effectiveness of mother and child health services. However, the percentage of fully breastfeeding women at the fourth month of the newborn varies greatly among Italian regions, from 18 to 56%. As in many other Countries in the European Union, in Italy the initial education of the mother and child caregivers often lacks a specific formal training on breastfeeding promotion, as do academic midwife-training courses. In 2004 the Italian Federation of the Colleges of Midwives implemented a cascade training project in collaboration with the Istituto Superiore di Sanita, to train trainer-midwives who in turn would train midwives, either already working (Continuing Medical Education) or during their formal academic education. Contents, techniques and methods have been the same as those adopted for the World Health Organization's 40+40 hours course "Breastfeeding: counselling: a training course" for trainers. A total of 39 training coordinators and teachers of academic midwifery courses have participated, in two separate groups. In their turn, the trainers have trained 74 working midwives, from almost every Italian region. Throughout the training program, the trainers were supervised by two tutors who assessed their learning-teaching performance and provided a final certificate. The program allowed the trainers and the other participants to reach a standard level of knowledge on the issue, regardless of their initial knowledge. Moreover, it helped to build and share a common language and attitude on the protection, promotion and support of breastfeeding. In the original course the final certification was not included; it was introduced in the present course to ensure high qualitative levels of teaching and to let the training groups better integrate with already existing training groups within the Local Health Authorities. To translate the training experience into an effective improvement of health objectives, as much as possible caregivers should be exposed to this kind of courses, from the beginning of their training. The WHO/UNICEF model proved to be a good basic model even for academic education, maybe with some additional elements aimed at the specific professionals. At present about half of the courses for midwives throughout Italy employ at least one teacher who is also in charge of the WHO/UNICEF course.

Breast Feeding↗
PubMed1997

The importance of traditional midwives in the delivery of health care in the Republic of South Africa.

From the data collected during qualitative research, in 1995, to determine the possibility of collaboration with traditional healers a number of themes were highlighted. The different types of traditional healers, the way in which they operate as well as the importance of collaboration was identified. In this article the contributions of traditional midwives in rendering health care, especially in the rural areas in the Northern Cape and the Free State will be discussed. The data was collected during interviews and observations, done over a period of seven months. When the respondents could not speak English or Afrikaans an interpreter was used. Interviews were also conducted with health care staff and patients. The contributions of the traditional midwives are of utmost importance and should not be discouraged. With the necessary training the traditional midwives could help in providing an effective and efficient health service to pregnant women. Traditional midwives have been an integral part of African medicine for centuries. This is not only because African people still love and fear the spirits, but also because a great number of the South African population do not have access to existing health services. This is especially so in the rural areas and informal settlements. According to the Reconstruction and Development Programme (RDP) of the Government of National Unity it is important that everyone who could make a contribution towards the provision of health care should be involved. This view is supported in the ANC Health Plan and a Policy Document for the Development of a District Health System for South Africa, where it is stated that traditional healers (traditional midwives are included in this category) could play a role in the delivery of health care. The research on which the article is based was done to determine the role traditional healers could play in collaboration with primary health care services. In this article only the role of the traditional midwife will be discussed.

Delivery of Health Care↗
PubMed1984

Malay midwives and witches.

This paper attempts to analyse professional rivalry and dissonance amongst traditional Malay midwives (bidan kampung) in the Northwest areas of Peninsular Malaysia. It elucidates how techniques of symbolic and ritual communication are carefully monitored by these female specialists, to develop regular clientele and professional credibility over time. However, since an integral element of Malay midwifery is protection from and mastery over mystical forces in nature and evil spirits harboured by witches, a midwife is also an exorcist with skills rather similar to the Malay bomoh (traditional medical practitioner, usually male) except that her range of knowledge of witchcraft is limited to diagnostic and curative rituals of spirit-possession, in infants and children, young unmarried women and pregnant mothers. Within a restricted population area, professional rivalries and competition amongst midwives regularly surface in oblique attacks of witchcraft accusations where the accused strives to maintain her credibility while her accuser gradually wins over her clientele. Significantly, codes of professionalism in traditional Malay midwifery are not only determined by skill and experience, but also religiousness (faith in Islam), benevolence, virtue, diligence and a sense of equality and fair-play in the practice of the trade. These qualities are seemingly lacking in witches who are conceived to be anti-Islamic, uncompromising, manevolent and destructive. Thus, government midwives who threaten the popularity of traditional midwives by being particularly active in their work or supervising and controlling midwives in an authoritarian way, are also labelled as witches. Generally, while midwifery and witchcraft reflect two forms of knowledge that are structurally opposed, in ideology and morality, they exist within the same sphere of ritual and symbolic communication where the practitioners aided by their clients, shift from one state of dissonance to another in an attempt to regulate behaviour.

Humans↗