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PubMed2005

Some lessons from Swedish midwives' experiences of approaching women smokers in antenatal care.

OBJECTIVE: to describe the qualitatively different ways in which midwives make sense of how to approach women smokers. DESIGN, SETTING AND PARTICIPANTS: a more person-centred national project 'Smoke-free pregnancy' has been in progress in Sweden since 1992. Using a phenomenographic approach, 24 midwives who have been regularly working in antenatal care were interviewed about addressing smoking during pregnancy. FINDINGS: four different story types of how the midwives made sense of their experiences in addressing smoking in pregnancy were identified: 'avoiding', 'informing', 'friend-making', 'co-operating'. KEY CONCLUSION: the midwives' story types about how they approached women who smoke illustrated the difficulties of changing from being an expert who gives information and advice to being an expert on how to enable a woman in finding out why she smoked and how to stop smoking. IMPLICATIONS FOR PRACTICE: health education about smoking that is built on co-operation and dialogue was seen by the midwives as a productive way of working. The starting point should be the lay perspective of a woman, which means that her thoughts about smoking cessation are given the space to grow while she talks.

Adult↗
PubMed2006

The importance of reciprocity in relationships between community-based midwives and mothers.

OBJECTIVE: to explore the emotion work experiences of community-based midwives, focusing on their relationships with clients. DESIGN: a qualitative study using an ethnographic approach. Data were collected via observation, interview and focus groups. SETTING: a National Health Service (NHS) Trust in South Wales, UK. PARTICIPANTS: a purposive sample of 19 NHS community-based midwives, working in different teams and with differing lengths of clinical experience. FINDINGS: relationships between midwives and women varied considerably, and could be the source of emotion work for midwives. A model of midwife-woman relationships is proposed, based on the concept of reciprocity. Four key situations are identified: balanced exchanges, rejected exchanges, reversed exchanges and unsustainable exchanges. Balanced exchanges occur when there is 'give and take' on both sides; these are emotionally rewarding for the midwife. The other exchanges are out of balance, and require emotion work by the midwife. KEY CONCLUSIONS: the concept of reciprocity is a useful analytical tool that enhances understanding of midwife-woman relationships and the emotion work that these may generate. Increased understanding of these issues is important, given the current national and international policy recommendations for health-care professionals to work in partnership with clients. IMPLICATIONS FOR PRACTICE: the midwife-woman relationship and the factors that affect it need to be explicitly addressed within educational settings, in order to further develop interpersonal and communication skills. In turn, this should enhance the emotional well-being of midwives and the quality of care that women receive. Additional research is needed to further develop and refine the model.

Adult↗
PubMed2006

A description of Swedish midwives' reflections on their experience of caring for teenage girls during pregnancy and childbirth.

OBJECTIVE: to describe Swedish midwives' reflections on their experiences of caring for teenage girls during pregnancy and childbirth. DESIGN: a hermeneutical approach was used, with focus-group discussions as the method of data collection. SETTING: three focus-group discussions were conducted in a county comprising urban, suburban and rural districts in south-western Sweden. PARTICIPANTS: a voluntary sample of 24 midwives, aged 32-61 years, who were caring for women in different birth settings, participated in 2004. FINDINGS: two main themes, with three sub-themes each, were generated by the midwives: (1) the teenage mother, as 'teenagers who are proud of becoming mothers', 'teenagers who are unprepared for becoming mothers' and 'teenagers with an immigrant background', and (2) 'the midwives' wish to care for the teenage mother', as 'taking the teenage mother seriously', 'being an important person for the teenage mother', and 'being a help for the teenage mother'. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the findings provide some understanding of the unique characteristics of caring for teenage mothers. For the midwives, the most important aspects of caring for the teenage mother included taking the teenage mother seriously, allowing the midwife herself to become an important person for the teenage mother, and being a help to the mother. This help requires the midwife to balance the different needs of each teenage mother.

Adolescent↗
PubMedDate not supplied

State regulation of midwives: issues and options.

In the United States, state governments play a central role in determining the extent to which midwives can provide care to women and babies. State laws and regulations establish midwives' scope of practice, set licensure requirements, and frequently determine their ability to get paid and obtain access to health care facilities. For certified nurse-midwives (CNMs), state regulation has evolved from a haphazard patchwork of highly variable regulatory models into a fairly uniform set of rules and requirements from one state to the next. For direct entry midwives (DEMs), there is much less uniformity, with some states outlawing practice by any midwife who is not a CNM, whereas other states have established rigorous standards and requirements for the licensure of DEMs. This article provides a broad overview of these state regulatory variables for both CNMs and DEMs, and explores issues and options that both state regulators and midwives should consider when developing or amending state laws and regulations governing their practice. In particular, the role of the state in regulating the practice of the certified midwife (CM) is examined in the context of existing regulatory frameworks for CNMs and DEMs.

Certification↗
PubMed2000

Evaluation of an adapted model of the World Health Organization partograph used by Angolan midwives in a peripheral delivery unit.

OBJECTIVE: To study the impact of an educational intervention of midwives' use of the Angolan model of the World Health Organization's (WHO) partograph. SETTING: A peripheral delivery unit with approximately 1500 deliveries per year, run by eleven midwives in Luanda, Angola. DESIGN: The quasi-experimental, One-Group Pre-test-Post-test design was used in this study. Fifty partographs plotted with an initial dilatation < 8 cm were randomly selected from the first period of six month to form sample I, and another fifty from the second six-months period to form sample II. INTERVENTION: In-service education (theory and practice) performed by a team of midwives and an obstetrician. MEASUREMENTS AND FINDINGS: When comparing sample II with sample I, statistically significant improvements were found in seven of 10 measured variables. This indicates a positive effect of the educational intervention on a proper use of the partograph. Due to the small sample size, however, this study cannot evaluate action taken in relation to prolonged labour. IMPLICATIONS FOR PRACTICE: The in-service educational programme may be of use when introducing the WHO partograph in similar settings, and the findings of this study may indicate which parts of the programme need more emphasis. CONCLUSIONS: The midwives improved in general their documentation of the partograph. However, they tended to exceed established criteria for responsibilities at the peripheral delivery unit, a fact supported by an increased number of missed transfers. The study did not, however, answer the question why the midwives acted as they did in the referred cases.

Adolescent↗
PubMed2001

Swedish midwives' care of women who are at high obstetric risk or who have obstetric complications.

OBJECTIVE: to describe how midwives experience the care of women who are at high obstetric risk or who have an obstetric complication during pregnancy, childbirth and early parenthood. DESIGN: a qualitative approach using a phenomenological method. PARTICIPANTS: 10 Swedish midwives, recognised as highly skilled clinicians with at least five years of clinical experience in the studied context, from four different hospitals. FINDINGS: the essence of midwifery when caring for women at high obstetric risk or with a manifested complication was defined as 'a struggle for the natural process'. Women's transition, physically as well as emotionally, during pregnancy, childbirth and early parenthood, was described as a genuinely natural process. The midwives' struggle consisted of encouraging and preserving this process within each woman. It was based on embodied knowledge and included a balancing between the medical and natural perspectives. Prerequisites, and therefore part of the struggle for the natural process, were sensitivity to the spontaneous, mutual interaction with the woman and enduring presence. KEY CONCLUSIONS AND IMPLICATION FOR PRACTICE: the midwives' responsibility is to promote the natural process during pregnancy, childbirth and puerperium within every woman at high obstetric risk or with obstetric complications. The findings could serve as a basis for reflection on the professional role of midwives, and on the organisation of modern maternity care.

Adaptation, Psychological↗
PubMed2001

Tanzanian midwives' views on becoming a good resource and support person for postpartum women.

OBJECTIVES: to explore midwives' views in relation to the provision of systematic postpartum care. DESIGN: qualitative focus group study using grounded theory approach. SETTING: Dar es Salaam, Tanzania. PARTICIPANTS: 49 nurse/midwives in five focus group discussions, each having 9-11 participants. FINDINGS: eight categories were identified: 'reflecting', 'getting ready', 'defining abilities', 'networking', 'integrating', 'balancing', 'dealing with reality', and 'caring'. The identified core category that integrated and encapsulated all other categories was 'becoming a good resource and support person for postpartum woman'. The mediating factors found to have potential for influencing how a midwife can function in order to become a good resource and support person were: a) the structure and approach in maternal and child health services, b) midwives' knowledge, attitude and skills, c) informal sources of knowledge to parents, and d) cultural beliefs and practices. CONCLUSION: the findings of this study provide an understanding of the way midwives feel and think about the provision of postpartum care. The findings demonstrate that midwives need support in their efforts to achieve what they consider necessary for postpartum care. Interventions for educating and supporting midwives should be targeted at enabling them to deal with all the factors that influence their role and help them to identify and use better strategies to provide quality care.

Anecdotes as Topic↗
PubMed2002

Developing a theoretical framework on postpartum care from Tanzanian midwives' views on their role.

OBJECTIVES: to describe a theoretical framework developed from the views of midwives in relation to provision of systematic postpartum care. DESIGN: qualitative focus group study using grounded theory approach. SETTING: Dar es Salaam, Tanzania. PARTICIPANTS: 49 nurse-midwives in five focus group discussions each having 9-11 participants. FINDINGS: the components of the Basic Social Process of 'Becoming a good resource and support person for the postpartum woman' consisted of 'reflection' as an entry point into the process. Integration, networking, balancing, and dealing with reality, emerged as categories related to process activities. The category of 'defining abilities' required that midwives become aware of their competency and their limitations in reflection and all process activities, so that improvement can be part of 'getting ready', a category that describes what needs to be done at individual and health system level to prepare for systematic postpartum care programmes. The 'caring' category was linked to an outcome of the process 'doing things in the right way', which means providing quality postpartum care. The conditional matrix shows the midwife as an individual affected by several micro and macro conditions. CONCLUSIONS: the proposed theoretical framework can be used in understanding the dynamics of work situations and in assisting midwives to achieve the goal of being good resource and support persons for postpartum women. Interventions for midwives should focus on the major components of the framework but also on the concepts that relate the proposed framework to other central concepts in midwifery and nursing, issues in the theory-practice gap, empowerment, political awareness, involvement in policy making, decision making and dealing with job stress.

Attitude of Health Personnel↗
PubMed1998

Knowledge, attitude, and practices related to hepatitis B virus infection among Nigerian obstetricians and midwives.

Obstetricians and midwives are exposed to the blood, vaginal secretions and amniotic fluid of their patients during vaginal examinations, deliveries, intracavity procedures and resuscitation of the newborn. They are therefore at risk of hepatitis B virus (HBV) infection that is endemic in developing countries. We studied the knowledge, attitude, and practices of obstetricians and midwives in four teaching hospitals in Southwestern Nigeria with respect to HBV infection. A self-administered questionnaire was used to elicit information about their demographic characteristics, knowledge about, and immunisation against HBV and the use of barrier methods. There were 83 respondents with a mean age of 34.9 years, 45 were midwives while 38 were obstetricians. The former had practised for a range of 2-26 years while the latter had practised for 1-16 years. In a test of knowledge about HBV infection, obstetricians had a mean score of 2.4 while midwives scored 1.8 marks out of five. Only 18.1% had received HBV immunisation and 8.4% always screen their patients for HBV antigens; 33.7% always use barrier methods with the commonest reason for non-use being non-availability. The difference in knowledge between obstetricians and midwives was statistically significant. In conclusion, we make recommendations about reducing the risk of occupationally acquired HBV infection in the labour ward.

Journal Article↗
PubMed2001

Making midwives: postmodern conditions and midwifery training in Saint Lucia.

Drawing on material from fieldwork conducted on the island of Saint Lucia, I examine how Saint Lucian nurse-midwives and student midwives negotiate multiple ways of understanding and evaluating their practices and roles in light of contradictory and powerful cultural, historical, and political forces. I argue that, although Saint Lucian nurse-midwives may not qualify as "postmodern" according to the criteria proposed by Davis-Floyd and Davis (1996), they are nonetheless struggling with postmodern conditions as they negotiate between competing healing ideologies. I illustrate the significance of these negotiations through analyzing: (1) the ways nurse-midwives understand and articulate the healing ideologies at play in Saint Lucia, (2) historical and ideological aspects of the Saint Lucian nurse-midwifery training program, and (3) a classroom discussion during which student reported on "bush-midwives."

Attitude of Health Personnel↗
PubMed1997

Contamination incidents among doctors and midwives: reasons for non-reporting and knowledge of risks.

A 6-month retrospective self-administered questionnaire study of 482 doctors and 380 midwives in two NHS Trusts was undertaken. The response rate was 384 (80%) and 293 (77%) respectively. The study revealed that only nine per cent of doctors and 46% of midwives had reported the contamination incidents they had received. The doctors' main reason for non-reporting was 'too time consuming' and midwives' was 'did not consider anything could be done', although their awareness of the active management of contamination incidents by occupational health departments was good. Seventy-seven per cent of doctors and 69% of midwives underestimated the risk of contracting hepatitis B virus from a needlestick injury, whilst 52% of doctors and 36% of midwives underestimated the risks of acquiring infection with HIV (human immunodeficiency virus) infection following such an injury. Strategies for improving the knowledge of the potential risks of contamination incidents and methods for facilitating ease of reporting are discussed.

Attitude of Health Personnel↗
PubMed1992

The role of the village midwives in antenatal care services in the Sudan.

A study was conducted to assess the obstetric care coverage provided by the Sudanese village midwives. Mothers and village midwives, from four villages were interviewed using structured questionnaires. A total of 130 mothers who had delivered within 6 months were included in the study. Seventy per cent of these mothers contacted the village midwives at least once during their pregnancy. The average attendance was 3.8 antenatal contacts per mother. Seventy-one per cent of those who contacted the village midwives did so during the first half of pregnancy. Half of these mothers were seen in the village midwife's own home and only 20 per cent were in the mothers' homes. The village midwife attended 76 per cent of the deliveries, 11 per cent were attended by the traditional birth attendants, and the remainder delivered in hospital. The village midwives demonstrated reasonable standard of knowledge and competence in various aspects of antenatal care, history taking, examination, and selection of cases for referral. They lack adequate support and supervision, and supplies of drugs such as iron, folic acid, and chloroquine tablets.

Adolescent↗
PubMed1996

Swedish midwives' awareness of, attitudes to and use of selected research findings.

Members of a county division of the Midwives' Association of Sweden were surveyed to examine their awareness of, attitudes to and use of selected research findings. A total of 14 findings from research within the midwifery field were identified from midwives' dissertations and the journal Jordemodern using the criterion of physical availability. Questionnaires were mailed according to the membership list (n = 146). The response rate was 74% (n = 118). The results demonstrated that 75% of the midwives were aware of research findings, 65% were convinced of their usefulness and 63% used findings at least sometimes. According to the stages of Rogers' innovation-decision model the midwives were in the 'persuasion' stage, which is consistent with the result in Brett's 1987 study. The results indicate that research findings are used when midwives believe that the findings provide good care for mothers and babies. Even though the midwife in Sweden is considered to be an independent practitioner she is a member of a limiting social system. With regard to the interests influencing the health care system there is a need to examine the innovation-decision process from an organizational perspective to effectively improve the quality of care.

Chi-Square Distribution↗
PubMed2004

The impact of a microfinance program on client perceptions of the quality of care provided by private sector midwives in Uganda.

OBJECTIVE: To assess the impact of a microfinance program that provided business skills training and revolving loans to private sector midwives on perceived quality of services and client loyalty. STUDY DESIGN: A quasi-experimental study with a pretest, posttest design was used to evaluate the impact of the intervention. Exit interviews were conducted at 15 clinics that received the intervention and 7 clinics that did not. Baseline exit interviews were conducted between November and December 2000. Five days of business skills training were provided to midwives, and loans (averaging $454) were given during January and February 2001. A follow-up clinic visit was made to assess whether midwives were implementing what was emphasized during the training. The loans were to be repaid with interest within 6 to 12 months, at an interest rate that is standard within the local commercial market. For those who repaid the first set of loans (11 clinics), a second set of loans (averaging $742) was provided after June 2001. Follow-up exit interviews were conducted at the same clinics between February and March 2002. We assessed the effect of the intervention at both clinic and client levels. T-tests, the analysis of variance, and multivariate logistic regression analysis were conducted. PRINCIPAL FINDINGS: These findings should be interpreted cautiously since secular trends were observed during the study period. The intervention was associated with improvement in clients' perceptions of the quality of care received at intervention clinics. The intervention was also associated with a higher level of client loyalty. CONCLUSIONS: The enthusiastic response of midwives and the high loan repayment rate indicate that midwives were very receptive to the microfinance program. Overall, these findings suggest that microfinance may have an important role in strengthening private sector health services by increasing private providers' business skills and clients' satisfaction with services.

Female↗
PubMed2004

Injury prevention training: a cluster randomised controlled trial assessing its effect on the knowledge, attitudes, and practices of midwives and health visitors.

OBJECTIVE: To evaluate the effectiveness of injury prevention training. DESIGN: Cluster randomised controlled trial. SETTING: Primary care facilities in the East Midlands area of the United Kingdom. SUBJECTS: Midwives and health visitors. INTERVENTION: Evidence based training session on the risks associated with baby walkers. MAIN OUTCOME MEASURES: The primary outcome measures were knowledge of baby walker use and walker related injury, attitudes towards walkers and towards walker education, and practices relating to walker health education. RESULTS: Trained midwives and health visitors had greater knowledge of the risks associated with baby walkers than untrained midwives and health visitors (difference between the means 0.22; 95% confidence interval (CI) 0.12 to 0.33). Trained health visitors had more negative attitudes to baby walkers (difference between the means 0.35; 95% CI 0.10 to 0.59) and more positive attitudes towards baby walker health education (difference between the means 0.31; 95% CI 0.00 to 0.62) than untrained health visitors. Midwives who had been trained were more likely to discuss baby walkers in the antenatal period than those who were not trained (odds ratio 9.92; 95% CI 2.02 to 48.83). CONCLUSIONS: Injury prevention training was associated with increased knowledge, more negative attitudes towards walkers, and more positive attitudes towards walker education. Trained midwives were more likely to give advice antenatally. Training did not impact on other practices. Larger trials are required to assess the impact of training on parental safety behaviours, the adoption of safety practices, and injury reduction.

Attitude of Health Personnel↗
PubMed2006

Breastfeeding support for adolescent mothers: similarities and differences in the approach of midwives and qualified breastfeeding supporters.

BACKGROUND: The protection, promotion and support of breastfeeding are now major public health priorities. It is well established that skilled support, voluntary or professional, proactively offered to women who want to breastfeed, can increase the initiation and/or duration of breastfeeding. Low levels of breastfeeding uptake and continuation amongst adolescent mothers in industrialised countries suggest that this is a group that is in particular need of breastfeeding support. Using qualitative methods, the present study aimed to investigate the similarities and differences in the approaches of midwives and qualified breastfeeding supporters (the Breastfeeding Network (BfN)) in supporting breastfeeding adolescent mothers. METHODS: The study was conducted in the North West of England between September 2001 and October 2002. The supportive approaches of 12 midwives and 12 BfN supporters were evaluated using vignettes, short descriptions of an event designed to obtain specific information from participants about their knowledge, perceptions and attitudes to a particular situation. Responses to vignettes were analysed using thematic networks analysis, involving the extraction of basic themes by analysing each script line by line. The basic themes were then grouped to form organising themes and finally central global themes. Discussion and consensus was reached related to the systematic development of the three levels of theme. RESULTS: Five components of support were identified: emotional, esteem, instrumental, informational and network support. Whilst the supportive approaches of both groups incorporated elements of each of the five components of support, BfN supporters placed greater emphasis upon providing emotional and esteem support and highlighted the need to elicit the mothers' existing knowledge, checking understanding through use of open questions and utilising more tentative language. Midwives were more directive and gave more examples of closed questions. These differences could reflect the considerable emphasis upon person-centred approaches within the BfN curriculum and, in the case of midwives, the bureaucratic and institutional constraints upon them making it difficult, if not impossible, to take time and touch base with women. CONCLUSION: Follow up ethnographic work is required to assess the differences in the supportive approaches of BfN supporters and midwives in the practice areas. Such research, which specifically focuses upon how the different approaches are received and experienced by parents, is required before meaningful policy and practice recommendations can be made.

Journal Article↗
PubMed2001

Midwives and HIV antibody testing: identifying the key factors for achieving the targets.

A questionnaire study was designed to assess whether differences in knowledge and attitudes to HIV infection existed between midwives working in areas of higher and lower HIV prevalence, and the extent to which this influenced the uptake of HIV antibody testing by their clients. The response rate was 75% (219/292). Midwives in an area of a higher HIV prevalence had significantly greater experience with HIV-positive mothers, were more confident with HIV-related issues and were less judgemental in their attitudes than midwives in an area of lower HIV prevalence. However, midwives who had been offering HIV testing for more than 2 years were significantly less likely to achieve an HIV antibody test uptake rate of more than 75% than those who had been offering testing for less than 2 years, 35% (95% confidence interval [CI]: 22.2-48.6%) vs 67% (95% CI: 56.3-76.0%), respectively. This demonstrates the need for regular updating of midwives about HIV antibody testing.

Female↗
PubMed2003

The quality of routine examinations of the newborn performed by midwives and SHOs; an evaluation using video recordings.

OBJECTIVE: To evaluate the quality of the routine examination of the newborn as carried out by senior house officers (SHOs) and midwives. DESIGN: Randomised controlled trial set in a district general hospital in Southeast England. Eligible babies were randomised to a midwife (11) or an SHO (8) who were then video recorded undertaking the routine newborn examination. MAIN OUTCOME MEASURES: Quality of 62 observed technical and communication components of the newborn examination, as agreed between independent consultant paediatrician and senior midwife raters. RESULTS: Major differences were found in the rated quality of examinations between midwives and SHOs for the examinations of the heart and lungs, for the overall quality of the examination, and in areas of communication skills. Quality of examination of the hips was assessed as poor for both professional groups. Where there were significant differences between examiners, the quality of the midwives' examinations was higher. Inter-rater agreement between the consultant paediatricians and senior midwives ranged from excellent to poor for different items of the examination with a mean kappa value of 0.42 across all items indicating moderate agreement. CONCLUSIONS: The quality of midwife examinations exceeded that of SHOs. All midwives who examine receive formalized training in the examination of the newborn; SHOs may benefit from similar specific training. Training for both professional groups may need to be reviewed, particularly in relation to agreement on 'gold standards' for the screening of developmental dysplasia of the hip.

England↗