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PubMed2005

A survey of e-mentoring among New Zealand midwives.

Mentoring is a strategy that may assist the midwifery profession to support new graduates and midwives working in rural and remote areas. We conducted a survey of 1,577 New Zealand midwives about their opinions and experiences of mentoring. The questionnaire comprised 33 questions, nine of which were open questions. There was a 44% response rate. While the telephone was commonly utilized by mentors (37%) and mentored midwives (37%), the Internet and email played only a small part. Participants acknowledged the potential of these avenues for communication, but midwives felt that mentoring could be provided only by immediate, face-to-face contact. Nevertheless, e-mentoring could be a viable option and requires further investigation. About one-third of midwives identified geographical isolation as a barrier to being a mentor (38%) and being mentored (36%). The use of e-mentoring could remove the barrier of location and allow the midwife to chose a mentor who meets her needs, rather than because she is the only mentor available.

Attitude of Health Personnel↗

PubMed1999

[Tolerance and resistance: abortion from the point of view of traditional midwives in a rural area of Mexico].

OBJECTIVE: An evaluation of the perception, resources and practices regarding abortion of traditional midwives in a rural area in the municipality of Yecapixtla, state of Morelos, located in the central region of Mexico. METHODS: A qualitative methodology consisting of a detailed interview, focal groups and participating observation, was used. The subjects investigated were socio-cultural aspects, reproduction, sexuality and health related to abortion. Nine midwives were interviewed and a focal group was formed in which 16 midwives participated. RESULTS: The results demonstrated a profound rejection of abortion whether inducted or spontaneous. The former was considered a major sin and the latter a serious failure of a womańs reproductive function. Women who abort are called "pigs", "hogs" or "bitches" and the midwives are reluctant to attend them. However, a common practice among the women in the community is to "regulate the menstruation", that is, to use substances that provoke menstruation when this is delayed. This specific practice is not considered abortive by these women. CONCLUSION: Local popular beliefs about abortion are indispensible for the construction of effective strategies, which when provided by the institutional health services, reinforce the bonds between these and the traditional midwives in such a way as to increase accessibility to the health services as well as the quality of care to women.

Abortion, Induced↗

PubMed2003

Genetics education for midwives.

Advances in genetic science have increased the number of health interventions undertaken with regard to genetic disorders. Genetics is therefore expanding into the domains of national screening programmes, disease prediction and pharmacogenetics. This expansion means that a growing range of health professionals, including midwives, need skills and knowledge in genetics in order to take on new roles. The government is increasingly recognising the importance of genetic science for health and an expansion of genetic services is now underway. It is acknowledged that education of a wide range of health professionals will be required, although current educational provision does not reflect this. A growing range of genetic disorders can now be detected by prenatal tests, including chromosome disorders and single gene disorders. Pregnant women may choose to discuss their concerns with midwives, who therefore need to understand genetic testing, and know what disorders can be detected and when to refer women to specialist genetic services. Their clients would also benefit from midwives having sufficient skills to understand the processes of genetic counselling, which would enable them to discuss the decision to undertake a test, help women to cope with the result and minimise its effects on the family. Educational provision on genetics for midwives is insufficient and has not been coherently planned. A strategy is being developed to provide a framework for genetics education for front-line healthcare professionals. This aims to meet the needs of practising professionals who are already being asked to take on genetic roles, and also ensure future practitioners receive pre-registration education in genetics. Practising midwives and their teachers are invited to take part in this process.

Female↗

PubMed2003

Differences in episiotomy technique between midwives and doctors.

OBJECTIVES: To examine the practice of making an episiotomy and to determine any differences in practice between professional groups. DESIGN: A prospective survey. SETTING: A large tertiary referral obstetric hospital and the obstetric department of a district general hospital. POPULATION: All staff routinely involved in the care of women in labour. METHODS: A novel validated pictorial questionnaire was designed, validated and distributed to the study population. Differences in outcome measures were compared by profession and by seniority. MAIN OUTCOME MEASURES: Measurements taken from the questionnaire: the length of episiotomy drawn; the distance from the sagittal plane at which the episiotomy was begun; and the angle of the episiotomy from the sagittal plane. RESULTS: Fifty doctors and 78 midwives completed the forms. Median distance of the episiotomy from the midline was 0 mm (-2 to 11). Episiotomies drawn by doctors were significantly longer and more angled than those drawn by midwives (P = 0.002 and P = 0.001). Sixteen percent of doctors and 1% of midwives drew an episiotomy longer than 20 mm (difference 15%, 95% CI 6 to 24). Twenty-three percent of midwives and 2% of doctors drew an episiotomy angled 30 degrees or less (difference 21%, 95% CI 9 to 34). CONCLUSIONS: This study has demonstrated differences in the reporting of episiotomy practice by doctors and midwives. Theoretically, the differences demonstrated could predispose to a greater risk of anal sphincter injuries. These data need to be confirmed by observational studies of actual practice and by studies to investigate the mechanics of sphincter injury during childbirth.

Episiotomy↗

PubMed2002

The American College of Nurse-Midwives Domestic Violence Education Project (DVEP).

OBJECTIVE: The American College of Nurse-Midwives implemented a 4-year Domestic Violence Education Project (DVEP) with the goal of educating all midwives in the USA to respond appropriately to abuse experienced by the women they serve. METHOD: A four-pronged set of objectives was used that included policy, basic preservice education, continuing education and activism/advocacy. RESULT: The success of this project is the sustainable impact on education of student midwives and a continued commitment to this issue. CONCLUSION: The full impact of the DVEP on practicing midwives may not be measurable for some time.

Adult↗

PubMed1989

Characteristics of traditional midwives and their beliefs and practices in rural Bangladesh.

This study has analyzed the characteristics, beliefs and practices of midwives in rural Bangladesh. The midwives were mainly above age 30, married or widowed, and illiterate. Most of them learned their midwifery from informal sources such as female relatives or neighbours. Often, during pregnancy, childbirth, and post-partum period, midwives imposed dietary restriction on the mothers. Similarly, devices used in the cutting of the umbilical cord and placenta were not properly sterilized and potentially dangerous substances were applied at the navel after cutting the umbilical cord or placenta. There was a practice of withholding breast-feeding up to 3 days after the birth of a child. However, there were also some beliefs or practices among the midwives that could be regarded as based on scientific understanding such as the practice of cutting the umbilical cord by boiled razor blade or the belief that child death could occur from tetanus caused by the unsterilized device used in the cutting of the umbilical cord.

Bangladesh↗

PubMedDate not supplied

Use of precautions by nurse-midwives to prevent occupational infections with HIV and other blood-borne diseases.

A questionnaire was designed with these objectives: (1) to determine the frequency and type of adverse exposures experienced by certified nurse-midwives (CNMs); (2) to determine the extent to which CNMs used recommended precautions to prevent such incidents; and (3) to identify the sources used for obtaining information on AIDS. The questionnaire was mailed to all CNMs with the exception of associate and student members of the American College of Midwives. A response rate of 1,784/2,963 (60.2%) was obtained. These midwives reported frequent exposures to blood and body fluids. Sixty-five percent reported being soaked to the skin with blood or amniotic fluid; 50.7% had face-splashes with blood or amniotic fluid; and 24.0% experienced one or more needlestick(s). Only 55.1% reported using Universal Precautions (UP). Interference with the midwife-client relationship was identified most frequently as the reason for not using UP. Strategies need to be developed for midwives that will increase the use of UP and minimize the frequency of adverse exposures, while maintaining a caring midwife-client relationship.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Political participation behaviors of nurse-midwives.

Political participation, which is promoted by nurse-midwifery leaders, is a widely studied topic in this country. Yet, there is little data that describes political participation among health care providers such as nurse-midwives. The descriptive findings presented here are from a national survey of a random sample of members of the American College of Nurse-Midwives. The data indicate that nurse-midwives are inclined to be liberal and Democrats and they believe that individuals such as themselves can influence governmental activities. As in the general population of the country, the electoral act of voting is the predominant political activity. Nurse-midwives are more apt to demonstrate nonelectoral political behaviors in regard to women's issues. Overall, there is a general assumption that the representatives of the ACNM membership maintain the responsibility for political action.

Adult↗

PubMedDate not supplied

Nurse-midwives as faculty preceptors in medical student education.

Certified nurse-midwives (CNMs) are specialists in normal obstetrics and women's health care. In this capacity, CNMs have been actively involved in the education of nurses and student nurse-midwives. Nurse-midwives also have been consultants and mentors for medical students and residents during their clinical experiences. However, the nurse-midwife's contribution to the formal medical education process has not received the appropriate formal recognition that it deserves, nor has this contribution been utilized to its maximum potential. This article describes the development, philosophy, and implementation of an educational program utilizing nurse-midwives as the primary clinical preceptor for the obstetric rotation for third-year medical students. The long-range impact of this educational experience on the nurse-midwife/physician relationship is also explored.

Curriculum↗

PubMedDate not supplied

Guide to the use of the vacuum extractor by nurse-midwives.

The vacuum extractor has become a widely used instrument in many settings. It has proven to be a reliable method of ensuring safe passage of the fetus and/or enhancing maternal effort during the second stage of labor. The principles of vacuum-assisted birth are learned relatively easily and have been incorporated into many nurse-midwifery practices. This article reviews the principles of vacuum extraction as they apply to the practice of nurse-midwifery. Vacuum extractors available to nurse-midwives are compared. Nurse-midwives are familiarized with vacuum extraction so that they can make an informed choice concerning the vacuum extractor as an appropriate tool within their practice. This article is not intended to teach nurse-midwives to use the vacuum extractor. It does, however, provide guidelines for credentialing those nurse-midwives choosing to incorporate the principles of vacuum extraction into their practice.

Clinical Protocols↗

PubMedDate not supplied

How nurse-midwives define themselves in relation to nursing, medicine, and midwifery.

The way members of an occupation or profession define themselves influences both their interaction with other occupations in the workplace and the future direction of their profession. In order to determine how certified nurse-midwives define their occupational identity, a two-phase study was done. In the first phase, 20 nurse-midwives were interviewed at length. It was found that they used traditional midwifery ideologies of advocacy, normalcy, and competency to differentiate themselves from physicians and nurses. A nationwide survey was then sent to 300 nurse-midwives in which they were asked whether they identified more with midwifery, nursing, or medicine. Their choice of identity was then examined in light of midwifery, ideologies, situational and background factors, and ability to tolerate ambiguity. The analysis of the survey indicated that nurse-midwives identify occupationally with midwifery, rather than nursing or medicine, even though there is some alliance with both of the other occupations. The variables that were most predictive of a positive midwifery occupational identity were philosophical agreement with nurse-midwifery ideologies and increased years of nurse-midwifery practice. A short discussion of the implications of a midwifery versus a nursing identity concludes the article.

Adult↗

PubMed1994

Professional development in midwifery: findings from a longitudinal study of midwives' careers.

Although much importance is attached to continuing professional education for nurses, midwives and health visitors, there is a paucity of empirical studies on the subject. This article reviews research in continuing education for midwives and adds to the body of literature by reporting on findings on continuing education obtained in the course of a longitudinal study of midwives' careers. The original impetus for the study was concern about attrition from the profession; the method chosen to examine the problem was a longitudinal study in which two large cohorts of midwives were followed-up by means of questionnaires sent to them at regular intervals from qualification onwards. Information has been obtained on the relationship to retention of career intentions, careers followed and many aspects of life as a midwife. Those aspects relating to continuing professional education and development include obtaining post-basic qualifications, opportunities for in-service education, professional development during breaks for child care, support and feedback from senior colleagues and views on the importance of continuing education and support in relation to retention.

Career Mobility↗

PubMed1994

A cross-national analysis of midwifery politics: six lessons for midwives.

Research based on interviews and analysis of documentary sources on the politics of midwifery in Canada, Denmark, the Netherlands, the UK and the US, suggests six political lessons for midwives and the organisations that represent them. The lessons are: general health reforms represent both an opportunity and a threat to midwives' status, and midwives must learn to communicate in ways policy makers understand; research matters; coalition building is essential; the media cares (a little); it is much easier to defend the status quo than create new policy; it is essential to clarify who is to be considered a midwife. A constant grass roots awareness of and involvement in a country's political and policy making process is seen as a necessity if midwives are to prosper as a profession.

Cross-Cultural Comparison↗

PubMedDate not supplied

Gynecologic and contraceptive services provided by certified nurse-midwives in North Carolina.

Gynecologic care by midwives has been little represented in the peer-reviewed literature despite the fact that the majority of midwives provide these services. Offering patients a variety of contraceptive options is important for informed choice and consent and for reducing the unintended pregnancy rate, which is nearly 50% in the United States. This study describes the volume of gynecologic care and the contraceptive methods provided by certified nurse-midwives (CNMs) in North Carolina. The study was conducted using a cross-sectional, confidential, self-administered mail questionnaire completed by 133 CNMs in clinical practice in North Carolina. The majority of the CNMs worked in private practice settings (67%), in urban areas (60%), and had 10 or fewer years of experience (62%). The median number of women seen weekly for gynecologic care was 15 (range 0-80), and 30% of CNMs provided gynecologic care to more than 25 women each week. The contraceptive methods discussed and provided by the CNMs were comprehensive. The high percentage of midwives providing gynecologic care merits further study of the content and quality of this care.

Adult↗

PubMed2006

The effects of smoking cessation counseling by midwives on Dutch pregnant women and their partners.

OBJECTIVE: Smoking during pregnancy is an important problem in the Netherlands. We tested the effectiveness of a health counseling method by midwives using a RCT. METHODS: Four provinces with 42 practices including 118 midwives were randomly assigned to the experimental or control condition. Midwives in the experimental group provided brief health counseling, self-help materials on smoking cessation during pregnancy and early postpartum, and a partner booklet. Controls received routine care. The main outcome measures were 7-day abstinence, continuous abstinence, and partner smoking at 6 weeks post-intervention (T1) and 6 weeks postpartum (T2). RESULTS: Multi-level analysis revealed significant differences between both conditions at T1 and T2 using intention-to-treat analysis. Nineteen percent of the experimental group reported 7-day abstinence compared to 7% of the control group at T1, and 21 and 12%, respectively, at T2. For continuous abstinence these percentages were 12% in the experimental group and 3% in the control group. The partner intervention was not successful. CONCLUSION: The intervention resulted in significant effects on smoking behavior for pregnant women, but not for partner smoking. PRACTICE IMPLICATIONS: The program realized short-term effects. An important precondition is that midwives need a proper training.

Adult↗

PubMed2000

Complementary and alternative medicine in pregnancy: a survey of North Carolina certified nurse-midwives.

OBJECTIVE: To determine the prevalence and types of complementary and alternative medicine therapies used by certified nurse-midwives in North Carolina. METHODS: Surveys were sent to all 120 licensed certified nurse-midwives in North Carolina requesting information concerning their recommendations for use of complementary and alternative medicine for their pregnant or postpartum patients. RESULTS: Eighty-two responses were received (68.3%). Seventy-seven (93.9%) reported recommending complementary and alternative medicine to their pregnant patients in the past year. Forty-seven (57.3%) reported recommending complementary and alternative medicine to more than 10% of patients. The percentage of nurse-midwives who recommended each type of complementary and alternative medicine was as follows: herbal therapy (73.2%), massage therapy (67.1%), chiropractic (57.3%), acupressure (52.4%), mind-body interventions (48.8%), aromatherapy (32.9%), homeopathy (30.5%), spiritual healing (23.2%), acupuncture (19.5%), and bioelectric or magnetic applications (14.6%). The 60 respondents who reported prescribing herbal therapies gave them for the following indications: nausea and vomiting, labor stimulation, perineal discomfort, lactation disorders, postpartum depression, preterm labor, postpartum hemorrhage, labor analgesia, and malpresentation. CONCLUSION: Complementary and alternative medicine, especially herbal therapy, is commonly prescribed to pregnant women by nurse-midwives in North Carolina.

Adult↗

PubMedDate not supplied

Professional autonomy for midwives. An essential component of collaborative practice.

Although full admission privileges are considered the hallmark of full practice autonomy, the majority of certified nurse-midwives (CNMs) are denied the right to autonomously admit and discharge patients or have access to privileges only through the authority of a physician. This practice jeopardizes the independence of certified nurse-midwives and identifies them as adjuncts to the attending medical staff. The situation can only become more complicated now that the American College of Nurse-Midwives certifies nonnurses (CMs). Midwifery has a unique and a once autonomous history that is separate in philosophy from medicine. Midwives require physician services for consultation, referral, and collaborative management, but not for authority to practice midwifery. State legislation is not consistent nationwide concerning the definition and governing of nurse-midwifery practice. The Joint Commission on the Accreditation of Health Care Organizations does not regulate admission privileges but provides standards for hospitals. These standards do provide an avenue for admission privileges. Recognizing the CNM/CM as competitive in the health care market is essential. Denial of privileges can be interpreted as a restraint of trade. Without professional autonomy, unfavorable economics may limit the professional practice of midwifery.

Facility Regulation and Control↗

PubMed1980

Post-partum tubal ligation by nurse-midwives and doctors in Thailand.

A shortage of doctors limits the provision of post-partum sterilisation services in rural areas of Thailand. To overcome this problem nurse-midwives with theatre experience were trained to perform post-partum tubal ligation by a mini-laparotomy incision under local anaesthesia. The performance of the nurse-midwives was compared with that of doctors in a controlled, randomised clinical trial. Some operative difficulty was encountered by the nurses in 4.9% of cases and by the doctors in 2.0% of cases. This difference is not statistically significant and arose largely because the nurse-midwife cases were more obese. Nurse-midwives required a significantly longer operating-time (18.5 min) than doctors (11.9 min). However, postoperative morbidity was similar in the two groups (7.0% and 6.0%, respectively). These results suggest that trained nurse-midwives with theatre experience can safely provide post-partum sterilisation services. A further field trial is underway.

Clinical Trials as Topic↗