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A theory of caring for midwifery.

It is time that Australian midwives developed and published their own theories and models for midwifery. This paper proposes a practical model for midwifery based on caring concepts. The needs of midwifery clients have been analysed and supported by various authors and four concepts of caring have been selected and applied to these needs to bring about a positive birth experience. Philosophical assumptions have been made to form the grounding for the theory, the core of which is a caring midwifery interaction.

Australia↗

Trends in nursing and midwifery research and the need for change in complementary therapy research.

In recent years there has been a change in nursing and midwifery research. Whilst many of the subjects being studied remain the same, nurses and midwives have started to employ a range of data collection methods that are relatively new to the profession. Predominantly quantitative research, which concentrates on reduction, objectivity, manipulation, categorization, passivity, control, prediction, causality and generalizability (Munhall & Oiler 1986), is starting to be replaced by other approaches perhaps more congruent with nursing, midwifery and caring. As Moody (1990) stated, 'the 1980s ushered in an array of diverse, sophisticated research methods...' with other authors adding that 'nursing is just beginning to authenticate new territory that incorporates a plurality of methods' (Nagle & Mitchell 1991). The following is an exploration of the recent apparent shift away from a focus on quantitative research in nursing and midwifery towards the use of qualitative methods which emphasize a greater degree of individuality, humanism, participation and interaction. It is suggested that the traditional quantitative research paradigm still exists in the field of complementary therapy research and that the shift that has taken place in nursing and midwifery research needs to be considered more seriously in the field of research in complementary therapies.

Complementary Therapies↗

'Knowing your place': student midwives' views of relationships in midwifery in Ireland.

OBJECTIVE: to explore the feelings and views of student midwives of their education as they progressed through their two-year programme in Ireland, with the intention of interpreting and understanding the working and learning world of the participants so that future students might be assisted to improve their educational experiences. DESIGN: phenomenology, using the technique of triangulation in a number of ways. SETTING: all seven midwifery schools in Southern Ireland. PARTICIPANTS: all students in the first intake of 1995 in every midwifery school in Ireland (n=125). DATA COLLECTION: individual and group interviews, diary-keeping and questionnaires. KEY CONCLUSIONS: the findings presented in this paper illustrate the students' views of their relationships with qualified midwives and obstetricians. IMPLICATIONS FOR PRACTICE: an attitude of respect for all students needs to be fostered in hospitals educating midwives if we are to produce caring midwives in the future. The new, extended programme of midwifery education in Ireland should include an emphasis on communication skills and conflict management. A re-organisation of the hierarchical structures evident in midwifery management would lead to an improvement in the experiences of students and childbearing women alike.

Adult↗

Evaluation of satisfaction with midwifery care.

OBJECTIVE: to determine if there were differences in women's satisfaction with maternity care given by doctors and midwives. In addition a simple, six-question, satisfaction questionnaire was to be tested. DESIGN: a randomised controlled trial comparing two models of maternity care. SETTING: a tertiary referral centre in Alberta, Canada. PARTICIPANTS: one hundred and ninety four women with a low-risk pregnancy were randomly assigned to either the midwife care, experimental group (n = 101), or the doctor care, control group (n = 93). INTERVENTIONS: a pilot midwifery programme was introduced into a maternity services delivery system that did not have established midwifery. MEASUREMENTS: women's satisfaction was measured, at two weeks postpartum, with the Labour and Delivery Satisfaction Index (LADSI), general attitudes toward the birth experience, also at two weeks postpartum; with the Attitudes about Labour and Delivery Experience (ADLE) questionnaire. Fluctuations in satisfaction were measured with a Six Simple Questions (SSQ) questionnaire at 36 weeks gestation and 48 hours, two and six weeks postpartum. FINDINGS: women in the midwife group reported significantly greater satisfaction and a more positive attitude toward their childbirth experience than women in the doctor group (p < 0.001). The SSQ demonstrated scores similar to the LADSI. Satisfaction in both groups was lowest at 36 weeks gestation and highest immediately postpartum. KEY CONCLUSIONS: women experiencing low-risk pregnancies were more satisfied with care by midwives than with care provided by doctors. Satisfaction scores were high for both groups and may have been lower for women in the doctor group as a result of disappointment with caregiver assignment as all women had sought midwifery care. The SSQ measures similar dimensions to the LADSI but the agreement is not strong enough to recommend its use as a substitute at this time. IMPLICATIONS FOR PRACTICE: the significantly higher satisfaction of the women with the care provided by the midwives together with better clinical outcomes reported elsewhere suggest that the option of midwifery care should be accessible as an option for all women in Canada. Further research is suggested to determine the usefulness of the SSQ.

Female↗

The rise, fall and rise of nurse-midwifery in America.

For most of history, the care of women, particularly childbearing women, has been delivered by healers and health care providers who were women. This article is an overview of the historical, social, political, economic, and philosophic forces that shaped the role of women, especially midwives, who care for childbearing families. As healers and health care providers, midwives (and later, nurse-midwives) have based their practice on the natural process of pregnancy and birth. Their holistic view dominated childbirth until the 18th century, when the existence of midwives began to be challenged by institutions. In the United States, the marriage of midwifery with nursing in the 1920s, followed by the consumer childbirth revolution of the 1960s, gave new strength to the profession of nurse-midwifery. Later, health economics provided additional support for nurse-midwifery practice, with demonstrated reduced costs and improved quality. At the cusp of the 21st century, internal and external political forces have now led to the inclusion of nonnurses in the profession of midwifery in the United States. Despite the ever-changing political, economic, and societal climate, midwives consistently have brought superior outcomes and family-centered caring to their practice and their patients.

Female↗

A randomized, controlled trial of nurse-midwifery care.

BACKGROUND: In 1990 a pilot nurse-midwifery program was implemented in a tertiary care hospital in a major western Canadian city. a randomized, controlled trial was conducted to determine if, when maternal and newborn patient outcomes were compared, the midwifery program was as effective as traditional, low-risk health care available in the city. METHODS: All low-risk women who requested and qualified for nurse-midwifery care were randomly assigned to an experimental or control group. RESULTS: One hundred one women received care from nurse-midwives and 93 received standard care from either an obstetrician or family physician. The rate of cesarean delivery in the nurse-midwife group was 4 percent compared with 15.1 percent in the physician group. The episiotomy rate, excluding cesarean deliveries, for the nurse-midwife group was 15.5 percent compared with 32.9 percent in the physician group. The rates of epidural anesthesia for pain relief in labor were 12.9 percent and 23.7 percent, respectively. Statistically significant differences were found ultrasound examinations, amniotomy, intravenous drug administration during labor, dietary supplements, length of hospital stay, and admission of infants to the neonatal intensive care unit. CONCLUSIONS: The results clearly support the effectiveness of the pilot nurse-midwifery program and suggest that more extensive participation of midwives in the Canadian health care system is an appropriate use of health care dollars.

Adult↗

Linking obstetric and midwifery practice with optimal outcomes.

OBJECTIVE: To compare midwifery and medical care practices and measure optimal perinatal outcomes using a new clinimetric instrument. DESIGN: Prospective descriptive cohort design. SETTING: A large, inner city obstetric service with medical and midwifery services. PARTICIPANTS: Three hundred seventy-five of 400 consecutively enrolled patients were participated (25 excluded due to extreme risk status or missing data); 92% were of minority race/ethnicity and 54% had less than a high school education. Of the 375 patients, 179 received physician care and 196 received nurse-midwife care. MAIN OUTCOME MEASURES: The Optimality Index-US was measured. Health record data were extracted and scored using the Optimality Index-US to summarize the optimality of processes and outcomes of care as well as the woman's preexisting health status. RESULTS: Midwifery patients had more optimal care processes (less use of technology and intervention) with no difference in neonatal outcomes, even when preexisting risk was taken into account. CONCLUSION: Even among moderate-risk patients, the midwifery model of care with its limited use of interventions can produce outcomes equivalent to or better than those of the biomedical model.

Adolescent↗

Knowledge, perception and practice with regards to occupational risks of HIV/AIDS among nursing and midwifery students in Ibadan, Nigeria.

Nursing and midwifery students constitute a subgroup of health care providers exposed to occupational risk of HIV infection became of direct contact with blood and body fluids during clinical practice. The occupational risk faced by these students is of serious concern, given their limited experience and proficiency in nursing care skills. This study was carried out to provide important baseline data about knowledge, perception and practice with regards to occupational risks of HIV/AIDS among 359 nursing and 120 midwifery students (N = 479) in Ibadan, Nigeria. The study utilized both qualitative and quantitative methods to gather information from nursing and midwifery students. The result showed a poor knowledge of WHO recommended universal precaution for preventing HIV transmission among students in all the schools. Students of the schools of midwifery performed more highrisk occupational practises compared to those in the nursing schools, but received less supervision.

Adolescent↗

Certified nurse-midwifery in Kansas: survey of physicians.

Following U.S. trends, the number of practicing certified nurse-midwives in Kansas is growing. Since collaboration with physicians is vital to the successful practice of nurse-midwifery, Kansas obstetrician-gynecologists and family practice physicians were surveyed regarding certified nurse-midwifery. Seventy-two randomly-selected physicians received an 11-item questionnaire. The majority of responding physicians (n = 40) expressed an interest in certified nurse-midwifery. Most obstetricians indicated they would consider bringing a certified nurse midwife into their practices. Obstetricians were more knowledgeable about certified nurse midwifery and were more open to collaboration with nurse-midwives than were family practice physicians. Results indicate that the environment is ripe for certified nurse-midwife/physician collaboration in Kansas.

Certification↗

Gossip, stories and friendship: confidentiality in midwifery practice.

Women often seek midwifery care as an alternative to the maternity services that are readily available within the insured health care system in Alberta. Some aspects of community-based, primary care midwifery in Alberta that characterize this alternative are the use of story-telling as a form of knowledge, the development of social connections among women seeking midwifery care, and nonauthoritarian relationships between midwives and women. In this paper, the concept of confidentiality, as it relates to these aspects of midwifery practice, is explored, using traditional, caring and feminist models of ethics.

Beneficence↗

Impact of Integrated Continuous Team Midwifery Care on Breastfeeding Success within the Iranian Health System: A Randomized Controlled Trial.

INTRODUCTION: Supporting women during the perinatal period helps build confidence, strengthens early bonding between mother and baby, and encourages successful breastfeeding. Continuous midwifery care models are one of the ways that support women in this periods. OBJECTIVE: This study aimed to evaluate the effect of integrated continuous team midwifery care (ICTMC) in enhancing breastfeeding success in the Iranian health system. METHODS: In this randomized controlled trial, 200 low-risk primiparous women with a gestational age of less than 12 weeks were recruited from public health centers. Participants were randomly assigned to either the intervention group, which received continuous midwifery care throughout pregnancy, childbirth, and postnatal follow-up, or the control group, which received routine care. The primary outcomes were early skin-to-skin contact and breastfeeding success at the time of discharge and at 4-6 weeks postpartum. Data were analyzed using Stata, employing descriptive statistics, Chi-square, independent t-test, Phi/Cramer's V, and Cohen's d. The p < 0.05 is significant. Data were analyzed with SPSS 26. RESULTS: ICTMC groups were significantly more likely to initiate skin-to-skin contactearly skin-to-skin contact immediately after birth (92% vs. 74%, p < 0.001) and achieve successful breastfeeding at the discharge time (88% vs. 70%, p = 0.002) compared to the control group. At 6 weeks postpartum, breastfeeding success remained higher in the intervention group (82% vs. 65%, p = 0.004). CONCLUSION: Women with ICTMC, effectively support skin-to-skin contactearly mother-infant bonding and enhance breastfeeding success among low-risk primiparous women. Integrating this model into routine maternal care may improve perinatal outcomes.

Humans↗

Negotiating public and professional interests: a rhetorical analysis of the debate concerning the regulation of midwifery in Ontario, Canada.

This article investigates the uneasy process of integrating midwifery's alternative, women-centered model of childbirth care within the medically-dominated healthcare system in Canada. It analyses the impure processes of rhetorical identification and differentiation that characterized the debate about how to regulate midwifery in Ontario by examining a selection of submissions from diverse health care groups with vested interest in the debate's outcome. In divergent ways, these groups strategically appeal to the value of the "public interest" in order to advance professional concerns. The study considers the implications of this rhetorical process for re-defining midwifery's distinctive professional identity in relation to other health professions, to the state, and to the women for whom midwives care. Likewise, it suggests the relevance of rhetorical analysis for understanding the discursive formation and re-formation of health models, values, and professions in Western culture.

Attitude of Health Personnel↗

Midwifery education and research in the future.

This paper is adapted from a plenary lecture presented at the 22nd International Congress, International Confederation of Midwives, Kobe, Japan, October 11, 1990. Midwifery education and research in the past, present, and future are discussed. Special emphasis is placed on innovation in midwifery education to address more adequately the worldwide concern about safe motherhood. Midwifery research and the integral components of information and inquiry are also discussed, with emphasis on five major areas in need of further research. Collaborative education and research are explored from both an interdisciplinary and an international perspective.

Forecasting↗

An approach to measuring quality of midwifery care.

In perinatology "Outcome" is almost always defined in terms of mortality or serious morbidity. Evaluation of care for normal pregnancy and midwifery care in particular cannot rely only on outcome measures per se, but must also take the means and interventions by which these are achieved into account. Perinatal Background and Perinatal Outcome Indexes were developed for the assessment of midwifery care in women with low-risk pregnancies. These indexes were applied in a prospective study of midwifery care during labor and childbirth for a population of 1836 women with low-risk pregnancies in The Netherlands. The Perinatal Background Index confirmed that the study population was indeed a population at low risk of perinatal complications. The Perinatal Outcome Index gave an adequate description of both the result and process of childbirth, with a lower score indicating a further deviation from the optimal situation of "maximum outcome with minimal intervention."

Female↗

Clinical teaching and learning in midwifery and women's health.

Although there is an abundance of literature about clinical teaching in the health professions, a much smaller body of information focuses on the art and science of clinical teaching in midwifery and women's health. We reviewed preceptor handbooks, training manuals, and Web sites created by nursing and nurse-midwifery education programs, medical and pharmacy schools, and national associations of health professionals. Using the search terms "clinical teaching, clinical learning, preceptor, clerkship, residency training, and midwifery education", we searched the MEDLINE and CINAHL databases and health sciences libraries for relevant articles and books. The information and practical strategies about clinical teaching that we found are synthesized and presented in this article. It includes a discussion of challenges in clinical teaching; an overview of expectations and responsibilities of the education program, students, and preceptors; suggestions about orienting students to clinical sites; clinical teaching strategies and skills; suggestions for incorporating critical thinking and evidence-based care into clinical teaching; guidelines for giving constructive feedback and evaluation; characteristics of excellent clinical teachers; and suggestions about how education programs and professional associations can support and develop clinical sites and preceptors. The Appendix contains manuals, books, and Web sites devoted to clinical teaching.

Clinical Competence↗

Service learning: applications in midwifery education.

Service learning is learning acquired through experiential education that deliberately links service to others with the goal of achieving specific academic objectives. Service learning is an educational innovation that encompasses a wide range of activities and pedagogies while maintaining a commitment to principles of service. Although midwifery is a profession rooted in service to women and their families, scant attention has been paid to the purposeful inclusion of service-learning experiences in midwifery curricula. This article describes service learning and discusses practical applications in midwifery education.

Altruism↗

A human rights framework for midwifery care.

This article presents a rights-based model for midwifery care of women and childbearing families. Salient features include discussion of the influence of values on how women are viewed within cultures and societies, universal ethical principles applicable to health care services, and human rights based on the view of women as persons rather than as objects or chattel. Examples of the health impact on women of persistent violation of basic human rights are used to support the need for using a human rights framework for midwifery care--a model supported by codes of ethics, the midwifery philosophy of care, and standards of practice.

Ethics, Medical↗

Storytelling as an educational strategy for midwifery students.

This article describes the use of purposive storytelling as a creative teaching strategy in the nurse-midwifery education program at San Diego State University and the University of California, San Diego. Student evaluations over a 4-year period showed overwhelming support for the inclusion of storytelling into a weekly didactic midwifery course. Benefits, such as increased cognitive learning, enhanced role transition, and emotional clarification were identified in the students' comments. The students' comments further supported the efficacy of incorporating storytelling into midwifery education. A review of the literature confirms the growing popularity of storytelling in both health care and education, and a conceptual framework is also provided. Further research is needed to examine the benefits of this worthwhile technique in promoting learning, stimulating interest, and facilitating the development of critical thinking.

California↗