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PubMed1996

Midwives' motivation for continuing education.

This study examined midwives' motivations for continuing their education by conducting a survey amongst a sample population of midwives, employed in 4 Health Authorities in the North West of England. The survey was carried out using a questionnaire which asked midwives to indicate the 'importance' of a series of requirements of continuing education. Of 120 midwives who received the questionnaire, 83 (69%) replied. Motivational factors included: learning for professional and personal development; fulfilling legal or statutory practice requirement, or as a social activity. The results showed that motivation for continuing education was strongest in relation to professional competence and an innate desire for knowledge. Where personal development was achieved, the emphasis was to promote professional advancement rather than social interaction. Less emphasis was placed on fulfilling the legal requirements for practice. The strongest motivators were learning orientated, which suggests that the subjects were self-directed to fulfil their needs, based on a desire to learn, this being less dependent on external motivators, which may be activated by statutory or employer requirements. Social interaction was seen as the least important aspect, although subjects found it beneficial to meet colleagues from other areas and felt that they learnt from exchanging views about various clinical practices.

Adult↗
PubMed1990

HIV infection and community midwives: experience and practice.

To assess the effects of HIV infection on the work of community midwives, a postal survey of 1 in 5 in Scotland and England was carried out. The 907 respondents represent an 83% response rate. While only 1% of respondents had experience of patients with AIDS, 8% had been involved with known asymptomatic HIV infection and 32% had encountered those that they considered to be 'at high risk'. While the workload generated by HIV-infected patients for individual midwives at this time was small, almost all midwives themselves considered that they had a role to play in the prevention of HIV infection through health education and in counselling. While less than a quarter of those who had encountered HIV-positive patients had provided health education, more than half had done so to those worried about HIV infection and almost a quarter had counselled them. However, confidence to provide these aspects of practice was low, even among those who had received in-service education, although higher than among those who had not done so. A minority of community midwives had read policies or guidelines about aspects of practice and service provision, except for infection control where two thirds had read what they considered an adequate policy.

Community Health Nursing↗
PubMed1994

Hungarian midwives and their practice: a national survey.

In 1975 the Hungarian educational system for midwives was shortened from a three year programme to one of ten months duration in order to provide a more immediate supply of midwives in a relatively short period of time, and to reduce the costs associated with midwifery education. Ten years after the educational programme change, a national survey of Hungarian midwives (n = 290) was conducted by the European Regional Office of the World Health Organization and the Hungarian Ministry of Health. This study describes the effects of the two educational programmes and years of practice on Hungarian midwives' self-perception of competency, satisfaction and summative score of responsibility and autonomy. Significantly different group mean scores on variables related to competency and satisfaction were found for the two groups.

Adult↗
PubMed2006

Nurse-midwives' attitudes towards adolescent sexual and reproductive health needs in Kenya and Zambia.

Adolescent sexuality is a highly charged moral issue in Kenya and Zambia. Nurse-midwives are the core health care providers of adolescent sexual and reproductive health services but public health facilities are under-utilised by adolescents. The aim of this study was to investigate attitudes among Kenyan and Zambian nurse-midwives (n=820) toward adolescent sexual and reproductive health problems, in order to improve services for adolescents. Data were collected through a questionnaire. Findings revealed that nurse-midwives disapproved of adolescent sexual activity, including masturbation, contraceptive use and abortion, but also had a pragmatic attitude to handling these issues. Those with more education and those who had received continuing education on adolescent sexuality and reproduction showed a tendency towards more youth-friendly attitudes. We suggest that critical thinking around the cultural and moral dimensions of adolescent sexuality should be emphasised in undergraduate training and continuing education, to help nurse-midwives to deal more empathetically with the reality of adolescent sexuality. Those in nursing and other leadership positions could also play an important role in encouraging wider social discussion of these matters. This would create an environment that is more tolerant of adolescent sexuality and that recognises the beneficial public health effect for adolescents of greater access to youth-friendly sexual and reproductive health services.

Abortion, Induced↗
PubMed1996

The diagnosis of foetal distress: a challenge to midwives.

The diagnosis of foetal distress is complex: it is influenced by a number of factors which range from the physical examination of the mother and foetus to the psychological and social world in which the mother, the midwife and other health care professionals work. The consequences of an incorrect diagnosis of normality or foetal distress are potentially serious for both mother and baby. Recent changes in the practice and delivery of midwifery care have placed more responsibility on midwives. It is therefore imperative that midwives become more aware of the complexity of the diagnosis as well as of some of the factors which can improve the quality of their diagnosis. This paper reviews the literature associated with the diagnosis of foetal distress, physiological and pathological changes during pregnancy and labour, and the usefulness and limitation of the tools readily available to midwives for the diagnosis. It also examines the limits of the relationship that exists between intra-uterine and neonatal markers. The purpose of this paper is to provide background information that would support midwives in the diagnosis of foetal distress in the hope that the false positive diagnoses can be reduced for the benefit of mothers and babies. Ultimately an improvement in outcome should be reflected in the more efficient and effective use of resources available to maternity services.

Cesarean Section↗
PubMed1997

HIV and AIDS awareness: an evaluation of a short training programme for midwives.

In response to a Department of Health, England, circular encouraging policies of named voluntary antenatal HIV antibody testing, one West Midlands health authority in England introduced a policy of raising the issue proactively at the first antenatal attendance. In order to facilitate this policy a short staff education programme was provided for midwives. This paper reports on part of a study which aimed to evaluate the impact of the HIV awareness training programme. A sample of midwives (n = 65) was randomly selected for inclusion in the study. Thirty-three had attended training and 32 had not. Data were collected using a self-administered questionnaire exploring knowledge of aetiology of HIV/AIDS, knowledge of transmission, knowledge of obstetric and paediatric HIV, attitudes to HIV, issues related to antenatal HIV antibody testing and opinions about the HIV awareness training programme. Results indicated no significant difference in levels of knowledge or in attitude between those who had attended the training programme and those who had not. Similarly, no significant difference was found in terms of how midwives would react to women requesting HIV antibody testing. Many of the results contradict the current literature and as a conclusion it is suggested that there is a need to review HIV-related training for midwives.

AIDS Serodiagnosis↗
PubMed1998

Women and midwives in partnership: a problematic relationship?

Midwives in New Zealand have been practising independently of medicine and nursing since 1990 using the concept of partnership as a basis for their practice. This article shows, however, that the beliefs which underpin the practice of the midwives are not always the same as those of their clients. Supporting evidence is provided in the form of verbatim data provided by participants. Three major areas in which contradictions were found were in the work of midwives, the knowledge for practice and reflections on the experience. It is recommended that midwives become more visible by removing themselves from hegemonic structures, valuing alternative forms of knowledge and respecting the knowledge of their clients.

Clinical Competence↗
PubMed2002

'Great fleas have little fleas': Irish student midwives' views of the hierarchy in midwifery.

BACKGROUND: Many studies have investigated the world of the student nurse, but there is little work into the lives and experiences of student midwives. Studies of Irish midwives' provision of care have demonstrated that they are not fulfilling their complete role, and research into their education was deemed to be necessary. AIM: To explore the opinions, feelings and views of student midwives as they progressed through their 2-year education programme in Ireland. METHODS: Both quantitative and qualitative methods were used and the qualitative sections of the study were guided by the phenomenological approach. Ethical approval was granted. All students in the first intake of 1995 in all seven midwifery schools in Southern Ireland agreed to take part (n=125). Individual and group interviews, diary-keeping and questionnaires collected data. RESULTS: The findings presented in this paper describe the students' views of the hierarchical structures in midwifery, and the role and behaviours of the 'Matron'. The data describes a subculture of nursing/midwifery subordination. DISCUSSION: One reason for the hierarchical nature of the midwifery profession may be because it is an almost totally female-dominated profession, with the female hierarchy exercising control over other women within a male-based power structure. Many hospitals preferred to employ their own students as staff, ensuring a continuation of the hierarchical regime. CONCLUSION: The recurring nature of this problem may be because midwives now fear change more than they desire it. Further research is required to ascertain whether the reason for the strong hierarchy is because of the continuation of midwifery from the male-dominated profession of nursing, to the existence of the industrial/economic model of maternity care or to the impact of the medicalization of childbirth.

Attitude of Health Personnel↗
PubMed2001

Patterns in midwives' and expectant/new parents' ways of relating to each other in ante- and postnatal consultations.

Patterns in midwives' and expectant/new parents' ways of relating to each other in ante- and postnatal midwifery consultations were described by means of qualitative content analysis of 58 video-recorded consultations in a Swedish primary care setting. The midwives appeared to steer the consultations by adopting a basic pattern and occasionally including other patterns. Of the five patterns disclosed, three were revealed as basic and named 'the respectful gardener and her developing plants', 'the propagandist teacher and her ignorant pupils' and 'the steering inspector and the representatives of the population at disposal'. The midwives related in individually oriented ways in the first pattern while the latter two indicated generalized ways of relating. The expectant/new mothers were more active in the two additional patterns 'the mediating counsellor and the discreet seekers of guidance' and 'the personal women-friends'. The expectant/new fathers mostly had a minor role, only appearingly actively involved within the 'gardener' pattern. Midwives need to reflect over their ways of relating as these influence how expectant/new parents deal with the information given and their satisfaction with the care.

Female↗
PubMed2001

'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↗
PubMedDate not supplied

Challenges and opportunities for nurse-midwives.

This article reviews the major indicators of the growth in nurse-midwifery practice and education over the past 10 years. The major issues the profession has addressed are identified, as well as future challenges and opportunities. These challenges and opportunities are identified within the major dimensions of nurse-midwifery, that is, in practice, education, research, and within the public sector. The two major issues facing nurse-midwives are legislative initiatives related to the practice of nurse-midwives, such as reimbursement, and the mixed societal image of midwifery as a contemporary, cost-effective practice versus a peripheral activity by "old fashioned," informally educated individuals. The professional organization of nurse-midwives, the American College of Nurse-Midwives (ACNM), is addressing these issues through interdisciplinary and interorganizational legislative and marketing initiatives.

Humans↗
PubMed2000

Contemporary issues in the workforce and education of Australian midwives.

This paper, which is based on the preliminary findings of the Australian Midwifery Action Project (AMAP), outlines the issues around the midwifery labour force and education in Australia. One of the most alarming features is the lack of comprehensive data on midwives. Where data is available it demonstrates the shortage of midwives and the lack of consistency in educational programs for midwives within states and nationally. It is difficult to form a national picture with published sources of data because there are differences in definition and a lack of relevant information. Strategies for educational reform are discussed in relation to improving the supply and preparation of midwives.

Adult↗
PubMed1990

Smoking habits of nurses and midwives.

A study was designed to examine the hypothesis that increased awareness of the health hazards of smoking aids smoking cessation in female health care workers. One hundred and thirteen nurses and midwives completed a questionnaire about their smoking habits. When the group was tested as a whole against the national average for the same socio-economic group, it was found that there was a strong similarity between the subject's smoking habits and the national average. However, when the nurses and midwives were separated into two groups, the nurses smoked significantly more than the national average, whereas the midwives smoked significantly less. In addition, there was an intriguing finding that a highly significant number of the midwives had never smoked compared to the national average.

Attitude of Health Personnel↗
PubMed2005

Outcomes of planned home births with certified professional midwives: large prospective study in North America.

OBJECTIVE: To evaluate the safety of home births in North America involving direct entry midwives, in jurisdictions where the practice is not well integrated into the healthcare system. DESIGN: Prospective cohort study. SETTING: All home births involving certified professional midwives across the United States (98% of cohort) and Canada, 2000. PARTICIPANTS: All 5418 women expecting to deliver in 2000 supported by midwives with a common certification and who planned to deliver at home when labour began. MAIN OUTCOME MEASURES: Intrapartum and neonatal mortality, perinatal transfer to hospital care, medical intervention during labour, breast feeding, and maternal satisfaction. RESULTS: 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated. CONCLUSIONS: Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.

Breech Presentation↗
PubMed1995

Midwives, their employers and the UKCC: an eternally unethical triangle.

The majority of midwives in the UK are employed within the NHS. They are legally bound to fulfil their contractual obligations to their employers. At the same time they are professionally mandated to interpret and act on the UKCC's Code of professional conduct. Midwives have always maintained that they are autonomous practitioners, and the Code is written in a way that endorses this belief. Underlying the Code is the assumption that midwives have moral and professional freedom to act on its imperatives. However, midwives' claim to autonomy is flawed, and therefore the Code's claim to be a source of empowerment is also flawed. Underlying the difficulties is a conflict derived from the imposition of a deontologically-based professional Code on to a workforce that is constrained within and employed by the utilitarian-based NHS.

Employment↗
PubMed1992

Professional relationships between midwives and physicians: collaboration or conflict?

This study examines the professional relationships between midwives and physicians providing obstetrical care in Washington State. Four hundred ninety-six randomly sampled family physicians and obstetrician-gynecologists and 211 certified nurse, licensed, and lay midwives were surveyed to learn more about midwife/physician consulting relationships. Only certified nurse midwives have forged mutually satisfactory relationships with the physician community. Increased hospital-based training and practice opportunities are needed before licensed midwives can improve their professional relationships with physicians.

Certification↗
PubMed1988

Women's health and social change: the case of lay midwives.

One reaction to the medicalization of birth has been the comeback of lay midwives in the past 10 years. While many practice alone as did midwives 80 years ago, now midwives are networking and organizing in regional and statewide groups, an important new distinction in the light of increasing regulatory policy formation by many states. Are these groups the beginnings of traditional bureaucratic health professional organizations or are they better described as alternative women's health groups that espouse nonhierarchical philosophies of women's health? In this article, we describe an empirical study of one such group, the Michigan Midwives' Association, and explore the philosophies and practices of individual members as well as the internal organization of the group and its influence on members. Data were collected using individual telephone interviews with 48 of 50 members, group newsletters and documents, and two spokespersons who developed an oral history of the Association since its origin in 1978. Results suggest that the group plays an important role in reinforcing individually held philosophies about women-controlled birth and in providing social support to health workers practicing outside the traditional system.

Adult↗
PubMed1975

Traditional midwives and family planning in Asia.

The objectives of this article are (1) review the contribution of traditional midwives to family planning communication in several Asian countries; (2) organize knowledge gathered from various studies into general guidelines for the most effective use of traditional midwives in family planning programs; and (3) present hypotheses for future research. In certain countries where pilot projects have tested the potential performance of traditional midwives in family planning programs, results have been encouraging. In other nations, more research is needed to determine the contribution traditional midwives can make to the family planning program.

Asia↗