Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “MIDWIFERY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 253 records · Page 14Linked to original sources
PubMed2004

Conflicting ideologies as a source of emotion work in midwifery.

OBJECTIVE: to explore how a range of midwives experienced and managed emotion in their work. DESIGN: a qualitative study using an ethnographic approach. Data were collected in three phases using focus groups, observations and interviews. SETTING: South Wales, UK. PARTICIPANTS: Phase One: self-selected convenience sample of 27 student midwives in first and final years of 18-month (postnursing qualification) and 3-year (direct entry) programmes. Phase Two: opportunistic sample of 11 qualified midwives representing a range of clinical locations and clinical grades. Phase Three: purposive sample of 29 midwives working within one NHS Trust, representing a range of clinical locations, length of clinical experience and clinical grades. FINDINGS: community and hospital environments presented midwives with fundamentally different work settings that had diverse values and perspectives. The result was two primary occupational identities and ideologies that were in conflict. Hospital midwifery was dominated by meeting service needs, via a universalistic and medicalised approach to care; the ideology was, by necessity, 'with institution'. Community-based midwifery was more able to support an individualised, natural model of childbirth reflecting a 'with woman' ideology. This ideology was officially supported, both professionally and academically. When midwives were able to work according to the 'with woman' ideal, they experienced their work as emotionally rewarding. Conversely, when this was not possible, they experienced work as emotionally difficult and requiring regulation of emotion, i.e. 'emotion work'. KEY CONCLUSIONS: unlike findings from other studies, that have located emotion work primarily within worker/client relationships, the key source of emotion work for participants was conflicting ideologies of midwifery practice. These conflicts were particularly evident in the accounts of novice midwives (i.e. students and those who had been qualified for less than 1 year) and integrated team midwives. Both groups held a strong commitment to a 'with woman' ideology. IMPLICATIONS FOR PRACTICE: understanding the dilemmas created by conflicting occupational ideologies is important in order to improve the quality of midwives' working lives and hence the care they give to women and families. In the short term, strategies involving education and supervision may be of assistance in enabling midwives to reconcile these conflicting perspectives. However, in the long term more radical solutions may be required to address the underpinning contradictions.

Burnout, Professional↗
PubMed2004

Interprofessional education in a midwifery curriculum: the learning through the exploration of the professional task project (LEAPT).

OBJECTIVE: to develop interprofessional education for students of midwifery, nursing and medicine. To foster collaborative working and learning between students of midwifery, nursing and medicine. DESIGN: a quasi-experimental method to evaluate the outcomes of an intervention (a problem-based learning (PBL) scenario) with interprofessional students and facilitators. Data were collected using pre- and post-test questionnaires. SETTING: a University and National Health Service healthcare facilities in the North of England. PARTICIPANTS: 40 students of midwifery, nursing and medicine. FINDINGS: student midwives participating in the PBL scenario in this interprofessional format improved their attitudes to working in this environment. All students enjoyed the opportunity to learn in an interprofessional team, and they felt that the experience provided a safe environment to help prepare for their future roles. The learning opportunity enabled all students to reflect on each other's role and to discuss differing perspectives of care, although the student midwives had mixed feelings about the PBL experience. IMPLICATIONS FOR PRACTICE: interprofessional learning using PBL is a useful environment for students to learn about each others' role, and to prepare for working together as qualified professionals in a collaborative manner. However, time and commitment is required to plan joint working in order to maximise the benefits.

Curriculum↗
PubMed2005

Emotion work and boundary maintenance in hospital-based midwifery.

OBJECTIVE: To identify and explore the emotion work of hospital-based midwives. DESIGN: An ethnographic approach using focus groups, observations and interviews. SETTING: South Wales, UK. PARTICIPANTS: Phase one of the study: self-selected convenience sample of 27 student midwives in first and final years of 3-year (direct entry) and 18-month (post-nursing) programmes. Phase two: opportunistic sample of seven qualified hospital-based midwives. Phase three: Purposive sample of 10 hospital-based midwives working within one National Health Service Trust. Sample representative of a range of clinical locations, length of clinical experience and clinical grades. FINDINGS: The emotion work of midwives was strongly influenced by the context of practice. For hospital-based midwives, relationships with midwifery colleagues were of key importance, providing the main source of feedback on individual practice. Negotiating these relationships was a major source of emotion work. Although collegial relationships could provide support and affirmation, they were also a frequent source of conflict, particularly between junior and senior midwives. This discord was underpinned by conflicting ideologies of midwifery practice. KEY CONCLUSIONS: The theoretical framework of boundary maintenance was used to interpret the findings. Senior and junior midwives frequently held contradictory models of practice, resulting in competing claims for occupational jurisdiction. Midwives made use of a variety of devices in order to establish and maintain intra-occupational boundaries. Senior midwives attempted to maintain their position through unwritten rules and sanctions, supported by their claim to greater clinical expertise and experience. Junior midwives rarely challenged this authority; their responses were often subversive and designed to create an appearance of compliance. IMPLICATIONS FOR PRACTICE: These findings contribute to our understanding of inter-collegial conflict in UK midwifery, providing insights into workplace harassment and low staff morale, which are likely to exacerbate workforce attrition. The underpinning ideological dissonance experienced by midwives must be acknowledged and tackled for these issues to be effectively addressed.

Adult↗
PubMed2005

Midwifery training to improve ante- and perinatal health in low- and middle-income countries of the former Soviet Union.

Whether in the community or in the hospital, high-quality midwifery care is the preferable model of care for mothers and babies at the first level of care. Countries with professional midwifery care within a supportive system have the best outcomes for mother and babies. The low- and middle-income countries of the former Soviet Union report some of the highest maternal mortality and neonatal mortality in the European region, yet childbirth occurs in institutions with 'skilled attendants' (96-100%). Specific characteristics of maternal and neonatal care in countries of the former Soviet Union include over-medicalization, inappropriate use of technology, unnecessary hospitalizations, and ineffective and/or harmful interventions. This article highlights two midwifery trainings developed specifically to change the maternal and newborn care practices in countries of the former Soviet Union: the Family Centred Maternity Care Training of Trainers and the World Health Organization Essential Antenatal, Perinatal and Postpartum Care Training.

Delivery, Obstetric↗
PubMed1996

Anthropology, nursing and midwifery: a natural alliance?

Anthropology, and its supposed operationalisation within transcultural nursing, is becoming increasingly prominent in educational curricula in the U.K. This increase in interest is driven both by governmental pressure to provide more culturally appropriate care, and an intuitive notion that anthropology, nursing and other related professions such as midwifery have a common basis of mutually overlapping and re-enforcing theory and practice. This paper explores the question of whether there is a natural alliance between anthropology, and the applied aspects of health care disciplines such as nursing and midwifery, by examining some of the concepts underlying each discipline, and the ways in which these concepts are applied in practice. Anthropology is the study of culture, and it is suggested that a more complete understanding of this central concept is essential if it is to be utilised in the applied disciplines encompassed by the practice of nursing and midwifery.

Anthropology↗
PubMed2002

Midwifery education today.

Today, there are more than 7000 CNMs and CMs in the United States, who attend approximately 9% of American births annually in hospitals, birth centers, and homes. Midwives work in a variety of practice models, including group practices with physicians, HMOs, private practices, rural and urban community health centers, and large managed care organizations. CNMs and CMs also serve as administrators, policy makers, and consultants in international maternal and child health. Midwifery education has come a long way since 1931, when the first education program started. The dedication of CNMs to our clients and the midwifery model of care, as well as these midwifery educational innovations, will continue to support the profession's goals of offering humane, holistic, and safe health care to women and their families.

Curriculum↗
PubMedDate not supplied

The University of California, San Diego Nurse-Midwifery Bridge Program. An opportunity to learn intrapartum nursing skills.

This article describes an innovative program developed by the University of California, San Diego Nurse-Midwifery Education Program to supplement the experiential background of prospective nurse-midwifery students. This preprogram enables RNs without previous labor and delivery (maternal/newborn) nursing experience to complete the bridge program and enter the UCSD student nurse-midwifery program on the same clinical level as other students and complete it within the standard time frame. The rationale for the program, its structural framework, and evaluation tools are presented. The authors hope that a description of the program will allow other institutions to replicate UCSD's success.

California↗
PubMedDate not supplied

Service-learning within a midwifery curriculum.

Service-learning entwines community work/volunteerism with midwifery academic instruction, taking the student outside the traditional clinical realm and placing the experience into community-based projects. These projects draw on academic principles, public/community health, liberal arts, and hands on delivery, enticing the student to delve deeper into the lives of the women and families they will be serving. Service-learning directs the student to fully embrace the midwifery philosophy as espoused by the American College of Nurse-Midwives. The experiences of the nurse-midwifery students at the University of Missouri-Columbia are described to show the depth and variety of service-learning as it reflects the scope of well woman care.

Community Health Nursing↗
PubMedDate not supplied

Preserving midwifery practice in a managed care environment.

Since 1925 when nurse-midwifery emerged as a new health profession in the United States, and over the past 30 years under the auspices of the American College of Nurse-Midwives (ACNM), national standards for education, certification, and practice have enabled nurse-midwives to provide the quality of care that is highly valued by policy-makers and consumers. This paper describes the education and practice of over 7,000 midwives who have received national certification through mechanisms developed by the ACNM, describes the strengths of the profession, and reviews the impact of managed care on the practice of midwifery. Also highlighted is ACNM's development of a partnership, with the Maternal and Child Health Bureau, to study the impact of changes in the health care environment on pregnant women and ACNM certified midwives. This partnership is presented as an example of how the ACNM has evolved into an organization that is well-positioned to preserve midwifery in a managed care environment.

Certification↗
PubMed2003

Strategies for interprofessional education: the Interprofessional Team Objective Structured Clinical Examination for midwifery and medical students.

This paper provides an overview of the processes involved in implementing an interprofessional education (IPE) strategy in a recently established School of Human Development at the University of Nottingham. The merger of the academic divisions of child health, midwifery, obstetrics and gynaecology was a deliberate initiative to create an organisational infrastructure intended to enhance opportunities for interprofessional collaborations in research and education. As a first step, a small group of academic midwives and obstetricians formed a project group to find the best way of facilitating IPE for medical and midwifery students at undergraduate level. A discussion is provided of the work the project group undertook to: determine an agreed definition of IPE; decide an action research approach was needed; determine the ways in which teaching and learning strategies were to be implemented, evaluated and compared; and identify the factors inhibiting and enhancing developments. Evaluations have demonstrated that the Interprofessional Team Objective Structured Clinical Examination (ITOSCE) focusing on intrapartum scenarios is effective in promoting interprofessional learning. Both medical and midwifery students and facilitators agree that team working and understanding each other's roles has been enhanced and that although resource intensive, IPE is worth the time and effort involved.

Education, Medical, Undergraduate↗
PubMed1989

Who continue? A preliminary examination of data on continuation of employment in midwifery.

A follow-up descriptive survey of the employment practice of midwives has been undertaken in an attempt to identify factors associated with more long term midwifery practice. Existing data on Notification of Intention to Practise as a Midwife was used to follow up a cohort of midwives who qualified in 1981 and 1982 in Scotland. Midwives who were older, married and who had a higher level of education when starting their midwifery training were more likely to practice long term. The implications for the Scottish midwifery service are discussed.

Employment↗
PubMed1998

Being a midwife or doing midwifery?

As a profession, we need to be more conscious of the way in which our discipline has been subsumed into techno-rational science and away from our 'with women' focus. The ACMI Philosophy says that we value 'being with' women as the foundation for midwifery practice, therefore the concept 'being with' should be a competency which is reflected in the ACMI Professional Standards and Competencies. Currently, there is no Professional Standard for "Being With Women": all midwifery care has been subsumed under the rubric of problem-solving. The problem-solving approach is part of the modernist, techno-rational approach to human life experiences. Problem-solving, I am claiming, has been over-generalised and imposed upon human experiences where it is not appropriate. This paper argues against adopting problem-solving as the framework for practice because this means that every aspect of midwifery care has to be problematised. This paper concludes by suggesting one way in which our philosophy could be honoured in our professional standards and competencies.

Australia↗
PubMed1998

A review of midwifery legislation in Australia--history, current state & future directions.

The legislative regulation of midwifery in Australia, as elsewhere, governs the practice of midwives in the profession and controls the entry of new practitioners. Legislation exists in all states of Australia, and since 1992 there have been marked changes in the nature and scope of legislated control. This paper explores the origins of midwifery regulation, the recent changes in legislation and reviews the current Acts, Ordinances & Rules governing midwifery. In doing so, it examines common themes and areas of discrepancy across the country. The implications of both are discussed in terms of present implementation and future development.

Australia↗
PubMed2003

Women-centred care and caseload models of midwifery.

OBJECTIVE: A partnership caseload model of midwifery-led practice was developed and introduced as an option of maternity care for low risk women at our local health service. To assess the benefits of this new practice model, aspects of continuity, choice, control and satisfaction were examined in women receiving Primary Health Midwifery Care (PHMC) and standard hospital care (SHC). DESIGN AND SETTING: A descriptive comparative design was used and survey data were collected using a modified version of the Mason Survey of Womens' Experience of Maternity Care from a convenience sample of women receiving PHMC (n = 357) and SHC (n = 202) from a large metropolitan health service. FINDINGS: Overall, more women receiving PHMC experienced key aspects of women-centered care-choice, control and continuity than women receiving SHC. KEY CONCLUSIONS: This study, within the limitations of its design and sample size, confirms that low risk women have positively responded to partnership caseload midwifery practice, and the practice model has supported women-centred care with special benefits for primipara women.

Adult↗
PubMed2001

The professionalisation of midwifery through education or politics?

The midwifery profession is redefining itself, with a national initiative to separate from nursing using several strategies at political, legal, educational and professional levels. These include lobbying for a Midwives' Act, a national approach to co-ordinate the education of student midwives, the introduction by the ACMI of competency based practice, the initiation of various models of practice and a three-year Bachelor of Midwifery. This paper argues that the educational strategy employed by midwifery is similar to that used by nursing. This strategy was overtaken by political and economic reforms within the health care sector. We argue that achieving professional dominance is not achieved simply through education but is fundamentally a political process.

Australia↗
PubMedDate not supplied

The evolution of the core competencies for basic midwifery practice.

The Core Competencies for Basic Midwifery Practice, as promulgated by the American College of Nurse-Midwives (ACNM), was first published in 1978 to provide a standard approach to nurse-midwifery education. Since then, it has been revised three times, most recently in 1997, and now serve as the curricular template for ACNM-accredited education programs. This paper discusses the historic evolution of the core competencies and the document's use in midwifery education and practice.

Certification↗
PubMedDate not supplied

Serving women in need: nurse-midwifery practice in the United States.

OBJECTIVE: Nurse-midwifery practices in the United States were examined to study the relationship between certified nurse-midwives' (CNMs) demographic, work setting, and practice characteristics in terms of clientele, practice size, and practice type. Factors that might influence the ability of CNMs to serve populations at risk for poor outcomes were given particular attention. METHODOLOGY: A total of 2,405 responses to a 1998 mailed survey of 6,365 nurse-midwives ever-certified by the American College of Nurse-Midwives were analyzed. RESULTS: Study results indicated that CNMs continue to serve a population who are, based on a social risk profile, disproportionately at risk for poor pregnancy outcomes, including women who are uninsured (16%), immigrant (27%), adolescent (29%), and women of color (50%). It was also found that clientele varied according to practice settings: CNMs working in non-hospital, nonprofit settings served a clientele that was 65% nonwhite, 44% immigrant, 40% adolescent, and 29% uninsured; these CNMs received 61% of their client payments from Medicaid. CNMs working in private offices or for managed care organizations were less likely to serve women with these characteristics. CONCLUSION: Study results, taken in conjunction with research that documents the safety of nurse-midwifery practice, reinforce policy recommendations that support expanded access to nurse-midwifery services. Findings also indicate a need for further research in the areas of CNM workload and productivity in managed care settings and the association between CNM race and ethnicity and the race and ethnicity of their clients.

Ethnicity↗
PubMedDate not supplied

Measuring outcomes of midwifery care: development of an instrument to assess optimality.

Research on the outcomes of midwifery care is hampered by the lack of appropriate instruments that measure both process and outcomes of care in lower risk women. This article describes an effort to adapt an existing measurement instrument focused on the optimal outcomes of care (The Optimality Index-US) to reflect the contemporary style of U.S.-based nurse-midwifery practice. Evidence for content validity of the instrument was derived from literature reports of randomized clinical trials, synthetic reviews, and the clinical consensus of professional reviewers. Eleven perinatal health professionals and consumers, representing disciplines of obstetrics and gynecology, midwifery, epidemiology, and neonatology reviewed the instrument. The instrument was then applied to an existing data set of women who intended to give birth at home (N = 1,286 women) to determine its utility in measuring events in the process and outcome of perinatal health care as managed by nurse-midwives. Results suggest that the tool holds promise for use in outcomes studies of U.S. perinatal care. Further testing of the instrument among diverse multicultural population groups, with various providers, and in diverse birth settings is warranted.

Female↗