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PubMed2004

[8 out of 10 midwives informed about folic acid. Most of them considered their knowledge about folic acid not sufficient].

UNLABELLED: Deficiency of folic acid increases the risk for neural tube defects among newborn children and megaloblastic anaemia in the mother. The aim of this study was to make a survey of how midwives working in maternity health care, family planning guidance, and specialist prenatal care in a Swedish county inform women of childbearing age about folic acid. The questionnaire study showed that 79% of the midwives informed the women about folic acid. Usually, the women received information first when they asked for it and midwifes were less prone to inform young women about folic acid. 87% of the midwives felt that they did not know enough about folic acid. CONCLUSIONS: Midwives play an important role in information about the need of folic acid intake for women in childbearing age. Changes in local routines, guidelines and further education of midwifes would subsequently provide information about the importance of folic acid to women in childbearing age.

Education, Nursing, Continuing↗
PubMed2004

Working time schedule of midwives in obstetric-neonatal unit versus the level of mother satisfaction with care.

The majority of studies by international and Polish authors focus on the evaluation of the level of patient satisfaction with health care. A relatively small number of reports concern factors which determine satisfaction. According to the modern approach towards care of mother and baby, a mother hospitalized in a rooming-in system is expected to independently take care of her baby and feed it on demand from its birth. A midwife should teach the mother the nursing of the baby and herself, inform, educate, support and communicate. Such care requires that the majority of time is spent with mothers and their babies. It was assumed that one of the organizational factors determining the level of satisfaction with care may be the time devoted by midwives to mothers. The following research problem was formulated: Does working time schedule of midwives taking care of women after labour affect the level of mother satisfaction with care? The results of preliminary studies showed that the percentage of direct nursing time offered to mothers by midwives in obstetric ward was small (29%), while that devoted by midwives to care of babies in neonatal unit was slightly higher (42.5%).

Appointments and Schedules↗
PubMed1994

Nurse practitioners, certified nurse midwives, and nurse anesthetists: changing care in acute care hospitals in New York City.

To respond to the shrinking pool of primary care physicians and to demands from managed care programs for cost containment, hospitals in New York City have increased their use of nurse practitioners, certified nurse midwives, and nurse anesthetists, creating an increased demand for these personnel. We report here on a survey of hospitals and schools of nursing in New York City and present findings on (a) current use of, and projected demand for nurse practitioners (NPs), certified nurse midwives (midwives) and nurse anesthetists (anesthetists) in hospitals in New York City; (b) the practice patterns of NPs, midwives, and anesthetists currently employed in hospitals; and (c) current and projected enrollment and curriculum in NP, midwifery, and anesthetist education programs in the New York metropolitan area.

Adult↗
PubMed1996

Why should midwives be concerned with ethics?

Is there such a thing as midwifery ethics? Yes, there is. As human beings (moral agents), midwives are to be ethical, moral, responsible persons and professionals. Midwives work in moral relationships with other persons. They serve by the moral standards of their profession as now embodied in written codes of ethics, a profession that is part of the larger health care profession. As part of the professional world, midwives participate in the general standard that to be professional is to be ethical and to be unethical is to be unprofessional. The professions, in turn, are part of what Eric Fromm calls "human ethics." If midwives are to be ethical, we suggest they need to understand ethics and to reason morally. Better health care for all is the result.

Ethics, Nursing↗
PubMed1998

[A century of midwives' trade organization activity].

In Finland, the first midwifery associations were founded in 1898. During the early years, the central aim of the associations was to improve the social and economical status of midwives. General meetings of midwives were held where, in addition to following presentations, midwives had a chance to discuss specific issues of the profession. In the third general meeting, the initiative was taken to form a central administration and, through different stages The Central Federation of the Finnish Midwife Associations was founded in 1919. Later the name was changed into The Finnish Federation of Midwives.

Finland↗
PubMed1995

Comparison of obstetric outcome of a primary-care access clinic staffed by certified nurse-midwives and a private practice group of obstetricians in the same community.

OBJECTIVE: The purpose of this study was to compare the obstetric outcome of a primary-care access clinic staffed by certified nurse-midwives, supervised by a private practice group of four obstetricians, with the obstetric outcome of that group's private practice patients. STUDY DESIGN: A retrospective cohort study was performed. Obstetric outcome of 496 clinic patients was compared with that of 611 private patients in the same community from Aug. 1, 1991, to March 31, 1994. RESULTS: Obstetric outcomes as measured by (1) perinatal morbidity and mortality, (2) Apgar score, (3) birth weights, and (4) prematurity rates were comparable between the two groups. Significant was the cesarean section rate of 13.1% (10.5% primary) for the clinic patients and 26.4% (18.5% primary) for the private patients and the high percentage (81.8%) of private patients who elected to have repeat cesarean sections. CONCLUSIONS: (1) Low-income, uninsured, and underinsured women who have access to excellent prenatal care with supervised certified nurse-midwives can have obstetric outcomes similar to women having prenatal care with private obstetricians. (2) Prenatal care with supervised certified nurse-midwives can reduce the cesarean section rate without compromising infant outcome. (3) Utilization of certified nurse-midwives supervised by obstetricians may provide the optimum model for perinatal care, particularly for those women who are at high risk because of social and economic factors and who are currently underserved.

Adult↗
PubMed1993

Midwives in the Mexican health system.

The health care system in Mexico was built upon a western model in which curative rather than preventive medicine is emphasized. However, the incorporation of indigenous midwives into maternal and child care and family planning programs by several public health agencies is an exception to the governmental health policies. An analysis of midwife preferences among rural women indicates that primarily poor illiterate women with children, living in remote areas with difficult access, rely on midwives. The continued reliance on midwives by this sector of the population makes the government programs most important. These programs are a unique case in which the incorporation of traditional practitioners in the modern health system has occurred. However, in order to implement programs that have the capability to offer rural women the benefits of both health systems, the incorporation of the traditional midwives requires not only the upgrading of their skills in modern antiseptic techniques, but the recognition of the contributions of traditional health practices, and the research of elements and practices to foster its understanding.

Adolescent↗
PubMedDate not supplied

Caring for women from culturally diverse backgrounds: midwives' experiences.

The aim of this study was to show how midwives cared for women from culturally diverse backgrounds. In-depth interviews were used to collect data from 12 experienced midwives who volunteered to participate in the study from a midwifery unit with a culturally diverse population. Study findings revealed that midwives preserved and accommodated the cultural preferences of women from a Chinese background by incorporating the forces of yin-yang into care, heeding the maternal hierarchy and women's stoicism; and for women from an Islamic background by heeding modesty and gender preferences (Hejab), the place of prayer in daily life (Salat), and the imperative of visiting by others (Hadith). Hence, midwives negotiated care that was culturally comfortable for women and their families. Furthermore, triangulated studies addressing the partnership between the midwife and the diverse client are needed, as well as the development of aspects of the health service that are more culturally sensitive.

Adult↗
PubMed2005

Evaluation of World Health Organization partograph implementation by midwives for maternity home birth in Medan, Indonesia.

OBJECTIVE: to assess the effectiveness of promoting the use of the World Health Organization (WHO) partograph by midwives for labour in a maternity home by comparing outcomes after birth. SETTING: Medan city, North Sumatera Province, Indonesia. PARTICIPANTS: 20 midwives who regularly conducted births in maternity homes, randomly allocated into two equal groups. DESIGN: cluster randomised-control trial. INTERVENTION: under supervision from a team of obstetricians, midwives in the intervention group were introduced to the WHO partograph, trained in its use and instructed to use it in subsequent labours. MEASUREMENTS AND FINDINGS: there were 304 eligible women with vertex presentations among 358 labouring women in the intervention group and 322 among 363 in the control group. Among the intervention group, 304 (92.4%) partographs were correctly completed. From 71 women with the graph beyond the alert line, 42 (65%) were referred to hospital. Introducing the partograph significantly increased referral rate, and reduced the number of vaginal examinations, oxytocin use and obstructed labour. The proportions of caesarean sections and prolonged labour were not significantly reduced. Apgar scores of less than 7 at 1min was reduced significantly, whereas Apgar scores at 5mins and requirement for neonatal resuscitation were not significantly different. Fetal death and early neonatal death rates were too low to compare. IMPLICATIONS FOR PRACTICE: a training programme with follow-up supervision and monitoring may be of use when introducing the WHO partograph in other similar settings, and the findings of this study suggest that the appropriate time of referral needs more emphasis in continuing education. CONCLUSION: the WHO partograph should be promoted for use by midwives who care for labouring women in a maternity home.

Adult↗
PubMed2005

Are Slovenian midwives and nurses ready to take on a greater role in caring for women with postnatal depression?

OBJECTIVE: to answer the question of whether Slovenian midwives and nurses feel prepared to take over the responsibility for the care of women with postnatal depression. DESIGN: questionnaire survey using a tool designed with data from previously conducted focus groups and a literature review. SETTING: the central maternity hospital and six community centres in the Slovenian capital city of Ljubljana. PARTICIPANTS: 134 participants completed the questionnaire, out of 175 distributed. The sample consisted of 86 participants from the maternity hospital, who were almost evenly divided into midwives and nurses, and 48 participants from the community services, where nurses prevailed over midwives. FINDINGS: participants lacked knowledge of postnatal mental health, and 99% of them expressed the need for more information. They considered the woman's partner to be the most appropriate person to detect postnatal depression, and doctors to be the key people involved in the treatment. In order to take over the role of prevention, detection and management of postnatal depression, midwives and nurses felt that they would need more knowledge and more continuous contact with women. KEY CONCLUSIONS: most participants did not know the main characteristics of postnatal depression, and were not confident in their knowledge. They felt that they lacked continuity in the care they could provide, and this affected their ability to establish a trusting relationship with women. IMPLICATIONS FOR PRACTICE: information on postnatal mental health should be provided during undergraduate study of midwifery and nursing, and with continuous education through seminars and workshops in Slovenia. In order to enable continuity of carer, the role of the midwife should be expanded in pregnancy, and more visits in the puerperium should be planned.

Adult↗
PubMed2000

The potential of midwives providing primary obstetric care to reduce perinatal deaths in a rural region.

OBJECTIVE: To determine the proportion of perinatal deaths that could be reduced by midwives providing primary obstetric services. METHOD: The study was conducted in a rural region of the Eastern Cape, South Africa. The primary obstetric and final causes of perinatal deaths and avoidable factors related to these deaths were determined in a large town and two small towns. RESULTS: In the three towns 52 (48.6%) of the 107 avoidable factors were related to medical care while 20 (38.5%) of these had the potential to be prevented at the level of care rendered by midwives. In the large town 21 (20.6%) of 102 and in the smaller towns 15 (24.6%) of 61 perinatal deaths had potential for intervention by midwives. CONCLUSION: The 22.1% of perinatal deaths potentially preventable by midwives presupposes complete patient cooperation within an optimally functioning health system.

Adolescent↗
PubMed2001

Intrapartum fetal heart rate monitoring: do Swiss midwives implement evidence into practice?

OBJECTIVE: Evidence Based Medicine has shown that the results of continuous electronic fetal heart rate (FHR) monitoring are equivalent to those of intermittent auscultation. We were interested in the method midwives preferred to use to monitor FHR during labour and the factors which influenced their choice of method. STUDY DESIGN: A questionnaire with Likert scaled questions was sent to 500 German speaking Swiss midwives. Data analysis was performed by using SPSS for Windows. RESULTS: The majority of the midwives were confident monitoring FHR using intermittent auscultation as their main method during low risk delivery. The essential factors influencing the choice of method of FHR monitoring were their own personal experience and hospital guidelines. Less important were factors such as risk category, litigation, the mother's preferences, research results, time and staffing levels. CONCLUSIONS: Although the skills necessary to implement evidence into obstetrical practice are still available, evidence based research results do not seem to be of great importance, when midwives decide which method to use for intrapartum FHR monitoring. Hospital policies and the professional training received were more important factors. Programs designed to implement evidence in care should reflect the identification and use of these factors in order to facilitate the process of realisation.

Evidence-Based Medicine↗
PubMed2003

How midwives learn about breastfeeding.

Little is known about how midwives learn about breastfeeding. This study asked midwives to identify breastfeeding information resources used and perceived value for their learning. A mail questionnaire was sent to midwives (n = 3500) through the Australian College of Midwives Inc. (ACMI). A response rate of 31.6% (n = 1105) was obtained. On-the-job experience was the most common source accessed and continuing education the most valuable. Very few respondents (3.1% n = 34) acknowledged either their hospital or university midwifery education program as a valuable breastfeeding information source. There is scope for continuing education programs to address evidence-based lactation and infant feeding information. Midwifery curricula need to teach in-depth knowledge of human lactation and develop clinicians' skill base to assist breastfeeding women. The development of national standards for course accreditation on lactation and infant feeding by ACMI, Baby Friendly Hospital Initiative (BFHI) and Australian Breastfeeding Association (ABA) would be a useful quality measure.

Adult↗
PubMed2001

A survey of midwives who participated in a randomised trial of perineal massage in labour.

A multi-centred randomised perineal massage in labour trial (PMLT) was conducted in which participating midwives randomised eligible women in the second stage of labour. A survey of these midwives was conducted after completion of the PMLT, but before results had been analysed and presented. The aim of the study was to seek from midwives, following the PMLT, their reasons why some eligible women were not randomly allocated to a group; why others did not receive care as allocated and the midwives' views about the massage, including whether significant trial results would influence their clinical practice. (This paper presents the results of this survey.)

Adult↗
PubMed2004

North Queensland midwives' experience with a team model of midwifery care.

This qualitative study investigated midwives' perception of a team midwifery model of care implemented in North Queensland, Australia. A midwifery model of care is the use of primary health care principles to deliver care throughout the woman's entire pregnancy and postpartum period in partnership with other members of the health care team. Four focus groups were undertaken with 22 midwives to determine their perception of the team midwifery model of care. The study found the experience of the team midwifery model of care for midwives had been influenced by organisational characteristics, team structures, and accountability. Recommendations from this study include the need for an appropriate environmental scan and implementation of planning process and team building before the introduction of any new model of care, transportability of health care services to any new model of care, and a shared governance to allow midwives to meet both organisational and professional goals.

Attitude of Health Personnel↗
PubMed2003

Postregistration genetics education provision for nurses, midwives and health visitors in the UK.

BACKGROUND: Rapid advances in genetics following the sequencing of the human genome will progressively reach all aspects of health care. Developments in genetics will increasingly having a significant influence on the work of nurses, midwives and health visitors. Therefore, these practitioners need to understand the impact that genetics will have for their patients and should be able to incorporate this new knowledge into their clinical practice to ensure that they continue to offer holistic care and influence the strategic development of health care. An earlier survey of higher education institutions in the United Kingdom (UK) offering preregistration courses for nurses, midwives and health visitors showed that the teaching of genetics was very limited in most curricula. AIM: To assess the provision of education on genetics for postregistration and postgraduate nurses, midwives and health visitors in the UK, as these practitioners are mostly likely to influence current health care provision and initiate changes in clinical practice. METHOD: A total of 38 higher education institutions from 11 regions were surveyed via telephone or e-mail, using a semi-structured interview schedule. RESULTS: The findings showed that the inclusion of genetics in the curriculum was highly variable. A small number of institutions (n = 3) offered courses with whole modules on genetics, whereas 19 of the 38 responding did not include any genetics in their curriculum at a postregistration level. CONCLUSION: The findings suggest that there is lack of recognition of the impact genetics is likely to have on health care. It is, therefore, recommended that the profile and relevance of genetics to nurses, midwives and health visitors should be promoted by the major organizations responsible for developing, commissioning and providing health care education.

Community Health Nursing↗
PubMed1999

Protective steering: a grounded theory study of the processes by which midwives facilitate informed choices during pregnancy.

Helping women to make informed choices during pregnancy is an important and complex part of a midwife's role that does not appear as yet to have been investigated in depth. The purpose of this study was to use a grounded theory approach to investigate the processes involved when midwives engage in facilitating the making of informed choices for women in the United Kingdom. Interactions between midwives and pregnant women were observed and recorded and focused interviews were conducted with the midwives. Data were analysed according to the grounded theory method. The core category was identified as protective steering, whereby midwives were concerned to protect the women in their care, as well as themselves, when choices were made. Substantive categories were orienting, protective gatekeeping and raising awareness.

Decision Making↗
PubMed2002

Midwives and human rights: dream or reality?

Midwives as predominantly women caring for other women are subject to the same human rights violations and abuse that affect all the women of the world. They need to know and recognise these human rights violations before being able to take action that will reduce or eliminate such harmful practices. In this article, I address gender-based violations of the basic human rights of particular concern to women during their childbearing years, such as personal safety, respect for human dignity, fair and equitable access to health services, along with autonomous decision-making based on complete and unbiased information. The ethical and legal foundations of human rights are discussed in relation to viewing women as fully human, fully persons. Guidance for midwives taken from key documents of the International Confederation of Midwives are offered as midwives work together with women to end gender-based violations of one's human rights.

Decision Making↗