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PubMed1994

Care for the imminent miscarriage by midwives and GPs.

A postal questionnaire was sent to a random sample of 495 Dutch general practitioners (GPs) and 278 midwives to evaluate the use of the 'imminent miscarriage' standard used by the Dutch College of General Practitioners. The response rates were 63 and 87% respectively. The first questions asked related to the respondents' routine management of an imminent miscarriage. The second part of the questionnaire addressed the respondents' attitude to the 17 most important guidelines in the standard. Finally, the respondents were invited to describe problems arising in adhering to the standard. Midwives and GPs differed in their management of an imminent miscarriage. Midwives used more 'technology' such as ultrasound scans or a doptone to trace complications or see if the fetus was still viable, whereas the GPs more often carried out vaginal and speculum examinations. Midwives also paid more attention to care following a miscarriage. The guidelines that many respondents did not adhere to involved the period of 10 days for the follow-up appointment and counselling after 6 weeks. Guidelines restricting ultrasound scans and the decision only to refer the patients to an obstetrician after three consecutive miscarriages were also not accepted by all respondents. Respondents mentioned several practical problems or obstacles in adhering to the standard, including women's requests for ultrasound scans or referrals and also the attitude of obstetricians who sometimes simply assumed control. The results will serve as a starting point for updating the standard.

Abortion, Spontaneous↗
PubMed2005

Nurses' and midwives' assertive behaviour in the workplace.

AIM: This paper reports a study describing the assertive behaviour of a group of professional nurses and midwives and exploring potential barriers and facilitators to the use of assertiveness skills in the workplace. BACKGROUND: As nurses and midwives move away from traditional roles, it is increasingly being recognized that they need to behave in an assertive manner. Much literature supports the use of assertive behaviour in clinical practice. Although specific individual assertive behaviours and skills have been examined in many settings, little empirical evidence exists about the frequency and use of assertiveness skills by nurses and midwives in the workplace. While there is evidence on barriers to the use of assertive skills, there is little information about factors that may facilitate their use. METHOD: A survey design was adopted, using a 44-item questionnaire to collect data from a 2.5% random sample of nurses/midwives registered with the National Nursing Board of Ireland. The data were collected in 2003. RESULTS: While respondents frequently complimented their colleagues and often allowed them to express opinions, they were less accomplished at expressing their own opinions or making requests. Assertive behaviours were used more frequently with nursing/midwifery colleagues than with management/medical colleagues. Most used assertiveness skills with other grades of staff in their own profession. Responsibility to patients/clients emerged as a supporting factor for using assertive behaviour. Managers, the work atmosphere and fear were viewed as obstacles. CONCLUSION: Nurses and midwives needs to learn how to behave assertively, and this should be included in both pre- and post-registration education programmes. As use of assertiveness skills was reported to be least frequent with nurse/midwife managers, local policies and guidelines may be needed to encourage clinical practitioners to act autonomously and as client advocates.

Adult↗
PubMed1983

Perceptions of labour: discrepancies between midwives' and patients' ratings.

Women's ratings of their experience of childbirth were compared with midwives' ratings of the women's experience. The midwives' ratings were significantly different from those of their patients. Midwives presented a more positive picture of the woman's experience than did the woman herself. Furthermore, the women reported using psychoprophylactic techniques for controlling discomfort for significantly more of the time than the midwives reported that the women used such techniques. The results are discussed in the context of similar findings reported in the literature.

Adult↗
PubMed2003

Evaluation of a dental health education program for midwives.

OBJECTIVE: The aim of the present study was to evaluate the effect of a dental health program for the midwives in primary health care services in Izmir, Turkey. METHODS: One hundred sixty-four midwives participated in the pilot project. The program was evaluated by quantitative and qualitative methods. The quantitative method assessed the improvement of the dental knowledge level, whereas the qualitative method was conducted to determine the assessments of the participants. RESULTS: The percentages of correct responses given to knowledge items were higher after the program. The midwives defined their role as an important first step for dental services. Education atmosphere was the best characteristic of the program, whereas lack of a written document was an important limitation. CONCLUSION: Despite some limitations, the program was an effective way of improving the oral health knowledge of the midwives and their motivation for dental services.

Adult↗
PubMed2003

Predictive genetic testing for breast cancer and Huntington's disease: the opinions of midwives and nurses in Flanders.

OBJECTIVE: Investigate attitudes of midwives and nurses regarding predictive testing for hereditary breast cancer and Huntington's disease. METHODS: Mail questionnaires were sent to 119 midwives and 881 nurses. RESULTS: The response rate was 58% for midwives, but only 33% for nurses. The attitude toward predictive testing in an asymptomatic adult was more favourable in case of hereditary breast cancer than in case of Huntington's disease, mostly because prevention or therapy is unavailable for the latter condition. Prevention of breast cancer through prophylactic mastectomy elicited adverse reactions among 40% of the participants. Predictive testing for these diseases in an adolescent at the own request was also rated favourably while testing in children at the parents' request was less acceptable. For both diseases, concealing carrier status information from the employer or the insurance company was judged as acceptable by the majority. CONCLUSION: Our findings contribute to the understanding of nurses' and especially midwives' attitudes to predictive testing, which may in turn serve as a basis for genetic education for these groups of health care professionals.

Attitude of Health Personnel↗
PubMed2003

The reactions of general practitioners, nurses and midwives in Flanders concerning breast cancer risks in a high-risk situation.

OBJECTIVE: To investigate the reactions of general practitioners (GPs), nurses and midwives concerning the cancer risks in a high-risk family. METHODS: Questionnaires were sent to 356 GPs, 881 nurses and 119 midwives. RESULTS: The response rate was 60% for GPs, 58% for midwives and 33% for nurses. The breast cancer risk of an unaffected patient from a high-risk family as well as the risk of her daughter were mostly (>80%) correctly evaluated as increased. The percentage answering 'increased risk' dropped to 40% for the daughters of the patient's brother. Half of the GPs and nurses/midwives explicitly mentioned that a predictive DNA test was available. Less than one third would recommend such a test for a young child. Reluctance was also observed regarding prophylactic mastectomy. CONCLUSION: These results should be taken into account in genetic education initiatives for GPs, nurses and midwives.

Attitude of Health Personnel↗
PubMed1994

[Midwives in Switzerland: a study of the work and recruitment status].

The aim of this study was an analysis of the working conditions for midwives in- and outside of obstetric clinics. The study is based on a representative survey carried out among Swiss midwives in 1991 and on statistics of the Swiss Red Cross and the Swiss Federal Statistical Office. It could be shown that there is a high degree of professional satisfaction especially among midwives working on their own; of the negative aspects, the irregular work load and an inadequate income were among the most often named problems. Recruitment problems were evident, as there is a clear lack between the available places in the Swiss schools for midwifery and the need for midwives in this country, at least during periods of a relatively favorable economic situation.

Female↗
PubMed1992

Granny midwives in Mississippi: career and birthing practices.

In this study career and birthing practices of Mississippi granny midwives who held permits and practiced in the early 1980's are reported. Leininger's (1978, 1985) mini ethnonursing method was used as the primary research approach. Although other authors have studied granny midwives in the South using alternate research methods such as Mongeau (1973) in North Carolina using analysis of historical documents and field research; Campbell (1946) in Georgia using field study research; Kroska (1985) in Alabama using mini-ethnography, to date no one has systematically studied granny midwives and their practices in Mississippi. Patterns and themes from verbatim and record analysis data indicate that the Mississippi granny midwives were practitioners who were called by God to practice. The majority had a mother or aunt who had also been a midwife. They used an oligopolistic market approach combined with altruism and care. They practiced family centered maternity care while using three practice modalities of folk, professional and motherwit for enacting their practice. Although their practice was externally regimented, they practiced in an autonomous way as their individual judgment dictated.

Career Mobility↗
PubMed2005

Ways of relating during childbirth: an ethical responsibility and challenge for midwives.

The way in which midwives relate to expectant parents during the process of childbirth greatly influences the parents' childbirth experiences for a long time. We believe that examining and describing ways of relating in naturally occurring interactions during childbirth should be considered as an ethical responsibility. This has been highlighted in relation to parents' experiences and in the light of the relational ethics of Løgstrup. Four couples' and nine midwives' ways of relating were documented by 27 hours of observation, including 14.5 hours of video-recorded sessions. A qualitative content analysis was conducted. The midwives strongly influenced the different ways of relating and three aspects of professional competence were disclosed. The results can contribute to reflections about current praxis as an ethical demand for midwives.

Female↗
PubMed2003

Abortion beliefs and practices among midwives (parteras) in a rural Mexican township.

Reproduction and motherhood are among the most important components of women's identity throughout Mexico and, for many women, are the only vehicles for gaining recognition and status in the family and community. At the same time, however, abortion is a central experience in the lives of many women and carries with it the complexities and contradictions of women's reproductive and sexual health. This paper presents results from an ethnographic study conducted with midwives in one rural township of Morelos, Mexico to understand their conceptualizations of and practices related to abortion and postabortion care. Overall, midwives viewed miscarriage as a woman's failure to fulfill her primary role as mother and induced abortion as a grave sin or crime. Nevertheless, under certain circumstances induced abortion was justified for many midwives. Helping women to "let down the period" in situations when a woman's menstrual period was delayed was acceptable to midwives as it was not viewed as abortion and enabled women to regain health and well-being.

Abortion, Induced↗
PubMed1999

Leprosy elimination through integrated basic health services in Myanmar: the role of midwives.

Myanmar is one of the top 16 countries identified by WHO as being hyperendemic for leprosy. Multi-drug therapy (MDT) was introduced in 1988 as a vertical programme and gradually integrated into the basic health services (BHS), achieving 100% coverage over the registered cases by 1995. To achieve maximum coverage of and benefit for patients, both leprosy vertical staff and BHS staff were trained to implement MDT whilst performing routine BHS activities. This included a total of 8615 trained midwives who were mobilized for the nationwide leprosy elimination programme (LEP). They worked at village level in various parts of the country and were willing and able to carry out basic tasks in leprosy management, such as the implementation of MDT using blister-calender packs carrying a month's supply of drugs. This study was performed to assess the workload of midwives and their attitude towards LEP. The authors conclude that midwives in Myanmar show a high level of commitment and reliability, which are essential contributing factors to achieve the current goal of leprosy elimination by the year 2000. Along with the present trend of decreasing prevalence rate, leprosy could no longer be considered as a public health problem at national level by the year 2000 in Myanmar. However, because of its long incubation period, new leprosy patients may arise even after the elimination target is achieved, whilst many other patients may become disabled. A community-based sustainable approach for the post-elimination phase, after the year 2000, will be essential and the contribution of the midwives may be of considerable importance.

Adult↗
PubMed1999

[Birth and death of a profession. Certified midwives in Mexico (Spanish)].

This study examines the rise and development of professional midwifery in Mexico. The authors sustain that this profession was created in the 19th century by the medical profession as a means to eliminate traditional midwives and obtain access to pregnant women, women about to give birth, and women in the puerperal period. The relationship between physicians and midwives was never without its contradictions; however, conflicts increased after the establishment of gynecology as a specialty in Mexico. In the 20th century, physicians imposed increasingly stringent limitations on the activities of certified midwives and instead promoted training for traditional midwives, until professional midwifery was abandoned.

History, 19th Century↗
PubMed2003

What men think of midwives.

It is now widely accepted that woman-centred maternity care is important. But surely planners and service providers should also examine the needs of expectant fathers? A postal survey of a randomly selected sample of 837 fathers-to-be throughout the UK found that midwives are not meeting all men's information and support needs. Although midwives were more highly rated than GPs and hospital doctors, men felt that midwives could still listen to them more, enable them to ask questions and explain things to help them better understand physical processes, clinical procedures, the baby's behaviour and their partner's needs. Most men wanted to be involved in their partner's pregnancy and care, but many felt left out by health professionals. Men play a pivotal role in supporting their partner during pregnancy and influence women's baby-feeding choices and esteem after giving birth. It is crucial that midwives see men not as an extra burden, but as individuals with needs of their own who are usually the main supporters of the women and babies at the centre of midwifery care.

Adolescent↗
PubMed2005

Neonatal examination: are midwives clinically effective?

The objective of the pilot study was to test the appropriateness of an audit tool developed to determine the clinical effectiveness of midwives carrying out neonatal examination of the newborn. The audit was undertaken by reviewing retrospective data, collected from midwives' personal clinical records of neonates and the case records of the babies they had examined. The data was gathered over a period of 18 months, and included the records of 482 term babies. The setting was a district general hospital in the east of England. The participants were all midwives who had successfully completed the neurobehavioural examination of the newborn course, and practising at a local district general hospital. The findings of the study indicate that the audit tool was sufficiently robust to test the clinical effectiveness of midwives' detection of specific congenital abnormalities. Clinical effectiveness rates were reassuringly high. The study also began to highlight the positive impact on the improvement of the service available to women. A further study has been started to compare the clinical effectiveness rates between professional groups.

Adult↗
PubMed2005

Retaining valued midwives.

In a Delphi study of 42 experienced midwives at an NHS Trust in south-east England, it was established that leadership issues were at the centre of what encouraged practitioners to continue in post. Central to midwives' interest was the equitable management of off-duty/leave arrangements, opportunities to influence practice and protocol decision-making, feeling stimulated, valued and challenged as a practitioner, receiving professional development support and working with senior midwives who proved effective role models. Beyond reward opportunities associated with Agenda for Change or other initiatives, it is argued that midwifery managers have a key opportunity to influence the employment experience of midwives and enhance retention of staff by actively engaging in the above activities.

Clinical Competence↗
PubMedDate not supplied

Are midwives ready for the proposals for change?

This paper analyses the results of a small study into what midwives feel about the specific proposals for changes to the delivery of maternity services as outlined in Changing Childbirth. The paper explores the important issues of midwives' attitudes to the proposed changes and how they view their current working situation. The author concludes from the survey that midwives need to reappraise their attitudes to women and childbirth, and that greater support from senior midwives is essential.

England↗
PubMed1989

Mothers', midwives' and obstetricians' views on the features of obstetric care which influence satisfaction with childbirth.

A sample of 15 women was interviewed 18-96 h postnatally to identify objective features of labour and postnatal care about which they expressed preferences. The importance of each item to a mother's satisfaction was then rated by a sample of 224 similar women. The same questionnaire was also completed by 28 midwives and 52 obstetricians. The items rated most important concerned the explanation of procedures and the involvement of mothers in administering or choosing them. Second was support from the presence of a partner and qualified hospital staff, third the physical comfort of the postnatal ward. The avoidance of obstetric interventions, such as episiotomy or use of forceps, was less important than the presence of these other features. The mean ranking given to each item by the midwives and obstetricians correlated very highly with that given by the mothers; those caring for obstetric patients are much more sensitive to their preferences than is popularly believed. There was no evidence that midwives perceived patients' needs more accurately than did the obstetricians. Discrepancies between the three groups' ranking of specific items may reflect the defence of their respective roles by each profession.

Adolescent↗
PubMed1994

Stress in midwifery: a comparison of midwives and nurses using the Work Environment Scale.

Previous research into midwifery has identified a number of potential sources of stress without attempting to understand the variables that might contribute to it. The study sample was drawn from a population of registered nurses and midwives and compares the work environment of 29 midwives with 180 nurses, using the Work Environment Scale Questionnaire. Significant differences were found between midwives and nurses for involvement, supervisor support, autonomy, work pressure and clarity of roles. These results have the potential for forming the basis of future research.

Analysis of Variance↗