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PubMedDate not supplied

Credentialing certified nurse-midwives.

As the U. S. health care system struggles to respond to demands for accessible, quality, sensitive, and cost-effective care, the contribution of nurse-midwives is receiving renewed attention. Many institutions are seeking assistance as they move to credential certified nurse-midwives for the first time or as they reassess their credentialing policies and procedures. This article provides an extensive review of multiple issues relating to credentialing nurse-midwives including nurse-midwifery education, licensure, scope of practice, professional liability, relationship with physicians, and delineation of privileges. The article also reviews Medicare Hospital Conditions of Participation and Joint Commission on Accreditation of Healthcare Organizations requirements as they relate to nurse-midwifery practice.

Credentialing↗
PubMedDate not supplied

The International Confederation of Midwives. Past history, present activities, and future challenges.

The International Confederation of Midwives is celebrating its 75th anniversary in 1994. The Confederation is composed of 61 member associations from 50 countries and thus includes more than 100,000 midwives. Its aims are to advance midwifery education and the role of the professional midwife, to improve the standard of maternal and child health care, and to support and advise associations of midwives in liaison with their governments. This article reviews the history and current activities of the Confederation, and discusses future challenges and new directions for the organization.

Forecasting↗
PubMedDate not supplied

An update on the credentialing of midwives by the ACNM.

This paper chronicles the events that took place between April 1994 and February 1995 specific to setting the standard for professional midwifery in the United States through the credentialing of midwives (other than nurse-midwives) by the American College of Nurse-Midwives (ACNM). A collection of documents that record the actions of ACNM leaders and the views of ACNM members related to this issue is also provided. The ACNM Board of Directors has determined that any non-nurse who is a graduate of an ACNM Division of Accreditation accredited midwifery program and has passed an ACNM Certification Council (ACC) national midwifery examination will be called an ACC Certified Midwife.

Credentialing↗
PubMed1993

Combining work with caring for children, findings from a longitudinal study of midwives' careers.

Facilities that enable women to combine work with caring for children are of particular importance to professions comprised primarily of women, such as midwifery. This article presents findings on four aspects of this topic obtained in the course of a 13-year longitudinal study of midwives' careers: the numbers who had children and had taken breaks for pregnancy and child care, opportunities for professional development during periods of child care; the effect of such breaks on career progression, and the importance of family commitments in relation to retention. The majority of both cohorts were single women in their twenties at the time that they qualified as midwives. During the course of the study more than half the respondents had children; pregnancy was cited as the main reason for leaving midwifery followed in later years by being unable to find posts with hours of work that could be combined with family commitments. Findings showed little evidence of employers keeping in touch with midwives during child care breaks about job opportunities and professional developments; the majority of respondents however, said that they would have welcomed such contact. In common with other work on women's careers, this study demonstrated that breaks for child care are associated with slower rates of promotion. A wide range of issues were identified by respondents as relevant to retention, with those relating to combining work and family rated consistently as among the most important. The study demonstrates the importance that should be accorded to this issue when overall policies to improve retention in midwifery are being considered.

Adult↗
PubMed1994

A descriptive study of childbirth education provided by midwives in Sweden.

OBJECTIVE: to describe the content, modes of working and reaction/interaction of childbirth education provided by midwives in Sweden. DESIGN: qualitative, using non-participant observation to collect the data. Grounded theory approach was used. SETTING: antenatal classes provided in the community in Sweden. PARTICIPANTS: twelve midwives with varying lengths of experience in teaching antenatal classes, and the prospective parents who attended these classes. MEASUREMENTS AND FINDINGS: three perspectives on the content and three modes of working were found. Combinations of the differing perspectives and working modes provided differing interactions within the classes. KEY CONCLUSIONS: the confirming/mixed model resulted in dialogue in the classes. It was assumed that this model would contribute to an increased understanding of the coming experience of giving birth. IMPLICATIONS FOR PRACTICE: the findings provide midwives with a basis for reflection on their experiences as leaders in the childbirth preparation part of education for parenthood.

Curriculum↗
PubMed2005

Complementary therapies in pregnancy: midwives' and obstetricians' appreciation of risk.

Complementary medicine is increasingly being integrated into maternity care, primarily by midwives in response to mothers' demands. Midwives and obstetricians must, however, develop a comprehensive evidence-based knowledge of risks, as well as benefits, to ensure that any complementary therapies in pregnancy and childbirth are not only effective but also safe. This paper discusses the results of an evaluative audit of midwives' and obstetricians' knowledge of and attitudes to complementary therapies in pregnancy in an NHS antenatal clinic which revealed a generalised lack of knowledge and poor understanding of the possible risks to women.

Attitude of Health Personnel↗
PubMedDate not supplied

The American College of Nurse-Midwives and its antecedents: a historic time line.

In celebration of the 50th anniversary of the American College of Nurse-Midwives, this time line presents a chronologic history of the development of nurse-midwifery in the United States. It places the introduction of nurse-midwifery in American health care into its historic context and follows the evolution of the profession through early attempts at forming a national organization, the eventual formation of the American College of Nurse-Midwifery, and the subsequent merger with the American Association of Nurse-Midwives, to create the American College of Nurse-Midwives. The work of the College between 1955 and the turn of the 21st century is highlighted.

Female↗
PubMedDate not supplied

The American College of Nurse-Midwives' dream becomes reality: The Division of Accreditation.

Recognized continuously by the US Department of Education since 1982 as a specialized accrediting agency, the American College of Nurse-Midwives' Division of Accreditation (DOA) accredits not only nurse-midwifery education programs at the postbaccalaureate or higher academic level as certificate and graduate programs for registered nurses (RNs), but also precertification programs for professional midwives from other countries who are licensed as RNs in the United States. The DOA also accredits midwifery education programs for non-nurses at the postbaccalaureate or higher academic level as certificate and graduate programs, and precertification programs for professional midwives from other countries. The accreditation process is a voluntary activity involving both nurse-midwifery and/or midwifery education programs and the DOA. Present plans include another expansion of recognition: to become an institutional accreditation agency for independent and proprietary schools and to continue as a programmatic accrediting agency. Since its inception, the accreditation process has been viewed as a positive development in nurse-midwifery education.

Accreditation↗
PubMed2005

What do midwives and nurses in Turkey know about nutrition in the first six months of life.

OBJECTIVE: to discover what midwives and nurses in Turkey know and advise about nutrition in the first 6 months of life. DESIGN: a descriptive, cross-sectional study. SETTING: health clinics and mother and baby health and family planning centres in the municipality of Ankara. PARTICIPANTS: 301 midwives and nurses selected by stratified, random sampling. FINDINGS: nine questions related to the features and benefits of breast milk. The mean number of questions answered correctly was 7.55 (standard deviation [SD]=1.25). Participants agreed that the babies should be breast fed for the first 6 months of life (n=184; 61.1%) and that complementary food could be introduced at 6 months of age (n=291; 96.7%). Most participants (n=223; 74.1%) recommended that mothers who have to resume work should express and store breast milk, and their babies should be fed with it. Many participants noted that there may be one or more situations when artificial milk should be given in the first 6 months of life (n=286; 95.0%). Almost all of the participants (n=292; 97.0%) gave one or more suggestions of when breast milk was sufficient or insufficient. CONCLUSIONS: most midwives and nurses in this research had adequate knowledge related to babies in the first 6 months of life. However, with continuing education, knowledge deficits can be corrected, and awareness of their roles and responsibilities can be increased in achieving one of Turkey's priority goals for the 21st Century, that of decreasing the baby death rate.

Adult↗
PubMed2003

The effect of small peer group continuous quality improvement on the clinical practice of midwives in The Netherlands.

OBJECTIVE: To study the effects of small group continuous quality improvement (CQI) on the clinical practice of midwives in the Netherlands. DESIGN: Randomised pre-/post-test (balanced block). INTERVENTION: The CQI groups were assigned to either the set of peer review topics including 'perineal repair' and 'artificial rupture of the membranes (ARM)', or to the set of topics including 'airway aspiration' and 'measuring blood pressure'. The two research groups acted as each other's control group. SETTING: The Netherlands. PARTICIPANTS: Two hundred and fifty-five individual midwives practising in primary and secondary care who made up 28 peer groups. MEASUREMENT AND KEY FINDINGS: Questionnaires were used to collect data on clinical practice prior to the start of the intervention and one year later. Pre- and post-test data were received from 156 respondents. The intervention had a positive effect on adherence to the recommendations with respect to airway aspiration of the baby and measuring blood pressure. For ARM, no difference was found between pre- and post-test adherence to recommendations in the intervention group, while in the control group, the percentage of midwives that adhered to the recommendations decreased in the period between pre- and post-test. No significant effect was found for perineal repair. IMPLICATIONS FOR PRACTICE: Small group CQI had a positive effect on changing clinical practice when the learning of new skills (e.g. learning a new suturing technique) was not necessary. Additional interventions are needed when implementing guidelines that recommend the learning of new skills.

Adult↗
PubMed1996

'Burnout' among Dutch midwives.

OBJECTIVE: to determine the effect of workload on 'burnout' having considered work capacity. DESIGN: cross-sectional study. SETTING: Dutch community midwives in independent practice. PARTICIPANTS: 200 Dutch community midwives. MEASUREMENTS: three-week diary recordings, a questionnaire on practice and personal characteristics, and a questionnaire on 'burnout', social support and coping style. FINDINGS: differences in 'burnout' can be explained partly by the midwife's workload and partly by her work capacity. A high workload may lead to 'burnout' when a midwife is unable to handle stressful situations. KEY CONCLUSIONS: when a higher percentage of the supervised births occurred at the client's own home instead of during a short-stay hospital visit, the chances of 'burnout' are lower. IMPLICATIONS FOR PRACTICE: changes in the organisation of Dutch community midwifery care may contribute to the reduction of 'burnout'. 'Burnout' is a complex phenomenon influenced both by individual and organisational factors. When formulating policy to reduce 'burnout' among midwives specific work-related factors must be considered and emphasis be placed on the importance of personal resources.

Adaptation, Psychological↗
PubMed2003

Integration of post-abortion care: the role of township medical officers and midwives in Myanmar.

Complications of unsafe abortion are a significant cause of maternal morbidity and mortality in Myanmar, and are recognised by the Ministry of Health as a priority. The Department of Health developed a strategy to address the problem of abortion complications by integrating post-abortion care and contraceptive services into the existing township health system. The quality of post-abortion care was assessed by the Department of Health in 2000, using a baseline survey of health providers and post-abortion women in Bago Division. The integration of post-abortion care was led by the Township Medical Officers, who provided monthly in-service training and supervision of health care workers in each township. Hospital-based doctors and nurses, clinic midwives, village midwives and other volunteer health providers, including traditional birth attendants, were all trained. The role of the local clinic midwife was extended to make follow-up home visits to the women with post-abortion complications and provide them with contraception when requested. Preliminary results show positive outcomes. However, donor-funded projects may have a destabilizing effect on township services by diverting attention and resources; donors need to work with government to support its priorities for health care. The future nationwide integration of post-abortion care services into township services should be planned in consultation with Township Medical Officers and midwives, the key providers of these services.

Abortion, Induced↗
PubMed1996

Midwives, breastfeeding, and Baby Friendly Australia.

Breastfeeding is a fundamental practice area for all midwives in Australia, and most midwives and maternity units claim that they recommend breastfeeding. Midwives have the opportunity to support women, or to erect barriers to the early establishment of breastfeeding. The author contends that through an understanding of the Baby Friendly Hospital Initiative's "Ten steps to successful breastfeeding", within the social/holistic model of midwifery care, long term health and social benefits will ensue.

Australia↗
PubMedDate not supplied

Assessment of breastfeeding knowledge of nurse practitioners and nurse-midwives.

The purpose of this study was to replicate a national study of physician knowledge, experience, and attitudes about breastfeeding. All family, pediatric, and women's health care nurse practitioners and nurse-midwives in a northwestern state were surveyed using a mail questionnaire; the response rate was 60.4%. Respondents were nearly unanimous in believing that "breast is best" and in recommending breastfeeding to expectant mothers as a part of their role. In general, 70% of respondents considered themselves effective or very effective in meeting the needs of breastfeeding patients. Although respondents were very supportive of breastfeeding, they were less knowledgeable about specific management strategies. There were differences in attitudes among nursing specialties and with years of experience. Overall, this statewide sample of nurse practitioners and nurse-midwives had a better understanding of the benefits of breastfeeding and an increased sense of effectiveness in managing breastfeeding problems than the physician participants in the national study. A national sample of nurse practitioners and nurse-midwives is needed to verify and expand on the results from this single jurisdiction, where 40% of the respondents were graduates of the home institution of the co-investigators.

Breast Feeding↗
PubMedDate not supplied

An evaluation of process and protocols for planned home birth attended by regulated midwives in British Columbia.

Midwifery emerged as a self-regulated profession in British Columbia in the context of a 2-year demonstration project beginning in 1998. The project evaluated accountability among midwives, defined as the provision of safe and appropriate care and maintenance of standards of communication set by the College of Midwives of British Columbia. Adherence to protocols was measured by using documentation designed specifically for the Home Birth Demonstration Project. Hospital and transport records for selected clients were reviewed by an expert committee. Outcomes among Home Birth Demonstration Project clients were compared with outcomes among women eligible for home birth but planning to deliver in hospital. Adherence to clinical and communication protocols was 96% or higher. Planned home birth was not associated with an increase in risk but prevalence of adverse outcomes was too low to be studied with precision. Recommendations of an expert review committee have been implemented or are under review. Midwives have demonstrated a high degree of compliance with reporting requirements and protocols. Comparisons of birth outcomes of planned home versus hospital births, while supporting home birth as a choice for women, were limited in scope and require ongoing study. Integration of home birth has been a dynamic process with guidelines and policy continuing to evolve.

Adult↗
PubMedDate not supplied

On the road to collaboration: nurses and newly regulated midwives in British Columbia, Canada.

This study describes some of the results of a survey conducted shortly after the introduction of midwives as a regulated and publicly funded provider within the British Columbia health care system. The survey asked hospital-based perinatal nurses about their knowledge and attitudes of midwifery and their experiences with midwives. Results suggest that nurses, for the most part, had a negative view of midwives and their practice and that inattention to the necessary conditions for interprofessional collaboration and positive interprofessional relationships have resulted in parallel practice between the professions instead of interdisciplinary practice.

Adult↗
PubMed1997

Clinical decision-making by midwives: managing case complexity.

In making clinical judgements, it is argued that midwives use 'shortcuts' or heuristics based on estimated probabilities to simplify the decision-making task. Midwives (n = 30) were given simulated patient assessment situations of high and low complexity and were required to think aloud. Analysis of verbal protocols showed that subjective probability judgements (heuristics) were used more frequently in the high than low complexity case and predominated in the last quarter of the assessment period for the high complexity case. 'Representativeness' was identified more frequently in the high than in the low case, but was the dominant heuristic in both. Reports completed after each simulation suggest that heuristics based on memory for particular conditions affect decisions. It is concluded that midwives use heuristics, derived mainly from their clinical experiences, in an attempt to save cognitive effort and to facilitate reasonably accurate decisions in the decision-making process.

Case Management↗
PubMed1999

Attitudes towards, and knowledge of, clinical effectiveness in nurses, midwives, practice nurses and health visitors.

The dual concepts of evidence-based practice and clinical effectiveness have become ever more important for nurses, midwives and health visitors in recent years. In order that suitable initiatives can be derived and future policy shaped and evaluated it is important that the current level of knowledge and attitudes towards these concepts are recorded. The current study set out to examine these variables in a large, representative sample (n = 370, response rate = 74%) of nurses, midwives and health visitors. Results indicated that although a positive attitude towards evidence-based practice exists, individuals consider themselves to be lacking in certain key skills. Specifically, these appeared to be related to research-based skills. However, despite this, respondents indicated a large take up of evidence-based practice, although this may have been greater were it not for the considerable clinical workload. The necessity for greater dissemination of key research principles to nurses, midwives and health visitors by members of their own profession is emphasized.

Adult↗