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PubMed1990

Midwifery in Ontario: a survey of interest in services.

Maternity care for women in Ontario is provided almost exclusively by physicians, the majority of whom are obstetricians. Using a self-administered questionnaire, pregnant women in one Ontario city were surveyed about their interest in midwifery care as an alternative to physician care. Although 3 percent of the women surveyed had used a midwife, 60 percent expressed an interest in midwifery care, particularly the counseling and support aspects. Over 11 percent showed an interest in complete primary midwifery care.

Attitude to Health↗
PubMed1994

Beyond rhetoric: building and achieving community consensus in planning and developing an innovative public health nurse-midwifery education program.

Program planners collaborated with communities to achieve the goal of increasing the number of public health-educated nurse-midwives, and thus improve women's access to health services. By developing an innovative master's degree in public health nurse-midwifery education program. Boston University School of Public Health revitalized a model first developed at Johns Hopkins University School of Hygiene and Public Health. The dearth of nurse-midwifery education programs in the Northeast, coupled with the critical deficit of obstetric providers, had contributed to an alarmingly is an exciting alternative for meeting the health care needs of mothers and children and achieving the year 2000 objectives for the nation. Such a program, coupled with a foundation in public health education, synthesizes the best in nursing, nurse-midwifery, and public health Graduate nurse-midwives will have an enhanced understanding of the health care delivery system, the causal factors that contribute to disease, and the environmental, legal, and management dimensions surrounding the delivery of care.

Boston↗
PubMed1996

Midwifery, birth centers, and health care reform.

Midwifery and birth centers are placed within a concept of social structuring of difference between dominant and subordinate groups and their resultant inequality. Midwifery, and the birth center as a place for the practice of midwifery, present a philosophical view of childbirth that is different from the existing medical and acute care view and rooted in the education and socialization of the respective practitioners. In exercising freedom to act on that philosophical view, nurse-midwives and the physicians and nurses with whom they practice in birth centers are well positioned to be included in the reform efforts to devise a system for improving access to affordable quality health care.

Birthing Centers↗
PubMedDate not supplied

Evaluation of the midwifery pilot projects in Quebec: an overview. L'Equipe d'Evaluation des Projets-Pilotes Sages-Femmes.

In 1990, the province of Quebec adopted a law authorizing the evaluation of the practice of midwifery through eight pilot projects. The projects, which took the form of birth centres outside hospitals, started operating in 1994. The objectives of the evaluation were 1) to compare midwives' services to current physician services with regard to maternal and neonatal mortality and morbidity, the use of obstetrical intervention, individualization and continuity of care as perceived by clients, and cost; and 2) to identify the professional and organizational factors associated with the integration of midwives into the health care system. A mixed evaluative design was used: a multiple case study with each pilot project representing a case and a cohort study where 1,000 women followed by midwives in the birth centres were matched with 1,000 women followed by physicians in the usual hospital-based services. Various quantitative and qualitative data collection instruments were used. Overall, many results were favourable to midwifery practice, while some were favourable to medical care. Following the evaluation, the Government of Quebec decided to legalize the practice of midwifery.

Birthing Centers↗
PubMedDate not supplied

Comparison of midwifery care to medical care in hospitals in the Quebec pilot projects study: clinical indicators. L'Equipe dEvaluation des Projets-Pilotes Sages-Femmes.

The purpose of this study was to compare indicators of process and outcome of midwifery services provided in the Quebec pilot projects to those associated with standard hospital-based medical services. Women receiving each type of care (961 per group) were matched on the basis of socio-demographic characteristics and level of obstetrical risk. We found midwifery care to be associated with less obstetrical intervention and a reduction in selected indicators of maternal morbidity (caesarean section and severe perineal injury). For neonatal outcome indicators, midwifery care was associated with a mixture of benefits and risks: fewer babies with preterm birth and low birthweight, but a trend toward a higher stillbirth ratio and more frequent requirement for neonatal resuscitation. The study design does not permit to conclude that the associations were causal in nature. However, the high stillbirth rate observed in the group of women who were selected for midwife care raises concerns both regarding the appropriateness of the screening procedures for admission to such care and regarding the quality of care itself.

Adult↗
PubMed1995

Midwifery in Canada: the struggle for recognition.

The pattern of development of midwifery as a profession in Canada and the UK has been similar, but Canada is nearly 75 years behind. Despite its size and international stature, Canada is one of only eight countries in the world where midwifery has not yet been legally recognised nationally. Each of the 12 provincial governments of Canada enacts its own legislation. So far, four provinces have passed appropriate legislation. Midwifery degree programmes are now under way in some provinces.

Canada↗
PubMed1996

Nurse midwifery. Advanced practice nursing?

This article traces the roots and history of nurse-midwifery in the United States in order to demonstrate the reality of midwifery as a profession in its own right. From its beginnings in the late 1920s, the profession has gradually evolved from its clear roots in nursing to an identity of its own expressed through its professional organization, the American College of Nurse-Midwives. A review of other countries' experiences with midwifery reflect much of the U.S. process and results. The future challenge for both professions is to determine how they can exist in harmony, recognizing that they are complementary roles.

Canada↗
PubMed1995

[A study on autonomy in hospital-based midwifery practices in New York].

The purpose of this study was to identify the reality and understanding of American midwives in hospitals by focusing on autonomy as a profession. The method was conducted by interview and participant observation to 13 nurse-midwives in four hospitals. The data indicated that midwifery services belonged to obstetric and gynecology departments in three hospitals. Nurse-midwives had midwifery clinics and had responsibility to normal women antepartally, intrapartally, and postpartally. They distinguished midwifery as a profession from medicine and nursing. However, some midwives stated conflicts with doctors and nurses. Most of them had been motivate to be a midwife directly. It was said that nurse-midwives in New York City have struggled to gain autonomy in hospital systems.

Female↗
PubMed1978

Midwifery, 1977.

On January 1, 1974, an autonomous midwifery service was formed at Roosevelt Hospital in New York City to provide an obstetric service to "private" patients. While the autonomy was complete, physician consultation and participation provided by the "full-time or senior resident" staff were always available. We are now aware that this plan as opposed to any other, provided the ingredient of consumer-desired empathy of the midwife coupled with instant obstetric expertise that assured every patient the availability of modern obstetric practice. Four hundred and fifty-four patients cared for by midwives were compared to a random sample of 500 patients cared for by attending obstetricians. A striking similarity in the two groups was evident. Certain items, such as operative deliveries, were higher in the private patient group. The midwifery group had a low incidence of complications, but the incidence of acute complications made it apparent that an operating room suite must be immediately available. It is eminently clear that a low-risk group can be identified but there is no possible way to identify a "no risk" population.

Adolescent↗
PubMed1988

Nursing hours per patient: a method for allocation of staff in midwifery.

This paper describes the findings of a study of 43 midwifery wards in Northern Ireland. The Nursing Hours Per Patient (NHPP) index is extended to the calculation of appropriate indices for five categories of midwifery ward, antenatal, delivery, postnatal, special care baby units, combined units (including delivery wards) and combined antenatal and postnatal wards. These indices are used to examine the distribution of nursing staff in relation to occupied beds.

Bed Occupancy↗
PubMedDate not supplied

Development and validation of the Nurse-Midwifery Clinical Data Set.

This paper describes the procedures used to develop and validate the Nurse-Midwifery Clinical Data Set (NMCDS), a uniform, standardized tool for the purpose of data collection about midwifery clinical practice. The instrument was developed under the auspices of the ACNM Division of Research, and it was shown to be valid for the purposes of quality assessment data collection through the use of specific instrument development and field testing procedures. These procedures included consensus panel development, expert panel review, standardization, feasibility analysis, and validation through comparison with previous outcome data and record review. The 1990 version of the NMCDS is appended to the article.

Data Collection↗
PubMed1984

Obstacles to the practice of licensed lay midwifery.

Intensive interviews with licensed lay midwives in one of ten states that have recently reactivated and revised legislation legalizing such alternative practitioners for low risk clientele revealed a number of obstacles to their practice. The obstacles stem from the same rules and regulations developed by medical practitioners that made their homebirth service legal. Even after surmounting the difficulties of obtaining a license, the midwives find widespread unwillingness among private physicians to provide the required prenatal screening examination and medical back-up. The opposition of physicians to the licensed midwifery program is voiced in terms of concern about the safety of homebirths, particularly those attended by nonphysicians. Yet, the outcomes from the first 4 years of the program give no support for such concerns. Physician reluctance to cooperate with the legal program, combined with restrictions prohibiting the licensed midwives from suturing minor tears and administering a single dose of an antihemorrhagic drug in an emergency transfer, do compromise the overall quality of midwifery care. While accepting their subordinate position to medical practitioners, the midwives are struggling to establish the continuum of care for homebirth women implied in their licensure law.

Adult↗
PubMed2004

Identifying research priorities in nursing and midwifery service delivery and organisation: a scoping study.

This paper reports on a scoping study commissioned by the National Co-ordinating Centre Service Delivery and Organisation (NCCSDO) Research and Development (R&D) to identify priorities for nursing and midwifery research funding in England and Wales. The study comprised three strands (i) nationally held focus groups with service user representatives (32, plus six written submissions) (ii) semi-structured telephone interviews with 64 stakeholders (nursing, midwifery, medical, social care and allied health professionals; research commissioners; policy makers; educators; managers; researchers) and (iii) literature analysis. Five priority areas for research were identified-appropriate, timely and effective interventions; individualised services; continuity of care; staff capacity and quality; user involvement and participation-from which exemplar research questions and issues for strategic commissioning are suggested.

Attitude of Health Personnel↗
PubMed2006

Service user involvement in nursing, midwifery and health visiting research: a review of evidence and practice.

OBJECTIVES: In the UK policy recommends that service users (patients, carers and the public) should be involved in all publicly funded health and social care research. However, little is known about which approaches work best in different research contexts and why. The purpose of this paper is to explain some of the theoretical limitations to current understandings of service user involvement and to provide some suggestions for theory and methods development. This paper draws upon findings from a review of the research 'evidence' and current practice on service user involvement in the design and undertaking of nursing, midwifery and health visiting research. DESIGN: A multi-method review was commissioned by the NHS Service Delivery and Organisation (SDO) Research and Development Programme. The timeframe was April 2004-March 2005. The full report (Ref: SDO/69/2003) and supplementary bibliography are available from: http://www.sdo.lshtm.ac.uk. REVIEW METHODS/DATA: Initial searches of the health and social care literature and consultations with researchers were used to develop a broad definition of the topic area. A service user reference group (26 members) worked with the project team to refine the scope of the review, to set inclusion criteria and develop a framework for the analysis. Systematic searches of the literature were undertaken online and through library stacks (345 relevant documents were identified). Ongoing and recently completed studies that had involved service users were identified through online databases (34 studies) and through a national consultation exercise (17 studies). Selected studies were followed up using telephone interviews (n=11). Members of the service user reference group worked with the research team to advise on key messages for dissemination to different audiences. RESULTS: Information was gained about contextual factors, drivers, concepts, approaches and outcomes of service user involvement in nursing, midwifery and health visiting research, as well as developments in other research fields. Synthesis of this information shows that there are different purposes and domains for user involvement, either as part of researcher-led or user-led research, or as part of a partnership approach. A number of issues were identified as being important for future research. These include: linking different reasons for service user involvement with different outcomes; understanding the relationship between research data and service user involvement, and developing conceptualisations of user involvement that are capable of accommodating complex research relationships. Suggestions for the development of practice include: consideration of diversity, communication, ethical issues, working relationships, finances, education and training. CONCLUSIONS: Because research is undertaken for different reasons and in different contexts, it is not possible to say that involving service users will, or should, always be undertaken in the same way to achieve the same benefits. At a research project level uniqueness of purpose is a defining characteristic and strength of service user involvement.

Community Health Nursing↗
PubMedDate not supplied

The Journal of Midwifery & Women's Health 1955-2005: Its historic milestones and evolutionary changes.

From its very inception, the Journal of Midwifery & Women's Health (JMWH) played a critical role in fostering and documenting major shifts in the professional landscape of midwifery through its editorial content. This article traces the history and evolution of JMWH, commemorates its rich heritage and monumental growth over the last half century, highlights issues that have transcended its 50-year history, and acknowledges the contributions of its leadership ...past and present.

Female↗
PubMedDate not supplied

Doubling back over roads once traveled: creating a national organization for nurse-midwifery.

The quest for a new national organization began in 1940 and concluded in November 1955 in Kansas City, Missouri, with the founding meeting of the American College of Nurse-Midwifery. This article looks at the conflicts with organized nursing about the place and role of nurse-midwives in the newly reorganized American Nurses Association and the National League for Nursing. Discussions and disagreements within nurse-midwifery over the need for a nonexclusive national organization that would set professional standards are examined.

Adult↗
PubMedDate not supplied

Midwifery curriculum for auxiliary maternity nurses: a case study in the Dominican Republic.

Although most deliveries in the Dominican Republic occur within hospitals, maternal mortality in that nation remains high. In nonteaching hospitals, almost all of the vaginal births are attended by maternity auxiliary nurses. This article reports on a series of educational conferences for maternity auxiliary nurses in 1 hospital that were developed in response to the maternal mortality rate there. These conferences, taught by a team of midwives from the continental United States and Puerto Rico, used a midwifery curriculum with a participatory action methodology. The educational initiative has developed into a nongovernmental organization named Proyecto ADAMES to build capacity among auxiliary nurses. A qualitative evaluation of the effectiveness of Proyecto ADAMES in improving the knowledge, skills, and attitudes of the auxiliary nurses revealed positive behavioral changes despite weak documentation of their newly acquired knowledge and skills. Findings suggest that midwifery education for auxiliary maternity nurses in the Dominican Republic may contribute to maternal mortality reduction.

Attitude of Health Personnel↗
PubMedDate not supplied

Maternal body mass index, delivery route, and induction of labor in a midwifery caseload.

The purpose of this study was to identify the association between prepregnancy body mass index (BMI), weight gain in pregnancy, and newborn birth weight on route of delivery and induction of labor in patients receiving nurse-midwifery care. This retrospective cohort study examined the outcomes of 1500 consecutively delivered women who were cared for by two midwifery practices and delivered between January 1, 1998, and December 31, 2000. Cesarean delivery was significantly associated with the obese BMI (P < .001), nulliparity (P < .02), and newborn birth weight (P =.006). Prenatal weight gain did not have a significant correlation with cesarean birth (P = .24). In multivariable modeling, obese BMI, high newborn birth weight, nulliparity, and induction of labor increased the risk of cesarean birth. There was also a significant association between higher BMI and risk of induction of labor (P < .001). In a secondary analysis, obese BMI was associated with increased risk of induction in cases with ruptured membranes (OR 2.2; 95% CI 1.4-3.4) and postdates pregnancy (OR 2.0; 95% CI 1.1-3.4).

Adult↗