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PubMedDate not supplied

Midwives and women in partnership: the ideal and the real.

This qualitative study sought to identify the strategies used by hospital based midwives in assisting women to manage pain in labour, as well as the support they offer in all aspects of the birth process. Data were collected via participant observation of five birthing mothers and their midwives, and pre and post birth interviews. Analysis was by means of the software package QSR NUD.IST (Non numerical, Unstructured, Data, Indexing, Search and Theorizing) Version 3. Analysis of observation of labour and pre and post birth interviews revealed that all women wanted a birth with minimal intervention, however safety was an overriding consideration. During labour women relied on the midwife to oversee and direct care, and trust in care by a midwife was established as a result of prior experience, or during antenatal care. Factors inhibiting full partnership between women and midwives, and also the use of alternative pain strategies, included staffing levels, lack of emphasis on evidence based care and environmental constraints such as the room set up.

Adult↗
PubMed2003

[Knowledge and practice of doctors and midwives working in primary health care regarding screening for cervical and breast cancers].

We assessed the knowledge and practices of breast and cervical cancer of 286 physicians and 126 midwives working in primary health care in Tunis who responded to an anonymous questionnaire. Questions were related to knowledge of the epidemiology and survival rates in the early stages of breast and cervical cancers, to training in this domain and to the degree of involvement in this screening. The knowledge of the two cancers was relatively modest among both physicians and midwives. The systematic practice of Pap smear was significantly more frequent among midwives than physicians. The same result was observed for systematic clinical breast examination. Lack of training about carrying out Pap smears and the large number of consultations were the main factors negatively associated with systematic Pap smear and clinical breast examination practice.

Breast Neoplasms↗
PubMed2005

Lesotho midwives' utilization of non-pharmacological pain management methods during the first of stage labour.

The purpose of this study was to determine the use of non-pharmacologic methods of pain management used by midwives in Lesotho. The research design was non-experimental and of a descriptive nature. The data was obtained by means of a structured questionnaire which was compiled after a thorough literature analysis was done. Midwives, working in the Maternity wards of the Christian Hospital Association of Lesotho as well as the government Hospitals completed the questionnaires. All data was analysed on a nominal descriptive level. According to the results, the midwives indicated that they were taught non-pharmacologic methods of pain management, however they expressed that they inadequately use these methods during the first stage of labour due to shortage of staff, lack of privacy and space, a high midwife-mother ratio, culture and hospital policies. In the light of these findings, recommendations were made of maximizing the use of non-pharmacologic methods during the first stage of labour.

Adaptation, Psychological↗
PubMed1995

An assessment of barangay health midwives' knowledge regarding tuberculosis case finding and treatment procedures in urban health centers of metropolitan Manila, Philippines.

A survey was done from August to September, 1992 to determine the level of knowledge of 48 barangay health midwives (BHW) from urban health centers in Metropolitan Manila with regards to tuberculosis case finding and treatment procedures, as recommended by the National Tuberculosis Control Program (NTCP) of the Department of Health. Questionnaires were administered by personal interview. A cut-off mark of 17 correct answers out of 23 or 74% was arbritrarily chosen to signify a satisfactory level of knowledge. Results revealed that a substantial proportion of midwives still have inadequate knowledge regarding casefinding, case holding and NTCP policies. Type of training (p < 0.01) and age (p < 0.05) were found to be significant factors affecting level of knowledge while length of service was found to be marginally insignificant (p = 0.06). It is therefore highly recommended that urban health midwives be subjected to more regular formal training to increase their level of competence in attaining the goals of the NTCP.

Adult↗
PubMed1997

Is there a place for traditional midwives in the provision of community-health services?

Traditional midwives (TM) have been involved in delivering babies, and providing a broad range of other services to women, for hundreds of years. They are usually local women with little formal education. As they are well known in their communities they are often called to assist women at the time of delivery. Two opposite views persist about the continuation of their role; some health workers would like to see them trained better and incorporated into the formal health system. Other health workers feel that all deliveries should be attended by either a nurse/midwife or a doctor, and that TM should eventually be phased out. Traditional midwives currently perform > 60% of deliveries in some developing countries and have had their role expanded in some places. Recruiting nurse/midwives and doctors to work in remote areas remains difficult and, even if they were recruited, there is no guarantee that their obstetric services would be used. The evaluation of training programmes has not produced any clear-cut answers in the debate about the long-term role or existence of TM. Rather, the studies have shown that the success of the programmes depends on the resources available, the people involved in the training and how the training is carried out. Some of the lessons learnt from working with TM apply to any two groups of people working together. If TM are going to be offered training, and this must be a local decision made after consultation and an evaluation of prevailing resources and conditions, the training should be a two-way process, with both parties learning from each other.

Community Health Services↗
PubMed2002

Ethical decision-making in prenatal diagnosis and termination of pregnancy: a qualitative survey among physicians and midwives.

OBJECTIVES: This study was aimed at exploring the conflicts and ethical problems experienced by professionals involved in prenatal diagnosis and termination of pregnancy (TOP) in order to improve the understanding of decision-making processes and medical practices in the field of prenatal diagnosis. METHODS: Qualitative study with in-depth tape-recorded interviews conducted in three tertiary care maternity units in France, between May 1999 and March 2000. All full-time obstetricians and half of the full-time midwives were contacted. Seventeen obstetricians and 30 midwives participated (three refusals, five missing). Interviews were transcribed and analysed successively by two different researchers. RESULTS: All respondents stated that prenatal diagnosis and TOP raised important ethical dilemmas, the most frequent being request for abortion in case of minor anomalies. They pointed out the inability of our society to appropriately care for disabled children and the risk of eugenic pressures. The decisions and practices in prenatal diagnosis should be debated throughout society. All respondents reported that their unit did not have protocols for deciding when a TOP was justifiable. The transmission of information to the women appeared to be a problematic area. Moral conflicts and emotional distress were frequently expressed, especially by midwives who mentioned the need for more discussions and support groups in their department. CONCLUSION: Health professionals involved in prenatal diagnosis face complex ethical dilemmas which raise important personal conflicts. A need for more resources for counselling women and for open debate about the consequences of the current practices clearly emerged.

Abortion, Eugenic↗
PubMed1988

Content of care by independent midwives: assistance with pain in labor and birth.

The proliferation of alternative health care systems in the United States raises numerous policy issues involving (1) those providing and receiving alternative services and (2) the established medical care system. This paper identifies some of these issues by examining an alternative system of independent (lay) midwifery and, in particular, midwifery approaches to pain during uncomplicated labor and birth. The paper summarizes medical care system approaches to pain in labor and birth: leading textbooks, prevailing topics in the journal literature, and empirical research reports are consistent in giving primary emphasis to analgesic and anesthetic drugs, accepting childbirth preparation, and questioning the efficacy of other approaches. The practices of independent midwives working in metropolitan areas of Utah are strikingly different. The midwives, who oppose any use of conventional obstetric pain medications, have a diverse repertoire of alternative approaches, including prenatal preparation, various physical manipulations, hydrotherapy, administration of herbs and nutritive substances, breathing and relaxation techniques, and psychological techniques. The midwives emphasize responsiveness to the needs of a particular woman at a particular time. They enhance and mobilize the resources of the mother and her support network for therapeutic ends. Their work emphasizes innovation and exploration. Relative to medical practices, midwifery practices seem to involve low iatrogenic risks, to be cost-effective, and to be appreciated by those seeking empowerment and minimal intervention in childbirth. It is recommended that these practices be formally evaluated for safety, efficacy, consumer acceptability, cost-effectiveness, and their potential for favorable impact on the practice of medical obstetrics.

Adult↗
PubMed1990

Self-certification in lay midwives' organizations: a vehicle for professional autonomy.

The recent resurgence of lay midwifery in the United States has been intimately connected with the establishment of grassroots organizations which address women's health issues and make the reappearance of the lay midwife a different kind of phenomenon than was the case earlier in this century. This paper describes the organizational structure of 32 lay midwives' organizations and compares them to a model of alternative women's health groups as well as more traditional health professional organizations. Are lay midwives' groups the beginnings of new professional organizations which eventually will become part of the dominant system or do they model themselves more closely after alternative women's health groups? Voluntary self-certification in five lay midwives' groups is described in detail as a means of determining how a group handles the question of integration with or separation from the existing medical care system. Certification plays a critical role in promoting acceptance and credibility of midwifery practice and is seen increasingly as a mechanism to preempt regulation by another body.

Age Factors↗
PubMed1991

An alternative to unattended delivery--a training programme for village midwives in Papua New Guinea.

Certain linguistic groups in the Southern Highlands of Papua New Guinea are unique in that there is no cultural role for a traditional birth attendant and, therefore, women deliver alone unattended. A programme to train village women as midwives was begun at Nipa Health Centre im 1981 and later expanded to a province-wide scope in 1986. Thirty-two Angal Heneng village midwives were trained during the period 1981-1989. Women of this language group have traditionally given birth alone. By 1989 the Angal Heneng village midwives had supervised 623 deliveries while 24 of them were still practicing. Well accepted in the community, they attended 11% of all births in 1989. Their efforts contributed to infant and perinatal mortality rates that were lower among the Angal Heneng than those of the neighbouring language group.

Community Health Workers↗
PubMedDate not supplied

Liability concerns: a view from the American College of Nurse-Midwives.

The national office of the American College of Nurse-Midwives (ACNM) is the center of day-to-day administration for the professional organization. Staff members respond to requests for information and assistance from certified nurse-midwives or certified midwives and facilitate the work of the Board, Divisions, and Committees. This article reviews the questions most frequently asked of the Professional Services department about risk management and professional liability issues and summarizes the most important lessons learned from the calls received. The focus is on 5 topic areas: 1) collaboration confusion, 2) systems needed to implement and effectively track diagnostic tests and referrals, 3) expansion of services beyond the core competencies, 4) patient satisfaction and patient complaints, and 5) maintaining medical malpractice coverage.

Cooperative Behavior↗
PubMedDate not supplied

Perceptions and use of smoking cessation in nurse-midwives' practice.

The objective of this study was to examine Ohio nurse-midwives' perceptions and use of a smoking cessation protocol in assisting pregnant smokers. The total population of licensed Ohio nurse-midwives (n = 300) was surveyed by using a cross-sectional survey design. Only 4 of 10 items that assessed a nationally recommended method of promoting smoking cessation were done by 50% or more of respondents. Few nurse-midwives identified barriers to counseling pregnant patients who smoked, but the most common were lack of time (14%) and not knowing where to send pregnant smokers for treatment (14%). Most respondents believed that nicotine replacement therapy (NRT) would be most likely to reduce the number of pregnant smokers (74%), yet few (26%) were confident in their ability to prescribe/recommend nicotine replacement therapy. Respondents more likely to use 5 A's can be characterized as the following: had higher efficacy expectations in their ability to communicate issues about the 5 A's and had higher outcome expectations regarding the effects of using the 5 A's. Nurse-midwife training programs and continuing education needs to include current research in nicotine replacement therapy use in pregnant patients and 5 A's techniques to assist pregnant smokers in quitting.

Female↗
PubMed2005

Midwives' experience of organisational and professional change.

OBJECTIVE: to describe midwives' experiences of changes in their caring role and professional function in postpartum wards in the northern part of Sweden. In this part of the country, three out of eight maternity departments have been closed over the last 5 years. During the same period, hospital stays have reduced in length, and an early discharge model has been introduced. DESIGN: focus-group discussions. SETTING: four focus groups at two hospitals in northern Sweden. PARTICIPANTS: 21 midwives experienced in midwifery practice in maternity wards. FINDINGS: the analysis revealed four categories of comments: 'to have limited time when caring for the mother and the baby'; 'no longer being valued as the expert'; 'a wish to have responsibility for childbirth in its entirety'; 'to see future possibilities in the development of the profession'. The theme identified is 'being ahead in ideas about caring but still partly caught up in the past'. KEY CONCLUSIONS AND IMPLICATIONS: the identified theme of being ahead in ideas about caring but still partly caught up in the past can be understood as representing a transition. The midwives experienced loss and grief over their former midwifery practice, but had ideas and visions for developing and expanding their future professional role. A healthy transition requires support, participation and skilled management.

Adult↗
PubMed2005

An exploratory mixed-methods study of Scottish midwives' understandings and perceptions of clinical near misses in maternity care.

OBJECTIVE: adverse outcomes and near misses are believed to share many characteristics in terms of clinical situations and care management problems. Little is documented concerning what prevents adverse outcomes from happening once the 'accident trajectory' begins. This two-stage pilot study set out to investigate midwives' understandings and recollections of clinical near misses. DESIGN: anonymous self-completion questionnaire and follow-up group interviews. SETTING/PARTICIPANTS: clinically based midwives working in four maternity units in Scotland (questionnaire [n = 34]; interviews [n = 26]). FINDINGS: despite a low response rate to the questionnaire, the cited examples seem to confirm that near misses and adverse outcomes follow essentially similar routes until the former are halted by a saving intervention. Dangerous situations are created by heavy workloads, and are aggravated by sub-optimal skill-mix, poor communication and individuals making mistakes or not following accepted procedures. Overwhelmingly, what prevents this situation from resulting in an adverse outcome is an intervention by another practitioner--often reported to be by chance and not design. In the interviews, these situations were discussed with reference to unit culture, the causes of errors and near misses, helping to prevent mistakes, the consequences of near misses and staff confiding in one another. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: this limited study reaffirms the view that clinical near misses have the same origins as actual poor outcomes. Practitioners need to be able to discuss clinical and operational matters openly with colleagues. Although the 'blame culture' was reported to be less prevalent when things go wrong, not all midwives feel comfortable about discussing incidents or near misses. This exploratory study makes no claim to encapsulate this complex and sensitive subject. Further detailed research into the nature and extent of near misses is required. Identifying what prevents a poor outcome from happening may be a valuable clinical resource.

Adult↗
PubMedDate not supplied

Population-based primary health care for women. An overview for midwives.

This home study program has as its focus population-based care for women. Although clearly significant, concentrating effort solely on the individual does not ensure that the population as a whole is healthier. Experts are encouraging health care providers to consider the population as their "patient" and to begin documenting the incidence and prevalence of its disease. This article addresses the following issues: the definition of population-based health care; the relationship between primary care, women's health care, and population-based health care; the importance of a population-based approach or perspective for midwives; the use of population-based care in the provision of prenatal care; the definition of the populations to whom midwives have historically provided care and the documentation of how those populations are changing; and the research and policy issues for midwives related to population-based health care.

Female↗
PubMedDate not supplied

A national survey of herbal preparation use by nurse-midwives for labor stimulation. Review of the literature and recommendations for practice.

To document the use of herbal preparations for cervical ripening, induction, and augmentation of labor by certified nurse-midwives (CNMs) and nurse-midwifery education programs, a national survey of 500 members of the American College of Nurse-Midwives was conducted. Forty eight nurse-midwifery education programs were also surveyed to determine whether they were formally or informally educating students in the use of herbal preparations for cervical ripening, induction, or augmentation of labor. The results of this study, a review of the literature, professional issues, and recommendations for clinical practice are presented in this article. Of 500 questionnaires mailed to ACNM members, 90 were returned from CNMs who used herbal preparations to stimulate labor and 82 were returned from CNMs who did not use herbal preparations to stimulate labor. Three questionnaires were excluded due to incomplete data or blank questionnaires. No significant differences were noted in relations to geographical region, midwifery education, or highest level of education between the CNM respondents who did and those who did not use alternative methods to stimulate labor. Of the CNMs who used herbal preparations to stimulate labor, 64% used blue cohosh, 45% used black cohosh, 63% used red raspberry leaf, 93% used castor oil, and 60% used evening primrose oil. CNMs who used herbal preparations to stimulate labor were younger (43 versus 45 years, P < .01) and more likely to deliver at home or in an in-hospital or out-of-hospital birthing center (P < .0006), than CNMs who never used herbal preparations to stimulate labor. The most cited reason for using herbal preparations to stimulate labor was that they are "natural," whereas the most common reason for not using herbal preparations was the lack of research or experience with the safety of these substances. Sixty-nine percent of CNMs who used herbal preparations to stimulate labor learned about using them from other CNMs, 4% from formal research publications, and none from their formal education programs. Although 78% of the CNMs who used herbal preparations to stimulate labor directly prescribed them and 70% indirectly suggested them to clients, only 22% had included them within their written practice protocols. Seventy-five percent of the CNMs who used herbal preparations to stimulate labor used them first or instead of pitocin. Twenty-one percent reported complications including precipitous labor, tetanic uterine contractions, nausea, and vomiting. Sixty-four percent of the nurse-midwifery education programs included instruction in the use of herbal preparations to stimulate labor in their formal curricula, and 92% included informal discussions on the use of herbal preparations. Evening primrose oil was the most common herbal preparation discussed in nurse-midwifery education programs. Castor oil was the most commonly used herbal preparation used by nurse-midwives in clinical practice.

Adult↗
PubMed2003

From student to midwife: the experiences of newly graduated midwives working in an innovative model of midwifery care.

In 2001, a new model of midwifery care was established in the Birth Centre at St George Hospital, a metropolitan hospital in NSW. The new model was designed to encompass the principles and recommendations from numerous government reports and research. The model also build on the previous successful implementation of a team midwifery program (Homer et al 2001b; Homer et al 2001a). Four newly graduated midwives, together with four more experienced midwives were employed to work in the models of midwifery care. This small study evaluates the first 10 months' using qualitative and quantitative data. As this is a small study, no firm conclusion can be reached. The results of the evaluation however demonstrated that with appropriate support and mentoring, newly graduated midwives can work in an innovative model of midwifery care within a birth centre environment.

Attitude of Health Personnel↗
PubMedDate not supplied

International connections among midwives.

Women's health throughout the world is adversely affected by low status and literacy, poor nutrition, environmental toxins, violence, and other social, cultural, and economic factors. The majority of maternal deaths and disability occur in the developing nations of the world, such as Africa, where being born female is often a tragedy. The International Confederation of Midwives and the American College of Nurse-Midwives have nearly a century of commitment to making pregnancies and births safer and women's lives better. The shared vision of women as persons who are due full human rights guides the efforts of nurses and midwives in their global efforts of working with women and childbearing families and promoting health for all.

Developing Countries↗
PubMed1999

Effect of the maternal care manual of the perinatal education programme on the ability of midwives to interpret antenatal cards and partograms.

OBJECTIVE: To assess the ability of midwives to interpret antenatal cards and partograms correctly following completion of the Maternal Care Manual of the Perinatal Education Programme. STUDY DESIGN: We conducted a prospective, controlled trial in a study town and two control towns in the Eastern Cape Province of South Africa. All 93 midwives caring for pregnant women in the three towns were included in the study. Samples were compared using the two-tailed Student's t-test. RESULTS: The marks achieved by the study group for questions from the antenatal card and the partogram improved by 33.0% (p < 0.001) and 17.5% (p = 0.001), respectively. No changes were observed in the control group. CONCLUSION: Midwives that studied the Maternal Care Manual significantly improved their ability to interpret clinical information and apply knowledge. If this ability is applied in clinical practice, a reduction in maternal and perinatal deaths is possible.

Achievement↗