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At least 343 records · Page 19Linked to original sources
PubMed2005

Techniques to reduce perineal pain during spontaneous vaginal delivery and perineal suturing: a UK survey of midwifery practice.

OBJECTIVE: To investigate use of pharmacological and non-pharmacological methods of perineal analgesia used by midwives during the second stage of labour and perineal repair in the UK. DESIGN: Postal survey. METHODS: Self-complete questionnaires were sent to Heads of Midwifery in all 219 maternity units in the UK. Information was requested on the number and type of deliveries undertaken in the previous year and on the midwifery procedures used to provide pain relief immediately before delivery and for perineal repair. Details were also sought on local anaesthetics given before episiotomy or perineal repair. FINDINGS: 207 completed questionnaires were returned providing information on 210 maternity units. Midwives reported using a variety of non-pharmacological analgesic methods to control pain at the end of the second stage of labour. Hot packs were used in 70 (33%) maternity units, cold packs in 44 (21%) and perineal massage in 109 (52%). Midwives in 131 (62%) maternity units used injectable local anaesthetics to control perineal pain. All units advocated use of local anaesthetic before episiotomy or perineal repair, but the reported doses used varied widely. CONCLUSIONS: The literature on levels of pain experienced immediately before spontaneous vaginal delivery and during perineal repair is sparse, but what evidence exists suggests that, for some women, these occasions are accompanied by severe pain. Findings from this survey show that there is considerable variation in what midwives provide to control pain. Formal evaluation of the perineal analgesia offered to women during the second stage of labour is urgently required.

Analgesia, Obstetrical↗
PubMed2004

Implementation of a key skills agenda within an undergraduate programme of midwifery studies.

There are a multitude of external forces that impinge on curriculum planning. This paper reports on a DfEE funded development project, which looked at overtly assessing key skills within an undergraduate midwifery curriculum. The aims of the project were developed to fit within University agreed objectives and included: Identification of the main stakeholders. Assessment of the current situation. Identification of how to develop a strategy for key skills within the department. Implementation and evaluation of any changes. Cascading information throughout the Faculty of Health on completion of the evaluation. Two undergraduate midwifery programmes of study leading to professional qualification were included in the project. All stakeholders were identified and their responsibility with regard to key skills was explored. Audit of all modules was undertaken highlighting both the embedded nature and some imbalance in the provision of key skills. Meetings were held with both academic and clinical staff to enable understanding, co-operation and implementation of any changes. Focus groups were undertaken to investigate student perceptions of key skills and the usability of documentation devised to assess key skills. A tool was designed by which undergraduate students assessed their key skill development. The outcomes from these meetings, student focus groups and module audit are reported briefly here. Recommendations for future research and development are also stated.

Attitude of Health Personnel↗
PubMed2006

Midwifery: "at the edge of history".

The paper focuses on possible future pathways in maternity care for midwives and nations to consider. The paper blends personal and professional experiences to outline priority areas facing midwives in the future. It begins by examining maternal mortality and morbidity in the developing world and considering the potential of the ten high priority action messages (1997) in helping to improve the plight of women and children in the future. The paper then examines major issues facing midwives in the developed world including: the way birth is viewed; the medical-midwifery divide; marketing midwifery; and finally the challenge of dealing with fear around birth. The third part of the paper examines a part of society where the two worlds meet and there are issues from both the developed and developing world to consider. The paper focuses on women from culturally and linguistically diverse communities, Aboriginal and Torres Strait Islander women and women birthing in remote and rural areas. By looking at these three worlds separately the paper examines different concerns facing midwives in the future but also draws on common issues that face us all as citizens of this planet and particularly as predominantly women. The paper challenges midwives to be politically active and dare to change the world.

Adolescent↗
PubMed2006

Birth Territory: a theory for midwifery practice.

The theory of Birth Territory describes, explains and predicts the relationships between the environment of the individual birth room, issues of power and control, and the way the woman experiences labour physiologically and emotionally. The theory was synthesised inductively from empirical data generated by the authors in their roles as midwives and researchers. It takes a critical post-structural feminist perspective and expands on some of the ideas of Michel Foucault. Theory synthesis was also informed by current research about the embodied self and the authors' scholarship in the fields of midwifery, human biology, sociology and psychology. In order to demonstrate the significance of the theory, it is applied to two clinical stories that both occur in hospital but are otherwise different. This analysis supports the central proposition that when midwives use 'midwifery guardianship' to create and maintain the ideal Birth Territory then the woman is most likely to give birth naturally, be satisfied with the experience and adapt with ease in the post-birth period. These benefits together with the reduction in medical interventions also benefit the baby. In addition, a positive Birth Territory is posited to have a broader impact on the woman's partner, family and society in general.

Australia↗
PubMed2006

Challenging midwifery care, challenging midwives and challenging the system.

The purpose of this paper is to generate debate and discussion about the state of midwifery services in Australia today. While numerous reports have been published that highlight what women want in maternity care, widespread change has not occurred. This paper presents the story of Alice (a real woman with a fictitious name). Alice's story highlights the challenges that women face in dealing with a system that is often inflexible. While the health systems, and those who work within them, usually have the best intentions to try to provide the type of care that women want, they are not always successful. The paper summarises the evidence and support for models of continuity of midwifery care and outlines a series of strategies to ensure that change can occur. Finally, the paper challenges all midwives to work towards widespread, system-level change in Australian maternity services.

Adult↗
PubMedDate not supplied

Enabling conception and pregnancy. Midwifery care of women experiencing infertility.

This article provides a comprehensive and thoughtful overview of primary midwifery care of the woman experiencing infertility. Midwifery assessment and management strategies that can assist women and their partners experiencing infertility to achieve a successful pregnancy are reviewed. In addition to physiologic considerations, the article addresses psychosocial, spiritual, legal, and financial issues essential to understanding the ramifications of infertility care. The authors frame their approach in a feminist perspective that enables the woman to achieve control of fertility and self-determination of care.

Female↗
PubMedDate not supplied

Ethics in reproductive health care: a midwifery perspective.

Knowledge and technologic advancements have created a myriad of new screening, diagnostic, and treatment options for women of reproductive age. These new options often raise ethical issues as the women, their health care professionals, and society adapt to the benefits while coping with the pressures and burdens these options create. Threats to accomplishing the good that midwifery strives to contribute to health care for the benefit of women are identified from the perspective of the midwife's instrumental and expressive roles. Suggestions are presented for resolving ethical dilemmas that may occur in the selection and implementation of health care options. A distinction is made between midwifery practice at the microlevel, which achieves the good through direct interaction with the woman, and the institutional macrolevel that promotes accomplishing the good in reproductive health care through policy developmental and management decisions.

Beneficence↗
PubMedDate not supplied

Midwifery education models. A contemporary review.

Midwifery education has a rich tradition of blending innovation with educational methods that have demonstrated their value to the profession. Examples of innovations that have influenced midwifery education include the use of the asynchronous modular system, the development of distance methodologies, and most recently the use of computer and telecommunications technologies to mediate education. This study was designed to explore trends in approaches to the education of midwives in both traditional and distance education programs. Program directors were surveyed and interviewed to assess their degree of instructional synchrony, their use of distance modalities, and their predominate methods of curriculum presentation. Results of the survey suggest that programs are using a variety of these approaches to educate their students. Decisions to integrate new educational technologies appear to be based on institutional values, community resources, and student needs.

Education, Nursing, Graduate↗
PubMedDate not supplied

Therapeutic touch. A viable link to midwifery practice.

Through the use of their hands, their intelligence, and their compassion, midwives have traditionally taken a noninterventionist approach to labor and childbirth. Therapeutic Tough, known by its practitioners as simply TT, is a contemporary healing modality through which a practitioner's hands are used to facilitate healing. Midwives and practitioners of TT share an appreciation of the value of a holistic and noninterventionist approach to maintaining patient health. This article explores the potential use of TT as a tool to complement the practice of midwifery. It provides an explanation of the theories underlying TT, the history of its development, and the process involved in its practice. Additionally, the results of studies both supportive and critical of the practice of TT are analyzed. Finally, possible applications of TT to the practice of midwifery are suggested.

Female↗
PubMed1997

Assessment of clinical skills in midwifery: some ethical and practical problems.

The assessment of clinical midwifery skills can present ethical and practical problems. Following an outline of recent changes in midwifery education, this paper discusses the conflict between research-based and traditional knowledge, the preparation of assessors and their understanding of assessment documents which may be couched in educational language unfamiliar to them, the involvement of recently qualified midwives as assessors and the stress this may cause, frequent change in clinical placement, and lack of regular contract between student and assessor. All these factors impinge on the validity and reliability of assessment. Recommendations to address these problems include greater collaboration between teachers and practitioners in promoting research-based practice, and increased teacher involvement in clinical areas helping practitioners develop as assessors. This would, it is suggested, lead to increased consistency in standards and increase the validity and reliability of clinical assessment.

Clinical Competence↗
PubMed2003

The International Confederation of Midwives' study of essential competencies of midwifery practice.

OBJECTIVE: To delineate the knowledge, skills, and behaviours that would characterise the domain of competencies of the midwife who is educated according to the international definition of the profession. DESIGN: Phase I: a qualitative Delphi study; Phase II: a descriptive survey research process. PARTICIPANTS: A stratified random sample of member organisations of the International Confederation of Midwives (ICM) and regulatory representatives from these same countries. FINDINGS: A list of basic (essential) and additional competencies for midwives who have been educated in keeping with the ICM/WHO/FIGO international definition of the midwife was developed through an interative Delphi process, and then affirmed, using a survey research method. The final list includes 214 individual task statements within six domains of midwifery practice. IMPLICATIONS FOR PRACTICE: This list of competencies can serve as a basis for educational curriculum design, as a guideline for regulatory policy development, as a reference document for individual practitioners in an assessment of their initial and continued competency and by the ICM and its member associations as a resource for advocating for the role of midwifery within health-care systems world-wide.

Adult↗
PubMed2004

Partnership in midwifery care in New Zealand.

OBJECTIVE: to examine whether equal power is essential to the perceptions of partnership in midwifery practice and to propose an alternative model of how power might best be shared. DESIGN: a cross-sectional design was employed using the predominant methods of interview, questionnaires and thinking aloud tape recordings as triangulation of data. SETTING: two large metropolitan hospitals in Auckland, New Zealand and home birth settings. SAMPLE: Forty one independent and hospital-based midwives and 37 nulliparous women at low obstetric risk for whom labour care was provided. FINDINGS: the majority of the midwives and the women in the two studies presented believed they had achieved a midwifery partnership with little emphasis placed on the need for equality in decision making. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the model proposed provides a framework that identifies how power can be shared without the need for equality. The integration of this model into practice may assist midwives and women to recognise and utilise differences in their experience and knowledge to achieve their aims of achieving a partnership and a successful birth.

Adult↗
PubMed2004

An intrapartum intervention scoring system for the comparison of maternity units' intrapartum care of nulliparous women suitable for midwifery-led care.

OBJECTIVE: To develop an intrapartum intervention scoring tool which could be used to define maternity units as either 'lower intrapartum intervention' or 'higher intrapartum intervention' units. This scoring tool was designed to form the basis of a comparison of the perception of risk by midwives working in either 'lower intrapartum intervention' or 'higher intrapartum intervention' units. DESIGN: Three aspects were included: (1) the systematic data reduction of the St. Mary's Maternity Information System database used by 11 maternity units to include Caucasian nulliparous women suitable for midwifery-led care; (2) the calculation and the ranking of frequency distributions for the following interventions/management: (a) the management of breech presentation and of one previous caesarean section, the choice of home birth; and (b) augmentation of labour, use of electronic fetal monitoring, use of epidural, method of delivery; (3) the sum of the individual intrapartum ranking marks made up the final intrapartum score for each unit. RESULTS: Intrapartum interventions varied considerably between units. The scoring system enabled units to be described as either 'Lower intrapartum intervention' or 'Higher intrapartum intervention' units. CONCLUSIONS: Routinely collected computerised data can be used to identify the outcomes of intrapartum care. This study suggests that the analysis of computerised data could provide a suitable basis for the audit and the comparison of intrapartum interventions for the care of women suitable for midwifery-led care.

Adult↗
PubMed2003

Burning bridges: policy, practice, and the destruction of midwifery in rural Costa Rica.

The trend toward hospitalization of birth has a long history in Costa Rica and currently approximately 98% of births take place in the clinical setting. Impoverished rural areas, like the town of Buenos Aires, lag behind national trends and only recently has birth moved from the home to the hospital. Costa Rica's midwife certification program co-opted rural midwives as bridges to biomedicalization, responsible for both pushing women into the biomedical setting and filling the gaps left by a limited national health care system. Despite the eventual illegalization of key practices and of home birth itself, local use of midwives' services continues, albeit with local demands that have transformed midwives into bridges to biomedical care in ways unanticipated by and invisible to national programmers. Midwives provide key services like prenatal massage, treatment of pregnancy crises, and attending unforeseen home births and women unable to afford the modest costs of hospitalization. Yet, midwives report increasing dissatisfaction and the desire to stop providing services in their communities. Practices like prenatal massage are in demand, but are no longer embedded in a system of local exchange that is socially and economically meaningful. Midwives blame their clientele for their dissatisfaction, but directly link these changes to the notions of professionalism, compensation, and changing community values. Thus, the social relationship between midwives and their clients must also be understood as a destructive force burning midwifery as a bridge to safe birth. In this essay, I argue that the process of both remodeling and subsequently destroying midwifery practices begun in the formal health care sector at the national level continues at the local level through changing values and meanings associated with midwives' practices.

Anthropology, Cultural↗
PubMed1992

Midwifery education: whither will we wander?

The results of a study into the nature and conduct of midwifery programs in higher education institutions in Australia indicate diversity and disparity both between and within states. This paper presents data from this study and raises issues that arise from the findings. As midwives strive for professional authority and integrity, midwifery education must be recognised at both national and local levels to promote congruency for registration and practice.

Australia↗
PubMed1996

Practising midwifery independently: for the majority of midwives?

This paper explores the proposition that all midwives can practice independently regardless of their place of practice or employment status. That independence can be defined by the way in which the midwife practises is discussed. The theory of midwifery as a partnership is reviewed and its effects on midwifery as a profession will be explored. How this relates to Victoria and the absence of regulations will also be discussed. The need for continuity of care and women centred practice will be analysed in this context. Advocacy, as used by midwives, will be examined, as will midwife empowerment of the woman and the midwife.

Australia↗
PubMed1998

The lost voice of midwifery.

The proposed review and amendments to the Nurses' Act in South Australia has caused intense debate in this state especially between nurses and midwives. On the one hand midwives claim that the new changes will affect their ability to deliver optimum care to the childbirthing woman and so affect their role as midwife. While on the other hand nurses counter claim that the proposed changes to the Act will not make any difference to midwifery care and cannot understand what all the fuss is about. Yet midwifery has never sat comfortably under the umbrella of nursing and this debate is not new. This paper takes a historical look at the professionalisation of nursing prior to the implementation of the original Nurses' Registration Act of South Australia in 1920. It explores the implications of this for the midwife of the time, highlighting the unresolved differences between these two professions that have contributed to the debate of today.

Female↗
PubMedDate not supplied

Science and midwifery: paradigms and paradoxes.

The everyday world of clinical practice is filled with paradigms and paradoxes that stem from the issues of who defines knowledge, how it is generated, and how the individual midwife applies it when providing care for women and families. Research useful for clinical practice should provide evidence to support scientific approaches (models) or strategies (interventions) in caring for women. In a clinical discipline, the answers to research questions should eventually inform clinical decision-making by providing practical clinical knowledge. This article presents an application of Stevenson's research steps for the development of clinically applicable knowledge that the midwife can use to analyze and evaluate research findings as a basis for practice decisions. Specific examples of midwifery research are used to illustrate each stage in the process and the circular nature of knowledge development. The challenge is to prepare midwives who can apply research findings skillfully using the best evidence to support clinical practice, as well as to groom midwife researchers who will develop systematic programs of relevant research about midwifery practice and outcomes.

Clinical Competence↗