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PubMed1994

Teamwork in primary care: the views and experiences of nurses, midwives and health visitors.

This paper reports on findings from a study of teamwork in primary care in one family health services authority in England. It is based on interviews using a semi-structured questionnaire with practice nurses, district nurses, health visitors and midwives in 20 practices. Six topics emerged as important in relation to the views of nurses, midwives and health visitors and their experiences of teamwork: team identity; leadership; access to general practitioners; philosophies of care; understanding of team members' roles and responsibilities; and, disagreement regarding roles and responsibilities. Differences in the various views and experiences of teamwork were identified. Midwives and health visitors emerged as the least integrated members of the primary health care team. Recent changes to the organization of primary health care services, as well as professional changes, are seen as accounting for the different experiences of the nursing groups. The potential for teamwork in the future is discussed.

Attitude of Health Personnel↗
PubMed1997

What do registered nurses and midwives feel and know about research?

This research is in the form of a quantitative study aimed at discovering 'What registered nurses and midwives feel and know about research'. Data were gathered on a fixed response questionnaire, with open spaces for comments to support the results with written factual qualitative evidence. The questionnaire was directed towards obtaining results associated with 'Attitudes' towards research; 'Understandings' about research, and 'Obstacles' to implementing research. A sampling technique was used in which a total population of 765 registered nurses and midwives working in this district general hospital were involved in the study. The results demonstrate (inferential statistics chi-square and correlation tests) that registered nurses and midwives are largely in agreement with research based practices, although understanding about research is minimal and dependent on grade, length qualified, shifts and numbers of hours worked.

Attitude of Health Personnel↗
PubMed2002

Midwives' experience of the encounter with women and their pain during childbirth.

OBJECTIVE: to describe midwives' experience of the encounter with women and their pain during childbirth. DESIGN: qualitative study using a phenomenological approach. Data were collected via tape-recorded interviews. SETTING: Sahlgrenska University Hospital, Göteborg, and Karolinska Hospital, Stockholm, Sweden in 2000. PARTICIPANTS: nine experienced midwives between 12 and 28 years of midwifery practice. KEY FINDINGS: the essential structure was described as a striving to become an 'anchored companion'. 'To be a companion' was to be available to the woman, to listen to and see her situation mirrored in her body, and to share the responsibility of childbirth. To be 'anchored' was to show respect for the limits of the woman's ability as well as one's own professional limits. Five constituents can further describe the essential structure: listening to the woman; giving the woman an opportunity to participate and to be responsible; a trusting relationship; the body expresses the woman's situation; and to follow the woman through the process of childbirth. IMPLICATIONS FOR PRACTICE: the basis for maternity care should give an opportunity for midwives to be anchored companions. This could be done by emphasising listening to the woman, participation, responsibility, a trusting relationship and a clear understanding of the professional limits and the limits of the woman's ability.

Adaptation, Psychological↗
PubMed2004

The impact of maternal mortality interventions using traditional birth attendants and village midwives.

Traditional birth attendants (TBAs) and village midwives have been employed in many interventions to reduce maternal mortality in developing countries. This study reviews the results of 15 TBA- and midwife-based interventions that aim to improve skilled assistance in delivery and recognition and referral of complications. Outcome measures used to evaluate the impact of the programmes varied. Five of the five programmes reviewed that evaluated their impact on maternal mortality demonstrated a decline in maternal mortality ratios, two of three studies measuring morbidity-related indicators found improvement of some but not all morbidity outcomes, six of seven showed a trend of improved referral rates, and three of three found high levels of knowledge retention among trained TBAs. Programmes with the greatest impact utilised TBAs and village midwives within multisectoral interventions. These findings suggest that TBAs and village midwives contribute to positive programme outcomes. Further investigation is needed to determine the nature of their contribution within larger programmes.

Adolescent↗
PubMed1996

Shift work, nitrous oxide exposure and subfertility among Swedish midwives.

BACKGROUND: Shift work and nitrous oxide exposure have both been suspected of having adverse influence on the reproductive performance of health workers. Time to pregnancy has been suggested as a sensitive measure of fecundity in occupationally exposed groups. We investigated the effects of shift work and nitrous oxide exposure on the fertility of Swedish midwives. METHODS: A questionnaire was mailed to all members of the Swedish Midwives Association who were born 1940 or thereafter, 3985 in all. Eighty-four per cent responded. Detailed information on the number of menstrual cycles required to achieve pregnancy and the working conditions during that period were obtained concerning the most recent, planned pregnancy occurring after 1983. The per cycle probability of becoming pregnant was calculated for each exposure category, and the relation to the unexposed was expressed as fecundability ratios. RESULTS: Midwives who worked two-shift, three-shift rotas, or only nights had reduced fertility compared to those working in the day time. The fecundability ratios were 0.78 (95% confidence interval [CI]: 0.65-0.94), 0.77 (95% CI: 0.60-0.98), and 0.82 (95% CI: 0.64-1.03), respectively, after adjustment for covariates. No effect of nitrous oxide exposure was noted except in the small group reporting that they assisted at more than 30 deliveries per month when nitrous oxide was used (fecundability ratio = 0.64; 95% CI: 0.44-0.95). CONCLUSION: Shift work and frequent, high occupational exposure to nitrous oxide may have a negative influence on the ability of women to become pregnant.

Female↗
PubMed2001

On display: portraits of seventeenth-century French men-midwives.

This article examines the portraits of seventeenth-century French accoucheurs [men-midwives] that regularly appeared as the first plate in their obstetrical treatises, representing the body from which the text had issued. It argues that these visual documents were forms of strategic display in keeping with the wider goals of the treatises--to present their authors as cultivated, skilled, and vastly experienced experts in childbirth. At a time when the visual evaluation of character was commonplace within medical and other contexts, author portraits presented the public image of accoucheurs. Before analysing the idealized images of men-midwives. however, the article explores the author portrait of Louise Bourgeois, royal midwife to Queen Marie de Médicis from 1601-9, and the first French woman to write obstetrical treatises. Bourgeois is portrayed not only as an exceptional practitioner granted royal favour, but also as a hybrid figure whose identity fluctuated between efficient female midwife and educated theoretical writer. Portraits of accoucheurs represent the unstable identity and rather flexible 'masculinity' of male practitioners who likewise blurred gendered categories. Some images identify male practitioners exclusively with theoretical knowledge, while others associate them more directly with the maternal qualities traditionally admired in female midwives.

France↗
PubMed2005

Midwives' visual interpretation of intrapartum cardiotocographs: intra- and inter-observer agreement.

AIM: This paper reports an examination of intra- and inter-observer agreement in midwives' visual interpretation of intrapartum cardiotocographs (CTGs). BACKGROUND: The issue of intra- and inter-observer agreement in the interpretation of CTG interpretation has serious implications for the validity of electronic fetal heart rate monitoring and subsequent decisions on intrapartum management. However, no studies were found that assessed intra- and inter-observer agreement in midwives' interpretations of CTG tracings. METHODS: Twenty-eight midwives independently interpreted three intrapartum CTG tracings on two separate occasions using a self-administered Cardiotocograph Interpretation Skills Test. Inter-rater agreement in interpretation was assessed by cross-tabulating the two sets of raw data obtained at time 1 and time 2 and computing Cohen's Kappa (kappa). Intra-rater agreement was assessed by computing kappa for each rater with the two sets of raw data (time 1 and time 2) obtained from each individual. The data were collected in 2000. RESULTS: Overall intra-rater agreement ranged from 'fair to good' (kappa = 0.48) to 'excellent' (kappa = 0.92). Raters' classifications altered in 18% (n = 5) of cases for the normal tracing, in 29% (n = 8) for the suspicious tracing and in 11% (n = 3) for the pathological tracing. Inter-rater agreement was fair to good, with kappa statistics ranging from 0.65 to 0.74, respectively. Agreement was highest in the classification of decelerations (kappa = 0.79) and lowest in the assessment of baseline variability (kappa = 0.50). Overall inter-rater agreement was highest in the suspicious tracing (kappa = 0.77, excellent) and lowest in the normal tracing (kappa = 0.54, fair to good). CONCLUSION: Inter- and intra-observer variability are intrinsic characteristics of the interpretation of intrapartum CTGs. Levels of agreement revealed degrees of variation that expose room for improvement. Efforts are needed to reduce inter- and intra-observer variation in interpretation of intrapartum CTG tracings. In addition, research should focus on the development and evaluation of non-invasive, low observer variability methods of intrapartum assessment of fetal well-being. The subjectivity of CTG interpretation and inconsistencies in interpretation should also be considered in intrapartum management, clinical audit and in medico-legal settings.

Adult↗
PubMed1994

Conceptualization of differing levels of educational attainment: what are the characteristics of nurses and midwives who have undertaken diploma and degree educational programmes?

This paper looks at the differences in the characteristics of registered nurses and midwives who have achieved differing levels of educational attainment. A review of the pertinent literature demonstrates that there is little published material on this topic and therefore, proposals are put forward with regard to a conceptual model to frame outcome characteristics. The model is seen as being appropriate when trying to identify the different characteristics of nurses and midwives educated to diploma, degree, post-graduate diploma, masters and doctoral level. The model is subsequently applied to identifying core outcomes and composite statements of nurses and midwives who have undertaken diploma or degree programmes. Initial work examining the validity and reliability of the core outcomes and composite statements with regard to degree preparation is described. Areas for further research are also identified.

Education, Nursing, Baccalaureate↗
PubMed2004

Prevalence of domestic violence when midwives routinely enquire in pregnancy.

OBJECTIVE: To assess the prevalence of domestic violence in pregnancy when midwives are trained to enquire about it routinely. DESIGN: A cross sectional study during a period after midwives had been trained to routinely enquire about it and a retrospective case note survey at an earlier period. SETTING: The maternity services of Guy's and St Thomas' NHS Hospital Trust in South London. SAMPLE: Women aged 16 and over booking for maternity care between 14th September 1998 and 21st January 1999. METHODS: Midwives were required to routinely enquire about domestic violence at booking, 34 weeks of gestation and postpartum (within 10 days) using a series of structured questions. MAIN OUTCOME MEASURES: The lifetime and annual rates of domestic violence. The prevalence of domestic violence in pregnancy. RESULTS: The prevalence of domestic violence in pregnancy was 1.8% at booking, 5.8% at 34 weeks of gestation and 5.0% at 10 days postpartum. Eight hundred and ninety-two women were asked about domestic violence on at least one occasion, of whom 22 (2.5%) reported domestic violence in pregnancy. Two hundred and sixty-five maternity notes were reviewed for the retrospective case note survey and one (0.37%) case of domestic violence in pregnancy was identified. Routine questioning increased the rate of detection of domestic violence by 2.1% (95% CI = 0.1-3.4%; P= 0.03). The lifetime prevalence of domestic violence was 13%, and 6.4% in the previous 12 months. CONCLUSIONS: Routine enquiry for domestic violence can increase the rate of detection in maternity settings, thereby providing an opportunity for women to access help early.

Adolescent↗
PubMed1994

Mississippi public health nurses and midwives: a partnership that worked.

At the turn of the century maternal and infant mortality rates were high in this southern state. Untrained midwives conducted many of the deliveries. Initial support for locating and training midwives by public health nurses was provided by the American Red Cross and the United States Public Health Services. Later, funding from a philanthropic organization (Rockefeller International Foundation) provided a mechanism that brought Mississippi public health nurses and midwives to a partnership that endured for over a half a century, and contributed to better maternal-infant health care outcomes for that state.

Black or African American↗
PubMed2000

Reduced risk of low weight births among indigent women receiving care from nurse-midwives.

STUDY OBJECTIVE: To examine the effect of a comprehensive prenatal and delivery programme administered by nurse-midwives on the risk of low weight births among indigent women. STUDY DESIGN: Historical prospective study. Birth outcomes among the cohort were compared with all county births during the same period, adjusting for maternal age and race. Results are expressed as relative risks with 95% confidence intervals. SETTING: An enhanced Medicaid funded pre-natal programme administered by nurse-midwives from 1992 to 1994 in Westchester County, New York. PARTICIPANTS: Indigent mothers (n = 1443), between the ages of 15 and 44, who were residents of Westchester County and indicated having Medicaid or no health care coverage. RESULTS: There were 1474 live births among cohort mothers. Mean (SD) gestational age was 39.4 (1.9) weeks. Less than 6% of births occurred before 37 weeks gestation. The mean birth weight of cohort infants was 3365.6 (518.6) g. Only 4.1% of the cohort births were less than 2500 g. Compared with all county births, the cohort showed a 41% reduction in the risk of low weight births (RRlbw = 0.59, 95% CI: 0.46 to 0.73, p < .001) and a 56% reduction when compared with county Medicaid births only (RR = 0.44, 95% CI: 0.34 to 0.57, p < .005) adjusting for maternal age and race. Larger reductions were found for very low weight births. CONCLUSIONS: Mothers need not be considered at high risk for adverse pregnancy outcomes based on their socioeconomic status alone. Moreover, a comprehensive prenatal programme administered by nurse-midwives may promote a reduction in adverse pregnancy outcomes among indigent mothers.

Adolescent↗
PubMed2003

Occupational exposure of midwives to nitrous oxide on delivery suites.

AIMS: To compare environmental and biological monitoring of midwives for nitrous oxide in a delivery suite environment. METHODS: Environmental samples were taken over a period of four hours using passive diffusion tubes. Urine measurements were taken at the start of the shift and after four hours. RESULTS: Environmental levels exceeded the legal occupational exposure standards for nitrous oxide (100 ppm over an 8 hour time weighted average) in 35 of 46 midwife shifts monitored. There was a high correlation between personal environmental concentrations and biological uptake of nitrous oxide for those midwives with no body burden of nitrous oxide at the start of a shift, but not for others. CONCLUSIONS: Greater engineering control measures are needed to reduce daily exposure to midwives to below the occupational exposure standard. Further investigation of the toxicokinetics of nitrous oxide is needed.

Air Pollutants, Occupational↗
PubMed2000

Do patients matter? Contribution of patient and care provider characteristics to the adherence of general practitioners and midwives to the Dutch national guidelines on imminent miscarriage.

OBJECTIVE: To assess the relative contribution of patient and care provider characteristics to the adherence of general practitioners (GPs) and midwives to two specific recommendations in the Dutch national guidelines on imminent miscarriage. The study focused on performing physical examinations at the first contact and making a follow up appointment after 10 days because these are essential recommendations and there was much variation in adherence between different groups of providers. DESIGN: Prospective recording by GPs and midwives of care provided for patients with symptoms of imminent miscarriage. SETTING: General practices and midwifery practices in the Netherlands. SUBJECTS: 73 GPs and 38 midwives who agreed to adhere to the guidelines; 391 patients were recorded during a period of 12 months. MAIN MEASURES: Adherence to physical examinations and making a follow up appointment were measured as part of a larger prospective recording study on adherence to the guidelines on imminent miscarriage. Patient and care provider characteristics were obtained from case recordings and interviews, respectively. Multilevel analysis was performed to assess the contribution of several care provider and patient characteristics to adherence to two selected recommendations: the number of recommended physical examinations at the first contact and the number of days before a follow up appointment took place. RESULTS: In the multilevel model explaining variance in adherence to physical examinations, the care provider's acceptance of the recommendations was the most important factor. Severity of symptoms and referral to an obstetrician were significant factors at the patient level. In the model for follow up appointments the characteristics of the care provider were less important. Referral to an obstetrician and probability diagnosis were significant factors at the patient level. CONCLUSIONS: The study showed that characteristics of both the patient and care provider contribute to the variability in adherence. Furthermore, the contribution of the characteristics differed per recommendation. It is therefore advised that the contribution of both patient and care provider characteristics per recommendation should be carefully examined. If implementation is to be successful, strategies should be developed to address these specific contributions.

Abortion, Spontaneous↗
PubMed2006

A methodology for assessing the professional development needs of nurses and midwives in Indonesia: paper 1 of 3.

BACKGROUND: Despite recent developments, health care provision in Indonesia remains suboptimal. Difficult terrain, economic crises, endemic diseases and high population numbers, coupled with limited availability of qualified health care professionals, all contribute to poor health status. In a country with a population of 220 million, there are currently an estimated 50 nurses and 26 midwives per 100,000 people. In line with government initiatives, this series of studies was undertaken to establish the training and development needs of nurses and midwives working within a variety of contexts in Indonesia, with the ultimate aim of enhancing care provision within these domains. METHODS: An established, psychometrically valid and reliable training needs instrument was modified for use within the Indonesian context. While this technique has had widespread international use in the developed world, its application for developing countries has not yet been established. The standard form consists of a biographical cover sheet and a core set of 30 items (all health-related tasks), which have to be rated along two seven-point scales. The first of these scales asks respondents to assess how important the task is to their job and the second scale is a self-assessment of respondents' current performance level of the task. By comparing the importance rating with the performance rating, an index of training need can be obtained (high importance and low performance indicating a significant training need). The modifications incorporated for use in this series of studies were a further 10 items, which were constructed following expert group and focus group discussions and a review of the relevant literature. Pilot trials with 109 respondents confirmed its feasibility and acceptability. The instrument was then administered to 524 nurses and 332 midwives across Indonesia. RESULTS: The data were subjected to a retrospective factor analysis, using a Varimax rotation and Cronbach's alpha to check the instrument's validity and reliability following modification. The results yielded six factors, which accounted for >53% of the variance, each of which had a Cronbach's alpha score of between 0.8644 and 0.7068. CONCLUSION: The results suggest that the modified instrument remained valid and reliable for use in the Indonesian nursing and midwifery context.

Journal Article↗
PubMedDate not supplied

[Surgeons, midwives and physicians in Senta in the 18th and 19th centuries].

INTRODUCTION: Authors present history data on development of the medical profession in Prussia, Germany, Austria and Hungary, that is countries from which surgeons, midwives and physicians most often came to work in Senta. It has been established that mostly junior physicians and "surgeons" came to our country, and from the forties till nineties of the 19th century they made a considerable number of our first medical professionals. In 1872 a law was passed according to which only doctors of medicine with university degrees were allowed to practice medicine, and so junior physicians gradually disappeared. OUR INVESTIGATIONS AND DATA: The earliest data on health care of Senta date back to the tax register for 1771 according to which the expenditure for November contained expenses for bread and half of the allowance for fodder which were paid to the city surgeon. According to the census from 1774/75 the first registered barber surgeon was Mihalj Nad, whereas four years later he was advertised as a surgeon in the tax register. In the following years more surgeons were registered: Janos Grubanovic, Jozef Forgac, Antal Kovac and Johan Brun. The first city midwife registered in the city court record in 1794 was Doroteja Gubik. During 18th century at the territory of Senta only barbers and surgeons were known, and there were no graduated physicians. The first city physician who received a degree from the School of Medicine was Samuel Borod who started working in Senta on April 24, 1822. After that, during 19th century the following physicians worked in Senta: Dr. Laslo Eres, Dr. Jozef Cendic, Dr. Simon Slezinger, Dr. Janos Nepomuki Revai, Dr. Zigmund Veksler, Dr. Adolf Glikstal, Dr. Jozef Kelner, Dr. Mor Lendvai, Dr. Sandor Meri, Dr. Jozef Havel and Dr. Jozef Rejcer. Dr. Janos Nepomuki Revai was at the head of the public health care of our town for 40 years, whereas his predecessor Dr. Jozef Cendić was engaged in this honorable profession for 30 years. Dr. Janos Revai was an outstanding person who introduced vaccination against smallpox and diphtheria, prevented further spreading of trachoma, stopped a great epidemic of cholera in 1892/93 and continually worked on promotion and improvement of health care in Senta. During 19th century the following surgeons worked in Senta: Istvan Budai, Mihajlo Zivković, Jozua Veksler, Istvan Kalman, while the last surgeon working in Senta was Lajos Kuti. In the 19th century the following midwives were registered in Senta: Apolonija Hauser, Verona Kremzer, Regina Zinger, Jozefa Vig, Apolonija Bauc, Apolonija Hauber and Rozalija Huska. At the end, authors list all surgeons, midwives and physicians with complete data on them from all available documents.

Barber Surgeons↗
PubMed1996

[The Protomedicato Tribunal and midwives. A relationship at the service of surgery].

We reviewed the bibliography on the history of midwives, and examined municipal and legislative sources, to investigate the relationship between midwives and the Protomedicato in Castile during the 16th to 18th centuries. Our thesis is that the Protomedicato exerted little control over the professional activity of midwives or over improvements made in the The Art of Attending Childbirths. Instead, it appears to have played a greater role in the professional and scientific consolidation of surgeons, by recognizing their authority in obstetric matters.

General Surgery↗
PubMed2001

[Are women satisfied with the assistance provided by midwives in childbirth?].

OBJECTIVE: To describe the women's satisfaction index regarding the cares provided by the midwife during the normal labour and delivery. DESIGN: This is a descriptive transversal study. Data were collected using a questionnaire that permitted assess the women's perceptions and expectatives referred to the attention received from midwives. SAMPLE: The sample consisted on 316 women who were assisted in the labour and delivery by midwives or midwives trainees. RESULTS: The women conferred a remarkable importance to the majority of the cares supplied by the midwife. The mean value of satisfaction with these cares was x = 8.62 (over 10). The most satisfied cares were "treating the women with respect", "supporting the immediate contact with the baby", and "praising the women's efforts", and the least satisfied cares were "keeping the partner informed", "permitting participation in making decisions" and "helping in the precocious beginning of the maternal lactation". The satisfaction with the emotional attention was superior than the satisfaction with the informational or tangible attention. CONCLUSIONS: The importance of the cares provided by the midwife during the labour and delivery in order to cope with the stress of this process, was confirmed by the women. The quality of the emotional support should be promoted to continue supplying an integral attention. It's convenient to reinforce the quantity and quality of the information provided to the woman and partner, the user's participation in making decisions, and the help in the precocious beginning of the maternal lactation.

Female↗
PubMed2002

The pressure is on: midwives and decubitus ulcers.

Research regarding pressure area care and management in nursing extends back many years, but remains relevant and cited today. With relevant knowledge, midwives can help prevent the development of pressure sores in the maternity setting. Clinical governance and risk management should ensure that the incidence and occurrence of pressure sores in the midwifery arena is reported and fed into appropriate audit analysis at local, regional and national levels. Midwives need to seriously consider the implications of modern midwifery care and management in relation to the development of pressure sores in our population. Labour suite, high dependency, ward and community areas should include guidelines for the prevention, treatment and management of pressure sores, including mattress policies. Prophylactic measures and assessment scores could be incorporated into partogram documentation in the labour suite and as part of postoperative documentation in the ward environment for women who have undergone caesarean section. Trusts may find that a link midwife liasing with tissue viability nurses proves beneficial. Community midwives should forge links with the district nursing services in their Primary Care Trust areas with regard to developing or adapting tools. Knowledge of pathophysiology, prophylaxis and subsequent management of decubitus ulcers in maternity care is sadly lacking in midwifery textbooks. Future authors and editors should include this subject and it should feature more prominently in midwifery education curricula. It is clear that there is much work to be done in this area, both educationally and clinically. Further research is required to evaluate pressure prevention strategies in the midwifery arena, including the increasing provision of one-to-one care in labour suite units. Improvements in the appropriate prevention and subsequent treatment and management of pressure sores will benefit women and help save the NHS hundreds of thousands of pounds in treatment and litigation costs.

Bandages↗