Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “MIDWIFERY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 361 records · Page 20Linked to original sources
PubMedDate not supplied

Vaginal birth after cesarean birth: a national survey of U.S. midwifery practice.

Midwives have been providing care for women choosing vaginal birth after cesarean birth (VBAC) for over 20 years. The 1999 American College of Obstetrician Gynecologist (ACOG) guidelines and recent studies questioning the relative safety of VBAC have raised concerns about continuing to offer this option. As part of an effort to understand VBAC care provided by midwives, this study used a national survey sample to examine practices, scope, and recent changes in the provision of VBAC care. The survey, which included demographic and practice items was mailed in late 2000 to a purposeful sample of 325 midwifery practices. The return rate was 62%. Nearly all (94%) of the responding practices were providing VBAC care, and almost half of them (43%) stated that their ability to do so had changed within the past 2 years secondary to recent studies in the obstetric literature, the 1999 ACOG statement, and concerns from third-party payers. Criteria for offering VBAC are stricter, and consent forms are more extensive. Other changes included the need for additional or more intensive support services, in-house anesthesia, and surgery backup. Midwives continue to provide VBAC care, although with some increased restrictions. This study provides background for future research that will determine how midwifery care affects the rate of successful VBACs.

Adult↗
PubMedDate not supplied

A systematic approach for midwifery students: how to consider evidence-based research findings.

The midwifery profession is increasingly applying the results of evidence-based research findings. Several researchers were asked if they would answer questions regarding the essential research skills necessary for midwives, the relevance of applying valid evidence to practice, and concerns regarding evidence-based practice overall. The objectives were to share expert researchers' responses that could be used by educators to help introductory midwifery students understand the importance of developing skills in assessing "the best evidence" and to stimulate interactive discussion in the classroom. Consideration of the expert opinions stimulated student thinking on the relation of evidence-based findings to practice in an exciting approach characterized by inquiry and debate, which got favorable responses and evaluations from the students.

Clinical Competence↗
PubMedDate not supplied

Integrating qualified nurses and non-nurses in midwifery education: the two-year experience of an ACNM DOA Accredited Program.

In 1996, the Division of Accreditation (DOA) of the American College of Nurse-Midwives (ACNM) preaccredited the first direct entry program of midwifery education for candidates who already possess undergraduate degrees in non-nursing disciplines. Inaugurated through the partnership of the State University of New York Health Science Center at Brooklyn and the North Central Bronx Hospital, this 1-year, postbaccalaureate, certificate program of studies graduated two integrated classes of 22 registered nurse (RN) and nine direct entry (DE) students between 1997 and 1998. This article presents the experience of the first 2 years of this innovative program, focusing on the profiles of the DE students, their achievements, and their experiences entering the workforce. All of the data comparing nurse and non-nurse student progress through the program of studies strongly support the conclusion that, within an ACNM DOA preaccredited/accredited midwifery education program, DE students can achieve standards of academic excellence and clinical competency that are at least equivalent to those demonstrated by their RN peers.

Accreditation↗
PubMed2002

Optimising the reproducibility of a performance-based assessment test in midwifery education.

Despite problems concerning generalisability of test results - largely due to limited sampling of the task domain - and questions about test efficiency, the popularity of OSCEs in medical education has motivated the use of similar assessment methods in other health care domains. Purpose of this study was to investigate reproducibility of scores on an OSCE-based test in the relatively narrow domain of midwifery, as compared to the broad medical domain. The influence of global rating scales and adoption of a mastery-oriented test perspective on reproducibility of test scores was investigated in order to explore possibilities to increase test efficiency.A 3-hr, 6-station performance based test was administered to third and fourth year students at Kerkrade Midwifery School (the Netherlands). Students' performance was recorded using a station specific checklist and a global rating scale. For the 3-hr OSCE the generalisability coefficient based on checklist scores is 0.48. Based on global ratings alone, the generalisability coefficient is 0.61. Adjusted dependability indices are 0.85 based on checklist scores and 0.95 for global ratings respectively. Results suggest that even for small domains the problem of case-specificity remains a major impediment to high stakes performance testing. Findings furthermore suggest that use of global rating scales and professional expert judgements in professional competence evaluation is to be preferred to task specific checklists for reasons of reproducibility and efficiency in test development and administration. Adoption of a mastery oriented test perspective may reduce testing time requirements even further.

Certification↗
PubMed1999

The culture of midwifery in the National Health Service in England.

The culture of midwifery in the National Health Service was examined in order to foster understanding of the context of midwifery practice. In-depth interviews were conducted with midwives in five, very different, sites across England. The culture which emerged was one of service and sacrifice where midwives lacked the rights as women which they were required to offer to their clients. There was a lack of mutual support and of positive role models of support with considerable pressure to conform. Guilt and self-blame were common as was learned helplessness and muting. The dilemmas of this culture are considered and the resistance which it offered to change in relationships. Change was either resisted, brought about by stealth or strategically planned to equip midwives to change their culture.

Clinical Nursing Research↗
PubMed1999

Women's perceptions of midwifery care: a longitudinal study to shape curriculum development.

BACKGROUND: Health and education services are increasingly expected to focus on the consumer. The perceptions of childbearing women should be incorporated into midwifery curricula, but often they are given minimal attention or not sought for this purpose. This study was designed to enable the views and experiences of local women to influence curriculum development in a large university in England. METHODS: A descriptive, longitudinal, qualitative study was conducted using semistructured and unstructured interviews with women, and data from their maternity records. Forty-one pregnant women were recruited and interviewed during pregnancy, in the early postpartum period in hospital, and in their homes 2 to 3 weeks after the birth. RESULTS: Themes were clustered into three categories: the characteristics and qualities of the caregivers, the individualized nature of care, and the clinical competence of the caregivers. Continuity of caregiver was desired but accepted as probably unrealistic by many. Developing a "special" trusting relationship with a female midwife was perceived as essential to promoting a positive childbirth experience. Clinical competence was expected and largely experienced. Negative feelings related to individual caregivers more than the type of care given. CONCLUSIONS: Most women had positive experiences, finding midwives and doctors with good knowledge, interpersonal skills, and abilities. Examples of poor communication skills and interprofessional conflict indicated a need to give priority to developing and assessing students' interpersonal skills. Evidence of interprofessional conflict acted as the catalyst to merge midwifery with the department of obstetrics in the university to enhance interprofessional learning.

Adult↗
PubMed2000

The use of aromatherapy in intrapartum midwifery practice an observational study.

The authors report the process and results of an evaluation of a midwifery aromatherapy service for mothers in labour: This study of 8058 mothers in childbirth, is the largest research initiative in the use of aromatherapy within a health-care setting. The study involved a wide range of participants, from mothers who experienced a low risk, spontaneous labour and birth, to those whose labour was induced, and those who had vaginal operative delivery and Caesarean section. The study-took place over a period of 8 years, which enabled a more challenging test of the effect of aromatherapy on intrapartum midwifery practice and outcomes. In the study a total of 10 essential oils were used, plus a carrier oil, which were administered to the participants via skin absorption and inhalation. The study found little direct evidence that the practice of aromatherapy per se reduces the need for pain relief during labour, or the incidence of operative delivery. But a key finding of this study suggests that two essential oils, clary sage and chamomile are effective in alleviating pain. The evidence from this study suggests that aromatherapy can be effective in reducing maternal anxiety, fear and/or pain during labour. The use of aromatherapy appeared to facilitate a further reduction in the use of systemic opioids in the study centre, from 6% in 1990 to 0.4% in 1997 (per woman). Aromatherapy is an inexpensive care option. In 1997 when 1592 mothers used aromatherapy, the total cost was 769.17 Pounds. The study reports a minimal incidence of associated symptoms. Out of 8058 mothers, 1% (100) recorded an associated symptom. These were mild in nature. The successful model of integrated practice that this aromatherapy study presents, offers a useful example for other units to consider.

Adult↗
PubMed2000

A randomised study of midwifery caseload care and traditional 'shared-care'.

OBJECTIVES: To evaluate caseload midwifery care in comparison to traditional 'shared care'. DESIGN: Comparative study with area randomisation. SETTING: District general hospital in England. MAIN OUTCOME MEASURES: 'Known carer at delivery,' 'normal vaginal delivery' and 'obstetric intervention'. SUBJECTS: All pregnant women delivering in the six areas chosen for the study. MAIN FINDINGS: A highly significant difference was found between caseload and traditional care groups in terms of level of 'known carer at delivery' (696/770 94.7%; cf. 52/735 (6.7%), p < 0.001). However, no differences in 'normal vaginal delivery' rates were found (542/770 (70%) cf. 509/735 (69%). There were fewer 'obstetric interventions' in the caseload group, particularly epidural analgesia (80/770 (10%) cf. 110/735 (15%) p = 0.01) and oxytocin augmentation (351/77 (46%) cf. 387/735 (53%), p = 0.01). There were no significant differences found in terms of neonatal outcome. CONCLUSIONS: Caseload midwifery results in high levels of 'known carer at delivery' which appears to be associated with a reduction in augmentation and epidural rates but which were not associated with an increase in normal vaginal delivery rate.

Anesthesia, Epidural↗
PubMed2000

Action research to improve the pre-registration midwifery curriculum Part. 3: Can fitness for practice be guaranteed? The challenges of designing and implementing an effective assessment in practice scheme.

OBJECTIVE: To design and implement a robust assessment scheme to more effectively identify student midwives' fitness for midwifery practice. DESIGN: Five inter-related action research cycles. Methods included: documentary analysis, interviews, observation, questionnaires, focus groups. SETTING: A large university in England. PARTICIPANTS: Student midwives, practising midwives and midwife teachers, childbearing women, course planning team and EME project team collaborators. FINDINGS: Whilst there was evidence that the majority of students are fit for midwifery practice by the end of the course, assessment schemes were found to be unreliable. In particular there was the potential for 'borderline' students to register as midwives if assessors were inadequately prepared for their responsibilities; assessment documentation was not 'user' friendly; evidence of competence was inadequately recorded or there was a lack of systematic monitoring by university teachers and examiners of the assessment in practice scheme. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The gap between curriculum aspirations and actual implementation needs to close. The assessment matrix, developed as part of the national evaluation study, could usefully be used as a framework when designing assessment schemes. The difficulties for midwife assessors in each locality need to be identified and solutions incorporated into workable but robust strategies. University midwife teachers/lectures have a responsibility to work in partnership with assessors and students to monitor assessment in practice schemes and, where local circumstances and confidence in reliability permit, grade and award credits for practice-based assessment of student capability.

Clinical Competence↗
PubMed2000

Incorporating cultural diversity in randomised controlled trials in midwifery.

The randomised controlled trial is currently the 'gold standard' that guides health-care practices. The implementation of new models of midwifery care often relies on results from randomised controlled trials. However, many randomised controlled trials exclude women who do not speak English or are designed in such a way that cultural diversity is not facilitated. This can mean that the sample is not representative of the population from which it was drawn or to which it will be applied. Culturally diverse representation can be achieved through a number of strategies. These include utilising health-care interpreters, ensuring materials are translated into common community languages and engaging the local community. These strategies can be used to ensure that the sample in a randomised controlled trial is culturally and linguistically diverse, and representative of the community. We have conducted a randomised controlled trial of a community-based model of midwifery providing continuity of care in a culturally diverse population. A number of issues in the conduct of a trial within a culturally diverse society are discussed in this paper. The trial will be used to illustrate some of the strategies used to ensure that the sample represented the population from which it was drawn.

Catchment Area, Health↗
PubMed2004

Rethinking midwifery refresher programs as a recruitment strategy.

This paper presents a case study on an innovative Midwifery Refresher Program in the context of current midwifery workforce issues. The refresher program was developed specifically as a recruitment strategy to address a staffing crisis at the Mater Misericordiae Mothers' Hospital, a busy tertiary maternity hospital in Brisbane, Australia. Features of the program that contributed to its success include collaboration with an industry partner, high levels of clinical support for participants, flexibility for women with family responsibilities and low financial costs for all stakeholders. This type of recruitment strategy may be useful for health care services experiencing staff shortages.

Catholicism↗
PubMed2001

Childbirth and pragmatic midwifery in rural Ghana.

Conceptual categories such as traditional, modern, and postmodern do not further our understanding of the empirical situation of midwifery in late 20th-century rural Ghana. Processes of "modernization," it is argued, have not had much impact on the domain of childbirth. And, despite efforts to "medicalize" birth (by the state and the international movement for safe motherhood and child survival), in Anlo-Ewe cultural contexts in the mid-1990s the lineage still controlled most deliveries, with many babies continuing to be born at home. This article provides an in-depth portrait of one midwife, Sena, who practiced in this rural locale--a locale that is marked by increased "professionalization" and competing ideologies of healing and health. Exemplifying what might best be referred to as critical midwifery grounded in pragmatism, Sena mediated, translated, and maneuvered as she involved herself in the imbroglios of birth and as she worked to improve maternal and infant health.

Delivery Rooms↗
PubMed2000

An investigation into the use of aromatherapy in intrapartum midwifery practice.

OBJECTIVE: The principal aim of the study was to examine the contribution of aromatherapy to the promotion of maternal comfort during labor and as a tool to improve the quality of midwifery care. DESIGN: Evaluative study. SETTING: Delivery suite in a large British teaching hospital with approximately 6,500 deliveries per annum. SUBJECTS: A total of 8,058 mothers were evaluated between 1990 and 1998. INTERVENTIONS: Women were offered aromatherapy to relieve anxiety, pain, nausea and/or vomiting or to strengthen contractions. Routine data collected on the use of aromatherapy over the period were analyzed. Data from the unit audit were used to provide a comparison group of mothers not given aromatherapy (n = 15,799) from the study center. OUTCOME MEASURES: Outcome measures include mothers' ratings of effectiveness, outcomes of labor, use of pharmacologic pain relief, uptake of intravenous oxytocin, reported associated symptoms, and annual costs. RESULTS: The use of aromatherapy during childbirth was an increasingly popular care option with mothers and midwives. More than 50% of mothers rated it as helpful, and only 14% found it unhelpful. The use of aromatherapy was not confined to low-risk mothers. Sixty percent of the sample were primigravidae, and 32% overall had had their labor induced. The administration of aromatherapy in childbirth did appear to reduce the need for additional pain relief in a proportion of mothers. More than 8% of primigravidae and 18% of multigravidae used no conventional pain relief during labor after using essential oils. During the years of the study, the use of pethidine in the study center declined from 6% to 0.2% of women. The study also showed that aromatherapy may have the potential to augment labor contractions for women in dysfunctional labour. A very low number of associated adverse symptoms were reported (1%). CONCLUSION: This study represents a successful example of the integration of a complementary therapy into mainstream midwifery practice and forms a basis for future research.

Anxiety↗
PubMed1998

Profession, skill, or domestic duty? Midwifery in Sheffield, 1881-1936.

Midwives today trace their professional identity back to the period following the midwifery regulation of 1902, when provisions were made for the training and registration of all midwives, and for the gradual elimination of the untrained practitioner. Some historians have argued that this represented a definite break and signalled the willingness of midwives to move towards a professional status. A comparison of midwifery in Sheffield pre- and post-regulation demonstrates no significant change in the practice and profiles of those in the occupation; all midwives remained primarily married or widowed part-time workers. Training for midwives was instituted early in Sheffield. Those trained had fairly high caseloads for the period, but their social and economic status was no different from non-trained midwives in the area. Regulation had a significant impact on the attitude of doctors towards midwives, who were increasingly viewed as part of a medical structure of care. Some midwives attempted to pursue collective action in order to improve their prospects, but they were in the minority. The limits to their professional development were demonstrated by their lack of control over supervision, their subordinate relationship to doctors, and their inability to work in unison.

Accreditation↗
PubMed2003

Midwifery and society in restoration York.

This article is a micro-historical study of the social networks of an elite mid-wife in seventeenth-century England, and discusses the implications of these networks for our understanding of early modem midwifery. Bridget Hodgson was the daughter-in-law to the former Lord Mayor of York, and closely connected to some of the city's most influential families. Analysis of the connections found in her will and the depositions from a defamation trial in which she was involved illustrates Hodgson's place among York's elite, but also indicates that her work as a midwife took her outside of these circles. This article also compares Hodgson's experience with that of her maidservant and deputy, discussing the different meanings that midwifery could have for its practitioners, depending on their social background. Testimony from the defamation case indicates the ways in which her work as a midwife shaped her relationship to parish authorities and to the female community. Midwives were expected to report illegitimate births to parish officials, an obligation which overlapped with female efforts to control the sexuality of neighbourhood women through gossip. This article highlights the complexity of the midwife's place in early modern society, and contributes to our understanding of this important class of women.

England↗
PubMedDate not supplied

Down the rabbit hole: examining outcomes of nurse midwifery care.

Care of the laboring woman and subsequent birth interventions have generally been based on tradition rather than a systematic examination of the cost-effectiveness of the interventions. This retrospective study examined the outcomes of nurse midwifery care at a large metropolitan university clinic setting. Findings suggest that more sensitive cost and quality indicators of nurse midwifery care need to be developed, and the effect of these on outcomes needs to be elucidated.

Adolescent↗
PubMed1985

Licensed lay midwifery and the medical model of childbirth.

Previous research has tended to equate lay midwifery with demedicalized care. This paper analyzes how licensed lay midwives in Arizona have been pressured towards a more medical model of childbirth. Licensing has affected midwives' beliefs and practices through increasing their exposure to medical definitions of childbirth and making them legally accountable to the medically dominated State Department of Health Services. The midwives' cumulative experience with handling obstetrical problems has also affected their definitions of childbirth. The midwives have maintained a commitment to holistic care, but have moved towards a more hierarchical style of practice due to changes in their clientele, the need for efficient bureaucratic arrangements, and the desire to earn a living at midwifery.

Arizona↗
PubMed1995

Reflection and critical incident analysis: ethical and moral implications of their use within nursing and midwifery education.

Despite the dearth of rigorous empirical investigation, reflection and reflective practice have become buzz words in nursing and midwifery education. Reflection and critical incident analysis may be tools which can facilitate the integration of theory and practice. It is proposed that in the absence of explicit and thorough preparation of lecturers and students, together with very careful curriculum planning, these activities may be counter-productive or even harmful. In the absence of structure, reflection and associated critical incident analysis may lead to student disaffection or, worse, the potential for actual psychological disturbance. Empirical studies on the use of identified models of reflection and critical incident analysis are urgently needed to assist nursing and midwifery lecturers and students to achieve predictable learning outcomes for this potentially valuable activity.

Attitude of Health Personnel↗