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PubMedDate not supplied

The essence of nurse-midwifery care. The woman's story.

The purpose of this qualitative research study was to discover the experience of the woman cared for by a nurse-midwife. Six variously situated and ethnically diverse women were interviewed about their experience with nurse-midwifery care. Using Colaizzi's phenomenological method, the data were analyzed extracting 151 significant statements that were clustered into nine themes. A picture of the essential structure of the women's experience of nurse-midwifery care unfolded and was returned to them for their comments and confirmation. Women talked about a relationship built on respect, trust, and alliance. It was the nurse-midwife herself, her qualities and behaviors, her concern and caring, and her respect for women that laid the foundation for how the women in this study perceived the experience. Repeatedly, women articulated the respect for their time, their families, their fears, and their need for information. Ultimately, it was this respect from the nurse-midwife that empowered the women to determine and direct their care.

Adult↗
PubMed1989

The introduction of computer assisted learning in a school of midwifery using the Wessex Care Plan Program.

This case study was the result of attending the Computer Assisted Learning (CAL) Course sponsored by the Wessex Regional CAL Project. This was the Region's initiative to prepare Nurse and Midwife Teachers in developing CAL in the curriculum. The small scale qualitative classroom study was conducted in the School of Midwifery. The aim of the study was to evaluate the use of the content-free Wessex Care Plan Program (WCPP) in the Midwifery curriculum. For the evaluation of the study, a triangulation of data were obtained from the following sources: 1) classroom observation 2) questionnaires and interviews of eight Student Midwives 3) colleagues' responses to the introduction of CAL and personal experience The findings of this study showed that the content-free WCPP was easy to prepare and implement. The Student Midwives found the program easy to follow and a useful means of learning. At the same time it was enjoyable and fun; a dimension of learning that we could do with more often!

Computer-Assisted Instruction↗
PubMed1994

The views of students and teachers on the use of portfolios as a learning and assessment tool in midwifery education.

As the introduction of devolved continuous assessment in midwifery education has led to the introduction of new and varied learning and assessment strategies, there is a need to evaluate their use. The focus of this study is on the views of students and teachers and on portfolios as a learning and assessment tool in midwifery education. In a small exploratory study questionnaires were used to obtain both quantitative and qualitative data from 24 student midwives. Eight tutors were also interviewed. Data was analysed using an adapted version of grounded theory. Many students had negative feelings about the use of portfolios. In particular problems related to lack of motivation, uncertainty about what was expected of them, difficulty in expressing personal thoughts and feelings and the subsequent anxiety that this created. Tutors showed some awareness of the relative merits associated with the use of portfolios for learning and assessment. Although some of the students problems in keeping the portfolio were appreciated by the tutors, the students perceived there were few attempts made to rectify or minimise these difficulties.

Attitude of Health Personnel↗
PubMedDate not supplied

International rural health needs and services research: a nursing and midwifery response.

As the importance of evidence-based practice in global health care increases, the need for constant, accurate feedback from those in practice is critical, yet the requirement to rapidly obtain and disseminate data on a global basis is a challenge for all health professionals. The Internet allows for global participation in data collection that dramatically streamlines the traditional survey process. This new paradigm applies to surveys that are short, issue focused, and time sensitive. The Global Network of World Health Organization (WHO) Collaborating Centres for Nursing and Midwifery Development used a sample of international nurses in 70 countries to identify the worldwide rural health issues of WHO priority health needs, treatment modalities, health care interventions, and providers, as well as the current state of rural health research on a global level. This article presents the results of the survey regarding rural health needs and nursing and midwifery's response to them internationally, demonstrates Internet data collection, and shows how this research paradigm can help establish an evidence base for nursing practice.

Education, Nursing↗
PubMedDate not supplied

Nurse-midwifery service in a rural setting.

This article describes the structure and development of a successful, rural nurse-midwifery service consisting of nine certified nurse-midwives and four obstetricians. The model has shown that the addition of a nurse-midwifery service and the adoption of a collaborative care model can improve obstetric outcomes. The outcomes of this model include an increase in the number of women served each year, a decrease in the cesarean section rate, an increase in the number of twin gestations delivered vaginally, an increase in the number of breech presentations delivered vaginally, an increase in the success rate of vaginal birth after cesarean section, and decreased numbers of episiotomies, with a resulting decrease in the number of third- and fourth-degree lacerations.

Delivery, Obstetric↗
PubMedDate not supplied

Outcomes of macrosomic infants in a nurse-midwifery service.

The purpose of this study was to compare outcomes of term infants of average birth weight with outcomes of large infants in a nurse-midwifery service. A retrospective study design was used. Data were retrieved from a computer data base that contained information from a data form routinely completed for all births. Subjects were women cared for by the nurse-midwives including those for whom the birth was conducted by a physician. The final n study population was 2,228; 322 (14.5%) of the infants weighed 4,000 g or more. Women who delivered large infants had a significantly higher prepregnant body mass index and pregnancy weight gain. Shoulder dystocia occurred more often in large infants; however, newborn intensive care unit admission rates did not differ between the average birth weight and the large infants. Apgar scores at 1 and 5 minutes were significantly lower for infants weighing > or = 4,500 g compared to those with birth weights of 2,500-3,999 g and those 4,000-4,449 g; however, these differences were not clinically significant. A trend for fewer occurrences of shoulder dystocia in the side-lying birth position was observed. Logistic regression predicting poor Apgar scores (< 7) showed parity as a protective factor and increased gestational age and higher maternal body mass index as predictive of low Apgar scores. Large infants had birth outcomes comparable to those reported by others in the medical literature, suggesting that nurse-midwifery management, including consultation with physician colleagues, can be appropriate and safe.

Adult↗
PubMedDate not supplied

The midwifery solution to contemporary problems in American obstetrics.

This article focuses on midwifery as one solution to many of the problems that confront contemporary American obstetrics. Documented evidence with historic perspective that supports the view that midwifery should become the mainstream in maternity care in the United States, not an alternative, is presented. The role differences and conflicts that tend to arise between doctors and midwives are discussed and collaboration between the two professional groups is suggested as yet another solution to the problem.

Female↗
PubMedDate not supplied

Clostridium difficile-associated disease. Implications for midwifery practice.

Clostridium difficile-associated disease (CDAD), a gastrointestinal infection with a wide range of manifestations whose primary symptom is diarrhea, occurs when antibiotic medications, or rarely other drugs or conditions, disrupt the normal colonic microflora, making it susceptible to the growth of toxigenic C difficile. It is a significant nosocomial infection and an increased incidence has been noted in recent years. Although infrequently seen in midwifery practices, it does occur and may increase with the growing usage of intrapartal antibiotics. Midwives may evaluate and treat a client with an initial episode of mild to moderate CDAD; they also may manage collaboratively or refer for medical management those clients with recurrent or severe disease. This article reviews the epidemiology, pathogenesis, clinical presentation, prevention, and midwifery management of initial and recurrent CDAD. The limitation in the use of oral vancomycin due to the emergence of vancomycin-resistant enterococcus, resulting in metronidazole becoming the primary agent for treatment of CDAD, and the implications of this in the treatment of CDAD during pregnancy and lactation are addressed.

Adult↗
PubMedDate not supplied

Midwifery triage and management of trauma and second/third trimester bleeding.

Trauma affects approximately 8% of all pregnancies, and bleeding affects nearly 5% of gestations. These two conditions are potentially life-threatening and require immediate management by the midwife. Trauma in pregnancy is commonly caused by motor vehicle accidents, falls, and assault. Although abruption resulting from trauma is a rare occurrence, injury caused by domestic violence, is associated with the greatest risk of obstetric complications. Bleeding in pregnancy has a number of etiologies. Midwives are well-prepared to safely and competently make a differential diagnosis of bleeding in the second and third trimesters. A sequence for midwifery triage of clients who present to the emergency room/triage area for trauma and bleeding is presented. Considerations for stabilization, history, physical examinations, diagnostic testing, initial management, and follow-up are described. Practical considerations for midwifery services incorporating provisions for triage into their caseloads are also provided.

Female↗
PubMed1995

The need for nursing and midwifery programmes of education to address the health care needs of minority ethnic groups.

The article reviews some of the more influential literature of the past decade on the health needs of ethnic groups, in an effort to identify what is being done by nursing and midwifery education to address the health care needs of these groups and to prepare practitioners who are able to respond to these needs. The article suggests that despite the relative lack of progress in this field of health care and education, there still exists much confusion, disagreement and lack of clarity around many issues, such as the identification of relevant content, the integration of this content into the curriculum and more importantly the delivery of this content. The literature seems to point to a lack of cultural knowledge, particularly for certain ethnic groups, which needs to be rectified. But even when knowledge is available, the evidence clearly indicates that both educators and practitioners are failing to translate this into effective and culturally sensitive care. The article suggests that nursing and midwifery education could and should play an important role in the development and dissemination of culturally sensitive care.

Curriculum↗
PubMed1996

Home births in The Netherlands: midwifery-related factors of influence.

OBJECTIVE: identification of midwifery-related factors influencing the varied percentage of home births in the practice of Dutch midwives. DESIGN: cross-sectional study. SETTING: independent midwifery practices in the Netherlands. PARTICIPANTS: 115 independent midwives. MEASUREMENTS: recordings of time spent on professional activities over three weeks. Questionnaires were completed on practice characteristics and opinion regarding the place and risks of birth. FINDINGS: attending home births is no more time consuming for midwives than assisting at short-stay hospital births. The percentage of home births in a practice is not related to the average number of hours worked per week, nor to the size or type of practice. The percentage of home births is lowest in major cities. Midwives who think more positively about home births and do not consider these to involve greater risks assist at more home births. IMPLICATIONS FOR PRACTICE: the assumption that a heavy workload will interfere with the policy of de-medicalising birth is found to be false. The opinion of a midwife about the desirability and safety of home confinement has a slight positive effect on the percentage of home births in her practice. Those attempting to promote an increase in births at home must take these factors into account.

Attitude of Health Personnel↗
PubMed1999

Towards an understanding of the cultural roots of homophobia in order to provide a better midwifery service for lesbian clients.

Research has indicated that homophobia amongst health professionals, including midwives, has negative consequences for the care received by lesbian clients. Social scientists recognise that homophobia is neither inevitable nor universal, rather it is culturally specific and culturally constructed. This recognition is potentially very positive, since it suggests that homophobia in midwifery practice may successfully be theorised and critiqued in order to support the development of better services for lesbian clients. In this paper discourse analysis methodology from the cultural and social sciences is used to interrogate textual evidence of the nature of homophobia in British and North American culture. The analysis results in the identification of five 'themes' underlying cultural expressions of homophobia: anxiety about sexual difference, fear of female sexuality, the sexualisation of lesbianism, the characterisation of lesbianism as 'sick' or 'unnatural', and the inability to identify lesbians with any certainty. In the context of midwifery, these themes emerge as particularly powerful, suggesting that, while the deep-rooted nature of homophobia is resistant to rapid change, midwives may be uniquely well placed to develop appropriate professional services for the growing minority of their clients who are lesbian.

Attitude of Health Personnel↗
PubMed1999

An ethnographic study of women's experience of partnership caseload midwifery practice: the professional as a friend.

OBJECTIVES: To explore the experience of a known midwife for labour and birth as provided through the partnership caseload model of care in women who had a previous baby under an alternative system of care. DESIGN: A qualitative study using an ethnographic approach. Data were collected by tape-recorded interviews. SETTING: The maternity unit at Leicester Royal Infirmary NHS Trust, Leicester, UK in 1998. PARTICIPANTS: 10 multiparous women cared for by Birth Under Midwifery Practice Scheme (BUMPS) midwives were interviewed between eight- and 12 weeks' postpartum. KEY FINDINGS: Women's perceptions and experiences were predominantly influenced by the relationships they had with their midwives who they described as 'friends'. All other themes were filtered through these relationships, including previous negative experiences of maternity care, the valuing of a known midwife for labour and birth, their positive birth experiences, expressions of delight at their care, their liking of home antenatal care, and the appreciation of their existing children and partners meeting their midwives. IMPLICATIONS FOR PRACTICE: Partnership caseload midwifery practice has significant positive impact on women's experience of childbirth. The midwife/woman relationship that has evolved in this context is highly valued by women and challenges traditional professional roles. The model should be explored in other settings to see if its benefits to women are transferable.

Anthropology, Cultural↗
PubMed1996

Does midwifery-led intrapartum care require anaesthetic services?

The report of the Expert Maternity Group 'Changing Childbirth' (The Cumberlege Report) advocates a greater role for midwives in the care of the low risk pregnant woman, and has promoted much discussion about the future development of maternity services in the UK. At Leicester Royal Infirmary NHS Trust the 'Home from Home' delivery scheme provides midwifery-led antenatal and intrapartum care of women with uncomplicated pregnancies. We have performed a retrospective review of the requirements for anaesthetic services in this unit. During the 12 month review period 1610 women were admitted to the 'Home from Home' delivery scheme in labour. One hundred and eighty one women subsequently received anaesthetic intervention. Of this group, 137 (77.0%) required an epidural, 17 (9.6%) a spinal, 18 (10.1%) a general anaesthetic, 5 (2.8%) an epidural and a general anaesthetic and 1 (0.6%) an epidural and a spinal. Our results demonstrate that low risk pregnant women in labour being cared for in a midwifery led unit have a considerable need for anaesthesia and analgesia.

Journal Article↗
PubMed1995

Ways of knowing in midwifery.

Scientific ways of knowing dominate our society today and this has major ramifications for midwifery. This article outlines the historical development and cultural understanding of ways of knowing in our society today. It is suggested that the patriarchal societies in which our ways of knowing have developed have emphasised scientific ways of knowing while other ways such as intuition and embodied knowledge received little acknowledgement. This article then goes on to explore these other ways of knowing, discusses their implications for midwifery care and suggests that to embrace many and varied ways of knowing is to more fully realise our abilities and potential as midwives.

Cultural Characteristics↗
PubMed1997

The more things change, the more they stay the same: whither midwifery?

The pace of change is said to increase over the next few years. One of the most significant recent changes has been the "McDonaldization of Society". The notion of "fastness" is permeating all society, including health and education. The concentration of rationalization through the principles of efficiency, calculability predictability and control, when extended to its logical conclusion, results in irrationality or dehumanization. Childbirth has been "McDonaldized" by the medical profession, but modern midwifery, is leading the way in an anti McDonald's movement to rehumanize it. Returning to past values contained in aesthetics, use of the partnership model, different forms of research and political action, midwifery is taking control of childbirth away from the rationalists and returning it to women. It is reclaiming childbirth by placing value on women and empowering them to take control of their own childbirth.

Australia↗
PubMed1995

The cost of registered nurse-midwifery education in Malawi.

Educational institutions are challenged to produce more graduates with few resources in current sub-Saharan Africa. in such an environment, it is critical that cost information pertaining to nursing education be available to assist nursing education programmes in meeting the challenges of producing more nurse-midwives with less cost. This study explores the cost of registered nurse-midwifery education and describes factors which influence the cost of such education in Malawi. Results demonstrate that nursing education is costly, be it in a developing or develop country. The findings on cost of nurse-midwifery education have implications for policies related to the overall educational planning for the supply of registered nurse-midwives, the efficiency of nursing education programmes, the organization of nursing education curricula and the sharing of cost of education among the government, students, their families, and other sources.

Costs and Cost Analysis↗
PubMed1998

The integration of nursing and midwifery education within higher education: implications for teachers--a qualitative research study.

This study was a qualitative narrative that reviewed the historical developments that led to the integration of nursing and midwifery education with higher education in the United Kingdom (UK). A sample of teachers was investigated with particular reference to role conflicts they may have experienced as a result of integration. In addition to this the views of established academic university staff were assessed. The methodology adopted for the research was an eclectic qualitative one, drawing on several approaches, and sought to inquire into individuals personal perception of these events. In this paper the progression of events, nationally and locally, that led to the educational reforms in nursing and midwifery in the 1990s are examined. This narration includes a brief history of the creation of a new university department. Following this there is detail of how data were collected and analysed from a teacher population within this new department. The findings, whilst difficult to generalize to the wider population of nurse and midwife teachers, demonstrate that the sample of teachers examined, all of whom have been involved in the process of integration, have been exposed to stress that has resulted in role conflict. Established university staff, however, were more objective, expressing some broad anxieties regarding the resource demands and research capability of the new department.

Adult↗