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 451 records · Page 25Linked to original sources
PubMedDate not supplied

History of midwifery in New Mexico: partnership between curandera-parteras and the New Mexico Department of Health.

Curandera-parteras (traditional Hispanic midwives) have been in northern New Mexico since before its statehood. In the 1930s, the New Mexico Department of Health began a valuable relationship with the curandera-parteras through the Midwife Consultant Program. This article describes the relationship between the curandera-parteras and the New Mexico Department of Health originating in the 1920s. The amenable and effective working relationship achieved between curandera-parteras and public health during this time period helped create the positive support for midwifery that is apparent in New Mexico today.

Cooperative Behavior↗
PubMedDate not supplied

Midwifery care measures in the second stage of labor and reduction of genital tract trauma at birth: a randomized trial.

Genital tract trauma after spontaneous vaginal childbirth is common, and evidence-based prevention measures have not been identified beyond minimizing the use of episiotomy. This study randomized 1211 healthy women in midwifery care at the University of New Mexico teaching hospital to 1 of 3 care measures late in the second stage of labor: 1) warm compresses to the perineal area, 2) massage with lubricant, or 3) no touching of the perineum until crowning of the infant's head. The purpose was to assess whether any of these measures was associated with lower levels of obstetric trauma. After each birth, the clinical midwife recorded demographic, clinical care, and outcome data, including the location and extent of any genital tract trauma. The frequency distribution of genital tract trauma was equal in all three groups. Individual women and their clinicians should decide whether to use these techniques on the basis of maternal comfort and other considerations.

Adult↗
PubMedDate not supplied

The National Practitioner Data Bank: information for and about midwifery.

The National Practitioner Data Bank (NPDB), mandated by federal legislation in 1986, serves as a mechanism to protect the public from unsafe practitioners who attempt to avoid discovery of prior negligent behavior or malpractice record(s) by moving from state to state. Reporting to the NPDB about malpractice payments on behalf of nurse-midwives began in 1990. Reporting of providers excluded from Medicare and Medicaid program participation began in September 1999. Practitioners who were already in an excluded status at that time were reported. Reports of adverse action against a nurse-midwife can be submitted to the NPDB by a state licensure board, a governmental agency, hospitals, health maintenance organizations, or other health care organizations. Reporting of licensing actions and clinical privilege actions are not required, although these may be voluntarily reported. The NPDB received 484 reports about nurse-midwives from September 1, 1999, to March 31, 2005. Of the 484 reports, 375 have an obstetric malpractice code. The median claim payment made on behalf of nurse-midwives during this period is 225,000 dollars. Although limited, the NPDB is the only systematic national source of nurse-midwifery malpractice data collection.

Confidentiality↗
PubMedDate not supplied

Predictors of successful pessary fitting and continued use in a nurse-midwifery pessary clinic.

Women with incontinence and/or pelvic organ prolapse presenting to an urogynecology service were offered referral to a dedicated midwifery pessary clinic. Charts of these women were reviewed for demographic information, physical examination, pelvic floor disorders, and details of pessary-fitting sessions. Successful fitting was defined as a comfortable fit and retention of the pessary with valsalva and voiding. Continuation was defined as a successfully fit patient who returned at least once after the initial fitting with the pessary still in use. Spearman's correlations identified variables associated with successful fitting and continuation of use. Logistic regression identified variables that predicted continued use. Eighty-six percent of women were successfully fit, and 89% continued pessary use for a mean of 6 months. Predictors of unsuccessful fitting included a history of a prior prolapse procedure or hysterectomy (P < or = .001). Severe posterior prolapse was associated with pessary discontinuation after adjustment for patient's age (P < .04). Success rates for treatment of stress urinary incontinence, pelvic organ prolapse, or both were not significantly different (success rates of 94%, 89%, and 81%, respectively; P = .50). Predictors of unsuccessful pessary fitting include history of a prior prolapse procedure and hysterectomy. Severe posterior prolapse was the single predictor of pessary discontinuation.

Female↗
PubMed2004

A report of a midwifery model for training traditional midwives in Guatemala.

OBJECTIVE: to describe the specific characteristics of one model of training traditional birth attendants (TBAs) in Guatemala. DESIGN: participant observation, unstructured and semi-structured interviews undertaken between 1997 and 2003 to gather the data to report on the characteristics of this training programme as it is evolving in the field. SETTING: the birth centre site of Ixmucane in Antigua, Guatemala, as well as community sites in the Departments of Saquetepequez, Chimaltenango, and Quetzaltenango in the western highlands of Guatemala. PARTICIPANTS: traditional midwives, certified nurse-midwives and certified professional midwives, as well as many allied health professionals and volunteers. INTERVENTION: training philosophy, participant selection, curriculum content, intensity, and planned follow-up are the key components of the training programme described. MEASUREMENT AND FINDINGS: 93 TBAs have received training through the development of a 150 hrs contact course for self-selected TBAs in the Midwives for Midwives Program. Formal evaluation of this training is underway but results are not yet available. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the value of incorporating midwifery philosophy and praxis in TBA training has received scant attention in the TBA literature. This report suggests that TBA training programme characteristics are important considerations in any evaluation of training efficacy of TBAs to improve maternal-child health.

Adult↗
PubMed2006

A retrospective study of the success, safety and effectiveness of external cephalic version without tocolysis in a specialised midwifery centre in the Netherlands.

BACKGROUND: to evaluate the effectiveness of external cephalic version (ECV) without tocolysis or epidural analgesia, the complications associated with the procedure and the association between the number of ECV attempts and cephalic presentation at birth and caesarean section. METHODS: retrospective cohort study of all (n=924) ECVs carried out between 1996 and 2000 in a specialised midwifery centre in the Netherlands. After bivariate analysis, those variables with a p value under 0.05 were considered statistically significant and were tested in a logistic regression model using backward stepwise selection. Analyses were carried out separately for first ECV attempts and second ECV attempts. FINDINGS: in total, 958 ECVs were analysed, 889 first attempts and 69 repeat attempts. Seventy per cent of all first ECVs were carried out before 37 weeks, but half of those were carried out between 36 and 37 weeks. The success rate for first ECV was 41% and for the second ECV 29%. Bivariate analysis showed that the success of the first ECV was positively influenced by parity, non-Dutch origin, higher birth weight, higher age and longer duration of pregnancy. After logistic regression, parity (odds ratio [OR] 2.8, 95% CI 2.1 to 3.7), non-Dutch origin (OR 1.8, 95% CI 1.2 to 2.8) and birth weight (OR 1.7, 95% CI 1.4 to 2.0) remained factors that independently influenced the success of ECV. The odds ratio for duration of pregnancy at first ECV was borderline significant: OR 1.2 (1.0 to 1.4). After an unsuccessful first ECV, only 13% of the women received a second ECV. The prevalence of cephalic presentation at birth increased with 3% after a second ECV. Three cases of complications were reported during or very shortly after the first ECV, and these did not result in serious complications. No complications were reported after a second ECV. CONCLUSION: ECV without tocolysis is a safe procedure for pregnant women and their babies. Repeat ECV increases the number of cephalic presentations at birth and should be considered after an unsuccessful ECV.

Adult↗
PubMed2004

Authorizing tradition: vectors of contention in Highland Maya midwifery.

In Guatemala, midwives deliver the majority of children and play an important health care role in rural areas. Maya midwives, using time-proven methods, are the chief providers of care for mothers and infants in these areas. In recent decades, however, the medical establishment has become interested in Maya midwives, and is currently engaged in training and certifying many of them. This study examines how Guatemalan health authorities have sought to change Maya midwifery, refashioning its vocational framework and retooling it in accordance with Western medical principles. I focus on the place of obligatory formal training and the use of biomedical materials in the experience of Kaqchikel Maya midwives, and consider how the health officials employ these means to undermine the midwives' knowledge base. Encounters between midwives and formal health personnel reveal an ongoing privileging of biomedical knowledge, one that preserves asymmetrical relationships between these practitioners. This creates an environment favorable to health personnel, and helps them to extend their influence through the midwives into the community. Given this, I contend that health personnel value local Maya midwives primarily for their role in furthering the goals of biomedicine.

Attitude of Health Personnel↗
PubMed2006

The influence of the birthplace and models of care on midwifery practice for the management of women in labour.

This paper will examine how the settings in which midwives practice (the birthplace) and models of care affect midwives' decision making during the management of labour. One-hundred-and-four independent, team and hospital based midwives and 100 low obstetric risk nulliparous women to whom labour care was provided were surveyed. These midwives and women resided in the Auckland metropolitan area of New Zealand. The majority of midwives who participated worked in models of care which provided women with continuity of carer and care, however, this was not found to influence the way the midwives provided labour care. Instead, practice was found to be relatively homogenous regardless of whether the midwives worked in independent, team, or hospital-based practice. The birthplace setting in which the labour care took place did influence midwifery practice. The majority of midwives provided labour care in large obstetric hospitals and identified practices dominated by the medical model of care. Practice was described as being influenced by intervention and the need for technology, however, this did not prevent the majority of women from perceiving they were actively involved in the decision making process and that they worked in partnership with their midwives. Closer examination of the midwives' decision making processes whilst providing the labour care revealed that the midwives' individual decisions were influenced by the needs of the women rather than the hospital protocols. What became evident was that the midwives in this study had adopted a humanistic approach to care whereby technology was used alongside relationship-centred care.

Adult↗
PubMed1998

Outcomes of intended home births in nurse-midwifery practice: a prospective descriptive study.

OBJECTIVE: To describe the outcomes of intended home birth in the practices of certified nurse-midwives. METHODS: Twenty-nine US nurse-midwifery practices were recruited for the study in 1994. Women presenting for intended home birth in these practices were enrolled in the study from late 1994 to late 1995. Outcomes for all enrolled women were ascertained. Validity and reliability of submitted data were established. RESULTS: Of 1404 enrolled women intending home births, 6% miscarried, terminated the pregnancy or changed plans. Another 7.4% became ineligible for home birth prior to the onset of labor at term due to the development of perinatal problems and were referred for planned hospital birth. Of those women beginning labor with the intention of delivering at home, 102 (8.3%) were transferred to the hospital during labor. Ten mothers (0.8%) were transferred to the hospital after delivery, and 14 infants (1.1%) were transferred after birth. Overall intrapartal fetal and neonatal mortality for women beginning labor with the intention of delivering at home was 2.5 per 1000. For women actually delivering at home, intrapartal fetal and neonatal mortality was 1.8 per 1000. CONCLUSION: Home birth can be accomplished with good outcomes under the care of qualified practitioners and within a system that facilitates transfer to hospital care when necessary. Intrapartal mortality during intended home birth is concentrated in postdates pregnancies with evidence of meconium passage.

Adolescent↗
PubMedDate not supplied

Midwifery management of pain in labor. The CNM Data Group, 1996.

Joint data collection by nine nurse-midwifery practices in the United States permitted a description of pain management practices with intrapartum patients. Observational data are reported for healthy gravidas at term (N = 4,171). A wide variety of techniques for pain management, including both pharmacologic and nonpharmacologic methods, were used. High prevalence modalities were paced breathing (used by 55.2% of this clinical sample), activity and position change (42.4%), narcotics (30.0%), and epidurals (18.7%). Paced breathing plus narcotics was the most common combination. Variations are reported for subgroups of women according to age, parity, race/ethnicity, education, insurance, marital status, activity in labor, and type of delivery. The only methods associated with a lowered rate of spontaneous delivery were epidurals and intrathecal narcotics.

Adult↗
PubMedDate not supplied

Learning leadership: students' experiences of a midwifery mentoring practicum.

A leadership mentoring practicum is described wherein nurse-midwifery students are placed with leader/mentors at the state, regional, and national levels of organizations. Logs are kept by the students and discussions at student-faculty seminars focus on linking leadership theory to observations of leadership qualities and behaviours in the mentors. A profile of a "composite leader" derived from the students' experience experiences is presented.

Female↗
PubMedDate not supplied

Oral intake in labor. Trends in midwifery practice. The CNM Data Group, 1996.

Joint data collection by nine nurse-midwifery practices in the United States in 1996 permitted a description of oral intake in labor. Observational data are reported for healthy gravidas at term (n = 3,338). The majority of women ingested only clear fluids in labor. Over one fourth consumed nonclear liquids or solid foods, and fasting was rare. Variations are reported for subgroups of women according to several demographic and clinical characteristics. Ingestion of nonclear liquids or solids was least common in hospital settings as compared with home births.

Adult↗
PubMedDate not supplied

What accounts for physician opinions about midwifery in Canada?

The objective of this study was to identify the characteristics of physicians practicing obstetrics in the province of Quebec, Canada and relate these to their opinions about midwifery practice. A self-administered questionnaire was sent to a systematic random sample of 844 physicians; 597 physicians answered (response rate = 71%). Results show that physicians who were more open to midwives had a more client-centered approach to maternity care. They had attended premed school outside Canada but received their specialty training in Canada. They also had often collaborated with midwives since they had begun practicing. Physicians who were more open to midwives were less demanding in terms of level of midwife training. They agreed that midwives should be self-regulating. It is concluded that greater knowledge of midwives' practice, gained through collaboration in the workplace and interdisciplinary education, could help physicians to better understand the significant contributions that midwives can make to the health care system.

Adult↗
PubMed2003

Midwifery and the enlarged European Union.

The freedom of movement of midwives within the European Union has been guaranteed by the application of midwives' sectoral directives signed in 1980 and applied in 1983. Since then the size of the European Union has grown from 9 to 15 members and is due for a next wave of enlargement of another 10 member states in 2004. The rules and regulations that govern the European Union are being revisited to accommodate this change. Midwifery will be affected and some changes are potentially worrying, in particular the proposed loss of the Advisory Committee on the Training of Midwives. Six other professions regulated in a very similar way are also to lose their own advisory committees. The European Commission has proposed the adoption of a single directive for all professions, together with the setting up of an expert group whose function would be to deal principally with health professions. However, neither its remit nor its membership has been determined. Whereas previous movement of midwives within Europe has been minimal, it is anticipated that this may well be changed at the next enlargement stage. Without clear directives and some form of controlling power at European level, public health may be threatened. In this paper the developments to date and the concerns that have emerged from the recent proposals are outlined.

Education, Nursing↗
PubMed2004

The influence of maternity units' intrapartum intervention rates and midwives' risk perception for women suitable for midwifery-led care.

OBJECTIVE: to test the hypothesis that midwives working in higher intervention units would have a higher perception of risk for the intrapartum care of women suitable for midwifery-led care than midwives working in lower intervention units. METHODS: an initial retrospective analysis of the computerised records of 9887 healthy Caucasian women in spontaneous labour enabled the categorisation of 11 units as either 'lower intrapartum intervention' or 'higher intrapartum intervention' units. A survey of the midwives involved in intrapartum care in these 11 units, using standardised scenario questionnaires, was used to investigate midwives' options for intrapartum interventions, their perceptions of intrapartum risk and the accuracy of these perceptions in the light of actual maternity outcomes. FINDINGS: midwives working in maternity units that had a higher level of intervention generally perceived intrapartum risks to be higher than midwives working in lower intervention units. However, midwives generally underestimated the ability of women to progress normally and overestimated the advantages of technological interventions, in particular epidural analgesia. CONCLUSIONS: variations in intrapartum care cannot be solely explained by the characteristics of the women. The influence of the workplace culture plays a significant role in shaping midwives' perceptions of risk, but it seems even more likely that the medicalisation of childbirth has had an influence on midwives' appreciation of intrapartum risks. Intervention rates for low-risk births are often higher than recommended by research. The level of interventions varies across hospitals and higher rates are associated with higher perception of risk by midwives. Attention needs to be given to the influence the workplace plays in shaping midwives' perception of risk; and to the effect of organisational culture on intervention rates.

Adult↗
PubMed2004

A midwifery practice dichotomy on oral intake in labour.

OBJECTIVE: to assess the views and practices of midwives regarding oral intake in labour for women with low-risk pregnancies. DESIGN: an exploratory survey design including open- and closed-ended questions. SETTING: four hospitals in Sydney, Australia. PARTICIPANTS: 89 practising midwives who provided care for labouring women. FINDINGS: midwives were divided on the issue of what and when labouring women should, or should not, be allowed to eat and drink. The views and practices of these midwives were influenced by the accepted practice in the hospital in which they were employed and the types of midwifery models in which they have practised. KEY CONCLUSIONS: there is insufficient conclusive research evidence to support any stance on oral intake for labouring women. Most information purported by supporters of oral intake is based on anecdotal evidence and assumptions based on the physiology of the body. 'Nil by mouth' policies have never been researched while clear fluid policies are based on research performed with non-obstetric patients. IMPLICATIONS FOR PRACTICE: without reliable research evidence for the management of oral intake for labouring women no hospital practice or policy is valid. This leaves midwives with the responsibility of deciding what they believe is the best management for the oral intake of labouring women in their care.

Adult↗
PubMed1989

Developing a midwifery workload management system: a preliminary report.

Individualised care, quality assurance and resource management are words frequently on the lips of midwives today. This paper describes a project currently being undertaken in West Glamorgan Health Authority where these criteria each form an important part of the study. It is in considering these varying aspects concurrently that the authors claim a unique approach. Resources are only considered to be managed appropriately when client centred quality care is provided. As an additional benefit, the review of policy and practice and an evaluation of the implementation of the 'midwifery process' form an integral part of the study.

Adult↗