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This paper examines the findings of a Department of Health-funded evaluation of pre-registration midwifery education in England and explores whether there is any need for midwives to train first as nurses. The research was completed in 1993 and this paper accepted for publication in January 1994.
Midwives are often exposed to blood during delivery procedures. A study aimed at clarifying actual status of blood contact during midwifery procedures was performed. Observations in a delivery room were conducted to record blood contact events experienced by midwives from the time of episiotomy until 2 hour after expulsion of the placenta. All gloves used by midwives were collected and tested for holes. Blood contact was defined as any contact with blood of a parturition woman as recognized visually by an observer. During a one-month study period data was obtained from a total of 19 midwives (12 midwives and 7 student midwives) who assisted in 8 deliveries. All of the midwives wore gowns with long sleeves, gloves and caps but did not use eye protection or masks. None of the parturient women had Hepatitis B, Hepatitis C or acquired immunodeficiency syndrome. Deliveries caused widespread blood exposure to the midwives throughout the complete course. Protection from most of this exposure was provided by the gowns and gloves. However, direct blood contacts occurred to the fingers, hands or forearms in several midwives. These events were caused by partly because the midwives unintentionally performed procedures without gloves and partly because blood penetrated the gown and soaked to the skin. Direct blood contacts to the foot in two midwives and to the mouth in one also occurred. The overall perforation rate for gloves examined was 4 out of 154 (2.6%). Two gloves were broken during washing sharp instruments contaminated with blood, one was torn when wearing, and the remaining one appeared to have had a hole prior to use.(ABSTRACT TRUNCATED AT 250 WORDS)
The author of the famous midwifery text book Der schwangeren Frauen und Hebammen Rosengarten has until now thought to have been Eucharius Rösslin the Elder, in whose name the first printed edition of the work appeared in 1513. According to him, he compiled the text from various sources in the years 1508-1512 at the suggestion of the Duchess Catherine of Brunswick-Luneburg. In the SB und UB Hamburg there is a handwritten preliminary draft of Rosengarten (Cod. med. 801, p. 9-130), dated by the scribe in the year 1494 (this is borne out by watermark analysis). It reproduces the text of Rosengarten without the privilegium, the dedication and the rhyming 'admonition' of the pregnant women and the midwives, as well as the glossary and the illustrative woodcuts almost identically. The printed version of Rosengarten was also expanded by Eucharius Rösslin the Elder with passages among others from Ps.-Ortolfs Frauenbüchlein. The author of this paper was also able to trace a handwritten preliminary draft of Frauenbüchlein, until now unknown, in manuscript 2967 of the Austrian National Library in Vienna. The remark Hic liber pertinet ad Constantinum Roeslin written in the manuscript by a previous owner, and a treatise on syphilis in the hand Eucharius Rösslin the Younger, would indicate that Cod. med. 801 was once in the possession of the Rösslin family. Since Eucharius Rösslin the Elder was born around 1470, and since errors and omissions in Cod. med. 801 indicate that it is a copy of an older text, we are confronted with the question of whether or not the handwritten edition of Rosengarten originates from him or from some other author.
Is the student who is likely to leave a course recognisable from the outset? The Maggs Research Associates (MRA) study on pre-registration midwifery education, funded by the Department of Health, recently reported its findings and recommendations. This paper looks closely at the reasons why people left these innovative courses for preparation as a midwife.
Increasingly, nurses nationwide are assuming expanded roles in the provision of health care. Certified nurse-midwives (CNMs) are one example. These practitioners function in varied settings from the home to the level three hospital. As with any change, the transition to this present role has been a long and, very often, a difficult one. Their efficacy, safety, and cost-effectiveness is today unquestioned; however, impediments to practice still exist. Whether the impediment be in securing hospital privileges or prescriptive capability, the CNM continues to strive to overcome these obstacles in order to ensure the accessibility of nurse-midwifery care to all women.
Maternity home care assistants in the Netherlands assist the midwife (or GP) during the delivery, help and advise the new mother with the baby during the postnatal period at home. They are trained separately from nurses. Currently, more than three-quarters of mothers use this service. Birth statistics of deliveries attended by maternity home care assistants compare favourably with national statistics. The existence of this profession allows midwives to concentrate on midwifery tasks. It also enables pregnant women to consider giving birth at home or during a short-stay hospital delivery. These options are limited to certain groups in other industrialized countries.
Previous research into midwifery has identified a number of potential sources of stress without attempting to understand the variables that might contribute to it. The study sample was drawn from a population of registered nurses and midwives and compares the work environment of 29 midwives with 180 nurses, using the Work Environment Scale Questionnaire. Significant differences were found between midwives and nurses for involvement, supervisor support, autonomy, work pressure and clarity of roles. These results have the potential for forming the basis of future research.
International work is an unforgettable experience that promotes personal growth and fosters adaptability to any professional environment thereafter. The author describes highlights of her own professional career with the hope of encouraging others to undertake midwifery service in less developed countries.
This paper is a response to an article previously published in JNM's Issues and Opinions column. It provides another perspective regarding the recent troubles of Boston City Hospital's nurse-midwifery service.
This study examined outcome data from two nurse-midwifery operated home birth services in Texas. All clients who planned a home birth within the two services during 1987 comprised the population. Analyses revealed that women choosing home birth with these nurse-midwives were more frequently married, usually white, and more educated when compared with the overall U.S. childbearing population. Analgesia, episiotomy, and cesarean delivery were all found at lower rates than is reported when birth occurs in a hospital setting; complications occurred less frequently or at similar rates to those reported in the home birth literature and national statistics. Research, educational, and clinical implications of the study are discussed.
Pakistan is a relatively new nation of predominantly Islamic influence. Like many developing countries, it is plagued by extensive communicable diseases, malnutrition, inadequate sewage systems, and illiteracy. Religious beliefs and cultural influences impact heavily on access to health care and on maternal-child health outcomes. This paper examines the major maternal-child health problems encountered, as well as implications for midwifery practice in an Islamic country.
This article reviews the normal hematologic changes in pregnancy and the kinetics of iron metabolism. The differences between iron depletion and anemia are described. The hematocrit levels of a nurse-midwifery caseload in a tertiary-care setting are described and compared with recently published population norms. Hematocrits of the sample compared favorably to the population hematocrits until 24 weeks' gestation, when the sample hematocrit mean became statistically lower and remained that way throughout pregnancy. Further analysis was done on the sample hematocrits, comparing differences in parity, age, pregnancy spacing, and AS versus AA hemoglobin. Parous women with a pregnancy interval > 12 months had a higher mean hematocrit than nulliparous women. Mean hematocrits of age groups varied significantly only at the 29-32-week interval, with women younger than 18 having lower mean hematocrits than those > or = 18. A trend of women with AS hemoglobin having higher hematocrits than women with AA hemoglobin was identified, reaching statistical significance at the 29-32-week interval.
The Clinical Practice Committee of the American College of Nurse-Midwives is frequently confronted with questions related to clinical practice. Many questions relate to specific clinical procedures and the position of the College as to their appropriateness for nurse-midwifery practice. This paper presents a discussion of a document developed to assist nurse-midwives when such questions arise.
To identify selected research trends, 69 research reports were analyzed from a sample of feature articles that were published in the Journal of Nurse-Midwifery between 1987 and 1992. Systematic appraisal was performed to classify these articles according to topic, design, sampling methodology, sample size, and funding. The largest proportion of studies were conducted on clinical topics (83%). Descriptive study designs were utilized most frequently (67%). Nonprobability sampling (81%) far exceeded probability sampling (19%); however, in 1992, probability sampling increased to 75%. With the exception of 1988, funding steadily increased over the study period. These results suggest that research has primarily focused upon clinical issues and has utilized descriptive designs and nonprobability sampling.
Over the last several years, there has been a steady increase in the number of women experiencing abnormal Papanicolaou test results. Whether the nurse-midwife is performing a colposcopic examination or making a referral, she or he needs to have a clear understanding of cervical pathophysiology, diagnostic modalities, and therapeutic management. This article provides the nurse-midwife with a basic review of the cytologic and histologic findings of the cervix, a description of the colposcopy procedure, observations, terminology, and follow-up treatment, and considerations for adding colposcopy to a nurse-midwifery practice.
Subdermal contraceptive implants have only recently been approved for use in the United States. At present, only one subdermal contraceptive implant, Norplant, is approved in the United States. This article describes the development of Norplant, its efficacy and safety, a description of the system, education for clients, side effects, indications and contraindications, insertion and removal, incorporation into midwifery practice, and education for health professionals regarding its use.
This article suggests that nurse-midwifery today has an exceptional opportunity to play a leadership role in the restructuring of health care policy in the United States. A case is made for the profession to initiate the actions necessary to meet the need for at least 50,000 and possible as many as 100,000 practicing nurse-midwives in this country within the next three decades. The choice for action is in the hands of today's 4,000 nurse-midwives.
The organization of maternity services in Denmark, Sweden, and the Netherlands was studied under the sponsorship of the World Health Organization European Headquarters Office of Maternal and Child Health. Midwifery care is highly respected and is a central feature of obstetric care in each of these countries. In Denmark and Sweden, almost all births are in the hospital, and autonomous midwives are employed by national health services. About three-quarters of Dutch midwives are in independent practice, and 34% of Dutch women give birth at home. In each country midwives provide "the first line" of care for normal pregnant women and are viewed as essential to the excellent perinatal outcomes these three countries enjoy.