[Newly graduated midwives remain in Africa. Village midwives' instruments are few but they can depend on their knowledge].
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Female↗
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[Problems concerning midwives - at opening of an ambulatory care facility manned by midwives].
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Ambulatory Care Facilities↗
[Survey on the midwives' attitude toward obstetrical ambulatory care services manned mainly by midwives].
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Ambulatory Care Facilities↗
Midwives' Journal. Radical midwives' meeting.
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Female↗
Team midwifery: the views and job satisfaction of midwives.
OBJECTIVE: As part of an evaluation of a team midwifery scheme we assessed the satisfaction of community and hospital midwives and their views about working practices and care provided. DESIGN: Survey of complete enumeration of community midwives (most working in teams) and hospital midwives providing antenatal, intrapartum and postnatal care to a population of women. SETTING: Community and district general hospital, in the UK. MEASUREMENTS: Socio-demographic data about midwives, ratings on Likert-type scales of job satisfaction, quality of care variables, relationships with other professionals and women; Glasgow Midwifery Process Questionnaire. FINDINGS: 80 out of 92 midwives (87%) responded. Community midwives were younger, more recently qualified, employed on lower grades, less likely to be married and have children than hospital midwives. The Glasgow Midwifery Process Questionnaire revealed that midwives, particularly hospital midwives, had low morale. Community midwives were more likely to report that their job was satisfying, offered a variety of work, enabled them to use skills and knowledge fully, and offered opportunities for professional development. Hospital midwives were more likely to report following strict guidelines. Community midwives, however, disliked the long on call and unsociable hours, and reported disruption to family/social life. Forty-one per cent of hospital midwives (12) and 28% of community midwives (14) reported regularly working beyond their shift. Whilst midwives thought that team midwifery was, in theory, a good idea, in practice it was not working well because of the size of teams and caseload. About half the community midwives felt that teams had detrimentally affected the quality and continuity of care. CONCLUSIONS: Whilst team midwifery aims to improve continuity of maternity care, in this instance, it does not appear to achieve this aim. Many midwives reported it had adversely affected care. Team midwifery is a source of disillusionment for midwives, since the continuity of carer ideal is unachievable in a system based on teams of seven or more. Attendance at the delivery may be a luxury provided at the expense of antenatal and postnatal continuity. IMPLICATIONS: Midwives recommended remedial measures: reducing team sizes, reducing caseloads, ensuring teams were fully staffed, reducing 'on call' and labour ward hours. It remains to be seen whether these will have the desired effects on continuity of care.
Adult↗
Midwives' perception of the intrapartum risk of healthy nulliparae in spontaneous labour, in The Flanders, Belgium.
OBJECTIVE: to explore midwives' perception of intrapartum risk for healthy nulliparous women in spontaneous labour at term of a healthy singleton pregnancy, in the Belgian Flanders, and to compare these results with those of a previous study undertaken in England. DESIGN: survey of the care midwives would advocate and their perception of intrapartum risk using a standardised scenario. This study replicates part of a survey undertaken with British midwives (Mead & Kornbrot 2004b). With an added section to capture the particulars of the Belgian situation and explore the likelihood of midwives being fully responsible for the whole intrapartum care of healthy women, including their delivery. The questionnaire was translated into Dutch by MR and distributed by the Flemish Midwives' Association (Vlaamse Organisatie van Vroedvrouwen-VLOV). PARTICIPANTS: all 845 midwives and 143 student midwives who were members of VLOV were sent a questionnaire with their invitation to take part in their annual conference. Two hundred and seventy-five midwives and 107 students attended the conference, and 128 questionnaires were returned at the conference: 99 midwives (36% of the attendees), 26 students (24% of attendees), with three unidentified respondents. This convenience sample represented 12% of all midwives and 18% of all students. ANALYSIS: SPSS for Windows was used for the statistical analysis. Descriptive statistics were used and differences between categorical variables were analysed using chi(2) and Fisher's Exact tests, and differences between continuous variables were analysed by analysis of variance. FINDINGS: midwives generally described a more medicalised approach to intrapartum care on admission and during the first stage of labour than their British counterparts, but were much more optimistic about the chances of healthy women in spontaneous labour achieving a normal delivery within 12 hours. However, Belgian midwives had only a limited ability to undertake normal deliveries because of the high proportion of obstetricians who fulfil this responsibility. This contravenes the European Union (EU) directive on the activities of the midwife. KEY CONCLUSIONS: despite much greater involvement of obstetricians in the care, of women suitable for full midwifery care, and a more medicalised approach to intrapartum care, the Belgian Flanders have a significantly lower caesarean section rate than the UK. The inability of Belgian midwives to fulfil the activities of the midwives as identified by the EU directives raises questions about the migration of midwives trained in Belgium to other EU member states.
Adult↗
Changes in midwives' attitudes to their professional role following the implementation of the midwifery development unit.
OBJECTIVE: to examine changes in midwives' attitudes to their professional role following the implementation of the midwifery development unit (MDU). DESIGN: prospective cohort study. SETTING: the MDU is based at a major teaching hospital in Glasgow, UK. The MDU midwives provide care via a new self-rostering system which is intended to improve continuity of care. Midwives aim to provide total care for each woman from the antenatal period through delivery and the postnatal period. PARTICIPANTS: 21 midwives who joined the MDU were compared with a group of 64 midwives at the hospital who were also eligible and who continued in their usual pattern of work (non-MDU midwives). MEASUREMENTS: an audit questionnaire was distributed to MDU and non-MDU midwives prior to the implementation of the unit and about 15 months afterwards. In addition, the MDU midwives were sent the questionnaire every three months. Extra questions were added at each time period in order to identify specific problems. This information was then fed back to the midwifery management team to aid in the planning and implementation of the care programme. FINDINGS: the MDU midwives experienced a significant positive change in attitudes; no significant change was evident for the non-MDU group. There was no evidence of increased stress in the MDU midwives. In general, both groups of midwives had positive attitudes towards the unit and felt that MDU-style care had a role to play in the future provision of maternity care. A number of areas of concern were also highlighted, such as the system of liaison with colleagues. CONCLUSIONS: innovative models of midwifery care such as an MDU can have a positive impact on midwives' attitudes towards their professional role. IMPLICATIONS FOR PRACTICE: if change is managed in a systematic manner which involves the midwives, it may be possible to increase midwives' professional satisfaction, while at the same time minimising any negative effects such as increased stress.
Adult↗
A survey of information given during pregnancy by midwives to parents about neonatal unit care, whether or not the baby was likely to require such care.
OBJECTIVE: To determine what information is given by midwives to parents in Scotland about care in a neonatal unit (a designated nursery offering special and/or intensive care to preterm and sick/vulnerable newborn babies), whether or not the baby is expected to require such care. DESIGN: A survey using self-completion questionnaires. SETTING: The questionnaires were sent to identified senior midwives in community and hospital settings in Scotland. PARTICIPANTS: 155 midwives, including 100 midwives involved in preparation for parenthood classes, 21 midwives responsible for hospital-based antenatal care, 17 midwives responsible for care in labour wards and 17 midwives responsible for care in neonatal units. FINDINGS: Information about care in a neonatal unit was offered by all groups surveyed to all parents with whom the midwives were in contact. Eight rural community midwives did not routinely give information. Midwives involved in preparation for parenthood classes offered specific information at a median gestation of 28 weeks. The midwives addressed most suggested topics. The most commonly included topics were why babies require neonatal care and what problems they may have. The least commonly included topic was the long-term problems the baby may have. Several methods of teaching were used, especially discussion and question and answer, with a visit to the neonatal unit a common strategy. Few midwives shared information using audio-visual methods. KEY CONCLUSIONS: The majority of midwives sampled offered information prenatally about neonatal unit care, with many tailoring this to the womanís needs. IMPLICATIONS FOR PRACTICE: There should be consideration of the need to give information to all pregnant women and their partners, the most appropriate time for giving such information and the use of audio-visual teaching resources. The findings will inform further study of the extent to which such information meets the needs of parents.
Female↗
Who can provide antenatal care? The views of obstetricians and midwives.
OBJECTIVE: To describe the types of antenatal services in NSW maternity hospitals and examine the views of midwives and obstetricians about who can provide adequate routine antenatal care. MEASUREMENTS: A mail-out questionnaire to nursing unit managers (NUMs) explored the types of antenatal services available in their hospitals. The questionnaire for 196 midwives and 114 obstetricians asked whether they believed six provider/service types could provide adequate antenatal care either alone or in conjunction with an obstetrician. FINDINGS: 80% of hospitals had GPs providing antenatal care, 53% had obstetricians and 3% had visiting midwives; 33% had a public antenatal clinic, 28% a shared care program with GPs and 26% midwives' antenatal clinics. Midwives were more likely than obstetricians to rate the following as able to provide adequate care alone: hospital antenatal clinic (4.7 times more likely); independent midwife (42.9x); and community midwives as an outreach hospital service (17x). Obstetricians were 8.2x more likely than midwives to rate private obstetricians as being able to provide adequate care. Midwives were more likely to perceive that independent midwives (24.7x more likely) and community midwives as an outreach hospital service (15.3x more likely) were able to provide adequate care either alone or in conjunction with an obstetrician. CONCLUSION: Most NSW hospitals have GPs providing care, but midwives' clinics and independent midwives are less available. While midwives and obstetricians hold similar beliefs about GPs providing care, substantial differences emerged about the midwife's role. Such disparity in opinion may be central in providing options and consistency in care for women.
Attitude of Health Personnel↗
What psychosocial well-being in the postnatal period means to midwives.
OBJECTIVE: to explore midwives' views of psychosocial well-being in the postnatal period. DESIGN: qualitative study using focus-group interviews conducted in 1999. SETTING: two community health centres and a school of nursing and midwifery in Scotland. PARTICIPANTS: a convenience sample of community and student midwives. ANALYSIS: thematic analysis was undertaken through the identification of codes, categories and themes. FINDINGS: the categories were generated from the interview questions: 'the meaning midwives give to women's psychosocial well-being', 'midwives' assessment of women's well-being', and 'midwives views of worrying behaviours' displayed by women. From the first two categories, themes of 'coping', 'expectations', 'observation and communication skills', 'labour debriefing', and 'previous contact with women' emerged. Midwives assessed coping and unmet expectations through a range of communication and observational skills, including the use of a form of labour debriefing. Midwives who knew women during their pregnancy thought that they were able to assess coping and expectations better in the postnatal period. The midwives tended to describe women using stereotypical categories. From the third category, 'worrying behaviours', three themes emerged; 'extreme or obsessive behaviours about self, the baby or house' 'wanting to detain you' and 'quiet women'. CONCLUSIONS: the meaning midwives give to psychosocial well-being includes a complex interplay between midwives' views of psychosocial well-being and their assessment of it. The importance midwives give to knowing women in pregnancy has implications for the ongoing debate about the provision of continuity of carer. Midwives used a range of techniques to elicit accurate information, to confirm problems or be reassured that all was well. Views based on stereotypical generalisations should be challenged.
Adaptation, Psychological↗
Differential uptake of a smoking cessation programme disseminated to doctors and midwives in antenatal clinics.
AIMS: Two methods of dissemination (simple and intensive) were used to disseminate a smoking cessation programme to doctors and midwives working in antenatal clinics. This paper describes the differential uptake of the smoking cessation programme by doctors and midwives. It investigates whether the number of smoking cessation interventions used differ due to the type of dissemination. It also examines the frequency with which doctors and midwives provide smoking cessation interventions after dissemination. DESIGN: Clinics were randomized to the method of dissemination (simple or intensive). Pre-post test design was used to examine the relationship between dissemination method and professional status at baseline and follow-up. A baseline survey collected data on the use of smoking cessation intervention in the clinics prior to dissemination. A follow-up survey was conducted 18 months after the dissemination. SETTING: Twenty-three public hospital antenatal clinics in NSW. PARTICIPANTS: All clinical staff (midwives and doctors) working in the clinic during the 1-2-week survey period prior to dissemination and 18 months after the dissemination were asked to participate. The response rate was 63% (223) at baseline and 64% (182) at follow-up. Only 48% of midwives and doctors at follow-up were working in the original clinic. MEASURES: The proportion of clinicians who initially adopted the programme; the proportion of clinicians who had used one or more programme components in the last week); the number of types of smoking cessation intervention provided (maximum = 13), and the estimated proportion of clients offered smoking cessation intervention. FINDINGS: More midwives than doctors "ever used" the programme (76% vs. 25%) and continued to implement (58% vs. 22%) the programme 18 months after dissemination. Both midwives and doctors increased the number of types of smoking cessation intervention offered at follow-up compared to baseline (mean difference 2.8). Midwives provided more smoking cessation interventions than doctors at baseline (mean difference 0.9) and at follow-up (1.6), regardless of method used to disseminate the programme. Midwives' mean estimates of the proportion of clients offered interventions were greater than doctors' (midwives' 59% vs. doctors' 35%) at follow-up. CONCLUSION: The dissemination of a smoking cessation programme increased the level of smoking cessation interventions used by doctors and midwives. Doctors and midwives differ in their uptake of smoking cessation programmes. This information can be used to plan programme dissemination strategies in the future.
Analysis of Variance↗
[Dutch midwives: image and occupation. Developments in midwifery in Leiden, Arnhem, 's-Hertogenbosch and Leeuwarden, 1650-1865].
My study on the social position of Dutch midwives in early modern Europe was induced by the consistently negative image in the literature at the time. Medical doctors and accoucheurs (obstetricians) expressed critical opinions on both the occupation of midwifery and the midwives themselves. They disparaged the behaviour, activities, training, income, additional jobs and social background of midwives. Later, medical doctors and historians reproduced and promulgated this negative image of midwives. At issue is the extent to which the attitudes of medical doctors and accoucheurs corresponded to those of the broader population, and how these attitudes were related to the actual place in society. The question is if midwives took a marginal position in urban society. My work focusses on four Dutch cities: Arnhem, Leeuwarden, Leiden and 's-Hertogenbosch. It deals with the period 1650-1685. The criticism of medical practitioners and of a accoucheurs on midwives are described. The occupation itself is discussed: the activities of midwives and the development of the profession (regulation, training and rivalry). At the end of the seventeenth and the beginning of the eighteenth century, the medical profession began to show an interest in childbirth. Rivalry between accoucheurs and midwives, competition between legal and illegal practitioners of midwifery, and in-fighting within the profession tell us something about the development of the profession. From the eighteenth century on, attending problematic births was claimed as a privilege of accoucheurs. Data from municipal archives were used to find out if and to what extent midwives were marginalised. Their geographical mobility, social background (occupations of parents), occupations of husbands, income and domicile are discussed. Analysis of this material indicates that midwives belonged to the common urban labouring class (consisting of artisans and workers), and were not very different from other members of this class. Certainly they were not marginalised, instead they had a relatively privileged position within the common labouring class. Five motives can be distinguished for the negative image expressed by medical doctors and accoucheurs in their publications: 1) professional rivalry, 2) division of theoretical and practical knowledge, 3) class differences, 4) gender, and 5) 'polluting' activities. Studies on ideas of pollution and 'infamous' occupations might lead one to conclude that midwives in the Dutch Republic were stigmatised. I found no evidence, however, that the opinions of medical doctors and accoucheurs were shared by the broader public. Official recognition of midwives - the regulation of their practice and education - protected tham. This has contributed to their position as independent practitioners in the Netherlands up to today.
History, Modern 1601-↗
The emotions of integrating breastfeeding knowledge into practice for English midwives: a qualitative study.
BACKGROUND: Breastfeeding prevalence in the United Kingdom is one of the lowest in Europe. The midwife provides feeding support for new mothers but research suggests that midwives' knowledge of breastfeeding is limited. OBJECTIVE: To discover the views of English midwives in relation to their breastfeeding support role. DESIGN: Qualitative design. SETTINGS: Two maternity hospitals in Northwest England. PARTICIPANTS: Thirty midwives who cared for normal, healthy babies. Midwives were selected for interview using theoretical sampling principles from a pool of midwives who volunteered. Volunteers were accessed using a poster exhibited in relevant clinical areas. METHODS: Data were collected using audiotaped, in-depth interviews and were analysed using constant comparison techniques. RESULTS: The study highlights that differing professional knowledge and beliefs about breastfeeding support created intense, mainly negative, emotions for these midwives. Irritation and despair was experienced with the greater emphasis placed on research, rather than practice knowledge in policy and recommendations for practice. Disappointment was experienced when mothers did not conform to midwives' expectations. Conflict with differing peer-based knowledge generated feelings of intimidation and annoyance for some midwives. Some midwives demonstrated that they can sustain clinical decisions whilst based in a hostile environment, but others conformed to the practice expectations of their peers. Happiness was experienced when midwives described positive relationships with mothers, rather than their professional colleagues. CONCLUSIONS: The utilisation of professional knowledge in breastfeeding practice was a highly complex issue, and generated significant negative emotional distress, for these midwives.
Breast Feeding↗
An exploration of midwives' attitudes to research and perceived barriers to research utilisation.
OBJECTIVE: To explore midwives' views about research and their perceived barriers to research utilisation. SETTING: Thirty-two midwives from four midwifery units in the north west of England. The units ranged in size from a small district unit (52 midwives, and 1200 deliveries per annum), to a large regional centre (290 midwives, 6500 deliveries per annum). METHODS: Midwives' opinions concerning research were explored using focus group interviews; within the interviews midwives were asked to discuss how they viewed the relevance of research to midwifery care, the constraints which they felt prevented them from delivering research-based care and existing and potential methods of disseminating research. FINDINGS: There was a consensus among the midwives that they aspired to deliver research-based care. However, there are clearly a number of barriers preventing this. Research was poorly accessible to most midwives, both in terms of its physical location and complexity. Furthermore, midwives felt they lacked the knowledge and skills to appraise research, and lacked the confidence to judge when research should be implemented. CONCLUSIONS: The current trend to demedicalise childbirth demands that midwives become proficient users of research. However, the means of disseminating research findings to midwives in the north west of England does not meet their needs.
Attitude of Health Personnel↗
Attitudes of midwives towards perinatal bereavement in Hong Kong.
OBJECTIVE: to explore attitudes towards perinatal bereavement care among midwives working in Hong Kong through examination of relationships between attitudes towards bereavement support, need for bereavement education and appropriate hospital policy. DESIGN: a descriptive correlational survey. SETTING: the obstetric and gynaecology units at two hospitals. INSTRUMENT: a structured self-report questionnaire on attitudes towards perinatal bereavement support; required support and education needs for midwives on bereavement care. PARTICIPANTS: 154 out of 202 midwives (76.2% response rate) working at the two units. FINDINGS: two-step cluster analysis yielded two clusters. Cluster 1 consisted of 91 (59.1%) midwives and cluster 2 consisted of 63 (40.9%) midwives. Cluster 2 midwives were younger, had less obstetric and gynaecology experience, junior ranking and less post-qualification education than cluster 1 midwives. Cluster 1 midwives had additional personal grieving experiences and experience of caring for grieving parents. Attitudes towards bereavement care were positively correlated with educational needs (r(s)=0.55, p< 0.001) and hospital policy support (r(s)=0.50, p< 0.001). CONCLUSIONS: Hong Kong midwives require increased bereavement care knowledge and experience, improved communication skills, and greater hospital and team member support. Findings may be used to improve support of midwives, to ensure sensitive bereavement care in perinatal settings and to reflect training needs in the midwifery education curricula. Study findings highlight the universality of grief for a lost baby, irrespective of cultural differences in approaching emotional topics. This study may help midwives internationally to gain a broader perspective in this area.
Adult↗
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↗
The training and development needs of midwives in Indonesia: paper 2 of 3.
BACKGROUND: There is a shortfall in midwives in Indonesia (an estimated 26 per 100,000 people), which means that the quality of antenatal, perinatal and postnatal care varies widely. One consequence of this is the high rate of maternal and perinatal mortality, which has prompted a number of health initiatives. The current study was part of a review of the existing complex system of midwifery training and the development of a coherent programme of continuing professional development, tighter accreditation regulations and clearer professional roles. Its aims were to identify the occupational profiles and development needs of the participating midwives, and to establish whether any differences existed between grades, geographical location and hospital/community midwives. METHODS: A psychometrically valid training-needs instrument was administered to 332 midwives from three provinces, covering both hospital and community staff and a range of midwifery grades. The instrument had the capacity to identify occupational roles and education/training needs of the respondents. RESULTS: The occupational roles of the midwives varied significantly by province, indicating regional service delivery distinctions, but very little difference in the roles of hospital and community midwives. The most educated midwives attributed more importance to 35 out of the 40 tasks, suggesting an implicit role distinction in terms of level of activity. All midwives reported significant training needs for all 40 tasks. The most-educated midwives recorded training needs for 24 tasks, while the less-educated had training requirements for all tasks, which suggests that new training programmes are effective. Few differences in training needs were revealed between hospital and community midwives CONCLUSION: The results from this survey suggest important regional differences in how the midwife's role is discharged and underline the importance of this sort of research, in order to ensure the suitability of basic and postbasic educational provision. The study also highlights the need for further development and training of midwives in a wide range of tasks. These results provide a systematic and reliable overview of current midwifery roles and development needs and could serve to inform future training.
Journal Article↗
[Exposure to blood during midwifery procedures--blood contact events to midwives occurred in a delivery room].
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)
Adolescent↗