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PubMedDate not supplied

Interviews with Mexican midwives.

Mexican society contains a variety of indigenous cultures as well as European influences. Most babies in rural areas are delivered by midwives. Traditional midwives, government-trained and empirical midwives, nurse-midwives, and foreign-trained midwives all practice in Mexico. Nurse-midwives in one project are demonstrating their ability to meet the needs of urban childbearing women. A midwifery organization is developing under the leadership of midwives influenced by the contemporary midwifery movement in the United States. In this article, some traditional Mexican midwifery practices are discussed and interviews with several different Mexican midwives from a variety of backgrounds are presented.

Cultural Characteristics↗
PubMed2004

An explorative study of Sudanese midwives' motives, perceptions and experiences of re-infibulation after birth.

OBJECTIVE: to explore Sudanese midwives' motives for and perceptions and experiences of re-infibulation after birth and to elucidate its context and determinants. DESIGN: triangulation of methods, using observational techniques and open-ended interviews. SETTING AND PARTICIPANTS: two government hospitals in Khartoum/Omdurman, Sudan, for the observations and in-depth interviews with 17 midwives. FINDINGS: midwives are among the major stakeholders in the performance of primary female genital cutting (FGC) as well as re-infibulation. Focusing on re-infibulation after birth, midwives were trying to satisfy differing, and sometimes contradictory, perspectives. The practice of re-infibulation (El Adel) represented a considerable source of income for the midwives. The midwives integrated the practice of re-infibulation into a greater whole of doing well for the woman, through an endeavour to increase her value by helping her to maintain her marriage as well as striving for beautification and completion. They were also trying to meet socio-cultural requests, dealing with pressure from the family while balancing on the edge of the law. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the findings confirm that midwives are important stakeholders in perpetuating re-infibulation, and indicate that the motives are more complex than being only economic. The constant balancing between demands from others puts the midwives in a difficult position. Midwives' potential role to influence views in the preventative work against FGC and re-infibulation should be acknowledged in further abolition efforts.

Adult↗
PubMed2003

A qualitative study exploring junior paediatricians', midwives', GPs' and mothers' experiences and views of the examination of the newborn baby.

OBJECTIVE: to explore the experiences and attitudes of midwives, junior paediatricians (SHOs), GPs, and mothers to the examination of the newborn baby. To provide an appreciation of their views on several issues, in particular the purpose and value of the examination, who is thought to be appropriate to carry it out and when and where it should take place. DESIGN: qualitative using semi-structured interviews, which were exploratory and interactive, in order to examine the range and diversity of experiences and attitudes to the neonatal examination. SETTING: South-east England. PARTICIPANTS: four samples were purposefully selected to include ten each of midwives, SHOs, GPs and recently delivered mothers. SHOs were currently working in paediatric departments of a district general hospital or teaching hospital and their experience of conducting examinations of the newborn baby ranged from several months to several years. Midwives included both those trained in the examination and currently conducting examinations, and those not so trained and not carrying out the examination. Most of the midwives had been qualified for over ten years and had a wide range of clinical experience in hospital and community settings. The GPs were from ten practices in two Health Authorities and all had some experience of conducting neonatal examinations. Of the mothers, a few had had their babies examined at home by midwives, others in hospital by an SHO. Mothers included those with a family history of problems relevant to the examination, those with previous pregnancy complications and others with no problems or complications. Some were first-time mothers. FINDINGS: all groups perceived the examination to be a useful screening tool providing reassurance to parents. They considered both midwives and SHOs to be appropriate professionals to carry out the examination, if adequately trained. Most thought that midwives have a better rapport with mothers, are able to provide continuity of care and more often discuss health-care issues than do SHOs. Few SHOs reported receiving any formal training in the examination of the newborn baby. IMPLICATIONS FOR PRACTICE: the extension of the practice of midwives examining the newborn baby following relevant training would be acceptable to all stakeholders. The implications of increased demands on the midwives' workload may need to be considered.

Adult↗
PubMed2004

An exploration of midwives' views of the current system of maternity care in England.

OBJECTIVE: to explore, in-depth, the views of midwives working in maternity services about birth setting, models of care and philosophy of care. DESIGN: an Appreciative Inquiry approach was adopted utilising focus group interviews as the method of data collection. SETTING: 15 focus group interviews were conducted at 14 sites in England. PARTICIPANTS: a purposive sample of 120 midwives and six student midwives who were serving women in different birth settings (home, free-standing maternity units, midwife-led units, and traditional obstetric units) participated, in 2001/2002. FINDINGS: the main themes generated by the midwives were: cultural changes; midwifery leadership; appropriate role models; training in normality; appropriate responsibility of care divisions; choice for women; equity of care provision between women considered to be at high or low risk; and staff morale. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: this study highlighted the consistency of views amongst midwives working in different settings. Midwives wanted support to practice autonomously in an environment that facilitated equity of care for women and job satisfaction for midwives. Suggestions were put forward by midwives on how to improve maternity services. A unified approach is required to develop these suggestions into strategies, that will remove the identified barriers and promote normality.

Clinical Competence↗
PubMedDate not supplied

A study of the beliefs and birthing practices of traditional midwives in rural Guatemala.

This is a descriptive study of the beliefs and practices of the traditional midwives in a rural Guatemalan village. During pregnancy and birth, traditional midwives who have received minimal or no training attend more than 80% of the indigenous Mayan women. Data were obtained from interviews with the midwives and from direct observation of midwives attending births. The midwives had few skills with which to handle complications. They failed to use basic aseptic technique and were unfamiliar with lifesaving skills such as fundal massage and proper infant stimulation. Even though most of the midwives interviewed had attended a Ministry of Health training course, they lacked basic knowledge of safe obstetric practices. To reduce infant and maternal mortality rates, traditional midwives must be adequately trained. The teaching methods used by an indigenous Guatemalan group training elderly, illiterate midwives are described as an example of an effective training program.

Adult↗
PubMed2000

Midwives' support needs as childbirth changes.

This paper reports on midwives' support needs as they were described by midwives in a large study of the supervision of midwives in England. The data are derived from six sites: five, very different, National Health Service (NHS) sites, and one composed of midwives outside the NHS. In-depth, ethnographic interviews were conducted with 168 midwives and a grounded theory approach was used for the analysis. The findings identified midwives' many and varied support needs. Midwives also clearly described the culture of midwifery in the NHS. This culture inhibited midwives from arranging to have their support needs met and acted as an obstacle to progress in developing midwifery practice. The dilemmas and tensions inherent in this situation are explored and suggestions made as to the way forward.

Attitude of Health Personnel↗
PubMed2003

Smoking cessation in New Zealand: education and resources for use by midwives for women who smoke during pregnancy.

This study describes the development and evaluation of education programmes and associated resource materials to support smoking cessation and reduction, and breastfeeding promotion strategies for pregnant women who smoke, during usual primary maternity care by midwives. Education programmes and resource materials were developed by midwives and researchers as part of a cluster randomized trial of Midwifery Education for Women who Smoke (the MEWS study). Development included a cohort study, advice from lactation consultants and smoking cessation counsellors (including Ma-ori professionals), and early consultation with midwives who would be delivering the programmes. Resources developed included videotapes, charts and laminated information cards. Resources were pre-tested with pregnant women and opinion leaders. Consultation with the midwives allocated to each of the intervention groups in the trial raised a number of issues. These were addressed, and solutions incorporated into each of the programmes, to enable effective delivery within usual care. Following delivery of the programmes, women and their midwives were surveyed and a sample interviewed to ascertain attitudes to the programmes and resources. Women and their midwives responded positively to the smoking cessation education programme, the breastfeeding promotion programme and the resources used. Those women who did not stop smoking completely often succeeded in significantly reducing their tobacco consumption. Women identified their midwife as a valuable resource and appreciated her ongoing encouragement. Involvement of health professionals who are to deliver health promotion interventions is essential for successful integration of programmes into usual care. Midwives were able to effectively deliver programmes that were developed and targeted to their needs as health educators. The pregnancy-specific resources developed for women who smoke played an important part in helping midwives deliver their health promotion messages more effectively.

Adult↗
PubMed2002

A survey of obstetricians willingness to practice collaboratively with midwives in Taiwan.

This study was designed to investigate obstetricians willingness to practice collaboratively with midwives in Taiwan. Systematic random sampling was used to access the 500 participants from the 2,256 registered members of the Association of Obstetrics and Gynecology of the Republic of China. A questionnaire and four open-ended questions were designed to examine obstetricians willingness to work collaboratively with midwives and other related factors. A total of 78 physicians returned the questionnaires, providing a response rate of 15.6%. Thirty-six (46.2%) of subjects worked as private obstetricians, with a mean age of 47.1 years. About 79.5% (n = 62) had over 10 years of experiences in their role. Fifty percent (n = 39) worked in areas with birth rats less than 50 infants per month. The findings of the current study demonstrate, regarding the seven midwifery practice items on the questionnaire, that all 78 obstetricians were unwilling to work collaboratively with midwives. However, results showed that if midwifery education were to be advanced to college level, the degree of willingness to work collaboratively with midwives improved significantly (t > 1.96, p <.05). Furthermore, 56.4% (n = 44) obstetricians would then agree to work collaboratively with midwives. However, 43.6% (n = 34) were unwilling to accept midwives as independent practitioners. Reasons included: unwillingness to share risks, worry about the incapability of midwives, worry that it would impair the professional image of physicians, and unwillingness to share interests. The authors conclude that advancing and enhancing midwifery education in Taiwan should be the first step to negotiate in order to raise the profile of midwives specifically and the midwifery profession generally. Ultimately, such a strategy would improve the quality of care provided to women and their infants and consequently improve the health and social well-being of present and future generations.

Adult↗
PubMed2002

Between professional duty and ethical confusion: midwives and selective termination of pregnancy.

This qualitative study describes midwives' experiences in relation to termination of pregnancy for fetal abnormalities, and their corresponding professional and ethical position. Thirteen midwives working in a university clinic were interviewed about their problems in this respect. The information gathered was evaluated by using qualitative content analysis. The study focused on the emotional experience of the midwives, their professional position, and ethical conflict. In this situation, midwives are faced with a conflict between the woman's right to self-determination on one hand and the right to life of the child on the other. This conflict causes a high level of emotional stress and, subsequently, professional identity problems. Although questions concerning the child's right to life are generally suppressed, the ethical principle of the woman's right to self-determination is rationalized. Although this process of rationalization seems to present a false ethical decision, it enables midwives to continue with their daily professional duties. As far as orientating midwives to the value of these women's right to self-determination is concerned, it must be assumed that they have made an ethical decision to which they have given insufficient thought. This problem is exacerbated by the fact that midwives are largely excluded from the decision-making process of the parents in question. They cannot therefore help in this process in a valuable and responsible way by providing clear information and proposing objective criteria. In relation to the tasks they are expected to fulfill, these midwives revealed that they were in a state of professional confusion.

Abortion, Therapeutic↗
PubMed1994

Midwives call for more support in safe motherhood.

Midwives need more backing to help them carry out their roles effectively. Midwives at an international workshop in May called for midwifery practice to be evaluated and improved so as to better achieve the goals of safe motherhood. The workshop on "Midwifery Practice--Measuring, Developing and Mobilizing Quality of Care" was the third in a series of workshops run jointly by the International Confederation of Midwives (ICM), the United Nations Children's Fund (UNICEF) and WHO. 41 midwives from 27 countries with high maternal mortality attended the workshop in Vancouver, Canada, on 7-8 May just prior to the ICM congress. Participants exchanged ideas on how midwives themselves can take responsibility for assessing and promoting high standards of maternity care. Plenary sessions and group work gave midwives the chance to learn how to determine what constitutes quality midwifery care. At the end of the workshop midwives drew up individual action plans to implement when they got back to their own countries. Workshop participants agreed an action statement addressed to ICM, WHO, UNICEF and to midwives themselves.

Delivery of Health Care↗
PubMedDate not supplied

Nurse midwives' attitudes toward abortion performance and related procedures.

In 1990 a symposium was held by the American College of Obstetricians and Gynecologists and the National Abortion Federation to address the national shortage of physician abortion providers. One symposium recommendation was that nurse-midwives be trained to perform first-trimester legal abortions under physician supervision. A national mail survey was conducted to determine the attitudes of nurse-midwives toward performing abortion and related procedures. One-half of the nurse-midwives who were members of the American College of Nurse-Midwives as of October 1991 were polled, and 1,208 questionnaires (71.1%) were returned, resulting in a sample representative of the general membership and students. Seventy-nine percent of respondents would not support federal and state efforts to limit access to abortion, 52% would or possibly would vote in a secret ballot to permit the performance of abortion by certified nurse-midwives; 24% would, or possibly would, incorporate abortion procedures into their practice; and 19% would, or possibly would, perform abortions in an abortion clinic. The lowest level of support to permit the certified nurse-midwife practice of abortion came from the midwest (31%) and southeast (41%) and the greatest from the west coast (65%). Supporters for the nurse-midwife performance of abortion were more likely to have practiced well-woman gynecology and provided abortion-related services such as abortion referrals, pre- and postabortion workups and the treatment of abortion-related complications. They were more likely to have inserted intrauterine contraceptive devices and laminaria, and to have performed circumcision. Opinions about the performance of abortion were not related to age, education, or student status. The majority of nurse-midwives (91%) would be willing to refer a woman to another provider for an abortion, prescribe RU 486 (57%), and perform dilation and curettage for spontaneous abortion (56%). The American College of Nurse-Midwives membership reported many different reasons for support of and opposition to professional involvement with abortion. Further research suggestions for institutional policy and individual practice are offered.

Abortion, Legal↗
PubMedDate not supplied

English midwives' views and experiences of intrapartum fetal heart rate monitoring in women at low obstetric risk: conflicts and compromises.

Over the last 20 years in the United Kingdom, midwives have implemented the routine use of intrapartum fetal monitoring regardless of the risk status of laboring women. This practice is at odds with the published research. The discrepancy between practice and best evidence merits further investigation. A qualitative study was conducted to evaluate midwives' attitudes and experiences about the use of fetal monitoring for women at low obstetric risk. Fifty-eight midwives working in two hospitals in the north of England were interviewed by using a semistructured approach. The taped interviews were transcribed and analyzed by using a general thematic approach. Issues included midwives' perceptions of low-risk status, the socialization of midwives, and the loss of woman-centered care. Midwives subscribed to the notion of woman-centered care, but because of a complexity of factors experienced in their daily working lives, they felt vulnerable when attempting to implement evidence-based fetal monitoring practices. Midwives regretted the loss of a woman-centered approach to care when technologic methods of intrapartum fetal heart rate monitoring were used indiscriminately. An appreciation of the complex factors affecting the ability of midwives to implement evidence-based practice is important when attempting to facilitate the development of appropriate fetal monitoring practices for women at low obstetric risk.

Adult↗
PubMed2005

Midwives' experiences of routine antenatal questioning relating to men's violence against women.

OBJECTIVE: to describe and use the experience gained by antenatal-care midwives who routinely questioned pregnant women about personally experienced violence. DESIGN: qualitative, using focus-group discussions. SETTING: antenatal care in a city in south-central Sweden. STUDY POPULATION: 21 midwives. DATA COLLECTION AND ANALYSIS: the midwives participated in any one of five focus-group discussions held by the same moderator and observer. The discussions were audiotaped, transcribed verbatim and analysed using qualitative content analysis. FINDINGS: the importance of routine questioning about violence was emphasised in all groups. Midwives felt they had failed in their duty when women were not questioned. The two main obstacles to such questioning were the delicacy of the subject and the routine of inviting the partner to all visits. The perceived delicacy underlined the need to devise a natural setting for the questioning. The midwives wanted to connect questions about abuse with related subjects routinely established in early pregnancy. As the partner was invited to every visit, it was not practicable to establish a procedure whereby the assessment was connected with a particular visit. Other obstacles included the following: time constraints, oversight, a preconceived notion of who might be a victim of abuse and language difficulties. The midwives emphasised the importance of training, easy access to support for abused women, and personal counselling for midwives. They described their role as raising awareness of the problem of male violence, reducing the shame of being abused, informing, giving emotional support and mediating help. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: in order to ensure that the establishment of experience of violence is a routine enquiry in antenatal care, midwives must have a reasonable opportunity of carrying out such questioning. A routine that offers each woman a private consultation will ease the questioning and save time and distress.

Adult↗
PubMed2005

The use of exploratory factor analysis in evaluating midwives' attitudes and stereotypical myths related to the identification and management of domestic violence in practice.

OBJECTIVE: to investigate the suitability of the 'Midwives' Attitudes to Domestic Violence Scale' for evaluating midwives' attitudes and stereotypical myths related to the identification and management of domestic violence in practice. Other objectives were to assess midwives' perceived role and experience of raising the issue of domestic violence with their clients, and to assess their perceived prevalence of domestic violence in their current practice. DESIGN: survey using a postal quesnionnaire. The questionnaire included a scale on attitudes to, and stereotypical myths surrounding, domestic violence within maternity care, and assessed demographic details. SETTING: Northern Ireland. PARTICIPANTS: 861 hospital and community midwives. FINDINGS: 488 midwives returned a completed questionnaire leading to a 57% response rate. Exploratory factor analysis of the 22-item attitude questionnaire produced three factors that accounted for 36% of the variance: namely, factor 1: non-susceptible to myths; factor 2: training and information; and factor 3: confidence. In general, as indicated by the mean summary score, most of the midwives (82%) did not subscribe to the numerous stereotypical myths surrounding domestic violence. Similarly, there was general agreement with issues associated with factor 2: training and information (mean summary score 74%). Importantly, however, factor 3, associated with confidence levels, indicated that, in general, midwives lacked confidence in dealing with the issues addressing domestic violence (mean summary score 33%). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the measure provides a reliable method for assessing midwives' attitudes and training needs for identifying and dealing with domestic abuse. It may also serve to evaluate training and policy interventions in domestic violence.

Adult↗
PubMed2006

Midwives' attitudes to counselling women about their smoking behaviour during pregnancy and postpartum.

OBJECTIVE: to investigate the attitudes of midwives to counselling women about their smoking behaviour during pregnancy and postpartum. DESIGN: survey using postal questionnaires. SETTING: the entire federal state of Mecklenburg-West-Pomerania in Germany. PARTICIPANTS: 189 midwives constituting 77% of all midwives working in that State. FINDINGS: midwives reported that they assessed smoking behaviour regularly (77%), addressed the consequences of smoking (70%) and advised women to quit. Among the midwives, 81% saw low chances of success and parents' expectations as the biggest barriers to counselling. Midwives reported that about 28% of women quit following their advice. KEY CONCLUSIONS: smoking and exposure to environmental tobacco smoke are seen as prominent health threats that midwives reported they addressed routinely, including giving advice to stop smoking. IMPLICATIONS FOR PRACTICE: midwives should be supported in learning effective intervention strategies to further strengthen their work. They are a target population to deliver brief smoking interventions.

Adult↗
PubMed2005

An exploratory study of the conditions important in facilitating the empowerment of midwives.

OBJECTIVE: to explore the conditions important in facilitating the empowerment of midwives, as judged by practising midwives. DESIGN: a cross-sectional, descriptive, national survey of nurses and midwives practising in Ireland was undertaken in 2002. The questionnaire used in the survey included the 'Understanding of Empowerment Scale'. PARTICIPANTS: the data come from a larger national study of empowerment among nurses and midwives carried out by the authors in 2001/2 (Scott et al., 2003). A random sample of 4050 nurses and midwives in Ireland was obtained from the Live Register of An Bord Altranais (Irish Nursing Board). There was an overall response rate of 46% (n = 1781). Of these, 1340 people completed questionnaires, as 441 of those who replied were not in practice at the time. Of those who completed the questionnaire, 7% (n = 95) were practising midwives. Their findings are reported in this paper. MEASUREMENTS AND FINDINGS: factor analysis using the Principal Axis Factoring method of extraction and an oblique (Direct Oblimin) rotation was carried out on the Understanding of Empowerment Scale. This suggested four factors or conditions important for the empowerment of midwives: control, support, recognition and skills. KEY CONCLUSIONS: these findings relating to the conditions that facilitate empowerment in midwifery reflect the professional distinctiveness of midwifery and take into account the specific role and working environment of the midwife. IMPLICATIONS FOR PRACTICE: the identification of the important conditions to facilitate empowerment in midwifery provides a framework with which to explore ways of building on strengths and addressing weaknesses within the current situation for midwives in Ireland and elsewhere. These suggestive findings offer an opportunity to further develop a tool to measure levels of these conditions necessary to facilitate empowerment in midwifery.

Adult↗
PubMed1997

The continuing professional education needs of midwives.

The philosophy behind Post Registration Education and Practice (PREP) dictates that continuing professional education (CPE) must be tailored to the needs of the individual and relevant to the practice environment. The study is set within the context of PREP and other changes that are currently affecting midwives and midwifery educational establishments. This study sought to explore the CPE needs of midwives. The main objective of the study was to seek information on a number of issues that would assist with the planning and implementation of continuing education programmes to meet the needs of midwives. The study takes the form of a descriptive survey. Questionnaires were sent to 696 midwives employed by 7 National Health Service Trusts in the South-West of England. A 45% response rate was achieved. Seven midwife managers were also interviewed to gain insight into their perspectives of CPE and to enhance the findings from the questionnaire. Results show that midwives use a variety of strategies to identify their CPE needs. One of the more significant seems to be through interaction with colleagues. 'Professional issues' and 'management topics' were the categories identified by both midwives and managers alike to be the greatest need. There is a demand for part-time and distance learning. The format and timings that would ensure that midwives find it easy to attend CPE events were identified. Findings illustrate how midwifery managers and educationalists can facilitate midwives with their CPE and career development.

Education, Nursing, Continuing↗
PubMed2001

Perceptions of labour pain by mothers and their attending midwives.

AIMS: The aim of the current study was to examine the perception of pain by labouring women and their attendant midwife, from the onset of labour to delivery. RATIONALE: Accurate measurement and appropriate management of pain is a significant problem for attendant medical and nursing personnel. Both the experience and perception of pain are regarded as subjective and are therefore difficult to measure objectively. Indeed, much of the literature reports that pain is often under- or over-estimated by nursing staff who as a consequence consistently fail to administer adequate analgesia. Few studies have specifically examined the ability of midwives to assess the pain of labouring women. DESIGN: The short form McGill Pain Questionnaire (SF-MPQ), routinely used to assess pain in obstetric environments, was used to determine pain perception. Thirteen labouring women and nine midwives completed the SF-MPQ every 15 minutes beginning at the time of admittance to the delivery suite. Peak pain ratings for the preceding 15 minutes were obtained without reference to prior ratings or each other's scores. Further, midwives in the maternity unit of The Queen Elizabeth Hospital (TQEH), Adelaide, South Australia completed a survey investigating the cues they use to assess pain during labour. RESULTS: On each measure of pain on the SF-MPQ, the midwives scores correlated with the mothers' scores across the entire pain range. Further analysis showed that mothers' and midwives' pain scores were similar at mild-moderate pain levels, but midwives significantly underestimated pain intensity at levels that mothers described as severe. The survey responses indicated that midwives rely on both verbal and nonverbal cues to assess pain levels. CONCLUSIONS: The cues used by midwives to differentiate pain intensities and qualities are similar to those used in other clinical settings, but may have limited discriminatory value as pain levels become severe.

Adult↗