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PubMed2003

Improving the standards of midwifery education and practice and extending the role of a midwife in Korean women and children's health care.

BACKGROUND: A midwife is a medical professional who has a nursing license, and is also licensed as a midwife with one additional year of education. In this globalization era, a midwife's role is increasing in importance for women and children's health care worldwide. PURPOSE: The primary purpose was to analyze midwifery education programs in Korea and other nations. The secondary purpose was to define strategies to improve midwifery education and practice, and to extend the role of a midwife women and children's health care in Korea. METHODS & RESULTS: 1) The definition of a midwife and midwifery practice recognized internationally by World Health Organization (WHO) and International Council of Nurse Midwives (ICNM) was identified. 2) Midwifery education programs of Korea, U.S.A., Sweden, Australia, and Japan, were investigated and discussed. 3) Core competencies for the basic midwifery practice suggested by ACNM of the U.S.A. were reviewed as standard of midwifery practice. 4) As for the midwifery education system, a Masters degree program in a college of nursing is suggested. 5) The role of a midwife includes not only health care of childbirth women and newborn babies, but also a lifelong health care of women as well as her family and children. CONCLUSION: An effort to extend the midwife's role and to improve service is imperative. The Laws/Acts related to midwives should be revised in regard to education, and practices, and the national examination for midwifery licensure needs revision to qualify for international approval. Also, midwifery curriculum and standards of practice need to be evaluated periodically, and an effective system needs to be established to renew midwife licenses.

Journal Article↗
PubMedDate not supplied

How nurse-midwives define themselves in relation to nursing, medicine, and midwifery.

The way members of an occupation or profession define themselves influences both their interaction with other occupations in the workplace and the future direction of their profession. In order to determine how certified nurse-midwives define their occupational identity, a two-phase study was done. In the first phase, 20 nurse-midwives were interviewed at length. It was found that they used traditional midwifery ideologies of advocacy, normalcy, and competency to differentiate themselves from physicians and nurses. A nationwide survey was then sent to 300 nurse-midwives in which they were asked whether they identified more with midwifery, nursing, or medicine. Their choice of identity was then examined in light of midwifery, ideologies, situational and background factors, and ability to tolerate ambiguity. The analysis of the survey indicated that nurse-midwives identify occupationally with midwifery, rather than nursing or medicine, even though there is some alliance with both of the other occupations. The variables that were most predictive of a positive midwifery occupational identity were philosophical agreement with nurse-midwifery ideologies and increased years of nurse-midwifery practice. A short discussion of the implications of a midwifery versus a nursing identity concludes the article.

Adult↗
PubMed2006

An Australian history of the subordination of midwifery.

This paper analyses the history of the subordination of midwifery to medicine and nursing. With the important exception of Evan Willis' work on medical dominance and Annette Summers' work on the takeover of midwifery by nursing, other histories of Australian midwifery have taken a neutral approach to issue of power and control. The aim of analysing this period is to identify the strategies of power that were used to subordinate midwifery. With increased consciousness of how power has operated in the past, midwives and woman of today can be more empowered when seeking to promote normal birth and midwifery models of care. Concepts of 'power', 'the state' and midwife are defined and discussed. A summary of the decline of midwifery and the rise of obstetrics in Europe and the United Kingdom (UK) gives a background against which to understand the Australian experience. The historical account given here draws to a climax by focussing on the period 1886-1928. It was during this time that medicine forged an alliance with nursing and achieved both legal and disciplinary control of midwifery. Knowing how this was done is important because it helps us to recognise the power strategies that are currently being used by medicine. This is helpful when planning how these strategies might be matched or countered by contemporary woman and midwives when seeking to promote normal birth and midwifery models of care.

Australia↗
PubMed2003

An exploratory metasynthesis of midwifery practice in the United States.

OBJECTIVES: To conduct a metasynthesis of six qualitative studies of midwifery care and process; identify common themes and metaphors among the six studies for further exploration and theory development; and create a framework for further metasynthesis of qualitative studies of midwifery practice in the USA. DESIGN: A qualitative metasynthesis to analyse, synthesise, and interpret six qualitative studies on the process and practice of midwifery care. SAMPLE AND SETTING: Hospital, birth centre, and home birth settings were represented across all of the studies. Participants included nurse- and direct-entry midwives who provided both childbearing and gynaecological care. Recipients of midwifery care also received both childbearing and gynaecological care. FINDINGS: Four overarching themes were identified: the midwife as an 'instrument' of care; the woman as a 'partner' in care; an 'alliance' between the woman and midwife; and the 'environment' of care. These were interpretively and conceptually arrayed into a helix model of midwifery care. KEY CONCLUSIONS: The findings from this exploratory metasynthesis clearly indicate that the practice of midwifery is a dynamic partnership between the midwife and the woman, and reflects an environmental perspective. In a country that has a standard of highly technical childbirth care, perhaps the most outstanding concept of this model is that of the midwife as an 'instrument' of care. The significance of the findings will be determined by their ability to guide further research efforts to support a standard of midwifery care for all women in the USA. IMPLICATIONS FOR PRACTICE: This model offers a benchmark and a structure for considering the dynamic elements of midwifery practice and key roles that the midwife plays in the health care of women and babies.

Anecdotes as Topic↗
PubMed2001

Legalized, regulated, but unfunded: midwifery's laborious professionalization in Alberta, Canada, 1975-99.

In 1992, Alberta became the second Canadian province to legalize midwifery. This happened even though there were only approximately 20 midwives in practice at the time, and despite strong opposition from the medical and nursing professions. Between 1992 and 1999. Alberta established a regulatory framework for midwifery as a profession but. unlike Ontario and British Columbia, failed to pay midwives out of the provincial health care budget. This sent midwifery in Alberta into a crisis as many midwives closed their practices. This article first considers why midwifery was legalized and then professionalized in Alberta. Our answer emphasizes the leading role of state health bureaucrats in promoting midwifery as part of the state's challenge to medical dominance. Second. the article addresses why midwifery received so little governmental support at the same time that it attained professional status. This analysis includes a comparison with how midwifery developed in Ontario and British Columbia. Our conclusion is that midwifery in Alberta became a victim in the post-1993 period when a new Right government set aside bureaucratic initiatives in health care and committed itself to major cuts in government spending.

Alberta↗
PubMedDate not supplied

Midwifery care research: what questions are being asked? What lessons have been learned?

PURPOSE: To create and critically evaluate a research database about midwifery care that identifies topics studied, research methods, results, funding, publication data, and implications for a future midwifery research agenda. METHODS: Systematic literature review. Studies included were 1) data-based research; 2) about midwifery care or practice; 3) in the United States; and 4) published between 1984-1998. The CINAHL and MEDLINE electronic databases were searched using a defined strategy, and relevant journals and bibliographies were searched by hand. RESULTS: This 15-year review identified 140 studies of midwifery care published in 161 papers. A midwife was the lead author on 60%. Sixty percent were published in the Journal of Nurse-Midwifery. Six to 15 studies were published each year, and both the number of publications and funding increased over the time period. The six major areas of focus were: 1) midwifery management, 2) structure of care, 3) midwifery practice, 4) midwife-physician comparisons, 5) place of birth, and 6) care of vulnerable populations. DISCUSSION: Although retrospective descriptive studies still predominate, more prospective studies, randomized controlled trials, multi-site studies, and quasi-experimental designs are being conducted. Qualitative methods are helping to measure nontraditional outcomes. A research agenda should be established based on discussion and debate within the profession. Midwife investigators need to build research teams and collaborate with other disciplines. Key areas for future research include alternative therapies, breastfeeding, cost-effectiveness, cultural studies, gynecology, health policy, menopause, postpartum care, substance abuse interventions, and the woman's experience of birth and midwifery care.

Data Collection↗
PubMed2000

Action research to improve the pre-registration midwifery curriculum--Part I: An appropriate methodology.

OBJECTIVE: To improve the pre-registration midwifery curriculum locally and influence national policy and guidelines for these programmes. DESIGN: Action research provided the framework for the study where a multi-method approach was largely qualitative to attempt to capture the context and complexity in which the midwifery programme operates. The study comprises a synthesis of two separate but interwoven research projects: a national study about the effectiveness of midwifery education (the EME project) and an evaluation and re-design of the three year pre-registration midwifery programme in a large multi-sited university in England. SETTING: A large university in England. PARTICIPANTS: The EME project 39 case study students, their teachers, practice-based mentors/assessors, preceptors and supervisors of midwives or managers; 50 students from the local university's midwifery programme, their teachers and practice-based mentors/assessors from six sites; 41 women who gave birth to their babies in a large teaching hospital in the East Midlands; and a professional network of experienced midwives whose role is to advise the statutory body regulating midwifery programmes in England. FINDINGS: Overall the three-year, pre-registration route into midwifery was found to be an effective preparation for contemporary midwifery practice as judged against a model of a competent midwife at the point of registration. However, there was evidence to suggest that not all students are equipped to practise competently and confidently in contexts of uncertainty and change in the National Health Service. Factors which emerged as influencing curriculum effectiveness related to: recruitment and selection; curriculum structure, appropriateness; and robustness of assessment schemes; the preparation of and support for assessors; and the role of the midwife teacher in assessment in practice settings. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Diagnosing problems and initiating actions as a collaborative process formed an important part of designing and implementing an 'ideal' curriculum in constrained health and higher education contexts. The need for on-going dialogue, critical reflection, and research to facilitate and assess learning more effectively in the 'caring' professions emerged as necessary to ensure that only competent practitioners have a license to practise.

Curriculum↗
PubMedDate not supplied

Innovations in midwifery education.

Midwifery educators and the American College of Nurse-Midwives (ACNM) have created educational pathways for Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs) based on sound principles and creativity. A review of these educational innovations portrays the strong foundation that exists and provides direction for the future. Accreditation of educational programs, the development of core competencies, and the certification process for graduates of midwifery education programs form the foundation for excellence in midwifery education, while the early development of the modular mastery learning curriculum provided a transition to later use of telecommunications and the incorporation of various instructional technologies into midwifery education. Midwifery educators have continued to innovate with distance-learning, Web-enhanced curricula and community-based clinical preceptorships, and a master's degree in midwifery option to increase access to midwifery education and degree programs. Continued innovation and creativity will be required to prepare midwives for the 21st century.

Certification↗
PubMedDate not supplied

Student perceptions of ideal and actual midwifery practice.

This research was conducted to document midwifery students' observations of ideal midwifery care in different educational and clinical midwifery settings. A survey questionnaire using the 39 processes of exemplary midwifery process identified by Kennedy in 2000 was sent to a group of newly graduated certified nurse-midwives, all members of the American College of Nurse-Midwives. The questionnaire was constructed to permit the respondent to evaluate "ideal" and "actual" midwifery practices. Significant differences between actual observations and ideal perceptions of midwifery practice were found in two of the four clinical settings (birth centers and homebirth) and one type of education program (BA to BSN to CNM). No difference was found between traditional versus distance learning programs. Of most concern was that half of the respondents perceived a lack of congruity on ideal and actual midwifery practices that supported normal birth. The results of this study represent a "theory-practice" gap and should be considered by educators and preceptors in the development of curriculum and clinical experiences.

Attitude of Health Personnel↗
PubMed1999

The midwifery curriculum--preparing beginning or advanced practitioners?

Midwifery education in Australia has undergone rapid change in the last decade. It has been transferred from a traditional hospital based program developed to suit the service needs of an organisation, to a tertiary course of studies. This move has not been completed in all States/Territories and some still have hospital based courses. A diverse range of University awards for midwifery education have been developed. The curriculum, in the majority of these courses, has been developed by the academic staff based on their expertise and experience in the field of midwifery. This paper will give a brief overview of midwifery education in Australia and report the findings of a small study to define beginning and advanced midwifery practice as a curriculum development exercise and identify that beginning and advanced midwifery practice are different. It will also demonstrate the need for Universities to provide midwifery programs that are flexible, creative and appropriate for the learner.

Attitude of Health Personnel↗
PubMed2002

Midwifery: a profession in transition.

This study sought to explore midwifery self-identity in relation to two major, competing discourses-medicine and midwifery. In-depth interviews were conducted with twenty-two midwives working in different settings. Although the study was exploratory, the findings showed conclusively that midwifery is not a static, discrete body of knowledge (Commonwealth Department of Human Services and Health 1996); nor should midwifery be seen necessarily falling neatly into one stream or another (Davis-Floyd 1992). Rather, midwifery is a discursive practice (Kent 2000). The midwife (like the obstetrician and nurse) trawls through a range of discourses (or ways of understanding and knowing) about the body and childbirth in order to construct their own practice. Midwifery is a fluid process of subject formation which changes over time according to age; experience; and setting of practice (private or public hospital, birth centre or home). Of primary significance is the way midwives viewed the body. Few midwives fell into either the medical (obstetric assistant) model or the midwifery (professional, independent) model. Most midwives could be classified 'hybrid' in the sense that their clinical practice drew variously on each of the major discourses according to contextual factors.

Anecdotes as Topic↗
PubMedDate not supplied

From nursing outposts to contemporary midwifery in 20th century Canada.

Knowledge of the history of one's profession is always related to the informed practice of the profession and can aid midwifery in its expansion and recognition. Understanding the long and diverse history of Canadian midwifery expands the appreciation by midwives in the United States of midwifery north of our border, which, although newly regulated, has much experience to share. This article documents the evolution of midwifery in Canada during the 20th century. Government-sanctioned midwifery prior to 1991, the year when Ontario passed legislation to regulate midwifery for the first time in modern Canadian history, was limited to isolated, usually northern, frontier and outpost regions of Canada, but the providers who practiced it were well-educated and important figures in the broader history of midwifery.

Canada↗
PubMed2003

Training needs of midwifery assistants.

BACKGROUND: Increasingly in the United Kingdom (UK) assistants are being introduced as part of the midwifery workforce. However, there appears to be little standardization in the qualifications and training provided. AIM: The aim of this study was to investigate what an educational programme for midwifery assistants should contain. RESEARCH METHODS: A total of 100 qualified midwives and 58 midwifery students were asked to complete a mailed questionnaire and subsequently 20 of these respondents were interviewed. RESULTS: Respondents identified three levels of competencies that midwifery assistants should possess. They also acknowledged that midwives required specific training in how best to supervise assistants. Respondents maintained that each assistant should have a clinically-based midwifery mentor and that rotation around different clinical areas should be included as part of a training programme. Furthermore, it was stressed that because midwives initiate, teach and supervise assistants, they should have a key role in planning training programmes and in the teaching and assessment processes. Nonetheless, it was accepted that such a role could divert the midwife from valuable contact time with the mother and baby, the opposite of what the introduction of assistants was intended to do. CONCLUSIONS: Before working in clinical areas midwifery assistants need practice-based training that focuses on skills development. Communications and interpersonal skills should be included in the training as should placement experience in a variety of clinical settings. Midwives have a role in providing this training, and in mentoring and supervising midwifery assistants, but it is accepted that this could add to their workloads. Developments of this kind need to be evaluated, especially in terms of the impact on direct care by midwives.

Attitude of Health Personnel↗
PubMed2002

Medical and midwifery students: how do they view their respective roles on the labour ward?

BACKGROUND: It has been suggested that much of the medical and midwifery student curricula on normal pregnancy and birth could be taught as a co-operative effort between obstetric and midwifery staff. One important element of a successful combined teaching strategy would involve a determination of the extent to which the students themselves identify common learning objectives. AIM: The aim of the present study was to survey medical and midwifery students about how they perceived their respective learning roles on the delivery suite. METHODS: A descriptive cross-sectional survey study was undertaken. The study venue was an Australian teaching and tertiary referral hospital in obstetrics and gynaecology Survey participants were medical students who had just completed a 10 week clinical attachment in obstetrics and gynaecology during the 5th year of a six year undergraduate medical curriculum and midwifery students undertaking a one year full-time (or two year part-time) postgraduate diploma in midwifery. RESULTS: Of 130 and 52 questionnaires distributed to medical and midwifery students, response rates of 72% and 52% were achieved respectively The key finding was that students reported a lesser role for their professional colleagues than they identified for themselves. Some medical students lacked an understanding of the role of midwives as 8%, 10%, and 23% did not feel that student midwives should observe or perform a normal birth or neonatal assessment respectively. Of equal concern, 7%, 22%, 26% and 85% of student midwives did not identify a role for medical students to observe or perform a normal birth, neonatal assessment or provide advice on breastfeeding respectively. SUMMARY: Medical and midwifery students are placed in a competitive framework and some students may not understand the complementary role of their future colleagues. Interdisciplinary teaching may facilitate co-operation between the professions and improve working relationships.

Clinical Clerkship↗
PubMed2006

Nursing and midwifery students' approaches to study and learning.

AIM: This paper reports an investigation of the approaches to study and learning of nursing and midwifery students at a school of nursing and midwifery in Iran. BACKGROUND: Current knowledge suggests that students approach their studies in surface, deep or strategic manners. Students' approaches to study have an important impact on their academic success. Awareness of their approaches to study and factors that affect their choices is important for curriculum planners as well as nurse and midwife educators. METHODS: A cross-sectional design was used with a convenience sample of nursing and midwifery students in all 3 years of study at one university in Iran. The validated Persian translation of Entwistle and Ramsden's Approaches and Study Skills Inventory was administered in a classroom context in 2003. RESULTS: Sixty-four per cent (95% CI; 57-72%) of nursing and 63% (95%; CI 50-75%) of midwifery students adopted a deep approach. The use of a surface approach was negatively correlated to the stage of study for midwifery but not nursing students. There was also a statistically significant positive correlation between level of interest in the field of study and use of strategic approach for both nursing and midwifery students. Grade point average for the nursing students adopting the strategic approach was statistically significantly higher than for those adopting deep or surface approach. The grade point average for midwifery students adopting strategic approach was statistically significantly higher than that for those adopting deep approach, but not different from the grade point average of those adopting surface approach. CONCLUSION: Our findings suggest that adoption of strategic or deep approaches to learning was associated with better educational outcome, as indicated by higher grade point averages. Moreover, the findings emphasize the impact of students' interest in their field on their academic success. Therefore, the adoption of factors which foster deep or strategic approaches and activities which increase students' interest should lead to improved academic outcomes.

Attitude of Health Personnel↗
PubMed1992

The role of selection bias in comparing cesarean birth rates between physician and midwifery management.

OBJECTIVE: The midwifery service at our hospital has been observed to have a 2% cesarean birth rate consistently over a 10-year period. There are substantial differences in labor management style between the midwives and physicians. We sought to test the hypothesis that the low cesarean birth rate on the midwifery service was the result of patient selection bias. METHODS: A randomized blinded clinical trial was conducted in which 492 low-risk patients were assigned to either physician or midwifery management. The provider responsible for labor management was unable to determine group assignment. Patients in the midwifery group were managed by previously established protocols, and outcome was attributed to the midwives even if the patients subsequently required transfer to physician management. Route of delivery was the primary outcome measurement. Continuous variables were analyzed using Student t test and discrete variables using chi 2. RESULTS: There were no demographic differences between the groups, and the admission pelvic examinations were the same. The patients assigned to the midwifery group had a 2.1% cesarean birth rate, whereas those assigned to physician management had a 0.4% rate. The higher rate of operative vaginal deliveries in the physician group was statistically significant. There were no differences in neonatal outcomes. The physician-managed group had significantly more episiotomies and third- and fourth-degree extensions. CONCLUSIONS: The 2% cesarean birth rate observed on the midwifery service appeared to be the result of patient selection bias. A low cesarean birth rate can be achieved by either physician or midwifery management in a selected low-risk population.

Adult↗
PubMedDate not supplied

Public education: promoting the midwifery model of care in partnership with the Maternity Center Association.

Most people who are ignorant or misinformed about midwifery are also misinformed about birth, the needs of pregnant women, and problems related to the care provided to most pregnant women in this country. An understanding of these issues is the conceptual substrate that makes it possible to understand and value midwifery. Although midwives need to educate people about midwives and midwifery, it is also necessary for them to educate people about the nature of childbirth, the needs of pregnant women in general, and appropriate (and inappropriate) maternity care. Midwives are experts in these subjects, but they have to go beyond talking about midwifery--beyond talking about themselves. To maximize their effectiveness, midwives should work in partnership with individuals and organizations that support the midwifery model of care--regardless of the professional background of the person who practices this model. Midwives can advance public education by collaborating with organizations, such as the Maternity Center Association (MCA), which supports family-centered maternity care, based on the midwifery model. MCA's current public education activities are described and two new MCA brochures are presented. Information that supports midwifery care may be particularly effective when it is presented by an organization with broader objectives.

Female↗
PubMed1992

The rebirth of midwifery in Canada: an historical perspective.

The history of midwifery in Canada, beginning in the 17th century in New France, is characterised by periods of suppression and rebirth. At present, the long standing dominance of the medical establishment is giving way to the demand of women to assume greater control over the birthing process. Several provinces in Canada are in the process of obtaining midwifery legislation designed to strengthen, support and legalise the practice of midwifery. Lack of supportive legislation has discouraged the practice of midwifery. Though midwifery care has not been readily accessible, women have persisted in their search for care by a midwife. In response, female friends with a variety of educational preparation have found ways to prepare themselves and respond to women's need for an expert in normal birth. From an historical analysis of midwifery in Canada it would appear that a primary factor influencing midwifery's rebirth has been the power and determination of women to demedicalise normal birth and return it to the domain of women.

Canada↗