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At least 127 records · Page 7Linked to original sources
PubMed2005

A critical ethnographic study of encounters between midwives and breast-feeding women in postnatal wards in England.

OBJECTIVE: To explore the nature of interactions between midwives and breast-feeding women within postnatal wards. DESIGN: A critical ethnographic study using participant observation and focused interviews. SETTING: Two maternity units in Northern England, UK. PARTICIPANTS: 61 postnatal women and 39 midwives. FINDINGS: The interactions between midwives and women were encompassed by the global theme of 'taking time and touching base'. However, most encounters were characterised by an absence of 'taking time' or 'touching base'. This related to midwives' experiences of temporal pressure and inability to establish relationality with women due to their working patterns. The global theme was underpinned by five organising themes: 'communicating temporal pressure'; 'routines and procedures'; 'disconnected encounters'; 'managing breast feeding'; and 'rationing information'. KEY CONCLUSIONS: The organisational culture within the postnatal wards contributed to midwives experiencing profound temporal pressures and an inability to establish relationality with women. Within this context, the needs of breast-feeding women for emotional, esteem, informational and practical support were largely unmet. IMPLICATIONS FOR PRACTICE: Transformative action is required to dramatically reorganise the provision of hospital-based, postnatal ward midwifery care in parts of the UK. This should include a re-conceptualisation of caring time, with recognition that midwives need sufficient time in order to give time to others. This, in turn, requires recognition that caring time is cyclical and rhythmical, allowing for relationality, sociability, mutuality and reciprocity. The midwifery staffing structure in postnatal wards needs to be reviewed, as it is unacceptable to midwives and service users for staff to be rapidly relocated according to other demands within the institution. Most radically, it is argued that now is the time to reconsider the suitability of the hospital as the place and space within which women commence their breast-feeding journey.

Adolescent↗
PubMed2005

Dutch community midwives' views on preconception care.

OBJECTIVE: to explore the opinions of midwives on the desirability of preconception care for all couples contemplating pregnancy, their willingness to introduce preconception care to midwifery practice and, if it were to be implemented, the necessary conditions, including knowledge, postgraduate education and referral possibilities for successful implementation in the community. PARTICIPANTS: all community midwives (n = 129) working in 49 midwifery practices that refer their high-risk clients to the Erasmus University Medical Centre, Rotterdam (the Netherlands). SETTING: Rotterdam and its immediate surrounding communities. DESIGN: midwives working at the midwifery practices were recruited by telephone. All agreed to participate, and subsequently received a questionnaire by post. FINDINGS: 102 (79%) questionnaires were returned. Ninety-five (93%) of the 102 midwives were familiar with the concept of preconception care, and 71 (70%) of them already provided it to some extent. Of the 102 respondents, 84 (83%) seemed to be willing to provide such care in the future, and 56 (55%) felt that preconception care should be part of their professional domain. Midwives, however, lack time and knowledge to do so. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: community midwives already provide counselling, although not on a structural basis, and usually not earlier than in the first trimester of pregnancy. Midwives seem willing to play an active role in the provision of preconception care in the future. There is, however, great need for postgraduate training.

Community Health Nursing↗
PubMed2006

Norwegian midwives' perception of the labour admission test.

OBJECTIVE: To explore what information and knowledge the labour admission test is perceived to provide and what meaning the test carries in the daily work of practising midwives. DESIGN: In-depth interviews transcribed verbatim and analysed using the grounded theory technique. SETTING: Four different labour wards in Norway. PARTICIPANTS: A theoretical sample of 12 practising midwives. FINDINGS: The core category "experiencing contradictions" was identified during the analyses, indicating that the midwives found conflicting interests within themselves, or between themselves and others when using the labour admission test. They experienced contradictions between professional identity and the increasing use of technology, between feeling safe and feeling unsafe and between having power and being powerless. KEY CONCLUSIONS: The labour admission traces could be difficult to interpret, especially for newly qualified midwives. Some midwives thought that a labour admission trace could protect them in case of litigation. The hierarchy of power in the labour ward influences the use and interpretation of the labour admission test. Some midwives felt their professional identity threatened and that midwives in general are losing their traditional skills because of the increasing use of obstetric technology. IMPLICATIONS FOR PRACTICE: The findings of the present study should be taken into consideration when changing practice to not routinely perform the labour admission test. There is also a need for further research on what effect the increasing use of obstetric technology has on traditional midwifery skills.

Adult↗
PubMed2003

An Australian study of midwives' breast-feeding knowledge.

OBJECTIVE: To investigate midwives' breast-feeding knowledge, assess associations between knowledge and role, and report on the validity and reliability of the Breast-feeding Knowledge Questionnaire for the Australian context. DESIGN: Postal questionnaire. SETTING: National Australia. PARTICIPANTS: Midwives (n=3500) who are members of the Australian College of Midwives Inc (ACMI). FINDINGS: A response rate of 31% (n=1105) was obtained. Respondents were knowledgeable of the benefits of breast feeding and common management issues. Key areas requiring attention included management of low milk supply, immunological value of human milk, and management of a breast abscess during breast feeding. Participants over the age of 30, possessing IBCLC qualifications; having personal breast-feeding experience of more than three months; and more clinical experience achieved higher knowledge scores. Role perceptions were positive with 90% of midwives reporting being confident and effective in meeting the needs of breast-feeding women in the early postnatal period. Midwives' role perception contributed 39% of the variance in general breast-feeding knowledge scores and was a significant predictor of participants' breast-feeding knowledge. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The level of basic breast-feeding knowledge of Australian midwives was adequate but there are deficits in key areas. Knowledge variations by midwives may contribute to conflicting advice experienced by breast-feeding women. Further research is needed to investigate in-depth breast-feeding knowledge, breast-feeding promotion practices, and associations between knowledge and practice.

Adult↗
PubMed2006

Midwives in Morocco: seeking recognition as skilled partners in women-centred maternity care.

Around the world, midwives are increasingly being called upon to provide skilled care for pregnant women and newborns. In Morocco, there is a persistent lack of professional recognition of midwifery, which is consistent with widespread gender inequality and women's low status. Midwifery training in Morocco has evolved since the 1960s into a three-year undergraduate programme. Despite this, there is currently a shortfall of midwives to attend the large number of births in Morocco. Midwives have only partially replaced traditional birth attendants, especially in rural areas. Maternal mortality remains high. However, several recent government policies reflect increased attention to women's needs, e.g. since February 2006, midwives may be eligible for reimbursement should a medical doctor be unavailable. Since 1990, the Moroccan Midwives Association has been actively encouraging midwifery curriculum review, improvements in training and the professional status of midwifery. Partnerships with international midwifery associations have revealed challenges encountered elsewhere and helped us to establish specific strategies for promoting the professional recognition, autonomy and visibility of midwifery in Morocco. In a cultural context such as Morocco's, a disciplinary link between midwives and the medical community seems crucial. However, only with recognition of midwives as competent, skilled and valued partners can midwifery practice in Morocco progressively evolve into women-centred maternity care.

Cultural Characteristics↗
PubMed2003

Midwives' knowledge of, attitudes to and practice with baby walkers.

OBJECTIVE: to determine community midwives' knowledge, attitudes and practice with regard to baby walkers. DESIGN: survey, using questionnaires. SETTING: primary care, East Midlands, UK. PARTICIPANTS: Sixty-five community midwives participating in a cluster randomised controlled trial to reduce baby walker use. FINDINGS: there was a 94% response. Seventy per cent of the midwives, felt that it was part of their role to discuss baby walkers, and 62% felt that giving advice about walkers before birth acceptable. The midwives had a limited knowledge of baby walker injury risk and only one midwife had any baby walker-related health education material. Three attitude scales were computed and indicated that the midwives held a negative view of baby walkers and were positive about baby walker health education, believing that parents hold a positive attitude to baby walkers. Those midwives who had used a walker with their own children were more positive about baby walkers and less positive about baby walker health education. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: midwives are willing to be involved in baby walker health education during pregnancy. However, they require evidence-based knowledge and materials rather than relying on personal experience.

Adult↗
PubMed2003

Midwives and women together for the family of the world: the place of research.

In this paper, I explore the place of research in the theme 'Midwives and women: together for the family of the world'. I begin by examining each of the concepts involved. What is the family of the world? Midwives: what do they contribute to the family of the world? Women: what do they contribute to the family of the world? Putting midwives and women together what is the impact on the family of the world. What is the place of research and what is its impact? I build an argument to show that midwifery research covers social, cultural and political spheres. It breaks the barriers between midwives and women and helps create a true partnership where there is interactivity rather than just one-way information giving from midwife to woman. Once midwives interact with women, they are more likely to persuade them and the world around the women to change their way of doing things. By evaluating what they do using research, midwives are able to capture the safe motherhood success stories and effect replication where needed. With research, midwives become unified, assertive, and mutually supportive in order to reinforce professional identity, accountability and autonomy in the delivery of quality care for women and their families. The family of the world therefore has a ready source of care and support, leadership, knowledge and policies that have been tried and tested to be effective in contributing to the health of women and their families.

Female↗
PubMed2005

'The true assistant to the obstetrician': state regulation and the legal protection of midwives in nineteenth-century Prussia.

In recent years, historians of eighteenth- and nineteenth-century European midwifery have drawn attention to the great differences between midwives' experiences in England and the United States, where obstetricians succeeded by and large in displacing female practitioners, and midwives' experiences on the continent, where their fate was far more varied. While some countries witnessed the decline of midwives, in many others they were licensed and integrated into a government-sanctioned medical hierarchy. Scholars have disagreed, however, on how to evaluate the government's role in regulating midwives. Some have been critical, portraying midwives as victims of an alliance between the State and elite physicians who sought to place all other practitioners under their control. Others have cast midwives as beneficiaries of the State's protectionist policies, emphasizing their success in withstanding physicians' attempts to eliminate them entirely. Whilst these different interpretative models may reflect some regional variations, this article suggests that, in many cases, midwives both lost and won simultaneously: as State employees they lost much of their independence, but in exchange they gained protection not only from elite physicians, but also from unlicensed practitioners, who posed every bit as much of a threat.

Female↗
PubMed2005

The rhetoric of informed choice: perspectives from midwives on intrapartum fetal heart rate monitoring.

OBJECTIVE: To investigate midwives' attitudes, values and beliefs on the use of intrapartum fetal monitoring. DESIGN: Qualitative, semi-structured interviews. SUBJECTS AND SETTING: Fifty-eight registered midwives in two hospitals in the North of England. RESULTS: In this paper two main themes are discussed, these are: informed choice, and the power of the midwife. Midwives favoured the application of informed choice and shared a unanimous consensus on the definition. However, the idealistic perception of informed choice, which included contemporary notions of empowerment and autonomy for women expressing an informed choice, was not reportedly translated into practice. Midwives had to implement informed choice on intrapartum fetal monitoring within a competing set of health service agendas, i.e. medically driven protocols and a political climate of actively managed childbearing. This resulted in the manipulation of information during the midwives' interactions with women. This ultimately meant that the women often got the choice the midwives wanted them to have. CONCLUSIONS: The information that a midwife imparts may consciously or subconsciously affect the woman's uptake and understanding of information. Therefore, the midwife has a powerful role to play in balancing the benefits and risk ratios applicable to fetal heart rate monitoring. However, a deeply ingrained pre-occupation with technological methods of intrapartum fetal monitoring over many years has made it difficult for midwives to offer alternative forms of monitoring. This has placed limits on the facilitation of informed choice and autonomous decision making for women.

Choice Behavior↗
PubMed1996

Important components of antenatal care: midwives' and obstetricians views.

This study sought the views of midwives and obstetricians about what they considered to be important aspects of routine antenatal care. Midwives and obstetricians were randomly selected from the NSW membership lists of the Australian College of Midwives and the The Royal Australian College of Obstetricians and Gynaecologists, respectively. Seventy-eight percent of midwives (n = 196) and 52% of obstetricians (n = 114) completed a questionnaire which itemised components of routine care derived from the National Health and Medical Research Council's Guidelines for Antenatal Care. Participants were asked to rate each of the 77 components on a 4-point scale as either: very important; desirable but not essential; not necessary; or, don't know. Twenty-four (31%) of the components were rated as very important by at least 90% of midwives and 19 (22%) were rated as very important by at least 90% of obstetricians. 'Recording details of previous pregnancy complications' was the component most commonly rated as being very important by both groups. On 37 (48%) of the components there was a significant difference between midwives and obstetricians in terms of whether or not they rated the component as very important (p < 0.01). There were considerable differences between midwives' and obstetricians' views about the important components of routine antenatal care and a substantial proportion of both groups did not consider many of the components listed in the guidelines to be essential in routine care. The findings suggest that a revision of the current antenatal care guidelines is necessary.

Attitude of Health Personnel↗
PubMed2004

Use of complementary therapies in pregnancy: the perceptions of obstetricians and midwives in South Australia.

OBJECTIVE: To examine South Australian obstetricians and midwives attitude's towards the use of complementary and alternative medicines (CAM) during pregnancy, to examine their referral patterns and their views on the usefulness and safety of these therapies during pregnancy. DESIGN: All members of the South Australian branch of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and a 50% sample of midwives belonging to the South Australian Branch of The Australian College of Midwives, were sent a postal self-completion questionnaire. RESULTS: A response rate of 78% was obtained. Only 14% of doctors considered CAM was a threat to public health. Over 90% of midwives and obstetricians thought they should have some knowledge about CAM. A greater proportion of obstetricians (72%) held a view there needs to be an evidence base for CAM compared with 26% of midwives. The majority of obstetricians (68%) and midwives (78%) had formally referred a patient for use of one of the complementary therapies. Over 70% of obstetricians and midwives considered massage, acupuncture, vitamins, yoga, meditation and hypnosis to be useful and safe to use during pregnancy. CONCLUSION: The majority of clinician's held positive views towards CAM and considered some complementary therapies to be useful and safe for use during pregnancy. Limited evidence exists on the safety and efficacy of these therapies and attention needs to be given to undertaking high quality randomised controlled trials.

Attitude of Health Personnel↗
PubMedDate not supplied

[The midwives' experiences in the identification of battered women in pregnancy].

OBJECTIVE: To explore the experiences of midwives in the identification of battered women during pregnancy and to describe the types of violence they identify most easily. MATERIAL AND METHODS: A qualitative study was conducted between January and September 2001 among twelve midwives from a group of midwives ascribed to the Instituto Nacional de Antropología e Historia (INAH, National Institute of Anthropology and History), in Morelos, Mexico. Participants were selected from those living in Cuernavaca City and surrounding areas. RESULTS: Study findings show that: a) the identification of battered pregnant women in prenatal care should be triggered by a pattern of behaviors and attitudes of battered women, such as being unkempt, shyness, and above all, poor control over decisions on their health care; b) physical and emotional violence were the most frequently types of violence identified by midwives during prenatal care visits. Sexual violence was more difficult to identify. CONCLUSIONS: It is necessary to incorporate midwives in the national plans and programs to prevent domestic violence. Midwives' practices provide opportunities to care for battered women. Specialized training strategies must be directed to midwives caring for pregnant women in Mexico.

Adult↗
PubMed2000

Assisting women to establish breastfeeding: exploring midwives' practices.

Breastfeeding is recognised by many mothers, families and health professionals to be important for the health and wellbeing of mothers and babies. Successful breastfeeding depends on the acquisition of basic skills, accurate information and practice, and is strongly influenced by the support provided following childbirth. Midwives' practices may therefore have the potential to influence breastfeeding outcomes. Correct positioning and attachment of the newborn at the breast is a crucial component of the successful establishment of breastfeeding. A literature review revealed that minimal research exists on the practices that midwives use when assisting women to initiate breastfeeding. A series of focus group interviews were therefore conducted to stimulate in-depth exploration of midwives' understanding and practices in the positioning and attachment of a newborn infant at the breast. Eighteen midwives, each of whom had worked at least 12 months in the postnatal environment of a large metropolitan hospital in Adelaide, participated in the focus group discussions. Using thematic analysis, the following broad themes emerged from discussions--education, problem-solving, support, midwives' views about breastfeeding and influences on midwives' practice. These themes identify the roles and practices that midwives take on when assisting women to establish breastfeeding following childbirth, and also raise awareness of influences on their practice.

Breast Feeding↗
PubMed2005

Australian rural midwives: perspectives on Continuing Professional Development.

INTRODUCTION: Continuing Professional Development (CPD) provides an important counter to workforce pressures affecting rural midwives; however, there is a lack of information about how rural midwives understand and perceive CPD and how this is situated in the practising and social context. This research aimed to explore rural midwives' experiences and perceptions of CPD in context. METHODS: A qualitative approach gathered focus group data on the beliefs, opinions and perceptions of a total of 52 rural midwives (nine focus groups), across three Australian states: Western Australia, Victoria and Tasmania. The focus groups were taped and transcribed verbatim and data was analysed thematically using an inductive approach, with the aid of an NVivo (QSR Software, Durham, UK) computer program. RESULTS: Four key themes emerged from the data: midwives' views of CPD; their motivations for undertaking CPD; the choices they make around CPD; and how context factors facilitate their involvement in CPD. Congruence with issues evident in the literature were: the difficulties associated with role diversity, the need for acquiring key skills before engaging in CPD, and the importance of a culture supportive of ongoing learning. CONCLUSIONS: CPD can be considered an important strategy for the retention and professionalism of midwives. The study findings helped fill a gap in the literature about rural and regional Australian midwives' perspectives on CPD.

Attitude of Health Personnel↗
PubMed1992

Antenatal care of low risk obstetric patients by midwives. A randomised controlled trial.

OBJECTIVES: To assess the practicality, acceptability to patients and salary costs of the antenatal care of low risk obstetric patients by midwives. DESIGN: A randomised controlled trial. SETTING: The antenatal clinic at Westmead Hospital, a teaching hospital of the University of Sydney in western Sydney. PATIENTS: From January 1989 until November 1990, 89 women booking for full antenatal care at Westmead Hospital and classified as low risk were randomly allocated to one of two groups. Group 1 (43 patients) had their antenatal care provided by registered midwives. Group 2 (46 patients) had their antenatal care provided by an obstetrician (either Visiting Medical Officer or Staff Specialist) in a routine hospital antenatal clinic. INTERVENTIONS: Patients in the midwives' clinic were seen by an obstetrician at their first visit to the antenatal clinic and again at 30 weeks and at 40 weeks. MAIN OUTCOME MEASURES: These were the salary costs of each clinic and the patients' levels of satisfaction. Maternal and neonatal indicators, delivery details and analgesic requirements were also considered. These indicators were planned before data collection commenced. RESULTS: The major differences found were a 28% to 68% salary cost saving and that patients cared for by midwives showed appreciation of the continuity of care and information given at the midwives' clinic. CONCLUSIONS: The care of low risk obstetric patients by midwives in a midwives' clinic showed salary cost savings and high patient acceptance.

Continuity of Patient Care↗
PubMedDate not supplied

[Midwives' perception of reproductive risk factors].

Midwives in rural areas of the State of Morelos are one of the most important resources used by rural women for health care of pregnancy, delivery and the puerperium. This work was aimed at identifying midwives perceptions of pregnant women's risk factors, in order to include this knowledge in reproductive health programs which articulate institutional and traditional health systems. We applied a questionnaire to all midwives in the Municipalities of Ocuituco, yecapixtla and Zacualpan, Morelos (n = 35). Four key informants were selected and interviewed. These instruments enabled us to measure variability in perception of risk factors. Knowledge of risk factors is defective among midwives. Previous training made a big difference. Sixty three per cent of midwives who attended training courses are better qualified from an academic medicine point of view. Only 28.7 per cent of non-trained midwives (43% for both groups), indicating that sociocultural aspects prevail over technical training in midwives perceptions of reproductive risk factors.

Adult↗
PubMed1998

[Medical responsibility of midwives in public and private maternity units. Results of a survey of 11 French regions].

OBJECTIVE: To describe medical responsibilities of midwives in maternity units and to compare these responsibilities between categories of maternity units. METHOD: A mail survey was carried out in 1996 on a random sample of midwives. The analysis was based on 884 midwives providing antepartum, perpartum or postpartum care in public or private maternity units. RESULTS: For many procedures and decisions, medical responsibilities of midwives were more important in the public sector than in the private sector. Responsibilities were more extended in university hospitals than in other public hospitals. These differences were observed in the postnatal ward, in the antenatal ward, and for some specific tasks in the labor ward. In the private sector, responsibilities varied according to the status of the maternity unit: midwives performed fewer procedures in profit-based maternity units than in non-profit ones. CONCLUSION: The roles of midwives vary from one type of maternity unit to another, but differences are also observed within the same categories of units. Consensus on what are the medical responsibilities of midwives does not exist in a variety of situations, even with regard to the management of normal pregnancies and deliveries.

France↗
PubMed1994

Task analysis in education and evaluation: an application among midwives in the Republic of Yemen.

The political union between the countries of North and South Yemen prompted nurse-midwife educators to re-examine the midwifery curricula of both countries and define the roles midwives play as members of the health team, based on the unique circumstance in which Yemeni midwives operate within the health care system. The faculty of the Health and Manpower Institute (HMI), the main educational institution for the education of midwives, recognised that the delineation of tasks attributed to the practice of midwifery varied widely within Yemen, and between Yemen and other countries, despite the existing international definition of the role. In 1992, the Agency for International Development (AID) funded a workshop for the HMI faculty. Nineteen midwives, nurses and other health care professionals used task analysis techniques to define key knowledge, skills and attitudes that a midwife should be taught in Yemen. Task analysis, a psychometric (test development) technique, is a process that can be used to develop specific role delineations. This article describes in detail the process of task analysis in identifying key skills, knowledge and attitudes to be taught to student midwives in Yemen, clarifying the role of midwives and identifying the usefulness of a derived task listing in educational development and student evaluations.

Curriculum↗