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PubMedDate not supplied

Comparison of rural and urban certified nurse-midwives in Arizona.

A survey of certified nurse-midwives (CNMs) in Arizona was carried out in 1990 to provide data for maternity service planning in the state. Information was gathered on location and scope of CNM practice, barriers to practice, and the contribution of CNMs to maternity care. Demographic and clinical practice characteristics of urban and rural CNMs were also compared. Urban and rural CNMs are significantly different in terms of education (urban CNMs are much more likely to have master's degrees) and number of years since first certification (urban CNMs have been certified significantly longer). Rural midwives are more likely to be under the age of 40. Health services provided by urban and rural CNMs were compared with each other and with national data. Midwives in rural areas of Arizona are more likely to provide comprehensive nurse-midwifery services than are either urban Arizona midwives or U.S. midwives as a whole. Urban and rural CNMs described lack of physician backup as a major barrier to nurse-midwifery practice in rural areas. Lack of hospital privileges was another major obstacle noted by rural nurse-midwives. Arizona CNMs felt they could provide comprehensive, cost-effective maternity services in rural areas that would improve access to care, patient satisfaction, and maternal and child health outcomes.

Adult↗
PubMed2000

An exploratory pilot study of nurse-midwives' attitudes toward active euthanasia and abortion.

Over the past three decades, active euthanasia and abortion have received increasing international attention. Since both these practices are relevant to the role of the nurse-midwife, it is important to know what influences their attitudes towards them. Therefore, the purpose of this study was: 1, to survey the attitudes of nurse-midwives' to active euthanasia and its legalization; 2, to determine the relationship between nurse-midwives' attitudes toward active euthanasia and its legalization, and attitudes toward abortion, self-reported religiosity and religious affiliation. The study setting was an international midwifery conference and the sample consisted of 139 nurse-midwives attending the conference. The majority of nurse-midwives displayed a positive attitude toward active euthanasia and its legalization. In addition, there was a positive relationship between their attitude to abortion and active euthanasia. Self-reported religiosity and religious affiliation were significantly related to attitudes toward active euthanasia and its legalization. An interesting positive relationship between country of practice and attitudes to euthanasia was also found. Nurse-midwives practicing in countries with more liberal euthanasia and assisted suicide legislation were more supportive of active euthanasia. With the increasing acceptance of active euthanasia's legalization, the results of this study pose some ethical questions that nurse-midwives internationally will have to consider.

Abortion, Induced↗
PubMed1990

Private midwives: a new approach to family planning service delivery in Ghana.

Data on 134 private sector midwives who were educated and trained in family planning service delivery by the Ghana Registered Midwives' Association (GRMA) showed that, for most, the course was the first they had received since qualifying as a midwife. Four out of five of the new family planning clients served by these midwives were first time contraceptive users. Approximately 9% of the clients were men, most of whom requested condoms. While delivering women is still the main function of the maternity homes, it is clear that family planning services have come to represent an important element of the health care the midwives provide. A follow-up study of family planning acceptors found extremely encouraging continuation rates. In addition, a survey of the women that the midwives had delivered showed that the contraceptive prevalence rate among these women was higher than the national rate. Providing family planning services through private sector midwives has been shown to be a very successful approach in Ghana, and one that has the potential to become a pillar of the nation's overall family planning delivery programme. As several other countries in Africa also have active private sector health networks, this approach holds promise far beyond its initial success in Ghana.

Adolescent↗
PubMed1997

Challenges of clinical learning for student midwives.

OBJECTIVE: to identify factors which affect the learning of clinical skills by student midwives. DESIGN: ethnographic, grounded theory. SETTING: a large urban maternity hospital and its community area in the south of England. PARTICIPANTS: student midwives, midwives, midwifery managers and teachers. DATA COLLECTION: by observation in clinical settings and interviews. KEY CONCLUSIONS: observation, indirect learning and trial and error were the strategies used by midwives and students in order to obtain competency in clinical skills. However, anxiety, because of inadequate instruction and supervision and poor communication, interfered with learning and students felt ill prepared to function as midwives. IMPLICATIONS FOR PRACTICE: clinical midwives need to be educated to facilitate the transfer of theoretical learning into clinical practice, and teachers need to re-learn the experience of being a clinical midwife.

Anxiety↗
PubMedDate not supplied

Findings from the American College of Nurse-Midwives' annual membership survey, 1995-1999.

American College of Nurse-Midwives (ACNM) membership data collected from 1995-1999 offer a description of the evolution of the profession of midwifery, as shown in the characteristics of certified nurse-midwives and certified midwives, including basic demographics, practice characteristics, and employment components. During the period studied, slight increases were noted in age, number of years in practice, salary, and education level. Although the overall proportion of midwives of color did not change appreciably during the 5-year period, the absolute numbers of culturally diverse midwives increased. Student midwives were found to be younger and more culturally diverse than they were in the early 1990s. Data about midwifery practice provide valuable information to health care managers, educators, policy makers, legislators, and professional organizations, which may guide allocation of resources and reflect how members of the professions can influence access to health care for women and their families.

Adult↗
PubMed2001

Midwives' perceptions of the use of technology in assisting childbirth in Northern Ireland.

AIM OF THE PAPER: The aim of this paper is to report a survey of midwives' views on the use of technology in assisting births. BACKGROUND: The research was designed to provide a deeper understanding of the integration of technology into midwives' practice and to identify and examine aspects of training needs. METHODS: Over 400 midwives responded to a questionnaire seeking information on their experiences and perceived competence with labour ward technology, with a particular focus on the use of cardiotocograph machines (CTGs) for electronic foetal monitoring. The survey sought views on the extent to which midwives trust the technology, their perceived levels of training and competence, their awareness of policy relating to technological intervention and the issue of women's choice in whether the progress of their delivery is technologically monitored. FINDINGS: The majority of midwives in this survey trust the use of technology but have concerns about issues of safety in relation to potential faults, and to their perceived lack of training in technology usage. The majority also indicated that they prefer a nontechnological birth although many point to the benefits of technological support when difficulties are encountered. The use of technology is seen as multi-professional and there was much support among the respondents for multi-disciplinary training in the use of technologies in future curricula. CONCLUSIONS: If the various findings of this sample survey were to be consolidated for midwives as a whole, they suggest that provisions for continuing professional development may need to address technological awareness and competence in a more focused manner than is discernible at present.

Adult↗
PubMed2000

Feelings and experiences of midwives who do not have children about caring for childbearing women.

OBJECTIVES: To gain insight into the feelings and experiences of midwives who do not have children of the effects of a negative response to the question, 'Have you got children?', on the midwife's perception of herself in the midwife/mother relationship and to formulate strategies which promote successful midwife/mother relationships. DESIGN: Survey using a questionnaire. PARTICIPANTS: 184 midwives who did not have children throughout the UK who were recruited via an advertisement in a national midwifery journal. FINDINGS: As in the general population, some midwives do not want children at the moment, some do not want then at all, and some want children but are unable to have them. Some found the question, 'Have you got children?', legitimate and conversational; others found it annoying, implying a deficit in either themselves as women, or as midwives. They considered their response a key factor in maintaining good relationships with women, assuring them of compassionate care despite lack of personal experience. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Respondents clearly identified the need for thought about how they would respond to the question 'Have you got children?' in a way which left them and their clients feelings comfortable. This could be incorporated into initial programmes of midwifery and revisited thereafter; to help students and midwives explore aspects of their own fertility. Midwives who experience pregnancy loss, or the loss of potential motherhood through age or medical reasons, need specific support as they go through a grieving process. Helpful interventions include counselling outside the workplace, and sensitive clinical placements, avoiding those areas which lead to constant contact with babies.

Attitude of Health Personnel↗
PubMed2000

An exploration of midwives' attitudes to health promotion.

OBJECTIVE: To explore midwives' attitudes to health promotion. DESIGN: Quantitative study, data collected using self-completed postal questionnaires in 1996. SETTING: The North West of England, UK. PARTICIPANTS: 182 senior midwives who were working in hospital and community settings. KEY FINDINGS: The patterns of views towards health promotion approaches were complex as midwives stated that they preferred societal approaches but worked in approaches that focused on the individual. Health promotion methods that centre on the individual were also preferred. Clinical practice base, educational qualifications and age were influential in midwives' opinions. IMPLICATIONS FOR PRACTICE: There is a need for further clarification of the midwife's understanding of their role as a health promoter. Educators should ensure that health promotion is explained within its practical context and there should be opportunity for midwives to develop skills of lobbying, negotiating, implementing and policy planning. Liaison with other disciplines should be fostered to understand their roles and develop joint health promotion strategies. There is a need for further research exploring midwives' opinions from a qualitative perspective.

Adult↗
PubMed2002

A delphi survey of midwives and midwifery students to identify non-midwifery duties.

AIM OF THE STUDY: to explore the skill mix requirements for the potential role of an unqualified midwifery assistant in the clinical setting. Using results from the study we report the difference between student midwives' and qualified midwives' perceptions of what constitute non-midwifery duties. DESIGN: a two-round Delphi survey. SETTING: large maternity hospital in Ireland. PARTICIPANTS: population of midwives (n=194) and midwifery students (n=79). FINDINGS: the non-midwifery duties identified were wide ranging and could be categorised under the headings of clerical, stock, porter, domestic and other basic-care-related duties. CONCLUSION: although no agreed definition of non-midwifery duty exists it can be seen that, through the process undertaken in this study, a definition is created. This suggests that the values and beliefs that qualified midwives and students hold regarding their role shapes the role of the care assistant. IMPLICATIONS FOR PRACTICE: the inclusion of perceptions from student and staff midwives enabled the researchers to compare and contrast similarities and differences regarding how these different parties constitute a non-midwifery duty. The process also gave respondents a sense of ownership and involvement in the development of the midwifery assistant role. In addition, this study has demonstrated the need for further clarification of how midwives perceive and understand their role.

Attitude of Health Personnel↗
PubMed2005

Predictors of perceiving smoking cessation counselling as a midwife's role: a survey of Dutch midwives.

BACKGROUND: Smoking during pregnancy can have many serious consequences. As the usual providers of pregnancy care in the Netherlands, midwives could serve as effective counsellors to pregnant women about cigarette smoking. The aim of the present study was to identify relevant factors that hamper or promote the provision of effective smoking cessation advice and counselling. METHODS: Questionnaires were mailed to midwives; 237 (64.4%) were returned. Questions were asked about advantages and disadvantages of giving smoking cessation advice, perceived health benefits for mother and child, smoking behaviour and normative beliefs of colleagues, self-efficacy and role definition of midwives with regard to giving smoking cessation advice. RESULTS: Midwives who have a more positive role definition regarding giving smoking cessation advice are more convinced of the advantages of giving advice, the advantages of quitting for their clients and perceive more support from their colleagues with regard to giving advice. CONCLUSION: In general, midwives were motivated to provide their clients with smoking cessation advice. They were less comfortable with guiding women through the cessation process. Therefore, effective materials and training should be developed to facilitate and stimulate midwives in their role as effective counsellors.

Adult↗
PubMed1994

Controversies in maternity care: where do physicians, nurses, and midwives stand?

Through a mail survey in 1991, we compared the opinions of 597 physicians practicing obstetrics, 723 maternity care nurses, and 70 midwives from the province of Quebec, Canada, about selected maternity care issues, including the practice of midwifery. Results showed that divergent points of view existed between and within the three groups on many maternity care issues. Physicians were more divided over the routine use of obstetric intervention than the approach to care or their opinion about midwives. Midwives held more client-centered and less interventionist attitudes than nurses or physicians. Nurses were much more open to midwives than physicians, but 20 to 30 percent of physicians saw some advantages in legalizing the practice of midwifery. Physicians and nurses generally considered midwives as a greater professional threat to the other group than to themselves. The fact that many physicians were critical of current maternity care is difficult to reconcile with their general opposition to midwives. How and to what extent physicians will respond to women's desire for more humanized and less interventionist care remains an open question. Given the problems facing maternity care in North America, expanding midwifery services is an alternative to examine seriously.

Attitude of Health Personnel↗
PubMed2003

Overcoming the undersupply--supporting midwives' return to practice.

UNLABELLED: The current critical shortage of midwives is a worldwide phenomenon that has created the need for educational programs that prepare midwives, who have previously left midwifery practice, for return to the contemporary clinical workforce. This paper focuses on the support requirements of midwives involved in a refresher program as determined by a research project conducted at The Northern Hospital in Melbourne during 2001. The project was a small-scale case study involving eight program participants. Questionnaires and semi-structured interviews were used to generate data. Analysis of the data revealed that the concept of support must be considered from personal and professional perspectives, if successful outcomes are to be achieved. INTRODUCTION: The response of the Federal Government to the dire shortage of midwives currently working in public healthcare facilities has been to allocate funding to the states and territories for education and re-skilling programs, with the aim of enticing midwives back to clinical practice (Walsh 2001). In Victoria, refresher programs have been developed to meet the needs of midwives whose level of expertise has diminished due to lack of clinical experience, but who have fulfilled the necessary requirements.

Adult↗
PubMed2006

Midwives' approach to genetic diseases and genetic counseling in Denizli, Turkey.

The purpose of this study was to evaluate Denizli midwives' self-reported knowledge of genetic diseases and genetic counseling. Data was collected on forms that obtained information about midwives approaches to basic genetics, genetic disorders, and genetic counseling (response rate = 70.1%). The highest response rate of midwives describing themselves as "knowledgeable" about basic genetic information was for mitosis and meiosis with 4.8%, about genetic disorders was for phenylketonuria with 61.1%, and about genetic counseling was for recommending ultrasonography during pregnancy with 98.1%. The source for basic genetics information for 56.4% of participants was in their school level classes. None of the midwives felt that they had sufficient knowledge about genetic counseling or screening and 76.4% would like to attend an educational course. Even though the midwives have recognized their knowledge deficit they occasionally give genetic counseling. As a result of this study a genetics course is planned for midwives so they can actively participate in the prevention and early diagnosis of genetic diseases.

Adult↗
PubMedDate not supplied

Midwives, physicians, and the timing of maternal postpartum discharge.

Hospitalization for childbirth has traditionally provided the opportunity to assure that infants and mothers have adjusted to the birth and that ongoing care has been arranged, but economic and social pressures have resulted in a dramatic decrease in the duration of hospitalization. Using a sample of mothers who delivered well infants from the 1988 nationally representative National Maternal and Infant Health Survey, this study examines how midwives and physicians used an extra day of hospitalization in response to demographic, economic, behavioral, health status, and health care risk factors. Although midwives were much more likely to discharge mothers early (OR = 2.29) there were marked differences between risk factors and discharge timing for midwives and physicians. For the patients of midwives, the only factor associated with early discharge timing was attendance at childbirth classes. For the patients of physicians, less than a high school education, inadequate prenatal care, receipt of Medicaid or lack of insurance, and no childbirth classes were associated with early discharge. In spite of the intense pressures to discharge patients early, midwives appear to have been more attentive to potential risk factors in making discharge decisions in 1988. Because brief hospitalization is now prevalent, attention to maternal and newborn adjustment after birth, as apparently practiced by midwives, is crucial.

Adaptation, Physiological↗
PubMed2005

Beliefs and practices of Ontario midwives about influenza immunization.

With an increasing number of births in Ontario being conducted by midwives, we undertook a survey of the beliefs and practices of 256 licensed Ontario midwives and student midwives about immunization, particularly against influenza. Overall, 42.9% (48/112) of midwives considered that they knew a lot about immunization; however, 36.2% (38/105) reported no education about immunization during their training. A small majority (55.9%) were in favour of vaccination in general and only 2 of 113 reported spending more than 1h discussing vaccination with their clients. Only 26.9% reported having received influenza vaccine in the previous season (compared to 60% of all health care workers in Ontario). Overall, only 37% believed that influenza vaccine is effective, and 22% believed that the vaccine was a greater risk than influenza. Graduation in 1998 or prior was associated with belief in the effectiveness in vaccine, having been vaccinated, and recommending vaccine to clients. Midwives who reported being immunized themselves were more likely to believe in the safety and efficacy of influenza vaccine, and to recommend vaccination to their clients (26% versus 3%, p=0.001). If greater attention is not focused on promoting the utility of immunization to midwives, the success of population immunization programs may be compromised.

Confidence Intervals↗
PubMed1994

The attitudes of midwives to maternal serum screening for Down's syndrome.

An anonymous questionnaire was sent to determine the opinions and attitudes of 342 Leicestershire midwives who are responsible for counselling antenatal patients about maternal serum screening for Down's syndrome. This asked questions regarding grade, background training, attitudes towards testing for spina bifida and Down's syndrome, and opinions upon termination of pregnancy for these and other conditions. A total of 188 (55%) midwives completed the questionnaire. In all, 40.4% of midwives admitted that they did not feel confident counselling for the serum screening test for Down's syndrome; 38.3% of midwives did not feel termination of pregnancy for Down's syndrome was justified; 25% of midwives admitted that they were not in favour of this prenatal test. In conclusion, if such a screening programme is to be introduced across the UK, more attention must be paid in advance to the views and training requirements of those midwives who will be associated with the test. It should not be assumed that ethical considerations, relating to a prenatal test, are of minor significance to those health care professionals involved in its implementation.

Abortion, Induced↗
PubMed2004

Can support and education for smoking cessation and reduction be provided effectively by midwives within primary maternity care?

OBJECTIVE: To test the hypothesis that appropriate interventions delivered by midwives within usual primary maternity care, can assist women to stop or reduce the amount they smoke and facilitate longer duration of breast feeding. DESIGN, SETTING AND PARTICIPANTS: In a cluster randomised trial of smoking education and breast-feeding interventions in the lower North Island, New Zealand, midwives were stratified by locality and randomly allocated into a control group and three intervention groups. The control group provided usual care. Midwives in the intervention groups delivered either a programme of education and support for smoking cessation or reduction, a programme of education and support for breast feeding or both programmes. Sixty-one midwives recruited a total of 297 women. INTERVENTIONS: Structured programmes provided by midwives. FINDINGS: Women receiving only the smoking cessation or reduction programme were significantly more likely to have reduced, stopped smoking or maintained smoking changes than women in the control group, at 28 weeks and 36 weeks gestation. Women receiving both the smoking cessation and breast-feeding education and support programmes were significantly more likely than women in the control group to have changed their smoking behaviour at 36 weeks gestation. There was no difference in rates of cessation or reduction between the groups in the postnatal period. There was no difference in rates of full breast feeding between the control and intervention groups for women who planned to breast feed. KEY CONCLUSIONS: Education and support by midwives, as part of primary midwifery, can facilitate smoking cessation and reduction during pregnancy.

Breast Feeding↗
PubMed1998

The use of midwives as first assistants in cesarean section.

Introduction: In 1997, medical insurance gives limited financial reimbursement to physicians who first assist cesarean sections. Therefore, a formal program was developed at our community teaching hospital using midwives in place of physicians as first assistant in cesarean section. Midwives on the midwifery service were taught the principles and procedures of obstetrical anesthesia, anatomy, and physiology of the gravid abdomen.A team approach using obstetrician/gynecologist, anesthesiologist, midwives, and operating nurses performed the tracking in a 1-day course. A 28-minute video was developed to depict the role of the midwife as first assistant. Additionally, the principles of operation room set-up and instrumentation were taught.Result: All 24 midwives on the midwifery service were involved in the teaching of first assisting an attending obstetrician. After taking the course, nurse-midwives received formal certification from the department of obstetrics and gynecology and were approved by risk management. They also received clinical privileges outlining these guidelines. Their malpractice rates have not increased. The time to complete a cesarean section has not increased for the physician, and an emergency cesarean section is no longer delayed by waiting for an assistant to arrive. Patient satisfaction has increased because of decreased waiting time for a cesarean section and increased familiarity with the entire operating team.Discussion: Midwives can be trained to first assist the obstetrician/gynecologist in a cesarean section. Since the duration of a cesarean section is not prolonged, the patient will not experience increased blood loss or infection secondary to a prolonged procedure. The patient is more relaxed since they know that their provider during labor is also one of their surgeons for the cesarean section.

Journal Article↗