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PubMed1997

Maternal serum screening for Down's syndrome: a survey of midwives' views.

The lack of consensus regarding the implementation of maternal serum screening, has led to a widespread variation in practice. The importance of the role of midwives within the service has been recognised. All maternity units in the Northern region now have a designated 'co-ordinator' in an attempt to improve service delivery, professional liaison and training. This study was designed to obtain midwives' views about maternal serum screening in principle and to assess whether any changes had occurred since the introduction of co-ordinators. Semi-structured, postal questionnaires were sent to all midwives in one health authority for them to complete and return. Within this authority, one maternity unit offered universal screening whereas the other maintained a selective policy. Responses were obtained from 90 out of 133 (67.7%). There was almost unanimous support for the principle of screening 86 out of 90 (95.5%) and most midwives considered the offer of screening should be an NHS service, independent of age 78 out of 90 (86.7%). Half of the respondents 46 out of 90 (51.2%) reported that the introduction of a co-ordinator had been successful in improving staff education but requests for further training and updating were made by 69 out of 90 (76.6%) despite having had this organized training input: although those midwives who were regularly involved with screening made significantly fewer requests 27 out of 45 (60%). These findings confirmed our previous recommendation that ongoing responsibility for such provision would be required. The results of the study provided a useful contribution towards the review of screening policy undertaken by the health authority, as well as evidence upon which to base further development of the role of the co-ordinators in their support of midwives.

Attitude of Health Personnel↗
PubMed1999

Dutch midwives: relational care and birth location.

The objective of this study was to investigate whether midwives' care is influenced by their work setting, i.e. place of birth: at home or in the hospital. The design was a random sample survey, the setting was primary obstetrical care in the Netherlands. Some 150 independently practising midwives were interviewed as the subjects for the study. And variables of behaviour of midwives towards labouring women were covered by a questionnaire consisting of 19 relevant elements of that behaviour; behaviour which shapes their relational care. Results show that all midwives indicate differences in their behaviour according to the place where they provide the relational care towards the labouring woman; at home or in the hospital. However, the amount in which they indicate their functioning is affected by their work setting is not the same. The most striking findings are that midwives say to be more relaxed whilst providing care in a home situation, they take on a more informal approach and the interaction with the birthing woman is easier. Home birth is more time consuming than hospital birth: more visits and longer presence. During a home birth more activity of the expectant parents is to be expected regarding small domestic jobs than at a hospital birth. This study confirms that the location of a delivery has consequences for the professional functioning of midwives in case of home births. Their relational care is more intense and woman-centred.

Journal Article↗
PubMed2001

Midwives' attitudes to the use of the cardiotocograph machine.

BACKGROUND: The literature would suggest that midwives' attitudes towards the use of birth technology are mainly focused around issues of "trust and dependence" yet there has been no published research to refute or substantiate these beliefs. AIM: This paper reports on an empirical study that aimed to identify midwives' attitudes to technology usage in the labour ward and specifically the use of the cardiotocograph machine (CTG) for electronic foetal monitoring. DESIGN: A postal survey was conducted and the questionnaire included a 25-item attitude scale, which was designed to assess attitudes towards the use of the CTG machine. All midwives (1086) on the United Kingdom Central Council register for Northern Ireland were surveyed. The data were factor analysed and compared using several categorical groupings including age, perceived skill, prior training with computers and trust in the machines. RESULTS: The results indicate that midwives reject any notion of them being, or becoming, dependent on machines in their practice. However, midwives who trust machines are more disposed to their use and trust is affected by perceived competence. CONCLUSION: The paper concludes with a recommendation for the future education of midwives to develop and maintain competence based craft skills in natural birth as well as high-tech birth.

Adult↗
PubMed2001

Changing roles and identities of midwives in rural Costa Rica.

The roles and social identities of rural midwives in Costa Rica reflect the changing history of local birth practices vis-à-vis pragmatic local needs as well as the changing relation of the nation-state to the production of birth. This article explores how midwifery practices changed over time in relation to Costa Rican state policy and why prenatal massage (an important element of prenatal care historically) retains its importance despite the massive hospitalization of birth. Home birth's history as a heterogeneous, flexible model for care, combined with the pragmatic needs of women, make midwives and prenatal massage central in the production of hospital birth. Costa Rican midwives survive in the interstices of the biomedical model of care, providing interventions demanded by women (although demeaned by biomedicine) and serving as a safety net for pregnancy crises in hinterland communities. While acknowledging the potential for maternal or child death during pregnancy crises in isolated regions, midwives generate acute critiques of the biomedical model of birth and clearly articulate the practical need for (and continuing importance of) their practices in rural areas. This case study illustrates the obstacles to international awareness faced by midwives in so-called Third World countries like Costa Rica-midwives who must overcome not only geographic and socioeconomic marginalization, but also overwhelming opposition from the state and multilateral "reproductive development" policies.

Attitude of Health Personnel↗
PubMed2004

Ethical decision-making for extremely preterm deliveries: results of a qualitative survey among obstetricians and midwives.

OBJECTIVE: To explore the practices, attitudes and feelings of obstetricians and midwives in cases of extreme prematurity. METHODS: A qualitative study was conducted as part of a European Concerted Action (EUROBS) in three tertiary-care maternity units, located in three cities in the northern, southern and central areas of France. Semi-structured interviews lasted an average of 60 min and were tape-recorded. They were independently analyzed by two different researchers using a content analysis. All full-time obstetricians and half of the full-time midwives were eligible for the study. Overall, 17 obstetricians and 30 midwives participated. RESULTS: Both obstetricians and midwives considered that decision-making in case of very preterm births raised ethical problems concerning the mother and the fetus. Despite some birth weight and gestational age criteria defined in advance, management around delivery appeared to be decided on a case-by-case basis. At birth, the neonatologists made the decisions. They were perceived as being more inclined than the obstetric team to initiate intensive care. If the child was born alive, intensive care was started, in the knowledge that it could be withdrawn later, if appropriate. Parents were sometimes involved in decision-making during pregnancy, in particular when there was no emergency situation. Compared with obstetricians, midwives tended to have a less favorable perception of the neonatologists' practices, and to report less parental involvement in decision-making. CONCLUSIONS: Decisions about the obstetric management and resuscitation of extremely preterm infants are usually made on a case-by-case basis. Parents are sometimes involved in decision-making. Midwives express serious concerns about the current practices.

Attitude of Health Personnel↗
PubMed2005

Views of midwives and gynecologists on legal abortion--a population-based study.

BACKGROUND: Little is known about staffs' attitudes and experiences of legal abortion. The aim of this study was to gain knowledge about the views of Swedish midwives and gynecologists on legal abortion. Another aim was to investigate differences between professions and possible impacting factors on these views. METHODS: A questionnaire was sent to a random sample of 258 midwives and 269 gynecologists. The response rate was 84%. RESULTS: The vast majority of all respondents supported the legislation on induced abortion. A great majority also believed that the woman alone should make the decision, and that abortion was not used as a form of contraception. Generally, there were smaller differences among views of female and male gynecologists than among views of female gynecologists and female midwives. For example, female midwives disagreed more than female gynecologists with the statement: 'Legal abortion should be permitted even if the woman has felt fetal movements'. The most impacting factors on views were the extent to which the staffs had been working with legal abortion, especially during the last year, and type of profession. Views were, however, not influenced by private experiences of legal abortion. CONCLUSIONS: The present study highlights that midwives and gynecologists overwhelmingly agree that legal abortion should be allowed. The more experience of working with legal abortion, especially current experience, the less restrictive gynecologists and midwives are in their views. Compared with previous studies, staffs have become more liberal in their attitudes toward abortion and the relevant legislation.

Abortion, Legal↗
PubMed1992

Midwives as providers of prenatal care in Finland--past and present.

This study analyzes the role of the midwife in prenatal care by exploring the history of the midwifery profession in Finland and by interviewing midwives. Midwifery education started in Finland in the beginning of the 19th century due to the utilitarian population policy aiming to reduce the high infant mortality rate. Because of a shortage of physicians professional midwives attained an important status in the care of births. With industrialization a state-directed welfare policy with state-subsidized health care developed. After World War II, the midwifery were legally defined as care during pregnancy, delivery, and the postpartum period. In the 1950s, the scope of work of midwifery was further altered because hospital deliveries had become routine. Some midwives provided prenatal care in ambulatory maternity health centers while others worked in hospitals managing normal childbirths. Separate midwifery education ended in 1968 and resumed 1986. Since 1972, public health nurses have increasingly provided prenatal and postnatal care in maternity centers, and specialized nurses have managed normal childbirths. In the future, public health nurses may totally replace midwives in prenatal care, and the role of midwives may return to care of normal deliveries. Midwife interviews revealed the "medicalization" of pregnancy caused both by physicians and midwives' own medical concept of pregnancy and by clients' demands for good care.

Female↗
PubMed2004

Midwives' knowledge of newborn feeding ability and reported practice managing the first breastfeed.

Continuous uninterrupted skin-to-skin contact is known to facilitate newborn transition to extrauterine life, the ability to actively find the nipple and establishment of effective breastfeeding but is not promoted consistently in practice. The Newborn Feeding Ability Questionnaire (NFAQ) was developed to measure midwives' knowledge and practice in supporting the first breastfeed. The NFAQ was administered to 3 500 midwives in Australia through a mailed survey. A response rate of 31.6% (n=1 105) was achieved and the sample was representative of the national midwifery population for age sex, education and experience. Mean total score for knowledge was 85.94 (range 40-110 out of 110), SD=10.55) and mean practice score was 95.89 (range 57-117 out of 120), SD=9.19). Knowledge of newborn feeding ability was consistently associated with best practice in managing the first breastfeed. Almost all midwives reported that skin-to-skin contact for newborn infants immediately after birth was important, but few understood the significance of 'continuous uninterrupted' skin-to-skin contact to facilitate correct attachment and effective suckling. One-third reported separting mother and baby for routine interventions before allowing the opportunity to demonstrate pre-feeding behaviour or actually breastfeed. Although midwives attempt to ensure the first breastfeed is facilitated soon after birth, the practice of continuous uninterrupted skin-to-skin contact seems poorly understood and not uniformly practised. Further research is needed to investigate how midwives teach mothers' positioning and attachment for the first breastfeed. Education of midwives so they can optimally facilitate the first breastfeed is required to improve breastfeeding initiation rates.

Australia↗
PubMed1988

Opinions of physicians assisting births in Ottawa-Carleton about the licensing of midwives.

The Ontario Ministry of Health announced in January 1986 that midwives would be licensed to practise in Ontario. In September of that year we surveyed all physicians in Ottawa-Carleton who were assisting at births to determine their opinions on midwifery. A total of 78 (74%) of the eligible physicians completed the questionnaire. Almost half thought that midwives should be licensed. Most felt that midwives should be trained as nurses first and should work under the supervision of a physician in hospital-based clinics or in a group practice with physicians. A small proportion thought that midwives should be able to practise as independent practitioners. Some obstetricians thought that legalization of midwifery would allow them to concentrate on high-risk obstetrics, and some family physicians thought this would make it easier for them to continue to be involved in maternity care. Those opposed to the introduction of midwives did not think the public would benefit, and some were concerned that midwives would reduce the size of their own obstetric practices.

Attitude of Health Personnel↗
PubMedDate not supplied

Trends and characteristics of births attended by midwives.

In 1994 there were 218,466 births attended by midwives in the United States more than seven times the number in 1975 (29,413). The percent of all births attended by midwives rose from 0.9 percent in 1975 to 5.5 percent in 1994. The vast majority of midwife attended births were by certified nurse-midwives (CNMs) and occurred in hospitals. Births attended by other midwives comprised only 6 percent of all midwife-attended births (down 11 percent since-1989) and are becoming increasingly concentrated in out of hospital settings, particularly residences. Due in large part to population characteristics, the proportions of births attended by midwives varies markedly between states. The percentages range from 19 percent in New Mexico to less than 1 percent in Kansas Louisiana Missouri and Nebraska Mothers with midwife attended births in out of hospital settings generally had demographic and lifestyle characteristics that were lower risk for obstetric complications and poor birth outcomes compared with mothers with physician- or midwife attended births in hospitals. That is these mothers were more likely to be married older more educated having higher order births and were less likely to smoke and gain and adequate amount of weight during pregnancy. However women with midwife attended births regardless of type of midwife or birth setting were more likely to initiate prenatal care later in the pregnancy and have fewer overall visits than were women whose births were attended by physicians. Despite less prenatal care a smaller proportion of babies whose births were attended by midwives were preterm or were of low or very low birth weight.

Adult↗
PubMedDate not supplied

Prescriptive authority and nurse-midwives.

The purpose of this paper is to provide an overview of issues relevant to the question of prescriptive authority for nurse-midwives. Nurse-midwives can be held liable for prescriptive competency as evidenced by the American College of Nurse-Midwives' statements, physician delegation of prescribing privileges, and recent court rulings. Despite this liability, nurse-midwives are denied legally sanctioned authority if they are not granted prescriptive privilege by specific legislation. This discussion concludes with a position in favor of direct prescriptive authority, regulated by boards of nursing, for all nurse-midwives in order to remove unnecessary restrictions to the practice of an important member of the health-care team.

Drug Prescriptions↗
PubMedDate not supplied

Findings of the 1990 Annual American College of Nurse-Midwives Membership Survey.

The 1990 Annual ACNM Membership Survey was conducted by the Division of Research for the purpose of obtaining current information about certified nurse-midwives (CNMs) who were members of ACNM. Of the 2,899 surveys sent, 1,992 surveys were returned from 1,877 CNMs and 115 student nurse-midwives (a response rate of 68.7%). The mean age of the CNMs was 41.8 years. Most were female (97.9%) and white (95.3%); 85.1% were active members and 6% were life members of ACNM. The CNMs had been employed in nurse-midwifery-related employment a mean of 8.5 years. The greatest proportion were in clinical nurse-midwifery practice attending births (64.2%). An additional 10.0% were in clinical nurse-midwifery practice not attending births. Experienced nurse-midwives employed full-time reported a mean annual income of $45,229 and being on-call 71.4 hours per week. New nurse-midwives employed full-time reported a mean annual income of $40,504 and being on-call 59.6 hours per week. Most nurse-midwives employed full-time were salaried (57.4%), whereas most CNMs working part-time were paid based on the number of hours worked (49.7%).

Adult↗
PubMed1994

Bridging the gap between research and practice: an assessment of the value of a study day in developing critical research reading skills in midwives.

Despite increasing professional pressure on midwives to make their clinical practice research based, their remains a considerable amount of clinical activity which relies only on historical ritual rather than on rational scientific evidence. This apparent failure to integrate research into practice has generated a lot of debate regarding its cause. One widely accepted reason for midwives' non-use of empirical findings is simply that a large proportion of the workforce does not have the knowledge and training in the necessary skills to enable them to assess the value of published articles. Clearly the cost in time and human resources involved in providing a thorough training for the entire midwifery workforce in research skills would probably be unnecessary for the majority of midwives who simply want to be able to translate published research into their clinical practice. Consequently, a more pragmatic approach might be to assess the value of brief training days in developing midwives' competencies in reading research articles critically as a precursor to facilitating the integration of theory and practice. If the value of such courses could be demonstrated, then it is conceivable that study days of this type might be made more widely available for all midwifery personnel. This study investigated the effectiveness of one such study day in (a) modifying the participating midwives' evaluations of a published research article in accord with those of expert judges and (b) influencing the longer term use by the participants of published research. The day provided a brief introduction to basic research techniques both in theory and in practice, as well as a set of structured guidelines for evaluating research articles.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Competence↗
PubMed1994

Women's views of their postnatal care by midwives at an Adelaide Women's Hospital.

OBJECTIVE: to determine the characteristics of a sample of women giving birth in one hospital in South Australia and these women's perceptions of the usefulness of the advice and care that they were given during the puerperium DESIGN: survey using questionnaires, incorporating Lipsett's (1984) questions, administered before the women left hospital and at six weeks postdelivery. SETTING: one hospital in South Australia. PARTICIPANTS: a sample of convenience of 235 women completed the hospital questionnaire and 222 (95%) returned the six weeks postpartum questionnaire. FINDINGS: the women's ages ranged from 17-44 years, 86% were living in a stable relationship and 42% were primiparous. Most women (74%) made comments on the helpfulness of midwives. The midwife provided emotional support (57%), answered questions (32%) and gave information (30%). However, midwives' attitudes were perceived as insensitive (18%) and judgemental (9%). Midwives gave conflicting advice (10%) and 40% of the women made one or more comments about midwife unhelpfulness. Sixteen per cent of the women made no comment on the helpfulness of the midwife. IMPLICATIONS FOR PRACTICE: contact with midwives in the early postnatal period is an ideal time for helpful advice and support to be given but midwives are not always perceived as fulfilling this part of their role. There is a need to address the issue of conflicting advice.

Adolescent↗
PubMed1995

A factor analytic study of midwives' attitudes to research.

Midwives are increasingly being encouraged to undertake research activities at various levels, as a routine part of their job. However, despite topdown directives to this end, there is some evidence that relatively little research is published and reasons, such as lack of time, confidence and skill have been put forward to explain the short-fall. While these reasons may be valid obstacles, it is also conceivable that they are manifestations of a set of underlying attitudes to research in midwifery. If attitudes are assumed to be predictors of behaviour, then it may be relevant to study midwives' attitudes to research more closely in order to identify whether these are responsible in some measure for the short-fall in research output. To this end, a national survey of 397 midwives was undertaken to establish their attitudes to research. The results were subjected to factor analysis, using an orthogonal solution, in order to establish whether any coherent source components existed in the sample's attitude responses. The factor analysis yielded four coherent factors, which were (i) other health care professionals' views of the value of midwifery research; (ii) the value of research for midwifery practice; (iii) the research role of the midwife; (iv) midwives' competence to carry out research. On further analysis the first two factors were also found to be significantly related to midwives' likelihood of undertaking research and publishing research findings. These factors could form the basis for future attitude change and staff development and training programmes as a means by which midwifery research output could be increased.

Attitude of Health Personnel↗
PubMed1994

Midwives in Niger: an uncomfortable position between social behaviours and health care constraints.

Maternal mortality rates are very high in developing countries. In Niamey, the capital of Niger, maternal mortality rate is 280/100,000, in spite of a high concentration of health services and of health personnel. Several studies demonstrated that the efficiency of maternal health services was low, both because the quality and the quantity of work were insufficient. The usual response to the poor performances of health services in developing countries is mainly technical. If improvement of the training of health personnel and re-organization of health services are necessary, they are not sufficient. A good effectiveness of care cannot be achieved without a mutual confident relationship between providers and patients. Focus group discussions were held in Niamey with women users of maternal health services, with student midwives and experienced midwives. Sources of complaints between providers and patients appeared to be numerous. However, they are centered around two themes, delivery techniques and cultural requirements, which correspond to two types of constraints: technical constraints and social representations and practices of the population. A description of traditional practices and beliefs related to delivery were obtained through discussion groups with old women and traditional birth attendants (TBAs). Both women and midwives are tied up by the same social rules (e.g. linguistic taboos, respect and shame) but technical constraints force midwives to violate those rules, making the application of their technical skills very difficult. Thus, the mutual relationship between users and providers is source of dissatisfaction, which often degenerates into an open confrontation. Midwives must learn how to implement obstetrical techniques within specific cultural environments.

Cultural Characteristics↗
PubMedDate not supplied

Findings from the analysis of the American College of Nurse-Midwives' membership surveys: 2000-2003.

Findings from the American College of Nurse-Midwives (ACNM) membership data provide descriptive information about selected characteristics of certified nurse-midwives (CNMs), certified midwives (CMs), and students enrolled in ACNM-accredited programs who are members of the organization. This article presents findings from the analysis of membership data for the years 2000 to 2003. Members remain predominantly white and female, with their age averaging in the mid-40s. Similarly, student demographics reflect little change from those reported in prior years. Students are primarily white, female, and in the mid-30s. Proportionately, there has been little increase in the diversity of members. The proportion of CNMs/CMs with a bachelor's degree continues to rise, as does the proportion of CNMs/CMs holding doctoral degrees. The majority of CNMs/CMs identified a broad domain of clinical midwifery practice as their primary responsibility in their primary employment, and hospitals remain the largest employer of responding midwives. The salaries of employed midwives appear to be increasing, although the modal salary (60,000 US dollars to 69,000 US dollars ) is unchanged from prior years. The profile of the membership has remained fairly constant, with small changes in the trend over time noted for age, employment patterns, and attendance at birth sites for the 4 years analyzed.

Adult↗
PubMed2004

A report of a midwifery model for training traditional midwives in Guatemala.

OBJECTIVE: to describe the specific characteristics of one model of training traditional birth attendants (TBAs) in Guatemala. DESIGN: participant observation, unstructured and semi-structured interviews undertaken between 1997 and 2003 to gather the data to report on the characteristics of this training programme as it is evolving in the field. SETTING: the birth centre site of Ixmucane in Antigua, Guatemala, as well as community sites in the Departments of Saquetepequez, Chimaltenango, and Quetzaltenango in the western highlands of Guatemala. PARTICIPANTS: traditional midwives, certified nurse-midwives and certified professional midwives, as well as many allied health professionals and volunteers. INTERVENTION: training philosophy, participant selection, curriculum content, intensity, and planned follow-up are the key components of the training programme described. MEASUREMENT AND FINDINGS: 93 TBAs have received training through the development of a 150 hrs contact course for self-selected TBAs in the Midwives for Midwives Program. Formal evaluation of this training is underway but results are not yet available. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the value of incorporating midwifery philosophy and praxis in TBA training has received scant attention in the TBA literature. This report suggests that TBA training programme characteristics are important considerations in any evaluation of training efficacy of TBAs to improve maternal-child health.

Adult↗