Chinese Midwives Research Articles

To explore the impact of traumatic birth experiences on midwives' experience of empathy: A qualitative study

ObjectiveThis study aimed to investigate the experiences of Chinese midwives during traumatic birth experiences and their impact. By doing so, we hope to develop effective empathetic educational strategies and provide valuable insights to improve the midwifery support system in China. MethodsThis study adopted Colaizzi's phenomenological approach, which aimed to understand and explore human experiences from the standpoint of the participants. A purposive sampling method was used to select 16 midwives for semi-structured interviews. The Colaizzi 7-step method was used to analyze the interview data. FindingsThree themes and eight sub-themes were developed by analyzing and integrating the interview data. These included intertwined negative experiences (self-blame and guilt, regurgitated disturbances, intense and persistent physical and psychological discomfort, and low confidence in midwifery decision-making behaviours), the coexistence of positive effects (increased ability to tolerate life uncertainty, increased sense of control in coping with traumatic birth experiences), and needs and expectations (confiding in co-workers, an expectation of professional psychological support interventions). ConclusionsThe experiences of midwives in showing empathy during traumatic birth experiences are complex and multifaceted. It is crucial to recognize and address negative empathic experiences, provide coping strategies, and enhance positive empathic experiences. Midwives' grief counselling competence education should be strengthened, as should their psychological well-being and the midwifery support system.

Prevalence and bidirectional association of sleep quality and gut health among Chinese midwives: a large population, multi-center cross-sectional study.

Shift work can disrupt sleep quality and gut health. Nurses and midwives constitute approximately half of the global healthcare shift-working workforce. Our previous study revealed that most midwives were experiencing suboptimal health conditions, characterized by poor sleep quality and a high prevalence of gastrointestinal diseases. The gut-brain axis theory highlights the potential interplay between sleep quality and gut health. However, limited research focuses on this relationship among midwives. A cross-sectional survey included 2041 midwives from 87 Chinese hospitals between March and October 2023. Participants completed standardized questionnaires assessing sleep quality, gut health, depression, anxiety, and work stress. Binary logistic regression analyzed factors associated with poor sleep, and multiple linear regression examined the influence of sleep quality on gut health. Over 60% of midwives reported poor sleep, with many experiencing gastrointestinal disorders. We observed a bidirectional relationship between sleep quality and gut health among midwives. After multivariable adjustments, midwives with higher gut health scores were more likely to experience poor sleep quality (odds ratio = 1.042, 95% confidence interval = 1.03-1.054). Conversely, midwives with higher sleep quality scores were also more likely to have poor gut health (β = 0.222, 95% confidence interval = 0.529-0.797). These associations remained robust across sensitivity analyses. Furthermore, depression, anxiety, and work stress significantly affected both sleep quality and gut health among midwives. This study enhances our understanding of the intricate relationship between sleep quality and gut health among midwives. Poor gut health was associated with a higher risk of poor sleep, and vice versa. To improve the overall wellbeing of midwives, the findings emphasize the importance of addressing poor sleep quality and promoting gut health through maintaining a healthy diet, lifestyle, and good mental health. Further studies are needed to confirm our findings and clarify the underlying mechanisms.

A survey of bloodborne occupational exposure protection behavior among qualified Chinese midwives: A cross-sectional study

BackgroundBloodborne occupational exposure is a major public health concern of the China Health Commission, especially among midwives who are at high risk among healthcare workers. Knowledge of occupational exposure and appropriate protective behaviors play important roles in reducing occupational exposure. The purpose of this study was to understand the knowledge and level of protection against bloodborne occupational exposure among midwives in China. MethodsThis was a multi-center, cross-sectional study. Midwives from hospitals that are members of Infectious Disease Nursing Committee of Chinese Nursing Association were selected as survey participants from February 2019 to February 2022 using a judged sampling method. Data were collected by using a self-developed questionnaire for Chinese midwives to report their current knowledge and behavior related to bloodborne occupational exposure protection. ResultsA total of 2850 questionnaires were distributed and 2742 valid questionnaires were obtained, resulting in an effective rate of 96.21 %. Midwives scored 2742 (6.495 ± 1.529) points for their knowledge about bloodborne occupational exposure protection, with the level and type of hospital being independent factors affecting the midwives' knowledge of bloodborne occupational exposure protection (χ2 = 27.284, P = 0.038; χ2 = 28.374, P = 0.000). Of the midwives, 1460 were qualified for bloodborne occupational exposure protection behavior, with a qualified rate of 53.25 %. Working years (χ2 = 9.372, P = 0.002) and working hours (χ2 = 13.933, P = 0.000) were also the independent factors for bloodborne occupational exposure protective behavior in midwives. ConclusionChinese midwives possess relatively good knowledge of bloodborne exposure protection against bloodborne infectious diseases, but their behavioral level is not optimistic. Improvements to both knowledge and behavioral level of bloodborne occupational exposure protection are necessary.

Prevalence and risk factors of sub-health and circadian rhythm disorder of cortisol, melatonin, and temperature among Chinese midwives.

This study aimed to explore the influencing factors of sub-health and circadian rhythm disorder among midwives and whether circadian rhythm disorder was associated with sub-health. A multi-center cross-sectional study was conducted among 91 Chinese midwives from six hospitals through cluster sampling. Data were collected by demographic questionnaire, Sub-Health Measurement Scale version 1.0, and circadian rhythm detection. Minnesota single and population mean cosine methods were used to analyze the rhythm of cortisol, melatonin, and temperature. Binary logistic regression, nomograph model, and forest plot were performed to identify variables associated with midwives' sub-health. There were 65 midwives with sub-health and 61, 78, and 48 midwives with non-validation of circadian rhythms of cortisol, melatonin, and temperature among 91 midwives, respectively. Midwives' sub-health was significantly related to age, duration of exercise, weekly working hours, job satisfaction, cortisol rhythm, and melatonin rhythm. Based on these six factors, the nomogram was presented with significant predictive performance for sub-health. Furthermore, cortisol rhythm was significantly associated with physical, mental, and social sub-health, whereas melatonin rhythm was significantly correlated with physical sub-health. Sub-health and circadian rhythm disorder were generally common among midwives. Nurse administrators are supposed to pay attention and take measures to prevent sub-health and circadian rhythm disorder among midwives.

Compassion fatigue and compassion satisfaction among Chinese midwives working in the delivery room: A cross-sectional survey

Background and AimsCompassion fatigue can negatively affect not only healthcare professionals’ physical and mental health but also the quality of care they provide and organizational outcomes. However, little is known about compassion fatigue among Chinese midwives working in the delivery room. This study aimed to examine compassion fatigue and compassion satisfaction levels among Chinese midwives working in the delivery room and correlate their compassion fatigue and compassion satisfaction. MethodsA multisite cross-sectional study with a convenience sampling approach was conducted at 62 hospitals in Henan Province, central China, from May to July 2020. The participants were recruited through an online survey. A self-designed sociodemographic and work-related data sheet, the Social Support Rating Scale (SSRS), and the Professional Quality of Life Scale (ProQoL) were used to measure the participants'basic information, level of social support, compassion fatigue(consists of burnout and secondary traumatic stress) and compassion satisfaction. Descriptive analysis was used to describe the characteristics of the participants’ social support, compassion fatigue and compassion satisfaction. Multiple linear regression analysis was employed to identify associations with the participants’ sociodemographic and professional characteristics, compassion fatigue and compassion satisfaction. ResultsA total of 213 questionnaires were completed, 206 of which were valid (96.71%). The majority of the participants reported moderate risks for compassion satisfaction (75.24%) and burnout (59.71%) and low risks for secondary traumatic stress (61.65%). Higher job satisfaction as a midwife, lower average working hours per week in the past year, higher social support, extroverted personality, and work recognition in the past month were positively associated with compassion satisfaction, explaining 48.7% of the total variance. Always considering giving up a midwifery career, lower social support, working a day-night shift, poor health condition, more exposure to traumatic birth events per month on average in recent years, and lower job satisfaction as a midwife were negative factors for burnout, explaining 35.3% of the total variance. Four factors, including more exposure to traumatic birth events per month on average in recent years, always considering giving up a midwifery career, working a day-night shift and poor sleep quality, were negatively related to secondary traumatic stress, explaining 14.2% of the variance. ConclusionsIn this study, midwives showed moderate levels of compassion satisfaction and burnout and low levels of secondary traumatic stress which should attract the attention of health institutions. A healthy and supportive work environment is crucial to midwives’ health, well-being and job satisfaction. Tailored strategies such as trauma management, emotional literacy, peer and social support networks should be implemented to support midwives’ compassion satisfaction, while prevent and lower midwives’ burnout and secondary traumatic stress.

Current status and high-risk factors of blood-borne occupational exposure among midwives in China: A cross-sectional survey

To identify the problems and high-risk factors of blood-borne occupational exposure among midwives in China. Midwives from the obstetrics department and delivery room of hospitals in institutions. The self-compiled questionnaire on the current status of blood-borne occupational exposure of Chinese midwives was used for data collection. The incidence rate of blood-borne occupational exposure was 46.77%. The independent risk factors were working years ≤5 years (P=.001), unable to take standard prevention at work (P=.000), unaware of human immunodeficiency virus treatment procedures (P=.000), and average daily working hours of 8 hours (P=.002), the high risk of blood-borne occupational exposure at work (P=.000), and contact with patient fluids, blood without gloves (P=.000). Midwives are at high risk of blood-borne occupational exposure, and midwives with ≤5 years of service are the focus group. Failure to achieve standard prevention, the length of working hours and the ignorance of the treatment process of acquired immunodeficiency syndrome have a certain impact on the occurrence of blood-borne occupational exposure. It is necessary to focus on cultivating high-level midwifery talents to overcome the shortage of midwives and rationally use midwifery resources, as well as to strengthen standard prevention and improve the occupational protection and guarantee system for midwives.

Developing a midwifery service task list for Chinese midwives in the task-shifting context: a Delphi study

ObjectiveTo develop and validate a midwifery-led task list in the task-shifting context.DesignAn extensive literature review followed by a two-iterative Delphi survey.SettingTwenty university hospitals, three non-university hospitals and four university colleges...

Chinese midwives’ perceptions on upright positions during the second stage of labour: A qualitative study

Objective: Upright positions are recommended by many international organizations due to their positive effects on improving birth outcomes. The effects can only be achieved when upright positions are properly adopted by women under the guidance of midwives. However, whether midwives in China have a clear understanding of upright positions during the second stage of labour is an issue that has not been explored. The aim of this study was to explore midwives’ perceptions on assisting women in upright positions during the second stage of labour in the context of China.Design: A qualitative descriptive design was adopted. We analysed the data using the conventional content analysis and reported the study in line with the COREQ checklist.Setting: The study was conducted at the labour wards of two maternity hospitals and two general hospitals in China where the adoption of upright positions was encouraged during the second stage of labour.Participants: Semi-structured individual interviews with 17 midwives were conducted between May and July 2020.Findings: Three main themes were identified: (1) safety and availability; (2) unclear method of implementation; (3) lack of knowledge of the potential risks and precautions. Midwives’ perceptions were based primarily on clinical experience rather than evidence-based practice. Their perceptions on the indications and contraindications of upright positions were divergent and ambiguous. Midwives’ suggested that the indications and contraindications should be adjusted in the context of China. Time limit for keeping an upright position and maternal pushing during uterine contractions were two questions that still confused midwives. Midwives lacked knowledge of the potential risks of upright positions and rarely systematically summarized the precautions.Key conclusions: This study shows that assisting women to give birth in upright positions during the second stage of labour can be a challenge for midwives in China, and also highlights the need for clarifying the detailed implementation methods of upright positions in the context of China by evidence-based approaches.Implications for practice: An evidence-based protocol for implementing upright positions during the second stage of labour should be developed to guide midwives’ practice and facilitate the successful use of upright positions in China.

Comparison of midwives' self-perceived essential competencies between low and high maternal mortality ratio provinces in China.

To present and compare midwives' self-perceived essential competencies in regions with different maternal mortality ratios, and explore possible competency-related factors. In China, there is an urgent need for high-quality maternal health care with equal access, as the regional disparity in the maternal mortality ratio remains a big challenge. Midwives' essential competencies refer to the minimum knowledge, skills, and professional behaviours required by midwives, and directly affect the quality of maternal care they provide. However, there is very limited literature evaluating Chinese midwives' essential competencies, especially for midwives working in regions with high maternal mortality ratios. A cross-sectional survey design. The national cross-sectional study using an online questionnaire was conducted with a convenience sample of 2,022 midwives working in regions with different maternal mortality ratios. The STROBE guideline for cross-sectional studies was used in this study. Midwives rated themselves higher on their essential competencies in intrapartum care and lower on their essential competencies in assisting or performing the operative vaginal delivery. Specifically, when compared to those from regions of low maternal mortality ratios, midwives from regions with high maternal mortality ratios reported comparatively poor self-perceived essential competencies, especially in the area of detecting and treating pregnancy and childbirth-related complications. The factors influencing midwives' self-perceived essential competencies included majors, education levels, years of experience as a midwife, participation in teaching, and access to in-service training. In regions with high maternal mortality ratios, improving midwives' essential competencies is a key priority. Furthermore, it is recommended that midwifery education could be conducted in universities, and relevant regulations could be developed to enable midwives to provide a wider scope of care, thereby promoting the development of the midwifery workforce in China. Understanding self-perceived essential competencies of Chinese midwives working in regions with different maternal mortality ratios could guide the midwifery workforce, management, especially midwives' capability building.

Comfort With Touch and Influencing Factors Among Chinese Midwives: A Cross-sectional Survey.

The aim of this study was to identify comfort with touch (CT) and influencing factors among Chinese midwives. Midwives (N = 252) from 7 hospitals in Guangdong, China, were asked to complete a self-report questionnaire between November 2018 and April 2019. The questionnaire included the Nurses' Comfort with Touch Scale (NCTS), the Nurses' Perceived Professional Benefits (NPPB) Scale, the Maslach Burnout Inventory-General Survey (MBI-GS), and a self-designed demographic questionnaire. Multivariate linear regression was used to identify influencing factors for CT. Mean NCTS total score was 88.90 ± 14.40, and the mean item score was 5.23 ± 0.91, which indicated a respectable score. Within the NCTS, CT was highest in the comfort support category (5.32 ± 0.29) whereas CT was lowest in the physical comfort category (4.28 ± 0.28). Multivariate regression analysis demonstrated that CT among Chinese midwives was associated with positive experiences or feelings surrounding the patient-nurse relationship (B = 3.239, P < .001), perceived professional benefit (PPB, positive professional identity) (B = 0.240, P < .001), emotional exhaustion (B = -0.414, P < .001), depersonalization (negative attitude toward the work setting) (B = -0.773, P < .001), and personal accomplishment (evaluation of self-worth) (B = 0.170, P = .015). Touch training and educational programs are recommended for Chinese midwives to enhance awareness and acceptance of touch care. In addition, promoting positive patient-nurse relationships, improving PPB, and reducing burnout are recommended to enhance CT among Chinese midwives. Because of the size and racial homogeneity of the sample, further studies are recommended to identify CT and influencing factors in a larger, more diverse population of midwives worldwide.

A multi-center cross-sectional study on midwives' self-efficacy and influencing factors.

Healthcare professionals who lack self-efficacy may fail to cope with stressful situations, which increases job burnout and turnout. Self-efficacy of midwives with high workload may affect the quality of service. However, little is known about midwives' self-efficacy and related factors. This study aimed to examine the level and influencing factors of self-efficacy among midwives, and to assess the relationships between their self-efficacy and job burnout. This was a multi-center cross-sectional study involving 700 midwives from 33 hospitals in China. Data were collected by three self-administered questionnaires, including a socio-demographic questionnaire, General Self-Efficacy Scale and Maslach Burnout Inventory. Pearson correlation was utilized to analyze the association of self-efficacy with job burnout. A multiple linear regression model was performed to identify variables associated with midwives' self-efficacy. The score of self-efficacy among Chinese midwives was 24.34 ± 5.28. The incidence of job burnout was 52.9%. The influencing factors of self-efficacy among midwives were low personal accomplishment, emotional exhaustion, length of service, interest in the midwifery field, marital status and whether they came from a one-child family or not. Chinese midwives had a moderate level of self-efficacy which easily led to job burnout. Also, several personal-related and work-related factors would affect the self-efficacy of midwives. Nursing managers are called on to attach importance to self-efficacy of midwives and provide effective interventions to improve their self-efficacy.

Factors associated with workplace fatigue among midwives in southern China: A multi-centre cross-sectional study.

To identify the level of workplace fatigue among midwives and factors influencing their fatigue. Midwives who play an important role in medical care are prone to experience workplace fatigue, which negatively affects their well-being and work quality. A multi-centre cross-sectional study was conducted among 666 Chinese midwives from 38 hospitals in March 2019. Data were collected by four questionnaires of self-designed demographic questions, the Pittsburgh Sleep Quality Index, the Social Support Self-Rating Scale and the 14-item Fatigue Scale. Descriptive statistics, univariate analysis and multiple linear regression were used to analyse the data. Midwives had moderate levels of fatigue with the mean scores of physical fatigue, mental fatigue and total fatigue being 9.53, 6.25 and 15.79, respectively. Multiple linear regression results showed that sleep quality, social support, job satisfaction, occupational injuries, adverse life events, frequency of irregular meals and employment type were statistically significant factors influencing fatigue among the participants. Physical and mental fatigue were generally common among midwives and were affected by personal-related and work-related factors, sleep quality and social support. Nurse administrators have the opportunity to advocate for improved health policy under the two children rule to prevent workplace fatigue amongst midwives.

'Hands-off/poised' or 'Hands-on' method among Chinese midwives: A cross-sectional survey.

To determine midwives' preference for "Hands-on" and "Hands-off/poised" methods and to explore the impact factors. With the increasing rate of obstetric anal sphincter injuries, great controversy surrounds the "Hands-on" or "Hands-off" method during childbirth to decrease obstetric anal sphincter injuries incidence. Without regular records and related research, determining the use of this technique in China is difficult. This study used a quantitative study design, following the EQUATOR guidelines (STROBE). A nationwide cross-sectional online survey was conducted using respondent-driven sampling across 31 provinces in China from 1st October 2017-31st December 2017. A total of 6,425 midwives were involved. Descriptive analyses, chi-square test and binary logistic regression were undertaken. A total of 5,225 questionnaires were returned; 55.8% of the participants preferred the "Hands-off/poised" method. The impact factors included hospital categories, total work experience in a birth unit in years, theoretical education and skill training. In the study, for situations with increased OASI risk, 100% of the midwives in the "Hands-off" group expressed willingness to change to the "Hands-on" method whether there was concern about impending obstetric anal sphincter injuries. The "Hands-off/poised" method is heavily practised by Chinese midwives. However, majority of the midwives adopt "Hands-on" method in the face of high risk for obstetric anal sphincter injuries. Further studies are needed to determine the association between obstetric anal sphincter injuries rate and perineal management for low-risk birth. The result indirectly illustrates the application of "Hands-off/poised" technique in China and provides evidence for the international midwifery organisation to understand the status of Chinese midwifery to some extent. It also provides the latest data for further study of these two methods and the study of the relationship between hands-off/poised method and obstetric anal sphincter injuries.

Urban Chinese midwives’ knowledge, attitudes and practices toward umbilical cord blood donation

ObjectiveThis study aimed to assess the knowledge, attitudes and factors associated with promotion of umbilical cord blood (CB) donation by Chinese midwives to expectant mothers. DesignAn anonymous cross-sectional survey using self-administered questionnaires. SettingHong Kong, China. ParticipantsOne-hundred-and-forty-seven registered Chinese midwives were recruited by convenience sampling from government obstetric clinics and public and private hospitals. Measurements and findingsIn addition to collecting demographic background information, the study examined the midwives’ cord blood-related knowledge and perceptions as well as past-year practices and future intention of giving cord blood advice.Hong Kong midwives generally showed high levels of knowledge about the medical uses of cord blood but they were not as familiar with the administrative, legal and financial aspects of donation and storage. Only about 10% had received formal cord blood training and the majority felt that it should be integrated into midwifery program curricula. Although the midwives showed strong positive attitudes towards cord blood donation, only 10.9% consistently gave information and 7.5% consistently advised cord blood donation to expectant mothers in the preceding year while slightly higher percentages planned to do so in the future.In the multivariable models, higher educational attainment and hospital employment were the most consistent predictors of past-year practices of giving cord blood information and future intention to provide advice. Higher score in cord blood-related attitudes was significantly associated with giving past-year cord-blood advice, future intention to provide advice and future intention to recommend donation in the multivariable models. Key barriers to advising expectant mothers were the lack of a formal work protocol, lack of time in the clinic routine and fear of criticism by peers. Key conclusions and implications for practiceIncreasing education, improving perceptions and changing workplace protocols will likely increase cord blood advising by Hong Kong midwives to their patients.

Navigating the self in maternity care: How Chinese midwives work on their professional identity in hospital setting

Objectiveto explore the strategies Chinese midwives employed to work on their professional identity in hospital setting and the consequence of such identity work. Design and methodsthis paper draws upon findings from a Constructivist Grounded Theory study that explored the professional identity construction of 15 Chinese midwives with a mixture of midwifery experiences, practising in three different types of hospital settings in a capital city in Southeast China. The accounts from participants in the form of in-depth individual interviews were collected. Work journals voluntarily provided by three participants were also included. Findingsin everyday practice, hospital midwives in China were working on their professional identity in relation to two definitions of the midwife: the external definition (‘obstetric nurse’), bound up in the idea of risk management under the medical model of their work organisations; and the internal definition (‘professional midwife’), associated with the philosophy of normal birth advocacy in the professional discourse. Six strategies for identity work were identified and grouped into two principle categories: ‘compromise’ and ‘engagement’. The adoption of each strategy involved a constant negotiation between the external and internal definitions of the midwife, being influenced by midwifery experiences, relationships with women, opportunities for professional development and the definition of the situation. A ‘hybrid identity’, which demonstrated the dynamic nature of midwifery professional identity, was constructed as a result. Key conclusions and implicationsthis paper explored the dynamic nature of midwifery professional identity. This exploration contributes to the body of knowledge regarding understanding the professional identity of hospital midwives in China, while also extending the current theoretical knowledge of identity work by elaborating on the various strategies individuals use to work on their professional identity in the workplace.

The effectiveness of a Chinese midwives’ antenatal clinic service on childbirth outcomes for primipare: A randomised controlled trial

BackgroundAntenatal care is an important component of maternity care. In many parts of the world, midwives are the primary caregivers for childbearing women, providing a high level of continuity of care during a normal pregnancy. While in China, obstetricians are the primary providers of antenatal care for all childbearing women; and midwives only provide intrapartum care to labouring women. Today midwifery as a profession in China has been marginalised. Pregnant women usually lack individualised continuity of care from midwives during the perinatal period. There have been few randomised controlled trials of midwifery care practice in mainland China. Objective(1) To develop and implement a model of Chinese midwives’ antenatal clinic service and (2) to explore its effect on childbirth outcomes, psychological state and satisfaction, for primiparae. Design and methodsTwo-group randomised controlled trial. One hundred and ten pregnant women were assessed for eligibility and invited to participate in either the intervention group (midwives’ antenatal clinic service) or the control group (routine antenatal care) in the Obstetrics and Gynaecology Hospital of Fudan University from September 2011 to December 2011. Baseline data were collected, and then women were randomised to individual midwives’ antenatal clinic care (intervention group) or regular antenatal clinic service by obstetricians and obstetric nurse (control group). The research hypothesis was that compared with regular obstetrician-led antenatal care, the midwives’ antenatal clinic service would decrease the caesarean section rate, produce more favourable birth outcomes and women's greater satisfaction with care. Data were collected by retrospective review of case records and self-report questionnaires. The sample size of 110 was calculated to identify a decrease in caesarean birth from 70% to 40%. Birth outcomes, satisfaction and anxiety score in the two groups were compared. SettingThe midwives’ antenatal clinic in the Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China. Participants55 women, attending the midwives’ antenatal clinic (the intervention group) and 55 women, entering the control group. ResultsWomen in the intervention group were more likely than women in the control group to have a vaginal birth (35 [66.04%] versus 23 [43.40%]; 95% CI for difference 3.69–41.60). Women in the intervention group had a higher perinatal satisfaction but lower anxiety score than those in the control group. No differences were seen in neonatal Apgar score and in the amount of bleeding 2h post partum. Conclusion and implications for practiceThe midwives’ antenatal clinic can decrease the rate of caesarean section and enhance women's satisfaction with midwifery care. Further research needs to be conducted to implement this model of care more widely. We will attempt to make midwifery care a true choice for Chinese women.

Chinese midwives’ experience of providing continuity of care to labouring women

Objective to explore and describe Chinese midwives’ experience of providing one-to-one continuity of care to labouring women. Design a qualitative study using a phenomenological approach. Data were collected using open-ended, tape-recorded interviews. The analysis of the transcribed texts included searching for themes sorted into clusters for a final expression of the essential structure of the phenomenon. Setting Obstetrics and gynaecology hospital of Fudan University, Shanghai, China. Participants 12 midwives, providing one-to-one continuity of care to labouring women. Findings two main categories were identified: (1) midwives’ feelings on providing continuity of care, and (2) impact of on-call system on midwives providing continuity of care. Key themes emerged from each main category: (1) ‘playing important roles in labour care’, ‘gaining a sense of self-achievement’, ‘falling into exhaustion and frustration’ and ‘coping with caring work’; and (2) ‘on-call syndrome’, ‘affecting personal lives’ and ‘managing on-call shift’. The midwives experienced mixed feelings of being with women and expressed their adaptation to being on-call, which was the essence of this study. They played important roles in caring for women, gained a sense of self-achievement and developed suitable coping strategies. However, they also indicated the impact of the on-call system upon them in the process of providing continuity of care. Conclusion and implications for practice midwives have gained both positive and negative experiences when providing continuity of care to labouring women. The positive aspects may facilitate other professional midwives working in a similar role, whereas the negative aspects may inform them of learning to live with this situation, and may also have implications for managers to develop new approaches to the organisation and provision of continuity of care to support midwives’ practice, and to fully utilise ‘flexibility’ under an on-call system.

Chinese midwives’ views on a proposed midwife-led normal birth unit

Objective to investigate and assess Chinese midwives’ views of their roles and ability to practice in a proposed midwife-led normal birth unit (MNBU). Design a self-completed questionnaire supplemented with semi-structured telephone interviews. Memos, diaries, correspondence and comments of Chinese collaborators were also accessed. Setting six hospitals in Hangzhou, the capital of Zhejiang province. Participants 143 midwives were contacted and completed the questionnaire survey. Three midwives were subsequently interviewed. Findings the response rate was 100%; 86% of midwives supported the development of an MNBU, and 94.4% expressed confidence that they would be able to practice in an MNBU. The study shed new light on: (1) the meaning of an MNBU in the Chinese context; (2) the need for development of an MNBU; (3) role conflicts among midwives, doulas, nurses and obstetricians; (4) professional expertise and tension; and (5) the low status of Chinese midwives. Conclusion the proposed MNBU is welcomed by Chinese midwives. Their consensus and confidence show that there is enthusiasm for this project to proceed. However, the Chinese have never thought of MNBU services before. There is a need to develop well-structured philosophy, policy, procedures and outcome measures. Implications for practice the findings highlight the importance of an MNBU to re-establish Chinese midwives’ support of physiological childbirth. The extent to which Chinese midwives understand an MNBU could be further explored. The result may provide a possible route to the continuity of midwifery care and support.

Chinese midwifery: the history and modernity

Aim to investigate how and why Chinese midwife numbers are dwindling, and to help understand the role of midwives in society in general. Method to critically examine Chinese midwifery in three stages: (1) historical literature overview; (2) identification and reinterpretation of Chinese midwifery and its development; (3) placing issues that have arisen within a sociological context (i.e. the modernisation of obstetric technologies and the meaning of modernity). Findings no books on the history of Chinese midwifery were found. History was classified into three stages: (1) before 1929, a period of an indigenous model; (2) 1929–1996, the highs and lows of the bio-medical model; (3) after 1996, the demise of Chinese midwives. The issues identified were the legitimacy and professionalisation of Chinese midwives, the meaning of modernity and the reasons for the decline of Chinese midwifery. Conclusion no sufficient evidence-based research was conducted to support the recent changes made to Chinese midwifery. The modernisation of maternity care in China took place amid dramatic social and cultural changes within society. As a consequence, midwifery as a profession in China has been marginalised. The modernisation of maternity care has failed to deliver on personal choice, quality of service and professional diversity. Implications for practice evidence-based research and the state's responsibility are essential to ensure the quality of maternity care and to protect the interests of women. The state's responsibilities include legislation regarding the role of midwives, code of practice, professional standards, responsibility and accountability in order to make midwifery care a true choice for women.