Midwives Research Articles

English

Neonatal tetanus, a completely preventable disease, still contributes to morbidity and mortality in Akwa Ibom State, despite the fact that there should have been a global eradication many years back. It therefore still constitutes a public health problem. The aim of this work is to highlight the importance of continuous educational actions for pregnant women, mother and midwives with a view to preventing neonatal tetanus and promoting the improvement of the quality of life and health of the mother-child binomial, family members and other care givers. This work is a review of delivery practices and intervention measures in a traditional birth attendant’s home where four babies delivered at the home presented at the University of Uyo Teaching Hospital with features of neonatal tetanus within a three week period between late June 2005 and July 2005. The intervention measures which included teaching clean delivery practices, proper cord care, involvement of the TBA in counseling sessions and postnatal checks eliminated the incidence of neonatal tetanus in the home. These interventions, when applied to other TBAs will help eliminate neonatal tetanus. Key words: Cluster, Lay mid wife, newborn, tetanus.

The effect of the community midwifery model on maternal and newborn health service utilization and outcomes in Busia County of Kenya: a quasi-experimental study

BackgroundPoor women in hard-to-reach areas are least likely to receive healthcare and thus carry the burden of maternal and perinatal mortality from complications of childbirth. This study evaluated the effect of an enhanced community midwifery model on skilled attendance during pregnancy/childbirth as well as on maternal and perinatal outcomes against the backdrop of protracted healthcare workers’ strikes in rural Kenya.MethodsThe study used a quasi-experimental (one-group pretest-posttest) design. The study spanned three time periods: December 2016-February 2017 when doctors were on strike (P1), March-May 2017 when no healthcare providers were on strike (P2), and June-October 2017 when nurses/midwives were on strike (P3), which was also the period when the project enhanced the capacity of community midwives (CMs) to provide services at the community level. Analysis entailed comparison of frequencies/means of maternal and newborn health service utilization data across the three periods.ResultsThe monthly average number of clients obtaining services from CMs across the three time periods was: first antenatal care (ANC) (P1-1.8, P2-2.3, P3-9.9), fourth ANC (P1-1.4, P2-1.0, P3-7.1), skilled birth (P1-1.5, P2-1.7, P3-13.1) and the differences in means were statistically significant (p < 0.05). Over the period, the monthly average number of clients obtaining services from health facilities was: first ANC (P1-55.7, P2-70.8, P3-4.0), fourth ANC (P1-29.6, P2-38.1, P3-1.2) and skilled birth (P1-63.1, P2-87.4, P3-5.6), p < 0.05. There were no statistically significant differences in the average number of clients obtaining services from CMs or health facilities between P1 and P2 (p > 0.05). There was, however, a statistically significant increase in the average number of clients obtaining services from CMs in P3 accompanied by a statistically significant decline in the average number of clients obtaining services from health facilities (p < 0.05). First ANC increased by 68%, fourth ANC by 75%, skilled births by 68%, and postnatal care by 33% in P3 (p < 0.0001). There was a non-significant decline in macerated stillbirths and neonatal deaths in P3.ConclusionsThe findings underscore the importance of integrating community-level health service providers (CMs and health volunteers) into the primary health care system to complement service delivery according to their level of expertise, especially in low-resource settings.

Analysis of Factors Affecting the Selection of Midwives and Shaman Labor Workers in Haria State Saparua District

Maternal mortality ratio (MMR) is an important indicator of a country’s public health. MMR is currently thehighest number in Southeast Asia. The coverage of childbirth in 2018 Haria State is 66.67%, still far fromthe Target Of Central Maluku Regency in 2018 which is 76.27%. There are 14 active child shamans who aretrained shamans and there are still many wild shamans who do maternity assistance, while only 3 midwives.The purpose in this study is to analyze the factors that influence the selection of midwives and shamanlaborers in Haria State saparua sub-district. This research is quantitatively descriptive using cross sectionaldesign. The population in this study was mothers who performed childbirth, either stillborn or born alive inthe working area of Porto Haria public health center saparua sub-district in 2018. The sampling used totalsampling, namely all mothers who did childbirth helped by midwives as many as 62 respondents and shamansas many as 31 respondents in Haria State in 2018. Data analysis uses univariate and bivariate analysis. Theresults showed no influence between the number (parity) of children on the selection of maternity helpersin Haria State saparua sub-district (p value=0.769), There is a work influence (p value = 0.012), knowledge(p value = 0.000) and attitude (p value = 0.000) on the selection of labor helpers in Haria State saparua subdistrict.It is important to improve the mother’s knowledge of healthy childbirth and instill a positive attitudetowards health workers so that the mother will choose a healthcare person as a helper in childbirth.

Analysis of Maternal Referral System in Wulur Public Health Center Working Area in Damer Sub-District of Southwest Maluku Regency (Qualitative Study)

Referral of pregnant women and high-risk neonatals is an important component of the maternal healthcare system. In order for the maternal referral system to run it is necessary to prepare a referral strategyin accordance with the prevailing health system with the condition of the local community. The purposeof this study is to analyze the picture of maternal referral system at the level of community analysis onmaternal mortality cases in Damer Sub-district. The type of research used in this study is qualitative researchwith phenomenological approaches. The informants in this study had 27 people consisting of 10 husbands/families of patients accompanying mothers who died in childbirth in 2017 – 2018, 6 village shamans orintegrated healthcare center cadres who know the chronological pregnancy and childbirth of the mother, 5village chiefs / village staff / village heads from the village where the patient lives and is in place during thelabor process until the death of the patient, 1 nurse in the village, 2 midwives of Wulur health center, 1 doctorof public health center, 1 head of Wulur public health center, 1 head of Damer Sub-district. The resultsshowed that at the level of analysis of high-risk pregnancy communities and health services by midwiveshave not woken up well. While the perception of complications in pregnancy is good enough. Culturalfactors, still high trust in the village shaman. Transportation costs, tools and communication processes. ToWulur public health center to further incentiize health promotion, especially related to high-risk pregnancyand to change the role of village shamans as labor helpers into preventive promotive personnel

Wendy Kline. Coming Home: How Midwives Changed Birth.

Wendy Kline. Coming Home: How Midwives Changed Birth.

Climate Special: New sustainable parenting project

On 19 March, as the UK was on the cusp of going into COVID-19 lockdown, Hywel Dda University Health Board launched an environmental initiative targeting prospective and new parents to coincide with NHS Sustainability Day. Community Midwife Becci Johnson initiated the sustainable parenting project, motivated by the Welsh Government’s declaration of a ‘climate emergency’1 and the UN biodiversity report2 conclusions that an unprecedented decline in nature and biodiversity now threatens humanity.

The Brabant study: design of a large prospective perinatal cohort study among pregnant women investigating obstetric outcome from a biopsychosocial perspective

BackgroundPregnancy is characterised by many biological and psychosocial changes. Adequate maternal thyroid function is important for the developing fetus throughout gestation. Latent class analyses recently showed three different patterns of...

Yenidoğanın Doğum Odasında Aspirasyon İlkelerinde Güncel Yaklaşımlar; Ebelerin Rol ve Sorumlulukları

Neonatatal mortalite istatistikleri incelendiğinde, önemli bir bölümünün yaşamın ilk günü meydana geldiği görülmektedir. Bu durum yenidoğanın doğum odasındaki bakım ve izleminin ne kadar önemli olduğunu ortaya koymaktadır. Doğum odasında yenidoğanlara yapılan uygulamalar arasında yer alan aspirasyon işlemi yaygın olarak kullanılmaktadır. Aspirasyon işlemine bağlı solunum ve dolaşım sisteminin çalışmasını olumsuz etkileyen birçok komplikasyon gelişebilmektedir. Bu açıdan yenidoğanda dikkatli uygulanması gereken bir girişimdir. Yıllar içerisinde yenidoğanlara doğum odasında yaklaşım uygulamaları değişiklik göstermiştir. Yenidoğan bakımına yön veren Dünya Sağlık Örgütü, Türk Neonatoloji Derneği, Amerikan Kalp Derneği ve Uluslararası Resüsitasyon Komitesi’nin güncel önerileri incelendiğinde, yenidoğanlara rutin aspirasyon işlemi önerilmemektedir. Ebelerin görev ve sorumlulukları arasında yenidoğanın ilk bakım ve muayenesi ve gerektiğinde acil resüsitasyon gerçekleştirmesi de yer almaktadır. Bu durum ebelerin yenidoğanın aspirasyon işleminde anahtar role sahip olduğunu göstermektedir. Bu açıdan ebelerin yenidoğanda aspirasyon ilkeleri hakkında ayrıntılı bilgi sahibi olması ve konuyla ilgili güncel yaklaşımları bilmesi önemli bir konudur. Aspirasyon yenidoğanlara doğum odasında oro-nazofarenks, endotrakeal ve mide içeriği aspirasyonu yöntemlerinde uygulanmakta ve ebelik bakımında önemli yer tutmaktadır. Bu makalede, yenidoğanın doğum odasında aspirasyon ilkelerinde güncel yaklaşımlar ve ebelerin rol ve sorumlulukları literatür bilgisi kapsamında derlenmiştir.

Year of the Nurse and Midwife: AARP and WHO

Year of the Nurse and Midwife: AARP and WHO

Os significados atribuídos pela mulher ao trabalho das enfermeiras obstetras no parto domiciliar planejado

Introdução: Considerando que a busca pela experiência do parto fisiológico no ambiente domiciliar vem aumentando entre gestantes e suas famílias, o presente artigo tem como objetivo compreender os significados atribuídos por mulheres ao parto domiciliar planejado assistido por enfermeiras obstetras. Metodologia: Trata-se de estudo exploratório, descritivo, com abordagem qualitativa, com quatro mulheres que vivenciaram o parto natural domiciliar planejado com uma equipe de enfermeiras obstetras da região centro-sul do estado de Mato Grosso, Brasil. A coleta de dados deu-se por intermédio de entrevistas semiestruturadas, analisadas conforme a análise de conteúdo do tipo temática. Resultados: Através da análise dos dados, emergiram duas categorias: a) a atuação das enfermeiras obstetras no parto domiciliar planejado e b) a vivência do parto em casa: ambiência e o respeito à individualidade da mulher. Considerações finais: Os sentidos conferidos pelas mulheres ao parto domiciliar com a assistência das enfermeiras obstetras permearam-se de sentimentos positivos, denotando confiança e respeito à autonomia e individualidade da mulher e família.

Coming Home: How Midwives Changed Birth

Coming Home: How Midwives Changed Birth

AIDS 2020: Resiliency in the Year of the Nurse and Midwife.

AIDS 2020: Resiliency in the Year of the Nurse and Midwife.

Development of new health provision models by advanced practice midwives - The Master of Science in Midwifery at the Bern University of Applied Sciences (BFH): an educational concept for the future

Background: The increase in chronic diseases, dealing with a diverse clientele, the rapidly developing digitalization in healthcare as well as the demand for interprofessionalism poses complex demands on the midwifery as profession. Within this context institutions of higher education are expected to train midwives as trendsetters in the development of new, integrated healthcare models which can meet the health needs of mothers and their families. Goal: The goal of the master course in midwifery is to increase awareness of the relevance of current challenges in maternity care. Midwives are prepared to competently deal with current health issues, using innovative healthcare models, by taking on advanced and specialized roles. Methods: The course imparts knowledge and know-how for midwives who wish to prepare to take on duties in modern obstetric and maternity care. Midwifery master students complete interprofessional course modules, such as Ethics, Advanced Practice or Health Policy and Health Economics, conjointly with fellow students of nursing, physiotherapy as well as nutrition and dietetics degrees. Three profession-specific course modules focus on the challenges imposed by complex processes in perinatal care. Results: The case study of a 5th semester student shows how the course supports the development of the new role of an Advanced Practice Midwife (APM) in the field of perinatal mental health. As an assignment within the profession-specific course module Perinatal Mental Health the student developed a concept draft for an APM role. She presented the concept in her own field of work, where she was charged with further developing and advancing the project. Furthermore, the student focused her Transfer Course modules on the project and deepened her skills in mental health and research skills through work shadowing in a research department and mental health ward, also called ,,Crisis lntervention Centre", in a university psychiatric clinic. Based on the APN model she finally developed how to establish the APM role in her master thesis. To conduct the needs assessment for mentally ill pregnant women and mothers she is conducting a secondary data analysis of a research project of the Division of Midwifery of BFH. Relevance: The establishment of integrated and intersectoral healthcare models is currently being discussed in Switzerland. The models require specific skills in healthcare professionals. The interprofessionally oriented master studies at BFH teach midwives to meet the requirements of needs-based, family-centred perinatal healthcare and strengthen its quality. Recommendations/Conclusions: The interlocking of master studies and practice offers the unique opportunity to further develop innovative healthcare models which are aimed at addressing present and future challenges in healthcare delivery and which are based on research.

The Experiences of Midwifery Student in Learning Model of CoC (Continuity of Care)

Introduction:Midwife student in the continuity of care experience is an innovative midwifery education strategy in facilitating learning for midwifery students. But students also identified a number of challenges they faced, one of which was in recruiting women. Purpose: The purpose of this scoping review is to find out the experience of midwife students in the continuity of midwifery care with the CoC learning model. Methods: In this scoping review, the authors identify studies that explain the experience of midwife students in the continuity of care with the CoC learning model from three databases (PubMed, Science Direct, and Pro-quest). Searches are limited to studies published in English and present data for the 2009-2018 period. The identified study was reviewed using the PRISMA Flowchart. Studies with a qualitative design related to continuity of care with the CoC learning model are then selected for review. Results: From A total of 5 journals were found, then analyzed in the form of scoping reviews. Then classify them in the theme of the process of implementing midwifery student learning, the benefits, impacts and challenges in the continuity of care with the CoC learning model. Conclusion: From the results of a journal review, it can be concluded that the experience through CoC is intended to enable students to experience continuously with a woman throughout the period of pregnancy, childbirth and childbirth, where the care desired by women can be provided through a continuous midwifery care model. Equally beneficial between midwifery and female students, it can provide insight into the experience of midwife students to support, facilitate learning, provide a unique opportunity to build strong relationships with women by developing a range of skills and knowledge for midwifery students.

Occupational health of midwives.

The midwifery profession varies greatly from one country to another. There are, however, a number of common features such as exposure to biological risks through contact with pregnant women and women in labor, exposure to postural stresses during examinations and medical acts, but also, increasingly, exposure to organizational constraints (work schedules, shift work, etc.). This article aims to give an overview of what is known about the occupational health risks of midwives (MWs). A review of the literature on Medline, from January 1, 2006 to December 31, 2017, was carried out. Articles focused principally on burnout (BO) and post-traumatic stress disorder. Several BO questionnaires were used. For the Copenhagen Burnout Inventory, the prevalence of personal BO ranged 20-57%; the percentage of work-related BO fell between 15-57%; and the prevalence of client-related BO ranged 5-15%. For the Maslach Burnout Inventory, the prevalence of emotional exhaustion varied between 23-60.7%; the prevalence of depersonalization ranged 3.3-30.3%; and the pervasiveness of personal accomplishment varied between 5-30.3%. There was little data concerning musculoskeletal problems or accidental exposure to biological fluids. The literature review on occupational pathologies demonstrates high levels of BO. Several gaps exist on the evolution of the impact of their work on the health of MWs, like the effect of shift work, postural stresses, etc. This review will make it possible to better focus future research on the occupational health of this population. Med Pr. 2020;71(4):473-81.

What midwives think of the continuity of carer model

How effective is the continuity of carer model? India Wentworth finds out by asking midwives to share their experiences

Knowledge, behaviours and attitudes for human papillomavirus (HPV) prevention among educators and health professionals in Greece.

Globally, human papillomavirus (HPV) is one of the most common sexually transmitted diseases in both men and women. The objective of this study was to investigate the knowledge, attitudes, and behaviour of educators and health professionals regarding the prevention of HPV infection in Greece. The analysis of the results shows that most of the participants (44.7%) had good knowledge about the human papillomavirus, regardless of occupation. A cross-sectional survey was carried out with seven hundred and fifty participants. The participants completed a thirty-one-item questionnaire regarding their knowledge, attitude and behaviour towards the prevention of HPV. Knowledge scores were calculated with a grading system which was designed for accurate knowledge assessment. The Score was adjusted on a scale from 0 to 100 and was divided into five levels, from Excellent to Very Bad level of total knowledge. Of all the participants, 26.4% had excellent knowledge, 44.7% had good, 23.6% had moderate, 4.7% had bad, and 4.7% had a very bad level of total knowledge. Specifically, physicians of different specialities had 80.32%, and educators 65,31 % excellent level of knowledge, respectively. Also, participants had a high degree of awareness regarding prevention and adherence to the annual Papanikolaou test (65.8%) and gynaecological exam. Despite the positive response (94.1%) in terms of vaccination of boys, and girls, as well as information on HPV vaccination, many participants themselves were not vaccinated (74.8%), nor were their children (19.7%). The present study showed good level of knowledge for HPV prevention regardless of occupation and is characterized by a high degree of awareness of the usefulness of prevention in adhering to the annual Pap smear test and gynaecological examination. The study shows the need for more information workshops for healthcare professionals, because physicians and midwives had high levels of knowledge, but not excellent as expected and required due to health-related profession.

A feasibility study of implementing a patient-centered outcome set for pregnancy and childbirth.

Background and AimsPatient‐reported outcome and experience measures (PROM and PREM) can facilitate shared decision making and hold potential to improve healthcare quality. However, their adoption in perinatal care is still limited. The International Consortium for Health Outcomes Measurement (ICHOM) developed a Pregnancy and Childbirth (PCB) outcome set, including PROM and PREM questionnaires. We studied the feasibility to use these PROMs/PREMs in Dutch perinatal care, addressing both women's and professionals' perspective.MethodsPatients and professionals in primary and hospital care participated. Women under care at one of five timepoints for PROM/PREM collection of the PCB set (2 during pregnancy, 3 postpartum) were e‐mailed a questionnaire and discussed their answers with their obstetric professional the next regular visit. Compliance was recorded. After discussing the PROMs/PREMs, usability and experience were assessed with separate surveys amongst women and professionals.ResultsOf 26 women approached, 21 completed and discussed their PROM/PREM questionnaire. Mean questionnaire completion rate was 97%. Average reported time completing the questionnaires was 10 minutes; most women (90%) stated this was acceptable. Women preferred completing questionnaires digitally and discuss their answers with an obstetric professional rather than other care professionals, also 6 months postpartum. Over half of women agreed PROMs/PREMs supported shared decision making (58%), ability to raise issues (60%), and patient‐clinician relationship (52%). Six professionals participated: two obstetricians, two clinical midwives, and two community midwives. Most professionals experienced sufficient time to discuss the responses, except at 6 months postpartum. They knew what items to discuss but did not always feel responsible to act upon them. Professionals agreed PROMs/PREMs supported symptom detection and personalized care.ConclusionsPatients and obstetric professionals consider the PCB set a feasible instrument for PROM/PREM assessment, with good compliance, acceptability and usability. Important determinants of successful implementation are a well‐equipped ICT‐tool, agreements regarding professionals' responsibilities and how outcomes are discussed or acted upon.

The academization of midwifery: State-wide implementation of the new law governing the education of midwives (Hebammenreformgesetz) is leading to heterogeneous education.

The academization of midwifery: State-wide implementation of the new law governing the education of midwives (Hebammenreformgesetz) is leading to heterogeneous education.

Informed consent in obstetrics – a survey of pregnant women to set a new standard for consent in emergency obstetric interventions

Informed consent is necessary for all medical, surgical and obstetric interventions. Whilst informed consent can be obtained for elective procedures, it is much more challenging to obtain for emergency interventions. It can be difficult for women to understand the need for emergency intervention when pregnancy has been low risk. This can lead to problems with psychological trauma from the delivery being foremost in their minds in the postnatal period and in future pregnancies. The Montgomery ruling of 2015 encouraged informing women about risks and benefits of interventions and letting the women take responsibility for their own decision-making. Here, a patient-focused survey collected information on pregnant women’s knowledge and wishes regarding emergency interventions. The responses were analysed in relation to local and Scottish national delivery data. We have initiated a novel programme to ensure all of our pregnant women are empowered to give informed consent for emergency interventions. IMPACT STATEMENT What is already known on this subject? There has been very little published on this subject to date and what has been published has involved focus groups or very small numbers of women. What do the results of this study add? This study adds significantly to our understanding of current Scottish and Highland regional delivery statistics to help foster realistic delivery expectations in our pregnant women. This study is the first to report on pregnant women’s understanding of the possibility of requiring emergency intervention in labour and the relevant risks. It also highlights the fact that women prefer to get their information from community midwives, friends and family rather than their obstetricians or GPs. This study is also the first to report women’s actual preferences and comments with regard to information provision, labour and delivery experiences and their wishes for the future. What are the implications of these findings for clinical practice and/or further research? The findings from this study have allowed us to develop and implement a novel means of obtaining informed consent in emergency obstetrics and the success of this programme will be reported following future analysis of patient experiences.