Consultant Midwives Research Articles

The public health role of maternity support workers

Most of the work of midwives and obstetricians is directed at improving pregnancy outcomes. Part of this work is built on the public health strategy developed by the national health services around the UK. Pregnancy and early parenthood are times when expectant and new parents are receptive to public health information. Midwives and maternity support workers work together to convey public health messages. The positive outcomes of this work include reductions in rates of stillbirth, preterm birth and low-birthweight babies. Other outcomes are increased parental satisfaction, stronger family bonds and better family health. Specialist and consultant midwives' views on the role of maternity support workers in public health are included in this paper.

Normalising pregnancy and birth with advanced midwifery practice in Ireland

As midwifery in Ireland evolves to meet a need for standardised, high-quality, woman-centred care, Roisin Lennon reflects on her journey as an advanced midwife practitioner. She shows how this exciting area of practice is in prime position to be a resource for supported and assisted care pregnancies, guide midwives to provide continuity of care in the supported care pathway and help to fully implement the National Maternity Strategy by 2026 in Ireland.

Collaborative strategic initiative between a university and hospital network group: Advanced nurse/midwife practice forum.

The Faculty of Nursing and Midwifery, one of a few nursing and midwifery faculties worldwide, was established in 1974 by Ms Mary Frances Crowley, for postgraduate nursing education, and is situated within the Royal College of Surgeons in Ireland, University of Medicine and Health Sciences. The RCSI operates through a network group of university hospitals: Beaumont, Connolly, Drogheda, Cavan, Monaghan and the Rotunda. Combined these hospitals have 120 registered and candidate ANP/AMPs and caters for general, psychiatric, children and maternity patients/clients. The drive to establish the forum between the faculty and the six Dublin hospitals was to build capacity among advanced nurse practitioners and advanced midwife practitioners (ANP/AMPs) who are seen as intelligent consumers of evidence-based research and safe practice. The SCAPE report identified research as the single domain that was underdeveloped within the ANP role, in the study exploring the role of ANPs and CNSs. Latterly, the Nursing and Midwifery Board of Ireland highlighted research as a vital component of the ANP/AMP role in its standards for advanced nurse and midwife practice. The faculty acted collaboratively to introduce an ANP/AMP forum to support advanced practitioners working in the university hospital group in their education and professional development, support the expansion of their knowledge base through practice-based enquiry and research and act as a conduit for interactions between ANPs/AMPs by keeping them up to date with practice and research. The Initiation phase was undertaken through a survey of needs; Implementation phase by extensive literature review and research-based newsletters sent to individuals by the forum coordinator; and the Evaluation phase through focus groups.

Sustaining the quality of midwifery practice in Belgium: Challenges and opportunities for advanced midwife practitioners

BackgroundMidwifery practice is essential in achieving high-quality maternal and newborn care in all settings and countries. However, midwifery practice has become more complex over the past decades. Considerable demands are being placed on midwives to meet increasing epidemiological, socio-economic, and technological challenges. These require a well-trained midwifery workforce ready to shape the care in the near and long-term future. ObjectiveTo discuss advanced midwife practitioner role implementation in Belgium as a possible answer to healthcare-related challenges that impact midwifery practice. Furthermore, to stimulate a debate within the profession at all levels in Belgium and in countries considering advanced midwife practitioner roles. MethodThe framework by De Geest et al. (2008) served as a basis for discussing the drivers for advanced midwife practitioner role implementation: the legal, policy and economic context, workforce issues, education, practice patterns, and healthcare needs of the population. FindingsA legal basis for advanced midwife practitioner role implementation is lacking in Belgium. Remuneration opportunities for the non-clinical part of these roles (e.g. leadership and innovation activities) are missing. It might be challenging for healthcare organisations to support the implementation of such roles, as immediate revenues of non-clinical activities are absent. However, sufficient potential resources are available to fill in future advanced midwife practitioner positions. Additionally, advanced midwife practitioner specific master programmes are being planned in the near future. ConclusionsAlthough several barriers for the implementation of advanced midwife practitioner roles were identified, a discussion should be held on the opportunities of implementing these roles to facilitate the development of new models of care that meet current and future challenges in midwifery practice and healthcare. After initial discussions amongst midwives in academic, managerial, and policy positions, stakeholders such as obstetricians, general practitioners, associations representing healthcare organisations, and policy makers should be involved as a next step.

Surviving Maternity – From Trauma to Around the Table

In this article, Dr Kathryn Gutteridge provides valuable insights regarding restorative debriefing following serious adverse incidents. Crucially, this involved all members of staff that felt affected by the incident, bringing together midwives and doctors into a non-hierarchal space. Drawing upon her psychotherapist background and integrating psychotherapy-informed principles during her time as a Consultant Midwife, we can see a powerful and meaningful way in which to mitigate against professional trauma.

Hello My Name is Amanda…Part 2

Consultant midwife roles perform a strategic function in the clinical direction of maternity services. Urgent and emergency care providers, including NHS 111 and 999 services, routinely manage a range of calls where a woman may be pregnant, or recently given birth; however, the influence and contribution of this role in this setting has not been described in the literature. The inception of the consultant midwife within the ambulance service is a key milestone in promoting greater integration and seamless care for those women who utilise the service, ensuring the response times for those women that may require transfer when becoming unwell; or in labour, are safe, and staff providing care and advice have access to midwifery expertise.

Hello My Name is Amanda

Consultant midwife roles perform a strategic function in the clinical direction of maternity services. Urgent and emergency care providers, including NHS 111 and 999 services, routinely manage a range of calls where a woman may be pregnant, or recently given birth; however, the influence and contribution of this role in this setting has not been described in the literature. The inception of the consultant midwife within the ambulance service is a key milestone in promoting greater integration and seamless care for those women who utilise the service, ensuring the response times for those women that may require transfer when becoming unwell; or in labour, are safe, and staff providing care and advice have access to midwifery expertise.

The Role of Advanced Midwife Practitioner

Ireland ranks 21st out of 36 countries for its healthcare system. Emergency department (ED) waiting times in Ireland are the worst in Europe (Edwards 2018). Since 2000, overcrowding in the ED has become critical, with nursing unions becoming involved in industrial action and trolley counts, to highlight the crisis (Doran 2003). Byrne and Heyman (1997) state that nursing staff in ED are focused on offering vital physical care and, in busy departments, those needs regarded as non-urgent, non-physical are sometimes overlooked. Interventions such as the implementation of an AMP service and designated obstetric ED would aid in lightening the obstetric burden on these ever-expanding ED queues, while facilitating improved patient safety and quality care.

Establishing a valid construct of fear of childbirth: findings from in-depth interviews with women and midwives

BackgroundFear of childbirth (FOC) can have a negative impact on a woman’s psychological wellbeing during pregnancy and her experience of birth. It has also been associated with adverse obstetric outcomes and postpartum mental health difficulties. However the FOC construct is itself poorly defined. This study aimed to systematically identify the key elements of FOC as reported by women themselves.MethodsSemi-structured interviews with pregnant women (n = 10) who reported to be fearful of childbirth and telephone interviews with consultant midwives (n = 13) who regularly work with women who are fearful of childbirth were conducted. Interviews were analysed using thematic analysis for each group independently to provide two sources of information. Findings were reviewed in conjunction with a third source, a recently published meta-synthesis of existing literature of women’s own accounts of FOC. The key elements of FOC were determined via presence in two out of the three sources at least one of which was from women themselves, i.e. the reports of the women interviewed or the meta-synthesis.ResultsSeven themes were identified by the women and the consultant midwives: Fear of not knowing and not being able to plan for the unpredictable, Fear of harm or stress to the baby, Fear of inability to cope with the pain, Fear of harm to self in labour and postnatally, Fear of being ‘done to’, Fear of not having a voice in decision making and Fear of being abandoned and alone. One further theme was generated by the women and supported by the reports included the meta-synthesis: Fear about my body’s ability to give birth. Two further themes were generated by the consultant midwives and were present also in the meta-synthesis: Fear of internal loss of control and Terrified of birth and not knowing why.ConclusionsTen key elements in women’s FOC were identified. These can now be used to inform development of measurement tools with verified content validity to identify women experiencing FOC, to support timely access to support during pregnancy.

Labial trauma post birth: A delphi study of classification and suturing requirements

ObjectivesPrimary objectives were to establish consensus of opinion for classification of post birth labial trauma and which types of post birth labial trauma require suturing. Secondary objectives were to establish optimal method, material and anaesthetic for suturing labial trauma. DesignDelphi study consisting of 3 rounds. SettingUK and Europe Participants8 midwives, 4 obstetricians, 7 specialist perineal midwives, 1 consultant midwife and 2 midwifery lecturers all with relevant expertise and or recent, regular clinical experience of assessing and suturing labial trauma from 2 United Kingdom (UK) universities, 12 UK healthcare trusts and 1 European healthcare organisation. MethodsA Delphi study consisting of an initial round of 6 professional medical illustrations of labial trauma with 6 open questions attached to each sent to panel members. 2 further rounds developed from the first round with between 2 and 10 opt-in statements for the 6 questions for each illustration to 20 and 22 panel members respectively. Consensus was set at 70% opt-in for each statement. FindingsConsensus was reached that unilateral or bilateral vertical skin separation with minimal trauma to underlying tissues was described as a graze and does not require suturing. Consensus was reached that unilateral or bilateral deeper vertical trauma with involvement of the underlying tissue and horizontal trauma across the labia does require suturing with interrupted technique, injected local anaesthetic and using Vicryl Rapide 3.0 or equivalent. ConclusionA pilot study and definitive randomised controlled trial are required to establish in vivo whether labial tears including those which are transverse, are less painful and heal better with interrupted suturing compared to continuous or subcuticular sutures.

Use of the partogram in a private hospital in South Africa

Objectiveto explore and describe the use of the partogram in private hospitals in South Africa. Designan explanatory mixed method design. In-depth interviews were conducted with the midwives and midwife specialists to explicate the significance of the initial quantitative questionnaires. Settinga private maternity hospital in Gauteng Province, South Africa. Participants11 midwives and 3 advanced midwives working in the labour unit of the private maternity hospital. Findingsalthough all the midwives and midwife specialists knew the purpose of the partogram, where to find the recommendations on the use of the partogram and the signs of true labour, not all were sure when the partogram had to be completed and who is accountable for plotting the findings. Fetal heart rate monitoring during the active phase of labour remains a concern. Key conclusionthe findings revealed that the midwives understood the importance of the partogram but are not using it within the parameters for which it was intended. The obstetricians intervened during labour with no or little use of the partogram. Implications for practicethe study identified the knowledge strengths and deficits of midwives working in a private hospital on partogram use that would benefit from training interventions and professional development. Evidence suggests a culture where the partogram is not central to care as obstetricians are not using the partogram. The purpose of the partogram in the private sector needs to be reviewed.

So Far Yet So Similar: Reflections from a Florence Nightingale Travel Scholarship

I am the consultant midwife for Powys Teaching Health Board and have been qualified for 22 years. During my career, I have developed my passion for woman-centred care, autonomy, choice and trust. In 2015 I completed a PhD exploring the concept of trust within the midwife-mother relationship. In the study I highlighted the importance of partnership working and models currently practised that can support the development of meaningful relationships. The commitment to continuity and empowerment of women through the New Zealand model of care featured as an example of good practice. Following completion, I began to formulate ideas for further study and a passion for clinical quality improvement to help implement my research findings. This is not without some challenges and, to assist in my thinking, I applied in 2017 for a Florence Nightingale Foundation travel scholarship. In this article I aim to share my reflections of completing the scholarship and encourage others to apply for similar opportunities for learning.

Obstetrics knowledge and skills training as a catalyst for change

Poor emergency obstetric care has been shown by national confidential enquiries into maternal deaths to contribute to a number of maternal deaths in South Africa. To assess whether a structured training course can improve knowledge and skills and whether this can influence the capacity of a healthcare facility to provide basic and comprehensive emergency obstetric care signal functions. A baseline survey was conducted to assess the seven basic emergency obstetric and neonatal care signal functions in 51 community health centres (CHCs) and the nine comprehensive emergency care signal functions in 62 district hospitals (DHs). Are-assessment was conducted 1 year after saturation training had been provided in each district. The delegates were trained using a structured training programme (Essential Steps in Managing Obstetric Emergencies, ESMOE) and their knowledge and skills were tested before and after the training. Saturation training was considered to have been achieved once 80% of the healthcare professionals involved in maternity care had been trained. There was a significant improvement in the knowledge and skills of doctors, namely by 16.8% and 32.8%, respectively, of advanced midwives by 13.7% and 29.0%, and of professional nurses with midwifery by 16.1% and 31.2%. The seven basic emergency care functions improved from 60.8% to 67.8% in the CHCs and from 90.7% to 92.5% in the DHs before and after training. If the two signal functions that are not within the scope of practice of professional nurses with midwifery are excluded (viz. assisted delivery and manual vacuum aspiration), the functionality of CHCs increased from 85.1% to 94.9%. The ESMOE training programme improved knowledge and skills, but there was a modest improvement in the functionality of the facilities. Improvement in functionality requires changes in the structure of the health system, including changing the scope of practice of professional nurses with midwifery and employing more advanced midwives in CHCs.

Factors influencing the implementation of advanced midwife practitioners in healthcare settings: A qualitative study

ObjectiveTo explore factors influencing the implementation of advanced midwife practitioner roles. DesignSemi-structured individual face-to-face and focus group interviews were conducted. Data analysis was performed using the Framework Method. Setting and participantsA purposive sample (n = 32) included chief nursing officers, middle managers, head midwives/nurses, primary care team leaders, midwives with and without advanced midwife practitioner roles, heads of midwifery educations, and obstetricians. FindingsBudgetary constraints on a governmental and healthcare organizational level were mentioned as main barriers for role implementation. The current fee-for-service financing model of healthcare professionals was also seen as an impediment. Obstetricians considered the implementation of advanced midwife practitioner roles as a possible financial and professional threat. Documenting the added value of advanced midwife practitioner roles was regarded a prerequisite for gaining support to implement such roles. Healthcare managers’ and midwives’ attitudes towards these roles were considered essential. Participants warned against automatically transferring the concept of advanced practice nursing to midwifery. Although participants seldom discussed population healthcare needs as a driver for implementation, healthcare organizations’ heightened focus on quality improvement and client safety was seen as an opportunity for implementation. University hospitals were perceived as pioneers regarding advanced midwife practitioner roles. Key conclusions and implications for practiceMultiple factors influencing role implementation on a governmental, healthcare organizational, and workforce level illustrate the complexity of the implementation process, and highlight the need for a well-thought-out implementation plan involving all relevant stakeholders. Pilot projects for the implementation of advanced midwife practitioners in university hospitals might be useful.

Current status about certification of advanced midwife and expectation

Current status about certification of advanced midwife and expectation

Where are the consultant midwives?

Background Nearly two decades after the introduction of the consultant midwife post in the UK, little is understood about where they are and the roles they fulfil within their organisations. Aim A study was undertaken to determine the overall number of consultant midwives, explore the range of clinical specialities and map their location and coverage across the UK, Channel Islands and Isle of Man. Methods A survey and intelligence gathering exercise took place with an online survey being sent to key networks including Heads of Midwifery and consultant midwives in 2016/17. Findings A total of 84 consultant midwives were identified as being employed by around one third of the NHS Trusts and Health Boards. A number of issues were highlighted, including potential retirements and the gradual incorporation of managerial roles in the job description of consultant midwives. Conclusion Given the national imperatives for high quality maternity care, there needs to be a focus on succession planning and growth of the role of consultant midwives across all organisations.

‘Keeping birth normal’: Exploratory evaluation of a training package for midwives in an inner-city, alongside midwifery unit

Objectivesto gain understanding about how participants perceived the value and effectiveness of ‘Keeping Birth Normal’ training, barriers to implementing it in an along-side midwifery unit, and how the training might be enhanced in future iterations. Designexploratory interpretive. Settinginner-city maternity service. Participants31 midwives attending a one-day training package on one of three occasions. Methodsdata were collected using semi-structured observation of the training, a short feedback form (23/31 participants), and focus groups (28/31 participants). Feedback form data were analysed using summative content analysis, following which all data sets were pooled and thematically analysed using a template agreed by the researchers. FindingsWe identified six themes contributing to the workshop's effectiveness as perceived by participants. Three related to the workshop design: (1) balanced content, (2) sharing stories and strategies and (3) ‘less is more.’ And three related to the workshop leaders: (4) inspiration and influence, (5) cultural safety and (6) managing expectations. Cultural focus on risk and low prioritisation of normal birth were identified as barriers to implementing evidence-based practice supporting normal birth. Building a community of practice and the role of consultant midwives were identified as potential opportunities. Key conclusions and implications for practicea review of evidence, local statistics and practical skills using active educational approaches was important to this training. Two factors not directly related to content appeared equally important: catalysing a community of practice and the perceived power of workshop leaders to influence organisational systems limiting the agency of individual midwives. Cyclic, interactive training involving consultant midwives, senior midwives and the multidisciplinary team may be recommended to be most effective.

Healthcare professionals’ response to intrapartum death: a cross-sectional study

Exposure to adverse perinatal events can impact on the way healthcare professionals (HCPs) provide patient care. The aim of this study was to document the experiences of HCPs following exposure to intrapartum death (IPD), to identify opinions surrounding education and suitable support strategies, and to ascertain if involvement with an IPD had any impact on clinical practice. A questionnaire study, with open and closed questions, was developed and set in a tertiary maternity hospital. Consultant obstetricians, trainee obstetricians and midwives were invited to participate. Respondents were questioned about the impact that an intrapartum death had on them, the support they received in the immediate aftermath and their opinions regarding ongoing education and training in the areas of intrapartum death and self-care. Eighty percent of HCPs in our study had a direct involvement with an IPD. Most (82%) HCPs received no training in dealing with IPD while 94% had no education on self-care strategies. Despite it being desired by most (80%), debriefing was offered to just 11% of HCPs who were involved in an IPD. Three main qualitative themes emerged from the data; the personal impact of IPDs on HCPs, implications for professional practice and future patient care, and the importance on non-judgemental support. Maternity hospitals need to improve their support structures for HCPs following an IPD. It is hoped that this study will inform future educational practice and identify potential support strategies.

PERAN BIDAN DALAM PELAKSANAAN PERMENKES NOMOR 631/MENKES/ PER/III/2011 SEBAGAIMANA TELAH DIUBAH DENGAN PERMENKES NOMOR 2562/MENKES/PER/XII/2011 TENTANG PETUNJUK TEKNIS JAMINAN PERSALINAN (Studi Kasus Pelayanan Kebidanan Di RSUD dr. H. Soewondo Kendal

The role of midwives in service delivery assurance in dr. H. Soewondo Kendal based on Permenkes No. 2562/MENKES /PER/XII/2011 on Technical Guidelines for Labor Warranty. The aim is to implement the appropriate authority midwifery services, with the ultimate goal of reducing the MMR (Maternal Mortality Rate) and IMR (Infant Mortality Rate). If viewed from Permenkes 1464/Menkes /Per/X/2010 number of licenses and the implementation of midwifery practice, it is not really appropriate authority for the role of the midwife in the hospital to service delivery is a delivery service assurance of advanced midwives in hospitals. The scope of service includes pregnant women, maternity (risti), childbirth, newborns, family planning and treatment of complications in obstetrics. So based on the authority role of the midwife in the hospital should not be for the scope of services for maternity delivery guarantee (risti) and treatment of complications in obstetrics

Improving the care pathway for women who request Caesarean section: an experience-based co-design study.

BackgroundMaternal request for Caesarean section is controversial and yet the NICE Caesarean section Guideline recommends that that if this is requested, following discussion of the risks and benefits, women should be supported in their choice. There was a desire to improve the pathway at Birmingham Women’s NHS Foundation Trust.MethodsExperience-based co-design methodology uses service user and clinicians experiences collected using qualitative methods to jointly re-design services. Firstly semi-structured interviews were conducted to elicit the views and experiences of health care professionals and women who requested Caesarean section (with and without medical indication). Analysis identified key themes arising from the health care professionals’ interviews and ‘touch points’ (key moments or events related to the experience of care) arising from the interviews with women.. Separate workshops were then held with each group to ensure these resonated and to identify key areas for service improvement. At the first joint workshop a pathway using ‘audio clips’ demonstrating women’s agreed ‘touch points’ prompted discussion and joint working began to change the pathway. A final second workshop was held to agree changes to the pathway.ResultsInterviews were conducted with health care professionals (n = 22, 10 consultant obstetricians and 12 midwives) and women (n = 15). The women’s ‘touch points’ included repetition of request, delay in the decision for Caesarean section to be made, feeling judged, and that information was poor with similar findings identified from the health care professionals. Joint working resulted in a revised pathway for women who request Caesarean section. Changes to the pathway for women as a result of the work include written information about ‘The way your baby may be born’ which is given to the woman followed by a discussion about mode of birth around the 16 week appointment. If the woman wishes to have a Caesarean section, referral is made to appropriate health care professionals (e.g., Consultant Midwife, counsellor) only if support and information would be useful. If Caesarean section is requested, woman is referred to a consultant obstetrician for an appointment at 20/40, with a decision by 28/40. Recording this in the notes minimises repeated challenge described by women. Final consent and timing of Caesarean section remain as recommended.ConclusionThis has resulted in changes to the pathway agreed by a co-design process and which are acceptable to both health care professionals and women. Use of such methodologies should be considered more frequently when implementing service change.