Group Of Midwives Research Articles

Finding a way: The experiences of UK educated midwives finding their place in the midwifery workforce in Australia

Background the number of midwives and nurses migrating from the United Kingdom (UK) and seeking registration in Australia is growing annually. Studies examining nurse migration have yet to identify features of the experience that apply specifically to the midwifery workforce. This information is vital to inform future international recruitment practice and to promote midwifery retention. This paper reports on a study examining the experiences of a group of midwives from the United Kingdom settling into the workforce within one state in Australia. Design this descriptive phenomenological study examined the lived experience of UK migrant midwives practising in Queensland using open ended interviews and reflective journaling. Data analysis was conducted following the guidance of Moustakas, adapted from the van Kaam method of analysis of phenomenological data. Setting all data gathered from midwives living and working in Queensland. Participants midwives ( n=18) working in Queensland who had left the UK after 1 January 2000. Findings a central theme emerging from participants' experiences is described as ‘finding a way’. Their experience was encompassed in a model of acculturation used by the midwives to find their way through the health-care systems in Queensland to be the kind of midwife that suited them and their life style. The three ways of being were influential association, capitulation and detachment. The most common feature of the experience was that of influential association. Key conclusions midwives need to be well informed to provide realistic expectations prior to migration. Recruitment and management personnel should seek to match midwifery capacity with roles where their skills will be maximised.

Genetic educational needs and the role of genetics in primary care: a focus group study with multiple perspectives

BackgroundAvailable evidence suggests that improvements in genetics education are needed to prepare primary care providers for the impact of ongoing rapid advances in genomics. Postgraduate (physician training) and master (midwifery training) programmes in primary care and public health are failing to meet these perceived educational needs. The aim of this study was to explore the role of genetics in primary care (i.e. family medicine and midwifery care) and the need for education in this area as perceived by primary care providers, patient advocacy groups and clinical genetics professionals.MethodsForty-four participants took part in three types of focus groups: mono-disciplinary groups of general practitioners and midwives, respectively and multidisciplinary groups composed of a diverse set of experts. The focus group sessions were audio-taped, transcribed verbatim and analysed using content analysis. Recurrent themes were identified.ResultsFour themes emerged regarding the educational needs and the role of genetics in primary care: (1) genetics knowledge, (2) family history, (3) ethical dilemmas and psychosocial effects in relation to genetics and (4) insight into the organisation and role of clinical genetics services. These themes reflect a shift in the role of genetics in primary care with implications for education. Although all focus group participants acknowledged the importance of genetics education, general practitioners felt this need more urgently than midwives and more strongly emphasized their perceived knowledge deficiencies.ConclusionThe responsibilities of primary care providers with regard to genetics require further study. The results of this study will help to develop effective genetics education strategies to improve primary care providers' competencies in this area. More research into the educational priorities in genetics is needed to design courses that are suitable for postgraduate and master programmes for general practitioners and midwives.

Male Midwives in France

Of 19,208 midwives polled in France in 2010, 349 were men. Based on interviews from a selected group of male midwives and midwifery students, as well as data from a recent study of the midwife profession in France, this study shows that the masculinity brought to this profession by male practitioners can be qualified as respective masculinity. This theoretical perspective permits a broader consideration of the existing models that explain male presence in non-traditional professions. These models describe their presence as either a power struggle, a means by which to be promoted, or even as a possible questioning of male identity. Male midwives assert their masculinity by seeking autonomy in their work. They are able to work around the obstacle of showing empathy to female patients, typically considered a gendered predisposition. The case of male midwives shows the dynamics of masculinization when taking into account socio-professional contexts.

Using video narratives of women's lived experience of breastfeeding in midwifery education: exploring its impact on midwives' attitudes to breastfeeding

Strong evidence supports the health benefits of breastfeeding contributing to the public health campaign to improve initiation and duration of breastfeeding globally, yet breastfeeding continuation rates are persistently low in the UK. Inadequate support from health professionals appears to be an underlying feature, aggravated by a dearth of professional education that uses a biopsychosocial approach. This paper describes how using women's video narratives of their lived experience of breastfeeding within higher education impacted positively on the attitudes of a group of midwives in relation to supporting breastfeeding women. It reports on the qualitative element of a two-phase sequential mixed methods study where focus group methods generated rich data about how and why the educational intervention altered attitudes. Analysis was thematic. Six major themes emerged, 'listening and learning from real women's experiences'; 'generation of emotions'; 'acquisition of new knowledge and learning'; 'reflection on practice'; 'promotion of independent learning' and 'sharing learning and ideas with peers'. 'Listening and learning from real women's experiences' was central to learning, and was pivotal to attitudinal change, motivating an intense need to improve practice. Findings support the value of using women's video narratives within midwifery education, through their power to integrate affective and cognitive learning, and to promote a transformative learning process. This novel approach brings value-added learning benefits by enhancing the potential to improve attitudes towards supporting breastfeeding women and improving clinical practice.

Birth Companions: working with women in prison giving birth

The needs of women giving birth from prison were highlighted in 1995. A group of antenatal teachers and midwives in London met and decided to offer birth support to women in Holloway prison. Birth Companions has been working with pregnant women and mothers and babies in Holloway for 14 years and has expanded the birth support service to include breastfeeding and working with women post release. The aim of the project is to improve the experience of this vulnerable group of women and babies. Studies show that birth support can improve outcomes for mothers and babies and the feedback from women in Holloway is very encouraging. However, there is a need for more research into the needs and experiences of women and babies who are in prison during the perinatal period.

Access to Skilled Care at Home during Pregnancy and Childbirth: Dhaka Bangladesh

In Bangladesh the majority of childbirth takes place at home by unskilled persons. The objective of this study was to strengthen maternity care services through provision of skilled midwives and to explore people's perception of skilled birth attendants. As part of a quasi-experimental community trial conducted among selected urban area of Dhaka city, a group of skilled midwives were posted in selected urban centers between January to December 2002 to provide obstetric care services and some social mobilization activity in the community. Analysis of skilled midwives self-reported case records and monitory reports of the researchers was done on selected themes. The perception of the skilled midwife was not clear to people. They thought traditional birth attendants who conducts delivery over years were skilled midwives. Preparedness for obstetric emergency and birth planning was non-existent in the families. The skilled midwives were well accepted in the community but discouraged by center authority for home birth, apprehending that it will reduce their client flow and earning. Non-cooperation by other health care providers was common.

Counselling young immigrant women worried about problems related to the protection of ‘family honour’- from the perspective of midwives and counsellors at youth health clinics

Annually, thousands of women are exposed to violence and murder by male relatives in the name of family honour. In Sweden young women with immigrant backgrounds consult primary healthcare services for problems related to the protection of 'family honour' (PFH). However, there is little knowledge about how to manage this specific type of family violence in the primary healthcare systems of industrialized countries. To generate a theoretical model to promote knowledge about how youth clinic (YC) personnel in Swedish primary care perceive and manage problems related to the PFH. Seven midwives and five counsellors at four YCs in Stockholm suburbs participated in four group interviews. Data were analysed according to the grounded theory method. The YC staff's main concern is to avoid making the young womens' situation worse with their constant anxiety about having breeched the 'honour rules'. Three consecutive steps have been discerned in the worry analysis process to help the girls struggling with problems related to PFH: (i) creation of a refuge where their secret can be safely disclosed, (ii) risk assessment consisting of assessing the degree of the young women's anxiety, the risk of disclosure of the secret and the risk of repercussions if the secret is disclosed and (iii) worry-reducing measures, which may take the form of four different strategies: empowerment, keeping the secret, mediation and secondary prevention. Youth clinics have a key role in preventing repercussions caused by problems related to PFH. The study provides a theoretical model that can be used as a tool in preventive work with young women anxious about honour-related family violence. The findings were presented to a group of midwives and counsellors for validation.

Dar a luz en Chile, siglo XIX: De la “ciencia de hembra” a la ciencia obstétrica

Dar a luz en Chile, siglo XIX: De la “ciencia de hembra” a la ciencia obstétrica

WHO maternal death and near-miss classifications

Reducing maternal mortality is Millennium Development Goal 5. To reach this goal, countries need an accurate picture of the causes and levels of maternal deaths. Recent systematic reviews have shown that there are many inconsistencies in the way maternal deaths are classified due to a lack of standard definitions and criteria for maternal deaths and near misses.1,2 WHO established a technical working group of obstetricians, midwives, epidemiologists and public health professionals from developing and developed countries to develop a maternal death classification system. The group established three principles for its work. First, the classification must be practical and understood by its users (clinicians, epidemiologists and programme managers), Second, underlying causes must be exclusive of all other conditions; as in the International Statistical Classification of Diseases and Related Health Problems (ICD), the underlying cause is the disease or injury which initiated the sequence of events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury. Third, the new classification system should be compatible with and contribute to the 11th revision of the ICD. Incorporating this maternal death classification into the ICD will encourage consistent use in both death certificates and confidential enquiries into maternal deaths, and improve the comparability of data. The proposed maternal death classification system was sent to more than 40 individual reviewers and the International Federation of Gynecology and Obstetrics, the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) and national professional organizations including the Royal College of Obstetricians and Gynaecologists, the American College of Obstetricians and Gynecologists and the Canadian College of Obstetricians and Gynaecologists. Revised after this feedback, the second version was tested on eight databases of maternal deaths: national databases from Colombia, Jamaica and South Africa, other databases from Kenya, Malawi and Zimbabwe and verbal autopsy data from Afghanistan and Nigeria. All sites found the classification workable and useful. The new WHO classification of cause of maternal death has a simple structure to facilitate tabulation: group, disease category and individual underlying causes. The group includes three categories: direct maternal deaths, indirect maternal deaths and “unanticipated complications of management”. This addition makes it possible to track trends in iatrogenic disease as, for example, related to caesarean sections. Underlying causes are clearly separated from conditions contributing to fatal outcomes. Finally, the working group decided to classify suicide in pregnancy, deaths from puerperal psychosis and postpartum depression in the category of direct maternal deaths.3 The working group reached consensus on how to define maternal near miss – “a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy”.4 Signs of organ dysfunction that follow life-threatening conditions are used to identify maternal near misses so that the same classification of underlying causes is used for both maternal deaths and near misses. This consistency also enables assessments of the quality of care provided to pregnant women. The WHO technical working group recommends that the new maternal death classification system be adopted by all countries and the maternal near-miss approach be considered in national plans for improving maternal health. By using the same classifications, reliable comparisons can be made within and between countries and regions. Applying this classification should help to identify the health system shortfalls that countries need to address in order to reduce complications and fatal outcomes of pregnancy and childbirth. ■

Smoking cessation intervention among pregnant women in South Africa

The objective was to determine the practices and beliefs of disadvantaged women with high smoking rates, their perceptions of antenatal services and their preference for smoking cessation intervention materials. The readiness of smokers to quit, in terms of stages of change, was also determined. The study took place in public sector antenatal clinics situated in Cape Town, Kimberley, Port Elizabeth, Johannesburg and Pretoria that provide care to predominantly women of mixed ancestral descent. A cross-sectional survey was used. Data were collected via a self-administered questionnaire from pregnant women who were currently smoking, had quit smoking before or during pregnancy and who had never smoked. A total of 796 women were interviewed of which 365 (45.9%) were smokers, 117 (14.7%) were quitters and 314 (39.4%) were non-smokers. Being in the pre-contemplation stage was reported by 28%, 36% indicated that they thought about quitting, while 36% said that they were in the preparation stage. Of the smokers and quitters 9.3% had stopped in the last 6 months (action stage), and 15% had stopped for longer (maintenance phase). 86% of women reported satisfaction with midwives and more than 60% rated interactive intervention methods such as support groups and talks by women who had stopped smoking most favourably. Most women who smoked were contemplating or preparing to stop smoking. Intervention programmes should target these groups of women and midwives could be used to implement the interventions by facilitating support from women who had successfully quit.

Managing demand: telephone triage in acute maternity services

A project providing triage in acute maternity settings was developed to better manage demand and ensure the right service was available at the right time and in the right place. Data collected prior to implementing the telephone triage project identified that a significant number of women accessed the labour ward as their first point of contact for advice with maternity services resulting in an unnecessarily high volume and throughput where labour ward was in effect gate-keeping other clinical areas. The project was designed and introduced to maximize the use of the clinical expertise possessed by a group of practice development midwives. Early results suggest that demand and patient flow is better managed following the introduction of the telephone triage service. The development of a telephone triage service within an acute maternity service is beneficial and can result in a reduction in inappropriate admissions. There are benefits at a client, clinician, service and organizational level.

Managing a work–life balance: the experiences of midwives working in a group practice setting

Objective To explore how a group of midwives achieved a work–life balance working within a caseload model of care with flexible work hours and on-call work. Design in-depth interviews were conducted and the data were analysed using a data-driven thematic analysis technique. Setting Children, Youth and Women's Health Service (CYWHS) (previously Women's and Children's Hospital), Adelaide, where a midwifery service known as Midwifery Group Practice (MGP) offers a caseload model of care to women within a midwife-managed unit. Participants 17 midwives who were currently working, or had previously worked, in MGP. Findings analysis of the midwives’ individual experiences provided insight into how midwives managed the flexible hours and on-call work to achieve a sustainable work–life balance within a caseload model of care. Key conclusions it is important for midwives working in MGP to actively manage the flexibility of their role with time on call. Organisational, team and individual structure influenced how flexibility of hours was managed; however, a period of adjustment was required to achieve this balance. Implications the study findings offer a description of effective, sustainable strategies to manage flexible hours and on-call work that may assist other midwives working in a similar role or considering this type of work setting.

Obstetricians’ and Midwives’ Attitudes toward Cesarean Section

The cesarean section rate has increased worldwide over the past 20 years; in Italy, it is now more than 35 percent. Although clinical factors are important, the attitudes of health practitioners toward cesarean section need further investigation to correctly identify facilitators and barriers to changes. The objective of this study was to explore the attitudes toward cesarean section of midwives and obstetricians who worked in the same geographical area. Face-to-face structured interviews using an adaptation of the Survey of Clinicians' Views on Caesarean Section, an anonymous questionnaire with 35 open and closed answers on practitioners' views on cesarean section, were conducted. The questionnaire was given to the entire group of midwives and obstetricians working in Modena, a northern Italian district. Of 262 eligible practitioners, 248 were interviewed (response rate 94.6%). The midwives' attitudes toward cesarean section differed from those of the obstetricians. Sixty-five percent of midwives considered the rates of cesarean section in their hospitals to be too high compared with 34 percent of obstetricians (p < 0.001). Midwives were also less inclined to believe that cesarean section provides benefits to the mother (p = 0.02) or that it is indicated by previous cesarean delivery (p < 0.001). No differences were observed between male and female obstetricians. In this survey, the attitudes toward cesarean section were correlated more with professional role than with gender. This information can help policy makers to shape interventions aimed at providing better care for pregnant and childbearing women.

A healthy settings framework: an evaluation and comparison of midwives’ responses to addressing domestic violence

Objectives to compare and contrast how midwives working in either hospital- or community-based settings address domestic violence by evaluating their views on: prevalence of domestic violence; their role in addressing domestic violence; the acceptability of routine enquiry; and barriers encountered in asking clients questions about violence and abuse in pregnancy. Design a postal survey questionnaire. Setting Northern Ireland. Study population 983 hospital and community midwives. Findings overall, 488 midwives returned a completed questionnaire; a 57% response rate. Comparisons were made using descriptive, inferential statistics and cross-tabulation. Although there were significant differences between hospital- and community-based midwives in relation to domestic violence, both groups of midwives tended to underestimate its prevalence. Key conclusions the findings suggest that midwives per se identify and respond to a fraction of the cases of domestic abuse in pregnancy, due to lack of confidence, education and training. This reinforces the need for both hospital and community midwives to gain further confidence and an understanding of the many psychosocial factors that surround domestic violence. Implications for practice healthy settings theory can be used effectively to identify good practice with women who experience domestic violence. Effective investment for health care requires the gaps between hospital- and community-based practice to be bridged, and for work to be integrated.

Kecerdasan Emosional Bidan Desa serta Kaitannya dengan Kinerja Mereka dalam Pelaksanaan Tugas

The midwives have an importance role in lowering death rate of giving birth women. Therefore, it is necessary for them to have the optimal performance on their duty. On the other hand, Emotional Quotient is the capability to motivate themselves, hold not to be frustrated, arrange sense of filling, an empathy and to prevent of stress in order to maintain their thought capability, and to keep human relation. This study was aimed to find out the performance of the midwives in their duty, their Emotional Quotient, and correlation between them. The population studied was a group of midwives working in Bogor in 2004. A number of 70 midwives was purposively selected fulfilling two criteria i.e. at least one year experience and voluntarily available to join the study. Variable of performance included capability to care pregnant women, post partum women, helping to give birth to and to lead the traditional midwives. The study showed that 48.6% of the midwives had high performance, and 41.4% had sufficient performance. Meanwhile, their Emotional Quotient, were 38.6% sufficient, but some of them (34.3%) showed high Emotional Quotient. Furthermore, there was a positive correlation between performance and Emotional Quotient of the midwives. The higher the Emotional Quotient, the higher their performance or 18.2% of their performance was determined by their Emotional Quotient.

Institutionalized disadvantage: older Ghanaian nurses’ and midwives’ reflections on career progression and stagnation in the NHS

This paper explores the perceptions of career progression in the NHS of a group of midwives and nurses trained in Ghana and working in the UK. It draws on semi-structured interviews with nurses, midwives and managers which were conducted as part of the Researching Equal Opportunities for Overseas trained Health Professionals project (REOH). Research into overseas nurses in the UK has tended to focus on their experiences of discrimination in relationships with colleagues, managers and patients. There is limited statistical evidence indicating that migrant nurses experience slower career progression than their UK-trained counterparts. However, there is little analysis of their experiences and perceptions of the process of career progression or their understandings of the factors that could account for their limited entry into higher grades. This paper argues that many Ghanaian nurses and midwives can experience difficulty in progressing into senior positions because of cultural differences and gaps in knowledge. However, this paper indicates that these problems can become institutionalized and entrenched by practices on the ward, particularly support from managers being dispensed as patronage that is not given equally to all. This creates an informal system of promotion to management which is not transparent, is based on subjective and culturally specific criteria and can undermine egalitarian formal procedures and create spaces where discriminatory practices can operate. These processes can lead to sectors of the workforce becoming demoralized, to the wastage of skills and other resources and problems in staff retention.

New midwifery? A qualitative analysis of midwives’ decision‐making strategies

This paper is a report of a study to explore the reasons why midwives decided to adopt observed decision-making strategies relating to the use of technology. Literature on the development of midwifery and nursing has suggested that they are developing more egalitarian relationships with clients in decision-making processes. A qualitative approach was adopted, using participant observation with a convenience sample of midwives (n=16), and a focus group of midwives (n=8). Data collection took place over 9 months in 2004. The dominant mode of decision-making was bureaucratic decision-making, which involved adherence to written policies and procedures. The least frequently used was 'new professional' decision-making, which involved collaboration with clients. The reasons for midwives' approaches could be categorized under three main headings: first, context, including possible litigation, management strategies, workload pressures, and medical dominance; second, midwives' characteristics, including both lack of experience and the reliance on tradition of some experienced midwives; and third, women's perceived characteristics, some of whom were seen by midwives as either unwilling or unable to participate in decision-making. There was also implicit evidence that some midwives were uncomfortable with the new professional rebalancing of power relations between professionals and the laity. Managers need to question whether the strategies they adopt hinder or support clinicians in their efforts to involve women in decisions. Clinicians need to consider whether they wish to be selective or universal in their use of new professional strategies.

An evaluation, at the 1-year stage, of a 3-year project to introduce practice education facilitators to NHS Tayside and Fife

As a result of the Scottish Executive Health Department (SEHD) initiative, Facing the Future [Scottish Executive Health Department, 2002. Facing the Future. SEHD, Edinburgh], a need was identified for a group of experienced nurses and midwives to help support students and mentors within practice settings. It was agreed to fund one hundred "G" grade posts across NHS Scotland for an initial period of three years. As a result of this initiative, in 2004 a group of fifteen Practice Education Facilitators (PEFs) were employed by NHS Tayside and NHS Fife in Scotland. Their brief was to maintain and improve learning environments within the practice setting. This paper describes an evaluation of this new role as carried out at key stages within the first year of the project. A combination of focus groups and questionnaires were used, both to analyse the perceptions of the NHS staff that PEFs would be working with and to explore the lived experience of the PEFs during their first year in post. There was a general welcome for the role across all groups. Perceptions varied on the PEF role itself, most staff groups expecting PEFs to work mainly with students. The PEFs, however, saw the main thrust of their work with mentors, their associates and other staff.

The development and testing of an algorithm for diagnosis of active labour in primiparous women

Objectives to describe the development and testing of an algorithm for diagnosis of active labour in primiparous women. Design qualitative and quantitative methods were used. A literature review was first conducted to identify the key cues for inclusion in the algorithm. Focus groups of midwives were then conducted to assess content validity, finally a vignette study assessed the inter-rater reliability of the algorithm. Setting midwives from two study sites were invited to participate. Data were collected during 2002 and 2003. Participants midwives from the first site took part in the focus groups ( n=13), completed vignettes ( n=19), or both. Midwives from the second site then completed vignettes ( n=17). Findings an algorithm, developed from the key informational cues reported in the literature, was validated in relation to content validity by the findings from the focus groups. Inter-rater reliability was tested using vignettes of admission case histories and was found to be moderate in the first test ( K = 0.45 ). However, after modifying the algorithm the kappa score was 0.86, indicating a high level of agreement. Key conclusions diagnosis of labour may be straightforward on paper but is frequently problematic in practice. This may be because the diagnosis of labour is made in a high pressured environment where conflicting pressures of workload, limited resources and emotional pressures add to the complexity of the judgement. Implications for practice we offer a valid and reliable decision-support tool as an aid for diagnosis of labour. The evaluation of the implementation of this tool is under way and will determine whether it is effective in reducing unnecessary admissions and improving clinical outcomes for women.

Homeopathy as a choice: the new holistic antenatal clinic

Increasing numbers of pregnant women are turning to homeopathy and other complementary therapies to help with pregnancy and childbirth. In response to this, a programme was put together to provide safe education and treatment by a multidisciplinary team of professionals. Working collaboratively, a multidisciplinary group of midwives and staff from two departments within a large NHS Trust have set up this innovative new service. This paper describes a pilot scheme to introduce homeopathy and other complementary therapies into mainstream care provision. Pregnant women can attend the new clinic for their routine follow up antenatal checks and at the same time experience a parent education session initially including homeopathy, stress management and relaxation, and also nutrition for mother and baby.