Midwife Practitioner Research Articles

Bouncing your way to labour and birth using biomechanics and fetal optimal positioning

Background/Aims ‘Labour hopscotch’ is a visual tool that encourages activity during pregnancy and childbirth. It has been used in one advanced midwife practitioner service since 2017 and more widely across in Ireland since 2020. The biomechanics for birth toolkit was added to advanced midwife practitioner care in 2022. This study's aim was to ascertain if the biomechanics for birth toolkit impacted gestation of spontaneous onset of labour rates and birth outcomes. Methods A retrospective study of onset of labour and birth outcomes was conducted for women before (n=155) and after (n=154) the biomechanics for birth toolkit was incorporated into care. Results Before the toolkit was included, there was a 57.2% spontaneous onset of labour rate, with 33.2% birthing before 41 weeks. After the kit's inclusion, there was a 72.2% spontaneous onset of labour, with 91.8% birthing before 41 weeks. Induction rates dropped from 42.8% to 27.8%, with emergency caesarean section rates following induction dropping from 33.1% to 23.8%. Conclusions Using the biomechanics for birth toolkit alongside the labour hopscotch tool could increase spontaneous onset of labour rates, optimise physiological birth, reduce inductions and emergency caesarean section following induction.

Advanced nurse and midwife practitioners' experience of interprofessional collaboration when implementing evidence-based practice into routine care: An interpretative phenomenological analysis.

To understand advanced nurse and midwife practitioners' experience of interprofessional collaboration in implementing evidence-based practice into routine care. A qualitative interpretative phenomenological analysis. A purposeful sample of 10 Registered Advanced Nurse and Midwife Practitioners from a range of practice settings in the Republic of Ireland participated in semi-structured interviews over a 10-month timeframe. Interviews were transcribed verbatim and data were analysed using a multi-stage approach in line with guidance for interpretative phenomenological analysis. Six superordinate themes emerged: Understanding of advanced practice; 'Treated as an equal and as a "nurse"'; Nursing management support; 'A voice to implement anything new'; Confidence and Emotional intelligence. These factors impacted interprofessional relationships and the extent to which advanced practitioners could implement evidence-based practice. There is scope to improve advanced practitioners' ability to collaborate with the interprofessional team in implementing evidence-based practice into routine care. The study findings demonstrate that enhancing understanding of the advanced practice role; increasing organizational support for advanced practitioners and augmenting specific practitioner skills and attributes will increase their ability to collaborate effectively and implement evidence-based practice. Supporting advanced practitioners in this important aspect of their role will positively influence health outcomes for patients. As numbers of both nurse and midwife practitioners increase globally, this study provides timely evidence from a range of practice settings to guide the design of education programmes and policies governing advanced practice. Study recommendations have broad applicability to all healthcare professionals who are engaged in implementing evidence-based practice into routine care. Consolidated criteria for reporting qualitative research (COREQ). No patient or public contribution.

The Insler and Johnson formulas for determining estimated fetal weight to baby's birth weight

Fetal weight has a very important meaning for planning midwifery care. Deviations found can be corrected immediately both during pregnancy and childbirth so that treatment is carried out on time. Clinical decisions made include the choice of type of delivery. This is expected to improve pregnancy outcomes for the welfare of the mother and fetus. The purpose of this study was to determine the difference in estimated fetal weight using the Insler Formula and the Johnson Formula compared to the baby's birth weight. This study used a cross sectional design. Sample taken by consecutive sampling. The criteria selected were third trimester pregnant women > 37-42 weeks pregnant, carrying out pregnancy checks until giving birth at the Garuda and Ibrahim Aji Public Health Centers in Bandung City from July to November 2022. Estimated fetal weight was measured during antenatal checks using the Insler and Johnson formulas. The estimated fetal weight is compared with the actual weight of the newborn. Based on the results of a study that compared the estimated fetal weight with the baby's birth weight, it was found that there was no significant difference between the use of the Insler and Johnson formulas to measure the estimated fetal weight and birth weight p value > 0.05. The Johnson and Insler formula can be applied by student midwives or midwife practitioners when conducting antenatal care in the third trimester (gestational age > 37-42 weeks). This formula is a simple detection method, using simple tools, easy to obtain and can be used anytime and anywhere, namely a measuring tape. In addition, the measurement guidelines and calculation formulas are simple and easy to apply.

Women's experiences accessing continuity of care in Ireland: a qualitative study

Background/Aims In January 2017, a continuity of care advanced midwife practitioner service was introduced in an Irish maternity unit. Continuity is central to high-quality maternity care, but little is known about it at an advanced practice level or about women's experiences of this model of caregiving. This study's aim was to provide insight into the experiences of women accessing a continuity of care service in Ireland. Methods A qualitative descriptive design and thematic analysis was used. A total of 11 women, who attended the advanced midwifery practitioner service and had experienced a different model of care in a previous pregnancy, were interviewed. Results Two themes were identified. Positive comparison to previous care, which had three subthemes, and access to the advanced midwifery practitioner, with four subthemes. Conclusions Continuity from an approachable and competent practitioner with time for discussion and unscheduled access to the service was rated highly. Participants wanted to ‘future proof’ the service and recommended that continuity of care needs to be available to all pregnant women and at the forefront of service development.

VBAC or elective CS? An exploration of decision-making process employed by women on their mode of birth following a previous lower segment caesarean section

BackgroundPart of the caseload of an Advanced Midwife Practitioner (AMP) service in a Northwest of Ireland maternity unit includes vaginal birth after caesarean section (VBAC) women. Despite evidence about VBAC being a safe option for women, the numbers attempting a VBAC remain small. This research was undertaken to give an insight into how VBAC eligible women opt for an elective repeat CS (ERCS) or VBAC birth. MethodsForty-four postnatal women with one previous CS who birthed between August 2021 and March 2022 were invited to participate in a qualitative study. Thirteen semi-structured interviews were undertaken in 2022. Thematic Analysis guided the analysis of the data and the findings are framed using the domains of the Socio-Ecological Model. FindingsDecision making in relation to ERCS and VBAC is complex. Women want accurate VBAC information and time for discussions. Decisions are influenced by the woman’s own confidence to birth naturally, family size, rite of passage to motherhood, control, previous birth experience, postnatal recovery and friends and family. DiscussionPrevious experience can influence but not predict the next mode of birth. However, there is no one script that healthcare professionals (HCP) can use for this decision making given the various factors that influence this. To meet women’s individual needs, HCPs should discuss VBAC suitability postnatally, offer VBAC antenatal clinics and specific VBAC classes. ConclusionDiscussions about suitability for VBAC should occur following the primary CS. Continuity of care (COC), time for discussions and VBAC supportive HCP should be an option for all of this cohort.

To weigh or not to weigh in pregnancy: a retrospective study

Introduction A rise in the number of caesarean sections and the rate of birth weight over 4kg prompted an advanced midwife practitioner service to introduce routine weighing for all service users and target weight gain based on Institute of Medicine guidelines. The study's aims were to ascertain if maintaining weight gain reduced pre-eclampsia, caesarean section births, birth weight over 4kg and neonatal intensive care unit admissions. Methods A retrospective study of weight gain and outcomes for 53 pre- and 46 post-routine weighing service users was conducted. Results Over a third (40%) of participants gained excess weight, with a 22% caesarean section rate and 22% of babies weighed over 4kg at birth. There was an overall 6% reduction in caesarean section births and a 22% reduction in babies weighing over 4kg. Conclusions Routine weighing and health promotion techniques have the potential to maximise health and wellbeing and could be a long-term investment in the health and wellbeing of mothers and babies.

The nutritional needs of moderate-late preterm infants.

This article discusses the nutritional needs of moderate and late preterm infants (born between 32+0weeks and 36+6weeks' gestation) and makes recommendations for best practice both while these infants are in hospital and when they are discharged into the community. These recommendations were derived following a roundtable meeting of a group comprising two neonatologists, three paediatric dietitians, a health visitor/paediatric nurse and a midwife practitioner. The meeting and medical writing assistance was sponsored by Nutricia. None of the participants accepted honoraria for their contributions to the discussion.

Using Service Users’ Feedback to Inform and Evolve an Irish Advanced Midwife Practitioner Service

This article, the last in a two-part series, reports the service users’ feedback of Advanced Midwife Practitioner (AMP) care using a specially designed online Surveyhero® questionnaire. The findings will be used to inform and evolve the service. The response rate was 23%. Surveyhero® automatically reported the quantitative data in graphs. Thematic analysis was used to interpret the qualitative responses. The service was rated favourably by the users. They wanted more information on emergency procedures and more written discharge information. They also want more AMPs, the service to be extended to seven days a week and to include intrapartum care and a postnatal follow-up appointment.

Using Service Users’ Feedback to Inform and Evolve an Irish Advanced Midwife Practitioner Service

In The Spotlight 1. Using Service Users’ Feedback To Inform And Evolve An Irish Advanced Midwife Practitioner Service Roisin Lennon – Registered Advanced Midwife Practitioner, Women and Infants Service, Sligo University Hospital, The Mall, Sligo, Republic of Ireland Twitter @roisingetz Summary This article is the first in a two-part series that provides an insight into […]

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.

The Assessment of Continuous Antenatal Care Competence in Midwifery Diploma Education: Instrument Development and Content Validation

This research aims to develop a construct of an assessment instrument of the continuous antenatal care in Midwifery Diploma Education, as well as to carry out the validity of the instrument developed. This research is a development study that adopts and modifies the procedures of Wilson Model and Oriondo Model, which consist of 3 steps that are: 1) preliminary study 2) test design; 3) trial (content validity). The construct of the continuous ANC competence assessment instrument in the Midwifery Diploma education is 18 constructs in the form of basic competence (BC). The number of question items arranged in accordance with the number of indicators in the BC and CS, which were 116 items. Instrument items that had been developed were then assessed by experts using the Delphi method. The number of experts validating the contents was 21 experts, consisting of 15 experts from ANC lecturers from the Poltekkes Surakarta and Poltekkes Yogyakarta and also involving six experts from the midwife practitioners. The results of expert assessments (content validity) are then calculated using the Aiken approach. The calculation results show the average index obtained on the ANC assessment instrument of 0.830, which means that the instrument content is declared as valid and can be used to measure ANC competence.

Midwifery students’ experiences and expectations of using a model of holistic reflection

BackgroundReflective practice is a core professional competency and the hallmark of an autonomous, evidence-based midwife practitioner committed to lifelong learning. Despite this professional imperative little is currently known about how the development of reflective capacity is facilitated with midwifery students. AimThis study aimed to determine (1) the extent to which a holistic, structured model of reflection develops reflective capacity in midwifery students; and (2) their perceptions of learning and teaching strategies that build reflective capacity. DesignA qualitative cross-sectional design involving focus groups and thematic analysis. ParticipantsThe Bass Model of Holistic Reflection was introduced to promote development of reflective capacity in midwifery students enrolled in entry to practice programs in two Australian universities. Students were provided with guidance on how to apply the model to their reflections. After using the model for at least one trimester twenty-seven (27) participants volunteered to participate in focus groups. FindingsFour themes emerged ‘safe space within a circle of trust’, ‘deep personal learning’, ‘consistency of application by skilled facilitators’, and ‘integration and connection’. Key conclusions and implications for practiceUse of a holistic model combined with integrative and structured reflective activities supports the scaffolded and developmental nature of reflection. Alignment of the model with a woman centred midwifery philosophy generates midwifery knowledge and reflects student expectations of their role as aspiring midwives. Midwives’ attitudes regarding reflection influences students’ perceptions of value. Quality of feedback provided by educators affects levels of student motivation and engagement with reflection.

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.

Operating department practitioners and midwives: The undervalued obstetric care collaboration

More than one-quarter of births in the UK are reported to be by caesarean section, requiring the skills and expertise of operating department practitioners (ODPs) and midwives, an often-overlooked care collaboration. This reflective case study looks back at an experience that the author, a registered ODP, had as a third-year student. It provides an example of how a lack of understanding of roles and poor interprofessional communication between the midwife and postoperative practitioner detrimentally affected a woman's care. The aim is to demonstrate areas for improvement and make recommendations highlighting the need for inclusive education and learning in perioperative obstetric care.

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.

Standards for midwife practitioners of external cephalic version: A Delphi study

Introductionexpansion of advanced and specialist midwifery practitioner roles across professional boundaries requires an evidence-based framework to evaluate achievement and maintenance of competency. In order to develop the role of Breech Specialist Midwife to include the autonomous performance of external cephalic version within one hospital, guidance was required on standards of training and skill development, particularly in the use of ultrasound. Methodsa three-round Delphi survey was used to determine consensus among an expert panel, including highly experienced obstetric and midwife practitioners, as well as sonographers. The first round used mostly open-ended questions to gather data, from which statements were formed and returned to the panel for evaluation in subsequent rounds. Findingsstandards for achieving and maintaining competence to perform ECV, and in the use of basic third trimester ultrasound as part of this practice, should be the same for midwives and doctors. The maintenance of proficiency requires regular practice. Conclusionsmidwives can appropriately expand their sphere of practice to include ECV and basic third trimester ultrasound, according to internal guidelines, following the completion of a competency-based training programme roughly equivalent to those used to guide obstetric training. Ideally, ECV services should be offered in organised clinics where individual practitioners in either profession are able to perform approximately 30 or more ECVs per year in order to maintain an appropriate level of skill.

Advanced nurse practitioner registration in Ireland: An RANP cardiology's experience

Advanced nursing practice in Ireland is tightly regulated by the Nursing and Midwifery Board of Ireland (NMBI) with a structured framework for registered advanced nurse practitioner/advanced midwife practitioner (RANP/AMP) post accreditation and individual registration. The process leading to successful RANP/AMP registration is multifactorial incorporating: education to master's degree; site preparation; job description creation; competency attainment; evidence of 500 hours of supervised clinical practice; and portfolio submission. As a recently registered RANP (cardiology), the author of this article aims to highlight the key aspects of the process, including the scope of practice, evidence of the benefits of advanced nursing practice, the framework of nursing practice and patient safety.

Measuring job satisfaction of advanced nurse practitioners and advanced midwife practitioners in the Republic of Ireland: a survey

To describe the level of job satisfaction of advanced nurse practitioners (ANP) and advanced midwife practitioners in the Republic of Ireland (RoI). Job satisfaction is related to productivity, performance, turnover and health, and thus is a challenge for nursing and healthcare organisations. Job satisfaction data were collected from 47 ANPs using the Misener Nurse Practitioner Job Satisfaction Scale. High levels of global job satisfaction were reported. All ANPs reported satisfaction with autonomy, sense of accomplishment, challenge, social interaction and status in the organisation. Lower levels of job satisfaction were attributed to the amount of involvement in research (55%), opportunities to receive compensation for services provided outside normal working hours (55%), the amount (44%) and the quality of administrative support (51%), and the opportunity to negotiate bonuses and resources in return for productivity (36%). Advanced nurse practitioners in RoI have high levels of job satisfaction with areas relating to clinical practice but are dissatisfied with areas that lead to empowerment within organisations. Efforts to improve the negotiating and leadership skills of ANPs may improve job satisfaction. Enhancing inter-professional collegial relationships and improving managerial recognition of the role within nursing are key areas to be targeted to promote job satisfaction of ANPs.