Midwifery Education Programs Research Articles

The state of midwifery in small island Pacific nations.

Strengthening midwifery is a global priority. Recently, global evidence has provided momentum toward developing the midwifery workforce. In 2014, the State of the World's Midwifery 2014 Report explored midwifery services in 73 low to middle income countries. In the South Pacific region, only Papua New Guinea and the Solomon Islands were included. This means that there is little known on the state of midwifery in the small island countries in the South Pacific. To explore the current situation of the education, regulation and association of midwives in 12 small island nations of the South Pacific and determine the gaps in these areas. A descriptive study was undertaken. Data were collected through a survey completed by key representatives (usually the Chief Nursing and Midwifery Officer) from each of the 12 countries. Ethical approval was received from the relevant Human Research Ethics Committee. Many of the countries had few midwives, in some instances, only two midwives for the whole country. Midwifery education programs included post-graduate diploma, certificates and bachelor degrees. Midwives were required to be registered nurses in all countries. Regulation and licensing also varied - most countries did not have a separate licensing system for midwives. Only three countries have a specific professional association for midwives. The variation and the small number of midwives poses challenges for workforce planning. Consideration could be given to developing regional standards and potentially a shared curriculum framework. Ongoing collaboration and networking between countries is a critical part of future developments.

A Needs Assessment for Recognizing Midwifery Educational Programs That Meet the International Confederation of Midwives Global Educational Standards

BACKGROUND: Quality midwifery education globally is essential to improving maternal and infant outcomes worldwide.PURPOSE: Determine midwife educators’ perceptions of the need for an international recognition program identifying a midwifery educational program having met the International Confederation of Midwives’ (ICM) Global Standards for Midwifery Education.STUDY DESIGN: A descriptive web-based survey available in English, French, and Spanish. Midwife educators were asked about (a) perceived need for a recognition program identifying programs meeting ICM Education Standards, (b) ability and resources to complete a self-evaluation report, (c) kinds of verification activities expected and needed resources, and (d) willingness of local educators to be trained as evaluators.RESULTS: Surveys completed from 52 countries and all four ICM regions (n = 197) with 14% from low-/lower middle income countries. Majority of respondents (79%) endorsed a need for a recognition program. Most were capable of creating a self-evaluation report (88%), only 18% identified not needing any additional resources. The vast majority favored an on-site process to verify the report with over 81% stating local midwife educators would volunteer to be trained as validators.CONCLUSION: There is a perceived need for an international process that recognizes midwifery education programs that meet the ICM Education Standards.

Global Workshops in Midwifery Competency-Based Educational Methodologies: Lessons Learned

The LancetSeries on Midwifery and The State of the World’s Midwifery 2014 called on countries to expand the midwifery workforce as a key strategy to improve the health of women and newborns and lower maternal and newborn morbidity and mortality. Well-prepared midwife teachers and preceptors are required to prepare midwives to provide competent, high quality care for women and childbearing families. This article describes the design of competency-based education (CBE) capacity development workshops building on the International Confederation of Midwives’ (ICM) essential competencies and education standards, led by eight English-, Spanish-, and French-speaking CBE Master Educators (MEs). Common content and processes used in three English, one Spanish, and one French workshop are briefly described, noting the influence of participants’ backgrounds, location, and teacher preferences in modifications to common content. As of December 2016, 30 CBE Master Teachers and 22 CBE Teachers have attended a CBE capacity development workshop and, in turn, have provided CBE continuing education (CE) sessions for more than 300 midwife teachers and preceptors in over 20 countries in the Caribbean, Latin America, and Anglophone and Francophone Africa. Lessons learned are shared along with suggestions for next steps in assessment and evaluation of the use of CBE in midwifery education programs.

An evaluation of the appropriateness and effectiveness of structured reflection for midwifery students in Ireland

Midwifery students undertaking the undergraduate midwifery education programme in Ireland participate in facilitated reflective sessions that aim to develop their skills of reflecting on and in clinical practice. This paper presents a qualitative evaluation of the appropriateness and effectiveness of the facilitated reflection sessions for pre and post-registration midwifery students in two large Dublin maternity teaching hospitals. The aim was to evaluate structured reflective practice sessions which sought to assist midwifery students to become competent reflective practitioners. Group reflection sessions were conducted weekly in a clinical practice area at the same time each week over one academic year. After the series of structured reflective sessions, midwifery students and facilitating staff were invited to evaluate the reflective process. This evaluation consisted of a self-completion survey to identify the factors that facilitated and impeded student participation in the sessions. Respondents answered a series of questions about the reflective practice sessions and were also invited to enter qualitative data regarding their subjective experiences of the process in free text boxes. The data were then collated into themes by an independent reviewer. The results of the evaluation clearly indicate that midwifery students and facilitators welcomed the opportunity to engage in group reflection sessions as a form of peer support and as a catalyst for learning from clinical practice. Findings suggest that reflective practice can contribute to the development of skilled, self-aware and engaged practitioners.

Experiences of student midwives learning and working abroad in Europe: The value of an Erasmus undergraduate midwifery education programme

Backgrounduniversities in the United Kingdom are being challenged to modify policies and curricula that reflect the changing global reality through internationalisation. An aspect of internationalisation is study abroad which the European Commission Erasmus exchange programme is just one means of addressing this. Objectiveto explore the experiences of student midwives who are engaged in the Erasmus exchange programme and the effect it has on their learning and working in an international context. Designapproval for the small phenomenological cohort study was obtained from two participating universities: the University of Malta and University of Nottingham. Data were collected from 13 student midwives from a total of five cohorts in the form of diaries to explore their experiences of learning and working in another country. Thematic analysis supported by Computer-Assisted Qualitative Data Analysis Software was used to identify five recurrent themes emerging from the data: the findings of which have served further in developing this programme. Findingsstudents valued the opportunity of undertaking study and midwifery practice in another culture and healthcare system, extending their knowledge and development of clinical competence and confidence. For some, this was the first time outside of their home country and adaptation to a new environment took time. Support from their contemporaries, lecturers and midwife mentors however, was overwhelmingly positive, enabling the students to feel ‘part of the local university / midwifery team’ By the end of the programme, the students recognised that they had become more independent and felt empowered to facilitate developments in practice when they returned home. Implications for Education / Practicethis innovative development embracing internationalisation within the curricula has the potential to increase students’ employability and further study within Europe and beyond. It can be used as a vehicle to share best practice within an international context, ultimately making a difference to the quality of care childbearing women, their babies and families experience worldwide.

Midwifing the Student: Creating an Effective Learning Environment

Midwifing the Student: Creating an Effective Learning Environment

The Impact of Racism and Midwifery's Lack of Racial Diversity: A Literature Review.

The United States is increasingly racially diverse. Racial disparities in maternal-child health persist. Despite national calls for workforce diversification, more than 90% of certified nurse-midwives are white. This systematic review examines how racism and midwifery's lack of racial diversity impact both midwives and their patients. Databases were searched in January 2016 for studies that explored 1) racially concordant or racially discordant maternity care provided, at least in part, by midwives; 2) women of color's experience of race and discrimination in maternity care provided, at least in part, by midwives; and 3) midwives of color's experience of race and discrimination in clinical, educational, and/or professional settings. Studies were excluded if they were conducted outside the United States, focused on recent immigrant populations, or didn't have an English-language abstract. Selected studies were each reviewed by 2 independent reviewers, and data from the studies were entered into literature tables and synthesized for discussion. A total of 7 studies was retained for review-3 on the experience of patients and 4 on the experience of providers. The studies show racism is common in midwifery education, professional organizations, and clinical practices. Racism and midwifery's lack of racial diversity act as a barrier to people of color completing midwifery education programs and fully participating in midwifery professional organizations. Both patients and midwives of color identified midwives of color as uniquely positioned to provide high-quality care for communities of color. The midwifery profession and its patients stand to substantially benefit from diversification of the field, which requires addressing racism within the profession. Structural competency is a new theory that offers an effective framework to guide these efforts.

Precepting 101: Teaching Strategies and Tips for Success for Preceptors.

The current shortage of certified nurse-midwives and certified midwives willing to serve as preceptors for midwifery education programs limits the number of students accepted into education programs. Preceptors are an essential link between academic programs and clinical practice and are indispensable to the growth of the midwifery profession. Preceptors create a safe environment for learning and teach adult learners through a variety of clinical teaching strategies. Novice preceptors need training and support to learn a new role, and experienced preceptors desire continued support and training. Before starting, preceptors need to identify sources of support and mentoring as well as understand the academic program's expectations for the student. This article draws on the clinical education literature to describe approaches to teaching all types of students. Practical strategies for integrating all levels of students into busy clinical settings are identified. Two approaches for clinical teaching, the Five Minute Preceptor and SNAPPS, are discussed in detail. Strategies for providing effective feedback and approaches to student evaluation are provided.

Research progress on midwifery competency and the implication for Chinese midwifery education

Midwifery competency is the foundation for sustainable development of the midwifery profession. The promotion of midwives' competency can improve their ability, strengthen midwifery competitiveness and enhance the quality of midwifery care services. This study gave an overview of the worldwide research progress on midwifery competency, we can draw the conclusion that there are urgent needs to improve midwifery education programs in China, emphasize competency-based midwifery education, as well as standardize the in-service training system to support the development of midwifery competency. Key words: Nurse midwives; Competency; Midwifery education

Culturally capable and culturally safe: Caseload care for Indigenous women by Indigenous midwifery students.

Evidence is emerging of the benefits to students of providing continuity of midwifery care as a learning strategy in midwifery education, however little is known about the value of this strategy for midwifery students. To explore Indigenous students' perceptions of providing continuity of midwifery care to Indigenous women whilst undertaking a Bachelor of Midwifery. Indigenous Bachelor of Midwifery students' experiences of providing continuity of midwifery care to Indigenous childbearing women were explored within an Indigenous research approach using a narrative inquiry framework. Participants were three Indigenous midwifery students who provided continuity of care to Indigenous women. Three interconnected themes; facilitating connection, being connected, and journeying with the woman. These themes contribute to the overarching finding that the experience of providing continuity of care for Indigenous women creates a sense of personal affirmation, purpose and a validation of cultural identity in Indigenous students. Midwifery philosophy aligns strongly with the Indigenous health philosophy and this provides a learning platform for Indigenous student midwives. Privileging Indigenous culture within midwifery education programs assists students develop a sense of purpose and affirms them in their emerging professional role and within their community. The findings from this study illustrate the demand for, and pertinence of, continuity of care midwifery experiences with Indigenous women as fundamental to increasing the Indigenous midwifery workforce in Australia. Australian universities should provide this experience for Indigenous student midwives.

Ethics Education in Midwifery Education Programs in the United States.

Familiarity with ethical concepts is a required competency for new graduates and a component of accreditation for midwifery education programs in the United States. While midwifery educators have acknowledged the importance of ethics education in midwifery programs, little is known about current methods, format, or evaluation of ethics education. A Web-based survey was developed for program directors of accredited midwifery education programs in the United States. Clock hours, formats, venues, content topics, barriers, and evaluation methods were evaluated by descriptive analysis. Fifty-one percent of programs completed the online survey (25/49). Of these, only 7 (28%) offer ethics as a stand-alone class, although all responding programs integrate some ethics education into other core classes. Programs show variation in format, venue, resources, and clock hours dedicated to ethics education. The most frequent barrier to ethics education is an already crowded curriculum (60%), although 32% of programs denied any barriers at all. The majority of programs include the ethical concepts of informed consent, shared decision making, and effective communication in curriculum content. This survey found that there is considerable variation in ethics education in terms of content, format, and evaluation among accredited midwifery education programs in the United States. Midwifery educators have an opportunity to explore the ethical dilemmas unique to maternity care from a midwifery perspective. There is also the opportunity to create a comprehensive and dynamic midwifery ethics curriculum, which incorporates both stand-alone ethics courses and ethics concepts that are woven throughout the core midwifery curriculum.

A Model for Enhancing Midwifery Education With a Global Health Certificate.

Global health is centered on promoting health equity for all populations. There is a growing need for midwives to receive education in the field of global health in order to be equipped to care for diverse populations within the United States and internationally. Midwifery students benefit from the opportunity to complete global health coursework and a global health practicum, as these experiences help them learn how to reduce local and global health disparities through interdisciplinary collaboration and international partnerships. The purpose of this article is to provide an overview of how a graduate certificate in global health can be used to enhance and enrich midwifery education. The article evaluates the numerous benefits of the global health certificate for midwifery students, and it discusses the logistical challenges of implementation, including potential areas for improvement. By collaborating together, midwifery education programs can expand the breadth of global health courses and practicum experiences available to midwifery students and prepare them to engage in global health projects that improve maternal and neonatal health outcomes in the United States and around the world.

A review of the literature to inform a best-practice clinical supervision model for midwifery students in Australia.

Effective clinical supervision in midwifery programs leading to registration is essential to ensure that students can provide safe and competent woman centred care by the completion of their program. A number of different clinical supervision models exist in Australia and internationally, with varying levels of support and facilitation of student learning opportunities. In Australia, midwifery students must achieve specified learning outcomes and midwifery practice requirements to be eligible to register as a midwife. Identifying a best practice clinical supervision model for Australian midwifery students is therefore a priority for all key stakeholders, particularly education and maternity care providers. The aim of this literature review was to explore different types of clinical supervision models in order to develop and implement a best practice model in midwifery education programs.

Universal Newborn Hearing Screening in Midwifery Education: A Survey

Universal newborn hearing screening has been adopted by all 50 states in the United States. However, there is currently a lack of knowledge about how health care providers learn about universal newborn hearing screening during their education programs. The purpose of this study was to identify whether midwifery education programs in the United States currently include information regarding universal newborn hearing screening in the standard curricula and, if so, what specific information is covered. A survey that assessed whether specific topics related to universal newborn hearing screening are presented during midwifery education was sent to directors of midwifery education programs. Seventy-one midwifery education program directors were contacted, and the response rate was 38% (27 surveys). Most respondents reported that universal newborn hearing screening is discussed in the program, with the amount of time spent covering these topics varying considerably. Programs provide information about the midwife's role in universal newborn hearing screening, legal obligation to provide hearing screening information, and tests used to complete universal newborn hearing screening. How to complete the hearing screening, counseling for parents about results, and follow-up after a newborn does not pass the screening are topics that were not often discussed. There was no influence of program type or program length on the universal newborn hearing screening content discussed. The majority of midwifery education program directors that responded indicated that their programs include information about universal newborn hearing screening to midwifery students. There is a need for further information and resources specific to universal newborn hearing screening. Providing additional information to midwifery students about newborn hearing screening may result in increased awareness and education for families.

Barriers and facilitators related to implementation of regulated midwifery in Manitoba: a case study.

BackgroundIn 2000, midwifery was regulated in the Canadian Province of Manitoba. Since the establishment of the midwifery program, little formal research has analyzed the utilization of regulated midwifery services. In Manitoba, the demand for midwifery services has exceeded the number of midwives in practice. The specific objective of this study was to explore factors influencing the implementation and utilization of regulated midwifery services in Manitoba.MethodsThe case study design incorporated qualitative exploratory descriptive methods, using data derived from two sources: interviews and public documents. Twenty-four key informants were purposefully selected to participate in semi-structured in-depth interviews. All documents analyzed were in the public domain. Content analysis was employed to analyze the documents and transcripts of the interviews.ResultsThe results of the study were informed by the Behavioral Model of Health Services Use. Three main topic areas were explored: facilitators, barriers, and future strategies and recommendations. The most common themes arising under facilitators were funding of midwifery services and strategies to integrate the profession. Power and conflict, and lack of a productive education program emerged as the most prominent themes under barriers. Finally, future strategies for sustaining the midwifery profession focused on ensuring avenues for registration and education, improving management strategies and accountability frameworks within the employment model, enhancing the work environment, and evaluating both the practice and employment models. Results of the document analysis supported the themes arising from the interviews.ConclusionThese findings on factors that influenced the implementation and integration of midwifery in Manitoba may provide useful information to key stakeholders in Manitoba, as well as other provinces as they work toward successful implementation of regulated midwifery practice. Funding for new positions and programs was consistently noted as a successful strategy. While barriers such as structures of power within Regional Health Authorities and inter and intra-professional conflict were identified, the lack of a productive midwifery education program emerged as the most prominent barrier. This new knowledge highlights issues that impact the ongoing growth and capacity of the midwifery profession and suggests directions for ensuring its sustainability.

A Rapid Assessment Tool for affirming good practice in midwifery education programming

Objectiveto design a criterion-referenced assessment tool that could be used globally in a rapid assessment of good practices and bottlenecks in midwifery education programs. Designa standard tool development process was followed, to generate standards and reference criteria; followed by external review and field testing to document psychometric properties. Settingreview of standards and scoring criteria were conducted by stakeholders around the globe. Field testing of the tool was conducted in Myanmar. Participantseleven of Myanmar׳s 22 midwifery education programs participated in the assessment. Findingsthe clinimetric tool was demonstrated to have content validity and high inter-rater reliability in use. Key conclusionsa globally validated tool, and accompanying user guide and handbook are now available for conducting rapid assessments of compliance with good practice criteria in midwifery education programming.

Young Midwifery Leaders Programs: Capacity Building for the Future

This article describes the program components, program outcomes and challenges of two iterations of a leadership development program that was intended to contribute not only to individual capacity building but also to succession planning within midwifery professional associations. The young midwifery leaders programs were similarly designed, using self-study modules that focused on essential leadership knowledge and skills, and a mentor–mentee relationship to provide guidance and support to selected midwives early in their professional careers. The International Confederation of Midwives (ICM) implemented a 3-year leadership program conducted from 2004 to 2007 for five mentee participants. A collaborative United Nations Population Fund (UNFPA)/ICM team in Latin America designed and implemented an 18-month program with 12 mentees that began in 2013. Examples of leadership outcomes in policy and education include assumption of elected offices in midwifery associations, integration of evidence-based topical content into an established midwifery education program, and development of a new preservice education program in a rural zone of a large country. The vision for the future is to expand this program globally while simultaneously adapting the program content and strategies to reflect the leadership needs of the regional context in which it is implemented.

Forging the Future: Maintaining Midwifery Momentum in the Next Decade

Forging the Future: Maintaining Midwifery Momentum in the Next Decade

Embedding continuity of care experiences: An innovation in midwifery education

Midwife-led continuity of care models demonstrate a number of benefits to women with no adverse effects. These benefits include a reduction in childbirth interventions, an increase in spontaneous vaginal births for women of low and increased risk (Begley et al., 2011; Hartz et al., 2013; Sandall et al., 2015) and a reduction in rates of caesarean sections in women of low risk (McLachlan et al., 2012). This model of care also demonstrates increased satisfaction for women when compared to other models of maternity care (Sandall et al., 2015). Given the significant benefits to women, the inclusion of a requirement for students to experience midwife-led continuity of care models was considered to be fundamental to all midwifery education programs. Prior to the introduction of Bachelor of Midwifery programs in Australia in 2002 there were no requirements for midwifery students to experience midwifery continuity of care. Indeed, there were very few continuity of midwifery care models in Australia (Gray, 2010) and students therefore gained their midwifery knowledge, skills and abilities by working with women in models of care with little exposure to the concept of continuity. Midwifery leaders were aware of the integration of continuity experiences in midwifery education programs in the United Kingdom (Anderson and Lewis, 2000) and in New Zealand (Pairman, 2000) and the opportunities that these provided to

Teaching research methodology to student midwives through a socio-constructivist educational model: The experience of the high school for science and health techniques of Tunis

Since its independence in 1956, Tunisia’s maternal health indicators have steadily improved as the result of the implementation of a national holistic strategy that emancipated women and developed midwifery education and maternal health services provision.The last review of the midwifery education programme, occurred in 2008, and was based on evidence based core competencies.This paper describes the implementation process of the socio-constructivist educational model used by to teach research methodology to student midwives, the changes observed among them, the challenges and the lessons learned.