Midwifery Leaders Research Articles

Nurses' and midwives' perception of the leadership skills and attributes required of future leaders.

Identify the skills and knowledge future nurse and midwife leaders might require in the next 6 years. Design/methodology/approach: An online questionnaire elicited health professionals' perspectives on the future requirements for nurse and midwife leaders. Qualitative data were generated in response on health care and the likely leadership skills for the future. Data were extracted and analysed using qualitative content analysis. Four generic categories were abstracted from the core category 'Nursing and Midwifery Leadership'. These were values/traits; creating positive healthcare cultures; digital capability/competence; and systems thinking. Limitations/implications. This first stage evaluation has gained a wide variety of perspectives regarding the perceived skills and knowledge future nurse and midwife leaders might need. This is important to enable those who deliver leadership development programmes to plan appropriately, ensuring their programmes are designed and adjusted in response to the needs of a shifting health and care landscape. However, over 50% of respondents were White, so the data may not be representative of the diversity of registered nurses and midwives. The findings may not have direct relevance to the global context due to geographical limitations.

Cultivating Curiosity in Midwifery Leadership

This article advocates for curiosity as a crucial element in midwifery leadership. It highlights the importance of curiosity in fostering innovation, enhancing communication and promoting a learning culture. The article emphasises that curious leaders can better navigate challenges, implement evidence-based practices and create a more supportive environment for midwives and women.

Empowering Midwives in Humanitarian Settings: Integrating Heat-Stable Carbetocin and Tranexamic Acid into Postpartum Hemorrhage Training

Background and Objective Maternal mortality remains extremely high in fragile settings, with hemorrhage as the leading cause. This study describes a new model for more effective training on postpartum hemorrhage (PPH) prevention and treatment. Methods Using a low-dose (of information) and high-frequency (of repetitions) approach (LDHF), the strategy comprised an introductory webinar, self-paced study, 2-day in-person workshops, cascade training, continuous facility-based skills drills, and a WhatsApp community of practice and supervision (CoP). Innovations consisted of the practical, midwifery-centered, and short-duration training, and the integration of tranexamic acid (TXA) and heat-stable carbetocin (HSC) into existing modules from the “Bleeding-After-Birth-Complete” toolkit. Effects were assessed through mixed-methods evaluation. Confidentiality and “do-not-harm” principles were respected. Results Nine training sessions were conducted in South Sudan and Uganda combined, engaging 126 participants. Average knowledge increases of 21% in South Sudan and 18% in Uganda were recorded. Feedback also indicated changes in practices and attitudes: enhanced competency, teamwork, clinical protocols adherence, appreciation for midwife-led practical sessions, the LDHF method, and continuous support through the WhatsApp CoP. In post-workshop action plans, facility teams outlined steps to apply acquired knowledge and skills. These included training colleagues, establishing quality improvement projects, conducting skill drills, ensuring job aid visibility, and systematically reporting on PPH in the data collection templates of the facilities. Conclusion and Global Health Implications This case study highlights the value of a practical, LDHF refresher training strategy. This strategy bolstered providers’ skills, knowledge, and confidence in using HSC and TXA for PPH prevention and treatment. Findings can guide future training in similar fragile, low-resource, and humanitarian settings. Strengthening midwifery leadership, fostering interdisciplinary collaboration, and using the LDHF training approach can contribute to resilient health systems and taskforce, aligning with global efforts to reduce maternal mortality.

O72 - "Unleashing Midwifery Leaders: The North West Maternity Services Transition Project"

O72 - "Unleashing Midwifery Leaders: The North West Maternity Services Transition Project"

Developing a career and education framework for advanced clinical practice in midwifery.

This study outlines the nature of Advanced Clinical Practice in Midwifery (ACPiM), reporting on a stakeholder analysis as part of a national project to develop a career framework for advanced practice in midwifery on behalf of the National Health Service (NHS) in England. Between June and July 2022, 31 advanced practice midwives were recruited across England within the NHS settings. Convenience sampling was used to identify midwives working as advanced practitioners, and those pursuing this career route. Focus group and one-to-one interviews were conducted, recorded, and transcribed. These stakeholder data were then analyzed using a reflexive thematic approach. ACP midwives were active across many professional settings. The findings resulted in three themes: Midwifery autonomy, Desire for progression, and Avenues of support. Midwifery autonomy highlighted a midwifery desire to utilize specialist skills and expert decision-making to provide holistic care directly to women and families. Desire for progression highlighted that, regardless of career stage, midwives aspired to advance their practice requiring a range of pathways to fulfil career satisfaction and meet local population health needs. Avenues of support discussed the barriers and facilitators to progression, highlighting the need for service vision, a multi-disciplinary approach to facilitate support for individuals, and strong midwifery leadership. Although the ACPiM role is desired by maternity institutions and organizations, midwives remain unclear about how to achieve this position, and employers remain unsure of how an ACPiM could transform services. If midwives are to successfully achieve ACPiM status, organizational support is needed to facilitate individuals drive for career progression, resulting in a strengthened workforce and improved patient experience.

Characteristics of strong midwifery leaders and enablers of strong midwifery leadership: An international appreciative inquiry

ObjectivesThis research aimed to identify the characteristics of strong midwifery leaders and explore how strong midwifery leadership may be enabled from the perspective of midwives and nurse-midwives globally. DesignIn this appreciative inquiry, we collected qualitative and demographic data using a cross-sectional online survey between February and July 2022. SettingResponses were received from many countries (n = 76), predominantly the United Kingdom (UK), Australia, the United States of America (USA), Canada, Uganda, Saudi Arabia, Tanzania, Rwanda, India, and Kenya. ParticipantsAn international population (n = 429) of English-speaking, and ethnically diverse midwives (n = 211) and nurse-midwives (n = 218). MeasurementsReflexive thematic analysis was used to make sense of the qualitative data collected. Identified characteristics of strong midwifery leadership were subsequently deductively mapped to established leadership styles and leadership theories. Demographic data were analysed using descriptive statistics. FindingsParticipants identified strong midwifery leaders as being mediators, dedicated to the profession, evidence-based practitioners, effective decision makers, role models, advocates, visionaries, resilient, empathetic, and compassionate. These characteristics mapped to compassionate, transformational, servant, authentic, and situational leadership styles. To enable strong midwifery leadership, participants identified a need for investment in midwives’ clear professional identity, increased societal value placed upon the midwifery profession, ongoing research, professional development in leadership, interprofessional collaborations, succession planning and increased self-efficacy. Key conclusions and implications for practiceThis study contributes to understandings of trait, behavioural, situational, transformational and servant leadership theory in the context of midwifery. Investing in the development of strong midwifery leadership is essential as it has the potential to elevate the profession and improve perinatal outcomes worldwide. Findings may inform the development of both existing and new leadership models, frameworks, and validated measurement tools.

Community postnatal care delivery in England since Covid-19: A qualitative study of midwifery leaders’ perspectives and strategies

ProblemCOVID-19 impacted negatively on maternity care experiences of women and staff. Understanding the emergency response is key to inform future plans. BackgroundBefore the COVID-19 pandemic, experts highlighted concerns about UK community postnatal care, and its impact on long-term health, wellbeing, and inequalities. These appear to have been exacerbated by the pandemic. AimTo explore community postnatal care provision during and since the pandemic across a large diverse UK region. MethodsA descriptive qualitative approach. Virtual semi-structured interviews conducted November 2022-February 2023. All regional midwifery community postnatal care leaders were invited to participate. Findings11/13 midwifery leaders participated. Three main themes were identified: Changes to postnatal care (strategic response, care on the ground); Impact of postnatal care changes (staff and women’s experiences); and Drivers of postnatal care changes (COVID-19, workforce issues). DiscussionChanges to postnatal care during the pandemic included introduction of virtual care, increased role of Maternity Support Workers, and moving away from home visits to clinic appointments. This has largely continued without evaluation. The number of care episodes provided for low and high-risk families appears to have changed little. Those requiring additional support but not deemed highest risk appear to have been most impacted. Staffing levels influenced amount and type of care provided. There was little inter-organisation collaboration in the postnatal pandemic response. ConclusionChanges to postnatal care provision introduced more efficient working practices. However, evaluation is needed to ensure ongoing safe, equitable and individualised care provision post pandemic within limited resources.

Reflections on The International Confederation of Midwives Congress 2023

There is something inspiring about a group of thousands of the world’s most passionate and experienced midwives coming together, as was the case at the International Confederation of Midwives (ICM) congress, held in Bali earlier this year. This triennial conference fosters empowerment, knowledge exchange and collaboration. The purpose and significance of the conference is multifaceted, bringing together professionals dedicated to improving maternal and newborn health outcomes globally. Attendees were spoiled for choice with a programme filled with inspirational midwifery leaders from all corners of the world. If only we could hear from them all!

Costs and intermediate outcomes for the implementation of evidence-based practices of midwifery under a MIDWIZE framework in an urban health facility in Nairobi, Kenya

BackgroundThree evidence-based midwife-led care practices: dynamic birth positions (DBP), immediate skin-to-skin contact (SSC) with zero separation between mother and newborn, and delayed cord clamping (DCC), were implemented in four sub-Saharan African countries after an internet-based capacity building program for midwifery leadership in quality improvement (QI). Knowledge on costs of this QI initiative can inform resource mobilization for scale up and sustainability. MethodsWe estimated the costs and intermediate outcomes from the implementation of the three evidence-based practices under the midwife-led care (MIDWIZE) framework in a single facility in Kenya through a pre- and post-test implementation design. Daily observations for the level of practice on DBP, SSC and DCC was done at baseline for 1 week and continued during the 11 weeks of the training intervention. Three cost scenarios from the health facility perspective included: scenario 1; staff participation time costs ($515 USD), scenario 2; staff participation time costs plus hired trainer time costs, training material and logistical costs ($1318 USD) and scenario 3; staff participation time costs plus total program costs for the head trainer as the QI leader from the capacity building midwifery program ($8548 USD). ResultsAt baseline, the level of DBP and SSC practices per the guidelines was at 0 % while that of DCC was at 80 %. After 11 weeks, we observed an adoption of DBP practice of 36 % (N = 111 births), SSC practice of 79 % (N = 241 births), and no change in DCC practice. Major cost driver(s) were midwives’ participation time costs (56 %) for scenario 1 (collaborative), trainers’ material and logistic costs (55 %) in scenario 2(collaborative) and capacity building program costs for the trainer (QI lead) (94 %) in scenario 3 (programmatic). Costs per intermediate outcome were $2.3 USD per birth and $0.5 USD per birth adopting DBP and SSC respectively in Scenario 1; $6.0 USD per birth adopting DBP and $1.4 USD per birth adopting SSC in Scenario 2; $38.5 USD per birth adopting DBP and $8.8 USD per birth adopting SSC in scenario 3. The average hourly wage of the facility midwife was $4.7 USD. ConclusionImproving adoption of DBP and SSC practices can be done at reasonable facility costs under a collaborative MIDWIZE QI approach. In a programmatic approach, higher facility costs would be needed. This can inform resource mobilization for future QI in similar resource-constrained settings.

A survey of Australian midwives: Experts in nitrous oxide administration within the peripartum setting

ProblemThere is little documented evidence of midwives’ perspectives regarding the use of nitrous oxide in the peripartum period. BackgroundNitrous oxide is an inhaled gas used widely in the peripartum period; usually offered and managed by midwives. AimExplore midwives’ knowledge, perceptions, and practices of facilitating women’s use of nitrous oxide in the peripartum period. MethodsAn exploratory cross-sectional survey design was used. Quantitative data were analysed using descriptive and inferential statistics; open-ended responses underwent template analysis. FindingsMidwives (n = 121) working in three Australian settings reported regularly recommending the use of nitrous oxide and high levels of knowledge and confidence supporting its use. There was a significant association between midwifery experience, and perspectives on women’s capacity to use nitrous effectively (p = 0.004); and desire for refresher education (p < 0.001). Midwives working in continuity models were more likely to support women using nitrous oxide in any situation (p = 0.039). DiscussionMidwives demonstrated expertise in facilitating nitrous oxide use, citing utility to relieve anxiety and distract women from pain or discomfort. Nitrous oxide was identified as an important adjunct to the provision of supportive care requiring midwifery therapeutic presence. ConclusionThis study provides novel insight into midwives’ support of nitrous oxide use in the peripartum setting revealing high levels of knowledge and confidence. Recognition of this unique expertise held by midwives is important to ensure transfer and development of professional knowledge and skills and emphasises the need for midwifery leadership in clinical service provision, planning and policy.

Sustaining Ourselves – Beyond the Obvious

The psychological and administrative fallout from the current staffing crisis, hot on the heels of a three-year pandemic, is clearly taking its toll on midwives and midwifery leaders. A younger (and larger) intake of student midwives raises the risk of also failing to meet their psychological and wellbeing needs, particularly in clinical practice, either as students or as newly-qualified midwives. As we lose midwives more quickly that we can replace them, this article asks what a radical approach to wellbeing could look like and explores tools and mindsets for staying well in the day-to-day and on the road ahead.

Effective Midwifery Leadership: Knowing Your Roots and Finding Your Passion

In this feature article, a third article in our leadership collective, Professor of Midwifery Caroline Homer was invited to write about effective leadership, collaboration and midwifery. This informative and personal article explores Caroline’s own leadership journey and she gives important tips for future midwives along their own leadership journeys.

An overview of nursing and midwifery leadership, governance structures, and instruments in Africa

BackgroundInvestment in nursing and midwifery leadership and governance are key suggested approaches by the World Health Organization (WHO) Africa Regional Office to address the shortages in the nursing health workforce. However, there are few if any studies that have investigated the existence and operationalization of the nursing and midwifery leadership and governance structures in Africa. This paper fills this gap by, providing an overview of nursing and midwifery leadership, governance structures, and instruments in Africa.MethodsWe conducted a descriptive cross-sectional study of the nursing and midwifery leadership, structures, and instruments in 16 African countries using quantitative methodology. Data was analyzed using SPSS IBM 21 statistical software. Data was summarized in frequencies and percentages and presented as tables and charts.ResultsOnly (9,56.25%) of the 16 countries included had retrievable evidence of all expected governance structures while (7, 43.75%) lacked one or more of the structures. A quarter (4, 25%) of the countries did not have a department of nursing and midwifery or chief nursing and midwifery officer at their Ministry of Health (MOH). The dominant gender representation across all the governance structures was female. Only Lesotho (1, 6.25%) had all expected nursing and midwifery governance instruments while the remaining (15, 93.75%) had either one or four of these instruments missing.ConclusionsThe lack of complete nursing and midwifery governance structures and instruments in various African countries is a matter of concern. Without these structures and instruments, the strategic direction and input of the nursing and midwifery profession cannot be maximized for the public good in relation to health outcomes. Addressing the existing gaps requires a multipronged approach with the need to strengthen regional collaboration, and advocacy, creating awareness, and advancing nursing and midwifery leadership training to enable nursing and midwifery governance capacity development in Africa.

Leadership Link: Evaluation of an Online Leadership Curriculum for Certified Midwives and Certified Nurse-Midwives.

Midwifery leadership is vital for improving maternal health outcomes, yet limited leadership training opportunities exist. This study evaluated acceptability and preliminary outcomes of Leadership Link, a scalable online learning program that aims to increase midwives' leadership competencies. The program evaluation study enrolled early-career midwives (<10 years since certification) into an online leadership curriculum using the LinkedIn Learning platform. The curriculum consisted of 10 courses (approximately 11 hours) of self-paced, non-health care-specific leadership content supplemented with brief midwifery-specific introductions from midwifery leaders. A preprogram, postprogram, and follow-up study design was used to evaluate changes in 16 self-assessed leadership abilities, self-perception as a leader, and resilience. Data were also collected on the application of leadership skills acquired through, and career advancements attributed to, program participation. A total of 186 individuals activated LinkedIn Learning accounts. Almost half (41.9%) completed the full curriculum. Satisfaction was high, with 83.3% of postprogram survey respondents reporting the program was "probably" or "definitely" worth the time invested. Seventy-six participants (40.9%) provided matched pre- and immediate postprogram survey data on at least some of the 16 self-assessed leadership abilities. All 16 abilities showed statistically significant increases in pre- to postprogram mean scores, ranging from 6.4% to 32.5%. Both self-perception as a leader and resilience scores significantly increased from baseline. More than 87% of postprogram and follow-up survey respondents reported having applied new or improved leadership abilities to at least a small degree. Fifty-eight percent of follow-up survey respondents reported at least one midwifery career advancement, of whom 43.6% attributed the advancement, at least in part, to Leadership Link. The findings suggest that the online Leadership Link curriculum is acceptable and may be effective in improving midwives' leadership capacity, potentially enhancing career opportunities and engagement in system change.

The PNG Midwifery Leadership Buddy Program: An evaluation

ProblemPapua New Guinea (PNG) has a high rate of preventable maternal and neonatal deaths. BackgroundDeveloping midwifery leadership is vital to addressing the current deficits in health outcomes for women and their babies. The PNG Midwifery Leadership Buddy Program responds to this need through leadership training and partnering of midwives across PNG and Australia. Participants in the program undertake a workshop in Port Moresby and commit to a 12-month peer support relationship with a midwife ‘buddy’. AimTo evaluate participants’ experiences of the Buddy Program and the impact of the program on leadership skills. MethodsAll 23 midwives who had completed the program were invited to participate in the evaluation. The study used a concurrent mixed methods approach. Qualitative data were collected via interviews and then thematically analysed. Quantitative data were collected via a survey and analysed with descriptive statistics, then findings were triangulated. FindingsParticipants reported increased confidence for leadership, action and advocacy. Numerous quality improvement projects were implemented in health services in PNG. Challenges to the success of the program included technological limitations, cultural differences and the COVID-19 pandemic. DiscussionParticipants reported the PNG Midwifery Leadership Buddy Program was successful in increasing their leadership skills and collaborative opportunities, as well as strengthening midwifery more broadly. While there were barriers, most participants valued the experience and believed it benefited them professionally and personally ConclusionThe Buddy Program provides a practical model for building midwifery leadership capacity that may be transferrable to other contexts.

The commitment to a midwifery centre care model in Bangladesh: An interview study with midwives, educators and students.

Midwifery-led care is a key factor in reducing maternal and new-born mortality globally. In Bangladesh, only a third of births are attended by professionals and almost 70% of births occur outside healthcare facilities. Midwifery is a relatively new profession in Bangladesh and a midwifery centre care model has only recently been introduced. This study aims to explore the willingness within the healthcare system to support a greater role for midwifery centres in maternity services. Data were collected through individual semi-structured interviews with 55 midwives, midwifery educators and final year midwifery students. Two of the midwifery educators were principals of nursing institutes involved in the government's midwifery leadership and considered as experts in the midwifery care system. The data was analysed using qualitative content analysis. The transcribed interviews comprised 150 pages. The study received ethical approval from the Directorate General of Nursing and Midwifery in Bangladesh. One main category emerged from the study: "The foundations of a midwifery centre care model need to be strengthened for the sustainable implementation of midwifery centres in Bangladesh to continue". Five additional categories were identified: 1) The midwifery centre care model is inaccessible for communities, 2) Striving for acceptable standards of care within a midwifery centre care model is not a priority 3) Respectful, woman-centred care is weak, 4) Community engagement with the midwifery centre care model is insufficient, and 5) The midwifery centre care model is not integrated into the healthcare system. These categories were supported by the identification of 11 sub-categories. The willingness to commit to a midwifery centre care model is not yet in place in Bangladesh. Advocacy, information, and education about the benefits of normal birth assisted by professional midwives is needed at all levels of Bangladeshi society.

The Effect of Leadership Style on Midwives' Performance, Southwest, Ethiopia.

Leadership is the basis of professional and organizational commitment, teamwork and success. Midwives leaders' leadership skills and capabilities have long been recognized as essential contributors to health services and outcomes. However, there are insufficient reports on the effect of leadership styles on midwives' performance in African countries including Ethiopia. Therefore, this study aimed to determine the effect of leadership style on midwives' performance in public health Institutions, southwest Ethiopia. This study aimed to determine the effect of leadership style on midwives' performance, Southwest Ethiopia/2022. A cross-sectional study was conducted on 121 midwives using a random sampling technique and a pre-tested questionnaire from May 19/2022-June to 6/2022. Data were entered into Epi-data version 4.4.2.1, edited, coded, categorized and cleaned before analysis. Data were analyzed using the SPSS version 24; and the results are presented in tables, and statements. Correlations and linear regressions were conducted to identify the relationship between leadership style and midwives' performance. In this study, the autocratic leadership style was predominantly practiced by midwifery leaders with a mean score of 2.996 followed by democratic (Mean=2.632) and laissez-faire (Mean=2.49) leadership styles. Inferential statistics (Correlation) analysis revealed a positive relationship between democratic and laissez-faire leadership styles and a negative relationship between autocratic styles and midwives' performance. Multiple linear regressions showed that both democratic (P=0.02) and laissez-faire leadership styles (P=0.00) had a positive effect where as autocratic leadership style (P=0.60) had a negative effect on midwives' performance. Autocratic Leadership is the most practiced leadership style in the study area. An autocratic leadership style was negatively related to midwives' performance, while democratic and laissez faire styles were positively related. Therefore, health care leaders, administrators, supervisors and department heads should implement democratic and laissez-faire leadership styles to enhance midwives' performance.

Qualitative study of the roles of midwives in the provision of sexual and reproductive healthcare services in the Somaliland health system

ObjectivesTo explore midwives’ perspectives in providing sexual reproductive healthcare services in the Somaliland health system.MethodsAn exploratory qualitative design using focus group discussions (n=6) was used. The study was conducted in...

Taking up the challenge of trans and non-binary inclusion in midwifery education: Reflections from educators in Aotearoa and Ontario Canada

Perinatal services are being challenged to acknowledge that not all pregnant and birthing people are women and to ensure the design and delivery of services that are inclusive of, and deliver equitable outcomes for, trans, non-binary, and other gender diverse people. This is posing unique challenges for midwifery with its women-centred philosophy and professional frameworks. This paper presents the critical reflections of midwifery educators located in two midwifery programmes in Aotearoa11Aotearoa is the Māori language name for New Zealand. In recognition of Aotearoa as the Indigenous land of tangata Māori (the Māori people) the title Aotearoa will be used throughout the article. and Ontario Canada, who are engaged in taking up the challenge of trans and non-binary inclusion in their local contexts. The need to progress trans and non-binary inclusion in midwifery education to secure the human rights of gender diverse people to safe midwifery care and equitable perinatal outcomes is affirmed. We respond to an existing lack of research or guidance on how to progress trans and non-binary inclusion in midwifery education. We offer our insights and reflections organised as four themes located within the frameworks of cultural humility and safety. These themes address midwifery leadership for inclusion, inclusive language, a broader holistic approach, and the importance of positioning this work intersectionally. We conclude by affirming the critical role of midwifery education/educators in taking up the challenge of trans and non-binary inclusion to ensure a future midwifery workforce skilled and supported in the provision of care to the growing gender diverse population.

Validation and prioritisation of health informatics competencies for Australian nursing and midwifery leaders: A modified Delphi study

BackgroundHealth informatics competency standards for nurses are required to ensure the use and management of health information technologies contributes to the delivery and management of safe, quality care delivery. Historically, these competencies have been identified for nurses as a general group and specifically for undergraduate nursing students but not to the same extent for nurse leaders. AimThe aim of this study was to validate and prioritise health informatics competencies for Australian nurse leaders. MethodThis study utilised a modified Delphi technique to validate and prioritise 26 health informatics competencies for the Australian setting. The competencies were previously developed for Canadian nurses through literature review and consulation with experts. This modified Delphi study included invitations to 20 Australian Chief Nursing Information Officers who were then asked to extend the invitation to nurse leaders in their corresponding organisations. ResultsEleven Chief Nursing Information Officers and seven Nurse Leaders completed the study including 3 rounds of informatics competencies consensus surveys. As a result, 22 revised competency statements were agreed to by the study participants. The top priority competency (Nursing and Midwifery leaders support clinicians to adopt and use information and communication technologies that support safe, quality care delivery) was also the highest ranked in the Canadian team’s initial work. This reflects a common objective of nurses’ need to ensure technology is fit for purpose, not only for nurses and midwives, but for patient safety and quality of care. ConclusionKnowledge is required in the digital health landscape in order for nursing leaders to increase their capability in decision-making in the current and future digital healthcare environments. Differences in the competencies validated and prioritised by Australian nurse leaders and previous work by Canadian nurse leaders support the need to examine context-specific factors for nurse leaders to utilise these competencies.