Midwifery Policy Research Articles

Medical ethics in childbirth: a structural equation modeling approach in south of Iran

BackgroundThe existence of a valid instrument to evaluate the attitude of mothers towards compliance with medical ethics during childbirth can lead to appropriate interventions to create a positive attitude. The purpose of this study is to determine the construct validity of the MEAVDQ (Medical Ethics Attitude in Vaginal Delivery Questionnaire).MethodsThe study was carried out with 350 women. The main research instrument was MEAVDQ. This 59-item questionnaire comprises three parts A, B, J. Part A is concerned with the first principles. Part B deals with the second and third principles and part J addresses the fourth principle of medical ethics. Structural Equations Modeling (SEM) was used to determine the construct validity of MEAVDQ.Results The results of SEM revealed that there was a positive correlation between structures A and B. The relationship between structures B and J was also positive and significant. On the other hand, there was a direct and indirect relationship between structures A and J. One-unit increase in structure A led to 0.16 (95% CI: 0.01, 0.33) direct increase in structure J. Also, one-unit increase score increases in structure A caused 0.39 indirect rise (95% CI: 0.26, 0.53) in structure J with the mediating role of the structure B.ConclusionsIt can be suggested to midwifery policy maker and midwives that respect for the first principle of medical ethics and autonomy is the most important principle of medical ethics in childbirth. By respecting the autonomy of mothers, a positive birth experience can be created for them.

The experiences and perceptions of rural and remote nurses who provide care to pregnant women in the absence of midwives.

Maternity unit closures in rural and remote settings of Australia have left a substantial gap in services for pregnant women. In the absence of midwives, and when women are unable to attend a maternity facility, registered nurses (RNs) are required to fill the void. While maternity education can attempt to prepare RNs for such encounters, there is little documented to suggest it meets all their physical and psychological needs. The existing challenges for health professionals, practising a vast generalist scope of practice while living and working in a rural and remote location, have been well researched and documented. How nurses feel about the expectation that they work outside their scope of practice to provide maternity care in a rural and remote setting in Australia has not been asked until now. This study explores the perceptions and experiences of RNs who find themselves in this situation. The study utilised a hermeneutic phenomenological methodology to examine the experiences and perceptions of rural and remote nurses providing care for pregnant women. RNs working in rural and remote health facilities that had no maternity services were recruited by a purposive sampling method. Semistructured conversational interviews were recorded and transcribed verbatim. Data analysis was guided by van Manen's analytical approach. Eight nurses participated, and from the data three themes, each with several subthemes, emerged: 'being-in-the-world of the rural and remote nurse' - described how participants viewed rural and remote nursing as an entity with unchangeable aspects that could not be considered in isolation; 'scope of practice - unprepared or underprepared' described how, despite their existing and extensive nursing skills, participants felt ill-equipped theoretically, practically and mentally to care for pregnant women; 'moral distress' - participants expanded their feelings of unpreparedness to include inadequacy, fear, and appropriateness of care delivery. The realism of rural and remote nursing practice demonstrates that at some point in their career, rural and remote nurses will care for a labouring and/or pregnant woman at high risk for complications. Participants in this study appeared open and honest in their interviews, displaying pride at their extensive nursing skills and job satisfaction. However, they were unanimous in their discussions of what being a nurse and providing maternity care in a rural and remote setting meant to themselves and to pregnant women. They suggested care was fragmented and inadequate from a workforce that is inadequately prepared and stressed. This study has highlighted another concerning aspect of rural and remote midwifery care - the experiences and perceptions of eight nurses delivering care that has previously been overlooked. The united voice of the RNs in this study warrants a platform to speak from and deserves acknowledgement and attention from government and midwifery policy drivers. These nurses, and the women receiving their care, deserve more.

Toward Equity in Access to Midwifery in Saskatchewan: Key Informants’ Perspectives

In this article, we report on the second phase of our exploratory research into issues related to equity in access to midwifery in Saskatchewan. This phase of the research project aimed to explore equity in access to midwifery as understood and experienced by key stakeholders involved in the early stages of midwifery implementation in Saskatchewan. A total of 19 interviews were conducted with participants from Saskatchewan Health, the Midwifery Transitional Council, and Saskatoon’s Regional Midwifery Operations Committee, as well as practitioners, primary health care managers, directors from select regional health authorities, and Saskatchewan midwives. Additionally, all available midwifery policy documents and relevant Primary Health Care and Health Human Resource documents complemented the qualitative analysis. Initial thematic analysis led to five policy recommendations: (1) develop a provincial definition of “priority population” for midwifery clients, (2) establish a midwifery health human resource plan, (3) identify provincial midwifery research priorities, (4) facilitate growth in interprofessional relationships, and (5) develop a provincial “road map” for implementation. A secondary analysis of participants’ responses revealed concern over the poor public education about midwifery services and lack of provincial government prioritization, as well as varied perceptions of the concept of “equity.” We conclude that although general commitments to equity in midwifery service and access are enshrined in Saskatchewan’s health care policies and midwifery regulations, insider perspectives suggest that significant yet modifiable barriers to equity in access to care currently exist. This article has been peer reviewed

Bibliometric Analysis of Research Trends and Novelty of Midwifery Policy

Midwifery policy is important in regulating services, and its significance cannot be overstated. Despite the ongoing efforts in formulating policy, there remains a need for further analysis. This is because evidence-based research in midwifery serves as a foundation for enhancing the professionalism of the service practices. Bibliometric analysis of publications pertaining to midwifery policy is absent, leaving a gap in understanding trends and concepts. Therefore, this research aimed to determine trends in the number of publications, and visualisation of the relationship on the topic of midwifery policy through bibliometric analysis. The method used systematic reviews with the stages following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram. Scientific publication data related to midwifery policy was retrieved through dimensions.ai from 2010 to 2022 and the data was analysed using VOSviewer. The results showed that first, there was an annual exponential growth in the number of publications and citations on the topic. Second, there were 224 items, 8 clusters, and 10047 links with a strength of 63352 on the topic of midwifery policy. Third, trends of research related to the topic were focused on hospitals, behaviour, and framework. Fourth, the research related to policy were topics with a low-density category, namely professional development, registration, and public health. Research results could identify trends and novelty in midwifery policy and recommend directions for further analysis.

Nursing and midwifery education, regulation and workforce in Kenya: A scoping review.

To explore contextual literature on nursing and midwifery education, regulation and workforce in Kenya to develop an understanding of the current state and inform opportunities to strengthen the nursing and midwifery professions. Kenya has yet to achieve the minimum nursing and midwifery workforce threshold, despite the exponential increase in population and epidemiologic disease transitions. There are glaring health gaps and inequities in sub-Saharan African countries. Health systems are evolving into complex and costly utilities, increasing the demand for nurses and midwives. It is, therefore, necessary to re-examine systems that educate, deploy and retain the nursing workforce, especially given the ongoing COVID-19 pandemic and increase in non-communicable diseases. This scoping review was guided and reported following the PRISMA-ScR guidelines. Four electronic databases (PubMed, Scopus, CINAHL and Web of Science) were probed for relevant studies conducted in Kenya between 1963 and 2020. The search was supplemented using Google Scholar. Findings from selected studies were extracted and analysed thematically. Of the 238 retrieved studies, 37 were included in this review: 10 articles on nursing and midwifery education, 11 on regulation and 16 on the workforce. There have been changes in regulation and an increase in nursing and midwifery enrolment and graduates. However, maldistribution and shortage of nurses and midwives persist. Kenya's nursing and midwifery professions have undergone significant changes to meet the demand for a skilled workforce. However, the shortage of qualified and specialised nurses and midwives persists. Moreover, this shortage is exacerbated by underinvestment, outmigration and a need for more reforms to expand the nursing and midwifery workforce. Investment in nurse and midwifery education, mentorship and legislation is needed to build the capacity of the profession to provide quality health services. Several nursing and midwifery policy changes utilising a multipronged approach involving stakeholders' collaboration are suggested to address the bottlenecks from education to deployment.

The Family as “Best Weapon.” Instrumentalizing German Health Care Discourses in Upper Silesia During the Interwar Period

Pro-German family and health policies were, at their core, anti-Polish measures that cleared the path for later racially determined politics. The sources demonstrate how these policies were justified and how their character developed from protective to invasive. Therefore, I examine first protective discourses about the fight against venereal diseases, then analyze supportive regulations such as the midwifery policies and the later invasive measures like sterilizations. Although these seem to be different topics, I show that the German “people's family” ( Volksfamilie) and its significance for the health of the German “people's body” ( Volkskörper) is always implied. Using a close-reading approach that considers newspaper articles, administrative and private files, I show the extent to which national and nationalist beliefs interfered with the everyday life of citizens. The text thus scrutinizes unpublished sources regarding the strategic importance of families in German biopolitics and its interpretation in the conflicted border region of Upper Silesia. In 1921, a plebiscite was held to decide on the division of the region. This intensified conflicts between Germany and Poland, which had just gained independence in 1918. I argue that the unstable position of the new emerged country was instrumentalized in German discourses to underline the image of the disorganized and underdeveloped East.

COVID-19 and the global need for knowledge on nurses' health.

AimTo emphasize that nurses need to be fully protected to carry out their vital role, particularly during pandemics, yet the lack of a standardized and systematic collection of high‐quality disaggregated data on nurses health inhibits our ability to assess this within and across countries.BackgroundNurses are the largest workforce group in the health sector, yet only 59 countries worldwide report on nurse COVID‐19 infections and related deaths, and the standardized, systematic collection of disaggregated health data is not yet in place.Sources of evidenceMedline, International Council of Nurses, World Health Organization, Centers of Disease Control and Prevention and the experiences of the authors.DiscussionInconsistent recording and definitions of nurses, precarious and informal employment conditions, limited transparent and reliable data, lack of mass testing and long‐standing structural issues and biases have affected nursing for too long.ConclusionsThese issues are reflected in the limited capacity of many national public health information systems to collect, monitor and report on the health of the largest group of health workers. Political will, accountability and public data transparency at different levels are essential to adequately protect nurses at work.Implications for nursing practice, and nursing and health policyBuilding on current momentum in the nursing field, immediate political action is required to strengthen existing nursing and midwifery policies, standards and regulatory capacity, as well as existing public health services and information and surveillance systems. The generation of up‐to‐date, context‐specific knowledge is needed to inform and monitor political decisions related to the protection of nurses, and the improvement of their employment conditions, as well as to strengthen accountability for these areas at various levels.

Midwives and Maternal Mortality: Evidence from a Midwifery Policy Experiment in 19th-century Sweden

AbstractThis paper estimates the causal effect of a historical midwifery policy experiment on maternal mortality, infant mortality, and stillbirth during the period of 1830–1894 in Sweden. Exploiting sharp changes or “discontinuities” across time and place in the availability of trained and licensed midwives as an exogenous source of variation, we find that a doubling of trained midwives led to a 20%–40% reduction in maternal mortality and a 20% increase in the uptake of midwife-assisted homebirths. The results thus suggest that a 1% increase in the share of midwife-assisted homebirths decreased maternal mortality by as much as 2%, which is a remarkable finding given that midwife training was only 6–12 months at that time. The results of this study contribute to the current debate about the most effective strategy to reduce the unacceptably high rate of maternal mortality in many developing countries, especially in low-resource settings.

Undertaking a scoping review: A practical guide for nursing and midwifery students, clinicians, researchers, and academics.

AimThe aim of this study is to discuss the available methodological resources and best‐practice guidelines for the development and completion of scoping reviews relevant to nursing and midwifery policy, practice, and research.DesignDiscussion Paper.Data SourcesScoping reviews that exemplify best practice are explored with reference to the recently updated JBI scoping review guide (2020) and the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Scoping Review extension (PRISMA‐ScR).Implications for nursing and midwiferyScoping reviews are an increasingly common form of evidence synthesis. They are used to address broad research questions and to map evidence from a variety of sources. Scoping reviews are a useful form of evidence synthesis for those in nursing and midwifery and present opportunities for researchers to review a broad array of evidence and resources. However, scoping reviews still need to be conducted with rigour and transparency.ConclusionThis study provides guidance and advice for researchers and clinicians who are preparing to undertake an evidence synthesis and are considering a scoping review methodology in the field of nursing and midwifery.ImpactWith the increasing popularity of scoping reviews, criticism of the rigour, transparency, and appropriateness of the methodology have been raised across multiple academic and clinical disciplines, including nursing and midwifery. This discussion paper provides a unique contribution by discussing each component of a scoping review, including: developing research questions and objectives; protocol development; developing eligibility criteria and the planned search approach; searching and selecting the evidence; extracting and analysing evidence; presenting results; and summarizing the evidence specifically for the fields of nursing and midwifery. Considerations for when to select this methodology and how to prepare a review for publication are also discussed. This approach is applied to the disciplines of nursing and midwifery to assist nursing and/or midwifery students, clinicians, researchers, and academics.

The COVID-19 pandemic: A focusing event to promote community midwifery policies in the United States.

The COVID-19 pandemic has placed unprecedented stress on health care systems across the globe. This stress has altered prenatal, labor, delivery, and postpartum care in the U.S., motivating many pregnant people to seek maternal health care with community midwives in a home or freestanding birth center setting. Although the dominant maternal health care providers across the globe, community midwives work on the margins of the U.S. health care system, in large part due to policy restrictions. This commentary extends previous research to theorize that the COVID-19-related disrupted health care system and the heightened visibility of community midwives may create a “focusing event,” or policy window, which may enable midwives and their advocates to shift policy.

Systems Thinking in Upstream Social Marketing: Using Soft Systems Methodology to Improve Midwifery Policy in Jordan

Background: Despite being acknowledged worldwide as essential maternal care providers, midwives remain marginalized in the Jordanian healthcare system. Further, considering Jordan’s goal to achieve a total fertility rate of 2.1 by 2030 and Jordanian women’s preference for female providers, enhancing midwives’ role could significantly promote the use of reproductive health and family planning services. Focus of the Article: We report on opportunities created by opening the boundary of our social marketing understanding to systems thinking in practice (STiP), using soft systems methodology (SSM) to engage with the complex situation of midwifery policy in Jordan. Research Question: In what ways could STiP benefit upstream social marketing interventions? We attempt to answer this question from the perspective of an SSM action research in Jordan. Program Design/Approach: The intervention combines stakeholder analysis and evidence-based policy with an SSM seven-stage cycle. We analyze the compatibility of SSM with social marketing through the NSMC’s eight benchmark criteria. Importance to the Social Marketing Field: The case offers to learn experientially about the relevance of a systems’ approach to complement social marketing frameworks. Drawing from the practical application of SSM, this study suggests that using systems’ tools in social marketing interventions might significantly contribute to achieving intended behavioral outcomes. Methods: Gordon’s alternative framework for upstream social marketing, “advocacy, relationship building and stakeholders’ engagement,” was enacted through the SSM’s seven stages. Research findings provided advocacy arguments. Rich pictures, conceptual modeling, and the CATWOE exercise fostered relationship building and stakeholders’ engagement toward the accommodation stage. Results: At the systematic level, that is, the linear chain of programmatic activities, the policy objective was achieved with an amended Law submitted to the Parliament for debate. At the systemic level, that is, the dynamic relationships among stakeholders, the social learning that emerged during the SSM process reduced policymakers’ resistance and fostered their collective action. Recommendations for Research or Practice: Social marketers can benefit from further experimentation with systems’ approaches to develop their STiP capabilities. Thus, social marketing practice, at this historical moment, could be better equipped conceptually and practically to manage for the emergence of positive behavior change in messy upstream situations where policy and politics are always enmeshed. Limitations: SSM calls for several iterations until stakeholders feel that no more change is needed. However, these iterations are challenging to implement during the limited time frame of development projects. In this case, another iteration was suggested to diffuse the conflict between midwives and obstetrician-gynecologists who saw themselves as victims of this policy reform. However, with Jordan Communication Advocacy and Policy ending in December 2019, this case legacy might be passed on to other projects.

Salutogenic qualities of midwifery care: A best-fit framework synthesis

BackgroundAlthough midwifery care is wellness-based and promotes normal physiology, it exists within a medical model that focuses on risk aversion and disease prevention. Salutogenic theory could provide an alternative approach to midwifery care, supporting health-promoting factors, rather than solely avoiding adverse events. AimsThe aim of this study was to explore women’s experiences of their midwifery care and identify salutogenic aspects of midwifery care. MethodsBest-fit framework synthesis was used to analyse 349 quotes about women’s experiences of midwifery care from 31 qualitative studies in ten high-income countries. Key salutogenic concepts of comprehensibility, manageability and meaningfulness were used as the basis for coding, and thematic analysis was used to expand and clarify the framework to best fit the data. FindingsDefinitions for the salutogenic aspects of midwifery care were developed. Comprehensibility (cognitive aspects of health): ways that midwives help women increase predictability and preparation during childbearing through apredictable caregiver, a predictable system and preparation for an unpredictable experience. Manageability (behavioural aspects of health): ways that midwives enhance and support a woman’s internal resilience, adding extra support when needed, and strengthen women’s external resources through connections to family, community and specialist care. Meaningfulness (emotional/spiritual aspects of health): ways that midwives encourage the commitment and engagement of childbearing women by providing care through a personalised relationship, by cultivating a woman’s autonomy. ConclusionFindings of this study may be used to further research into ways that salutogenic theory can bring a health and wellness-focused agenda to midwifery policy and practice.

Are the Global Strategic Directions for Strengthening Nursing and Midwifery 2016\u20132020 being implemented in countries? Findings from a cross-sectional analysis

BackgroundNurses and midwives are the largest component of the health workforce in many countries. The World Health Organization (WHO) together with its partners facilitates the joint development of strategic policy guidance for countries to support the optimization of their nursing and midwifery workforce. The Global Strategic Directions for Strengthening Nursing and Midwifery 2016–2020 (SDNM) is a global policy guidance tool that provides a framework for Member States, the WHO and its partners to adapt, develop, implement and evaluate nursing and midwifery policy interventions in Member States. As part of the broader monitoring and accountability functions of the WHO, assessing the progress of the SDNM implementation at a country level is key to ensuring that countries stay on track towards achieving universal health coverage (UHC) and the sustainable development goals (SDGs).MethodsThis is a cross-sectional mixed methods study involving the analysis of quantitative and qualitative data on the implementation of country-level interventions in the SDNM. Data was provided by government chief nursing and midwifery officers or their representatives using an online self-reported questionnaire. The quantitative data was assessed using a three-level scale and descriptive statistics while qualitative comments were analysed and presented narratively.ResultsThirty-five countries completed the survey. Summing up the implementation frequency of interventions across all thematic areas, 19% of responses were in the category of “completed”; 55% were reportedly “in progress” and 26% indicated a status of “not started”. Findings reveal a stronger level of implementation for areas of nursing and midwifery development related to enhancing regulation and education, creating stronger roles for professional associations and policy strengthening. Leadership and interprofessional collaboration are intervention areas that were less implemented.ConclusionMonitoring and accountability of countries’ commitments towards implementing nursing and midwifery interventions, as outlined in the SDNM, contributes to strengthening the evidence base for policy reforms in countries. This stock-taking can inform policy- and decision-makers’ deliberations on strengthening the contributions of nurses and midwives to achieving UHC and the SDGs.

A review of the definition and scope of practice of midwives in five representative countries

Abstract Objective To review the definition and scope of the practice of midwives in Sweden, Finland, the United Kingdom, the United States, and Australia to find models and make suggestions for reforms in the midwifery policies of China. Methods This article reviewed the midwifery policies published by authorities, organizations, and governments of these countries and relevant literature in the databases of PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), and Wanfang database. Results The definition and scope of practice of midwives in five representative countries and China were reviewed. The similarities and differences in midwifery policies among them show that most countries set standards based on the definition and scope of practice of midwives recommended by International Confederation of Midwives. Conclusions The definition of midwives should include registration, midwifery education, and acceptance standards. The scope of practice of midwives should specify an autonomous environment, the objective of care, the period of care involved, prescribing rights, emergency treatment, and health counseling.

Midwifery policy in contemporary and modern China: From the past to the future

Objective: This study aims to outline the progress of midwifery-related policies in contemporary and modern China as well as the obstacles in this process, and to provide recommendations for policy makers in the establishment of Chinese midwifery policies, ultimately promoting the development of midwifery in China. Background and introductionPolicy plays an increasingly important role in midwifery development, particularly needed in modern China. A review of policies of midwifery could help policy makers develop effective strategies to address current problems in China, including the insufficient numbers of midwives, the shrinking of responsibility and the degradation of midwives’ competency. MethodsThe Policy Triangle was used to examine through literature the laws and regulations regarding midwifery from 1928 in China and was conducted from April to September in 2013. This was followed by insider interviews with two senior policy makers from the National Health Commission to explain nursing policy progress, thereby identifying the reasons why midwifery has developed more slowly than nursing. ResultsThe development of midwifery in China could be classified into four stages: (1) the beginning period (1928–1949), beginning with the first midwifery rules; (2) the development period (1949–1979), in which the quality and quantity of midwives were significant; (3) the unclear positioning period (1979–2008), without clear midwifery policy; and (4) the subordination to nursing period (2008–present), with the Nurse Byelaw 2008 stating that midwives must apply for nursing licenses. DiscussionThe main factors influencing midwifery policies are: (1) social background, such as the changes of different governments and health care reform, and (2) the powers of the actors. Currently, it is an appropriate time to develop strategies for policy makers to facilitate midwifery development in China. Conclusions and Implications for Health PolicyMidwifery policy should be independently included in the frame of national medical industry reform because midwives are an indispensable part of the health care workforce. In-depth research should be conducted to confirm the position of midwifery in China to ensure its sustainable development.

Assessing the policy and practice impact of an international policy initiative: the State of the World\u2019s Midwifery 2014

BackgroundUnderstanding how policies lead to changes in health systems and in practice helps policymakers and researchers to intervene more successfully. Yet identifying all the possible changes that occur as a result of a new policy is challenging not only methodologically and logistically, as limited resources are available to conduct indefinite evaluations, but also theoretically, as a complete mapping and attribution of post-hoc changes requires a full understanding of the mechanisms underpinning all change. One option is to identify possible changes across a number of policy impact domains.MethodsUsing a Policy Impact Framework, we brought together data from media, documents and interviews to identify changes to midwifery policy, practice and provision, following the launch of a new global policy initiative, the State of the World’s Midwifery (SoWMy 2014) report published in 2014. We used these identified impacts to develop a map of the mechanisms underpinning these changes.ResultsSoWMy 2014 contributed to a number of changes at national levels, including increased status of midwifery within national governments, improved curricula and training opportunities for midwives, and improved provision of and access to midwifery-led care. These contributions were attributed to SoWMy 2014 via mechanisms such as stakeholder interaction and acquisition of government support, holding national and international dissemination and training events, and a perceived global momentum around supporting midwifery provision. Policy initiatives of this kind can lead to changes in national and international policy dialogue and practice. We identify factors and mechanisms that are likely to increase the scope and scale of these changes, at contextual, national and global levels.ConclusionsIdentifying changes following a policy using a policy impact framework can help researchers and policymakers understand why policies have the effect they do. This is important information for those wishing to increase the effectiveness of future policies and interventions.

The Politics of Collaboration and the Care Continuum

Introduction: Collaboration is considered a necessary constituent of good healthcare practice and a means to integrate care. While much research has focused on defining collaboration, this research focused on the processes underpinning the construction and application of the concept of collaboration. Methods: The research focused on knowledge and meaning construction at both the individual and social levels. The context was the transition between hospital and community healthcare interpreted through semi-structured interviews with women, nurses and midwives. Three key concepts were generated through an interpretive analysis. The concepts of identity, knowledge and institutions of care formed the lens for a critical analysis of 25 Australian government and professional nursing and midwifery policy statements published between 2006 and 2013 that referenced collaboration. Results: The policy analysis produced four key analytical findings. First, policies conceived of collaboration as a largely professional concern which positioned clients as less salient identities in the process. Second, collaboration appeared as a taken for granted, unproblematic concept that assumed knowledge was neutral and interests were shared within complex healthcare systems. Third, policy documents reflected a predilection with formal agreements, guidelines and decision frameworks that clearly defined roles for collaboration while concealing how these artefacts functioned to shape the behaviours of others. Fourth, while the policies of professional healthcare groups focused on boundaries that reified status, it is shared goals and the distribution of power that underpins collaborative work. Discussion: Of importance was the way in which the language of policies around collaboration obscured issues of power and competing interests. The concept of collaboration concealed how power and authority defined healthcare interactions and context. Collaboration assumed multiple meanings which allowed prevailing views to be reconfigured for specific purposes. As a result, healthcare consumers, professionals and governments become socialised to the rhetoric of collaboration in a way that supports the status quo despite calls for change. Conclusion: The ambiguity surrounding collaboration means it is a potent political resource because it can be invoked to service disparate interests in different situations. Lessons learned: Rather than adopting an unquestioning attitude to the concept of collaboration health professionals should assume the presence of particular interests where this term is applied. Looking beyond the veneer of consensus to recognise the value in the process of collaboration may hold important lessons for future work. Limitations: The research acknowledges that contextually situated realities exist in specific healthcare situations. While this implies that the application of findings is limited, the focus on process broadens the relevance of the research. Further research: This research has highlighted a significant practice/policy disjuncture. This gives credence to the call for policy-making to be more closely aligned with the interactional level of healthcare. Further work must focus on the process of collaboration and engage clinicians and consumers in the policy process.

Integrating public health practice into the graduate's role through pre-registration education

Public health is now clearly defined in policy and statute as an integral part of the midwife's role and this work continues to develop as health challenges emerge and diversify. To clarify the knowledge and skills required by contemporary midwives, this article provides an overview of health promotion and public health concepts and discusses how these are embedded in midwifery policy. The approaches and processes midwives should adopt are considered and an analysis of public health learning in midwifery education highlights areas that need to be addressed. This paper concludes with recommendations for midwifery pre-registration education to develop the underpinning public health knowledge and skills that midwives require for optimum practice.

Maternity care for undocumented migrant women: The impact of charging for care

Maternity care in the NHS is chargeable for most women without indefinite leave to remain in the UK, despite evidence that recent migrants face higher risks of adverse pregnancy outcomes than the general population. Maternity care must be offered regardless of a woman's ability to pay but, in practice, charging deters many pregnant women from accessing maternity care, or results in late booking and missed appointments. Standard midwifery policy stresses the importance of early booking and continuity of midwifery care, especially for women with high-risk pregnancies due to underlying medical conditions and complex social factors. The government has justified charging ‘overseas visitors’ to prevent ‘health tourism’ and to save costs, but there is no evidence to support the claim of ‘health tourism’ or that charging actually saves the NHS money. Midwives need to be well-informed about women's entitlements to maternity care and the importance of ensuring that care is provided.

Approaches to improving the contribution of the nursing and midwifery workforce to increasing universal access to primary health care for vulnerable populations: a systematic review.

BackgroundDespite considerable evidence showing the importance of the nursing and midwifery workforce, there are no systematic reviews outlining how these cadres are best supported to provide universal access and reduce health care disparities at the primary health care (PHC) level. This review aims to identify nursing and midwifery policy, staffing, education and training interventions, collaborative efforts and strategies that have improved the quantity, quality and relevance of the nursing and midwifery workforce leading to health improvements for vulnerable populations.MethodsWe undertook a structured search of bibliographic databases for peer-reviewed research literature using a focused review question and inclusion/exclusion criteria. The quality of retrieved papers was appraised using standard tools. The characteristics of screened papers were described, and a deductive qualitative content analysis methodology was applied to analyse the interventions and findings of included studies using a conceptual framework.ResultsThirty-six papers were included in the review, the majority (25) from high-income countries and nursing settings (32). Eleven papers defined leadership and governance approaches that had impacted upon the health outcomes of disadvantaged groups including policies at the national and state level that had led to an increased supply and coverage of nursing and midwifery staff and scope of practice. Twenty-seven papers outlined human resource management strategies to support the expansion of nurse’s and midwives’ roles that often involved task shifting and task sharing. These included approaches to managing staffing supply, distribution and skills mix; workloads; supervision; performance management; and remuneration, financial incentives and staffing costs. Education and training activities were described in 14 papers to assist nurses and midwives to perform new or expanded roles and prepare nurses for inclusive practice. This review identified collaboration between nurses and midwives and other health providers and organizations, across sectors, and with communities and individuals that resulted in improved health care and outcomes.ConclusionsThe findings of this review confirm the importance of a conceptual framework for understanding and planning leadership and governance approaches, management strategies and collaboration and education and training efforts to scale up and support nurses and midwives in existing or expanded roles to improve access to PHC for vulnerable populations.