Midwifery Profession Research Articles

Challenges and needed reforms in midwifery and nursing regulatory systems in India: Implications for education and practice.

BackgroundIn India, nursing regulation is generally weak, midwifery coexists with nursing, and 88% of nursing and midwifery education is provided by the private health sector. The Indian health system faces major challenges for health care provision due to poor quality, indeterminate regulatory functions and lack of reforms.MethodsWe undertook a qualitative investigation to understand midwifery and nursing education, and regulatory systems in India, through a review of the regulatory Acts, and an investigation of the perceptions and experiences of senior midwifery and nursing leaders representing administration, advocacy, education, regulation, research and service provision in India with an international perspective.ResultsThere is a lack of importance accorded to midwifery roles within the nursing system. The councils and Acts do not adequately reflect midwifery practice, and remain a barrier to good quality care provision. The lack of required amendment of Acts, lack of representation of midwives and nurses in key governance positions in councils and committees have restrained and undermined leadership positions, which have also impaired the growth of the professions. A lack of opportunities for professional practice and unfair assessment practices are critical concerns affecting the quality of nursing and midwifery education in private institutions across India. Midwifery and nursing students are generally more vulnerable to discrimination and have less opportunities compared to medical students exacerbated by the gender-based challenges.ConclusionsIndia is on the verge of a major regulatory reform with the National Nursing and Midwifery Commission Bill, 2020 being drafted, which makes this study a crucial and timely contribution. Our findings present the challenges that need to be addressed with regulatory reforms to enable opportunities for direct-entry into the midwifery profession, improving nursing education and practice by empowering midwives and nurses with decision-making powers for nursing and midwifery workforce governance.

A Change Will Do You Good!: Exploring Pre-Midwifery Careers

Some people have childhood aspirations to become midwives, while others become interested in midwifery as a second, third or even fourth career – it is never too late to train as a midwife. Previous career experiences can make your midwifery training application stand out and positively shape your practice as a qualified midwife. In this uplifting article, two registered midwives and a student midwife describe what led them to pursue midwifery after successful careers as a head of English, singer and copywriter, and explain how their previous occupations have prepared them to enter the midwifery profession.

A BRIEF OVERVIEW OF MIDWIFERY EDUCATION AND PROFESSION FROM HISTORY TO TODAY

Doğum günümüze kadar insanlığın varoluşu ve devamlılığı için önemini korumuştur. Doğumda kadınların en büyük yardımcısı olan ebelerin, doğumu yönetmek ve doğum yapan kadını psikolojik olarak rahatlatmak gibi rolleri bulunmaktadır. Eski çağlarda eğitim almadan geleneksel olarak usta-çırak ilişkisi ile yürütülen ebelik, günümüzde bilimsel profesyonel bir meslek olarak yürütülmektedir. Türkiye’de ebelik eğitimi, sağlık hizmetlerinde yaşanan gelişmeler, sağlık politikaları çerçevesinde şekillenmiştir. Bu derleme, ebelik eğitimi ve mesleğinde günümüze kadar olan değişim ve gelişimini ortaya koymak amacıyla yazılmıştır.

PMA Reflections on Adaptation to Continuity of Carer

In the year following implementation of continuity of carer (CoC) caseloading teams in my trust, I noticed some initial anxiety in the midwives for whom I provide support as professional midwifery advocate (PMA). Over time, however, midwives reflected that they simply needed to adapt their behaviours, having been institutionalised by years in an on-call model and faced with more flexible boundaries on their working hours. Adapting to a new way of working takes time and honest reflection to achieve a shift in mindset and a healthy respect for those boundaries, after which midwives report a better-than-ever work/life balance.

Predictors of competency on delivery care service among final year undergraduate midwifery students in higher education institutions of Ethiopia, 2019: A cross sectional study

BackgroundCompetence is the documentation of an acceptable level of performance, through a process of structured assessment. Focusing on generating highly competent midwives with essential skills, more specifically on childbirth care services helps to improve maternal and newborn health outcomes. This study was aimed to assess determinants of competency on delivery care among newly graduated bachelor midwifery students in Amhara regional state Higher Education Institutions, Ethiopia, 2019. MethodInstitution-based cross-sectional study was conducted. A total of 420 participants were included in the study. A structured, pretested and self-administered questionnaire was used to collect the data. A stratified random sampling technique was employed to select the study participants. The data was entered into Epi info version 7.0 and then exported to SPSS version 20.0 for analysis. Both bivariate and multivariable logistic regression models were fitted. Crude and Adjusted Odds ratio with 95% confidence interval has been computed and variables with p-value < 0.05 were considered statistically significant. ResultThe overall proportion of delivery care competency was 28.8%. Midwives’ choice to midwifery profession as their first field of study [AOR: 3.2, 95%CI; (1.6–6.5)], teachers who allocate enough time at clinical practice sites [AOR: 2.5, 95%CI; (1.5–4.2)], and absence of practitioners from other disciplines [AOR: 2.4, 95%CI; (1.4–4.1)], were significantly associated. ConclusionThe overall proportion of delivery care competency was found to be low. Insuring regular mentoring and supervision, staying with students at the practical sites and avoiding attachment sites for clinical practice crowded by other discipline students are strongly recommended.

Professional image of nursing and midwifery in East Africa: an exploratory analysis

BackgroundEvidence suggests that there is a negative image of nursing and midwifery that does not promote these professions as attractive career options. Furthermore, there is a paucity of studies documenting how nursing and midwifery is perceived in East Africa and where such studies exist they are country-specific. The aim of this study was to explore views regarding the image of nursing and midwifery among nurses and midwives in three East African countries, Kenya, Tanzania and Uganda.MethodsAn exploratory descriptive cross-sectional study administered online using Survey Monkey Questionnaires assessed the views and perceptions of nurses and midwives regarding the image of nursing and midwifery professions. Descriptive statistics and Pearson’s Chi square tests were used to analyse the data. The semi-structured questions were analysed using content analysis.ResultsA total of 551 participants took part in the study. The majority were females (61.8%), registered nurses/midwives (45.8%), and aged 30–39 years (34.2%). Most of the respondents were from Kenya (39.7%) and Uganda (32.9%). About two-thirds of the nurses and midwives in this study perceived nursing/midwifery as both trusted and respected professions and expressed having a level of control over how their image was portrayed. Conversely, the nurses and midwives were conscious that the public had mixed responses about the nursing/midwifery professions specifically, some members of the public described nurses/midwives as professionals, knowledgeable and caring, others perceived nurses/midwives to be rude, cruel, unkind, lazy, unkempt, and maids.ConclusionThis study offers an interesting insight about the image of nursing/midwifery in East Africa. Findings from this study will inform policy makers and educators about key concepts that affect the image of nursing and midwifery in East Africa. The findings will be used to design marketing materials to help improve the image of nursing and midwifery in the region and other African countries.

Social culture and the bullying of midwifery students whilst on clinical placement: A qualitative descriptive exploration

The context within which midwifery students are professionally socialised is thought to impact upon the development of their sense of belongingness, their attitudes and values, and their commitment to the midwifery profession. Negative forms of socialisation are known to lead to undesirable outcomes including desensitisation about humanistic needs. This has potential to extend to an acceptance of workplace bullying and unfair treatment of others, including midwifery students whilst on clinical placement. This study aimed to explore how the social culture of the maternity setting influences midwifery students’ experiences of being bullied whilst on clinical placement. One hundred and twenty midwifery students from Australia and the United Kingdom completed a qualitative online survey and the data was thematically analysed. One main overarching theme and four sub themes were identified. These were: 'the organisational culture of acceptance: “in front of”', 'brazen expression', 'group buy-in', 'suppression of dissent', and 'collateral damage'. Each of these factors enabled replication of the problem and led to perpetuation of the bullying cycle. This study illuminated that an entrenched culture of acceptance exists which impacts the students educational experience, the care received by mothers and babies, and the reputation of the midwifery profession.

How is organisational fit addressed in Australian entry level midwifery job advertisements

BackgroundMidwifery job retention is an ongoing global issue. Prior research has recognised that considering an individual’s attributes in relation to their work environment may assist in improving job satisfaction among midwives, leading to improved long-term job retention in the midwifery profession. The aim of this study was to evaluate whether, and how organisational fit is addressed in current entry level midwifery job advertisements within Australia.MethodsMidwifery jobs were searched for within 12 search engines, using the search term ‘midwife’, including Seek.com, Indeed.com, government employment websites for all Australian states and territories, and private health organisation websites. Data were extracted from eligible job advertisements by three independent researchers. Extracted data encompassed elements addressing person-job fit and person-organisation fit. Content analysis involving chi-square and Fischer exact tests were completed on extracted data.ResultsKey findings demonstrate private health care organisations (29.2%) are more likely than public health care organisations (8.8%) to ask potential candidates to have additional qualifications, however, public health care organisations (34.1% vs. 16.7%) are more likely to ask for dual registration as a midwife and nurse. This is further supported by private health care organisations being more likely to refer to the candidate as a midwife (72.9% vs. 48.4%) than as a nurse. Private health care organisations more often noted access to support for employees and were more likely to mention access to employee assistance programs (41.7% vs. 13.2%), orientations (16.7% vs. 0%) and included benefits (72.9% vs. 42.9%). Clinical skills and personality traits were more frequently addressed in public health organisation advertisements; these included a requirement of employees to be accountable (49.5% vs. 6.3%), innovative (28.6% vs. 0%), have teamwork (69.2% vs. 52.1%) and conflict resolution skills (36.3% vs. 8.3%), and have knowledge of legislation (44.0% vs. 25.0%) and contemporary midwifery issues (28.6% vs. 4.2%).ConclusionThis study highlights that organisations employing midwives may be unwittingly contributing to the problem of midwife attrition through inattention to factors that endear midwives to workplaces in job advertisements. Further work developing employee selection and recruitment processes that are informed by the concept of person-job-organisation fit, is necessary.

Leveraging momentum of 2020-Reflections from an International Conference.

This Commentary illustrates how innovative clinical and research initiatives highlight the ingenuity and creativity of nursing and midwifery professions thus leveraging the momentum of 2020 that commenced with the Year of the Nurse and Midwife and the Nursing Now Challenge. Speakers demonstrated through vision, creativity and policy generation how the world is now in a different place due to COVID-19 and how the global crisis will change and shape the future of health care delivery. Speakers were invited because of their reputation as international leaders in global health and population. Participants evaluated content and its relevance to research, education and practice in group discussions. The current global crisis determines that the capabilities and capacity of nurses and midwives will become more crucial than ever to the delivery of universal health coverage (UHC) and population health by 2030. Global leaders and policymakers must seek the knowledge and skills they need to support their work during a global crisis. Achieving population health and equitable access to health care is dependent on an adequate health workforce.

“Taking our blindfolds off”: acknowledging the vision of First Nations peoples for nursing and midwifery

This editorial responds to a recent reminder from an Elder to acknowledge and respect First Nations ways of knowing, doing, and being as health professionals and researchers. This reminder asked us to critically reflect on our professional stance and practices as nurses, midwives and researchers in the light of the fire that still burns at the Aboriginal tent Embassy and recent dialogues for Australia Day. In light of the international Black Lives Matter movement in 2020, we discuss the importance of our shared roles and responsibilities to continue to challenge racism and oppressive practices in Australian health care. Decolonising nursing and midwifery practice, policy, research, and education approaches offer a clear transformational reform process to address oppressive practices and racism including attitudes, ignorance and bias, generalisations, assumptions, uninformed opinions and commit to developing and embedding cultural safety in the nursing and midwifery profession.

Smoking and tobacco: working towards the endgame as a vital part of post-COVID-19 recovery

Smoking and tobacco: working towards the endgame as a vital part of post-COVID-19 recovery

Professional autonomy for midwives in the contemporary UK maternity system: part 2

In this article, professionalisation, the midwifery profession and professional autonomy are explored from a sociological perspective to answer whether it is possible for a midwife to achieve professional autonomy within the contemporary UK system. Within part 1, obstetric influences and frictions, government policy and guidelines, risk, litigation and increasing managerialisation were considered, highlighting the complexities of professional midwifery and the challenges it faces. In part 2, choice, service pressures, evidence-based care, consumerism, leadership and reflexive practice are considered in the context of professional autonomy and the intention of retaining women's choice as the core belief of the profession. A conceptual framework has been devised to enable this, utilising the concept ‘New Professional Midwifery’.

The prevalence of the technocratic model in obstetric care from the perspective of health professionals.

to identify the reasons for the prevalence of the technocratic model in obstetric care from the perspective of health professionals. Grounded Theory. Study approved by two Research Ethics Committees and conducted by theoretical sampling, from July 2015 to June 2017. Twenty-nine interviews were conducted with health professionals from two maternity hospitals in the Southern Region of Brazil. Data collection and analysis was performed alternately; and analysis by open, axial, and selective coding/integration. the technocratic model still persists because the assistance is performed in a mechanized way, centered on the professionals. There is a lack of systematization of care, and under-dimensioning of the nursing staff. obstetric nurses need to review their performance in obstetric centers, the internal organization, the dimensioning of nursing professionals, and become protagonists of care. Investment in academic training/updating the knowledge of midwifery professionals, based on scientific evidence and user-centered care is necessary.

The Regulation of Professional Midwifery in the United States

The World Health Organization (WHO) designated 2020 as the International Year of the Nurse and the Midwife. Part of the WHO campaign focuses on the fact that nurses and midwives comprise more than half of the shortfall in the global health workforce. In the United States, maternity care is critical because half of rural counties have no access to maternity providers and because the rate of maternal morbidity and mortality continues to climb, surpassing rates of countries with similar incomes. Midwives have a proven record for quality, safety, cost-savings, and high patient satisfaction, yet they attend only 10.2% of births in the United States. In many countries with better maternal mortality and morbidity outcomes, midwives attend 50% to 70% of births. This article reviews the history of professional midwifery in the United States, including the development of the certified midwife credential, outlines current challenges in regulation of the profession, and summarizes widely accepted recommendations to improve access to high quality maternal and child health through support of the midwifery workforce. It is intended to assist state boards of nursing in understanding how they might expand their authority to include the licensing and regulation of certified midwives.

Professional autonomy for midwives in the contemporary UK maternity system: part 1

The history and professionalisation of midwifery has travelled through turbulent times to arrive at an opportunity for transformation in the contemporary UK maternity system. This professionalisation, the midwifery profession and professional autonomy are explored in this article from a sociological perspective, to answer the question of whether a midwife can achieve professional autonomy within the UK system. This is a two-part article. Part one has a strong focus on the historical context of midwifery, government policy and guidelines, risk, litigation and increasing managerialisation to frame the discussion in part two. The second part provides a discussion of autonomy, choice, managerialisation and reflexive practice, to create a conceptual framework utilising the concept New Professional Midwifery. This is to centralise a core belief in midwifery autonomy and women's choice facilitation. This paper is part one of two.

Midwifery as a Future Career: Determinants of Motivation Among Prep Students in Harar, Eastern Ethiopia.

BackgroundMidwifery is a profession that deals with care and advice during pregnancy, labor, childbirth and postpartum period including support for the newborn. Like other professions, the sustainability of midwives depends on recruiting new professionals who are inspired to train as their future career. In this regard, the inspiration of preparatory students to embracing the profession and secure the future midwife workforce is critical. In Ethiopia, there is no literature on the assessment of students’ intention toward the midwifery profession. Hence, this study is crucial to fill data scarcity.ObjectiveTo assess the intention and related factors to choose midwifery as a future profession among preparatory students at Harar.MethodologyAn institutional cross-sectional study was conducted on preparatory students from March 20 to April 12/2019. Self-administered questionnaires were randomly given to 423 students. Multivariate logistic regression analysis was done for variables with p-value <0.2 in binary logistic regression. The odds ratio was used to measure the degree of association.ResultsOnly 18.1% intended to choose midwifery as a future profession. The odds of considering to choose midwifery is 5 times higher in those who have a health professional mother [AOR= 5.518 p-value 0.009]. Students who have good perceptions are 7 times more likely to choose the profession [AOR= 7.072 p-value 0.00]. Students who perceived low regard toward the profession [AOR= 0.231 p-value 0.001] and blood contact as a barrier to be a midwife [AOR= 0.174 p-value 0.001] are less likely to choose it.ConclusionPreparatory students in Harar have minimal intention to choose midwifery. This is due to a lack of information about the profession, poor perception, low regard to the profession, and fear of blood contact. This finding contributes to the midwifery association and ministry of health to enhance positive perception toward the profession.

Utilization of partograph during labour: A case of Wolaita Zone, Southern Ethiopia

The World Health Organization recommends the utilization of partograph for all laboring mothers. Partograph is a cost-effective, single sheet of paper that is used to follow maternal and fetal condition and progress of labour. Obstructed and prolonged labours are major causes of maternal deaths. These causes can be minimized by routine utilization of partograph. However, several maternal and fetal deaths occur in health facilities due to poor quality of labour follow-up. Therefore, this study aims to assess the utilization of partograph and associated factors among obstetric care providers working in Wolaita zone health facilities, Southern Ethiopia.An institution-based cross-sectional survey was conducted from April to May 2016. A pretested and structured self-administered questionnaire was used to collect the data. Data entry and analysis was conducted using SPSS Version 21.0. Logistic regression was used to identify associations. A P value <0.2 in binary logistic regression were transferred to multiple logistic regressions. Odds ratio with 95% CI, P-value <0.05 were considered as statistically significant.Of a total of 442 participants, 73.6% utilize partograph routinely. From the total variables in the study, a midwifery profession showed a significant association with the dependent variable (AOR = 4.7,95% CI:1.8–12).The utilization of partograph in the study area was low as per the World Health Organization recommendation. This study recommends that assigning midwives in the obstetric ward other than other health professionals will increase the routine utilization of partograph.

Professional Midwifery Advocacy in Higher Education: An Evaluation of an Innovative Implementation of the A-EQUIP Model

Educational PMAs are developing ways of working with the A-EQUIP model. PMAs at Birmingham City University have developed restorative clinical supervision (RCS) sessions using appreciative inquiry with midwifery students. Evaluation was overwhelmingly positive and RCS has been rolled out across all years of the programme. There is a distinct role for educational PMAs.

A nationwide initiative to increase nursing and midwifery research leadership: overview of year one programme development, implementation and evaluation.

To report on the development, implementation and evaluation of the first year of the National Institute for Health Research 70@70 Senior Nurse Research Leader Programme. Internationally, there is a lack of nursing and midwifery research and policy contribution to healthcare sectors. To address this, funding was obtained for a Senior Nurse and Midwife Research Leader Programme in England. The programme aimed to increase nursing and midwifery research capacity and capability and support the development of future research leaders. The programme had three phases: development, implementation and evaluation. The cohort study's evaluation phase consisted of a survey and qualitative written feedback. An online survey was sent to cohort members (n=66). Quantitative survey data was analysed in Survey Monkey. Written feedback asked cohort members to summarise their activities and any challenges. Data were thematically analysed. The "Strengthening the Reporting of Observational Studies in Epidemiology" reporting checklist was used. Thirty-nine (59%) cohort members responded to the survey. Responders valued being part of a network (46%), having protected time (22%) and having workplace autonomy (13%). Challenges reported included difficulties accessing online resources (32%), lack of collaborative opportunities (17%) and organisational barriers (10%). Fifty-six (85%) cohort members submitted the written report. The main themes were "relationship and profile building", "developing capability and capacity", "developing the workforce", "patient and public involvement and engagement" and "quality improvement." The 70@70 programme has increased the research profile of the nursing and midwifery professions at a local and national level. International healthcare systems can learn from this, by considering optimal ways to provide nurses and midwives with the tools, resources and confidence to actively contribute to research policy and practice. The initiatives undertaken through year 1 of the programme have created a platform through which research can be incorporated into clinical practice, education and teaching.

“Costuma fornecer a diversas pessoas drogas abortivas”: o ofício das parteiras, disputas profissionais e sociabilidades femininas (Porto Alegre, RS, Primeira República)

O artigo versa sobre o ofício das parteiras, sua importância social, as disputas por clientela e as sociabilidades femininas que giravam em torno deste exercício profissional. A parteira era uma presença limite entre a vida e a morte, entre um bom parto e um desfecho indesejado. Era ela que trazia a criança ao mundo, cortava o cordão umbilical, cuidava da mulher que acabara de parir, limpava o recém-nascido, providenciava (às vezes, no próprio pátio da casa dos pais) o enterro do natimorto, batizava os nascidos in periculo mortis, amadrinhava os sobreviventes. A análise dessa trabalhadora da saúde usa documentos judiciários como observatórios sociais e através deles maneja o cruzamento com outras fontes, procurando as experiências sociais das agentes ali presentes, tanto no exercício do ofício como recebendo atendimentos diversos. Parte das mulheres que aparecem neste artigo, se consultando ou usando efetivamente os serviços das parteiras, são trabalhadoras do serviço doméstico, assim, também versaremos sobre questões desse universo laboral. O lócus de nossa pesquisa é a cidade de Porto Alegre, capital do estado do Rio Grande do Sul, na parte mais meridional do Brasil.