Midwifery Training Programmes Research Articles

Exploring clinical practice education for student midwives: Hospital and community opportunities and challenges

Understanding the experiences of student midwives during clinical training is crucial amid evolving midwifery practices in the Philippines. This training is a vital component of their education, offering real-world experience in hospital and community settings. Although existing literature covers various aspects of midwifery training, detailed accounts of the specific challenges and opportunities faced by Filipino student midwives are limited. This study explores the experiences of student midwives across different levels of training in public and private institutions, focusing on the opportunities and challenges they encountered. A qualitative descriptive research design was conducted with 26 purposively selected student midwives. Data collected through in-depth interviews were analyzed to identify recurring themes. Key themes included the importance of a supportive learning environment, exposure to diverse cases, and the acquisition of practical skills. Challenges such as hierarchical barriers and communication challenges, role confusion, resource limitations and adaptation struggles, balancing autonomy and supervision, emotional toll of challenging situations and limited community experiences were highlighted. The findings stress the need for a more supportive and resourceful training environment. Addressing these challenges through targeted interventions could enhance the learning experience and better prepare student midwives for their professional roles. Collaborative efforts with other healthcare professionals and continuous learning opportunities are also essential for their development. This study offers valuable insights for educators and healthcare institutions to optimize midwifery training programs, ultimately fostering the holistic growth of future midwives.

The Role of Midwives in US Perinatal Palliative Care: A Scoping Review.

Perinatal palliative care (PPC) is a rapidly growing and essential reproductive health care option for pregnant persons with a diagnosed life-limiting fetal condition who continue their pregnancy. The provision of PPC is within the scope of basic midwifery competencies, and midwives are well-positioned to make unique and valuable contributions to interprofessional PPC teams. However, little is known about midwives' past or current involvement in PPC in the United States. This scoping review of the literature investigated what is known about the role of midwives in PPC in the United States. Multiple databases of published literature were used for this review: PubMed, CINAHL, Embase, Web of Science, ProQuest, Google Scholar, and relevant citations from identified studies. All types of English language publications addressing midwives' involvement in PPC in the United States were included, without any limitations on publication date. The role and contributions of midwives in PPC is not well represented in existing literature. Of the 259 results identified, 7 publications met criteria for inclusion. These included 5 case reports, one quantitative research article, and one conference abstract. Midwives are involved in PPC through the provision of direct clinical care (including antepartum, intrapartum, postpartum, neonatal, bereavement, postmortem, and follow-up care) and care planning and coordination as part of an interprofessional team. Despite midwives being uniquely positioned to provide holistic, family-centered, and person-centered care in situations of pregnancy with life-limiting fetal conditions, there is limited literature about their involvement in PPC in the United States. PPC should be incorporated into midwifery education and training programs. Midwives should play a central role in shaping future research and policies to ensure the accessibility and quality of PPC.

Balancing nursing and midwifery student equity and public safety: An Australian case study

BackgroundNursing and midwifery academics have multiple responsibilities, including developing curricula that promote public safety and ethical practice. Effective governance processes are required to help academics manage students who pose a risk to public safety. However, the pressure to increase graduate numbers and prioritise student-centred approaches can pose challenges. AimTo discuss the challenges facing Australian nursing and midwifery academics who endeavour to optimise the number of successful graduates whilst fulfilling their legislative duty to identify and manage students who may pose a risk to public safety. MethodsA case study approach is used to gain insight into implementing governance processes that maintain quality, safety, and public safety in nursing and midwifery education and training programs. Discussion and conclusionsAcademics must understand their responsibilities, including the need for transparency in accessibility and equity policies. Awareness of the definition of impairment and the provision of reasonable adjustments as defined by the Australian Health Practitioner Regulation Agency are vital to support students in making informed career choices.

Clinical teaching practices in maternal mental health care: An integrated review.

WHAT IS KNOWN ABOUT THE TOPIC?: Mental health-related problems in pregnancy are now becoming a global health concern. However, most studies have reported that midwives are unable to assess and support maternal mothers due to poor preservice education. The findings of these studies needed to be explored further from the available literature to address the gap. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The paper has identified maternal mental health core competencies and innovative clinical teaching strategies that nurse educators can utilize when supporting students theoretically and during clinical practice so that students should be adequately prepared for maternal mental health practice. Challenges and recommendations for clinical teaching were also identified. However, there are still gaps in the literature related to the effectiveness of teaching strategies to promote competence acquisition in maternal mental health. WHAT ARE THE IMPLICATIONS FOR EDUCATION?: The study results can be used by nurse educators to develop effective clinical teaching practices in maternal mental health care. The findings can be used in the development of best clinical teaching guidelines for maternal or perinatal mental health to be used by nurse educators for the undergraduate midwifery training programmes. ABSTRACT: Introduction Maternal mental health problems are commonly experienced by women; however, they are usually not adequately recognized and treated by midwives in Malawi. Evidence suggests poor preservice education by nursing colleges which affects the development of essential maternal mental health competencies. Aim The aim of the study was to review existing evidence on clinical teaching practices by nurse educators in teaching student midwives maternal mental health care. Method Integrative review method was used, and various databases were searched. Out of 1768 articles, 27 research articles met the inclusion criteria. The critical appraisal skills programme checklist tools were used to assess data quality. Thematic analysis was done by comparing, grouping and integrating data. Results Six themes emerged, namely: core maternal mental health competencies, professional regulation, interactive teaching strategies, collaborative partnerships, capacity building and shortage of resources. Discussion Clinical teaching is an important aspect of midwifery education. Utilizing student-centred teaching approaches helps students acquire competencies in maternal mental health care. Further research is required to identify the effectiveness of the clinical teaching methods. The Implication to Practice The study results can assist nurse educators to provide comprehensive clinical teaching practices in maternal mental health care which will aid in the development of maternal mental health competencies among student midwives.

Mapping of Iranian midwifery curriculum according to the International Confederation of midwives competencies

BackgroundEvaluating the curriculum based on its success rate in preparing skilled midwives proficient in performing professional skills is a fundamental component of the midwifery education system. This study aimed to evaluate the content, strengths, and weaknesses of the midwifery curriculum in Iran based on the most recent ICM midwifery education standards in all competence areas, as well as to obtain expert feedback on the necessary courses or lessons for the curriculum using the Delphi method.MethodsThis research was conducted in two phases: comparative analysis and the Delphi method. In the comparative analysis, the curriculum mapping tool was used to compare Iran’s midwifery curriculum for bachelor’s degrees to the international standards for midwifery education proposed by ICM in 2019 by a four-point Likert scale (adequate- relatively adequate- relatively inadequate- inadequate). Two individuals evaluated the curriculum independently for the presence of theoretical and clinical courses for attaining each relevant competency. In case of disagreement, the opinion of a third person was used. After identifying the academic deficiencies and weaknesses of the curriculum, the Delphi technique was used with the cooperation of the midwifery board members and directors of midwifery groups from across the country to collect feedback about new courses or lessons that need to be incorporated into the curriculum.ResultsAfter a comparative analysis, 24 out of 315 essential competencies for ICM in the midwifery curriculum were found to be inadequate or relatively inadequate based on the three experts’ opinions after reviewing the programmatic courses and lessons in the curriculum. In 79.5% of the knowledge area and 71.6% of the skill area, the curriculum for midwifery in Iran corresponded to ICM essential competencies. After surveying expert members during multiple Delphi rounds, the members agreed to add some lessons to the midwifery curriculum, design a new course, and hold related workshops to cover the competencies identified as inadequate or relatively inadequate in the comparative analysis.ConclusionThe Iranian midwifery curriculum for acquiring 24 items of ICM essential competencies was deemed inadequate or relatively inadequate. Therefore, it seems in addition to revising Iran’s midwifery curriculum following ICM competencies, providing midwifery policymakers with infrastructure and additional support to develop and implement effective midwifery training programs is necessary to ensure that midwives are trained and equipped with the necessary competencies for practice.

A secondary mixed methods analysis examining midwives’ responses regarding patient sexual orientation and gender identity (SOGI) disclosure

ObjectiveRecent research suggests that midwives generally have positive attitudes towards sexual and gender minority (SGM) clients; however, little research has examined whether and how these attitudes translate into specific clinical practices. In this study, we performed a secondary mixed methods analysis to examine midwives’ beliefs and practices regarding the importance of asking and knowing their patients’ sexual orientation and gender identity (SOGI). MethodsA confidential, anonymous paper survey was mailed to all midwifery practice groups (n = 131) in Ontario, Canada. Participants were midwives who were members of the Association of Ontario Midwives who responded to the survey (n = 267). Sequential explanatory mixed methods analysis was employed: quantitative SOGI questions were analyzed first, followed by qualitative open response comments to explain and contextualize the quantitative findings. FindingsMidwives’ responses indicated that it was not important to know or ask about clients’ SOGI because (1) it is not necessary to be able to provide the best care to everyone, and (2) the onus is on the client to disclose SOGI. Midwives indicated that they would like more training and knowledge to be able to confidently care for SGM. Key Conclusions and Implications for PracticeMidwives’ hesitancy to ask or know SOGI demonstrates that positive attitudes do not necessarily translate into current best practices for obtaining SOGI data in the context of SGM care provision. Midwifery education and training programs should address this gap.

A Sierra Leone 2021 Midwifery Clinical Training Needs Assessment: A Call to Action to Augment Clinical Precepting.

Sierra Leone has one of the highest maternal mortality and infant mortality rates globally. We share findings from a Midwifery Clinical Training Needs Assessment, conducted in 2021 as a collaboration between the Government of Sierra Leone and Seed Global Health. The assessment identified existing needs and gaps in midwifery clinical training at health facilities in Sierra Leone from various stakeholders' perspectives. The descriptive needs assessment utilized mixed methods, including surveys, focus group discussions (FGDs), interviews, and reviews of maternal medical records. The following showed needs and gaps in labor and delivery management; record keeping; triage processes; clinical education for students, recent graduates, and preceptors; and lack of infrastructure and resources. The knowledge gained from this needs assessment can further the development of midwifery clinical training programs in Sierra Leone and other low-income countries facing similar challenges. We discuss the implication of our findings.

Obstetric ultrasound training programmes for midwives: A scoping review.

Antenatal care is essential for all expectant mothers and assists in reducing maternal mortality rates thus addressing the Sustainable Development Goal 3. Obstetric ultrasound complements antenatal care and is used in pregnancy to identify and monitor high-risk pregnancies. However, disparities exist and in low- and middle-income countries, ultrasound services are not readily available. This contributes to maternal and neonatal morbidity and mortality within these populations. Short ultrasound training programmes for midwives can be beneficial in alleviating some of the challenges experienced. The aim of this scoping review was to identify global ultrasound education programmes for midwives. Articles containing suitable keywords were retrieved from databases suitable to nursing, education and ultrasound. Themes were developed based on the articles included in the review. A total of 238 articles were identified, and after the duplicates and irrelevant studies were removed, 22 articles were included. Articles were analysed and discussed under the identified themes and categories. It is essential that sufficient training is provided to medical professionals performing obstetric ultrasound so that adequate and safe care is offered to expectant mothers. With the introduction of ultrasound in low-resource settings, the knowledge of safety and competencies required to operate the equipment necessitate adequate training. Developed programmes have been found to meet the demands of the ever-changing workforce and allow for midwives to perform focused obstetric ultrasound examinations. This scoping review highlighted ultrasound training programmes for midwives and provided guidance on the development of future midwifery ultrasound training programmes.

The effect of Mobile-based and Lecture-Based training methods on Midwives' knowledge regarding Management of Pre-Eclampsia/ Eclampsia

Background & aim: Preeclampsia is a serious pregnancy hypertensive disorder which is associated with high maternal and perinatal morbidity and mortality. One of the ways to reduce the risk of preeclampsia during pregnancy and childbirth is training midwives regarding its management. We aimed to compare the effects of mobile-based and lecture-based training methods on midwives' knowledge regarding management of pre-eclampsia/ eclampsia in 2017. Methods: This experimental study was conducted on 70 midwives working in Lar, Iran, in 2017. The patients who met the inclusion criteria and provided informed consent were included in the study. The subjects were randomly assigned to two educational groups of lecture-based and mobile-based education. To measure knowledge a questionnaire was completed before the intervention, one week and one month after the intervention by the participants. To analyze the data, independent t-test for inter-group comparison and paired t-test for intra-group comparison were run in SPSS. Results: No significant differences was seen between the two groups before the intervention, while one week and one month after the intervention, the knowlege scores were significantly different (P=0.001). The results of paired t-test in both groups showed significant changes at the end of the study. Results were significant in both groups, but according to the mean score of knowledge before and after the intervention, the mobile-based had a greater score than lecture-based training group. Conclusion: Both mobile-based and lecture-based training methods increased the awareness of midwives regarding the management of preeclampsia and eclampsia, but the highest increase in knowledge was seen in mobile-based training group.. Thus, the implementation of midwifery training programs using mobile applications can increase midwives’ awareness concerning the management of midwifery emergency services.

Exploring the Pedagogical Practices used in Competence Based Education Training of Nurses and Midwives in Uganda

In Uganda CBE was introduced in 2006 and since then no study has been done to find out its suitability in the preparation of competent nurses and midwives. In recent years, there is increased attention given to Competence Based Education (CBE) in nursing and midwifery training programs as means of improving quality healthcare services. The use of suitable pedagogical practices in CBE training is critical for assisting students to effectively learn important concepts needed for their practice. The purpose of this study was to explore the suitability of pedagogical practices utilized in the CBE training programs in Uganda. The study was conducted from March to June 2015, at Mulago National Referral Hospital (MNRH). Concurrent mixed methods were used to gather both quantitative and qualitative data from respondents. A total of 193 participants were drawn from nurses and midwives trained under the CBE program and other key stakeholders, namely school principals, nursing and midwifery tutors, hospital administrators/medical consultants, officials at both Uganda Nursing and Midwifery Examination Board (UNMEB) and Uganda Nurses and Midwives Council (UNMC). Results by the majority of nurses and midwives who benefitted from the CBE training, revealed that the pedagogical practices used were suitable to enable them become competent nurses and midwives. However, the opinion of some key stakeholders differed. They noted that the implementation of suitable pedagogical practices in CBE training faced numerous challenges that needed to be addressed. These challenges included inadequate resources in terms of medical supplies and equipment as well as insufficient support given to trainees during clinical training due to shortage of staffing. This resulted into big workloads due to large student numbers, coupled with insufficient follow up by their tutors who are poorly motivated and have negative attitudes towards students. The study recommended the necessity to sensitize all implementers and stakeholders on the best pedagogical practices for CBE programs. There is also need to improve resources and conditions of students’ practicum training sites as well as to recruit more clinical instructors to specifically support the increasing numbers of students during their practicum training sites. https://doi.org/10.26803/ijlter.17.1.8

Midwives’ Views on Improved Use of the Partogram in Vhembe District of Limpopo Province, South Africa

The purpose of the study was to explore and describe the views of midwives on the improved use of the partogram. A qualitative, explorative, descriptive and contextual study on the partogram as a clinical practice guideline was conducted in Limpopo Province as a requirement for a doctoral degree. Midwives working at Vhembe District hospitals formed the population of the study. A sample of 17 midwives was conveniently selected from the three hospitals in the district. Semi-structured interviews were conducted with midwives who signed the consent form. Midwives were asked to describe their experiences with the use of the partogram and their views on how its implementation could be improved. Interviews were recorded and transcribed verbatim. Tesch’s eight steps of qualitative data analysis were used to analyse the data. The findings of the research study highlight several challenges experienced by midwives, including their views on the improved use of the partogram. In this article, only the views of midwives on the improved use of the partogram are discussed. Midwives suggested that they be empowered with knowledge and given support by ward managers, that the partogram document be redesigned and that communication take place with midwives by ward and district managers related to changes on the partogram. It is recommended that midwifery training programmes and in-service training emphasise the partogram; that midwives be encouraged and supported by ward managers and provided with enough staff and equipment; that managers redesign the partogram document format and that communication with midwives be improved when changes are made.

Trainers' perception of the learning environment and student competency: A qualitative investigation of midwifery and anesthesia training programs in Ethiopia

BackgroundEthiopia has successfully expanded training for midwives and anesthetists in public institutions. This study explored the perceptions of trainers (instructors, clinical lab assistants and preceptors) towards the adequacy of students' learning experience and implications for achieving mastery of core competencies. MethodsIn-depth interviews with 96 trainers at 9 public universities and 17 regional health science colleges across Ethiopia were conducted to elicit their opinions about available resources, program curriculum suitability, and competence of graduating students. Using Dedoose, data were thematically analyzed using grounded theory. ResultsPerceptions of anesthesia and midwifery programs were similar. Common challenges included unpreparedness and poor motivation of students, shortages of skills lab space and equipment, difficulties ensuring students' exposure to sufficient and varied enough cases to develop competence, and lack of coordination between academic training institutions and clinical attachment sites. Additional logistical barriers included lack of student transport to clinical sites. Informants recommended improved recruitment strategies, curriculum adjustments, increased time in skills labs, and better communication across academic and clinical sites. ConclusionsAn adequate learning environment ensures that graduating midwives and anesthetists are competent to provide quality services. Minimizing the human resource, infrastructural and logistical gaps identified in this study requires continued, targeted investment in health systems strengthening.

Complementary and Alternative Medicine in Midwifery

The World Health Organization defines “complementary and alternative medicine” (CAM) as a “broad set of health care practices that are not part of that country’s own tradition and are not integrated into the dominant health care system” (1). Complementary therapy is usually used in combination with current treatments, and alternative treatments are used instead of current treatments. Commonly utilized types of CAM include acupuncture, aromatherapy, herbal and homeopathic medicines, meditation, movement therapies, chiropractic and osteopathic manipulation and so on (2). An overview of the recent research around the world showed that in developing country 5-74.8% of people use these therapeutic methods especially for chronic diseases (3). In Iran, some of these methods such as herbal medicine have been used for thousands of years and are rapidly expanding. There is no clear estimation of CAM users in Iran but studies showed that 62.5% of people in Isfahan city and 66.3% in Tehran city use CAM therapy (4, 5). Women use CAM more than men. Many women prefer to use CAM during pregnancy because of fewer side effects compared to chemical drugs. Studies have shown that 73% of pregnant mothers in Australia (6) and 83.7% in Mashhad city used CAM during pregnancy (7). Today, around the worldwide, midwives use complementary therapies in their profession more than the other medical practitioners. A literature review estimated that between 65% - 100% of midwives have used one or more complementary therapies. Common types of CAM that are recommended by midwives were: massage therapy, herbal medicines, relaxation techniques, nutritional supplements, aromatherapy, homeopathy and acupuncture (8). However, one survey in Iran found that CAM methods are prescribed by 37.3% of obstetricians with the most common methods being acupressure, massage and herbal therapy (9). Another study also showed that 44% of midwifery students had recommended CAM therapies to others (10). These methods can be used for treatment of nausea and vomiting, back pain, anxiety, postpartum depression, anemia, striae gravidarum, insomnia, hemorrhoid, vaginal infection, mal-presentation, augmentation and induction of labor, perineal care, retained placenta and lactation problems (8, 11, 12). Since midwives are care providers to women during puberty and reproductive periods, especially at pregnancy and also during menopause and post-menopausal periods, therefore use of complementary and alternative therapies gives an opportunity to midwives for providing holistic care and enables them to respond to the community and women’s needs. Hence, all midwives who are interested in/or are practicing CAM for their clients should be empowered in this field through participating in educational programs to acquire the necessary skills. In midwifery training programs, evidence based CAM therapy should be included. Midwives not only need to know the strengths and limitations of CAM methods, but also they should be able to talk to women about the effectiveness and possible risks of these procedures. Given the widespread use of CAM in the midwifery field, it is necessary for medical organizations to prepare relevant guidelines for using these medicines in midwifery practice, especially for maternity care. It seems that further research to evaluate the prevalence, safety, efficacy and economic benefits of these methods are required.

Genetic educational needs and the role of genetics in primary care: a focus group study with multiple perspectives

BackgroundAvailable evidence suggests that improvements in genetics education are needed to prepare primary care providers for the impact of ongoing rapid advances in genomics. Postgraduate (physician training) and master (midwifery training) programmes in primary care and public health are failing to meet these perceived educational needs. The aim of this study was to explore the role of genetics in primary care (i.e. family medicine and midwifery care) and the need for education in this area as perceived by primary care providers, patient advocacy groups and clinical genetics professionals.MethodsForty-four participants took part in three types of focus groups: mono-disciplinary groups of general practitioners and midwives, respectively and multidisciplinary groups composed of a diverse set of experts. The focus group sessions were audio-taped, transcribed verbatim and analysed using content analysis. Recurrent themes were identified.ResultsFour themes emerged regarding the educational needs and the role of genetics in primary care: (1) genetics knowledge, (2) family history, (3) ethical dilemmas and psychosocial effects in relation to genetics and (4) insight into the organisation and role of clinical genetics services. These themes reflect a shift in the role of genetics in primary care with implications for education. Although all focus group participants acknowledged the importance of genetics education, general practitioners felt this need more urgently than midwives and more strongly emphasized their perceived knowledge deficiencies.ConclusionThe responsibilities of primary care providers with regard to genetics require further study. The results of this study will help to develop effective genetics education strategies to improve primary care providers' competencies in this area. More research into the educational priorities in genetics is needed to design courses that are suitable for postgraduate and master programmes for general practitioners and midwives.

Remaking the Guatemalan Midwife: Health Care Reform and Midwifery Training Programs in Highland Guatemala

Midwifery practice and identity in Guatemala is constantly being transformed because midwives must negotiate their practices in response to changing international and national health care agendas and processes. Recently, the Guatemalan government implemented the Sistema Integral de Atención en Salud (SIAS). Framed by neoliberal processes and global reproductive health paradigms, SIAS is designed to attain the reproductive health goals outlined in the 1996 Peace Accords by reducing maternal and infant mortality rates. As the primary birthing specialists in rural areas, midwives are essential to this task. A central focus of SIAS is incorporating midwives into the national health care system through midwifery training programs. Drawing on observations of midwifery training programs and interviews with midwives in the municipality of San Martín Jilotepeque, I argue that the incorporation of midwives into SIAS is redefining the position by establishing a new model of recruitment to the role, education, and practice and authority.

An economic analysis of midwifery training programmes in South Kalimantan, Indonesia.

In order to improve the knowledge and skills of midwives at health facilities and those based in villages in South Kalimantan, Indonesia, three in-service training programmes were carried out during 1995-98. A scheme used for both facility and village midwives included training at training centres, peer review and continuing education. One restricted to village midwives involved an internship programme in district hospitals. The incremental cost-effectiveness of these programmes was assessed from the standpoint of the health care provider. It was estimated that the first scheme could be expanded to increase the number of competent midwives based in facilities and villages in South Kalimantan by 1% at incremental costs of US$ 764.6 and US$ 1175.7 respectively, and that replication beyond South Kalimantan could increase the number of competent midwives based in facilities and villages by 1% at incremental costs of US$ 1225.5 and US$ 1786.4 per midwife respectively. It was also estimated that the number of competent village midwives could be increased by 1% at an incremental cost of US$ 898.1 per intern if replicated elsewhere, and at a cost of US$ 146.2 per intern for expanding the scheme in South Kalimantan. It was not clear whether the training programmes were more or less cost-effective than other safe motherhood interventions because the nature of the outcome measures hindered comparison.

How is the midwife's training and practice defined in policies and regulations in Australia today?

This paper describes the current definitions of a midwife found in Australian State policies and regulations. It examines these for internal consistency and external comparability. It also discusses the links between nursing and midwifery in Australia and their influence on the midwife's practice. The basis on which midwifery training programmes are established is examined, particularly in the light of characteristics and career plans of midwifery students and the questionable cost-effectiveness of current training. The assumption that nursing leadership is necessarily satisfactory, fitting or appropriate for midwifery is challenged.