Work Of Midwives Research Articles

Midwife-led maternity services and consumer ‘choice’ in an Australian metropolitan region

Objective: identify the factors determining women's support for midwife-led maternity care in an Australian metropolitan region, and identify the implications for the role of midwives and for the expansion of options for childbearing women.Design: a two-stage research design was utilised. In the first stage a sample of women were surveyed regarding their choice of maternity service provider and site of provision of maternity services. In the second stage, in-depth interviews were used to collect the birthing narratives of a sample of 50 women involved in the first stage of the research.Setting: a metropolitan region of Adelaide, South Australia.Participants: women who had given birth to a live baby in the 1991 calendar year, who lived within a designated region and who gave birth at one of four hospitals in or near the region. In the first stage of the study, 519 women returned surveys, giving a response rate of 61.7%. Sixty-four per cent of these women expressed an interest in being involved in further research, and fifty of these were randomly selected for interview.Findings: despite recent calls in Australia to increase the choices available to childbearing women, these choices are limited by, amongst other things, insufficient information about midwife-led maternity services. The work of midwives remains silenced and invisible to many women pregnant for the first time, who have little idea about what midwives can do. This research shows that women's main source of information about midwife care is developed through the actual experience of it, particularly in giving birth. This experience leads to an extremely positive recognition and appraisal of the work of midwives, such that the majority of women indicate that they would be happy with midwife care for subsequent births. First-time mothers are significantly disadvantaged in terms of choices available to them because of this lack of information about midwife-led maternity care.Implications: in the interests of providing childbearing women with real choices for maternity care, strategic interventions to better publicise the role of midwives and of midwife-led services are needed.

Barriers to learning from reflection: a study of the use of groupwork with post-registration nurses.

There are few studies which describe the use of groups to facilitate reflection and even fewer which evaluate the effectiveness of such groups. Much of the literature discussing the techniques used to facilitate reflection suggests that learners willingly engage in such processes and find them enjoyable. This paper reports on a qualitative study of the use of groups to develop learning through reflection on a part-time post-registration diploma programme for nurses. The findings suggest that there are many barriers to learning which must be overcome before practitioners can use the opportunities to reflect on and learn from their experience. It is also contended that such learning may not necessarily be an enjoyable experience. The findings suggest that previous educational experience and the current culture in which nurses and midwives work, impose tremendous barriers to reflecting on, and learning from, experience. In particular these affect the willingness of learners to expose themselves to the judgement of others and their ability to be open to taking responsibility for their own learning. Other barriers to learning in groups are the effects of other group members, their commitment or resistance to shared learning, the ways in which group members interact with each other and facilitation styles.

Fathers' experiences of childbirth

Objective: to describe how fathers who are present during childbirth experience the event, what they feel during childbirth and how they understand the meaning of childbirth. Design: survey using questionnaire. Setting: maternity unit in Finland. Participants: a non-random sample of fathers ( n = 137) who were present at the birth of their baby at one university hospital in Finland. The response rate was 81% ( n = 107). Measurements and findings: young fathers and those expecting their first baby reported feeling uncomfortable during delivery more frequently than others. Almost all said that they had plenty of good experiences, younger fathers more so than older fathers. The fathers expressed their confidence in the staff and described the environment at the hospital as pleasant. They said their presence at delivery was important for their growth into fatherhood. The best experience was the moment that the baby entered the world. The hardest things were the pain experienced by their partner and being unable to help. Most of the fathers were very pleased with current midwifery practices followed in childbirth, however, it was felt that more attention ought to be paid to pain relief and to supporting and providing guidance to the father during delivery. Implications for practice: the work of midwives should be planned so that fathers can feel secure and comfortable. Further studies are needed into the ability of midwives to support fathers in their fatherhood.

Women and midwives in partnership: a problematic relationship?

Midwives in New Zealand have been practising independently of medicine and nursing since 1990 using the concept of partnership as a basis for their practice. This article shows, however, that the beliefs which underpin the practice of the midwives are not always the same as those of their clients. Supporting evidence is provided in the form of verbatim data provided by participants. Three major areas in which contradictions were found were in the work of midwives, the knowledge for practice and reflections on the experience. It is recommended that midwives become more visible by removing themselves from hegemonic structures, valuing alternative forms of knowledge and respecting the knowledge of their clients.

Midwifery in Germany Its past and present

This article introduces midwifery in Germany to the North American midwife. The development of the midwifery profession since the 12th century is presented. Some regulations that govern midwifery practice today were initiated by the clergy, city government, and physicians during past centuries. Present-day midwifery training and professional opportunities are described. The organization and pecullarities of the German health care system and some effects of German reunification that are relevant to midwifery practice are also discussed. Midwives work in several areas and are regulated by federal and state laws which support and secure their practice. The promotion of midwifery interests frequently encounters resistance by obstetricians. There is a long-standing conflict related to an overlap of skills and services that both professions claim as their own. In recent years, more women have demanded and used midwifery services. In 1992, 811,774 deliveries were performed by midwives in 1,176 German hospitals with varying styles of labor management. This variety ranged from university hospitals, which emphasized modern technologies, to institutions that supported a comprehensive midwifery approach. The author challenges the classical practice of midwifery and contrasts it with a delivery that incorporates several features in a comprehensive approach.

Assessing the consequences of changing childbirth

While more antenatal care is now being given outside of hospitals, the data concerning the work of community midwives is inadequate, and general standards of audit and data collection are falling rather than rising.

Ethiopian traditional veterinary practices and their possible contribution to animal production and management.

The wide variety of traditional veterinary practices maintained within different ethnic groups provides an indication of the potential usefulness of this neglected knowledge for the Ethiopian livestock husbandry. In Ethiopia, as in other countries, traditional veterinary medicine involves the work of bone-setters, midwives, religious healers and people who claim the ability to communicate with devils. The knowledge of pastoralists in the areas of tick control, recognition of toxic plants, traditional surgery and traditional vaccination methods is described. Efforts by a Chinese veterinary team to promote traditional Ethiopian veterinary practices have been encouraging. Further evaluation of traditional veterinary practices is recommended as a condition for the integration of these practices with those of modern veterinary medicine. It is also suggested that this evaluation be coordinated and encouraged by the Veterinary Service of the Ministry of Agriculture in Ethiopia.

The citizen-patient in revolutionary and imperial Paris

In The Citizen-Patient in Revolutionary and Imperial Paris, Dora B. Weiner examines the experiences of the sick and handicapped indigent men, women, and children in Paris during the French Revolution and Empire. Weiner argues that significant groups of Revolutionary physicians and reformers interpreted equality to include every citizen's right to health care. These reformers faced political, religious, and professional opposition, and daunting problems of funding. And they needed the participation of the poor as citizen-patients, patients with both rights and duties, who acted as responsible partners in the pursuit and maintenance of public and personal health. Weiner surveys the 20,000 patients institutionalized in twenty Paris hospitals and hospices and explains how the Revolution changed the status and work of nurses, pharmacists, midwives, and students, as well as doctors. Clinical teaching, professional specialization, and approaches to public health were all affected. Weiner emphasizes health care for children, deaf and blind people, and mentally ill patients and underscores the role of women as administrators and dispensers of hospital care.

HIV infection and community midwives: experience and practice

To assess the effects of HIV infection on the work of community midwives, a postal survey of 1 in 5 in Scotland and England was carried out. The 907 respondents represent an 83% response rate. While only 1% of respondents had experience of patients with AIDS, 8% had been involved with known asymptomatic HIV infection and 32% had encountered those that they considered to be 'at high risk'. While the workload generated by HIV-infected patients for individual midwives at this time was small, almost all midwives themselves considered that they had a role to play in the prevention of HIV infection through health education and in counselling. While less than a quarter of those who had encountered HIV-positive patients had provided health education, more than half had done so to those worried about HIV infection and almost a quarter had counselled them. However, confidence to provide these aspects of practice was low, even among those who had received in-service education, although higher than among those who had not done so. A minority of community midwives had read policies or guidelines about aspects of practice and service provision, except for infection control where two thirds had read what they considered an adequate policy.

Treatment of umbilical cords: a randomised trial to assess the effect of treatment methods on the work of midwives

The national code of practice for midwives practising in England and Wales defines duties during the postnatal period for the care of mothers and their babies. This period is a minimum of 10 days, and up to 28 days. Visits after the 10th day are at midwives' discretion, but a survey of heads of midwifery services suggests that most midwives would extend postnatal care beyond the 10th day if the baby's umbilicus was not healed. Methods used for routine treatment of the umbilical cord in the newborn babies vary widely. Previous studies suggest that the rate of healing depends on the treatment method used. This, in turn, can affect the workload of midwives responsible for the care of newborn babies. Babies born in the Royal Berkshire Hospital in the summer of 1984 were allocated at random to have their cords treated by one of four dusting powders, one of three cleansing methods and one of two frequencies of treatment, in a trial with a factorial design. The effect of treatment on the time to separation of the cord and the number of midwives' visits was estimated. It was found that the treatment method used could significantly affect the healing process and therefore the number of visits made by midwives after the 10th day, and that the choice of cord powder could significantly affect the midwifery workload in the district. The difference would be enough to account for the work of one whole-time equivalent community midwife for every 3000–5000 births.

Reduction in perinatal mortality in developing countries: experiences from Zululand.

The principles governing the reduction of perinatal mortality are: 1) provision of good prenatal care; 2) safe delivery at term; and 3) the maintenance of infant nutrition and the prevention of infection. The author speaks of her experiences in a rural area of the Zulu country of South Africa. Cultural attitudes and beliefs are very different in rural Africa than they are in developed countries. Zulu mothers have a sense of fatalism--the baby is not ill it just dies. When the author began her work in 1945 the small hospital in the Nqutu district of Zululand was largely ignored. The people are poor; the roads bad. The author learned to build confidence. She tried to reach the remotest parts of the district. 11 centers were established throughout the 700 square miles served. The visiting team consisted of a doctor a nurse and a dispenser-driver. Prenatal exams were done in these clinics. They became places where mothers at particular risk could be selected. High-risk factors made hospital delivery essential. A number of the clinics were tended by a resident nurse. She had a single labor ward and a lying-in ward for delivery of low-risk cases. Training was begun for midwives in diagnosis pelvic assessment and decision-making. Also learned was application of the vacuum extractor resuscitation of the newborn setting up scalp vein infusions and taking blood for bilirubin estimation. Recognition of low-weight babies is an important part of midwife work. After initial training midwives returned for refresher courses. Breastfeeding must be taught even to Zulu mothers. This is done in the hospital.

Technology as a Last Resort in Home Birth: The Work of Lay Midwives

This paper considers an example of demedicalization in U.S. society by examining how 10 lay midwives described their work in attending home births. Committed to childbirth as a family event as opposed to a medical one, they tried to accomplish this by reallocating knowledge and responsibility among participants and by working to keep birth at home “natural,” relegating childbirth technology to a position of last resort before transporting women to the hospital. The midwives determined limits to their use of such technology according to their respective interpretations of collectively held norms. This work suggests that definitions of demedicalization rest upon two related bases: (1) participants abandoning their reliance upon the “technological fix;” and (2) experts becoming educators in a context of shared knowledge and responsibility.

Technology as a Last Resort in Home Birth: The Work of Lay Midwives

Technology as a Last Resort in Home Birth: The Work of Lay Midwives

Medical surveillance of the work of the clinic-based midwife

The comprehensive Health Programme of the South African Department of Health is based upon the concept of a base hospital linked with peripheral clinics staffed by nursing sisters. Supervision and training of such nurses is normally carried out by medical staff visiting from the base hospital. In the case of midwifery, the methods of medical supervision of the staff must be different from those employed in a hospital situation.

The use of paramedics in family planning services in Iran.

In the Family Planning Department of Farah Maternity Hospital, from 1968 to 1976, paramedics were trained to administer all reversible methods of family planning and pregnancy termination up to ten weeks and to perform a limited number of abdominal and vaginal tubectomies (1). From 1974 to 1976, all the above methods, except tubal ligation, were performed satisfactorily on 460 417 acceptors at a clinic not located in the hospital. The complication rate of 1%-5% was the same whether the procedures were performed by paramedics or by physicians. The project has been economical. It has been accepted by both patients and paramedics and has freed doctors to carry out other work.

ASSESSMENT OF THE APGAR SCORE

Abstract The Apgar score has made a major contribution to neonatal assessment, but are all parts of it equally useful ? In a survey of 436 babies, heart-rate and reflex irritability were found to be best associated with two non-Apgar measures of a baby's state—namely, time to first breath and time to first cry. Heart-rate with time to first breath or time to first cry and time to first cry only were then used in simplified scoring systems on 3 or 4 point scales in place of the 10 in the Apgar score. It seems that a score, based on heart-rate and time to first cry, would simplify the midwife's work without impairing the efficiency of neonatal scoring as a warning for action.

ASSESSMENT OF THE APGAR SCORE

The Apgar score has made a major contribution to neonatal assessment, but are all parts of it equally useful ? In a survey of 436 babies, heart-rate and reflex irritability were found to be best associated with two non-Apgar measures of a baby's state—namely, time to first breath and time to first cry. Heart-rate with time to first breath or time to first cry and time to first cry only were then used in simplified scoring systems on 3 or 4 point scales in place of the 10 in the Apgar score. It seems that a score, based on heart-rate and time to first cry, would simplify the midwife's work without impairing the efficiency of neonatal scoring as a warning for action.

Work of the Central Midwives' Board

THE recently issued Report on the Work of the Central Midwives' Board in Great Britain for the year ended March 31, 1935 (H.M. Stationery Office, 3d. net) is of general interest now that so much attention is being directed to the subject of maternal mortality, in view of the midwives' work for the safety and well-being of mothers. The Midwives' Roll contained the names of 58,964 women, of whom, however, only 15,434 are practising. Of 3,922 new candidates examined, 2,936 passed. Only 18 mid-wives were dealt with by the Board on account of malpractice, negligence or misconduct, a tribute to the general efficiency of the service. The Report contains replies to various questions submitted to the Board for adjudication, and revisions of certain of the rules. Attention is directed to the scarcity of midwifery cases for the training of medical students, and this important matter is now the subject of consideration in conjunction with the General Medical Council.

The work of the midwife

The work of the midwife