Perspectives Of Midwives Research Articles

Perspective of Midwives in Turkey Regarding Sexual Health Literacy and Sexual Healthcare Services.

This study aimed to examine the factors associated with the level of sexual health literacy of midwives and their views on sexual healthcare. This is a descriptive and correlational study. A total of 324 midwives with at least 1 year of professional experience and at least a bachelor's degree participated in the study. Data were collected with the "Midwife Information Form" and "Sexual Health Literacy Scale." The professional work experience, marital status, and education related to sexual health did not affect the sexual health literacy of midwives. Age, educational status, and voluntary choice of the profession willingly affected sexual health literacy. The sexual health literacy of midwives who hold positive views on sexuality and sexual healthcare services is higher. The midwives' perspectives on sexual health, their level of knowledge, and the sexual health education they receive impact the quality of care they provide. Sexual and reproductive health should be emphasized within the scope of midwifery education.

Views from midwives and perinatal nurses on barriers and facilitators in responding to perinatal intimate partner violence in Japan: baseline interview before intervention

BackgroundMidwives and perinatal nurses play a crucial role in responding to intimate partner violence (IPV) against pregnant women; however, these roles are often not performed adequately. This study aimed to identify provider-related, healthcare system, and social barriers and facilitators to IPV response from the perspective of midwives and perinatal nurses.MethodsThis qualitative descriptive study used semi-structured interviews with five midwives and a nurse from perinatal care facilities in Tokyo, Japan. A framework approach was employed to analyze the interview transcripts.ResultsBarriers included inadequate knowledge about IPV and reluctance to provide support by healthcare providers. Barriers in the healthcare system included the absence of structural infrastructure for IPV response. This involved the lack of screening tool adoption, the partner’s presence during interviews, and time constraints. Additionally, there was insufficient systematic and collaborative coordination within and outside the team. Another barrier was the lack of in-service training to develop IPV-related knowledge and skills. Finally, there was uncertainty about how the support at healthcare facilities impacts women’s lives. Further barriers in the social system included the absence of additional reimbursement for IPV response. There was also a lack of a comprehensive approach to IPV that provides for the rehabilitation of perpetrators and care for the children of victims and a culture that discourages separation from the perpetrator. Conversely, facilitators included healthcare providers recognizing the perinatal period as an opportunity to address IPV. They also acknowledged IPV as a prevalent issue, practiced conscious self-care, and systematically collaborated within the healthcare team.ConclusionThis study emphasized the need for routine IPV screening in perinatal care and the importance of team-based educational interventions for healthcare providers to facilitate implementation.

Midwives’ account of virtual reality childbirth education

In Finland, prenatal clinics and birthing hospitals struggle with resources to provide expectant parents with childbirth education (CBE) and a tour of the hospital birthing unit. Not preparing for birth is common, and not knowing how and where to give birth causes parents unnecessary stress during pregnancy. One new possibility to complement CBE is using virtual reality (VR) to deliver content. The aim of this study is to describe midwives' views of the status of parents' preparation for birth and provide information on the VR CBE program's advantages and challenges from the midwife's perspective. The study consisted of two focus group sessions with seven participants. Participants were midwives with experience from a hospital birthing ward and had provided childbirth education. The data was analysed using a thematic content analysis approach. According to the midwives, the parents do not prepare for birth well enough. Preparing for birth affects the parents' knowledge about childbirth, their cooperation with the healthcare personnel, and how they trust the birthing process, themselves, and the healthcare personnel. Preparation can also have adverse effects if the birthing person is trying to give birth with a detailed plan or has false expectations. Parents should focus on knowledge, attitude, and mental and physical exercise in preparing for childbirth. By preparing from trusted sources, parents can make informed decisions. They have the skills to stay calm, relaxed, and open-minded during labour and birth. Physical and mental exercise will help them cope with labour and relax their mind and bodies during birth. Midwives see VR as offering great potential for concrete, realistic, and flexible childbirth education that can address current challenges. They were also worried that VR could replace face-to-face contact. However, since there is minimal such contact in the current CBE, VR could enhance childbirth education and offer a realistic and concrete image of birth and a hospital tour. Midwives want families to prepare better for birth and work on their knowledge, attitude, and exercise. By preparing, parents understand childbirth, trust themselves, the birthing process, and the midwives; cooperation works better. Midwives see VR as an excellent addition to childbirth education by offering realistic and concrete online childbirth education. VR should not replace face-to-face contact.

Perspectives of midwives on the use of Kaligutim (local oxytocin) for induction of labour among pregnant women in the government hospitals in Tamale

BackgroundThe use of herbal medicine and/or its products is common throughout the world. In Tamale Metropolis, pregnant women frequently use local oxytocin to induce labour, as shown by the fact that 90% of midwives reported managing patients who used kaligutim (local oxytocin) to speed up labour. Early career midwives are also aware of this and have personally observed it being used by their clients. The purpose of the study was to assess midwives’ opinions on pregnant women’s use of the well-known kaligutim (local oxytocin) for labour induction in the Tamale Metropolis.MethodsA facility-based, quantitative, cross-sectional research design was used for the study. A total of 214 working midwives from Tamale’s three main public hospitals participated. Data for the study were gathered through a standardized questionnaire. For the analysis and presentation of the data, descriptive and analytical statistics, such as basic frequencies, percentages, Fisher’s exact test, chi square test and multivariate analysis, were employed.ResultsAccording to the findings of this study, the safety, dosages, and contraindications of kaligutim during pregnancy and labour are unknown. The cessation of contractions was reported by 44 (22.4%) of the respondents whose clients used local oxytocin. The study also revealed that women in Tamale metropolis use “walgu”, a spiritual form of oxytocin, to induce and augment labour. Respondents who responded, “yes” to baby admission to the new-born care unit were 25% more likely to use kaligutim (local oxytocin) than were those who responded, “no” to baby admission to the new-born care unit (AOR = 0.25 95% CI (0.01, 0.53), P = 0.021).ConclusionsIt can be concluded that using kaligutim to start labour has negative effects on both the mother and the foetus. Additional research is required to evaluate the efficacy, effectiveness, biochemical makeup, and safety of these herbal medicines, particularly during pregnancy and delivery, as well as the spiritual significance of kaligutim (Walgu) and its forms.

Strengthening open disclosure in maternity services in the English NHS: the DISCERN realist evaluation study.

There is a policy drive in NHS maternity services to improve open disclosure with harmed families and limited information on how better practice can be achieved. To identify critical factors for improving open disclosure from the perspectives of families, doctors, midwives and services and to produce actionable evidence for service improvement. A three-phased, qualitative study using realist methodology. Phase 1: two literature reviews: scoping review of post-2013 NHS policy and realist synthesis of initial programme theories for improvement; an interview study with national stakeholders in NHS maternity safety and families. Phase 2: in-depth ethnographic case studies within three NHS maternity services in England. Phase 3: interpretive forums with study participants. A patient and public involvement strategy underpinned all study phases. National recruitment (study phases 1 and 3); three English maternity services (study phase 2). We completed n = 142 interviews, including 27 with families; 93 hours of ethnographic observations, including 52 service and family meetings over 9 months; and interpretive forums with approximately 69 people, including 11 families. The policy review identified a shift from viewing injured families as passive recipients to active contributors of post-incident learning, but a lack of actionable guidance for improving family involvement. The realist synthesis found weak evidence of the effectiveness of open disclosure interventions in the international maternity literature, but some improvements with organisation-wide interventions. Recent evidence was predominantly from the United Kingdom. The research identified and explored five key mechanisms for open disclosure: meaningful acknowledgement of harm; involvement of those affected in reviews/investigations; support for families' own sense-making; psychological safely of skilled clinicians (doctors and midwives); and knowing that improvements to care have happened. The need for each family to make sense of the incident in their own terms is noted. The selective initiatives of some clinicians to be more open with some families is identified. The challenges of an adversarial medicolegal landscape and limited support for meeting incentivised targets is evidenced. Research was conducted after the pandemic, with exceptional pressure on services. Case-study ethnography was of three higher performing services: generalisation from case-study findings is limited. No observations of Health Safety Investigation Branch investigations were possible without researcher access. Family recruitment did not reflect population diversity with limited representation of non-white families, families with disabilities and other socially marginalised groups and disadvantaged groups. We identify the need for service-wide systems to ensure that injured families are positioned at the centre of post-incident events, ensure appropriate training and post-incident care of clinicians, and foster ongoing engagement with families beyond the individual efforts made by some clinicians for some families. The need for legislative revisions to promote openness with families across NHS organisations, and wider changes in organisational family engagement practices, is indicated. Examination of how far the study's findings apply to different English maternity services, and a wider rethinking of how family diversity can be encouraged in maternity services research. This study is registered as PROSPERO CRD42020164061. The study has been assessed following RAMESES realist guidelines. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research Programme (NIHR award ref: 17/99/85) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 22. See the NIHR Funding and Awards website for further award information.

Needs Assessment for the Development of a Leadership Course for Midwives: a Qualitative Study.

Midwives play a vital role in the attainment of Sustainable Development Goals related to the health and well-being of mothers and newborns. Strengthening the leadership and management capacities of midwives is pivotal to the fulfillment of their mandate beyond assisting in birth and delivery. The study explores the perspectives of midwives about professional education and practice, which are aimed to serve as bases for developing a leadership course for midwives to enhance their roles in public health. The study employed a descriptive-qualitative design. Using a semi-structured questionnaire, online focus group discussions (FGDs) with midwives from the academe, professional organization, and clinical practice were conducted. Through directed content analysis, the gathered information was analyzed to include the participants' insights on midwifery competencies, teaching methods and assessment strategies, supplementary courses and training, and factors affecting midwifery practice. A total of eleven (11) participants contributed to the FGDs, which included midwives from the academe (dean, faculty), professional organization (board member of the Professional Regulation Commission), and clinical practice (public and private institutions). Notably, participants shared their perspectives regarding the similarities/differences in the terminal competencies of midwifery programs. The demands of outcomes-based education, coupled by the shift to online learning due to the pandemic, pushed the need for modifications in program delivery for the students. Results highlighted the need for supplementary courses and capacity building on leadership and management, research, and interprofessional collaboration. Midwives shared factors that affect their professional practice, which include insufficient training, inadequate manpower, and differences in expectations/standards in task performance. The findings indicate the need to develop capacity-building courses for midwives to enhance their contribution towards universal health care. The results of this study also highlight the importance of understanding and improving the competencies of midwives across the building blocks of the health system, which include health service delivery, human resources for health, health information systems, health financing, health governance, and health regulation. Notably, key concepts recommended for the Leadership Development Course for Midwives include: leadership and management, research, and interprofessional collaboration.

Umbilical cord clamping: Midwife's perspective at one of the regional general Hospitals of Gorontalo Province

The incidence of iron deficiency anemia in infants is a problem that often occurs in all countries, especially in developing countries, which is caused by visible dan invisible blood loss, decreased red blood cell production, premature cell destruction, premature birth, LBW, small gestational age, maternal anemia dan time of umbilical cord clamping. Delaying cord clamping by 1-3 minutes allows blood flow between the placenta dan neonate to continue, which can improve iron status in the baby for up to six months after birth. In Indonesia, 62.7% of births are attended by midwives, so the midwife's perception plays an important role in deciding when to clamp the umbilical cord during childbirth care. Objectives: To determine the perception of midwives in one of the regional general hospitals of Gorontalo province regarding delays in clamping the umbilical cord. Methods: This research uses a qualitative method with a phenomenological approach. Data collection was carried out on 7 informants using in-depth interviews dan the results of the interviews were analyzed using thematic analysis. Results: There is a difference between the informant's perception dan the practice carried out by the informant regarding the delay in clamping the umbilical cord. Conclusion: This difference in perception is caused by the informant's education which is dominated by DIII level, less than optimal training, experience during work, dan the work environment.

‘It was horrible to watch, horrible to be a part of’: Midwives’ perspectives of obstetric violence

BackgroundObstetric violence, including unconsented interventions, coercion and disrespect, violates human rights; impacting the physical and psychosocial health of women. The perspective and experience of midwives related to obstetric violence have been explored in low and middle-income countries, with limited research into the experience of midwives in high income nations. AimTo explore Australian midwives’ perspectives of obstetric violence. MethodsThematic analysis of qualitative in-depth interviews with 15 midwives experienced in supporting women during birth. Critical feminist theory underpinned each stage of the research. FindingsInterviews with 15 Australian midwives from diverse care settings were analysed thematically. Four key themes were developed from the data: ‘the operationalisation of obstetric violence’, ‘the impact of obstetric violence’ ‘the historical and situational context’ and ‘hope for the future’. Midwives considered entrenched patriarchal structures and gender inequity as fundamental to the occurrence of obstetric violence. This societal scaffold is intensified within health care systems where power imbalances facilitate maternal mistreatment through coercion and grooming women for compliance in the antenatal period. Fragmented care models expose women to mistreatment with continuity models being protective only to a point. Midwives experience their own trauma, as a result of what they have witnessed, and due to the lack of support they receive when advocating for women. ConclusionsObstetric violence occurs in Australian maternity systems with unconsented interventions, overmedicalisation, coercion, and disrespect observed by midwives. Care-related trauma impacts on the mental health of midwives, raising workforce concerns for policy makers, consumer advocates and professional bodies.

Mental Illness in Refugee and Immigrant Women: A Midwife's Perspective on Culturally Competent Care

The assessment, diagnosis and referral for mental illness management have been recognized as indispensable roles within midwifery practice both in the United States and in Canada. War, civil unrest and natural disasters, have made mental health assessment crucial for refugee and new immigrant women who present as midwifery clients. Since 1991, National Depression Screening Day (NDSD) had been conducted in cities across the United States and Canada using the Harvard Department of Psychiatry National Depression Screening Day Scale (HANDS©). It facilitates the diagnosis of depression based on DSM-IV criteria. The HANDS© tool includes a 10-item interview guide which is a “self-report scale”. HANDS© demonstrated good internal consistency and validity and was 95 percent sensitive.33 Responses could indicate the need for thyroid screening, referral for mental health counselling or psychiatric care. Strategies for transforming midwifery practice are explored: taking a holistic approach, communication strategies, continuing education strategies, documentation and empowerment issues, multidisciplinary team approach, clinic environment issues, resources and referral base. As we develop expertise in the care of torture and trauma survivors, it behooves us to identify the experts amongst our ranks and to refer our clients to these midwives who will best meet their needs. Further research is needed to guide our incorporation of the skills for treating survivors in our educational programs for the midwives of the future.

Limitations for the management of sexually transmitted infections in Peruvian indigenous pregnant women: Perspectives of midwives.

SynopsisThere are cultural and institutional limitations for the management of sexually transmitted infections in Peruvian indigenous pregnant women, highlighting the myths and lack of biomedical tools.

Utilization of technology to provide on-the-job trainings on Emergency Obstetric and Neonatal Care: Perspectives of nurses and midwives working in Rwanda's remote health facilities.

One of the targets for the third sustainable development goals is to reduce worldwide maternal mortality ratio (MMR) to less than 70 deaths per 100,000 live births by 2030. To address issues affecting women and the newborns during childbirth and postnatal period, concerted efforts from governments and their stakeholders are crucial to maximize the use of technology to enhance frontline health professionals' skills to provide the emergency obstetric and newborn care (EmONC). However, no study has garnered nurses' and midwives' perspectives regarding the application of technology-enhanced learning approach to provide on-the-job Continuous Professional Development (CPD) and factors that may influence the application of this training approach in the Rwandan context. The study collected data from nurses and midwives from forty (40) public health facilities in remote areas nationwide. The study applied a qualitative descriptive design to explore and describe nurses' and midwives' perspectives on the feasibility and acceptability of technology enhanced learning approaches such as e-learning, phone-based remote training, and other online methods to provide trainings in EmONC. Two focus group discussions with EmONC mentors, two with nurses and midwives were conducted. Twelve key informant interviews were conducted. Participants were selected purposively. In total, 54 individuals were included in this study. A thematic approach was used to analyse data. Nurses and midwives highlighted the need to provide refresher trainings about the management of pre-eclampsia. Most of the EmONC trainings are still provided face-to-face and the use of technology enhanced learning approaches have not yet been embraced in delivering EmONC CPDs for nurses and midwives in remote areas. Nurses and midwives found the first developed prototype of smartphone app training of the EmONC acceptable as it met the midwives' expectations in terms of the knowledge and skills' gap in EmONC. Although the newly developed application was found acceptable, further research involving practical sessions by nurses and midwives using the developed application is needed to garner views about the ease of use of the application, relevance of the EmONC uploaded content on the app, and needed improvements on the app to address their needs in EmONC.

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

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

Examining the Challenges of Using Accompanying Midwife from the Perspective of Midwives and Pregnant Women Referring to Hospitals in Shahrekord

Background: The presence of accompanying midwives (doulas) in the delivery room always entails many challenges. This study was carried out to determine the challenges of attendance with training from the point of view of midwives and expectant mothers in selected hospitals of Chaharmahal and Bakhtiari province, Iran
 Methods: The present study was a descriptive study on 70 midwives working in the delivery block, 120 pregnant mothers, and 20 trained attendants. The sampling of midwives and doulas was performed using the census method, and the sampling of pregnant mothers was conducted using the convenience method. The study tool included questionnaires made by the researcher about demographics and socioeconomics, therapeutics, and psychological challenges for the group of mothers and midwives. The face validity and content validity of the questionnaires were confirmed by midwifery professors and reproductive health specialists, and their reliability was confirmed by internal consistency. The data were analyzed using descriptive statistics with SPSS software (version 21).
 Results: In this study, 70 midwives working in selected hospitals of Chaharmahal and Bakhtiari province, 120 pregnant mothers, and 20 trained attendants were examined. Most of the pregnant women (n = 39, 32.5%) mentioned that the most important motivation for requesting a doula during pregnancy and labor was to overcome the fear of childbirth. Most of them (n = 101, 84.9%) also stated that they used doula services at the right time. Meanwhile, 54 women (45%) were familiar with doula services during pregnancy, and most of them (n = 67, 56.3%) stated that doula services can be useful and effective in all three stages of pregnancy, labor, and delivery.
 Conclusions: There are dissatisfactions and challenges regarding the support of doulas during pregnancy and childbirth. Therefore, it is recommended to provide the necessary training to healthcare providers, especially obstetricians, midwives, and mothers, regarding the importance and place of doula’s supportive care in this era. Additionally, doula activities should be integrated and promoted in the care of the health team

Can an advanced practice nursing framework address workforce shortages? A case study of a regional health service

Background Across the globe, shortages of nurses and midwives in rural regions persist. Advanced practice nursing has been found to address workforce shortages through career progression aimed at retention. A regional health service sought to consult with staff about developing an advanced practice nursing framework. Aims This study aimed to explore the perspectives of nurses and midwives at a regional health service on (i) how their roles aligned with the modified Advanced Practice Role Delineation (APRD) tool and (ii) the potential for implementation of such a framework at their service. Design A case study conducted at Goulburn Valley Health (GVH) in southeast Australia used a mixed method design with a survey of all nursing and midwifery staff and focus groups with senior staff. Methods All nurses and midwives were asked to complete a validated modified ARPD questionnaire and those in Grades 3–6 were asked to participate in a focus group. Results From 183 questionnaires and 38 participants in the focus group discussions, findings concurred that nurses and midwives at GVH reported spending most time on direct patient care and minimal time on research activities, publication and/or leadership. While education was strongly embraced and advanced practice usually supported, senior staff cited the lack of resources, the culture and staff shortages as restricting opportunities for education, career development and implementation of an advanced practice framework. Conclusions While an advanced practice framework could address staff shortages at this health service, implementation of such a framework is constrained by the lack of resources and workforce shortages common in rural health services. A national strategy that embeds advanced practice roles and resources implementation of advanced practice nursing and midwifery frameworks in areas of need is recommended.

Telehealth use in maternity care during a pandemic: A lot of bad, some good and possibility

BackgroundTo reduce transmission risk during the COVID-19 pandemic, ‘telehealth’ (health care delivered via telephone/video-conferencing) was implemented into Australian maternity services. Whilst some reports on telehealth implementation ensued, there was scant evidence on women and midwives’ perspectives regarding telehealth use. MethodsA qualitative study was conducted in Australia during 2020–2021 using two data sources from the Birth in the Time of COVID-19 (BITTOC) study: i) interviews and ii) surveys (open-text responses). Content analysis was utilised to analyse the data and explore telehealth from the perspective of midwives and women accessing maternity care services. In-depth interviews were conducted with 20 women and 16 midwives. Survey responses were provided from 687 midwives and 2525 women who were pregnant or gave birth in 2021, generating 212 and 812 comments respectively. FindingsTelehealth delivery was variable nationally and undertaken primarily by telephone/videoconferencing. Perceived benefits included: reduced COVID-19 transmission risk, increased flexibility, convenience and cost efficiency. However, women described inadequate assessment, and negative impacts on communication and rapport development. Midwives had similar concerns and also reported technological challenges. ConclusionDuring the COVID-19 pandemic, telehealth offered flexibility, convenience and cost efficiency whilst reducing COVID-19 transmission, yet benefits came at a cost. Telehealth may particularly suit women in rural and remote areas, however, it also has the potential to further reduce equitable, and appropriate care delivery for those at greatest risk of poor outcomes. Telehealth may play an adjunct role in post-pandemic maternity services, but is not a suitable replacement to traditional face-to-face maternity care.

AI-driven decision support systems and epistemic reliance: a qualitative study on obstetricians’ and midwives’ perspectives on integrating AI-driven CTG into clinical decision making

BackgroundGiven that AI-driven decision support systems (AI-DSS) are intended to assist in medical decision making, it is essential that clinicians are willing to incorporate AI-DSS into their practice. This study takes as a case study the use of AI-driven cardiotography (CTG), a type of AI-DSS, in the context of intrapartum care. Focusing on the perspectives of obstetricians and midwives regarding the ethical and trust-related issues of incorporating AI-driven tools in their practice, this paper explores the conditions that AI-driven CTG must fulfill for clinicians to feel justified in incorporating this assistive technology into their decision-making processes regarding interventions in labor.MethodsThis study is based on semi-structured interviews conducted online with eight obstetricians and five midwives based in England. Participants were asked about their current decision-making processes about when to intervene in labor, how AI-driven CTG might enhance or disrupt this process, and what it would take for them to trust this kind of technology. Interviews were transcribed verbatim and analyzed with thematic analysis. NVivo software was used to organize thematic codes that recurred in interviews to identify the issues that mattered most to participants. Topics and themes that were repeated across interviews were identified to form the basis of the analysis and conclusions of this paper.ResultsThere were four major themes that emerged from our interviews with obstetricians and midwives regarding the conditions that AI-driven CTG must fulfill: (1) the importance of accurate and efficient risk assessments; (2) the capacity for personalization and individualized medicine; (3) the lack of significance regarding the type of institution that develops technology; and (4) the need for transparency in the development process.ConclusionsAccuracy, efficiency, personalization abilities, transparency, and clear evidence that it can improve outcomes are conditions that clinicians deem necessary for AI-DSS to meet in order to be considered reliable and therefore worthy of being incorporated into the decision-making process. Importantly, healthcare professionals considered themselves as the epistemic authorities in the clinical context and the bearers of responsibility for delivering appropriate care. Therefore, what mattered to them was being able to evaluate the reliability of AI-DSS on their own terms, and have confidence in implementing them in their practice.

Paper Dolls

This article addresses the striking resemblance of a late nineteenth-century obstetrical simulator to contemporary commercial paper dolls. This period is often characterised in histories of medicine as one of increasing institutionalisation and professionalisation of childbirth through hospital training and state regulation. But this narrative is only part of the story. It marginalises the perspective of patients and midwives, and those outside of the geographic ‘West’, and it silences aspects of medical culture: social and caring relationships, emotion, play, and humour. While these aspects of medical history are less well represented in textual sources, material objects like Shibata Kōichi’s ‘Obstetrical Pocket-Phantoms’ can help to give a fuller picture. Beginning by situating Shibata’s phantoms in the conventional histories of obstetric training and the intermedial spaces of the clinic and lecture theatre, I then ask how the phantoms might have been used and understood differently outside of these spaces. Using Robin Bernstein’s concept of ‘scriptive things’, I employ a visual and material study of the objects, informed by the wider cultural contexts of dolls and popular print culture in Germany, the USA and Japan, to argue for a history of Shibata’s phantoms as paper dolls that encouraged many forms of play: from learning and explorative, to mothering and caring, to humorous and subversive. By acknowledging that Shibata’s phantoms would also have been recognised as paper dolls, I present a history that centres unrecorded aspects of, and under-studied agents in, medical culture.

Structural Empowerment, Resilience, and Intent to Stay Among Nurses and Midwives in Obstetrics and Gynecology Departments: A Phenomenological Inquiry Study in Saudi Arabia.

Staff turnover is a major obstacle to the success of Saudi Arabia's health transformation agenda and the realization of Saudi Vision 2030. Nurses' and midwives' intentions to remain with the organization are heavily influenced by their sense of structural empowerment and resilience. To gain insight into the perspectives of nurses and midwives working in the Obstetrics and Gynecology departments of a selection of Saudi Arabian governmental hospitals about structural empowerment, resilience, and intentions to stay in their current positions. Qualitative Descriptive Phenomenology. Purposive sampling was used to choose eighteen nurses and midwives working in the OB/GYN department in three government hospitals in the Eastern Province of Saudi Arabia. Semi-structured interviews were conducted to gather the participants' perceptions. Colaizzi's steps were used as a data analysis method. The narratives of the selected participants generated five major themes: (a) "nurturing physical and physiological," (b) "developing psychological," (c) "managing financial," (e) "restructuring organizational," and (f) "enriching professional and occupational." The emerging major themes highlighted the perceptive elements of nurses and midwives that keep them empowered, resilient, and determined to stay in their organization. A failure to fulfill any one of these elements will affect the others. To improve organizational outcomes, empowerment and resilience must be obtained.

Rules, Responsibility, and Empathy in Maternity Hospitals: A Qualitative Study in Iran

Background: Empathy has been known as one of the fundamental principles of medical professions. Objectives: This study aimed to explore the perspectives of midwives’ trainers, students, and personnel about empathy in maternity hospitals. Methods: A qualitative design using a content analysis approach was used to explore the experiences of midwives’ trainers, students, and personnel in the maternity setting in Gachsaran, Iran. The study involved the recruitment of 41 participants, including 24 students, 14 personnel, and 3 midwifery trainers, who were selected using purposive sampling. Data were collected through 2 rounds of semi-structured interviews conducted via WhatsApp, with participants responding to 2 sets of questions. The text was analyzed using conventional qualitative content analysis, and the extracted codes were managed using MAXQDA software. Results: In general, 265 codes were extracted from the participants' interviews, which were classified into 3 categories (ie, “Client management is a top priority for every midwife, “the meaning of empathy," and “essentials in empathy”) and 9 subcategories. A total of 121 codes explained how to manage clients, 64 codes were related to the meaning of empathy, and 77 codes were linked to what people must consider in empathy. Conclusions: Empathy is a crucial concept in the field of midwifery and should be included in the curriculum. It is essential to emphasize the correlation between empathy and other aspects of midwifery, such as communication skills, clinical competence, and ethics. We recommend that both staff and students undergo ongoing training in the area of professional conduct to enable them to make informed decisions in challenging situations.

How do midwives deal with women’s preferences during childbirth in Germany? An action model

Abstract Background Midwifery care is increasingly discussed in terms of its ability to promote a self-determined childbirth. The degree of self-determination (SD) depends on the extent to which women's preferences are negotiated and implemented. From the perspective of midwives in different obstetric settings in Germany, this study answered the research question: “How do midwives deal with women's preferences during birth?”. Methods 11 semi-structured face-to-face interviews were conducted with active midwives. The sample showed a high variance in terms of obstetric settings (clinics, birth centers, home births), regions, and participants’ characteristics (e. g. experience, age). All interviews were recorded, transcribed, anonymized, and analyzed using the Grounded Theory Methodology (Strauss/Corbin, 1994). Results A model consisting of 7 steps was developed: 1) Interpret the situation; 2) Prioritize relevant parameters; 3) Determine a frame of possibilities; 4) Match the preference(s) to the frame of possibilities; 5) Negotiate preference(s); 6) Continuously monitor contextual/situational changes; 7) Adjust the frame of possibilities. The actions are related to contextual conditions (structural; interpersonal; personal; health situation; course of birth; understanding of birth). The model shows how midwives can promote SD even if prior preferences are discarded or modified at birth. Conclusions The model describes how midwives in Germany deal with women's preferences during birth, which factors they consider decisive in doing so, and how SD may be promoted despite of discarded or modified preferences. Further research should examine the role of relationship building, test the model with regard to its generalizability, and use it to analyze and support person-centered midwifery care. Key messages • The model describes how midwives in different obstetric settings in Germany deal with women’s preferences during birth and, thereby, influence self-determination. • Midwives can promote self-determination also if prior preferences are discarded, modified, or redeveloped at birth.