Practice Of Midwives Research Articles

The Effect of Foot Massage on Comfort and Pain Intensity After Vaginal Delivery

Childbirth is a mother's subjective experience that is very memorable in her life. It is important to maintain maternal comfort so that the process of adapting to motherhood can run well. Pain during postpartum is one of the factors that prevents mothers from having difficulty adapting during the postpartum period, especially in primapara mothers. A pharmacological method that can be given to increase comfort and reduce the intensity of pain is foot massage. The aim of this study was to determine the effect of foot massage on the comfort and intensity of maternal pain after vaginal delivery during the postpartum period. This type of quasi-experimental research sample consisted of 38 respondents and the sampling technique used simple random sampling. This research was conducted at the Independent Early Midwife Practice in Lubuk Pakam. Respondents consisted of 2 groups, namely the intervention group and the control group. The instruments used were questionnaires, Visual Analog Scale (VAS), Post Partum Comfort Scale (PCS). Data analysis used chi-square/Fisher's exact test, independent-samples t test and one-way analysis of variance (ANOVA). The mean maternal comfort score in the intervention group was higher than the control group (143.45 ± 8.96, 119.00 ± 14.65, respectively) with a value of p = 0.000. The mean pain score in the intervention group was lower than the control group (1.36 ± 1.22, 4.95 ± 2.27) and the p value = 0.000. Foot massage is effective in increasing comfort and reducing the intensity of pain after vaginal delivery. The increase in maternal comfort after intervention was 18.34% and the reduction in pain intensity after vaginal delivery was 73%. In this way, midwives can apply foot massage to every mother after vaginal delivery.

Aromatherapy blended lemon and lavender has an effect on nausea and vomiting in first trimester pregnant women at PMB Entin Hartini

<p><strong><em>Introduction:</em></strong><em> Nausea and vomiting are common complaints in the first trimester of pregnancy. One treatment to reduce nausea and vomiting is non-pharmacological therapy by providing a mixture of lemon and lavender aromatherapy. In this study, there was only one group, namely the intervention group, which received blended lemon and lavender aromatherapy. Before carrying out the intervention, pregnant women in the first trimester are given a pre-test to find out how often pregnant women feel nauseous and vomit. Then the pregnant mother is taught how to use aromatherapy blended lemon and Lavender with Roll On which will be done in the morning and evening for 6 consecutive days. -continuously. Next, another post-test was carried out to determine the effectiveness of providing aromatherapy.</em></p><p><strong><em>Objectives:</em></strong><em> The aim of this study was to determine the effectiveness of giving a mixture of lemon and lavender aromatherapy against nausea and vomiting in first trimester pregnant women at PMB (Independent Midwife Practice) Entin Hartini, A.Md. Keb Mrebet District, Purbalingga Regency.</em></p><p><strong><em>Methods:</em></strong><em> The type of research used in this research is pre-experimental with a One Group Pre-Test and Post-Test design.</em></p><p><strong><em>Results:</em></strong><em> The Wilcoxon test results were obtained by Asymp. signature. 0.00 that there is an effect of giving a mixture of lemon and lavender aromatherapy in reducing nausea and vomiting (</em><em>𝜌</em><em>- value = 0.00).</em></p><strong><em>Conclusions:</em></strong><em> There is effectiveness of giving a mixture of lemon and lavender aromatherapy for nausea and vomiting in first trimester pregnant women at PMB Entin Hartini, A.Md.Keb.</em>

Knowledge, attitude, and practice toward pharmacological and non- pharmacological methods for labor pain management among midwives

This review focuses on labor pain management during childbirth, encompassing non-pharmacological and pharmaceutical methods. A thorough literature search was conducted across databases like Scopus, PubMed, Google Scholar, and the Cochrane Database of Systematic Reviews. The review, comprising eleven studies, explores topics such as the theoretical framework of labor pain management, midwives' knowledge, attitudes, and practices, pharmacologic and non-pharmacologic methods, factors influencing midwives’ strategies, and identified gaps and challenges. The conclusion highlights existing literature gaps and emphasizes the potential for future research to enhance midwifery practices, informed decision making, and obstetric outcomes.

The Association Between the Characteristics of Pregnant Women with Knowledge and Attitudes Toward Midwifery Care Based on Gender Sensitivity

Respectful maternity care must be ensured that all pregnant women can accept it. It is necessary to understand all pregnant women receiving midwifery care with a gender-sensitive approach to prevent the possibility of mistreatment, harassment, or violence during midwifery practice. This study aimed to assess the association between the characteristics of pregnant women and the knowledge and attitudes regarding gender-sensitive midwifery care. This was a cross-sectional study on 200 pregnant women who came to get antenatal care services at independent practice midwives. The sample was selected using a purposive sampling technique. Multivariate logistic regression analysis was performed to obtain the odds ratio, 95% confidence interval, and p-value for the trend to assess the strength of the association. Data was collected using a questionnaire that was developed and has been assessed for validity and reliability. Pregnant women who actively participate in community activities are associated with good knowledge of midwifery care with a gender sensitivity approach (OR equal 1.51, OR equal 1.16-1.97, p-value equal 0.03). Pregnant women with higher education levels are associated with a good attitude toward midwifery care with a gender sensitivity approach (OR equal 2.02, 95% CI equal 1.01-4.05, p-value equal 0.04). Pregnant women participating in community activities are associated with good knowledge about midwifery care with a gender sensitivity approach, and pregnant women with higher education levels are associated with good attitudes about midwifery care with a gender sensitivity approach (p-value less than 0.001). Midwives and other health workers educate pregnant women in all health facilities at every antenatal visit and community activities such as the village community health center.

When Midwives Burn Out: Differences in the Experiences of Midwives in British Columbia and Alberta

Background: Internationally, continuity of care has been identified as a possible strategy to prevent burnout. The majority of midwives in British Columbia and Alberta practice within a continuity-based model of care, but British Columbia midwives have significantly higher burnout scores. Methods: We compared data from midwives from Alberta and British Columbia who responded to the Canadian arm of the WHELM (Work, Health, and Emotional Lives of Midwives) survey through invitations via their professional organizations. The survey included demographic questions, items about work patterns, occupational stressors, burnout, and intentions and reasons to leave the profession. Results: Workload was the most commonly reported stressor in both British Columbia and Alberta. Midwives in British Columbia were more likely (54%) to have seriously considered leaving the profession in the last 12 months than midwives in Alberta (26%). One-third of British Columbia midwives and no Alberta midwives cited poor pay as a reason to leave the profession. In answers to open-ended questions, 47% of respondents from British Columbia, but none from Alberta, highlighted poor pay as something that would need to change in order for them to successfully manage workplace stress. Discussion and Conclusion: Our comparison of similar midwifery contexts in Western Canada suggests burnout and intention to leave the profession are associated with how the care is remunerated. Midwives in British Columbia and Alberta care for a similar volume of clients and are paid with a similar type of payment system, but midwives in British Columbia are paid significantly less per course of care. A revised payment system or a significant increase in pay per client may ensure that midwives in British Columbia can continue to provide high-quality relationship-based care while maintaining longevity in the profession. This article has been peer reviewed.

The Safety and Feasibility of Contraception Care by Midwives and Other Nonphysician Providers: A Scoping Review of Randomized Control Trials

Background: Although midwives in most Canadian provinces and other high-income countries have contraceptive prescribing ability, it is not within the Ontario midwifery scope of practice.Aim: To outline the contraceptive-related scope of practice of midwives in Canada and other high-income countries and to review the outcomes of contraceptive provision by physician versus nonphysician providers.Methods: We conducted an environmental scan through a search of grey literature to summarize contraception-related scopes of practice of midwives in provinces across Canada and in other high-income countries. We then conducted a scoping review of randomized controlled trials (RCTs) that examined the outcomes of physicians compared with nonphysician providers for the provision of contraception care, and summarized that evidence.Findings: Our environmental scan revealed that Quebec and Ontario are the only provinces in Canada in which midwives cannot prescribe contraception. In the following industrialized countries, midwives with education similar to that of Ontario midwives are able to prescribe contraception: New Zealand, Australia, United States, Sweden, Norway, Netherlands, Finland, and France. Our review of RCTs indicates that for most measures of competency, the outcomes of physician and nonphysical providers are similar when providing contraception care. This article has been peer reviewed.

The effect of the SUMPING E-module as a labor companion on the duration of labor in independent midwife practice

The effect of the SUMPING E-module as a labor companion on the duration of labor in independent midwife practice

The Evaluation Of Universal Child Immunization (UCI) Management In The Work Area Of Bah Kapul Health Center, Siantar Sitalasari District In 2023

Background: Immunization is the governments promise to get Sustainable Development Goals (SDGs), especially to decrease the number of infant death rates. Universal Child Immunization (UCI) is an indicator of success in basic immunization in babies immune against a disease. Purpose: To analyze the process of management in achieving UCI. Research Methods: The research used qualitative phenomenological methods. The objective of the research was to analyze the process of management in achieving UCI. The research used qualitative phenomenological methods. It was done in the working area of Bah Kapul Puskesmas. The data were gathered by conducting in-depth interviews with 8 Informantts from Surveillance and Immunization Section Head, the Heads of Puskesmas, participants of immunization program, and practice midwife. Result : The result of the research showed that human resources were inadequate since their qualification was not in accordance with the standards, training was only done by the participants, facility and infrastructure such as KMS preparation and the facility outside the building were inadequate, lacked of staff cars for immunization personnel, there was no counseling about immunization in the field, people were not interested in the program, there were ignorance and lack of involvement of cross-sectors, and there was no monitoring from the Heads of Puskesmas for immunization outside the building. Conclusion : The Heads of Puskesmas should monitor directly immunization service outside the building and not only monitor through the report. The management of Puskesmas should provide counseling about the importance of immunization for targeted parents before posyandu service is done. The cross-sectors should support the implementation of immunization, actively play and collaborate in its implementation.

The Influence of Assistance and the Success of Early Breastfeeding Initiation on Maternity Mothers

Colostrum, which is yellowish breast milk, is considered vital because it is the first immunization for newborns and plays a significant role in the newborn's immune defence system. This research aimed to determine the effect of assistance in early breastfeeding initiation and the success of early breastfeeding initiation among mothers giving birth at the Independent Midwife Practice in Pematangsiantar City. The method used in this research was a quasi-experiment with a two-group design pretest-posttest with the control group, which was carried out on 67 mothers divided into two groups, using consecutive sampling (n=34 and unaccompanied mothers n=33). Assistance in the form of providing information on Early Breastfeeding Initiation (EBI) using materials, leaflets, and AVA/videos. The Early Breastfeeding Initiation Satisfaction Questionnaire was adopted from the Maternal Breastfeeding Evaluation Scale. The non-parametric Wilcoxon test was used for testing. Testing used the SPSS.The results of this study showed a significant relationship between mothers' knowledge and satisfaction with success before and after being given the intervention with (p=0.001) and (p=0.025). Assistance for mothers giving birth will increase the success of women in labour to breastfeed their babies as early as possible.

Pregnancy Associated Plasma Protein-A (PAPP-A) as a Marker to Distinguish Normotensive with Early 2nd Trimester and Late 3rd Trimester Onset of Preeclampsia

Introduction: Preeclampsia is a hypertensive condition that occurs after 20 weeks of gestation accompanied by target organ damage. Complications of preeclampsia can cause intrauterine fetal growth retardation, and placental hypoperfusion, even in the most serious situations, namely termination of pregnancy and death of the fetus and/or mother. Pregnancy-associated plasma protein-A (PAPP-A) is a high molecular weight glycoprotein that is produced in the placenta and secreted into the maternal bloodstream. However, based on several studies that have been conducted, there is uncertainty in the results of assessing PAPP-A levels obtained in pregnant women in the second and third trimesters. Aim: Proving differences in PAPP-A levels in the second and third trimesters in the incidence of early-onset preeclampsia and normotensive pregnancy. Methods: An analytic observational study with a cross-sectional approach was carried out in the delivery room of RSUP Dr. Kariadi Semarang, Halmahera Health Center, Ngesrep Health Center, Bulu Health Center, and private midwife practice in Semarang City. The subjects of the study were six 2nd-trimester preeclampsia patients, fourteen 3rd-trimester preeclampsia patients, and twenty normotensive pregnancy patients who met the inclusion and exclusion criteria. Data were analyzed using Mann Whitney with a significance of p<0.05 Results: There was a significant difference in PAPP-A levels (p<0.001) between the preeclampsia and normotensive pregnancy groups, whereas PAPP-A levels were higher in the preeclampsia group. There were significant differences in PAPP-A levels (p<0.001) between the 2nd-trimester preeclampsia, 3rd-trimester preeclampsia, and normotensive pregnancies, where the highest PAPP-A levels were found in the 2nd-trimester preeclampsia group. Conclusion: There was a significant difference in PAPP-A levels between the second and third trimesters of early-onset preeclampsia compared to normotensive pregnancies, where PAPP-A levels were higher in the second and third trimesters of early-onset preeclampsia. Elevated PAPP-A levels in the second and third trimesters are associated with an increased risk of early-onset preeclampsia.

Measuring Women's Satisfaction with Childbirth: A Literature Review of Measurement Properties.

Patient satisfaction is an important indicator of the quality of care provided. Evaluating women's satisfaction with childbirth is essential to improving obstetric care and ensuring a positive experience for mothers and newborns. The tools used to measure women's satisfaction with childbirth are very heterogeneous and multidimensional. Assessment tools used in practice should be tested and meet characteristics that are consistently validated.The aim is to identify currently available instruments measuring women's satisfaction with childbirth and to evaluate their structure, content and psychometric properties. A systematic search for sources was carried out according to the criteria set. For the included studies, psychometric properties were assessed in accordance with the principles of the guideline for completing systematic reviews of patient-reported outcome measures, COSMIN. The review included 31 studies that reported the psychometric properties of six measurement instruments (questionnaires, scales). Content validity, structural validity, internal consistency, reliability and cross-cultural validity were assessed for the included studies. The Childbirth Experience Questionnaire (CEQ/CEQ2) and Birth Satisfaction Scale - Revised (BSS-R) were the most commonly used questionnaires in the studies. Thorough testing of tools measuring women's satisfaction with childbirth, and adapting them to cultural and social contexts, is still essential. It is crucial that valid and reliable questionnaires are available for midwives in practice, for use in research, to inform clinical practice and for the results to help develop the services offered.

Scopes of practice for advanced practice nursing and advanced practice midwifery in Kenya: A gap analysis.

There is increasing global evidence on the impact of advanced nursing and midwifery practitioners, and Kenya's healthcare system has an excellent opportunity to develop scopes of practice and other regulatory frameworks for the integration of these roles. The primary purpose of this gap analysis was to explore the existing evidence on opportunities and threats toward the integration of the advanced practice nursing (APN) and advanced practice midwifery (APM) roles in Kenya's healthcare system. The study team conducted a structured electronic database search of PubMed, CINAHL, Scopus, EBSCOhost Academic Search Complete, and PsycINFO to retrieve articles and credible websites for reports highlighting the opportunities and threats toward the integration of the APN and APM roles in Kenya's healthcare systems. The retrieved articles were screened for relevance and synthesized for reporting using the traditional literature review approach. The Kenya Health Policy Framework 2014-2030, growing population needs, and implementation of universal health coverage provide an opportunity to harness and leverage advanced practice roles in nursing and midwifery. There is also momentum to develop advanced practice because of strategic alliances and global evidence showing the contributions and quality of services offered by advanced practice nurses and advanced practice midwives. However, lack of financial support, structural challenges, and lack of national policies, regulations, and legislation continue to obstruct progress. Developing scopes of practice for APN and APM in Kenya will benefit the professions, the country's healthcare delivery system, and the population. Achieving universal health coverage depends on a health workforce trained and practicing at optimal levels in tandem with education and training to deliver quality care.

The Effect of Benson Relaxation and Dhikr on Decreasing Pain Scale in Active Phase I Delivery Mothers at Yosi Trihana Independent Midwifery Practice

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>Pain management uses pharmacological and non-pharmacological approaches, to reduce pain by treating accompanying symptoms. One of the non-pharmacological pain treatments is Benson relaxation therapy and dhikr. Benson relaxation therapy is a non-pharmacological strategy that combines relaxation techniques with the patient's belief system. It aims to reduce pain and encourage calmness by focusing on Allah SWT and releasing all emotions to the mother. The purpose of this study was to determine the effect of Benson relaxation and dhikr on reducing the pain scale in mothers inpartu kala I active phase. The research method used is quantitative with a pre-experimental research design, with the type of research one group pre-post test. The research location was at the Yosi Trihana Independent Practice Midwife, Klaten Regency, Central Java. They were carried out in November 2023 to January 2024. The population used was all active mothers inpartu active phase I. The sampling technique was total sampling, so the research sample was 30 respondents. The research instrument used the Numeric Rating Scale (NRS) pain scale. Data analysis was performed using the Wilcoxon test, which was processed using SPSS software version 20.0. The results showed a significant relationship with a p-value = (0.000). There is a decrease in the intensity of pain experienced during the labour process in Yosi Trihana's Independent Midwife Practice. These findings indicate that benzene relaxation and dhikr significantly impact reducing pain levels during labour. It is recommended that nurses and other health workers use dhikr relaxation as a non-pharmacological technique to reduce pain during labour. </em><em></em></p><p> </p></td></tr></tbody></table></div><strong><em>Keywords: Benson Relaxation, Dhikr, Pain Intensity Scal</em></strong>

THE DEVELOPMENT OF ANDROID- BASED MIDWIFERY LAW APPLICATIONS IN THE IMPLEMENTATION OF INDEPENDENT MIDWIFE PRACTICES

Problems in health services are closely related to the midwifery Profession, in providing health services neglicences or malpractice can occur. some problems arises when a midwife Is negligent in carrying out health services and does not comply with her authority. This research using normative development Research, this research is to create Android-based Midwifery Law application software as a reference that can be easily applied in carrying out independent midwifery practices that apply in accordance with the Law.Number 17 of 2023 concerning Health, onArticle 454 of Law 17/2023 regulates 11 laws that are revoked and declared invalid. The results of this research conclude that the Android-based Midwifery Law application can be installed, so that the Android-based Midwifery Law application becomes an electronic means for understanding and searching for applicable midwifery regulations. All statutory regulations which constitute the implementing regulations of the Midwifery Law are declared to still be valid as long as they do not conflict with the provisions of the Health Law, namely, Minister of Health Regulation No. 28 of 2017 concerning Licensing and Implementation of Midwife Practice,Minister of Health Decree 320 of 2020 concerning Midwifery Professional Standards,Minister of Health Decree 1261 of 2022 concerning Work Competency Standards in the Field of midwifery.

Pelindungan Hukum bagi Bidan Memberikan Pelayanan Obat kepada pasien dalam Praktik Kebidanan di Daerah Terpencil

Providing drug services to patients in midwifery practice in remote areas is regulated in Article 273 of the Health Law which states that: "personnel in carrying out practice have the right to obtain legal protection as long as they carry out their duties in accordance with professional standards, professional service standards, and standard operational procedures and professional ethics, as well as patient's health needs. Likewise, Article 19 of the Minister of Health's Permit and Practice of Midwives also states that "in carrying out practice/work, midwives have the right to obtain legal protection in carrying out practice/work as long as they comply with standards." The purpose of this paper is to analyze the authority of midwives to provide drug services to patients in midwifery practice and examine the form of legal protection for midwives in carrying out practice. The author uses a research method with a normative juridical type and approaches the problem using legislation, a conceptual approach and a comparative approach.
 
 Keywords: Medication Administration by Midwives, Legal Protection

DUKUNGAN KELUARGA DENGAN KEPATUHAN KUNJUNGAN ANC PADA IBU HAMIL TRIMESTER III

The purpose of this study was to determine the correlation between family support and compliance with ANC visits in third trimester pregnant women at the Independent Practicing Midwife Amirul Cholifah S.Tr. Keb in Sumberwono Village, Bangsal District, Mojokerto Regency. The results showed that most of the respondents were in the Supporting category, namely 24 people (80%), and most of the respondents were in the Compliant category, namely 20 people (66.7 The results of the Fisher Exact test p value = 0.000 means that there is a correlation between family support and compliance with ANC visits in third trimester pregnant women at Independent Practice Midwife Amirul Cholifah S.Tr. Keb in Sumberwono Village, Bangsal District, Mojokerto Regency. Family support and pregnancy checks are important motivations for pregnant women in the form of compliance with ANC visits to maintain the condition of the mother and the growth of the fetus. It is expected that health workers will provide education and counseling about ANC to pregnant women so that families pay more attention to the physiological and psycholoical conditions of pregnant women

Laid-back breastfeeding: knowledge, attitudes and practices of midwives and student midwives in Ireland.

Despite concerted efforts by policy developers, health professionals and lay groups, breastfeeding rates in Ireland remain one of the lowest in world, with 63.6% of mothers initiating breastfeeding at birth, dropping to 37.6% of mothers breastfeeding exclusively on hospital discharge. Nipple trauma and difficulties with baby latching are major contributors to the introduction of formula and discontinuation of breastfeeding. Research shows laid-back breastfeeding (LBBF) significantly reduces breast problems such as sore and cracked nipples, engorgement, and mastitis as well as facilitating a better latch. Although the benefits of LBBF are well documented, this position does not seem to be routinely suggested to mothers as an option when establishing breastfeeding. This study aims to determine midwives' and student midwives' knowledge, attitudes, and practices of using laid-back breastfeeding in Ireland. A cross-sectional descriptive survey distributed to midwives and student midwives in three maternity hospitals in Ireland and two online midwifery groups based in the Republic of Ireland, during June, July, and August 2021. Two hundred and fifty-three valid responses were received from nine maternity units. Most participants (81.4%) were aware of laid-back breastfeeding. However, only 6.8% of respondents cited it as the position they most frequently use. Over one-third (38.34%) had never used this position with mothers. Those more likely to suggest LBBF had personal experience of it, were lactation consultants or working towards qualification, or had participated in specific education about LBBF. Barriers included lack of education, confidence, time, and experience. Further issues related to work culture, a tendency to continue using more familiar positions and concerns about mothers' anatomy and mothers' unfamiliarity with LBBF. Although there was a high level of awareness of laid-back breastfeeding among midwives and student midwives, there are challenges preventing its use in practice. Education specifically related to using LBBF in practice is required to overcome the barriers identified. A greater understanding of mothers' and babies' intrinsic feeding capacities may give midwives more confidence to recommend this method as a first choice, potentially leading to more successful breastfeeding establishment and maintenance.

Analysis of Qualitative Studies on ANC Services During the Covid 19 Pandemic at PMB Ana Hasanah

Background : In this COVID-19 pandemic situation, there are many restrictions on almost all routine services including maternal and newborn health services. Pregnant women are advised to continue to routinely carry out pregnancy checks during the pandemic even though there are service modifications (social distancing). Purpose of Writing: To obtain in-depth information about ANC services during the Covid-19 pandemic at PMB Ana Hasanah. Research Methods: The research used is a qualitative approach with the type of Rapid Assessment Procedures (RAP) research. The informants of this study consisted of 8 pregnant women who made antenatal care visits at PMB Ana Hasanah. While the key informants were husbands or families of pregnant women and Ana Hasanah PMB officers. Research Results: input components, human resources are sufficient and according to standards. Funds are available and sourced from clinic revenue turnover. SOPs are available which refer to the RI Ministry of Health Guidelines. The facilities and infrastructure are complete. For the process component, midwives' independent practice has carried out the flow of antenatal care services and health protocols according to the guidelines, but level 3 PPE is still limited. For the output component, the scope of ANC services has decreased significantly during the pandemic. For the outcome component, pregnant women are satisfied with antenatal care services, but some pregnant women do not have routine checks. Conclusions and Suggestions: The results of this study are expected to provide information to the Mandiri Midwife Practice as a place for maternal and neonatal health services so that they can provide the best service to pregnant women during the pandemic both online and offline so that monitoring of pregnant women during the COVID-19 pandemic can run well.

Knowledge, attitude, and practices of midwives on premature rupture of membranes (PROM): A cross-sectional study in Samosir and Toba, Indonesia.

Indonesia has a significantly higher maternal mortality ratio (MMR) than other countries in Southeast Asia, and infection is one of the most common causes of maternal deaths, of which premature rupture of membranes (PROM) can be the consequence of the infections. In primary healthcare settings, midwives play an important role in identifying and managing PROM appropriately; however, studies on their knowledge, attitudes, and practices related to PROM are limited. The aim of this study was to determine the midwives' knowledge, attitude and healthcare practice on PROM in Indonesia. A cross-sectional study was conducted among midwives at primary healthcare facilities in Samosir and Toba Regency, North Sumatra, Indonesia, from July to November 2022. The knowledge, attitude and practice towards PROM were assessed. Results showed that 57.5% of midwives had poor knowledge and 35.1% had poor attitude levels. There were 4.9% of midwives referred the patients immediately to the hospital. Our data indicated that aged 31-40 or 41-50 years, having a lower than bachelor degree and having a higher monthly number of referred PROM patients were significantly associated with poor knowledge compared to younger, having a bachelor degree, and lower monthly referral patient number, respectively. Similarly, younger, having higher degree and a having lower monthly referral number of PROM cases were associated with higher chances of having a sufficient-good attitude towards PROM. This study highlights that a significant percentage of midwives had poor levels of knowledge and attitude, and age, educational level and monthly referral number of PROM cases were associated with the level of knowledge and attitude.

An exploration of the contraceptive counselling practices of midwives who provide postpartum care in Australia

ObjectiveWe sought to explore and describe midwives’ attitudes and practices relating to their provision of postpartum contraception counselling. DesignWe used an exploratory cross-sectional design. Recruitment used an anonymous online survey using electronic communication platforms of professional, and special-interest organisations, over six months . Descriptive and quantitative analysis was used. Setting and participantsAustralian Midwives who provide postpartum care. Meaning and findingsA total of 289 complete responses were included. Findings from this national survey of midwives showed that almost 75% of Australian midwives reported providing some contraceptive advice to women. Those working in continuity of care models were significantly more likely to fulfil this responsibility. More than half (67%) indicated they had not received any formal contraception education or training. Those working in private obstetric-led settings were significantly less likely to have received education compared to midwives in community settings. Systems barriers preventing the provision of contraceptive counselling included: clinical workload; lack of management support; lack of education; and models of care. Key conclusionsMost midwives (82%) wanted to provide postpartum contraception counselling as part of their role. They cited barriers from within the health system, ambiguity about roles and responsibilities and offered solutions to improve the provision of postnatal contraception counselling. Implications for practiceRecommendations include the development of education programs for midwives. Continuity of care models provided the time, autonomy and opportunity for midwives to undertake contraceptive counselling and fulfil this part of their professional scope. Consideration should be given to expanding access and provision of continuity of midwifery care. An urgent investment in the education and skills of midwives is recommended to ensure all women across acute and community services benefit from improved outcomes associated with pregnancy spacing.