Qualified Midwives Research Articles

‘SINK or SWIM’: The experience of newly qualified midwives in England

Objective to explore newly qualified midwives' and preceptors' view of the preceptorship period. Design qualitative design utilising focus groups as a means of collecting data. Setting hospital trusts partnered with three Universities in England. Participants in total there were 62 participants; 40 newly qualified midwives, 20 preceptors and two practice development midwives participated in focus group interviews. Findings the findings suggested that newly qualified midwives and preceptors found it difficult to meet due to time constraints and either working different shifts or in different clinical areas. In addition three main themes emerged in relation to what affected effective preceptorship. The most important areas to improve the preceptorship period were to appoint midwives responsible for the organisation and support of newly qualified midwives. In addition, each new midwife should have a programme tailored to their needs which avoids repetitive learning. Conclusions the transition period causes anxiety for newly qualified midwives, especially when there is a long delay between qualification and taking up their first post. There appears to be some confusion over induction and preceptorship paperwork. The majority of midwives described their initial experience of working as a qualified midwife as ‘SINK or SWIM’.

Poor standards of care in small, private hospitals in Maharashtra, India: implications for public–private partnerships for maternity care

The private health sector in India is generally unregulated. Maharashtra is among the few states which require registration of private hospitals. This paper reports on a study of standards of care in small, private hospitals (less than 30 beds) in Maharashtra state, India, with a focus on maternity care, based on interviews with the hospitals' owners or senior staff, and observation. In the absence of reliable information on the number of private hospitals in the state, a physical listing was carried out in 11 districts and an estimate drawn up; 10% of hospitals found in each location were included in the study sample. We found poor standards of care in many cases, and few or no qualified nurses or a duty medical officer in attendance. Of the 261 hospitals visited, 146 provided maternity services yet 137 did not have a qualified midwife, and though most claimed they provided emergency care, including caesarean section, only three had a blood bank and eight had an ambulance. Government plans to promote public–private partnerships with such hospitals, including for maternity services, create concern, given our findings. The need to enforce existing regulations and collect information on health outcomes and quality of care before the state involves these hospitals further in provision of maternity care is called for.

Impact of midwife staffing level on outcome of labour

The Healthcare Commission Maternity Services Review highlights the importance of well-resourced maternity units operating with coordinated multidisciplinary teams. The RCM (Royal College of Midwives) annual survey of UK heads of...

A review of the literature: Midwifery decision-making and birth

Clinical decision-making was initially studied in medicine where hypothetico-deductive reasoning is the model for decision-making. The nursing perspective on clinical decision-making has largely been shaped by Patricia Benner's ground breaking work. Benner claimed expert nurses use humanistic-intuitive ways of making clinical decisions rather than the 'rational reasoning' as claimed by medicine. Clinical decision-making in midwifery is not the same as either nursing or medical decision-making because of the woman-midwife partnership where the woman is the ultimate decision-maker. CINHAL, Medline and Cochrane databases were systematically searched using key words derived from the guiding question. A review of the decision-making research literature in midwifery was undertaken where studies were published in English. The selection criteria for papers were: only research papers of direct relevance to the guiding research question were included in the review. Decision-making is under-researched in midwifery and more specifically birth, as only 4 research articles met the inclusion criteria in this review. Three of the studies involved qualified midwives, and one involved student midwives. Two studies were undertaken in England, one in Scotland and one in Sweden. The major findings synthesised from this review, are that; (1) midwifery decision-making during birth is socially negotiated involving hierarchies of surveillance and control; (2) the role of the woman in shared decision-making during birth has not been explored by midwifery research; (3) clinical decision-making encompasses clinical reasoning as essential but not sufficient for midwives to actually implement their preferred decision. We argue that existing research does not inform the discipline of the complexity of midwifery clinical decision-making during birth. A well-designed study would involve investigating the clinical reasoning skills of the midwife, her relationship with the woman, the context of the particular birthing unit and the employment status of the midwife. The role of the woman as decision-maker in her own care during birth also needs careful research attention.

Comparison of abdominal palpation, Johnson’s technique and ultrasound in the estimation of fetal weight in Northern Iran

Objectives to assess the accuracy of abdominal palpation, Johnson's technique and ultrasound in the estimation of fetal weight (EFW). Design, setting and participants 174 pregnant women were recruited at random in a large teaching hospital in Iran. Fetal weight was estimated by palpation and Johnson's technique at the time of admission by one qualified midwife, and then estimated by ultrasound by one radiologist. After birth, all newborns were weighed using the same scale. Findings a significant correlation was found between EFW by ultrasound, palpation and Johnson's technique and actual birth weight. The differences between EFW by palpation, ultrasound and Johnson's technique and actual birth weight were significant for small-for-gestational-age fetuses ( p<0.05, p<0.01 and p<0.001, respectively), but not for appropriate-for-gestational-age fetuses. These differences were significant for ultrasound ( p<0.001) and palpation ( p<0.05) in large-for-gestational-age fetuses. The sensitivity of ultrasound for EFW of low-birthweight fetuses (72.2%) and the sensitivity of Johnson's technique for EFW of normal-weight and macrosomic fetuses (97.3% and 75%, respectively) appeared to be higher than the sensitivities of the other methods. Conclusion palpation and Johnson's technique can be used as alternatives to ultrasound for EFW, particularly if the measurements are taken by experienced, skilled personnel.

Work-related stress and work ability among Croatian university hospital midwives

Objective to explore the sources and levels of stress at work and work ability among Croatian midwives. Background midwives are subjected to multiple stressors. Among health-care professionals, psychological distress for a prolonged period of time has negative effects on the worker's health, work ability and quality of patient care. ‘Work ability’ is a term describing a worker's resources related to physical, mental and social demands at work. As a measure of work ability in midwifery, the Work Ability Index (WAI) is considered to be a very predictive instrument; midwives with a poor WAI score usually leave their current job within five years. Setting university hospitals in Zagreb, Croatia. Design cross-sectional design survey. Participants 300 health-care workers (105 qualified midwives and 195 paediatric nurses) were invited to complete the questionnaire. The total response rate was 53% (158/300). The sample included 14.7% of all hospital-based midwives in Zagreb hospitals. Methods the Occupational Stress Assessment Questionnaire (OSAQ) for health-care workers and the WAI questionnaire. Findings over three-quarters of the midwives (46/60, 76.7%) believed that their job was stressful, and considered that insufficient work resources caused the most stress. More than half of the midwives associated an insufficient number of coworkers, unexpected situations, inadequate income, night work, incurable patients and poor organisation at work with a high level of stress. The perceived specific stressors differed between midwives and paediatric nurses in the same hospital. Insufficient work resources and poor organisation at work were more common stressors among midwives than paediatric nurses ( p<0.05). Midwives and nurses differed significantly with respect to age ( p=0.002). Midwives were younger and had spent fewer years working in their current workplace compared with paediatric nurses ( p<0.001). Also, midwives had a lower level of education than paediatric nurses ( p=0.044). The mean WAI score for midwives was 40.0 [95% confidence interval (CI) 38.4–41.4], compared with 37.5 (95% CI 36.4–38.8) for paediatric nurses, both indicating good work ability. After adjusting for age, the difference in WAI score between the groups of workers was not significant. Conclusions Croatian midwives experienced work-related stress due to: insufficient work resourses, insufficient number of coworkers, poor organisation at work, communication with superiors and emotional work. Midwives’ work ability in relation to the demands of their job was good. These results confirmed that the WAI score decreases significantly with age. Implications for practice hospital management needs to improve organisational factors and resources, as well as midwives’ education and position in the health-care system.

Building capacity to care: learning for maternity support workers

Maternity support workers (MSW) are an increasingly important part of the maternity workforce. This article describes the results of an extensive study of the reasons why maternity units in London introduced MSWs, the service areas they work in, the duties they undertake and it explores views on effective training and development for the role. The study found that MSW is a reasonably established role in London; typically one MSW is employed for every qualified midwife and works across all care settings. Maternity services introduced the role for a wide range of reasons. There is a pressing need to develop a single accredited learning programme for MSWs to overcome problems with transferability. The study identified the features heads of midwifery would like to see learning programmes address.

Defining obstetric terms: The need for gold standards

SummaryTo test the hypotheses that: (1) standard definitions of common obstetric terms exist and (2) frontline workers in daily obstetric practice have common understandings of these terms, we undertook (a) a review of definitions for nine common terms from latest editions of standard texts and resources, and (b) an exploratory questionnaire survey of these definitions applied in a work setting among four groups; trainee and consultant obstetricians, student and qualified midwives (five of each). Definitions for nine selected obstetric terms in common use (labour, parity, precipitate labour, primary postpartum haemorrhage, primiparity, PROM, secondary postpartum haemorrhage, term and viability) were inconsistent in standard texts. Obstetric staff had no agreed perception of the precise definitions. There is a potentially hazardous lack of clarity about obstetric terms, and a need to develop standard definitions. This would benefit students, practitioners, information technology experts and, most importantly, patients.

A study exploring UK midwives’ knowledge and attitudes towards caring for women who have been sexually abused

Objective to investigate midwives’ knowledge and attitudes in relation to caring for women who have been sexually abused. Design survey using a postal questionnaire. The questionnaire looked at midwives’ knowledge and attitudes towards a range of aspects of sexuality and childbirth. The area of caring for women who have been sexually abused was one aspect of this study. The questionnaire included fixed response and open-ended questions. Quantitative data were analysed using χ 2-test, logistic regression, Mann–Whitney U-test, Kruskal Wallis test and Mantel–Haenszel test. Qualitative data were analysed using a modified constant comparative approach as described by Morse and Field [1995. Qualitative research methods for health professionals, second edn. Sage Publications, London]. Setting four National Health Service trusts within the East and West Midlands. Participants 489 community and hospital-based midwives. Findings 372 midwives returned their questionnaire giving a 76% response rate. The majority of midwives in the sample group did not feel adequately prepared to deal with a disclosure of sexual abuse ( n=207, 56%), with a further 109 (29%) midwives being ‘unsure’ if they could deal with such a disclosure. Community midwives rated themselves as more able to deal with disclosures of sexual abuse compared with hospital-based midwives ( χ 2=4.044, df=1, p=0.044). The analysis of the in-depth responses to the open-ended questions showed that a small number of midwives were very knowledgeable about the topic of sexual abuse and had experience in dealing with these situations. In contrast, it emerged that the majority of midwives had little if any education in this area and felt unable to deal effectively with disclosures of sexual abuse. Key conclusions and implications for practice the finding that the majority of midwives did not feel adequately prepared to deal with disclosures of sexual abuse may have implications for the quality of care received by survivors of sexual abuse. It is possible that midwives who have been inadequately prepared for dealing with such disclosures may give inappropriate advice, and may inadvertently compound the feelings of powerlessness that women have experienced. Aspects of sexuality and, in particular, caring for women who have been sexually abused should be included in all pre-registration curricula, and post-registration education should include this topic to either update midwives or introduce these topics to qualified midwives. As the incidence of sexual abuse is high and may potentially affect a significant number of childbearing women, it is recommended that further good-quality research should be conducted in this area.

‘A tale of two cities’: auditing midwifery practice and perineal trauma

A lot of interest has been expressed on reduction of morbidity from perineal trauma sustained after childbirth with emphasis on doctors' training. It is of great concern however that similar effort has not been directed toward midwifery colleagues who perform most of the deliveries. This audit was carried out in two district general hospitals (A and B) and aimed to assess the adherence to standards of management of perineal trauma sustained following vaginal delivery. Questionnaires were distributed at random to qualified midwives attending their routine shifts in the respective labour wards. The midwives were asked to complete and return the form during their shift. Only 35% (A) and 30.4% (B) of midwives had had formal training on repair of perineal tears. Less than 65% could correctly identify a first degree perineal tear and the percentages were much less on the more severe tears. Eighteen per cent in A and less than 30% in B performed rectal examinations as recommended. More than 90% of the midwives felt inadequately prepared to assess and/or repair perineal tears in both units and all of the midwives were keen to attend study days on perineal trauma. There was a general lack of knowledge on the agreed classification of perineal trauma, and most midwives involved in the assessment and/or repair of perineal trauma felt inadequately trained in this area. Up to a third of the midwives who participated do not perform rectal examinations on assessment or after repairing the perineal tear, which falls short of Royal College of Obstetrics and Gynaecology (RCOG) standards. It is imperative that the training needs of midwives on this aspect of midwifery care are addressed. It is particularly important because midwives conduct more than half of all deliveries in the UK.

Exploring autonomy in education: preparing student midwives

The following article aims to describe the findings from a piece of research which examined whether a sample of senior midwifery students, close to registration, believed that their preregistration midwifery education had prepared, empowered and enabled them to be autonomous practitioners upon qualification. Most of the participants believed that their midwifery education had in the most part prepared them to be qualified midwives, but it had failed to equip them for professional autonomy. They believed that the concept and realization of midwifery autonomy had not been explicit enough in their educational programme. Any perceived barriers which the students felt inhibited qualified midwives from practising with professional autonomy will also be discussed, as many of the participants interviewed considered that they had only witnessed midwifery autonomy in midwiferyled birthing units and that it was almost invisible in obstetric led units. They considered that the medicalization of childbirth had prevented most of their midwifery mentors practising autonomous midwifery.

The developing role of the maternity care assistant

Maternity care assistants (MCAs) are becoming a necessary part of the healthcare workforce as the workload of the midwife increases and the number of qualified midwives falls. These MCAs have been under fire by the press recently for taking on duties not suited to their experience or qualifications. This article will consider what they are are actually allowed to do in the field of midwifery and and how their developing role will benefit themselves, their colleagues and most of all, their patients.

Breastfeeding Best Start study: training midwives in a 'hands off' positioning and attachment intervention.

The most common reasons cited by women for giving up breastfeeding early can be attributed to ineffective positioning and attachment and are therefore preventable. This study aimed to determine whether a 4-h training programme in 'hands off' positioning and attachment support increases midwives' knowledge and problem-solving skills. Using an unrelated comparison group and a pre- and post-intervention design, 108 midwives (experimental group) completed a 4-h standard breastfeeding training workshop focusing on effective positioning and attachment and the use of hands-off teaching methods. Knowledge and problem-solving skills were assessed using a modified form of the previously validated Breastfeeding Support Skills Tool. Pre- and post-training scores were compared with those of 27 student midwives (control group) who undertook the same assessments but without the breastfeeding training. Baseline knowledge scores of the midwives and the student midwives did not differ significantly (average difference 0.7 points to qualified midwives' advantage, 95% CI = -3.4 to 1.9). Following training, the qualified midwives' total scores increased significantly (7.2 points, 95% CI = 6.2-8.2). Minimal changes (1.4 points, 95% CI = -0.15 to 2.9) in students' scores were found. The additional increase owing to training above that which might be expected due to practice (i.e. the average difference in change scores between the two groups) was 5.8 points (95% CI = 3.75-7.96), representing a large effect size for the training (d = 0.95). There is a large variation in the breastfeeding knowledge of midwives working in post-natal care and, on average, they are no more skilled than senior student midwives. The study has shown that a 4-h workshop in a positioning and attachment intervention, using a 'hands-off' approach, can increase midwives' knowledge of breastfeeding support relevant to the immediate post-natal period. It is applicable to all midwives, and could be a cost-effective way of improving the ability of mothers to begin and continue to breastfeed successfully.

Thirty years of psychosexual nursing

December 2005 marks thirty years since the end of the first experimental psychosexual seminar training scheme provided specifically for nurses in the United Kingdom. This pilot study, which ran from January 1974 until December 1975, was funded by the Department of Health and Social Security and run under the auspices of the Family Planning Association. It provided psychosexual training for three groups of nurses, midwives and health visitors who worked predominantly in contraception services. Drawing on archival sources, this paper describes the pilot study and reviews its contribution to two subsequent developments in psychosexual care provided by nurses: the creation, by the then Joint Board of Clinical Nursing Studies, of a short course on the principles of psychosexual counselling for qualified nurses and midwives (Course 985); and the foundation of psychosexual nursing based on Balint-style seminar training. The aim of such training in psychosexual nursing is not to turn nurses into psychosexual counsellors – although some seminar-trained nurses do work in this role – but to enable them to recognise and respond constructively to the psychosexual issues encountered in their everyday practice.

A Basic Study on Palm Contact Pressure to Support a Head of Newborn Baby while Bathing

This study focused on basic research for establishing a method of teaching bathing techniques to beginners. By analyzing the palm contact pressure of a midwife supporting the head of a newborn baby, this study aimed to clarify how an experienced person uses their hands. The subjects were five right-handed qualified midwives aged 34 to 46 years with 5 years or longer of continuous experiences in bathing newborns. To evaluate the contact between the subject and the bathing doll, a sheet-type body pressure distribution measurement system (BIG-MAT2000 by Nitta Corp.) was used. The subject held the bathing doll in both hands at the bosom and places the bathing doll into the bathtub using the left hand only. These actions were classified into the double-hand holding and single-hand holding patterns. Each action was measured for 6 seconds five times in a row. Of these measurements, two measurement results that were comparatively free from noise were adopted as measurement data. Pressure distribution on the entire palm at bathing indicated three-point support in both the double-hand holding and single-hand holding patterns, as reported in an earlier study.

Expanding the workforce through return to practice

In February 1999 the government acknowledged a national shortage of qualified midwives in the NHS. Return to midwifery practice courses have been seen as one answer to the problem. The courses need to reflect a cohesiveness between education, clinical practice and midwifery supervision. Simultaneously returnees need to be supported whilst being reoriented to the reality of midwifery practice. In order to evaluate the effectiveness of the return to midwifery practice courses, transparent audit mechanisms need to be in place. This article debates the reasons as to why midwives continue not to practice and the procedures that are in place to facilitate their return.

The use of imagination in professional education to enable learning about disadvantaged clients

AbstractProfessional education is delivered equally on campus and in practice placements but until lately, theories of learning and teaching in higher education have focused mainly on processing text‐based forms of knowledge. Even more recently introduced learning methods such as reflection and problem or enquiry based learning do not fully address the complex and often challenging learning needs of student health and social care professionals as they face the reality of everyday professional practice (Hall 2001). Working in a practice placement requires students to be able to make sense of the chaotic events going on around them that frequently evoke emotional responses, and challenge the individual's value and belief systems, which can lead to a changed outlook on life (Howard 2002). This means that the type of learning, which occurs in practice settings, is often implicit in nature and the knowledge gained is likely to be tacit making it difficult to share with others. However, what is learnt implicitly both within the placement and campus will have a significant impact on later practice and therefore we need a mechanism to ‘unlock’ this tacit knowledge.In this paper we propose that creative methods of learning such as developing the use of imagination may have more direct application in bringing into the public domain previous implicit learning experiences. As a means of exploring this issue we present our recent research (Hart et al. 2001), which assessed how qualified and pre qualified midwives are educationally prepared to work with disadvantaged women, an area of crucial importance, and one that is personally and professionally challenging. From the findings of this research we created a learning model which can be used by lecturers or practice educators either in the campus or practice settings. We conclude the paper with a discussion evaluating its fitness for enabling students to learn about disadvantaged clients.

Planned homebirths in Victoria, 1995-1998.

This paper reports and comments on quantitative aspects of 440 planned homebirths attended by registered midwives in Victoria during the three years studied, 1995-1998. The spontaneous labour rate was 96.4%, and 91.6% of women planning a home birth experienced a spontaneous cephalic birth. The overall transfer to hospital rate was 20%, the most common reason for transfer being delayed progress in labour. 64.2% of women experiencing a vaginal birth had no perineal trauma. Postpartum haemorrhage was noted in 5.5% of participants, and 1.1% had a retained placenta. Infants were an older gestation and heavier than those in the state in general, although the Apgar scores were similar. These data support the claim that planned home birth with a qualified midwife remains a demonstrably safe option for women who choose this model.

Who's afraid of the graduate midwife?

Midwifery has almost come of age. It is showing all the signs of being a profession, and in keeping with that maturity it is time for all midwifery education to be at degree level. Diploma level qualifications should be phased out and in the future all student and qualified midwives should have the benefit of a university education.

Midwives access to the higher award: a management or supervision issue?

The English National Board (ENB) framework to the higher award has become an option for continuing professional education throughout Britain. At a colege of health studies based in north London, the first students indexed in September 1994. The college research unit and the team of teachers Involved in the planning and Implementation of the process decided to be proactive in evaluating the success of this approach to education for qualified nurses and midwives. Therefore a number of small research projects were set up to be conducted over the first few years In order to examine the complexities of the implementation process as well as the effectiveness of the education provided. This report describes the findings of one of those small projects; one which considered the way that midwives would access the higher award — through managers or supervisors of midwives?