Support Midwives Research Articles

Midwives’ experiences regarding adverse events in obstetric units of the selected district of Gauteng province, South Africa

Adverse events are a global challenge and the leading cause of litigation in the world. In the current study, a qualitative, exploratory, and descriptive design was used to explore and describe the experiences of midwives in relation to adverse events that occurred in the obstetric units of the selected district of Gauteng province, South Africa. Non-probability purposeful sampling was used to select 25 midwives who work in obstetric units in the selected district of Gauteng Province, South Africa, In-depth face-to-face interviews were conducted with each participant at their workplace. Tesch method was used to analyse the data. Measures to ensure the trustworthiness of the study were observed. The study results revealed that midwives experienced a lack of recognition and acknowledgment of their efforts; poor support and unequal opportunities; blame, litigation, and psychological effects due to adverse events. The failure to recognize, acknowledge, and support midwives during an adverse event had a detrimental effect on productivity and affected the quality of maternal health care. For midwives to provide maternal health care services effectively regardless of an AE, adequate support, effective communication, and referral for appropriate counseling were recommended.

Women’s experiences of intermittent auscultation fetal monitoring in labour: A qualitative study

BackgroundInternationally, intermittent auscultation (IA) is recommended for monitoring the fetal heart rate during labour and birth for women with uncomplicated pregnancies. IA can identify changes in the fetal heart rate that may indicate the need for additional care or intervention. IA is a central facet of midwifery practice, but there is little evidence about women’s experience of IA. AimOur study aimed to explore women’s experiences of IA in the UK. MethodsBetween February and May 2023, 23 women were recruited through social media, service user organisations and charities, for a single episode, online interview or focus group with informed consent. Audio recordings were transcribed and thematically analysed. FindingsThe analysis constructed two over-arching themes: ‘Choice takes work’ and ‘Impact of IA monitoring on the labouring woman’. DiscussionWomen reported a lack of informed decision-making in relation to intrapartum fetal monitoring. The experience of our participants showed that not all women for whom IA would be recommended according to current clinical guidelines were offered it, while others experienced IA without understanding its function or the availability of other options. ConclusionLimited antenatal communication from maternity care professionals about fetal monitoring in labour has an impact on women’s opportunities to make informed decisions. A committed approach to informed decision making in the antenatal period could reduce practice variation and better support midwives to support women in their birth choices.

One size does not fit all: Perspectives from Swedish midwives on fetal movement counselling

ProblemMigration continues to play a role in determining health outcomes related to pregnancy and childbirth in Sweden. BackgroundMigrant women have, compared to Swedish-born women, increased risks of adverse birth outcomes. Previous research suggests that migrant women seek care for decreased fetal movements less than Swedish-born women. Given these documented risks, understanding midwives’ perspectives in this context is crucial to address maternal health inequities. AimTo explore midwives’ experiences conveying information about fetal movement to migrant women in antenatal healthcare settings. MethodsSemi-structured, individual interviews with midwives (n=15) experienced in providing information about fetal movements to migrant women. The interviews were analysed using reflexive thematic analysis. FindingsThe midwives’ efforts to compensate for the deficiencies within the antenatal healthcare organisation and to ensure that all women received access to information and care regarding fetal movements are described in four themes: (a) building a trusting relationship; (b) empowering women through guidance and support; (c) overcoming communication challenges; and d) navigating safety measures. DiscussionOur findings suggest that the standard antenatal care programme does not support midwives to provide holistic and individualised care that aligns with midwifery care philosophy. ConclusionTo reduce health inequities for migrant women, this study highlights the need for more flexible guidelines within the standard antenatal care programme. These guidelines should prioritise the individual woman’s needs over institutional protocols, acknowledge the midwife-woman relationship as the core of midwifery practice and support midwives to build a partnership with women through continuity of care.

Midwives as Adult Educators: An investigation of midwives’ perceptions about the educational dimension of their profession

This article deals with the educational dimension of Midwifery, as manifested in the context of perinatal education programmes in Greece. Despite the internationally recognized value of childbirth education in reducing perinatal mortality and morbidity, and despite the rich activity of midwives in terms of perinatal education, their role as adult educators has received limited scientific attention and support. The purpose of this study is to investigate whether and to what extent midwives teaching in perinatal programmes perceive their role as educators, as well as whether and in what way they are prepared for this role. It also investigates whether and what form of training midwives receive to their role in perinatal education. The study followed the specifications of qualitative design and data was collected through in-depth semi-structured interviews with twelve (12) midwives - trainers in perinatal education, as well as with eight (8) women and men who have participated in childbirth classes in Greece. The findings highlight the need to further support midwives in their educational role and to enhance their educational practice by integrating the principles of Adult Education.

Midwives' experiences of encountering immigrant women during labour and birth who do not master the host country's language. A lifeworld hermeneutic study.

Immigrant women are in a vulnerable position during labour and birth due to language barriers. Communication with women who do not master the host country's language is difficult for midwives, but there are few studies about midwives' experiences. To explore Norwegian midwives' experiences of encountering immigrant women during labour and birth who do not master the native language. A hermeneutic lifeworld approach. Interviews with eight midwives working at specialist clinics and hospital maternity wards in Norway. The findings were interpreted based on four concepts in the theory "Birth territory: A theory for midwifery practice" by Fahy and Parrat presented in five themes: language barriers can cause disharmony and prevent participation, language barriers can lead to midwifery domination and poorer care, midwives strive for harmony and to be a guardian, medicalisd birth due to language barriers, and disharmony can lead to crossing boundaries. The main interpretation shows that it is midwifery domination and disintegrative power that are prominent. However, the midwives strived to use their integrative power and be guardians, but in doing so they encountered challenges. Midwives need strategies for better communication with immigrant women involving the women and for avoiding a medicalised birth. To be able to meet immigrant women's needs and to establish a good relationship with them, challenges in maternity care need to be addressed. There are needs of care that focus on cultural aspects, leadership teams that support midwives, and both theoretical and organisational care models that support immigrant women.

What are the benefits and challenges of mentoring in midwifery? An integrative review.

Aim:The aim of this review was to synthesize best available evidence on mentoring programmes for midwives who have worked within the clinical setting for more than 1 year.Background:Lack of job satisfaction, stress, burnout and limited managerial support contributes to midwifery workforce attrition and the ongoing global shortage of midwives. Mentoring may be one way to improve staff retention, leading to positive clinical and organizational outcomes.Design:A five-step integrative review approach, based on a series of articles published by the Joanna Briggs Institute for conducting systematic reviews, was used to develop a search strategy, selection criteria, method for quality appraisal and the extraction and synthesis of data.Methods:Relevant articles were sought from the following databases: Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PubMed, MIDIRS and Scopus. The search and screening process was guided by the Preferred Reporting Items for Systematic Reviews and Meta Analysis 2009 checklist. Narrative analysis was used to develop four main categories derived from the results from the included studies.Results:Eight studies were included in this review from which four themes were developed that are relevant to mentoring in midwifery; the impact on midwives’ direct environment, their immediate relationships with peers and management, and the overarching influence of the organization directly impact the accessibility and support midwives receive in mentoring programmes.Conclusion:To enhance staff retention in the workforce, midwives require support from the wider organization in which they work.Relevance to clinical practice:Understanding midwives’ perspectives of mentoring programmes will directly influence the development of midwifery-specific mentoring programmes, which may lead to improved staff retention in the midwifery workforce.

Midwifery leaders’ views on the factors considered crucial to implementing evidence-based practice in clinical areas

ProblemThe evidence-to-practice gap continues to persist in healthcare and midwives report limited knowledge and use of effective intervention strategies to support the implementation of new evidence-based practices in clinical settings. BackgroundDespite ongoing development and dissemination of high quality research findings, the translation of latest research evidence by midwives into new evidence-based practices remains sub-optimal. This inefficiency places consumers at risk of obsolete or potentially dangerous healthcare interventions. AimTo explore midwifery leaders’ views on what information and support midwives require to lead practice change initiatives in clinical areas. MethodsThe study formed part of a broader Participatory Action Research (PAR) project designed to improve the processes by which midwives implement evidence-based practice change in clinical settings. The study employed a qualitative design and was guided by the methodological underpinnings of Action Research (AR). FindingsOne core finding emerged to fulfil the aim and objectives of the study. To lead implementation of evidence-based practices, midwives need practical solutions and a map of the process, packaged into a centralised web-based resource. DiscussionThe findings reported in this study provide valuable insight into the specific needs of midwives wanting to improve the uptake and longevity of new evidence based practices in clinical areas. This includes information specific to evidence implementation, support networks and knowledge of Implementation Science. ConclusionTo lead practice change initiatives, midwives require a web-based resource that standardises the process of evidence implementation, while providing midwives with clear direction and the support needed to confidently champion for evidence base change in clinical areas.

Support nurses and midwives to strengthen healthcare systems.

Support nurses and midwives to strengthen healthcare systems.

Traumatic Experiences and the Midwifery Profession: A Cross-Sectional Study Among Dutch Midwives.

IntroductionTraumatic events that occur in a clinical setting can have long‐lasting adverse effects on persons who are affected, including health care providers. This study investigated the prevalence of work‐related traumatic events, posttraumatic stress disorder (PTSD), anxiety, and depression among Dutch midwives. Additionally, differences between midwives working in primary care (independently assisting births at home and in birthing centers) and midwives working in secondary or tertiary care (hospital setting) were examined. Finally, this study investigated the support midwives would like to receive after experiencing a work‐related adverse event.MethodsA descriptive, cross‐sectional online survey of Dutch midwives was conducted. The respondents completed a questionnaire about demographic and work‐related events, as well as the Trauma Screening Questionnaire and the Hospital Anxiety and Depression Scale.ResultsThe estimated response rate was 23%, with 691 questionnaires eligible for analysis. Thirteen percent of respondents reported having experienced at least one work‐related traumatic event. Among these, 17% screened positive for PTSD, revealing an estimated PTSD prevalence of 2% among Dutch midwives. Clinically relevant anxiety symptoms were reported by 14% of the respondents, significantly more often among midwives working in primary care (P = .014). Depressive symptoms were reported by 7% of the respondents. The desired strategies to cope with an adverse event were peer support by direct colleagues (79%), professional support from a coach or psychologist (30%), multidisciplinary peer support (28%), and support from midwives who are not direct coworkers (17%).DiscussionDutch midwives are at risk of experiencing work‐related stressful or traumatic events that might lead to PTSD, anxiety, or depression. Midwives working in primary care reported higher levels of anxiety compared with their colleagues working in a clinical setting (secondary or tertiary care). Most midwives preferred peer support with direct colleagues after an adverse event, and some could have profited from easier access to seeking professional help. It could be speculated that midwives would benefit from increased awareness about work‐related traumatic events as well as implementation of standardized guidelines regarding support after a traumatic event.

Telephone triage in midwifery practice: A cross-sectional survey

BackgroundChildbearing women commonly access maternity services via the telephone. A midwife receiving these calls listens to the woman’s concerns and then triages women according to their assessment. This may result in the provision of advice and instruction over the telephone or inviting the woman into the health service for further assessment. Midwives are responsible for all care and advice given to women, including via the telephone. ObjectivesThe purpose of this study was to explore the experiences and practices of midwives regarding their management of telephone triage. DesignA cross-sectional survey. Setting and participantsPurposive non-probabilistic sampling of currently practising midwife members of professional organisations was used to recruit participants. From this, 242 midwives responded and 230 returned valid surveys were used in data analysis. MethodsParticipant demographics, telephone triage processes, skills, educational preparation, confidence and anxiety levels, and external factors that influence midwives’ management of telephone triage were collected via an on-line survey. Descriptive statistics and further analyses were conducted to explore relationships between variables. ResultsEighty-three percent of midwives respond to 2–5 telephone calls per shift, with only 11.7% (n = 24) of midwives reporting that this is included in their workloads. Telephone triage is frequently managed in environments with distractions. Most midwives (84%; n = 177) report receiving no training in this skill. Confidence in performing telephone triage was reported, with higher confidence levels related to midwives’ increased years of experience (p < 0.05) and age (p < 0.01). Anxiety related to managing telephone triage has been experienced by 73% (n = 151) of midwives, with this being greater in midwives with less years of experience. Anxiety is reported less by midwives in rural or remote settings compared to metropolitan or regional (p < 0.05) settings in this study. A variety of standards and aids to guide practice, and document calls are utilised in a range of ways. ConclusionTo the authors’ knowledge, this is the first study conducted to explore midwives’ practises in telephone triage. The findings suggest the need for appropriate environments to conduct telephone calls and the inclusion of telephone triage in midwifery workloads. In addition, consistent education and processes are required to reduce anxiety and support midwives provision of this service to women.

Knowledge, confidence, skills and practices among midwives in the republic of Ireland in relation to perinatal mental health care: The mind mothers study

ObjectiveThe study aimed to identify midwives’ competency in perinatal mental health care in terms of their knowledge, confidence, skill and educational priorities, and to explore their clinical practices in relation to the assessment and management of perinatal mental health problems. Research designAn exploratory descriptive study design was used on a sample of 438 midwives in the Republic of Ireland. Data were collected over a two-month period in 2016 using an anonymous, self-completed survey designed by the research team. FindingsThe majority of midwives cared for women with perinatal mental health problems in their clinical practice; however, beyond depression and anxiety, their knowledge of perinatal mental health problems was quite limited. Similarly, midwives reported a lack of skill in opening a discussion with women on sensitive issues, such as sexual abuse, intimate partner violence and psychosis, and providing information to women's partners/families. The findings indicated that midwives adopted a selective approach to screening for perinatal mental health problems, with a tendency not to inquire about sensitive topics, or address them only with women deemed at-risk. ConclusionsTimely and appropriate care is required to ensure the best outcomes for women with perinatal mental health problems and their families. A greater understanding of perinatal mental health among midwives is required to enable them to provide support and information to women and their families, and to identify when specialist intervention is required. Education and other structural supports, such as care pathways and documentation, is required to train and support midwives in their key role of caring for, and collaborating with, women with perinatal mental health problems.

The Postcode Lottery of Care

This series stresses the importance of perinatal mental health and wellbeing. Policy and guidelines have been written to help support midwives in delivering care so that a woman’s mental health is treated as comparable with her physical health. In this fourth article, Claire Homeyard et al explain that one in five women will experience mental health problems during pregnancy or up to a year following birth. Whilst timely access to perinatal mental health services should be available for all women who need them, there continues to be an unacceptable variation in the UK. This article describes what one service in north-east London is doing to meet women’s needs, demonstrating what can be implemented to improve perinatal mental health provision for women and families in other services.

Empowering Women and their Partners

This series stresses the importance of perinatal mental health and wellbeing. Policy and guidelines have been written to help support midwives in delivering care so that a woman’s mental health is treated as comparable with her physical health. This third article in the series emphasises the promotion of perinatal mental wellbeing through the endorsement of self-efficacy. It demonstrates the difference midwives can make in sharing and signposting to specific resources that can help support women and families to maintain good mental wellbeing and educate about sub-optimal mental health. The authors draw on their experience of designing and using various local and national resources and discuss how these can help reduce stigma, encourage conversations and place mental health on a par with physical health in pregnancy.

Shared Voices: Perinatal Mental Health and Wellbeing

This series stresses the importance of perinatal mental health and wellbeing. Policy and guidelines have been written to help support midwives in delivering care so that a woman’s mental health is treated as comparable with her physical health. Between January and August 2016, as part of a project reviewing perinatal mental health services, mothers and midwives came together to share their views and perceptions of asking and being asked about mental health and wellbeing. The ‘Picture Pathway’ tool was devised and developed to facilitate conversations during service evaluation by members of the Polyanna Project. In this second article, Anna shares perspectives, thoughts and suggestions gained from this service evaluation (Gaudion 2016). She ends by reflecting on the value of talking about perinatal mental health and sharing experiences; most importantly, of listening.

Achieving Consensus for the Design and Delivery of an Online Intervention to Support Midwives in Work-Related Psychological Distress: Results From a Delphi Study.

BackgroundSome midwives are known to experience both professional and organizational sources of psychological distress, which can manifest as a result of the emotionally demanding midwifery work, and the traumatic work environments they endure. An online intervention may be one option midwives may engage with in pursuit of effective support. However, the priorities for the development of an online intervention to effectively support midwives in work-related psychological distress have yet to be explored.ObjectiveThe aim of this study was to explore priorities in the development of an online intervention to support midwives in work-related psychological distress.MethodsA two-round online Delphi study was conducted. This study invited both qualitative and quantitative data from experts recruited via a scoping literature search and social media channels.ResultsIn total, 185 experts were invited to participate in this Delphi study. Of all participants invited to contribute, 35.7% (66/185) completed Round 1 and of those who participated in this first round, 67% (44/66) continued to complete Round 2. Out of 39 questions posed over two rounds, 18 statements (46%) achieved consensus, 21 (54%) did not. Participants were given the opportunity to write any additional comments as free text. In total, 1604 free text responses were collected and categorized into 2446 separate statements of opinion, creating a total of 442 themes. Overall, participants agreed that in order to effectively support midwives in work-related psychological distress, online interventions should make confidentiality and anonymity a high priority, along with 24-hour mobile access, effective moderation, an online discussion forum, and additional legal, educational, and therapeutic components. It was also agreed that midwives should be offered a simple user assessment to identify those people deemed to be at risk of either causing harm to others or experiencing harm themselves, and direct them to appropriate support.ConclusionsThis study has identified priorities for the development of online interventions to effectively support midwives in work-related psychological distress. The impact of any future intervention of this type will be optimized by utilizing these findings in the development process.

Confidentiality, anonymity and amnesty for midwives in distress seeking online support - Ethical?

Midwife health is intrinsically linked to the quality of safe patient care. To ensure safe patient care, there is a need to deliver emotional support to midwives. One option that midwives may turn to may be a confidential online intervention, instead of localised, face-to-face support. Following the Realist And MEta-narrative Evidence Syntheses: Evolving Standards publication standards, this realist synthesis approach explores the ethical considerations in permitting confidentiality, anonymity and amnesty in online interventions to support midwives in work-related psychological distress. An iterative search methodology was used to select nine papers for review. To assimilate information, papers were examined for ideas relating to ethical dimensions of online interventions to support midwives in work-related psychological distress. This review takes a narrative approach. Online interventions can support the development of insight, help seeking and open discussion. Additionally, Internet support groups can become morally persuasive in nature. Anonymity and confidentiality are both effective and therapeutic features of online interventions when used in collaboration with effective online moderation. Yet, ethical dilemmas remain where users cannot be identified. Confidentiality and anonymity remain key components of successful online interventions. However, sanctioning the corollary component of amnesty may provoke moral discomfort for those seeking immediate accountability. For others, amnesty is seen as essential for open disclosure and help seeking. Ultimately, the needs of midwives must be balanced with the requirement to protect the public and the professional reputation of midwifery. In supporting midwives online, the principles of anonymity, confidentiality and amnesty may evoke some resistance on ethical grounds. However, without offering identity protection, it may not be possible to create effective online support services for midwives. The authors of this article argue that the principles of confidentiality, anonymity and amnesty should be upheld in the pursuit of the greatest benefit for the greatest number of people.

The African maternity Health Link: Report on a visit to Freetown, Sierra Leone

Last year, five midwives from the UK visited Freetown, Sierra Leone, to teach, update and support midwives working in a range of midwifery units across the region. Helena White reports on the trip's success.

Achieving Consensus in the Development of an Online Intervention Designed to Effectively Support Midwives in Work-Related Psychological Distress: Protocol for a Delphi Study.

BackgroundThe development of an online intervention designed to effectively support midwives in work-related psychological distress will be challenging due to the ethical, practical, and therapeutic issues surrounding its design. Related literature suggests that midwives may require an anonymous, confidential, and therapeutic platform that facilitates amnesty and nonpunitive approaches to remedy ill health. However, it is unclear which requirements may be most salient to midwifery populations.ObjectiveThe objective of this paper is to describe the design of a Delphi study, intended to achieve expert consensus on the needs of midwives in work-related psychological distress who may be supported via an online intervention. This protocol may also serve as a research framework for similar studies to be modeled upon.MethodsA heterogeneous sample of at least thirty experts on psychological well-being and distress associated with midwifery work will be recruited. Their opinions regarding the development of an online intervention designed to support midwives in work-related psychological distress will be collected through 2 rounds of questioning, via the Delphi Technique. When 60% (≥18, assuming the minimum is 30) of panelists score within 2 adjacent points on a 7-point scale, consensus will be acknowledged. This Delphi study protocol will invite both qualitative and quantitative outcomes.ResultsThis study is currently in development. It is financially supported by a full-time scholarship at the Centre for Technology Enabled Health Research at Coventry University (Coventry, UK). The implementation of this Delphi study is anticipated to occur during the autumn of 2015.ConclusionsThe results of this study will direct the development of an online intervention designed to support midwives in work-related psychological distress, summarize expert driven consensus, and direct future research.

With or without the group: Swedish midwives' and child healthcare nurses' experiences in leading parent education groups.

The aim of the study was to describe and to understand midwives' and child healthcare nurses' experiences of working with parent education groups through their descriptions of the role and what they find rewarding and challenging in that work. Data were collected through three open-ended questions from a web survey: 'How do you refer to your role when working in parent education?', 'What is the biggest challenge or difficulty for you when working in parent education?' and 'What is most rewarding when working in parent education?' The answers were analysed by using qualitative content analysis and correlation analysis. The results show that the midwives and child healthcare nurses either included or excluded the group when describing their role as leaders and their influence on parents. The same applies to what they found rewarding and what was difficult and challenging for them in working with the groups. Primarily, the leaders who excluded the group expressed a lack of competence on a professional level in managing groups and using the right teaching methods to process the knowledge content. One important question to deal with is how to best support midwives and nurses in child healthcare to be prepared for working with parent education groups. One obvious thing is to provide specialized training in an educational sense. An important aspect could also be providing supervision, individually or in groups.

Exposure to traumatic perinatal experiences and posttraumatic stress symptoms in midwives: Prevalence and association with burnout

BackgroundMidwives provide care in a context where life threatening or stressful events can occur. Little is known about their experiences of traumatic events or the implications for psychological health of this workforce. ObjectivesTo investigate midwives’ experiences of traumatic perinatal events encountered whilst providing care to women, and to consider potential implications. DesignA national postal survey of UK midwives was conducted. Participants421 midwives with experience of a perinatal event involving a perceived risk to the mother or baby which elicited feelings of fear, helplessness or horror (in the midwife) completed scales assessing posttraumatic stress symptoms, worldview beliefs and burnout. Results33% of midwives within this sample were experiencing symptoms commensurate with clinical posttraumatic stress disorder. Empathy and previous trauma exposure (personal and whilst providing care to women) were associated with more severe posttraumatic stress responses. However, predictive utility was limited, indicating a need to consider additional aspects increasing vulnerability. Symptoms of posttraumatic stress were associated with negative worldview beliefs and two domains of burnout. ConclusionsMidwives may experience aspects of their work as traumatic and, as a consequence, experience posttraumatic stress symptomatology at clinical levels. This holds important implications for both midwives’ personal and professional wellbeing and the wellbeing of the workforce, in addition to other maternity professionals with similar roles and responsibilities. Organisational strategies are required to prepare midwives for such exposure, support midwives following traumatic perinatal events and provide effective intervention for those with significant symptoms.