Midwife-led continuity models versus other models of care for childbearing women

Midwifery education in Canada

OBJECTIVE

This article is part of a special series on midwifery education and describes the approach to midwifery education in Canada

DESIGN

We begin with an overview of the model of midwifery practice introduced in Canada in the 1990s. We describe the model of midwifery education developed and report how it is implemented, with particular attention to the two longest established programs.

SETTING

Midwifery education programs in Ontario and British Columbia.

FINDINGS

Midwifery education programs in Canada are offered at the undergraduate baccalaureate level at universities and are typically four years in length. Programs are competence-based and follow a spiral curriculum. The first semesters focus on on core sciences, social sciences and introduction to midwifery concepts. Students spend fifty percent of the program in clinical practices with community-based midwives. Innovative education models enable students to be placed in distant placements and help to align theoretical and practice components. Clinically active faculty adds to the credibility of teaching but bring its own challenges for midwifery educators.

CONCLUSIONS

The Canadian model of midwifery education has been very effective with low attrition rates and high demand for the number of places available. Further program expansion is warranted but is contingent on the growth of clinical placements.

Quality of intra-partum care at a university hospital in Nepal: A prospective cross-sectional survey

OBJECTIVE

To investigate the quality of intra-partum care provided to women with an expected normal birth at a university hospital in Nepal.

METHODS

A prospective cross-sectional study was conducted during three weeks in November 2013. Nurses at the labor ward collected data from 292 consecutive births. Of these, 164 women of low risk were expected to have a normal birth and were included in the study; 107 (65%) were nulliparous. The self-administered questionnaire covered maternal characteristics, previous pregnancies and births, current pregnancy, labor and birth. Nine items assessed care management, five of which comprised the Bologna score with a total possible score of 5: presence of a companion, use of partograph, non-use of augmentation, non-supine position, and skin-to-skin contact.

RESULTS

The women were assisted by physicians (56%), nurses (42%) or students under supervision (2%). All were in good health after birth. Two had a postpartum hemorrhage exceeding 500 ml and 49% had an episiotomy. Apgar score in all neonates was ≥ 7 at five minutes. Mean Bologna score was 1.43 (variance 0-3).

CONCLUSIONS

The management of care in normal birth could be improved in the studied setting, and there is a need for more research to support such improvement.

Swedish women's interest in models of midwifery care - Time to consider the system? A prospective longitudinal survey

BACKGROUND

Sweden has an international reputation for offering high quality maternity care, although models that provide continuity of care are rare. The aim was to explore women's interest in models of care such as continuity with the same midwife, homebirth and birth center care.

METHODS

A prospective longitudinal survey where 758 women's interest in models such as having the same midwife throughout antenatal, intrapartum and postpartum care, homebirth with a known midwife, and birth center care were investigated.

RESULTS

Approximately 50% wanted continuity of care with the same midwife throughout pregnancy, birth and the postpartum period. Few participants were interested in birth center care or home birth. Fear of giving birth was associated with a preference for continuity with midwife.

CONCLUSIONS

Continuity with the same midwife could be of certain importance to women with childbirth fear. Models that offer continuity of care with one or two midwives are safe, cost-effective and enhance the chance of having a normal birth, a positive birth experience and possibly reduce fear of birth. The evidence is now overwhelming that all women should have maternity care delivered in this way.