SCIENCE AND MIDWIFERY: PARADIGMS AND PARADOXES

Meaning of 'Natural Childbirth' and Experiences of Women Giving Birth using Midwifery: A Feminist Approach

PURPOSE

The purpose of this study was to explore the meanings of 'Natural childbirth' from experiences of Korean women who gave birth to a baby in the midwifery using a feminist approach.

METHODS

This paper is a qualitative research study and applies a feminist epistemology and methodology to the experiences of women who gave birth in midwifery. The data were collected by individual in-depth interviews with eleven participants.

RESULTS

Two main themes emerged from the feminist content analyses and each main theme had three sub themes. A. transformation of control and knowledge on childbirth and the body 1) refusing coercive medicalization and building a new normality, 2) specific expectations about biological health and maternity rather than a return to nature, 3) the subject of pregnancy and childbirth, B. 'natural childbirth' practice as a new embodied discipline 1) helpers to support mothers, midwives, 2) helping the body to do 'natural childbirth', 3) from isolated labor to cooperative reproduction.

CONCLUSION

These results indicate that women desired to practice being a subject, consultation with professionals, self-discipline and named actors except for women as 'other subjects' in childbirth.

A clinical evaluation of evidence-based maternity care using the Optimality Index

The Optimality Index-US (OI-US) reflects the use of evidence-based practices in obstetrics. This paper's objective is to apply the OI-US to a "typical" nurse-midwifery service data set to demonstrate its use outside of a research context. The OI-US score for the sample practice was 80%. The OI-US can be used by obstetric and gynecologic nurse clinicians to demonstrate the relationship of various care practices to optimal outcomes.

The contextual influence of professional culture: Certified nurse-midwives’ knowledge of and reliance on evidence-based practice

This paper reports research undertaken to assess US certified nurse-midwives' (CNMs) knowledge of, access to, and use of evidence-based medicine (EBM). Findings are presented in the context of interprofessional, institutional, and popular culture. The descriptive study follows concepts of diffusion of innovation, evidence-based patient choice, and authoritative knowledge to analyse incentives and barriers to the implementation of evidence-based midwifery care. Structured interviews were conducted with practicing CNMs in an urban practice site and a regional teaching centre. The analysis of responses explored congruence between practitioner knowledge, professed practice, and published professional as well as hospital-based internal practice guidelines, for two specific interventions for which there is ample systematic review, epidural and episiotomy. The CNMs demonstrated enthusiasm for their own individual understanding of EBM, but responses to specific questions about EBM-supported practice indicate that many had an incomplete understanding of the concept. Furthermore, in those cases where CNMs demonstrated accurate knowledge of EBM, practice protocols followed subspecialty dictates, thereby preventing their knowledge from translating into adherence to EBM-guided clinical practice guidelines. Finally, patient expectations for technological intervention appeared to influence CNMs' care decisions, even when those expectations lacked sound supporting evidence. If, as conceived by its originators and champions, EBM is to be widely adopted, then practitioners such as CNMs need to accurately understand its concepts and also to be afforded the opportunity to exercise professional control over its implementation. Central to an epistemically balanced EBM is the need to ensure that midwifery knowledge contributes in a robust and ongoing fashion to EBM's scientific research base. Lastly, EBM advocates must identify balanced strategies to both rationally and fairly address consumerist pressures for aggressive health care consumption.

Midwifery's research heritage: A Delphi survey of midwife scholars

A Delphi survey was conducted with midwife scholars to determine the top 10 midwifery studies worthy of recognition in 2005, the 50th anniversary of the American College of Nurse-Midwives (ACNM). This survey was undertaken by students of Philadelphia University's Graduate Midwifery Program as a service-learning project on behalf of the ACNM Division of Research. Selected midwife scholars participated in 2 or 3 rounds of response and feedback to achieve consensus about research deemed historically or currently important to midwifery practice. The top 10 studies, as determined by the 19 participating midwife scholars, are presented here. These results are offered as reflection on research that has helped to shape and define the discipline of midwifery in the United States.

Priorities for midwifery research in Perth, Western Australia: A Delphi study

This paper reports a two-round Delphi study undertaken to identify the research priorities of midwives at five public maternity hospitals in Western Australia's metropolitan area of Perth. In round one, 117 midwives identified 64 different problems or issues for research. Using thematic content analysis, these problems were grouped together and then collapsed to develop 17 specific research topics within four major categories. In round two, 152 midwives were asked to rank how important each of the topic statements were to women, their families and midwives. Research focusing on 'the postnatal experience' was ranked by midwives as the most important to the care of women and their families. From a midwife's perspective, the highest ranked topic was 'examining the professional issues that impact on midwives' clinical practice' (e.g. midwifery and medical collaboration, potential litigation and horizontal violence in the workplace). The results of the study show that Western Australian midwives, like their national and international colleagues, are concerned about the delivery and organization of maternity services, the invisibility of the postnatal experience and how to operationalize evidence-based care in the clinical area.

An exploratory metasynthesis of midwifery practice in the United States

OBJECTIVES

To conduct a metasynthesis of six qualitative studies of midwifery care and process; identify common themes and metaphors among the six studies for further exploration and theory development; and create a framework for further metasynthesis of qualitative studies of midwifery practice in the USA.

DESIGN

A qualitative metasynthesis to analyse, synthesise, and interpret six qualitative studies on the process and practice of midwifery care.

SAMPLE AND SETTING

Hospital, birth centre, and home birth settings were represented across all of the studies. Participants included nurse- and direct-entry midwives who provided both childbearing and gynaecological care. Recipients of midwifery care also received both childbearing and gynaecological care.

FINDINGS

Four overarching themes were identified: the midwife as an 'instrument' of care; the woman as a 'partner' in care; an 'alliance' between the woman and midwife; and the 'environment' of care. These were interpretively and conceptually arrayed into a helix model of midwifery care.

KEY CONCLUSIONS

The findings from this exploratory metasynthesis clearly indicate that the practice of midwifery is a dynamic partnership between the midwife and the woman, and reflects an environmental perspective. In a country that has a standard of highly technical childbirth care, perhaps the most outstanding concept of this model is that of the midwife as an 'instrument' of care. The significance of the findings will be determined by their ability to guide further research efforts to support a standard of midwifery care for all women in the USA.

IMPLICATIONS FOR PRACTICE

This model offers a benchmark and a structure for considering the dynamic elements of midwifery practice and key roles that the midwife plays in the health care of women and babies.

New directions in midwifery education: the master's of science in midwifery degree

Midwifery is reclaiming its perspective as a discipline separate from, yet integrally related to nursing and medicine. Emerging trends in health care place increased demands on the knowledge base and clinical practice of midwifery, stimulating a need for new directions in midwifery education. The master's of science with a major in midwifery is a new degree option available to midwifery students in the United States. This article presents the argument that midwifery is a distinct discipline and describes the importance of a master's of science in midwifery degree toward furthering the work of the discipline of midwifery. Descriptions of the current master's of science in midwifery degree programs are included.