Midwives' experiences of professional learning when practicing collegial midwifery assistance during the active second stage of labour: data from the oneplus trial

BACKGROUND

Learning is a lifelong process and the workplace is an essential arena for professional learning. Workplace learning is particularly relevant for midwives as essential knowledge and skills are gained through clinical work. A clinical practice known as 'Collegial Midwifery Assistance' (CMA), which involves two midwives being present during the active second stage of labour, was found to reduce severe perineal trauma by 30% in the Oneplus trial. Research regarding learning associated with CMA, however, is lacking. The aim was to investigate learning experiences of primary and second midwives with varying levels of work experience when practicing CMA, and to further explore possible factors that influence their learning.

METHODS

The study uses an observational design to analyse data from the Oneplus trial. Descriptive statistics and proportions were calculated with 95% confidence intervals. Stratified univariable and multivariable logistic regression analysis were performed.

RESULTS

A total of 1430 births performed with CMA were included in the study. Less experienced primary midwives reported professional learning to a higher degree (< 2 years, 76%) than the more experienced (> 20 years, 22%). A similar but less pronounced pattern was seen for the second midwives. Duration of the intervention ≥ 15 min improved learning across groups, especially for the least experienced primary midwives. The colleague's level of experience was found to be of importance for primary midwives with less than five years' work experience, whereas for second midwives it was also important in their mid to late career. Reciprocal feedback had more impact on learning for the primary midwife than the second midwife.

CONCLUSIONS

The study provides evidence that CMA has the potential to contribute with professional learning both for primary and second midwives, for all levels of work experience. We found that factors such as the colleague's work experience, the duration of CMA and reciprocal feedback influenced learning, but the importance of these factors were different for the primary and second midwife and varied depending on the level of work experience. The findings may have implications for future implementation of CMA and can be used to guide the practice.

Women's experiences of being assisted by two midwives during the active second stage of labour: Secondary outcomes from the Oneplus trial

BACKGROUND

'Collegial Midwifery Assistance' (CMA) is a clinical practice aiming to reduce severe perineal trauma (SPT) during childbirth. This practice involves two midwives being present during the active second stage of labour rather than one, which is the case in standard care. The effectiveness of CMA was evaluated in the Oneplus trial and a 30% reduction in SPT was shown.

AIM

The aim was to investigate the experience of women who received the CMA intervention in the trial and to explore factors influencing their experiences.

METHODS

A cohort study using data from the Oneplus trial and a one-month postpartum follow-up questionnaire. Descriptive statistics, univariable and multivariable logistic regression analyses were performed.

RESULTS

A total of 1050 women who received the CMA intervention responded to the questionnaire. Of these, 35.8% reported that they strongly agreed with feeling safe during the second stage of labour and 42.6% were inclined to have an additional midwife present at a subsequent birth. The intervention was favourably received by women who experienced fear of birth, who were non-native Swedish speakers, and had lower educational attainment. Furthermore, women were more positive towards CMA the longer the intervention lasted.

CONCLUSIONS

The results of this study suggest that the CMA intervention is accepted well by women and can be safely implemented into standard care. The duration of the CMA intervention was an important factor that influenced women's experiences and should be used to guide future practice.

Primary midwives' experiences of collegial midwifery assistance during the active second stage of labor: Data from the Oneplus trial

BACKGROUND

Collegial midwifery assistance during the active second stage of labor that involves a second midwife being present has been shown to reduce severe perineal trauma (SPT) by 30%. The aim of this study was to investigate primary midwives' experiences of collegial midwifery assistance with the purpose of preventing SPT during the active second stage of labor.

METHODS

This study uses an observational design with data from a multicenter randomized controlled trial (Oneplus). Data consist of clinical registration forms completed by the midwives after birth. Descriptive statistics as well as univariable and multivariable logistic regression were used to analyze the data.

RESULTS

The majority of the primary midwives felt confident (61%) and were positive (56%) toward the practice. Midwives with less than 2 years' work experience were more likely to completely agree they felt confident (aOR 9.18, 95% CI: 6.28-13.41) and experience the intervention as positive (aOR 4.04, 95% CI: 2.83-5.78) than those with over 20 years' work experience. Factors such as duration of time spent in the birthing room by the second midwife, opportunity for planning and if the second midwife provided support were further associated with the primary midwife's experience of the practice as being positive.

CONCLUSIONS

Our findings indicate that having a second midwife present during the active second stage of labor was an accepted practice, with the majority of primary midwives feeling confident and positive toward the intervention. This was especially pronounced among midwives with less than 2 years' work experience.

A complex and demanding situation - Midwifery preceptors and midwifery students' experiences of teaching and learning prevention of severe perineal trauma

BACKGROUND

Many high-income countries have seen an increase in severe perineal trauma. Teaching strategies and conditions for learning during the active second stage of labour are scarcely described.

AIM

To describe midwifery preceptors and midwifery students' experiences' of teaching and learning how to manage the second stage of labour, with the specific aim of preventing severe perineal trauma.

METHODS

A qualitative study with focus group discussions and individual in depth-interviews with preceptor midwives (n = 23) and student midwives (n = 10). Data were analysed by qualitative content analysis.

RESULTS

"A complex and demanding situation with mutual need for feedback, reflection and safety" was the overall theme describing the conditions. Three sub-themes were identified. "Adapting to a unique situation" refers to the difficulty of teaching and learning the aspects needed to prevent severe perineal trauma, and to provide care during this stage. "Hindering and limiting circumstances" describes teaching strategies that were perceived negatively, and how midwifery students tried to adapt to the preceptors rather than the birthing women. "A trustful and communicative relationship" describes the importance of the relationship between the student and the preceptor, where communication was a central, but not obvious part.

CONCLUSION

An increased awareness among preceptors is needed to optimize teaching strategies, enabling the students to focus on learning the art of the second stage of labour; supporting the woman, preventing severe perineal trauma and ensuring the safety of the unborn baby. Future research should address how existing prevention models can include training to increase preceptors' confidence in teaching.

Ear Acupuncture in Psychiatric Care From the Health Care Professionals' Perspective: A Phenomenographic Analysis

Ear acupuncture is used as a non-pharmacological complement in psychiatric and addiction care to reduce anxiety, depression and insomnia. The aim of this study was to describe health care professionals' perceptions of giving ear acupuncture in different psychiatric settings. Twenty-four professionals providing ear acupuncture to patients with a variety of psychiatric symptoms and/or addiction were interviewed in focus groups. Data were analyzed with a phenomenographic approach. Ear acupuncture was provided, individually or in groups, to in- and outpatients with a variety of psychiatric symptoms and/or addiction. Three descriptive categories emerged: Another tool in the toolbox, Strengthening the profession and Person-centered care. Participants perceived ear acupuncture to be an effective and safe therapeutic tool, easy to use in concert with other methods and easy to adjust to the patients' needs and requests. They perceived that their professional self-confidence increased when having this non-verbal, person-centered and non-pharmacological tool in their hands as a complement to ordinary care. Professionals perceived that patients trained their social skills while participating in acupuncture, and that the treatment helped patients to influence their subjective psychiatric health through gaining control over symptoms. Acupuncture helped professionals to build a trustful relationship and communicate with their patients, verbally and non-verbally. The finding shows ear acupuncture as a safe treatment and promising in relieving psychiatric and somatic symptoms. Acupuncture facilitates the communication with patient, emphasizing participation and shared decision-making, valuable dimensions of person-centered care. Managers' role and attitude in supporting staff needs to be explored in future research.

Not now but later - a qualitative study of non-exercising pregnant women's views and experiences of exercise

BACKGROUND

Evidence has shown that there are several physical and mental advantages of exercise during pregnancy. Despite this, the recommendations for exercise during pregnancy are poorly fulfilled. The aim of this study was to illuminate non-exercising pregnant women's views and experiences concerning exercise before and during pregnancy.

METHOD

The study had a qualitative design with an inductive approach and was analysed by content analysis. A total of 16 individual and face-to-face interviews were conducted with healthy pregnant women, mainly in the third trimester and living in Sweden. The participating women had not been exercising 3 months before pregnancy or during pregnancy.

RESULTS

The main category "Insurmountable now, but possible in the future" was based on the four categories: "Lost and lack of routines", "Feelings of inadequacy", "Having a different focus" and "Need for support". The women experienced that their lack of routines was a major barrier that prevented them from exercising. Other factors that contributed were, for example, pregnancy-related problems, long working days and prioritizing family life. The women described it as difficult to combine exercise with their focus on the pregnancy and they missed continuous support from the antenatal care provider. The women expressed a need for suggestions concerning exercise during pregnancy and follow-up on previous counselling, especially when pregnancy-related issues arose. Information about easily accessible alternatives or simple home exercises was requested. They felt immobile and were not satisfied with their inactivity and tried to partly compensate with everyday activities. The women identified the postpartum period as an important possibility for becoming more active, for their own sake, but also because they wanted to become role models for their children.

CONCLUSION

Continuous support during pregnancy is needed concerning exercise. Pregnancy is mostly a barrier that prevents exercise for this group of women but, at the same time, may be a motivator and a possibility for better health. As the result showed that these women were highly motivated to a life-style change post-pregnancy, it may be crucial to support previously non-exercising women postpartum.

"I Didn't Know What to Ask About": First-Time Mothers' Conceptions of Prenatal Preparation for the Early Parenthood Period

The aim of this phenomenographic study was to describe first-time mothers' conceptions of prenatal preparation for the early parenthood period in relation to their experiences of early parenthood. Eighteen first-time mothers were interviewed approximately 1 month after giving birth. The categories identified in the analysis were: accessing appropriate sources of support, gaining knowledge to form realistic expectations, and mobilizing and strengthening personal resources. First-time mothers want health professionals to actively address postnatal issues as they have difficulties in knowing prenatally what knowledge will prepare them for early parenthood. Both professional and peer support during pregnancy were conceived as important for gaining knowledge. Professionals can support by guidance to reliable sources of information and encouraging personal reflections and partner communication.

Midwifery students' experiences of learning through the use of written reflections - An interview study

In an effort to strengthen midwifery students' learning process, written reflections during the students' clinical practice at birth units have been applied. The aim of this study was to examine how students of midwifery experienced the writing of daily reflections on their practice at birthing units. An interview study was carried out using an inductive method with descriptive design. During 2013 (n = 12) and 2014 (n = 7), respondents were recruited from two cohorts of midwifery students (n = 19) at a university in southern Sweden. Narrative interviews were carried out. The interviews were analysed with thematic content analysis. One theme including four categories emerged from the analysis. The theme was "An educational strategy for the present and the future". The four categories were "Towards personal and professional development", "Reflection requires effort", "Supervisors' commitment" and "Clarification of the rationale". Daily written reflections are useful for students' personal and professional development during clinical practice/placement. In order for the reflections to be used optimally, students must be given clear instructions on the purpose of their use and be given enough time to write them. Furthermore, supervisors must provide constructive feedback on the students' written reflections.

Monitoring progression of clinical reasoning skills during health sciences education using the case method - a qualitative observational study

BACKGROUND

Outcome- or competency-based education is well established in medical and health sciences education. Curricula are based on courses where students develop their competences and assessment is also usually course-based. Clinical reasoning is an important competence, and the aim of this study was to monitor and describe students' progression in professional clinical reasoning skills during health sciences education using observations of group discussions following the case method.

METHODS

In this qualitative study students from three different health education programmes were observed while discussing clinical cases in a modified Harvard case method session. A rubric with four dimensions - problem-solving process, disciplinary knowledge, character of discussion and communication - was used as an observational tool to identify clinical reasoning. A deductive content analysis was performed.

RESULTS

The results revealed the students' transition over time from reasoning based strictly on theoretical knowledge to reasoning ability characterized by clinical considerations and experiences. Students who were approaching the end of their education immediately identified the most important problem and then focused on this in their discussion. Practice knowledge increased over time, which was seen as progression in the use of professional language, concepts, terms and the use of prior clinical experience. The character of the discussion evolved from theoretical considerations early in the education to clinical reasoning in later years. Communication within the groups was supportive and conducted with a professional tone.

CONCLUSIONS

Our observations revealed progression in several aspects of students' clinical reasoning skills on a group level in their discussions of clinical cases. We suggest that the case method can be a useful tool in assessing quality in health sciences education.

Danish women's experiences of the rebozo technique during labour: A qualitative explorative study

OBJECTIVE

The study aimed to explore women's experiences of the rebozo technique during labour.

METHODS

This was a qualitative study based on individual telephone interviews, analysed by means of qualitative content analysis and inspired by interpretive description. 17 participants were recruited from two different-sized Danish hospitals and identified by applying a purposeful sample strategy.

RESULTS

The main theme expressed the women's overall experience with the rebozo: "Joined movements in a harmless effort towards a natural birth". The women experienced that the technique created bodily sensations, which reduced their pain, and furthermore they expressed that it interrelated the labour process and produced mutual involvement and psychological support from the midwife and the women's partner. The rebozo technique was in most situations carried out because the midwife suspected a foetus malposition.

CONCLUSION

The experiences of the rebozo technique were overall positive and both of a physical and psychological nature. The results indicate that health professionals should view rebozo as an easy accessible clinical tool with high user acceptance and possible positive psychological and clinical implications. The study contributes with a deeper and more nuanced understanding of a topic where only limited knowledge exists, however, efficacy studies are warranted.

Swedish high school students' knowledge and attitudes regarding fertility and family building

BACKGROUND

Infertility is a serious problem for those who suffer. Some of the risks for infertility are preventable and the individual should therefore have knowledge of them. The purposes of this study were to investigate high-school students' knowledge about fertility, plans for family building and to compare views and knowledge between female and male students.

METHODS

A questionnaire containing 34 items was answered by 274 students. Answers from male and female students were compared using student's t-test for normally distributed variables and Mann-Whitney U-test for non-normal distributions. The chi-square test was used to compare proportions of male and female students who answered questions on nominal and ordinal scales. Differences were considered as statistically significant at a p-value of 0.05.

RESULTS

Analyses showed that 234 (85%) intended to have children. Female students felt parenthood to be significantly more important than male students: p = <0.01. The mean age at which the respondents thought they would like to start to build their family was 26 (± 2.9) years. Men believed that women's fertility declined significantly later than women did: p = <0.01. Women answered that 30.7% couples were involuntarily infertile and men answered 22.5%: p = <0.01. Females thought it significantly more likely that they would consider IVF or adoption than men, p = 0.01. Men felt they were more likely to abstain from having children than women: p = <0.01. Women believed that body weight influenced fertility significantly more often than men: p = <0.01 and men believed significantly more often that smoking influenced fertility: p = 0.03. Both female and male students answered that they would like to have more knowledge about the area of fertility.

CONCLUSIONS

Young people plan to start their families when the woman's fertility is already in decline. Improving young people's knowledge about these issues would give them more opportunity to take responsibility for their sexual health and to take an active role in shaping political change to improve conditions for earlier parenthood.

Parents' worried state of mind when fetal ultrasound shows an unexpected finding: a comparative study

OBJECTIVE

Most parents yearn for a second-trimester ultrasound examination and feel excitement about it, but some also worry about what the examination will show. According to prior research, using only generic instruments or specific questionnaires, anxiety decreases when the ultrasound findings are normal. The aim of this study was to compare parents' worry (Parents' Expectations, Experiences, and Reactions to Ultrasound [PEER-U] State of Mind Index) and sense of coherence before and after a routine second-trimester ultrasound examination when it showed normal or abnormal findings.

METHODS

A 1-year cohort study was performed at a Swedish university hospital. A total of 2049 parents who had their second-trimester ultrasound examinations there filled in a questionnaire consisting of 2 parts before and after the examinations.

RESULTS

Parents with normal ultrasound findings were less worried than parents with abnormal findings. The group with normal findings also showed less worry after the examination than before. A sex analysis showed similar patterns.

CONCLUSIONS

Parents with abnormal ultrasound findings are more worried and anxious. The new instrument, the PEER-U State of Mind Index, not only measures parents' worry but can also expose what influences their ultrasound examination experience.

A qualitative study of mothers’ and fathers’ experiences of routine ultrasound examination in Sweden

OBJECTIVE

to conceptualise mothers' and fathers' thoughts and feelings before, during and after the routine ultrasound examination during the second trimester of pregnancy.

DESIGN, SETTING AND PARTICIPANTS

a grounded theory study. Two to four weeks after their ultrasound examination, 22 Swedish mothers and 22 fathers were interviewed in their homes.

FINDINGS

the basic social process was confirmation of a new life. The four categories, visualising-the evident option, overwhelming to see life; becoming a family and reassuring, all represent a time span in the parents' process towards confirmation of a new life. The caregivers' way of assisting and supporting the process by information and treatment was very important to parents.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

as the ultrasound examination is perceived as a confirmation of a new life it is an extremely important milestone for both parents so the father should be encouraged to participate. It is an important and unique event for both women and men in their process towards becoming parents. This process was largely dependent on the treatment the parents had received during the examination and the information given. The findings of this study are of interest to midwives and others who perform ultrasound examinations as it explains why adequate time must be allowed for the examination and the importance of the information given before hand. When introducing new forms of fetal diagnosis in the future it should be kept in mind that this might irrevocably be accepted by parents who long for confirmation of a new life.

Midwives' attitudes to and knowledge about a newly introduced foetal screening method

A number of screening procedures are offered by midwives during pregnancy and the number is increasing rapidly. The measurement of nuchal translucency is a fairly new ultrasound method for antenatal screening, primarily for Down syndrome. The results give a better risk calculation than maternal age alone and can mean a decrease in the number of invasive procedures needed to identify this syndrome prenatally. The aim of this study was to gain insight into the midwives' point of view concerning the introduction of the method in two different hospitals. In one hospital it had been introduced as part of a research project while in the other it had been integrated as an offer in the antenatal care programme. A questionnaire was sent to the 80 midwives working in the antenatal clinics serving these two hospitals. A total of 79% of the questionnaires were answered. The results indicate that in both districts, the similarities are greater than the differences with regard to the midwives' education, knowledge and their own opinions of their ability to inform pregnant women about the method. Although most of the respondents were positive to it, a number of midwives felt that, in general, information about foetal diagnosis was a difficult part of their work, mentioning both ethical and practical aspects. This highlights the need for continuing education, standardized policy and an ongoing ethical debate.