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Podder L, Bhardwaj G, Siddiqui A, Agrawal R, Halder A, Rani M. Utilizing Midwifery-Led Care Units (MLCU) for Enhanced Maternal and Newborn Health in India: An Evidence-Based Review. Cureus 2023; 15:e43214. [PMID: 37692683 PMCID: PMC10488993 DOI: 10.7759/cureus.43214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
The allocation of the midwife-led care unit (MLCU), a midwifery-led care model in which midwives carry out eminent roles to enrich maternal and newborn outcomes with minimal standard interventions, has appeared to be productive in furthering the quality of care and positive childbirth experiences. In the present article, we review the investments needed in MLCUs for their inclusion into the public health system by describing their advantages, the latest trends in maternal mortality, the roles of midwives, the relevant background, and the current advances in midwifery practices in India. Midwifery-led care is directed by a philosophy that considers pregnancy and childbirth as normal physiological events for women. Making use of a midwife, especially in low-risk pregnancies, extends satisfactory and cost-effective care. The Government of India has begun to introduce midwifery services to the country to improve the quality, righteousness, and worthiness in the provision of care and to offload higher-level hospitals. The year 2020 was designated as the "Year of the Nurse and the Midwife" by the WHO, highlighting the importance of nurses' and midwives' roles in sustaining quality health care. Further, the acceptability among clinicians and the public is crucial for the future advancement and implementation of MLCUs in India.
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Affiliation(s)
- Lily Podder
- Obstetric and Gynecological Nursing, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Geeta Bhardwaj
- Obstetric and Gynecological Nursing, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | | | - Rachna Agrawal
- Obstetrics and Gynecology, Sarojini Naidu Medical College, Agra, IND
| | - Ajay Halder
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Manisha Rani
- Child Health Nursing, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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Ferguson B, Baldwin A, Henderson A, Harvey C. The grounded theory of Coalescence of Perceptions, Practice and Power: An understanding of governance in midwifery practice. J Nurs Manag 2022; 30:4587-4594. [PMID: 36325759 PMCID: PMC10099921 DOI: 10.1111/jonm.13892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
AIMS This study aimed to understand midwifery care during labour, particularly decision-making processes, within Australian health systems. BACKGROUND Midwifery, founded on a wellness model of motherhood, is at risk of being medicalized. Whilst medical intervention is lifesaving, it requires judicious use. Governance provides oversight to care. Exploring decision-making contributes to understanding governance of practices. METHOD Straussian grounded theory using semi-structured interviews. Eighteen Australian registered midwives were interviewed about their practice when caring for women during labour. RESULTS Midwives were caught between divergent positions; birth as natural versus birth as risk. Experienced midwives discussed focussing on the woman, yet less experienced were preoccupied with mandatory protocols like early warning tools. Practice was governed by midwives approach within context of labour. The final theory: The Coalescence of Perceptions, Practice and Power, comprising three categories: perceptions and behaviour, shifting practice and power within practice, emerged. CONCLUSIONS Coalescence Theory elucidates how professional decision making by midwives during care provision is subject to power within practice, thereby governed by tensions, competing priorities and organizational mandates. IMPLICATIONS FOR MIDWIFERY MANAGERS Midwifery managers are well positioned to negotiate the nuanced space that envelopes birthing processes, namely, expert knowledge, policy mandates and staffing capability and resources, for effective collaborative governance. In this way, managers sustain good governance.
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Affiliation(s)
- Bridget Ferguson
- Central Queensland University, North Rockhampton, Queensland, Australia
| | - Adele Baldwin
- Central Queensland University, Townsville, Queensland, Australia
| | - Amanda Henderson
- Central Queensland University, Brisbane City, Queensland, Australia
| | - Clare Harvey
- Central Queensland University, Townsville, Queensland, Australia.,Massey University, Wellington Campus, Wellington, New Zealand
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Adnani QES. Progress and challenges of midwifery education in Indonesia. Eur J Midwifery 2021; 5:50. [PMID: 34782890 PMCID: PMC8559270 DOI: 10.18332/ejm/142496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/24/2022] Open
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Cleary-Holdforth J, O'Mathúna D, Fineout-Overholt E. Evidence-Based Practice Beliefs, Implementation, and Organizational Culture and Readiness for EBP Among Nurses, Midwives, Educators, and Students in the Republic of Ireland. Worldviews Evid Based Nurs 2021; 18:379-388. [PMID: 34750977 DOI: 10.1111/wvn.12543] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence-based practice (EBP) is an approach to health care that combines best available evidence, healthcare professionals' expertise, and patient preferences, yielding benefits for patients, healthcare professionals, and organizations. However, globally, EBP implementation remains inconsistent among nurses. Exploring this in an Irish context will establish a national baseline from which progress can be made on system-wide integration of EBP in nurse and midwife (i.e., clinician) practice, nursing/midwifery education, and the Irish healthcare system. AIM To establish clinician, educator, and student's EBP beliefs, knowledge, and implementation, and the organizational culture of the clinical and educational settings within the Republic of Ireland. METHODS Using a descriptive study design, a national survey with demographic questions, uniquely focused EBP scales, and an open-ended question were administered to clinicians, nursing/midwifery educators, and students. Ethical review was obtained. Descriptive and inferential statistics were used to analyze the quantitative data. RESULTS Clinicians, educators, and students reported positive beliefs about EBP (M = 59.98, SD 8.68; M = 87.72, SD = 10.91; M = 55.18, SD = 10.29, respectively). Beliefs regarding their ability to implement EBP were lower overall. EBP implementation was low across all groups (clinicians: M = 12.85, SD = 14; educators: M = 31.09, SD = 16.54; students: M = 16.59, SD = 12.11). Clinicians, educators, and students reported varying perceptions of organizational support and readiness for EBP (M = 74.07, SD = 19.65; M = 86.43, SD = 15.01; M = 93.21, SD = 16.21, respectively). Across all measures, higher scores indicated higher beliefs, implementation, and organizational culture and readiness for EBP. LINKING EVIDENCE TO ACTION Clinicians have a unique opportunity to facilitate system-wide integration of EBP. Furthermore, given the variable EBP knowledge, beliefs, and implementation, opportunities to enhance these attributes abound, particularly when supported by their organizations. This study established a contemporary baseline in Ireland from which to engage the identified strengths, challenges, and opportunities required to craft an organizational culture and environment that supports and advances an EBP approach to nursing and midwifery practice and education.
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Affiliation(s)
- Joanne Cleary-Holdforth
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin 9, Ireland
| | - Dónal O'Mathúna
- College of Nursing, Ohio State University, Columbus, Ohio, USA
| | - Ellen Fineout-Overholt
- Gallup Certified Strengths Coach, College of Nursing & Health Sciences, University of Texas at Tyler, Tyler, Texas, USA
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Md. Sharif S, Yap WS, Fun WH, Yoon EL, Abd Razak NF, Sararaks S, Lee SWH. Midwifery Qualification in Selected Countries: A Rapid Review. Nurs Rep 2021; 11:859-880. [PMID: 34968274 PMCID: PMC8715462 DOI: 10.3390/nursrep11040080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND While the global maternal mortality ratio (MMR) shows a decreasing trend, there is room for improvement. Midwifery education has been under scrutiny to ensure that graduates acquire knowledge and skills relevant to the local context. OBJECTIVE To review the basic professional midwifery qualification and pre-practice requirements in countries with lower MMR compared with Malaysia. METHODS A rapid review of country-specific Ministry of Health and Midwifery Association websites and Advanced Google using standardised key words. English-language documents reporting the qualifications of midwives or other requirements to practise midwifery from countries with a lower MMR than Malaysia were included. RESULTS Sixty-three documents from 35 countries were included. The minimum qualification required to become a midwife was a bachelor's degree. Most countries require registration or licensing to practise, and 35.5% have implemented preregistration national midwifery examinations. In addition, 13 countries require midwives to have nursing backgrounds. CONCLUSION In countries achieving better maternal outcomes than Malaysia, midwifes often have a degree or higher qualification. As such, there is a need to reinvestigate and revise the midwifery qualification requirements in Malaysia.
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Affiliation(s)
- Shakirah Md. Sharif
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (W.S.Y.); (W.H.F.); (E.L.Y.); (N.F.A.R.); (S.S.)
| | - Wuan Shuen Yap
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (W.S.Y.); (W.H.F.); (E.L.Y.); (N.F.A.R.); (S.S.)
| | - Weng Hong Fun
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (W.S.Y.); (W.H.F.); (E.L.Y.); (N.F.A.R.); (S.S.)
| | - Ee Ling Yoon
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (W.S.Y.); (W.H.F.); (E.L.Y.); (N.F.A.R.); (S.S.)
| | - Nur Fadzilah Abd Razak
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (W.S.Y.); (W.H.F.); (E.L.Y.); (N.F.A.R.); (S.S.)
| | - Sondi Sararaks
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (W.S.Y.); (W.H.F.); (E.L.Y.); (N.F.A.R.); (S.S.)
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Garbelli L, Lira V. Maternal positions during labor: Midwives' knowledge and educational needs in northern Italy. Eur J Midwifery 2021; 5:15. [PMID: 34046561 PMCID: PMC8138948 DOI: 10.18332/ejm/136423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Maternal positions and mobility during childbirth can have different and specific effects on labor and affect some birth outcomes. The aim of the survey is to investigate the knowledge and skills regarding maternal positions in labor among midwives and to consider the need of training. METHODS A semi-structured questionnaire was distributed in August and September 2020 among midwives working in eight hospitals of Brescia, Northern Italy. The sample consisted of 115 midwives and data were analyzed using a quantitative, descriptive approach. RESULTS The majority of the sample identified the general and specific benefits of maternal positions. Factors limiting the proposal of maternal positions were the context, the relationships with healthcare providers, the woman features, the fetal heart rate registration, continuous cardiotocography, amniotomy, episiotomy, operative vaginal birth, and epidural analgesia. Vaginal examination, the detection of uterine contractions, intrapartum ultrasounds, and ‘hands-on’ perineum technique were considered irrelevant by the participating midwives. The promoting factors were the presence of the partner, the telemetry, and the partogram with a section dedicated to positions. Nearly the totality of the sample considered appropriate to deepen the topic with training. CONCLUSIONS Post-graduate courses are desirable to improve midwives’ skills. An educational toolkit is proposed to make the promotion of maternal positions more effective and appropriate. In order to improve midwifery intrapartum care, further research addressed to midwives of other settings appears essential to compare different training contexts, to expand the proposed toolkit, and to invest on midwifery practice and education.
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Affiliation(s)
- Laura Garbelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Viviana Lira
- Department of Obstetrics and Gynaecology, ASST Spedali Civili Hospital, Brescia, Italy
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Dahlen HG, Kumar-Hazard B, Chiarella M. How COVID-19 Highlights an Ongoing Pandemic of Neglect and Oppression When It Comes to Women's Reproductive Rights. J Law Med 2020; 27:812-828. [PMID: 32880400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The coronavirus disease-19 (COVID-19) pandemic has exposed an underlying pandemic of neglect affecting women's reproductive rights, particularly in the provision of abortion services and maternity care. The systemic neglect in the Australian context has resulted in a rise in demand for the services provided by privately practising midwives (PPMs) that is not matched by systemic support for, nor recognition of, women choosing to birth at home. As a result, PPMs are unable to meet the rise in demand, which in itself reflects decades of limited State support for the choice to birth at home and opposition by incumbent stakeholders in the provision of maternity care to healthy women with low-risk pregnancies. We discuss the historical backdrop to these currently erupting issues, along with the real reasons for the opposition to PPMs in Australia. Finally, we offer solutions to this ongoing issue.
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Affiliation(s)
- Hannah G Dahlen
- Professor of Midwifery (Associate Dean Research and HDR | Midwifery Discipline Lead) School of Nursing and Midwifery, Western Sydney University
| | | | - Mary Chiarella
- Professor Emerita, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney
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Matlala MS, Lumadi TG. Perceptions of midwives on shortage and retention of staff at a public hospital in Tshwane District. Curationis 2019; 42:e1-e10. [PMID: 31368315 PMCID: PMC6676782 DOI: 10.4102/curationis.v42i1.1952] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 02/25/2019] [Accepted: 03/18/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Midwifery is the backbone of women and child healthcare. The shortage of staff in maternity units is a crisis faced by many countries worldwide, including South Africa. OBJECTIVES This study aims to explore the perceptions of midwives on the shortage and retention of staff at a public institution. METHOD The study was conducted at one of the tertiary hospitals in Tshwane District, Gauteng Province. A total of 11 midwives were interviewed through face-to-face and focus group interviews. An explorative, descriptive generic qualitative design method was followed, and a non-probability, purposive sampling technique was used. Thematic coding analysis was followed for analysing data. RESULTS The impact of shortage of midwives was reported to be directly related to poor provision of quality care as a result of increased workload, leading to low morale and burnout. The compromised autonomy of midwives in the high obstetrics dependency units devalues the status of midwives. CONCLUSION Midwives are passionate about their job, despite the hurdles related to their day-to-day work environment. They are demoralised by chronic shortage of staff and feel overworked. Staff involvement in decision-making processes is a motivational factor for midwives to stay in the profession. The midwives need to be in the centre of the decision-making processes related to their profession. The revision of the scope of practice and classification of midwifery profession away from general nursing complex by the South African Nursing Council (SANC) could place midwifery in its rightful status.
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Affiliation(s)
- Mosehle S Matlala
- Department of Health Studies, School of Social Sciences, University of South Africa, Pretoria.
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Mthombeni CS, Maputle MS, Khoza LB. Perceptions of Postpartum Mothers towards the Care Provided by Male Student Midwives at Labour Units in Limpopo Province, South Africa. Afr J Reprod Health 2019; 22:60-67. [PMID: 30052334 DOI: 10.29063/ajrh2018/v22i2.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Student midwives should always provide cultural sensitive care and respect the rights of every woman when choosing health care providers during pregnancy and childbirth. The aim of this study was to describe and explore the perceptions of postpartum mothers towards the care provided by male student midwives during their midwifery practice. A qualitative explorative, descriptive, and contextual research design was used. A non-probability, convenience sampling method was used to sample 42 postpartum mothers who received care from male student midwives at the five district hospitals in Limpopo province, South Africa. Data was collected through in-depth individual interviews until data saturation was reached by repeating data. Open coding approach was used to analyse data. All ethical principles were adhered to. Results revealed that postpartum mothers, preferred care by male students' midwives; they were viewed to be respectful, sympathetic, and caring; however, they discussed their fears of midwifery practice with mothers. It is recommended that midwives should play a pivotal role in informing pregnant women during antenatal visits that male student midwives can conduct deliveries. The community awareness campaign should be strengthened that male student midwives are availability in maternity units.
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Affiliation(s)
- Courage S Mthombeni
- Department of Advanced Nursing, University of Venda South Africa. Private BagX5050, Thohoyandou 0950
| | - Maria S Maputle
- Department of Advanced Nursing, University of Venda South Africa. Private BagX5050, Thohoyandou 0950
| | - Lunic B Khoza
- Department of Advanced Nursing, University of Venda South Africa. Private BagX5050, Thohoyandou 0950
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Abstract
Aims or Objectives: This study explored the perspectives of Obstetricians and Registered Nurses/Midwives on the presence of expectant fathers in the birth room. METHODS A qualitative research design was used to explore perceptions and attitudes of Obstetricians and Registered Nurses/Midwives. Data were collected using five focus group and five key informant interviews and analysed using van Manen's [2007. Phenomenology of practice. Phenomenology & Practice, 1(1), 11-30] interpretative phenomenological approach. RESULTS Four themes emerged (i) perception of the Obstetrician/Registered Nurse/Midwife, (ii) demands on the practitioner, (iii) support for staff and (iv) potential challenges for practice. While participants held positive views, the nature of the birth experience could have negative implications for themselves and expectant fathers. Poor communication could exacerbate negative perceptions in emergency settings. CONCLUSIONS The presence of expectant fathers in the delivery room could have a positive impact on the birth experience for mothers, fathers and health professionals in the Caribbean. However, it could be challenging in emergencies.
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Affiliation(s)
- Oscar Noel Ocho
- a School of Nursing , University of the West Indies , St Augustine , Trinidad and Tobago
| | - Calvin Moorley
- b Nursing Research and Diversity in Care, London South Bank University , London , UK
| | - Kathy Ann Lootawan
- a School of Nursing , University of the West Indies , St Augustine , Trinidad and Tobago
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Jefford E, Jomeen J, Wallin M. Midwifery abdication - is it acknowledged or discussed within the midwifery literature: An integrative review. Eur J Midwifery 2018; 2:6. [PMID: 33537567 PMCID: PMC7846030 DOI: 10.18332/ejm/92529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/01/2018] [Accepted: 06/22/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In this review we explore the concept of Midwifery Abdication and whether it is acknowledged or discussed within the midwifery literature. METHODS A modified Whittemore and Knafl integrative review framework of 2005 enabled consideration of quantitative and qualitative literature. A total of 1508 papers were located. Duplicate records were removed, leaving 1197 records. All titles, abstracts, or case facts were reviewed using a framework derived from the definition of Midwifery Abdication. Three qualitative studies were selected for analysis; the NICE Quality Appraisal Checklist was used to determine study quality. RESULTS Midwifery Abdication occurs, as reported within the wider midwifery literature, and indicated in three studies from different countries. However, the original constructs need to be widened to include: 'external perceptions of midwifery practice' and 'how can reflection facilitate change'. The extent of philosophy in these environments leads to the adoption of midwifery philosophy failure. Such an environment impacts on a midwife's ability to fully exercise autonomy, and to advocate for normality and women. This renders Midwifery Abdication almost inevitable or at least very difficult to prevent. A midwife's professional identity, environmental hierarchy and associated culture of social obedience, acceptance and finding one's place, all act as influencing factors in abdication. CONCLUSIONS Midwifery education needs to ensure that midwives are prepared and able to embrace their professional status as independent practitioners. Promotion of reflexive practice to facilitate personal and professional change is warranted. Practice policies that are not supportive of a midwife's professional autonomy and scope of practice reinforce the technocratic work environment.
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Fontein-Kuipers Y, de Groot R, van Staa A. Woman-centered care 2.0: Bringing the concept into focus. Eur J Midwifery 2018; 2:5. [PMID: 33537566 PMCID: PMC7846029 DOI: 10.18332/ejm/91492] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/30/2018] [Accepted: 05/22/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Woman-centered care has become a midwifery concept with implied meaning. In this paper we aim to provide a clear conceptual foundation of woman-centered care for midwifery science and practice. METHODS An advanced concept analysis was undertaken. At the outset, a systematic search of the literature was conducted in PubMed, OVID and EBSCO. This was followed by an assessment of maturity of the retrieved data. Principle-based evaluation was done to reveal epistemological, pragmatic, linguistic and logic principles, that attribute to the concept. Summative conclusions of each respective component and a detailed analysis of conceptual components (antecedents, attributes, outcomes, boundaries) resulted in a definition of woman-centered care. RESULTS Eight studies were selected for analyses. In midwifery, woman-centered care has both a philosophical and a pragmatic meaning. There is strong emphasis on the woman-midwife relationship during the childbearing period. The concept demonstrates a dual and equal focus on physical parameters of pregnancy and birth, and on humanistic dimensions in an interpersonal context. The concept is epistemological, dynamic and multidimensional. The results reveal the concept’s boundaries and fluctuations regarding equity and control. The role of the unborn child is not incorporated in the concept. CONCLUSION An in-depth understanding and a broad conceptual foundation of womancentered care has evolved. Now, the concept is ready for research and educational purposes as well as for practical utility.
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Affiliation(s)
- Yvonne Fontein-Kuipers
- Rotterdam University of Applied Sciences - Research Centre Innovations in Care & School of Midwifery, Netherlands.,Rotterdam University of Applied Sciences - Research Centre Innovations in Care, Netherlands
| | | | - AnneLoes van Staa
- Rotterdam University of Applied Sciences - Research Centre Innovations in Care, Netherlands
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Abstract
INTRODUCTION There is a shortage of primary care providers in the United States. As more individuals obtain health insurance coverage with the Patient Protection and Affordable Care Act, the number seeking care will increase dramatically. Both the Institute of Medicine and the American College of Nurse-Midwives state that certified nurse-midwives and certified midwives should function at their full scope of practice, which includes primary care services as delineated by the Core Competencies for Basic Midwifery Practice. Nonetheless, the percentage of midwives who self-identify as primary care providers is decreasing. Dedicated primary care educational experiences may increase student confidence and encourage the incorporation of primary care into midwifery practice after graduation. METHODS Midwifery students in 2 cohorts completed questionnaires before and after a dedicated primary care practicum to study changes in the perceived level of confidence in primary care provision. The students in cohort A participated in 45 hours of primary care clinical time, whereas the students in cohort B participated in 88 hours of primary care clinical time. Postclinical focus groups provided qualitative data on student perceptions and attitudes about the clinical experience. Student responses were coded by cohort and analyzed using qualitative descriptive analysis. RESULTS Seventeen midwifery students from 2 cohorts completed questionnaires. Students in both cohorts reported increased perceived confidence in almost all primary care domains. DISCUSSION Participation in a dedicated primary care clinical rotation increased student-perceived confidence in primary care practice. The inclusion of designated primary care clinical education in nurse-midwifery education may contribute to meeting the national need for primary care providers. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.
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Abstract
Rationale and key points Skilful repair of an episiotomy is an important aspect of maternal health care. It is essential that midwives and doctors have the knowledge and skills to undertake this procedure in a safe and effective manner. ▶ An episiotomy should be repaired promptly to reduce blood loss and prevent infection. ▶ Repair of an episiotomy is undertaken in three stages: repair of the vaginal mucosa, repair of the muscle layer and repair of the skin layer. ▶ Adequate pain relief should be provided before suturing. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. Why a rectal examination is recommended before and following repair of an episiotomy. 2. What you would do to improve your suturing skills. 3. The factors that may prevent or delay an episiotomy from healing. Subscribers can upload their reflective accounts at rcni.com/portfolio .
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Affiliation(s)
- Mary Steen
- School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Bernie Cummins
- Women's and Babies Division, SA Health, Government of South Australia, Adelaide, Australia
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Abstract
RATIONALE AND KEY POINTS: An episiotomy may be necessary to assist some women to give birth. An episiotomy is a surgical incision intentionally made to increase the diameter of the vulval outlet to enable childbirth. ▶ Midwives and doctors should use their clinical judgement and skills to assess when to perform an episiotomy. ▶ An episiotomy should not be performed routinely; its use should be restricted to certain indications. ▶ Adequate pain relief should be provided before performing an episiotomy. REFLECTIVE ACTIVITY: Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How you think this article will change your practice. 2. The risk factors that can predispose a woman to having an episiotomy. 3. What you would do if a woman refused to have an episiotomy despite the presence of a clinical indication, such as fetal distress. Subscribers can upload their reflective accounts at: rcni.com/portfolio.
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Affiliation(s)
- Mary Steen
- School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Bernie Cummins
- Women's and Babies Division, SA Health, Government of South Australia, Adelaide, Australia
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Abstract
Since the 1970s, men have been encouraged to actively participate in the childbirth process, resulting in a shared experience for couples. Nevertheless, after the baby is born, many fathers find themselves displaced, unsure of how to embrace the transition to parenthood. The shift in cultural practice and evolving needs of families calls for the recognition of fathers as well as mothers in the provision of midwifery services. Innovative strategies must be considered to enhance postnatal education that is father-inclusive and responsive to the needs of families in the 21st century. This article introduces one strategy created from an action research study conducted to develop, implement, and evaluate strategies to improve postnatal education for parents.
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Affiliation(s)
- Lois McKellar
- LOIS McKELLAR is a lecturer in the School of Population Health and Clinical Practice at the University of Adelaide, South Australia. She is also a member of the College of Midwives
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Bick DE, Ismail KM, Macdonald S, Thomas P, Tohill S, Kettle C. How good are we at implementing evidence to support the management of birth related perineal trauma? A UK wide survey of midwifery practice. BMC Pregnancy Childbirth 2012; 12:57. [PMID: 22731799 PMCID: PMC3472238 DOI: 10.1186/1471-2393-12-57] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 06/01/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The accurate assessment and appropriate repair of birth related perineal trauma require high levels of skill and competency, with evidence based guideline recommendations available to inform UK midwifery practice. Implementation of guideline recommendations could reduce maternal morbidity associated with perineal trauma, which is commonly reported and persistent, with potential to deter women from a future vaginal birth. Despite evidence, limited attention is paid to this important aspect of midwifery practice. We wished to identify how midwives in the UK assessed and repaired perineal trauma and the extent to which practice reflected evidence based guidance. Findings would be used to inform the content of a large intervention study. METHODS A descriptive cross sectional study was completed. One thousand randomly selected midwives were accessed via the Royal College of Midwives (RCM) and sent a questionnaire. Study inclusion criteria included that the midwives were in clinical practice and undertook perineal assessment and management within their current role. Quantitative and qualitative data were collated. Associations between midwife characteristics and implementation of evidence based recommendations for perineal assessment and management were examined using chi-square tests of association. RESULTS 405 midwives (40.5%) returned a questionnaire, 338 (83.5%) of whom met inclusion criteria. The majority worked in a consultant led unit (235, 69.5%) and over a third had been qualified for 20 years or longer (129, 38.2%). Compliance with evidence was poor. Few (6%) midwives used evidence based suturing methods to repair all layers of perineal trauma and only 58 (17.3%) performed rectal examination as part of routine perineal trauma assessment. Over half (192, 58.0%) did not suture all second degree tears. Feeling confident to assess perineal trauma all of the time was only reported by 116 (34.3%) midwives, with even fewer (73, 21.6%) feeling confident to perform perineal repair all of the time. Two thirds of midwives (63.5%) felt confident to perform an episiotomy. Midwives qualified for 20 years or longer and those on more senior clinical grades were most likely to implement evidence based recommendations and feel confident about perineal management. CONCLUSIONS There are considerable gaps with implementation of evidence to support management of perineal trauma.
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Affiliation(s)
- Debra E Bick
- Professor of Evidence Based Midwifery Practice Kings College London, Florence Nightingale School of Nursing and Midwifery, 57 Waterloo Road, London SE1 8WA, UK
| | - Khaled M Ismail
- School of Clinical & Experimental Medicine, College of Medical & Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Sue Macdonald
- Education and Research Manager, Royal College of Midwives, 15 Mansfield Street, London WIG 9NH, UK
| | - Peter Thomas
- Centre of Postgraduate Medical Research and Education, School of Health and Social Care, Bournemouth University, R506A Royal London House, Christchurch Road, Bournemouth, Dorset BH1 3LT, UK
| | - Sue Tohill
- Research Manager West Midlands (South) Comprehensive Local Research Network, University Hospitals Coventry and Warwickshire NHS Trust, University Hospital, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Christine Kettle
- Maternity Centre, Professor of Women’s Health Staffordshire University and University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent, Staffordshire ST4 6QG, UK
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