Lessons from past epidemics and pandemics and a way forward for pregnant women, midwives and nurses during COVID-19 and beyond: A meta-synthesis

OBJECTIVE

To consolidate qualitative research studies that examined the experiences and needs of pregnant women, midwives, and nurses of maternity units to provide a way forward for future research and practices during the current pandemic and future epidemics and pandemics.

DESIGN

Qualitative systematic review and meta-synthesis.

DATA SOURCE

Four electronic databases-PubMed, Scopus, PsycINFO, and Cumulative Index to Nursing and Allied Health (CINAHL).

REVIEW METHODS

Qualitative studies with samples of pregnant women, midwives, and/or nurses of maternity units who experienced epidemics and/or pandemics were searched from 1 January 2000 to 4 April 2020. The included studies were critically appraised using the ten-item Critical Appraisal Skills Programme (CASP) tool.

FINDINGS

Eight studies were included in this review. Four themes emerged from the synthesis: (1) psychological responses, (2) challenges faced, (3) coping strategies, and (4) sources of support and support needs.

KEY CONCLUSIONS

Pregnant women, midwives, and nurses experienced negative psychological responses during epidemics and pandemics. Challenges, such as limited available information and public stigma, were faced. Various coping strategies, such as actively looking for more information and seeking solace in religions, were practiced by pregnant women, midwives, and nurses. Families were both sources of support and stress and they expressed needs for more informational, emotional, and financial support during pandemics.

IMPLICATIONS FOR PRACTICE

More culturally diverse research in the future that includes the development of technology-based programs, trained community volunteer-led programs, psychosocial interventions, and anti-stigma and awareness initiatives are needed to combat the current pandemic and future public health crises.

Oral Histories of Nurse-Midwives in Georgia, 1970-1989: Blazing Trails, Building Fences, Raising Towers

INTRODUCTION

This article provides an account of the establishment and development of the contemporary nurse-midwifery profession in Georgia, which was previously undocumented. Oral history interviews with nurse-midwives who were in clinical and educational practice in Georgia during the 1970s and 1980s were collected and analyzed to identify factors that affected the establishment of nurse-midwifery in this state.

METHODS

This study relied on historical methodology. Oral history interviews provided primary sources for analysis. Secondary sources included archives belonging to the narrators' nurse-midwifery services as well as scholarly and professional publications from 1923 to the present. Data were analyzed using Miller-Rosser and colleagues' method.

RESULTS

In-depth interviews were conducted with 14 nurse-midwives who worked in clinical practice or education in Georgia in the 1970s and 1980s. The narrators' testimonies revealed facilitators for the establishment of nurse-midwifery in Georgia, including increasing access to care, providing woman-centered care, interprofessional relationships, and the support of peers. Resistance from the medical profession, financial constraints, and public misconceptions were identified as barriers for the profession.

DISCUSSION

Oral histories in this study provided insight into the experiences of nurse-midwives in Georgia as they practiced and taught in the 1970s and 1980s. Interprofessional connections and cooperation supported the nurse-midwifery profession, and relationships with peers anchored the nurse-midwives. Mentoring relationships and interprofessional collaboration supported the nurse-midwives as they adapted and evolved to meet the needs of women in Georgia.

Attrition from midwifery programmes at a midwifery school in the English midlands 1939-1973: A historical study

OBJECTIVE

This paper explores the features of attrition from a Midwifery Training programme in mid-twentieth century England.

DESIGN

The research uses an historical methodology to explore rates of attrition from a Midwifery Training School in the English Midlands between 1939 and 1973. It uses principally the record books of the Training School which gave details about pupils across the period. This evidence is contextualised through national written and oral archive material.

SETTING

Mid-twentieth century England. The period was a time of significant change in the maternity services, at both a philosophical and organisational level with the creation of the National Health Service and a move towards institutional rather than community based maternity care. Midwifery pupils were regulated by the Central Midwives Board, the national body which governed midwifery, and sat national exams based on national syllabi.

PARTICIPANTS

Pupil midwives based at the Midwifery Training School whose records are being explored. These included pupils who were had nursing qualifications and those who did not.

FINDINGS

Numbers of pupils entering training varied across the period in relation to external workforce factors. The greatest proportions of those in training were pupils who already held a nursing qualification, although numbers of untrained pupils rose across the period. Rates of attrition were particularly high within this group, but across all groups rates rose across the period.

CONCLUSIONS

The evidence suggests that despite the very different organisation of midwifery training and care across the period in comparison to contemporary practice, rates of attrition from training programmes appear remarkably consistent.

Frontier nurse-midwives and antepartum emergencies, 1925 to 1939

This article examines how the Frontier Nursing Service (FNS) utilized nurse-midwives to respond to antepartum emergencies such as preterm birth, eclampsia, malpresentation, and hemorrhage in the women of Appalachia in the years 1925 to 1939. Particular attention is given to the preparation that nurse-midwives received during their midwifery education to prevent and respond to emergencies. Using traditional historical research methods and primary source material from the FNS papers in the Special Collections, University of Kentucky Libraries, Lexington, Kentucky, this article describes the nurse-midwives' experiences and how they implemented skills they had learned during their training in Great Britain. Working in the isolated mountainous area of Leslie County, Kentucky-for the most part without direct assistance from physicians-FNS nurse-midwives decreased maternal and neonatal mortality rates. During their first 2000 births, they had only 2 maternal deaths, whereas the national average maternal mortality rate was approximately 7 deaths per 1000 births. The nurse-midwives performed external cephalic versions on a routine basis. For pregnancy and birth emergencies, they administered sedation, gave general anesthesia, and performed invasive lifesaving techniques in order to protect the lives of the women in their care. During these 14 years, their cross-cultural engagement, assessment skills, clinical judgment, and timely interventions improved maternal and child health throughout the region.

"It's been a long road to acceptance": midwives in Rhode Island, 1970-2000

A resurgence of midwifery came to Rhode Island in the 1970s. Midwives acted as modern health care professionals to conserve a traditional woman-centered birth, but the battle was long and arduous, from Dr. Ellen Stone attempting to eliminate midwives in the state in 1912 to doctors using the death of 2 home birth infants in the 1980s to undermine the growing presence of professional nurse-midwives in the state. Midwives prevailed when the state legislature passed measures in 1988 and 1990 increasing the power and authority of midwives, and when a federal grant in 1993 allowed the University of Rhode Island to open the first training program for nurse-midwives in the state.

The campaigns for men to become midwives in the 1970s

The oral testimony of forty men entering nursing (1950-2000) and twenty men entering midwifery (1970-2000) in Australia is littered with descriptions of gender discrimination. Men identify many of the barriers they encountered entering a female dominated profession. The Nurses' Registration Act in the States of Victoria (1958) and Tasmania (1952) explicitly stated no male could be registered as a midwife and this paper focuses on the personal accounts of three men (1974-1976) to change this legal impediment. In twenty-first century Australia the percentage of male midwives, like many countries around the world, remains very small, and depending on the state or territory of Australia is between 1 to 2.7 percent.

The History and Evolution of the Core Competencies for Basic Midwifery Practice

The Core Competencies in Nurse-Midwifery were first published in 1978 to provide a standard approach to nurse-midwifery education and now serve as the template for curriculum in nurse-midwifery/midwifery education. This article is an expansion of an earlier publication documenting the development of the Core Competencies document and describes its history and use in midwifery education and professional practice. The development and continued revision of this document are a significant part of ACNM and midwifery history in the United States. It defines the competencies essential to basic practice and can be used to define the scope of midwifery practice in both professional and policy arenas.

Presidential Priorities: 50 Years of Wisdom as the Basis of an Action Agenda for the Next Half-Century

Each of the living presidents of the American College of Nurse-Midwives (ACNM), past and current, was asked to select one or more issues that were of particular importance during her term(s) in office. Some of the issues identified by the presidents were amenable to review using existing quantitative data; this article presents those findings. The substantial increase in growth of ACNM membership in the 1980s and 1990s as well as the plateau that occurred at the beginning of the 21st century is documented. The relationship between ACNM and the professions of nursing, medicine, and other public health providers is illustrated. The increase in the number of Certified Nurse-Midwife/Certified Midwife (CNM/CM) education programs and the evolution and current profile of curriculum models are discussed. Finally, expansion of the scope of midwifery practice and the growing number of opportunities for entrepreneurial practice are presented in terms of current practice profiles, practice sites and settings, various employer-employee relationships, and the variety of financial reimbursement streams. This article is intended to complement the broader body of information about ACNM's history, and particularly, to supplement the richness of information derived from the qualitative and historical research inquiries conducted by others.

The Development of the Community-Based Nurse-Midwifery Education Program: An Innovation in Distance Learning

Since the inception of nurse-midwifery education 80 years ago, educators have looked for ways in which to educate enough nurse-midwives. The application of distance learning to nurse-midwifery education expanded opportunities for a greater number of students to have access to an education in nurse midwifery. The story of the Community-based Nurse-midwifery Education Program is presented as an exemplar.

The American College of Nurse-Midwives and Its Antecedents: A Historic Time Line

In celebration of the 50th anniversary of the American College of Nurse-Midwives, this time line presents a chronologic history of the development of nurse-midwifery in the United States. It places the introduction of nurse-midwifery in American health care into its historic context and follows the evolution of the profession through early attempts at forming a national organization, the eventual formation of the American College of Nurse-Midwifery, and the subsequent merger with the American Association of Nurse-Midwives, to create the American College of Nurse-Midwives. The work of the College between 1955 and the turn of the 21st century is highlighted.

Doubling Back Over Roads Once Traveled: Creating a National Organization for Nurse-Midwifery

The quest for a new national organization began in 1940 and concluded in November 1955 in Kansas City, Missouri, with the founding meeting of the American College of Nurse-Midwifery. This article looks at the conflicts with organized nursing about the place and role of nurse-midwives in the newly reorganized American Nurses Association and the National League for Nursing. Discussions and disagreements within nurse-midwifery over the need for a nonexclusive national organization that would set professional standards are examined.

The American College of Nurse-Midwives' Dream Becomes Reality: The Division of Accreditation

Recognized continuously by the US Department of Education since 1982 as a specialized accrediting agency, the American College of Nurse-Midwives' Division of Accreditation (DOA) accredits not only nurse-midwifery education programs at the postbaccalaureate or higher academic level as certificate and graduate programs for registered nurses (RNs), but also precertification programs for professional midwives from other countries who are licensed as RNs in the United States. The DOA also accredits midwifery education programs for non-nurses at the postbaccalaureate or higher academic level as certificate and graduate programs, and precertification programs for professional midwives from other countries. The accreditation process is a voluntary activity involving both nurse-midwifery and/or midwifery education programs and the DOA. Present plans include another expansion of recognition: to become an institutional accreditation agency for independent and proprietary schools and to continue as a programmatic accrediting agency. Since its inception, the accreditation process has been viewed as a positive development in nurse-midwifery education.

"Go to Ruth's House": the social activism of Ruth Lubic and the family health and birth center

This case of the work of Ruth Watson Lubic, an internationally known nurse midwife and women's and children's health care activist, provides a modern-day example of the intersection of forceful individual personalities, nursing as a type of activism in itself, and grassroots and local actions that produce larger movement-based activist organizations. Her work as a nurse midwife, in partnership with other nurse midwives, physicians, and community members, illustrates how the efforts of individual actors at a grassroots community level can be as significant as larger traditionally situated activist movements on the lives of everyday citizens.

Special deliverers. Interview by Carol Davis

Forty years on, a group of midwives who joined forces in Liverpool as nursing students are now contemplating retirement. Their working lives have been revolutionised in the interim.

Chinese midwifery: the history and modernity

AIM

to investigate how and why Chinese midwife numbers are dwindling, and to help understand the role of midwives in society in general.

METHOD

to critically examine Chinese midwifery in three stages: (1) historical literature overview; (2) identification and reinterpretation of Chinese midwifery and its development; (3) placing issues that have arisen within a sociological context (i.e. the modernisation of obstetric technologies and the meaning of modernity).

FINDINGS

no books on the history of Chinese midwifery were found. History was classified into three stages: (1) before 1929, a period of an indigenous model; (2) 1929-1996, the highs and lows of the bio-medical model; (3) after 1996, the demise of Chinese midwives. The issues identified were the legitimacy and professionalisation of Chinese midwives, the meaning of modernity and the reasons for the decline of Chinese midwifery.

CONCLUSION

no sufficient evidence-based research was conducted to support the recent changes made to Chinese midwifery. The modernisation of maternity care in China took place amid dramatic social and cultural changes within society. As a consequence, midwifery as a profession in China has been marginalised. The modernisation of maternity care has failed to deliver on personal choice, quality of service and professional diversity.

IMPLICATIONS FOR PRACTICE

evidence-based research and the state's responsibility are essential to ensure the quality of maternity care and to protect the interests of women. The state's responsibilities include legislation regarding the role of midwives, code of practice, professional standards, responsibility and accountability in order to make midwifery care a true choice for women.

An Australian history of the subordination of midwifery

This paper analyses the history of the subordination of midwifery to medicine and nursing. With the important exception of Evan Willis' work on medical dominance and Annette Summers' work on the takeover of midwifery by nursing, other histories of Australian midwifery have taken a neutral approach to issue of power and control. The aim of analysing this period is to identify the strategies of power that were used to subordinate midwifery. With increased consciousness of how power has operated in the past, midwives and woman of today can be more empowered when seeking to promote normal birth and midwifery models of care. Concepts of 'power', 'the state' and midwife are defined and discussed. A summary of the decline of midwifery and the rise of obstetrics in Europe and the United Kingdom (UK) gives a background against which to understand the Australian experience. The historical account given here draws to a climax by focussing on the period 1886-1928. It was during this time that medicine forged an alliance with nursing and achieved both legal and disciplinary control of midwifery. Knowing how this was done is important because it helps us to recognise the power strategies that are currently being used by medicine. This is helpful when planning how these strategies might be matched or countered by contemporary woman and midwives when seeking to promote normal birth and midwifery models of care.

[The life and works of Han Shin Gwang: a midwife and nurse of Korean modern times]

Han Shin Gwang, born in an early Christian family in Korea in 1902, could get western education different from the ordinary Korean girls in that period. She participated in the 1919 Samil Independence Movement in her teens, and got nursing and midwifery education in a missionary hospital. She got a midwife license and worked as a member in an early mother-and-child health center. She organized 'Korean Nurses' Association (see text)' in 1924 and focused on public health movement as the chairwoman. She actively participated in women's movement organizations, and Gwangjoo Student's Movement. She was known to be a representative of leading working women, and wrote articles on woman's right, the needs and works of nurses and midwives. From late Japanese colonial period, she opened her own clinic and devoted herself to midwifery. After the Korean Liberation in 1945, she began political movement and went in for a senate election. During the Korean War, she founded a shelter for mothers and children in help. After the War, she reopened a midwifery clinic and devoted to the works of Korean Midwives' Association. Han Shin Gwang's life and works belong to the first generation of Korean working women in modern times. She actively participated in women's movement, nurses' and midwives professional movement, Korea liberation movement, and mother-and-child health movement for 60 years. Her life is truly exemplary as one of the first generation of working women in modern Korea, distinguished of devotion and calling.

The nurse midwives' story, an allegory. 1952

This is an excerpt from a fictional account of a nurse midwifery student on the verge of graduation from the Maternity Center Association (MCA) School of Nurse Midwifery. The original article was written by 6 students at MCA about nurse midwifery and published in the original Public Health Nursing in 1952. After graduation, 4 of the authors served in mission groups in Saudi Arabia, Formosa, and the Philippines, and the others were employed in California and New York. The story conveys the hopes and limitations perceived by the midwifery students and serves as an allegory for those who push the boundaries of accepted practice.

The decline in maternal mortality in Sweden: the role of community midwifery

The maternal mortality rate in Sweden in the early 20th century was one third that in the United States. This rate was recognized by American visitors as an achievement of Swedish maternity care, in which highly competent midwives attend home deliveries. The 19th century decline in maternal mortality was largely caused by improvements in obstetric care, but was also helped along by the national health strategy of giving midwives and doctors complementary roles in maternity care, as well as equal involvement in setting public health policy. The 20th century decline in maternal mortality, seen in all Western countries, was made possible by the emergence of modern medicine. However, the contribution of the mobilization of human resources should not be underestimated, nor should key developments in public health policy.

Genealogic origins of nurse-midwifery education programs in the United States

This article presents a genealogy of all known basic and refresher nurse-midwifery education programs enabling every CNM and CM to track their individual lineage back to Hattie Hemschemeyer or Mary Breckinridge. Feeling connected to our founding foremothers increases our understanding of who we are and what our commitment is to the families we serve. Genealogy also gives us an opportunity to reflect on the early history and continuing historical trends of our education programs.