Barriers and enablers for midwives using endorsement for scheduled medicines: A literature review

ProblemThere are currently 429 midwives in Australia who hold the Nursing and Midwifery Board of Australia’s Endorsement for scheduled medicines for midwives. Little is known about how midwives are using the endorsement and what factors impact on its use.ObjectiveTo critically examine the literature to discover what the barriers and enablers are for midwives to use the endorsement.MethodA search was undertaken examining literature published since 2004. Due to a lack of articles specific to midwifery, the search was widened to include literature related to similar non-medical health professions. The search was divided into two streams: accessing the Medicare Benefits Schedule and accessing the Pharmaceutical Benefits Scheme and prescribing. Twenty-six primary articles from 2009 onward met the review criteria.FindingsAlthough singular barriers and enablers to both streams were identified, many of the themes act as both enabler and barrier. Themes common to both the Medicare Benefits Schedule focus and the Pharmaceutical Benefits Scheme and prescribing focus are that of medical support, scope of practice, ongoing support from health care consumers and management, and endorsement processes. Barriers occur approximately three times more frequently than enablers.ConclusionBarriers and enablers occur for various reasons including legislative, regulatory, organisational, and the individual’s support for and attitude towards these roles. To overcome barriers and facilitate the success of emerging non-medical extended practice roles, significant buy-in and investment is needed across all levels of the health system. The review highlights a significant gap in knowledge about the endorsement’s use in midwifery.     

The birth of 'MidPLUS': Australia's new national continuing professional development program for midwives

The national continuing professional development (CPD) program of the Australian College of Midwives, MidPLUS, was officially launched in September 2007. In our role as program developers we were dedicated to the belief that this national CPD program would be an important step for Australian midwives, and contribute to demonstrating a commitment to providing safe and effective care for Australian women and families. This paper outlines key issues involved in providing CPD programs for professional groups and highlights how this information was used in the decision making behind the design of MidPLUS. The key operational elements of CPD programs included program design, program administration and related professional issues. Important features and functions of the MidPLUS program are highlighted and justification is given for our overall design. This information may assist midwives who are considering using the MidPLUS program and are asking the question: CPD-what does it mean for me?     

Development of a tool to measure holistic reflection in midwifery students and midwives

BackgroundHolistic reflection encompasses reflection as a continuum, incorporating critical reflection, reflexivity, critical thinking and a whole-of-person approach. The development of holistic reflection in midwifery students and midwives is rarely measured in a standardised way.AimTo develop and test a tool to measure holistic reflection in midwifery students and midwives, for use in pre-registration and post-graduate education, and research.DesignThe eight-step approach to tool development by DeVellis was followed with psychometric testing of data from a cross-sectional survey.ParticipantsMidwifery students (pre-registration and postgraduate), and midwifery alumni of an Australian university.MethodsDraft items (n = 84) were generated from review of the literature, qualitative research, and a theoretical model. An expert panel (n = 19) reviewed draft items resulting in 39 items. The survey included demographic details, the draft Holistic Reflection Assessment Tool, emotional intelligence subscale, and a social desirability scale. Participants repeated the online survey at two weeks to confirm test-retest reliability.ResultsThe 187 responses were received. Exploratory factor analysis with varimax rotation revealed three factors accounting for 49% of variance. Internal consistency of the tool was high (α = .91) and test-retest reliability at two weeks (α = .93) demonstrated stability. There were low correlations between social desirability (r = .22, p < .001) and emotional intelligence (r = .21, p < .001) with the new holistic reflection scale.ConclusionsThe Holistic Reflection Assessment Tool is the first for midwifery. The tool was reliable, stable, and valid. Further research is warranted for criterion validity.     

Experiences of and visions for collaboration between midwives and nurses in Nova Scotia

ProblemIn jurisdictions where midwifery and nursing are autonomous and separate health care professions, little is known about how they collaborate during the delivery of perinatal health care services.BackgroundMidwifery became a regulated profession in the province of Nova Scotia, Canada in 2009. Since regulation, midwives and nurses have worked together at three models sites for the delivery of midwifery services and perinatal care.QuestionHow do midwives and nurses collaborate during the provision of birthing care in Nova Scotia, Canada?MethodsThis was an instrumental case study guided by feminist poststructuralism. Individual interviews of 17 participants were audio-recorded and transcribed verbatim. Twenty-five documents were reviewed, and field notes were gathered. Feminist poststructuralist discourse analysis was used.FindingsMidwives and nurses collaborated well together. Participants described how positive collaborative experiences could influence a new way for midwives and nurses to work together. In this paper we present the theme Moving forward: A Modern Model for Nurses and Midwives working together, and its sub-themes of 1)’The birthing culture has changed’ and 2) ‘Allies and advocates’.DiscussionWithin the global context of strengthening midwifery and nursing, this study illustrated the potential for developing formal, collaborative perinatal models of care led by midwife and nurse teams to address inequities in perinatal health care services.ConclusionMidwives and nurses need more opportunities to collaborate and to build professional relationships. Establishing a midwife-led and nurse supported model of care may transform existing perinatal health care values, beliefs, and practices.     

Not addressing the root cause: An analysis of submissions made to the South Australian Government on a Proposal to Protect Midwifery Practice

BackgroundReports of unregulated birth workers attending birth at home, with no registered midwife in attendance (freebirth), have become more frequent in Australia in recent years. A Coronial Inquiry (2012) into the deaths of three babies born at home in South Australia resulted in a call for legislation to restrict the practice of midwifery to registered midwives. A Proposal to Protect Midwifery Practice in South Australia was issued as a consultation paper in January 2013.AimTo report the views of those making a submission to the Proposal to Protect Midwifery Practice in South Australia.MethodsThirty submissions to the South Australian Government were downloaded, read and thematically analysed.FindingsTwenty-five (81%) submissions supported the legislation, 5 (16%) opposed it and 2 (6%) were neither for nor against. Support for the proposed legislation was strong, however the underlying root causes that have led to the rise of UBWs attending homebirth in Australia were not addressed. Recommendations called for all stakeholders to work with women to develop a better framework of care that respected and met their needs and choices whilst safeguarding maternal and neonatal health.ConclusionsThe Proposal to Protect Midwifery Practice may promote greater protection of midwifery practice however, Private Indemnity Insurance (PII), collaborative agreements and power struggles associated with the medical domination of childbirth continue to marginalise homebirth and prevent women from accessing the care they want and need. These unresolved issues represent the root causes for UBWs attending homebirth; hence the proposal is only a partial solution.     

Validation of the Australian Midwifery Standards Assessment Tool (AMSAT): A tool to assess midwifery competence

Background

There is no current validated clinical assessment tool to measure the attainment of midwifery student competence in the midwifery practice setting. The lack of a valid assessment tool has led to a proliferation of tools and inconsistency in assessment of, and feedback on student learning.

Intentions to leave and actual turnover of community midwives in the Netherlands: A mixed method study exploring the reasons why

BackgroundIn the Netherlands, the turnover of midwives of relatively young age is high. This is concerning since a lack of midwifery experience can negatively affect the quality of maternity care.AimTo study the rate and the reasons for intending to leave, and to explore the reasons for leaving midwifery jobs in the Netherlands.MethodsWe used a mixed-methods design including a quantitative survey (N = 726) followed by qualitative interviews (N = 17) with community midwives.FindingsAlmost one third of the respondents considered leaving the profession. The decision to actually leave the job was the result of a process in which midwives first tried to adapt to their working conditions, followed by feelings of frustration and finally feelings of decreased engagement with the work. The reasons for leaving midwifery practice are an accumulation of job demands, lack of social resources and family responsibilities.DiscussionCompared to international figures, we found a lower rate of midwives who considered leaving the profession. This could be explained by the differences in the organisation of midwifery care and the relatively high job autonomy of midwives in the Netherlands. Nevertheless, changes must be made in terms of decreasing the demands of the job and creating more job resources.ConclusionInnovations in the organisational structure that focus on continuity of care for pregnant individuals, job satisfaction for midwives and building a sustainable workforce may result in an increase in the retention of midwives. These innovations would ensure that women and their babies receive the best care possible.     

Experiences and outcomes on the use of telemetry to monitor the fetal heart during labour: findings from a mixed methods study

BackgroundWireless continuous electronic fetal monitoring (CEFM) using telemetry offers potential for increased mobility during labour. United Kingdom national recommendations are that telemetry should be offered to all women having CEFM during labour. There is limited contemporary evidence on experiences of telemetry use or impacts it may have.AimTo gather in-depth knowledge about the experiences of women and midwives using telemetry, and to assess any impact that its use may have on clinical outcomes, mobility in labour, control or satisfaction.MethodsA convergent parallel mixed-methods study was employed. Grounded theory was adopted for interviews and analysis of 13 midwives, 10 women and 2 partners. Satisfaction, positions during labour and clinical outcome data was analysed from a cohort comparing telemetry (n = 64) with wired CEFM (n = 64). Qualitative and quantitative data were synthesised to give deeper understanding.FindingsWomen using telemetry were more mobile and adopted more upright positions during labour. The core category A Sense of Normality encompassed themes of ‘Being Free, Being in Control’, ‘Enabling and Facilitating’ and ‘Maternity Unit Culture’. Greater mobility resulted in increased feelings of internal and external control and increased perceptions of autonomy, normality and dignity. There was no difference in control or satisfaction between cohort groups.ConclusionsWhen CEFM is used during labour, telemetry provides an opportunity to improve experience and support physiological capability. The use of telemetry during labour contributes to humanising birth for women who have CEFM and its use places them at the centre and in control of their birth experience.     

Barriers to women's disclosure of and treatment for substance use during pregnancy: A qualitative study

IntroductionThe use of alcohol and or illicit drugs during pregnancy is a complex public health issue. There are many adverse short- and long-term health implications of substance use during pregnancy that can potentially affect the mother-foetal dyad. Although prevention and treatment options — such as counselling, pharmacotherapy, rehabilitation, support and case management and withdrawal management — are available, a range of barriers impedes women's ability to disclose their substance use, which limits access and engagement with available services.ObjectiveThis research explored barriers women encountered in disclosing substance use and accessing substance use treatment in pregnancy.MethodsParticipants were recruited from a longitudinal cohort study of people with a history of injecting drug use from metropolitan Melbourne. One-on-one in-depth interviews with 15 participants were conducted using a semi-structured interview guide. To be included in this study, participants must have reported a history of substance use during one or more of their pregnancies.ResultsThe fear of losing child custody associated with the involvement of the child protection services was one of the main barriers to disclosing substance use during pregnancy and accessing treatment and rehabilitation services. Other barriers including stigma and perceived limited treatment options impacted women in various ways.ConclusionPregnancy is an important time for women and offers opportunities for service providers to support women who are using substances. While not all barriers can be removed, careful consideration of individual cases and circumstances may help service providers to tailor interventions that are likely to be more successful.     

Women's use of complementary and alternative medicine in pregnancy: A search for holistic wellbeing

BackgroundA number of studies have found increased use of complementary and alternative medicine (CAM) during pregnancy and birth. However, little is known about women's motivation in seeking CAM during pregnancy or their experiences of use in relation to their pregnancy and childbirth journey.MethodsA narrative study sought to explore the meaning and significance of CAM use in pregnancy from the perspective of CAM users. Narrative style interviews were conducted with 14 women who had used a range of CAMs during pregnancy and birth. Data analysis focussed on the meaning and significance of CAM use in pregnancy and a number of core themes emerged.FindingsThis paper focusses on the theme which illustrates the meaning behind women's use of CAM in pregnancy and childbirth as one of seeking holistic wellbeing.ConclusionParticipants engaged with CAM as a way of fulfilling their physical, emotional and spiritual needs during pregnancy. Use of CAM signified women's desire to be proactive in health seeking behaviours.     

Effectiveness of training to promote routine enquiry for domestic violence by midwives and nurses: A pre-post evaluation study

Background

Asking women about experiences of domestic violence in the perinatal period is accepted best practice. However, midwives and nurses may be reluctant to engage with, or effectively respond to disclosures of domestic violence due a lack of knowledge and skills.

Australian midwives views and experiences of practice and politics related to water immersion for labour and birth: A web based survey

Background

There is little published research that has examined practitioners’ views and experiences of pain relieving measures commonly used during labour and birth, particularly for non-pharmacological measures such as water immersion. Furthermore, there is minimal published research examining the process of policy and guideline development, that is, the translation of published research to usable practice guidance.

Statistically tested comparisons of the accuracy of forecasting methods for age-specific and sex-specific mortality and life expectancy

Although there are continuing developments in the methods for forecasting mortality, there are few comparisons of the accuracy of the forecasts. The subject of the statistical validity of these comparisons, which is essential to demographic forecasting, has all but been ignored. We introduce Friedman's test statistics to examine whether the differences in point and interval forecast accuracies are statistically significant between methods. We introduce the Nemenyi test statistic to identify which methods give results that are statistically significantly different from others. Using sex-specific and age-specific data from 20 countries, we apply these two test statistics to examine the forecast accuracy obtained from several principal component methods, which can be categorized into coherent and non-coherent forecasting methods.     

城市化过程中征地农民社会保障安置的难点及对策思考

为确保征地农民的基本权益,各地正在推广以土地换取社会保障的做法。从传统的就业安置模式过渡到社会保障安置模式,将不可避免地面临征地劳动力市场就业、征地农民社会保障费用来源、新旧安置模式衔接等难题。对这些问题要进行前瞻性研究,群策群力,切实保护好征地农民的利益。     

Tobacco use in the third trimester of pregnancy and its relationship to birth weight. A prospective study in Spain

BackgroundFew studies have been carried out in Spain examining the use of tobacco amongst expectant mothers and its effect on birth weight.AimsTo observe the proportion of expectant mothers who smoke during their pregnancy, and the impact of tobacco consumption on maternal and birth weight. We also aimed to identify the trimester of pregnancy in which tobacco use produced the greatest reduction in birth weight.MethodsProspective observational study in Spain. A random sampling strategy was used to select health centres and participant women. A total of 137 individuals were enrolled in the study. Exposure to tobacco was measured through a self-reported questionnaire. Regressions were performed to obtain a predictive model for birth weight related to smoking.FindingsOverall, 35% of study participants were smokers during the pre-gestational period (27% in the first trimester, 21.9% in the second and 21.2% in the third). 38.7% of smoking cessation attempts took place in the third-trimester. Pregnant women who smoked up to the third trimester had a higher risk of giving birth to a baby under 3000 g, compared to non-smokers (OR = 5.94, CI 95%: 1.94–18.16). Each additional unit of tobacco consumed daily in the 3rd trimester led to a 32 g reduction in birth weight.ConclusionAn important proportion of pregnant women in Spain smoke during pregnancy. Pregnant women exposed to tobacco have newborns with lower birth weight. Smoking during the 3rd trimester of pregnancy is associated with the greatest risk of lower birth weight.