A historical narrative of the development of midwifery education in Indonesia

AimTo describe the history of midwifery education, present the current education programmes and explore the ways that have been undertaken to advance the midwifery profession in Indonesia.MethodsHistorical and contemporary government documents were reviewed.FindingsThe history of midwifery education in Indonesia shows a complex picture during and since colonisation with government, education institutes and association proposing different ways in which midwives were to be educated. Advocacy from the midwifery profession in Indonesia meant increasingly it is midwives who are determining how midwifery education is provided. Recent initiatives have resulted in a diploma, advanced diploma, bachelor’s degree, and a master’s degree in midwifery. The work of the midwifery profession advocating for midwifery education culminated in the Midwifery Act 2019. These changes in this Act will ensure that midwifery education meets the needs of women and their families but also lead to competent midwives who have the knowledge and skills to provide midwifery services at all levels of health provision. The history of midwifery in Indonesia illustrates the importance of the ICM pillars of association, regulation, and education.ConclusionThe history of midwifery education in Indonesia shows that for too long midwifery education was decided, determined and even regulated by authorities and disciplines other than midwifery. However, when the midwifery association and regulation inform and regulate midwifery education then there is an opportunity to provide care that will make a difference in outcomes for women and their families. The historical analysis of the story of Indonesia midwifery gives insight into what is required for quality education.     

Telephone triage and midwifery: A scoping review

Background

Midwives use telephone triage to provide advice and support to childbearing women, and to manage access to maternity services. Telephone triage practises are important in the provision of accurate, timely and appropriate health care. Despite this, there has been very little research investigating this area of midwifery practice.

A historical account of the governance of midwifery education in Australia and the evolution of the Continuity of Care Experience

Background

Midwifery programs leading to registration as a midwife in Australia have undergone significant change over the last 20 years. During this time accreditation and governance around midwifery education has been reviewed and refined, moving from state to national jurisdiction. A major change has been the mandated inclusion of Continuity of Care Experiences as a clinical practice-based learning component.

Midwifery in Middle Eastern and North African countries: A scoping review

BackgroundWhile midwives are positioned as critical providers for improving sexual, reproductive, maternal and newborn health outcomes in the Middle East and North African (MENA) countries, the standards of midwifery have not been explored systematically in this region.AimThe purpose of this scoping review was to provide an overview of existing literature on midwifery practice, education, and regulation in MENA countries in the context of ICM standards.MethodsA search was conducted inclusive of English and Persian written studies published between 2000 and 2019 in CINAHL plus; Ovid MEDLINE; PubMed; Scopus; and grey literature. Title and abstract and full-text review were performed in Covidence, and data extraction and synthesis performed using NVivo 12.ResultsThe initial search identified 7,994 articles. Overall, 139 studies were included in the review. Although, the primary concept of most included studies was “midwifery practice”, “midwifery regulation” was addressed in limited way. Approximately 90% were from Middle Eastern countries. Forty-two per cent of studies used cross-sectional designs, and most originated from Iran, Jordan, and Palestine. Diversity was found in midwifery education, practice and regulation across the MENA countries. Midwives from different nations had uneven levels of proficiency, scope of practice, and education. Midwifery curricula were aligned with ICM competencies in some countries. Most countries had midwifery associations and were members of ICM. Some countries had regulations recognising midwifery as an autonomous profession.ConclusionMidwifery practice, education and regulation in MENA countries were not always comparable with ICM standards, although some progress was evident.     

A global review of the inferred meaning of woman centred care within midwifery professional standards

BackgroundAs an integral and guiding approach, woman centred care is well-grounded as the cornerstone of midwifery training and practice. A previous global review established that the concept, even though acknowledged as pivotal, has limited attention within the professional standards documents that underpin the discipline [1]. Whilst not detracting from the overall importance of woman centred care, it is further suggested that a broader meaning is generally being implied.ObjectiveWhether other related inferences and meanings of the actual term ‘woman centred care’ are also being utilised, has not yet been established. Therefore, this review of professional documents sought to investigate the occurrence of further depictions of the concept.MethodsWith an implied and inferred meaning of ‘woman centred care’ as the focus, a review and synthesis of narrative from a global sample of midwifery professional standards was conducted. The principles of meta-ethnography were utilised to develop a qualitative approach. Rather than the actual words ‘woman centred care’ further phrases implying or inferring the concept were sought. ‘A priori’ phrases were developed and narrative and examples were synthesised for each.FindingsStandards and governance documents were located from within Australia, the United Kingdom and New Zealand and a further 139 nations. Overall, the seven phrases, each considered as an inference to woman centred care, were all substantiated. As a proportion of all documents, these were collated with the outcomes being a woman’s right to choice (89%), being culturally sensitive (80.5%), a woman’s voice and right to be heard (78%), the woman as an individual (68%), universal human rights (40%), being holistic (39%) and being self-determined (17.5%).ConclusionThe outcomes of this review demonstrate that woman centred care may be a multidimensional concept. There were occurrences of all seven phrases across a broad scope of global professional midwifery documents, and each can be shown through its meaning to contribute something to an understanding of woman centred care. The creation of a universal meaning is recommended.     

Identifying the priorities for midwifery education across Australia and New Zealand: A Delphi study

ProblemIn countries where education programmes are assessed as meeting international standards there is limited knowledge about the challenges facing midwifery education.Background/aimThe positive impact of quality midwifery education on maternal and newborn health is acknowledged by the World Health Organisation. However, there is limited research identifying the issues faced in providing quality midwifery education. The aim of this study was to identify the challenges and determine priority projects to strengthen midwifery education across Australia and New Zealand.MethodsA two-round Delphi study with experts in midwifery education was undertaken.FindingsIn round one, 85 participants identified an initial 366 issues for midwifery education. Through thematic content analysis these were categorised into 89 statements reflecting five major themes: In round two, 105 midwifery experts from Australia n = 86 (79%) and New Zealand n = 23 (21%) rated the 89 statements in order of priority. Across the combined data (Australia and New Zealand) a total of 19 statements gained consensus of ≥80%.DiscussionFive priority themes were identified including; (1) enabling success of First Peoples/Māori midwifery students; (2) increasing the visibility and influence of midwifery within regulation, accreditation and university governance; (3) determining how best to deliver the clinical practicum component of programmes; (4) reviewing midwifery programmes to enhance design, content and delivery; and (5) ongoing education and support for the midwifery workforce.ConclusionIn Australia and New Zealand, it is imperative that collaborative work is undertaken to design and action identified projects addressing these priorities.     

Factors that support change in the delivery of midwifery led care in hospital settings. A review of current literature

Problem

In hospital units, the network of interdependent relationships between midwives and doctors has positioned midwives within hierarchical relationships of power. Others argue that the physical layout of hospital wards created by biomedicine makes it difficult for midwives to provide midwifery led care. The aim of this review is to identify factors that support change in the delivery of the midwifery led care in hospital settings.

Access,boundaries and confidence: The ABC of facilitating continuity of care experience in midwifery education

BackgroundTo register as a midwife in Australia, students must complete minimum requirements of clinical experiences throughout their programme. This includes following women through their childbirth journey in order to gain continuity of care experience. Research suggests that women and students find the continuity of care experience (COCE) valuable. Nevertheless, students cite difficulty in achieving these experiences.Aim This project sought to explore the challenges and identify supportive strategies for midwifery students undertaking the COCE.MethodsThis project adopted an action research approach incorporating the four stages of planning, action, observation and reflection. This paper specifically reports the findings from the planning stage in which a focus group with education providers, facilitator and students was conducted and a survey with students (n = 69) was undertaken. Key themes were identified through thematic analysis and a number of actions were proposed.FindingsThree main themes, ‘access’, ‘boundaries’ and ‘confidence’ were identified as challenges for students undertaking the COCE. Students raised concern regarding lack of access to women for COCE. They identified a need to establish clear professional and personal boundaries in managing the COCE. Students also highlighted the significance of confidence on the success of their experience. Throughout the study students identified strategies that could assist in the COCE.ConclusionThere is a need for clarity and support around the COCE for all stakeholders. Placing the COCE within a Service Learning model is one response that ensures that this experience is understood as being symbiotic for women and students and enables supportive actions to be developed and implemented.     

Students as researchers: An example of high-level participation of undergraduate midwifery students as co-investigators in research

BackgroundThere is a shift in focus of the curricula of undergraduate midwifery research-education - from research content to the research process, and the student from being an observer to a participant.Aim and MethodsTo explore an example of how to involve midwifery students as co-investigators in research. This paper discusses the experiences of an educational research project that adopted the highest level of student autonomy in research, involving six Bachelor of Midwifery final-year students participating as co-investigators in qualitative research focusing on women’s lived experiences of traumatic childbirth. The experiences are supported by the parameters of research-education and learning, and are discussed in the context of the dimensions of framing undergraduate research: Motivation, Inclusivity, Content, Originality, Setting, Collaboration, Focus and AudienceDiscussionCrucial for this educational research project is the recognition of the motivation, interests, (experiential) knowledge and real-world experiences of students. It starts with listening to the questions, thoughts and ideas that students bring, recognising and respecting the content and importance of their work and what is important and meaningful to them, while facilitating a student-led learning process. Collaboration between students and students and supervisors needs to be formally facilitated and supported, as this contributes to qualitative products for curricular and extra-curricular products. An academic infrastructure is necessary to support extra-curricular activities.ConclusionTo embed research adequately and effectively in the curriculum, a pedagogical approach, institutional learning and student-centred teaching strategies and practices, including high impact practices to mainstream undergraduate research and enquiry, are crucial.     

Maternity high-dependency care and the Australian midwife: A review of the literature

Background

Maternity high-dependency care has emerged throughout the 21st century in Australian maternity hospitals as a distinct sub-speciality of maternity care. However, what the care involves, how and why it should be provided, and the role of midwives in the provision of such care remains highly variable.

Implementing midwifery continuity of care models in regional Australia: A constructivist grounded theory study

Problem/backgroundStrong international evidence demonstrates significantly improved outcomes for women and their babies when supported by midwifery continuity of care models. Despite this, widespread implementation has not been achieved, especially in regional settings.AimTo develop a theoretical understanding of the factors that facilitate or inhibit the implementation of midwifery continuity models within regional settings.MethodsA Constructivist Grounded Theory approach was used to collect and analyse data from 34 interviews with regional public hospital key informants.ResultsThree concepts of theory emerged: ‘engaging the gatekeepers’, ‘midwives lacking confidence’ and ‘women rallying together’. The concepts of theory and sub-categories generated a substantive theory: A partnership between midwives and women is required to build confidence and enable the promotion of current evidence; this is essential for engaging key hospital stakeholders to invest in the implementation of midwifery continuity of care models.DiscussionThe findings from this research suggest that midwives and women can significantly influence the implementation of midwifery continuity models within their local maternity services, particularly in regional settings. Midwives’ reluctance to transition is based on a lack of confidence and knowledge of what it is really like to work in midwifery continuity models. Similarly, women require education to increase awareness of continuity of care benefits, and a partnership between women and midwives can be a strong political force to overcome many of the barriers.ConclusionImplementation of midwifery continuity of care needs a coordinated ground up approach in which midwives partner with women and promote widespread dissemination of evidence for this model, directed towards consumers, midwives, and hospital management to increase awareness of the benefits.     

Embracing the continuity of care experience: A new Australian graduate entry master of midwifery course with a student caseload of 15 women per year

BackgroundWomen receiving continuity of midwifery care have increased satisfaction and improved outcomes. Preparation of midwifery students to work in continuity models from the point of graduation may provide an ongoing midwifery workforce that meets rising demand from women for access to such care.Aim of the paperThe aim of this paper is to describe an innovative midwifery course based on a continuity model, where students acquire more than 50 % of clinical hours through continuity of care experiences. Additional educational strategies incorporated in the course to enhance the CCE experience within the philosophy of midwifery care, include a virtual maternity centre, case-based learning and the Resources Activities Support Evaluation (RASE) pedagogical model of learning.DiscussionAustralian accredited midwifery courses vary in structure, format and philosophy; this new course provides students with an alternative option of study for those who have a particular interest in continuity of midwifery care.ConclusionA midwifery course which provides the majority of clinical hours through continuity of care may prepare graduates for employment within midwifery group practice models by demonstrating the benefits of relationship building, improved outcomes and the reality of an on-call lifestyle.     

The politics of midwifery education and training in New South Wales during the last decades of the 19th Century

This paper focuses on the introduction and development of midwifery education and training in Sydney during the last decades of the 19th century. The aim of the training, it is argued, was to displace the lay midwives by trained midwifery nurses who would work under medical control. The lay midwives were one of the largest occupational groups among women and two-thirds of births in NSW were being delivered by them in the late 19th century. It was a period of professionalisation of medicine and medical men laid claim to midwifery as a legitimate sphere of their practice and saw it as the gateway for establishing a family practice. The lay midwife stood in the way of their claim. The training programs were established purportedly to control maternal mortality. From the beginning in 1887 medical men were in control of midwifery nurse training. In addition to training at the Benevolent Society Asylum, three more women's hospitals were established in the 1890s in Sydney making it possible to train a stream of midwifery nurses. The midwifery nurses were charged exorbitant fees for their training; the fees contributed substantially towards running the new hospitals that delivered birth services to the poor and destitute women mostly in their homes. The midwifery nurses worked hard in miserable conditions under the guise of clinical experience required for training. When a critical mass of poorly trained midwifery nurses were in the offing, a Bill was introduced into the Parliament in 1895, restricting registration to midwifery nurses and this would have eliminated the lay midwife if passed. It took more than two decades to get a Registration Bill passed in the NSW Parliament.     

Examining the transformation of midwifery education in Australia to inform future directions: An integrative review

BackgroundIntegral to quality midwifery practice is the education of midwives. Like other countries, Australia faces ongoing challenges in delivering midwifery education programs. Reasons include escalating program costs, challenges in securing meaningful clinical experiences, subsumption of midwifery with nursing, and associated loss of identity in some institutions.AimTo critically examine the literature exploring the historical and current drivers, supports and impediments for entry-to-practice midwifery programs to identify strategies to strengthen midwifery education in Australia.MethodsA structured integrative literature review using Whittemore and Knafl’s five-stage framework was undertaken; 1) problem identification, 2) literature search, 3) data evaluation, 4) data analysis, and 5) presentation of results.FindingsThe literature search identified 50 articles for inclusion. The thematic analysis identified four key themes: i. a commitment to educational reform, ii. building a midwifery workforce, iii. quality maternity care through midwifery education, and iv. progressing excellence in midwifery education.DiscussionExtensive literature describes the evolution of midwifery education in Australia over the last 30 years. Through collaboration and amidst opposition, quality midwifery education has been established in Australia. Identification of midwifery as a distinct profession and transformative leadership have been integral to this evolution and must be grown and sustained to prevent a decline in standards or quality.ConclusionThere is a need to address priorities in midwifery education and for the evaluation of midwifery programs and pedagogy. The provision and maintenance of quality education and practice require shared responsibility between education providers and health care services.     

Models of midwifery care for Indigenous women and babies: A meta-synthesis

Issue

Indigenous women in many countries experience a lack of access to culturally appropriate midwifery services. A number of models of care have been established to provide services to women. Research has examined some services, but there has not been a synthesis of qualitative studies of the models of care to help guide practice development and innovations.

International consensus definition of critical thinking in midwifery practice: A Delphi study

ProblemCurrently there is no discipline-specific definition of critical thinking in midwifery practice.BackgroundCritical thinking in midwifery practice is the cornerstone for safe, evidence based, and woman centred clinical decision-making. Available definitions of critical thinking in other disciplines do not align with midwifery practice which is distinctive, multidimensional and complex.AimTo develop an international consensus definition of critical thinking in midwifery practice.MethodsA two round Delphi study was used. Thirty-two international midwifery experts contributed to the first round which was qualitative in nature. Twenty one of these experts then ranked the relevance and clarity of concepts from round one.FindingsA consensus definition of critical thinking in midwifery practice was achieved. The expert panel identified and defined 14 ‘Habits of Mind’ and 12 Skills that are the core of critical thinking in midwifery practice. Skills included; analysis, constructive application and contextualisation of best available evidence, problem solving, discriminating, predicting, evaluation of care, collect and interpret clinical cues, collaboration/ negotiation, reflexivity, facilitates shared decision-making, communication, and transforming knowledge. Habits of Mind included; intellectual curiosity, reflective, holistic view, intellectual integrity, flexibility, questioning/challenging, participatory, open mindedness, listening with understanding and empathy, cultural humility, woman centred, being brave, confidence, and creativity.Discussion/conclusionThis study is an international first and delineates characteristics of critical thinking in midwifery. Development of a consensus definition provides a common and shared understanding of the skills and attributes required for critical thinking in midwifery practice and can also be applied in education and research.     

Paperbark and pinard: A historical account of maternity care in one remote Australian Aboriginal town

Background and aimMaternity care in remote areas of the Australian Northern Territory is restricted to antenatal and postnatal care only, with women routinely evacuated to give birth in hospital. Using one remote Aboriginal community as a case study, our aim with this research was to document and explore the major changes to the provision of remote maternity care over the period spanning pre-European colonisation to 1996.MethodsOur research methods included historical ethnographic fieldwork (2007–2013); interviews with Aboriginal women, Aboriginal health workers, religious and non-religious non-Aboriginal health workers and past residents; and archival review of historical documents.FindingsWe identified four distinct eras of maternity care. Maternity care staffed by nuns who were trained in nursing and midwifery serviced childbirth in the local community. Support for community childbirth was incrementally withdrawn over a period, until the government eventually assumed responsibility for all health care.ConclusionsThe introduction of Western maternity care colonised Aboriginal birth practices and midwifery practice. Historical population statistics suggest that access to local Western maternity care may have contributed to a significant population increase. Despite population growth and higher demand for maternity services, local maternity services declined significantly. The rationale for removing childbirth services from the community was never explicitly addressed in any known written policy directive. Declining maternity services led to the de-skilling of many Aboriginal health workers and the significant community loss of future career pathways for Aboriginal midwives. This has contributed to the current status quo, with very few female Aboriginal health workers actively providing remote maternity care.