Educating student midwives around dignity and respect

Focus

There is currently limited information available on how midwifery students learn to provide care that promotes dignity and respect.

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.

The influence of yarning circles: A cultural safety professional development program for midwives

BackgroundA university educated, First Peoples health workforce is paramount to improving health outcomes for Australia’s First Peoples. However, a significant gap exists between the academic success of First Peoples and non-Indigenous students. The facilitation of culturally safe learning and teaching environments by academics is essential to closing this gap. There is little research on midwifery academics’ understanding of Cultural Safety and the translation of this understanding in learning and teaching.ObjectivesTo explore the influence of yarning circles within a professional development program to enhance midwifery academics’ awareness of Cultural Safety.MethodsA six-month staff development program which consisted of two workshops and a series of yarning circles was offered to all midwifery academics. Eight participants agreed to be interviewed after completion of the program. Interviews were transcribed verbatim, read and re-read, and analysed using a six staged thematic analysis process.ResultsSix key themes centred on participants’ Sense of Belonging, Sense of Safety, Sense Knowing, Sense of Support, Sense of Difference, and Sense of Challenge were identified. These concepts were supportive of participants’ developing awareness of Cultural Safety.ConclusionYarning circles can encourage midwifery academics’ awareness of Cultural Safety. Awareness is the first step towards becoming culturally safe. Yarning provided a safe and supportive space for challenging discussions and reflective learning about racism, white privilege, and difference. Midwifery academics described steps they could take to promote Cultural Safety in the classroom.     

The profile of women who consult midwives in Australia

BackgroundThere is no Australian data on the characteristics of women who consult with midwives.AimTo determine the profile of women who consult midwives in Australia.MethodsThis cross-sectional research was conducted as part of the Australian Longitudinal Study on Women's Health (ALSWH). Participants were the younger (31–36 years) cohort of the ALSWH who completed a survey in 2009, and indicated that they were currently pregnant (n = 801). The main outcome measure was consultation with a midwife.FindingsOf the 801 women who indicated that they were currently pregnant at the time of the survey, 19%, 42%, and 70% of women in the first, second and third trimesters respectively had consulted with a midwife. Women were more likely to consult a midwife if they: also consulted with a hospital doctor (OR = 2.70, 95% CI: 1.66, 4.40); also consulted with a complementary and alternative medicine practitioner (OR = 1.94, 95% CI: 1.25, 3.03); were depressed (OR = 1.84, 95% CI: 1.03, 3.28); constipated (OR = 1.80, 95% CI: 1.04, 3.13); or had been diagnosed or treated for hypertension during pregnancy (OR = 2.78, 95% CI: 1.27, 6.09). Women were less likely (OR = 0.34, 95% CI: 0.21, 0.56) to consult with a midwife if they had private health insurance.ConclusionWomen were more likely to consult with midwives in conjunction with consultations with hospital doctors or complementary and alternative medicine practitioners. Women with private health insurance were less likely to consult midwives. More research is necessary to determine the implications of the lack of midwifery care for these women.     

Red flags for episiotomy in a midwife-led birth: Using co-production with midwives to capture clinical experience

BackgroundOne of four key points in the Obstetric Anal Sphincter Injury Care Bundle, first piloted in the UK in 2016, was the directive to perform episiotomy when clinically indicated. Midwives are the primary health care professional for straightforward births in the UK and there is very little published literature that relates to their practice in this area.AimThe aim of the study was to explore experienced midwives’ decision-making processes in their assessments for episiotomy during birth.Methods43 midwives self-identifying as confident in performing episiotomy were sampled across 8 NHS Trusts in England and Wales. Data collection was via online focus groups and 1:1 interviews. Primary thematic analysis was undertaken by the research team. Preliminary themes were used to structure a co-production analysis workshop where eight experienced midwives undertook a secondary analysis of the data resulting in four overall themes.FindingsFour themes were identified, ‘Optimising Perineal Function’, ‘Red Flags to Stimulate Decision-Making’, ‘The Midwives’ Episiotomy’ and ‘Infiltration as a Catalyst for Birth’.DiscussionMidwives use a number of visual, auditory and touch cues to inform their assessments for episiotomy during birth.ConclusionThis study provides valuable insight into the cues that guide experienced midwives’ decision-making in relation to episiotomy and contributes evidence related to performing episiotomy when clinically indicated in spontaneous vaginal birth.     

Development of a Model of Holistic Reflection to facilitate transformative learning in student midwives

Background

Reflective practice is considered an essential aspect of personal and professional development, and critical reflection is considered the cornerstone of being an accountable and autonomous practitioner. Tertiary education should lay the foundations of lifelong learning by ensuring students develop into critically reflective and reflexive practitioners, who demonstrate self-awareness and an ability to reflect on personal values and beliefs and their impact on the wider healthcare system. This level of reflective practice is essential to effect change at both an individual and societal level. Reflection should therefore be embedded into education programs as a learning, teaching and assessment strategy.

Rumour of angels and heavenly midwives: anthropology of transpersonal events and childbirth

Some contemporary women can experience non-ordinary states of consciousness when childbearing. The purpose of this paper is to bring a ‘transpersonal’ frame to these non-ordinary states of consciousness (hereafter: NOSC). Transpersonal psychology is an interdisciplinary movement in Western science that studies ‘religious’, ‘peak’ or ‘healing’ experiences in different cultures and social contexts. Between 2001 and 2006 in Auckland, New Zealand, while engaged in anthropological fieldwork, I collected stories from mothers, fathers, and midwives who had participated in transpersonal events during childbirth.I will compare the local women's NOSC with ethnographic accounts of spirit-possession and its relationship to indigenous midwifery then revisit and reconstruct the witch-hunts of Medieval Europe from this perspective. Midwives are encouraged to learn to identify and support women's NOSC during labour and birth as many women find strength and wisdom by passing through these states in labour. The subject is also critical to men, whether they are present with women and birth as fathers or health professionals. The hoped for result of this inquiry is to revalorise NOSC among birth-giving mothers, and to educate birth attendants in this field.     

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.     

Complementary and alternative medicine: Interaction and communication between midwives and women

BackgroundMany pregnant women use complementary and alternative medicine. Although midwives are often supportive, how they communicate with women about the safe use of these therapies has received limited research attention.AimThe aim of this study was to explore how midwives interact with women regarding use of complementary and alternative medicine during pregnancy.MethodsWe utilised grounded theory methodology to collect and analyse data. Twenty-five midwives who worked in metropolitan hospitals situated in Melbourne, Australia, participated in the study. Data were collected from semi structured interviews and non-participant observations, over an 18-month period.FindingsHow midwives communicate about complementary and alternative medicine is closely associated with the meaning they construct around the woman's role in decisionmaking. Most aim to work in a manner consistent with the midwifery partnership model and share the responsibility for decisions regarding complementary and alternative medicine. However, although various therapies were commonly discussed, usually the pregnant woman initiated the dialogue. A number of contextual conditions such as the biomedical discourse, lack of knowledge, language barriers and workplace constraints, limited communication in some situations.ConclusionMidwives often interact with women interested in using CAM. Most value the woman's autonomy and aim to work in partnership. However, various contextual conditions restrain overt CAM communication in clinical practice.     

Neonatal resuscitation training for midwives in Australia: A discussion of current practice

BackgroundMore than 300,000 babies are born in Australia each year, with almost 20% of newborns requiring some form of neonatal resuscitation at birth. The most common first responders to a neonatal resuscitation emergency are midwives. While the Australian and New Zealand Council on Resuscitation guides midwives’ practice during a neonatal resuscitation, each state and territory uses varying strategies to train and assess midwives proficiency in neonatal resuscitation.AimTo examine the neonatal resuscitation training requirements for midwives and raise awareness for the lack of consistency in training in Australia.DiscussionA significant variation was found in the teaching methods and frequency of training for neonatal resuscitation across Australia. Neonatal resuscitation is mandated through a state-wide guideline or policy in only four of the states with seven formal neonatal resuscitation training programs used across seven states and territories. Although a multi-modal approach to learning is present in all of the programs, the combination of teaching methods differ.Conclusion and RecommendationsA standardised, evidence-based training program is required to ensure consistency in training for midwives in Australia. Multi-modal learning is common across all current training programs; however, the best combination of multi-modal teaching methods needs to be determined. Neonatal resuscitation training needs to occur at least annually, as recommended by the Australian and New Zealand Council on Resuscitation.     

Influencing factors in midwives’ decision-making during childbirth: A qualitative study in the Netherlands

Background

Dutch maternity care is based on the principle that pregnancy and childbirth are physiological processes. However, the last decade an increase of intra-partum referrals to obstetric-led care has been observed. Most of these referrals are among nulliparous women, non-urgent and occur during the first stage of labour. The increase in referrals seems not associated with better perinatal outcomes.

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.     

A qualitative document analysis of policies influencing preeclampsia management by midwives in Ghana

BackgroundPreeclampsia is a global issue that causes significant morbidity and mortality in low- and middle-income countries (LMICs). The care women with preeclampsia receive in LMICs is below the standard experienced by women in westernised countries due to multiple interacting factors. A review of policy factors influencing the management of preeclampsia in Ghana is needed.AimThis study focuses on the midwife’s role and scope of practice concerning preeclampsia management. The study aimed to explore the congruence between Ghanaian preeclampsia guidelines and international best practice recommendations for midwifery practice. The study also aimed to describe how recommendations are incorporated into Ghanaian guidelines.Method/designThis study was a qualitative document analysis of national and tertiary hospital policies related to midwives’ scope of practice in Ghana. Altheide’s five-step process (sampling, data collection, data coding and organisation, data analysis and report) was used to systematically source and analyse the content of written documents.ResultsThe findings illustrated several recommendation shortcomings in Ghanaian documents at the national and tertiary hospital levels. The content of Ghanaian preeclampsia management guidelines was not comprehensive, contained conflicting information, and was not backed by research evidence. The standards of practice for midwives were consistent at both the national and tertiary hospital levels. Midwives had limited roles in detection, management, stabilisation, and referral of women with preeclampsia.ConclusionUniform guidelines incorporating international recommendations are urgently needed to improve multi-professional collaboration, solidify midwives’ roles, and optimise maternal and fetal outcomes.     

Providing maternity care for disadvantaged women in Aotearoa New Zealand: The impact on midwives

BackgroundHealth inequities and socio-economic disadvantage are causes for concern in Aotearoa New Zealand. Becoming pregnant can increase a woman’s vulnerability to poverty, with the potential for an increase in multiple stressful life events. Providing midwifery care to women living in socio-economic deprivation has been found to add additional strains for midwives. Exploring the perspectives of the midwives providing care to women living with socio-economic deprivation can illuminate the complexities of maternity care.AimTo explore the impact on midwives when providing care for socio-economically disadvantaged women in Aotearoa New Zealand.MethodInductive thematic analysis was used to analyse an open-ended question from a survey that asked midwives to share a story around maternal disadvantage and midwifery care.FindingsA total of 214 stories were received from midwives who responded to the survey. Providing care to disadvantaged women had an impact on midwives by incurring increased personal costs (time, financial and emotional), requiring them to navigate threats and uncertainty and to feel the need to remedy structural inequities for women and their wider families. These three themes were moderated by the relationships midwives held with women and affected the way midwives worked across the different maternity settings.ConclusionMidwives carry a greater load when providing care to socio-economically deprived women. Enabling midwives to continue to provide the necessary support for women living in socio-economic deprivation is imperative and requires additional resources and funding.     

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.

Working in caseload midwifery care: The experience of midwives working in a birth centre in North Queensland

BackgroundPregnancy, birth and child rearing are significant life events for women and their families. The demand for services that are family friendly, women focused, safe and accessible is increasing. These demands and rights of women have led to increased government and consumer interest in continuity of care and the establishment in Australia of birth centres, and the introduction of caseload midwifery models of care.AimThe aim of this research project was to uncover how birth centre midwives working within a caseload model care constructed their midwifery role in order to maintain a positive work–life balance.MethodsA Grounded Theory study using semi-structured individual interviews was undertaken with seven midwives who work at a regional hospital birth centre to ascertain their views as to how they construct their midwifery role while working in a caseload model of care.FindingsThe results showed that caseload midwifery care enabled the midwives to practice autonomously within hospital policies and guidelines for birth centre midwifery practice and that they did not feel too restricted in regards to the eligibility of women who could give birth at the centre. Work relationships were found to be a key component in being able to construct their birth centre midwifery role. The midwives valued the flexibility that came with working in supportive partnerships with many feeling this enabled them to achieve a good work–life balance.ConclusionThe research contributes to the current body of knowledge surrounding working in a caseload model of care as it shows how the birth centre midwives construct their midwifery role. It provides information for development and improvement of these models of care to ensure that sustainability and quality of care is provided to women and their families.