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1.
Kate Dawson Della A. Forster Helen L. McLachlan Michelle S. Newton 《Women and birth : journal of the Australian College of Midwives》2018,31(3):194-201
Background
Despite high-level evidence of the benefits of caseload midwifery for women and babies, little is known about specific practice arrangements, organisational barriers and facilitators, nor about workforce requirements of caseload. This paper explores how caseload models across Australia operate.Methods
A national cross-sectional, online survey of maternity managers in public maternity hospitals with birthing services was undertaken. Only services with a caseload model are included in the analysis.Findings
Of 253 eligible hospitals, 149 (63%) responded, of whom 44 (31%) had a caseload model. Operationalisation of caseload varied across the country. Most commonly, caseload midwives were required to work more than 0.5 EFT, have more than one year of experience and have the skills across the whole scope of practice. On average, midwives took a caseload of 35–40 women when full time, with reduced caseloads if caring for women at higher risk. Leave coverage was complex and often ad-hoc. Duration of home-based postnatal care varied and most commonly provided to six weeks. Women’s access to caseload care was impacted by many factors with geographical location and obstetric risk being most common.Conclusion
Introducing, managing and operationalising caseload midwifery care is complex. Factors which may affect the expansion and availability of the model are multi-faceted and include staffing and model inclusion guidelines. Coverage of leave is a factor which appears particularly challenging and needs more focus. 相似文献2.
Leonie Hewitt Holly Priddis Hannah G. Dahlen 《Women and birth : journal of the Australian College of Midwives》2019,32(2):168-177
Background
Despite well-known benefits of continuity of midwifery care, less than 10% of women have access to this model of care in Australia. Staff retention and satisfaction are strongly related to the quality of management; however, little is known about the attributes required to effectively manage a midwifery group practice.Purpose
To explore the attributes midwifery group practice managers require to be effective managers and how these attributes can be developed to promote service sustainability.Methods
A qualitative interpretive approach, employing in-depth interviews with eight midwifery leaders was undertaken and analysed using thematic analysis.Results
The overarching theme described the ideal midwifery group practice manager as someone who stands up for midwives and women and is ‘Holding the ground for midwifery, for women’. Subthemes demonstrate midwifery group practice management is complex: ‘having it’, describes the intrinsic traits of an effective leader; ‘someone with their hand on the steering wheel’ illustrates the day to day job of being a manager and the role of ‘juggling the forces’ that surround group practice; ‘helping managers to manage better’ explored the need for managers to be educated and supported for the role.Conclusions
Managers require certain attributes to effectively manage these unique services, whilst also juggling the needs of the organisation as a whole. Having transformational leadership qualities with vision to lead the practice into the future are key. There needs to be better support and preparation for the role if midwifery group practice is to be a sustainable option for women and midwives. 相似文献3.
Malin Hansson Ingela Lundgren Gunnel Hensing Ing-Marie Carlsson 《Women and birth : journal of the Australian College of Midwives》2019,32(1):80-86
Background
Midwives’ professional role has been changing drastically over time, from handling births in home settings to being part of a team in labour wards in hospitals. This demands a greater effort of interprofessional collaboration in childbirth care.Aim
Explore midwives’ work in a hospital-based labour ward from the perspectives of other professions, working in the same ward.Method
Classical grounded theory, using a constant comparative analysis, was applied to focus group interviews with obstetricians, assistant nurses and managers to explore their views of midwifery work during childbirth.Findings
The substantive theory of ‘veiled midwifery’ emerged as an explanation of the social process between the professions in the ‘baby factory’ context. The other professionals perceive midwifery through a veil that filters the reality and only permits fragmentary images of the midwives’ work. The main concern for the other professions was that the midwives were ‘marching to own drum’. The midwives were perceived as both in dissonance with the baby factory, and therefore hard to control, or, alternatively more compliant with the prevailing rhythm. This caused an unpredictability and led to feelings of frustration and exclusion. Which in turn resulted in attempts to cooperate and gain access to the midwifery world, by using three unveiling strategies: Streamlining, Scrutinising and Collaborating admittance.Conclusions
Findings provide a theoretical conceptualisation of a ‘veiled midwifery ‘that causes problems for the surrounding team. This generates a desire to streamline and control midwifery in order to increase interprofessional collaboration. 相似文献4.
Ingrid Jepsen Edith Mark Maralyn Foureur Ellen A. Nøhr Erik E. Sørensen 《Women and birth : journal of the Australian College of Midwives》2017,30(1):e61-e69
Background
Caseload midwifery is expanding in Denmark. There is a need for elaborating in-depth, how caseload midwifery influences the partner and the woman during childbirth and how this model of care influences the early phases of labour.Aim
To follow, explore and elaborate women’s and their partner’s experiences of caseload midwifery.Methods
Phenomenology of practice was the analytical approach. The methodology was inspired by ethnography, and applied methods were field observations followed by interviews. Ten couples participated in the study. Most of the couples were observed from the onset of labour until childbirth. Afterwards, the couples were interviewed.Findings
The transition from home to hospital in early labour was experienced as positive. During birth, the partner felt involved and included by the midwife. The midwives remembered and recognized the couple’s stories and wishes for childbirth and therefore they felt regarded as “more than numbers”. Irrespective of different kinds of vulnerability or challenges among the participants, the relationship was named a professional friendship, characterised by equality and inclusiveness. One drawback of caseload midwifery was that the woman was at risk of being disappointed if her expectations of having a known midwife at birth were not fulfilled.Key conclusions
From the perspective of women and their partners, attending caseload midwifery meant being recognised and cared for as an individual. The partner felt included and acknowledged and experienced working in a team with the midwife. Caseload midwifery was able to solve problems concerning labour onset or gaining access to the labour ward. 相似文献5.
Ling-ling Gao Hong Lu Nicky Leap Caroline Homer 《Women and birth : journal of the Australian College of Midwives》2019,32(2):e279-e283
Background
With the recent surging economic and social development in China, midwifery has undergone transformation.Aim
A narrative review of literature relating to midwifery in mainland China was undertaken to examine the characteristics of midwifery’s potential development within relevant historical, economic and sociopolitical contexts. The aim was to assist future planning and the setting of strategic directions in policy in China.Methods
Online bibliographic databases from 2000 to 2015 were searched including MEDLINE, WanFang Data and Chinese National Knowledge Infrastructure. A process of narrative synthesis was used to analyse the selected papers and major issues were identified.Results
Twenty-one papers were included in the review. Two overarching issues were identified in relation to midwifery in mainland China: the history and status of midwifery education; and the practice and regulation of the midwifery profession. In recent decades, midwifery education, regulation and practice have occurred within systems that view midwifery as a specialisation of nursing. This means that there continues to be little opportunity for midwives to practise according to the international definition and scope of practice of the midwife.Conclusion
Midwifery in China must continue to develop in parallel with international trends. Investment in midwifery education alone will not suffice; it will have to operate within strong government policy regarding regulation, effective human resources management, visibility of the role of the midwife and development of the service delivery environment in which future midwives will work in China. 相似文献6.
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Aim
A theoretical discussion using categorisation theory to discuss the final analysis of findings from research which investigated midwives’ responses to the changed registration-renewal requirements in Australia after the introduction of national registration.Background
In 2010 the Health Practitioner Regulation National Law Act introduced national registration to standardise the regulation of health professionals in Australia. Annual registration-renewal standards required all health professionals to meet the same standards of clear police check, insurance for scope of practice, Continuing Professional Development (CPD) and Recency of Practice (ROP).Question
How did dual registered midwives respond to the changed registration-renewal requirements when national registration was introduced?Methods
A longitudinal single case study was conducted in two phases between 2011–2013 with a purposive sample of 24 midwives from five states of Australia to perform individual or group interviews.Findings
Participants used inclusion and exclusion criteria to create boundaries around practice to illustrate how they met the registration-renewal standards. Accentuation (exaggeration) of practice helped them define their separate professional registrations. Boundaries included the type of person being cared for, practice activities. and place of practice.Conclusion
The theory of categorisation helped explain the dual registrants’ behaviour and rationalise their midwifery responses. 相似文献9.
Allison M. Cummins Christine Catling Caroline S.E. Homer 《Women and birth : journal of the Australian College of Midwives》2018,31(5):343-349
Background
High-level evidence demonstrates midwifery continuity of care is beneficial for women and babies. Women have limited access to midwifery continuity of care models in Australia. One of the factors limiting women’s access is recruiting enough midwives to work in continuity. Our research found that newly graduated midwives felt well prepared to work in midwifery led continuity of care models, were well supported to work in the models and the main driver to employing them was a need to staff the models. However limited opportunities exist for new graduate midwives to work in midwifery continuity of care.Aim
The aim of this paper therefore is to describe a conceptual model developed to enable new graduate midwives to work in midwifery continuity of care models.Method
The findings from a qualitative study were synthesised with the existing literature to develop a conceptual model that enables new graduate midwives to work in midwifery continuity of care. Findings: The model contains the essential elements to enable new graduate midwives to work in midwifery continuity of care models. Discussion: Each of the essential elements discussed are to assist midwifery managers, educators and new graduates to facilitate the organisational changes required to accommodate new graduates.Conclusion
The conceptual model is useful to show maternity services how to enable new graduate midwives to work in midwifery continuity of care models. 相似文献10.
Kim Russell 《Women and birth : journal of the Australian College of Midwives》2018,31(2):e134-e141
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.Methods
A narrative review was chosen as this method allows for greater flexibility in the selection of studies and can lead to the inclusion of a wider range of literature.Results
Eight high quality papers from the UK, Sweden, Canada and Australia were selected for review. Papers focused on improving the delivery of midwife led care in hospital midwifery units, labour and postnatal wards. Key themes were identified as supporting change in the delivery of midwifery led care were ownership of change, capability to change and transformational leadership.Conclusion
The findings demonstrate the importance of social support and clinical leadership in bringing about subtle changes in hospital based midwifery led care. Ultimately improved understanding of the factors that support the delivery of the midwifery led care in hospital settings may improve women’s choice and highlight the role of the midwife as the practitioner of normal childbirth. 相似文献11.
12.
Linda Sweet Maryam Bazargan Lois McKellar Joanne Gray Amanda Henderson 《Women and birth : journal of the Australian College of Midwives》2018,31(1):59-68
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.Objective
This research aimed to develop and validate a tool to assess competence of midwifery students in practice-based settings.Design
A mixed-methods approach was used and the study implemented in two phases. Phase one involved the development of the AMSAT tool with qualitative feedback from midwifery academics, midwife assessors of students, and midwifery students. In phase two the newly developed AMSAT tool was piloted across a range of midwifery practice settings and ANOVA was used to compare scores across year levels, with feedback being obtained from assessors.Findings
Analysis of 150 AMSAT forms indicate the AMSAT as: reliable (Cronbach alpha greater than 0.9); valid—data extraction loaded predominantly onto one factor; and sensitivity scores indicating level of proficiency increased across the three years. Feedback evaluation forms (n = 83) suggest acceptance of this tool for the purpose of both assessing and providing feedback on midwifery student’s practice performance and competence.Conclusion
The AMSAT is a valid, reliable and acceptable midwifery assessment tool enables consistent assessment of midwifery student competence. This assists benchmarking across midwifery education programs. 相似文献13.
Comprehensive maternity support and shared care in Switzerland: Comparison of levels of satisfaction
Lucia Floris Olivier Irion Jocelyne Bonnet Maria-Pia Politis Mercier Claire de Labrusse 《Women and birth : journal of the Australian College of Midwives》2018,31(2):124-133
Background
According to the woman-centred care model, continuous care by a midwife has a positive impact on satisfaction. Comprehensive support is a model of team midwifery care implemented in the large Geneva University Hospitals in Switzerland, which has organised shared care according to the biomedical model of practice. This model of care insures a follow up by a specific group of midwives, during perinatal period.Aim
The goal of this study was to evaluate the satisfaction and outcomes of the obstetric and neonatal care of women who received comprehensive support during pregnancy, childbirth and the postpartum period, and compare them to women who received shared care.Methods
This was a prospective comparative study between two models of care in low risk pregnant women. The satisfaction and outcomes of care were evaluated using the French version of the Women’s Experiences Maternity Care Scale, two months after giving birth.Findings
In total, 186 women in the comprehensive support group and 164 in the control group returned the questionnaire. After adjustment, the responses of those in the comprehensive support programme were strongly associated with optimal satisfaction, and they had a significantly lower epidural rate. No differences were observed between the two groups in the mode of delivery. The satisfaction relative to this support programme was associated with a birth plan for intrapartum and postnatal care.Conclusions
Team midwifery had a positive impact on satisfaction, with no adverse effects on the obstetric and neonatal outcomes, when compared to shared care. 相似文献14.
Lindsay Cole Amanda LeCouteur Rebecca Feo Hannah Dahlen 《Women and birth : journal of the Australian College of Midwives》2019,32(1):e95-e101
Problem
Studies of women’s childbirth preferences repeatedly show that natural birth remains highly valued, yet the majority of births involve some form of medical intervention. Reasons for this lack of correspondence have typically been investigated through interviews and focus-groups with women. Relatively little research explores the ways in which women describe their experiences of childbirth outside of such research settings.Background
Most maternity services promote woman-centred care, whereby women are encouraged to take active roles in deciding how to give birth. However, recent research indicates that women often report feeling disempowered during labour and birth in hospital settings.Aim
We sought to examine how women account for use of medical intervention in hospitals by examining narratives posted on online discussion forums.Method
A thematic analysis of 106 publically available birth stories, sourced using the Internet search terms ‘birth story’, and ‘birth narrative’, was undertaken.Findings
Medical interventions in childbirth were routinely described as unwanted, yet as unavoidable, and two types of account were typically drawn on to explain their use: Protection of the baby/mother; and inflexible hospital policy/practice. We examine these two types of account, focusing on how their design oriented to the discordance between mothers’ reported desires for a natural birth, and their experiences in hospital.Conclusion
The experience of medical intervention in childbirth is routinely oriented to as a matter that requires explanation or account in online birth narratives. Women repeatedly referred to their preference to avoid intervention, but described being unable to do so in hospital. 相似文献15.
Linda Sweet Janice Bass Mary Sidebotham Jennifer Fenwick Kristen Graham 《Women and birth : journal of the Australian College of Midwives》2019,32(2):119-126
Background
Practice-based or clinical placements are highly valued for linking theory to practice and enabling students to meet graduate outcomes and industry standards. Post-practicum, the period immediately following clinical experiences, is a time when students have an opportunity to share, compare and engage critically in considering how these experiences impact on their learning. Reflective practice has merit in facilitating this process.Aim
This project aimed to optimise the learning potential of practice-based experiences by enhancing midwifery students’ capacity for reflective practice through writing.Methods
Design-based research was used to implement an educational intervention aimed at developing reflective practice skills and enhance reflective writing. The Bass Model of Holistic Reflection was introduced to promote the development of reflective capacity in midwifery students. Academics and midwifery students were provided with guidance and resources on how to apply the model to guide reflective writing. Students’ written reflections completed before (n = 130) and after the introduction of the intervention (n = 96) were evaluated using a scoring framework designed to assess sequential development of reflective capacity.Findings
The pre-intervention scores ranked poorly as evidence of reflective capacity. All scores improved post-intervention.Conclusions
The introduction of a holistic structured model of reflection resulted in improved scores across all five components of reflective writing; self-awareness, sources of knowledge, reflection and critical reflection, evidence informed practice and critical thinking. While further work is required the results show that the implementation process and use of the Bass Model enables students to demonstrate their capacity to reflect-on-practice through their writing. 相似文献16.
Kiri A. Latuskie Naomi C.Z. Andrews Mary Motz Tom Leibson Zubin Austin Shinya Ito Debra J. Pepler 《Women and birth : journal of the Australian College of Midwives》2019,32(1):e57-e64
Background
Substance use during pregnancy is a major public health concern, stemming from potential physical and psychosocial harms to both the mother and child.Purpose
To understand women’s experiences using substances during pregnancy and the reasons that women continue and/or discontinue using substances.Methods
Focus groups were conducted with women who attended an early intervention program for pregnant or parenting women with substance use issues.Results
Women identified that external and internal stressors, feelings of guilt and low-self efficacy, and a lack of understanding of the scientific and medical consequences of substance use contributed to their continued substance use. Conversely, women highlighted the importance of high self-efficacy and the quality of relationships when trying to make positive changes to their substance use during pregnancy.Conclusions
Recommendations are proposed for easier access to and more comprehensive services. Healthcare professionals and service providers should offer non-judgmental care by building high-quality relationships with pregnant women with substance use issues, to increase these women’s self-efficacy and empower them to discontinue substance use. 相似文献17.
Bridget Roache Jennifer Kelly 《Women and birth : journal of the Australian College of Midwives》2018,31(3):e216-e221
Background
Priorities of the National Maternity Services Plan (NMSP) are a significant contrast to current standard hospital maternity service provision. This paper demonstrates the applicability of case study methods to explore the views of midwives during a period of midwifery reform.Aim
This research aims to highlight key findings and insights surrounding recommended changes facing midwives that can be shared with education providers to incorporate strategies into education programs to ensure contemporary midwifery practice.Methods
Exploratory Case Study methodology was employed using ethical processes and designing semi-structured interview questions to explore participants’ views. Purposive sampling ensured participants were currently practicing midwives in order to reflect the perspective and intent of this study. Data were analysed and findings presented in categories and subcategories.Results
Case Study methodology enables an in-depth understanding of a phenomenon to be explored within a natural context. The participants of this study formed a single unit of analysis to ensure the research makes a worthwhile contribution to the profession of midwifery.Conclusion
This paper demonstrates that Case Study methodology is a valid research approach to exploring the views of midwives employed in standard care settings during a period of national reform. The rigorous processes and versatility of Case Study methodology ensured a systematic, critical enquiry was undertaken to gain understanding of the views of participants in implementing the NMSP. This understanding is reflective of the real life contexts of midwives to promote understanding and provide a body of knowledge where there is ambiguity and uncertainty. 相似文献18.
Rima Kaddoura Jocelyn DeJong Huda Zurayk Tamar Kabakian Christine Abbyad Fadi G. Mirza 《Women and birth : journal of the Australian College of Midwives》2019,32(2):e223-e228
Problem
There is lack of data on the rate of episiotomy in Lebanon and the study’s hospital.Background
Only a few studies have addressed episiotomy practice in Lebanon and the Middle East and they show varying rates.Aim
To identify the rate, and change in rate, of episiotomy practice over the years at a teaching hospital in Lebanon and to assess whether maternal age, parity, fetal weight, woman’s hospital admission class, and physician’s gender were associated with episiotomy. We also tested the association between episiotomy and postpartum hemorrhage and/or high degree perineal tears.Methods
A retrospective observational study was conducted on 1756 records for women having a normal vaginal birth at a single centre from January 2009 to January 2014.Findings
The rate of episiotomy at the hospital was very high, with 97.4% of women receiving an episiotomy in 2009. A major decrease in the rate was identified with a decline from 97.4% in 2009 to 73.3% in January 2014. Episiotomy was found to be associated with parity, maternal age, and with high degree perineal tears.Discussion
The episiotomy rate at this centre remains higher than the 10% rate recommended by the World Health Organization, although there has been a significant reduction after a call for restrictive rather than liberal use.Conclusion
Raising awareness among providers appeared to play a significant role in reducing this rate, although more efforts remain warranted. Other strategies – such as raising awareness of women about potential risks of episiotomy – are also worth exploring. 相似文献19.
Patricia M. Corcoran Christine Catling Caroline S.E. Homer 《Women and birth : journal of the Australian College of Midwives》2017,30(1):77-86
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.Aim
To undertake a review of qualitative studies of midwifery models of care for Indigenous women and babies evaluating the different types of services available and the experiences of women and midwives.Methods
A meta-synthesis was undertaken to examine all relevant qualitative studies. The literature search was limited to English-language published literature from 2000–2014. Nine qualitative studies met the inclusion criteria and literature appraisal – six from Australia and three from Canada. These articles were analysed for coding and theme development.Findings
The major themes were valuing continuity of care, managing structural issues, having negative experiences with mainstream services and recognising success.Discussion
The most positive experiences for women were found with the services that provided continuity of care, had strong community links and were controlled by Indigenous communities. Overall, the experience of the midwifery services for Indigenous women was valuable. Despite this, there were still barriers preventing the provision of intrapartum midwifery care in remote areas.Conclusion
The expansion of midwifery models of care for Indigenous women and babies could be beneficial in order to improve cultural safety, experiences and outcomes in relation to pregnancy and birth. 相似文献20.
Ans Luyben Mary Barger Melissa Avery Kuldip Kaur Bharj Rhona O’Connell Valerie Fleming Joyce Thompson Della Sherratt 《Women and birth : journal of the Australian College of Midwives》2017,30(3):184-192