Shared learning on an international clinical placement: Promoting symbiotic midwifery practice knowledge

AimThe aim of this study was to explore the experiences of shared learning between Australian and Balinese midwifery students during a two-week clinical placement in Bali Indonesia.BackgroundCultural safety in midwifery is a key concept that is underpinned by the provision of holistic quality midwifery care to all women. Therefore, culturally safe midwifery care identifies, protects and promotes women’s individual cultures and is a key concept that is fostered in midwifery education. To educate culturally safe midwives, international placements to resource limited countries have become more common within midwifery education programs.MethodsThis study used a qualitative research design with a convenience sampling design. The participants were enrolled in midwifery courses in a University in the Northern Territory of Australia (n = 9), a Balinese private midwifery school (n = 4) and a Balinese public midwifery school (n = 4). Thematic analysis was used to analyse the data.FindingsThe findings were categorised into major themes under the headings of “Learning together despite differences”; “Cultural differences”, “Communication, Resources”, and “Recommendations for future placements”.ConclusionThis study provides a valuable insight into how shared learning increases students’ midwifery knowledge and is fundamental in understanding cultural differences that could be applied to students’ clinical midwifery practice.     

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.     

Barriers to delivering quality midwifery education programmes in the Democratic Republic of Congo — An interview study with educators and clinical preceptors

BackgroundIn the Democratic Republic of Congo, the education of midwives at a higher education level has recently been introduced as a strategy to improve maternal and neonatal health. However, little is known about the preconditions for such an education.AimTo explore the barriers to delivering high-quality midwifery education programmes in the DRC and reflect on potential areas for improvement.MethodData was collected through 14 focus group discussions with 85 midwifery educators and clinical preceptors, at four higher education institutions delivering midwifery education programmes. Transcribed discussions were inductively analysed using content analysis.FindingsOverall, the teaching environment was insufficient. Most midwifery educators and clinical preceptors had deficient competencies, and there was a shortage of didactic resources and equipment as well as poor communication routines between the education institutions and clinical education sites. The barriers varied between locations; for instance, the institution in the country’s capital was overall well equipped.ConclusionThe identified barriers constitute major risks undermining the quality of future midwives in the DRC. Reforming the education of midwives, together with general higher education reform, will be critical for achieving the Sustainable Development Goal on health in the country. We therefore suggest that (i) midwifery educators have at least one academic level above the programme in which they teach, (ii) continuing education be available for midwifery educators and clinical preceptors, (iii) education institutes and clinical sites are fit for purpose, and (vi) routines for clear communication links between education and clinical sites be used.     

Is it possible to incorporate evidence-based professional midwifery practices into public health services in Mexico?

Problem and backgroundDuring the past two decades, Mexico has launched innovative maternal health initiatives to improve maternal and neonatal outcomes, placing emphasis on the incorporation of professional midwifery practices into the healthcare system. This study explored the perceptions of healthcare providers and women using public birth care services regarding professional midwifery practices and how can the inclusion of evidence-based midwifery techniques improve the quality of service.MethodologyWe conducted a qualitative, cross-sectional study of three healthcare networks in Mexico. A content analysis was performed of data collected through 109 semi-structured interviews: 72 with healthcare providers and 37 with women.ResultsHealthcare providers and women had minimal knowledge of the competencies and skills of professional midwives. Medical personnel accepted the incorporation of some evidence-based midwifery practices. Women had experienced fear and anguish during childbirth so they considered that incorporating professional midwifery practices into maternal health services would be favourable in that it would render birth care more respectful.Discussion and conclusionsHealthcare providers are willing to consider the inclusion of some evidence-based midwifery practices in health services and regard assistance from professional midwives. They believe that structural conditions will complicate their incorporation. Although the women interviewed had experienced fear, anxiety and loneliness during childbirth, most of them admitted to feeling “safer” in a hospital (secondary-care health centre) setting where possible complications could be resolved. This perception of safety served to justify the delivery of healthcare in a manner that is inattentive to women’s needs, which go beyond biomedical issues and include emotions and the positive experience of childbirth.     

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.     

How a perineal care bundle impacts midwifery practice in Australian maternity hospitals: A critical,reflexive thematic analysis

BackgroundA care bundle to reduce severe perineal trauma (the bundle) was introduced in 28 Australian maternity hospitals in 2018. The bundle includes five components of which only one – warm perineal compresses – has highest level evidence. There is scant published research about the impact of implementation of perineal bundles.QuestionHow does a perineal care bundle impact midwifery practice in Australian maternity hospitals?MethodsPurposively sampled midwives who worked in hospitals where the bundle had been implemented. Interested midwives were recruited to participate in one-to-one, semi-structured interviews. The researchers conducted critical, reflexive thematic analysis informed by Foucauldian concepts of power.FindingsWe interviewed 12 midwives from five hospitals in one state of Australia. Participants varied by age, clinical role, experience, and education. Three themes were generated: 1) bundle design and implementation 2) changing midwifery practice: obedience, subversion, and compliance; and 3) obstetric dominance and midwifery submission.DiscussionThe bundle exemplifies tensions between obstetric and midwifery constructs of safety in normal birth. Participants’ responses appear consistent with oppressed group behaviour previously reported in nurses and midwives. Women expect midwives to facilitate maternal autonomy yet decision-making in maternity care is commonly geared towards obtaining consent. In our study midwives encouraged women to consent or decline depending on their personal preferences.ConclusionThe introduction of the perineal bundle acts as an exemplar of obstetric dominance in Australian maternity care. We recommend midwives advocate autonomy – women’s and their own – by using clinical judgement, evidence, and woman-centred care.     

The experiences of Aboriginal and Torres Strait Islander Bachelor of Midwifery students: An integrative literature review

IssueThere is an underrepresentation of Aboriginal and Torres Strait Islander midwives across Australia and an inadequate number of graduating midwives to redress this. A major pillar for the Birthing on Country Model is maternity care workforce development.AimThe purpose of this review is to examine the enablers and barriers that Aboriginal students experience while undertaking the Bachelor of Midwifery degree in Australia.MethodsA search of the literature was undertaken through electronic databases. When only three papers were found looking at the experiences of Aboriginal midwifery students the search was broadened to include Aboriginal undergraduate health students.FindingsThe literature review reported a strong need for cultural safety in both the clinical and education systems. Students with access to cultural supports, relationships with Aboriginal mentors and academics and Aboriginal clinical placements felt empowered and were able to navigate the ‘two worlds’ in a meaningful way.DiscussionThis review highlights a significant gap in the literature. Despite the expanded search terms to include Aboriginal health students, a relatively narrow range of papers were found. Interestingly, the combined search revealed similar themes: kinship, personal factors, and cultural issues.ConclusionEmpowering and supporting Aboriginal Peoples to become midwives is essential. While systems and societies aim for cultural safety, this review shows there is still a way to go. Further research is essential to decolonise higher education and health care systems, and provide strong, well supported pathways for Aboriginal midwifery students.     

A complex and demanding situation – Midwifery preceptors and midwifery students’ experiences of teaching and learning prevention of severe perineal trauma

BackgroundMany high-income countries have seen an increase in severe perineal trauma. Teaching strategies and conditions for learning during the active second stage of labour are scarcely described.AimTo describe midwifery preceptors and midwifery students’ experiences’ of teaching and learning how to manage the second stage of labour, with the specific aim of preventing severe perineal trauma.MethodsA qualitative study with focus group discussions and individual in depth-interviews with preceptor midwives (n = 23) and student midwives (n = 10). Data were analysed by qualitative content analysis.Results“A complex and demanding situation with mutual need for feedback, reflection and safety” was the overall theme describing the conditions. Three sub-themes were identified. “Adapting to a unique situation” refers to the difficulty of teaching and learning the aspects needed to prevent severe perineal trauma, and to provide care during this stage. “Hindering and limiting circumstances” describes teaching strategies that were perceived negatively, and how midwifery students tried to adapt to the preceptors rather than the birthing women. “A trustful and communicative relationship” describes the importance of the relationship between the student and the preceptor, where communication was a central, but not obvious part.ConclusionAn increased awareness among preceptors is needed to optimize teaching strategies, enabling the students to focus on learning the art of the second stage of labour; supporting the woman, preventing severe perineal trauma and ensuring the safety of the unborn baby. Future research should address how existing prevention models can include training to increase preceptors’ confidence in teaching.     

Facilitators of and barriers to providing high-quality midwifery education in South-East Asia—An integrative review

BackgroundWith a diversity in midwifery education across the South-East Asia region, and with the knowledge about the lifesaving competency of the midwife profession, this study’s aim is to describe facilitators of and barriers to providing high-quality midwifery education in South-East Asia.MethodsInspired by Whittemore and Knafl, we conducted a systematic integrative literature review including the five key stages of problem identification, literature search, data evaluation, data analysis, and presentation of results. The literature searches were conducted in October 2020 in the databases CINAHL, PubMed, and Scopus. A deductive data analysis based on global standards was performed.ResultsThe search identified 1257 articles, 34 of which were included. Countries in South-East Asia did not fully comply with the ICM global standards. Midwifery education was not separated from that of nursing, and educators lacked formal qualifications in midwifery. Curriculum implementation in the clinical area was a key barrier to achieving learning outcomes. Higher academic education for midwifery educators and mentorship programs facilitated the pedagogic and assessment process, focusing on the abilities of critical thinking, reflection, and decision-making.ConclusionsCountries in South-East Asia still have a long way to go before they can provide high-quality midwifery education. The identified facilitators can lead to a difference in students’ academic achievement and confidence in their clinical work. Coordinated actions will enable the progress in achieving competent midwives matching national health priorities. The findings highlight a need for more research on midwifery education in both theory and practice across the region.     

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.     

Acknowledging the primacy of continuity of care experiences in midwifery education

BackgroundContinuity of midwifery care is the best maternity care model for women at any risk level, and there is a global imperative to improve access to midwifery-led care. However, diverse perspectives about how best to prepare graduates for working in midwifery continuity of care models persist. The continuity of care experience standard in Australia was anticipated to address this.AimTo challenge the dearth of published information about the structures and processes in midwifery education programs by identifying: the educational value and pedagogical intent of the continuity of care experience; issues with the implementation, completion and assessment of learning associated with continuity of care experience; and discuss curriculum models that facilitate optimal learning outcomes associated with this experience. We discuss the primacy of continuity of care experience in midwifery education programs in Australia.DiscussionThe inclusion of continuity of care experience in midwifery programs in Australia became mandatory in 2010 requiring 20, however this number was reduced to 10 in 2014. Research has shown the beneficial outcomes of continuity of care experience to both students and women. Continuity of care experience builds mutual support and nurturing between women and students, fosters clinical confidence, resilience, and influences career goals. We require curriculum coherence with both structural and conceptual elements focusing on continuity of care experience.Implications and recommendationsEducation standards that preference continuity of care experience as the optimal clinical education model with measurable learning outcomes, and alignment to a whole of program philosophy and program learning outcomes is required.