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Sandra Healy Eileen Humphreys Catriona Kennedy 《Women and birth : journal of the Australian College of Midwives》2017,30(5):367-375
Background
Maternity care is facing increasing intervention and iatrogenic morbidity rates. This can be attributed, in part, to higher-risk maternity populations, but also to a risk culture in which birth is increasingly seen as abnormal. Technology and intervention are used to prevent perceived implication in adverse outcomes and litigation.Question
Does midwives’ and obstetricians’ perception of risk affect care practices for normal birth and low-risk women in labour, taking into account different settings?Methods
The research methods are developed within a qualitative framework. Data were collected using semi-structured interviews and analysed thematically. A purposive sample of 25 midwives and obstetricians were recruited from three maternity settings in Ireland. This included obstetric-led hospitals, an alongside midwifery-led unit and the community.Findings
Midwifery is assuming a peripheral position with regard to normal birth as a progressive culture of risk and medicalisation affects the provision of maternity care. This is revealed in four themes; (1) professional autonomy and hierarchy in maternity care; (2) midwifery-led care as an undervalued and unsupported aspiration; (3) a shift in focus from striving for normality to risk management; and (4) viewing pregnancy through a ‘risk-lens’.Discussion
Factors connected to the increased medicalisation of birth contribute to the lack of midwifery responsibility for low-risk women and normal birth. Midwives are resigned to the current situation and as a profession are reluctant to take action.Conclusion
Improved models of care, distinct from medical jurisdiction, are required. Midwives must take responsibility for leading change as their professional identity is in jeopardy. 相似文献3.
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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6.
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Johan Wrammert Sabitri Sapkota Kedar Baral Ashish KC Mats Målqvist Margareta Larsson 《Women and birth : journal of the Australian College of Midwives》2017,30(3):262-269
Problem
The ability of health care providers to work together is essential for favourable outcomes in neonatal resuscitation, but perceptions of such teamwork have rarely been studied in low-income settings.Background
Neonatal resuscitation is a proven intervention for reducing neonatal mortality globally, but the long-term effects of clinical training for this skill need further attention. Having an understanding of barriers to teamwork among nurse midwives can contribute to the sustainability of improved clinical practice.Aim
To explore nurse midwives’ perceptions of teamwork when caring for newborns in need of resuscitation.Methods
Nurse midwives from a tertiary-level government hospital in Nepal participated in five focus groups of between 4 and 11 participants each. Qualitative Content Analysis was used for analysis.Findings
One overarching theme emerged: looking for comprehensive guidelines and shared responsibilities in neonatal resuscitation to avoid personal blame and learn from mistakes. Participants discussed the need for protocols relating to neonatal resuscitation and the importance of shared medical responsibility, and the importance of the presence of a strong and transparent leadership.Discussion
The call for clear and comprehensive protocols relating to neonatal resuscitation corresponded with previous research from different contexts.Conclusion
Nurse midwives working at a maternity health care facility in Nepal discussed the benefits and challenges of teamwork in neonatal resuscitation. The findings suggest potential benefits can be made from clarifying guidelines and responsibilities in neonatal resuscitation. Furthermore, a structured process to deal with clinical incidents must be considered. Management must be involved in all processes. 相似文献8.
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Hlengiwe Mohale Linda Sweet Kristen Graham 《Women and birth : journal of the Australian College of Midwives》2017,30(4):298-307
Background
Increasing global migration is resulting in a culturally diverse population in the receiving countries. In Australia, it is estimated that at least four thousand Sub-Saharan African women give birth each year. To respond appropriately to the needs of these women, it is important to understand their experiences of maternity care.Objective
The study aimed to examine the maternity experiences of Sub-Saharan African women who had given birth in both Sub-Saharan Africa and in Australia.Design
Using a qualitative approach, 14 semi-structured interviews with Sub-Saharan African women now living in Australia were conducted. Data was analysed using Braun and Clark’s approach to thematic analysis.Findings
Four themes were identified; access to services including health education; birth environment and support; pain management; and perceptions of care. The participants experienced issues with access to maternity care whether they were located in Sub-Saharan Africa or Australia. The study draws on an existing conceptual framework on access to care to discuss the findings on how these women experienced maternity care.Conclusion
The study provides an understanding of Sub-Saharan African women’s experiences of maternity care across countries. The findings indicate that these women have maternity health needs shaped by their sociocultural norms and beliefs related to pregnancy and childbirth. It is therefore arguable that enhancing maternity care can be achieved by improving women’s health literacy through health education, having an affordable health care system, providing respectful and high quality midwifery care, using effective communication, and showing cultural sensitivity including family support for labouring women. 相似文献11.
Jenny S. Hall Mary Mitchell 《Women and birth : journal of the Australian College of Midwives》2017,30(3):214-219
Focus
There is currently limited information available on how midwifery students learn to provide care that promotes dignity and respect.Background
In recent years the importance of dignity in healthcare and treating people with respect has received considerable emphasis in both a national and international context.Aim
The aim of this discussion paper is to describe an educational workshop that enables learning to promote dignity and respect in maternity care.Discussion
An interactive workshop, using different creative methods as triggers for learning will be described. Provision of learning opportunities for students around dignity and respect is important to ensure appropriate care is provided in practice. The use of creative methods to inspire has contributed to deep learning within participants. An evaluation of the workshop illustrated how learning impacted on participants practice. Data to support this is presented in this paper.Conclusion
The use of creative teaching approaches in a workshop setting appears to provide an effective learning opportunity around dignified and respectful care. These workshops have evoked a deep emotional response for some participants, and facilitators must be prepared for this outcome to ensure a safe space for learning. 相似文献12.
Catherine Adams Angela Dawson Maralyn Foureur 《Women and birth : journal of the Australian College of Midwives》2017,30(2):107-113
Objective
To identify the predominant culture of an organisation which could then assess readiness for change.Design
An exploratory design using the Competing Values Framework (CVF) as a self-administered survey tool.Setting
The Maternity Unit in one Australian metropolitan tertiary referral hospital.Subjects
All 120 clinicians (100 midwives and 20 obstetricians) employed in the maternity service were invited to participate; 26% responded.Main outcome measure
The identification of the predominant culture of an organisation to assess readiness for change prior to the implementation of a new policy.Results
The predominant culture of this maternity unit, as described by those who responded to the survey, was one of hierarchy with a focus on rules and regulations and less focus on innovation, flexibility and teamwork. These results suggest that this unit did not have readiness to change.Conclusion
There is value in undertaking preparatory work to gain a better understanding of the characteristics of an organisation prior to designing and implementing change. This understanding can influence additional preliminary work that may be required to increase the readiness for change and therefore increase the opportunity for successful change. The CVF is a useful tool to identify the predominant culture and characteristics of an organisation that could influence the success of change. 相似文献13.
Magdalena Ohaja Jo Murphy-Lawless 《Women and birth : journal of the Australian College of Midwives》2017,30(4):e165-e171
Background
Despite the promotion of hospital-based maternity care as the safest option, for less developed countries, many women particularly those in the rural areas continue to patronise indigenous midwives or traditional birth attendants. Little is known about traditional birth attendants’ perspectives regarding their pregnancy and birth practices.Aim
To explore traditional birth attendants’ discourses of their pregnancy and birthing practices in southeast Nigeria.Method
Hermeneutic phenomenology guided by poststructural feminism was the methodological approach. Individual face to face semi-structured interviews were conducted with five traditional birth attendants following consent.Findings
Participants’ narratives of their pregnancy and birth practices are organised into two main themes namely: ‘knowing differently,’ and ‘making a difference.’ Their responses demonstrate evidence of expertise in sustaining normal birth, safe practice including hygiene, identifying deviation from the normal, willingness to refer women to hospital when required, and appropriate use of both traditional and western medicines. Inexpensive, culturally sensitive, and compassionate care were the attributes that differentiate traditional birth attendants’ services from hospital-based maternity care.Conclusion
The participants provided a counter-narrative to the official position in Nigeria about the space they occupy. They responded in ways that depict them as committed champions of normal birth with ability to offer comprehensive care in accordance with the individual needs of women, and respect for cultural norms. Professional midwives are therefore challenged to review their ways of practice. Emphasis should be placed on what formal healthcare providers and traditional birth attendants can learn from each other. 相似文献14.
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15.
Lena Bäck Ingegerd Hildingsson Carina Sjöqvist Annika Karlström 《Women and birth : journal of the Australian College of Midwives》2017,30(1):e32-e38
Background
Midwives have a significant impact on the clinical outcome and the birthing experience of women. However, there has been a lack of research focusing specifically on clinical midwives’ learning and development of professional competence.Aim
The objective of the study was to describe how midwives reflect on learning and the development of professional competence and confidence.Methods
A qualitative study based on focus groups with midwives employed in maternity services.Findings
Four categories describe the results: (1) Feelings of professional safety evolve over time; (2) Personal qualities affect professional development; (3) Methods for expanding knowledge and competence; and (4) Competence as developing and demanding. The meaning of competence is to feel safe and secure in their professional role. There was a link between the amount of hands-on intrapartum experience and increasing confidence that is, assisting many births made midwives feel confident. Internal rotation was disliked because the midwives felt they had less time to deepen their knowledge and develop competence in a particular field. The midwives felt they were not seen as individuals, and this system made them feel split between different assignments.Discussion
External factors that contribute to the development of knowledge and competence include the ability to practise hands-on skills in an organisation that is supportive and non-threatening. Internal factors include confidence, self-efficacy, and a curiosity for learning.Conclusions
Midwives working within an organisation should be supported to develop their professional role in order to become knowledgeable, competent and confident. 相似文献16.
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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