The impact of three-dimensional visualisation on midwifery students’ application of knowledge of the third stage of labour to practice: Qualitative findings of a pilot randomised controlled trial

ProblemComplex physiological processes are often difficult for midwifery students to comprehend when using traditional teaching and learning approaches. Online resources for midwifery education are limited.BackgroundFace to face instructional workshops using simulation have had some impact on improving understanding. However, in the 21st century new technologies offer the opportunity to provide alternative learning approaches. Virtual and artificial realities have been shown to increase confidence in decision making during clinical practice.AimExplore the impact of using three-dimensional (3D) visualisation in midwifery education, on student’s application, when educating women about the birth of the placenta, and membranes.MethodsFace to face individual interviews were performed, to collect deep, meaningful experiences of students, learning about the third stage of labour.FindingsPrior clinical experiences impacted on student’s ability to articulate how they would discuss birth of the placenta and membranes, and the process of haemostasis with women.DiscussionThe narrative findings of this pilot study identified ways that students traditionally learn midwifery, through theory, and clinical practice. Interview narratives illustrated how midwifery students who had previous experiences of witnessing birth, had superior ability to discuss the third stage of labour with women. While students with limited birth experiences, found the 3DMVR assisted them in their understanding of the physiology of the third stage of labour.ConclusionIn an environment of increasing technological advances, clinical placements remain an essential component of midwifery education.     

Writing for publication: the basics

PROBLEM: Most midwives and nurses do not write for publication. Previous authors on this topic have focussed on the processes of writing and getting published. Although definitive English usage style guides exist, they are infrequently consulted by new midwifery authors. PURPOSE: To enable new writers to confidently apply the basic skills of scientific writing when preparing a paper for publication. OVERVIEW: The basic skills needed for scientific writing are the focus of this paper. The importance of careful word choices is discussed first. Next, the skills of writing sentences are presented. Finally, the skills of writing paragraphs are discussed. Examples of poor and better writing are given in relation to each of these basic elements.     

A feminist history of Australian midwifery from colonisation until the 1980s

This paper uses a feminist interpretation and secondary sources to describe the history of Australian midwifery from colonisation until the 1980s. There have been too few midwife scholars who have had access to or used primary data collections to describe the role and place of midwives in the colonising community. I draw on a range of biography, medical literature and work by sociologists and economic historians to produce a limited picture of the history of professional midwifery. This helps to explain the position of midwives today and the problematic relationship we often have with medicine.     

支持资源作用下的工作-家庭促进:情感倾向的调节作用

基于组织支持理论和资源保存理论,构建了支持资源作用下的工作-家庭促进模型,通过对40家制造业企业员工的问卷调查,采用多元调节回归的方法进行统计分析。研究结果表明,支持资源作用下的工作-家庭促进对员工组织情感承诺、工作满意度和离职意向有显著影响;情感倾向对支持资源作用下的工作-家庭促进与结果变量之间的关系有调节作用。当个体的情感倾向处于积极时,由组织支持资源带来的工作-家庭促进会显著提高员工的工作满意度、组织情感承诺,降低离职意向。     

Women's expectations and experiences with labour pain in medical and midwifery models of birth in the United States

BackgroundThis research focuses on how women understand and experience labour as related to two competing views of childbirth pain. The biomedical view is that labour pain is abnormal and anaesthesia/analgesia use is encouraged to relieve the pain. The midwifery view is that pain is a normal part of labour that should be worked with instead of against.AimsTo determine differences in the preparation for and experiences with labour pain by women choosing midwives versus obstetricians.MethodsPrenatal and postpartum in-depth semi-structured interviews were conducted with a convenience sample of 80 women in Florida (United States): 40 who had chosen an obstetrician and 40 who had chosen a licensed midwife as their birth practitioner.FindingsWomen in both groups were concerned with the pain of childbirth before and after their labour experiences. Women choosing midwives discussed preparing for pain through various non-pharmaceutical coping methods, while women choosing physicians discussed pharmaceutical and non-pharmaceutical pain relief.ConclusionsEqual numbers of women expressed concerns with childbirth pain during the prenatal interviews, while more women choosing doctors spoke about pain after their births. Women had negative experiences when their planned pain relief method, either natural or medical, did not occur. The quandary facing women when it comes to labour pain relief is not choosing what they desire, but rather preparing themselves for the possibility that they may have to accept alternatives to their original preferences.     

Getting the first birth right: A retrospective study of outcomes for low-risk primiparous women receiving standard care versus midwifery model of care in the same tertiary hospital

BackgroundThere is national and international concern for increasing obstetric intervention in childbirth and rising caesarean section rates. Repeat caesarean section is a major contributing factor, making primiparous women an important target for strategies to reduce unnecessary intervention and surgeries in childbirth.AimThe aim was to compare outcomes for a cohort of low risk primiparous women who accessed a midwifery continuity model of care with those who received standard public care in the same tertiary hospital.MethodsA retrospective comparative cohort study design was implemented drawing on data from two databases held by a tertiary hospital for the period 1 January 2010 to 31 December 2011. Categorical data were analysed using the chi-squared statistic and Fisher's exact test. Continuous data were analysed using Student's t-test. Comparisons are presented using unadjusted and adjusted odds ratios, with 95% confidence intervals (CIs) and p-values with significance set at 0.05.ResultsData for 426 women experiencing continuity of midwifery care and 1220 experiencing standard public care were compared. The study found increased rates of normal vaginal birth (57.7% vs. 48.9% p = 0.002) and spontaneous vaginal birth (38% vs. 22.4% p = <0.001) and decreased rates of instrumental birth (23.5% vs. 28.5% p = 0.050) and caesarean sections (18.8% vs. 22.5% p = 0.115) in the midwifery continuity cohort. There were also fewer interventions in this group. No differences were found in neonatal outcomes.ConclusionStrategies for reducing caesarean section rates and interventions in childbirth should focus on primiparous women as a priority. This study demonstrates the effectiveness of continuity midwifery models, suggesting that this is an important strategy for improving outcomes in this population.     

Functional discomfort and a shift in midwifery paradigm

ObjectiveTo determine and critically examine maternity attitudes surrounding labour pain and how midwives can best facilitate women navigating intrapartum discomfort without relying on ‘pain-relief’ strategies or immediate recourse for analgesic assistance.ApproachThis article examines current literature using seminal research and wider international perspectives, exploring the complex and fluctuating needs of women negotiating the composite factors of labour discomfort are investigated.FindingsFactors such as birth environment, fear, midwifery presence, and self-efficacy, have a significant impact on the uptake of intrapartum analgesia. A holistic view of intrapartum discomfort is needed to shift the current paradigm of pathologising labour pain into one which situates it as a source of positive physiology and functional discomfort.ConclusionContinuing to practice with a pharmacological outlook, aiming to rid the labouring body of discomfort, is reductionist for both midwives and women. Midwives must seek to employ a new lexicon with which to communicate and facilitate women within the dynamic and continually changing territory of labour. If this conceptual shift is realised, the subsequent positive sequalae of women rediscovering their innate birthing capabilities could create a situation where birth can be considered as an aesthetic peak experience, improving satisfaction on both sides of the midwife-mother diad.     

集体土地收益权实现的现实困境与制度促进

文章结合物权权能理论,在中国现行法律框架中界定集体土地收益权及其当代价值。研究发现：集体土地收益权是集体土地所有制法律化的重要形式,存在重要的制度功能和时代价值;集体土地收益权制度的缺失,制约农村集体经济发展,影响集体分配调整功能实现和农民财产性收入增长,阻滞中国特色农村土地权利理论的发展。文章进一步研究了集体土地收益权制度改革的应然进路,探索了促进成员集体、集体成员各自集体土地收益权实现的权利制度。     

Normalisation process theory as a conceptual framework for continuity of carer implementation

ProblemDespite long standing strategic level ambitions to increase access to continuity of carer (CoC) models in maternity services, implementation of CoC in the United Kingdom (UK) has been generally small-scale and short lived. This indicates problems in implementing and sustaining CoC as the main model of care provision, and as such a need to better understand the process of implementation itself.AimTo use normalisation process theory (NPT) to underpin development of a conceptual implementation framework for CoC in order to improve understanding of the implementation process.MethodsLiterature review on CoC implementation and NPT development and use, combined with immersion in the implementation of CoC context.Results and DiscussionA conceptual framework for the implementation of CoC is developed and individual components discussed, with a view to better understanding the implementation process for CoC models. The will of a critical mass of midwives to work in a CoC model and the provision and maintenance of the ‘organisational space’ required for CoC within the National Health Service (NHS) emerge as key barriers to mainstreaming CoC in the UK.ConclusionThere is utility in NPT as a means of understanding and conceptualising large scale implementation of CoC. With testing and further development into a practical tool, the conceptual framework developed here could become a useful aid to those involved in implementing and evaluating CoC in the context of renewed strategic direction and Governmental level support in the UK.     

因势利导与自生能力:可持续基层治理创新的分析框架

基层治理创新是推进基层治理体系和治理能力现代化的重要内容。在政府因势利导和社会自生能力的分析框架中研究基层治理创新兴衰的发生机制，发现：为做出政绩，采取不符合地区要素禀赋结构的创新战略，引发创新制度的扭曲和社会自生能力的弱化，导致基层治理的恶性循环，造成创新的衰退；以人民为中心，采取符合地区要素禀赋结构的创新战略，催生新规则新制度，增强社会自生能力，促进基层治理的良性循环，推动基层治理创新的持续。面向未来的基层治理创新，必须根据未来地区要素禀赋结构和地区发展目标的变化，构建简约高效的创新体系，提高社会自生能力，营造良性创新生态。