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.     

An Australian history of the subordination of midwifery

This paper analyses the history of the subordination of midwifery to medicine and nursing. With the important exception of Evan Willis’ work on medical dominance and Annette Summers’ work on the takeover of midwifery by nursing, other histories of Australian midwifery have taken a neutral approach to issue of power and control. The aim of analysing this period is to identify the strategies of power that were used to subordinate midwifery. With increased consciousness of how power has operated in the past, midwives and woman of today can be more empowered when seeking to promote normal birth and midwifery models of care.Concepts of ‘power’, ‘the state’ and midwife are defined and discussed. A summary of the decline of midwifery and the rise of obstetrics in Europe and the United Kingdom (UK) gives a background against which to understand the Australian experience. The historical account given here draws to a climax by focussing on the period 1886–1928. It was during this time that medicine forged an alliance with nursing and achieved both legal and disciplinary control of midwifery. Knowing how this was done is important because it helps us to recognise the power strategies that are currently being used by medicine. This is helpful when planning how these strategies might be matched or countered by contemporary woman and midwives when seeking to promote normal birth and midwifery models of care.     

工作家庭平衡的结构验证及其因果分析

本文研究中国大陆已婚员工工作家庭平衡四因素的前因和结果变量。验证性因子分析的结果支持了Frone有关工作家庭平衡的四因素模型,表明工作家庭平衡是一个双重指向的(工作-家庭,家庭-工作)包括冲突和促进的四重构面概念。多元逐步回归分析结果揭示了工作家庭冲突与促进的不同形成机制,角色过载是工作家庭冲突的首要前因变量,角色投入是工作家庭促进的首要前因变量。此外,工作-家庭冲突与工作满意度和生活满意度显著负相关,家庭-工作促进与生活满意度显著正相关。     

Midwives’ views of changing to a Continuity of Midwifery Care (CMC) model in Scotland: A baseline survey

BackgroundThere is good evidence that Continuity of Midwifery Care (CMC) is associated with improved clinical outcomes, greater maternal satisfaction, and improved work experiences for midwives. Changes made to the organisation require careful implementation, with on-going evaluation to monitor progress.AimTo develop a survey tool that incorporates several validated scales, which was used to collect baseline data prior to implementing a high-quality Continuity of Midwifery Care (CMC) model in Scotland (Hewitt et al., 2019). This tool gathered data about midwives’ personal and professional wellbeing prior to service reorganisation, with a longitudinal study intended to measure change in midwives’ reportage across time. This paper reports the baseline data-collection.MethodsAn on-line survey was shared with practising midwives (n = 321) in Scotland via the NHS intranet, verbally, email, and paper. The survey elicited midwives views about Continuity of Midwifery Care (CMC); values and philosophies of care; attitudes towards their professional role; personal and professional demographics; quality of life and wellbeing. Psychometric attitudinal scales were scored and free text comments themed according to positive/negative opinions of the new Continuity of Midwifery Care (CMC) model to highlight key concerns to be addressed and identify change barriers or facilitators.FindingsThe majority of midwives indicated support for philosophies underpinning Continuity of Midwifery Care (CMC), which includes physiological birth and providing autonomous midwifery care. Participants also indicated positive attitudes towards their current role and organisation, with some worrying about how the organisation was going to implement the changes required. Worries included, receiving an overburdening workload, being deskilled in certain areas of midwifery practice, and lack of support were litigation to arise.ConclusionMidwives support the values and philosophies that underpin Continuity of Midwifery Care (CMC), yet worry about organisational change involved in evolving systems of care. Hence, management require to implement strategies to reduce fears. For example, delivering accurate and honest information, enabling midwives to plan, design and implement changes themselves, and providing emotional and material help.     

Maternal mental health and partner-delivered massage: A pilot study

BackgroundAnxiety and depression affects many pregnant women. Massage may be beneficial for supporting mental wellbeing during this time. The aim of this study was to assess the feasibility and acceptability of a partner-delivered relaxation massage program for pregnant women, and its impact on symptoms of antenatal anxiety, stress and depression.MethodsA feasibility randomised controlled trial was conducted to compare partner-delivered relaxation massage (intervention) with self-directed stress management (control). Women attended an initial workshop at 28–32 weeks gestation followed by completion of a self-directed massage or stress management program. Qualitative data about the feasibility and acceptability (primary outcomes) were collected via online participant diaries and post-birth interviews. Anxiety, depression and stress symptoms (secondary outcomes) were assessed using the Depression and Anxiety Stress Scale (DASS-21). Birth outcomes were collected at the post- birth interview.ResultsA total of 14 women/partner dyads in the massage group and 13 women in the self-directed stress management group, attended the initial workshops. When interviewed, participants from both groups reported that the programs were feasible and acceptable. Women’s mean scores on all subscales of the DASS-21significantly decreased over time in both the intervention and the control group.ConclusionPregnant women found the partner-delivered massage program to be feasible and acceptable. Both programs decreased women’s symptoms of anxiety, depression and stress with no significant differences identified between the two groups. An adequately powered experimental study with a large representative sample is needed to determine whether partner-delivered relaxation massage reduces pregnant women’s symptoms of anxiety, depression and stress.     

Validation of the MidACE tool – Students’ perceptions of the Midwifery Academic role in clinical environments

BackgroundSituating Midwifery Academics in clinical environments can have an important impact on students’ clinical learning. Students’ perceptions of this support role in the clinical environment using standardised measures has been under-investigated.AimsTo develop and test a tool that measures midwifery students’ perceptions of the Midwifery Academic role on clinical learning and development of professional knowledge, skills and clinical capability.MethodsA staged process for tool development included draft item generation, review by expert panel for face and content validity and pilot testing with a convenience sample of undergraduate midwifery students. Dimensionality, internal consistency and test–retest reliability were evaluated.ResultsTwo hundred and seventy-nine midwifery students completed an online survey (74% response rate). Responses on the ten-item tool loaded strongly on one factor, explaining 69.6% of variance. Cronbach's alpha (0.94) and test–retest reliability (intraclass coefficient = .92; 95%CI .89–.95) were good. Most students agreed that the Midwifery Academic role supported the integration of midwifery theory and practice and critical self-reflection. Areas for improvement included working in partnership with preceptors; assessing students’ development; and increased presence in the clinical environment.ConclusionsThis study established reliability and validity of the Midwifery Academic in Clinical Environments (MidACE) tool. Students perceived Midwifery Academics could contribute further to their professional knowledge, skills and clinical capability through a strong collaborative presence in the clinical environment.     

Using Rasch analysis to identify midwifery students’ learning about providing breastfeeding support

AimTo report on a study measuring midwifery students’ self-reported abilities in teaching and supervising breastfeeding mothers. Abilities were assessed at two time intervals, before and after completing a maternal and infant nutrition topic with simultaneous clinical opportunities to consolidate their skills.MethodA convenience sample of midwifery students in an Australian university completed a pre- and post-intervention survey to assess their self-rated ability to teach and supervise breastfeeding mothers. Rasch analysis was used to gain conjoint estimates of students’ self-reported abilities to teach and supervise breastfeeding mothers across 37 items with varying complexity of care needs. Rasch analysis was used to determine validity and reliability of the 37-item tool, to develop a hierarchical linear scale reflecting difficulty of breastfeeding supportive activities, and to determine student learning between the two time points.ResultsFrom 95 responses, 34 of the 37 items met the requirement for unidimensionality. Outcomes identified that midwifery students’ self-efficacy measures for breastfeeding support abilities can be reliably estimated. A hierarchical scale for learning these clinical skills has been generated to inform curricula development and learning processes. While there was an overall increase in the ease of difficulty of 21 items in the survey at time point two, eight items were identified as becoming more difficult.ConclusionThe findings of this study challenge midwifery educators to reconsider the educational activities provided for midwifery students’ that aim to develop the requisite skills to provide effective breastfeeding support, including the provision of specific clinical opportunities to learn from breastfeeding women.