Midwifery education: Challenges for the future in a dynamic environment

Influence of gestational weight gain on the nutritional status of offspring at birth and at 5 years of age

OBJECTIVE

To determine the influence of pre-pregnancy maternal BMI and increases in maternal weight during pregnancy on perinatal and child outcomes at birth and at 5 years.

RESEARCH DESIGN/SETTING

A prospective cohort study was conducted between November 2016 and December 2021. The participants were a total of 115 women-child dyads, selected from among pregnant women receiving routine prenatal care in different health centres belonging to 2 health districts. Follow-ups were conducted with the women during pregnancy and with their children during the 10 days after birth and at 5 years.

FINDINGS

The total weight gain during pregnancy is influenced by an inadequate pre-pregnancy BMI (0.03; 95 % CI, 0.004 - 0.25; P=.001) and a greater increase in maternal BMI during the first and second term of pregnancy. A greater increase in BMI during pregnancy was associated with higher breastfeeding rates both in the short term (1.21; 95 % CI, 1.01-1.44; P = 0.04) and the long term (12 months: 1.30; 95 % CI, 1.02 - 1.67; P = 0.04; 24 months: 1.30; 95 % CI, 1.02 - 1.69; P = 0.04). No links were found between gains in maternal weight and the weight of the newborn, nor between maternal weight and/or pre-pregnancy BMI with the nutritional status of the child.

KEY CONCLUSIONS

After studying these results, it was concluded that promoting and implementing health and education policies focused on enhancing maternal nutritional status is essential to improve the nutritional status of children.

IMPLICATIONS FOR PRACTICE

Healthy gestational weight gain (GWG) is an important issue to be addressed by the midwife in primary care, both in the preconception period and throughout pregnancy. As a result, it is important that the midwife is trained and has the appropriate resources and tools to work with pregnant women individually and collectively. In addition to paying attention to overweight and obese pregnant women, the midwife should also pay attention to women with a normal BMI, as they seem to have greater difficulty in maintaining a healthy weight gain. Another line of intervention to be addressed is breastfeeding (BF), where the midwife should be the main point of reference from the beginning of this process, taking into account the relationship between BMI and BF.

Midwives' occupational wellbeing and its determinants. A cross-sectional study among newly qualified and experienced Dutch midwives

OBJECTIVE

Internationally, about 40 percent of midwives report symptoms of burnout, with young and inexperienced midwives being most vulnerable. There is a lack of recent research on burnout among Dutch midwives. The aim of this study was to examine the occupational wellbeing and its determinants of newly qualified and inexperienced midwives in the Netherlands. The majority of practicing Dutch midwives are aged under 40, which could lead to premature turnover.

DESIGN

A cross-sectional study was conducted using an online questionnaire that consisted of validated scales measuring job demands, job and personal resources, burnout symptoms and work engagement. The Job Demands-Resources model was used as a theoretical model.

SETTING AND PARTICIPANTS

We recruited Dutch midwives who were actually working in midwifery practice. A total of N=896 midwives participated in this study, representing 28 percent of practicing Dutch midwives.

MEASUREMENTS AND FINDINGS

Data were analysed using regression analysis. Seven percent of Dutch midwives reported burnout symptoms and 19 percent scored high on exhaustion. Determinants of burnout were all measured job demands, except for experience level. Almost 40 percent of midwives showed high work engagement; newly qualified midwives had the highest odds of high work engagement. Master's or PhD-level qualifications and employment status were associated with high work engagement. All measured resources were associated with high work engagement.

KEY CONCLUSIONS

A relatively small percentage of Dutch midwives reported burnout symptoms, the work engagement of Dutch midwives was very high. However, a relatively large number reported symptoms of exhaustion, which is concerning because of the risk of increasing cynicism levels leading to burnout. In contrast to previous international research findings, being young and having less working experience was not related to burnout symptoms of Dutch newly qualified midwives.

IMPLICATIONS FOR PRACTICE

The recognition of job and personal resources for midwives' occupational wellbeing must be considered for a sustainable midwifery workforce. Midwifery Academies need to develop personal resources of their students that will help them in future practice.

Midwifery Qualification in Selected Countries: A Rapid Review

BACKGROUND

While the global maternal mortality ratio (MMR) shows a decreasing trend, there is room for improvement. Midwifery education has been under scrutiny to ensure that graduates acquire knowledge and skills relevant to the local context.

OBJECTIVE

To review the basic professional midwifery qualification and pre-practice requirements in countries with lower MMR compared with Malaysia.

METHODS

A rapid review of country-specific Ministry of Health and Midwifery Association websites and Advanced Google using standardised key words. English-language documents reporting the qualifications of midwives or other requirements to practise midwifery from countries with a lower MMR than Malaysia were included.

RESULTS

Sixty-three documents from 35 countries were included. The minimum qualification required to become a midwife was a bachelor's degree. Most countries require registration or licensing to practise, and 35.5% have implemented preregistration national midwifery examinations. In addition, 13 countries require midwives to have nursing backgrounds.

CONCLUSION

In countries achieving better maternal outcomes than Malaysia, midwifes often have a degree or higher qualification. As such, there is a need to reinvestigate and revise the midwifery qualification requirements in Malaysia.

Comparison of midwives' self-perceived essential competencies between low and high maternal mortality ratio provinces in China

AIMS AND OBJECTIVES

To present and compare midwives' self-perceived essential competencies in regions with different maternal mortality ratios, and explore possible competency-related factors.

BACKGROUND

In China, there is an urgent need for high-quality maternal health care with equal access, as the regional disparity in the maternal mortality ratio remains a big challenge. Midwives' essential competencies refer to the minimum knowledge, skills, and professional behaviours required by midwives, and directly affect the quality of maternal care they provide. However, there is very limited literature evaluating Chinese midwives' essential competencies, especially for midwives working in regions with high maternal mortality ratios.

DESIGN

A cross-sectional survey design.

METHODS

The national cross-sectional study using an online questionnaire was conducted with a convenience sample of 2,022 midwives working in regions with different maternal mortality ratios. The STROBE guideline for cross-sectional studies was used in this study.

RESULTS

Midwives rated themselves higher on their essential competencies in intrapartum care and lower on their essential competencies in assisting or performing the operative vaginal delivery. Specifically, when compared to those from regions of low maternal mortality ratios, midwives from regions with high maternal mortality ratios reported comparatively poor self-perceived essential competencies, especially in the area of detecting and treating pregnancy and childbirth-related complications. The factors influencing midwives' self-perceived essential competencies included majors, education levels, years of experience as a midwife, participation in teaching, and access to in-service training.

CONCLUSION

In regions with high maternal mortality ratios, improving midwives' essential competencies is a key priority. Furthermore, it is recommended that midwifery education could be conducted in universities, and relevant regulations could be developed to enable midwives to provide a wider scope of care, thereby promoting the development of the midwifery workforce in China.

RELEVANCE TO CLINICAL PRACTICE

Understanding self-perceived essential competencies of Chinese midwives working in regions with different maternal mortality ratios could guide the midwifery workforce, management, especially midwives' capability building.

The initiation of Dutch newly qualified hospital-based midwives in practice, a qualitative study

In the Netherlands, a percentage of newly qualified midwives start work in maternity care as a hospital-based midwife, although prepared particularly for working autonomously in the community.

AIM

This study aimed to explore newly qualified Dutch midwives' perceptions of their job demands and resources during their initiation to hospital-based practice.

DESIGN

We conducted a qualitative study with semi structured interviews using the Job Demands-Resources model as theoretical framework.

METHODS

Twenty-one newly qualified midwives working as hospital-based midwives in the Netherlands were interviewed individually between January and July 2018. Transcripts were analyzed using thematic content analysis.

FINDINGS

High workload, becoming a team member, learning additional medical procedures and job insecurity were perceived demands. Participants experienced the variety of the work, the teamwork, social support, working with women, and employment conditions as job resources. Openness for new experiences, sociability, calmness and accuracy were experienced as personal resources, and perfectionism, self-criticism, and fear of failure as personal demands.

CONCLUSION

Initiation to hospital-based practice requires from newly qualified midwives adaptation to new tasks: working with women in medium and high-risk care, managing tasks, as well as often receiving training in additional medical skills. Sociability helps newly qualified midwives in becoming a member of a multidisciplinary team; neuroticism and perfectionism hinders them in their work. Clear expectations and a settling-in period may help newly qualified midwives to adapt to practice. The initiation phase could be better supported by preparing student midwives for working in a hospital setting and helping manage expectations about the settling-in period.

Learning experiences of final-year student midwives in labor wards: A qualitative exploratory study

INTRODUCTION

Clinical placements are an integral part of midwifery education and are crucial for achieving professional competencies. Although students' experiences on placements have been shown to play a meaningful role in their learning, they have received scant attention in the literature. The aim of this paper is to describe the learning experiences of final-year student midwives in labor wards within the Brussels metropolitan region, Belgium.

METHODS

A qualitative exploratory study was conducted using two focus groups (N=20). Data analysis included: transcription of audio recordings, thematic content analysis with coding into recurrent and common themes, and broader categories. Discussions among researchers were incorporated in all phases of the analysis for integrity and data fit.

RESULTS

Data analysis identified the following categories as determining student learning experiences in labor wards: 1) managing opportunities, 2) being supported, and 3) dealing with the environment. Overall, respondents were positive and enthusiastic about their learning experiences, although some felt tense and unprepared. Students expressed concerns about differences in learning opportunities between placements and found it challenging to achieve all competencies. Student learning experiences were enhanced when they had placements for longer periods with the same supportive mentors.

CONCLUSIONS

Factors related to students' functioning, the healthcare professional, midwifery education and hospital environment affected their learning in labor wards. The combination of a more persevered preparation of students and mentors, together with a student-centered organization of placements, is crucial to create a positive learning experience for midwifery students in labor wards.

Attitudes towards Bachelor-level education amongst Bavarian midwives: Results of a descriptive cross-sectional survey in Bavaria, Germany

INTRODUCTION

In Germany, the traditional vocational midwifery training lasts three years. This training is marked as Qualification Level 4 of the European Qualification Framework (EQF). There are very few midwives with a Bachelor degree, and an even smaller number of universities that offer a qualification program at EQF Level 6 (Bachelor). The aim of this paper is to analyze the attitude and interests of traditionally educated German midwives in undertaking a university degree.

METHODS

Midwives were surveyed within the framework of a descriptive cross-sectional study. The survey has 13 items and was available as a web-based survey between 1 November 2016 and 31 January 2017. Alternatively, the midwives were able to send a hardcopy version of the questionnaire back by mail, anonymously. Data was obtained from 534 midwives. The quantitative data were analyzed using SPSS (Version 23). The qualitative data were structurally analyzed using a qualitative content analysis.

RESULTS

It was found that 57.7% of the surveyed midwives are interested in completing a university degree, and 40.1% could imagine themselves pursuing a degree. The respondents were overwhelmingly positive in their opinion of university qualifications and qualification upgrades. Nevertheless, the open-question responses indicated that there are strong concerns surrounding the level of proficiency and experience-based knowledge taught for a university degree, which are essential elements in the traditional training system.

CONCLUSIONS

Although midwives understand the importance of a Bachelor degree, they need to be informed about the expertise and practical skills taught in the degree curriculum.