'Keeping birth normal': Exploratory evaluation of a training package for midwives in an inner-city, alongside midwifery unit

A postgraduate Optimum Birth module to increase midwives' readiness to work in midwifery-led settings: A mixed-methods evaluation

BACKGROUND

Midwifery-led birth settings have been recommended as the most cost-effective birthplaces for healthy women experiencing uncomplicated pregnancies. However, midwives complete most of their training in obstetric units where birth interventions are common. To prepare for working in a midwifery-led setting training is a key priority. This study evaluated a postgraduate-level midwifery module on Optimum Birth (defined as birth which supports physiology and empowerment, avoiding unnecessary intervention) designed to prepare midwives for supporting women in midwifery-led settings.

METHODS

A mixed-methods design was employed. Pre-module and post-module questionnaires measured attitudes, knowledge, confidence, and learning outcomes. Qualitative data collection included a final-day focus group and 8- to 10-week follow-up interviews. The target for recruitment was 15 postgraduate midwives. Fifteen midwives practicing in three London boroughs enrolled of whom 14 completed the module. Pre-total and post-total scores were analyzed with paired-sample t tests. Qualitative data were analyzed using thematic analysis.

RESULTS

Quantitative and qualitative data indicated that the module increased participants' self-reported skills, knowledge, and confidence in practicing Optimum Birth. Qualitative data indicated ways in which midwives were implementing changes to promote Optimum Birth in their place of work. Attitudes were highly positive pre-module and post-module.

CONCLUSIONS

The Optimum Birth module provided appropriate training for preparing midwives for the shift toward working in midwifery-led settings. Midwifery leaders and managers should implement strategies to develop midwives' philosophy, knowledge, and skills to increase their readiness to work in midwifery-led birth settings.

The midwifery-led care model: a continuity of care model in the birth path

BACKGROUND AND AIM OF THE STUDY

The birth path is affected by a fragmentation in the patient care process, creating a discontinuity of this last one. The pregnant woman has to interface with many professionals, both during the pregnancy, the childbirth and the puerperium. However, during the last ten years, there has been an increasing of the pregnancy care operated by the midwife, who is considered to be the operator with the right competences, who can take care of every pregnancy and may avail herself of other professionals' contributions in order to improve the outcomes of maternal and neonatal health.

AIM

To verify whether there are proofs of effectiveness that support the caseload midwifery care model, and if it is possible to apply this model in the birth path in Italy.

METHODS

A revision of literature has been done using some search engine (Google, Bing) and specific databases (MEDLINE, CINAHL, Embase, Home - ClinicalTrials.gov). There has also been a consultation of the Italian regulations, the national guidelines and the recommendations of WHO.

RESULTS

The search string, properly adapted to the three databases, has given the following results: MEDLINE 64 articles, CINAHL 94 articles, Embase 88 articles. From this selection, 14 articles have been extracted: 1 systematic review, 3 controlled random trial, 7 observational studies, 3 qualitative studies.

CONCLUSIONS

The caseload midwifery care seems to be an effective and reliable organisational/caring method. It responds to the criterions of quality and security, to the needs of women not only during the pregnancy but also during the post-partum phase. For these reasons, it seems very useful also for the birth path in the Italian reality.