Urgency to build a connection: Midwives’ experiences of being ‘with woman’ in a model where midwives are unknown

Advanced midwifery practice: A scoping review

PROBLEM

There is no international standard for advanced midwifery scope of practice.

BACKGROUND

Globally, there is variance in how scope of midwifery practice is determined and regulated, with no consensus on extended or advanced scope. This can lead to under-utilised staff potential, un-met consumer need, and loss of professional skill.

AIMS

The aim of this scoping review was to synthesise and map what is reported in the international literature on the advanced scope of midwifery practice.

METHODS

A systematic scoping review methodology was adopted utilising Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A full search was conducted of databases including MEDLINE, CINAHL, Scopus, Google. Publications from 2019 to August 2022 that met criteria were included. Reported skills were mapped to the International Confederation of Midwives (ICM) competencies of pre-conception, antenatal, labour and birth, postnatal plus globally identified areas for midwifery investment.

FINDINGS

28 articles met inclusion criteria. Reported skills included abortion care (n = 6), prescribing (n = 7), ultrasound (n = 2), advanced practice skills (n = 7), midwifery-led skills, primary health, post-graduate education, HIV/AIDS testing, advocacy, and acupressure (all n = 1).

DISCUSSION

This review presents a synopsis of publications describing what has been defined as advanced midwifery scope of practice in international contexts.

CONCLUSION

Establishing evidence of midwives working to the peak of professional scope is important to continue to develop professional capacity and support contemporary practice, regulation, governance, and policy while improving consumer access to equitable care. Findings aid service development, provision, and professional planning.

The role and scope of contemporary midwifery practice in Australia: A scoping review of the literature

PROBLEM

Little is known about the breadth of midwifery scope within Australia, and few midwives work to their full scope of practice.

BACKGROUND

Midwives in Australia are educated and professionally accountable to work in partnership with childbearing women and their families, yet they are currently hindered from practicing within their full scope of practice by contextual influences.

AIMS

To perform a scoping review of the literature to map out the role and scope of contemporary midwifery practice in Australia To identify any key issues that impact upon working within the full scope of midwifery practice in the Australian context METHODS: A scoping review of the literature guided by the Arksey and O'Malley's five-stage methodological framework, and the 'best fit' framework synthesis using the Nursing and Midwifery Board of Australia's Midwifery Standards for Practice.

FINDINGS

Key themes that emerged from the review included Partnership with women; The professional role of the midwife; and Contextual influences upon midwifery practice.Discussion Tensions were identified between the midwifery scope of practice associated with optimal outcomes for women and babies supported by current evidence and the actual role and scope of most midwives employed in models of care in the current Australian public healthcare system.

CONCLUSIONS

There is a mismatch between the operational parameters for midwifery practice in Australia and the evidence-based models of continuity of midwifery carer that are associated with optimal outcomes for childbearing women and babies and the midwives themselves.

Making sense of adaptive expertise for frontline clinical educators: a scoping review of definitions and strategies

Adaptive expertise has been promoted as an emerging model of expertise in health professions education in response to the inherent complexities of patient care; however, as the concept increasingly influences the structure of professional training and practice, it creates the potential for misunderstandings of the definition and implications of adaptive expertise. To foster a common understanding of the concept, we conducted a scoping review to explore how adaptive expertise has been discussed within health professions education literature. Five databases-MedLine, PubMed, ERIC, CINAHL, and PsycINFO-were searched using the exact term "adaptive expertise", producing 212 unique articles. Fifty-eight articles met inclusion criteria. In the included articles, authors discussed the conceptual implications of adaptive expertise for health professions education, strategies for training for adaptive expertise, and research findings aimed at supporting the development of adaptive expertise or utilizing adaptive expertise as a theoretical framework. The goal of this scoping review is to establish a resource for frontline educators tasked with fostering the development of adaptive expertise in learners through education initiatives. A common understanding of adaptive expertise is essential to ensuring effective implementation in training programs.

An integrative review of supportive relationships between child-bearing women and midwives

AIMS

To review and evaluate the literature on the factors related to developing supportive relationships between women and midwives, including facilitators and barriers.

DESIGN

An integrative review.

METHOD

The search used CINAHL, MEDLINE, Embase, EMcare, Maternity and Infant Care, PsycINFO, and Google Scholar from January 2009-June 2020. Two reviewers screened the eligible studies, and 2,399 records were identified. Quality was assessed with the mixed methods appraisal tool, and 14 articles were included.

RESULTS

The findings highlight that successful relationships require therapeutic communication, trust, respect, partnership, and shared decision-making. Supportive relationships improve women's satisfaction and birth outcomes, and continuity of care model is an enabling factor. Further research is required to understand supportive relationships in non-continuity of care models and when different cultural backgrounds exist.

A systematic integrative literature review of the factors influencing the professionalization of midwifery in the last decade (2009-2019)

BACKGROUND

The professionalization of midwifery is not only important for midwives themselves, but for women and society in general since professionalism is associated with high-quality services and moral and ethical standards.

AIM

This systematic integrative literature review seeks to investigate the factors that have affected the professionalization of midwifery in the last decade (2009-2019).

METHODS

Systematic searches were conducted in EBSCO, PubMed, ScienceDirect, SAGE and the Web of Science Core Collection. Critical appraisal was conducted using the Mixed Methods Appraisal Tool (MMAT). The findings were synthesised through a thematic analysis. The PRISMA statement was used to guide the reporting.

FINDINGS

Analysis of the 20 studies included detected two main themes: professionalization barriers and professionalization opportunities. The first theme includes issues concerning power imbalance, social recognition, conflicting perspectives on childbirth, professional autonomy, work characteristics, midwifery associations, and regulation. The second theme includes opportunity issues related to woman-centred care, expansion of professional competency, interprofessional collaboration, and education.

KEY CONCLUSIONS

Over the last decade, the midwifery profession has faced several barriers that seem to be historically entrenched in the professionalization of midwifery, yet changes in the professionalization process are visible in the shift towards elements of the 'new professionalism' that is rising to the surface during this process.

IMPLICATIONS FOR PRACTICE

The findings suggest the socialisation process of midwifery candidates must focus on raising their self-awareness, self-esteem and confidence in their professional role; woman-centred care needs to be further promoted and implemented; and interprofessional collaboration should be addressed in educational programmes for all health professionals.

Client experiences of expertise in midwifery care in New Brunswick, Canada

OBJECTIVE

This study contextualizes client experiences of midwifery in New Brunswick within the broader literature on midwifery in Canada and contributes to understandings of how midwifery care fits into the landscape of reproductive healthcare in the province.

DESIGN

Semi structured interviews with 32 clients and supportive others of the New Brunswick midwifery program were carried out in 2019 and 2020, and transcripts were analysed using general thematic analysis.

SETTING

N New Brunswick, Canada PARTICIPANTS: Clients of midwifery care provided by the Fredericton Midwifery Centre, as well as their supportive others (partners and spouses, family members, friends) FINDINGS: Participants in this study reported a high degree of satisfaction with midwifery services and identified several approaches to practice that they felt contributed to high quality midwifery care. These include competence and expertise, time and access as abundance rather than scarcity, attention to the familial context, trauma informed care and attention to mental and emotional health, postpartum care, and supporting agency and autonomy. In short, participants' responses indicate that midwifery care in New Brunswick meets the criteria for respectful maternity care, as outlined by Shakibazadeh et al. (Shakibazadeh et al., 2018) and Butler et al. (Butler et al., 2020). Our findings are in line with research on midwifery care in other settings, although there is a significant emphasis on the medical expertise and training of midwives amongst our participants which is less evident in the scholarly literature.

KEY CONCLUSIONS

In a province where reproductive health care has been systematically underfunded, clients celebrate the expertise and competence of midwives, challenging the narrative which constructs midwifery as 'traditional' care, and hospital-based obstetrics as expert care. Instead, midwives are recognized as highly specialized evidence-based practitioners, and this is particularly prized by clients in relation to processes of information sharing.

Providing woman-centred care in complex pregnancy situations

OBJECTIVE

Midwifery philosophy and practice is grounded in providing woman-centred care. The available evidence was reviewed to better understand how to provide Woman-centred midwifery care in complex pregnancy situations. Complexity in this context is defined as psychosocial or biomedical risk factors that place the mother and/or her baby at increased risk for adverse outcomes.

DESIGN

A comprehensive integrative review was undertaken to identify peer reviewed research in English over the last 5 years. The quality of the studies was assessed using the Critical Appraisal Skills Programme Tool.

SETTING/PARTICIPANTS

Published studies which discussed enablers and barriers to woman-centred care for pregnant women with complex needs. 13 papers met the inclusion criteria for this review.

FINDINGS

This review identifies that Organisational and Professional power differentials create barriers to woman-centred care and provoke professional boundary tensions. For a woman with a complex pregnancy, this places her at risk for 'falling through the gaps' between maternity services, models of care and health providers.

KEY CONCLUSIONS

Women, birth and midwifery care are still largely constrained within a biomedical model of maternity care. Whilst barriers to woman-centred care have been identified, for women with complexity in pregnancy there appear to be few solutions when care requires multi-specialist input and crossing the boundaries and silos of healthcare.

Parturescence: A theorisation of women's transformation through childbirth

PROBLEM

The potential for positive transformation through giving birth is under-acknowledged and poorly understood.

AIM AND METHOD

By drawing on theories of new feminist materialism to open up ways of thinking about childbirth and maternity care, we discuss how aspects of the process of matrescence, a woman's 'mother-becoming', pertain to women's opportunities in childbirth. We introduce the term, 'parturescence', as a moniker for the opportunity for 'becoming', and therefore transformation, offered in birth giving.

RESULTS AND DISCUSSION

Using Davies' interpretation of Bergson's lines of descent and ascent we suggest the conditions of a woman's parturescence (whether birth giving will result in a positive or negative transformation) is enabled by 'with woman' midwifery care. The intra-action between this care, and the materiality of birth - the pain and exhaustion women experience in labour and birth, results in a rematerialisation of who and what women are and the opportunity for women's transformation.

CONCLUSION

The development of this theory of parturescence unifies disparate aspects of maternity care and birth literature, provides insight into the potential mechanisms and conditions that impact women's parturescence, and suggests that birth, including the challenging and destabilising parts, is not just for the production of a baby, but also a site of women's 'becoming'.

Midwives' experiences of learning and teaching being 'with woman': A descriptive phenomenological study

Being 'with woman' is a fundamental concept of midwifery philosophy. Minimal evidence explicates ways this important construct is learned or taught. This paper reflects one part of a larger study and explored midwives' experiences of learning and teaching related to the phenomenon of being 'with woman'. Using a descriptive phenomenological approach, 31 midwives working in a variety of models in Western Australia were interviewed to explore the phenomenon of being 'with woman'. Rich descriptions of how midwives learned and taught others to be 'with woman' were obtained. Descriptive phenomenology is useful in revealing features of the phenomenon through description of lived experiences of purposively sampled participants. Giorgi's method was used to analyse data from the two main interview questions. The themes for learning to be 'with woman' were observing midwives; inspirational leaders; learning from the women; a variety of experiences enhances learning; and, develops over time. The themes for teaching being 'with woman' were, approaches for teaching; teaching is implicit; reliance on observation, comprehension and assimilation. Insights into the learning and teaching of practices supported by professional philosophy offer educators and leaders new knowledge and ways to enhance the transfer of knowledge and skills of being 'with woman'.

Midwives' perceptions of being 'with woman': a phenomenological study

BACKGROUND

Being 'with woman' is a central construct of the midwifery profession however, minimal research has been undertaken to explore the phenomenon from the perspective of midwives. The aim of this study was to describe Western Australian midwives' perceptions of the phenomenon of being 'with woman' during the intrapartum period.

METHODS

Descriptive phenomenology was selected as the methodology for this study. Thirty one midwives working across a variety of care models participated in individual interviews. Giorgi's four stage phenomenological approach was employed to analyse data.

RESULTS

Three themes were extracted 1) Essential to professional identity; 2) Partnership with women; and 3) Woman-Centred Practice. Midwives described the importance of being 'with woman' to the work and identification of midwifery practice. Developing a connection with the woman and providing woman-centred care inclusive of the woman's support people was highlighted.

CONCLUSIONS

For the first time, we are able to offer evidence of how midwives understand and perceive the phenomenon of being 'with woman' which has theoretical and practical utility. Findings from this study provide evidence that supports expert commentary and confirms that midwives conceptualise the phenomenon of being 'with woman' as essential to the identity and practice of the profession. Some previously identified 'good midwifery practices' were revealed as practical manifestations of the phenomenon. This new knowledge facilitates clarity and provides evidence to support statements of professional identity, which is useful for the development of educational curricula as well as supporting graduate and professional midwives. The findings emphasise the importance of the development of language around this important philosophical construct which permeates midwifery practice, enhances professional agency and supports the continued emphasis of being 'with woman' with new understanding of its applied practices in a variety of care models.

"It's what midwifery is all about": Western Australian midwives' experiences of being 'with woman' during labour and birth in the known midwife model

Background

The phenomenon of being ‘with woman’ is fundamental to midwifery as it underpins its philosophy, relationships and practices. There is an identified gap in knowledge around the ‘with woman’ phenomenon from the perspective of midwives providing care in a variety of contexts. As such, the aim of this study was to explore the experiences of being ‘with woman’ during labour and birth from the perspective of midwives’ working in a model where care is provided by a known midwife.

Methods

A descriptive phenomenological design was employed with ten midwives working in a ‘known midwife’ model who described their experiences of being ‘with woman’ during labour and birth. The method was informed by Husserlian philosophy which seeks to explore the same phenomenon through rich descriptions by individuals revealing commonalities of the experience.

Results

Five themes emerged 1) Building relationships; 2) Woman centred care; 3) Impact on the midwife; 4) Impact on the woman; and 5) Challenges in the Known Midwife model. Midwives emphasised the importance of trusting relationships while being ‘with woman’, confirming that this relationship extends beyond the woman – midwife relationship to include the woman’s support people and family. Being ‘with woman’ during labour and birth in the context of the relationship facilitates woman-centred care. Being ‘with woman’ influences midwives, and, it is noted, the women that midwives are working with. Finally, challenges that impact being ‘with woman’ in the known midwife model are shared by midwives.

Conclusions

Findings offer valuable insight into midwives’ experiences of being ‘with woman’ in the context of models that provide care by a known midwife. In this model, the trusting relationship is the conduit for being ‘with woman’ which influences the midwife, the profession of midwifery, as well as women and their families. Descriptions of challenges to being ‘with woman’ provide opportunities for professional development and service review. Rich descriptions from the unique voice of midwives, provided insight into the applied practices of being ‘with woman’ in a known midwife model which adds important knowledge concerning a phenomenon so deeply embedded in the philosophy and practices of the profession of midwifery.