Midwives’ responsibility with normal birth in interprofessional teams: A Swedish interview study

Midwives' experiences of professional learning when practicing collegial midwifery assistance during the active second stage of labour: data from the oneplus trial

BACKGROUND

Learning is a lifelong process and the workplace is an essential arena for professional learning. Workplace learning is particularly relevant for midwives as essential knowledge and skills are gained through clinical work. A clinical practice known as 'Collegial Midwifery Assistance' (CMA), which involves two midwives being present during the active second stage of labour, was found to reduce severe perineal trauma by 30% in the Oneplus trial. Research regarding learning associated with CMA, however, is lacking. The aim was to investigate learning experiences of primary and second midwives with varying levels of work experience when practicing CMA, and to further explore possible factors that influence their learning.

METHODS

The study uses an observational design to analyse data from the Oneplus trial. Descriptive statistics and proportions were calculated with 95% confidence intervals. Stratified univariable and multivariable logistic regression analysis were performed.

RESULTS

A total of 1430 births performed with CMA were included in the study. Less experienced primary midwives reported professional learning to a higher degree (< 2 years, 76%) than the more experienced (> 20 years, 22%). A similar but less pronounced pattern was seen for the second midwives. Duration of the intervention ≥ 15 min improved learning across groups, especially for the least experienced primary midwives. The colleague's level of experience was found to be of importance for primary midwives with less than five years' work experience, whereas for second midwives it was also important in their mid to late career. Reciprocal feedback had more impact on learning for the primary midwife than the second midwife.

CONCLUSIONS

The study provides evidence that CMA has the potential to contribute with professional learning both for primary and second midwives, for all levels of work experience. We found that factors such as the colleague's work experience, the duration of CMA and reciprocal feedback influenced learning, but the importance of these factors were different for the primary and second midwife and varied depending on the level of work experience. The findings may have implications for future implementation of CMA and can be used to guide the practice.

Navigating a maze: Midwives' identity response to the enactment of an abortion law in Chile

BACKGROUND

Chilean midwives have been identified as essential for successfully implementing an abortion law, a practice which could potentially be understood as contradicting their central mission. Nevertheless, to date, there has been no investigation into how Chilean midwives have incorporated induced abortion care provision into their professional identity.

OBJECTIVE

To elucidate how Chilean midwives understand and provide abortion care and how they have (re)defined their professional identity to include induced abortion care. This article reports the findings of the second part of this aim.

METHODS

This study was underpinned by a constructivist grounded theory methodology informed by a reproductive justice and feminist perspective. Midwives from Chile who have cared for women undergoing abortion were invited to participate in the study. After purposive and theoretical sampling, fifteen midwives were recruited.

FINDINGS

Midwives' identity is woman-centred, with high value placed on their role protecting life. These two aspects of midwives' identity are in contradiction when providing abortion care. Midwives' identity results from and informs midwives' practice. Midwifery regulation influences both practice and identity. The model 'Navigating a maze' explains the interaction of these three elements.

CONCLUSION

Midwives' identity response to the enactment of the Chilean abortion law is an example of how professional identity must navigate regulation and practice to make sense of its purpose. In light of this study's findings, the current tension experienced in midwives' identity should be carefully attended to prevent adverse outcomes for midwives and the Chilean population.

Labor unit culture and attitudes toward supporting vaginal birth-The Swedish version of the labor culture survey (S-LCS)-Psychometric properties

BACKGROUND

In order to evaluate interventions aimed at reducing cesarean births, care practitioners' attitudes are important to measure. The Labor Culture Survey (LCS) is a scale that measures individual and unit attitudes towards supporting vaginal birth. As no equivalent scale exists in Sweden, the aim was to translate, adapt, and validate the LCS and to investigate whether there were differences in attitudes toward supporting vaginal birth between maternity care practitioners.

METHODS

A cross-sectional study including midwives, physicians, and nurse assistants working with intrapartum care in five labor wards in Sweden. The original LCS was translated into Swedish, and six context-specific items were developed for the Swedish setting (SLCS). The translation was tested for face validity. Psychometric analysis was conducted using exploratory factor analysis with principal component analysis, parallel analysis, and principal axis factoring. Reliability was estimated using Cronbach's alpha. One-way ANOVA and Tukey HSD were calculated to analyze differences in attitudes between professions on the subscales of the S-LCS.

RESULTS

A total of 539 midwives, physicians, and nurse assistants participated. The final S-LCS showed a five-factor solution with the following subscales: Best Practices to reduce cesarean overuse, Unpredictability of vaginal birth, Unit Microculture, Maternal Agency, and Organizational Oversight. Chronbach alpha values varied from 0.60 to 0.83. Midwives were more supportive towards vaginal birth and less fearful of potential consequences of vaginal birth compared with physicians.

CONCLUSIONS

The S-LCS demonstrated satisfactory psychometric properties for use in Swedish maternity care. Further work to improve the scale should include additional items reflecting the subscale Maternal Agency.

A global overview of midwives' working conditions: A rapid review of literature on positive practice environment

BACKGROUND

In the United Kingdom (UK), a critical shortage of midwives puts pressure on the already overworked midwives working in maternity services. Considering the challenges that midwives in the UK face, this rapid review was conducted to inform a larger-scale initiative to improve the working conditions of midwives in an acute NHS Trust in the Midlands area of the UK.

OBJECTIVE

To describe midwives' perceptions and experiences of positive practice environments.

METHODS

A search strategy to identify literature about midwives' perceptions and experiences of positive practice environments was conducted in Medline, CINAHL Plus and Embase databases. Literature screening was conducted independently in two steps using an eligibility tool. The articles' quality assessment was conducted using the Mixed Method Appraisal Tool. Data were extracted using the Job Quality framework and managed using NVivo12.

RESULTS

Seventy articles were included in this review. Midwives' working conditions can be improved in all seven areas of the Job Quality framework. Most articles in the review reported the negative aspects of midwives' working environments, making it challenging for the team to define a positive practice environment for midwives. Despite this, authors discuss that a positive practice environment is at least sustained by ensuring midwives' ability to provide care; providing good employment conditions; developing respectful organisations; and increasing team resources, such as those that improve team resilience.

CONCLUSIONS

Midwives' working conditions are universally challenging. Failure to address the situation will compromise recruitment and retention, increasing the shortage of midwives. Provision of safe and respectful care appears to be directly linked to midwives' safe and respectful working conditions.

Primary midwives' experiences of collegial midwifery assistance during the active second stage of labor: Data from the Oneplus trial

BACKGROUND

Collegial midwifery assistance during the active second stage of labor that involves a second midwife being present has been shown to reduce severe perineal trauma (SPT) by 30%. The aim of this study was to investigate primary midwives' experiences of collegial midwifery assistance with the purpose of preventing SPT during the active second stage of labor.

METHODS

This study uses an observational design with data from a multicenter randomized controlled trial (Oneplus). Data consist of clinical registration forms completed by the midwives after birth. Descriptive statistics as well as univariable and multivariable logistic regression were used to analyze the data.

RESULTS

The majority of the primary midwives felt confident (61%) and were positive (56%) toward the practice. Midwives with less than 2 years' work experience were more likely to completely agree they felt confident (aOR 9.18, 95% CI: 6.28-13.41) and experience the intervention as positive (aOR 4.04, 95% CI: 2.83-5.78) than those with over 20 years' work experience. Factors such as duration of time spent in the birthing room by the second midwife, opportunity for planning and if the second midwife provided support were further associated with the primary midwife's experience of the practice as being positive.

CONCLUSIONS

Our findings indicate that having a second midwife present during the active second stage of labor was an accepted practice, with the majority of primary midwives feeling confident and positive toward the intervention. This was especially pronounced among midwives with less than 2 years' work experience.

Early Labour App: Developing a practice-based mobile health application for digital early labour support

BACKGROUND

Pregnant women in early labour have felt excluded from professional care, and their partners have been restricted from being involved in the birthing process. Expectant parents must be better prepared to deal with fear and stress during early labour. There is a need for evidence-based information and digital applications that can empower couples during childbirth.

OBJECTIVE

To develop and identify requirements for a practice-based mobile health (mHealth) application for Digital Early Labour Support.

METHODS

This research started with creating an expert group composed of a multidisciplinary team capable of informing the app development process on evidence-based practices. In consultation with the expert group, the app was built using an agile development approach (i.e., Scrum) within a continuous software engineering setting (i.e., CI/CD, DevOps), also including user and security tests.

RESULTS

During the development of the Early Labour App, two main types of challenges emerged: (1) user challenges, related to understanding the users' needs and experience with the app, and (2) team challenges, related to the software development team in particular, and the necessary skills for translating an early labour intervention into a digital solution. This study reaffirms the importance of midwife support via blended care and the opportunity of complementing it with an app. The Early Labour App was easy to use, the women needed little to no help, and the partner's preparation was facilitated. The combination of the app together with blended care opens up awareness, thoughts and feelings about the method and provides good preparation for the birth.

CONCLUSION

We propose the creation of the Early Labour App, a mHealth app for early labour support. The preliminary tests conducted for the Early Labour App show that the app is mature, allowing it to be used in the project's Randomised Control Trial, which is already ongoing.

Experiences of health providers regarding implementation of the physiologic birth program in Iran: A qualitative content analysis

INTRODUCTION

The rate of cesarean section is on the rise in both developed and developing countries, and Iran is no exception. According to the WHO, physiologic labor is one of the main strategies for reducing cesarean section and improving the health of mothers and newborns. The aim of this qualitative study was to explain the experiences of health providers regarding implementation of the physiologic birth program in Iran.

METHODS

This study is a part of a mixed-methods study, in which 22 health providers were interviewed from January 2022 to June 2022. Data analysis was performed using Graneheim and Lundman's conventional content analysis approach and using MAXQDA10 software.

RESULTS

Two main categories and nine subcategories emerged from the results of this study. The main categories included "the obstacles to the implementation of the physiologic birth program" and "strategies for improving implementation of the program". The subcategories of the first category included: lack of continuous midwifery care in the healthcare system, lack of free accompanying midwives, lack of integrated healthcare and hospitals in service provision, low quality of childbirth preparation and implementation of physiologic birth classes, and lack of requirements for the implementation of physiologic birth in the maternity ward. The second category included the following subcategories: Supervising the implementation of childbirth preparation classes and physiologic childbirth, support of midwives by insurance companies, holding training courses on physiologic birth, and evaluation of program implementation.

CONCLUSIONS

The experiences of the health providers with the physiologic birth program revealed that policymakers should provide the ground for the implementation of this type of labor by removing the obstacles and providing the particular operational strategies needed in Iran. Important measures that can contribute to the implementation of the physiologic labor program in Iran include the following: Setting the stage for physiologic birth in the healthcare system, creating low- and high-risk wards in maternity hospitals, providing professional autonomy for midwifery, training childbirth providers on physiologic birth, monitoring the quality of program implementation, and providing insurance support for midwifery services.

Swedish midwives' experiences of collegial midwifery assistance during the second stage of labour: A qualitative study

BACKGROUND

There has been an increased focus on clinical practice that may reduce severe perineal trauma due to awareness of the associated morbidity. Knowledge regarding the best practice to reduce these injuries is limited. Collegial midwifery assistance during the second stage of labour that involves an additional midwife being present has recently been implemented into many Swedish birth units with the aim of reducing severe perineal trauma. However, no studies have been conducted to evaluate midwives' experiences and views of this practice.

AIM

The aim of this study was to explore midwives' experiences of collegial midwifery assistance during the second stage of labour.

METHODS

A qualitative study was undertaken with five focus groups conducted with 37 midwives who were part of a multisite randomised controlled trial. The data was analysed with reflexive thematic analysis.

FINDINGS

Four key themes were generated: (i) "challenging the professional role"; (ii) "a balancing act between different roles"; (iii) "not just why and how - but who"; (iv) "a potential arena for learning".

CONCLUSION

This practice enabled valuable collegial support and learning. The midwives' experiences were multifaceted and influenced by several factors, including norms and culture in the birth units as well as personal relationships and the midwives' views on their role and childbirth. Staffing should be adapted in clinical practice to optimise the conditions for collegial support and learning while avoiding unintended consequences.

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.

Turkish midwives' experiences and opinions in promoting normal births: A grounded theory study

INTRODUCTION

Worldwide, the biomedical model of maternity care has been dominant, with the overuse of interventions.

AIM

This study aimed to gain a deeper understanding of the experiences and opinions of Turkish midwives regarding the promotion of normal births.

METHODS

In-depth interviews were conducted with 12 midwives; data were analysed using grounded theory. The data were analysed according to the constant comparative method.

FINDINGS

The study generated a core category (We want to promote normal births, but have no power to do it), which means all participants wanted to promote normal births. However, they have been disempowered by the medicalised systems of care. There were also three main categories (different ideologies in the labour ward, the midwives have no power, unempowered women). The participants reported that different ideologies in the labour ward were a challenge to promoting normal births. Their working conditions and education level were not enough to support normal birth. The pregnant women were described as unempowered due to a lack of antenatal education and having a fear of childbirth.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

Normal birth could be promoted by enhancing the power and responsibilities of midwives. The women need antenatal education to have a normal birth. The normal birth may promote the enhanced readiness of women and midwives.