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Juschka ML, Agricola CJ, Neumann FA, Mohr S, Zyriax BC. Status quo of interprofessional education for midwifery and medical students in Germany, Austria, and Switzerland. GMS JOURNAL FOR MEDICAL EDUCATION 2024; 41:Doc31. [PMID: 39131889 PMCID: PMC11310787 DOI: 10.3205/zma001686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/27/2024] [Accepted: 04/29/2024] [Indexed: 08/13/2024]
Abstract
Objectives The care of women and their families around childbirth requires effective interprofessional collaboration of the midwifery and medical profession. Given the academisation of midwifery, early interaction between students of midwifery and medicine is both necessary and feasible. As there is a lack of comprehensive data on interprofessional education (IPE) for midwifery and medical students at higher education institutions in Germany, Austria, and Switzerland (DACH region), the aim was to identify existing IPE activities, and their curricular determination. Methods The exploratory study was conducted in the DACH region over three months (Dec. 2022-Feb. 2023). Higher education institutions offering midwifery science and/or medicine were invited to participate in a web-based survey. The questionnaire focused on the structure and curricular implementation of IPE courses, on cooperation, financial support and more. Results A total of 58 out of 96 invited institutions (60%) participated in the survey, of which 34 (59%) offered IPE. Eighteen institutions (19%) offered 32 IPE courses for midwifery and medical students through cooperation within faculty (n=8) and between faculties (n=10). Notably, most of these IPE courses (60%) were integrated into the required curriculum of both study programmes. Most IPE courses were offered without financial support (71%). Conclusion The current status quo highlighted the existence of numerous IPE offers for midwifery and medical students in the DACH region that warrant further curricular integration of proven and well-established best practice examples to further enhance these initiatives.
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Affiliation(s)
- Merle Linnea Juschka
- University Medical Center Hamburg-Eppendorf, Midwifery Science-Health Care Research and Prevention, Institute for Health Service Research in Dermatology and Nursing, Hamburg, Germany
| | - Caroline Johanna Agricola
- University Medical Center Hamburg-Eppendorf, Midwifery Science-Health Care Research and Prevention, Institute for Health Service Research in Dermatology and Nursing, Hamburg, Germany
| | - Felix Alexander Neumann
- University Medical Center Hamburg-Eppendorf, Midwifery Science-Health Care Research and Prevention, Institute for Health Service Research in Dermatology and Nursing, Hamburg, Germany
| | - Sonja Mohr
- University Medical Center Hamburg-Eppendorf, Faculty of Medicine, Dean's Office for Student Affairs, Hamburg, Germany
| | - Birgit-Christiane Zyriax
- University Medical Center Hamburg-Eppendorf, Midwifery Science-Health Care Research and Prevention, Institute for Health Service Research in Dermatology and Nursing, Hamburg, Germany
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Pezaro DS, Zarbiv G, Jones J, Feika ML, Fitzgerald L, Lukhele S, Mcmillan-Bohler J, Baloyi OB, Maravic da Silva K, Grant C, Bayliss-Pratt L, Hardtman P. Characteristics of strong midwifery leaders and enablers of strong midwifery leadership: An international appreciative inquiry. Midwifery 2024; 132:103982. [PMID: 38579551 DOI: 10.1016/j.midw.2024.103982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 02/22/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES This research aimed to identify the characteristics of strong midwifery leaders and explore how strong midwifery leadership may be enabled from the perspective of midwives and nurse-midwives globally. DESIGN In this appreciative inquiry, we collected qualitative and demographic data using a cross-sectional online survey between February and July 2022. SETTING Responses were received from many countries (n = 76), predominantly the United Kingdom (UK), Australia, the United States of America (USA), Canada, Uganda, Saudi Arabia, Tanzania, Rwanda, India, and Kenya. PARTICIPANTS An international population (n = 429) of English-speaking, and ethnically diverse midwives (n = 211) and nurse-midwives (n = 218). MEASUREMENTS Reflexive thematic analysis was used to make sense of the qualitative data collected. Identified characteristics of strong midwifery leadership were subsequently deductively mapped to established leadership styles and leadership theories. Demographic data were analysed using descriptive statistics. FINDINGS Participants identified strong midwifery leaders as being mediators, dedicated to the profession, evidence-based practitioners, effective decision makers, role models, advocates, visionaries, resilient, empathetic, and compassionate. These characteristics mapped to compassionate, transformational, servant, authentic, and situational leadership styles. To enable strong midwifery leadership, participants identified a need for investment in midwives' clear professional identity, increased societal value placed upon the midwifery profession, ongoing research, professional development in leadership, interprofessional collaborations, succession planning and increased self-efficacy. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE This study contributes to understandings of trait, behavioural, situational, transformational and servant leadership theory in the context of midwifery. Investing in the development of strong midwifery leadership is essential as it has the potential to elevate the profession and improve perinatal outcomes worldwide. Findings may inform the development of both existing and new leadership models, frameworks, and validated measurement tools.
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Affiliation(s)
- Dr Sally Pezaro
- Research Centre for Healthcare and Communities, Coventry University, UK; Adjunct Associate Professor, University of Notre Dame, Australia.
| | - Gila Zarbiv
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jude Jones
- TALENT Groups Project Manager, University of Salford, Salford, United Kingdom
| | | | - Laura Fitzgerald
- Jhpiego, an affiliate of Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Jacquelyn Mcmillan-Bohler
- Duke University, School of Nursing, 307 Trent Drive, Durham, NC 27710, 2043 Pearson Hall, North Carolina, United States of America
| | - Olivia B Baloyi
- University of KwaZulu-Natal, School of Nursing and Public Health, Durban, South Africa
| | | | - Christine Grant
- The Centre for Healthcare Research, Coventry University, United Kingdom
| | - Lisa Bayliss-Pratt
- Director - Chief Academic Officer Fatima College of Health Sciences. United Arab Emirates
| | - Pandora Hardtman
- Chief Nursing and Midwifery Officer, Jhpiego, United States of America
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Ranchoff BL, Paterno MT, Attanasio LB. Continuity of Clinician Type and Intrapartum Experiences During the Perinatal Period in California. J Midwifery Womens Health 2024; 69:224-235. [PMID: 38164766 DOI: 10.1111/jmwh.13603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/21/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Continuity of care with an individual clinician is associated with increased satisfaction and better outcomes. Continuity of clinician type (ie, obstetrician-gynecologist or midwife) may also impact care experiences; however, it is unknown how common it is to experience discontinuity of clinician type and what its implications are for the birth experience. We aimed to identify characteristics associated with having a different clinician type for prenatal care than for birth and to compare intrapartum experiences by continuity of clinician type. METHODS For this cross-sectional study, data were from the 2017 Listening to Mothers in California survey. The analytic sample was limited to individuals with vaginal births who had midwifery or obstetrician-gynecologist prenatal care (N = 1384). Bivariate and multivariate analysis examined characteristics of individuals by continuity of clinician type. We then examined associations of clinician type continuity with intrapartum care experiences. RESULTS Overall, 74.4% of individuals had the same type of clinician for prenatal care and birth. Of individuals with midwifery prenatal care, 45.1% had a different birth clinician type, whereas 23.5% of individuals who had obstetrician-gynecologist prenatal care had a different birth clinician type. Continuity of clinician type was positively associated with having had a choice of perinatal care clinician. There were no statistically significant associations between clinician type continuity and intrapartum care experiences. DISCUSSION Findings suggest individuals with midwifery prenatal care frequently have a different type of clinician attend their birth, even among those with vaginal births. Further research should examine the impact of multiple dimensions of continuity of care on perinatal care quality.
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Affiliation(s)
- Brittany L Ranchoff
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Mary T Paterno
- Baystate Midwifery and Women's Health, Springfield, Massachusetts
| | - Laura B Attanasio
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
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Campos ASDQ, Rattner D, Diniz CSG. Achievement of appropriate cesarean rates using Robson's 10-Group classification system in Brazilian private practice. BMC Pregnancy Childbirth 2023; 23:504. [PMID: 37430192 PMCID: PMC10332037 DOI: 10.1186/s12884-023-05803-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/21/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Increasing cesarean section (CS) rates are a global concern because they are related to higher maternal and neonatal complication rates and do not provide positive childbirth experiences. In 2019, Brazil ranked second globally, given its overall CS rate of 57%. According to the World Health Organization (WHO), populational CS rates of 10-15% are associated with decreased maternal, neonatal, and infant mortality rates. This study aimed to investigate whether multidisciplinary care following evidence-based protocols associated with a high motivation of both women and professionals for a vaginal birth leads to less overuse of CS in a Brazilian private practice (PP). METHODS This cross-sectional study evaluated CS rates by Robson group for women who sought vaginal birth in a private practice in Brazil comparing with Swedish data. Collaborative care of midwives and obstetricians who adopted evidence-based guidelines was offered. CS rates, overall and by Robson group, contribution of each Robson group to the overall CS rate, clinical and nonclinical interventions, vaginal birth, pre-labor CS, and intrapartum CS proportions were estimated. The expected CS rate was calculated using the World Health Organization C-model tool. The analysis used Microsoft Excel and R Studio (version 1.2.1335. 2009-2019). RESULTS The PP overall CS rate was 15.1% (95%CI, 13.4-17.1%) versus the 19.8% (95%CI, 14.8-24.7%) rate expected by the WHO C-model tool. The population included 43.7% women in Robson Group 1 (nulliparous, single, cephalic, at term, spontaneous labor), 11.4% in Group 2 (nulliparous, single, cephalic, at term, induced labor or CS before labor), and 14.9% in Group 5 (multiparous women with previous CS), the greatest contributors to higher CS rates (75.4% of them). The Swedish overall CS rate was 17.9% (95%CI, 17.6-18.1%) in a population of 27% women in Robson Group 1, 10.7% in Group 2, and 9.2% in Group 5. CONCLUSIONS Multidisciplinary care following evidence-based protocols, associated with high motivation of both women and professionals for vaginal birth, may lead to a significant and safe reduction of CS rates even in contexts such as Brazil, with high medicalization of obstetric care and excess CS.
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Affiliation(s)
- Andrea Silveira de Queiroz Campos
- Faculdade de Saúde Pública, Universidade de São Paulo, Av. Doutor Arnaldo, 715, 2º andar, Cerqueira César, São Paulo, 01246904 SP Brasil
| | - Daphne Rattner
- Faculdade de Ciências da Saúde, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, 70910900 DF Brasil
| | - Carmen Simone Grilo Diniz
- Faculdade de Saúde Pública, Universidade de São Paulo, Av. Doutor Arnaldo, 715, 2º andar, Cerqueira César, São Paulo, 01246904 SP Brasil
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Sweet L, O'Driscoll K, Blums T, Sommeling M, Kolar R, Teale G, Wynter K. Relationships are the key to a successful publicly funded homebirth program, a qualitative study. Women Birth 2023:S1871-5192(22)00365-1. [PMID: 36604197 DOI: 10.1016/j.wombi.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/01/2022] [Accepted: 12/15/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND In Australia, publicly-funded homebirth is a relatively new option for women and their families. Two years after the inception of two publicly funded homebirth services in Victoria in 2009, a study found that midwives' experiences were more positive than doctors. There is no recent evidence on the perspectives of midwives and doctors of publicly-funded homebirth programs. AIM To explore the experiences of midwives and doctors participating in or supporting one publicly-funded homebirth program in Australia. METHODS An interpretive descriptive approach was used following individual in-depth interviews via 'Zoom'. Participants included midwives and doctors who provide or support the homebirth service at a large metropolitan health service in Melbourne's western suburbs. Data were thematically analysed. FINDINGS Interviews were conducted with 16 homebirth midwives, six hospital-based midwives, and nine doctors. One central theme and three sub-themes demonstrate that effective relationships are critical to a successful publicly-funded homebirth program. Collaboration, teamwork, and mutual respect across professions were reported to be integral to success. The midwife-woman relationship was highly valued and especially important to provide continuity during transfers to the hospital where this occurred. DISCUSSION Effective relationships underpin collaborative practice and are critical for safe healthcare. Shared common learning opportunities such as simulation training sessions and multi-professional forums to discuss cases were perceived to assist the development of these relationships. CONCLUSION Effective relationships within and between midwives and doctors are key to collaborative practice, which underpins a successful publicly-funded homebirth service. Health services can support this by maintaining a respectful and supportive culture amongst staff.
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Affiliation(s)
- Linda Sweet
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research, Western Health Partnership, Victoria, Australia.
| | | | | | | | | | | | - Karen Wynter
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research, Western Health Partnership, Victoria, Australia
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Aderoba AK, Adu-Bonsaffoh K. Antenatal and Postnatal Care. Obstet Gynecol Clin North Am 2022; 49:665-692. [DOI: 10.1016/j.ogc.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yilmaz K, Taşçi-Duran E. Examining the views of nurses working in gynecology and obstetrics clinics on collaborative practice. Health Care Women Int 2022; 45:1081-1101. [PMID: 36409711 DOI: 10.1080/07399332.2022.2144861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022]
Abstract
We aimed to reveal the attitudes and perceptions of a group of nurses toward collaborative work and the barriers to collaborative practice. At the end of the study, we obtained four main themes: leadership in health services, interpersonal interaction factors, cooperation in patient care, standardization. The nurses emphasized the critical elements of respect, relationships and communication as components of effective collaborative practice. As a result, it was stated that the practice of cooperation between doctors and nurses is weak and there are some difficulties and obstacles.
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Affiliation(s)
- Kubra Yilmaz
- Health Sciences Faculty, Obstetrics and Gynecology Nursing Department, Süleyman Demirel University, Isparta, Turkey
| | - Emel Taşçi-Duran
- Health Sciences Faculty, Obstetrics and Gynecology Nursing Department, Süleyman Demirel University, Isparta, Turkey
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8
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Adeyemo OO, Morelli EE, Kennedy HP. How to Foster Effective Midwife-Obstetrician Collaboration on Labor and Birth Units: Qualitative Analysis of Experiences of Clinicians in the United States. J Midwifery Womens Health 2022; 67:552-560. [PMID: 35754313 DOI: 10.1111/jmwh.13382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/03/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Effective collaboration between midwives and obstetricians on labor and birth units in hospitals has been shown to improve birth outcomes and quality of care. Guidelines for collaborative care in the United States exist; however, studies describing the actual lived experiences of midwives and obstetricians in collaborative practice are lacking. The goal of this study was to explore the experiences and perspectives of midwives and obstetricians working in collaborative practices on labor and birth units across the United States and to identify strategies that foster effective collaboration between them. METHODS We performed qualitative analyses of open-ended comments obtained in an instrument validation survey assessing collaboration between midwives and obstetricians on labor and birth in the United States. Certified nurse-midwives, certified midwives, attending general obstetricians, maternal-fetal medicine attending physicians, and fellows across the United States were included in this study, herein called midwives and obstetricians. The final sample in the original validation survey included 232 midwives and 471 obstetricians (n = 703). Of these, 79 midwives and 132 obstetricians (n = 211) provided narrative comments on their perspectives and experiences with collaborative practice on labor and birth units in the United States. The narrative comments were analyzed using inductive techniques derived from grounded theory. RESULTS Four themes around how to foster effective collaboration were identified: (1) developing trust and respect, (2) promoting effective communication, (3) individual variability and need for clear guidelines, and (4) balancing autonomy. The midwives and obstetricians shared lived experiences that they perceived affected their work satisfaction and clinical outcomes in collaborative practices. DISCUSSION These findings hold potential to inform clinicians and health care leaders on ways to foster effective collaboration between midwives and obstetricians on labor and birth units. This in turn can improve quality of care for birthing persons, perinatal outcomes and clinician job satisfaction.
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Affiliation(s)
- Oluwatosin O Adeyemo
- Division of Obstetric Specialties and Midwifery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States
| | - Erin E Morelli
- Yale School of Nursing, Orange, Connecticut, United States
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Modha B. Utilising dentist-dental health educator skill-mix to implement oral health promotion that better supports diverse communities. JOURNAL OF INTEGRATED CARE 2022. [DOI: 10.1108/jica-08-2021-0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PurposeDentists may be seen as the most prominent figures within dentistry. Yet, a number of dental care professionals make significant contributions to the profession. The dental health educator (DHE) is one prime example. This teammate is typically a dental nurse who has achieved a post-registration qualification in oral health education (OHE). Through interactions with patients, members of the community and other pertinent stakeholders, the DHE empowers people through promoting the importance of good oral health. The purpose of this paper is to cast light on the unique and invaluable roles that DHEs can play within their organisations.Design/methodology/approachThis paper aims to share some examples of dentist-DHE collaborations, where OHE initiatives were implemented within an ethnically diverse London Borough in England.FindingsIt was found that such interprofessional, skill-mix efforts were more productive, when the dentist and DHE worked together, rather than the latter working independently.Originality/valueThere exists great potential for DHEs to act as ambassadors for their dental establishments, network and collaborate with other organisations and build worthwhile relations with other healthcare professionals and stakeholders.
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10
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Burns ES, Duff M, Leggett J, Schmied V. Emergency scenarios in maternity: An exploratory study of a midwifery and medical student simulation-based learning collaboration. Women Birth 2020; 34:563-569. [PMID: 33268297 DOI: 10.1016/j.wombi.2020.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/21/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PROBLEM In Australia, interprofessional education has been embedded into pre-registration course accreditation standards. Little is known about Australian midwifery and medical students experiences of interprofessional learning when the focus is on emergency scenarios during birth. AIM This study aimed to evaluate student experience of Interprofessional Simulation-Based Learning workshops focused on emergency scenarios with midwifery and medical students. METHODS This was a descriptive, exploratory study of an educational activity designed to enhance inter-professional and collaborative learning between Bachelor of Midwifery students and Bachelor of Medicine students at a Simulation Centre in Sydney, Australia. A pre and post survey design enabled data collection before and after the 6-h simulation-based workshop. FINDINGS A total of 45 students attended two interprofessional simulation learning days, 14 were midwifery students and 31 medical students. Students disclosed a level of apprehension in the pre workshop survey and ambivalence towards the values of collaborative simulation-based learning. Following the workshop students reported that the workshop enhanced their ability to work collaboratively in practice. Both student cohorts commented on a perceived power imbalance and a sense of each profession having to 'prove' their knowledge levels. Students stated that learning to work together in a safe environment allowed them to develop an appreciation for each other's scope of practice and responsibilities in an emergency situation. CONCLUSION This form of collaborative learning has the potential to improve new graduate experience in the workplace, especially during emergency situations, and ultimately improve care for women and babies.
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Affiliation(s)
- Elaine S Burns
- School of Nursing and Midwifery, Western Sydney University, New South Wales, Australia.
| | - Margie Duff
- School of Nursing and Midwifery, Western Sydney University, New South Wales, Australia
| | - Janie Leggett
- School of Medicine, Western Sydney University, New South Wales, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, New South Wales, Australia. https://twitter.com/@VirginiaSchmie1
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Mattison CA, Lavis JN, Wilson MG, Hutton EK, Dion ML. A critical interpretive synthesis of the roles of midwives in health systems. Health Res Policy Syst 2020; 18:77. [PMID: 32641053 PMCID: PMC7346500 DOI: 10.1186/s12961-020-00590-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Midwives' roles in sexual and reproductive health and rights continues to evolve. Understanding the profession's role and how midwives can be integrated into health systems is essential in creating evidence-informed policies. Our objective was to develop a theoretical framework of how political system factors and health systems arrangements influence the roles of midwives within the health system. METHODS A critical interpretive synthesis was used to develop the theoretical framework. A range of electronic bibliographic databases (CINAHL, EMBASE, Global Health database, HealthSTAR, Health Systems Evidence, MEDLINE and Web of Science) was searched through to 14 May 2020 as were policy and health systems-related and midwifery organisation websites. A coding structure was created to guide the data extraction. RESULTS A total of 4533 unique documents were retrieved through electronic searches, of which 4132 were excluded using explicit criteria, leaving 401 potentially relevant records, in addition to the 29 records that were purposively sampled through grey literature. A total of 100 documents were included in the critical interpretive synthesis. The resulting theoretical framework identified the range of political and health system components that can work together to facilitate the integration of midwifery into health systems or act as barriers that restrict the roles of the profession. CONCLUSIONS Any changes to the roles of midwives in health systems need to take into account the political system where decisions about their integration will be made as well as the nature of the health system in which they are being integrated. The theoretical framework, which can be thought of as a heuristic, identifies the core contextual factors that governments can use to best leverage their position when working to improve sexual and reproductive health and rights.
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Affiliation(s)
- Cristina A Mattison
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, Canada.
| | - John N Lavis
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
| | - Michael G Wilson
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, Canada
| | - Michelle L Dion
- Department of Political Science, McMaster University, 1280 Main St. West, KTH-533, Hamilton, ON, L8S 4M4, Canada
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Avery MD, Jennings JC, Germano E, Andrighetti T, Autry AM, Dau KQ, Krause SA, Montgomery OC, Nicholson TB, Perry A, Rauk PN, Sankey HZ, Woodland MB. Interprofessional Education Between Midwifery Students and Obstetrics and Gynecology Residents: An American College of Nurse-Midwives and American College of Obstetricians and Gynecologists Collaboration. J Midwifery Womens Health 2020; 65:257-264. [PMID: 31965745 PMCID: PMC7187383 DOI: 10.1111/jmwh.13057] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 01/17/2023]
Abstract
Despite areas of excellence, US perinatal care outcomes lag behind most developed countries. In addition, a shortage and maldistribution of health care providers exists. The American College of Nurse-Midwives and the American College of Obstetricians and Gynecologists (ACOG) partnered to obtain funding to develop interprofessional education modules and other learning activities for midwifery students and obstetrics and gynecology residents in 4 demonstration sites. The multidisciplinary 2016 ACOG document Collaboration in Practice: Implementing Team-Based Care was adopted as a framework. Core competencies of values and ethics, roles and responsibilities, interprofessional communication, and teams and teamwork developed by the Interprofessional Education Collaborative were used to guide the work. Seven modules have been developed including guiding principles, patient-centered care, role clarification, collaborative practice, history and culture, care transition, and difficult conversations. Learners participate in laboratory and simulation activities and work together in clinical care settings. Stakeholder experiences as well as barriers to implementation are discussed. Learning materials and activity descriptions are open resourced and shared on a project website for use by programs interested in implementing an interprofessional curriculum. Ongoing formal evaluation including pilot testing of a program evaluation method is described.
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Affiliation(s)
| | - John C. Jennings
- Texas Tech University Health Sciences Center, Permian BasinTexas
| | | | - Tia Andrighetti
- Department of Midwifery and Women's HealthFrontier Nursing UniversityHydenKentucky
| | - Amy M. Autry
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of California San Francisco School of MedicineSan FranciscoCalifornia
| | - Kim Q. Dau
- Department of Family Health Care NursingUniversity of California San Francisco School of NursingSan FranciscoCalifornia
| | | | - Owen C. Montgomery
- Drexel University College of Medicine, Philadelphia, Pennsylvania. Dr. Montgomery is now with Thomas Jefferson UniversityPhiladelphiaPennsylvania
| | - Tonya B. Nicholson
- Department of Midwifery and Women's HealthFrontier Nursing UniversityHydenKentucky
| | - Audrey Perry
- Department of Midwifery and Women's HealthFrontier Nursing UniversityHydenKentucky
| | - Phillip N. Rauk
- University of Minnesota School of MedicineMinneapolisMinnesota
| | - Heather Z. Sankey
- Department of Obstetrics and GynecologyUniversity of Massachusetts‐BaystateSpringfieldMassachusetts
| | - Mark B. Woodland
- Drexel University College of MedicineOBGYN Reading Health SystemReadingPennsylvania
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13
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The paradoxes of communication and collaboration in maternity care: A video-reflexivity study with professionals and parents. Women Birth 2020; 34:145-153. [PMID: 32063528 DOI: 10.1016/j.wombi.2020.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Research on maternity care often focuses on factors that prevent good communication and collaboration and rarely includes important stakeholders - parents - as co-researchers. To understand how professionals and parents in Dutch maternity care accomplish constructive communication and collaboration, we examined their interactions in the clinic, looking for "good practice". METHODS We used the video-reflexive ethnographic method in 9 midwifery practices and 2 obstetric units. FINDINGS We conducted 16 meetings where participants reflected on video recordings of their clinical interactions. We found that informal strategies facilitate communication and collaboration: "talk work" - small talk and humour - and "work beyond words" - familiarity, use of sight, touch, sound, and non-verbal gestures. When using these strategies, participants noted that it is important to be sensitive to context, to the values and feelings of others, and to the timing of care. Our analysis of their ways of being sensitive shows that good communication and collaboration involves "paradoxical care", e.g., concurrent acts of "regulated spontaneity" and "informal formalities". DISCUSSION Acknowledging and reinforcing paradoxical care skills will help caregivers develop the competencies needed to address the changing demands of health care. The video-reflexive ethnographic method offers an innovative approach to studying everyday work, focusing on informal and implicit aspects of practice and providing a bottom up approach, integrating researchers, professionals and parents. CONCLUSION Good communication and collaboration in maternity care involves "paradoxical care" requiring social sensitivity and self-reflection, skills that should be included as part of professional training.
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The clinical learning environment of a maternity ward: A qualitative study. Women Birth 2019; 32:e523-e529. [DOI: 10.1016/j.wombi.2019.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 01/04/2019] [Accepted: 01/06/2019] [Indexed: 12/30/2022]
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Kristienne McFarland A, Jones J, Luchsinger J, Kissler K, Smith DC. The experiences of midwives in integrated maternity care: A qualitative metasynthesis. Midwifery 2019; 80:102544. [PMID: 31655307 DOI: 10.1016/j.midw.2019.102544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 09/16/2019] [Accepted: 09/29/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To conduct a metasynthesis of eight qualitative studies of the experiences of midwives in integrated maternity practice; to identify common motifs among the eight studies through a thematic interpretive integration known as reciprocal translation; and to explore the effects on midwifery processes of care in the setting of integrated maternity practice. DESIGN A qualitative metasynthesis to analyze, synthesize, and interpret eight qualitative studies on the experiences of midwives and the effect on the midwifery processes of care in the setting of integrated maternity practice. SAMPLE AND SETTING Participants from the primary studies included a total of 160 midwives providing hospital-based intrapartum care. All primary studies were conducted in settings with midwives and obstetricians working together in an integrated or collaborative manner. FINDINGS Three overarching themes emerged from the data: professional dissonance, functioning from a position of risk, and practicing down. KEY CONCLUSIONS The findings indicated that integrated maternity practice affects the professional experience of midwives. Through a qualitative exploration, a clear process of deprofessionalization and deviation from the midwifery model of care is detailed. Midwives experienced decreasing opportunity to provide the quality woman-centered physiologic care that evidence shows benefits childbearing women. IMPLICATIONS FOR PRACTICE Integrated maternity practice, where low-risk and high-risk pregnancies are managed by midwife/physician teams, have proliferated as a solution to the need for quality, safe, and efficient health care. Insufficient evidence exists detailing the success or failure of this model of care. Qualitative studies suggest that the increasing medicalization occurring in integrated maternity practices minimizes the profession of midwifery and the ability to provide evidence-based quality midwifery care.
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Affiliation(s)
- A Kristienne McFarland
- University of Colorado, Anschutz Medical Center College of Nursing 13120 E 19th Ave, Aurora, CO 80045, United States.
| | - Jacqueline Jones
- University of Colorado, Anschutz Medical Center College of Nursing 13120 E 19th Ave, Aurora, CO 80045, United States
| | - Jackie Luchsinger
- University of Colorado, Anschutz Medical Center College of Nursing 13120 E 19th Ave, Aurora, CO 80045, United States
| | - Katherine Kissler
- University of Colorado, Anschutz Medical Center College of Nursing 13120 E 19th Ave, Aurora, CO 80045, United States
| | - Denise C Smith
- University of Colorado, Anschutz Medical Center College of Nursing 13120 E 19th Ave, Aurora, CO 80045, United States
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White VanGompel E, Main EK, Tancredi D, Melnikow J. Do provider birth attitudes influence cesarean delivery rate: a cross-sectional study. BMC Pregnancy Childbirth 2018; 18:184. [PMID: 29843622 PMCID: PMC5975533 DOI: 10.1186/s12884-018-1756-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 04/19/2018] [Indexed: 11/12/2022] Open
Abstract
Background When used judiciously, cesarean sections can save lives; but in the United States, prior research indicates that cesarean birth rates have risen beyond the threshold to help women and infants and become a contributor to increased maternal mortality and rising healthcare costs. Healthy People 2020 has set the goal for nulliparous, term, singleton, vertex (NTSV) cesarean birth rate at no more than 23.9% of births. Currently, cesarean rates vary from 6% to 69% in US hospitals, unexplained by clinical or demographic factors. This wide variation in cesarean use is also seen among individual providers of intrapartum care. Previous research of birth attitudes found providers of intrapartum care hold widely differing views, which may be a key underlying factor influencing practice variation; however, further study is needed to determine if differences in attitudes are associated with differences in clinical outcomes. The purpose of this study was to estimate the association between individual provider attitudes towards birth and their low-risk primary cesarean rate. Methods Four hundred providers were drawn from a stratified random sample of all California providers of intrapartum care in 2013 and surveyed for their attitudes towards various aspects of labor and birth. Providers’ NTSV cesarean birth rates were obtained for 2013 and 2014. Covariates included gender, years of experience, practice location, and primary hospital’s NTSV cesarean rate. We used adjusted multivariate Poisson regression to compare cesarean rates and linear regression to compare attitude scores of providers meeting versus not meeting the Healthy People 2020 (HP2020) goal. Results Two hundred nine total participants (obstetricians, family physicians, and midwives) completed surveys, of which 109 perform cesareans. Providers’ NTSV cesarean rate was significantly associated with their composite attitudes score [IRR for each one-point increase 1.21 (95% CI 1.002–1.45)]. Physicians meeting the HP2020 goal held attitudes which were significantly more favorable towards vaginal birth: mean 2.70 (95% CI 2.58–2.83) versus 2.91 (95% CI 2.82–3.00), p < 0.01. Conclusions Provider attitudinal differences are associated with NTSV cesarean rates. Those meeting the HP2020 goal hold attitudes more favorable towards vaginal birth. These findings may present a modifiable target for quality improvement initiatives to decrease low risk primary cesareans.
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Affiliation(s)
- Emily White VanGompel
- Department of Family Medicine, The University of Chicago, Pritzker School of Medicine, NorthShore University HealthSystem Research Institute, 1001 University Place, Evanston, IL, 60201, USA. .,Department of Obstetrics and Gynecology, The University of Chicago, Pritzker School of Medicine, NorthShore University HealthSystem Research Institute, 1001 University Place, Evanston, IL, 60201, USA.
| | - Elliott K Main
- California Maternal Quality Care Collaborative, Stanford University, Stanford Medical School Office Building, 1265 Welch Road, MS 5415, Stanford, CA, 94305, USA
| | - Daniel Tancredi
- Center for Healthcare Policy and Research and Department of Pediatrics, University of California Davis School of Medicine, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Joy Melnikow
- Center for Healthcare Policy and Research and Department of Family and Community Medicine, University of California Davis School of Medicine, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
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Thumm EB, Flynn L. The Five Attributes of a Supportive Midwifery Practice Climate: A Review of the Literature. J Midwifery Womens Health 2018; 63:90-103. [DOI: 10.1111/jmwh.12707] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 09/05/2017] [Accepted: 10/03/2017] [Indexed: 11/29/2022]
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Warmelink JC, Wiegers TA, de Cock TP, Klomp T, Hutton EK. Collaboration of midwives in primary care midwifery practices with other maternity care providers. Midwifery 2017; 55:45-52. [PMID: 28926751 DOI: 10.1016/j.midw.2017.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 08/27/2017] [Accepted: 08/27/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inter-professional collaboration is considered essential in effective maternity care. National projects are being undertaken to enhance inter-professional relationships and improve communication between all maternity care providers in order to improve the quality of maternity care in the Netherlands. However, little is known about primary care midwives' satisfaction with collaboration with other maternity care providers, such as general practitioners, maternity care assistance organisations (MCAO), maternity care assistants (MCA), obstetricians, clinical midwives and paediatricians. More insight is needed into the professional working relations of primary care midwives in the Netherlands before major changes are made OBJECTIVE: To assess how satisfied primary care midwives are with collaboration with other maternity care providers and to assess the relationship between their 'satisfaction with collaboration' and personal and work-related characteristics of the midwives, their attitudes towards their work and collaboration characteristics (accessibility). The aim of this study was to provide insight into the professional working relations of primary care midwives in the Netherlands. METHODS Our descriptive cross-sectional study is part of the DELIVER study. Ninety nine midwives completed a written questionnaire in May 2010. A Friedman ANOVA test assessed differences in satisfaction with collaboration with six groups of maternity care providers. Bivariate analyses were carried out to assess the relationship between satisfaction with collaboration and personal and work-related characteristics of the midwives, their attitudes towards their work and collaboration characteristics. RESULTS Satisfaction experienced by primary care midwives when collaborating with the different maternity care providers varies within and between primary and secondary/tertiary care. Interactions with non-physicians (clinical midwives and MCA(O)) are ranked consistently higher on satisfaction compared with interactions with physicians (GPs, obstetricians and paediatricians). Midwives with more work experience were more satisfied with their collaboration with GPs. Midwives from the southern region of the Netherlands were more satisfied with collaboration with GPs and obstetricians. Compared to the urban areas, in the rural or mixed areas the midwives were more satisfied regarding their collaboration with MCA(O)s and clinical midwives. Midwives from non-Dutch origin were less satisfied with the collaboration with paediatricians. No relations were found between the overall mean satisfaction of collaboration and work-related and personal characteristics and attitude towards work. CONCLUSIONS Inter-professionals relations in maternity care in the Netherlands can be enhanced, especially the primary care midwives' interactions with physicians and with maternity care providers in the northern and central part of the Netherlands, and in urban areas. Future exploratory or deductive research may provide additional insight in the collaborative practice in everyday work setting.
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Affiliation(s)
- J Catja Warmelink
- Midwifery Science, AVAG, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands; Midwifery Academy Amsterdam Groningen, The Netherlands.
| | - Therese A Wiegers
- Netherlands institute for health services research (NIVEL), Utrecht, The Netherlands
| | - T Paul de Cock
- Midwifery Science, AVAG, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands; Midwifery Academy Amsterdam Groningen, The Netherlands; The Bamford Centre for Mental Health and Wellbeing, University of Ulster, Coleraine, United Kingdom
| | - Trudy Klomp
- Midwifery Science, AVAG, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands; Midwifery Academy Amsterdam Groningen, The Netherlands
| | - Eileen K Hutton
- Midwifery Science, AVAG, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands; Faculty of Health Sciences, McMaster University, Hamilton, Canada
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Thornton P. Characteristics of Spontaneous Births Attended by Midwives and Physicians in US Hospitals in 2014. J Midwifery Womens Health 2017; 62:531-537. [PMID: 28806489 DOI: 10.1111/jmwh.12638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 04/06/2017] [Accepted: 04/13/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study compares characteristics and birth outcomes of women attended by certified nurse-midwives/certified midwives (midwives) and physicians in US hospitals in 2014. METHODS Data reported in 2014 on the 2003 version of the US birth certificate were examined. Spontaneous vaginal births attributed to midwives and physicians and occurring in hospitals were included. Demographic and risk profiles and adjusted odds ratios for maternal and newborn outcomes were compared by provider type. RESULTS Midwives attended 294,604 (12.21%) and physicians attended 2,117,376 (87.79%) of all spontaneous vaginal births occurring in 47 states. Small but statistically significant differences (P < .05) were evident in most characteristics. Substantively, profiles were remarkably similar along all demographic and many medical risk variables. Age, race, and insurance status varied by less than 2 percentage points; education status and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation varied by less than one percentage point. Parity, body mass index, maternal weight gain, tobacco use, trimester care began, and average number of prenatal visits also varied by less than one to 2 percentage points. Midwives attended women with hypertension, diabetes, and infections in proportions similar to physicians. Physicians attended more women with preterm birth and multiple gestation. Midwives attended more women beyond 41 weeks' gestation. There were no differences in 5-minute Apgar scores, neonatal seizures, anomalous neonates, or those no longer living at the time of data collection. Third- or fourth-degree lacerations (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.78-0.84), labor induction (OR, 0.76; 95% CI, 0.76-0.77), and epidural analgesia use (OR, 0.54; 95% CI, 0.53-0.54) were less likely in midwife-attended births. Birth at greater than 42 weeks' gestation was more likely (OR, 2.07; 95% CI, 1.97-2.17) among midwife-attended births. DISCUSSION In 2014, midwives practicing in US hospitals attended women with a range of risks similar to those of women attended by physicians. Small but statistically significant differences were noted in most characteristics and should be controlled in comparative studies. This contrasts with earlier reports of midwives caring for disproportionately disadvantaged women compared to physicians.
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Warmelink JC, de Cock TP, Combee Y, Rongen M, Wiegers TA, Hutton EK. Student midwives' perceptions on the organisation of maternity care and alternative maternity care models in the Netherlands - a qualitative study. BMC Pregnancy Childbirth 2017; 17:24. [PMID: 28077073 PMCID: PMC5225585 DOI: 10.1186/s12884-016-1185-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A major change in the organisation of maternity care in the Netherlands is under consideration, going from an echelon system where midwives provide primary care in the community and refer to obstetricians for secondary and tertiary care, to a more integrated maternity care system involving midwives and obstetricians at all care levels. Student midwives are the future maternity care providers and they may be entering into a changing maternity care system, so inclusion of their views in the discussion is relevant. This study aimed to explore student midwives' perceptions on the current organisation of maternity care and alternative maternity care models, including integrated care. METHODS This qualitative study was based on the interpretivist/constructivist paradigm, using a grounded theory design. Interviews and focus groups with 18 female final year student midwives of the Midwifery Academy Amsterdam Groningen (AVAG) were held on the basis of a topic list, then later transcribed, coded and analysed. RESULTS Students felt that inevitably there will be a change in the organisation of maternity care, and they were open to change. Participants indicated that good collaboration between professions, including a shared system of maternity notes and guidelines, and mutual trust and respect were important aspects of any alternative model. The students indicated that client-centered care and the safeguarding of the physiological, normalcy approach to pregnancy and birth should be maintained in any alternative model. Students expressed worries that the role of midwives in intrapartum care could become redundant, and thus they are motivated to take on new roles and competencies, so they can ensure their own role in intrapartum care. CONCLUSIONS Final year student midwives recognise that change in the organisation of maternity care is inevitable and have an open attitude towards changes if they include good collaboration, client-centred care and safeguards for normal physiological birth. The graduating midwives are motivated to undertake an expanded intrapartum skill set. It can be important to involve students' views in the discussion, because they are the future maternity care providers.
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Affiliation(s)
- J. Catja Warmelink
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, Amsterdam/Groningen, The Netherlands
| | - T. Paul de Cock
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, Amsterdam/Groningen, The Netherlands
- The Bamford Centre for Mental Health and Wellbeing, University of Ulster, Coleraine, UK
| | - Yvonne Combee
- Midwifery Academy Amsterdam Groningen, Amsterdam/Groningen, The Netherlands
| | - Marloes Rongen
- Midwifery Academy Amsterdam Groningen, Amsterdam/Groningen, The Netherlands
| | - Therese A. Wiegers
- Netherlands institute for health services research (NIVEL), Utrecht, The Netherlands
| | - Eileen K. Hutton
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
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Perdok H, Jans S, Verhoeven C, Henneman L, Wiegers T, Mol BW, Schellevis F, de Jonge A. Opinions of maternity care professionals and other stakeholders about integration of maternity care: a qualitative study in the Netherlands. BMC Pregnancy Childbirth 2016; 16:188. [PMID: 27459967 PMCID: PMC4962345 DOI: 10.1186/s12884-016-0975-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background This study aims to give insight into the opinions of maternity care professionals and other stakeholders on the integration of midwife-led care and obstetrician-led care and on the facilitating and inhibiting factors for integrating maternity care. Methods Qualitative study using interviews and focus groups from November 2012 to February 2013 in the Netherlands. Seventeen purposively selected stakeholder representatives participated in individual semi-structured interviews and 21 in focus groups. One face-to-face focus group included a combined group of midwives, obstetricians and a paediatrician involved in maternity care. Two online focus groups included a group of primary care midwives and a group of clinical midwives respectively. Thematic analysis was performed using Atlas.ti. Two researchers independently coded the interview and focus group transcripts by means of a mind map and themes and relations between them were described. Results Three main themes were identified with regard to integrating maternity care: client-centred care, continuity of care and task shifting between professionals. Opinions differed regarding the optimal maternity care organisation model. Participants considered the current payment structure an inhibiting factor, whereas a new modified payment structure based on the actual amount of work performed was seen as a facilitating factor. Both midwives and obstetricians indicated that they were afraid to loose autonomy. Conclusions An integrated maternity care system may improve client-centred care, provide continuity of care for women during labour and birth and include a shift of responsibilities between health care providers. However, differences of opinion among professionals and other stakeholders with regard to the optimal maternity care organisation model may complicate the implementation of integrated care. Important factors for a successful implementation of integrated maternity care are an appropriate payment structure and maintenance of the autonomy of professionals.
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Affiliation(s)
- Hilde Perdok
- Department of Midwifery Science, Midwifery Academy Amsterdam/Groningen (AVAG) and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. .,Catharina Hospital, Eindhoven, The Netherlands.
| | - Suze Jans
- Department of Clinical Genetics, Section Community Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,TNO Quality of Life, Leiden, The Netherlands
| | - Corine Verhoeven
- Department of Midwifery Science, Midwifery Academy Amsterdam/Groningen (AVAG) and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Maxima Medical Centre, Veldhoven, The Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, Section Community Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Therese Wiegers
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Ben Willem Mol
- Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - François Schellevis
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, Midwifery Academy Amsterdam/Groningen (AVAG) and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Abstract
Healthcare delivered by teams is becoming more common, and an estimated 50% of obstetricians in the United States (US) work with or employ nurse practitioners or nurse-midwives. The number of midwife-attended births in the United States is also growing. Interprofessional collaboration between midwives and physicians can increase access to safe, quality maternity care for women in the United States. A review of the literature indicates that successful collaborative practice includes effective communication, trust, and respect between providers. A review of concepts and theoretical frameworks offers a foundation for scholarly inquiry, suggests a research agenda for future study, and provides suggestions for organizational leaders to translate current knowledge into the clinical setting. Midwifery, through increasing collaborative practices, has the potential to change care delivery in the years to come.
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Shaw-Battista J, Belew C, Anderson D, van Schaik S. Successes and Challenges of Interprofessional Physiologic Birth and Obstetric Emergency Simulations in a Nurse-Midwifery Education Program. J Midwifery Womens Health 2015; 60:735-43. [PMID: 26624963 DOI: 10.1111/jmwh.12393] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article describes childbirth simulation design and implementation within the nurse-midwifery education program at the University of California, San Francisco. Nurse-midwife and obstetrician faculty coordinators were supported by faculty from multiple professions and specialties in curriculum review and simulation development and implementation. The primary goal of the resulting technology-enhanced simulations of normal physiologic birth and obstetric emergencies was to assist learners' development of interprofessional competencies related to communication, teamwork, and patient-centered care. Trainees included nurse-midwifery students; residents in obstetrics, pediatrics, and family medicine; medical students; and advanced practice nursing students in pediatrics. The diversity of participant types and learning levels provided benefits and presented challenges to effective scenario-based simulation design among numerous other theoretical and logistical considerations. This project revealed practical solutions informed by emerging health sciences and education research literature, faculty experience, and formal course evaluations by learners. Best practices in simulation development and implementation were incorporated, including curriculum revision grounded in needs assessment, case- and event-based clinical scenarios, optimization of fidelity, and ample time for participant debriefing. Adequate preparation and attention to detail increased the immersive experience and benefits of simulation. Suggestions for fidelity enhancement are provided with examples of simulation scenarios, a timeline for preparations, and discussion topics to facilitate meaningful learning by maternity and newborn care providers and trainees in clinical and academic settings. Pre- and postsimulation measurements of knowledge, skills, and attitudes are ongoing and not reported. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.
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Appleton S, Nacht A. Interdisciplinary Education from a College of Nursing and School of Medicine. J Midwifery Womens Health 2015; 60:744-50. [DOI: 10.1111/jmwh.12325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pezaro S, Clyne W, Turner A, Fulton EA, Gerada C. 'Midwives Overboard!' Inside their hearts are breaking, their makeup may be flaking but their smile still stays on. Women Birth 2015; 29:e59-66. [PMID: 26522961 DOI: 10.1016/j.wombi.2015.10.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/20/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
Abstract
PROBLEM Midwifery practice is emotional and, at times, traumatic work. Cumulative exposure to this, in an unsupportive environment can result in the development of psychological and behavioural symptoms of distress. BACKGROUND As there is a clear link between the wellbeing of staff and the quality of patient care, the issue of midwife wellbeing is gathering significant attention. Despite this, it can be rare to find a midwife who will publically admit to how much they are struggling. They soldier on, often in silence. AIM This paper aims to present a narrative review of the literature in relation to work-related psychological distress in midwifery populations. Opportunities for change are presented with the intention of generating further conversations within the academic and healthcare communities. METHODS A narrative literature review was conducted. FINDINGS Internationally, midwives experience various types of work-related psychological distress. These include both organisational and occupational sources of stress. DISCUSSION Dysfunctional working cultures and inadequate support are not conducive to safe patient care or the sustained progressive development of the midwifery profession. New research, revised international strategies and new evidence based interventions of support are required to support midwives in psychological distress. This will in turn maximise patient, public and staff safety. CONCLUSIONS Ethically, midwives are entitled to a psychologically safe professional journey. This paper offers the principal conclusion that when maternity services invest in the mental health and wellbeing of midwives, they may reap the rewards of improved patient care, improved staff experience and safer maternity services.
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Affiliation(s)
- Sally Pezaro
- Faculty of Health & Life Sciences, Coventry University, United Kingdom.
| | - Wendy Clyne
- Research Development Lead in Health, Faculty of Health & Life Sciences, Coventry University, United Kingdom
| | - Andrew Turner
- Centre for Technology Enabled Health Research, Children and Families Research, Faculty of Health & Life Sciences, Coventry University, United Kingdom
| | - Emily A Fulton
- Centre for Technology Enabled Health Research, Faculty of Health & Life Sciences, Coventry University, United Kingdom
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Alliman J, Jolles D, Summers L. The Innovation Imperative: Scaling Freestanding Birth Centers, CenteringPregnancy, and Midwifery-Led Maternity Health Homes. J Midwifery Womens Health 2015; 60:244-249. [PMID: 25963548 DOI: 10.1111/jmwh.12320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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van Helmond I, Korstjens I, Mesman J, Nieuwenhuijze M, Horstman K, Scheepers H, Spaanderman M, Keulen J, Vries RD. What Makes for Good Collaboration and Communication in Maternity Care? A Scoping Study. INTERNATIONAL JOURNAL OF CHILDBIRTH 2015. [DOI: 10.1891/2156-5287.5.4.210] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND: Good communication and collaboration are critical to safe care for mothers and babies.OBJECTIVE: To identify factors associated with good collaboration and communication among maternity care professionals and between both professionals and parents.METHOD: Scoping study. We searched PubMed and Web of Science for peer reviewed, quantitative and qualitative, original, primary research in Western societies on communication and collaboration in maternity care among professionals (Search 1) and between professionals and parents (Search 2).FINDINGS: The 40 studies (14 in Search 1; 26 in Search 2) that met our selection criteria highlighted several factors associated with good communication and collaboration. We grouped these factors into 6 categories: Expertise, Partnership, Context, Attitude, Trust, and Communication style. Studies of communication and collaboration among professionals foregrounded work-related aspects, whereas studies examining collaboration between professionals and parents paid more attention to interpersonal aspects. Before 2012, few studies covered positive aspects of communication and collaboration. We also found an underrepresentation of parents in study populations.CONCLUSION: Our study is part of a growing trend of identifying the positive aspects of communication and collaboration in maternity care. As the study of collaboration in practice continues, researchers need to be sure to involve all stakeholders, including parents.
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DeCesare JZ, Jackson JR. Centering Pregnancy: practical tips for your practice. Arch Gynecol Obstet 2014; 291:499-507. [PMID: 25315379 DOI: 10.1007/s00404-014-3467-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/09/2014] [Indexed: 11/24/2022]
Abstract
IMPORTANCE With increased access to care, current health delivery systems will need expansion to meet higher demands and needs. PURPOSE To define Centering Pregnancy and practical tips for implementation into both private and academic practices. METHODS/EVIDENCE ACQUISITION Evidence was gathered through literature reviews. RESULTS It was found that Centering Pregnancy offers a patient-centered, evidence-based approach to helping with access issues, as well as improving outcomes. CONCLUSIONS This article describes the benefits of Centering Pregnancy to the practice, the provider, and the patient. RELEVANCE Practical implementation tips will be offered, with suggestions for negating common implementation barriers.
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Affiliation(s)
- Julie Z DeCesare
- OBGYN Residency Program, Florida State University College of Medicine, Pensacola, Florida,
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Playing Nice: Improving the Professional Climate Between Physicians and Midwives in the Calgary Area. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:590-597. [DOI: 10.1016/s1701-2163(15)30538-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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