Determining the psychometric properties of the Enhancing Decision-making Assessment in Midwifery (EDAM) measure in a cross cultural context

Task shifting for maternal and neonatal care in low-resource settings: A mixed-methods evaluation of a midwifery training program in rural Papua New Guinea

In an effort to reduce maternal and neonatal mortality, a rural health system in Papua New Guinea implemented a two-week midwifery training program for 47 nurses and community health workers. We evaluated this program by administering pre- and post-training knowledge tests, focus group discussions, a clinical vignette task, and key informant interviews. Participants improved significantly in their midwifery knowledge and demonstrated effective care in the clinical vignettes. Participants described the training as novel and beneficial. Program leaders were motivated to scale up the program and assess community-level impact. This program has strong potential to improve local obstetric care capacity.

Is the Concept of Midwifery Abdication Evident in Australian Case Law? A Systematic Review of Legal Literature, Court/Tribunal Decisions, and Coronial Findings

BACKGROUND

This review builds upon previous work exploring the concept of Midwifery Abdication, within the national midwifery literature. This article focuses on Australian legal literature, court/tribunal decisions and coronial or coroner's court findings.

OBJECTIVE

To explore Midwifery Abdication and whether it is evident within Australian caselaw.

DATA SOURCES

Australian Legal literature, coronial findings, and court/tribunal decisions reported by the Australian Health Practitioner Regulation Agency, during 2005–2020.

ELIGIBILITY CRITERIA

1,246 cases were located using the presented search terms. Use of exclusion criteria resulted in the inclusion of 41 cases.

METHODS

While there are no validated tools to appraise caselaw, this review followed a robust protocol that guides the preparation and reporting of systematic reviews. Midwifery Abdication was identified using previously validated, interrelated constructs.

RESULTS

Midwifery Abdication occurred in 41 cases; that included one or more previously identified constructs. In line with the associated integrative review, a midwife's professional identity, environmental hierarchy and associated culture of social obedience are all shown to act as influencing factors in Midwifery Abdication.

LIMITATIONS

Rigorous and reproducible processes were used; however, limited search functionality of some data sources may have resulted in inadvertent omission of cases. While this review relates to case law in one high-income country it provides a platform for further international research.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

Acknowledging Midwifery Abdication in Australian caselaw may serve to strengthen the midwifery voice and encourage an enhanced educational and reflective focus on midwifery philosophy and decision-making. Midwifery education must empower midwives to embrace their autonomous status while enhancing their abilities to optimize informed decision-making within a woman-centered midwifery philosophy.

Applying a Midwifery-Specific Decision-Making Tool to Midwives’ Clinical Reasoning and Midwifery Practice When Managing a Woman’s Perineum in Labor: An Exploratory Study

Introduction: Many of the risk factors for perineal trauma are modifiable, and midwives are in an ideal position to mitigate such risks. To date, no investigation using a midwifery-specific decision-making tool has sought to determine how midwives make decisions within a midwifery philosophy/context or identify the factors that may contribute to that decision making about perineal management. We sought to apply such a tool to midwives’ narratives and explore their clinical reasoning and midwifery practice when managing a woman’s perineum in labor.

Methods: A qualitative interview-based study with practicing midwives in one regional Australian maternity unit was conducted. The decision-making matrix specified by a psychometrically robust and validated measure of clinical decision making and midwifery practice-guided analysis.

Results: Effective clinical decision making in response to perineal trauma is contingent on a heuristic and individualized “working hypothesis” that combines distinct elements of an optimal clinical decision-making process. Midwives’ narratives highlighted their ability to engage in some form of clinical reasoning. Some elements of midwifery practice was lacking within several midwives’ narratives, thus resulting in them abdicating their professional role.

Conclusion: The manner and processes by which midwives engage effectively with perineal management are complex. However, a significant influence on this process appears to be recollections from original training in perineal management, which appears to be largely rote and taught by example. We recommend balance between practical experience and synthesis with current evidence within a midwifery philosophy to optimize perineal care and risk modification.

Variables That Influence US Midwife and Physician Management of the Third Stage of Labor

INTRODUCTION

Midwives and physicians incorporate their knowledge, experiences, and other variables in making clinical decisions. Variations in the management of the third stage of labor may be a result of variables that influence providers' decision making. The purpose of this study was to describe variables that influence US midwives' and physicians' management of the third stage of labor.

METHODS

A randomly selected national sample of certified nurse-midwives and certified midwives, certified professional midwives, obstetricians, and family physicians was surveyed about the extent to which maternal characteristics, maternal history, and current birth characteristics influence their third-stage management. The extent of influence was defined in terms of always to never altering management. Descriptive summaries, group comparisons, and partial correlations were used to determine differences in influences between midwives and physicians. One free-text question was analyzed using qualitative methods.

RESULTS

A total of 1243 clinicians responded. There was considerable variability in the response patterns in that the same variable was reported to always alter management during the third stage of labor for some participants yet did not influence the management practices of others at all. Differences between responses from midwives and physicians were explored as a possible explanation for some of the variability. In response to the free-text inquiry about variables that most influenced changes in participants' usual management of the third stage, the participants most often included active bleeding, current recommendations or guidelines, and maternal or family preferences.

DISCUSSION

This study identifies variables reported as influencing clinical decision making during the third stage of labor. Therefore, these variables are important to consider when evaluating interventions and outcomes related to management of the third stage of labor and any attempts to design new interventions. The findings are descriptive of practice; they are not intended to guide changes in practice.