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You W, Donnelly F. A greater nurse and midwife density protects against infant mortality globally. J Pediatr Nurs 2024; 77:e158-e166. [PMID: 38614819 DOI: 10.1016/j.pedn.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE As the largest profession within the health care workforce, nurses and midwives play a critical role in the health and wellness of families especially children and infants. This study suggests those countries with higher nurse and midwife densities (NMD) had lower infant mortality rates (IMR). DESIGN AND METHODS With affluence, low birthweight and urbanization incorporated as potential confounders, this ecological study analyzed the correlations between NMD and IMR with scatterplots, Pearson r correlation, partial correlation and multiple linear regression models. Countries were also grouped for analysing and comparing their Pearson's coefficients. RESULTS NMD inversely and significantly correlated to IMR worldwide. This relationship remained significant independent of the confounders, economic affluence, low birthweight and urbanization. Explaining 57.19% of IMR variance, high NMD was implicated in significantly reducing the IMR. PRACTICE IMPLICATIONS Countries with high NMD had lower IMRs both worldwide and with special regard to developing countries. This may interest healthcare policymakers, especially those from developing countries, to consider the impacts of global nursing and midwifery staffing shortages. Nurses and midwives are the group of healthcare professionals who spend most with infants and their carers. This may be another alert for the health authorities to extend nurses and midwives' practice scope for promoting infant health.
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Affiliation(s)
- Wenpeng You
- Adelaide Nursing School, the University of Adelaide, Adelaide, Australia; Acute and Urgent Care, Royal Adelaide Hospital, Adelaide, Australia; Adelaide Medical School, the University of Adelaide, Adelaide, Australia; School of Nursing and Midwifery, Western Sydney University, Sydney, Australia.
| | - Frank Donnelly
- Adelaide Nursing School, the University of Adelaide, Adelaide, Australia
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Pezaro S, Pendleton J, van der Waal R, LaChance Adams S, Santos MJDS, Bainbridge A, Istha K, Maeder Z, Gilmore J, Webster J, Lai-Boyd B, Brennan AM, Newnham E. Gender-inclusive language in midwifery and perinatal services: A guide and argument for justice. Birth 2024. [PMID: 38822631 DOI: 10.1111/birt.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/04/2024] [Accepted: 05/02/2024] [Indexed: 06/03/2024]
Abstract
Effective communication in relation to pregnancy and birth is crucial to quality care. A recent focus in reproductive healthcare on "sexed language" reflects an ideology of unchangeable sex binary and fear of erasure, from both cisgender women and the profession of midwifery. In this paper, we highlight how privileging sexed language causes harm to all who birth-including pregnant trans, gender diverse, and non-binary people-and is, therefore, unethical and incompatible with the principles of midwifery. We show how this argument, which conflates midwifery with essentialist thinking, is unstable, and perpetuates and misappropriates midwifery's marginalized status. We also explore how sex and gender essentialism can be understood as colonialist, heteropatriarchal, and universalist, and therefore, reinforcing of these harmful principles. Midwifery has both the opportunity and duty to uphold reproductive justice. Midwifery can be a leader in the decolonization of childbirth and in defending the rights of all childbearing people, the majority of whom are cisgender women. As the systemwide use of inclusive language is central to this commitment, we offer guidance in relation to how inclusive language in perinatal and midwifery services may be realized.
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Affiliation(s)
- Sally Pezaro
- Research Centre for Healthcare and Communities, Coventry University, Coventry, UK
- The University of Notre Dame, Fremantle, Western Australia, Australia
| | - John Pendleton
- Research Centre for Healthcare and Communities, Coventry University, Coventry, UK
- Faculty of Health, Education, & Society, University of Northampton, Northampton, UK
| | - Rodante van der Waal
- Care Ethics Department, University for Humanistic Studies, Utrecht, The Netherlands
- Independent Midwife, Bristol, UK
| | - Sarah LaChance Adams
- The Florida Blue Center for Ethics, University of North Florida, Jacksonville, Florida, USA
| | - Mario J D S Santos
- Department of Sociology, Universidade da Beira Interior, Covilhã, Portugal
- Iscte - Instituto Universitário de Lisboa, CIES-IUL, Lisbon, Portugal
| | - Ash Bainbridge
- Three Counties School of Nursing and Midwifery, University of Worcester, Worcester, UK
| | | | | | - John Gilmore
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | | | - Bunty Lai-Boyd
- Three Counties School of Nursing and Midwifery, University of Worcester, Worcester, UK
| | | | - Elizabeth Newnham
- School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
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Kool L, Feijen-de Jong EI, Mastenbroek NJJM, Schellevis FG, Jaarsma DADC. Midwives' occupational wellbeing and its determinants. A cross-sectional study among newly qualified and experienced Dutch midwives. Midwifery 2023; 125:103776. [PMID: 37536117 DOI: 10.1016/j.midw.2023.103776] [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: 08/16/2021] [Revised: 05/26/2023] [Accepted: 07/22/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE Internationally, about 40 percent of midwives report symptoms of burnout, with young and inexperienced midwives being most vulnerable. There is a lack of recent research on burnout among Dutch midwives. The aim of this study was to examine the occupational wellbeing and its determinants of newly qualified and inexperienced midwives in the Netherlands. The majority of practicing Dutch midwives are aged under 40, which could lead to premature turnover. DESIGN A cross-sectional study was conducted using an online questionnaire that consisted of validated scales measuring job demands, job and personal resources, burnout symptoms and work engagement. The Job Demands-Resources model was used as a theoretical model. SETTING AND PARTICIPANTS We recruited Dutch midwives who were actually working in midwifery practice. A total of N=896 midwives participated in this study, representing 28 percent of practicing Dutch midwives. MEASUREMENTS AND FINDINGS Data were analysed using regression analysis. Seven percent of Dutch midwives reported burnout symptoms and 19 percent scored high on exhaustion. Determinants of burnout were all measured job demands, except for experience level. Almost 40 percent of midwives showed high work engagement; newly qualified midwives had the highest odds of high work engagement. Master's or PhD-level qualifications and employment status were associated with high work engagement. All measured resources were associated with high work engagement. KEY CONCLUSIONS A relatively small percentage of Dutch midwives reported burnout symptoms, the work engagement of Dutch midwives was very high. However, a relatively large number reported symptoms of exhaustion, which is concerning because of the risk of increasing cynicism levels leading to burnout. In contrast to previous international research findings, being young and having less working experience was not related to burnout symptoms of Dutch newly qualified midwives. IMPLICATIONS FOR PRACTICE The recognition of job and personal resources for midwives' occupational wellbeing must be considered for a sustainable midwifery workforce. Midwifery Academies need to develop personal resources of their students that will help them in future practice.
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Affiliation(s)
- Liesbeth Kool
- University of Groningen, University Medical Center Groningen, Department of Primary and Long-term Care, PO Box 196, 9700 AD, Groningen, the Netherlands; Midwifery Academy Amsterdam Groningen, InHolland, Groningen, the Netherlands; Midwifery Science, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Esther I Feijen-de Jong
- University of Groningen, University Medical Center Groningen, Department of Primary and Long-term Care, PO Box 196, 9700 AD, Groningen, the Netherlands; Midwifery Academy Amsterdam Groningen, InHolland, Groningen, the Netherlands; Midwifery Science, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | | | - François G Schellevis
- Midwifery Science, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands; NIVEL (Netherlands Institute for Health Services Research), Location VUmc, Utrecht, the Netherlands
| | - Debbie A D C Jaarsma
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands; Wenckebach Institute for Education and Training, Center for Education Development and Research in Health Professions, LEARN, University Medical Center Groningen, University of Groningen, the Netherlands
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Mharapara TL, Clemons JH, Greenslade-Yeats J, Ewertowska T, Staniland NA, Ravenswood K. Toward a contextualized understanding of well-being in the midwifery profession: An integrative review. JOURNAL OF PROFESSIONS AND ORGANIZATION 2023. [DOI: 10.1093/jpo/joac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Abstract
Our integrative review synthesizes and evaluates two decades of empirical research on well-being in the midwifery profession to reveal (1) how researchers have studied midwives’ well-being; (2) key findings of research on midwives’ well-being; (3) underlying assumptions of this research; and (4) limitations of this research. We find that research on midwives’ well-being is disproportionately focused on individual midwives, who are assumed to be largely responsible for their own well-being, and that well-being in the midwifery profession is generally equated with the absence of mental health problems such as burnout, anxiety, and stress. Researchers have largely taken a narrow and instrumental approach to study midwives’ well-being, focusing on work-related antecedents and consequences, and overlooking the influence of nonwork factors embedded in the broader socioeconomic and cultural environment. Drawing on more comprehensive and contextualized well-being frameworks, we propose a research model that (1) expands the well-being construct as it applies to midwives and (2) situates midwives’ well-being in broader social, economic, political, and cultural contexts. Although developed in the midwifery context, our proposed research model can be applied to a host of professions.
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Affiliation(s)
- Tago L Mharapara
- Management Department, Auckland University of Technology , 120 Mayoral Drive, Auckland, 1010 , New Zealand
| | - Janine H Clemons
- Midwifery Department , MH Building 640 Great South Road, Manukau, 2025 , New Zealand
| | - James Greenslade-Yeats
- Management Department, Auckland University of Technology , 120 Mayoral Drive, Auckland, 1010 , New Zealand
| | - Tanya Ewertowska
- Management Department, Auckland University of Technology , 120 Mayoral Drive, Auckland, 1010 , New Zealand
| | - Nimbus Awhina Staniland
- Management Department, Auckland University of Technology , 120 Mayoral Drive, Auckland, 1010 , New Zealand
| | - Katherine Ravenswood
- Management Department, Auckland University of Technology , 120 Mayoral Drive, Auckland, 1010 , New Zealand
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Pappu NI, Öberg I, Byrskog U, Raha P, Moni R, Akhtar S, Barua P, Das SR, De S, Jyoti HJ, Rahman R, Sinha GR, Erlandsson K. The commitment to a midwifery centre care model in Bangladesh: An interview study with midwives, educators and students. PLoS One 2023; 18:e0271867. [PMID: 37036838 PMCID: PMC10085017 DOI: 10.1371/journal.pone.0271867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 03/24/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Midwifery-led care is a key factor in reducing maternal and new-born mortality globally. In Bangladesh, only a third of births are attended by professionals and almost 70% of births occur outside healthcare facilities. Midwifery is a relatively new profession in Bangladesh and a midwifery centre care model has only recently been introduced. This study aims to explore the willingness within the healthcare system to support a greater role for midwifery centres in maternity services. METHODS Data were collected through individual semi-structured interviews with 55 midwives, midwifery educators and final year midwifery students. Two of the midwifery educators were principals of nursing institutes involved in the government's midwifery leadership and considered as experts in the midwifery care system. The data was analysed using qualitative content analysis. The transcribed interviews comprised 150 pages. The study received ethical approval from the Directorate General of Nursing and Midwifery in Bangladesh. RESULTS One main category emerged from the study: "The foundations of a midwifery centre care model need to be strengthened for the sustainable implementation of midwifery centres in Bangladesh to continue". Five additional categories were identified: 1) The midwifery centre care model is inaccessible for communities, 2) Striving for acceptable standards of care within a midwifery centre care model is not a priority 3) Respectful, woman-centred care is weak, 4) Community engagement with the midwifery centre care model is insufficient, and 5) The midwifery centre care model is not integrated into the healthcare system. These categories were supported by the identification of 11 sub-categories. CONCLUSION The willingness to commit to a midwifery centre care model is not yet in place in Bangladesh. Advocacy, information, and education about the benefits of normal birth assisted by professional midwives is needed at all levels of Bangladeshi society.
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Affiliation(s)
| | - Ida Öberg
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ulrika Byrskog
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Pronita Raha
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ratna Moni
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Shaheen Akhtar
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Priti Barua
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Sujata Rani Das
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Shipra De
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | | | - Rezaur Rahman
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Gita Rani Sinha
- School of Health and Welfare, Dalarna University, Falun, Sweden
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Jefford E, Nolan S. Two parts of an indivisible whole - Midwifery education and feminism: An exploratory study of 1st year students' immersion into midwifery. NURSE EDUCATION TODAY 2022; 119:105589. [PMID: 36228345 DOI: 10.1016/j.nedt.2022.105589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/14/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Emancipation and self-determination are critical elements of midwifery care and therefore should be explicit in midwifery education. If not, the woman-centred midwife with her trust in women and birth may become a thing of the past, and the patriarchal, technocratic medical model of maternity care, with its trust in machines and misguided interventions will continue to dominate childbearing practices. The optimal time for exposure to feminist principles within the midwifery educational journey, however, is unknown, despite recognition that teaching feminist theory and related concepts positively impacts the way students value women-centredness in midwifery practice. OBJECTIVE To understand midwifery student's perspectives of assimilating feminist theory and midwifery philosophy. DESIGN A qualitative approach using reflective journals was used to explore student midwives understanding of midwifery as a feminist profession. SETTING One regional Australian University that teaches midwifery at two campuses, one of which straddles a state border. PARTICIPANTS First session, first-year midwifery students undertaking a unit of study focusing on "what is midwifery" and how at its core, midwifery is a feminist emancipatory political discipline. METHODS Data from weekly reflective journals were analysed to produce themes. FINDINGS Three themes were identified 'Midwifery: Past and Present', 'What is this 'F' word? - feminism revisited', and 'Midwifery-feminism dyads'. These themes demonstrated transformative learning had occurred as participants appeared to value understanding feminism as the essence of midwifery philosophy early in their midwifery studies. CONCLUSION Students embarking on their journey appear to value assimilation of feminist theory as a core tenet of midwifery philosophy. Feminist principles, particularly the protection of women's rights to informed choice, trusted relationships, dignity, and control throughout their childbearing journey appear to illustrate the emancipatory nature, and importance of, truly 'woman-centred, partnership-based midwifery care'. RECOMMENDATIONS FOR PRACTICE AND FURTHER RESEARCH Whilst the findings of this study relate to midwifery students, the findings point to a need to explore ways to strengthen midwives' assimilation with feminist theory, and their ability to promote feminism and provide woman-centred, partnership-based approaches.
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Affiliation(s)
- Elaine Jefford
- University of South Australia, Frome Street, Adelaide 5000, SA, Australia.
| | - Samantha Nolan
- Women, Newborn & Children's Health Service, Gold Coast Health, Gold Coast Hospital, 1 Hospital Boulevard, Southport 4215, QLD, Australia.
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Alonso C. Integrating the midwifery model of care into abortion services. Sex Reprod Health Matters 2021; 28:1795448. [PMID: 32729381 PMCID: PMC7888103 DOI: 10.1080/26410397.2020.1795448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Cristina Alonso
- Doctoral Fellow, Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA. Correspondence :
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Is the Concept of Midwifery Abdication Evident in Australian Case Law? A Systematic Review of Legal Literature, Court/Tribunal Decisions, and Coronial Findings. INTERNATIONAL JOURNAL OF CHILDBIRTH 2020. [DOI: 10.1891/ijcbirth-d-20-00038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDThis 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.OBJECTIVETo explore Midwifery Abdication and whether it is evident within Australian caselaw.DATA SOURCESAustralian Legal literature, coronial findings, and court/tribunal decisions reported by the Australian Health Practitioner Regulation Agency, during 2005–2020.ELIGIBILITY CRITERIA1,246 cases were located using the presented search terms. Use of exclusion criteria resulted in the inclusion of 41 cases.METHODSWhile 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.RESULTSMidwifery 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.LIMITATIONSRigorous 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 FINDINGSAcknowledging 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.
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Sarmiento I, Paredes-Solís S, Morris M, Pimentel J, Cockcroft A, Andersson N. Factors influencing maternal health in indigenous communities with presence of traditional midwifery in the Americas: protocol for a scoping review. BMJ Open 2020; 10:e037922. [PMID: 33109651 PMCID: PMC7592283 DOI: 10.1136/bmjopen-2020-037922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/20/2020] [Accepted: 07/17/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Indigenous mothers often receive culturally unsafe services that do not fully respond to their needs. The objective of this scoping review is to collate and assess evidence that identifies factors, including the role and influence of traditional midwives, that affect maternal health in indigenous communities in the Americas. The results will map Western perspectives reflected in published and unpublished literature to indicate the complex network of factors that influence maternal outcomes. These maps will allow for comparison with local stakeholder knowledge and discussion to identify what needs to change to promote culturally safe care. METHODS AND ANALYSIS A librarian will search studies with iterative and documented adjustments in CINAHL, Scopus, Latin American and Caribbean Health Sciences Literature (LILACS), MEDLINE, Embase and Google Scholar without any time restrictions, and use Google search engine for grey literature. Included studies will be empirical (quantitative, qualitative or mixed); address maternal health issues among indigenous communities in the Americas; and report on the role or influence of traditional midwives. Two researchers will independently screen and blindly select the included studies. The quality assessment of included manuscripts will rely on the Mixed Methods Appraisal Tool (MMAT). Two independent researchers will extract data on factors promoting or reducing maternal health in indigenous communities, including the role or influence of traditional midwives. Fuzzy cognitive mapping will summarise the findings as a list of relationships between identified factors and outcomes with weights indicating strength of the relationship and the evidence supporting this. ETHICS AND DISSEMINATION This review is part of a proposal approved by the ethics committees at McGill University and the Centro de Investigación de Enfermedades Tropicales in Guerrero. Participating indigenous communities in Guerrero State approved the study in 2015. The results of the scoping review will contribute to the field of cultural safety and intercultural dialogue for the promotion of maternal health in indigenous communities.
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Affiliation(s)
- Iván Sarmiento
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Québec, Canada
- Grupo de Estudios en Sistemas Tradicionales de Salud (GESTS), Universidad del Rosario, Bogotá, Cundinamarca, Colombia
| | - Sergio Paredes-Solís
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, México
| | - Martin Morris
- Schulich Library of Physical Sciences, Life Sciences and Engineering, McGill University, Montreal, Québec, Canada
| | - Juan Pimentel
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Québec, Canada
- Grupo de Estudios en Sistemas Tradicionales de Salud (GESTS), Universidad del Rosario, Bogotá, Cundinamarca, Colombia
| | - Anne Cockcroft
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - Neil Andersson
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Québec, Canada
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, México
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Commentary: Creating a definition for global midwifery centers. Midwifery 2020; 85:102684. [DOI: 10.1016/j.midw.2020.102684] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/15/2020] [Accepted: 02/25/2020] [Indexed: 11/24/2022]
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