'Doing' is never enough, if 'being' is neglected. Exploring midwives' perspectives on the influence of an emotional intelligence education programme, a qualitative study

BACKGROUND

The role of the midwife is emotionally demanding with many midwives experiencing high levels of stress and burnout, and a great number considering leaving the profession. This has serious implications for the delivery of high-quality, safe maternity care. One of the major factors leading to job dissatisfaction is the conflict between midwives' aspiration of truly 'being' with the woman and the institutional expectations of the role which focuses on the 'doing' aspects of the job. 'Being' present to a woman's psychological needs, whilst meeting the institutional demands, requires high levels of emotional intelligence (EI) in the midwife. Therefore, enhancing midwives' EI could be beneficial.

EI EDUCATION PROGRAMME

An EI programme was made available to midwives with the intention to promote their emotional intelligence and enable them to utilise relaxation techniques for those in their care.

AIM

To explore midwives' perspectives on the influence of the EI education programme on their emotional wellbeing and experiences of practice.

METHOD

The study took a descriptive qualitative approach. Thirteen midwives participated in focus group interviews. The data were analysed using thematic analysis.

FINDINGS

The overarching theme of 'The Ripple Effect' included three themes of 'Me and my relationships', 'A different approach to practice' and 'Confidence and empowerment'. The programme was seen to create a positive ripple effect, influencing midwives personally, their approach to practice, and feelings of confidence in their role.

CONCLUSION

EI education can reduce emotional stress in midwives, enhance their empathy and feelings of confidence, thus, improving the quality of care they provide.

Chilean midwives' experiences while providing induced abortion care after the enactment of a law decriminalising abortion

INTRODUCTION

The recent change in Chilean legislation towards abortion enabled midwives to include the care of women having an induced abortion within their scope of practice. However, midwives' identity could be strained by induced abortion care provision as it is contrary to midwives' traditional role. Considering this, the aim of the study was to elucidate how Chilean midwives understand and provide abortion care.

METHODS

A constructivist grounded theory study was conducted using online semi-structured in-depth interviews. Midwives were purposively sampled considering maximum variation criteria and then theoretical sampling occurred. Saturation was achieved with fifteen interviews. Interviews were conducted in Spanish and then translated into English. Constant comparison analysis generated categories. Data were managed using NVivo 12. All interviewees provided their consent to be part of this study.

RESULTS

This article reports on the experiences of nine midwives who had provided lawful induced abortion care in Chile. The experiences of these midwives were grouped into two major categories: 'Defining a position towards abortion' and 'Abortion care is emotional labour'.

CONCLUSION

Midwives can successfully provide abortion care despite being challenged by certain areas of it. Considering the high demand for emotional labour in abortion care, efforts should be made to increase midwives' emotional self-regulation skills. Likewise, organisations should strengthen and implement their offer of well-being and emotional self-care support to midwives.

Midwives' experiences of providing pre-eclampsia care in a low- and middle-income country - A qualitative study

PROBLEM

Like other low- and middle-income countries, Ghana has high maternal mortality stemming from pre-eclampsia. Ghanaian midwives are frontline service providers of emergency care in obstetric complications and have the greatest potential to maximise pre-eclampsia outcomes. Little is known about the potential barriers and challenges to midwives' capacity to provide quality care in pre-eclampsia in Ghana. Therefore, we aimed to explore and gain insights into midwives' experiences of pre-eclampsia care including their knowledge, skills, and psychological aspects such as midwives' resilience.

BACKGROUND

There is a rising global incidence of pre-eclampsia. Quality midwifery care in inter-professional collaborative practice is crucial to reducing pre-eclampsia-related morbidity and mortality.

METHODS

A qualitative descriptive exploratory study. In-depth semi-structured interviews (n = 35) were performed in 2021 and analysed by thematic analysis.

FINDINGS

There were three main themes. 1) Competence and Confidence in care; midwives provided timely and appropriate care based on sound knowledge and skills; they explained how pre-eclampsia care was organised within a multidisciplinary context and described collaborative working amongst midwives for mutual learning and support. 2) Emotional concerns and empathy; midwives' described fulfillment in achieving positive pre-eclampsia outcomes. In contrast, maternal loss was distressing and traumatic. 3) Call for improved care resources for pre-eclampsia; midwives recommended expansion of continuing professional development opportunities, appropriate infrastructure, resources, tailored public education, and a review of pre-service education to support their participation in pre-eclampsia care.

CONCLUSION

To improve the quality of care in pre-eclampsia, midwives should be capacitated, systems should promptly address barriers, and prioritise midwives' emotional well-being.

Midwives' experiences of postpartum haemorrhage: A web-based survey in Sweden

OBJECTIVE

The objective was to describe midwives' experiences of postpartum haemorrhage (PPH) >1000 ml in connection with childbirth.

DESIGN

A qualitative web-based survey with open-ended questions was used and the results were analysed with content analysis.

SETTING

Participants were recruited through convenience sampling from a national Facebook group for midwives.

PARTICIPANTS

The study sample included 24 midwives with varying work experience at different maternity units in Sweden, all of whom had experience of postpartum haemorrhage >1000 ml.

FINDINGS

The midwives described that the treatment of PPH is limited by a lack of cooperation, knowledge, and assistance, as well as by staff inexperience. They also described how a high-pressure work environment contributed to feelings of inadequacy. Good cooperation, team training, having colleagues present, embodied knowledge, and good working conditions, led to successful handling of such situations, which contributed to feeling at ease with what had happened.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Good working conditions related to external contextual factors such as total load and support, as well as internal factors such as self-efficacy, can help midwives manage PPH while providing patient-safe care and feeling confident in their ability and at ease with the events. Therefore, midwives need to be given opportunities for emotional support, education, and team-based training to maintain the quality of midwifery care and avoid negative long-term effects for both midwives and patients.

Informed consent in episiotomy: Co-analysis with midwives and distillation of best practice

BACKGROUND

Performing an episiotomy where clinically indicated is a key intervention in the Obstetric Anal Sphincter Injury Care Bundle (OASI-CB) implemented across England and Wales to reduce the risk and increase the detection of severe perineal trauma after birth. Standards of consent provided to people in maternity care generally and for episiotomy specifically have been reported as suboptimal. Compromising birthing people's personal autonomy or sense of control has been linked to a dissatisfying birth experience, negative psychological sequelae, and litigation.

METHODS

This study explored experienced midwives' practice of informed consent for episiotomy during a midwife-led birth. We sampled 43 midwives across eight NHS Trusts in England and Wales using online focus groups and telephone interviews about their experience of consent in episiotomy. Using qualitative content analysis and art-based co-analysis methods with eight midwives from across the research sites, we co-analyzed and co-constructed three themes and four practice recommendations from the data.

RESULTS

Three themes were constructed from the data: Assent rather than consent, Change in culture to support best practice, and Standardized information. These themes informed the shaping of four recommendations for best practice in episiotomy informed consent.

CONCLUSION

This study has shown how variations in midwifery practice and culture may impact birthing people's experience of informed consent in episiotomy. Midwives may not have the knowledge or skills to conduct a detailed consent conversation, leading to variation in practice and messages for birthing people. The use of antenatal discussion aids can offer women the opportunity to become informed and fully participate in the decision-making process.

Recognizing and Adapting to Cultural Differences: Influence of International Educational Programs on Future Nursing and Midwifery Practice

INTRODUCTION

International educational programs build cultural humility and safety skills in nursing and midwifery students; however, long-term outcomes of these programs are unclear. The purpose of this study was to explore the impact of international educational programs on nurses' and midwives' future professional practice.

METHOD

Using grounded theory informed by Charmaz, 13 general nurses, two mental health nurses, three midwives, and four dual-qualified nurse/midwives across eight different countries were interviewed. Three categories evolved from the analysis. This article reports on the category Recognizing and adapting to cultural differences.

FINDINGS

Participants developed cultural safety and awareness from participation in programs extending into future practice. Experiencing and adapting to cultural similarities and differences, they developed culturally congruent practices many years after program completion.

DISCUSSION

International programs contributed to participants' professional practice. Positive and ongoing influences are important for employers to promote patient safety and culturally congruent quality care. Findings are also relevant for education providers to inform quality cultural learning.

Measuring job satisfaction of midwives: A scoping review

Background

Given the global shortage of midwives, it is of utmost interest to improve midwives’ job satisfaction and working environments. Precise measurement tools are needed to identify both predictors of job satisfaction and intervention strategies which could increase it. The aim of this study is to collate, describe and analyse instruments used in research to assess the job satisfaction of midwives working in hospitals, to identify valid and reliable tools and to make recommendations for the further development of specific instruments for midwifery practice and future midwifery research.

Methods

We conducted systematic literature searches of the following databases: CINAHL, MEDLINE, PsycINFO, Web of Science Core Collection, Cochrane Database. Studies which assessed the job satisfaction of midwives working in a hospital setting were eligible for inclusion.

Findings

Out of 637 records 36 empirical research articles were analysed, 27 of them cross-sectional studies. The studies had been conducted in 23 different countries, with sample sizes ranging between nine and 5.446 participants. Over 30 different instruments were used to measure midwives’ job satisfaction, with considerable differences in terms of domains evaluated and number of items. Twelve domains relevant for job satisfaction of midwives working in hospitals were identified from the empirical studies. Four instruments met the defined reliability and validity criteria.

Conclusion

Autonomy, the significance of the job, the challenges of balancing work and private life, and the high emotional and physical demands of midwifery are job characteristics which are underrepresented in instruments measuring job satisfaction. The influence of the physical working environment has also not yet been researched. There is a need to develop or adapt instruments to the working environment of midwives.

Decision-making during obstetric emergencies: A narrative approach

This study aims to explore how physicians make sense of and give meaning to their decision-making during obstetric emergencies. Childbirth is considered safe in the wealthiest parts of the world. However, variations in both intervention rates and delivery outcomes have been found between countries and between maternity units of the same country. Interventions can prevent neonatal and maternal morbidity but may cause avoidable harm if performed without medical indication. To gain insight into the possible causes of this variation, we turned to first-person perspectives, and particularly physicians’ as they hold a central role in the obstetric team. This study was conducted at four maternity units in the southern region of Sweden. Using a narrative approach, individual in-depth interviews ignited by retelling an event and supported by art images, were performed between Oct. 2018 and Feb. 2020. In total 17 obstetricians and gynecologists participated. An inductive thematic narrative analysis was used for interpreting the data. Eight themes were constructed: (a) feeling lonely, (b) awareness of time, (c) sense of responsibility, (d) keeping calm, (e) work experience, (f) attending midwife, (g) mind-set and setting, and (h) hedging. Three decision-making perspectives were constructed: (I) individual-centered strategy, (II) dialogue-distributed process, and (III) chaotic flow-orientation. This study shows how various psychological and organizational conditions synergize with physicians during decision-making. It also indicates how physicians gave decision-making meaning through individual motivations and rationales, expressed as a perspective. Finally, the study also suggests that decision-making evolves with experience, and over time. The findings have significance for teamwork, team training, patient safety and for education of trainees.

A survey of mental health status of obstetric nurses during the novel coronavirus pneumonia pandemic

To investigate the mental health status of obstetric nurses and its influencing factors during the novel coronavirus epidemic period, so as to provide theoretical reference for hospital decision-makers and managers.From February 25 to March 20, 2020, we conducted a cross-sectional survey through online questionnaire, and selected obstetric nurses from Jilin and Heilongjiang Provinces as the research objects by convenience sampling.Three hundred eighteen valid questionnaires were collected; the results of Symptom Checklist 90 showed that the scores of "obsessive-compulsive", "depression", "anxiety", "hostility", "phobia", and "psychosis" were higher than the Chinese norm (P < .01). There were 107 people whose total score of Symptom Checklist 90 was more than 160, and 83 people whose number of positive items was more than 43. Logistic regression results showed that married, temporary employment, lack of support and communication from family and relatives, onerous task, and unbearable responsibility were independent risk factors for mental disorder.There is a great psychological burden for obstetric nurses during the epidemic period. Decision makers should focus on necessary psychological intervention for those that are married, temporarily employed, and those lacking family supports including communication. At the same time, managers should distribute tasks reasonably to avoid psychological burdens caused by overwork.

Tensions Between Ethics and the Law: Examination of a Legal Case by Two Midwives Invoking a Conscientious Objection to Abortion in Scotland

This paper examines a legal case arising from a workplace grievance that progressed to being heard at the UK's Supreme Court. The case of Doogan and Wood versus Greater Glasgow and Clyde Health Board concerned two senior midwives in Scotland, both practicing Roman Catholics, who exercised their perceived rights in accordance with section 4(1) of the Abortion Act not to participate in the treatment of women undergoing abortions. The key question raised by this case was: "Is Greater Glasgow and Clyde Health Board entitled to require the midwives to delegate, supervise and support staff in the treatment of patients undergoing termination of pregnancy?" The ethical issues concerning conscientious objection to abortion have been much debated although the academic literature is mainly concerned with the position of medical practitioners rather than what the World Health Organization terms "mid-level professionals" such as midwives. This paper examines the arguments put forward by the midwives to justify their refusal to carry out tasks they felt contravened their legal right to make a conscientious objection. We then consider professional codes, UK legislation and church legislation. While the former are given strong weighting the latter was been ignored in this case, although cases in other European countries have been prevented from escalating to such a high level by the intervention of prominent church figures. The paper concludes by stating that the question put to the courts remains as yet unanswered but offers some recommendations for future policy making and research.

The key components of a successful model of midwifery-led continuity of carer, without continuity at birth: findings from a qualitative implementation evaluation

BACKGROUND

Recent UK maternity policy changes recommend that a named midwife supports women throughout their pregnancy, birth and postnatal care. Whilst many studies report high levels of satisfaction amongst women receiving, and midwives providing, this level of continuity of carer, there are concerns some midwives may experience burnout and stress. In this study, we present a qualitative evaluation of the implementation of a midwife-led continuity of carer model that excluded continuity of carer at the birth.

METHODS

Underpinned by the Conceptual Model for Implementation Fidelity, our evaluation explored the implementation, fidelity, reach and satisfaction of the continuity of carer model. Semi-structured interviews were undertaken with midwives (n = 7) and women (n = 15) from continuity of carer team. To enable comparisons between care approaches, midwives (n = 7) and women (n = 10) from standard approach teams were also interviewed. Interviews were recorded, transcribed and analysed using thematic analysis.

RESULTS

For continuity of carer team midwives, manageable caseloads, extended appointment times, increased team stability, and flexible working patterns facilitated both care provided and midwives' job satisfaction. Both continuity of carer and standard approach midwives reported challenges in providing postnatal continuity given the unpredictable timing of labour and birth. Time constraints, inadequate staffing and lack of administrative support were reported as additional barriers to implementing continuity of carer within standard approach teams. Women reported continuity was integral to building trust with midwives, encouraged them to disclose mental health issues and increased their confidence in making birth choices.

CONCLUSIONS

Our evaluation highlighted the successful implementation of a continuity of carer model for ante and postnatal care. Despite exclusion of the birth element in the model, both women and midwives expressed high levels of satisfaction in comparison to women and midwives within the standard approach. Implementation successes were largely due to structural and resource factors, particularly the combination of additional time and smaller caseloads of women. However, these resources are not widely available within the resources of maternity unit budgets. Future research should further explore whether a continuity of carer model focusing on antenatal and postnatal care delivery is a feasible and sustainable model of care for all women.

Midwives' challenges in the management of postpartum haemorrhage at rural PHC facilities of Limpopo province, South Africa: an explorative study

BACKGROUND

Postpartum haemorrhage is one of the causes of the rise in maternal mortality. Midwives' experiences related to postpartum haemorrhage (PPH) management remain unexplored, especially in Limpopo. The purpose of the study was to explore the challenges experienced by midwives in the management of women with PPH.

METHODS

Qualitative research was conducted to explore the challenges experienced by midwives in the management of women with PPH. Midwives were sampled purposefully. Unstructured interviews were conducted on 18 midwives working at primary health care facilities. Data were analysed after data saturation.

RESULTS

After data analysis, one theme emerged "challenges experienced by midwives managing women with PPH" and five subthemes, including: "difficulty experienced resulting in feelings of frustrations and confusion and lack of time and shortage of human resource inhibits guidelines consultation".

CONCLUSION

The study findings revealed that midwives experienced difficulty when managing women with postpartum haemorrhage. For successful implementation of maternal health care guidelines, midwives should be capacitated through training, supported and supervised in order to execute PPH management with ease.

Factors that influence management of postpartum hemorrhage among midwives in a rural setting in Kenya

Background

Postpartum hemorrhage is the cumulative blood loss of 500 milliliters or more in a spontaneous vaginal delivery and approximately 1,000 milliliters or more for caesarean section birth and a leading cause of maternal mortality1.

Objective

The overall aim of the study was to determine midwives' factors that influence the management of PPH.

Methods

A descriptive cross-sectional study that employed a quantitative approach through the use of a research self- administered questionnaire and an observational checklist targeting midwives were used. 85 midwives filled the questionnaire and 71 were observed respectively. The study was hospital- based conducted in Muranga County, Kenya. Convenience sampling technique was used to select the midwives in the study sites.

Results

The following factors were statistically significant in influencing management of postpartum hemorrhage; age (P-value = 0.021). professional qualification (P= 0.047), experience in management of PPH (P= 0.032) and training on emergency PPH (P= 0.010), knowledge factors that were found to influence the management of PPH positively include knowledge on; prevention of PPH (p value-0.000), correct use of prophylactic uterotonic agents (P= 0.000), uterotonics use (P= 0.043), uterine massage during 3^rd stage of labour (P= 0.012), examination of the placenta (P= 0.034), management of PPH (P= 0.028), causes and diagnosis of PPH (P= 0.001), (Fischer's exact value= 0.043).

Conclusion

Results of the study indicate a statistical association between midwives' factors and management of PPH.

The Role of Nurses and Midwives in Expanding and Sustaining Voluntary Medical Male Circumcision Services for HIV Prevention: A Systematic and Policy Review

ABSTRACT

Male circumcision reduces men's risk of acquiring HIV through heterosexual sex, and voluntary medical male circumcision (VMMC) is central to HIV prevention strategies in 15 sub-Saharan African countries. Nurses have emerged as primary VMMC providers; however, barriers remain to institutionalizing nurse-led VMMC. Patient safety concerns have hindered task sharing, and regulations governing nurse-performed VMMC are not always supportive or clear. We performed a systematic review on VMMC safety by provider cadre and a desk review of national policies governing the VMMC roles of nurses and midwives. Also, VMMC by nurses is safe and has become standard practice. Countries had multiple policy combinations among different documents, with only one disallowing VMMC by these cadres. Countries with alignment between policies often ensured that nursing workforces were equipped with clinical competencies through national certification. Regulatory clarity and formalized certification for nurse-performed VMMC can increase program sustainability and build nursing capacity to meet other critical basic surgical needs.

Swedish midwives' experiences and views of amniotomy: An interview study

OBJECTIVE

To explore midwives' experiences and views of amniotomy.

DESIGN

A qualitative inductive design was used. Data were collected using interviews and analysed with content analysis carried out with NVivo 12.

SETTING AND PARTICIPANTS

Sixteen midwives working at delivery wards at three hospitals in the south of Sweden.

FINDINGS

Three categories emerged: "Promote, protect and support the physiological process of labour", "To make the decision -to do or not to do" and "Unpredictable response". The overall theme linking the three categories was "We become our decisions", portraying how midwives carry the responsibility in the decision-making and represent themselves in their handling of amniotomy.

CONCLUSIONS

Amniotomy was experienced and viewed as both simple and complex, safe and risky, and deciding on it sometimes implied balancing contradicting perspectives. By using midwifery skills in the decision-making for an amniotomy, the midwives tried to predict the response, purposing to support physiological labour and promote health for women and babies.

Understanding how midwives employed by the National Health Service facilitate women's alternative birthing choices: Findings from a feminist pragmatist study

UK legislation and government policy favour women's rights to bodily autonomy and active involvement in childbirth decision-making including the right to decline recommendations of care/treatment. However, evidence suggests that both women and maternity professionals can face challenges enacting decisions outside of sociocultural norms. This study explored how NHS midwives facilitated women's alternative physiological birthing choices-defined in this study as 'birth choices that go outside of local/national maternity guidelines or when women decline recommended treatment of care, in the pursuit of a physiological birth'. The study was underpinned by a feminist pragmatist theoretical framework and narrative methodology was used to collect professional stories of practice via self-written narratives and interviews. Through purposive and snowball sampling, a diverse sample in terms of age, years of experience, workplace settings and model of care they operated within, 45 NHS midwives from across the UK were recruited. Data were analysed using narrative thematic that generated four themes that described midwives' processes of facilitating women's alternative physiological births: 1. Relationship building, 2. Processes of support and facilitation, 3. Behind the scenes, 4. Birth facilitation. Collectively, the midwives were involved in a wide range of alternative birth choices across all birth settings. Fundamental to their practice was the development of mutually trusting relationships with the women which were strongly asserted a key component of safe care. The participants highlighted a wide range of personal and advanced clinical skills which was framed within an inherent desire to meet the women's needs. Capturing what has been successfully achieved within institutionalised settings, specifically how, maternity providers may benefit from the findings of this study.

Primary healthcare midwives' experiences of caring for parents who have suffered an involuntary pregnancy loss: a phenomenological hermeneutic study

OBJECTIVE

To illuminate the experiences of primary healthcare midwives who care for parents who have suffered an involuntary pregnancy loss.

DESIGN

The phenomenological hermeneutic approach developed by Lindseth and Norberg was used to carry out narrative interviews.

SETTING AND PARTICIPANTS

A purposive sample of 11 public primary healthcare midwives from a municipality in northern Spain, was selected. The participants' ages ranged between 26 and 62 years, and they were all women.

FINDINGS

Four main themes were identified: (1) handling adversity, (2) finding a motive to get involved, (3) providing care from the rear, and (4) avoiding emotional connections with the parents. For the midwives, caring for parents who had suffered an involuntary pregnancy loss meant leaving their own comfort zone and handling adversity. They described acting in different ways such as going beyond task-focused care, following their intuition or avoiding encounters with the parents.

CONCLUSIONS

More knowledge and preparation in terms of communication skills and bereavement is crucial for midwives in order to meet the needs of parents who have suffered an involuntary pregnancy loss. A caring organizational culture and supportive leadership will facilitate care continuity between specialized and primary healthcare and promote the welfare of midwives.

Psychological effects of nurses and midwives due to COVID-19 outbreak: The case of Turkey

PURPOSE

The study was carried out to determine the psychological impact levels of nurses and midwives due to the COVID-19 outbreak.

METHODS

The research is planned in a descriptive type. Nurses and midwives working in any health institution in Turkey constituted the population of the research. The questionnaire form of the study was shared on social media tools between 01 and 14 April 2020 and a total of 758 nurses and midwives were included in the study sample. Personal Information Form, State-Trait Anxiety Inventory and Intolerance of Uncertainty Scale were used as data collection tools.

RESULTS

Participants who attended the study were 56.9% of nurses and 43.1% of midwives. Approximately half of the nurses and midwives (48.8%) participating in our study contacted the patient with suspected COVID-19, and 29.8% provided care to the patient diagnosed with COVID-19. Nurses and midwives were scored 52.75 ± 9.80 for State Anxiety, 44.87 ± 7.92 for Trait Anxiety Inventory and 35.16 ± 9.42 for Intolerance of Uncertainty Scale. It has been determined that 54.5% of nurses and midwives have been making their lives worse since the outbreak started, 62.4% had difficulties in dealing with the uncertain situation in the outbreak, 42.6% wanted psychological support and 11.8% had alienated from their profession. It was determined that there was a difference between scale scores and difficulties in work, family and private life due to COVID-19.

CONCLUSION

As a result, it is seen that the midwives and nurses in our country have high psychological effects due to the COVID-19 outbreak.

Midwifery care of non-vaccinating families - Insights from the Byron Shire

PROBLEM

Midwives may feel ill-equipped to manage clinical encounters with non-vaccinating parents.

BACKGROUND

Pregnancy is a peak time in the formation of parents' vaccination views and intention. Midwives are central to maternity care in Australia. While most midwives will have infrequent contact with families who intend not to vaccinate, when they do, they must feel equipped to communicate with them in a manner which fulfils their professional responsibilities, acknowledges parental autonomy and facilitates continued engagement.

AIM

To understand how midwives can most effectively communicate with non-vaccinating parents.

METHODS

We conducted in-depth interviews with 32 non-vaccinating parents and six key informant health professionals, and a focus group of six midwives. Data collection occurred in the Byron Shire of New South Wales, where childhood vaccination rates are persistently lower than national averages.

FINDINGS

This study explores four central codes. The first, 'hold on…I'm not sure about this' providing insights into moments of doubt preceding parents' decisions not to vaccinate. The second 'Pregnancy: a decision-making focal point' reinforces the importance of effective vaccination recommendations in the antenatal period. 'Manipulation and ambivalence' examines why overzealous or unclear recommendations about vaccination are unhelpful, and the fourth central code 'engage, inform and encourage' summarise recommendations from health professionals who are experienced in communicating, apparently effectively, with non-vaccinating families.

DISCUSSION

Insights from this study are used to recommend practical strategies which may be employed by midwives and maternity units to successfully and professionally manage clinical encounters with non-vaccinating parents.

CONCLUSION

Midwives are well positioned to provide clear recommendations to parents regarding childhood vaccination whilst maintaining engagement and meeting the goals of woman-centred care.

Effects of Benson's relaxation technique on occupational stress in midwives

PURPOSE

To examine the effect of Benson's relaxation technique on occupational stress in midwives working in a Labor and Delivery (L&D) unit.

METHODS

This pre- and post-quasi-experimental study involved 65 midwives with a minimum 1 year of experience using convenience sampling. After training, the participants performed Benson's relaxation technique twice a day for 4 weeks.

RESULTS

Occupational stress was measured using standard questionnaires of occupational stress. Data were analyzed using the Statistical Package for Social Sciences software. Statistical analysis was performed using the Kolmogorov-Smirnov goodness-of-fit test, Student's t-test, and Wilcoxon signed rank test.

CONCLUSION

This study demonstrated that Benson's relaxation technique may be effective in reducing occupational stress among midwives in L&D units.

Graduating midwifery students' preferred model of practice and first job decisions: A qualitative study

OBJECTIVES

To explore and describe the preferred model of practice and first job decisions of final stage midwifery students from three Western Australian universities.

DESIGN

Qualitative descriptive.

SETTING

Three Western Australian (WA) universities offering courses leading to registration as a midwife.

PARTICIPANTS

Twenty-seven midwifery students from undergraduate and postgraduate (pre-registration) courses.

METHODS

Data were collected from recorded interviews and focus groups. Thematic analysis of interview transcripts was used to identify commonalities. Data saturation guided when recruitment ceased and final sample size was achieved.

FINDINGS

Participants' preferred model of maternity care was influenced by learning about and witnessing both autonomous midwifery practice and collaborative care during their studies. The greatest influence was clinical experience, with most preferring a continuity of midwifery model (CoM) but first consolidating their practice in a public hospital. Most students reported that they would not choose a private hospital as their first option. Work/life balance was also considered, with some accepting that family commitments and a need to work close to home may prevent them from choosing a CoM model.

CONCLUSION AND IMPLICATIONS

Although many Australian midwifery students start their midwifery course with preconceived ideology of their eventual workplace, the influences of their educators, clinical placement environment, preceptors and continuity of care experience relationships with women helped determine their final direction. To provide students with the experiences to become woman-centred autonomous practitioners it is important for universities and all maternity care providers to carefully consider their responsibility in how they influence midwifery students in education and practice.

Perineal management: Midwives' confidence and educational needs

OBJECTIVE

The overall aim of this study was to collate information to inform the updating of a perineal management educational programme for midwives. This paper explores midwives' confidence and educational needs in managing the woman's perineum during the second stage of labour, focusing on future quality initiatives to improve midwives' experiences and expertise in the prevention of perineal trauma during birth.

DESIGN

A mixed-methods sequential exploratory design was used.

PARTICIPANTS AND SETTING

Midwives and clinical midwife managers assisting with births in the labour ward of a large urban university stand-alone maternity hospital in the Republic of Ireland with approximately 9,000 births per year participated in the study.

MEASUREMENTS

A questionnaire and two focus groups were used to collect the data.

FINDINGS

Fifty-two midwives from a total of 64 eligible labour ward midwives completed the questionnaire, a response rate of 81.2%. Midwives indicated that perineal management workshops did not cover prevention of perineal trauma, and mainly focused on suturing and repair of the perineum. The majority of midwives (85%) indicated that they would like further education on the prevention of perineal trauma. Higher levels of confidence in making a decision to perform an episiotomy, infiltrating the perineum and at performing an episiotomy were reported in experienced midwives. Midwives want improved and additional education in the management of women's perinea during the second stage of labour and made various recommendations regarding the content, format, timing and frequency of the workshop. Suggestions for further education included techniques for preventing perineal trauma during labour and birth and how to perform an episiotomy.

KEY CONCLUSIONS

This study provides key insights into midwives' confidence and educational needs in relation to managing the woman's perineum during the second stage of labour. The findings from this study demonstrates the appetite of midwives for additional education in the area of perineal management, particularly prevention strategies.

IMPLICATIONS FOR PRACTICE

Midwives play an essential role in reducing the rates of perineal trauma through regular education. It is therefore important that midwives keep up to date with the best available evidence. Updating existing perineal management educational programmes that are tailor made to midwives' needs could not only improve clinical skills and perineal protection techniques but also midwives' confidence in decision making. The overall aim is to reduce perineal trauma in women having a spontaneous vaginal birth.

Knowledge, attitude, and preparedness toward IPV care provision among nurses and midwives in Tanzania

BACKGROUND

With increasing recognition of intimate partner violence (IPV) as a public health challenge, nurses and midwives are recognized for their crucial role in providing front-line healthcare services for IPV. This study aimed to evaluate knowledge, attitude, and preparedness related to IPV care provision in health facilities among nurses and midwives in Tanzania.

METHODS

A self-administered anonymous questionnaire survey was conducted among nurses and midwives working in health facilities in the Mbeya region between December 2018 and January 2019. The questionnaire consisted of questions on their perceived and actual knowledge, attitudes, and preparedness to provide care in relation to IPV.

RESULTS

A total of 662 (50.1%) of 1321 nurses and midwives who worked in hospitals and/or health centers in the Mbeya region participated in this study, and 461 (69.6%) completed questionnaires were included in the analysis. The proportion of nurses and midwives with high scores in IPV perceived knowledge, actual knowledge, attitude, and preparedness to provide care was 59.9%, 53.1%, 54.2%, and 54.0%, respectively. Regardless of the type of facility, gender, educational level, and work experience, the use of IPV guidelines was significantly associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.004), and preparedness to provide care (P < 0.001), but not attitude, which was negatively associated (P = 0.048). Regardless of the type of facility, gender, educational level, and work experience, receiving preservice IPV training was associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.049), and preparedness to provide care (P = 0.002), but not attitude (P = 0.192). Regardless of the type of facility, gender, educational level, and work experience, in-service IPV training was associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.043), and preparedness to provide care (P = 0.001), but not attitude (P = 0.063).

CONCLUSIONS

Although guidelines and training could improve nurses' and midwives' knowledge and preparedness to provide care regarding IPV, attitudes against IPV care are a challenge. To improve attitudes regarding IPV among front-line nurses and midwives, it is necessary to address concepts of IPV care and sympathy with potential and actual victims of IPV in pre- and in-service training in addition to providing recall-level knowledge.

Midwives' experiences of the factors that facilitate normal birth among low risk women in public hospitals in Catalonia (Spain)

BACKGROUND

Normal birth has major benefits for women and infants. Nevertheless, during the last few decades, the advancement in technology and an increasing domination of obstetrician-led childbirths have resulted in the medicalization of childbirth. Midwives are interested in amending this trend and aim to support women to achieve the best possible birth experience for them.

OBJECTIVE

This study aimed to explore midwives' experiences on the facilitators and barriers of normal birth in conventional obstetric units.

DESIGN

A descriptive qualitative study. Three focus groups were audio recorded and transcribed verbatim. Recurrent themes were identified and formulated. Feedback from data were analysed using thematic analysis. Investigator triangulation was used during the analysis.

SETTING

Midwives from eleven different public hospitals in Catalonia participated in the study.

PARTICIPANTS

A purposive sample of 33 midwives participated in the focus groups.

FINDINGS

Midwives identified several factors that complicated their task of facilitating normal birth. Barriers included: (1) inadequate institutional support; (2) existing obstetrician-led practices, (3) lack of evidence-based practice and (4) midwives' lack of awareness of professional competencies. Factors facilitating normal birth included: (1) midwives' positive perceptions of normal birth, (2) midwives' additional effort and (3) women's awareness of normal birth.

KEY CONCLUSIONS

Midwives wishing to promote normal birth in obstetric units face a number of challenges and often feel unsupported. Nonetheless, the midwives perceive the increasing women's demand for normal births as an opportunity to implement changes in such a way that women are involved in the decision-making process and midwives act as their advocates.

IMPLICATIONS FOR PRACTICE

There is a need to increase the midwifery workforce and enhance regulations and funding strategies to support their practice as well as normal birth. Policy makers in settings without well-functioning midwife-led care should consider implementing this model after successfully scaling up of the number of midwives and ensuring an effective midwifery training.

Paving the way for successful twinning:: Using grounded theory to understand the contribution of twin pairs in twinning collaborations

BACKGROUND

Twinning collaborations, where two groups - from educational institutions, hospitals or towns - work together cross-culturally on joint goals, are increasingly common worldwide. Pairing up individuals, so-called twin pairs, is thought to contribute to successful collaboration in twinning projects, but as yet, there is no empirical evidence or theory that offers insight into the value of the pair relationship for twinning.

AIM

To explore the contribution of one-to-one relationships between twins to twinning projects, as exemplified in projects between Dutch and Moroccan, and Dutch and Sierra Leone midwives.

METHODS

We conducted thirteen in-depth interviews with midwives from two twinning collaborations. Interviews were transcribed and analysed using an iterative, grounded theory process, yielding a theoretical understanding of one-to-one twinning relationships for twinning collaborations.

FINDINGS

Participant comments fell into four substantive categories: 1) Being named a twin, 2) moving beyond culture to the personal level, 3) searching for common ground to engage, 4) going above and beyond the twinning collaboration. Their interplay demonstrates the value of twin pairs in paving the way for successful twinning.

DISCUSSION

A complex combination of contextual inequities, personality, and cultural differences affect the twin relationship. Trusting relationships promote effective collaboration, however, as 'trust' cannot be mandated, it must be built by coaching twins in personal flexibility and (cultural) communication.

CONCLUSION

By offering original insights into the ways twinning relationships are built, our research explores how twin pairs can enhance the success of twinning projects.

How can we best use opportunities provided by routine maternity care to engage women in improving their diets and health?

Pregnancy provides motivation for women to improve their diets and increase their physical activity. Opportunistic brief interventions delivered as part of routine primary care have produced improvements in patients' health behaviour. Consequently, there have been calls for midwives to use contacts during pregnancy in this way. This study explored the experiences of pregnant women and research midwives/nurses of a brief intervention called Healthy Conversation Skills (HCS) being delivered as part of a randomised control trial, assessing the acceptability and feasibility of including this intervention in routine maternity care. Three research questions were addressed using mixed methods to produce four datasets: face-to-face interviews with participants, a focus group with the HCS-trained midwives/nurses, case reports of participants receiving HCS and audio-recordings of mid-pregnancy telephone calls to the women which produced midwife/nurse HCS competency scores. Midwives/nurses used their HCS to support women to make plans for change and set goals. Women welcomed the opportunity to address their own health and well-being as distinct from that of their baby. Midwives/nurses were competent in using the skills and saw healthy conversations as an effective means of raising issues of diet and physical activity. Recent extension of maternity appointment times provides ideal opportunities to incorporate a brief intervention to support behaviour change. Incorporating HCS training into midwifery education and continuing professional development would facilitate this. HCS is a scalable, brief intervention with the potential to improve the diets and physical activity levels of women during pregnancy, and hence the health of themselves and their babies.

Recently graduated midwives in Uganda: Self-perceived achievement, wellbeing and work prospects

OBJECTIVE

to investigate how recent graduates from a combined work/study midwifery degree programme in Uganda viewed its effects on their wellbeing and work prospects.

DESIGN

Using an adapted version of the Qualitative Impact Protocol (QuIP), a phenomenological approach was applied to thematic analysis to examine semi-structured interviews and WhatsApp group discussion.

SETTING

Introduction of enhanced midwifery training (from Diploma to Degree level) combining study with professional practice within a low income country health system facing extreme capacity constraints.

PARTICIPANTS

14 members of the first cohort of graduates from the degree programme.

FINDINGS

The graduates were overwhelmingly positive about improved professional knowledge, clinical skills, confidence, career commitment and prospects. They also had to contend with resentment from colleagues, increased workload and debt. Counselling training, peer support, and experience of managing stress during the training helped them to cope with these challenges.

CONCLUSIONS

Qualitative feedback from those receiving advanced midwifery training highlights the importance of addressing social as well as technical skills, including leadership capacity and resilience in handling working relationships.

A qualitative study of factors that influence midwives' practice in relation to low-risk women's oral intake in labour in Australia

BACKGROUND

Restriction of food and fluids during labour increases women's discomfort, anxiety and stress which are associated with obstruction of the normal process of labour. Whilst research evidence and clinical guidelines recommend that normal uncomplicated labouring women should not be limited in their oral intake during labour, some midwives continue to restrict or discourage women's oral intake. To promote best practice, it is important to understand the influencing factors which affect midwives' decision-making processes.

OBJECTIVE

This study aimed to investigate the influences that affect midwifery practice regarding oral food and fluid intake for low-risk labouring women.

DESIGN

An interpretive descriptive approach employed 12 semi-structured interviews with registered midwives with current labour and birthing experience in Australia. Data was analysed using thematic analysis.

FINDINGS

Three themes were identified: midwives' knowledge and beliefs; work environment and women's expectations of care. Midwives' practice was affected by their knowledge and values developed from professional and personal experiences of labour, their context of practice and work environment, the clinical guidelines, policies and obstetric control, and women's choice and comfort.

CONCLUSION

This study indicates that midwives' decision-making in relation to women's oral nutrition during labour is multifaceted and influenced by complicated environments, models of care, and power relations between doctors and midwives, more so than clinical guidelines. It is important for midwives to be aware of factors negatively influencing their decision-making processes to enable autonomy and empowerment in the provision of evidence-based care of labouring women.

Future health providers' willingness to provide abortion services following decriminalisation of abortion in Chile: a cross-sectional survey

OBJECTIVE

To assess Chilean medical and midwifery students' attitudes and willingness to become trained to provide abortion care, shortly after abortion was decriminalised in 2017.

DESIGN

We fielded a cross-sectional, web-based survey of medical and midwifery students. We used generalised estimating equations to assess differences by type of university and degree sought.

SETTING

We recruited students from a combination of seven secular, religiously-affiliated, public and private universities that offer midwifery or medical degrees with a specialisation in obstetrics and gynaecology, located in Santiago, Chile.

PARTICIPANTS

Students seeking medical or midwifery degrees at one of seven universities were eligible to participate. We distributed the survey link to medical and midwifery students at these seven universities; 459 eligible students opened the survey link and 377 students completed the survey.

PRIMARY AND SECONDARY OUTCOMES

Intentions to become trained to provide abortion services was our primary outcome of interest. Secondary outcomes included moral views and concerns about abortion provision.

RESULTS

Most students intend to become trained to provide abortion services (69%), 20% reported that they will not provide an abortion under any circumstance, half (50%) had one or more concern about abortion provision and 16% agreed/strongly agreed that providing abortions is morally wrong. Most believed that their university should train medical and midwifery students to provide abortion services (70%-79%). Secular university students reported higher intentions to provide abortion services (beta 0.47, 95% CI: 0.31 to 0.63), more favourable views (beta 0.52, CI: 0.32 to 0.72) and were less likley to report concerns about abortion provision (adjusted OR 0.47, CI: 0.23 to 0.95) than students from religious universities.

CONCLUSION

Medical and midwifery students are interested in becoming trained to provide abortion services and believe their university should provide this training. Integrating high-quality training in abortion care into medical and midwifery programmes will be critical to ensuring that women receive timely, non-judgemental and quality abortion care.

Perceptions of midwives on shortage and retention of staff at a public hospital in Tshwane District

BACKGROUND

 Midwifery is the backbone of women and child healthcare. The shortage of staff in maternity units is a crisis faced by many countries worldwide, including South Africa.

OBJECTIVES

 This study aims to explore the perceptions of midwives on the shortage and retention of staff at a public institution.

METHOD

 The study was conducted at one of the tertiary hospitals in Tshwane District, Gauteng Province. A total of 11 midwives were interviewed through face-to-face and focus group interviews. An explorative, descriptive generic qualitative design method was followed, and a non-probability, purposive sampling technique was used. Thematic coding analysis was followed for analysing data.

RESULTS

 The impact of shortage of midwives was reported to be directly related to poor provision of quality care as a result of increased workload, leading to low morale and burnout. The compromised autonomy of midwives in the high obstetrics dependency units devalues the status of midwives.

CONCLUSION

 Midwives are passionate about their job, despite the hurdles related to their day-to-day work environment. They are demoralised by chronic shortage of staff and feel overworked. Staff involvement in decision-making processes is a motivational factor for midwives to stay in the profession. The midwives need to be in the centre of the decision-making processes related to their profession. The revision of the scope of practice and classification of midwifery profession away from general nursing complex by the South African Nursing Council (SANC) could place midwifery in its rightful status.

Management of late-term pregnancy in midwifery- and obstetrician-led care

Management of late-term pregnancy in midwifery- and obstetrician-led care.

BACKGROUND

Since there is no consensus regarding the optimal management in late-term pregnancies (≥41.0 weeks), we explored the variety of management strategies in late-term pregnancy in the Netherlands to identify the magnitude of this variety and the attitude towards late-term pregnancy.

METHODS

Two nationwide surveys amongst all midwifery practices (midwifery-led care) and all hospitals with an obstetric unit (obstetrician-led care) were performed with questions on timing, frequency and content of consultations/surveillance in late-term pregnancy and on timing of induction. Propositions about late-term pregnancy were assessed using Likert scale questions.

RESULTS

The response rate was 40% (203/511) in midwifery-led care and 92% (80/87) in obstetrician-led care. All obstetric units made regional protocols with their collaborating midwifery practices about management in late-term pregnancy. Most midwifery-led care practices (93%) refer low-risk women at least once for consultation in obstetrician-led care in late-term pregnancy. The content of consultations varies among hospitals. Membrane sweeping is performed more in midwifery-led care compared to obstetrician-led care (90% vs 31%, p < 0.001). Consultation at 41 weeks should be standard care according to 47% of midwifery-led care practices and 83% of obstetrician-led care units (p < 0.001). Induction of labour at 41.0 weeks is offered less often to women in midwifery-led care in comparison to obstetrician-led care (3% vs 21%, p < 0.001).

CONCLUSIONS

Substantial practice variation exists within and between midwifery-and obstetrician-led care in the Netherlands regarding timing, frequency and content of antenatal monitoring in late-term pregnancy and timing of labour induction. An evidence based interdisciplinary guideline will contribute to a higher level of uniformity in the management in late- term pregnancies.

Predictors of midwives' intention to provide planned home birth services to low-risk women: A theory of planned behaviour approach

OBJECTIVE

Planned home birth may increase women's access to skilled midwives in all settings. Using theory to understand and predict midwives' intention regarding planned home birth services is rare. Therefore, using the theory of planned behaviour, we determined the factors associated with midwives' intention to provide planned home birth services to low-risk women.

DESIGN

This cross-sectional study adopted a quantitative approach and a survey. Stratified random sampling was used to recruit 226 midwives in Sokoto, Nigeria. Data-including descriptive statistic and multiple linear regression analyses-were analysed using SPSS 23 and significant was set at 0.05.

SETTING

Ten public health facilities in Sokoto, northwestern Nigeria.

PARTICIPANTS

Among all 460 midwives (women aged 20-60 years), working in the maternity wards of health facilities in Sokoto, a sample of 226 midwives was calculated using a power of 0.80 and a 95% confidence interval.

FINDINGS

The multiple linear regression analyses confirmed that the major factors associated with midwives' intention to provide planned home birth services were midwives' attitude towards planned home birth (p < .001) and midwives' previous experience with planned home birth practice (p = .008).

CONCLUSIONS AND IMPLICATIONS

The theory of planned behaviour is a useful framework for identifying factors that affect midwives' intention to provide planned home birth services. While future research may employ a qualitative approach to explore other factors, planned home birth education campaigns should target information that enhances positive attitude and encourages midwives to provide planned home birth services.

Client and provider factors associated with companionship during labor and birth in Kigoma Region, Tanzania

BACKGROUND

Labor and birth companionship is a key aspect of respectful maternity care. Lack of companionship deters women from accessing facility-based delivery care, though formal and informal policies against companionship are common in sub-Saharan African countries.

AIM

To identify client and provider factors associated with labor and birth companionship DESIGN: Cross-sectional evaluation among delivery clients and providers in 61 health facilities in Kigoma Region, Tanzania, April-July 2016.

METHODS

Multilevel, mixed effects logistic regression analyses were conducted on linked data from providers (n = 249) and delivery clients (n = 935). Outcome variables were Companion in labor and Companion at the time of birth.

FINDINGS

Less than half of women reported having a labor companion (44.7%) and 12% reported having a birth companion. Among providers, 26.1% and 10.0% reported allowing a labor and birth companion, respectively. Clients had significantly greater odds of having a labor companion if their provider reported the following traits: working more than 55 hours/week (aOR 2.46, 95% CI 1.23-4.97), feeling very satisfied with their job (aOR 3.66, 95% CI 1.36-9.85), and allowing women to have a labor companion (aOR 3.73, 95% CI 1.58-8.81). Clients had significantly lower odds of having a labor companion if their provider reported having an on-site supervisor (aOR 0.48, 95% CI 0.24-0.95). Clients had significantly greater odds of having a birth companion if they self-reported labor complications (aOR 2.82, 95% CI 1.02-7.81) and had a labor companion (aOR 44.74, 95% CI 11.99-166.91). Clients had significantly greater odds of having a birth companion if their provider attended more than 10 deliveries in the last month (aOR 3.43, 95% CI 1.08-10.96) compared to fewer deliveries.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

These results suggest that health providers are the gatekeepers of companionship, and the work environment influences providers' allowance of companionship. Facilities where providers experience staff shortages and high workload may be particularly responsive to programmatic interventions that aim to increase staff acceptance of birth companionship.

Relationships between working conditions and emotional wellbeing in midwives

BACKGROUND

Emotional distress in midwives contributes to high attrition. To safeguard midwives' wellbeing, there is a need to identify the impact of workplace variables.

AIM

To review the existing evidence on the relationships between working conditions and emotional wellbeing in midwives, and construct an analytic framework for understanding these relationships.

METHODS

Systematic search and selection procedures using a range of databases. Results of included studies were synthesised into a thematic literature review of qualitative and quantitative research.

FINDINGS

Various types of poor emotional wellbeing in midwives correlate with a variety of interrelated working conditions, including low staffing/high workload, low support from colleagues, lack of continuity of carer, challenging clinical situations and low clinical autonomy. Staffing levels seem to be able to modify the effects of many other variables, and the impact of challenging clinical situations is affected by several other variables.

DISCUSSION

These workplace variables can be categorised as modifiable and non-modifiable risk indicators.

CONCLUSION

While certain conditions that correlate with midwives' wellbeing are non-modifiable, several crucial variables, such as staffing levels and continuity of carer, are within the control of organisational leadership. Future research and interventions should focus on these modifiable risks. Research design should maximise the chance of establishing causation, while any innovations in this area should anticipate the interrelatedness of these risk factors to avoid unintended negative consequences.

Preparing midwifery students for traumatic workplace events: Findings from the POPPY (programme for the prevention of posttraumatic stress disorder in midwifery) feasibility study

BACKGROUND

Midwifery students can experience events on clinical placements that they perceive to be traumatic. There is currently no requirement to provide training about the nature of trauma, normal responses, or the most helpful ways of self-managing these. The POPPY programme, developed for qualified midwives, incorporates educational (the POPPY workshop) and supportive resources to prevent the development of Post-Traumatic Stress Disorder in midwives. As part of the feasibility evaluation of POPPY, the POPPY workshop element was adapted for pre-registration midwifery students (PreR-POPPY). Attention to this issue during pre-registration education could improve student experience and support student retention.

OBJECTIVES

To identify students' perspectives on the contents (clarity, understandability, organisation of the workshop, utility, relevance), their understanding of trauma and psychological responses, and confidence in recognising and managing early signs of distress following participation in a PreR-POPPY workshop. Perspectives on preferred timing in their midwifery programmes, and methods of delivery were also sought.

DESIGN

In keeping with educational evaluations, anonymous feedback was collected from students.

SETTING

Two higher education institutes.

PARTICIPANTS

Midwifery undergraduate students on the three year or shortened programme for registered nurses (n = 131), and midwifery educators (n = 5).

METHODS

Students participated in the workshop and provided feedback immediately. Midwifery educators participated in a meeting with the researchers to provide feedback.

RESULTS

High levels of satisfaction with the contents of the workshop were identified. Ninety-nine percent of students would recommend the workshop to other midwifery students. Provision of the workshop early in midwifery programmes, revisited at later points, was strongly endorsed. Learning outcomes were very positive for understanding trauma/early stress responses, and recognising and managing early responses to trauma. Strong endorsement for the provision of the workshop was received from the midwifery educators.

CONCLUSIONS

The pre-registration adapted POPPY workshop should be routinely provided in preregistration midwifery.

Student midwives' intention to deliver weight management interventions: A theory of planned behaviour & self-determination theory approach

OBJECTIVES

Overweight and obesity during pregnancy is a risk to the health of mother and child. Midwives can modify this key risk factor by providing weight management interventions to women before and during pregnancy. This study investigated social cognitive determinants of pre-clinical student midwives' intention to provide weight management intervention in preconception and antenatal clinical contexts. Social cognitive determinants from the theory of planned behaviour (attitudes, subjective norms, perceived behavioural control) and self-determination theory (autonomous motivation) were used to predict pre-clinical students' intentions once they enter practice.

METHOD

The sample was 183 female pre-clinical student midwives from 17 Australian universities (age range = 18-54 years). Participants received a cross-sectional questionnaire that measured demographic items, attitudes, subjective norms, perceived behavioural control and autonomous motivation towards providing weight management intervention at two different stages of pregnancy - preconception and antenatal.

RESULTS

Attitudes, subjective norms, and perceived behavioural control accounted for 56% of intention to provide weight management interventions to women planning pregnancy; however, the addition of autonomous motivation was non-significant. In contrast, attitudes and subjective norms (but not perceived behavioural control) accounted for 39% of intention to provide weight management interventions to women during pregnancy. Furthermore, the addition of autonomous motivation to the model was significant and accounted for an additional 3.1% of variance being explained.

IMPLICATIONS AND CONCLUSIONS

Curriculum changes that support and increase pre-clinical student midwives' intention should focus on these specific correlates of intention in order to foster long term changes in clinical practice. Changes to the education and training of midwives should be carefully considered to understand their impact on these important determinants of intention to engage in this critical clinical skill.

Midwifery Professional Stress and Its Sources: A Mixed-Methods Study

INTRODUCTION

Professionally-related stress among midwives has been demonstrated in a global context to have deleterious effects on their professional, physical, and psychological health. Despite global interest in the subject, there has been no study about professional stress in a cohort of US midwives.

METHODS

A convergent parallel mixed-methods design was used. The Job-Related Tension Index (JRTI) survey was administered to a self-selected sample of certified nurse-midwives and certified midwives in clinical practice in the United States via email solicitation of the American College of Nurse-Midwives' membership. A single qualitative open-ended question was also included in the survey.

RESULTS

A total of 644 midwives participated in this study. The mean (SD) score on the JRTI across all midwife participants was 38.3 (9.65); the possible range of scores was 15 to 75. Midwives who were biologically older and/or had practiced longer and who had higher levels of education were shown to have higher levels of job-related tension. Those who believed their stress levels had negatively affected patient care showed higher job-related tension scores than those who did not. Call hours did not significantly affect tension scores in this study sample. Nearly all midwives in the cohort (97.1%) had experienced traumatic birth. Seven themes were identified after content analysis. These included the following: I'm SO tired, conflict with colleagues, selling your midwifery soul, leaving midwifery, non-respectful maternity care, balancing work and personal life, and medicolegal fears.

DISCUSSION

Systems should recognize and validate midwives' levels of work-related tension and develop specific interventions to help alleviate it. Because of the size and racial homogeneity of the sample, further studies are recommended to identify stress levels and their contributing factors in a larger, more diverse population of midwives. Qualitative themes should be more fully explored to identify specific contributors to midwifery stress.

Midwifery students' experiences of their clinical internship: A qualitative descriptive study

BACKGROUND

Globally the safety of mothers and babies is fundamental in maternity care. Central to ensuring this safety is appropriate preparation of midwifery students' to ensure graduates are equipped to assume the responsibilities of delivering safe and effective maternity care. In preparation for autonomous practice Irish midwifery students' undertake a 36 week internship in the final year of the BSc Midwifery programme. Within this paid internship midwifery students' have the opportunity to develop professional behaviours, consolidate knowledge and learn necessary skills to fulfil the role of midwife under the supervision of registered midwives.

OBJECTIVE

To explore midwifery students' experiences of the internship period.

DESIGN AND METHOD

A descriptive qualitative study using focus groups with ethical approval.

SETTING AND PARTICIPANTS

BSc Midwifery students' in the final year of their programme (n = 17) in an Irish University were invited to participate in a focus group interview midway through their internship. All participants (n = 13) had experience of working in two sites used for internship at the time of data collection.

RESULTS

Key findings include the importance of the internship period in consolidating clinical skills and building confidence and competence for midwifery practice. Midwifery students' experience considerable stress during the internship period. Demands identified as stressors include providing care in increasingly complex clinical areas, meeting academic deadlines and maintaining a work life balance. Negative interpersonal experiences and dismissive attitudes to reflection on practice were barriers to learning. Midwifery students' articulated the importance of learning through doing, a supportive learning culture and philosophy in the unit, protected time for reflection and being included and valued as part of the midwifery team.

CONCLUSIONS

The benefits and challenges associated with internship in midwifery are apparent, particularly when students' are contending with two geographically distant sites. Support mechanisms and suggestions for improvements are considered.

Support provided by midwives to women during labour in a public hospital, Limpopo Province, South Africa: a participant observation study

BACKGROUND

Physical presence during labour offer women opportunity of having positive childbirth experiences as well as childbirth outcomes. The study aimed to determine what support provided by midwives during intrapartum care at a public hospital in Limpopo Province. The study was conducted at a tertiary hospital in Limpopo Province.

METHODS

A participant observation approach was used to achieve the objectives of the study. The population comprised of all women who were admitted with labour and for delivery and midwives who were providing midwifery care in the obstetric unit of a tertiary public hospital in Limpopo Province. Non-probability, purposive and convenience sampling were used to sample 24 women and 12 midwives. Data were collected through participant observations which included unstructured conversations with the use of observational guide, field notes of all events and conversations that occurred when women interact with midwives were recorded verbatim and a Visual Analog Scale to complement the observations. Data were analysed qualitatively but were presented in the tables and bar graphs.

RESULTS

Five themes emerged as support provided by midwives during labour, namely; communication between women and midwives, informational support, emotional support activities, interpretation of the experienced labour pain and supportive care activities during labour.

CONCLUSION

The communication between woman and midwife was occurring as part of midwifery care and very limited for empowering. The information sharing focused on the assistive actions rather than on the activities that would promote mothers' participation. The emotional support activities indicated lack of respect and disregard cultural preferences and this contributed to inability to exercise choices in decision-making. The study recommended the implementation of Batho Pele principles in order to provide woman-centred care during labour.

Home deliveries in the capital: a qualitative exploration of barriers to institutional deliveries in peri-urban areas of Lusaka, Zambia

BACKGROUND

A shortage of skilled birth attendants and low quality of care in health facilities along with unattended home deliveries contribute to the high maternal and neonatal mortality in sub Saharan Africa. Identifying and addressing context-specific reasons for not delivering at health care facilities could increase births assisted by skilled attendants who, if required, can provide life-saving interventions.

METHODS

We conducted 22 in-depth interviews (IDIs) with midwives at three health facilities in peri-urban communities and 24 semi-structured surveys with mothers in two areas served by health facilities with the highest number of reported home deliveries in Lusaka, Zambia. Both IDIs and surveys were audio-recorded, transcribed and coded to identify themes around delivery and birthing experience.

RESULTS

We found that most women preferred institutional deliveries to home deliveries, but were unable to utilize these services due to inability to recognize labour symptoms or lack of resources. Midwives speculated that women used herbal concoctions to reduce the duration of delivery with the result that women either did not present in time or endangered themselves and the baby with powerful contractions and precipitous labour. Respondents suggested that disrespectful and abusive maternity care dissuaded some women from delivering at health facilities. However, some midwives viewed such tactics as necessary to ensure women followed instructions and successfully delivered live babies.

CONCLUSION

Difference in beliefs and birthing practices between midwives and mothers suggest the need for open dialogue to co-design appropriate interventions to increase facility usage. Further examination of the pharmaceutical properties and safety of herbal concoctions being used to shorten labour are required. Measures to reduce the economic burden of care seeking within this environment, increase respectful and patient-centred care, and improve the quality of midwifery could increase institutional deliveries.

Do estimates of blood loss differ between student midwives and midwives? A multicenter cross-sectional study

OBJECTIVE

the principal objective of this study was to assess the quality of blood loss estimates by midwives and student midwives. The secondary objectives were: to assess the intraobserver agreement of visual blood estimates and the rate of underestimation of blood loss by participants, and to estimate the sensitivity, specificity, and negative likelihood ratio of these estimates for clinically pertinent blood losses (≥ 500mL and ≥ 1000mL).

DESIGN

multicenter cross-sectional study.

SETTING

thirty-three French maternity units and 35 French midwifery schools participated in this study.

PARTICIPANTS

volunteer French midwifery students (n = 463) and practicing midwives (n = 578).

INTERVENTION

an online survey showed 16 randomly ordered photographs of 8 different simulated blood quantities (100, 150, 200, 300, 500, 850, 1000, and 1500mL) with a reference 50-mL image in each photo and asked participants to estimate the blood loss. The visual blood loss estimates were compared with Fisher's exact test. Intraobserver agreement for these estimates was assessed with a weighted kappa coefficient, and the negative predictive values (probability of no hemorrhage when visual estimate was negative) were calculated from prevalence rates in the literature.

FINDINGS

of the 16,656 estimates obtained, 34.1% were accurate, 37.2% underestimated the quantity presented, and 28.7% overestimated it. Analyses of the intraobserver reproducibility between the two estimates of the same photograph showed that agreement was highest (weighted kappa ≥ 0.8) for the highest values (1000mL, 1500mL). For each volume considered, students underestimated blood loss more frequently than midwives. In both groups, the negative predictive values regarding postpartum hemorrhage (PPH) diagnosis (severe or not) were greater than 98%.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

student midwives tended to underestimate the quantity of blood loss more frequently than the midwives. Postpartum hemorrhage (≥ 500mL) was always identified, but severe postpartum hemorrhage (≥ 1000mL) was identified in fewer than half the cases. These results should be taken into account in training both student midwives and practicing professionals.