Women want positive birth experiences with high quality maternity care that is neither too much, too soon, nor too little, too late. Research confirms the effectiveness of midwifery care, and the midwifery approach to birth as physiologic may counter the upward trend of the unnecessary medicalization of birth. The role of guardian of physiologic birth is seen as central to midwifery practice; however, medical hegemony has led to the subordination of midwives, which inhibits them in fulfilling the role as guardian of physiologic birth. Learning to become powerful advocates of physiologic birth creates midwives able to speak up for effective, evidence-based maternity care and challenge the unnecessary use of obstetric intervention. Midwifery education has a role to fulfil in molding midwives who are able to assume this role. This brief report describes the development of an educational prototype aimed at increasing student midwife agency as an advocate of physiologic birth. This was done using rapid prototyping (RP) methodology, in which important stakeholders gave input and feedback during the educational design and development process. Input from stakeholders led to the inclusion of persuasive communication strategies and discussion and debate as teaching methodologies in order to increase student midwife agency to argue for physiologic birth. Reflective evidence-based practice, using the Optimality Index-Netherlands, allowed students to reflect on their practice while providing a framework for discussion. Working with the RP methodology allowed for the development of a prototype that reflected the needs of midwifery stakeholders and was mindful of material and human resources.
Introduction: Midwifery education that strengthens self-efficacy can support student midwives in their role as advocates for a physiological approach to childbirth. Methods: To assess the effect of an educational intervention on self-efficacy, a pre- and post-intervention survey was administered to a control group and an intervention group of third year student midwives. The General Self-Efficacy Scale (GSES) was supplemented with midwifery-related self-efficacy questions related to behaviour in home and hospital settings, the communication of evidence, and ability to challenge practice. Results: Student midwives exposed to midwifery education designed to strengthen self-efficacy demonstrated significantly higher levels of general self-efficacy (p = .001) when contrasted to a control cohort. These students also showed significantly higher levels of self-efficacy in advocating for physiological childbirth (p = .029). There was a non-significant increase in self-efficacy in the hospital setting in the intervention group, a finding that suggests that education may ameliorate the effect of hospital settings on midwifery practice. Discussion: In spite of the small size of the study population, education that focuses on strengthening student midwife self-efficacy shows promise.
At the beginning of the twenty first century obesity entered Dutch maternity care as a ‘new illness’ challenging maternity care professionals in providing optimal care for women with higher BMI’s. International research revealed that obese women had more perinatal problems than normal weight women. However, the effect of higher BMIs on perinatal outcomes had never been studied in women eligible for midwife-led primary care at the outset of their pregnancy. In the context of the Dutch maternity care system, it was not clear if obesity should be treated as a high-risk situation always requiring obstetrician-led care or as a condition that may lead to problems that could be detected in a timely manner in midwife-led care using the usual risk assessment tools. With the increased attention on obesity in maternity care there was also increased interest in GWG. Regarding GWG in the Netherlands, the effect of insufficient or excessive GWG on perinatal outcomes had never been studied and there were no validated guidelines for GWG. A midwife’s care for the individual woman in the context of the Dutch maternity care system - characterised by ‘midwife-led care if possible, obstetrician-led care if needed’ - is hampered by the lack of national multidisciplinary consensus regarding obesity and weight gain. Obesity has not yet been included in the OIL and local protocols contain varying recommendations. To enable sound clinical decisions and to offer optimal individual care for pregnant women in the Netherlands more insights in weight and weight gain in relation to perinatal outcomes are required. With this thesis the author intends to contribute to the body of knowledge on weight and weight gain to enhance optimal midwife-led primary care for the individual woman and to guide midwives’ clinical decision-making.
Training nurses and midwives to treat their patients well There are some specific factors facilitating the modification of the nursing and midwifery bachelor curriculum The development of health literacy and respectful and compassionate care competences among bachelor nursing and midwifery students in Tanzania
De Nederlandse geboortezorg kent structurele capaciteitsproblemen, voornamelijk door personeelsgebrek in de ziekenhuizen. Dit leidt tot tijdelijke opnamestops op verloskundeafdelingen van uren tot dagen. Daarnaast is er in toenemende mate concentratie van zorg, waarbij verloskundeafdelingen permanent sluiten. Vrouwen kunnen hierdoor niet altijd binnen de eigen regio bevallen en aanrijtijden naar ziekenhuizen nemen toe. Wanneer een verloskundige voor een poliklinische bevalling naar een ziekenhuis buiten de regio moet, komt de zorg voor de overige cliënten in de praktijk in het gedrang. Dit heeft effecten op veiligheid van zorg, ervaringen van cliënten en op (werk)tevredenheid van verloskundigen. Verloskundigen worden geconfronteerd met gevolgen en oplossingen waar zij onvoldoende grip op hebben. Zij willen meer regie kunnen voeren over de inrichting van zorg die aansluit bij hun kernwaarden en die van cliënten, met behoud van kwaliteit van zorg. Samen met verloskundigen kwamen we tot de onderzoeksvraag: Op welke manieren kunnen eerstelijns verloskundigen eigen regie nemen in de regionale organisatie van hun zorg – in lijn met hun beroepsidentiteit - om nadelige gevolgen van concentratie van zorg en opnamestops te beheersen? Door participatief actieonderzoek werken we binnen dit project aan het identificeren en vormgeven van passende regionale samenwerkingsvormen, die bijdragen aan de toegankelijkheid van de geboortezorg in de regio en met voldoende draagvlak voor implementatie. Dit doen we door 1) een gedragen collectieve beroepsidentiteit binnen de regio te ontwikkelen met een herijking van kritisch kernwaarden. Dit vormt input voor 2) de ontwikkeling van een predictiemodel dat effecten op capaciteit voorspelt. Verloskundigen krijgen hiermee een instrument in handen waarmee zij onderbouwd invloed uit kunnen oefenen op de organisatie van de geboortezorg, ter voorkoming van negatieve effecten van opnamestops en concentratie van zorg. Doel is toegankelijke, kwalitatief goede en duurzame verloskundige zorg te realiseren met samenwerkingsvormen die aansluiten bij kernwaarden van cliënten en verloskundigen.
