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.
Aim: Midwives are expected to identify and help resolve ethics problems that arise in practice, skills that are presumed to be taught in midwifery educational programs. In this study, we explore how midwives recognize ethical dilemmas in clinical practice and examine the sources of their ethics education. Methods: We conducted semi-structured, individual interviews with midwives from throughout the United States (U.S.) (n = 15). Transcripts of the interviews were analysed using an iterative process to identify themes and subthemes. Findings: Midwives described a range of professional ethical dilemmas, including challenges related to negotiating strained interprofessional relationships and protecting or promoting autonomy for women. Ethical dilemmas were identified by the theme of unease, a sense of distress that was expressed in three subthemes: uncertainty of action, compromise in action, and reflecting on action. Learning about ethics and ethical dilemmas occurred, for the most part, outside of the classroom, with the majority of participants reporting that their midwifery program did not confer the skills to identify and resolve ethical challenges. Conclusion: Midwives in this study reported a range of ethical challenges and minimal classroom education related to ethics. Midwifery educators should consider the purposeful and explicit inclusion of midwifery-specific ethics content in their curricula and in interprofessional ethics education. Reflection and self-awareness of bias were identified as key components of understanding ethical frameworks. As clinical preceptors were identified as a key source of ethics learning, midwifery educators should consider ways to support preceptors in building their skills as role models and ethics educators.
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.
Vulnerable pregnant women are an important and complex theme in daily practice of birth care professionals. Vulnerability is an important risk factor for maternal and perinatal mortality and morbidity. Providing care for these women is often complex. First, because it is not always easy to identify vulnerability. Secondly, vulnerable women more often cancel their appointments with midwives and finally, many professionals are involved while they do not always know each other. Even though professionals are aware of the risks of vulnerability for future mothers and their (unborn) children and the complexity of care for these women, there is no international definition for ‘vulnerable pregnancies’. Therefore, we start this project with defining a mutual definition of vulnerability during pregnancy. In current projects of Rotterdam University of Applied Sciences (RUAS) we define a vulnerable pregnant woman as: a pregnant woman facing psychopathology, psychosocial problems, and/or substance abuse combined with lack of individual and/or social resources (low socioeconomic status, low educational level, limited social network). In the Netherlands, care for vulnerable pregnant women is fragmented and therefore it is unclear for birth care professionals which interventions are available and effective. Therefore, Dutch midwives are convinced that exchanging knowledge and best practices concerning vulnerable pregnancies between midwifery practices throughout Europe could enhance their knowledge and provide midwives (SMB partners in this project) with tools to improve care for vulnerable pregnant women. The aim of this project is to exchange knowledge and best practices concerning vulnerable pregnancies between midwifery practices in several European countries, in order to improve knowledge and skills of midwives. As a result, guidelines will be developed in order to exchange selected best practices which enable midwives to implement this knowledge in their own context. This contributes to improving care for vulnerable pregnant women throughout Europe.
