The training of midwives to perform obstetric ultrasound scan in Africa for task shifting and extension of scope of practice: a scoping review.

INTRODUCTION: Ultrasound scan is one of the essential assessments that is crucial in the early identification of health risks during antenatal care. Its accessibility to women in low-and middle-income countries remains a serious challenge because ultrasound scans are not within the scope of practice for midwives. However, task shifting and extension of scope of practice aim to train midwives to assess pregnant women through an ultrasound scan. This paper aims to report the findings of a scoping review on the training of midwives to perform obstetric ultrasound scans in Africa. METHODS: The 6-step iterative framework for scoping reviews by Arksey and O'Malley was used to determine the extent of qualitative and quantitative evidence available on the training of midwives on obstetric ultrasound scans, which includes specifying the research question, identifying relevant studies, selecting studies, extracting and charting data, collating, summarising, and synthesising and reporting findings. RESULTS: A total of 12 articles from eight African countries were included in this scoping review. Three main themes and 13 sub-themes emerged and they are: obstetric ultrasound scan training, challenges experienced by midwives from task shifting and extension of scope of practice regarding obstetric ultrasound scan, and the value of task shifting and extension of scope of practice regarding obstetric ultrasound scan to midwives. DISCUSSION: Despite the available evidence that the training of midwives on obstetric ultrasound scans is essential to ensure the accessibility of quality antenatal health services, the training of midwives on obstetric ultrasound scans in some African countries remains a serious challenge. It is evident from this scoping review results that there is a need for African countries to incorporate obstetric ultrasound scans as part of the scope of practice of midwives. Task shifting necessitates prioritising the training of midwives on the use of obstetric ultrasound scans as one of the steps towards the achievement of the United Nations Sustainable Development Goal number 3 targets by 2030.

Characteristics of strong midwifery leaders and enablers of strong midwifery leadership: An international appreciative inquiry.

OBJECTIVES: This research aimed to identify the characteristics of strong midwifery leaders and explore how strong midwifery leadership may be enabled from the perspective of midwives and nurse-midwives globally. DESIGN: In this appreciative inquiry, we collected qualitative and demographic data using a cross-sectional online survey between February and July 2022. SETTING: Responses were received from many countries (n = 76), predominantly the United Kingdom (UK), Australia, the United States of America (USA), Canada, Uganda, Saudi Arabia, Tanzania, Rwanda, India, and Kenya. PARTICIPANTS: An international population (n = 429) of English-speaking, and ethnically diverse midwives (n = 211) and nurse-midwives (n = 218). MEASUREMENTS: Reflexive thematic analysis was used to make sense of the qualitative data collected. Identified characteristics of strong midwifery leadership were subsequently deductively mapped to established leadership styles and leadership theories. Demographic data were analysed using descriptive statistics. FINDINGS: Participants identified strong midwifery leaders as being mediators, dedicated to the profession, evidence-based practitioners, effective decision makers, role models, advocates, visionaries, resilient, empathetic, and compassionate. These characteristics mapped to compassionate, transformational, servant, authentic, and situational leadership styles. To enable strong midwifery leadership, participants identified a need for investment in midwives' clear professional identity, increased societal value placed upon the midwifery profession, ongoing research, professional development in leadership, interprofessional collaborations, succession planning and increased self-efficacy. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study contributes to understandings of trait, behavioural, situational, transformational and servant leadership theory in the context of midwifery. Investing in the development of strong midwifery leadership is essential as it has the potential to elevate the profession and improve perinatal outcomes worldwide. Findings may inform the development of both existing and new leadership models, frameworks, and validated measurement tools.

Experience of midwives in providing care to labouring women in varied healthcare settings: A qualitative study.

BACKGROUND: Midwives are essential to timely, effective, family-centred care. In South Africa, patients have often expressed dissatisfaction with the quality of midwifery care. Negative interpersonal relationships with caregivers, lack of information, neglect and abandonment were consistent complaints. Less is known about how midwives experience providing care. AIM: This research explored and described the experiences of midwives in providing care to labouring women in varied healthcare settings. SETTING: Midwives practicing in the Gauteng province, South Africa, in one of three settings: private hospitals, public hospitals or independent maternity hospital. METHODS: A convenience sample of midwives (N = 10) were interviewed. An exploratory and descriptive design, with individual semi-structured interviews conducted, asked a primary question: 'How is it for you to be a midwife in South Africa?' Transcribed interviews were analysed using thematic coding. RESULTS: Five themes were found: proud to be a midwife, regulations and independent function, resource availability, work burden and image of the midwife. CONCLUSION: Midwives struggle within systems that fail to allow independent functioning, disallowing a voice in making decisions and creating change. Regardless of practice setting, midwives expressed frustration with policies that prevented utilisation consistent with scope of practice, as well as an inability to practice the midwifery model of care. Those in public settings expressed concern with restricted resource appropriation. Similarly, there is clear need to upscale midwifery education and to establish care competencies to be met in providing clinical services. CONTRIBUTION: This research provides evidence of the midwifery experience with implications for needed health policy change.