A satisfação da grávida com os cuidados das enfermeiras obstétricas durante a pandemia COVID-19 / Pregnant women's satisfaction with the care provided by nurse midwives during the COVID-19 pandemic / Satisfacción de las embarazadas con la atención de las enfermeras obstétricas durante la pandemia de COVID-19

Resumo Enquadramento: Em tempo de pandemia, as consultas de enfermagem de vigilância da gravidez sofreram alterações, nomeadamente na restrição de acompanhantes. Por esse motivo, é importante a avaliação da satisfação das grávidas com a assistência de enfermagem durante este contexto pandémico. Objetivo: Avaliar a satisfação da grávida com a assistência das enfermeiras obstétricas nas consultas de vigilância da gravidez durante o contexto de pandemia COVID-19. Metodologia: Estudo transversal descritivo de natureza quantitativa, com uma amostra de 196 grávidas. Aplicado a Escala de Satisfação dos Pacientes com a Assistência de Enfermagem (General Practice Nurse Satisfaction Scale - GPNS), constituída pelas dimensões: relacionamento interpessoal e comunicação, confiança, credibilidade e dedicação. Resultados: As grávidas apresentam-se em média mais satisfeitas na dimensão relacionamento interpessoal e comunicação e menos satisfeitas na dimensão dedicação. Conclusão: As grávidas apresentam-se satisfeitas com a assistência de enfermagem percecionando a sua importância. Tal reforça a pertinência das consultas serem realizadas por um Enfermeiro Especialista em Enfermagem de Saúde Materna e Obstétrica.

Abstract Background: Prenatal nursing appointments underwent changes during the COVID-19 pandemic, namely in the restriction of companions. For this reason, it is important to assess pregnant women's satisfaction with nursing care during this period. Objective: To assess pregnant women's satisfaction with nurse midwife-led prenatal appointments during the COVID-19 pandemic. Methodology: A qualitative descriptive cross-sectional study was conducted with a sample of 196 pregnant women. The Portuguese version of the General Practice Nurse Satisfaction Scale (Escala de Satisfação dos Pacientes com a Assistência de Enfermagem) was administered to the sample. The tool consists of the following dimensions: interpersonal relationship and communication, confidence, credibility, and dedication. Results: Pregnant women are, on average, more satisfied in the interpersonal relationship and communication dimension and less satisfied in the dedication dimension. Conclusion: Pregnant women are satisfied with nursing care and acknowledge its importance. This finding reinforces the importance of nurse midwife-led consultations.

Resumen Marco contextual: En tiempos de pandemia, las citas de enfermería para el seguimiento del embarazo cambiaron, sobre todo la restricción de acompañantes. Por esta razón, es importante evaluar la satisfacción de las mujeres embarazadas con los cuidados de enfermería durante este contexto pandémico. Objetivo: Evaluar la satisfacción de las mujeres embarazadas con la atención prestada por las enfermeras obstétricas en las consultas de seguimiento del embarazo durante la pandemia de COVID-19. Metodología: Estudio descriptivo transversal de carácter cuantitativo, con una muestra de 196 mujeres embarazadas. Se aplicó la Escala de Satisfacción de los Pacientes con Asistencia de Enfermería (General Practice Nurse Satisfaction Scale - GPNS), compuesta por las siguientes dimensiones: relaciones interpersonales y comunicación, confianza, credibilidad y dedicación. Resultados: Las mujeres embarazadas están, de media, más satisfechas en la dimensión relaciones interpersonales y comunicación, y menos satisfechas en la dimensión dedicación. Conclusión: Las embarazadas se mostraron satisfechas con los cuidados de enfermería y se dieron cuenta de su importancia. Esto refuerza la pertinencia de que las consultas sean realizadas por una enfermera especializada en Enfermería de Salud Materna y Obstétrica.

Women's empowerment for active labor: A qualitative study with nurse-midwives in antenatal education for childbirth.

INTRODUCTION: Recognizing the positive impact of movement and positions on labor progression and maternal and neonatal outcomes, there is a strong recommendation to empower women for active labor during antenatal education. This study investigates nurse-midwives' interventions in empowering women for active labor, during antenatal education within primary healthcare settings. METHODS: A qualitative descriptive study was conducted in Primary Healthcare Units that provide antenatal education for childbirth in Portugal. Semi-structured interviews were conducted with 10 nurse-midwives between August and October 2023. Content analysis, utilizing NVIVO software, was employed for data analysis, and the study adhered to the COREQ reporting guidelines. RESULTS: Six themes emerged: 1) Perspective of nurse-midwives and contextual influences; 2) Assessment of women's needs; 3) Enhancing women's knowledge; 4) Enhancing women's capabilities; 5) Supporting women in decision-making; and 6) Nurse-midwives' perspective on intervention outcomes. It is necessary to create environments conducive to knowledge and skill acquisition and invest in developing body awareness and its impact on labor progression. Encouraging women's involvement in decision-making is crucial, especially in less flexible hospital environments. CONCLUSIONS: This study highlighted the value nurse-midwives place on empowering women for active labor. Interventions featured sharing evidence-based practices and birth stories to foster reflection, emphasizing pelvic mobility training and partner involvement. Reflective practices could enable women to explore options and communicate effectively with healthcare professionals during labor.

Thirty Years of Midwifery Education in the Rural and Diverse State of New Mexico.

The purpose of this article is to discuss the evolution of the University of New Mexico (UNM) Nurse-Midwifery Education Program, its impact on New Mexico communities, and the vision moving forward for the program in a rural and culturally diverse state. New Mexico has a rich history of community-based midwifery and the UNM Nurse-Midwifery Education Program, founded in 1991, is rooted in this tradition. Graduates are prepared to practice in rural and underserved communities, advance birth equity, and decrease perinatal health disparities. Faculty have advanced the program mission to improve the health and well-being of New Mexico families through diversifying the midwifery workforce, growing community collaboration, and engaging in research and scholarship activities aimed at promoting access to care. Program faculty recognize the critical need to address factors underpinning the rising maternal morbidity and mortality crisis, including rurality, poverty, and structural racism. These efforts have yielded positive results, with 60% of program graduates serving New Mexico communities and increasingly diverse midwifery student cohorts (70% of currently enrolled students). Efforts to support midwifery student success are bolstered through a recently awarded Health Resources and Services Administration Maternity Care Nursing Workforce Expansion grant. Through such endeavors, the program will continue to strive toward social justice and human dignity.

The Availability of Midwifery Care in Rural United States Communities.

INTRODUCTION: Access to pregnancy-related and childbirth-related health care for rural residents is limited by health workforce shortages in the United States. Although midwives are key pregnancy and childbirth care providers, the current landscape of the rural midwifery workforce is not well understood. The goal of this analysis was to describe the availability of local midwifery care in rural US communities. METHODS: We developed and conducted a national survey of rural US hospitals with current or recently closed childbirth services. Maternity unit managers or administrators at 292 rural hospitals were surveyed from March to August 2021, with 133 hospitals responding (response rate 46%; 93 currently offering childbirth services, 40 recently closed childbirth services). This cross-sectional analysis describes whether rural hospitals with current or prior childbirth services had midwifery care with certified nurse-midwives available locally and whether rural communities with and without midwifery care differed by hospital-level and county-level characteristics. RESULTS: Among hospitals surveyed, 55% of those with current and 75% of those with prior childbirth services reported no locally available midwifery care. Of the 93 rural communities with current hospital-based childbirth services, those without midwifery care were more likely to have lower populations (37% vs 33%); majority populations that were Black, Indigenous, and people of color (24% vs 10%); and hospitals where at least 50% of births were Medicaid funded (77% vs 64%), compared with communities with midwifery care. Conversely, communities with midwifery care more often had greater than 30% of patients traveling more than 30 miles for hospital-based childbirth services (38% vs 28%). DISCUSSION: More than half of rural hospitals surveyed reported no locally available midwifery care, and availability differed by hospital-level and county-level characteristics. Efforts to ensure pregnancy and childbirth care access for rural birthing people should include attention to the availability of local midwifery care.

" We never considered it important ": a qualitative study on perceived barriers on use of non-pharmacological methods in management of labour pain by nurse-midwives in eastern Tanzania.

BACKGROUND: A significant number of women experience labour without effective pain management and thus suffer from unbearable labour pain to the extent they term labour as the most agonizing event in their lives. Unresolved labour pain can lead to stress, fear, and confusion, which may compromise placental perfusion and lead to birth asphyxia. Although various pharmacological and non-pharmacological labour pain management methods exist, the use of non-pharmacological methods (NPMs) to manage labour pain has remained low in low-resource settings. This paper explored the barriers for using NPMs to manage labour pain by nurse-midwives in eastern Tanzania. METHODS: We conducted an exploratory qualitative study with 18 nurse-midwives purposefully recruited from the labour wards of two selected district hospitals in eastern Tanzania. Qualitative content analysis guided the data analysis. RESULTS: Two categories illustrating barriers to using NPMs were generated: individual-level and institutional-level barriers. Individual-level barriers include (i) limited competencies of nurse-midwives on the use of NPMs for managing labour pain, (ii) inadequate exposure to labour pain management practices, (iii) misconceptions about labour pain relief, and (iv) a lack of opportunities for knowledge acquisition. The institutional barriers include (i) a critical staff shortage amidst many clients and (ii) an unfavourable healthcare facility environment. CONCLUSION: The implementation of NPMs for labour pain management by nurse-midwives in eastern Tanzania faces several institutional and individual barriers. We recommend addressing both supply- and demand-side barriers. Strengthening nurse midwives' competencies in NPMs adoption and use and improving the facility environment to ensure privacy during labour can be a starting point for addressing supply-side issues. We recommend dispelling myths and misconceptions through health promotion education to address demand-side barriers.

Job satisfaction in midwives working in labour ward: A systematic review with meta-analysis.

PROBLEM: There is little documented evidence of job satisfaction in midwives who work in birthing rooms. BACKGROUND: Job satisfaction in midwives who work in birthing rooms may have changed in recent decades due to the medicalization of maternal health. AIM: To analyse job satisfaction levels among midwives working in birthing rooms. METHODS: We searched Web of Science, SCOPUS, MEDLINE, CUIDEN and CINAHL for observational and mixed method studies. The literature search was carried out from September to October 2022. FINDINGS: A total of 13 studies were included in the systematic review. A meta-analysis of the variable "midwives' job satisfaction" was performed on 12 of the studies. Midwives rated their job satisfaction positively: DME, CI (95%) = 1.24 [0.78, 1.69]. Subgroup 1: DME, CI (95%) = 2.41 [2.05, 2.76]); Subgroup 2: DME, CI (95%) = 0.76 [0.65, 0.86]; subgroup 3: DME, CI (95%) = 1.11 [0.95, 1.27]; subgroup 4: DME, CI (95%) = 0.10 [-0.11, 0.31]. DISCUSSION: Although midwives show high levels of satisfaction, the heterogeneity of instruments, lack of specificity and limited number of studies found restrict the outcomes. CONCLUSION: There are no specific measurement instruments for assessing job satisfaction among midwives working in labour wards, so it is possible that these data do not correspond to reality as they do not take into account specific professional aspects within this field of practice.

Contraceptive Counseling: Construction and Validation of Instrument-"5C Contraceptive Counseling".

INTRODUCTION: Contraceptive illiteracy leads to non-adherence, discontinuation, and dissatisfaction with the method. Person-centered contraceptive counseling is based on quality care on a communicative basis that promotes shared decision-making, leading to a choice adapted to the woman's needs, lifestyle, and health condition. We intend to build and validate an instrument that serves as a guide for quality contraceptive counseling, facilitating decision-making about contraceptive methods. METHODS: We used the Delphi method in a total of two rounds. The content was validated through a panel of eighteen experts with experience in teaching, research in contraceptive counseling, and obstetric nursing. To assess the consensus and stability of the responses, two questionnaires were administered and the Content Validity Index and Content Validity Ratio were calculated. RESULTS: The initial version of the guide, consisting of six indicators and thirty-five items, was submitted to the panel of experts to obtain consensus and stability from respondents (first round). The results showed a response rate of 66.0%; thirty-four indicators reached consensus and one did not reach consensus. Suggestions for modifying the indicator were received by the experts and incorporated in the next round. In the second round, the response rate increased to 78.0%. Two indicators were resubmitted, of which one was accepted. This resulted in the final version of the instrument, with six points and thirty-five items. DISCUSSION: The guide proved to be a valid tool for nurse-midwives to provide quality contraceptive advice to women, allowing them to make autonomous and informed choices regarding their sexual and reproductive health.

Identifying Drivers and Barriers to Precepting Midwifery Students: "A Little Part of Me Lives on in Each Student Midwife".

INTRODUCTION: Increased access to midwifery care is one strategy that could improve perinatal health outcomes and help address the maternal health crisis in the United States. A modifiable barrier to increasing the workforce is greater access to midwifery preceptors for clinical training. The objective of this research is to use the socioecological framework to identify midwives' perceptions of the barriers and facilitators to precepting students in clinical areas. METHODS: Midwives attending a preceptor education and training workshop series responded to 3 different questions at the end of each session: (1) What makes precepting midwifery students challenging? (2) What makes precepting midwifery students possible? and (3) What makes precepting midwifery students worthwhile? Responses were coded to align with the socioecological framework, which distinguishes individual, interpersonal, community, institutional, and policy-level influences. RESULTS: Midwives' responses were spread across the levels of the socioecological model except for policy. Participants identified institutional influences such as support as factors that made precepting feasible, both individual and interpersonal factors such as time constraints as areas that presented challenges to precepting, and community factors, like the joy of sharing midwifery, contributing to what made precepting worthwhile. DISCUSSION: Multiple levels of influence were identified in the preceptor process. Participants were internally motivated to precept while also articulating that to make precepting possible, there is a need for support from both colleagues and the greater systems within which they worked. Further studies are needed to investigate an ecosystem that facilitates an effective and sustainable model for midwifery precepting. Additionally, there is a need for efforts to engage and educate midwives in clinical practice about government advocacy that could actualize policy initiatives to support clinical midwifery education.

Organizational Engagement: One State's Experience With Invigorating Affiliate Membership and Building a Sustainable Fundraising Model.

Over the last 6 years, the Pennsylvania Affiliate of the American College of Nurse-Midwives has worked to meet the needs of its diverse membership and increase the capacity of the affiliate board by taking a series of strategic steps. This article details the key components of this journey, which has culminated in a successful annual conference with over $118,000 in net revenue to help meet affiliate goals, including pursuing midwifery modernization legislation for Pennsylvania and an increase in our affiliate membership by almost 100 individuals. The annual conference, Midwifery Forward, which completed its fifth year in 2023, has also given our community of midwives a yearly reason to gather and reconnect, celebrate accomplishments, welcome new graduates, and make plans for the year ahead. The goal of this article is to share the specifics of our strategic planning, so that other affiliates and organizations may benefit as they develop strategic plans in the larger effort to increase membership and engagement and generate sustainable income for their midwifery organizations.

The effect of "typical case discussion and scenario simulation" on the critical thinking of midwifery students: Evidence from China.

BACKGROUND: Assessment ability lies at the core of midwives' capacity to judge and treat clinical problems effectively. Influenced by the traditional teaching method of "teacher-led and content-based", that teachers involve imparting a large amount of knowledge to students and students lack active thinking and active practice, the clinical assessment ability of midwifery students in China is mostly at a medium or low level. Improving clinical assessment ability of midwifery students, especially critical thinking, is highly important in practical midwifery education. Therefore, we implemented a new teaching program, "typical case discussion and scenario simulation", in the Midwifery Health Assessment course. Guided by typical cases, students were organized to actively participate in typical case discussions and to promote active thinking and were encouraged to practice actively through scenario simulation. In this study, we aimed to evaluate the effect of this strategy on the critical thinking ability of midwifery students. METHOD: A total of 104 midwifery students in grades 16-19 at the West China School of Nursing, Sichuan University, were included as participants through convenience sampling. All the students completed the Midwifery Health Assessment course in the third year of university. Students in grades 16 and 17 were assigned to the control group, which received routine teaching in the Midwifery Health Assessment, while students in grades 18 and 19 were assigned to the experimental group, for which the "typical case discussion and scenario simulation" teaching mode was employed. The Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV) and Midwifery Health Assessment Course Satisfaction Questionnaire were administered after the intervention. RESULTS: After the intervention, the critical thinking ability of the experimental group was greater than that of the control group (284.81 ± 27.98 and 300.94 ± 31.67, p = 0.008). Furthermore, the experimental group exhibited higher scores on the four dimensions of Open-Mindedness (40.56 ± 5.60 and 43.59 ± 4.90, p = 0.005), Analyticity (42.83 ± 5.17 and 45.42 ± 5.72, p = 0.020), Systematicity (38.79 ± 4.70 and 41.88 ± 6.11, p = 0.006), and Critical Thinking Self-Confidence (41.35 ± 5.92 and 43.83 ± 5.89, p = 0.039) than did the control group. The course satisfaction exhibited by the experimental group was greater than that exhibited by the control group (84.81 ± 8.49 and 90.19 ± 8.41, p = 0.002). CONCLUSION: The "typical case discussion and scenario simulation" class mode can improve the critical thinking ability of midwifery students and enhance their curriculum satisfaction. This approach carries a certain degree of promotional significance in medical education.

Inovação tecnológica ultrassom na prática profissional da enfermeira obstétrica: protocolo de revisão de escopo / Technological innovation ultrasound in the professional practice of the nurse midwives: scope review protocol

OBJETIVO: Identificar e mapear a prática profissional da enfermeira obstétrica em relação à utilização da ferramenta tecnológica ultrassom no âmbito mundial. MÉTODO: Protocolo de revisão do escopo de acordo com a metodologia Joanna Briggs Institute (JBI) e checklist Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A estratégia de busca será aplicada nas bases de dados selecionadas e serão acrescentados Resoluções e Pareceres do Conselho Federal de Enfermagem (Cofen) e Conselho Regional de Enfermagem de Minas Gerais (Coren-MG). Dois pesquisadores independentes cegados, realizarão todo o processo de busca, avaliação, seleção e extração de dados e, caso existam discordâncias um terceiro revisor auxiliará no processo. Para a extração dos dados será utilizada uma tabela, elaborada pelos pesquisadores. Os resultados serão apresentados de forma narrativa, com apoio de quadros e figuras. Protocolo registrado na Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/K8PGX.

OBJECTIVE: To identify and map the professional practice of nurse midwives regarding the use of ultrasound technology tools worldwide. METHOD: Scope review protocol according to the Joanna Briggs Institute (JBI) methodology and checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The search strategy will be applied to the selected databases, and resolutions and opinions of the Federal Nursing Council (Cofen) and Regional Nursing Council of Minas Gerais (Coren-MG) will also be added. Two self-employed researchers will carry out the entire process of searching, evaluating, selecting, and extracting data, and if there are disagreements, a third reviewer will assist in the process. A table, elaborated by the researchers, will be used to extract the data. The results will be presented in a narrative form, with the support of tables and pictures. The protocol is registered at Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/K8PGX.

Workforce Survey of Connecticut Midwives.

INTRODUCTION: Midwives in Connecticut lack resources for current, state-specific data regarding compensation, benefits, work hours, and scope of practice. The primary purpose of this study was to provide detailed information about the work and services provided by midwives in Connecticut and how they are compensated. METHODS: Certified nurse-midwives (CNMs) licensed in Connecticut were recruited for a 53-question online survey between October 2021 and February 2022. The survey included topics such as compensation, benefits, practice patterns, and precepting. RESULTS: For full-time salaried CNMs in Connecticut, compensation was higher than the national average for midwives. A majority of CNMs in the state work 40 hours per week or less in physician-owned private practices and are preceptors. DISCUSSION: For midwives planning to negotiate contracts in Connecticut, this report provides important information to ensure fair compensation and work hours. The survey also serves as a roadmap for midwives in other states who wish to collect and disseminate similar workforce data.