Midwives' approach to the prevention and repair of obstetric perineal trauma in Spain.

AIM: Different clinical practice guidelines include recommendations on how to prevent and repair obstetric perineal trauma, as well as the use of episiotomy. To evaluate the variability in midwives' professional practices for preventing and repairing perineal trauma, as well as the professional factors that may be associated with the restrictive use of episiotomy. DESIGN: Observational cross-sectional study. METHODS: Three hundred five midwives completed an anonymous questionnaire developed by the authors and distributed across various midwifery scientific societies. The main outcomes measured were the frequencies of adopting specific practices related to perineal injury prevention and repair, episiotomy technique and restrictive episiotomy use (<10%). Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals were estimated. RESULTS: Intrapartum perineal massage was not normally used by 253 (83%) of midwives, and 186 (61%) applied compresses soaked in warm water to the perineum. Regarding episiotomy, there was a great deal of variability, noting that 129 (42.3%) adopted a restrictive use of this procedure, 125 (41%) performed it between 10% and 20%, while 51 midwives (16.7%) performed it in more than 20% of cases. In addition, 165 (54.1%) midwives followed an incision angle of 60º. Concerning tears, 155 (50.8%) usually sutured first-degree tears and 273 (89.5%) always sutured second-degree tears. Midwives attending home births (aOR = 6.5; 95% CI: 2.69-15.69), working at a teaching hospital (aOR = 3.69; 95% CI: 1.39-9.84), and the ones who recently completed their professional training (aOR = 3.58; 95% CI: 1.46-8.79) were significantly more likely to adopt a restrictive use of episiotomy. CONCLUSIONS: There is a significant variability in Spanish midwives' practices for preventing and repairing perineal tears. Moreover, the restrictive use of episiotomy is associated with midwives attending home births, working in teaching hospitals and having recent professional training. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Care and services partnership in Quebec birthing centres: myth or reality?

CONTEXT: Working with women to best meet their needs has always been central to midwifery in Quebec, Canada. The creation of birthing centres at the end of the 1990s consolidated this desire to prioritize women's involvement in perinatal care and was intended to encourage the establishment of a care and services partnership between care providers and users. The aim of this pilot study is to evaluate the perceptions of clients, midwives and birth assistants of the way in which women are involved in partnership working in Quebec birthing centres. METHODS: A single qualitative case and pilot study was conducted with midwives (n = 5), birth assistants (n = 4), a manager (n = 1), clients (n = 5) and members of the users' committee (n = 2) at a birthing centre in Quebec, Canada in July and August 2023. The partnership was evaluated using the dimensions of a validated CADICEE questionnaire. RESULTS: The women and professionals stressed that the relationship was established in a climate of trust. The caregivers also attached importance to autonomy, information sharing and decision-making, adaptation to context, empathy and recognition of the couple's expertise. The women confirmed that they establish a relationship of trust with the professionals when the latter show empathy and that they adapt the follow-up to their knowledge and life context. Key factors in establishing this kind of care relationship are the time given, a de-medicalized environment, the comprehensive care received, and professionals who are well-informed about the partnership. In addition, the birthing centre has a users' committee that can put forward ideas but has no decision-making powers. CONCLUSIONS: Both the women and the professionals at the birthing centre appear to be working in partnership. However, at the organizational level, the women are not involved in decision-making. A study of all birthing centres in Quebec would provide a more comprehensive picture of the situation.

Patient perception of labor support behaviors provided by Finnish midwives.

BACKGROUND: Almost all births in Finland occur in hospitals, but the concept of labor support behavior is not well-known among Finnish midwives. OBJECTIVE: The primary aim was to increase perceived labor support as measured by BANSILQ. METHODS: This study was tailored to evaluate the impacts of short on-the-job training interventions for midwives (n=70) in labor support given to mothers. The training was conducted at one university hospital and and one regional hospital during 2012. The trainings were carried out twice at both hospitals to reach as many miwdwives as possible to participate. Two university hospitals-one regional and one central-were selected as controls. New mothers were asked to complete the Bryanton Adaptation of the Nursing Support in Labor Questionnaire (BANSILQ) in the postpartum wards at all the selected hospitals before the intervention (n=1500) and after the intervention (n=1500). The data were linked to the Finnish Medical Birth Register (MBR). As this is an in-job training intervention study and not a trial, it has not been registered in a trial registry. RESULTS: The response rate was 68% (n=1020) for the pre-intervention survey and 47% (n=704) for the post-intervention survey. At the regional-level intervention hospital, the mean length of the second stage of childbirth decreased significantly. A bonding time of at least three minutes was three times more likely at both intervention hospitals. Support for breastfeeding was twice as likely at the university-level hospital after the intervention. In all the study hospitals, mothers with less education were more likely to receive tangible and informal support than highly educated mothers. CONCLUSIONS: This short on-the-job intervention did not increase labor support provided by Finnish midwives in its entirety, and the effect on birth outcomes was minimal. However, support for breastfeeding increased, and some types of support were targeted at those who needed it most. To improve midwifery care, both training and sufficient resources are needed.

Midwives' views about the effects of climate change on maternal and child health: A qualitative study.

BACKGROUND: Midwives have important responsibilities to protect the health of mothers and children from the negative effects of climate change. AIM: This research was conducted to determine how midwives perceived climate change, the effects of climate change on maternal and child health, and what midwives could do to combat these effects. METHODS: The research was designed as a case study, one of the qualitative research designs. The research sample consisted of 11 midwives selected by snowball sampling, which is one of the non-random sampling methods. FINDINGS: The data obtained were collected under five main themes. The themes were determined as "(I) the causes of climate change, (II) concerns about the consequences of climate change, (III) the effects of climate change on mother-child health, (IV) measures to mitigate the effects of climate change, and (V) midwives' role in protecting mother-child health against the effects of climate change." CONCLUSION: Midwives are knowledgeable about climate change. They are aware of the effects of climate change on maternal and child health and they are doing some practices in this regard (breastfeeding, promoting the regulation of fertility and adequate/balanced nutrition, etc.). Midwives are aware of the importance of the midwifery profession in raising awareness of the individual and society, in addressing the effects of climate change on human health and in reducing the negative effects of climate change on health, and they want to take action at the national level (with the support of the midwifery organization and the state) for the sustainability of health.

Teaching family planning to nurse and midwife students: A constructivist grounded theory study.

AIM: This study aimed to describe nurse/midwife educators' understanding and enactment of teaching family planning methods with nursing/midwifery students in educational programs in Rwanda. More precisely, the aim of this study was to generate a substantive theory that explains how nurse/midwife educators introduce family planning methods into their teaching practice to facilitate learning among nurse/midwife students in Rwanda. BACKGROUND: High maternal mortality remains a global health issue. In 2017, approximately 295,000 women worldwide died from complications related to pregnancy or childbirth and 94% of these maternal deaths occurred in low-income countries. Evidence shows that family planning improves maternal health outcomes and significantly contributes to reducing maternal mortality. Low family planning uptake is partly attributed to inadequate education of healthcare providers to provide family planning services. DESIGN: This study followed the constructivist grounded theory methodology articulated by Kathy Charmaz (2006; 2014). METHODS: The primary data source was individual semi-structured interviews with 25 nurse/midwife educators recruited from all the schools/faculties/departments of nursing and midwifery in Rwanda, augmented with written documents related to family planning education in nursing/midwifery preservice programs. RESULTS: The substantive Theory that emerged from the data analysis indicated that the process of teaching family planning in preservice nursing/midwifery education among nurse/midwife educators has three phases: preparing, facilitating and evaluating. Factors that had an impact on the process and actions that nurse/midwife educators undertook to address the challenges related to those factors were identified. The main influential factors that had a significant impact on nurse/midwife educators' ability to teach family planning are contextual factors and personal factors related to the nurse/midwife educators. The contextual factors included the availability of resources, student-teacher ratio, number of students in clinical placements and the time allocated to the family planning unit. The personal factors related to the nurse/midwife educators included knowledge, skills, confidence, attitude, beliefs and moral values toward family planning methods. CONCLUSION: These study findings generated valuable knowledge that can guide the improvement of teaching family planning in preservice nursing/midwifery programs in Rwanda and other limited-resource countries and contexts. With the insights provided by this study, future research should investigate strategies to overcome highlighted barriers, increase nurse/midwife educators' expertise in teaching family planning and enhance the preparedness of nurse/midwife students on some family planning methods identified in this study.

Midwives' experiences of discussing health behaviour change within routine maternity care: A qualitative systematic review and meta-synthesis.

PROBLEM: Behaviours, such as smoking, alcohol use, unhealthy diet, lack of physical activity and vaccination non-adherence may lead to adverse pregnancy outcomes. BACKGROUND: Pregnancy has been identified as an opportune time for midwives to support women to make health behaviour changes. AIM: To synthesise existing qualitative research exploring midwives' experiences of discussing health behaviour change with women within routine care. METHODS: A systematic search was conducted across: Maternity and Infant Care, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Applied Social Sciences Index and Abstracts. Thematic analysis was used to synthesise the data. A professional and public advisory group provided feedback during the synthesis stage. FINDINGS: Twenty-two studies, published between 2005 and 2023, which represented findings from eight countries, were included in the review. The meta-synthesis revealed three themes: The midwife-woman relationship; Reflective and tailored behaviour change communication; Practical barriers to behaviour change conversations. This led to one overarching theme: Although midwives recognised the importance of behaviour change discussions, these conversations were not prioritised in clinical practice. CONCLUSION: Health behaviour change discussions were de-prioritised in midwives' clinical practice. Future research should explore intervention development to support midwives with their health behaviour change communication.

First alongside midwifery led unit in a high complexity public hospital in Spain: Maternal and neonatal outcomes.

PROBLEM: Midwifery led units are rare in Spain. BACKGROUND: Midwife-Led Care (MLC) is a widely extended model of care and, within this, the alongside midwifery-led units (AMLU) are those hospital-based and located in close connection with obstetric units. In Spain, CL is the first center belonging to the National Health System of these characteristics. AIM: To evaluate the first year of activity of this pioneering unit. METHODS: An observational cross-sectional study was carried out to assess maternal and neonatal outcomes of births facilitated at CL by comparing with those births that fulfilled the criteria to be admitted at the AMLU but were assisted at the standard obstetric care unit of the hospital. FINDINGS: 174 (20,3%) women and birthing people decided to give birth at CL, whereas 684 (79,7%) gave birth at the Obstetric Unit of the Hospital. Women assisted at the AMLU had lower intervention rates (episiotomy, epidural analgesia) and a higher rate of breastfeeding practice. There were no statistical differences in maternal outcomes (postpartum hemorrhage, third-or-four-degree laceration) or neonatal outcomes (Apgar< 7 at 5 min; birth weight < 2500 gr; macrosomia; shoulder dystocia, neonatal care transfer). DISCUSSION: There were differences in transfers from MLU to OU between nulliparous and multiparous; the main reason for transfer is the request for analgesia. Epidural analgesia should be considered when analyzing maternal outcomes. CONCLUSION: An alongside midwifery-led unit is a safe option with a low incidence of complications. This model of care can be positively implemented at the Public Healthcare System.

Knowledge and attitudes of midwives towards collaboration with traditional birth attendants for maternal and neonatal healthcare services in rural communities in South Africa.

OBJECTIVES: We assessed the knowledge and attitude of registered midwives towards collaborating with traditional birth attendants for maternal and neonatal healthcare services in rural communities. DESIGN: A descriptive cross-sectional survey was followed in this study. PARTICIPANTS: Registered midwives in selected clinics in the City of Tshwane Municipality. Participants were recruited by stratified random sampling. Data was collected at the Thirty-four primary healthcare facilities in Gauteng province, South Africa. MEASUREMENT AND RESULTS: A self-assessment questionnaire was administered to 304 registered midwives. Two-hundred and sixty respondents returned the questionnaire representing a response rate of 86.6 % which was statistically significant. The majority of Midwives in South Africa displayed a low level of knowledge (mean = 41.8, SD=1.7) on the role and practices of traditional birth attendants). Only 30.8 % (n = 80) of midwives knew of the roles of traditional birth attendants for maternal and neonatal healthcare (MNH) services. With respect to knowledge, there was significant associated with the Professional category (p < 0.015). In terms of attitude, registered midwives displayed negative attitudes towards collaborating with traditional birth attendants (mean = 46.8, SD=2.1). Approximately half (54.2 %, n = 140) of midwives were amenable towards collaborating in the provision of antenatal care, and 70.4 % (n = 183) of midwives agreed to collaborate with traditional birth attendants for extended roles such as accompanying women to health facilities. Association of demographic data and level of attitude showed there was significant relationship (p < 0.05) between registered midwives' level of education and their attitude towards collaboration. KEY CONCLUSIONS: Midwives demonstrated positive attitude towards collaborating with traditional birth attendants at the antenatal care level only. Midwives were not amenable to collaboration at the level of intrapartum and postpartum care. IMPLICATIONS FOR PRACTICE: Based on our results, collaboration should be at antenatal care level to allow for early detection, treatment, and prevention of antenatal complications thus reducing maternal mortality and morbidity.

"If I blink twice everything is OK" - A qualitative study of Swedish midwives' strategies for supporting birthing women while working in full personal protective equipment.

PROBLEM: Midwives all over the world have had to adapt to the use of personal protective equipment (PPE) during the COVID-19 pandemic. The issue of how they managed to support birthing women, despite the use of PPE, has been insufficiently studied. BACKGROUND: Midwives support birthing women in one of their most life-changing situations. Having COVID-19 at the time of childbirth makes birthing women even more vulnerable. PPE has been shown to impact the ability of providing support to birthing women. AIM: To describe midwives' strategies for supporting birthing women while working in full PPE METHODS: A qualitative study based on focus group discussons with Swedish midwives. Data were analysed by inductive content analysis. FINDINGS: To support birthing women while in full PPE, the midwives adapted existing working methods, increased collaboration with colleagues, unveiled, adapted to the requirements for contagion prevention, addressed women's concern for the midwife and maintained focus on the birth while remaining mindful of the risk of contagion. DISCUSSION: Midwives adopted strategies in order to uphold provision of support to the birthing women, as well as to address contextual factors related to PPE that hinder provision of support. CONCLUSION: The respective effects of different PPE types and models on the birth experience should be explored. Explicit strategies for supporting birthing women while working in full PPE must be created and discussed among midwives.

Antenatal cardiotocography in dutch primary midwife-led care: Maternal and perinatal outcomes and serious adverse events. A prospective observational cohort study.

PROBLEM: It is yet unknown whether shifting antenatal cardiotocography (aCTG) from obstetrician-led to midwife-led care leads to a safe reduction in referrals. BACKGROUND: ACTG is used to assess fetal well-being. In the Netherlands, the procedure has until now been performed as part of obstetrician-led care. Developments in E-health facilitates the performance of aCTG outside the hospital in midwife-led care, hereby increasing continuity of care. AIM: To evaluate 1) process outcomes of implementing aCTG for specific indications in primary midwife-led care; 2) maternal and perinatal outcomes of pregnant women receiving aCTG in midwife-led care; 3) serious adverse events (with outcomes, causes, avoidability, and potential prevention strategies) that have occurred during the innovation project 'aCTG in midwife-led care'. METHODS: Prospective observational cohort study and a case series study of serious adverse events. FINDINGS: A total of 1584 pregnant women with a specific aCTG indication were included in this cohort study for whom 1795 aCTGs were performed in midwife-led care. 1591 aCTGs(89.7%) were classified as reassuring. Referral to obstetrician-led care occurred for 234 women(13.0%) after an aCTG in midwife-led care of whom 202(86%) were referred back. Severe neonatal morbidity occurred in 27 neonates (1.7%). In the 5736 aCTGs included in the case series study, one case with a serious neonatal outcome was assessed as a serious adverse event attributable to human factors. DISCUSSION: ACTGs performed in midwife-led care increased continuity of care. In this innovation project, maternal and perinatal outcomes were in the expected range for women in midwife-led care.

User satisfaction with antenatal care in Norway.

BACKGROUND: In Norway, antenatal care is delivered free of charge in the municipality. Satisfaction with care is considered to be an important predictor of utilization of health care. The aim of this study was to examine women's satisfaction with antenatal care, and to identify factors that predict overall satisfaction with the service. METHODS: A total of 611 women completed a survey that collected information on demographic variables, pregnancy variables, and aspects of antenatal care; it also contained one open-ended question. A hierarchical multiple regression analysis was conducted to predict Overall Satisfaction with antenatal care based on four specific scales: User Participation, Accessibility, Information, and Midwife, adjusted for demographic variables. RESULTS: Survey responses showed that 95% of women were satisfied with antenatal care in general. The expectant mother's age, having Norwegian as the native language, and the scales User Participation, Information, and Midwife were all significant predictors of Overall Satisfaction with antenatal care. The open-ended user comments underlined the important role of midwifes in antenatal care. CONCLUSIONS: The results of this study indicate that women who attended antenatal care in Norway were satisfied with the care they received. Midwives had an important role, and their relational and professional competence was highly valuated by expectant mothers. The findings also suggest that there are still opportunities to improve satisfaction with antenatal care, for example, by increasing the focus on mental health during antenatal consultations.

Midwifery workforce challenges in Victoria, Australia. A cross-sectional study of maternity managers.

BACKGROUND: In Australia, there is a lack of accurate data on midwifery workforce staffing and skill mix, which in turn hinders workforce policy and planning. AIM: To describe the current staffing levels of the midwifery workforce in Victoria, Australia, explore workforce challenges and assess the impact of COVID-19 pandemic on staffing. DESIGN: Cross-sectional. METHODS: Midwifery managers in all public and private maternity services in Victoria, Australia were invited to complete a survey exploring midwifery staffing numbers and adequacy. Topics explored included midwifery turnover, recruitment, and skill mix. Descriptive statistics were used. FINDINGS: The survey was open March to October 2021, and 56 % (38/68) of managers responded. Of these, 76 % reported inadequate midwifery staff levels, with deficits ranging from one to 19 estimated Full-Time Equivalent (EFT) midwives, with a combined total deficit of 135 EFT. In the 12 months prior to the survey, 73 % of services had found it difficult to recruit midwives, with increased difficulty during the COVID-19 pandemic. Managers were concerned about retaining and recruiting 'experienced' midwives due to an ageing workforce and high turnover due to work/life imbalance and job dissatisfaction. These issues have led to a predominantly early career midwifery workforce and created concern about skill mix. CONCLUSION: Victorian maternity services have a midwifery workforce shortage and are experiencing significant skill mix issues. The pandemic has exacerbated these considerable gaps in the workforce. Urgent implementation of retention and recruitment schemes are needed, along with strategies to improve the working conditions for the current workforce.

Discursive constructions of student midwives' professional identities: A discourse analysis.

BACKGROUND: The construction and performance of professional identity is significant to broader socio-cultural understandings of who 'professionals' are and what they do. Importantly, it is also implicated in the development and enactment of policy, regulation, education, and professional practice. Professional identity is linked to self-esteem, self-efficacy, professional value, confidence and success. The salience of this in relation to midwifery practice is highly significant; aspects of autonomy, confidence, competence, responsibility, and accountability are all implicated in the provision of safe and effective care. AIM: To explore how student midwives are constructed in the discourses of policy, professionalism, and learning, to provide new perspectives to inform, policy, education, and practice. METHODS: An adapted critical discourse analysis of the United Kingdom (UK) Nursing and Midwifery Council's 2009 Standards for pre-registration midwifery education, using a three-step process: exploring discourse at the level of (1) discursive practice (2) linguistic features of the text, and (3) social practice. FINDINGS/ DISCUSSION: The discourses that relate to midwifery education and practice emerge within socio-political and historical contexts. Constructions of identity are articulated through a rule-bound framework which includes competence, confidence and 'good health and good character'. There is a requirement for midwives to 'be' responsible, accountable, autonomous, professional, competent, and confident. Regulatory power is reinforced through medico-legal discourses, with the status of midwifery discursively presented as inferior to medicine. CONCLUSION: According to the Standards, midwives must be a lot of things in their role and function. The Standards' discourses are authoritative, legislative and controlling, creating an ideology about professional status and agency which constructs an 'imaginary autonomy'; becoming a midwife is more automatic (with the perception of control), than agentic. All of which has significance for the social practice of midwifery. TWEETABLE ABSTRACT: 'How are midwives made? Discursive constructions of student midwives' professional identities: a discourse analysis.

Evaluation of a pilot online education program to develop midwives' knowledge, skill and confidence in perinatal mental health in rural South Australia.

One in five women will experience perinatal anxiety and/or depression. In South Australia, a rural health service identified a high proportion of women with risk of perinatal mental health challenges and sought additional education for midwives. In response, a six-week facilitated, online perinatal mental health education program (e-PMHEP) was piloted. AIM: The aim of this study was to evaluate the effectiveness of the (e-PMHEP) for rural midwives, nurses and Aboriginal maternal infant care practitioners. METHOD: Program evaluation incorporated a validated online pre/post survey to assess self-reported knowledge, skill and confidence regarding perinatal mental healthcare. Additional questions sought feedback on satisfaction and feasibility. FINDINGS: Sixteen participants from rural South Australia engaged in the project from June to August 2022. Twelve participants completed the online pre/post survey. The overall pre/post knowledge scores were statistically significant (t = 2.73, 8df, p = 0.025) with improvement from the pre to post-test. Pre/post data also showed a measurable increase in confidence and skills. All respondents agreed that the content addressed their learning needs and would recommend this program to other practitioners. DISCUSSION: The e-PMHEP appeared beneficial in developing knowledge, skills and confidence regarding perinatal mental healthcare in rural midwives and practitioners. Only a third of practitioners routinely developed a mental health care plan with women. Key strengths of the program included the accessible content, and the combination of an experienced mental health clinician and a facilitator with lived experience. CONCLUSION: Providing an accessible, facilitated online perinatal mental health education program could be beneficial for rural midwives.

Ethical Climate in the Delivery Wards of Educational Hospitals in Southeast Iran.

Ethical climate is one of the important factors in the working climate of the hospital. Considering the difference in the Ethical climate in different departments of the hospital and the importance of the ethical climate in the delivery ward, this study aimed to assess the characteristics of hospital ethical climate in delivery ward of educational hospitals in southeast Iran. This descriptive and multi-center study was conducted from 2020 to 2021 in educational hospitals in southeast Iran. Two hundred forty midwives working in delivery wards, midwifery instructors, and midwifery students were included in the study by census method. Data collection tools included a demographic information form, Olson's Hospital Ethical Climate Survey, completed using the self-report method. The mean ethical climate in the midwifery group (3.82 ± 0.63 out of 5) was higher than in the instructors' and students' groups. The lowest mean score obtained from the ethical climate questionnaire of participants was associated with the inability to use their experiences in the delivery ward. The lowest mean of ethical climate from the midwives' point of view is the Physicians' dimension and the patient's dimension from the instructors' point of view. The highest mean score belonged to the ethical climate of the supervisors. According to the results of the present study, it is suggested to implement protective laws to support the higher independence of midwives to improve the ethical climates by using their experiences in the delivery department.

Endorsed midwives prescribing scheduled medicines in Australia: A scoping review.

PROBLEM: Despite 10 years of prescribing scheduled medicines by Endorsed Midwives, little is known about prescribing practices. BACKGROUND: Endorsed Midwives can prescribe scheduled medicines and have access to Medicare rebates to support service provision. Endorsed Midwives have the potential to improve access to medications for women, however, are met with barriers, including inconsistencies in state and national legislation. AIM: To search for what is published regarding Endorsed Midwife prescribing of scheduled medicines in Australia, report on the literature, synthesise the findings and discuss the results. METHODS: A scoping review utilising the Joanna Brigg's Institute methodology. A search of CINAHL, PubMed, Science Direct and Medline databases was conducted. Seven peer-reviewed articles were identified; three discussion papers, one literature review and three research papers, published between 2016 and 2023 in English. Qualitative content analysis was used to identify topic areas. FINDINGS: Four topic areas were identified: 1) Endorsed Midwives increase women's access to prescribed medications; 2) the Pharmaceutical Benefits Scheme is restrictive and diminishes midwifery prescribing; 3) medication prescribing depends on internal and external structures; 4) professional relationships support prescribing. DISCUSSION: The authority to prescribe augments Endorsed Midwives' practice, improves timely access to medications and enhances role satisfaction. The effective use of midwifery prescribing is hampered by barriers such as the Pharmaceutical Benefits Scheme, inappropriate medication formularies, and poorly designed health service policy. CONCLUSION: To fully utilise Endorsed Midwife prescribing in all settings of maternity care, further work is required to develop education, remove barriers, and demonstrate the safety and effectiveness of midwifery prescribing.

Opinions and practices of midwives working in the delivery rooms on informed consent in vaginal deliveries.

Obtaining informed consent from women for vaginal birth both safeguards their autonomy and establishes a legal foundation for midwives. This study aimed to determine the opinions and practices of midwives on obtaining valid informed consent for vaginal deliveries. This descriptive study was conducted between November 2021 and December 2022 in two different cities of Turkey, Bursa and Kocaeli. Data were analyzed with Chi-square test. In the study all midwives who had not received ethics training had a common perception that informed consent merely involved obtaining a signature and was a standard practice for vaginal birth (p=0.002). In the study, 92.9% of the midwives reported that they found it necessary to obtain informed consent in vaginal deliveries, 97.6% reported that they provided verbal information. However, information provided by midwives for valid informed consent was mostly not comprehensive (range 44.4%-80.2%). Most midwives (80.2%) focused on highlighting the benefits of vaginal birth for mothers, with comparatively less emphasis on communicating information regarding the potential risks and complications associated with vaginal birth for newborns. The high percentage of midwives who considered it necessary to obtain informed consent in vaginal deliveries in our study suggests that these midwives are well aware of the significance of informed consent.

L'obtention du consentement éclairé des femmes pour un accouchement vaginal garantit à la fois leur autonomie et leur établit une base juridique pour les sages-femmes. Cette étude visait à déterminer les opinions et les pratiques des sages-femmes concernant l'obtention d'un consentement éclairé valide pour les accouchements par voie vaginale. Cette étude descriptive a été menée entre novembre 2021 et décembre 2022 dans deux villes différentes de Turquie, Bursa et Kocaeli. Les données ont été analysées avec le test du Chi carré. Dans l'étude, toutes les sages-femmes qui n'avaient pas reçu de formation en éthique avaient la perception commune que le consentement éclairé impliquait simplement l'obtention d'une signature et constituait une pratique standard pour l'accouchement vaginal (p = 0,002). Dans l'étude, 92,9 % des sages-femmes ont déclaré qu'elles jugeaient nécessaire d'obtenir un consentement éclairé lors d'un accouchement vaginal, 97,6 % ont déclaré avoir fourni des informations verbales. Cependant, les informations fournies par les sages-femmes pour obtenir un consentement éclairé valide n'étaient pour la plupart pas complètes (plage de 44,4 % à 80,2 %). La plupart des sages-femmes (80,2 %) se sont attachées à souligner les avantages de l'accouchement vaginal pour les mères, en mettant comparativement moins l'accent sur la communication d'informations concernant les risques et les complications potentiels associés à l'accouchement vaginal pour les nouveau-nés. Le pourcentage élevé de sages-femmes qui ont jugé nécessaire d'obtenir un consentement éclairé lors d'un accouchement vaginal dans notre étude suggère que ces sagesfemmes sont bien conscientes de l'importance du consentement éclairé.

Vaccine hesitancy among nursing and midwifery undergraduate students in Switzerland: protocol for an online national study.

Background: Vaccine hesitancy is a persistent challenge in public health, exacerbated by the proliferation of anti-vaccine sentiments facilitated by social networks. The COVID-19 pandemic has underscored the importance of addressing vaccine hesitancy, designated by the WHO as a top global health threat. This study explores vaccine hesitancy among nursing and midwifery undergraduate students in Switzerland-a cohort crucial to public health given their future roles as healthcare professionals-with a particular emphasis on the HPV vaccine, which exhibits lower confidence levels compared to other vaccines. Methods: This study will employ an online questionnaire distributed to nursing and midwifery undergraduate students from various healthcare universities. The questionnaire will collect data on vaccine hesitancy (general confidence in vaccines and specifically in the HPV vaccine), HPV vaccine coverage, socio-demographics, likelihood to recommend vaccines to patients, perception of vaccination education and interest in complementary medicine. Conclusion: The study's findings will contribute to our understanding of vaccine hesitancy among nursing and midwifery undergraduate students, providing insights that can inform targeted interventions and education strategies to bolster vaccine confidence among future healthcare professionals, thereby enhancing public health efforts.

Knowledge and Practice Behaviours of Obstetricians/Gynecologists and Midwives Concerning Periodontal Health and Pregnancy.

PURPOSE: The purpose of the present study was to evaluate the level of knowledge of prenatal health professionals concerning the relationship between periodontal diseases and pregnancy complications, as well as their professional implications in the oral health field. MATERIALS AND METHODS: A questionnaire was distributed to obstetricians/gynecologists, interns specialised in obstetrics/gynecology, midwives, and student midwives at Loire Atlantique and Vendée hospitals (France). The questionnaire included 5 sociodemographic questions and 14 questions regarding the level of knowledge about the relationship between periodontal diseases and pregnancy complications as well as the professionals' level of involvement in oral health care. RESULTS: Twenty-three obstetricians/gynecologists and 55 midwives responded to the questionnaire. Preterm delivery and chorioamnionitis were the most frequently mentioned complications of pregnancy, whereas the risk of pre-eclampsia was rarely mentioned. Half of the professionals said they were aware of the oral manifestations of pregnancy. Gingivitis and an increased risk of caries were the most frequently mentioned items, whereas epulis was the least frequently mentioned item. The level of involvement of prenatal care practitioners in oral health care was limited due to a lack of competence and time. Nevertheless, 64% of the participants discussed the risks of poor oral hygiene with their patients. CONCLUSION: There is good knowledge among French gynecologists/obstetricians and midwives regarding the oral manifestations of pregnancy. However, there is still a lack of knowledge concerning the links between periodontal diseases and pregnancy complications. The involvement and behaviour of pregnancy professionals in the oral health field is inadequate. The present survey highlights the need to improve the initial and continuing education of obstetricians and midwives on this topic.

Development and validation of a professional autonomy scale for Japanese midwives.

Japanese midwives are required to autonomously perform midwifery diagnosis and maternity care. However, education to promote the professional autonomy of midwives is inadequate, and previous studies have not been able to identify a measure for it. This study aimed to develop a professional autonomy scale for midwives, to be used for the education and career advancement of Japanese midwives. The Midwives Professional Autonomy Scale extracted items from the midwives' "autonomy" and "specialty" literature, and 10 professionals verified the surface and content validity of the scale. Overall, 695 Japanese midwives participated in a survey, of which a sample of 399 was recovered. Exploratory factor analysis was performed using the sample to confirm the validity of the construct and internal consistency of the scale (Cronbach's alpha value 0.95). Additionally, the validity of the criteria was confirmed using the self-efficacy scale, self-esteem scale, and job satisfaction, and the stability was confirmed by test-retest reliability. Consequently, the professional autonomy scale for Japanese midwives comprised 24 items and 5 factors. This scale can thus be used to evaluate the professional autonomy of Japanese midwives and for midwifery education.