Interprofessional Education Between Midwifery Students and Obstetrics and Gynecology Residents: An American College of Nurse-Midwives and American College of Obstetricians and Gynecologists Collaboration.

Despite areas of excellence, US perinatal care outcomes lag behind most developed countries. In addition, a shortage and maldistribution of health care providers exists. The American College of Nurse-Midwives and the American College of Obstetricians and Gynecologists (ACOG) partnered to obtain funding to develop interprofessional education modules and other learning activities for midwifery students and obstetrics and gynecology residents in 4 demonstration sites. The multidisciplinary 2016 ACOG document Collaboration in Practice: Implementing Team-Based Care was adopted as a framework. Core competencies of values and ethics, roles and responsibilities, interprofessional communication, and teams and teamwork developed by the Interprofessional Education Collaborative were used to guide the work. Seven modules have been developed including guiding principles, patient-centered care, role clarification, collaborative practice, history and culture, care transition, and difficult conversations. Learners participate in laboratory and simulation activities and work together in clinical care settings. Stakeholder experiences as well as barriers to implementation are discussed. Learning materials and activity descriptions are open resourced and shared on a project website for use by programs interested in implementing an interprofessional curriculum. Ongoing formal evaluation including pilot testing of a program evaluation method is described.

Midwifery Management of Pregnant Women Who Are Obese.

INTRODUCTION: Obesity is associated with increased risks for adverse health outcomes during and after pregnancy in both the woman with obesity and her infant. This study was designed to investigate midwifery management of pregnant women with obesity. METHODS: Certified midwives and certified nurse-midwives who were members of the American College of Nurse-Midwives were sent a survey. The survey instrument was divided into 4 sections: demographic characteristics; practice guidelines and protocols; the role of the 2015 Levels of Maternal Care guidelines for referral, including transfer to a higher level of care; and factors that influence management of pregnant women with obesity. Descriptive statistics were used to analyze data. RESULTS: In a sample of 546 midwives, 87% of respondents reported observing an increase in perinatal complications associated with obesity. Midwives reported increasing discomfort with the care of pregnant women with obesity as body mass index (BMI) increased. For pregnant women with extreme obesity, the respondents reported less frequent use of physiologic birth guidelines only and increased use of interventions, referral to physician care, and transfer to a higher level of care. Approximately half (270, 49.5%) reported having a guideline that addressed the care of women with obesity. Of these, 145 midwives (53.7%) reported that extreme obesity was the BMI threshold for identifying an increased or high risk for perinatal complications. Sixty percent (339) of midwives who participated requested guidance for management of laboring women who are obese. DISCUSSION: This study provides a greater understanding of midwifery management practices when caring for women with obesity and opportunities to improve care. The results suggest that midwifery management alters with increased BMI, specifically in the care of women with extreme obesity. Suggestions for future study include research on management of pregnant women with obesity and extreme obesity with outcome data examining management strategies that provide safe, satisfying care.

Factors that influence midwives to serve as preceptors: an American College of Nurse-Midwives survey.

INTRODUCTION: Projected shortages in the primary care workforce underlie a need for more women's health care providers. In order to prepare more midwives to address this deficit, educators require additional clinical placement sites for students. The purpose of this study was to determine factors that influence practicing midwives to serve as preceptors. METHODS: An e-mail invitation to participate in an online survey was sent to 7658 current and lapsed members of the American College of Nurse- Midwives (ACNM), who provided ACNM with a valid e-mail address. The survey assessed factors that enabled or were barriers for midwifery preceptors. Forced-choice questions were analyzed using descriptive statistics. Participant comments were analyzed using qualitative descriptive methods. RESULTS: There were a total of 1517 surveys completed, for a response rate of 19.8%. Participants were primarily certified nurse-midwives (96.0%) who were in clinical practice (83.9%), with 78.0% in full-scope clinical practice. Participants represented all geographic regions of the United States. The majority of the participants indicated they or someone in their practice could precept a midwifery student. A commitment to the midwifery profession was the most commonly identified motivating factor (58.5%). Larger practices were more likely to precept midwifery students and to accept more than one student at a time. The most frequently identified barrier to precepting was the need to maintain a high patient volume (6.9%). Write-in comments were provided by approximately 500 participants and coded into 9 themes: payment, barriers to precepting, incentives, student characteristics, mechanisms for placement, communication, giving back, preceptor qualifications, and professional issues. DISCUSSION: There is a strong commitment from preceptors to give back to the profession through the teaching of the future generation of midwives. Many of the barriers to precepting could be addressed by ACNM, the Accreditation Commission for Midwifery Education, and individual midwifery education programs.

The costs and benefits of nurse-midwifery education: model and application.

To promote nurse-midwifery education, it is important for educators to know the value students bring to clinical training sites and academic institutions, the value nurse-midwifery graduates bring to taxpayers who help support nurse-midwifery education, and the value an education in nurse-midwifery brings to the graduate. The first purpose of this study was to develop a model to include all costs and benefits of nurse-midwifery education to: 1) students; 2) clinical sites where nurse-midwifery students obtain clinical experience; 3) academic institutions that house nurse-midwifery education programs; and 4) others (most often taxpayers) who may contribute to nurse-midwifery education. The second purpose of the study was to develop a prototype nurse-midwifery education program to illustrate the use of the model. Considering the four entities together, the costs, benefits, and net benefits to society were estimated. Data were collected to estimate all costs and benefits to the four entities as they function within this prototypical program. For the prototype, all entities realize a net benefit from the investment in nurse-midwifery education. For society, the benefit-cost ratio is 1.57. Nurse-midwifery students show the highest benefit-cost ratio (2.05) of the four entities, followed by the clinical sites, others (primarily taxpayers), and academic institutions.