Developing an evidence-based practice protocol: implications for midwifery practice.

Evidence-based practice is defined and its importance to midwifery practice is presented. Guidelines are provided for the development of an evidence-based practice protocol. These include: identifying the clinical question, obtaining the evidence, evaluating the validity and importance of the evidence, synthesizing the evidence and applying it to the development of a protocol or clinical algorithm, and, finally, developing an evaluation plan or measurement strategy to see if the new protocol is effective.

Creating off-campus/distance learning courses for midwifery education. A brief introduction.

Midwifery education is undergoing a curriculum revolution that is reflective of current trends in other fields. Distance learning programs have developed in response to these changes. This article provides an overview of a student-centered transactional educational model, discusses the role of faculty as midwife-teachers, and reviews the factors influencing technology decisions for distance education. Curricular structure is discussed and ideas for learning activities are presented to assist faculty considering the development of off-campus, distance learning courses.

Criteria for accreditation of direct-entry midwifery education.

The American College of Nurse-Midwives' Division of Accreditation criteria for accreditating direct-entry midwifery education call for programs to require baccalaureate degrees for entry or award them at conclusion of the program and require faculty to be midwives certified by the ACNM Certification Council. Neither criteria can be met by any existing direct-entry program. The authors argue against these criteria, based in part on familiarity with the Seattle Midwifery School. The paper describes the development of the Seattle Midwifery School, summarizes reasons for and against requiring degrees for midwifery education, argues against excluding faculty of existing direct-entry schools who are not certified by the ACNM Certification Council, notes other efforts to develop credentials for direct-entry midwives, and concludes that professional direct-entry midwifery must be based on widely respected, rigorous national standards.

Community-based nurse-midwifery education program. Distance learning in nurse-midwifery education.

Distance-learning has greatly expanded the number of students admitted to a nurse-midwifery education program. This article describes the Community-Based Nurse-Midwifery Education Program (CNEP) of the Frontier School of Midwifery and Family Nursing. The organizational structure and curriculum of the CNEP combines apprenticeship learning with academic rigor, permitting students who cannot relocate to the university to pursue graduate education. New technology, such as an interactive electronic bulletin board, networks students and faculty. The program emphasizes theories of independent, adult learning. There is a master's completion option available through the affiliation with Case Western Reserve University.

The obstetrics scope of practice of master's prepared FNPs.

Ninety-four family nurse practitioners provided information about the extent of their obstetrics practice within the general activity categories of: diagnosing and managing normal pregnancy; diagnosing and managing problems in pregnancy; parent education during pregnancy; labor and delivery management; neonatal management and evaluation; and post-partum evaluation of the mother. Analysis of the results revealed that respondents provided education-related care more frequently than the management aspects of problem pregnancies, labor and delivery and neonatal care. Routine prenatal care--diagnosing pregnancy, counseling and referral of unwanted pregnancy, examining the pregnant woman, ordering and interpreting laboratory work, fundal measurement--was also more frequently carried out than were the other activity categories. In addition, more obstetrical work was done by individuals working in health departments than those in hospital outpatient clinics, and individuals titled family nurse practitioner diagnosed and managed normal pregnancies more frequently than those who had other titles.

An out-of-hospital birth center using university referral.

Out-of-hospital birth centers are controversial. A retrospective chart review was performed for 150 consecutive patients who had their prenatal care at The Birthplace, a Seattle birth center with certified nurse-midwives licensed by the state of Washington. Seventy-two percent of the women were nulliparous. Antepartum or intrapartum hospital referral was necessary for 28% of the patients. An additional 17% of the patients would have been transferred if specific written criteria for transfer had been precisely followed. The cesarean section rate was 6% (9 of 150). Nonoptimal 1-minute Apgar scores of 6 or less were more common in nulliparas (20%) than in multiparas (3%) who delivered at The Birthplace (P less than .05). All 5-minute Apgar scores were 7 or more. Three infants had birth weights less than 2500 g. Noncompliance with the transfer criteria was associated with untoward outcome. Patients considering out-of-hospital delivery should be counseled that a high rate of hospital transfer is necessary to minimize risk.