162 research outputs found
The future of midwife-led continuity of care: Call for a dialogue
Get PDFBackground/Purpose: Midwife-led continuity of care (MLCC) is an evidence-based care model positively influencing the health and wellbeing of women and their families. Despite the evidence, a sustainable future of the model is uncertain. The aim of this paper is to give an example of a theoretical exercise that enhances the understanding of the trends and developments impacting MLCC's future state. Methods: The industrial complex theory scaffolded the theoretical approach. The intuitive logics scenario development methodology was used to structure the key variables that influence the utility of MLCC. Dimensionally structured scenarios representing the probable, possible and probable MLCC futures were written. Results: Thirteen key variables that greatly impact the future MLCC, with varying degrees of certainty were identified. A theoretical framework representing two underlying meta dimensions of MLCC was constructed: identity system of midwife-led continuity of care (fixed vs fluid) and embodied orientation to the world (reasoning vs meaning making). Within the framework, four different storylines of possible, plausible prospective futures emerged: Sense & sensibility, The birth of mothers, Too many sisters and One-stop-shop. Conclusion: The paper is an example of how to approach the future of MLCC, the method serving as a tool to establish a theoretical truth of how its future state may unfold, the scenarios facilitating a dialogue among stakeholders and informing the public
Development of a Concourse for a Q-Method Study about Midwivesâ 2perspectives of Woman-Centered Care
Get PDFObjective: To transparently describe the development of a Q-set for a Q-method study about midwivesâ perspectives of woman-centered care.Research design: Q-methodology is a relevant study approach to identify key viewpoints that are relevant for practitioners and for educational purposes. The development of a set of statements (Q-sample) is the first phase of this studyâs methodology, forming the research instrument â and being the focus of this paper.Methods: Q-set development and construction included four steps: (1) Collections of items, (2) Q sample selection, (3) Formulating the Q statements, (4) Validation of the Q sample. Methods to collect items included a systematic review, a scoping review and personal narratives.Results: We used scientific literature, Dutch midwifery journals, international governmental and healthcare professional reports and guidelines, practising midwives, midwifery lecturers, media, fiction and art as sources to collect items. A collection of 45 Q-statements was formulated according the Attitude, Social influence & self-Efficacy (ASE) model. The statements were pre-tested among student midwives and pilot-tested by midwifery Master students and two individual midwives, resulting in a final Q-set of 39 statements.Conclusion: We systematically, thoroughly and transparently developed a valid and robust Q-set. Albeit a time consuming process and granting that the Q-statements might not represent thoughts of midwives in other countries than the Netherlands, we have constructed a concourse based on rich and detailed information that is appropriate for a Q-method study among Dutch midwives about their perspectives of woman-centered care
Exploring the uses of virtues in woman?centred care: A quest, synthesis and reflection
Get PDFWomanâcentred care is a philosophy authentic to the midwifery profession, scaffolding and preceding the capacity and utility of womanâcentred care in daily practice. Through providing guidance on the philosophical capacitiesâthe virtuesâthe practical capacity and utility of womanâcentred care becomes more clear and more tangible. This paper discusses the virtues of woman centred care in midwifery practice. Eighteen virtues, described by ComteâSponville, serve as a philosophical lens to explore and understand how each specific virtue integrates into the womanâcentred care concept or vice versa, herewith becoming womanâcentred care virtuous acts. The virtues are politeness, fidelity, prudence, temperance, courage, justice, generosity, compassion, mercy, gratitude, humility, simplicity, tolerance, purity, gentleness, good faith, humour and love. Exploring these virtues provides a manageable view of the complexity of womanâcentred care. In this paper, first each virtue is discussed in relation to the body of knowledge of womanâcentred care in midwifery. Thereafter, a sketch of pragmatism is provided through translating the virtues into practical recommendations for the professional socialization and transformation of becoming, being and doing womanâcentred care
Emotional wellbeing of student midwives during COVID-19
Get PDFBackgroundMental health of students in higher education was affected during the COVID-19 pandemic.AimTo examine the emotional wellbeing of midwifery students in the Netherlands and Flanders (Belgium) during COVID-19.MethodsA cross-sectional online-based survey with 619 Dutch and Flemish midwifery students. Sociodemographic details were obtained. Anxiety and depression were measured twice (T1, T2) during the COVID-19 pandemic.FindingsFlemish students had significantly higher mean depression and anxiety scores than Dutch students during the total period of study (p < .001; p < .001). Total group mean depression and anxiety scores were significantly higher at T2 compared to T1 (p < .001; p < .001). In the Dutch student group, there was a significant increase of depression from T1 to T2 (p < .001). In the Flemish student group, both depression and anxiety scores significantly increased from T1 to T2 (p < .001; p < .001). A history of psychological problems predicted both depression and anxiety, irrespective of COVID-19 period or country (p < .001; p < .001). Being single (p.015) and having a job (p.046) predicted depression, irrespective of period or country. A history of psychological problems predicted depression (p.004; p < .001) and anxiety (p.003; p.001) during the total period of study. Being single also predicted depression during T2 (p.024).ConclusionThese findings inform how emotional wellbeing of midwifery students was affected during the COVID-19 pandemic and identify those students that might need extra attention after the pandemic, during another pandemic or similar situations with social restrictions
Students as researchers: an example of high-level participation of undergraduate midwifery students as co-investigators in research
Get PDFBackgroundThere is a shift in focus of the curricula of undergraduate midwifery research-education - from research content to the research process, and the student from being an observer to a participant.Aim and MethodsTo explore an example of how to involve midwifery students as co-investigators in research. This paper discusses the experiences of an educational research project that adopted the highest level of student autonomy in research, involving six Bachelor of Midwifery final-year students participating as co-investigators in qualitative research focusing on womenâs lived experiences of traumatic childbirth. The experiences are supported by the parameters of research-education and learning, and are discussed in the context of the dimensions of framing undergraduate research: Motivation, Inclusivity, Content, Originality, Setting, Collaboration, Focus and AudienceDiscussionCrucial for this educational research project is the recognition of the motivation, interests, (experiential) knowledge and real-world experiences of students. It starts with listening to the questions, thoughts and ideas that students bring, recognising and respecting the content and importance of their work and what is important and meaningful to them, while facilitating a student-led learning process. Collaboration between students and students and supervisors needs to be formally facilitated and supported, as this contributes to qualitative products for curricular and extra-curricular products. An academic infrastructure is necessary to support extra-curricular activities.ConclusionTo embed research adequately and effectively in the curriculum, a pedagogical approach, institutional learning and student-centred teaching strategies and practices, including high impact practices to mainstream undergraduate research and enquiry, are crucial
Discursive constructions of student midwivesâ professional identities: A discourse analysis
Get PDFBackgroundThe construction and performance of professional identity is significant to broader socio-cultural understandings of who âprofessionalsâ 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.AimTo explore how student midwives are constructed in the discourses of policy, professionalism, and learning, to provide new perspectives to inform, policy, education, and practice.MethodsAn adapted critical discourse analysis of the United Kingdom (UK) Nursing and Midwifery Councilâs 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/ DiscussionThe 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 âgood health and good characterâ. There is a requirement for midwives to âbeâ 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.ConclusionAccording to the Standards, midwives must be a lot of things in their role and function. The Standardsâ discourses are authoritative, legislative and controlling, creating an ideology about professional status and agency which constructs an âimaginary autonomyâ; becoming a midwife is more automatic (with the perception of control), than agentic. All of which has significance for the social practice of midwifer
Human Communication Elements of the Continuity of Midwife Carer Newsletter: A Descriptive Case Report
Get PDFBackground: The Continuity of Midwife Care (CMC) model is an evidence-based care model that positively influences the health and well-being of women, their families, and midwives. Although effective communication strategies have not been determined, online resources are known to reach a wider audience and make CMC research more visible. The All-you-need-to-know-about-continuity-of-carer newsletter, distributed by the authors, is a strategy to communicate valuable and credible CMC content from knowledge producers to users. Purpose: To explore the newsletter's functional elements and the connection between it as a communication strategy and the individuals interacting with it and to present a case demonstration of a newsletter example. Methods: A descriptive case report with a theory-driven approach using 10 elements of human communication theories. Conclusions: The following elements of human communication contribute to understanding the functioning of the newsletter: Grounded Theoretical Theory, the Practical-Action Theory and goal-oriented communication (communication theory), the Syntactic Theory of Visual Communication and the rhetorical tradition of communication (tradition of communication), Elaboration Likelihood and the socio-cultural model of communication (communicator), implied compliance-gaining, parole, semiosis, narrative paradigm and rhetoric logic (message), social organisation communication, co-cultural communication and invitational rhetoric (conversation), the orientation and exploratory affective exchange stages of social exchange (relationship), Structuration Theory (group), the Theory of Bureaucracy (organisation), the Cultivation Theory (media), and the Diffusion of Innovation and Ethnography of Communication (culture and society). Implications: The newsletter succeeds in managing CMC information and reaching an interested audience. Further evaluation is required to explore if or how the newsletter affects information use
Predictors associated with low-risk women's pre-labour intention for intrapartum pain relief: a cross-sectional study
Get PDFBackground: Pregnant women have preferences about how they intend to manage labour pain. Unmet intentions can result in negative emotions and/or birth experiences. Objective: To examine the antenatal level of intention for intrapartum pain relief and the factors that might predict this intention. Design: A cross-sectional online survey-based study. Setting and participants: 414 healthy pregnant women in the Netherlands, predominantly receiving antenatal care from the community-based midwife who were recruited via maternity healthcare professionals and social media platforms. Methods: The attitude towards intrapartum pain relief was measured with the Labour Pain Relief Attitude Questionnaire for pregnant women. Personality traits with the HEXACO-60 questionnaire, general psychological health with the Mental Health Inventory-5 and labour and birth anxiety with the Tilburg Pregnancy Distress Scale. Multiple linear regression was performed with the intention for pain relief as the dependant variable. Results: The obstetrician as birth companion (p<.001), the perception that because of the impact of pregnancy on the womanâs body, using pain relief during labour is self-evident (p<.001), feeling convinced that pain relief contributes to self-confidence during labour (p=.023), and fear of the forthcoming birth (p=.003) predicted women were more likely to use pain relief. The midwife as birth companion (p=.047) and considering the partner in requesting pain relief (p=.045) predicted women were less likely to use pain relief. Conclusion: Understanding the reasons predicting womenâs intention of pain management during labour, provides insight in low-risk womenâs supportive needs prior to labour and are worth paying attention to during the antenatal perio.
The experiential knowledge of migrant women about vulnerability during pregnancy: A woman-centred mixed-methods study
Get PDFProblem: Within maternity care policies and practice, pregnant migrant women are regarded as a vulnerable population.Background: Womenâs experiential knowledge is a key element of woman-centred care but is insufficiently addressed in midwifery practice and research that involves migrant women.Aim: To examine if pregnant migrant womenâs experiential knowledge of vulnerability corresponds with sets of criteria of vulnerability, and to explore how migrant women make sense of vulnerability duringpregnancy.Methods: A sequential two-phased mixed-methods study, conducted in the Netherlands, integrating survey data of 89 pregnant migrant women and focus group data obtained from 25 migrant mothers -living in deprived areas according to the Dutch socio-economic index.Results: Criteria associated with vulnerability were reported by 65.2% of the participants and 62.9% of the participants reported adverse childhood experiences. On a Visual Analogue Scale, ranging from 0 (not vulnerable)to 10 (very vulnerable), participants self reported sense of vulnerability showed a mean score of 4.2 (2.56). Womenâs experiential knowledge of vulnerability significantly correlated with the mean sum score of clinical criteria of vulnerability (r .46, p .002) and with the mean sum score of adverse childhood experiences (r .48, p<.001). Five themes emerged from the focus group discussions: âLook beyond who you think I am and see and treat me for who I really amâ, âOwnership of truth and knowledgeâ, âDonât punish me for being honestâ, âProjection of fearâ and âCoping with labellingâ.Conclusion: Pregnant migrant womenâs experiential knowledge of vulnerability is congruent with the criteria. Calling upon experiential knowledge is an attribute of the humane woman-midwife relationshi
Midwivesâ perceptions of influences on their behaviour of woman-centered care: a qualitative study
Get PDFAim: To explore Dutch pregnant womenâs experiences of shared-decision making about place of birth to better understand this process for midwifery care purposes.Design: Qualitative exploratory study with a constant comparison/grounded theory design.Methods: We performed semi-structured interviews, including two focus groups and eight individual interviews among 16 primarous and multiparous women with uncomplicated pregnancies. Consent was obtained and interviews were audiotaped and fully transcribed. The interviews were analyzed utilizing a cyclical process of coding and categorizing, following which the themes were structured based on the three-step shared-decision making model of Elwyn.Results: We identified the three themes according to Elwynâs model: Choice talk, Option talk and Decision talk. We expanded the model with one additional theme: Decision ownership. The four themes explained womenâs decision making process about place of birth. Women perceived shared-decision making about place of birth as a decision to be taken with their partner instead of with the midwife. Women and their partners regarded the decision about place of birth as a choice to be made as a couple and expecting parents; not as a decision in which the midwife needs to be actively involved. Women and their partners considered their options and developed a strong preference about where to give birth; even before the initial contact with the midwife was made. Involvement of the midwife occurred during the later stages of the decision-making process, where the women sought acknowledgement of their choice which was already made.Conclusion: Women considered their partners as the most and actively involved in the shareddecision making process regarding the place of birth. The womenâs decision-making process about the place of birth did not fully occur during the antenatal care period. The midwife should ideally be involved before or during the early stages of pregnancy to facilitate the process
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