Change and Power in Midwifery (original) (raw)
Related papers
The Australian Journal of Midwifery, 2001
The current movement towards woman-centred midwifery care is creating many changes for practicing midwives. In order to address these changes, midwives, particularly those working in the hospital system, need to be clear about their rote in the care of childbearing women, and how they can be part of the solution in changing the fractured maternity care currently operating under the medical system. This article examines some of the issues arising for midwives, such as autonomous practice, use of obstetric language, and education for the new generation of midwives.
Essential midwifery practice : public health
2007
Chapter 1: The Midwifery Public Health Agenda - Setting the Scene. Chapter 2: Health and Inequality- What can midwives do?. Chapter 3: Smoking in Pregnancy- A growing Public Health Problem. Chapter 4: Teenage Pregnancy- Everyone's Business. Chapter 5: Sexual Health- A Potential Time Bomb. Chapter 6: Substance Abuse- What is the Problem?. Chapter 7: Domestic Abuse in Pregnancy- A Public Health Issue. Chapter 8: Maternal Mental Health- Working in Partnership. Chapter 9: Supporting Breastfeeding- Midwives Facilitating A Community Model. Chapter 10: Normal birth and Birth Centre Care- A Public Health Catalyst for Maternal and Societal Well-being
Redesigning postnatal care: exploring the views and experiences of midwives
Midwifery, 2013
Objective: women have consistently rated postnatal care less favourably than other episodes of maternity care. Midwives have also reported concerns with postnatal care, with challenges related to workloads, busy environments and lack of staff. Given these concerns, a regional hospital in Victoria, Australia redesigned its postnatal care provision. The changes included cessation of routine postnatal observations and the use of clinical pathways for women who gave birth vaginally; promotion of rest through minimal disturbances before 9 am; discouraging the use of the call bell system except in emergency situations; introduction of 'one-to-one' time with women; and promotion of normalcy and independence. This paper examines midwives' views of the changes and their impressions of the effects of the changes on women and their infants. Design: cross-sectional surveys of midwives were conducted six months after the changes to postnatal care were introduced then again, two years later. Midwives' views and experiences of the changes; the impact of the changes on confidence and autonomy of practice; views regarding the effect on women's satisfaction with care; and the perceived safety of the changes were explored. Setting: a regional hospital in Victoria, Australia where approximately 2,000 births occur each year. Participants: permanent part-time and full-time midwives. Findings: response rates were 64% (50/78) at baseline and 60% (50/84) two years later. Overall, midwives were supportive of, and complied with, the changes to postnatal care. They agreed that change was needed and believed that the new way of providing care would be better for women and increase individualised care. Midwives also agreed that the changes would facilitate rest for women, believed that removal of routine observations for women after a vaginal birth was safe and that it would allow more time with women. Over time, midwives were more likely to feel autonomous when providing postnatal care. However, some concerns were raised, mostly in relation to the challenges around postnatal documentation, care provision without the guidance of a care/clinical pathway, and about limiting the use of the call bell to only emergency situations. Midwives were not confident that the changes would necessarily translate to a measurable increase in women's satisfaction with care, and were not confident that the changes translated into more time to spend listening and providing support to women. Key conclusions and implications for practice: overall, midwives were supportive of the changes and agreed that change to postnatal care was needed. Challenges remain around the most effective method of
Improvement of maternal and newborn health through midwifery
Lancet, 2014
In the concluding paper of this Series about midwifery, we look at the policy implications from the framework for quality maternal and newborn care, the potential effect of life-saving interventions that fall within the scope of practice of midwives, and the historic sequence of health system changes that made a reduction in maternal mortality possible in countries that have expanded their midwifery workforce. Achievement of better health outcomes for women and newborn infants is possible, but needs improvements in the quality of reproductive, maternal, and newborn care, alongside necessary increases in universal coverage. In this report, we propose three priority research areas and outline how national investment in midwives and in their work environment, education, regulation, and management can improve quality of care. Midwifery and midwives are crucial to the achievement of national and international goals and targets in reproductive, maternal, newborn, and child health; now and...
Midwives' support needs as childbirth changes
Journal of Advanced Nursing, 2000
Midwives' support needs as childbirth changes This paper reports on midwives' support needs as they were described by midwives in a large study of the supervision of midwives in England. The data are derived from six sites: ®ve, very different, National Health Service (NHS) sites, and one composed of midwives outside the NHS. In-depth, ethnographic interviews were conducted with 168 midwives and a grounded theory approach was used for the analysis. The ®ndings identi®ed midwives' many and varied support needs. Midwives also clearly described the culture of midwifery in the NHS. This culture inhibited midwives from arranging to have their support needs met and acted as an obstacle to progress in developing midwifery practice. The dilemmas and tensions inherent in this situation are explored and suggestions made as to the way forward.
Midwives and maternal and child health: Building resource capacity
Journal of Midwifery & Women's Health, 2001
With dramatic changes in health, social services, and welfare systems and escalating pressure to increase clinical productivity, midwives need to enhance their capacity to work with federal, regional, and state partners to promote and protect comprehensive, culturally competent, and community-based quality health care for pregnant women and their families. Information about maternal and child health (MCH) regional and state resources is provided, and strategies for obtaining additional MCH resources are suggested, so that midwives and other women's health care providers can more effectively improve health care programs and systems that benefit women and their families. In addition, ways to work with MCH programs at the regional and state levels are described. J
Public health and wellbeing: A matter for the midwife?
British Journal of Midwifery, 2014
This paper will provide a critical narrative review of public health interventions in pregnancy and the role of the midwife in public health. The historical and political context of public health and midwifery will be examined to give a background to the current midwifery public health agenda. The article will identify specific public health interventions used in pregnancy by midwives and assess how midwives perceive their role in implementing them. Midwives are important public health practitioners, who alongside other agencies can make a long-term, positive contribution to the life course of women and their families.
Educating the midwife for her changing role
Midwives chronicle, 1976
IN OUR previous article we contrasted the complementary roles of education and instruction in the professional preparation of the midwife. We focused attention in principle on the general issues underlying these two models. In this article we present more specific reasons why we believe there should be a considerably greater emphasis on educational approaches than on instructional approaches in midwifery education. These reasons stem from changes in society and the growing fund of knowledge (in this case, in the medical, biological, technological and also in the behavioural sciences). These kinds of changes are challenging all professions and are leading to a continuous and occasionally cataclysmic reappraisal of professional roles (12,15,16). The effects of these influences are felt by many, to the extent that in our research into the MTD, we were able to conclude from views expressed by senior tutors that "the profession is deeply aware not only of the range and depth of the change in the midwife's role, but of inadequacies in her education and training to meet these changes"(2c). We submit that these inadequacies arise from the continued emphasis on instruction in the preparation of both the midwife and, to a lesser extent, the midwife teacher. We do acknowledge that this emphasis is a result of the need to produce a safe clinician. In this, courses are successful, though even this view is being challenged from within the profession(17). We would like to expand on this need by analysing some aspects of the midwife's role, in such a way as to enable teachers to use this sound training for safe practice, as a basis for educational extension.