Midwifery basics. Infant feeding: Managing baby related challenges

Infant feeding: is the twelfth series of ‘Midwifery basics’ targeted at practising midwives. It aims to provide information to raise awareness of the impact of the work of midwives on women’s experience and encourage midwives to seek further information through a series of activities. In this fifth article Joyce Marshall considers a range of baby related issues that pose challenges for both mothers and midwives in relation to infant feeding

Midwives\u27 knowledge, attitudes and learning needs regarding antenatal vaccination

Objective: To determine the knowledge, attitudes and learning needs of midwives regarding antenatal vaccination. Design & Setting: A cross-sectional, paper-based survey of midwives employed at the only public tertiary maternity hospital in the Australian state of XX between November 2015 and July 2016. Participants: 252 midwives providing care in antepartum, intrapartum, and/or postpartum settings. Measurements: Self-reported responses to a 41-item survey. Findings: The vast majority of midwives supported influenza and pertussis vaccination for pregnant women, with 90.0% and 71.7% reporting they would recommend pertussis and influenza vaccine, respectively, to a pregnant friend or family member, and almost all stating that midwives should administer vaccines to pregnant patients (94.8%). Seven out of ten midwives (68.1%) responded correctly to all knowledge items regarding vaccines recommended during pregnancy; 52.8% demonstrated correct knowledge regarding vaccine administration despite only 36.6% having attended an education session on antenatal vaccination in the previous two years. Nearly all midwives (97.3%) expressed a need for more education on vaccine administration. The most commonly reported barrier to administering influenza (61.3%) and pertussis (59.0%) vaccination was having staff available with the certification required to administer vaccines. Key Conclusions: Midwives view antenatal vaccination as their responsibility and are interested and receptive to education. Implications for Practice: There is an unmet need and demand among midwives for professional development that would enable them to recommend and administer vaccines to pregnant women in accordance with national immunisation guidelines and integrate vaccination into routine antenatal care

Midwives' competence : is it affected by working in a rural location?

Introduction: Rising health care costs and the need to consolidate expertise in tertiary services have led to the centralisation of services. In the UK, the result has been that many rural maternity units have become midwife-led. A key consideration is that midwives have the skills to competently and confidently provide maternity services in rural areas, which may be geographically isolated and where the midwife may only see a small number of pregnant women each year. Our objective was to compare the views of midwives in rural and urban settings, regarding their competence and confidence with respect to ‘competencies’ identified as being those which all professionals should have in order to provide effective and safe care for low-risk women. Method: This was a comparative questionnaire survey involving a stratified sample of remote and rural maternity units and an ad hoc comparison group of three urban maternity units in Scotland. Questionnaires were sent to 82 midwives working in remote and rural areas and 107 midwives working in urban hospitals with midwife-led units. Results: The response rate from midwives in rural settings was considerably higher (85%) than from midwives in the urban areas (60%). Although the proportion of midwives who reported that they were competent was broadly similar in the two groups, there were some significant differences regarding specific competencies. Midwives in the rural group were more likely to report competence for breech delivery (p = 0.001), while more urban midwives reported competence in skills such as intravenous fluid replacement (p <0.001) and initial and discharge examination of the newborn (p <0.001). Both groups reported facing barriers to continuing professional development; however, more of the rural group had attended an educational event within the last month (p <0.001). Lack of time was a greater barrier for urban midwives (p = 0.02), whereas distance to training was greater for rural midwives (p = 0.009). Lack of motivation or interest was significantly higher in urban units (p = 0.006). Conclusion: It is often assumed that midwives in rural areas where there are fewer deliveries, will be less competent and confident in their practice. Our exploratory study suggests that the issue of competence is far more complex and deserves further attention.NHS Education Scotlan

Relationships between university and practice, and the role of the link lecturer

Mentorship: is the fourteenth series of ‘Midwifery basics’ targeted at practising midwives. It aims to provide information to raise awareness of the impact of the work of midwives on student learning and ultimately on women’s experience and encourage midwives to seek further information through a series of activities. In this fifth article Pat Jones and Joyce Marshall consider the relationships between university and practice, and the role of the link lecturer in supporting mentors and students. Midwives are encouraged to seek further information through a series of activities

Offering weight management support to pregnant women with high body mass index: A qualitative study with midwives

Objective: The prevalence of pregnant women with high body mass index is increasing worldwide. High body mass index is associated with health risks for mother and baby and supporting healthy gestational weight gain is important. Midwives play an important role in supporting women to engage in behaviours such as healthy eating and physical activity. The aim of this study was to explore how midwives’ support pregnant women with high body mass index to establish a healthy lifestyle with emphasis on nutrition and physical activity in order to minimise gestational weight gain. Methods: Semi-structured interviews were conducted with 16 midwives working in antenatal health care in Sweden. Interviews were conducted shortly after new guidelines on care for pregnant women with high body mass index had been introduced. The interviews were recorded, transcribed and analysed by thematic analysis. Results: Three main themes were identified; use a conscious approach, invite to participate and have a long-term health perspective. Midwives built a relationship with a woman through identifying her concerns and circumstances, before sensitively discussing weight. Some midwives used Motivational Interviewing to help women identify their own resources. To reach long-term health benefits, midwives set achievable goals with the women. Conclusion: These study findings provide practical examples of how midwives can support women with weight management during pregnancy. Through being sensitive when developing a relationship, midwives enabled the women to identify their own resources and achievable goals. Support after the baby is born is needed subsequently to help women maintain their healthy behaviour changes

The Impact on Midwives of Undertaking Screening for Domestic Violence: Focus Group Findings

Objective: To investigate the impact mandatory screening for domestic violence has had upon registered midwives. Design: Three phase study – Phase one involved focus group interviews. Setting: Hospitals in South-East Queensland undertaking mandatory domestic violence screening. Participants: Registered midwives undertaking screening for domestic violence. Results: Several barriers were identified that directly impacted upon the midwives' potential to screen effectively. Barriers identified were classified as intrinsic (intrapersonal and perception) and extrinsic (interpersonal, environmental and organisational infrastructure). Principle, conclusions and implications for practice: Although midwives have strong beliefs about the value of domestic violence screening, there is a negative perception about it's efficacy and an assumption of failure due to the barriers identified by the registered midwives

Challenges of mentorship

Mentorship is the fourteenth series of ‘Midwifery basics’ targeted at practising midwives. It aims to provide information to raise awareness of the impact of the work of midwives on student learning and ultimately on women’s experience and encourage midwives to seek further information through a series of activities. In this sixth article Charlotte Kenyon, Stephen Hogarth and Joyce Marshall consider some of the challenges to mentorship and possible solutions to these

"A wealth of knowledge": A survey of the employment experiences of older nurses and midwives in the NHS

Background: The United Kingdom's National Health Service workforce is ageing, and the specific needs of this sector of its workforce need to be addressed. Nursing, and midwifery shortage is a worldwide issue, and with increasing demands for care the retention of older nurses and midwives is crucial. Objectives: To report on the employment experiences of nurses and midwives with it particular focus on issues relating to age, ethnicity, ill-health and disability. Design: The postal survey was developed following a literature review and analysis of National Health Service and Government policy documents. Settings: This was a UK-wide Survey of nurses and midwives working in National Health Service Trusts and Primary Care Trusts. Participants/methods: A postal Survey of nurses and midwives was undertaken between May and December 2005. National Health Service Trusts and Primary Care Trusts (n = 44) identified as having policies relevant to the Study were contacted regarding the procedure for seeking research governance approval. Thirteen National Health Service Trusts and Primary Care Trusts participated, with 2610 surveys distributed; 510 Surveys were returned (20% response rate). Results: Nurses and midwives aged 50 years and over had undertaken fewer Continuing Professional Development activities than nurses and midwives Under 50. Whilst not related to age, the study also found that 20% of the survey sample reported experiencing some form of discrimination. Nurses and midwives did not differ on either quality of life or psychological health using standard instruments. Having a disability did not lead to greater psychological morbidity but did have a negative effect on quality of life. Having a work-related illness had a negative impact on both quality of life and psychological morbidity. hi relation to ethnicity, black nurses and midwives reported lower psychological morbidity than other ethnic groups; that is, they enjoyed a higher level of mental well-being. Conclusion: The nursing and midwifery workforce is ageing worldwide with a significant proportion now approaching, or having already reached, potential retirement age. With the recent introduction of the age legislation the working lives of older nurses and midwives in the National Health Service have never been more relevant. Whilst access to Continuing Professional Development is pertinent to the retention of nurses and midwives of all ages, in this study, older nurses reported less access that younger nurses. (C) 2008 Elsevier Ltd. All rights reserved

Skills to facilitate learning in clinical practice

Midwifery Basics: Mentorship 2 Mentorship is the 14th series of 'Midwifery basics' targeted at practising midwives. The aim of these articles is to provide information to raise awareness of the impact of the work of midwives on women's experience, and encourage midwives to seek further information through a series of activities relating to the topic. In this second article Jayne Samples and Joyce Marshall consider some of the key issues that can affect student learning in clinical practice

Prevention of Fetal Alcohol Spectrum Disorders: Practice Behaviors, Attitudes, and Confidence among Members of the American College of Nurse-Midwives

As part of an ACNM collaboration with the Centers for Disease Control and Prevention (CDC) and its partners and grantees on a project to prevent fetal alcohol spectrum disorders (FASDs), ACNM members were surveyed to generate an assessment of practice behaviors of certified nurse-midwives and certified midwives related to the prevention of FASDs. The information will be used as a baseline from which to measure change in nurse-midwives’ and midwives’ practice behaviors over the course of the project. Results from the assessment will also be used to inform detailed collaborative activities between ACNM and CDC grantees whose efforts specifically target nurse-midwives (i.e., University of Alaska Anchorage (UAA), University of California San Diego, University of Pittsburgh).This report was supported by Cooperative Agreement Numbers DD001143 (University of Alaska Anchorage), DD001144 (University of California, San Diego), and DD001035 (University of Pittsburgh, School of Nursing), funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Service