‘Fighting a losing battle’: A Glaserian Grounded Theory of midwives’ workplace stress

The development of the midwifery profession and the culture of childbirth are inevitably entwined from an historical perspective through to current day practice. Early written accounts describe the fifteenth century midwife as dealing with high maternal and child mortality rates, the invention of forceps, the rise of male obstetric practitioners, and the complex social and cultural changes of that era. The twenty-first century midwife faces challenges in Australia and worldwide, which are not dissimilar to our midwifery predecessors. Midwifery clinical practice has become more complex due to the medicalisation of childbirth and 21st century lifestyles, which have contributed to a rise in critical incidents and emergency situations amongst labouring, birthing and postpartum women. Therefore, the purpose of this study was to examine whether clinical midwifery practice causes midwives work-related stress which may have implications for the emotional well-being and career decisions from the perspective of Western Australian midwives. Work-related stress has been extensively researched amongst other health professionals, but relatively little is known about Western Australian midwives and work-related stress, therefore this required further exploration. A classic grounded theory study design was used, which included 21 in-depth individual face-to-face interviews with Western Australian registered midwives from May 2014 to December 2015. ‘Midwifery is Stressful but it is not the Job Itself’, was the core problem to emerge from the collected data, with three major sub-categories emerging which included workloads, coordinators and traumatic incidents. These factors were identified as causing stress. The sub-categories are explored in relation to the consequences, context and process that affected, influenced and constrained the participants. Emotional distress, commitment to midwifery and future career decisions are the final sub-categories identified that provide an understanding of the relationship between the categories. A new substantive theory of work-related stress in midwifery is presented entitled ‘Fighting a Losing Battle’: Midwives’ Experiences of and Response to Workplace Stress

Importance of vitamin D in the antenatal period for maternal well-being

Vitamin D deficiency is widely recognised as a major public health issue around the world; and is essential for optimal development and strengthening of the musculoskeletal system including the prevention of conditions such as osteoporosis, osteopenia and rickets. The association between vitamin D and childhood rickets has led to the fortification of food sources and consequently the eradication of the rickets disease. Vitamin D levels are of particular importance for pregnant women, especially for the development of the bone and muscle development of the fetus. In the last decade there has been a substantial increase in the incidence of vitamin D deficiency and the re-emergence of the childhood rickets disease. It is vital that vitamin D levels are at optimal levels during pregnancy as maternal calcium demands increase significantly to meet the demands of the developing fetus, especially in the third trimester

The use of naltrexone in pregnancy in opiate-dependent mothers

There is an absence of sufficient evidence regarding naltrexone use in pregnancy due to the limited range of human studies. Naltrexone implants are being used in Western Australia as a treatment for opioid dependency, and although contraindicated for insertion during pregnancy, there are a number of women who conceive while undergoing treatment. A review of the available data revealed that naltrexone is associated with improved maternal and fetal outcomes. Extensive research into this area in the form of large, multicentre trials is required to confirm the results of the current research

In the shadow of the ivory tower: Experiences of midwives and nurses undertaking PhDs

Aims: The aims of this study were to gain an understanding of the experiences of nurses and midwives enrolled in a PhD, explore any barriers that PhD students encounter whilst completing the degree, and develop recommendations for consideration in formulating support strategies to encourage completion for nurses and midwives enrolled on a PhD degree. Background: It is important to understand what is happening at doctoral level education for nurses and midwives, and how those enrolled on PhD courses can successfully complete their studies, transition learning, and acquire the ability to undertake research into the clinical environments. Design: The criteria for inclusion into the study was that participants were either a Registered Nurse or Registered Midwife enrolled in a PhD degree. Methods: A mixed methodology, non-experimental design approach was used with purposive sampling in an anonymous survey, that included both qualitative and quantitative questions to collect data in 2017. Findings: Supervisors and supervision were the focus of the participant\u27s responses, and issues were identified in negotiating the right supervisors for nurse/midwife PhD students. PhD students would benefit from specific teaching and the opportunity to discuss issues that occur as part of the PhD process. Conclusion: Academia needs to consider new approaches to more effectively integrate teaching time into supervision, thereby optimising PhD completion for nursing and midwifery PhD student

Are midwifery students adequately prepared for vaginal breech birth in clinical practice?

While the value of the clinical skills and expertise required to enable safe vaginal breech birth remains high, midwives who possess these skills are becoming scarce. Additionally, for many midwifery students, vaginal breech birth is becoming somewhat of an elusive event, rarely experienced in clinical practice when completing their training. Not so long ago, this was a standard competency taught to and held by obstetricians and midwives alike, but for those in developed nations working within robust healthcare systems, the frequency of planned vaginal breech birth is on a downward trend, and this is reflected in midwifery educational curriculums

Casual for a cause: Exploring the employment status of nursing in Australia and China

This paper outlines obligatory nursing education and the registration process required to become a nurse in Australia, including nurses\u27 workload, career structure and pay. It also provides an overview of the nursing workforce in Australia, with particular reference to casual employment, and its implications. The aim of this paper is to outline the development strategies that may assist with China\u27s increasing need for nursing education, and how changes to healthcare policy and management are required to increase the recruitment and retention of nurses in hospitals worldwide

Understanding the barriers to Ghanaian midwives’ ability to provide quality care: Using classic grounded theory methodology in a new context

Background: Interpretive-naturalist methodologies, including Grounded Theory are increasingly being used in health research in Ghana however, none of the studies that have used Grounded Theory in the setting has used the methodology in full. Aim: The main aim of this article is to describe the experiences, the strengths and limitations of using Glaserian Grounded Theory methodology to understand the barriers to Ghanaian midwives’ ability to provide quality maternal and neonatal care. Design: Glaserian Grounded Theory methodological principles were adhered to in this study in relation to the use of literature, participant recruitment, data collection and analysis, and theory development. Data were collected through semi-structured interviews and non-participant observation. The study population comprised 33 participants, made up of 29 midwives and four other workers whose work was relevant to the functioning of the midwives that took part in the study. The midwives were recruited from 10 health facilities in seven districts in the Greater Accra Region of Ghana. Glaserian Grounded Theory was used in this study therefore constant comparison was employed in the data analysis. Findings: The study led to the discovery of a middle range grounded theory – “Doing magic with very little”, that explains the factors that affect the midwives’ ability to provide quality care to women and neonates. Conclusion: This paper contributes to the body of work on methodological knowledge. We provide new information about the factors that researchers planning to use Glaserian Grounded Theory in similar contexts could consider

Adherence to screening and management guidelines of maternal Group B Streptococcus colonization in pregnancy

Aims: To investigate Group B Streptococcus (GBS) colonization in pregnancy; adherence to antenatal GBS screening and adherence to the intrapartum antibiotics protocol within two models of care (midwifery and non-midwifery led). Design: This retrospective quantitative study has employed a descriptive design using administrative health data. Methods: Data from five maternity hospitals in metropolitan and regional Western Australia that included 22,417 pregnant women who gave birth between 2015 and 2019 were examined, applying descriptive statistics using secondary data analysis. Results: The study revealed an overall GBS colonization rate of 21.7% with similar rates in the different cohorts. A lower adherence to screening was found in the midwifery led model of care (MMC, 68.76 %, n = 7232) when compared with the non-midwifery led model of care (NMMC, 90.49 %, n = 10,767). Over the 5 years, screening rates trended down in the MMC with stable numbers in the counterpart. Adherence in relation to intrapartum antibiotic prophylaxis revealed discrepant findings between the study groups. Conclusion: Adherence to screening and management guidelines of maternal GBS colonization in pregnancy is lower within the MMC when compared with the NMMC. Impact: This is the first cohort study to describe the adherence to the recommended Western Australian GBS screening guidelines in the two different models of care. Findings may assist in the guidance and improvement of clinical protocols as well as the planning of clinical care in relation to GBS screening to reduce the risk of neonatal GBS infection

Breech presentation management: A critical review of leading clinical practice guidelines

Problem Clinical practice guidelines are designed to guide clinicians and consumers of maternity services in clinical decision making, but recommendations are often consensus based and differ greatly between leading organisations. Background Breech birth is a divisive clinical issue, however vaginal breech births continue to occur despite a globally high caesarean section rate for breech presenting fetuses. Inconsistencies are known to exist between clinical practice guidelines relating to the management of breech presentation. Aim The aim of this review was to critically evaluate and compare leading obstetric clinical practice guidelines related to the management of breech presenting fetuses. Methods Leading obstetric guidelines were purposively obtained for review. Analysis was conducted using the International Centre for Allied Health Evidence (iCAHE) Guideline Quality Checklist and reviewing the content of each guideline. Findings Antenatal care recommendations and indications for Caesarean Section were relatively consistent between clinical guidelines. However, several inconsistencies were found among the other recommendations in terms of birth mode counselling, intrapartum management and the basis for recommendations. Discussion Inconsistencies noted in the clinical practice guidelines have the potential to cause issues related to valid consent and create confusion among clinicians and maternity consumers. Conclusion Clinical practice guidelines, which focus on the risks of a Vaginal Breech Birth without also discussing the risks of a Caesarean Section when a breech presentation is diagnosed, has the potential to sway clinician attitudes and impact birth mode decision-making in maternity consumers. To respect pregnant women’s autonomy and fulfil the legal requirements of consent, clinicians should provide balanced counselling

Development of a breech-specific integrated care pathway for pregnant women: Protocol for a mixed methods study

Background: The development of an integrated care pathway with multidisciplinary input to standardize and streamline care for pregnant women experiencing breech presentation at 36 or more weeks of gestation poses several challenges because of the divisive and contentious nature of the phenomenon. Although many clinicians are interested in obtaining the skills required to safely support women desiring a vaginal breech birth, the primary trend in most health care facilities is to recommend a cesarean section. Objective: This paper aims to discuss the mixed methods approach used in a doctoral study conducted to generate new knowledge regarding women’s experiences of breech birth in Western Australia and professional recommendations regarding the care of women experiencing breech presentation close to or at term. This study was designed to inform the development of an integrated care pathway for women experiencing a breech presentation. This mixed methods approach situated within the pragmatic paradigm was determined to be the optimal way for incorporating multidisciplinary recommendations with current clinical practice guidelines and consumer feedback. Methods: A mixed methods study utilizing semistructured interviews, an electronic Delphi (e-Delphi) study, and clinical practice guideline appraisal was conducted to generate new data. The interviews were designed to provide insights and understanding of the experiences of women in Western Australia who are diagnosed with a breech presentation. The e-Delphi study explored childbirth professionals’ knowledge, opinions, and recommendations for the care of women experiencing breech presentation close to or at term. The clinical practice guideline appraisal will examine the current national and professional breech management and care guidelines. This study has the potential to highlight areas in practice that may need improvement and enable clinicians to better support women through what can be a difficult time. Results: Data collection for this study began in November 2018 and concluded in March 2020. Data analysis is currently taking place, and the results will be disseminated through publication when the analysis is complete. Conclusions: The results of this study will guide the development of an integrated care pathway for women experiencing a breech presentation close to or at term, with the hope of moving toward standardized breech care for women in Western Australia. This study protocol has the potential to be used as a research framework for future studies of a similar nature