The role and competence of midwives in supporting women with mental health concerns during the perinatal period: A scoping review

© 2019 John Wiley & Sons Ltd Perinatal mental health problems are linked to poor outcomes for mothers, babies and families. Despite a recognition of the significance of this issue, women often do not receive the care they need and fall between the gap of maternity and mental health services. To address this, there is a call for reform in the way in which perinatal mental healthcare is delivered. This paper responds to this by exploring the role and competence of midwives in delivering mental healthcare. Using a scoping review methodology, quantitative and qualitative evidence were considered to answer the research question ‘what is the nature of the evidence relevant to the provision of mental health interventions by midwives?’ To identify studies, the databases PubMed, Maternity and Infant Care, Science Citation Index, Social Sciences Citation Index, Medline, Science Direct and CINAHL were searched from 2011 to 2018, and reference lists of included studies were examined. Studies relevant to the role of midwives in the management and treatment of perinatal mental health issues were included; studies focussed on screening and referral were excluded. Thirty papers met inclusion criteria, including studies about the knowledge, skills, and attitudes of midwives and student midwives; the effectiveness of educational interventions in improving knowledge and skills; the delivery of counselling or psychosocial interventions by midwives; and barriers and enablers to embedding midwife-led mental healthcare in practice. Synthesis of the included studies indicates that midwives are interested in providing mental health support, but lack the confidence, knowledge and training to do so. This deficit can be addressed with appropriate training and organisational support, and there is some evidence that midwife-led counselling interventions are effective. Further research is needed to test midwife-led interventions for women with perinatal mental health problems, and to develop and evaluate models of integrated perinatal mental healthcare

Intrapartum fetal heart rate monitoring: using audit methodology to identify areas for research and practice improvement

The purpose of the study was to explore the fetal heart rate monitoring practices of midwives and doctors to determine compliance with an evidence-based guideline for fetal heart rate monitoring endorsed by one New Zealand (NZ) District Health Board (DHB). A retrospective audit of 193 randomly selected medical records was undertaken over six months (July-December 2006). The audit revealed deficiencies in choice of fetal heart rate monitoring modality, monitoring technique, documentation, communication and use of a standardised approach and language for interpreting cardiotocograph (CTG) traces especially the description and categorisation of the four main fetal heart rate features. Multidisciplinary education and a standardised template for reporting CTG's were key recommendations

The emotional and hormonal pathways of labour and birth: integrating mind, body and behaviour

Background: Women have described normal labour and birth in terms of their emotions. Major advances in knowledge have occurred within the sciences resulting in an understanding of emotions as prime directors of human behaviour which is orchestrated by neurohormones. Method: This paper focusses on key aspects of contemporary knowledge of childbirth physiology, neuroscience and behaviour. It integrates this understanding with womens descriptions of their emotions during labour. Findings: Neurohormones associated with labour and birth are designed to trigger a transformation in the body and behaviour and create an environment which supports both the mother and the baby. Hormones and emotions are intertwined and interconnected. Labour hormones are linked to the womans emotions and behaviour during labour and birth as well as the physical signs of labour. An interactive model is presented which explains labour in terms of both the physical effects and the emotional affects that women have described as part of their labour experience. The hypothesis for this model is that the hormones that initiate and sustain labour also cause the instinctual emotions that women feel, and the behaviour they exhibit, during spontaneous labour and birth

The Relationship between Pregnancy Planning and Breastfeeding Duration

This exploratory study, using a convenience sample of 102 primiparous women in New Zealand, examined the relationship between pregnancy planning and duration of breastfeeding. These women, who had chosen to exclusively breastfeed their infants, responded to a two-part survey: Part I self administered on the day of discharge from hospital; Part II completed during a telephone interview at 6 weeks postpartum. Results: No relationship was found between planning of pregnancy and duration of exclusive breastfeeding. At 6 weeks postpartum, 66 (65%) were exclusively breastfeeding and 34 (35%) were not. Women who had completed 12th grade were significantly more likely to exclusively breastfeed at 6 weeks postpartum than women who had not completed high school (X2= 5.38, p = 0.02)

Auscultation - The Action of Listening

The article focuses on the historical development of auscultation and listening to fetal heart beats. It mentions that auscultation defines as the action of listening to the sounds inside the body. It says that the use stethoscope in midwifery practice was introduced in 1819 wherein listening to fetal heart sounds helps determine the well-being of the fetus. It adds that intermittent auscultation was recommended for fetal heart monitoring by the professional evidence-based guidelin

Midwives' decision making about transfers for 'slow' labour in rural New Zealand

© 2015 Elsevier Ltd. Midwives who provided Lead Maternity Care (LMC) to women in rural areas were invited to share their experiences of decision making around transfer in labour.Ethics approval was obtained from the NZ National Ethics Committee. Objective: to explore midwives' decision making processes when making transfer decisions for slow labour progress from rural areas to specialist care. Design: individual and group interviews were conducted with a purposive sample of rural midwives. The recalled decision processes of the midwives were subjected to a content and thematic analysis to expose experiences in common and to highlight aspects of probabilistic (normative), heuristic (behavioural), and group decision making theory within the rural context. Setting: New Zealand. Participants: 15 midwives who provided LMC services to women in their rural areas. Findings: 'making the mind shift', 'sitting on the boundary', 'timing the transfer' and 'the community interest' emerged as key themes. The decision processes were also influenced by the woman[U+05F3]s preferences and the distance and time involved in the transfer. Key conclusions and implications for practice: the findings contribute insights into the challenge of making transfer decisions in rural units; particularly for otherwise well women who were experiencing slow labour progress. Knowledge of the fallibility of our heuristic decision making strategies may encourage the practitioner to step back and take a more deliberative, probabilistic view of the situation. In addition to the clinical picture, this process should include the relational and aspirational aspects for the woman, and any logistical challenges of the particular rural context

Mentorship, preceptorship and clinical supervision: three key processes for supporting midwives

New Zealand midwives are increasingly seeking and receiving professional support in clinical practice. This support is gaining acceptance within the profession and is now underpinned by government funding. There are a variety of ways in which support can be provided and this review of the literature describes three main approaches: mentoring, preceptorship and clinical supervision. These three key processes may be undertaken by all midwives whether new to practice or new to New Zealand and also by those who wish ongoing support and development