Journal Article•
Midwives rules and standards: the future.
About: This article is published in The practising midwife.The article was published on 2010-06-01 and is currently open access. It has received 3 citations till now.
Citations
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Dissertation•
01 May 2011
TL;DR: The extent to which working in a midwife-led service rather than a consultant-led service helps or hinders midwives’ capacity to manage the emotional and ideological demands of their practice is examined.
Abstract: Much has been written in recent years of a ‘crisis’ in the recruitment and retention of
midwives in the NHS The crisis has been attributed variously to burnout, a lack of
professional autonomy, a bullying culture, and an ideological conflict between the
way in which midwives wish to practise and the way they are required to practise
within large bureaucratic institutions, such as NHS Trusts Negotiating these
experiences requires a significant amount of emotional labour by midwives, which
they may find intolerable This thesis explores the strategies NHS midwives deploy
in order to continue working in NHS maternity services when many of their
colleagues are leaving It examines the extent to which working in a midwife-led
service rather than a consultant-led service helps or hinders midwives’ capacity to
manage the emotional and ideological demands of their practice
Ethnographic fieldwork was carried out in a consultant unit and an Alongside
Midwife-led Unit (AMU) in two NHS Trusts in England The findings from
negotiated interactive observation and in-depth unstructured interviews with eighteen
midwives were analysed using inductive ethnographic principles
In order to ameliorate the emotional distress they experienced, the midwives used
coping strategies to organise the people and spaces around them These strategies of
organisation and control were part of a personal and professional project which they
found almost impossible to articulate because it ran contrary to the ideals of the
midwifery discourse Midwives explained these coping strategies as firstly, necessary
in order to deal with institutional constraints and regulations; secondly, out of their
control and thirdly, destructive and bad for midwifery In practice it appeared that the
midwives played a role in sustaining these strategies because they formed part of a
wider professional project to promote their personal and professional autonomy
These coping strategies were very similar in the Consultant Unit and the Midwifery
Unit A midwife-led service provided the midwives with a space within which to
nurture their philosophy of practice This provided some significant benefits for their
emotional wellbeing, but it also polarised them against the neighbouring Delivery
Suite The resulting poor relationships profoundly affected their capacity to provide a
service congruent with their professional ideals This suggests that whilst Alongside
Midwife-led Units may attempt to promote a midwifery model of care and a good
working environment for midwives, their proximity to consultant-led services
compounds the ideological conflict the midwives experience The strength of their
philosophy may have the unintended consequence of silencing open discussion about
the negative influence on women of the strategies the midwives use to compensate
for ideological conflict and a lack of institutional and professional support
27 citations
Cites background from "Midwives rules and standards: the f..."
...14 Supervisory Authority annually of their intention to practise midwifery in the region; they are required to have a named Supervisor of Midwives and they are forbidden to carry out any procedure, except in an emergency, which they have not been trained to do (NMC 2004)....
[...]
...…to notify their Local 14 Supervisory Authority annually of their intention to practise midwifery in the region; they are required to have a named Supervisor of Midwives and they are forbidden to carry out any procedure, except in an emergency, which they have not been trained to do (NMC 2004)....
[...]
TL;DR: It was showed that prior booking of pregnant women for antenatal care was associated with lower prevalence of PPH as higher prevalence was recorded among unbooked clients, and midwives and other health care providers most especially at the rural area must ensure that women are mobilised and encouraged to register for antennatal care as early as possible for appropriate maternity care.
Abstract: One of the millennium development goals set by the United Nations is to reduce maternal mortality by three quarters by 2015. The achievement of this goal must focus on understanding the dynamics of the causes of maternal mortality and removing such causes. Postpartum haemorrhage ranks high among the causes of maternal mortality, especially in Nigeria. This study was designed to determine the prevalence, management and outcome of postpartum haemorrhage in selected health care settings. This study was a retrospective analysis of cases of postpartum haemorrhage (PPH) in selected health care facilities from primary, secondary and tertiary health care levels in Ile-Ife, Nigeria between January, 2004 and December, 2008. The prevalence of PPH during the study period was 1.6, 3.9 and 3.4% in the tertiary, secondary and primary health care institutions respectively. Chi square showed a significant association between booking status and occurrence of PPH (c2 = 18.51, df = 1, P = 0.001), parity and PPH (c2 = 21.49, df = 3, P = 0.000), and mode of delivery and PPH (c2 = 111.77, df = 2, P = 000). Retained placenta and retained placental bits of tissue were major causes of PPH (52.4%). Major risk factors identified were multiple gestation (20%), antepartum haemorrhage (15%) and previous PPH (12.5%). Uterotonic (ergometrine and/or syntocinon) was widely used (100%) as first line of management with misoprostol being rarely used (7.3%). This study showed that prior booking of pregnant women for antenatal care was associated with lower prevalence of PPH as higher prevalence was recorded among unbooked clients. Therefore, midwives and other health care providers most especially at the rural area must ensure that women are mobilised and encouraged to register for antenatal care as early as possible for appropriate maternity care, early identification of risk and preparation to reduce the untoward effect.
Key words: Maternal mortality, labour, primary postpartum haemorrhage, uterotonic, retrospective study.
12 citations
Cites background from "Midwives rules and standards: the f..."
...Good records have been documented as an indication that the quality of care given to women was of a good standard NMC (2004)....
[...]
Dissertation•
09 Sep 2015
TL;DR: The findings of this study demonstrate that this is not always achieved leading some women to make extreme birthing choices, and further research is essential to determine why there is such a gap between midwifery philosophy and actual care provision.
Abstract: Freebirthing or unassisted birth is the active choice made by a woman to birth without a trained professional present, even where there is access to maternity provision. This is a radical childbirth choice, which has potential morbidity risks for mother and baby. To date there have been no UK based studies. The aim of this study was to explore the decision making experience of women who chose to freebirth in a UK context.
An interpretative phenomenological study was carried out. A purposive sampling method combined with a ‘snowball’ technique was used to recruit women to the study (n=10). Inclusion and exclusion criteria were applied. Data collection comprised of women completing a narrative account. This was followed up with an in-depth interview. Data analysis was carried out using interpretative methods informed by Heidegger and Gadamer’s hermeneutic-phenomenological concepts.
Three main themes emerged from the data: ‘contextualising herstory’; ‘diverging paths of decision making’ and ‘the converging path of decision making’. With the exception of one participant, the women were making an active choice based upon their previous birth experiences. For some the decision was borne out of a negative experience which was then compounded by a further poor experience with maternity services. Namely obstructive practices by maternity professionals that limited their choice to book a homebirth. Therefore, in order to feel safe they opted to freebirth. For others this was borne out of a positive experience in which their decision evolved in trying to further improve their birthing experience, therefore a midwife became redundant.
The findings mirror that of the metasynthesis carried out by Feeley et al. (2015), but unique to this study is that it is based in a UK setting. This is an important finding as the UK has a strong midwifery culture which is philosophically embedded in woman-centred care. The findings of this study demonstrate that this is not always achieved leading some women to make extreme birthing choices. Further research is essential to determine why there is such a gap between midwifery philosophy and actual care provision.
4 citations
References
More filters
Dissertation•
01 May 2011
TL;DR: The extent to which working in a midwife-led service rather than a consultant-led service helps or hinders midwives’ capacity to manage the emotional and ideological demands of their practice is examined.
Abstract: Much has been written in recent years of a ‘crisis’ in the recruitment and retention of
midwives in the NHS The crisis has been attributed variously to burnout, a lack of
professional autonomy, a bullying culture, and an ideological conflict between the
way in which midwives wish to practise and the way they are required to practise
within large bureaucratic institutions, such as NHS Trusts Negotiating these
experiences requires a significant amount of emotional labour by midwives, which
they may find intolerable This thesis explores the strategies NHS midwives deploy
in order to continue working in NHS maternity services when many of their
colleagues are leaving It examines the extent to which working in a midwife-led
service rather than a consultant-led service helps or hinders midwives’ capacity to
manage the emotional and ideological demands of their practice
Ethnographic fieldwork was carried out in a consultant unit and an Alongside
Midwife-led Unit (AMU) in two NHS Trusts in England The findings from
negotiated interactive observation and in-depth unstructured interviews with eighteen
midwives were analysed using inductive ethnographic principles
In order to ameliorate the emotional distress they experienced, the midwives used
coping strategies to organise the people and spaces around them These strategies of
organisation and control were part of a personal and professional project which they
found almost impossible to articulate because it ran contrary to the ideals of the
midwifery discourse Midwives explained these coping strategies as firstly, necessary
in order to deal with institutional constraints and regulations; secondly, out of their
control and thirdly, destructive and bad for midwifery In practice it appeared that the
midwives played a role in sustaining these strategies because they formed part of a
wider professional project to promote their personal and professional autonomy
These coping strategies were very similar in the Consultant Unit and the Midwifery
Unit A midwife-led service provided the midwives with a space within which to
nurture their philosophy of practice This provided some significant benefits for their
emotional wellbeing, but it also polarised them against the neighbouring Delivery
Suite The resulting poor relationships profoundly affected their capacity to provide a
service congruent with their professional ideals This suggests that whilst Alongside
Midwife-led Units may attempt to promote a midwifery model of care and a good
working environment for midwives, their proximity to consultant-led services
compounds the ideological conflict the midwives experience The strength of their
philosophy may have the unintended consequence of silencing open discussion about
the negative influence on women of the strategies the midwives use to compensate
for ideological conflict and a lack of institutional and professional support
27 citations
TL;DR: It was showed that prior booking of pregnant women for antenatal care was associated with lower prevalence of PPH as higher prevalence was recorded among unbooked clients, and midwives and other health care providers most especially at the rural area must ensure that women are mobilised and encouraged to register for antennatal care as early as possible for appropriate maternity care.
Abstract: One of the millennium development goals set by the United Nations is to reduce maternal mortality by three quarters by 2015. The achievement of this goal must focus on understanding the dynamics of the causes of maternal mortality and removing such causes. Postpartum haemorrhage ranks high among the causes of maternal mortality, especially in Nigeria. This study was designed to determine the prevalence, management and outcome of postpartum haemorrhage in selected health care settings. This study was a retrospective analysis of cases of postpartum haemorrhage (PPH) in selected health care facilities from primary, secondary and tertiary health care levels in Ile-Ife, Nigeria between January, 2004 and December, 2008. The prevalence of PPH during the study period was 1.6, 3.9 and 3.4% in the tertiary, secondary and primary health care institutions respectively. Chi square showed a significant association between booking status and occurrence of PPH (c2 = 18.51, df = 1, P = 0.001), parity and PPH (c2 = 21.49, df = 3, P = 0.000), and mode of delivery and PPH (c2 = 111.77, df = 2, P = 000). Retained placenta and retained placental bits of tissue were major causes of PPH (52.4%). Major risk factors identified were multiple gestation (20%), antepartum haemorrhage (15%) and previous PPH (12.5%). Uterotonic (ergometrine and/or syntocinon) was widely used (100%) as first line of management with misoprostol being rarely used (7.3%). This study showed that prior booking of pregnant women for antenatal care was associated with lower prevalence of PPH as higher prevalence was recorded among unbooked clients. Therefore, midwives and other health care providers most especially at the rural area must ensure that women are mobilised and encouraged to register for antenatal care as early as possible for appropriate maternity care, early identification of risk and preparation to reduce the untoward effect.
Key words: Maternal mortality, labour, primary postpartum haemorrhage, uterotonic, retrospective study.
12 citations
Dissertation•
09 Sep 2015
TL;DR: The findings of this study demonstrate that this is not always achieved leading some women to make extreme birthing choices, and further research is essential to determine why there is such a gap between midwifery philosophy and actual care provision.
Abstract: Freebirthing or unassisted birth is the active choice made by a woman to birth without a trained professional present, even where there is access to maternity provision. This is a radical childbirth choice, which has potential morbidity risks for mother and baby. To date there have been no UK based studies. The aim of this study was to explore the decision making experience of women who chose to freebirth in a UK context.
An interpretative phenomenological study was carried out. A purposive sampling method combined with a ‘snowball’ technique was used to recruit women to the study (n=10). Inclusion and exclusion criteria were applied. Data collection comprised of women completing a narrative account. This was followed up with an in-depth interview. Data analysis was carried out using interpretative methods informed by Heidegger and Gadamer’s hermeneutic-phenomenological concepts.
Three main themes emerged from the data: ‘contextualising herstory’; ‘diverging paths of decision making’ and ‘the converging path of decision making’. With the exception of one participant, the women were making an active choice based upon their previous birth experiences. For some the decision was borne out of a negative experience which was then compounded by a further poor experience with maternity services. Namely obstructive practices by maternity professionals that limited their choice to book a homebirth. Therefore, in order to feel safe they opted to freebirth. For others this was borne out of a positive experience in which their decision evolved in trying to further improve their birthing experience, therefore a midwife became redundant.
The findings mirror that of the metasynthesis carried out by Feeley et al. (2015), but unique to this study is that it is based in a UK setting. This is an important finding as the UK has a strong midwifery culture which is philosophically embedded in woman-centred care. The findings of this study demonstrate that this is not always achieved leading some women to make extreme birthing choices. Further research is essential to determine why there is such a gap between midwifery philosophy and actual care provision.
4 citations