Team midwifery: the views and job satisfaction of midwives

OBJECTIVE: As part of an evaluation of a team midwifery scheme we assessed the satisfaction of community and hospital midwives and their views about working practices and care provided. DESIGN: Survey of complete enumeration of community midwives (most working in teams) and hospital midwives providing antenatal, intrapartum and postnatal care to a population of women. SETTING: Community and district general hospital, in the UK. MEASUREMENTS: Socio-demographic data about midwives, ratings on Likert-type scales of job satisfaction, quality of care variables, relationships with other professionals and women; Glasgow Midwifery Process Questionnaire. FINDINGS: 80 out of 92 midwives (87%) responded. Community midwives were younger, more recently qualified, employed on lower grades, less likely to be married and have children than hospital midwives. The Glasgow Midwifery Process Questionnaire revealed that midwives, particularly hospital midwives, had low morale. Community midwives were more likely to report that their job was satisfying, offered a variety of work, enabled them to use skills and knowledge fully, and offered opportunities for professional development. Hospital midwives were more likely to report following strict guidelines. Community midwives, however, disliked the long on call and unsociable hours, and reported disruption to family/social life. Forty-one per cent of hospital midwives (12) and 28% of community midwives (14) reported regularly working beyond their shift. Whilst midwives thought that team midwifery was, in theory, a good idea, in practice it was not working well because of the size of teams and caseload. About half the community midwives felt that teams had detrimentally affected the quality and continuity of care. CONCLUSIONS: Whilst team midwifery aims to improve continuity of maternity care, in this instance, it does not appear to achieve this aim. Many midwives reported it had adversely affected care. Team midwifery is a source of disillusionment for midwives, since the continuity of carer ideal is unachievable in a system based on teams of seven or more. Attendance at the delivery may be a luxury provided at the expense of antenatal and postnatal continuity. IMPLICATIONS: Midwives recommended remedial measures: reducing team sizes, reducing caseloads, ensuring teams were fully staffed, reducing 'on call' and labour ward hours. It remains to be seen whether these will have the desired effects on continuity of care.     

A qualitative study of how caseload midwifery is constituted and experienced by Danish midwives

Objectivethe aim of this study is to advance knowledge about the working and living conditions of midwives in caseload midwifery and how this model of care is embedded in a standard maternity unit. This led to two research questions: 1) What constitutes caseload midwifery from the perspectives of the midwives? 2) How do midwives experience working in caseload midwifery?Design and settingphenomenology of practice was the analytical approach to this qualitative study of caseload midwifery in Northern Denmark. The methodology was inspired by ethnography, and applied methods were field observations followed by interviews.Participantsthirteen midwives working in caseloads were observed during one or two days in the antenatal clinic and were interviewed at a later occasion.Findingsbeing recognised and the feeling of doing high quality care generate high job satisfaction. The obligation and pressure to perform well and the disadvantages to the midwives׳ personal lives are counterbalanced by the feeling of doing a meaningful and important job. Working in caseload midwifery creates a feeling of working in a self-governing model within the public hospital, without losing the technological benefits of a modern birth unit. Midwives in caseload midwifery worked on welcoming and including all pregnant women allocated to their care; even women/families where relationships with the midwives were challenging were recognised and respected.Key conclusionscaseload midwifery is a work-form with an embedded and inevitable commitment and obligation that brings forward the midwife׳s desire to do her utmost and in return receive appreciation, social recognition and a meaningful job with great job satisfaction. There is a balance between the advantages of a meaningful job and the disadvantages for the personal life of the midwife, but benefits were found to outweigh disadvantages.Implications for practiceIn expanding caseload midwifery, it is necessary to understand that the midwives׳ personal lives need to be prepared for this work-form. The number of women per full time midwife has to be surveilled as job-satisfaction is dependent on the midwives׳ ability of fulfilling expectations of being present at women׳s births.     

Chilean midwives and midwifery students’ views of women’s midlife health-care needs

Objective

to determine Chilean midwives’ views with regard to Chilean women’s health-care needs in midlife. The aim was also to explore Chilean midwifery students’ views on the clinical care provided to women in midlife.

Design

a qualitative study using focus group discussions and narratives which were analysed using thematic manifest and latent content analysis.

Setting

10 different primary health care (PHC) centres in Santiago, Chile.

Participants

22 midwives, working in PHC clinics and 13 (n=13) midwifery students with PHC clinical experience, attending their fourth or fifth year of midwifery education at the School of Midwifery in Santiago.

Findings

the midwives felt that women in midlife have special health-care service needs. They also considered themselves to be the most appropriate health staff to provide health care for women in midlife, but recognised that they lacked competence in attending psychological and social health-care needs of women in midlife such as violence, abuse and sexuality issues. The midwifery students remarked that many midwives focused their attention on fulfilling the biomedical requirements. Even if the midwives had knowledge about recent research on menopause, they had difficulties in approaching this issue and including it in their counselling. Some students also questioned the sometimes disrespectful attitude shown, especially towards Peruvian immigrants and women with psychosocial problems.

Conclusions and implications for practice

the findings suggest that midwives need more education about women’s health-care needs in midlife, and that more focus should be placed on the psychosocial aspects of midwifery. More reflections about the quality of the client-provider relationship in clinical practice are needed. Gender issues, the structure of power relationships, and empowerment should be incorporated and critically discussed during midwifery education and training, and also in clinics.     

Towards an integrated model of competence in midwifery

Currently in the UK, there is no consensus as to what constitutes an adequate definition of a competent midwife. Yet, given the rapidly changing midwifery needs of childbearing women and society, such clarification has never been more important. In this paper some concepts of competence taken from a review of midwifery, nursing, educational and industrial literature are reviewed, and it is hoped that discussion leading to conceptualisation of an integrated model of competence in midwifery will be stimulated. Questions raised include - What is it that makes midwives competent? Can competence be inferred from performance? How can capability be recognised? Can competence be broken into elements for assessment without losing meaning?     

Research in midwifery: are midwives their own worst enemies?

This study investigated the hypothesis that midwives will undervalue research they believed to have been undertaken by a midwife as compared with that believed to have been undertaken by an obstetrician. Eighteen midwives were asked to assess two comparable research articles on 5 criteria. Half the sample were informed that the first article was written by a midwife and the second by an obstetrician. The order of authorship was reversed for the remainder of the sample. A related t-test was carried out to compare the midwife's paper with the obstetrician's on each of the 5 criteria. These suggested that no difference was perceived between the midwife's and obstetrician's clarity of expression or expertise on the topic in question, but significant differences were found on attributed grasp of research methodology, understanding of statistical analysis and contribution to current understanding, with the midwife emerging worse on all three (t = 1.99, p less than 0.05, t = 2.28, p less than 0.025, t = 1.8, p less than 0.05 respectively). Comparison of the overall scores also revealed that the general quality of the midwife's paper was also perceived to be poorer than the obstetrician's (t = 2.24, p less than 0.025). The findings are partially explained in terms of the gender influences that operate in midwifery.     

A report of a midwifery model for training traditional midwives in Guatemala

OBJECTIVE: to describe the specific characteristics of one model of training traditional birth attendants (TBAs) in Guatemala. DESIGN: participant observation, unstructured and semi-structured interviews undertaken between 1997 and 2003 to gather the data to report on the characteristics of this training programme as it is evolving in the field. SETTING: the birth centre site of Ixmucane in Antigua, Guatemala, as well as community sites in the Departments of Saquetepequez, Chimaltenango, and Quetzaltenango in the western highlands of Guatemala. PARTICIPANTS: traditional midwives, certified nurse-midwives and certified professional midwives, as well as many allied health professionals and volunteers. INTERVENTION: training philosophy, participant selection, curriculum content, intensity, and planned follow-up are the key components of the training programme described. MEASUREMENT AND FINDINGS: 93 TBAs have received training through the development of a 150 hrs contact course for self-selected TBAs in the Midwives for Midwives Program. Formal evaluation of this training is underway but results are not yet available. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the value of incorporating midwifery philosophy and praxis in TBA training has received scant attention in the TBA literature. This report suggests that TBA training programme characteristics are important considerations in any evaluation of training efficacy of TBAs to improve maternal-child health.     

Redesigning postnatal care: exploring the views and experiences of midwives

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.     

Strengthening midwifery in Brazil: Education,regulation and professional association of midwives

This article describes Brazilian midwives' struggle to establish their professional field in the arena of maternal and child health in Brazil. Despite the obstacles, midwives continue trying to claim their social space, seeking to maintain and strengthen the profession, and legislative aspects of practice and regulation of their profession. They seek space in the job market, support from entities of civil society, representatives of judicial and political power, and from the movements organised for improvement and change in the birth care model in Brazil.     

A delphi survey of midwives and midwifery students to identify non-midwifery duties

AIM OF THE STUDY: to explore the skill mix requirements for the potential role of an unqualified midwifery assistant in the clinical setting. Using results from the study we report the difference between student midwives' and qualified midwives' perceptions of what constitute non-midwifery duties. DESIGN: a two-round Delphi survey. SETTING: large maternity hospital in Ireland. PARTICIPANTS: population of midwives (n=194) and midwifery students (n=79). FINDINGS: the non-midwifery duties identified were wide ranging and could be categorised under the headings of clerical, stock, porter, domestic and other basic-care-related duties. CONCLUSION: although no agreed definition of non-midwifery duty exists it can be seen that, through the process undertaken in this study, a definition is created. This suggests that the values and beliefs that qualified midwives and students hold regarding their role shapes the role of the care assistant. IMPLICATIONS FOR PRACTICE: the inclusion of perceptions from student and staff midwives enabled the researchers to compare and contrast similarities and differences regarding how these different parties constitute a non-midwifery duty. The process also gave respondents a sense of ownership and involvement in the development of the midwifery assistant role. In addition, this study has demonstrated the need for further clarification of how midwives perceive and understand their role.     

'Knowing your place': student midwives' views of relationships in midwifery in Ireland

OBJECTIVE: to explore the feelings and views of student midwives of their education as they progressed through their two-year programme in Ireland, with the intention of interpreting and understanding the working and learning world of the participants so that future students might be assisted to improve their educational experiences. DESIGN: phenomenology, using the technique of triangulation in a number of ways. SETTING: all seven midwifery schools in Southern Ireland. PARTICIPANTS: all students in the first intake of 1995 in every midwifery school in Ireland (n=125). DATA COLLECTION: individual and group interviews, diary-keeping and questionnaires. KEY CONCLUSIONS: the findings presented in this paper illustrate the students' views of their relationships with qualified midwives and obstetricians.Implications for practice: an attitude of respect for all students needs to be fostered in hospitals educating midwives if we are to produce caring midwives in the future. The new, extended programme of midwifery education in Ireland should include an emphasis on communication skills and conflict management. A re-organisation of the hierarchical structures evident in midwifery management would lead to an improvement in the experiences of students and childbearing women alike.