The menopause experience: a woman's perspective

OBJECTIVE: To understand the complexities of the experience of menopause in American women from diverse ethnic and socioeconomic backgrounds. The specific aims of this phenomenologic study were to (a) examine and interpret the reality of the menopausal transition as experienced by American women and (b) identify common elements and themes that occur as a result of the complexities of this experience. DESIGN: Data for this qualitative study were gathered through semistructured interviews with 15 women who experienced natural menopause. PARTICIPANTS: A multiethnic sample of 15 menopausal American women in Massachusetts was selected from a pool of voluntary participants from the Boston area. DATA ANALYSIS: The interviews were analyzed to identify themes pertinent to the personal experience of menopause. Those themes, extracted from the similarities and differences described, represent broad aspects of these women's experiences. RESULTS: Three major themes or phases were identified: expectations and realization, sorting things out, and a new life phase. Although some women expressed similar thoughts in particular categories, no two women had the same experience of menopause. CONCLUSIONS: The data support the premise that the experience of menopause in American women is unique to each individual and that the meaning or perspective differs among women. The data revealed the complexities of this human experience by explicating personal meanings related to experiences, expectations, attitudes, and beliefs about menopause.     

A model of exemplary midwifery practice: results of a Delphi study

What is unique and exemplary about the midwifery model of care? Does exemplary midwifery care result in improved outcomes for the recipient(s) of that care? These are the questions that the profession of midwifery grapples with today within the context of a changing health care arena. Exemplary midwives, and women who had received their care, came to consensus about these issues in a Delphi study. A model of exemplary midwifery care is presented based on the identification of essential elements aligned within three dimensions: therapeutics, caring, and the profession of midwifery. Supporting the normalcy of pregnancy and birth, vigilance and attention to detail, and respecting the uniqueness of the woman, were several of many processes of care identified. The critical difference that emerged was the art of doing “nothing” well. By ensuring that normalcy continued through vigilant and attentive care, the midwives were content to foster the normal processes of labor and birth, intervening and using technology only when the individual situation required. Health care, whether in the gynecologic setting or during pregnancy, was geared to help the woman achieve a level of control of the process and outcome. The ultimate outcomes were optimal health in the given situation, and the experience of health care that is both respectful and empowering. The model provides structure for future research on the unique aspects of midwifery care to support its correlation with excellent outcomes and value in health care economics.     

The integration of a woman's perspective in hysterectomy decisions

It has been argued, based on a limited amount of research data, that patient participation in decision-making regarding surgery, results not only in more patient satisfaction, but also in better surgery outcomes. Especially in a procedure such as hysterectomy, with far-reaching consequences and many potential side effects, it may therefore be relevant to promote an active role of the patient in the decision-making process. The article identifies contextual elements that might promote this active role. Subsequently a model of participative, informed decision-making is outlined. The model entails that clinical guidelines should be adjusted to the particular situation at hand and that patients should be fully informed about hysterectomy-involved risks. An overview of the various guidelines and risks is provided. Proper counseling in the decision-making phase as well as in the post-hysterectomy period is advocated. Throughout the article attention is paid to documented and undocumented ethnic differences regarding various aspects of hysterectomy, particularly differences in patient participation around the world.     

The integration of a woman's perspective in hysterectomy decisions

It has been argued, based on a limited amount of research data, that patient participation in decision-making regarding surgery, results not only in more patient satisfaction, but also in better surgery outcomes. Especially in a procedure such as hysterectomy, with far-reaching consequences and many potential side effects, it may therefore be relevant to promote an active role of the patient in the decision-making process. The article identifies contextual elements that might promote this active role. Subsequently a model of participative, informed decision-making is outlined. The model entails that clinical guidelines should be adjusted to the particular situation at hand and that patients should be fully informed about hysterectomy-involved risks. An overview of the various guidelines and risks is provided. Proper counseling in the decision-making phase as well as in the post-hysterectomy period is advocated. Throughout the article attention is paid to documented and undocumented ethnic differences regarding various aspects of hysterectomy, particularly differences in patient participation around the world.     

Assessing and managing women with depression: a midwifery perspective

Women are at disproportionate risk for depression. Depression often goes untreated because of lack of recognition by providers. The Institute of Medicine maintains that primary care providers are essential in the management of mental health disorders. The assessment and management of depression in women are sensitive topics and may require advanced training and skills.     

Meeting women's health needs in Yemen: a midwifery perspective

Maternal mortality in Yemen is one of the highest in the world. Reaching the rural majority of the population with primary health care services has been a continual priority for the nation. Despite efforts to expand health services, access to maternal and child health care remains low. The training of community midwives nationwide has been undertaken recently to address the need for maternal and child health services, particularly in rural areas. Several lessons have been gained through this initial training that will improve future efforts.     

An evaluation of the satisfaction of midwives’ working in midwifery group practice

Objective

to examine changes in midwives’ attitudes to their professional role following the introduction of midwifery group practice (MGP) (a caseload model of midwifery continuity of care provided to women of all risk levels) and to explore aspects of the model that were working well and those that were not working well.

Design

the questionnaire ‘Attitudes to Professional Role’ was used to measure midwives’ satisfaction in terms of professional satisfaction, professional support, client interaction, and professional development. Open-ended questions were also included to offer an opportunity for midwives to expand on their experiences of working in the MGP model. The questionnaire was administered at five time points over the 18-month evaluation period. Round 1 was prior to the implementation of MGP, Rounds 2–4 were at three-month intervals, with Round 5 six months later. Analysis of the structured part of the questionnaire was undertaken by comparing mean scores of satisfaction ranging from −2 (very negative attitudes) to +2 (very positive attitudes), and the open-ended questions were analysed using qualitative content analysis.

Setting

the Women's and Children's Hospital, Adelaide, South Australia.

Participants

questionnaires were distributed to all midwives (n=15) working in MGP in Rounds 1, 2 and 3, and to the 12 midwives remaining from the original sample in Rounds 4 and 5. Fourteen questionnaires were returned in Round 1, 12 in Round 2, 10 in Round 3, nine in Round 4, and 10 in Round 5.

Findings

overall, a positive change in attitudes to professional role was reflected in all sub-scales in the period between start-up and 18 months later; a reduction in scores occurred in Round 3. The mean increases were significant for all sub-scales apart from professional development. Five main themes were identified across the rounds in the content analysis: ‘continuity of care’, ‘working pattern’, ‘working environment’, ‘collegiality’ and ‘issues relating to midwifery practice’. Midwives gained particular satisfaction from providing continuity of care and building relationships with women and their families, and through practising autonomously as a midwife. While there was a struggle to manage the hours worked and being on call, high levels of professional satisfaction were maintained.

Key conclusions

while there were aspects of MGP that midwives were not satisfied with and wanted to change, overall they were satisfied with the model.

Implications

there is a need for ongoing evaluation in order to monitor the short- and long-term impact on midwives of working in a caseload model of continuity of midwifery care.     

Pharmaceutical therapy in midwifery practice: a culturally competent approach

The profession of midwifery can be part of the solution in America's quest for a culturally sensitive and competent health care system. Midwives who are familiar with a variety of health-related cultural beliefs and practice culturally sensitive inquiry, particularly when using pharmaceutical therapies, can effectively understand and respond to the cultural complexities that impact a client's health. This article describes needed cultural competencies, reviews a variety of health-related cultural beliefs, and relates how these beliefs impact the use and acceptability of pharmaceutical therapies. Specific examples related to culturally sensitive inquiry are discussed along with recommendations.     

A feminist perspective on the study of home birth: Application of a midwifery care framework

Studies of home birth have compared it with hospital birth, with a focus on perinatal outcomes. Although such studies have established the safety of midwife-attended home births, this narrow view does not include all of the concepts represented in a proposed midwifery care framework derived from the philosophy of the American College of Nurse-Midwives. In this essay, the authors recommend the employment of qualitative research with a feminist perspective as a method to elucidate other concepts in the midwifery care framework, and suggest that future home birth research should explore the recognition and validation of the woman and her experiences, appropriate use of technology, and the influences of the birth environment.     

Developing an evidence-based practice protocol: implications for midwifery practice

Evidence-based practice is defined and its importance to midwifery practice is presented. Guidelines are provided for the development of an evidence-based practice protocol. These include: identifying the clinical question, obtaining the evidence, evaluating the validity and importance of the evidence, synthesizing the evidence and applying it to the development of a protocol or clinical algorithm, and, finally, developing an evaluation plan or measurement strategy to see if the new protocol is effective.