Introducing herbal medicine into conventional health care settings.

Herbal therapy is one of several holistic therapies gaining recognition within the health care community in the United States. As a discipline, herbal medicine is in its infancy regarding educational standards for credentialling, standardization, and regulation of products and clinical applications within this health care system. This article discusses professional considerations for midwives who are interested in integrating herbal healing into their clinical practices, and offers examples of how to incorporate herbal medicine into midwifery care. Resources for practitioners including books, newsletters, journals, courses, computer sites, and databases are presented. The author offers guidance for creating an herbal practice manual for the midwifery office as well as the hospital setting and for documenting herbal healing in the medical record. Collegial support, barriers to practice, liability, and insurance issues are discussed. A clinical applications section includes specific herbal formulas for preconception health, pregnancy-induced hypertension, gestational diabetes, and postdates pregnancy.     

Educational Strategies to Help Students Provide Respectful Sexual and Reproductive Health Care for Lesbian,Gay, Bisexual,and Transgender Persons

Graduate medical, nursing, and midwifery curricula often have limited amounts of time to focus on issues related to cultural competency in clinical practice, and respectful sexual and reproductive health care for all individuals in particular. Respectful health care that addresses sexual and reproductive concerns is a right for everyone, including those who self‐identify as lesbian, gay, bisexual, or transgender (LGBT). LGBT persons have unique reproductive health care needs as well as increased risks for poor health outcomes. Both the World Health Organization and Healthy People 2020 identified the poor health of LGBT persons as an area for improvement. A lack of educational resources as well as few student clinical experiences with an LGBT population may be barriers to providing respectful sexual and reproductive health care to LGBT persons. This article offers didactic educational strategies for midwifery and graduate nursing education programs that may result in reducing barriers to the provision of respectful sexual and reproductive health care for LGBT clients. Specific ideas for implementation are discussed in detail. In addition to what is presented here, other educational strategies and clinical experiences may help to support students for caring for LGBT persons prior to entrance into clinical practice.     

Homeopathy: A State of the Science Review With Recommendations for Practical Therapies in Midwifery Practice

A substantial proportion of adults and children in the United States use complementary and alternative health practices, including homeopathy. Many homeopathic therapies are readily available over the counter, and many individuals access and self-administer these therapies with little or no guidance from health care practitioners. In addition, patients and health care providers are often confused by terminologies associated with complementary practices and may be unable to distinguish homeopathy from naturopathy, herbalism, holistic medicine, Ayurveda, traditional Chinese medicine, or other forms of health care. Compared with European and Asian countries, education in the United States about complementary and alternative health practices is not typically found within traditional nursing, midwifery, or medical education curricula. Given this lack of education and the broad acceptance and popularity of homeopathy, it is necessary for health care practitioners to improve their knowledge regarding similarities and differences among therapies so they can fully inform and make appropriate recommendations to patients. The intent of this article is therefore to examine the state of existing science of homeopathy, distinguish it from other complementary methods, and provide midwives and women's health care providers with an introduction to common homeopathic therapies that may be recommended and safely used by persons seeking midwifery care. This review also presents the evidence base, pharmacology, manufacturing, and regulation of homeopathic therapies. We also consider controversies and misunderstandings regarding safety and efficacy of homeopathic remedies relevant to women and birthing persons. Examples of practical applications of homeopathic therapies for use in midwifery practice are introduced. Implications for practice and sample guidelines are included.     

Interprofessional Obstetric Ultrasound Education: Successful Development of Online Learning Modules; Case‐Based Seminars; and Skills Labs for Registered and Advanced Practice Nurses,Midwives, Physicians,and Trainees

Ultrasound is an important aid in the clinical diagnosis and management of normal and complicated pregnancy and childbirth. The technology is widely applied to maternity care in the United States, where comprehensive standard ultrasound examinations are routine. Targeted scans are common and used for an increasing number of clinical indications due to emerging research and a greater availability of equipment with better image resolution at lower cost. These factors contribute to an increased demand for obstetric ultrasound education among students and providers of maternity care, despite a paucity of data to inform education program design and evaluation. To meet this demand, from 2012 to 2015 the University of California, San Francisco nurse‐midwifery education program developed and implemented an interprofessional obstetric ultrasound course focused on clinical applications commonly managed by maternity care providers from different professions and disciplines. The course included matriculating students in nursing and medicine, as well as licensed practitioners such as registered and advanced practice nurses, midwives, and physicians and residents in obstetrics and gynecology and family medicine. After completing 10 online modules with a pre‐ and posttest of knowledge and interprofessional competencies related to teamwork and communication, trainees attended a case‐based seminar and hands‐on skills practicum with pregnant volunteers. The course aimed to establish a foundation for further supervised clinical training prior to independent practice of obstetric ultrasound. Course development was informed by professional guidelines and clinical and education research literature. This article describes the foundations, with a review of the challenges and solutions encountered in obstetric ultrasound education development and implementation. Our experience will inform educators who wish to facilitate obstetric ultrasound competency development among new and experienced maternity care providers in academic and clinical settings. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.     

Alternative healing in nurse-midwifery practice.

This Clinical Practice Exchange focuses on alternative healing in nurse-midwifery practice. It features interviews with six certified nurse-midwives (CNMs) who practice complementary therapies (CTs). The healing modalities they use include homeopathy, Healing Touch, hypnosis, herbal healing, mindfulness meditation, and water healing. The CNMs discuss their training to practice CTs, how they use alternative healing with clients, and how they integrate this with midwifery practice. The interviews are followed by an Alternative Healing Directory composed of 37 CNMs who responded to a Call, which appeared several times in Quickening and JNM. Each midwife's listing includes contact information, CTs practices, and special interests in networking with other CNMs about alternative healing. The JNM hopes that this Directory will be a catalyst for networking and communication that will move forward the discussion, practice, and research of alternative healing within the midwifery community.     

The Clinical Learning Dyad Model: An Innovation in Midwifery Education

There is a national shortage of women's health and primary care providers in the United States, including certified nurse‐midwives and certified midwives. This shortage is directly related to how many students can be trained within the existing system. The current model of midwifery clinical training is based on apprenticeship, with one‐on‐one interaction between a student and preceptor. Thus, the number of newly trained midwifery providers is limited by the number of available and willing preceptors. The clinical learning dyad model (CLDM), which pairs 2 beginning midwifery students with one preceptor in a busy practice, addresses this problem. In addition, this model brings in a senior midwife student as a near‐peer mentor when the students are first oriented into outpatient clinical practice. The model began as a pilot project to improve the quality of training and increase available student spots in clinical education. This article discusses the origins of the model, the specifics of its design, and the results of a midterm and one‐year postintervention survey. Students and preceptors involved in this model identified several advantages to the program, including increased student accountability, enhanced socialization into the profession, improved learning, and reduced teaching burden on preceptors. An additional benefit of the CLDM is that students form a learning community and collaborate with preceptors to care for women in busy clinical settings. Challenges of the model will also be discussed. Further research is needed to evaluate the effectiveness of the CLDM. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.     

Research in midwifery--the relevance of a feminist theoretical framework

As midwifery develops as a discipline and new models of care are introduced within maternity services, research activity and inquiry into practice and professional issues will be required. This paper suggests that an appropriate theoretical underpinning for research in midwifery is one that is based on feminist theory. It is argued that by adopting this approach, midwifery practice will focus on the needs of women and change in the provision of services for childbearing women will be in response to women's evaluation of existing services. By addressing the needs of women it is argued that the profession will also benefit, as the role of midwifery in the health care of childbearing women will be defined.     

ALTERNATIVE HEALING IN NURSE-MIDWIFERY PRACTICE

This Clinical Practice Exchange focuses on alternative healing in nurse-midwifery practice. It features interviews with six certified nurse-midwives (CNMs) who practice complementary therapies (CTs). The healing modalities they use include homeopathy, Healing Touch, hypnosis, herbal healing, mindfulness meditation, and water healing. The CNMs discuss their training to practice CTs, how they use alternative healing with clients, and how they integrate this with midwifery practice. The interviews are followed by an Alternative Healing Directory composed of 37 CNMs who responded to a Call, which appeared several times in Quickening and JNM. Each midwife's listing includes contact information, CTs practiced, and special interests in networking with other CNMs about alternative healing. The JNM hopes that this Directory will be a catalyst for networking and communication that will move forward the discussion, practice, and research of alternative healing within the midwifery community.     

An exploratory metasynthesis of midwifery practice in the United States

OBJECTIVES: To conduct a metasynthesis of six qualitative studies of midwifery care and process; identify common themes and metaphors among the six studies for further exploration and theory development; and create a framework for further metasynthesis of qualitative studies of midwifery practice in the USA. DESIGN: A qualitative metasynthesis to analyse, synthesise, and interpret six qualitative studies on the process and practice of midwifery care. SAMPLE AND SETTING: Hospital, birth centre, and home birth settings were represented across all of the studies. Participants included nurse- and direct-entry midwives who provided both childbearing and gynaecological care. Recipients of midwifery care also received both childbearing and gynaecological care. FINDINGS: Four overarching themes were identified: the midwife as an 'instrument' of care; the woman as a 'partner' in care; an 'alliance' between the woman and midwife; and the 'environment' of care. These were interpretively and conceptually arrayed into a helix model of midwifery care. KEY CONCLUSIONS: The findings from this exploratory metasynthesis clearly indicate that the practice of midwifery is a dynamic partnership between the midwife and the woman, and reflects an environmental perspective. In a country that has a standard of highly technical childbirth care, perhaps the most outstanding concept of this model is that of the midwife as an 'instrument' of care. The significance of the findings will be determined by their ability to guide further research efforts to support a standard of midwifery care for all women in the USA. IMPLICATIONS FOR PRACTICE: This model offers a benchmark and a structure for considering the dynamic elements of midwifery practice and key roles that the midwife plays in the health care of women and babies.     

Therapeutic touch. A viable link to midwifery practice.

Through the use of their hands, their intelligence, and their compassion, midwives have traditionally taken a noninterventionist approach to labor and childbirth. Therapeutic Tough, known by its practitioners as simply TT, is a contemporary healing modality through which a practitioner's hands are used to facilitate healing. Midwives and practitioners of TT share an appreciation of the value of a holistic and noninterventionist approach to maintaining patient health. This article explores the potential use of TT as a tool to complement the practice of midwifery. It provides an explanation of the theories underlying TT, the history of its development, and the process involved in its practice. Additionally, the results of studies both supportive and critical of the practice of TT are analyzed. Finally, possible applications of TT to the practice of midwifery are suggested.     

Successes and Challenges of Interprofessional Physiologic Birth and Obstetric Emergency Simulations in a Nurse‐Midwifery Education Program

This article describes childbirth simulation design and implementation within the nurse‐midwifery education program at the University of California, San Francisco. Nurse‐midwife and obstetrician faculty coordinators were supported by faculty from multiple professions and specialties in curriculum review and simulation development and implementation. The primary goal of the resulting technology‐enhanced simulations of normal physiologic birth and obstetric emergencies was to assist learners’ development of interprofessional competencies related to communication, teamwork, and patient‐centered care. Trainees included nurse‐midwifery students; residents in obstetrics, pediatrics, and family medicine; medical students; and advanced practice nursing students in pediatrics. The diversity of participant types and learning levels provided benefits and presented challenges to effective scenario‐based simulation design among numerous other theoretical and logistical considerations. This project revealed practical solutions informed by emerging health sciences and education research literature, faculty experience, and formal course evaluations by learners. Best practices in simulation development and implementation were incorporated, including curriculum revision grounded in needs assessment, case‐ and event‐based clinical scenarios, optimization of fidelity, and ample time for participant debriefing. Adequate preparation and attention to detail increased the immersive experience and benefits of simulation. Suggestions for fidelity enhancement are provided with examples of simulation scenarios, a timeline for preparations, and discussion topics to facilitate meaningful learning by maternity and newborn care providers and trainees in clinical and academic settings. Pre‐ and postsimulation measurements of knowledge, skills, and attitudes are ongoing and not reported. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.     

A human rights framework for midwifery care

This article presents a rights-based model for midwifery care of women and childbearing families. Salient features include discussion of the influence of values on how women are viewed within cultures and societies, universal ethical principles applicable to health care services, and human rights based on the view of women as persons rather than as objects or chattel. Examples of the health impact on women of persistent violation of basic human rights are used to support the need for using a human rights framework for midwifery care--a model supported by codes of ethics, the midwifery philosophy of care, and standards of practice.     

Application of traditional Chinese medicine in the treatment of infertility

The philosophy and practice of traditional Chinese medicine (TCM) have been evolving for thousands of years in China, Japan and other Asian countries. TCM is now generating popular interest worldwide for reproductive health care and disease prevention, including applications for treating infertility and improving sexual function. This review focuses on the application of TCM for infertility patients, and provides a critical reflection on the efficacy and safety of selected Chinese herbal formulas. It has been claimed that some formulas produce high clinical pregnancy rates with few or no side effects, as well as improving the general well-being of patients. The need for randomized control trials and research into possible mechanisms of action, effective doses, contra-indications and toxicity is self-evident. However, the task is enormous in view of the number of herbal products currently available on the market; yet among these products are undoubtedly some that will prove to be safe and beneficial.     

THERAPEUTIC TOUCH

Through the use of their hands, their intelligence, and their compassion, midwives have traditionally taken a noninterventionist approach to labor and childbirth. Therapeutic Touch, known by its practitioners as simply TT, is a contemporary healing modality through which a practitioner's hands are used to facilitate healing. Midwives and practitioners of TT share an appreciation of the value of a holistic and noninterventionist approach to maintaining patient health. This article explores the potential use of TT as a tool to complement the practice of midwifery. It provides an explanation of the theories underlying TT, the history of its development, and the process involved in its practice. Additionally, the results of studies both supportive and critical of the practice of TT are analyzed. Finally, possible applications of TT to the practice of midwifery are suggested.     

Establishing a Volunteer Doula Program Within a Nurse‐Midwifery Education Program: A Winning Situation for Both Clients and Students

The use of labor doulas is beneficial for mothers and newborns, but availability and cost can be barriers. The Nashville Volunteer Doula Program was formed to provide labor support to clients of a faculty nurse‐midwifery practice. The volunteer doula pool is comprised of both nurse‐midwifery students who have trained as doulas and community doulas. Training and coordination of volunteers are managed by nurse‐midwifery students with faculty support. Students gain valuable exposure to providing supportive care during labor and birth, which augments their nurse‐midwifery education. This novel program operates at a low cost and offers benefits to students as well as women who use the doula service. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health     

Application of traditional Chinese medicine in the treatment of infertility

The philosophy and practice of traditional Chinese medicine (TCM) have been evolving for thousands of years in China, Japan and other Asian countries. TCM is now generating popular interest worldwide for reproductive health care and disease prevention, including applications for treating infertility and improving sexual function. This review focuses on the application of TCM for infertility patients, and provides a critical reflection on the efficacy and safety of selected Chinese herbal formulas. It has been claimed that some formulas produce high clinical pregnancy rates with few or no side effects, as well as improving the general well-being of patients. The need for randomized control trials and research into possible mechanisms of action, effective doses, contraindications and toxicity is self-evident. However, the task is enromous in view of the number of herbal products currently available on the market; yet among these products are undoubtedly some that will prove to be safe and beneficial.     

A Framework for Web‐Based Interprofessional Education for Midwifery and Medical Students

Scheduling interprofessional team‐based activities for health sciences students who are geographically dispersed, with divergent and often competing schedules, can be challenging. The use of Web‐based technologies such as 3‐dimensional (3D) virtual learning environments in interprofessional education is a relatively new phenomenon, which offers promise in helping students come together in online teams when face‐to‐face encounters are not possible. The purpose of this article is to present the experience of a nurse‐midwifery education program in a Southeastern US university in delivering Web‐based interprofessional education for nurse‐midwifery and third‐year medical students utilizing the Virtual Community Clinic Learning Environment (VCCLE). The VCCLE is a 3D, Web‐based, asynchronous, immersive clinic environment into which students enter to meet and interact with instructor‐controlled virtual patient and virtual preceptor avatars and then move through a classic diagnostic sequence in arriving at a plan of care for women throughout the lifespan. By participating in the problem‐based management of virtual patients within the VCCLE, students learn both clinical competencies and competencies for interprofessional collaborative practice, as described by the Interprofessional Education Collaborative Core Competencies for Interprofessional Collaborative Practice. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.     

Women's Health Care Minimum Data Set: pilot test and validation for use in clinical practice

Basic elements of the structure, process, and outcomes of midwifery practice have not been fully determined, particularly in the areas of women's gynecologic and primary health care. The American College of Nurse-Midwives (ACNM) supported the development of clinical data sets to describe structure, process, and outcomes of midwifery practice for use by clinical practitioners. The Woman's Health Care Minimum Data Set was developed using a panel of expert midwives and other women's health care professionals, as well as literature resources. Students of the Graduate Midwifery Program at Philadelphia University performed pilot testing of the Woman's Health Care Minimum Data Set as a service to the profession of midwifery while applying concepts learned in their research methods courses. Each student (n = 19) recruited a midwifery practice in which she had a clinical affiliation, and gathered data sets on the previous 30 consecutive women's health care encounters by CNMs or CMs (n = 569). Item analysis and refinement were done. Criterion-related validity and construct-related validity of the Woman's Health Care Minimum Data Set were explored through comparison with the medical record and through the testing of plausible hypotheses. The Woman's Health Care Minimum Data Set has the potential to be an important instrument in documenting and understanding the evolving nature of the practice of primary women's health care by midwives and other women's health care providers.     

Women’s use of complementary and alternative therapies in reproductive health care

Numerous studies have documented that health care consumers all over the world are spending money out of pocket for alternative therapies and that billions of dollars are spent in the United States alone. In this article, the use of complementary and alternative therapies by women health care consumers is discussed, particularly as this phenomenon relates to women’s reproductive health in the United States. Women use conventional health care services more frequently than men; thus, it is not surprising that women account for approximately two thirds of health care appointments for complementary and alternative therapies. The traditional conceptual frameworks of herbal medicine, homeopathy, acupuncture, and acupressure are presented, and common clinical applications to women’s reproductive care are discussed.