Experiences of midwifery care in English prisons

Background

In the United Kingdom (UK), all prisoners must receive healthcare equivalent to that available in the community. However, evidence suggests that equality in healthcare provision for perinatal women in UK prisons is not always achieved. The aim of this research was to examine pregnant women prisoners' and custody staffs' experiences and perceptions of midwifery care in English prisons.

Methods

A qualitative approach based on institutional ethnography was used to research women's experiences in three English prisons over a period of 10 months. In total, 28 women participated in audio-recorded, semi-structured interviews. Ten staff members were interviewed, including six prison service staff and four health care personnel. Ten months of prison fieldwork enabled observations of everyday prison life. NVivo was used for data organization with an inductive thematic analysis method.

Results

Women's experiences included: disempowerment due to limited choice; fear of birthing alone; and a lack of information about rights, with a sense of not receiving entitlements. Some women reported favorably on the continuity of midwifery care provided. There was confusion around the statutory role of UK midwifery.

Discussion

Experiences of perinatal prisoners contrast starkly with best midwifery practice—women are unable to choose their care provider, their birth companions, or their place of birth. In addition, a reliance upon “good behavior” in return for appropriate treatment may be detrimental to the health, safety, and well-being of the pregnant woman and her unborn baby.

Conclusion

Prison is an adverse environment for a pregnant woman. This study provides key insights into imprisoned women's experiences of midwifery care in England and shows that midwives play an essential role in ensuring that perinatal prisoners receive safe, high-quality, respectful care.     

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.     

Ethical considerations related to the inclusion of women in clinical trials

Clinical trials are the primary way the most promising new preventive, diagnostic, therapeutic, and palliative measures move from the basic science laboratory to the bedside. Attracting participants to clinical trials occurs at a painstakingly slow pace, delaying the public's access to new care modalities. Additional ways are needed to increase the public's awareness and understanding of the important role of clinical trials. As key members of the health and social welfare promotion team, nurse-midwives/midwives are well positioned to help advance the public's access to clinical trials information. Generic ethical issues related to human subjects review processes, their specific application to clinical trials, and the impact of recent HIPAA legislation are discussed.     

Clinical teaching and learning in midwifery and women's health

Although there is an abundance of literature about clinical teaching in the health professions, a much smaller body of information focuses on the art and science of clinical teaching in midwifery and women's health. We reviewed preceptor handbooks, training manuals, and Web sites created by nursing and nurse-midwifery education programs, medical and pharmacy schools, and national associations of health professionals. Using the search terms "clinical teaching, clinical learning, preceptor, clerkship, residency training, and midwifery education", we searched the MEDLINE and CINAHL databases and health sciences libraries for relevant articles and books. The information and practical strategies about clinical teaching that we found are synthesized and presented in this article. It includes a discussion of challenges in clinical teaching; an overview of expectations and responsibilities of the education program, students, and preceptors; suggestions about orienting students to clinical sites; clinical teaching strategies and skills; suggestions for incorporating critical thinking and evidence-based care into clinical teaching; guidelines for giving constructive feedback and evaluation; characteristics of excellent clinical teachers; and suggestions about how education programs and professional associations can support and develop clinical sites and preceptors. The Appendix contains manuals, books, and Web sites devoted to clinical teaching.     

Improving midwifery practice: the American College of Nurse-Midwives' benchmarking project

By learning that a much better way of doing something may be possible, midwives can stimulate interest by making changes that previously were thought unnecessary or unachievable. In this way, benchmarking becomes a positive and proactive goal-setting process used to change practice. In addition, by accepting responsibility for managing care and cost and using benchmarking to identify the most efficient and effective methods for meeting all of their customer’s needs, midwives will be able to document their effectiveness in terms of cost, quality, and satisfaction. The resulting improvement in quality of care rendered will reduce medical errors and liability risk. Promotion and evaluation of high quality care are priorities for the midwifery profession. Midwives who value their autonomy must accept the responsibility for maintaining high standards of practice.     

The outcome of midwife-led labor in low-risk women within an obstetric referral unit

Objective: To analyze maternal and neonatal outcomes of midwife-led labor in low-risk women at term.

Methods: Prospective observational cohort of 1788 singleton low-risk pregnancies in spontaneous term labor, managed according to a specific midwife-led labor protocol. Primary outcomes were mode of delivery, episiotomy, 3rd–4th degree lacerations, post-partum hemorrhage (PPH), need for blood transfusions, pH and Apgar score and NICU admissions.

Results: A total 1754 low-risk women (50.3% of all deliveries) were included in the analysis. Epidural analgesia was performed in 29.8% of cases. The rate of cesarean section was 3.7%. Episiotomy was performed in 17.6% of women. PPH?>?1000?ml occurred in 1.7% of cases. 3.2% and 0.3% of the cases had an Apgar score <7 and pH?Conclusions: In hospital settings, midwife-led labor in low-risk women might unfold its major advantages without additional risks of medicalization for the mother and the neonate.     

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.     

One-to-one midwifery: restoring the "with woman" relationship in midwifery

One-to-One Midwifery, a model of care developed in the United Kingdom, provides a continuous and personal relationship between each woman and her midwife. The organization of care and the outcomes are relevant to midwifery policy in all industrialized countries. One-to-One Midwifery is not solo practice. An important principle of the organization of the practice is to enable individual midwives to take time off and to provide supportive structures for the midwives. Here the implications of One-to-One Midwifery for childbearing women and their families, and the midwives involved, are explored. The One-to-One Midwifery model has particular relevance for Canada because it is very similar to the model of practice being developed in at least two provinces. It may also be of importance in the United States, particularly for midwives working shifts in hospitals who may want to develop a system that allows them to provide continuity to the women they serve.     

Reclaiming birth, health, and community: midwifery in the Inuit villages of Nunavik, Canada

This article describes the Inuulitsivik midwifery service and education program, an internationally recognized approach to returning childbirth to the remote Hudson coast communities of Nunavik, the Inuit region of Quebec, Canada. The service is seen as a model of community-based education of Aboriginal midwives, integrating both traditional and modern approaches to care and education. Developed in response to criticisms of the policy of evacuating women from the region in order to give birth in hospitals in southern Canada, the midwifery service is integrally linked to community development, cultural revival, and healing from the impacts of colonization. The midwifery-led collaborative model of care involves effective teamwork between midwives, physicians, and nurses working in the remote villages and at the regional and tertiary referral centers. Evaluative research has shown improved outcomes for this approach to returning birth to remote communities, and this article reports on recent data. Despite regional recognition and wide acknowledgement of their success in developing and sustaining a model for remote maternity care and aboriginal education for the past 20 years, the Nunavik midwives have not achieved formal recognition of their graduates under the Quebec Midwifery Act.     

Human Trafficking: The Role of the Health Care Provider

Human trafficking is a major public health problem, both domestically and internationally. Health care providers are often the only professionals to interact with trafficking victims who are still in captivity. The expert assessment and interview skills of providers contribute to their readiness to identify victims of trafficking. The purpose of this article is to provide clinicians with knowledge on trafficking and give specific tools that they may use to assist victims in the clinical setting. Definitions, statistics, and common health care problems of trafficking victims are reviewed. The role of the health care provider is outlined through a case study and clinical practice tools are provided. Suggestions for future research are also briefly addressed.     

Distance education to prepare nursing faculty in Eritrea: diffusion of an innovative model of midwifery education

The World Health Organization has identified 56 countries with critical health care provider shortages. This article describes an innovative collaboration between Stony Brook University, Stony Brook, NY, and the University of Asmara, Eritrea, aimed at increasing the number of qualified nursing faculty in Eritrea. Eritrean graduate nursing students used distance education technologies and in-country clinical support to complete a program of study that prepared them for an advanced practice nursing and faculty role. The 10 students were all highly successful and graduated in 4 semesters. These students and the Stony Brook faculty who supported them from the United States provided feedback and recommendations for future programming. The article provides key recommendations to other universities considering distance education collaboration to help build nursing capacity in developing countries. First, ensure bilateral understanding of the differences between the health care and educational systems in the partner countries. Second, select appropriate educational technology considering both technical and human factors. Third, ensure that students and faculty are sufficiently prepared for success. Fourth, maintain a strong focus on clinical education. Finally, remain flexible through program implementation, working together with students to adjust the program to address local needs and challenges.     

Screening for pesticide exposure: a case study

Pesticide use is ubiquitous in the United States in both agricultural and urban environments. Although pesticide exposure can occur anywhere, migrant and seasonal farmworkers in medically underserved communities are at particular risk. Health care providers often feel ill-equipped to recognize or manage pesticide exposure or pesticide-related illness. In 2002, the National Environmental Education Foundation published a series of reports that describe national goals for improving the recognition, management, and prevention of pesticide-related health conditions. This article illustrates how to diagnose and manage pesticide exposures by analyzing a pesticide exposure case using a framework suggested by the National Environmental Education Foundation. Basic screening techniques and available resources for use in the primary care setting are presented.     

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.     

Conducting international research in midwifery: a workshop held at the ICM Congress, Vienna, April 2002

A workshop on international research in midwifery was held at the International Confederation of Midwives (ICM) Triennial Congress in Vienna, April 2002. Thirty-five participants from 12 countries took part. The participants themselves defined the agenda, and subsequent discussion addressed the following issues: international research relationships and collaboration; ethical conduct in international research in midwifery; the role of the International Confederation of Midwives in international research; and identifying topics for an international midwifery research agenda. Recommendations arising from this workshop were as follows: develop guidelines and a code of ethics for the conduct of international research in midwifery; continue to actively support research and further develop that support; support education and capacity building for research at basic and continuing education levels; and update on a regular basis the priorities identified for collaborative international studies.     

Returning birth: The politics of midwifery implementation on First Nations reserves in Canada

Objective

to explore the role of midwives in the implementation of an elective birthing programme in one remote First Nation community in Canada, and to identify current barriers and challenges to the practice of midwifery in these settings

Design

the study is a multisited ethnography based on 15 months of fieldwork in Manitoba, Canada. Thirty-nine individual qualitative, semi-structured interviews were completed. The data from the interviews were coded into themes and presented in the paper.

Setting

the study focuses on one First Nation community and their process of implementation of midwifery services. This case study is used to address broader themes of midwifery and policy at a national level.

Participants

participants included Aboriginal midwives from across Canada, policy makers from provincial and federal jurisdictions, medical professionals involved in Aboriginal health care, Aboriginal political leadership, and Aboriginal women and their families.

Findings

national policy and issues of jurisdiction among levels of government were shown to be a barrier to midwifery implementation.

Key conclusions

the current policy of evacuation in most Aboriginal communities does not effectively address the Millennium Development Goal of having a skilled birth attendant at every birth. The role of midwifery is central to the process of returning birth to Aboriginal communities, and steps must be taken at both the policy and clinical level to ensure that midwifery implementation and education can become an option for all Aboriginal communities in Canada.

Implications for practice

when considering midwifery implementation in communities, midwives must engage in both political and clinical negotiations to ensure their ability to practice effectively. Understanding the complexity of the policy discourse, along with the place of midwifery within the existing clinical guidelines is integral to the success of this process.     

The limits of compromise: the range of perspectives on women's reproductive rights in Poland

Objectives: A discourse analysis was carried out to identify how women's reproductive rights and needs are reflected in pro-life and pro-choice public debate in Poland.

Methods: The research procedure was based on the need to answer the question: how do pro-life and pro-choice discourses define women's reproductive rights in Poland (including the right to abortion)? Discourse analysis was applied to answer this question. The analysis covered materials published in rightist-conservative and leftist-feminist social-political portals and in popular media during the period 2009–2014, when the so-called ‘abortion compromise’ was in force, and the period 2016–2017, when a proposal for an absolute ban on abortion caused women to protest throughout Poland.

Results: Our research showed that construction of the analysed discourses is of a processual nature. Owing to social changes, both discourses have become strongly radicalised. The rightist-conservative discourse is emotional and criticising, restricting women's rights to the benefit of the rights of the fetus. The leftist-feminist view is oriented towards emphasising freedom of choice and observing women's rights.

Conclusion: The pro-life movement’s discourse may be defined as promoting the restriction of women’s reproductive rights, while leftist-feminist discourse may be seen as promoting women’s reproductive rights.     

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.