Is caseload midwifery a healthy work-form? – A survey of burnout among midwives in Denmark

ObjectiveTo investigate the level of burnout among midwives working in caseloading practices compared to other models of midwifery care.Study design and settingIn this survey the Copenhagen Burnout Inventory was used to measure burnout among midwives working in a tertiary maternity unit Denmark.Main outcome measuresMean burnout scores and the proportion of midwives with high burnout scores (a score >= 50).ResultsThe response rate was 82.0% as 50 out of 61 midwives answered the questionnaire. In caseload midwifery the burnout scores in personal, work-related and client-related burnout were significantly lower when compared to “other models of care”. Among caseloading midwives, none had high scores of burnout in any of the measured domains. The proportions of high burnout scores among all of the participating midwives were 22% (95% CI: 12%–36%) in personal burnout, 20% (95% CI: 11%–34%) had high scores in work-related burnout, and 10% (95% CI: 4%–22%) had high scores in clientrelated burnout.ConclusionCaseload midwifery was associated with lower burnout scores, which is in accordance with the results from other studies on burnout among caseloading midwives. The proportion of high score among all the midwives in this study were low compared to results from other countries. According to the high response rate the results are valid for this maternity unit but this study is too small to be generalised. This study should be repeated among all midwives in Denmark. In studies of burnout in caseload midwifery the midwives’ self-selection into this workform needs consideration.     

地州级与县市级医疗机构助产士职业压力与应对方式的研究

目的：了解助产士职业压力与常用的应对方式,为促进护士健康提供参考依据。方法：采用问卷和国内常用的护士工作压力源量表,对124名助产士进行调查,并对结果进行分析。结果：助产士工作压力源主要来自职业风险、工作量和时间。结论：助产士的心理健康问题较突出,应针对助产士的职业特点,采取积极有效措施减轻工作压力,确保身心健康。     

Older nurses and midwives in the workplace: A scoping review

BackgroundAgeing workers are the fastest growing sector of the labour force. Older nurses and midwives encounter many challenges in the workplace and strategies are needed to support them to ensure successful working lives and improved workplace efficiency.AimThis scoping review aimed to identify challenges older nurses and midwives encounter in the workplace and the organisational support strategies required for them to remain in the workforce.MethodsUtilising a five-step scoping review framework, review questions were developed, a comprehensive search was undertaken, collected data was analysed using content analysis. Thirty-one studies were included in the review.FindingsChallenges specific to older nurses and midwives were identified: physical difficulties, tiredness, fatigue, treatment differences, lack of respect and lack of educational or promotional opportunities. Strategies were suggested by participants to support them at work, such as wellness programs, redeployment, flexible hours, support networks, recognition of knowledge and experience, improved workplace ergonomics, and ongoing education. However, there was very little evidence that organisational support strategies were available in the workplace.DiscussionChallenges for older nurses and midwives within the workplace were clearly addressed within the literature. While support policies have been advocated by older nurses and midwives, the review highlights the lack of evidence about how to best support them to continue to work to capacity.ConclusionEvidence shows the labour force is ageing and older nurses and midwives face challenges specific to their age, but further research is warranted to better understand which strategies will support them in the workplace.     

助产士职业危险因素分析及防护措施

职业暴露与职业安全已成为医护人员越来越关注的话题,尤其是在SARS暴发流行的初期在医护人员中迅速传播,给我们的职业防护敲响了警钟,通过对助产士职业危险因素进行简要分析,认为意外损伤和心理社会因素是影响助产士职业健康的主要因素,并提出了改变工作流程、防止意外损伤、学习相关法律知识、调整心理状态等防范职业危害的措施。     

Midwives' and doulas' perspectives of the role of the doula in Australia: a qualitative study

Objective

to explore midwives’ and doulas’ perspectives of the role of the doula in Australia.

Background

doulas are relatively new in Australia; nevertheless, demand for them is increasing. Research has not previously explored the role of a doula in Australia. This research aimed to answer the question: What are midwives’ and doulas’ perspectives of the role of a doula in Australia?

Design

qualitative study using focus groups that were digitally recorded, transcribed and the data analysed using thematic analysis.

Setting

New South Wales, Australia.

Participants

11 midwives and six doulas.

Findings

the key theme that emerged was that ‘the broken maternity system’ is failing women and midwives. The system is preventing midwives from providing woman- centred care. As a result, doulas are ‘filling the gap’ and midwives feel that doulas are ‘taking our role’. Doulas fill the gap by providing continuity of care, advocating for women, protecting normal birth and by providing breast-feeding advice and emotional support in the community. Midwives are concerned that doulas are taking the caring part of their role from them and want the ‘broken’ maternity system fixed. Midwives described that doulas take their role from them by changing the relationship between themselves and labouring women, by reducing their role to obstetric nurses, by overstepping the doula role boundaries, and by holding the power at births.

Implications for practice

despite the conflict reported between midwives and doulas, both groups identified that they see the potential for future collaboration. Taking into account the continued employment of doulas, it is important to improve collaboration between midwives and doulas for the sake of childbearing women.     

上海市助产人员上岗培训需求调查

目的:了解助产人员知识技能现状及培训需求,为优化助产培训模式提供参考。方法:对上海市55家接产医院182名接受上岗培训的助产人员采用自行设计的问卷进行调查。结果:①助产人员对产科急症识别与处理的正确率最低(68.68%),羊水栓塞的临床表现掌握欠佳(70.33%),判断胎儿监护异常的正确率为72.32%。②助产人员中84.10%为大、中专学历,61.00%为护理专业转岗。③助产人员培训需求为延长培训时间,增设人性化助产技术服务的内容。④助产人员对产程中高风险因素识别和处理技能培训需要加强。结论:为提高产科质量,急需加强助产队伍建设,规范助产人员培训。     

助产士组人员为孕妇提供连续性护理的效果评价

目的 探讨助产士组人员为孕妇提供连续性护理的效果.方法 将筛选的100例孕妇随机分为研究组和对照组各50例,研究组按照助产士组人员提供连续性护理的要求服务;对照组按照传统护理模式服务,比较不同护理措施对母婴的效果.结果 研究组孕产妇对产前认知行为的依从性高,自然分娩率高,母乳喂养率升高,孕产妇满意度提高,新生儿窒息率降低,产后抑郁症的发生率低,与对照组相比差异显著.结论 助产士组人员提供连续性护理能提高孕妇对产前认知、自然分娩率、母乳喂养率、产妇满意度、护理人员的综合素质,降低新生儿窒息率,减少产后抑郁症发生,提高了围生期保健质量.

Abstract：

Objective To investigate the effect of continuous care provided by midwife group personnel to pregnant women.Methods 100 cases of pregnant women were screened out and divided into the study group and the control group with 50 patients in each group randomly.The study group received continuous care provided by midwife group personnel,the control group received traditional nursing.Effect of different nursing measures on mothers and neonates were compared.Results Antenatal cognition and rate of natural delivery of the study group were higher than the control group.The rate of neonatal asphyxia and postpartum depression occurred in the study group were lower than the control group,Maternal and family sarisfaction and rates of breasffeeding of the study group were higher than the control group.Conclusions Continuoas care provided by midwife group personnel can increase antenatal cognition and rate of natural delivery,maternal and family satisfaction.breast feeding rates and the overall quality of nursing staff,reduce rate of neonatal asphyxia with few postpartum depression,then improve the quality of perinatal care.     

A pilot quasi-experimental study to determine the feasibility of implementing a partograph e-learning tool for student midwife training in Nairobi

Objective

the partograph is a tool used globally to record labour progress. Although it has the potential to improve maternal and neonatal outcomes, some midwives struggle with using it in practice. Training in partograph use is limited, and the theory is often divorced from practice. Innovative ways of improving training are urgently required. We therefore aimed to determine whether the use of an e-learning tool is beneficial for learning partograph skills.

Design

an uncontrolled before-and-after study was conducted, informed by Kirkpatrick's four-stage model of evaluation; we report on the first two stages. We included a cohort of third and fourth year midwifery students who were studying at one university in Nairobi. The same hypothetical case scenario was used, pre- and post-implementation of the World Health Organization partograph e-learning tool, to assess students' partograph completion ability. Views on the tool were also sought, using semi-structured questionnaires. Data were analysed using standard statistical techniques and framework analysis.

Findings

92 (88%) students participated. Students expressed positive views about the e-learning tool. However, the mean post-intervention score (27.21) was less than half of the maximum obtainable score. There was some improvement in test scores; year three mean score pre-intervention was 21.39 (SD 5.72), which increased to 25.10 (5.41) post-intervention (paired-t=3.47, p=0.001); year four mean score pre-intervention was 24.39 (5.98) which increased to 29.30 (6.77) post-intervention (paired t=3.85, df=91, p<0.001). In the post-test, year four students scored higher than year three students (unpaired t=3.28, df=90, p=0.001). Students were unable to plot cervical dilatation correctly, once established labour had been confirmed.

Key conclusion

e-Learning training is acceptable to student midwives and has the potential to be an effective means of teaching the practical application of the partograph. However, in this study, their inability to correctly plot transference from the latent to active phase of labour suggests that the partograph itself may be too complicated. Modifications and further evaluation of the e-learning tool would be required before any widespread implementation. Furthermore, students need the clinical support to operationalise their learning; educating qualified midwives and obstetricians to be positive role models when completing the partograph would be one potential solution. Further research is required, taking on board the recommendations from our pilot study, to investigate the impact of partograph e-learning on practice and clinical outcomes.     

Survey of prophylactic use of uterotonics in the third stage of labour in the Netherlands

Objective

aim of this study was to investigate current knowledge and practice regarding AMTSL in midwifery practices and obstetric departments in the Netherlands.

Design

web-based and postal questionnaire.

Setting

in August and September 2011 a questionnaire was sent to all midwifery practices and all obstetric departments in the Netherlands.

Participants

all midwifery practices (528) and all obstetric departments (91) in the Netherlands.

Measurements and findings

the response was 87.5%. Administering prophylactic uterotonics was seen as a component AMTSL by virtually all respondents; 96.1% of midwives and 98.8% of obstetricians. Cord clamping was found as a component of AMTSL by 87.4% of midwives and by 88.1% of obstetricians. Uterine massage was only seen as a component of AMTSL by 10% of the midwives and 20.2% of the obstetricians. Midwifery practices routinely administer oxytocin in 60.1% of births. Obstetric departments do so in 97.6% (p<0.01). Compared to 1995, the prophylactic use of oxytocin had increased in 2011 both by midwives (10–59.1%) and by obstetricians (55–96.4%) (p<0.01).

Key conclusions

prophylactic administration of uterotonics directly after childbirth is perceived as the essential part of AMTSL. The administration of uterotonics has significantly increased in the last decade, but is not standard practice in the low-risk population supervised by midwives.

Implications for practice

the evidence for prophylactic administration of uterotonics is convincing for women who are at high risk of PPH. Regarding the lack of evidence of AMTSL to prevent PPH in low risk (home) births, further research concerning low-risk (home) births, supervised by midwives in industrialised countries is indicated. A national guideline containing best practices concerning management of the third stage of labour supervised by midwives, should be composed and implemented.