Work and workload of Dutch primary care midwives in 2010

Objective

to re-assess the work and workload of primary care midwives in the Netherlands.

Background

in the Netherlands most midwives work in primary care as independent practitioners in a midwifery practice with two or more colleagues. Each practice provides 24/7 care coverage through office hours and on-call hours of the midwives. In 2006 the results of a time registration project of primary care midwives were published as part of a 4-year monitor study. This time the registration project was repeated, albeit on a smaller scale, in 2010.

Method

as part of a larger study (the Deliver study) all midwives working in 20 midwifery practices kept a time register 24 hours a day, for one week. They also filled out questionnaires about their background, work schedules and experiences of workload. A second component of this study collected data from all midwifery practices in the Netherlands and included questions about practice size (number of midwives and number of clients in the previous year).

Findings

in 2010, primary care midwives actually worked on an average 32.6 hours per week and approximately 67% of their working time (almost 22 hours per week) was spent on client-related activities. On an average a midwife was on-call for 39 hours a week and almost 13 of the 32.6 hours of work took place during on-call-hours. This means that the total hours that an average midwife was involved in her work (either actually working or on-call) was almost 59 hours a week. Compared to 2004 the number of hours an average midwife was actually working increased by 4 hours (from 29 to 32.6 hours) whereas the total number of hours an average midwife was involved with her work decreased by 6 hours (from 65 to 59 hours). In 2010, compared to 2001–2004, the midwives spent proportionally less time on direct client care (67% versus 73%), although in actual number of hours this did not change much (22 versus 21). In 2009 the average workload of a midwife was 99 clients at booking, 56 at the start of labour, 33 at childbirth, and 90 clients in post partum care.

Conclusion

the midwives worked on an average more hours in 2010 than they did in 2004 or 2001, but spent these extra hours increasingly on non-client-related activities.     

Swedish midwives' rating of risks during labour progress and their attitudes toward performing intrapartum interventions: a web-based survey

Objective

to study how Swedish midwives working in low-risk labour ward units rate intrapartum risks compared to their midwifery colleagues working in standard care labour wards. A second aim was to describe midwives' attitudes toward performing different types of interventions during a normal labour.

Design

an explorative study was carried out in 2009, using a web-based questionnaire containing 31 questions on midwives' risk ratings and attitudes to interventions during labour, as well as personal comments.

Setting

four labour ward units in Stockholm, Sweden. Two labour ward units with expected normal deliveries (‘low-risk’) and two standard care units with all types of deliveries.

Participants

seventy-seven registered clinically practicing midwives.

Findings

midwives in all units stated that factors to be considered for risk estimation were: previous delivery outcome, result of cardiotocography test (CTG) on admission to labour ward and quality of amniotic fluid. Midwives working at the low-risk units preferred to be more expectant during normal birth than their colleagues working at the standard care units. Examples of this were regarding second vaginal examination during labour (p=0.001) and/or amniotomy (p=0.012). Furthermore, midwives working at the low-risk units more often considered that first-time mothers could give birth without epidural analgesia during labour (p=0.019) and that the labouring woman should be encouraged to push according to her own spontaneous urge (p=0.040). Midwives at low-risk units were more reluctant to use an intravenous vein catheter than their colleagues at standard care units (p=0.001) and also to use oxytocin in order to augment contractions (p=0.013). Further, the open-ended question showed that attitudes to different types of interventions differed between midwives working at low-risk units or the standard care units working with all types of deliveries.

Conclusion

the Swedish midwives estimated risks similarly regardless of whether they worked in low-risk or in standard care units, but midwives working at low-risk units reported that they perform less routine interventions and have a more expectant attitude towards performing interventions.     

Perceptions of nearly graduated fourth year midwifery students regarding a ‘good midwife’ in the Netherlands

ObjectiveMidwifery students have the challenge to learn to be autonomous and capable midwives to ensure a safe and emotionally satisfying experience for mothers (to be) and their babies. They have to develop and acquire knowledge and skills for practice, and they have to adopt and internalize the values and norms of the midwifery profession in order to socialize as a midwife.In this study we explored conceptualisations of ‘good midwives’ among nearly graduated final year midwifery students as a result of their professional socialization process.DesignA cross-sectional study consisting of an one open-ended question was undertaken. Data was analyzed qualitatively, inductively and deductively by using Halldorsdottir’s theory of the primacy of a good midwife.SettingOne of three midwifery academies in the Netherlands in July 2016 were included.ParticipantsAll midwifery students (N=67) in their final year were included.FindingsStudent midwives gave broad interpretations of the features of a good midwife. Three themes - next to the themes already conceptualised by Halldorsdottir - were revealed and mentioned by nearly graduated Dutch midwifery students. They added that a good midwife has to have specific personal characteristics, organizational competences, and has to promote physiological reproductive processes in midwifery care.Key ConclusionsStudents’ views are broad and deep, reflecting the values they take with them to real midwifery practice. The results of this study can serve as an indicator of the level of professional socialization into the midwifery profession and highlight areas in which changes and improvements to the educational program can be made.     

国外集中群组孕期保健模式的应用研究进展

<正>孕期保健是降低孕产妇和新生儿死亡率,减少出生缺陷,保障母婴健康最重要的措施之一~([1])。近年来,我国孕期保健的内容在不断完善,技术与方法也趋向成熟。然而,保健的模式仍停留在传统的生物医学层面,主要关注产前疾病的筛查和诊断,对孕妇心理支持和社会支持有限。同时,由于孕期健康教育与孕期检查脱节,忽略了以孕妇为中心的理念,难以满足孕妇多样化、个性化的需求,导致孕期保健利用率不高~([2-3])。这种保健服务的供需矛盾,在二胎政策开     

助产士孕期营养指导对妊娠糖尿病患者母婴结局的影响

目的：探讨助产士孕期营养指导对妊娠糖尿病患者母婴结局的影响。方法：应用随机数字表法将2010年9月～2012年9月在我院产科收治的106例患者分为常规护理组和护理干预组,常规护理组患者在给予常规护理模式指导下的护理干预措施,而护理干预组患者则加用助产士孕期营养指导,比较两组患者母婴结局。结果：护理干预组患者剖宫产率、妊娠期高血压疾病、糖尿病急性并发症、羊水过多、孕期感染发生率、巨大胎儿、新生儿窒息、围生儿死亡发生率、性欲和性高潮明显低于常规护理组患者,有统计学意义（P〈0．05）;而新生儿转NICU治疗率明显高于常规护理组,有统计学意义（P〈0．05）。结论 助产士孕期营养指导能够提高自然分娩率,充分享受自然分娩带来的好处,改善母婴预后。     

A five year follow-up study of the Bristol pregnancy domestic violence programme to promote routine enquiry

Objective

a follow-up study to evaluate the degree to which practice changes identified in the 2004/2005 evaluation of the Bristol Pregnancy Domestic Violence Programme (BPDVP) for routine enquiry for domestic abuse have been maintained.

Methods

a multimethod approach was adopted, using a follow-up survey and focus groups.

Setting

an acute Trust within the South West of England.

Participants

58 midwives completed the survey, 73% (n=36) of whom had taken part in the original study in 2004/2005. Eleven of those surveyed also participated in focus group interviews.

Measurements

participating midwives completed a 54-item questionnaire, where possible the questions were the same as those utilised in the original follow-up questionnaire. Similar to the previous study, the questionnaire was divided into a number of sections, including view of professional education, knowledge of domestic violence and abuse, attitudes and efficacy beliefs, barriers and support. The aim of the focus groups discussion was to obtain the overall views of midwives with the regard to the on-going implementation of routine enquiry. Frequency distributions for midwife responses in 2010 were compared with the corresponding frequency distributions in 2004/2005 and a statistical assessment of differences was performed using the χ² test of association.

Results

midwives have to feel confident in their abilities to ask about abuse and the findings from this study demonstrate that across the cohort there was a tendency to have an increase in confidence in asking about domestic violence. Midwives have to feel confident in their abilities to ask about abuse. The findings from this study demonstrate that across the cohort there was a statistically significant increase in self-reported confidence in asking women about domestic abuse. In addition, there was a statistically significant increase in the degree of self-reported knowledge of how to deal with a disclosure of domestic violence when comparing the 2010 data with 2005 data.

Conclusions

results suggest that improvements in antenatal enquiry for domestic violence and abuse developed through the 2004/2005 BPDVP have improved over time, with the support of mandatory training. Nevertheless, barriers continue to exist, which include presence of a male partner and lack of face to face interpreting services, both these obstacles need to be addressed if all women and, in particular those who are most at risk of abuse are to be identified and supported.