Effect of Internet+continuous midwifery service model on psychological mood and pregnancy outcomes for women with highrisk pregnancies

BACKGROUND There are many drawbacks to the traditional midwifery service management model,which can no longer meet the needs of the new era.The Internet+continuous midwifery service management model extends maternal management from prenatal to postpartum,in-hospital to out-of-hospital,and offline to online,thereby improving maternal and infant outcomes.Applying the Internet+continuous midwifery service management model to manage women with highrisk pregnancies(HRP)can improve their psycho-emotional opinion and,in turn,minimize the risk of adverse maternal and/or fetal outcomes.AIM To explore the effectiveness of a midwife-led Internet+continuous midwifery service model for women with HRP.METHODS We retrospectively analyzed the clinical data of 439 women with HRP who underwent prenatal examination and delivered at Shanghai Sixth People's Hospital(affiliated to the Shanghai Jiao Tong University School of Medicine)from April to December 2022.Among them,239 pregnant women underwent routine obstetric management,and 200 pregnant women underwent Internet+continuous midwifery service mode management.We used the State-Trait Anxiety Inventory,Edinburgh Postnatal Depression Scale,and analysis of delivery outcomes to compare psychological mood and the incidence of adverse delivery outcomes between the two groups.RESULTS The data showed that in early pregnancy,the anxiety and depression levels of the two groups were similar;the levels gradually decreased as pregnancy progressed,and the decrease in the continuous group was more significant[31.00(29.00,34.00)vs 34.00(32.00,37.00),8.00(6.00,9.00)vs 12.00(10.00,13.00),P<0.05].The maternal self-efficacy level and strategy for weight gain management were better in the continuous group than in the traditional group,and the effective rate of midwifery service intervention in the continuous group was significantly higher than in the control group[267.50(242.25,284.75)vs 256.00(233.00,278.00),74.00(69.00,78.00)vs 71.00(63.00,78.00),P<0.05].The incidence of adverse delivery outcomes in pregnant women and newborns and fear of maternal childbirth were lower in the continuous group than in the traditional group,and nursing satisfaction was higher[10.50%vs 18.83%,8.50%vs 15.90%,24.00%vs 42.68%,89.50%vs 76.15%,P<0.05].CONCLUSION The Internet+continuous midwifery service model promotes innovation through integration and is of great significance for improving and promoting maternal and child health in HRP.

Women’s knowledge and preferences for midwife’s role within the range of maternal care professionals in Makkah, Saudi Arabia

Background:The midwife plays a critical role in health counselling and education,not just for women but also for their families and communities.At the current time,with the growth of the midwifery workforce globally,there is still a lack of understanding regarding the full scope and role of the midwife.Aim:To evaluate the current situation of knowledge of midwives’role among women in Makkah.In addition,this study identifies the effect of women’s knowledge on their preferences for receiving maternity care from health professionals.Methods:This study employed a descriptive quantitative cross-sectional method.The total resultant sample size(N)equalled 379 global respondents,of which 306,with a response rate=of 80.73%completed the entire survey as requested.An electronic questionnaire in the Arabic language was used in this study.Results:Results revealed that most women had incorrect knowledge regarding three aspects of the midwives’roles during pregnancy 53.9%,labour 52.8%and childbirth 61.9%.Also,results presented that most women preferred obstetricians to follow up on an uncomplicated pregnancy,labour,childbirth,and maternity care 69.6%,53.9%,64.7%and 46.1%,respectively.The study found that the women’s knowledge about midwives’roles affects their preferences for healthcare professionals in receiving maternity care(P<0.05).Conclusion:Responses showed that most participants had no experience and had negative views about midwives’roles.Thus,it would affect their health professionals’preferences for receiving maternity care.Therefore,midwifery services and maternity care professionals should prioritize educating women about midwives’competencies in maternity care.

Study on the Effectiveness of the Application of Perineal Wound Model in Teaching Midwife Interns

Objective:To discuss and analyze the effectiveness of the application of perineal wound model in teaching midwife interns.Methods:The research subjects in this study were 40 midwife interns who enrolled in our hospital from January 2020 to December 2022,which were divided into a control group(consisted of 20 interns,taught with the conventional method)and a research group(consisted of 20 participants,taught with the perineal wound model)using the random number table method.The outcomes of these two groups were compared.Results:The examination results of the research group were better than control group(P<0.05);the interns of the research group were more satisfied towards the teaching method compared to the control group(P<0.05).Conclusion:Applying the perineal wound model in teaching midwife interns could effectively improve their examination achievements and teaching satisfaction,which brings a significant clinical value.

Midwife’s experiences of using intuition as a motivating element in conveying assurance and care

The expectations of a successful outcome during childbirth are high for all of the parties concerned. The overall objective of prenatal care and birth care is that midwives contribute to create the most positive experience for the expectant parents concerning their pregnancy, the actual childbirth and the child’s infancy. During the past thirty years, there has been a significant increase in Caesarean section frequency both in Sweden and in the rest of the Western World. More parents feel an overall insecurity when it comes to the labor phase leading up to childbirth. The purpose of this study was to describe how midwives experience their work of creating a sense of security and providing good nursing care when meeting with the expectant parents. A phenomenological approach was implemented using eleven qualitative interviews and these were analyzed with Giorgis’ method of analysis. The results of this analysis revealed three themes: organizational-professional conditions, the communicative ability of the midwives and their reflective-emotional competence. The ability of the midwives to trust their inner sensibility and intuition was something that was characteristic of all the interviews and consequently this was the essence of the results. Managements’ organization of the workload and how management utilized competent and experienced midwives affected the midwives’ ability to contribute to a sense of security and provide competent nursing care for expectant parents. When the communication was based on sensibility and compassion, the midwives’ were enabled to create a sound and trusting relationship between themselves, the MVC and with the expectant parents. The emotional involvement on the part of the midwives was an essential requirement for carrying out the work in a satisfactory manner. Perhaps a question for future research is how inner knowledge based on practical experience can benefit new personnel and how the organization and the education of healthcare providers can utilize the intuitive knowledge of midwives.

A Brief Overview of How Male Medicine Co-Opted the Midwife’s Role in the Birth Process

The term medicalization has been defined as the process by which non-medical issues come to be defined and treated as medical problems. There are no better examples of this than pregnancy and childbirth. Prior to the intervention of physicians and hospitals, most females delivered unassisted or assisted by a relative or a midwife who usually had no formal education. As long as this remained the practice, pregnancy could not become a medical procedure. Through systematic changes, discussed in detail herein, this primarily female-oriented event involving family and amateur aids would come to be dominated by males who were the sole legally authorized providers of obstetrical care [1]. The increasing cultural authority of medicine facilitated the transfer of home delivery to hospital delivery and changed normal birth into a surgical procedure. This paper will examine the history of obstetrics and how a profession comes to redefine a normal life event as a disease state.

Effects of midwife-led psychological intervention on delivery outcomes:a meta-analysis

Objective:To systematically review the influence of psychological intervention of midwives on the delivery mode and outcomes.Methods:Databases including Cochrane Library,PubMed,Medline,EMBASE,CINAHL,CNKI,Wangfang,and VIP were searched for randomized controlled trials studying the effects of midwife-led psychological nursing on puerpera.Two evaluators independently searched and screened the papers,extracted relevant data,and quality assessment of the included studies,followed by a meta-analysis of the papers using RevMan 5.3 software.Results:12 studies with 1,395 patients were included.The results of the meta-analysis showed that compared to conventional nursing,midwife-led psychological intervention can improve the number of people who choose natural delivery[Z=7.53,95%CI(2.07,3.45),P<0.001],shorten the duration of the first stage of delivery[Z=45.10,95%CI(-4.43,-4.06),P<0.001),reduce postpartum hemorrhage after delivery for two hours[Z=21.68,95%CI(-63.92,-53.32),P<0.001];these differences were statistically significant.Conclusion:Psychological interventions led by midwives can improve the natural delivery rate of pregnant women,shorten the duration of the first stage of delivery,and decrease postpartum hemorrhage after delivery for two hours;thus,it can be popularized for clinical use.

Exploration moving beyond medical facility walls:opportunities,challenges and attitudes of midwives towards planned homebirth:a qualitative

Background:The establishment of Saudi Vision 2030 has led to a shift from obstetric care to midwifery-led care in maternity care,giving rise to planned home birth(PHB).This study may enable midwives to carry out PHB and achieve the goals of the Saudi health vision.The general aim is to explore Saudi midwives’attitudes towards the PHB,opportunities and challenges associated with PHB implementation in Saudi Arabia.Methods:We employed a qualitative study design and conducted interviews using open-ended questions with 19 Saudi midwives recruited from thirteen health regions.Thematic analysis was manually performed to analyze the qualitative data.Results:Thematic analysis revealed seven major themes:midwives as care providers in PHB,health institutions,academic institutions,national policy for PHB,Women’s health status,socio-economic and physical environment suitability,and maternal and neonatal health outcomes.However,Saudi midwives would exhibit a favorable attitude towards PHB if decision-makers from the Ministry of Health and the Ministry of Education addressed the challenges and promoted opportunities for providers,organizations,and the population.Conclusion:The findings of the thematic analysis shed light on several positive aspects,including job opportunities and high financial incomes for midwives.However,they also revealed challenges such as a shortage of midwifery staff,a scarcity of midwifery academic programs,and an ineffective administrative support system for midwives.Integrating both sets of findings enhances the understanding of the challenges and opportunities of planned home birth in Saudi Arabia from various perspectives,capturing the breadth and depth of the obtained data.

Moving beyond medical facility walls:opportunities,challenges and attitudes of midwives towards planned homebirth

Background/Aims:The Saudi Vision 2030 program has introduced midwifery-led maternity care in Saudi Arabia,which includes facilitating planned home births.This study aimed to investigate Saudi midwives’attitudes to planned home birth and the opportunities and challenges associated with its implementation.Methods:The study used a descriptive cross-sectional quantitative study design,including all hospitals of the Saudi Ministry of Health and primary healthcare centers in Saudi Arabia.Data were collected concurrently from 301 midwives through the provider attitude toward planned home birth questionnaire.Descriptive analysis and inferential statistical analyses were used for quantitative data.Results:The midwives had a neutral attitude to planned home birth.There were significant differences in attitude according to age,education and health region.Seven major themes emerged:midwives as care providers,health institutions,academic institutions,national policy,women’s health,the socioeconomic and physical environment and maternal and neonatal health outcomes.Conclusion:Saudi midwives are likely to have a favorable attitude to planned home births if the Ministry of Health and Ministry of Education decision-makers eliminate the associated challenges and promote opportunities for providers,organizations and the population.

The eligibility criteria,training content,and scope of practice for prescriptive authority for midwives:a modified Delphi study

Objective:To investigate the necessary eligibility criteria for prescriptive authority for midwives,gather suggestions from experts on training content for prescriptive authority for midwives,and explore the scope of practice of their prescriptive authority in certain circumstances.The results of this study could serve as a reference for the development of policies on prescriptive authority for midwives.Methods:Based on a literature search and semistructured interviews,a modified Delphi method was first used to conduct 2 rounds of expert consultation on eligibility criteria and training content for prescriptive authority for midwives.This stage included nursing experts(20)and medical experts(16)engaged in midwifery in many tertiary Grade A hospitals in China.Subsequently,consultation on the scope of practice of prescriptive authority for midwives was conducted with nursing experts(18)and medical experts(14)engaged in midwifery in many tertiary Grade A hospitals in China.The suggestions from the experts were analyzed using statistical methods to confirm the eligibility criteria for prescriptive authority,training content,circumstances,scope of practice for prescriptive authority,and the prescription forms.Results:Among the consulted experts,70.59%(the highest acceptance rate)considered an undergraduate degree to be the minimum educational requirement for midwives to be eligible for prescriptive authority,85.29%(the highest acceptance rate)considered the supervisor nurse to be the minimum technical position experience necessary for midwives to be eligible for having prescriptive authority,and 50%(the highest acceptance rate)considered 5 years to be the minimum number of years of experience in the specialty for midwives to be eligible for prescriptive authority.The applicants should at least be practicing at Grade C hospitals,which was the consensus among 91.18%of the consulted experts.Among the consulted experts,100%,100%,97.06%,94.12%,and 94.12%agreed that the applicants should have knowledge in pharmacology,laws and ethics,nursing,diagnostics,and midwifery,respectively.The consulted experts confirmed 22 related course topics and identified 6 specific circumstances in which the midwives could partially practice prescriptive authority,including uterine atony,excessive uterine contraction,postpartum hemorrhage,premature rupture of fetal membranes,normal labor,and neonatal asphyxia.Under these 6 circumstances,the consulted experts commonly agreed that there were 20 medication prescriptions and 13 auxiliary examination prescriptions that could be prescribed by midwives.Of these prescriptions,51.5%were independent prescriptions,30.3%were protocol prescriptions,and the remaining 18.2%were both independent and protocol prescriptions.Conclusions:Midwives who have an undergraduate degree,supervisor nurse position,and 5 years of practice in Grade C hospitals are considered eligible to apply for prescriptive authority.Partial prescriptive authority could be granted after regulated training in fundamental theories and practices,which could improve the independence and professionalism of midwifery.

Re-discussing the content of the prescription rights of midwives under certain circumstances using the Delphi method

Objective： This study sought to investigate the content of the prescription rights and the prescription types of midwives under certain circumstances in China. Methods： The Delphi method was used to consult 18 nursing experts and 14 medical experts, A total of 30 experts finished the consulting. The reliability of the expert opinions was analyzed to determine the specific situations in which midwives may write prescriptions, the content of the prescription rights and the prescription types. Results： In six specific circumstances （uterine contraction fatigue, uterine contractions that are too strong, postpartum hemorrhage, premature rupture of the membranes, normal delivery and neonatal asphyxia）, midwives have the right to prescribe and administer medication, including 20 drugs and 13 auxiliary examinations. Of these drugs and examinations, 51.5% of the drugs and adjuvant examination prescriptions tend to be independent prescriptions, 30.3% tend to be protocol prescriptions, and 18.2% are similar to both types. Conclusions： The midwives should be granted some prescription rights to enhance their autonomy and the professionalism of midwifery.

A review of the definition and scope of practice of midwives in five representative countries

Objective： To review the definition and scope of the practice of midwives in Sweden, Finland, the United Kingdom, the United States, and Australia to find models and make suggestions for reforms in the midwifery policies of China. Methods： This article reviewed the midwifery policies published by authorities, organizations, and governments of these countries and relevant literature in the databases of PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature （CINAHL）, China National Knowledge Infrastructure （CNKI）, and Wanfang database. Results： The definition and scope of practice of midwives in five representative countries and China were reviewed. The similarities and differences in midwifery policies among them show that most countries set standards based on the definition and scope of practice of midwives recommended by International Confederation of Midwives. Conclusions： The definition of midwives should include registration, midwifery education, and acceptance standards. The scope of practice of midwives should specify an autonomous environment, the objective of care, the period of care involved, prescribing rights, emergency treatment, and health counseling.

Quality of Intrapartum Care: Direct Observations in Selected Health Facilities in Zambia

Approximately 303,000 women die annually while giving birth, worldwide, and more than 99% of the deaths occur in developing countries. In Zambia, a developing country situated in sub-Saharan Africa, most of the maternal mortalities occur during the intrapartum and immediate postpartum periods, arising from postpartum hemorrhage, sepsis, obstructed labor, and hypertensive disorders. Aim: The aim of this study was to assess the quality of intrapartum services provided in health facilities in the country. Methodology: Guided by a descriptive cross sectional design, data were collected from 264 women in labor using a World Health Organization validated observation checklist. Convenience sampling was used to recruit the women, while multistage sampling was used to select four health facilities. The Social Package for Social Sciences, version 23 was used to analyze the data. Results: One health facility met the World Health Organization 80% minimum standard in four out of the five categories used to measure quality in intrapartum care, while the other three met the minimum standard in one category each. Conclusion: Low numbers of midwives, inadequate supplies and equipment were major obstacles to following national and international agreed standards for providing optimal care during intrapartum period. Recommendations: There is need for local and national stakeholders in Zambia to urgently address the structural barriers that were observed, as well as invest in sufficient numbers of adequately trained and motivated midwives.

Manifestations of Abuse of Women in Childbirth in Public Hospitals in Ivory Coast: Case of Hospital Center Regional from Divo

The aim of this study is to describe the manifestations of abuse of women in childbirth. The techniques and tools for collecting data are documentary research, observation, questionnaire and interview. The study was based on a sample of 72 people determined according to the method of reasoned choice. As for data analysis, the method of processing is qualitative and quantitative. In terms of results, it should be noted that the average age of women in childbirth is 23 and those aged 16 - 24 represent the largest segment of the survey population. Most of these women are illiterate or drop out very early. They belong to several religious communities and are of various nationalities. Regarding the manifestations of mistreatment, we retain that they are of several types the most significant of which are verbal abuse, physical abuse, neglect and psychological abuse. These abuses have taken place for some women at their first or last delivery, at all their deliveries or at a single delivery. In general, young women between the ages of 16 and 25 are the most victims of mistreatment in childbirth. Various authors are at the origin of the mistreatment of women in childbirth. They are young midwives often single and childless.

Evidence-Based Practice among Critical Care Nurse’s/Midwives in Qatar

Background: Successful implementation of evidence-based research into clinical practice was determined by four core elements, self-belief, the nature and level of evidence, the conductive context into which the study is to be implemented, and organizational factors facilitating the process. Aim: The current study aimed to examine barriers influencing evidence-based practice among critical care nurses in QATAR. Methods: A cross-sectional survey was utilized for the study resulting in data collected from 278 nurses during the period of Feb-2021 to March 2021 using the Barriers to Research Utilization Scale (BTRUS). The BTRUS consisted of data on various information sources utilized by nurses for support in practice, potential barriers for evidence-based practice, and perceived skills on applying research-based evidence. Result: The most significant organizational barriers were lack of time, lack of empowerment to change practice, lack of support from colleagues in implementing research evidence, and lack of access to research articles. Self-perceived barriers were irrelevance of research evidence to current practice, studies having methodological flaws, skepticism about research findings, a large amount of research evidence, and inability to understand statistics. The Nurse’s age, years of nursing practice, academic attainment, and organizational position influenced self-reported barriers and utilization of sources of Evidence. Conclusion: Organizational support, improved self-belief, and evidence-based practice expertise may reduce barriers to implementing research evidence in clinical Practice.

The Recollection of Morning Sickness and Their Support System as Documented by Women Post Pregnancy

Nausea during pregnancy affects about ten percent of all pregnant women. The causes of nausea and vomiting during pregnancy are unclear. The condition can lead to dehydration, electrolyte derangement, impaired organ function and lead to serious health issues or even death if left untreated. The treatment conducted today is symptomatic and is not completely satisfactory. Objective: The purpose of the study was to describe women’s experience of morning sickness and their experience of support. Design: Data was collected through a semi-structured questionnaire and analyzed by qualitative content analysis. Participants: Nine women responded to the survey. Results: The result shows that women who suffer from morning sickness during pregnancy feel a loss of control over their lives which has a significant impact on their mental and physical health making it difficult to function normally. Feelings of isolation, loneliness and alienation are common. It is essential that midwives are attentive in order to provide the help and support that these women require. Conclusion: It is essential that the personnel providing the care are knowledgeable about the condition. More research is necessary to find the root cause of the condition in order to develop effective strategies for treatment.

The Use and Misuse of Mobile Phones in the Maternity Ward—A Threat to Patient Safety?

An important task for the midwife is following up mother-child interaction to facilitate mother-infant attachment. The aim of this study was to explore midwives’ perceptions of parents’ use of mobile phones in the maternity ward. The research question was: Is the use of mobile phones in the maternity ward a threat to patient safety? Two focus group interviews exploring midwives’ perceptions (n = 10) of parent’ use of mobile phones during and after the birth were conducted in January 2016. Systematic text condensation was used to analyse the data, revealing three themes pertaining to safety concerns: Interrupted communication due to parents’ excessive use of mobile phones during labour and postnatally, Unsafe care caused by lack of attention to the newborn baby’s signals as a result of being disturbed by the mobile phone and Unsafe care because of parents interrupting their conversation with the midwife by answering the mobile, acting in a disrespectful manner and failing to pay attention. The midwives’ descriptions of parents’ use of mobile phones in the maternity ward included reflections on mobile phone usage as a permanent phenomenon. They were concerned that parents’ use of mobile phones in the maternity ward could negatively affect the attachment process and considered that it interrupted their work. In conclusion, there is a need for increased awareness of parents’ use of mobile phones in the maternity ward. Further research is required to gain greater insight into the consequences of mobile phone use in order to promote patient safety by ensuring effective communication between parents and midwives. In addition, research is needed to explore the safety discourse, clinical risks and/or health problems involved in the development of infant-parent attachment in newborn babies.

Why obese women feel better about their“big”condition when they are pregnant:A qualitative study performed in Sweden

Overweight and obesity as measured by the body mass index (BMI) is an increasing problem worldwide according to the World Health Organization (WHO) [1]. Women having a body mass index greater than or equal to30 kg/m2 are considered to be obese and they run a greater risk of complications when they are pregnant. Complications such as high blood pressure, gestational diabetes, risk of intrauterine fetal death and slower delivery when giving birth to the baby are risks that can affect the well being of the woman and the child. According to the study on the women, the midwife’s most important role when meeting with the pregnant obese woman is to inform them about potential risks during pregnancy. The midwife must withhold judgment. For many women living with obesity means that they are not seen as the person they actually are. Obese women feel that they do not conform to the societal ideal of an attractive woman because of their size and because of other people’s prejudices regarding their obesity. When an obese woman becomes pregnant they may feel more comfortable with their standing in society because there is a happy explanation for the size of their abdomen. They experience that they are happy and proud about their stomach and this gives them a sense of relief and belonging.

Analysis of the Effect of Midwives’ Psychological Care Intervention on the Progress of Labor and Cesarean Rate of Elderly Women in Labor

Objective:To analyze the effect of midwife psychological nursing intervention in the clinical care of elderly women in labor.Methods:According to the order of admission,74 elderly women were divided into the control group and the observation group.In addition to the routine perinatal nursing interventions,the observation group strengthened the implementation of midwives’psychological nursing interventions.The duration of labor,mode of delivery,psychological state,and stress response indexes of the two groups were analyzed and compared.Results:The observation group had a shorter duration of all labor stages and total duration of labor than the control group,a lower cesarean section rate than the control group,and a higher degree of improvement in anxiety,depression,and stress response indexes in the 3-day postpartum period as compared to the control group(P<0.05).Conclusion:The implementation of midwife psychological care intervention in perinatal care of elderly women can further shorten the duration of labor,reduce the cesarean section rate,and improve the psychological state and stress indicators,which is worth promoting.