Midwifery care measures in the second stage of labor and reduction of genital tract trauma at birth: a randomized trial.
(73/480)
Genital tract trauma after spontaneous vaginal childbirth is common, and evidence-based prevention measures have not been identified beyond minimizing the use of episiotomy. This study randomized 1211 healthy women in midwifery care at the University of New Mexico teaching hospital to 1 of 3 care measures late in the second stage of labor: 1) warm compresses to the perineal area, 2) massage with lubricant, or 3) no touching of the perineum until crowning of the infant's head. The purpose was to assess whether any of these measures was associated with lower levels of obstetric trauma. After each birth, the clinical midwife recorded demographic, clinical care, and outcome data, including the location and extent of any genital tract trauma. The frequency distribution of genital tract trauma was equal in all three groups. Individual women and their clinicians should decide whether to use these techniques on the basis of maternal comfort and other considerations. (+info)
Dilemmas and paradoxes in providing and changing antenatal care: a study of nurses and midwives in rural Zimbabwe.
(74/480)
This paper describes the experiences of caregivers in a rural district in Zimbabwe, in caring for pregnant women within a context of changing antenatal care routines. Data were generated using individual interviews with 18 nurses and midwives. The caregivers experienced their working situation as stressful and frustrating due to high staff turnover, inconsistent policies, parallel programmes and limited resources, including time. They also faced difficulties when implementing some of the proposed changes. Furthermore, the caregivers had to deal with the pressure and resistance from the pregnant women, whose reasoning and rationale for using care appeared different from those of the health professionals. In light of the above, we stress the necessity for reflecting on and including the experiences and perspectives of caregivers and the users of care, as well as their contexts and realities, when implementing change. (+info)
Perinatal group B streptococcal disease prevention, Minnesota.
(75/480)
In 2002, revised guidelines for preventing perinatal group B streptococcal disease were published. In 2002, all Minnesota providers surveyed reported using a prevention policy. Most screen vaginal and rectal specimens at 34-37 weeks of gestation. The use of screening-based methods has increased dramatically since 1998. (+info)
The neonatal resuscitation training project in rural South Africa.
(76/480)
A paediatrician trainer from Australia (JT) spent 3 months in South Africa to assist with the development of neonatal resuscitation training in rural areas, particularly in district hospitals. The project was initiated by the Rural Health Unit at the University of the Witwatersrand and coordinated through the Family Medicine Education Consortium (FaMEC). The Rural Workforce Agency of Victoria together with General Practice and Primary Health Care Northern Territory covered the salary and international travel costs of the trainer, while local costs were funded by provincial departments of health, participants and a Belgian funded FaMEC project. The trainer developed an appropriate one-day skills training course in neonatal resuscitation (NNR), using the South African Paediatric Association Manual of Resuscitation of the Newborn as pre-reading, and a course to train trainers in neonatal resuscitation. From July to October 2004 he moved around the country running the neonatal resuscitation course, and, more importantly, training and accrediting trainers to run their own courses on an ongoing basis. The neonatal resuscitation course involved pre- and post-course multiple-choice question tests to assess knowledge and application, and, later, pre- and post-course skills tests to assess competence. A total of 415 people, including 215 nurses and 192 doctors, attended the neonatal resuscitation courses in 28 different sites in eight provinces. In addition, 97 trainers were trained, in nine sites. The participants rated the course highly. Pre- and post-course tests showed a high level of learning and improved confidence. The logistical arrangements, through the departments of family medicine, worked well, but the programme was very demanding of the trainer. Lessons and experiences were not shared between provinces, leading to repetition of some problems. A clear issue around the country was a lack of adequate equipment in hospitals for neonatal resuscitation, which needs to be addressed by health authorities. A process of ongoing training has been established, with provincial coordinators taking responsibility for standards and the roll-out of training. A formal evaluation of the project is planned. The project serves as a model for skills training in rural areas in South Africa, and for collaboration between organisations. A number of specific recommendations are made for the future of this NNR training project, which offer lessons for similar programmes. (+info)
Australian rural midwives: perspectives on Continuing Professional Development.
(77/480)
INTRODUCTION: Continuing Professional Development (CPD) provides an important counter to workforce pressures affecting rural midwives; however, there is a lack of information about how rural midwives understand and perceive CPD and how this is situated in the practising and social context. This research aimed to explore rural midwives' experiences and perceptions of CPD in context. METHODS: A qualitative approach gathered focus group data on the beliefs, opinions and perceptions of a total of 52 rural midwives (nine focus groups), across three Australian states: Western Australia, Victoria and Tasmania. The focus groups were taped and transcribed verbatim and data was analysed thematically using an inductive approach, with the aid of an NVivo (QSR Software, Durham, UK) computer program. RESULTS: Four key themes emerged from the data: midwives' views of CPD; their motivations for undertaking CPD; the choices they make around CPD; and how context factors facilitate their involvement in CPD. Congruence with issues evident in the literature were: the difficulties associated with role diversity, the need for acquiring key skills before engaging in CPD, and the importance of a culture supportive of ongoing learning. CONCLUSIONS: CPD can be considered an important strategy for the retention and professionalism of midwives. The study findings helped fill a gap in the literature about rural and regional Australian midwives' perspectives on CPD. (+info)
Roles, risks, and responsibilities in maternity care: trainees' beliefs and the effects of practice obstetric training.
(78/480)
OBJECTIVES: To document the content of practice obstetric vocational training, the beliefs of general practitioner trainees about the roles of midwives and general practitioners in maternity care, and the risks of providing such care; and to ascertain if undergoing such training affects their beliefs. DESIGN: Confidential postal questionnaire survey. SUBJECTS: Random one in four sample of all general practitioner trainees in the United Kingdom on vocational training schemes or in training practices in autumn 1990. MAIN OUTCOME MEASURES: Beliefs scored on seven point Likert scales and characteristics of trainer and training practice. RESULTS: Of 1019 trainees sent questionnaires, 765 (75.1% response rate) replied; 638 (83.3%) had done some part of their practice year. Of their trainers, 224 (35.1%) provided full obstetric care. 749 (99%) and 364 (48%) trainees believed that midwives and general practitioners respectively have an important role in normal labour; 681 (91.7%) trainees believed that general practice intrapartum care is a high risk "specialty." Those trainees whose trainers provide full obstetric care were significantly more likely to believe that both midwives and general practitioners have an important role in abnormal labour and to see the provision of intrapartum care as an incentive to join a practice. CONCLUSION: In this series most general practitioner trainees believed that both midwives and general practitioners have important roles in maternity care. Exposure of trainees to the provision of full obstetric care while in their training practice resulted in a more positive attitude towards the provision of such care by general practitioners. (+info)
The global network of WHO Collaborating Centres for nursing and midwifery development: a policy approach to health for all through nursing and midwifery excellence.
(79/480)
In response to the complexities of health services delivery within the context of cultures, world events, medical technologies, and natural and manmade disasters, WHO recognized the need for external resources to assist it to meet its goals. In line with WHO's policy that research in the field of health is best advanced by assisting, coordinating and utilizing the activities of existing institutions, WHO Collaborating Centres were developed to support WHO with external expertise at the local, country and international levels. Of the 1,000 Collaborating Centres worldwide representing all the major health disciplines, 36, in 19 different countries, are dedicated to nursing and midwifery services, education, research and policy. These 36 Centres have joined forces as the Global Network of WHO Collaborating Centres for Nursing and Midwifery Development. Since its inception in 1987, the Global Network has developed into a significant force in international nursing leadership. Its far-reaching sphere of influence, its communications technology and its ability to develop collaborative projects, enable it to have a significant impact on the health of the people of the world. (+info)
Socio-demographic factors associated with smoking and smoking cessation among 426,344 pregnant women in New South Wales, Australia.
(80/480)
BACKGROUND: This study explores the socio-demographic characteristics of pregnant women who continue to smoke during the pregnancy, and identifies the characteristics of the smokers who were likely to quit smoking during the pregnancy period. METHODS: This was secondary analysis of the New South Wales (NSW) Midwives Data Collection (MDC) 1999-2003, a surveillance system covering all births in NSW public and private hospitals, as well as home births. Bivariate and multiple logistic regression analyses were performed to explore the associations between socio-demographic characteristics and smoking behaviour during pregnancy. RESULTS: Data from 426,344 pregnant women in NSW showed that 17.0% continued to smoke during pregnancy. The smoking rate was higher among teenage mothers, those with an Aboriginal (indigenous) background, and lower among more affluent and overseas-born mothers. This study also found that unbooked confinements, and lack of antenatal care in the first trimester were strongly associated with increased risk of smoking during pregnancy. About 4.0% of the smoking women reported they may quit smoking during their pregnancy. Findings showed that mothers born overseas, of higher socio-economic status, first time mothers and those who attended antenatal care early showed an increased likelihood of smoking cessation during pregnancy. Those who were heavy smokers were less likely to quit during pregnancy. CONCLUSION: Although the prevalence of smoking during pregnancy has been declining, it remains a significant public health concern. Smoking cessation programs should target the population subgroups of women at highest risk of smoking and who are least likely to quit. Effective antismoking interventions could reduce the obstetric and perinatal complications of smoking in pregnancy. (+info)