BACKGROUND & AIMS: :This study aimed to examine factors associated with utilization of village midwife and other trained delivery attendants for home deliveries. Information from 14,672 cases of the most recent home deliveries of mothers in the 5 year-period prior to the Indonesia Demographic and Health Survey 2002/2003 and 2007 were analysed. Multinomial logistic regression analysis was performed. The association between 26 factors categorised into external environment, predisposing, enabling, need and previous utilization of maternal health services, and utilization of village midwife and other trained delivery attendants, such as nurses, other midwives and doctors, for home deliveries was examined. The population attributable risk of selected significant predictors was calculated. The odds of using village midwives and other trained delivery attendants at childbirth for home deliveries increased with increasing household wealth index and levels of parental education. The odds increased among first birth, mothers who were exposed to mass media, mothers with knowledge of delivery complications, and mothers who had any delivery complications. However, mothers who attended less than four antenatal care visits, who had high parity, or who reported distance and transportation to health facilities was a major problem, had significantly reduced odds for utilizing any trained delivery attendants. Health promotion strategies to raise community awareness about the importance of safe delivery should target low educated parents, mothers from low household economic status, as well as high parity mothers. Efforts to promote antenatal care visits are likely to increase utilization of trained delivery attendants for home deliveries in Indonesia.

背景与目标： : 这项研究旨在研究与利用乡村助产士和其他训练有素的送货服务员进行家庭送货有关的因素。分析了印度尼西亚人口与健康调查2002/2003和2007之前5年期间14,672例母亲最近一次在家分娩的信息。进行多项logistic回归分析。研究了26个因素之间的关联，这些因素分为外部环境，孕产妇保健服务的诱因，使人，需要和以前的利用，以及乡村助产士和其他受过训练的分娩服务员 (例如护士，其他助产士和医生) 的家庭分娩。计算选定重要预测因子的人群归因风险。随着家庭财富指数和父母教育水平的提高，在分娩时使用乡村助产士和其他训练有素的分娩服务员进行家庭分娩的几率增加。首次分娩，接触大众媒体的母亲，了解分娩并发症的母亲以及有任何分娩并发症的母亲的几率增加。然而，参加不到四次产前检查的母亲，她们的均等程度很高，或者报告说距离和到卫生设施的交通是一个主要问题，她们利用任何训练有素的分娩服务员的几率大大降低了。提高社区对安全分娩重要性的认识的健康促进战略应针对受教育程度低的父母，家庭经济状况低的母亲以及均等的母亲。在印度尼西亚，促进产前护理就诊的努力可能会增加训练有素的分娩服务员在家分娩的利用率。

BACKGROUND & AIMS: :The purpose of this study was to evaluate Denizli midwives' self-reported knowledge of genetic diseases and genetic counseling. Data was collected on forms that obtained information about midwives approaches to basic genetics, genetic disorders, and genetic counseling (response rate = 70.1%). The highest response rate of midwives describing themselves as "knowledgeable" about basic genetic information was for mitosis and meiosis with 4.8%, about genetic disorders was for phenylketonuria with 61.1%, and about genetic counseling was for recommending ultrasonography during pregnancy with 98.1%. The source for basic genetics information for 56.4% of participants was in their school level classes. None of the midwives felt that they had sufficient knowledge about genetic counseling or screening and 76.4% would like to attend an educational course. Even though the midwives have recognized their knowledge deficit they occasionally give genetic counseling. As a result of this study a genetics course is planned for midwives so they can actively participate in the prevention and early diagnosis of genetic diseases.

背景与目标： : 这项研究的目的是评估Denizli助产士自我报告的遗传疾病和遗传咨询知识。收集有关助产士基本遗传学，遗传疾病和遗传咨询方法的信息的表格数据 (反应率 = 70.1%)。描述自己对基本遗传信息 “了解” 的助产士的最高反应率是有丝分裂和减数分裂伴4.8%，遗传性疾病是苯丙酮尿症伴61.1%，遗传咨询是推荐妊娠期间超声检查伴98.1%。56.4% 参与者的基本遗传学信息来源是他们的学校班级。没有一个助产士觉得他们对遗传咨询或筛查有足够的知识，76.4% 愿意参加教育课程。即使助产士已经意识到自己的知识不足，他们偶尔也会进行遗传咨询。这项研究的结果是计划为助产士开设遗传学课程，以便他们能够积极参与遗传疾病的预防和早期诊断。

BACKGROUND & AIMS: OBJECTIVE:to gain an understanding about midwives' experiences of providing a continuous supportive presence in the delivery room during childbirth, and to learn about factors that may affect this continuous support. DESIGN/SETTING:qualitative study at a maternity unit in Norway, where about 4000 births take place each year. In-depth interviews were conducted with ten midwives working in two different maternity wards. The qualitative data were analysed using systematic text condensation. FINDINGS:the analysis generated three main themes: relational competence, the midwife's ideology, the culture and philosophy of the maternity unit. The midwives identified being mentally present and actively developing mutual trust with the woman in labour as two very important factors for building a relationship with her. They suggested that the midwife's first encounter with the woman is a key opportunity for establishing rapport during labour. Successfully providing a continuous presence during labour fostered the midwives' perception of themselves as a 'good midwife'; this was considered a feature of holistic care and health promotion. The workload in the unit sometimes made it difficult for them to provide a continuous presence in the delivery room. The midwives experienced feelings of inadequacy when they felt that they had too little time available for the woman in labour. KEY CONCLUSIONS:midwives' skill in building a relationship with the woman in labour combined with their values and understanding of the midwifery profession are important factors influencing their decision to provide a continuous presence during childbirth. If it is policy that maternity units should provide continuous support to women in labour, managers should ensure that it is actually provided.

背景与目标：

BACKGROUND & AIMS: :A systematic search of studies of intrapartum management of the nuchal umbilical cord at term found no published controlled studies in this area. A postal survey containing both structured and open questions and a request for local protocols and guidelines was sent to all 637 midwives in 7 maternity units in England. There were 401 (63%) responses. There appeared to be no unit guidelines for this area of practice. Midwife approaches to nuchal cord during birth varied, and included clamping and cutting of loose nuchal cords and a hands-off approach to tight nuchal cords. Reasons for specific actions included doing what had been taught during midwifery training and learning from previous personal experiences. Theories of diffusion of innovation and of planned behaviour may provide a conceptual basis for understanding the adoption of specific practices. Future qualitative and controlled studies are needed to explore the nature and consequences of varying approaches to intrapartum nuchal cord management.

背景与目标： : 对足月胎儿脐带产时管理研究的系统搜索发现，该领域未发表对照研究。向英格兰7个产科单位的所有637名助产士发送了一份包含结构化和开放性问题的邮政调查，并要求提供当地协议和指南。有401 (63%) 个响应。这一实践领域似乎没有单位准则。助产士在出生时对脐带的方法各不相同，包括夹紧和切割松散的脐带，以及对紧脐带的不手方法。采取具体行动的原因包括做助产培训期间所教的事情以及从以前的个人经验中学习。创新传播和计划行为的理论可以为理解特定实践的采用提供概念基础。需要进行未来的定性和对照研究，以探索不同的产时脐带管理方法的性质和后果。

BACKGROUND & AIMS: INTRODUCTION:Home birth remains a strong preference and village midwives are the only option for maternal and neonatal care for many rural women in Sudan. This study assessed whether interventions such as strengthening linkages among health facility/staff, skilled birth attendants and village midwives (VMWs); strengthening the supervision system; and strengthening the governance capacity of local health departments improved their service delivery, and it examined factors linked with improved performance of VMWs in their communities. METHODS:This descriptive study comprised a cross-sectional baseline survey, two intervention years and an endline survey. Data collection involved in-depth, semi-structured questionnaire interviews. Fifty-seven VMWs and 151 community women were targeted for the study in Sinnar, a south-eastern state of Sudan. Participants were interviewed about demographic information, perceptions of operational barriers, training provided, function in the community, supervision and referral for emergency cases. RESULTS:Results showed the monthly average number of VMW-assisted home births increased from 1.4 at the baseline survey in October 2011 to 3.3 at the endline survey in October 2013. The annual average number of emergency cases referred by VMWs increased from 1.6 to 3.5, and the percentage of VMWs using official monthly reports increased from 33% to 80%. VMWs reported improved bonds with their supervisors and relationships in the community. CONCLUSION:Improved service provision may be associated with development of supervision systems for VMWs, active provision of community activities, strengthened linkages between health facilities and VMWs and enhanced community trust of VMWs. Given issues such as shortages and poor retention of human resources for maternal and newborn health service delivery in particular settings, international communities should focus on strengthening capacity of community midwives for home births as a realistic measure.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:The antenatal period is associated with a decline in physical activity among women. Midwives are viewed central to the dissemination of information during pregnancy, however, there is little research relating to their promotion of physical activity. The purpose of this study was to gain insight into midwives' perspectives of providing physical activity advice and guidance to pregnant women METHODS: Community midwives (N = 10) from ten randomly selected antenatal clinics in England took part in semi-structured interviews which were audio recorded, transcribed and analysed thematically RESULTS: In relation to perceived role and responsibilities in providing physical activity advice and guidance, midwives emphasised the extent to which their profession has evolved, the perceived burden of responsibility, and the tick box approach to physical activity discussion. Midwives identified a lack of training, knowledge, confidence, time, resources, and perceptions of vulnerability as barriers to effective physical activity promotion. Despite these issues midwives proposed eight opportunities to facilitate pregnant women's physical activity engagement: (1) recognising and addressing barriers in the uptake and maintenance of physical activities, (2) professional development, (3) inter-professional collaboration, (4) communicating effectively through simple, reliable resources, (5) improved access, availability, and awareness of suitable activities in the local community, (6) encouraging a support network, (7) "selling" physical activity by challenging misconceptions and focusing on benefits, and (8) suitable motivation, incentives and reward. CONCLUSIONS:These opportunities identified by midwives provide foundations from which improvements in practice can result. Whilst midwives are ideally placed to promote physical activity as part of a healthy pregnancy, this is likely to be most effective as part of a wider network of practitioners that share consistent and confident messages regarding physical activity engagement. This notion has far reaching implications for practice, policy, research and the normalisation of active pregnancies in the wider population.

背景与目标：

BACKGROUND & AIMS: AIM:This paper reports a study examining midwives' perceptions of the way in which they diagnose labour. BACKGROUND:Diagnosis of active labour is often problematic. A midwifery workforce planning tool identified that up to 30% of women admitted to United Kingdom labour wards subsequently turned out not to have been in labour. There is evidence that if a woman is admitted to a labour ward in early labour, she is more likely to have some form of medical intervention. However, despite the impact of misdiagnosis, there is little research on the process of decision-making by midwives in relation to diagnosis of labour. METHODS:This was a qualitative study, employing focus group methods. Participants were a convenience sample of midwives working in a maternity unit in the North of England during 2002. They were asked to discuss their experience of admission of women in labour. Data were analysed using latent content analysis. FINDINGS:Thirteen midwives participated in one of two groups. They described using information cues, which could be separated into two categories: those arising from the woman (Physical signs, Distress and coping, Woman's expectations and Social factors) and those from the institution (Midwifery care, Organizational factors and Justifying actions). Midwives' decision-making process could be divided into two stages. The diagnostic judgement was based on the physical signs of labour: the management decision would then be made by considering the diagnostic judgement as well as cues such as how the woman was coping, her expectations and those of her family and the requirements of the institution. CONCLUSIONS:Midwives may experience more difficulty with the management decision than with the initial diagnosis. It may be that the number of inappropriate admissions to labour wards could be reduced by supporting midwives to negotiate the complex management hurdles, which accompany diagnosis of labour.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Intimate partner violence (IPV) during pregnancy may jeopardize maternal and fetal health (IJFWM 49:159-164, 2004; IJGO 133:269-276, 2016). In recognition of the significant public health impact of IPV, the Norwegian Directorate of Health issued new guidelines in 2014, which recommend that health professionals routinely ask all women in antenatal care about their exposure to violence. The objective of this study was to gain an in-depth understanding of midwives' experiences with routine enquiry for intimate partner violence during the antenatal period. METHODS:The study had a qualitative design. Individual semi-structured interviews with eight midwives providing antenatal care at eight Mother and Child Health Centres (MCHC) in Norway were conducted. Graneheim and Lundmans method of content analysis inspired the analysis. RESULTS:Three main themes emerged: Midwives do ask about violence; It can be a challenge; and Factors that make it easier to ask. All midwives enquired, but not on a regular basis, about violence. The midwives' personal interest in the topic was an important factor that made it easier for them to ask about violence. Lack of time, fear of not knowing how to deal with a positive answer and lack of organizational support were barriers to asking pregnant women about their experiences of violence. CONCLUSION:Midwives were aware of the guidelines and made some efforts to implement them. However, further education and organisational support is needed to enable midwives to routinely ask all pregnant women about IVP.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:to explore the use of language by midwives reporting their experiences of baby-feeding practice. DESIGN:A qualitative approach incorporating a secondary analysis of data previously collected in a study based on grounded theory principles. Data were collected using in-depth interviews. The secondary analysis involved a content analysis method. SETTING:two maternity services in the north of England. PARTICIPANTS:30 midwives who worked across all clinical areas. FINDINGS:these midwives' explanations of how they supported women with baby feeding suggest that they used language to direct women towards decisions that the midwives thought best, without prior exploration of the woman's understanding and beliefs of baby feeding. Women were often described as 'girls' and 'ladies' indicating the power differentials in their relationship. The midwives were aware that, at times, the language they used was contradictory to woman-centred maternity care. KEY CONCLUSIONS:language may be used to control childbearing women and direct them to decisions that the midwife wants, rather than enabling the woman to make her own decisions. The terms used by midwives to relate to women, such as 'girls' and 'ladies', may be a strategy used to improve a midwife's perception of her status in maternity care. IMPLICATIONS FOR PRACTICE:language may be used to undermine women. It is important that the language used when interacting with women is considered carefully in order to facilitate an unbiased perspective and to promote partnership. The word 'women', rather than 'girls' or 'ladies', should be used when referring to users of the maternity services.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:Insight into perspectives and values of care providers on episiotomy can be a first step towards reducing variation in its use. We aimed to gain insight into these perspectives and values. SETTING:Maternity care in the Netherlands. PARTICIPANTS:Midwives, obstetricians and obstetric registrars working in primary, secondary or tertiary care, purposively sampled, based on their perceived episiotomy rate and/or region of work. PRIMARY AND SECONDARY OUTCOME MEASURES:Perspectives and values of care providers which were explored using semistructured in-depth interviews. RESULTS:The following four themes were identified, using the evidence-based practice-model of Satterfield et al as a framework: 'Care providers' vision on childbirth', 'Discrepancy between restrictive perspective and daily practice', 'Clinical expertise versus literature-based practice' and 'Involvement of women in the decision'. Perspectives, values and practices regarding episiotomy were strongly influenced by care providers' underlying visions on childbirth. Although care providers often emphasised the importance of restrictive episiotomy policy, a discrepancy was found between this vision and the large number of varying indications for episiotomy. Although on one hand care providers cited evidence to support their practice, on the other hand, many based their decision-making to a larger extent on clinical experience. Although most care providers considered women's autonomy to be important, at the moment of deciding on episiotomy, the involvement of women in the decision was perceived as minimal, and real informed consent generally did not take place, neither during labour, nor prenatally. Many care providers belittled episiotomy in their language. CONCLUSIONS:Care providers' underlying vision on episiotomy and childbirth was an important contributor to the large variations in episiotomy usage. Their clinical expertise was a more important component in decision-making on episiotomy than the literature. Women were minimally involved in the decision for performing episiotomy. More research is required to achieve consensus on indications for episiotomy.

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BACKGROUND & AIMS: OBJECTIVE:the ongoing attrition of the midwifery workforce frustrates future workforce planning and the provision of maternity services in Western Australia. This project determined factors contributing to the intention of the midwives to move jobs and/or leave the profession. DESIGN:a cross-sectional survey approach was taken for this descriptive research utilising a self-administered questionnaire developed by the Nursing and Midwifery Office, Department of Health, Western Australia. SETTING:public and private health sectors in Western Australia, April-May 2010. PARTICIPANTS:1,600 midwives employed in the public and private health sectors throughout Western Australia were invited to participate: 712 responded (44.5%), one-fifth of the state's registered midwives. FINDINGS:most midwives worked part-time in a clinical role in public hospitals. Almost half intended moving jobs within 5 years and/or leaving midwifery. Excluding midwives of retirement age, the most common reasons for intending to move jobs were family commitments, working conditions and role dissatisfaction. Those intending to leave midwifery cited work-life balance, career change and family commitments. Midwives thought addressing the following issues would improve midwifery retention: flexible work arrangements, remuneration, staffing and caseload, workplace culture, professional development and models of care. KEY CONCLUSIONS:retaining the midwifery workforce requires attention to workforce practices particularly flexible work arrangements and workloads; models of care to strengthen midwives' relationships with clients and colleagues; and accessible professional development. IMPLICATIONS FOR PRACTICE:a review of workplace practices at unit and institution levels is urgently required in Western Australia so that midwives can achieve work-life balance and practice to the full extent of their professional role. These changes are necessary to forestall premature retirement of skilled and experienced midwives from the profession and workforce churn.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Performing obstetric ultrasound is part of midwifery practice in Norway. Knowledge of these midwives' working situation can enhance understanding of what their work involves and the challenges they encounter in their practice. The aim of this study was to gain insight into how midwife sonographers perceive their work in obstetric ultrasound. METHODS:A qualitative study with individual interviews was conducted in 2018. Midwives (n = 13) with a postgraduate ultrasound qualification who performed obstetric ultrasound in private clinics and/or the public health sector were included. All four regional health authorities in Norway were represented. The data gathered were analysed using content analysis. RESULTS:The analysis resulted in three main themes. (1) Working as a midwife sonographer involves a holistic approach. By practising their competence, in both midwifery and sonography, they could answer questions and reassure pregnant women. The participants also had a feeling of great responsibility in their work. (2) Being part of a professional environment in obstetric ultrasound was important for professional interaction, belonging and learning. (3) Developing and maintaining competence as a midwife sonographer had a positive influence on midwives' motivation and confidence, and allowed for more variety in their work. CONCLUSIONS:Holistic care of the pregnant woman, her partner and the unborn baby was an important part of the participants' work. They wanted to meet colleagues within their field, develop their expertise and have influence over their work situation. Organizational factors seemed to affect the participants' overall ability to practise their skills and thus also their job satisfaction.

背景与目标：

BACKGROUND & AIMS: :As we approach the 21st century, the prospect of a new healthcare system in the United States should prompt us to reopen the question of who can best meet the healthcare needs of women. Nurse midwives are advanced practice nurses educated in the field of primary health care for essentially normal women and newborns. Their focus is wellness and health education. Once patients are introduced to the concept of a nurse practitioner and the services provided, the majority are satisfied with the quality of the care received. Evidence suggests that women, if given a choice, prefer the ministrations of a female practitioner over that of a male for their intimate healthcare needs. As a predominantly female group, nurse midwives are an excellent source of qualified providers for women. In this article, the cost effectiveness of nurse practitioner care and the issue of provider gender are discussed. A case for the utilization of nurse midwives as primary healthcare providers for women is presented.

背景与目标： : 随着我们21世纪的发展，美国新医疗保健系统的前景应促使我们重新讨论谁能最好地满足妇女的医疗保健需求的问题。护士助产士是在基本正常的妇女和新生儿的初级保健领域接受教育的高级执业护士。他们的重点是健康和健康教育。一旦向患者介绍了护士从业人员的概念和所提供的服务，大多数人对所接受的护理质量感到满意。有证据表明，如果有选择，女性更喜欢女性从业者的管理，而不是男性的管理，因为她们需要亲密的医疗保健。作为主要的女性群体，助产士护士是合格的女性提供者的极好来源。在本文中，讨论了护士执业护理的成本效益和提供者性别问题。提出了利用助产士作为妇女主要医疗保健提供者的案例。

BACKGROUND & AIMS: :In response to the new standards for resident work hours issued in 2003, Baystate Medical Center in Springfield, MA developed a program for midwifery involvement in resident and medical education. The Obstetrics Team consists of a midwife teaching first-year residents in obstetrics/gynecology and emergency medicine and third-year medical students on the labor and delivery unit. This program has successfully addressed the need for resident and medical education as well as service provision created by reduced resident work hours and provides a useful model for other institutions.

背景与目标： : 为响应2003年发布的新的居民工作时间标准，马萨诸塞州斯普林菲尔德的Baystate医疗中心制定了一项计划，以帮助助产士参与居民和医学教育。产科小组由一名助产士组成，负责产科/妇科和急诊医学的一年级居民以及劳动和分娩部门的三年级医学生。该计划已成功解决了居民和医学教育以及减少居民工作时间所产生的服务提供的需求，并为其他机构提供了有用的模型。

BACKGROUND & AIMS: BACKGROUND:The nursing faculty shortage has generated the interest of some nurse-midwives to teach in baccalaureate nursing programs. These seasoned practitioners bring a wealth of knowledge and clinical expertise to classrooms and clinical settings. The purpose of this study was to explore and describe the experiences of nurse-midwives who teach in baccalaureate nursing programs. METHOD:This study used a qualitative phenomenological research design based in the naturalistic paradigm. Colaizzi's procedure for analyzing phenomenological data was used to examine verbatim transcriptions from 16 interviews. Data saturation was achieved. RESULTS:Six themes emerged from the data: Emphasis on Normal; Knowing My Stuff: Confidence and Competence; Students Wanting to Become Nurse-Midwives in the Future; Students Desiring Nurse-Midwifery Care; Teaching and Imparting the Nurse-Midwifery Philosophy; and Professional Challenges: The Faculty Role. CONCLUSION:Nurse-midwives teaching in baccalaureate nursing programs are in strategic positions to influence nursing students. While helping the faculty shortage, they impart professional values and skills. They may inspire students to embrace the nurse-midwifery model of care. [J Nurs Educ. 2017;56(2):77-84.].

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