Cindy L. Farley

The Confidence to Practice Midwifery: Preceptor Influence on Student Self‐Efficacy

The imperative for midwifery educators is to transmit to their students midwiferys unique body of knowledge and hallmarks of care that guide midwifery practice. Concerns have been raised about the ability to maintain the unique aspects of midwifery practice in a culture where routine use of intervention prevails. A theory-practice gap may lead to fewer student midwives exposed to the perspective and practices of midwifery during their clinical education. Preceptor role modeling is important to developing student confidence, conceptualized as self-efficacy, to persist in the practice of midwifery hallmark behaviors, particularly under conditions that undermine these practices. This study examined student perceptions of preceptor behaviors of two midwifery hallmarks of practice: therapeutic presence and non-intervention in the absence of complication and student self-efficacy for performing these behaviors. Recent graduates of education programs accredited by the American College of Nurse-Midwives Division of Accreditation completed researcher-developed tools regarding perceptions of preceptor behaviors of therapeutic presence and non-intervention and their outcome expectancy and self-efficacy for the same behaviors. The results indicate that preceptor behaviors influence student confidence to perform hallmark behaviors. Student belief in the value of the hallmark to benefit women is the biggest predictor of self-efficacy for hallmark behaviors. Clinical and educational implications and directions for future research are discussed.

SCREENING FOR HYPOGLYCEMIA IN HEALTHY TERM NEONATES: EFFECTS ON BREASTFEEDING

Transient hypoglycemia in the early neonatal period is a common adaptive phenomenon as the newborn changes from the fetal state of continuous transplacental glucose consumption to intermittent nutrient supply following cessation of maternal nutrition at birth. Research has demonstrated that in the term, healthy newborn, this dynamic process is self-limiting and is not considered pathologic. The American Academy of Pediatrics and the World Health Organization recommend that neonatal blood glucose screening be reserved for newborns who are at risk or symptomatic and conclude that universal hypoglycemia screening is inappropriate, unnecessary, and potentially harmful. Nevertheless, many hospital nurseries continue the clinical practice of routine early glucose screening on healthy, term newborns. This results in the misidentification of neonates captured while experiencing the normal, self-correcting physiologic blood glucose nadir who are then diagnosed with pathologic neonatal hypoglycemia. Subsequent to this misdiagnosis, further surveillance and unnecessary, aggressive treatment interventions will follow that are potentially harmful to the successful establishment of positive maternal-infant interactions and the breastfeeding experience. Research studies indicate that routine hypoglycemia screens, treatments, and interventions in the healthy infant are not evidence-based and result in a serious disruption of the initiation process and duration patterns of lactation. Using the perspective of the theory of technology dependency, this inquiry explores the potential adverse sequelae of inappropriate glucose screening in the healthy breastfeeding newborn and describes selected outcome variables including: 1) the consequences of early maternal-infant separation, 2) the influence of early formula supplementation on breastfeeding discontinuance rates, 3) the effect of separation and supplementation on the onset of lactogenesis, and 4) the impact of hospital staff and provider recommendations of formula supplementation on maternal confidence to independently nurture her baby.

New directions in midwifery education: the master’s of science in midwifery degree

Midwifery is reclaiming its perspective as a discipline separate from, yet integrally related to nursing and medicine. Emerging trends in health care place increased demands on the knowledge base and clinical practice of midwifery, stimulating a need for new directions in midwifery education. The masters of science with a major in midwifery is a new degree option available to midwifery students in the United States. This article presents the argument that midwifery is a distinct discipline and describes the importance of a masters of science in midwifery degree toward furthering the work of the discipline of midwifery. Descriptions of the current masters of science in midwifery degree programs are included.

The Certified Midwife Credential and the Case for National Implementation

Midwifery is a distinct profession. The International Confederation of Midwives (ICM) recognizes this.1 The Association ofWomen’sHealth,Obstetric andNeonatalNurses recognizes this.2 Historically, in the United States, formal recognition of midwifery’s separate professional status came in 1955 through the formation of the American College of Nurse-Midwifery (now the American College of Nurse-Midwives [ACNM]). Full recognition of this status came in 1994. At that time, the ACNMDivision of Accreditation (ACNMDOA, now the Accreditation Commission for Midwifery Education [ACME]) developed standards for education programs to prepare midwives who had backgrounds other than nursing, and the ACNMCertification Council (ACC, now the American Midwifery Certification Board [AMCB]) amended its policies to allow persons without nursing backgrounds who completed an ACNM DOA-accredited midwifery education program to sit for the ACC national certification examination.3,4 Thus, the certified midwife (CM) credential was created by ACNM. This commentary was written by a geographically diverse group of certified nurse-midwives (CNMs) and CMs, all of whom strongly support recognition of midwifery as its own profession. The commentary argues for national implementation of the CM credential as a vital part of this recognition. It demonstrates the burden of requiring nursing education for midwives; discusses how CMs are educated and work; positions United States midwifery within the global midwifery community, which is not limited to nurse-midwifery; and, finally, shows that arguments posited against implementation of the CM credential are flawed.

Body Piercing: Motivations and Implications for Health

Body piercing has evolved from a behavior once considered extreme to an accepted choice among the general population. Earlobe piercing is so common that it is now considered a normative behavior. The motivations for choosing body piercing have changed and are associated with piercing site and number of piercings chosen by the individual. Meanings ascribed to body piercing were traditionally related to enhanced sexual desirability and experience, but now range from the innocuous, such as a fashion statement, to the risk laden, such as nonsuicidal self-injury. Professional piercers are the primary providers of piercing services, and people will first turn to their professional piercer for advice when complications of the site arise, thus delaying entry into needed health care. Health care providers are often perceived as uninformed, dismissive, and biased against individuals, who are pierced particularly those with multiple piercings and piercings in intimate areas of the body. Common complications of piercing include infection, bleeding, and problems relating to tissue trauma and scarring, and are reported by nearly 50% of individuals who are pierced. Metal allergies can develop as a result of piercing, making the type of jewelry used for body adornment an important consideration. Additionally, management of the piercing site becomes critical under certain conditions, such as during pregnancy and birth, lactation, or surgery. This article provides information supporting midwives and other health care providers to offer anticipatory guidance and health care services in a nonjudgmental and supportive manner to individuals choosing body piercing.