Mary Sidebotham

Level of burnout in a small population of Australian midwives

UNLABELLED The aim of the study was to describe the level of burnout in midwives working at a maternity unit in South East Queensland, Australia. METHOD A self-administered questionnaire was distributed to all registered midwives (N=110) working at the study site during November 2011. The questionnaire included a demographic survey and the Copenhagen Burnout Inventory. Fifty-eight (52.7%) staff completed the package. Data was entered into SPSS database version 19 and descriptive statistics were used to determine means, ranges and frequencies. RESULTS Almost 30% of the sample experienced moderate to high levels of burnout some 50% of participants scored moderate to high for personal burnout with a similar number scoring high for work-related burnout. In comparison, burnout related to working with clients was very low. Differences between participants were associated with years of experience, area of work and employment position (FT/PT, level of position and work area). Participants aged 35years or younger and with less than 10years midwifery experience scored highest on the personal and work-related domains whereas participants over 35years scored highest within the client-related domain. Midwives at level 1 (lowest pay group) scored highest for work-related burnout and client-related burnout. Midwives in more senior positions (level 2 and above) scored highest for personal burnout. CONCLUSION Personal and work-related burnout was high in this group of midwives while burnout related to caring for women was low. These results provide insight into the emotional health of midwives in one maternity unit. While more work is needed, strategies to decrease and/or prevent burnout may include clinical mentorship and reorganising models of maternity care to increase work satisfaction and autonomy and strengthen relationships between midwives and women.

Midwifery students׳ experiences of an innovative clinical placement model embedded within midwifery continuity of care in Australia

BACKGROUND midwifery continuity of care experiences can provide high quality clinical learning for students but can be challenging to implement. The Rural and Private Midwifery Education Project (RPMEP) is a strategic government funded initiative to (1) grow the midwifery workforce within private midwifery practice and rural midwifery, by (2) better preparing new graduates to work in private midwifery and rural continuity of care models. AIM this study evaluated midwifery students׳ experience of an innovative continuity of care clinical placement model in partnership with private midwifery practice and rural midwifery group practices. METHOD a descriptive cohort design was used. All students in the RPMEP were invited to complete an online survey about their experiences of clinical placement within midwifery continuity models of care. Responses were analysed using descriptive statistics. Correlations between total scale scores were examined. Open-ended responses were analysed using content analysis. Internal reliability of the scales was assessed using Cronbach׳s alpha. FINDINGS sixteen out of 17 completed surveys were received (94% response rate). Scales included in the survey demonstrated good internal reliability. The majority of students felt inspired by caseload approaches to care, expressed overall satisfaction with the mentoring received and reported a positive learning environment at their placement site. Some students reported stress related to course expectations and demands in the clinical environment (e.g. skill acquisition and hours required for continuity of care). There were significant correlations between scales on perceptions of caseload care and learning culture (r=.87 p<.001) and assessment (r=.87 p<.001). Scores on the clinical learning environment scale were significantly correlated with perceptions of the caseload model (rho=.86 p<.001), learning culture (rho=.94 p<.001) and assessment (rho=.65 p<.01) scales. CONCLUSIONS embedding students within midwifery continuity of care models was perceived to be highly beneficial to learning, developed partnerships with women, and provided appropriate clinical skills development required for registration, while promoting students׳ confidence and competence. The flexible academic programme enabled students to access learning at any time and prioritise continuity of care experiences. Strategies are needed to better support students achieve a satisfactory work-life balance.

The virtual international day of the midwife: social networking for continuing professional development.

In order to maintain competence to practice, midwives must become lifelong learners and engage in education and CPD activities. The Virtual International Day of the Midwife event (VIDM) is a free online annual synchronous conference that uses social networking tools to bring midwives together to network, share research and practice information. This paper presents the evaluation based on the 2010 and 2011 events. Participants appreciated the opportunity to be able to network with colleagues in an international context, believed the event provided access to quality material and presenters, and valued the accessibility and availability of the event and resources. Participants suggested that the event could be improved by making the program more accessible, with sessions spread over several days, as opposed to 24 hours; providing information about appropriate netiquette and extensive advertising. Further research is required to investigate how social networking and initiatives such as the VIDM impact on practice in the long term.

Further validation of the Perceptions of Empowerment in Midwifery Scale.

OBJECTIVE to assess the psychometric properties of the Perceptions of Empowerment in Midwifery Scale (PEMS) on a sample of New Zealand midwives. DESIGN cross sectional study. Midwives completed an online survey containing the 22 item PEMS, and a number of demographic and work-related questions. PARTICIPANTS active practising members listed on the New Zealand College of Midwives database were invited to participate. A sample of midwives who were currently employed by an organisation was extracted (n=600). FINDINGS exploratory factor analysis on the PEMS identified four subscales (Autonomy/Empowerment, Manager Support, Professional Support, Skills and Resources). This structure differed from that reported by the original scale developers. Each subscale showed adequate internal consistency reliability and was able to distinguish midwives who had considered leaving the profession in the past six months (p=.001). KEY CONCLUSIONS the psychometric properties of the revised 19-item four-subscale structure of PEMS were supported. IMPLICATIONS FOR PRACTICE The PEMS-Revised provides a psychometrically sound tool for further quantitative research to supplement the growing number of qualitative investigations of midwives perceptions and experiences of their workplace.

Development of a Model of Holistic Reflection to facilitate transformative learning in student midwives

BACKGROUND Reflective practice is considered an essential aspect of personal and professional development, and critical reflection is considered the cornerstone of being an accountable and autonomous practitioner. Tertiary education should lay the foundations of lifelong learning by ensuring students develop into critically reflective and reflexive practitioners, who demonstrate self-awareness and an ability to reflect on personal values and beliefs and their impact on the wider healthcare system. This level of reflective practice is essential to effect change at both an individual and societal level. Reflection should therefore be embedded into education programs as a learning, teaching and assessment strategy. AIM The aim of this paper is to describe a structured Model of Holistic Reflection embedded within an Australian Bachelor of Midwifery Program. The paper firstly outlines the theoretical and conceptual underpinnings of the newly developed model. Secondly describes the six integrated and inter-dependant phases of the model. DISCUSSION AND CONCLUSION The aim of developing the Holistic Reflective Model was to produce a sound educational tool to assist midwifery students to progressively build reflexivity and reflective practice. Furthermore, provide midwifery academics with an educational resource to facilitate development of reflective and critical thinking skills in students. The specific intention was to promote deep personal and transformative learning across an entry to practice program. This paper highlights a number of ways the model can be embedded within the curriculum to support the scaffolded development of critical reflection and reflexivity required to facilitate transformative learning. While evaluation is required the model may have transferability to other disciplines.

Commencing Undergraduate Midwifery Students' Beliefs About Birth and the Role of the Midwife

BACKGROUND: A shift has occurred in the last decade toward preregistration undergraduate Bachelor of Midwifery programs in Australia. This has led to an increase in the numbers of student midwives from diverse backgrounds with limited experience of university and socialization into hospital systems. AIM: This study aimed to explore commencing midwifery students’ beliefs about birth and expectations of the role of the midwife. METHOD: A qualitative descriptive approach was used. All 115 commencing first-year midwifery students enrolled in the first week of an undergraduate Bachelor of Midwifery program were invited and completed a self-administered survey. The survey used open-ended questions to elicit student beliefs about birth and the role of the midwife. Latent content analysis was used to analyze the data set. FINDINGS: Midwifery students’ beliefs were captured within the four themes: birth as “a miracle,” “a woman’s journey,” “a transformative event,” and “a natural process.” Students articulated the role of the midwife as one of support, education, advocacy, and partnership. Student beliefs and expectations were aligned with the emergent philosophy of the normality of birth and woman-centered care within the Australian maternity care context. CONCLUSION: Greater understanding is essential to designing quality midwifery education programs that are responsive to the needs of commencing student midwives. Supporting midwifery students’ successful transition into, and early engagement with the midwifery profession, may have long-term benefits in terms of retention and successful completion of their program. In addition, ensuring professional socialization occurs early is likely to develop graduates who are well prepared to work across their full scope and are willing to participate in the reform of maternity services in Australia.

The emotional and professional wellbeing of Australian midwives: A comparison between those providing continuity of midwifery care and those not providing continuity

BACKGROUND Continuity of midwifery care contributes to significant positive outcomes for women and babies. There is a perception that providing continuity of care may negatively impact on the wellbeing and professional lives of midwives. AIM To compare the emotional and professional wellbeing as well as satisfaction with time off and work-life balance of midwives providing continuity of care with midwives not providing continuity. METHOD Online survey. Measures included; Copenhagen Burnout Inventory (CBI); Depression, Anxiety and Stress Scale-21; and Perceptions of Empowerment in Midwifery Scale (PEMS-Revised). The sample (n=862) was divided into two groups; midwives working in continuity (n=214) and those not working in continuity (n=648). Mann Whitney U tests were used to compare the groups. RESULTS The continuity group had significantly lower scores on each of the burnout subscales (CBI Personal p=.002; CBI Work p<.001; CBI Client p<.001) and Anxiety (p=.007) and Depression (p=.004) sub-scales. Midwives providing continuity reported significantly higher scores on the PEMs Autonomy/Empowerment subscale (p<.001) and the Skills and Resources subscale (p=.002). There was no difference between the groups in terms of satisfaction with time off and work-life balance. CONCLUSION Our results indicate that providing continuity of midwifery care is also beneficial for midwives. Conversely, midwives working in shift-based models providing fragmented care are at greater risk of psychological distress. Maternity service managers should feel confident that re-orientating care to align with the evidence is likely to improve workforce wellbeing and is a sustainable way forward.

Factors influencing midwives’ use of an evidenced based Normal Birth Guideline

Problem or issue Rates of elective and unplanned caesarean section continue to increase in high income countries. Evidence-based clinical guidelines aim to promote and support normal birth but are rarely evaluated. What is already known The Queensland Normal Birth Guideline was developed in consultation with stakeholders and disseminated to public and private hospitals and released in 2012. Impact of the Guideline on practice has not been investigated. What this paper adds Although most midwives (90%) were aware of the guideline, only 71% reported that it routinely guided practice.

‘She knows how we feel’: Australian Aboriginal and Torres Strait Islander childbearing women's experience of Continuity of Care with an Australian Aboriginal and Torres Strait Islander midwifery student

BACKGROUND Marked differences exist between the maternal and neonatal outcomes of Australian Aboriginal and Torres Strait Islander women and their babies compared with the outcomes for other Australian women and their babies. Australian government policies underline the need to increase the number of practising Aboriginal and Torres Strait Islander midwives and nurses as a strategy for delivering culturally appropriate healthcare to improve health outcomes for Aboriginal and Torres Strait Islander families. Additional challenges are experienced by Aboriginal and/or Torres Strait Islander midwifery students providing Continuity of Care (COC) to Australian Aboriginal and/or Torres Strait Islander childbearing women. One such example is the challenge presented due to the close connections and relationships that exist within some Aboriginal and/or Torres Strait Islander cultures in terms of the maintenance of a professional relationship, in particular, the maintenance of professional boundaries. Whilst there is a growing body of evidence on the benefits to women of continuity of midwifery care models, little is known about the experiences of Aboriginal and Torres Strait Islander women who receive COC from Aboriginal and Torres Strait Islander midwifery students. AIM To explore the experiences of Australian Aboriginal and Torres Strait Islander childbearing women who participated in a Continuity of Care journey with an Aboriginal and/or Torres Strait Islander Bachelor of Midwifery student. METHODS Exploratory, descriptive study using semi-structured interviews informed by an Indigenous Research Methodology. FINDINGS Thematic analysis identified four major themes: (i) communicating our way, (ii) the role of relationships, (iii) support and assistance and (iv) challenges of the system. The findings illustrated the benefits Aboriginal women experience as a result of having Aboriginal and/or Torres Strait Islander midwifery students provide Continuity of Care. CONCLUSION Increasing the number of Australian Aboriginal and/or Torres Strait Islander midwives is essential to improving health outcomes for Australian Aboriginal and Torres Strait Islander childbearing women and their families. Caseload midwifery models with Aboriginal and Torres Strait Islander midwives across Australia are needed. Health services, in partnership with Universities and Aboriginal and Torres Strait Islander communities, have a vital role to play in the development and expansion of these models.

Factors influencing midwifery migration from the United Kingdom to Australia

BACKGROUND Within the current literature on the globalization of the healthcare workforce, it is difficult to separate the migration experience of nurses from that of midwives. As more countries are moving to offer direct entry educational programmes and provide separate registration for midwives, information specific to that professional group will be required to guide workforce planners and inform employment practice. This qualitative study tracks the migration experience of midwives moving between the UK and Australia. METHODS A purposeful sample of 18 midwives who had migrated from the UK to one state in Australia was interviewed within a descriptive phenomenological framework. Data were analysed using thematic coding within Nvivo (QSR International, Melbourne, Australia). RESULTS The strongest motivator for migration was to improve the familys lifestyle. Push factors included disillusionment with working conditions, standard of living in the UK and national politics. The majority of midwives had organized their own entry visa and employment. Most midwives had occupied senior positions in the UK but accepted employment initially within entry-level positions in Australia. DISCUSSION Despite both countries offering similar standards of living, the majority of midwives expected to achieve an improvement in family lifestyle in Australia. Midwives indicated they were prepared to lose professional status and seniority of position to gain a better overall lifestyle for their family. To examine the long-term sustainability of international recruitment processes, further research is indicated to examine the ongoing experience and integration of migrant midwives into the workforce in Australia.