Valerie Fleming

Women-with-midwives-with-women: a model of interdependence.

AIM To develop a research-based conceptual model of midwifery practice. DESIGN Qualitative using grounded theory. SETTING Midwifery practice in New Zealand and Scotland. PARTICIPANTS 250 midwives and 219 clients from the two countries. FINDINGS Data from the participants provided the contextual background as well as the major categories. Forming the background were the concepts of: beliefs, colleagues, culture, experience, expertise, education, environment, friends, families, intuition, knowledge and professionalism. The major categories of the model which emerged from the data were: attending and presencing, supplementing and complementing, reflection and reflexivity. These are discussed as pairs while the basic social process (core category) of reciprocity embraces the whole midwife-client relationship. CONCLUSIONS This model offers the beginnings of documentary evidence of the essence of the midwife-client relationship and may go some way towards the creation of a written body of midwifery knowledge. It has potential applicability for both midwifery education and practice.

The birth satisfaction scale

PURPOSE The purpose of this paper is to develop a psychometric scale--the birth satisfaction scale (BSS)--for assessing womens birth perceptions. DESIGN/METHODOLOGY/APPROACH Literature review and transcribed research-based perceived birth satisfaction and dissatisfaction expression statements were converted into a scored questionnaire. FINDINGS Three overarching themes were identified: service provision (home assessment, birth environment, support, relationships with health care professionals); personal attributes (ability to cope during labour, feeling in control, childbirth preparation, relationship with baby); and stress experienced during labour (distress, obstetric injuries, receiving sufficient medical care, obstetric intervention, pain, long labour and babys health). RESEARCH LIMITATIONS/IMPLICATIONS Women construct their birth experience differently. Views are directed by personal beliefs, reactions, emotions and reflections, which alter in relation to mood, humour, disposition, frame of mind and company kept. Nevertheless, healthcare professionals can use BSS to assess womens birth satisfaction and dissatisfaction. Scores measure their service quality experiences. SOCIAL IMPLICATIONS Scores provide a global measure of care that women perceived they received during labour. ORIGINALITY/VALUE Finding out more about what causes birth satisfaction and dissatisfaction helps maternity care professionals improve intra-natal care standards and allocate resources effectively. An attempt has been made to capture birth satisfactions generalised meaning and incorporate it into an evidence-based measuring tool.

Does perineal suturing make a difference? The SUNS trial

Objective To examine differences in outcome between primiparous women who do and who do not have suturing to first or second degree perineal lacerations sustained during spontaneous vaginal births after 37 weeks of gestation.

Autonomous or Automatons? an exploration through history of the concept of autonomy in midwifery in Scotland and New Zealand

Through the World Health Organization’s definition of midwifery, midwives are frequently heard to describe themselves as autonomous practitioners. In this article this notion is refuted. An overview of individual and collective autonomy is first presented to contextualize the subsequent discussion. Then the notion of autonomy in relation to midwifery practice in Scotland and New Zealand is critiqued through tracing the history of midwives and midwifery in these two countries. Issues relating to midwifery registration, medicalization of birth and consumerism are discussed. Each of these categories is suggested as limiting to autonomous practice within midwifery.

Exploring global recognition of quality midwifery education: Vision or fiction?

BACKGROUND Midwifery education is the foundation for preparing competent midwives to provide a high standard of safe, evidence-based care for women and their newborns. Global competencies and standards for midwifery education have been defined as benchmarks for establishing quality midwifery education and practice worldwide. However, wide variations in type and nature of midwifery education programs exist. AIM To explore and discuss the opportunities and challenges of a global quality assurance process as a strategy to promote quality midwifery education. DISCUSSION Accreditation and recognition as two examples of quality assurance processes in education are discussed. A global recognition process, with its opportunities and challenges, is explored from the perspective of four illustrative case studies from Ireland, Kosovo, Latin America and Bangladesh. The discussion highlights that the establishment of a global recognition process may assist in promoting quality of midwifery education programs world-wide, but cannot take the place of formal national accreditation. In addition, a recognition process will not be feasible for many institutions without additional resources, such as financial support or competent evaluators. In order to achieve quality midwifery education through a global recognition process the authors present 5 Essential Challenges for Quality Midwifery Education. CONCLUSION Quality midwifery education is vital for establishing a competent workforce, and improving maternal and newborn health. Defining a global recognition process could be instrumental in moving toward this goal, but dealing with the identified challenges will be essential.

A concept analysis of the term migrant women in the context of pregnancy

Abstract Aim This paper explores the concept of migrant women as used in European healthcare literature in context of pregnancy to provide a clearer understanding of the concept for use in research and service delivery. Methods Walker and Avants method of concept analysis. Results The literature demonstrates ambiguity around the concept; most papers do not provide an explicit or detailed definition of the concept. They include the basic idea that women have moved from an identifiable region/country to the country in which the research is undertaken but fail to acknowledge adequately the heterogeneity of migrant women. The paper provides a definition of the concept as a descriptive theory and argues that research must include a clear definition of the migrant specific demographics of the women. This should include country/region of origin and host, status within the legal system of host country, type of migration experience, and length of residence. Conclusion There is a need for a more systematic conceptualization of the idea of migrant women within European literature related to pregnancy experiences and outcomes to reflect the heterogeneity of this concept. To this end, the schema suggested in this paper should be adopted in future research.

Midwifery in New Zealand: Responding to changing times

This article provides a critical overview of midwifery in New Zealand. It first considers the influences in society that have assisted midwives in campaigning for change. Also outlined is the partnership of midwives and consumers that created the climate for an Act of Parliament permitting independent midwifery practice in 1990. Changes to midwifery practice since 1990 are documented, as well as some of the backlash that has occurred since then. In this article, New Zealand midwifery is set in its global context, and the major issue of partnership is also highlighted.

Mobilizing Foucault: history, subjectivity and autonomous learners in nurse education.

In the past 20, years the impact of progressive educational theories have become influential in nurse education particularly in relation to partnership and empowerment between lecturers and students and the development of student autonomy. The introduction of these progressive theories was in response to the criticisms that nurse education was characterized by hierarchical and asymmetrical power relationships between lecturers and students that encouraged rote learning and stifled student autonomy. This article explores how the work of Michel Foucault can be mobilized to think about autonomy in three different yet overlapping ways: as a historical event; as a discursive practice; and as part of an overall strategy to produce a specific student subject position. The implications for educational practice are that, rather than a site where students are empowered, nurse education is both a factory and a laboratory where new subjectivities are continually being constructed. This suggests that empowering practices and disciplinary practices uneasily co-exist. Critical reflection needs to be directed not only at structural dimensions of power but also on ourselves as students and lecturers by asking a Foucauldian question: How are you interested in autonomy?

Potential conflicts in midwifery practice regarding conscientious objection to abortions in Scotland

Background: This study was developed as a result of a court case involving conflicts between midwives’ professional practice and their faith when caring for women undergoing abortions in Scotland. Research questions: What are practising Roman Catholics’ perspectives of potential conflicts between midwives’ professional practice in Scotland with regard to involvement in abortions and their faith? How relevant is the ‘conscience clause’ to midwifery practice today? and What are participants’ understandings of Canon 1398 in relation to midwifery practice? Research design: The theoretical underpinning of this study was Gadamer’s hermeneutic out of which the method developed by Fleming et al. involving a five-stage approach was utilised. Participants and research context: The research was conducted in the south of Scotland. A purposive sampling method was used. Eight participants who were practising Roman Catholics familiar with the subject of conscientious objection who were either midwives, lawyers (civil, canon or both) or priests contributed. Ethical considerations: The major ethical issues related to respect for autonomy, maintaining confidentiality and obtaining voluntary informed consent. Parish priests agreed to act as gatekeepers to prospective participants. All legal requirements were addressed regarding data collection and storage. Approval was given by the ethics committee of the university with which one of the researchers were associated. Findings: Three key themes provide an understanding of the situation in which midwives find themselves when considering the care for a woman admitted for an abortion: competing legal systems, competing views of conscience and limits of participation. Conclusion: Clear guidelines for practice should be developed by a multi-professional and consumer group based on an update of the abortion law to reflect the change from a surgical to medical procedure. Clarification of Canon 1398 in relation to what is and is not participation in the procurement of abortion would be of benefit to midwives with a conscientious objection.

Freedom of conscience in Europe? An analysis of three cases of midwives with conscientious objection to abortion

While abortion has been legal in most developed countries for many years, the topic remains controversial. A major area of controversy concerns women’s rights vis-a-vis the rights of health professionals to opt out of providing the service on conscience grounds. Although scholars from various disciplines have addressed this issue in the literature, there is a lack of empirical research on the topic. This paper provides a documentary analysis of three examples of conscientious objection on religious grounds to performing abortion-related care by midwives in different Member States of the European Union, two of which have resulted in legal action. These examples show that as well as the laws of the respective countries and the European Union, professional and church law each played a part in the decisions made. However, support from both professional and religious sources was inconsistent both within and between the examples. The authors conclude that there is a need for clear guidelines at both local and pan-European level for health professionals and recommend a European-wide forum to develop and test them.