An intercultural birthing house was established in the Highlands of Chiapas, Mexico, as an intervention to reduce maternal mortality among indigenous women. This birth center, known locally as the Casa Materna, is a place where women can come to give birth with their traditional birth attendant. However, three months after opening, no woman had used the birthing house.
This study reports on the knowledge, attitudes and practices related to childbirth and use of the Casa Materna from the perspective of the health workers, traditional birth attendants and the program's target population. Structured interviews, in-depth interviews and focus group discussions were conducted with participants from each of these groups. Data was searched for emerging themes and coded.
Findings show that the potential success of this program is jeopardized by lack of transport and a strong cultural preference for home births. The paper highlights the importance of community participation in planning and implementing such an intervention and of establishing trust and mutual respect among key actors. Recommendations are provided for moving forward the maternal health agenda of indigenous women in Chiapas.
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Written daily reflections during clinical practice on birthing units have been used during several years in midwifery education at Lund University, Sweden. However, the usefulness of these reflections for evaluation of progression in learning and professional development of students has to date not been evaluated. In order to analyse written reflections, two taxonomies developed by Bloom and Pettersen have been applied to the texts. Progression in the professional development of midwifery students can be seen through levels of complexity in cognitive and psycho-motor learning areas and also in the description of learning situations. Progression can be seen from a basic description of facts in simple situations at the beginning of the students' practice to a complex description of complicated situations towards the end of the practice. Written daily reflections appear to be a suitable method to help students to reflect in a structured way, thereby helping their professional development. Reflections can help clinical supervisors to understand the needs of the individual student and to support their knowledge accruement. Daily written reflections on clinical practice can be of use in other health education programs.
AIM: to explore and describe the student midwife's experiences in offering continuous labour support. DESIGN: a qualitative research design was chosen. Each student midwife offered continuous labour support to five women/couples and wrote narratives about each of these occasions. Written narratives from 11 student midwives were analysed using qualitative content analysis. FINDINGS: when student midwives offer continuous labour support to women/couples, they try to establish rapport. When this works, their presence, their sense of confidence and their ability to offer reassurance increase. If establishing rapport does not work, students experience a sense of powerlessness, a need for reassurance and a lack of confidence. KEY CONCLUSIONS: offering continuous labour support to women and/or their partners made the students aware of the importance of establishing rapport, and it made them realise the impact that their mere presence in the room could have. The students had a need for reassurance which could hamper their efforts to establish rapport. Experiencing a lack of confidence made students focus more strongly on their clinical skills and on their perceived role as a student midwife. IMPLICATIONS FOR PRACTICE: this study can initiate discussions about how student midwives learn to be supportive, as well as about the role models that students encounter during their clinical training in Sweden.
An interprofessional team of maternity care providers and academics developed a pilot interprofessional education (IPE) program in maternity care for undergraduate students in nursing, midwifery and medicine. There are few published studies examining IPE programs in maternity care, particularly at the undergraduate level, that examine long-term outcomes. This paper outlines findings from a case study that explored how participation in an IPE program in maternity care may enhance student knowledge, skills/attitudes, and may promote their collaborative behavior in the practice setting. The program was launched at a Canadian urban teaching hospital and consisted of six workshops and two clinical shadowing experiences. Twenty-five semi-structured, in-depth interviews were completed with nine participants at various time points up to 20 months post-program. Qualitative analysis of transcripts revealed the emergence of four themes: relationship-building, confident communication, willingness to collaborate and woman/family-centered care. Participant statements about their intentions to continue practicing interprofessional collaboration more than a year post-program lend support to its sustained effectiveness. The provision of a safe learning environment, the use of small group learning techniques with mixed teaching strategies, augmented by exposure to an interprofessional faculty, contributed to the program's perceived success.
Cooperation in midwifery research between Zambia and Sweden is ongoing. Joint studies on gastric suctioning and maternity routines are used as examples, and breastfeeding is discussed from a global perspective. The midwife, who also interprets responses from mothers, is an important member of an assessment team. Cooperation over cultural boundaries is feasible and mutually rewarding.
With an increasing number of births in Ontario being conducted by midwives, we undertook a survey of the beliefs and practices of 256 licensed Ontario midwives and student midwives about immunization, particularly against influenza. Overall, 42.9% (48/112) of midwives considered that they knew a lot about immunization; however, 36.2% (38/105) reported no education about immunization during their training. A small majority (55.9%) were in favour of vaccination in general and only 2 of 113 reported spending more than 1h discussing vaccination with their clients. Only 26.9% reported having received influenza vaccine in the previous season (compared to 60% of all health care workers in Ontario). Overall, only 37% believed that influenza vaccine is effective, and 22% believed that the vaccine was a greater risk than influenza. Graduation in 1998 or prior was associated with belief in the effectiveness in vaccine, having been vaccinated, and recommending vaccine to clients. Midwives who reported being immunized themselves were more likely to believe in the safety and efficacy of influenza vaccine, and to recommend vaccination to their clients (26% versus 3%, p=0.001). If greater attention is not focused on promoting the utility of immunization to midwives, the success of population immunization programs may be compromised.
The practice of integrating western and traditional indigenous medicine is fast becoming an accepted and more widely used approach in health care systems throughout the world. However, debates about intercultural health approaches have raised significant concerns. This paper reports findings of five case studies on intercultural health in Chile, Colombia, Ecuador, Guatemala, and Suriname. It presents summary information on each case study, comparatively analyzes the initiatives following four main analytical themes, and examines the case studies against a series of the best practice criteria.
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