OBJECTIVE: To describe antenatal 'booking' interviews as regards content and illuminate the meaning of the ways midwives and expectant parents relate to each other. DESIGN: Content analysis and phenomenological hermeneutic analysis of transcribed texts from five video-recorded antenatal booking interviews. SETTING: Midwifery clinics at five health centres in the context of Swedish primary care. PARTICIPANTS: Five midwives, five pregnant women (less than 14 weeks pregnant) and two expectant fathers. FINDINGS: A variety of content themes and ways of relating were found. Combined themes of biomedical and obstetric content occurred as frequently as the sum of social, emotional, antenatal care and life-style themes. The midwives' ways of relating formed two main themes; considering and disregarding the uniqueness of the expectant parents. The midwives directed the interview through their choice of content themes and the way they related to the expectant parents. The expectant parents mainly shadowed the midwives' content themes and ways of relating. The expectant fathers seemed like strange visitors in the women's world. Two perspectives of antenatal midwifery care, obstetric and parental, operated alternately and in competition within the interviews. KEY CONCLUSIONS: The content and the ways of relating within the interviews seem to be connected and could be understood in the light of Buber's writings on dialogue. IMPLICATIONS FOR PRACTICE: The findings provide a basis for reflection on the education of midwives and the planning, training and implementation of midwifery care at antenatal 'booking' interviews.
AIM: To present the theoretical framework, design, methods, and baseline findings of the first Danish study on determinants and consequences of burnout, and the impact of workplace interventions in human service work organizations. METHOD: A 5-year prospective intervention study comprising 2,391 employees from different organizations in the human service sector: social security offices, psychiatric prison, institutions for severely disabled, hospitals, and homecare services. Data were collected at baseline and at two follow-ups. The authors developed a new burnout tool (the Copenhagen Burnout Inventory) covering work-related, client-related, and personal burnout. The study includes potential determinants of burnout (e.g. the psychosocial work environment, social relations outside work, lifestyle factors, and personality aspects) and consequences of burnout (e.g. poor health, low job satisfaction, turnover, and absenteeism). Here, the focus is on the description of the study population at baseline, including associations of work burnout with psychosocial work environment scales and absence. RESULTS: Response rate at baseline was 80.1%. Midwives and homecare workers had high levels on both work- and client-related burnout. Prison officers had the highest level on client-related burnout. Supervisors and office assistants had low levels on both scales. Work burnout showed the highest correlations with job satisfaction (r = -0.51), quantitative demands (r = 0.48), role-conflicts (r = 0.44), and emotional demands (r = 0.42). Sickness absence was 13.9 vs 6.0 days among participants in the highest and lowest work burnout quartile, respectively. CONCLUSION: The findings indicate that study design and methods are adequate for the upcoming prospective analyses of aetiology and consequences of burnout and of the impact of workplace interventions.
Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden; Mid Sweden University, Department of Health Science, Sundsvall, Sweden; Karolinska Institutet, Department of Women's and Children's Health, Stockholm, Sweden. Electronic address: firstname.lastname@example.org.
In many countries midwives tend to leave their profession. Factors associated with workforce attrition include high workload, stress, poor management and a lack of promotional opportunities. The aim of the study was to investigate Swedish midwives' levels of burnout and their attitudes towards leaving the profession.
A random sample of 1000 midwives who are members of the Swedish Midwifery Association were sent a questionnaire. Burnout was measured using the Copenhagen Burnout Inventory. In addition the midwives were asked if they had experienced any situation that made them consider leaving their work and to give a comment about the reason.
475 of 978 Eligible midwives (48.6%) returned the questionnaire. The Cronbach alpha values ranged from 0.81 to 0.93 for the burnout subscales. One hundred and eighty four (39.5%) scored high in the subscale Personal burnout, while Work burnout and Client burnout was around 15%. The strongest associations between Burnout and midwives' characteristics were age
Through a mail survey in 1991, we compared the opinions of 597 physicians practicing obstetrics, 723 maternity care nurses, and 70 midwives from the province of Quebec, Canada, about selected maternity care issues, including the practice of midwifery. Results showed that divergent points of view existed between and within the three groups on many maternity care issues. Physicians were more divided over the routine use of obstetric intervention than the approach to care or their opinion about midwives. Midwives held more client-centered and less interventionist attitudes than nurses or physicians. Nurses were much more open to midwives than physicians, but 20 to 30 percent of physicians saw some advantages in legalizing the practice of midwifery. Physicians and nurses generally considered midwives as a greater professional threat to the other group than to themselves. The fact that many physicians were critical of current maternity care is difficult to reconcile with their general opposition to midwives. How and to what extent physicians will respond to women's desire for more humanized and less interventionist care remains an open question. Given the problems facing maternity care in North America, expanding midwifery services is an alternative to examine seriously.
The objective of this study was to explore the essential structure of caring and uncaring encounters with nurse-midwives and other health professionals during labor and delivery as perceived by women who have given birth. The phenomenological perspective of qualitative research theory guided the methodological approach to the study, in which true dialogues were entered into with 10 mothers in Akureyri and Reykjavik, Iceland. The overriding theme of the women's experience of caring and uncaring was "empowerment or discouragement." Within that theme, four major categories were identified: (a) the nurse-midwife perceived as caring--an indispensable companion on the journey through labor and delivery; (b) the woman's perception of the effects of the encounter with the caring nurse-midwife--the sense of being empowered; (c) the nurse-midwife perceived as uncaring--an unfortunate hindrance to a successful birth experience; (d) the woman's perception of the effects of the encounter with the uncaring nurse-midwife--the sense of being discouraged. Findings indicate that the nurse-midwife who satisfies a woman's need for professional caring during the birth experience is likely to be more effective in meeting nursing and midwifery care goals than the nurse-midwife who does not and is perceived as uncaring.
The purpose of the study was to evaluate the influence of mediolateral episiotomy on the perineal state after spontaneous, singleton vaginal deliveries with the foetus in the occiput anterior position. The design was that of a population based, observational study. Two approaches were used in the analyses: Initially, we considered the parturients as quasi-randomised to one of three equally sized groups of midwives with different attitudes towards episiotomy. Secondly, we studied the effect of episiotomy on the state of the anal sphincter, controlling for birth weight, parity, and duration of second stage of labour. The subjects were 2188 pregnant women delivering consecutively, and the main outcome measures were perineal lacerations and tearing of the anal sphincter. Women allocated to the group of midwives with the lowest rate of episiotomy were more likely to have an intact perineum after delivery (OR = 1.8 (1.4-2.2)), had a slight tendency towards more perineal lacerations (OR = 1.3 (1.0-1.5)), but no increased risk of tearing of the anal sphincter, compared with the women allocated to the two groups of midwives with higher frequencies of episiotomy. The second approach showed that episiotomy was related to an increased risk of tearing of the anal sphincter (OR = 2.3 (1.2-4.6)). However, this relation was not found among the group of parturients delivered by the midwives with the lowest rate of episiotomy (22%). Our results encourage a conservative approach to the use of mediolateral episiotomy, and in the light of previous findings, it seems reasonable to suggest that episiotomy should ideally be used in about one in five spontaneous vaginal deliveries.
The aim of this study was to describe the sense of security associated with pregnancy and childbirth and to identify factors associated with it. Security was conceptualized in accordance with Kaufmann as a human need and as a human value. The instrument used was a questionnaire with a 4-point scale. The sample consisted of 481 pregnant Finnish women. The response rate was 69%. Rotated factor analysis was carried out and sum variables were produced. The effects of various background variables were calculated using the Kruskal-Wallis test and the Mann-Whitney U-test. The elements creating security were social support, knowledge, prenatal health-care experiences, support from the partner, livelihood, positive stories and, in multiparae, positive previous childbearing experiences. The most salient finding concerning factors related to security was that women who had no pregnancy-related problems in the current pregnancy reported social support, prenatal health-care experiences and support from the partner as security-creating elements more often than women with such problems. This was the only factor related to manifestation of security. The findings suggest that all pregnant women should be assisted by professionals to find security-creating elements in their particular situation to promote and strengthen the sense of security, paying special attention to women with pregnancy-related problems.
To describe fears associated with pregnancy and childbirth and to see whether women who have recently given birth feel that their fears were justified.
A qualitative study. Data were collected by semi-structured interviews. Data interpretation was based on the method of content analysis.
The maternity units of two university hospitals in Finland.
A convenience sample of 20 women, 10 primiparae and 10 multiparae. The interviews were held 2 or 3 days after childbirth.
The most common fears associated with pregnancy and childbirth were concerned with the baby's well-being, the course of pregnancy, and childbirth. The fears found expression in different kinds of behaviours, emotions and physical sensations. Many of the participants felt that their fears had not been justified, but some maintained that their fears had been justifiable.
There was much inter-individual variation in the fears associated with pregnancy and childbirth. It is important that diagnosis during pregnancy is undertaken sensitively and that midwifery staff remember that pregnant women may have very serious fears associated with pregnancy and childbirth. The participants in this study felt that fears associated with pregnancy and childbirth also had positive meanings. It may not be essential to try to protect women against these fears or to remove them altogether, but to give every pregnant women the opportunity to deal with her own fears and to obtain the help she needs in her situation.
To describe how front-line managers of maternity wards provide support to midwives as second victims in the aftermath of an adverse incident.
A qualitative study using critical incident technique and a content analytic approach of semi-structured in-depth interviews.
Maternity wards in 10 Norwegian hospitals with more than 200 registered births annually were included in the study.
A purposeful sample of 33 midwives with more than two years' working experience described 57 adverse incidents.
Maternity ward managers utilised four types of practices to support midwives after critical incidents: management, transformational leadership, distributed leadership and laissez-faire leadership.
The study shows that proactive managers who planned for how to handle critical incidents provided midwives with needed individual support and learning. Proactive transformational leadership and delegating roles for individual support should be promoted when assisting second victims after critical incidents. Managers can limit the potential harm to second victims by preparing for the eventuality of a crisis and institute follow-up practices.