Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and ...mortality, effectiveness and psychosocial outcomes between midwife-led continuity models and other models of care.
To compare midwife-led continuity models of care with other models of care for childbearing women and their infants.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (25 January 2016) and reference lists of retrieved studies.
All published and unpublished trials in which pregnant women are randomly allocated to midwife-led continuity models of care or other models of care during pregnancy and birth.
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach.
We included 15 trials involving 17,674 women. We assessed the quality of the trial evidence for all primary outcomes (i.e. regional analgesia (epidural/spinal), caesarean birth, instrumental vaginal birth (forceps/vacuum), spontaneous vaginal birth, intact perineum, preterm birth (less than 37 weeks) and all fetal loss before and after 24 weeks plus neonatal death using the GRADE methodology: all primary outcomes were graded as of high quality.For the primary outcomes, women who had midwife-led continuity models of care were less likely to experience regional analgesia (average risk ratio (RR) 0.85, 95% confidence interval (CI) 0.78 to 0.92; participants = 17,674; studies = 14; high quality), instrumental vaginal birth (average RR 0.90, 95% CI 0.83 to 0.97; participants = 17,501; studies = 13; high quality), preterm birth less than 37 weeks (average RR 0.76, 95% CI 0.64 to 0.91; participants = 13,238; studies = eight; high quality) and less all fetal loss before and after 24 weeks plus neonatal death (average RR 0.84, 95% CI 0.71 to 0.99; participants = 17,561; studies = 13; high quality evidence). Women who had midwife-led continuity models of care were more likely to experience spontaneous vaginal birth (average RR 1.05, 95% CI 1.03 to 1.07; participants = 16,687; studies = 12; high quality). There were no differences between groups for caesarean births or intact perineum.For the secondary outcomes, women who had midwife-led continuity models of care were less likely to experience amniotomy (average RR 0.80, 95% CI 0.66 to 0.98; participants = 3253; studies = four), episiotomy (average RR 0.84, 95% CI 0.77 to 0.92; participants = 17,674; studies = 14) and fetal loss less than 24 weeks and neonatal death (average RR 0.81, 95% CI 0.67 to 0.98; participants = 15,645; studies = 11). Women who had midwife-led continuity models of care were more likely to experience no intrapartum analgesia/anaesthesia (average RR 1.21, 95% CI 1.06 to 1.37; participants = 10,499; studies = seven), have a longer mean length of labour (hours) (mean difference (MD) 0.50, 95% CI 0.27 to 0.74; participants = 3328; studies = three) and more likely to be attended at birth by a known midwife (average RR 7.04, 95% CI 4.48 to 11.08; participants = 6917; studies = seven). There were no differences between groups for fetal loss equal to/after 24 weeks and neonatal death, induction of labour, antenatal hospitalisation, antepartum haemorrhage, augmentation/artificial oxytocin during labour, opiate analgesia, perineal laceration requiring suturing, postpartum haemorrhage, breastfeeding initiation, low birthweight infant, five-minute Apgar score less than or equal to seven, neonatal convulsions, admission of infant to special care or neonatal intensive care unit(s) or in mean length of neonatal hospital stay (days).Due to a lack of consistency in measuring women's satisfaction and assessing the cost of various maternity models, these outcomes were reported narratively. The majority of included studies reported a higher rate of maternal satisfaction in midwife-led continuity models of care. Similarly, there was a trend towards a cost-saving effect for midwife-led continuity care compared to other care models.
This review suggests that women who received midwife-led continuity models of care were less likely to experience intervention and more likely to be satisfied with their care with at least comparable adverse outcomes for women or their infants than women who received other models of care.Further research is needed to explore findings of fewer preterm births and fewer fetal deaths less than 24 weeks, and all fetal loss/neonatal death associated with midwife-led continuity models of care.
This study seeks to elucidate the enigmatic promise that woman "will be saved through childbearing" (σωθήσεται διὰ τῆς τεκνογονίας) in 1 Timothy 2:15. The idea is notoriously difficult to ...interpret within existing conceptions of Pauline soteriology due to its distinctively gendered horizon. What is the relationship between salvation and childbearing? Is the soteriology of 1 Timothy gender-differentiated? The central thesis is that being saved διὰ τῆς τεκνογονίας is about the divine preservation of women's bodies during childbirth. "Tokological deliverance" from the pain and danger to life normally associated with childbearing is, however, part of a wider soteriological scheme which culminates in the eschatological salvation of body and soul. The project is introduced with a history of the interpretation of 1 Timothy 2:15, which delineates the various grammatical, linguistic and theological points of contention. Part I examines the construals of childbearing-related salvation in an assemblage of early Jewish and Christian renarrativisations of Genesis 3:16: Apocalypse of Baruch (2 Baruch) 72-74, the Greek Life of Adam and Eve 25, in the Ascension of Isaiah 11, the Odes of Solomon 19, the Protevangelium of James 11, 17-20, and the Latin Acts of Andrew 25. I argue that in each case, Eve's paradigmatic maternal judgement is mitigated by the midwifery of God, who safely delivers the parturient. Part II interprets 1 Timothy 2:15 in light of these pseudepigraphical reworkings of Genesis 3:16, through the lens of the midwifery of God motif. The expression is conceptualised as the climax of the author's haggadic reworking of the myth of Eve's creation and transgression in Genesis 2-3, which subverts her sentence of difficult childbearing. This redescription of maternity as an occasion for "tokological deliverance" serves the polemical goal of the letter, namely to refute the sexually ascetic teaching of rival Torah-teachers, by marking procreation as a divinely blessed endeavour. In conclusion, I draw some wider implications for research on salvation and gender, and the positioning of 1 Timothy "within Judaism." Finally, in an appendix, I establish the sociological circumstance behind the concept of divine midwifery by estimating the prevalence of maternal death in the Graeco-Roman world.
Aim
This study aimed to investigate the challenges faced by midwifery staff working in hospitals from midwifery manager's perspectives and provide suggestions to solve them.
Design
Descriptive ...qualitative study.
Methods
The study was conducted in Tehran in 2021. Data were collected using fifteen semi‐structured interviews conducted with hospitals' clinical midwifery managers over 7 months. The interview data were grouped into three themes: recruitment, development, and maintenance.
Results
The midwifery workforce would face significant challenges in training hospitals. Lack of suitable patterns of midwifery workforce management, the non‐optimal midwives' utilization and deployment, unclear job boundaries, weak training programs for the midwives' professional development, and unpleasant working atmosphere were the main challenges. A well‐defined task description for midwives to determine their position in all spheres of reproductive health service provision, create training courses based on skill gaps, and focus on improving labour relations and organizational culture are suggested.
Patient or Public Contribution
Midwifery managers were interviewed. They talked about their experience with midwifery workforce challenges.
Background
Globally, midwifery‐led birthing units are associated with excellent maternal and neonatal outcomes, and positive childbirth experiences. However, little is known about what aspects of ...midwife‐led units contribute to favorable experiences and overall satisfaction. Our aim was to explore and describe midwifery service user experiences at Canada's first Alongside Midwifery Unit (AMU).
Methods
We used a qualitative, grounded theory approach using semi‐structured interviews with recipients of midwifery care at the AMU.
Findings
Data were collected from twenty‐eight participants between September 2018 and March 2020. Our generated theory explains how birth experiences and satisfaction were influenced by how well the AMU aligned with expectations or desired experiences related to the following four themes: (1) maintaining the midwifery model of care, (2) emphasizing control and choice, (3) facilitating interprofessional relationships, and (4) appreciating the unique AMU birthing environment.
Conclusion
Canada's first AMU met or exceeded service‐user expectations, resulting in high levels of satisfaction with their birth experience. Maintaining core elements of the midwifery model of care, promoting high levels of autonomy, and facilitating positive interprofessional interactions are crucial elements contributing to childbirth satisfaction in the AMU environment.
Our study found that birth experiences and satisfaction at Canada's first Alongside Midwifery Unit (AMU) were influenced by the degree to which the AMU aligned with service‐users' expectations or desired experiences, particularly as they related to four categories: 1) maintaining the midwifery model of care; 2) emphasizing control and choice; 3) facilitating interprofessional relationships; and 4) appreciating the unique AMU birthing environment. Canada's first AMU met or exceeded service‐user expectations, resulting in high levels of satisfaction with their birth experience.
In recent years, extensive studies have been designed and performed in the context of providing midwifery care in developed countries, which has been unfortunately neglected in some low resources and ...upper middle-income countries such as Iran. This study was conducted to identify the best strategies for improving the quality of midwifery care and developing midwife-centered care in Iran.
This was a qualitative study using focus group discussion and content analysis method. Data were collected from 121 participants including midwifery board members, gynecologists, heads of midwifery departments, midwifery students, in charge midwives in hospitals, and midwives in the private sector. Focused-group discussions were used for data collection, and data were analyzed using content analysis method.
The main themes extracted from the participants' statements regarding improving the quality of midwifery care were as follows: Promotion and development of education, Manpower management, Rules, and regulations and standards for midwifery services, and Policy making.
This study showed that to improve midwifery care, health policy makers should take into account both the quality and quantity of midwifery education, and promote midwifery human resources through employment. Furthermore, insurance support, encouragement, supporting and motivating midwives, enhancing and improving the facilities, providing hospitals and maternity wards with cutting-edge equipment, promoting and reinforcing the position of midwives in the family doctor program, and using a referral system were the strategies proposed by participants for improving midwifery care. Finally, establishing an efficient and powerful monitoring system to control the practice of gynecologists and midwives, promoting the collaborative practice of midwives and gynecologists, and encouraging team-work with respect to midwifery care were other strategies to improve the midwifery services in Iran. Authorities and policymakers may set the stage for developing high quality and affordable midwifery care by relying on the strategies presented in this study.
The concept of professional midwifery autonomy holds great significance in midwifery education. Notably, clinical placements play a crucial role in introducing students to its concept. However, the ...understanding and experiences of students regarding midwifery autonomy are relatively unknown.
This study aimed to examine the experiences and understanding of midwifery autonomy among final-year midwifery students.
A qualitative exploratory study using three focus group interviews with final-year midwifery students from each of the three Belgian regions; Flanders, Walloon and the Brussels Capital Region. Focus groups were recorded, transcribed verbatim and analysed using a thematic analysis.
Upon data analysis, five key themes emerged; 1) working independently, 2) positive learning environment, 3) professional context, 4) actions and decisions of others and 5) beneficial for women. Students emphasized the importance of promoting professional midwifery autonomy through the ability to make their own professional decisions and take initiatives. They highlighted the need for a safe and supportive learning environment that encourages independent practice, nurtures self-governance and facilitates personal growth. Additionally, collaborative relationships with other maternity care professionals and increased awareness among women and the broader healthcare community were identified as essential factors in embracing and promoting professional midwifery autonomy.
Our study provides valuable insights into the significance of midwifery autonomy among final-year midwifery students. To empower midwifery students to truly understand and experience professional midwifery autonomy, educators and preceptors should adopt strategies that enhance comprehension, foster independent yet collaborative practice, establish supportive learning environments, and equip students to navigate challenges effectively, ultimately improving maternal and new-born health.
•Students emphasized the importance of safe and supportive learning environments.•Collaboration with other professionals promotes professional midwifery autonomy.•Increased awareness among women and healthcare professionals may promote midwifery autonomy.•Supportive learning environments and education contributes to the development of an autonomous midwifery profession.
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