No / Is midwifery knowledge a relevant construct for contemporary practice? In other words, is it useful to think about the things midwives know and the skills they possess in terms of midwifery knowledge? Or, in an era of interprofessional practice, clinical governance and risk management, have midwives lost whatever was unique to their profession about how to help women give birth?

No / Midwifery programmes attract a large number of applications with an ever increasing demand for the small number of places available. Higher Education Institutions (HEI) are concerned with attracting students who have the right attributes for a career in midwifery and who are likely to succeed on the programme. Potential students however are concerned with making the right choice of HEI where they will be comfortable spending three years working towards attaining a degree in midwifery. The University of Bradford has sought an innovative approach to the selection of students. The programme is predominantly taught through problem based learning, which enables the development of a range of skills that will benefit them in professional practice. Personal attributes required for this process can be identified at an early stage therefore a system has been introduced whereby prospective students are selected purely through the utilization of the problem based learning process.

Yes / This study will undertake a preparatory phase summarising the body of literature on midwifery students’ knowledge, understanding and experiences of workplace bullying, and violence.

Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: During the period 2006-2008 more than 50% of midwifery students at the college under study failed the midwifery training programme. The academic performance of students can be attributed to various factors, ranging from personal uniqueness and institutional aspects to the course content itself. Accordingly, this study aims to explore the perceptions and experiences of student midwives with reference to their training programme. The objectives set for the study were set to determine the perceptions and experiences of the student midwives with regard to: • guidance in the practical field, • classroom experiences • assessment procedures and • whether the students attribute their academic successes or failures to the training programme. A qualitative approach with a descriptive design was applied to determine the perceptions and experiences of the undergraduate midwifery students concerning their training programme. The population of this study was fourth-year students who have successfully completed their midwifery-training programme. Nineteen students consented to participate in the study. The trustworthiness of this study was assured by using the Lincoln and Guba’s criteria of credibility, transferability, dependability and conformability. A pre-test was completed. All ethical principles were met. Data was collected through focus group interviews, using an interview guide. The analysis of the data revealed that students attributed their academic failures and success to guidance received in the theoretical as well as the practical field. The findings displayed the frustration that the students experienced with the lecture method as a teaching strategy. Discontentment was perceived among the participants regarding the demarcation, which differed among lecturers. Students were of the opinion that certain content of the curriculum was intended for the doctors, and they indicated a need for the extension of class time, for the instruction of the theory, as the curriculum was perceived as “content heavy”. Guidance in the clinical field, by the clinical educators, was perceived as being positive, yet the student-clinical educator ratio was proving to be a challenge. Marking of tests and examination answer sheets was perceived as too strict. Recommendations Students must be active participants in the learning process, not passive recipients of information. Teaching methods (such as role-play, brainstorming, case studies, simulations, and group work), that expand and reinforce basic communication, intellectual and interpersonal skills, should be employed. Uniformity amongst midwifery facilitators, in terms of content selection, demarcations, classroom activities and assessment techniques, should be agreed upon prior to the commencement of a block period. / AFRIKAANSE OPSOMMING: Tydens die periode 2006-2008 was meer as 50% van die verloskunde studente by die kollege waar die studie gedoen was, onsuksesvol in die verloskunde program. Akademiese prestasie van studente kan aan verskillende faktore toegeskryf word. Hierdie kwessies wissel van persoonlike uniekheid en institusionele aspekte tot die kursus inhoud self. Dus poog hierdie studie om die persepsies en ervaringe van die student vroedvroue ten opsigte van hul opleidingsprogram te verken. Die doelwitte van die studie was om die persepsies en ervaringe van die student vroedvroue met betrekking tot: • praktiese leiding, • klaskamerondervinding, • assesseringsprosedures te bepaal en • of die studente hul akademiese suksesse en mislukkings aan die opleidingsprogram toe skryf. ʼn Kwalitatiewe benadering met ʼn beskrywende strategie was gebruik om die persepsies en ervaringe van die voorgraadse studente rakende hul opleidingsprogram vas te stel. Die populasie van hierdie studie was studente, in hul vierde jaar, wat reeds die verloskunde opleidingsprogram suksesvol voltooi het. Negentien studente het ingestem om aan die studie deel te neem. Die vertrouenswaardigheid van die navorsing is verseker deur van die Lincoln en Guba kriteria – geloofwaardigheid, oordraagbaarheid, betroubaarheid en bevestiging – gebruik te maak. ʼn Voorafgaande toets is voltooi. Al die etiese beginsels is nagekom. Data is ingesamel deur onderhoude met fokusgroepe te voer. ’n Onderhoudsgids is vir die doeleinde gebruik. Die data-ontleding het getoon dat studente hul akademiese mislukkings en suksesse aan die leiding wat hulle op teoretiese en praktiese gebiede ontvang het, toeskryf. Die bevindinge het die frustrasie wat die studente met die lesmetode as ’n onderrigstrategie ervaar, getoon. Ontevredenheid rakende die werkafbakening, wat verskil van lektor tot lektor, is ook waargeneem. Studente voel dat dele van die kurrikuluminhoud vir dokters bedoel is. Hulle is van mening dat meer klastyd nodig is om teorie te onderrig, aangesien die kurrikulum oorvol is. Hoewel die leiding op kliniese gebied, deur die kliniese opvoeders, positief ervaar is, is die student-opvoeder verhouding as ʼn uitdaging beskou. Die studente het gevoel dat hul toetse en eksamenantwoordstelle te streng nagesien was. Aanbevelings: Studente moet aktief by die leerproses betrek word en moet nie bloot passiewe ontvangers van inligting wees nie. Onderrigmetodes, wat basiese kommunikasie-, intellektuele en interpersoonlike vaardighede aanvul en versterk (soos byvoorbeeld rolspel, dinkskrums, gevallestudies, simulasies en groepwerk), moet ingespan word. Die fasiliteerders moet ooreenkom en ʼn eenvormige beleid, betreffende die kurrikuluminhoud, afbakening van werk, klaskameraktiwiteite en assesseringsmetodes, voor die aanvang van die blokperiode, daarstel.

Thesis (MCurr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The midwives are the backbone of midwifery practice with needs and opportunities to create a tradition of caring in midwifery. However, there are problems that affect the midwifery practice. These problems include the increased maternal and perinatal mortality rate, shortage of material and human resources and poor implementation of policies and guidelines. The purpose of this study was to investigate factors that affect quality of care in a midwifery practice at a hospital complex in the Eastern Cape Province, South Africa. The objectives of the study focused on the structure and process standards. - 1 Structure Standards: To determine whether • policies and procedure manuals are available and updated • support from the supervisor is available • there is adequate staff • the required qualifications were available • the required experience of registered midwives were available • in-service training was being given - 2 Process standards : To determine whether • patients were assessed according to the national guidelines for maternity care • patients were diagnosed according to the national guidelines for maternity care • patients’ care plans were formulated according to the national guidelines for maternity care The descriptive research design with a quantitative approach was applied in this study. The target population (N=172) were the registered midwives working in the maternity department at a particular hospital in the Eastern Cape Province. A specific sampling method was not applied in this study as the total population of 155 was included and17 in the pilot study with a response rate of 81.3%. A self-administered structured questionnaire was used to collect the data. The researcher distributed the questionnaires personally to all respondents who met the criteria. Reliability and validity were assessed by means of a pilot study and the use of experts in Nursing Education, Midwifery, Research Methodology and Statistics. Ethical approval was obtained from Stellenbosch University and all other relevant parties. Computerized data analysis software namely the SPSS programmes and Stastica version 9 were used to analyze the data. The results of the study were interpreted, discussed and presented in tables and frequencies. The data was predominantly presented in a quantitative form with responses to a few close-ended questions. A confirmatory analysis to test the quality of properties across a level of variables was carried out. The Chi-square test was used to test association of variables between demographic data and the responses of midwives to factors affecting quality of care. A p-value of p< 0.05 represents statistical significance in hypothesis testing and 95% confidence intervals were used to describe the estimation of unknown parameters. Results showed that the majority of respondents had an experience of 2 to 5 years (n=34/27.0%) and (n=32/25.4%) more than 14 years working in the maternity department. The minority of respondents were those that are highly skilled. Only (n=4/3.2 %) of the midwives were registered in neonatology nursing and (n=9/7.1%) in advanced midwifery. The majority of respondents (n=118/93.7%) recorded that there was not enough staff to provide quality nursing care. Some respondents recorded that comprehensive in-service education was not offered in the hospital (n=18/14.3%). Recommendations include improvement of staffing, adherence to policies and guidelines, proper implementation of staff development and quality improvement programmes. In conclusion, in order to reduce high infant and maternal mortality rates and to reach the millennium development goals, shortcomings in midwifery should urgently be addressed. / AFRIKAANSE OPSOMMING: Die vroedvroue is die ruggraat van die verloskunde-praktyk met behoeftes en geleenthede om ’n tradisie van versorging in verloskunde te skep. Nietemin is daar uitdagings wat die praktisering van verloskunde beïnvloed. Hierdie uitdagings sluit in die toenemende moeder en perinatale mortaliteit, ’n tekort aan materiële en menslike hulpbronne, en die swak toepassing van beleid en riglyne. Die doel van hierdie studie was om die faktore te ondersoek wat die kwaliteit van sorg in ’n verloskunde-praktyk by ’n hospitaalkompleks in die Oos-Kaap in Suid-Afrika, beïnvloed. Die doelwitte van die studie was op struktuur en proses standaarde gefokus. - 1 Struktuur standaarde: Om te bepaal of • beleid en prosedure handleidings beskikbaar en opgedateer is • daar ondersteuning van die toesighouer is • daar voldoende personeel is • daar voldoen is aan die vereiste kwalifikasies • die vereiste ondervinding van geregistreerde vroedvroue teenwoordig • is indiensopleding gegee - 2 Proses standaarde: Om te bepaal of • pasiënte assesseer is volgens die nasionale riglyne vir verloskunde • pasiënte gediagnoseer is volgens die nasionale riglyne • pasiëntversorgingsplanne geformuleer is volgens die nasionale riglyne vir verloskunde. Die beskrywende navorsingsontwerp met ’n kwantitatiewe benadering is in hierdie studie toegepas. Die teikenbevolking (N=172) is die geregistreerde vroedvroue wat in die kraamafdeling van die spesifieke hospitaal in die provinsie van die Oos-Kaap werk. ‘n Spesifieke steekproefmetode is nie vir die studie toegespas nie maar wel die hele populasie is betrek van 155 en 17 in die lootsstudie met ‘n respons van 81.3%. ’n Self-geadministreerde gestruktureerde vraelys is gebruik om die data te versamel. Die navorser het die vraelyste persoonlik aan al die beskikbare respondente wat aan die kriteria voldoen het, versprei. Betroubaarheid en geldigheid is geassesseer deur middel van ’n loodsondersoek en deur gebruik te maak van spesialiste in Verpleegopleiding, die Navorsingssentrum en Statistiek. Etiese goedkeuring is verkry van die Universiteit Stellenbosch en al die ander relevante partye. Gerekenariseerde data-analise sagteware, naamlik die SPSS programme en Statistica uitgawe 9 is gebruik om die data te analiseer. Die resultate van die studie is geïnterpreteer, bespreek en aangebied in tabelle en frekwensies. Die data is oorwegend in ’n kwantitatiewe formaat aangebied met response op ’n paar geslote vrae. ’n Bekragtigingsanalise om die eienskappe oor ’n vlak van veranderlikes te toets, is gedoen. Die Chi-kwadraat toets is gebruik om assosiasie van veranderlikes te toets tussen demografiese data en die response van vroedvroue vir faktore wat die kwaliteit van versorging beïnvloed. ’n P-waarde van p<0.05 verteenwoordig statistiese beduidendheid in hipotese-toetsing en 95% sekerheidsintervalle is gebruik om die beraming van onbekende parameters te beskryf. Resultate dui aan dat die meerderheid van respondente 2 tot 5 jaar werkervaring (n=34/27.0%) het en (n=32/25.4%) meer as 14 jaar in die kraamafdeling het. Die minderheid respondente is diegene wat hoogsbekwaam is. Alleenlik (n=4/1.0%) vroedvroue is in neonatale verpleging gereistreer en (n=9/7.1%) in gevorderde verloskunde geregistreer is. Die meeste respondente (n=118/93.7%) het aangedui dat daar nie voldoende personeel is om kwaliteit verpleegsorg te gee nie. Sommige respondente het aangedui dat omvattende indiensopleiding nie in die hospitaal aangebied is nie (n=18/14.3%). Aanbevelings sluit in die verbetering van personeelvoorsiening, die nakoming van beleid en riglyne, behoorlike implementering van personeelontwikkeling en gehalte verbeteringsprogramme. Ten slotte, om die hoê insidensie in moeder en kind mortaliteit te verminder en die millennium ontwikkelingsdoelwitte te bereik, moet die tekortkomings in verloskunde dringend aangespreek word.

Thesis (M. Cur.) -- University of Limpopo, 2017 / BACKGROUND Midwifery learning encompasses both theory and experiential components. Experiential learning plays an important role in midwifery training. Conducting the first normal vaginal delivery seemed traumatic for the learner nurses when they witness the bulging of the perineum when the head of the fetus is crowning. The trauma and stress of learner nurses resulted in negative reactions such as fainting, vomiting, and failing midwifery experiential assessments. The aim of the study was to design the strategies to enhance the adaptation of learner nurses regarding midwifery experiential learning in the clinical settings of Limpopo Province. RESEARCH METHOD A quantitative descriptive cross-sectional research method was used to collect numeric data with regard to the factors that hinder the adaptation of learner nurses regarding midwifery experiential learning in the clinical settings of Limpopo province. Data was collected using a self-administered questionnaire and analysed using the Statistical Package for Social Sciences (SPSS) version 23 with the assistance of the statistician. RESULTS The study revealed that the factors that hinder the adaptation of learner nurses regarding midwifery experiential learning are lack of accompaniment of learner nurses to the maternity units, the anxiety experienced by learner nurses when they witnessed the first delivery, learner nurses not being included in decision making processes in the maternity units and the hostile attitudes of registered midwives towards the learner nurses in the maternity units. Strategies were developed to enhance the adaptation of learner nurses regarding midwifery experiential learning in the clinical settings of Limpopo province. CONCLUSION The study concluded that learner nurses faced challenges that hinder their adaptation to midwifery experiential learning in the clinical settings of Limpopo Province.

Introduction: In Ontario, prior to 1994, planned home birth attended by midwives was a self-paid service. Since the introduction of regulated midwifery in 1994, home birth is a government-funded service, and uses common resources. As such, there is a need to examine the impact that choice of planned location of birth puts on scarce resources. To date, costs associated with planned place of birth in Ontario have not been evaluated. Objectives: The primary objective is to answer the question: Do planned midwifery-attended home births from the onset of labour cost the Ontario health care system more or less than planned midwifery-attended hospital births from the onset of labour among a comparable low-risk cohort of women? Specifically, this analysis examines the cost of midwifery intrapartum care, from the onset of labour until hospital discharge or the first two days after delivery. Methods: This cost-analysis used a third-party payer perspective (health services costs) to analyze data from the Ontario Midwifery Program, which included 12, 886 midwife-attended births that occurred between April 1, 2003 and March 31, 2006. Three main sources of information were used to determine unit cost and health care utilization: the Ontario Midwifery Program data (2003-2006); data from the Ontario Case Costing Initiative; and the 2010 Schedule of Benefits for Physician Services. Data was analyzed using an intention to treat approach, i.e. based on planned rather than actual location of delivery. Results: Hospital birth is more expensive than planned home-birth. Results were significant with a P value =< .001. The median cost from the onset of labour was $995.95 (IQR $995.95 to $995.95) for planned home birth compared to $2118.12 (IQR $1467.12 to $3610.00) for planned hospital birth. Conclusions: Home birth, a choice that women in Ontario will continue to choose, does not result in costing the Ontario health care system more money. / Thesis / Master of Science (MSc) / This thesis answers the question: Do midwifery-attended planned home births cost the Ontario health care system more or less than midwifery-attended planned hospital births? This thesis examined midwifery-attended births that occurred in Ontario between April 1, 2003 and March 31, 2006 and associated costs that were incurred for both the mother and the baby from the onset of labour until two days following the birth. Since 1994 when midwifery was legislated in Ontario, registered midwives have been providing care to women in both home and hospital settings. While there is general consensus within the midwifery community that home births do not cost the health care system more money, a thorough analysis of costs incurred by midwifery-attended births has not been meaningfully analyzed. Midwifery is the only group of health care professionals providing maternity care that is increasing in size. Given the shortage and the current crisis of maternity care providers, the number of midwives in this province is likely to continue growing. At the same time, a cost analysis of the resources consumed through the provision of maternity care – both at home and at hospital- has not been conducted. This study provides key stakeholders with information regarding resources used and needed and the costs associated with these resources so that resource allocation and planning can be conducted in a responsive manner.

Background: The transition to clinical practice is a phenomenon that all health care professionals experience and one that has been studied in many fields of health care, yet remains largely unexamined for Canadian midwives. This study asked the question: How do new registrant midwives in Ontario navigate the transition from student to clinician during their first year of clinical practice? Methodology: In this grounded theory study, a total of 13 semi-structured interviews were conducted with Ontario midwives from three participant groups: A) New registrants in their first year of clinical practice; B) Registered midwives with 1-5 years of clinical experience; C) Registered midwives who work with new registrants as supervisors or mentors. Findings: The Building, Bridging, and Being theory describes how new registrants transitioned to clinical practice. During the Building phase, individuals developed the knowledge and skills for clinical practice; midwifery students experienced elements of this phase during their final clinical placement. The Bridging phase occurred when new registrants embarked on independent clinical practice; this phase was characterized by providing clinical care without the safety net of a preceptor. Finally, the Being phase occurred when new registrants developed confidence in their skills and professional identity as midwives. A final theme, Bettering, encompassed participants’ suggestions of ways to help improve the transition process. Conclusion: The Building, Bridging, Being theory contributes to the present understanding of the transition to clinical practice for midwives in Ontario. This study highlighted the importance of strengthening the Preparation, Orientation, Mentorship, and Ongoing Education of new registrants through their transition to clinical practice. The findings of this study are relevant to individuals and organizations invested in educating and integrating midwives into the Ontario health care system and provides a starting point for further research centered on the transition to clinical practice for midwives in Ontario and throughout Canada. / Thesis / Master of Science (MSc) / The transition to clinical practice is a phenomenon that all health care professionals experience and one that has been studied in many fields of health care, yet remains largely unexamined for Canadian midwives. This study asked the question: How do new registrant midwives in Ontario navigate the transition from student to clinician during their first year of clinical practice? Thirteen interviews were conducted with Ontario midwives from three participant groups: A) New registrants in their first year of clinical practice; B) Registered midwives with 1-5 years of clinical experience; C) Registered midwives who work with new registrants as supervisors or mentors. The findings of this study led to the development of the Building, Bridging, and Being theory, which helps explain how midwives in Ontario transition to clinical practice and provides a starting point for further research centered around the transition to clinical practice midwives in Ontario and throughout Canada.

Yes / An innovative new midwifery programme leading to midwifery registration with the Nursing and Midwifery Council (NMC) developing potential registrants at both BSc and MSc levels commenced in September 2016. The programme is delivered utilising problem-based learning (PBL) as both a content delivery method and a philosophical approach, underpinning student learning at the UK's University of Bradford, School of Midwifery. A requirement for NMC revalidation at a five-year juncture and institutional programme reapproval acted as a catalyst for change. The programme team embraced a new curriculum framework which emphasised a move to reviewing stage and programme outcomes rather than concentrating on the minutiae of module outcomes. This new approach suited the holistic nature of PBL ensuring an intellectually challenging and inclusive method of teaching and learning for midwifery practice. A further progression for the programme team was to develop an understanding of, and to integrate, ‘threshold concepts’ or ‘troublesome knowledge’. These are defined as knowledge, principles or components which students find difficult to understand and therefore to utilise to improve practice and deliver high-quality care. This article explores the integration of threshold concepts into a problem-based midwifery curriculum.

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