ABSTRACT
INTRODUCTION: Access to quality care is a problem in Texas, an ethnically diverse state with large birth numbers. The state has over 300 areas designated as medically underserved, and a severe lack of obstetricians and midwives. Minimal data exist on midwifery's contribution, and no known study compares the work environment and clinical practice of the 2 state-recognized midwifery paths, licensed midwives (LMs) and certified nurse-midwives (CNMs). The purpose of this study was to determine the differences in practice by CNMs and LMs, the latter of whom are generally certified professional midwives. The specific aims were to 1) describe the differences in demographic and employment characteristics of CNMs and LMs, 2) identify the geographic areas and population groups served by CNMs and LMs, and 3) compare the nature and scope of CNM and LM clinical practices. METHODS: Online parallel surveys of Texas LMs and CNMs were conducted in December 2015 and January 2016. The REDCap data management system housed the 123- and 125-item surveys for LMs and CNMs, respectively, addressing demographics, populations served, and clinical practice. A comparative statistical analysis, using Fisher's exact test, Pearson's chi-squared test, and Independent Samples t-tests, was performed. RESULTS: The survey response rates of LMs and CNMs were 35.4% (n = 75) and 31.9% (n = 143), respectively. Differences in demographics, employment status, workload, scope of practice, risk assessment, time-based care management, and technology use were observed. DISCUSSION: Findings represent the first attempt to describe the Texas midwifery workforce. In a large state with health care provider shortages, this step is pivotal in addressing strategies for providing services for women and infants. This groundwork can provide the foundation for including midwifery in a state health plan.
Subject(s)
Certification , Employment , Health Workforce , Licensure , Midwifery , Nurse Midwives , Professional Practice , Ethnicity , Female , Humans , Maternal-Child Health Services , Practice Patterns, Nurses' , Pregnancy , Professional Role , Surveys and Questionnaires , Texas , WorkloadABSTRACT
The complexity of caring for female adolescents with neurodisabilities often overshadows normal biological changes. These young women may require additional or individualized support as they adapt to normal puberty and sexual maturation. Many choices are available to assist in managing menstrual problems, hygiene issues, and contraception. Special considerations regarding contraceptive methods, sexual education, and improving service accessibility are explored for clinicians.
Subject(s)
Adolescent Behavior , Contraception/psychology , Neurodevelopmental Disorders , Pregnancy in Adolescence , Sex Education , Sexual Behavior , Adolescent , Adolescent Health Services , Female , Health Services Accessibility , Humans , Neurodevelopmental Disorders/psychology , Neurodevelopmental Disorders/rehabilitation , Pregnancy , Pregnancy in Adolescence/physiology , Pregnancy in Adolescence/prevention & control , Pregnancy in Adolescence/psychology , Sex Education/methods , Sex Education/organization & administration , Sexual MaturationABSTRACT
About 12 000 women of childbearing age sustain spinal cord injuries each year in the United States. Around 2000 of these women become pregnant in a given year, yet few providers are aware of the interprofessional team approach needed to achieve a successful pregnancy with healthy outcomes for both mother and fetus. A family-centered approach by an experienced team can make the childbearing experience both safe and optimal for the maternal-fetal dyad. The challenges related to caring for women with spinal cord injury during pregnancy, including skin breakdown, urinary tract infections, respiratory compromise, bowel motility, depression/anxiety, preterm labor, and autonomic dysreflexia, are reviewed.
