Midwives' views of traditional birth attendants within formal healthcare in Nigeria.

BACKGROUND: Discourses around the journey to motherhood in many poorly-resourced countries, particularly in the sub-Saharan African region, with no link to death and danger are limited. The custodians of traditional practices - the traditional birth attendants - are often blamed for the high maternal deaths in this region. Conventional institutional and international thinking about traditional birth attendants is that they are dangerous and therefore should no longer be allowed to practice. AIM: To explore midwives' views of traditional birth attendants' place within formal healthcare settings in Nigeria. METHODS: Hermeneutic phenomenological and poststructural feminist approaches were used. Seven midwives volunteered for semi-structured individual face to face interviews. FINDINGS: The responses of the midwives were diverse and conflicting. Some midwives believe that the traditional birth attendants should be banned, arguing that they are responsible for low uptake of hospital-based maternity care by women which in turn leads to an increase in maternal deaths. Contrastingly, other midwives expressed a view that the traditional birth attendants 'cannot be phased out' due to their valid contributions, particularly in the rural areas where access to formal maternity care is limited by intractable structural problems. CONCLUSION: Policy makers need to reconsider the role of traditional birth attendants. This should involve not only their integration into formal healthcare to work alongside formally trained maternity care providers, but also fostering a healthcare atmosphere where respect and recognition of each practitioner's skill is paramount.

Unilateral collaboration: The practices and understandings of traditional birth attendants in southeastern Nigeria.

BACKGROUND: Despite the promotion of hospital-based maternity care as the safest option, for less developed countries, many women particularly those in the rural areas continue to patronise indigenous midwives or traditional birth attendants. Little is known about traditional birth attendants' perspectives regarding their pregnancy and birth practices. AIM: To explore traditional birth attendants' discourses of their pregnancy and birthing practices in southeast Nigeria. METHOD: Hermeneutic phenomenology guided by poststructural feminism was the methodological approach. Individual face to face semi-structured interviews were conducted with five traditional birth attendants following consent. FINDINGS: Participants' narratives of their pregnancy and birth practices are organised into two main themes namely: 'knowing differently,' and 'making a difference.' Their responses demonstrate evidence of expertise in sustaining normal birth, safe practice including hygiene, identifying deviation from the normal, willingness to refer women to hospital when required, and appropriate use of both traditional and western medicines. Inexpensive, culturally sensitive, and compassionate care were the attributes that differentiate traditional birth attendants' services from hospital-based maternity care. CONCLUSION: The participants provided a counter-narrative to the official position in Nigeria about the space they occupy. They responded in ways that depict them as committed champions of normal birth with ability to offer comprehensive care in accordance with the individual needs of women, and respect for cultural norms. Professional midwives are therefore challenged to review their ways of practice. Emphasis should be placed on what formal healthcare providers and traditional birth attendants can learn from each other.

Are staffing shortages changing the culture of midwifery?

The effects of budgetary changes on midwives' practice environment have raised concerns in many settings. A survey of midwives and student midwives in the UK and Republic of Ireland in 2014 produced 280 responses. Staffing shortages were regarded as underpinning many changes, one of which was that of previously optional 'extra' activities, such as unpaid overtime, becoming mandatory. Shortages were aggravated in less acute areas by the transfer of midwives to more acute settings. One of the fears expressed by midwives was that a permanent change in the culture of midwifery would result. These phenomena are the everyday experiences of practising midwives, but they have failed to be addressed in the documents published by regulatory and review bodies.

Reflections on human rights as a reality for women and midwives.

We often speak of a woman's right to choose the way she wishes to give birth. This article discusses how 'real' that right is. Some of the legal background to human rights as they relate to childbirth is set out, centred on the 2010 European Court of Human Rights ruling in the home birth case, Ternovszky v Hungary. The limitations of this case point to why resorting to the law to achieve their rights about birth may not be the most fruitful remedy for women. Instead the argument is made for creating equality of voice in the clinical area to achieve a stronger collective voice for anchoring human rights in practice.

The politics of maternity.

Changes in the culture of health care require that, to be effective, midwifery practice should become more woman-centred. This may be facilitated by adopting a stronger community orientation. In this way the hegemony of maternity care may be addressed. This paper seeks to draw readers' attention to political developments and to inspire midwives to greater awareness and, possibly, activity.

Irish midwives' experiences of providing maternity care to non-Irish women seeking asylum.

BACKGROUND: Immigration and asylum seeking has been an important social and political phenomenon in Ireland since the mid 1990s. Inward migration to Ireland was seen in unprecedented numbers from 1995 onward, peaking in 2002 with 11,634 applications for refugee status. Asylum and immigration is an issue of national and international relevance as the numbers of displaced people worldwide continues to grow, reaching the highest level in 20 years at 45.2 million in 2012. Midwives provide the majority of care to childbearing women around the world, whether working as autonomous practitioners or under the direction of an obstetrician. Limited data currently exist on the perspectives of midwives who provide care to childbearing women while they are in the process of seeking asylum. Such data are important to midwifery leaders, educators, and policy-makers. The aims of this study were to explore midwives' perceptions and experiences of providing care to women in the asylum process and to gain insight into how midwives can be equipped and supported to provide more effective care to this group in the future. METHODS: Data were collected via indepth unstructured interviews with a purposive sample of ten midwives from two sites, one a large urban inner city hospital, and the second, a smaller more rural maternity hospital. The interviews were audio-recorded and transcribed verbatim. The data were analyzed using content analysis. RESULTS: Five themes emerged from the data, barriers to communication, understanding cultural difference, challenges of caring for women who were unbooked, the emotional cost of caring, and structural barriers to effective care. CONCLUSION: Findings highlight a need to focus on support and education for midwives, improved maternity services for immigrant women, and urgent policy revision.

Childbirth in exile: asylum seeking women's experience of childbirth in Ireland.

OBJECTIVES: the purpose of this study was to gain insight into women's experiences of childbirth in Ireland while in the process of seeking asylum. This paper will focus on one of the primary findings of the study, how lack of connection, communication and cultural understanding impacted the health and well-being of the women who participated. DESIGN: researchers adopted a structural approach to narrative analysis using Burke's (1969) dramatistic pentad to analyse 22 women's narrative accounts of their childbirth experiences. Ethical approval was granted, and the study was funded by the Irish Health Research Board. FINDINGS: Burke's (1969) dramatistic pentad revealed numerous accounts of Scene/Agent and Act/Agency imbalance in the women's experiences, highlighting lack of communication, connection and culturally competent care evident in their experiences and how this impacted the care they received. CONCLUSION: inadequate, poorly organised maternity services complicated by lack of training in cultural understanding and sporadic access to interpreter services had a detrimental impact on care provision. Providers appeared to have little insight into the specific needs of this vulnerable group already traumatised by pre and post migratory stressors. The resulting lack of effective connection and communication exacerbated women's experiences of alienation, loneliness, and isolation and were universal in the women's accounts. Implications for practice need to focus in Burkean terms on 'How' (Agency) providers can meet the maternity care needs of asylum seeking women. Dedicated community based services, mandatory training in cultural competence, 24 hour access to interpreters, information leaflets in several languages are essential measures. Further research looking specifically at the antenatal care and childbirth education needs of ethnic minority women is needed. Also, there is an urgent need for further exploration of the barriers to communication and the utilisation of trained interpreters in the provision of effective care to non-English speaking ethnic minority women.

Creating change in improbable places: the Birth Project Group.

The Birth Project Group, a collaborative initiative based in Edinburgh and Dublin and comprising practising midwives, academics and birth advocates, held its second weekend workshop in April 2010. This brought together those involved in working to sustain and strengthen changes to the contemporary birth culture so as to promote normality. This article reports on the feedback from some of the attendees, which included parents, midwives and student midwives.

Childbirth policies and practices in Ireland and the journey towards midwifery-led care.

OBJECTIVE: To describe the dominant policies and practices that have governed childbirth in Ireland, and to outline the progress made towards the introduction of midwifery-led care in one health region. LITERATURE REVIEW: A review of maternity-care policies in Ireland was conducted using government and regional health-authority documents and two historical reviews of government policies. A search was also carried out in PubMed and cinahl databases, using the keywords 'maternity care', 'childbirth', 'policy', 'midwifery-led', 'Ireland/Irish', with relevant Boolean and string operands. Childbirth as a social process is influenced by the model of care, and affects the physical and psychological outcomes for the woman and her family. In Ireland, routine intervention in labour is common, but, since the early 1990s, some changes in the Irish maternity services have taken place. Pilot projects on community midwifery have been introduced in some areas. Challenges to the provision of maternity care in the Health Service Executive, North Eastern area (formerly the North-Eastern Health Board) led to the production of the Kinder report, which included a recommendation to introduce pilot midwifery-led units (MLUs). THE INTRODUCTION OF MIDWIFERY-LED CARE: A Maternity Services Taskforce was established in January 2002 with a wide remit, including facilitation of the establishment of MLUs in Cavan General Hospital, Cavan and Our Lady of Lourdes Hospital, Drogheda, Co. Louth. The MLUs are being evaluated within the context of a randomised trial known as 'the MidU study', which compares midwife-led care with the present system of medical-led care for women who are at low risk of complications during pregnancy and labour. CONCLUSION: The journey to midwifery-led care in Ireland has been a long one. The phased introduction of MLUs, which are subject to rigorous evaluation, will provide quality evidence upon which to base the future development of maternity care across Ireland.

¿Volveré, no volveré? aportes al diálogo entre modelos culturales del partoº

El proyecto "Hacia la reducción de la mortalidad materna en Bolivia: práticas adecuadas del parto en los sectores formales e informales de la atención perinatal" tuvo dos objetivos: identificar prácticas adecuadas del parto para mujeres rurales y migrantes en Bolivia, y examinar los factores que conducen a la subutulización de los servicios formales de salud a la luz de la preocupación nacional e internacional en torno a las altas tasas de mortalidad materna.

¿Volveré, no volveré? aportes al diálogo entre modelos culturales del parto / Es

Se documentan los conocimientos tradicionales acerca del parto y de la atención en el parto, se enfoca el parto hospitalario desde el punto de vista de estos significados tradicionales; expone resultados cuantitativos del proyecto a la luz de los debates internacionales sobre políticas de salud, se examina la aparición de la mortalidad materna como un problema global en los últimos años y se presenta la situación actual en Bolivia

¿Volveré, no volveré?: aportes al diálogo entre modelos culturales del parto / ss

En el presente volumen se presenta la publicación en español del informe final del proyecto de investigación realizado de 1994 a 1996, "Hacia la reducción de la mortalidad materna en Bolivia: prácticas apropiadas del parto en los sectores formal e informal del cuidado perinatal". El proyecto fue financiado por la Comisión Europea como parte de su programa de investigaciones "Ciencias y Tecnologías para los Países en Vías de Desarrollo" (STD3 de la División General XII).