'Bringing forth' skills and knowledge of newly qualified midwives in free-standing birth centres: A hermeneutic phenomenological study.

AIM: To understand and interpret the lived experience of newly qualified midwives (NQMs) as they acquire skills to work in free-standing birth centres (FSBCs), as well as the lived experience of experienced midwives in FSBCs in Germany who work with NQMs. BACKGROUND: In many high-, middle- and low-income countries, the scope of practice of midwives includes autonomous care of labouring women in all settings, including hospitals, home and FSBCs. There has been to date no research detailing the skills acquired when midwives who have trained in hospitals offer care in out-of-hospital settings. METHODS: This study was underpinned by hermeneutic phenomenology. Fifteen NQMs in their orientation period in a FSBC were interviewed three times in their first year. In addition to this, focus groups were conducted in 13 FSBCs. Data were collected between 2021 and 2023. FINDINGS: Using Heidegger's theory of technology as the philosophical underpinning, the results illustrate that the NQMs were facilitated to bring forth competencies to interpret women's unique variations of physiological labour, comprehending when they could enact intervention-free care, when the women necessitated a gentle intervention, and when acceleration of labour or transfer to hospital was necessary. CONCLUSION: NQMs learned to effectively integrate medical knowledge with midwifery skills and knowledge, creating a bridge between the medical and midwifery approaches to care. IMPLICATIONS: This paper showed the positive effects that an orientation and familiarization period with an experienced team of midwives have on the skill development of novice practitioners in FSBCs. IMPACT: The findings of this study will have an impact on training and orientation for nurse-midwives and direct-entry midwives when they begin to practice in out-of-hospital settings after training and working in hospital labour wards. PATIENT AND PUBLIC CONTRIBUTION: This research study has four cooperating partners: MotherHood, Network of Birth Centres, the Association for Quality at Out-of-Hospital Birth and the German Association of Midwifery Science. The cooperating partners met six times in a period of 2 ½ years to hear reports on the preliminary research findings and discuss these from the point of view of each organization. In addition, at each meeting, three midwives from various FSBCs were present to discuss the results and implications. The cooperating partners also helped disseminate study information that facilitated recruitment.

Skills and knowledge of midwives at free-standing birth centres and home birth: A meta-ethnography.

PROBLEM: When midwives offer birth assistance at home birth and free-standing birth centres, they must adapt their skill set. Currently, there are no comprehensive insights on the skills and knowledge that midwives need to work in those settings. BACKGROUND: Midwifery care at home birth and in free-standing birth centres requires context specific skills, including the ability to offer low-intervention care for women who choose physiological birth in these settings. AIM: To synthesise existing qualitative research that describes the skills and knowledge of certified midwives at home births and free-standing birth centres. STUDY DESIGN: We conducted a systematic review that included searches on 5 databases, author runs, citation tracking, journal searches, and reference checking. Meta-ethnographic techniques of reciprocal translation were used to interpret the data set, and a line of argument synthesis was developed. RESULTS: The search identified 13 papers, twelve papers from seven countries, and one paper that included five Nordic countries. Three overarching themes and seven sub-themes were developed: 'Building trustworthy connections,' 'Midwife as instrument,' and 'Creating an environment conducive to birth.' CONCLUSION: The findings highlight that midwives integrated their sensorial experiences with their clinical knowledge of anatomy and physiology to care for women at home birth and in free-standing birth centres. The interactive relationship between midwives and women is at the core of creating an environment that supports physiological birth while integrating the lived experience of labouring women. Further research is needed to elicit how midwives develop these proficiencies.

[Readability of Information Material in Obstetrics]. / Lesbarkeit von Informationsmaterial in der Geburtshilfe.

Up-to-date health care implies users' autonomous decision-making on diagnostic and therapeutic measures (informed consent). Patients depend on comprehensible information material to be able to understand an intervention and its consequences. Informed consent sheets on cesarean section, other obstetrical measures, and anesthesia methods were assessed for readability using tools including the G-SMOG, Flesch Index, Amstad Formula, and LIX. In addition, comparative material on the same topics, e. g., from the Internet, was assessed. The assessment tools developed for the German language proved to be useful for readability screening. Most texts were found to be difficult or very difficult to read. Especially the included informed consent sheets were assessed as clearly above the recommended readability level. Efforts need to be made to prepare readable and comprehensible information material, e. g., by using the "Hamburg Model of Comprehensibility."

[Parents as co-producers in the healthcare system: Individual perspectives and consequences for educational concepts]. / Eltern als Ko-Produzenten im Gesundheitssystem ­ Individuelle Sichtweisen und Konsequenzen für edukative Konzepte.

INTRODUCTION AND OBJECTIVES: In selected healthcare sectors and settings, patients and their relatives are now regarded as co-producers of the healthcare system. This is associated with modified patient roles and new relationship models. Physiotherapists also have to face them by including educational interventions into their traditional scope of practice. However, corresponding intervention concepts for physiotherapy do not yet exist. Therefore, the aim of this contribution is to initiate an empirically supported concept development. METHODS: As part of a qualitative empirical study, interviews were conducted with 15 parents of children with life-limiting diseases in four federal states of Germany and then evaluated using the reconstruction method of the documentary method according to Bohnsack. The parents' experiences with the assumption of physiotherapeutic care were used as input for first reflections on an instructive intervention concept with reference to relevant learning theory approaches. RESULTS: In the course of the data evaluation, three divergent orientations (parent types) were identified. Parent type A (autonomy) acts largely autonomously and requires only occasional support. Parent type B (understanding) and C (relief) need more intensive support. While parent type B requires education in order to satisfy their pronounced need for knowledge, parent type C generally questions why they should have to carry out physiotherapeutic task and delegates responsibility back to the professional help system. DISCUSSION: Physiotherapeutic instruction should take into account the different types of parents with regard to the provision of care. Parents who are motivated to engage in learning processes would like to a) focus on central physiotherapeutic measures, b) be instructed face-to-face and c) be recognized as experts for their child and their situation. CONCLUSION: Supplemented by the perspective of professionals, insights into the parents' perspective can serve as the basis for empirical impact analysis. The empirically validated intervention concepts for instructive action must be integrated into existing educational, training and further education courses in order to ensure systematic dissemination of knowledge into physiotherapy. In addition, a debate on professional policy must be launched in order to secure instructive action more strongly in the physiotherapeutic repertoire.

[Needs of parents in bereavement care after perinatal loss of their preterm infant in the NICU]. / Unterstützungsbedarf von Eltern in der Trauerbegleitung nach dem Tod ihres frühgeborenen Kindes. Eine qualitative Untersuchung der Sichtweisen Pflegender in der Elternberatung.

BACKGROUND: In Germany, 9% of babies are born preterm, 32 % of them die. A neonatal death is a challenge for both parents and neonatal health care professionals alike. In 1994 the Department of pediatric nursing of the Klinik für Neonatologie/Charité launched an initiative to offer bereavement care for parents who have experienced a perinatal death. AIM: The aim of this study was to determine the needs of parents after the perinatal loss of their child from the perspective of health care professionals (HCP). METHOD: Six interviews were conducted with the HCP in Neonatology, Charité ­ University of Medicine in Berlin and analyzed using qualitative content analysis according to Mayring. RESULTS: The results show the differing needs of the parents and are focused on five main points: "Avoid and protection of overtaxing", "express emotions", "safety and family support", "bonding with the child" and "give understanding and meaning". CONCLUSIONS: The parents needs connected with the Caring Theory of Swanson show that they mostly correspond with the dimension of "Being with". It underlines the importance of the emotional and educational support of parents in bereavement care during the perimortal period. A major requirement here is to "get to know" the parents and their needs and to accompany them individually. Offering compassionate care and interaction between nurses and bereaved parents complys with the "doing for" and "enabling" from Swanson's model.