Women and their partners' perceptions of the key roles of the labor and delivery nurse.

This descriptive qualitative study examined the perspectives of women and their partners regarding the key roles of the labor and delivery nurse during labor and birth.Ten couples were interviewed separately.The data analysis, conducted through independent and team analysis, was both iterative and interpretive. Participants identified four key roles of the labor and delivery nurse: support person, educator, patient advocate, and provider of continuity. Nurses provided both physical and emotional support.As an educator, they normalized the birth experience and served as a coach for the couple. Nurses advocated on behalf of the woman in labor, particularly when there was an adverse event. The continuity of care provided by the nurses wove the above roles into a cohesive whole. Findings provide important information for nursing educators, supervisors, and hospital administrators to reinforce the meaningful roles nurses serve in the labor and birth experiences of women and their partners.

Ontario care providers' considerations regarding models of maternity care.

OBJECTIVE: There is currently a crisis in the delivery of maternity care in Canada, in part due to the significant decline in the number of professionals who provide intrapartum care. This study was undertaken (1) to elicit care providers' opinions regarding seven proposed models of maternity care, (2) to explore barriers to collaborative interprofessional practice, and (3) to identify factors that would encourage the practice of intrapartum care. METHODS: A survey seeking opinions about models of care, perceived barriers to interprofessional collaboration, and factors that might encourage practising intrapartum care was mailed to all registered midwives (N = 322) and obstetricians (N = 647) in Ontario and to a stratified random sample of family physicians (N = 750) in Ontario. RESULTS: Completed questionnaires were received from 80% of midwives, 64% of obstetricians, and 66% of family physicians. Midwives and obstetricians endorsed uniprofessional models and indicated an interest in multiprofessional practice. Family physicians were reluctant to choose any models that would have them practising intrapartum care. However, family physicians currently providing intrapartum care would consider the uniprofessional model in which they delivered the babies of the women they were caring for unless they were signed out. Midwives identified different philosophies of care as the main barrier to collaborative interprofessional maternity care (60.7%); obstetricians and family doctors identified liability and insurance issues (60.3% and 38.7%, respectively). An adequate on-call arrangement was the key factor potentially encouraging midwives and obstetricians to provide intrapartum care (70.3% and 70.0%, respectively). For family physicians, good medical and obstetrical back-up was the first priority (70.8%), followed by on-call arrangements. CONCLUSION: A variety of models for providing intrapartum care must be available, as no single model meets the needs of all maternity providers. Attention must be given to eliminating barriers to collaborative interprofessional practice, coupled with enhancing factors that facilitate the delivery of intrapartum care.

Level of acceptance of different models of maternity care.

To elicit nurses' opinions on five proposed models of maternity care in Ontario, to examine barriers to collaborative practice, and to identify factors that would encourage nurses to practise in the area of intrapartum care, a survey was mailed to a stratified random sample of nurses in Ontario (N = 750). Participants were asked whether they would consider practising in one or more of the five proposed models of maternity care. Almost half the participants endorsed the model of nurses' providing labour and delivery care to patients of family physicians and obstetricians. Almost one-third (28.7%) reported that they would consider working in an interprofessional maternity care clinic. There was minimal interest in working with midwives. Participants identified resistance to change (49.9%) and lack of communication (47.2%) as the two main barriers to collaborative practice. The majority of respondents (84.2%) ranked good medical and obstetrical backup as the key factor that would encourage them to provide intrapartum care. A respectful work environment and collaborative models of maternity care were also ranked highly.