The circle of safety: a tool for clinical preceptors.

The Circle of Safety is a tool for all clinical faculty, regardless of profession and regardless of locale. Applying principles of teaching-learning, the Circle of Safety was originally developed by the author for use by clinical preceptors in nurse-midwifery education. Its purpose is to provide a structure that removes a major obstacle to learning and facilitates student efforts to learn in accord with an individual's pattern of learning.

Sexually transmitted diseases and reproductive health in women.

The effect of sexually transmitted diseases (STDs) on the reproductive health of women, the reasons why women bear a disproportionate percent of STD morbidity and mortality, and the factors contributing to an increased risk for STDs and their complications in women are enumerated. Conclusions and recommendations from the 1997 Institute of Medicine report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases, are categorized and addressed. The categories are education, population groups, and clinical practice. The contributions of midwives to implementing pertinent Institute of Medicine recommendations in basic and continuing education programs, individual practice, and in influencing policy are detailed. Factual information about STDs, risk assessment history, essential STD-related services, and treatment guidelines are provided in tables.

History of nurse-midwifery in reproductive health care.

From the maternity cycle to the primary health care of women, this article traces the expansion of the role of midwives in reproductive health care over the past 3 decades. Included are the recollections of Shirley Okrent about the early development of this role expansion and a few of the author's personal memories.

PIP: This article traces the expansion of the role of midwives in reproductive health care, from the maternity cycle to the primary health care of women, over 3 decades of service. It is noted that until 1965 the scope of nurse-midwifery practice in the US was strictly the maternity cycle. Nurse-midwives first expanded their role in reproductive health through their efforts to meet the family planning needs of the women they delivered. These nurse-midwives who first addressed family planning saw their services as integrated with the provision of postpartum care, within the totality of maternity. In addition, other areas of care were also identified as part of the practice. These included sexuality and family life issues, vaginal infections, sexually transmitted diseases, pelvic inflammatory disease, and screening for gynecologic problems. These developments were reflected in the 1977 American College of Nurse-Midwifery¿s definition of the practice. Overall, the practice has evolved from an early focus on reproductive health care, including maternity cycle and gynecologic care, to the primary care of women of all ages.

An update on the credentialing of midwives by the ACNM.

This paper chronicles the events that took place between April 1994 and February 1995 specific to setting the standard for professional midwifery in the United States through the credentialing of midwives (other than nurse-midwives) by the American College of Nurse-Midwives (ACNM). A collection of documents that record the actions of ACNM leaders and the views of ACNM members related to this issue is also provided. The ACNM Board of Directors has determined that any non-nurse who is a graduate of an ACNM Division of Accreditation accredited midwifery program and has passed an ACNM Certification Council (ACC) national midwifery examination will be called an ACC Certified Midwife.

Nurse-midwifery as it reinforces and transforms the American ideology of gendered roles.

Nurse-midwives both reinforce and subvert American constructs of gender roles. They do this both within the context of their relationship with the medical establishment and within the context of their relationship with women and families they serve. The authors explore this paradox through an examination of American society's historical and present constructs of gender role, the ways in which the medical profession has absorbed and prescribed these constructs, the effect of these constructs on medical and nurse-midwifery childbirth management of care, and, within the contextual framework thus established, the role of nurse-midwives in reinforcing and subverting traditional gender role constructs. Finally, the impact of this paradox on the provision of nurse-midwifery care to women and families is explored.

Issues and concerns of healthy pregnant women.

The issues and concerns of the 85 percent of essentially healthy women who have normal pregnancies and births are reviewed. The importance of their issues in relation to their health care and outcomes is discussed.