Midwifery Trained Registered Nurses' Perceptions of Their Role in the Labor Unit

Introduction: A Midwifery Trained Registered Nurse (MTRN) is a member of the multi-professional maternity health care team in Sri Lanka. Her contribution to the maternity care team is poorly understood, often undermined, and undefined. In the context of low- and middle-income settings where traditional midwives play a crucial role in domiciliary care, the MTRNs role as a member of the multi-professional hospital-based maternity care team has not been well-described. Objective: The study aimed to describe MTRNs' perceptions of their role in the Labor Unit within the multi-professional maternity health care team at five tertiary care hospitals in the Capitol Province of Sri Lanka. Materials and Methods: A descriptive cross-sectional study was conducted among 186 MTRNs working in labor rooms in the study setting. All MTRNs in the selected hospitals were invited and included in the sample. A postal survey was carried out using a pre-evaluated, pretested self-administered questionnaire, and descriptive statistics were derived. Results: All respondents were females, aged 27 to 60 years (mean ±SD 40 ±8.3 years). The majority (66%)was less than 45 years old. Almost all (>96%) MTRNs perceived 12 tasks of the listed tasks as their primary responsibility. Regarding other tasks, they perceived a high degree of overlap between their role and those of the doctors and midwives. Although almost all MTRNs rated the level of interprofessional collaboration from registered nurses (RNs) and doctors as average to good, nearly half (49%) of them rated support from midwives ranging from very poor to average. Conclusion: A high degree of perceived overlap between MTRNs' tasks with those of the other members of the maternity care team can cause role confusion, conflicts, and poor patient care. MTRNs' role in the Labor Unit within the multi-professional maternity health care team was controversial. Clarifying the MTRNs scope of practice will help improve interprofessional understanding of roles and responsibilities and collaboration.

Integrative Maternity Health Care – The only logical way forward

In 2014-2015 I was the founding director of a global inaugural conference on Integrative Maternity Healthcare that was a groundbreaking and revolutionary symposium, held in Auckland New Zealand, which promoted a cross-discipline exchange of progressive research, innovative knowledge, enlightened experience and radical ideas; all in a medically professional and universally holistic environment of visionary open-mindedness

Using data to explore vulnerable women's utilization of maternity health care

IntroductionInequitable access to appropriate maternity health care is an issue for vulnerable women that negatively impacts health outcomes. As part of a feasibility study on midwifery services for vulnerable women, we used administrative data to further our understanding of socially disadvantaged women’s use of the primary care system during pregnancy. Objectives and ApproachTo better understand maternity health service utilization and social vulnerability of women in Calgary Alberta, a research partnership was formed between Alberta Health Services and a social service agency that serves clients experiencing, poverty, and food insecurity and were at risk for homelessness. This multi-phase study linked postal code data to data from provincial databases. Variables included socioeconomic characteristics, prenatal health care utilization and maternal and birth outcomes for the years 2013 to 2015. ResultsDatabases accessed included the Alberta Perinatal Health Program (APHP), Alberta Health Practitioner Claims Database, AHS Admission Discharge Transfer Database, Discharge Abstracts Database, National Ambulatory Care Reporting, and Provincial Registry Database. Data linkages yielded a total sample size of 7493 women, with 15.5% of women qualifying as ‘socially vulnerable’. Women receiving social assistance are relatively younger, experience more pregnancies, have higher antenatal risk scores and accessed maternal and emergency care more often and later in their pregnancy than those women who are not accessing social services. Our results suggest women living in vulnerable circumstances experience higher risk pregnancies that those not living in vulnerable circumstances. Therefore a maternity care model such as midwifery, which uses a holistic approach to care may be beneficial for vulnerable women. Conclusion/ImplicationsFindings from our study confirm that women experiencing poor social circumstances are at increased risk for complications during pregnancy and birth. Therefore, we need to further investigate utilizing maternity models of care that serve both the maternal health needs and the social needs of this population.