This study investigated the experience and perceptions of Georgia certified nurse-midwives about waterbirth and their level of support for establishing waterbirth in their work setting. A survey was distributed to a convenience sample of 119 certified nurse-midwives from the American College of Nurse Midwives, Georgia chapter; 45% of those surveyed responded. The majority of midwives had some exposure to waterbirth through self-education or through clinical practice. More than half supported the incorporation of waterbirth in their workplace setting. Maternal relaxation and reduced use of analgesia were perceived as the greatest benefit of waterbirth. Of 11 items related to disadvantages of waterbirth, certified nurse-midwives were moderately to severely concerned about none. The most concerning factors, with a mean of 2.4 to 2.5 on a scale of 1 (no worry) to 5 (severe worry), were maintenance of water temperature, physical stress on the midwife, and inability to see the perineum. Midwives' support for waterbirth focused mostly on the perceived benefits to the mother with little worry about the risks.
The objective of this study was to describe the system's initial pandemic response from the perspectives of perinatal health workers and to identify opportunities for improved future preparedness. An exploratory survey was designed to identify perinatal practice changes and workforce challenges during the initial weeks of the COVID-19 pandemic. The survey included baseline data collection and weekly surveys. A total of 181 nurses, midwives, and physicians completed the baseline survey; 84% completed at least 1 weekly survey. Multiple practice changes were reported. About half of respondents (50.8%) felt the changes protected patients, but fewer (33.7%) felt the changes protected themselves. Most respondents providing out-ofhospital birth services (91.4%) reported increased requests for transfer to out-of-hospital birth. Reports of shortages of personnel and supplies occurred as early as the week ending March 23 and were reported by at least 10% of respondents through April 27. Shortages were reported by as many as 38.7% (personal protective equipment), 36.8% (supplies), and 18.5% (personnel) of respondents. This
Introduction:The COVID-19 pandemic presented the midwifery workforce with challenges for maintaining access to high-quality care and safety for patients and perinatal care providers. This study analyzed associations between different types of professional autonomy and changes in midwives' employment and compensation during the early months of the pandemic.Methods: An online survey distributed to midwifery practices in fall 2020 compared midwives' employment and compensation in February 2020 and September 2020. Chi-square analysis determined associations between those data and measures of midwives' autonomy: state practice environment, midwifery practice ownership, intrapartum practice setting, and midwifery participation in practice decision-making.Results: Participants included lead midwives from 727 practices, representing 50 states and the District of Columbia. Full-time equivalent (FTE) positions and number of full-time midwives were stable for 77% of practices, part-time employment for 83%, and salaries for 72%. Of the remaining practices, more practices lost FTE positions, full-time positions, part-time positions, and salary (18%, 15%, 9%, and 18%, respectively) than gained (11%, 8%, 8%, and 9%, respectively). Early retirements and furloughs were experienced by 9% of practices, and 18% lost benefits. However, midwifery practice ownership was significantly associated with increased salaries (20.3% vs 7.1%; P < .001) and decreased loss of benefits (7.8% vs 19.9%; P = .002) and furloughs (3.8 vs 10.1%; P = .04). Community-based practice was significantly associated with increased FTE positions (19.0% vs 8.8%; P = .005), part-time positions (17.4% vs 5.1%; P < .001), and salary (19.7% vs 7.0%; P < .001), as well as decreased loss of benefits (11.5% vs 21.1%; P = .02) and early retirement (1.4% vs 6.6%; P = .03). State practice environment and participation in practice decision-making were not directly associated with employment and compensation changes.Discussion: Policies should facilitate midwifery practice ownership and the expansion and integration of community birth settings for greater perinatal care workforce stability, greater flexibility to respond to disasters, and improved patient access to care and health outcomes.
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