bluuebunny/crossref_metadata_2025 huggingface dataset:
Birth Where the Heart Is: Reflections on Broadening My Midwifery Learning in the Country I Call “Home”
Authors: St Bernard Hitz Jacqueline,
Published: July 2024

"In my split Grenada-Canada existence, I feel that this metaphorical third space is the one place I have always truly belonged to."
Student Commentary.
“This isn’t a high-risk body”: Reframing Risk and Reducing Weight Stigma in Midwifery Practice
Authors: Cook Katie M. , LaMarre Andrea , Rice Carla, , Friedman May
Published: July 2024

This article investigates the standards of care for fat recipients of midwifery care through a lens that questions common risk-focused narratives related to fat pregnant bodies. Throughout this article, we use the term "fat" rather than "obese" or "overweight". We avoid the language of obese/overweight because these medicalized terms are used to stigmatize fat people. Working from a fat liberation standpoint involves reclaiming the word “fat” as a morally-neutral descriptive term for larger bodies. Drawing on data from a research project exploring weight stigma during pregnancy care, we present findings from eleven interviews with fat parents including those who identify as women or transmen who accessed midwifery care during their pregnancy and/or childbirth experiences. Participants had both positive and negative experiences with midwives, often within the same care relationship. Related to weight specifically, many participants reported that midwives focused on the risk factors often associated with being fat while pregnant, even when their clients did not display signs of these risks. We discuss how practitioners—particularly midwives—might shift away from an anti-obesity, risk-based narrative. Instead, practitioners might acknowledge the potential risks of fatness during pregnancy while simultaneously honouring fat individuals' embodied realities and treating fat clients with respect to facilitate positive pregnancy and birthing experiences.

This article has been peer reviewed.
Early Life Exposures and the Development of the Infant Gut Microbiome: A Review
Authors: Li Jenifer , Dizzell Sara E. , Jones Sara L. , Kanji Sarah , Lau Jennifer T. , Mousseau Andrea , Yousuf Efrah I. , Holloway Alison C. , Ratcliffe Elyanne M. , Stearns Jennifer C. , Morrison Katherine , Hutton Eileen K.
Published: July 2024

The influence of the intestinal microbiota on metabolic, nutritional, and immunological processes is widely reported. With increasing literature associating altered microbial compositions with adverse health outcomes, it is important to understand how early life exposures may impact the development of gut microbial colonization and subsequent risk of altered metabolic and immune regulation.
The purpose of this review is to describe factors in the maternal prenatal and perinatal period that may impact the intestinal microbiome over the first 2 years of life. A comprehensive search of MEDLINE, EMBASE, and the Cochrane Library using Medical Subject Headings (MeSH) and keywords for studies reporting on determinants of gut microbiota in infants (0 to 24 months) born at full term was conducted. Articles using culture techniques were included but not those that exclusively used molecular techniques that lacked sensitivity. Each citation title and abstract was independently assessed for inclusion for full text review. Findings related to the maternal prenatal period, mode of birthing, infant diet and antibiotics were included. Bifidobacteria and Bacteroides abundance were consistently greater in the first weeks of life in children born vaginally, and increased Bacteroides presence persisted throughout the first year. Bifidobacteria abundance was greater in breastfed children. Introduction of solid food was associated with greater presence of bacteria of the Firmicutes phylum. Although these studies advance our knowledge of how exposures in prenatal, intrapartum, and early life may impact colonization, larger studies with longitudinal follow-up are needed to improve our understanding of how perturbations may contribute to early origins of disease.

This article has been peer reviewed.
Ontario Midwifery Clients' Experiences with the Management of Hyperbilirubinemia
Authors: Gure Faduma , Macdonald Tasha , Minichiello Alexa , Kehler Sophia
Published: July 2024

Hyperbilirubinemia is the most common reason for the hospitalization of a newborn within the first week of life. Very little is known, however, about the impact this diagnosis and subsequent management has on parents, particularly within the midwifery context. The Clinical Knowledge Translation department at the Association of Ontario Midwives conducted a multimethod qualitative research study in 2017 to better understand the experiences of midwifery clients whose newborns have been diagnosed with and required management of severe hyperbilirubinemia. Three focus-group discussions and one in-depth, in-person interview were conducted with midwifery clients in Ontario. Findings were analyzed using NVivo software, resulting in the extraction of key themes. Clients discussed how the transition from midwifery-led care to care being led by other health care providers in the hospital impacted them in the postpartum period. Clients also observed changes in the continuity of care provided by their midwives during management of hyperbilirubinemia, and discussed both the positive and negative impacts these changes had on their broader experience of the early postpartum period. These findings have informed the development of a series of knowledge translation tools that support midwives in providing optimal care to clients whose infants require phototherapy.

This article has been peer reviewed.
When Midwives Burn Out: Differences in the Experiences of Midwives in British Columbia and Alberta
Authors: Butska Luba , Stoll Kathrin
Published: July 2024

Background: Internationally, continuity of care has been identified as a possible strategy to prevent burnout. The majority of midwives in British Columbia and Alberta practice within a continuity-based model of care, but British Columbia midwives have significantly higher burnout scores.
Methods: We compared data from midwives from Alberta and British Columbia who responded to the Canadian arm of the WHELM (Work, Health, and Emotional Lives of Midwives) survey through invitations via their professional organizations. The survey included demographic questions, items about work patterns, occupational stressors, burnout, and intentions and reasons to leave the profession.
Results: Workload was the most commonly reported stressor in both British Columbia and Alberta. Midwives in British Columbia were more likely (54%) to have seriously considered leaving the profession in the last 12 months than midwives in Alberta (26%). One-third of British Columbia midwives and no Alberta midwives cited poor pay as a reason to leave the profession. In answers to open-ended questions, 47% of respondents from British Columbia, but none from Alberta, highlighted poor pay as something that would need to change in order for them to successfully manage workplace stress.
Discussion and Conclusion: Our comparison of similar midwifery contexts in Western Canada suggests burnout and intention to leave the profession are associated with how the care is remunerated. Midwives in British Columbia and Alberta care for a similar volume of clients and are paid with a similar type of payment system, but midwives in British Columbia are paid significantly less per course of care. A revised payment system or a significant increase in pay per client may ensure that midwives in British Columbia can continue to provide high-quality relationship-based care while maintaining longevity in the profession.

This article has been peer reviewed.
Access to Ontario Midwifery Care by Neighbourhood-Level Material Deprivation Quintile, 2006–2017: A Retrospective Cohort Study
Authors: Darling Elizabeth K. , Murray-Davis Beth , Ahmed Rashid J. , Vanstone Meredith
Published: July 2024

Objective: To describe access to Ontario midwifery care based on socio-economic status.Design: Two retrospective cohort studies.Setting: Ontario, Canada.Participants: (1) All Ontario midwifery billable courses of care discharged between April 1, 2006, and March 31, 2017 (N = 187,009), and (2) all Ontario residents who gave birth (≥ 20 weeks) in Ontario between April 1, 2012, and March 31, 2017 (N = 699,843).
Data Sources: The Ontario Midwifery Program Legacy Database and the Better Outcomes Registry & Network’s Ontario perinatal registry.Measurements and Findings: We used residential postal codes to assign socio-economic status quintiles, using the Ontario Marginalization Index’s material deprivation measure. Between 2006 and 2017, the proportion of midwifery clients in the two least-marginalized quintiles was consistently greater than the proportion of midwifery clients in the two most-marginalized quintiles. Between 2012 and 2017, physicians cared for a larger proportion of people in the most-marginalized quintile than midwives, while midwives cared for a larger proportion of people in the least-marginalized quintile.
Key Conclusions: People of low socio-economic status in Ontario are less likely to receive midwifery care than people of high socio-economic status. There was little change in this pattern over an 11-year period from 2006 to 2017.Implications: Efforts to reduce inequities in access to midwifery care should be prioritized and will require a multi-pronged approach that is supported by practicing midwives, government, midwifery stakeholder organizations, and other health care professionals.

This article has been peer reviewed.
The Application of Health Leadership Competencies Around the World to the Canadian Midwifery Profession: A Scoping Review
Authors: Corbin Abigail , Darling Elizabeth , Pearce-Kelly Tracy , Wise Kathryn
Published: July 2024

Objectives: To review and map the key leadership competencies and frameworks created by health care professionals and health leaders across the globe. To use the themes that emerge to create a new leadership framework for Canadian midwifery.
Background: Effective leadership has a significant impact on health care outcomes. In an effort to describe effective leadership, many health professions and organizations are creating lists of competencies within leadership frameworks. Midwifery is a relatively young profession in Canada. To date there has been no published Canadian work on leadership or leadership frameworks. Midwifery has a vital role to play within health care but needs to grow in leadership knowledge and capacity.
Methods: A scoping review was conducted using both a published literature search and a grey literature search. The published literature search was conducted using CINAHL and OVID, while the grey literature search included an online review of the websites of major health professions in Canada, the UK, the US, Ireland, Australia, and New Zealand.
Results: Twenty-three articles met the inclusion criteria. Within the articles were 582 key competencies, organized into 133 separate themes. Thematic analysis of the competencies results in competencies falling into five major themes of leadership: self, patient/client care, team, organization, and health systems.
Conclusion: A new framework was created using the emerging themes found in the scoping review: Leading Self, Leading the Team, Leading Client Care, Leading the Organization, and Leading Health Systems. This new framework was applied to the Canadian midwifery profession, using core midwifery documents. This scoping review can be used by Canadian midwifery organizations looking to create a leadership framework and by university midwifery programs as they look to incorporate leadership competencies into their curriculum.

This article has been peer reviewed.
Midwives’ Pathways from Health to Leaves of Absence and Return to Work
Authors: Thiessen Kellie , Benoit Cecilia , Atanackovic Jelena , Neiterman Elena , Gregory Kelly , Akuamoah-Boateng Henrietta , Freeman Angela , Mellor Andrea , Bourgeault Ivy
Published: July 2024

Background: The mental health of midwives is an area of increased investigation as these experiences affect their attrition from the profession.Aim: To examine the mental health experiences of midwives and midwifery students in Canada and how they respond to these experiences.Methods: A mixed methods study involved surveys with 202 midwives and midwifery students, complemented by qualitative interviews with 44 participants (33 midwives, 11 students).Findings: Midwives and midwifery students self-report a high percentage (79%) of personal mental health issues. Of those, over half changed their work (55%), and a similar number contemplated taking a leave (59%). Far fewer midwives took a leave (17%), and 70% who did, returned to work.Conclusion: Barriers to taking a leave of absence from work due to mental health concerns draw attention to the limited options in the models of midwifery practice currently in Canada and the need for alternatives.
RÉSUMÉContexte: La santé mentale des sages-femmes est un domaine qui fait l’objet de plus en plus d’études, car ces expériences ont une incidence sur l’abandon de la profession.
Objectif: Examiner les expériences de santé mentale des sages-femmes et des étudiantes en pratique sage-femme au Canada et la façon dont elles réagissent à ces expériences.Méthodes: Une étude à méthodes mixtes a comporté des enquêtes auprès de 202 sages-femmes et étudiantes en pratique sage-femme, complétées par des entretiens qualitatifs avec 44 participantes (33 sages-femmes, 11 étudiantes).Résultats: Les sages-femmes et les étudiants en pratique sage-femme déclarent un pourcentage élevé (79 %) de problèmes personnels de santé mentale. Parmi eux, plus de la moitié ont changé de travail (55%) et un nombre similaire a envisagé de prendre un congé (59%). Beaucoup moins de sages-femmes ont pris un congé (17%), et 70% de celles qui l’ont fait sont retournées au travail.Conclusion: Les obstacles à la prise d’un congé en raison de problèmes de santé mentale attirent l’attention sur les options limitées des modèles de pratique sage-femme actuellement en vigueur au Canada et sur la nécessité de trouver des solutions de rechange.
VAGINAL BIRTH AFTER CAESAREAN SECTION A N D THE ISSUE OF HOME BIRTH
Authors: Wilson Kathi
Published: July 2024

Commentary.
PRENATAL SCREENING IN CANADIAN AND UNITED STATES MIDWIFERY PRACTICES: AN EXPLORATORY STUDY
Authors: Anderson Cindi , Walker Deborah S.
Published: July 2024

Midwifery practice in Canada and the United States (U.S.) developed along similar philosophical principles, but different practice models have evolved. Within these two frameworks of midwifery practice, this retrospective, exploratory study investigated the prenatal screening tests that often pose decision-making dilemmas for both clients and midwives. Women in the U.S. (n=60) were more likely to have four of the five prenatal screening tests than Canadian women (n=56). U.S. midwifery clients (n=60) more frequently received the genetic screen (p=0.029), HIV (p=0.0005), ultrasound (p=0.0005) and serum glucose screen (p=0.0005). Canadian midwifery clients (n=56) were more likely to receivehte Group BStreptococcus screen (p=0.004) than their US.. counterparts. In addition, hte mean number of ultrasounds performed during pregnancy was significantly higher for U.S. women than Canadian women (p=0.001). Women with any post-secondary education were more likely to choose to have the glucose screen (p=0.017) and primiparous women were more likely to have an ultrasound (p=0.020) and the glucose screen (p=0.038). Factors that may influence which tests women receive are discussed ni relation to the philosophic framework of midwifery practice in Canada and the U.S.
GALACTAGOGUE HERBS: A QUALITATIVE STUDY AND REVIEW
Authors: Westfall Rachel Emma
Published: July 2024

Women often face challenges in their efforts to breast-feed their infants. One of these challenges may be a real or perceived insufficient milk supply. Presented here are some results from a qualitative study of self-care in pregnancy, birth and lactation among a purposeful sample of childbearing women in British Columbia. Twenty-three women were interviewed at one to four months postpartum, and were asked to share their experiences with childbirth and postpartum self-care. Interviews were tape recorded and transcribed. All 23 women were breast-feeding. Four women reported insufficient milk supply, whereas 14 women used galactagogue substances including herbal remedies, food items and pharmaceutical drugs to enhance their milk supply. Eleven women (48% of the sample) were using any of five galactagogue herbs, in many cases prophylactically. Each herb is reviewed and discussed here: blessed thistle (Cnicus benedictus), fennel (Foeniculum vulgare), fenugreek (Trigonella foenicum-graecum) raspberry leaf (Rubus idaeus), and stinging nettle (Urtica dioica). This study reveals that galactagogue herb use is an element of postpartum self-care for some women, and it also identifies a need for clinical testing of the herbs. A larger-scale survey of galactagogue herb use would be beneficial to the state of knowledge, as would clinical trials and case reports on the more popular herbs.
THE CONTRIBUTION OF BREAST-FEEDING TO THE DEPURATION OF DDE
Authors: Wainman Bruce C.
Published: July 2024

The presence of persistent organic halogens (POHs) in maternal plasma and milk has been recognized since the 1970s. Yet, the presence of these compounds in human milk poses a still undetermined risk to the health of mother and child. The vertical transfer of POHs during either pregnancy or after birth during breast-feeding remains a concern. The paucity of data on maternal plasma contaminant levels before and after long periods of breast-feeding poses a serious problem for researchers attempting to model contaminant changes in maternal plasma and contaminant transfer via milk to the baby. This issue is of clinical concern since there is inadequate data to model infant exposure to POHs, leading to uninformed decisions about risks and benefits of breast-feeding. To address this issue we carried out a longitudinal analysis of the association between maternal plasma p,p'-DDE (1,1-dichloro-2,2- bis(p-chlorophenyl) ethylene) load and breast-feeding duration and parity. This pesticide residue was chosen because it is both an ubiquitous and abundant POH. The women recruited for the study were 34.4 + 2.8 yr and had breast-fed an average of 2.1 children a total of 64.6 + 32.6 weeks when they were sampled at the end of the study. A questionnaire was used to determine the mother's breast-feeding activity. We found that the women had very low levels of p,p'-DDE in their plasma and milk compared to other populations in the world and that the trend in Canada towards lower contaminant loads has been sustained in our study population. The regression of change in plasma p,p'-DDE with breast-feeding duration is significant (p < 0.01, F = 15.80, and n=12). We found that maternal plasma p,p'-DDE levels changed by 0.0057 μg/L for every week of breast-feeding. Thus, women breast-feeding their infants lost, on average, 30 μg of this contaminant per week. These results suggest that maternal depuration of p,p'-DDE via breast-feeding is a significant cause of maternal contaminant loss and contaminant accumulation in the baby.
INFORMED CHOICE WITH A FOCUS ON RURAL AND NORTHERN MIDWIFERY IN THE NORTHWEST TERRITORIES
Authors: Becker Gisela , Paulette Lesley
Published: July 2024

Article.
THINKING THROUGH THE DEBATE ABOUT CAESAREAN SECTION “ON DEMAND” PART I: THINKING ABOUT CHOICE PART II: THINKING ABOUT RISK
Authors: Van Wagner Vicki
Published: July 2024

The debate about choosing Caesarean section when there is no medical indication raises many questions for midwives and other maternity care providers about choice, risk, normal birth and our role in a society where attitudes towards technology are changing. Both the popular and professional literature about this debate and the claims of benefit to fetus and mother need to be examined in a social and political context. Midwives have an important role to play in emphasizing that the safest system of care would support low intervention approaches to vaginal birth for the majority of women. The overwhelming reason women choose Caesarean section is fear and anxiety about birth. The request for Caesarean surgery “on demand” can be seen, in part, as a call to improve care for pregnant women and vaginal birth.
OBJECTIVE ASSESSMENT AND COMMUNICATION OF THE PHYSIOLOGIC STATUS OF THE SICK INFANT
Authors: Macnab Andrew J.
Published: July 2024

The practice of midwifery involves the initial and ongoing assessment of newborn infants in terms of their maturity, transition to extrauterine life, completeness of resuscitation and ongoing health status. The universally familiar Apgar score is an essential tool for initial neonatal assessment for midwives as for other medical professionals.1 The score was developed by Virginia Apgar as an objective measure of the physiologic status of the infant after birth, and to quantify the progress through, and adequacy of, resuscitation and adaptation to extra-uterine life.
While elements of the Apgar score are relevant for assessing and describing the status of the infant after 10 minutes of age, the score as a whole is not used routinely beyond this time. The Pediatric Assessment Triangle (PAT) is a newly developed tool for ongoing, objective assessment of an infant's (or child's) physical appearance.2,3 The PAT can be used to describe the presence of abnormal physiology, define whether an infant is in distress or actually experiencing system failure, and assess the infant's response to intervention by observing the resolution or progression of the clinical problem. The PAT has the potential to be a valuable tool for midwives, both for ongoing assessment, and as a means of describing the status of an infant to other health care professionals using objective terminology.
The use of objective criteria and precise terminology can strengthen the impact and relevance of communication and contribute to logical decision-making about immediate care and long-term disposition. A consistent framework is also valuable when providing follow-up, particularly where a treatment or intervention has been suggested and it is important to communicate whether the infant has responded.
The purpose of this paper is to describe the Pediatric Assessment Triangle, explain how it is applied and to suggest the use of this tool by midwives in practice.
BACTERIAL VAGINOSIS IN PREGNANCY
Authors: Van Os Susan
Published: July 2024

Article.
PREDICTING SELF-ASSESSED HEALTH STATUS IN WOMEN: WHAT COUNTS FOR GERMAN MIDWIVES AND MEDICAL OFFICE ASSISTANTS?
Authors: Reime Birgit , Tomaselli-Reime Sandra
Published: July 2024

Previous studies on women's work and health have tended to summarize women's occupations in broad categories and ignore job-specific workload. We compared occupational characteristics, burnout, health behaviour, and predictors of subjective health status between German midwives and medical office assistants (MOAs). We conducted a cross- sectional survey using a standardized questionnaire with items addressing aspects of the occupational biography, job characteristics, unpaid work, social support, gender role orientation, and health status and behaviour. Burnout was measured using the Maslach Burnout Inventory (MBI, Maslach and Jackson 1986). Altogether 386 questionnaires for midwives and 552 questionnaires for MOAs were sent out (response rates 60.4% and 44.1% respectively). Chi-square- and Mann-Whitney-U-tests and multiple regression models were conducted. Significant group differences were found regarding, for example, satisfaction with salary and control. More midwives than MOAs would choose their profession again (p<0.001). The level of burnout was medium for MOAs. Midwives had medium levels of burnout on two subscales and low levels on one subscale of the MBI. Health behaviours such as smoking, alcohol consumption and exercise did not differ between the occupations. Midwives conducted breast self-examination and ate whole-wheat products more often, whereas MOAs utilized GP and cancer checkups more frequently and consumed more medication. Satisfaction with salary and overtime hours predicted burnout in both occupations. Burnout and smoking were the only overlapping predictors of the health status of midwives and MOAs. Further studies should consider differences between female-dominated occupations when designing appropriate studies on women's health. Increases in salary and reductions in overtime hours may be appropriate interventions for health promotion in these occupations.
WORKING WITH MIDWIVES TO IMPROVE MATERNAL HEALTH IN RURAL GHANA
Authors: Matthews M. Kay , Walley Robert L.
Published: July 2024

This paper describes the implementation and evaluation of a safe motherhood project in rural Ghana. This project included a partograph and emergency skills program for rural midwives, training and monitoring traditional birth attendants (TBAs), a blood bank and an emergency obstetric transport service. The midwives' roles in caring for women in rural health centres, training and monitoring traditional birth attendants (TBAs) and in emergency obstetric transport are described. In this rural area of Ghana TBAs are responsible for approximately 65% of women in the district during birth. It is important to include them in projects to improve maternal health.
The results of process evaluation showed that the rural maternal health system was improved by the project activities through a good communication system, better support for rural midwives, better integration of traditional birth attendants into the health care system and more community involvement. Outcomes included an increase in the number of referrals of women with risk factors and complications to the district hospital, no cases of prolonged obstructed labour in the group of mothers cared for by rural midwives and trained TBAs, a comprehensive recording and reporting system for women cared for by TBAs, and a well established emergency obstetric transport service.
Integration of the TBAs into the health care system has had positive effects on TBA practice and morale. However, some TBAs had problems receiving remuneration for their work due to cultural beliefs and practices. The authors conclude that community education and participation are key components of safe motherhood projects.
THE WORLD HEALTH ORGANIZATION (WHO): THE HEALTH AND HUMAN RIGHTS RELATIONSHIP
Authors: Jurow Denise
Published: July 2024

As world leaders debate the relevancy of the United Nations (UN), the World Health Organization (WHO) presents as more relevant than ever. WHO's role as the world's health authority places it in a position to co-ordinate all aspects of global human rights issues annexed to health issues. WHO has spent the last 50 years in near avoidance of authority but now is rebounding from that position. Identification of the events that occurred to effect this evolution will be discussed. The identification by WHO that global health cannot be fully achieved without addressing basic human rights is applicable to all aspects of health care delivery and should guide the way we deliver care and set policy locally.
CONTINUITY OF CARER: WHAT DOES IT MEAN AND DOES IT MATTER TO MIDWIVES AND BIRTHING WOMEN?
Authors: McCourt Christine , Stevens Trudy
Published: July 2024

This paper discusses key themes from a large-scale, long-term multi-perspective evaluation of caseload midwifery practice in the United Kingdom (UK). Caseload practice was introduced in several UK settings, on a pilot scale, following the publication of Changing Childbirth intended to put into practice its core principles of continuity, choice and control for women.1 A range of new midwifery practices were piloted and evaluated across the UK. Relatively little attention was given to defining and exploring the nature and meanings of the new models of practice, or to midwives in this new practice context. This has led to difficulty in comparing the impact of different models of practice.
We draw on two aspects of our work – an ethnographic study of the experiences of midwives (with and without caseloads) and a study of the women's experiences and responses to care – to explore in greater depth the concepts involved in the caseload model and their meaning for women and for midwives in practice. Interviews were conducted with 40 women and 36 caseload midwives. Other forms of data collection, including questionnaires and observation were used and were analysed thematically using grounded theory principles. Themes emerging included autonomy, confidence, reciprocity and relationship: the idea of knowing and being known. On this basis we have argued that continuity is not an end in itself but an important means towards the end of women-centred care and should be considered in relation to other key themes such as autonomy and environment.
ARE LIABILITY ISSUES A BARRIER TO MULTIDISCIPLINARY COLLABORATIVE MATERNITY CARE?
Authors: Kryzanauskas Michelle
Published: July 2024

Article.
Optimal Timing of Umbilical Cord Clamping: A Commentary on Recent Evidence
Authors: Murray Davis Beth
Published: July 2024

Commentary.
A Comprehensive Review of the Research Literature on External Cephalic Version (ECV)
Authors: Hutton Eileen K. , Reitsma Angela H.
Published: July 2024

External cephalic version (ECV) is an approach to turning a fetus from the breech presentation by external maneuvering of the fetus through the maternal abdominal wall into a cephalic presentation. We conducted a systematic search of the current literature on ECV to provide a comprehensive overview of the procedure and associated success rates, risks, and alternatives to ECV. Tocolytics can improve ECV success, but none of the tocolytics shown to be effective for ECV are currently available in Canada. The factors that can best predict ECV success are low uterine tone (associated with parity or tocolytics), easy palpation of the fetal head, and an unengaged breech. The most common side effect of ECV is transient fetal bradycardia with an incidence of one to six percent of all ECV procedures. The risk of requiring an emergency caesarean section because of ECV appears to be around 0.5% or one in 200 ECV procedures performed. Our review suggested no significant risk of fetal/neonatal mortality or serious morbidity associated with ECV. Few alternative approaches to turning a fetus in the breech presentation have been adequately studied. ECV should be considered for all women with a fetus in the breech presentation at term in the absence of any contraindications to the procedure.
“Here It Is Not Like at Home”: Cross-Cultural Competencies for Midwives
Authors: Ellis Cathy
Published: July 2024

Cross-cultural competence in midwifery practice is an important skill when caring for childbearing women from different cultural backgrounds. Cross-cultural competence has many definitions and technical, professional, and personal skills vary by profession. In the midwifery profession it can be achieved through improved education curricula, greater faculty and student diversity, and the opportunity for students and faculty to participate in global placements. At the University of British Columbia (UBC), the Division of Midwifery has developed a 6-8 week Global Midwifery placement as an option during the end of the third year of the program. Students who experience a global placement face many challenges and a thorough orientation on local custom and expectations should occur. The benefits of an international placement experience are numerous, including increased cultural sensitivity and awareness of global health issues, skills to adapt to a low-resource environment and improved communication skills. Planning for an international placement program is discussed in this article from the perspective of an overseas placement coordinator and tutor.
Mental Illness in Refugee and Immigrant Women: A Midwife's Perspective on Culturally Competent Care
Authors: Wilson-Mitchell Karline
Published: July 2024

The assessment, diagnosis and referral for mental illness management have been recognized as indispensable roles within midwifery practice both in the United States and in Canada. War, civil unrest and natural disasters, have made mental health assessment crucial for refugee and new immigrant women who present as midwifery clients. Since 1991, National Depression Screening Day (NDSD) had been conducted in cities across the United States and Canada using the Harvard Department of Psychiatry National Depression Screening Day Scale (HANDS©). It facilitates the diagnosis of depression based on DSM-IV criteria. The HANDS© tool includes a 10-item interview guide which is a “self-report scale”. HANDS© demonstrated good internal consistency and validity and

was 95 percent sensitive.33

Responses could indicate the need for thyroid screening, referral for mental health counselling or psychiatric care. Strategies for transforming midwifery practice are explored: taking a holistic approach, communication strategies, continuing education strategies, documentation and empowerment issues, multidisciplinary team approach, clinic environment issues, resources and referral base. As we develop expertise in the care of torture and trauma survivors, it behooves us to identify the experts amongst our ranks and to refer our clients to these midwives who will best meet their needs. Further research is needed to guide our incorporation of the skills for treating survivors in our educational programs for the midwives of the future.
A Review of “An Estimation of Intrapartum-related Perinatal Mortality Rates for Booked Home Birth in England and Wales Between 1994 and 2003”
Authors: Reitsma Angela H.
Published: July 2024

Commentary.
Prenatal Screening for Chlamydia and Gonorrhea: An Evidence Based Approach
Authors: Darling Elizabeth
Published: July 2024

Various North American guidelines regarding prenatal screening for chlamydia and gonorrhea provide conflicting recommendations, and reflect differences in the values underlying interpretation of the available evidence. A systematic search of the literature was conducted to identify evidence regarding the risks and benefits of prenatal screening and treatment of chlamydia and gonorrhea. The available evidence suggests that there is an overall benefit to screening in both the first and third trimesters for women with risk factors for infection or for women living in settings with a high prevalence of infection. Women with no known risk factors who live in settings with a low prevalence of infection should be offered prenatal screening in the first trimester within a context of informed choice.
Essentialism as a Contributing Factor in Ideological Resonance and Dissonance Between Women and Their Midwives in Ontario, Canada
Authors: Sharpe Mary , Rudel Annette
Published: July 2024

The social reform movement that led to the regulation of midwifery care in Ontario benefited from a discourse that tended to essentialize depictions of the woman receiving midwifery care, the midwife and the woman- midwife relationship. The Philosophy of Midwifery Care in Ontario document for women and midwives reflects this history and supports certain essentialist tendencies. Examining the experiences of women and midwives in midwifery care post-legislation through life history qualitative research reveals ways in which this culture persists within contemporary midwifery discourse. However, the experiences of women and midwives also reveal contradictions within the philosophy of midwifery care document which tend to create problems for essentialism while supporting the element of choice in midwifery care.
L'ACCOUCHEMENT EN CENTRE HOSPITALIER AVEC UNE SAGE-FEMME AU QUÉBEC
Authors: Beauchemin Monique , Gagnon Raymonde
Published: July 2024

L'accouchement en centre hospitalier avec une sage-femme au Québec est maintenant devenu une réalité depuis 2005, avec la réalisation d'ententes inter-établissements. Cet article présente l'historique de la pratique sage-femme en projets-pilotes en regard de l'accouchement en centre hospitalier (CH), les choix ayant mené au type d'intégration des sages-femmes dans le réseau de la santé et des services sociaux ainsi que les raisons ayant conduit à l'établissement d'ententes inter-établissements pour l'accouchement en CH. Le modèle d'entente est décrit dans ses aspects législatifs et fonctionnels. Enfin, les résultats obtenus jusqu'à maintenant sont présentés et commentés. Les inconvénients et les avantages de ce modèle ainsi que l'impact de ces ententes sur la pratique des sages-femmes sont décrits à la lumière de l'expérience vécue par des sages-femmes québécoises.
The Professionalization of Midwifery in the Late Middle Ages
Authors: Piper Leanne
Published: July 2024

The concept of midwifery as an independent profession for women, one that gave them the opportunity for autonomyandeducation,isevidentinthehistoricalrecordofWesternEuropeinthelateMiddleAges. Thisstudy looks at several determinant factors that define the concept of professionalization in a medieval context – such as education, the establishment of standards of practice and the ability to earn income – concluding that midwifery should be considered by historians as a specialized profession, separate from other healers, physicians, and lay midwives. The study reflects on the work of early Greek medical scholars and the advancement of knowledge by Trotula of Salerno and St. Hildegard von Bingen, as well as the autonomy of practicing midwives and their relationship to the established Church, to illustrate the status of midwifery as a distinct profession during the established time period.
Educating Midwives with the World's First Simulator: Madame du Coudray's Eighteenth Century Mannequin
Authors: Carty Elaine
Published: July 2024

Madam Angelique Marguerite du Coudray (b.1712-d.1769) taught 10,000 midwifery students in 70 cities and towns in France at the command of Kings Louis XV and Louis XVI of France. Her goal was to reduce the high rates of infant mortality in France through careful teaching of the technical, ethical and moral aspects of midwifery to young women around the country. Her course of study included 40 lessons over two months. To enhance her teaching she developed an obstetrical mannequin and wrote six editions of a textbook. Her first mannequin was highly accurate in its anatomical measurements and had many pieces that allowed the student midwife (or physician) to practice normal birth, breech births, complicated births and births at different gestational ages. One of these mannequins is on view at Musée Flaubert et d'histoire de la medicine in Rouen, France. This remarkable midwife leaves an important legacy.
Methodological Triangulation in Midwifery Research
Authors: Stoll Kathrin
Published: July 2024

Midwifery researchers form an eclectic interdisciplinary group, and utilize a variety of research methods and data analysis approaches. Because of the interdisciplinary nature of midwifery research, there are many opportunities for using mixed-method research designs to enhance theory and knowledge development in this area of inquiry. The benefits of including both quantitative and qualitative research components in the same study are extensive, yet many researchers are uncertain about how to design and interpret mixed methods studies. This paper was written as an introduction to mixed methods study designs in midwifery research. Different approaches to methodological triangulation and its respective strengths are discussed as well as threats to validity in mixed-methods studies. Examples from midwifery research are used to illustrate core concepts.
Developing a Program for Midwives as First Assistants for Caesarean Sections in Ontario in an Isolated Setting
Authors: Wardle Fiona , Beale Terry , Zehr Pat
Published: July 2024

This paper documents the development of the midwifery first assist program in Sault Ste. Marie, Ontario. It outlines the need for midwives to expand their scope of practice, provides a short history of the midwife as first assist, the training process, the implementation and an evaluation of the program.
Persistent Organic Contaminants in Human Milk
Authors: Nagji Naushin , Wainman Bruce C.
Published: July 2024

Persistent organic pollutants (POPs) are always components of human milk and can be transferred to infants through lactation. This paper describes the POPs and discusses the risks that POPs in human milk pose to nursing infants. FeaturesofselectPOPsthatareexplainedinthispaperincludetheiruses,toxicityandtemporaltrends. The levels of most POPs are declining in human milk due to a series of international bans and restrictions that have been placed on the manufacturing and/or use of the chemicals. However, there is still concern regarding the continued exposure to POPs from leaks in electrical equipment and vector control programs. Although these contaminants continue to be detected in human milk samples, women are still encouraged to breastfeed their newborn children. It is firmly believed that the benefits of lactation for both the mother and her child outweigh the health hazards that POPs present.
Införande av betygskriterier i undervisning och examination
Authors: Lundkvist Emma , Swartling Maria
Published: July 2024

Vi har under de senaste tre åren arbetat med att införa betygskriterier i form av skriftliga förtydliganden av kursmålen vid såväl skriftliga tentamina som självständiga arbeten och muntliga examinationer. Kriterier med viktningssystem samt exempel för att förtydliga dessa har utformats, implementerats och utvärderats. Studenterna har upplevt arbetet med betygskriterier som ovant men positivt för kvaliteten. Lärarnas uppfattning är att bedömning med kriterier har gett en bättre och mer rättvisande helhetsbedömning av studenternas prestationer. En av de största fördelarna har varit att lärarna lättare kunnat kräva att studenterna uppfyllt samtliga kursmål för ett godkänt resultat. Fler studenter än tidigare har också uppfyllt samtliga mål vid examinationen. Artikeln beskriver hur vi arbetat med att ta fram målrelaterade betygskriterier och våra erfarenheter av att använda dem i undervisningen.
Digital competence in the Norwegian teacher education and schools
Authors: Krumsvik Rune Johan
Published: July 2024

The purpose of this article is to examine how policy documents in Norway the last ten years have interpreted ICT and digital competence in teacher education and in school. Norway implemented in 2006 a new national curriculum which increased the status of digital competence to be the fifth basic skill in the Norwegian elementary school (stage 1-13). This was a historic event and never before has digital competence achieved such status in curricula, neither nationally nor internationally. The same has newly happened with the new General Plan for Teacher Education where digital competence has become the fifth basic skill in all subjects. However, both teacher educators and teachers lack sufficient digital competence to fulfil these ambiguous policy goals and therefore the article suggest how a model of digital competence can bridge some of the gap between the intentions in the policy documents and the teachers/teacher educators’ practise. At the same time the article attempts to elaborate our perception of the concept digital competence in an educational discourse and how one can define digital competence in light of a Scandinavian educational perspective. The research question in this article is: how can digital competence be defined and what are the foundations of digital competence in teacher education and schools in light of the policy documents in Norway?
Arbeta med rangordningsövningar
Authors: Larsson Johan , Andersson-Chronholm Jannika , Elmgren Maja , Andersson Staffan
Published: July 2024

Som lärare söker man alltid efter nya undervisningsformer och övningar som ger bättre förutsättningar för studenternas lärande. Ett exempel på detta är rangordningsövningar. Rangordningsövningarna bygger på variation och jämförelse. Läraren väljer vilka egenskaper som varieras och kan rikta studenternas uppmärksamhet mot just de kritiska aspekter man vill uppmärksamma. Under 2010 har vi arbetat med ett pedagogiskt projekt vid Uppsala Universitet där rangordningsövningar prövats i flera olika naturvetenskapliga ämnen. Målet har varit att introducera, utveckla och pröva rangordningsövningar på svenska, där övningarna också breddats, utvecklats och kopplats till aktuell lärandeteori. Rangordningsövningar har visat sig värdefulla inom  fysik, biologi, kemi och geologi där de visat sig fungera i flera olika studentaktiverande sammanhang, t.ex. som aktiverande moment under föreläsningar, som uppgifter under laborationer och fältövningar, under räkneövningar och vid examination. Rangordningsövningarna har också visat sig fungera som utgångspunkt för mer kvalitativa vetenskapliga resonemang.
Inspirera och inspireras, och du får tusenfalt igen
Authors: Ossiannilsson Ebba S.I.
Published: July 2024

Fram till i dag har världens lärare publicerat mer än 1,5 miljoner lärobjekt och resurser på nätet. Allt från konkreta övningar till inspirerande reflektioner. Resurser som du helt fritt kan använda i din undervisning - Öppna digitala lärresurser (OER) .
Salstentor: Teknikstöd för examination
Authors: Ngaosuvan Leonard Suppatt
Published: July 2024

Debattinlägget beskriver praktiska problem med traditionella saltentor och föreslår att datorer med ordbehandlingsfunktion ska användas för att minska problemen.
Leadership and Management of Quality in Higher Education.
Authors: Lindberg-Sand Åsa
Published: July 2024

Åsa Lindberg-Sand recenserar: Leadership and Management of Quality in Higher Education, av Chenicheri Sid Nair, Leonard Webster and Patricie Mertova (redaktörer). Chandos Publishing, Woodhead Publishing Limited, Cambridge. 2010, 221 sidor. ISBN: 978 1 84334 576 3.
Att handleda en doktorand – en relationell balansgång som fordrar flexibilitet och struktur
Authors: Bergnéhr Disa
Published: July 2024

Handledningen är av central betydelse för en doktorands arbete och genomströmning. I föreliggande studie granskas kriterier för att handledningen ska uppnå hög kvalitet. Frågorna som står i fokus är: Vad karaktäriserar bra handledning, och hur kan handledningens kvalitet värderas och stärkas? Diskussionen baseras på tidigare forskning, styrdokument och intervjuer med några erfarna handledare. Resultaten tyder på att strukturellt och formaliserat stöd I forskningsmiljön såväl som vid handledningsträffarna gynnar handledningens kvalitet och doktorandens möjligheter att vid disputation nå examensmålen. Handledaren behöver vara flexibel och reflexiv i sitt förhållningssätt, eftersom doktoranders behov och förutsättningar skiljer sig och också förändras under utbildningens gång. Samtidigt behöver handledaren förhålla sig till olika krav, vilka kan skapa dilemman och leda till en svår balansgång i handledningen. Viktigt är att handledaren tar ansvar för att handledningen och relationen fungerar väl för samtliga inblandade parter, och uppmuntrar till samtal om problem och svårigheter när de uppstår. Samtidens krav på effektivitet och genomströmning fordrar arbetsplatsens och kollegiets stöd i handledningen, med ett kollektivt ansvar för doktorandens utbildning och utveckling.