Journal of nurse-midwifery最新文献

The problem of maternal-fetal conflict presents both ethical and legal challenges to birth attendants as well as to policymakers. This essay suggests that a crisis intervention approach to such conflicts fosters an adversarial view of the relationship between the pregnant woman and her fetus, which can be divisive and counterproductive. A better approach to maternal-fetal conflicts emphasizes mutually held goals rather than countervailing rights and uses the doctrine of informed consent to enhance the pregnant woman's ability to make responsible choices for both herself and her fetus. Nonphysician birth attendants can take a leading role by employing client-centered professional values to develop and extend this cooperative approach to maternal-fetal conflicts.

The purpose of the 1988 Mini-Survey was the collection of up-to-date data from the ACNM membership, focusing on nurse-midwifery income. These were the last data collected about CNMs for the 1930 decade. The final survey sample included 1,735 CNMs and 67 SNMs; 70.6% of the CNMs were in clinical practice. The demographic, employment, and income findings are presented for all CNM respondents by ACNM region of residence and for CNMs in full-scope clinical nurse-midwifery practice. Additional income findings for CNMs working full time and part time are also presented by ACNM region of residence, as well as by selected individual states. Nurse-midwifery income is compared with nursing income during the same time period. Demographic and/or employment characteristics are presented for CNMs doing home births, for student nurse-midwives, for nurse-midwifery faculty, and for nurse-midwives with doctorates. In surveys done from 1984 to 1988, the mean full-time CNM annual income increased by $10,000. The 1988 Survey data are now approximately two years old and the impact of the recent nursing shortage on both nursing and nurse-midwifery salaries was not necessarily reflected in these data.

Since the late nineteenth century, the average postpartum woman has been subjected to a great deal of swabbing, soaking, and spraying, all in the name of perineal care. Many elaborate regimens have been devised to prevent infection, promote healing, and provide comfort to the mother, often based on little physiologic rationale or research data. All of these regimens have taken away valuable time and energy that the new mother needs for more important tasks. A review of past and current perineal care practices and major research studies relative to perineal care can form a foundation from which to evaluate and update the management of perineal care.

This descriptive study was designed to identify the perceived learning needs of students with midwifery experience who enter nurse-midwifery education programs. Instruments were developed to gather data from nurse-midwifery educators and CNMs who had been experienced lay midwives (LM/CNMs). Results indicate that LM/CNMs and educators recognize the importance of identification of knowledge and skills gained before entering the educational program, but a variety of factors inhibit the implementation of creative, individualized curriculums. Issues related to nurse-midwifery education, including identification of valid knowledge and the need for a midwifery rather than obstetric model of teaching, are discussed.

Employees with high job satisfaction demonstrate a low job turnover rate. Identifying specific factors related to CNM job satisfaction and restructuring job designs accordingly may reduce CNM job turnover. This approach may also aid in recruiting nurses into the profession and CNMs into open positions. General theories of job satisfaction and the results of research in industry and general nursing are discussed. The results of a preliminary study of CNM job satisfaction indicate that CNMs are mostly satisfied with their jobs. In addition, CNMs in different types of practice show differences in the rank order of job satisfaction factors. Recommendations are made for future research.

This pilot study replicated the Arizmendi and Affonso study that identified the frequency and intensity of stressors related to childbearing.¹ The original study (n = 221) targeted chiefly middle-class white women. To date, there is no literature on stressful events as reported by African-American childbearing women. It was hypothesized that African-American women would identify differential patterns of stressful events in childbearing. A convenience sample of 50 African-American childbearing women were interviewed. Demographics were presented and compared with the original study. The frequency and intensity of stressors were analyzed and compared. It was proposed that the differential stressors between the chiefly white middle-class sample and the African-American sample relates to both the life experiences and the differential birth outcomes of African-American childbearing women. Areas for future research are targeted.

Increasing numbers of women with physical or sensory disabilities are choosing to bear children. Research and experience seem to indicate serious shortcomings in assisting disabled primiparas toward confident, healthy, and safe childbearing and childcaring. Guidelines are suggested for appropriate referral or direct provision of education and counselling services for such clients during prepregnancy, pregnancy, labor and delivery, and the postpartum period. Useful resources are identified to assist the nursemidwife in her role.

Few CNMs to date have been sued and fewer yet have been through the trauma of a malpractice suit. The following article is a synopsis of the malpractice process from summons through trial. Interspersed throughout are personal recollections and responses of one CNM who endured a two-week trial.