Midwives' competence

Is it affected by working in a rural location?

V. Hundley, Janet Stephen Tucker, Edwin Roland Van Teijlingen, Alice Kiger, J. A. Ireland, F. Harris, J. Farmer, Jane Lindsay Caldow, H. Bryers

Research output: Contribution to journalArticle

Abstract

Introduction: Rising health care costs and the need to consolidate expertise in tertiary services have led to the centralisation of services. In the UK, the result has been that many rural maternity units have become midwife-led. A key consideration is that midwives have the skills to competently and confidently provide maternity services in rural areas, which may be geographically isolated and where the midwife may only see a small number of pregnant women each year. Our objective was to compare the views of midwives in rural and urban settings, regarding their competence and confidence with respect to ‘competencies’ identified as being those which all professionals should have in order to provide effective and safe care for low-risk women. Method: This was a comparative questionnaire survey involving a stratified sample of remote and rural maternity units and an ad hoc comparison group of three urban maternity units in Scotland. Questionnaires were sent to 82 midwives working in remote and rural areas and 107 midwives working in urban hospitals with midwife-led units. Results: The response rate from midwives in rural settings was considerably higher (85%) than from midwives in the urban areas (60%). Although the proportion of midwives who reported that they were competent was broadly similar in the two groups, there were some significant differences regarding specific competencies. Midwives in the rural group were more likely to report competence for breech delivery (p = 0.001), while more urban midwives reported competence in skills such as intravenous fluid replacement (p <0.001) and initial and discharge examination of the newborn (p <0.001). Both groups reported facing barriers to continuing professional development; however, more of the rural group had attended an educational event within the last month (p <0.001). Lack of time was a greater barrier for urban midwives (p = 0.02), whereas distance to training was greater for rural midwives (p = 0.009). Lack of motivation or interest was significantly higher in urban units (p = 0.006). Conclusion: It is often assumed that midwives in rural areas where there are fewer deliveries, will be less competent and confident in their practice. Our exploratory study suggests that the issue of competence is far more complex and deserves further attention.
Original languageEnglish
Number of pages13
JournalRural and Remote Health
Volume7
Issue number764
Publication statusPublished - Aug 2007

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midwife
Midwifery
Mental Competency
rural area
Group
educational event
questionnaire
lack
Urban Hospitals
Scotland
centralization
Health Care Costs

Keywords

  • clinical competence
  • midwifery
  • questionnaire survey
  • rural health services

Cite this

Hundley, V., Tucker, J. S., Van Teijlingen, E. R., Kiger, A., Ireland, J. A., Harris, F., ... Bryers, H. (2007). Midwives' competence: Is it affected by working in a rural location? Rural and Remote Health, 7(764).

Midwives' competence : Is it affected by working in a rural location? / Hundley, V.; Tucker, Janet Stephen; Van Teijlingen, Edwin Roland; Kiger, Alice; Ireland, J. A.; Harris, F.; Farmer, J.; Caldow, Jane Lindsay; Bryers, H.

In: Rural and Remote Health, Vol. 7, No. 764, 08.2007.

Research output: Contribution to journalArticle

Hundley, V, Tucker, JS, Van Teijlingen, ER, Kiger, A, Ireland, JA, Harris, F, Farmer, J, Caldow, JL & Bryers, H 2007, 'Midwives' competence: Is it affected by working in a rural location?', Rural and Remote Health, vol. 7, no. 764.
Hundley V, Tucker JS, Van Teijlingen ER, Kiger A, Ireland JA, Harris F et al. Midwives' competence: Is it affected by working in a rural location? Rural and Remote Health. 2007 Aug;7(764).
Hundley, V. ; Tucker, Janet Stephen ; Van Teijlingen, Edwin Roland ; Kiger, Alice ; Ireland, J. A. ; Harris, F. ; Farmer, J. ; Caldow, Jane Lindsay ; Bryers, H. / Midwives' competence : Is it affected by working in a rural location?. In: Rural and Remote Health. 2007 ; Vol. 7, No. 764.
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T2 - Is it affected by working in a rural location?

AU - Hundley, V.

AU - Tucker, Janet Stephen

AU - Van Teijlingen, Edwin Roland

AU - Kiger, Alice

AU - Ireland, J. A.

AU - Harris, F.

AU - Farmer, J.

AU - Caldow, Jane Lindsay

AU - Bryers, H.

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N2 - Introduction: Rising health care costs and the need to consolidate expertise in tertiary services have led to the centralisation of services. In the UK, the result has been that many rural maternity units have become midwife-led. A key consideration is that midwives have the skills to competently and confidently provide maternity services in rural areas, which may be geographically isolated and where the midwife may only see a small number of pregnant women each year. Our objective was to compare the views of midwives in rural and urban settings, regarding their competence and confidence with respect to ‘competencies’ identified as being those which all professionals should have in order to provide effective and safe care for low-risk women. Method: This was a comparative questionnaire survey involving a stratified sample of remote and rural maternity units and an ad hoc comparison group of three urban maternity units in Scotland. Questionnaires were sent to 82 midwives working in remote and rural areas and 107 midwives working in urban hospitals with midwife-led units. Results: The response rate from midwives in rural settings was considerably higher (85%) than from midwives in the urban areas (60%). Although the proportion of midwives who reported that they were competent was broadly similar in the two groups, there were some significant differences regarding specific competencies. Midwives in the rural group were more likely to report competence for breech delivery (p = 0.001), while more urban midwives reported competence in skills such as intravenous fluid replacement (p <0.001) and initial and discharge examination of the newborn (p <0.001). Both groups reported facing barriers to continuing professional development; however, more of the rural group had attended an educational event within the last month (p <0.001). Lack of time was a greater barrier for urban midwives (p = 0.02), whereas distance to training was greater for rural midwives (p = 0.009). Lack of motivation or interest was significantly higher in urban units (p = 0.006). Conclusion: It is often assumed that midwives in rural areas where there are fewer deliveries, will be less competent and confident in their practice. Our exploratory study suggests that the issue of competence is far more complex and deserves further attention.

AB - Introduction: Rising health care costs and the need to consolidate expertise in tertiary services have led to the centralisation of services. In the UK, the result has been that many rural maternity units have become midwife-led. A key consideration is that midwives have the skills to competently and confidently provide maternity services in rural areas, which may be geographically isolated and where the midwife may only see a small number of pregnant women each year. Our objective was to compare the views of midwives in rural and urban settings, regarding their competence and confidence with respect to ‘competencies’ identified as being those which all professionals should have in order to provide effective and safe care for low-risk women. Method: This was a comparative questionnaire survey involving a stratified sample of remote and rural maternity units and an ad hoc comparison group of three urban maternity units in Scotland. Questionnaires were sent to 82 midwives working in remote and rural areas and 107 midwives working in urban hospitals with midwife-led units. Results: The response rate from midwives in rural settings was considerably higher (85%) than from midwives in the urban areas (60%). Although the proportion of midwives who reported that they were competent was broadly similar in the two groups, there were some significant differences regarding specific competencies. Midwives in the rural group were more likely to report competence for breech delivery (p = 0.001), while more urban midwives reported competence in skills such as intravenous fluid replacement (p <0.001) and initial and discharge examination of the newborn (p <0.001). Both groups reported facing barriers to continuing professional development; however, more of the rural group had attended an educational event within the last month (p <0.001). Lack of time was a greater barrier for urban midwives (p = 0.02), whereas distance to training was greater for rural midwives (p = 0.009). Lack of motivation or interest was significantly higher in urban units (p = 0.006). Conclusion: It is often assumed that midwives in rural areas where there are fewer deliveries, will be less competent and confident in their practice. Our exploratory study suggests that the issue of competence is far more complex and deserves further attention.

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KW - midwifery

KW - questionnaire survey

KW - rural health services

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JO - Rural and Remote Health

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SN - 1445-6354

IS - 764

ER -