Article Analysis and Evaluation of Research Ethics Template From the attached article:complete an article analysis and ethics evaluation of the research us

Article Analysis and Evaluation of Research Ethics Template From the attached article:complete an article analysis and ethics evaluation of the research using the “Article Analysis and Evaluation of Research Ethics” template (attached.) Article Analysis and Evaluation of Research Ethics
Article Citation and
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Point
Broad Topic Area/Title
Problem Statement
(What is the problem research
is addressing?)
Purpose Statement
(What is the purpose of the
study?)
Research Questions
(What questions does the
research seek to answer?)
Define Hypothesis
(Or state the correct hypothesis
based upon variables used)
Identify Dependent and
Independent Variables and
Type of Data for the
Variables
Article 1
Description
Population of Interest for
Study
Sample
Sampling Method
Identify Data Collection
Identify how data were
collected
Summarize Data Collection
Approach
Discuss Data Analysis
Include what types of
statistical tests were used for
the variables.
Summarize Results of Study
Summary of Assumptions
and Limitations
Identify the assumptions and
limitations from the article.
Report other potential
assumptions and limitations of
your review not listed by the
author.
Ethical Considerations
Evaluate the article and identify potential ethical considerations that may have occurred when sampling, collecting data, analyzing
data, or publishing results. Summarize your findings below in 250-500 words. Provide rationale and support for your evaluation.
Research
Midwives’ perceptions of their role
in mode of birth decisions
© 2019 MA Healthcare Ltd
M
idwives play an important role in the
journey of women in labour, from
conception to birth and beyond. It is
acknowledged globally that midwives
are critical care providers of pregnant
women and are the main professionals on birth wards,
providing healthcare education and information to
mothers- and fathers-to-be (Gunnervik et al, 2010). As
a result, one study in the UK emphasised that midwives
and other health professionals should be conscious of how
‘their own bias influences women’s choices’ (Houghton,
2008). Furthermore, Green (2015) cited a number of
sources indicating that women perceived the influence of
midwives as a critical factor regarding their birth position
choices. In another UK study, it was argued that women
in high-income countries, contrary to expectations, did
not necessarily have the freedom to choose when it
came to birth place (Coxon et al, 2014). This situation is
similar to middle-income countries, as confirmed by a
recent study exploring the birth stories of South African
women (Hastings?Tolsma et al, 2018). Hence, the role of
the midwife in improving women’s birth choices, such
as their choice of mode of birth, needs to be further
explored, especially in the context of women?centred
care (Sengane, 2013). It has been argued that the lack of
midwife involvement in such choices is a possible reason
for the high number of caesarean section births (James et
al, 2012), and that midwifery?led care leads to a greater
possibility of mothers choosing a spontaneous vaginal
birth (Soltani and Sandall, 2012). In terms of safety
outcomes, there is evidence demonstrating that there is
less likelihood of interventions when midwives are in
charge of maternity care (Sandall et al, 2009). This study
therefore sought to explore and describe how midwives
saw their role in women’s chosen mode of birth at South
African public sector birthing units.
Women have a right to an informed choice regarding
their mode of birth; however, they are sometimes
led to make an inappropriate choice due to the
contradictory opinions of attending health professionals
(Josefsson et al, 2011). In the UK, Lewis (2007) found
that poor communication and ineffective teamwork
among multiprofessional team members were often
the underlying causes of sub-standard care of women
in labour. This meant that women lacked advice and
British Journal of Midwifery, April 2019, Vol 27, No 4
Abstract
Background Midwives play an important role as advocates and
guides for women in labour regarding their choice of mode of
birth. However, there is a paucity of research exploring midwives’
perceptions of their role in how women make this choice.
Aim To explore and describe how midwives perceive their role
in facilitating the choice of mode of birth of women in labour at
public sector birthing units.
Method A quantitative, exploratory-descriptive design was used. A
questionnaire was used to collect data from 288 midwives in public
birthing units in the Eastern Cape, South Africa.
Findings The majority of the participants agreed that women in
labour should be allowed to choose their preferred mode of birth.
However, nearly half felt that care providers could overrule that
decision depending on the health of the mother and the baby.
Conclusion Midwives perceived themselves as the main role
players in assisting women in labour to make an informed decision
regarding the mode of birth that would best suit their circumstances.
Keywords
Role of midwife | Choice of mode of birth | Labour ward
midwives | Labouring women | Public hospital | Midwife obstetric unit
information about suitable modes of birth with regards
to how their labour was progressing, including the
option for vaginal birth. A study in the US concerning
women’s birth choices found that midwives provided
multiple options for birth and that the type of birth was
continuously discussed during antenatal care (Regan
and McElroy, 2013); however, women in the study also
indicated that their physicians did not appear to be
Noluthando Muthige
Practising midwife, Department of Health
Sindiwe James
Professor and Head of Department of Health, Nelson
Mandela University, South Africa
David Morton (corresponding author)
Senior lecturer and Research Co-ordinator, Nelson
Mandela University, South Africa
david.morton@mandela.ac.za
229
Research
Methods
A quantitative descriptive research design was used for
this study (Gray et al, 2017). The research population
included all the midwives who were working in labour
wards in the Nelson Mandela Bay Municipality and Sarah
Baartman districts, which are located in the western
half of the Eastern Cape Province. The population was
approximately 1800 midwives. Convenience sampling
was used and sample of 288 midwives was obtained.
A structured questionnaire was developed to collect
the data. The questionnaire was in English and consisted
of four sections:
?? Participants’ demographic information
?? Participants’ perceptions of their role in women’s
choice of mode of birth
230
Participants’ thoughts on strategies that could assist
women with their birth choices
?? Information provided to women in labour regarding
mode of birth when there were no complications and
when, or if, there were complications.
Ethical approval to conduct the research was obtained
from an authorised higher education institution. Access
to the hospitals and midwife obstetric units were sought
through the provincial office, chief executive’s office, and
with the aid of the operational managers. Participants
were informed of the objectives and methods of the
study. Care was also taken to explain their rights to
voluntary participation, privacy and confidentiality.
??
Findings
Biographical data
Of the 288 midwife participants, 8% (n=22) were men
and 92% were women (n=266). The majority (n=172;
60%) were 35 years old and older. Junior midwives were
in the majority with 53% (n=153) of the participants
having less than 1 year’s experience working in a labour
ward. More than one-third of participants (n=99; 35%)
had been working for more than 5 years. Nearly half of
the midwives (n=134; 47%) had a 4-year comprehensive
diploma qualification, while 31% (n=89) of the
participants had a nursing degree qualification.
Midwives’ role in mode of birth decisions
These results are shown in Table 1. A high percentage of
midwives (74%, n=210) indicated that women in labour
should be allowed to choose their preferred mode of
birth. A minority of respondents (n=50; 18%) disagreed,
with only 8% (n=22) neither agreeing nor disagreeing.
Overall, 76% (n=216) of the midwives felt that it
was appropriate that midwives should seek informed
consent for the mode of birth chosen by women in
labour. This response was opposed by only 14% (n=39)
of the midwives with just 10% (n=28) neither agreeing
nor disagreeing with the statement.
Of the participants, 81% (n=226) agreed that midwives
should enhance women’s chosen mode of birth during
labour through the use of sound midwifery judgement.
A few (n=23; 9%) disagreed with the statement and 11%
(n=31) neither agreed nor disagreed.
Just 12% (n=35) of the midwife participants felt that
midwives should be the only practitioners negotiating
mode of birth with women in labour. This perception
was opposed by a majority 80% (n=160) of the midwives,
while 8% (n=24) neither agreed nor disagreed.
A substantial percentage of midwives (n=221; 78%)
disagreed with the statement that only senior midwives
should advise women in labour regarding mode of birth.
A few (n=39; 18%) agreed, while 9% (n=26) of the
midwives neither agreed nor disagreed.
British Journal of Midwifery, April 2019, Vol 27, No 4
© 2019 MA Healthcare Ltd
willing to share information about birth choices. This
finding was supported by an Irish study (O’Hare and
Fallon, 2013), where women in labour felt as though they
were being ‘spoken at’ instead of being ‘communicated
with’ by the doctors. However, nearly all the women
reported that the midwives were good communicators
and played a pivotal role in preparing them for childbirth
(O’Hare and Fallon, 2013).
A major factor to ensuring a positive birth experience
was having the full support of a midwife. In an Iranian
study, Attarha et al (2016) concluded that when health
professionals had effective communication skills, there
were many benefits for the patients, such as reduced pain,
anxiety, and guilt, an increased peace of mind, and a sense
of cooperation from the medical team. Good interaction
is key to improving health outcomes and eliminating the
need for additional care, reducing hospital costs, litigation,
improving patient-oriented care and patient satisfaction
(Attarha et al, 2016).
Midwives are sometimes referred to as ‘agents of
change’ and by the very nature of their profession have
the ability to make a positive change in the lives of
women, babies, families and communities, acting as an
intermediary between the women and the healthcare
institution (Birthrights, 2013). It was found that being
a good advocate was based on respecting, implementing
and upholding women’s preferences and choices
(Birthrights, 2013).The midwife needs to be available to
the women in time of need, when, for example, having
to make a decision regarding a caesarean section birth;
however, being a change agent comes with its challenges,
especially when the midwife is working with other
health professionals (McCool et al, 2013).
There is little research exploring the midwife’s
perspective of their role in women’s preferred mode
of birth. This study focuses on the role of midwives
in women’s choices in public hospitals and midwife
obstetric units in South Africa, a middle-income country.
Research
© 2019 MA Healthcare Ltd
Strongly
disagree
n (%)
Disagree
n (%)
Neither
n (%)
Agree
n (%)
Strongly
agree n
(%)
Total
n (%)
Table 1. Midwives’ perceptions of their role in women’s mode of birth choices
Midwives should allow women in labour their choice of
mode of birth
13 (5)
37 (13)
22 (8)
116 (41)
94 (33)
282 (100)
Midwives should seek informed consent for the mode
of birth chosen by women in labour
5 (2)
34 (12)
28 (10)
119 (42)
97 (34)
283 (100)
Midwives should enhance women’s choices through
the use of sound midwifery judgement
7 (3)
16 (6)
31 (11)
135 (48)
91 (33)
280 (100)
Midwives should be the only practitioners negotiating
mode of birth with women in labour
73 (25)
157 (55)
24 (8)
22 (8)
11 (4)
287 (100)
Only senior midwives should advise women in labour
regarding mode of birth
65 (23)
156 (55)
26 (9)
27 (9)
12 (4)
286 (100)
Antenatal care clinic midwives should take
responsibility for helping women to choose a mode of
birth during pregnancy
23 (8)
88 (31)
39 (14)
93 (32)
44 (15)
287 (100)
Midwives should be directed by the cultural background
of the woman in labour
12 (4)
55 (20)
51 (18)
110 (39)
54 (19)
282 (100)
Midwives hold the responsibility for facilitating
women’s preferred mode of birth in labour
24 (8)
77 (21)
48 (17)
101 (36)
34 (12)
284 (100)
Midwives should gain the trust of women seeking
advice in labour
0 (0)
4 (1)
10 (3)
142 (49)
132 (46)
288 (100)
Midwives should communicate how a woman’s
pregnancy is progressing to ensure that their chosen
mode of birth is appropriate
0 (0)
2 (1)
17 (6)
131 (46)
136 (48)
286 (100)
Midwives should communicate how a woman’s labour
is progressing to ensure that their chosen mode of
birth is appropriate
12 (4)
33 (11)
17 (6)
112 (39)
114 (40)
288 (100)
Midwives should not involve themselves in the choices
made by women in labour regarding mode of birth
45 (16)
107 (37)
43 (15)
70 (24)
21 (7)
286 (100)
Regarding the statement that antenatal clinic midwives
should take responsibility for helping women to choose
a mode of birth during pregnancy, 47% (n=137)
participants agreed, while 39% (n=111) disagreed. A small
proportion (n=39; 14%) neither agreed nor disagreed.
A majority of participants (n=164; 58%) felt that
midwives should be directed by the cultural background
of the women in labour; however, nearly one-quarter of
the participants (n=67; 24%) participants disagreed.
Nearly half (n=135; 48%) of participants agreed
that midwives should take responsibility for facilitating
women’s preferred mode of birth in labour. However,
nearly one-third of the participants (n=101; 35%)
disagreed and 17% (n=48) neither agreed nor disagreed,
suggesting a degree of confusion over midwives’
understanding of their role in guiding women’s choices
during labour.
British Journal of Midwifery, April 2019, Vol 27, No 4
Of the participants, 95% (n=274) felt that midwives
should gain the trust of women in labour who were
seeking advice, and most (n=267; 94%) agreed that
midwives should inform pregnant women of how
their pregnancy was progressing, to help them to make
appropriate choices. Similarly, 79% (n=226) of participants
felt that midwives should inform women of how their
labour was progressing to help them make appropriate
decisions. Overall, 31% (n=91) of the participants felt that
midwives should not involve themselves in the choices
made by women in labour regarding mode of birth,
while 53% (n=152) disagreed and 15% (n=42) neither
agreed nor disagreed with the statement.
Discussion
A high percentage (74%) of midwives indicated that
women in labour should be allowed to make their own
231
Midwives play an important role in helping women to decide their preferred mode
of birth. Midwifery care has been associated with higher rates of vaginal birth
choices regarding their mode of birth. According to Klein
(2012), the increasing acceptance by health professionals
of a woman’s right to choose her mode of birth is based
on the assumption that the woman is fully informed;
however, a number of sources have demonstrated that
the proportion of births attributed to patient initiation
remains small (Klein, 2012). This argument is supported
by a UK study that indicated a lack of informed choice
among pregnant women (Thompson and Miller, 2014).
In this study, midwives understood the need to equip
women to make an informed choice, as the majority
felt that they should be involved in women’s choices
regarding the mode of birth. The results therefore
suggest that midwives understood their responsibility
towards women regarding their choice of birth. Indeed,
despite the apparent lack of informed choice, midwives
in this study were wholly in favour of women making
their own decisions. Linked to this was the fact that a
high percentage of midwives said that it was appropriate
to seek consent from the women in labour regarding
her choice of mode of birth. However, in a UK study,
midwives reported that they often felt that the provision
of informed consent was often restricted by time
(Thompson, 2013), meaning that, despite midwives’
good intentions, it is possible that keeping the women
fully informed does not always happen in reality. In line
with this statement, Shahid et al (2014) argued that
women required full and accurate information in order
to decide on a suitable mode of birth. Moreover, Mbye
et al (2011) noted that providing appropriate information
has been proven to help reduce anxiety, allaying fear and
motivating women in labour to tolerate pain.
232
The majority of midwives in this study agreed that
midwives should enhance the choice of women in labour
through the use of sound midwifery judgement. Cook
and Loomis (2012) stated that the knowledge of the
midwife, whether based on experience or philosophy,
played an important role in influencing the final birth
plan. Indeed, pregnant and women in labour have been
shown to rely on midwives who are able to skilfully
assess them and identify the need for a higher level of
care as soon as complications occur (Shahid et al, 2014).
Furthermore, midwives play a critical role in advocating
for women so as to ensure safe, adequate, immediate
and cost effective care (Seboni et al, 2013; International
Confederation of Midwives (ICM), 2018).
Most of the participants in this study said that
midwives should not be the only practitioners
negotiating the mode of birth with women in labour.
Seboni et al (2013) emphasised the collaborative role of
midwives with other health professionals for the sake of
care and referral. The midwives in this study appeared
to support this collaborative approach; however, this
can be complicated by the frequent disrespect shown to
midwives by other health professionals. In a global study
of midwifery, the World Health Organization (WHO)
found that 36% of midwife participants indicated that
they experienced a lack of respect from senior medical
staff (WHO, 2016).
There was a mixed response to the statement that
antenatal care clinic midwives should take responsibility
for helping women to choose a mode of birth during
pregnancy. South Africa has a relatively high percentage
(61.2%) of early bookings (within 20 weeks) for antenatal
care (Massyn et al, 2016); however, the majority of these
are inconsistent in their attendance. If the responsibility
to assist women in deciding their preferred mode of birth
were to lie with antenatal care clinic midwives alone,
defaulters could go unadvised and may be pushed into
a mode of birth that was not necessarily their choice.
Klein (2012) therefore argues that it is unreasonable
to expect health professionals to change the attitudinal
environment of birth on their own.
Almost half the midwives indicated that midwives
should take responsibility for helping women in labour
to choose their mode of birth. As midwives are mainly
trained in primary care while the doctors are trained
for the benefit of medical care (Newnham, 2010),
this implies that midwives have a crucial role to play
in bridging the gap between natural and the technical
contexts (Andrissi et al, 2015). Furthermore, midwives are
specialists in low?risk care midwifery care (Klein, 2010),
which in many high?income countries is restricted to
certain healthcare settings (Fawsitt et al, 2017).Therefore,
the degree of responsibility is largely restricted by the
type of unit.
British Journal of Midwifery, April 2019, Vol 27, No 4
© 2019 MA Healthcare Ltd
Adobe Stock/Gorodenkoff
Research
Research
A majority of midwives felt that they should be
directed by the cultural background of the woman in
labour. The ICM emphasises the need to work with
women and healthcare providers to overcome cultural
practices that harm women and babies, with a focus on
health promotion and disease pr…
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