Freeman Nicole, Moroney Tracey, Warland Jane, Cheney Kate, Hobday Michelle, Bradfield Zoe
School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
Women's and Newborn's Health Service, King Edward Memorial Hospital, Perth, WA, Australia.
BMC Pregnancy Childbirth. 2025 Apr 16;25(1):458. doi: 10.1186/s12884-025-07567-3.
The scope of practice of the contemporary midwife encompasses a range of sexual and reproductive healthcare, including care throughout pregnancy. Midwives are experts in pregnancy care, but many do not provide care for women with unexpected (acute) complications in early pregnancy (< 20 weeks) in Australia. Women experiencing acute pregnancy complications < 20 weeks usually attend an emergency department rather than a maternity unit. These settings do not typically employ midwives and may not meet women's need for timely and informed physical care and psychosocial support. A gap in evidence exists in relation to the role and scope of practice of the midwife in acute early pregnancy care provision in Australia.
Midwives and midwifery students in Australia were purposively sampled and invited to complete an online cross-sectional survey exploring midwifery practice in acute early pregnancy care. Data were collected from July 1st to September 30th, 2024. Quantitative data were analysed using descriptive and inferential statistics. Free-text responses were analysed using inductive content analysis.
Responses from 294 midwives and 46 midwifery students (n = 340) were analysed. Participants recognised that midwives should provide acute care in early pregnancy, and many had knowledge, confidence or experience in this area. The most reported setting for acute early pregnancy care provision was the general emergency department; early pregnancy assessment service models were also common. Some settings prioritised the employment of registered nurses over midwives in acute early pregnancy services. Challenges to midwives providing acute early pregnancy care included inadequate clinical exposure as qualified midwives, and women being placed in non-maternity settings.
Participants supported midwives providing acute care in early pregnancy, confirming that midwives' professional scope should not be impacted by pregnancy gestation or outcome. However, current midwifery education programs may not be adequately preparing midwives to provide comprehensive care for women with acute early pregnancy complications. Those midwives who are providing care may not be fulfilling professional scope. Findings have utility in supporting policy, education and service review, and highlight further gaps in evidence for future research.
当代助产士的执业范围涵盖一系列性与生殖健康护理，包括整个孕期的护理。助产士是孕期护理专家，但在澳大利亚，许多助产士并不为孕早期（<20周）出现意外（急性）并发症的女性提供护理。孕早期<20周出现急性妊娠并发症的女性通常前往急诊科而非产科病房。这些场所通常不雇佣助产士，可能无法满足女性对及时且信息充分的身体护理和心理社会支持的需求。在澳大利亚，关于助产士在急性孕早期护理中的角色和执业范围方面存在证据空白。
对澳大利亚的助产士和助产专业学生进行有目的抽样，并邀请他们完成一项在线横断面调查，以探究急性孕早期护理中的助产实践。数据收集时间为2024年7月1日至9月30日。定量数据采用描述性和推断性统计进行分析。自由文本回复采用归纳性内容分析进行分析。
分析了294名助产士和46名助产专业学生（n = 340）的回复。参与者认识到助产士应在孕早期提供急性护理，并且许多人在该领域有知识、信心或经验。报告最多的急性孕早期护理提供场所是综合急诊科；早期妊娠评估服务模式也很常见。在急性孕早期服务中，一些场所优先雇佣注册护士而非助产士。助产士提供急性孕早期护理面临的挑战包括作为合格助产士临床接触不足，以及女性被安置在非产科场所。
参与者支持助产士在孕早期提供急性护理，确认助产士的专业范围不应受孕周或妊娠结局影响。然而，当前的助产士教育项目可能未充分培养助产士为有急性孕早期并发症的女性提供全面护理的能力。那些提供护理的助产士可能未履行专业职责。研究结果有助于支持政策、教育和服务审查，并凸显未来研究证据方面的进一步差距。
