https://www.um.edu.mt/library/oar/handle/123456789/27909 2026-04-11T11:33:11Z https://www.um.edu.mt/library/oar/handle/123456789/28095 Title: The lived experiences of Maltese midwives and obstetricians caring for childbearing migrant women Abstract: The local healthcare system has witnessed steady growth in births within families of foreign nationals, thus exposing Maltese midwives and obstetricians to the diverse challenges of caring for multi-cultural people. While international studies have looked at how this phenomenon affects migrant women, little research has been done to explore the views of the healthcare providers themselves. The study aimed to explore the lived experiences of Maltese midwives and obstetricians caring for childbearing migrant women. The qualitative paradigm was used to conduct the research by using a semi-structured interview schedule. The interview guide was specifically designed for the purpose of the research. A total of four midwives and four obstetricians were recruited by purposive sampling, and all participants took part in one audio-recorded interview, the data of which was collected between December 2016 and January 2017. Ethical issues were taken into consideration and adhered to throughout the research process. This research was guided by the philosophical underpinnings of Heidegger. Data was analysed using Interpretative Phenomenological Analysis (IPA) as described by Smith, Flower and Larkin (2009). The resulting four super-ordinate themes identified how meeting with childbearing migrant women was initially a ‘wake-up call’ for midwives and obstetricians, which was followed by feelings of ‘powerlessness’ and a ‘process of metamorphosis’ to ultimately suggesting the need for ‘compassionate maternity care’. The findings demonstrated that midwives and obstetricians faced numerous challenges when caring for childbearing migrant women. These ranged from, difficulties in communicating, to lack of compliance to appointments and care plans. For this reason midwives and obstetricians have suggested a reorientation of our maternity service to provide more culturally compliant, sensitive, non-stereotyped, and compassionate care. Key recommendations include; better interpreting services, increase in transcultural education among healthcare professionals through the implementation of continuous professional development courses, provision of psychological support for healthcare professionals and improved inter-professional collaboration. Description: M.SC.MIDWIFERY 2017-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/28090 Title: Proposed guidelines for antenatal care of teenage mothers : a modified delphi study Abstract: It is generally accepted that a teenage pregnancy is a high-risk pregnancy associated with psychosocial problems causing these young women to default from antenatal care. Whilst pregnant teenage mothers are provided with antenatal care locally, the service provided is not directly focused on the needs of these teenage mothers. Being a vulnerable group, teenage mothers require additional antenatal care focusing mainly on their individualised needs. In view of this, a Modified Delphi study was carried out using a self-designed questionnaire/s to design and develop a set of guidelines with the aim of enhancing the provision of antenatal care for teenage mothers. To achieve this goal, the researcher identified and formulated clinical practice items required in the provision of antenatal care for teenage mothers through an in-depth literature review, and validated these items using a Modified Delphi approach. A heterogeneous sample comprising Clinical Midwives, Obstetric Doctors, Midwifery Educators, Mothers, Policy-Makers and Counsellors/Guidance Teachers were recruited by purposive, non-probability sampling technique and snowballing technique. This Modified Delphi Study consisted of two rounds of questionnaires. A sample size of 186 participants (68.6%) were recruited in Round 1. The response rate of Round 2 was 46.5% (n = 126) contributing to a total of 32% dropout rate. The homogeneity of the tool was demonstrated by testing its reliability using test-retest and internal consistency. Data analysis involved identifying the level of consensus for each clinical item in both rounds and was analysed using frequencies, cross-tabulations and correlational statistics. Through the in-depth literature review, 37 items and 4 themes were generated. These items formed the Modified Delphi questionnaire. Upon completion of Round 2, 34 items achieved the pre-determined 70% level of consensus, with the majority of items (n=21) scoring above 90%. Clinical items that gained consensus included those related to barriers issues, that is, amongst others, problems associated with a standard clinic and the socio-demographic statuses of the pregnant teenagers. Other items that gained consensus included those related to the need for follow-up sessions and additional support programmes for pregnant teenagers, family counselling sessions, continuity of care, alternative models of care, antenatal care in the community, after-school antenatal clinic, liaison with other relevant services, as well as the request for more training and guidelines for staff and student midwives. Items related to topics on the provision of transport for pregnant teenagers, the presence of older pregnant women in the antenatal clinic and the impact of unfriendly attitudes from health workers did not gain consensus and were excluded from the refined proposed guidelines. By using Carper’s Theory of Knowing, the Model of Change and the Practice Guidelines Evaluation and Adaptation Cycle as a guide, the researcher discussed how the responses of this study correlated with trends reported in previous literature. Based on the findings of this study, the conclusion provided recommendations for clinical practice, research and education, including among others, the need to publish the proposed guidelines for them to be used as a basis for the provision of local antenatal care, and the need to offer comprehensive training to those midwives who wish to extend their role and specialise in this field. It was concluded that the possibility of the development of a teenage antenatal clinic would require subsequent research, including the evaluation of the competencies needed of health professionals and the investigation of the success of this teenage antenatal clinic over time. Other suggestions for further practice, research and education were also drawn up. Description: M.SC.MIDWIFERY 2017-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/28058 Title: The birth environment : mothers' and fathers' lived experiences Abstract: The birth environment has a powerful impact on the mother and those with her during labour. An increasing amount of research is bringing to light fathers’ birth experiences. Fathers provide support to most women during labour therefore, their experience of the birth environment is also crucial. This study aimed to explore both mothers' and fathers' lived experiences of the birth environment. Objectives were set to explore how the physical, psychosocial, spiritual and cultural environment during labour, influences the parents' birth experience, and to delve into the similarities and differences between mothers' and fathers' views and experiences of the birth environment. Experiences of the birth environment at home during early labour and at hospital, in labour and during a normal vaginal birth were studied. The study adopted a hermeneutic phenomenological research design. A purposive homogenous sample of seven couples was recruited from the local public hospital. The method of data collection was a one-time, face-to-face, semi-structured interview. Interviews were carried out with the couple together. The birth territory theory by Fahy (2008) guided this study. Data was analysed using interpretative phenomenological analysis as described by Smith, Flowers and Larkin (2009). Three super-ordinate themes emerged from the data; ‘the home-hospital gap’, ‘midwifery care’ and ‘movement in labour’. A conflict between the comfort of home and homelike aesthetics, and the reassuring, but foreign, clinical environment and medical equipment, was felt by mothers and fathers. Movement in labour was important to mothers. Fathers became more involved in the labour when mothers were mobile during labour. The birth environment consisted of facilitating and impeding factors to movement, which influenced the parents’ experiences. The midwife was a fundamental part of the birth environment, taking precedence over the physical environment. The midwife’s role should go beyond the care of the mother to involve and support the father too. Mothers and fathers experienced the birth environment from different perspectives however, they have indicated similar needs and desires from the birth environment, creating a shared experience. Recommendations for improvements to the local birth environment, midwifery practice and further research were made. Description: M.SC.MIDWIFERY 2017-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/28055 Title: Genetics in midwifery : exploring the midwives’ views and educational needs in clinical practice Abstract: Genetics is becoming increasingly important within healthcare, but evidence indicates that midwives may not feel confident in dealing with the genetics need of patients and thus education is often inadequate. In Malta no studies have ever been conducted on genetics in midwifery. This study was useful to understand how it is best to enhance genetics education in this profession and served as an initial step towards the creation of continuous educational material targeted to midwives. The aim of this study was to explore the midwives’ views on genetics and in addition to assess the educational needs of midwives in the field of genetics in Malta. The main objectives were to explore the current status of midwives’ knowledge and its applicability in practice; to assess the attitudes of the midwives regarding genetics and its importance in their clinical role; to identify the barriers of integrating genetics into practice and to determine the genetic education needs of midwives in relation to their clinical settings. To fulfil the study’s aim, a ‘needs assessment analysis’ using a mixed method approach, combining both quantitative and qualitative methods, was used. Data was collected in the first phase, by means of a questionnaire, which focused on the current status of midwives’ knowledge, their attitudes, the identification of any barriers in integrating genetics and the educational needs of midwives. This was combined with a focus group interview, where midwives were allowed to discuss their views on how to implement improvement in genetics education. There was a presentation seminar at the end, with the aim of serving as the first continuous professional development (CPD) event on genetics. This was targeted to practicing and student midwives. Data collection took place in all the maternity settings within the state local public hospital. The sample consisted of 150 midwives and the sampling technique chosen was a purposive sampling. Frequencies, percentages and three non-parametric tests were used in this study. The data from the focus group was analysed using Burnard (1991) thematic-content analysis, where eight themes emerged and within each theme, further categories were elicited. Ninety-eight midwives participated in the questionnaire, resulting in a response rate of 65.3%. From these 98, five midwives agreed to exchange and share their ideas through the focus group interview. The majority of midwives felt that genetics is an important and an essential component of midwifery practice, however, the majority did not feel confident enough to undertake certain activities to integrate genetics into their clinical practice. The majority were found to have inadequate knowledge on genetic information, genetic services and epigenetics. In fact, the need for educational preparations in genetics at both pre- and post- graduate levels was highlighted. Most midwives agreed that lack of knowledge about genetics among educators and practitioners; lack of understanding of relevance to practice; limited number of clinical mentors and limited number of educators to explain difficult concepts, were considered as barriers for integrating genetics into their daily clinical practice. The midwives’ preferred learning approach was the workshops with a mixture of presentations and group activities. A need for a clear description of responsibilities to enable effective use of genetics in the midwives’ clinical practice was also identified. One main limitation of the study is that 59 out of 150 midwives did not attempt to answer the questionnaire and thus there may be bias. As an outcome of the study several recommendations were proposed. Continuous awareness should be made to student midwives and qualified midwives about the midwife's role in genetics. Hence, it is best to continue the current teaching of genetics in the undergraduate curriculum, and possibly expanding it even to the postgraduate programme, with the introduction of study days as part of every midwife’s CPD. Description: M.SC.MIDWIFERY 2017-01-01T00:00:00Z