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Barriers to completion of a nurse-midwifery education program
numbers of subjects involved, and the vakdity of some of the studtes needs further exploration. For instance. what is a “motor clusters” in a newborn. and how do they relate to breastfeeding? In the first article, maternal narcotic or sedative anaigesia is most definitely as. o&ted with an adverse effect on infant success at the breast. Epidu-al anesthesia has not been as well studied a’: parenterai analgesia, but the implications for breastfeeding are I;keiy to be quite profound because so many doctors rse epidurais. Tha perception that epidumis are “natural” is becoming an American cultural belief: if eve:,une on the maternity floor is offered one. and mother is alet t to see the birth. epidurals become normal. “Normal ’ soon becomes “natural” because we value natural childbirth. Anecdotally, natural childbirlh stories often include incidental mention of epiduml anesthesia. In cesarean delivery, epidural anesthesia improves breastfeeding success, compared to general anesthesia. A woman ;vho has had a vaginal birth after cesarean may view epidural anesthesia as the best part of her delivery. “1 was alert and able to see the birth” is heard oftrn. If mothers knew that their baby would perform poorly on orientation and motor c!usters during the first month after the epidural during delivery, they migirt not hold such benign views. The second article probably has more implications for midwifey practice because It examined how the obstetrician can either undermine or support brea&admg throughout the dsuraiion of care. Becarusc midwifery care results in fewer interventions (I), there may be a decrease in intervention-associated bresstfeeding problems in rnidwiiery care. Also, because studies in this area are few, few conclusions can be reached. In regard to induction. the effect of incrensed bilirubin ievels with the use of pitocin needs further study. The treatment of jaundice sornctimes interferes with milk sttpply: jaundiced Jabies often are sleepy, and artificial baby milk supplements are still used it> “push” the bilirubin out as is the incorrect use of glucose water for “flushing.” Newton described effectively and concisely the negative effects of separation of mother and infant. Ne &c&d the controversial concept of nippb c&&on beautiful!y. and for r-his reason alone, midwives may want to order this back issue from the ia Leche Leacrue Leader. His description of the actitivities of companies &o market artlfiziai baby milk is also excellent. Midwives o;tcn encounter mothers who supplement their milk with cirtliicial baoy miii;, we live in a culhm
ttmt s~!pports +mru~a
in d bofflc as the rmnn for
infant feeding. It is likely *at midwives naturally are more supportive of breastfeedi?:; as the norm than are obstetricians. simply because of Ihclr oneclation toward noriinrerventim.
research; if complete copies of the artic!es are required, La Leche League has a breastfeeding database and will copy articles for a fee. REFERENCE 1. Tumb~uflD, Holmes, A ct di. Randomized. controlled trial of effiracy of midwife mmaged care. Lmcet 1996:348:213-8
Rz-tiers to completion of a nose-midwifery education program. Carr KC. Fullerton ST, Severino R, McHugh MK. J Distance Educ 1996:11(1);111-131. Reviewed by: May C. Brucker, CIM, DNSZ,Director of Parkland School of Nurse-Midwifery. Dallas, Texas. Synopsis Education, like nrost of healthcare, is looking for varfcus innovative techniques to help educators meet their go& Distance education, although not new to many other disciplines, is of relatively recent virttage in midwiiey. The largest of the currert distance educction midwifey endeavors is the Community-Based NurseMidwifey Education Program (CNEP), which was bun&d less than a decsde ago. As befits a distance leat: r.ng program, students have selfdirected modular leamir y i ctivities with teiecommunications support and supe vi& clinical pmctice i-::pc ienres, usually near their hone communities. Although they do attend several intensive ~.n campus experiences. they d+ not relocate for this P-year program. Within the first 6 years of operation, several hundred nurses graduated from ‘Ire program within 14 discrete classes, while 59 indivlluals withdrew, failed, or were requested to leave the program. The purpose of the study was to focus on irdividuals who did not complete the educational progran to identify barriers to completion that could be rerned ed or ameliorated in the future. Using the CNEP compr shensive Stlrdent Management System (SMS) ro provide information about not only the but also about qraduates, a random 5!3 “drop-outs.” samp!e of 6S individuals was chosen for coniroi by simply choosing ever9 third name. Those 6s sod all 59 ot what was termed “drop-outs” were contacted with a questionnaire. Ultimately, 25 drop.outs responded to the questionnaire, and 52 control suhjccts participated. A large number of fa:.tors were considered as possible differences b&veer, the groups. Basic demographic informo!ion was not iound to be very discriminating. However, it was found that members of the drop-out group tended to haxre much younger nr much older chiidren ihdn the average control participant. DroP.outs &so appeared to be more likolv to work more hours than the control subjects and almost twice as iikely to report serious Enanciai coincerns, both personally and among extended fa.miiy nzxbers.
The most potent predictors r:f success appeared to 1~ dcilrlpmi(. l:~ihi;s, By lisinq a logistic reqessioi: ,l~&l hr prcdirtinq the o#&ls of dropping out (P .i. .OOl), three factors emerged. All of these taclo:-s described academic ha its. Those students who described themselves a? approaching teaming cornpulsively or vigorously were found to account for almost 81% of the control group, yet this was only 20% of the drop-out group. Secondly. the vxt majority of the drop-o-t group (80%) set aside 20 hours i;r less fat study ea:::~ week. whereas, 82.7% of the successful control group reported setting aside 21 ur more hours weekly. The third factor was the pressnce or ahse~e of a student colleague with whom tile individual could study by telephone. telecommunications, or in some cases, in person. Only 16% of the drop-outs had such a colleague, colloquially called a “study buddy.” whereas 76.9% of the control subjects did. In fact, almost 53.8% (28 iildividuals) of ihose who were successful reported daily or weekly c~ncac1 ties, whcraas only 16% (4 individuals) reported weekly contact, and no one reported daily. The presence of a study buddy had the greaiest affec! on predicted probability of dropping out All other factors being constant, the odds of dropping out wele nine times greater for a ztudent who had no coliegial partner compared to the student who did. Several different calcularions were made regarding the logistic reyression model used to predict the probability of dropping out. For example, the model was reported to have positive predictive v&tie (probability that someone expected to drop out actually does) of .76 and negative predictive value (prohsbihty thar someone expected co complete the program actually does) of .94. Other findings of note tieat differed between the tiw groups inclilded the prepx&r;xe ;f fcr!tics by t?e drgpoui, :!.‘a’ their were not part of the school communiry, ihat their interactions v&i in&‘, :‘limre icw than adequate and less than satisfactory. Both grcjirps shared PI-&~ dissatisfaction with the amount of time requrred to ob!ain feedback from facuiry as waii as teelinys thar the program had a negative affect on their personal, work, and fami!y lives. Family, work, and iinsncial rccponsibilities all were noted by both $zups tw !~ac.~ l~reser@d major baniers in their course of stud:;. The shxiy concluded with a list of 13 specific recomnendations tc prevent dropouts frcx n distance sducatio.~ programs.
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the relatively small number (N = 25) who ultimately participated. However. this article presents much intorr,lation of no,e for the profession of midwifery, in genar;;l, al:d edxatnrs specifically, and the findings SEII?‘I logical and cczgruent with general observations made by educators throughout the years. Often, midwives in both education and practice are approached by indtviduals who are contemplating whethe to apply io a rnidwifey program. Most midwives are pessionate abvat the profession and share their elithusiasm by encouraging others to join them. However, unlike some other :&uate programs, wherein students successtu& juggle f&time employment with academics, this study fcand data that confjrmed what mosl CNM; have alway:; known: midwifey education is an intensive course of study that is difficult to complete witholrt financial, psychological. and family support. good academic habits, and commitment. Individuals interested in rnidwifey would be weli advised to critically assess their current status. For soni.?, waiting a year or two until children are older, stings more ostab lished, and famiiy patterns more secure could make the difference and, at the very least, should be considered. Moreover, individ& msy also benefit from self-analysis of their study habits and perhaps even some local courses on increasing academic skills, regardless of whc?her the midw
ttmt s~!pports +mru~a
in d bofflc as the rmnn for
infant feeding. It is likely *at midwives naturally are more supportive of breastfeedi?:; as the norm than are obstetricians. simply because of Ihclr oneclation toward noriinrerventim.
research; if complete copies of the artic!es are required, La Leche League has a breastfeeding database and will copy articles for a fee. REFERENCE 1. Tumb~uflD, Holmes, A ct di. Randomized. controlled trial of effiracy of midwife mmaged care. Lmcet 1996:348:213-8
Rz-tiers to completion of a nose-midwifery education program. Carr KC. Fullerton ST, Severino R, McHugh MK. J Distance Educ 1996:11(1);111-131. Reviewed by: May C. Brucker, CIM, DNSZ,Director of Parkland School of Nurse-Midwifery. Dallas, Texas. Synopsis Education, like nrost of healthcare, is looking for varfcus innovative techniques to help educators meet their go& Distance education, although not new to many other disciplines, is of relatively recent virttage in midwiiey. The largest of the currert distance educction midwifey endeavors is the Community-Based NurseMidwifey Education Program (CNEP), which was bun&d less than a decsde ago. As befits a distance leat: r.ng program, students have selfdirected modular leamir y i ctivities with teiecommunications support and supe vi& clinical pmctice i-::pc ienres, usually near their hone communities. Although they do attend several intensive ~.n campus experiences. they d+ not relocate for this P-year program. Within the first 6 years of operation, several hundred nurses graduated from ‘Ire program within 14 discrete classes, while 59 indivlluals withdrew, failed, or were requested to leave the program. The purpose of the study was to focus on irdividuals who did not complete the educational progran to identify barriers to completion that could be rerned ed or ameliorated in the future. Using the CNEP compr shensive Stlrdent Management System (SMS) ro provide information about not only the but also about qraduates, a random 5!3 “drop-outs.” samp!e of 6S individuals was chosen for coniroi by simply choosing ever9 third name. Those 6s sod all 59 ot what was termed “drop-outs” were contacted with a questionnaire. Ultimately, 25 drop.outs responded to the questionnaire, and 52 control suhjccts participated. A large number of fa:.tors were considered as possible differences b&veer, the groups. Basic demographic informo!ion was not iound to be very discriminating. However, it was found that members of the drop-out group tended to haxre much younger nr much older chiidren ihdn the average control participant. DroP.outs &so appeared to be more likolv to work more hours than the control subjects and almost twice as iikely to report serious Enanciai coincerns, both personally and among extended fa.miiy nzxbers.
The most potent predictors r:f success appeared to 1~ dcilrlpmi(. l:~ihi;s, By lisinq a logistic reqessioi: ,l~&l hr prcdirtinq the o#&ls of dropping out (P .i. .OOl), three factors emerged. All of these taclo:-s described academic ha its. Those students who described themselves a? approaching teaming cornpulsively or vigorously were found to account for almost 81% of the control group, yet this was only 20% of the drop-out group. Secondly. the vxt majority of the drop-o-t group (80%) set aside 20 hours i;r less fat study ea:::~ week. whereas, 82.7% of the successful control group reported setting aside 21 ur more hours weekly. The third factor was the pressnce or ahse~e of a student colleague with whom tile individual could study by telephone. telecommunications, or in some cases, in person. Only 16% of the drop-outs had such a colleague, colloquially called a “study buddy.” whereas 76.9% of the control subjects did. In fact, almost 53.8% (28 iildividuals) of ihose who were successful reported daily or weekly c~ncac1 ties, whcraas only 16% (4 individuals) reported weekly contact, and no one reported daily. The presence of a study buddy had the greaiest affec! on predicted probability of dropping out All other factors being constant, the odds of dropping out wele nine times greater for a ztudent who had no coliegial partner compared to the student who did. Several different calcularions were made regarding the logistic reyression model used to predict the probability of dropping out. For example, the model was reported to have positive predictive v&tie (probability that someone expected to drop out actually does) of .76 and negative predictive value (prohsbihty thar someone expected co complete the program actually does) of .94. Other findings of note tieat differed between the tiw groups inclilded the prepx&r;xe ;f fcr!tics by t?e drgpoui, :!.‘a’ their were not part of the school communiry, ihat their interactions v&i in&‘, :‘limre icw than adequate and less than satisfactory. Both grcjirps shared PI-&~ dissatisfaction with the amount of time requrred to ob!ain feedback from facuiry as waii as teelinys thar the program had a negative affect on their personal, work, and fami!y lives. Family, work, and iinsncial rccponsibilities all were noted by both $zups tw !~ac.~ l~reser@d major baniers in their course of stud:;. The shxiy concluded with a list of 13 specific recomnendations tc prevent dropouts frcx n distance sducatio.~ programs.
--
I_-.._
the relatively small number (N = 25) who ultimately participated. However. this article presents much intorr,lation of no,e for the profession of midwifery, in genar;;l, al:d edxatnrs specifically, and the findings SEII?‘I logical and cczgruent with general observations made by educators throughout the years. Often, midwives in both education and practice are approached by indtviduals who are contemplating whethe to apply io a rnidwifey program. Most midwives are pessionate abvat the profession and share their elithusiasm by encouraging others to join them. However, unlike some other :&uate programs, wherein students successtu& juggle f&time employment with academics, this study fcand data that confjrmed what mosl CNM; have alway:; known: midwifey education is an intensive course of study that is difficult to complete witholrt financial, psychological. and family support. good academic habits, and commitment. Individuals interested in rnidwifey would be weli advised to critically assess their current status. For soni.?, waiting a year or two until children are older, stings more ostab lished, and famiiy patterns more secure could make the difference and, at the very least, should be considered. Moreover, individ& msy also benefit from self-analysis of their study habits and perhaps even some local courses on increasing academic skills, regardless of whc?her the midw