Promoting normal birthing: developing a midwifery focused scope of practice

S40 during the process of building a safe and effective maternity services system for the women and families of NSW. doi:10.1016/j.wombi.2011.07.128 Promoting normal birthing: developing a midwifery focused scope of practice Gina Kruger Victoria University, Victoria, Australia Midwives’ scope of practice has become an issue of significance and debate today. This relates to changes in Australian maternity service delivery and the evolving role of midwifery care. This presentation focuses on a doctoral research study that addressed how Australian midwives’ exercise their scope of practice when caring for birthing women in a hospital maternity unit. The research aims were to discover the processes midwives use when exercising their scope of practice during women’s normal birthing, and to identify and explore factors influencing how they develop their scope of practice. Grounded theory approach was used. Study methods included participant observation and the use of in-depth interviews. Seventeen midwives participated. The theoretical framework arising from the data, resulted in the core category: ‘Promoting normal birthing: Endeavouring to develop a midwifery focused scope of practice’. The framework encompasses a number of strategies through which midwives deal with tension between ambiguity of autonomy and fulfilling their practice boundaries and a desire to provide individualised care for women. Knowledge of this study is significant to midwifery practice as it identifies and explores the issues that challenge midwives currently. Such challenges relate to competition between the new midwifery paradigm and traditional medical models of care. These constraints influence the degree to which midwives can accommodate women’s individual expectations and needs and participation in care, and develop their practice to promote normal birthing. doi:10.1016/j.wombi.2011.07.129 Beyond the horizon—–clinical supervision—–a journey through reflection Bev Love Tweed Hospital, NSW, Australia Intention of journey (Aim): • To encourage midwives to access Clinical Supervision (CS). • To increase awareness of benefits to oneself, the client and the system. • To give travellers (midwives) time to reflective on their journey. • To inform midwives that a precedent exists in policy that CS is available. The journey begins (Originality): • CS started in UK in response to a coroner’s report. • Well utilised in allied health, mental health, CFH and Justice Health.

Posters • Midwives (and the system) aren’t good at making time for ourselves. • I am one of 100 trainees beginning the journey to implement this innovation. Journey of innovation (Description): • Forums recognised (CS) had potential to retain midwifery work force’s energy. • CS Training for NSW ‘rural midwives’ was funded by 2007 election promise. • 100 rural midwives trained in Clinical Supervision. • AHSs are to ensure that staff receive regular clinical supervision. (May 2010 NSW Maternal & Child Health Primary Health Care Policy Directive). • Local management Support for CS has encouraged innovative CS support to ‘caseload’ groups and core staff. Appraisal by travellers (Evaluation): • Participant feedback indicates they feel listened to and heard and able to return to work with new perspective and energy. • Informal verbal feedback. • Formal survey of supervisees. Other routes (Applied elsewhere): • The Role Development Model of CS is transferable to other professions as the skill is in assisting reflective practice. • Innovative ways of making CS available in a sustainable way is a work in progress. Taking hold of the future (Implications): • By implementing CS managers fulfil their responsibilities to Policy Directive and have staff that are energised to practice in bold new ways. • Clinicians and Students are supported in their reflective journey in professional development; they have a safe haven on their path. • Clients benefit from motivated and supported midwives. • Fellow Conference Travellers (relevance to audience) are urged to demand this innovative opportunity for self growth and reflection from their managers. • Managers are urged to demonstrate support for their staff by implementing this strategy. doi:10.1016/j.wombi.2011.07.130 Maternal mortality in Cambodia, Thailand, Malaysia and Sri Lanka: a systematic review of local and national policy and practice initiatives Alexa McArthur Joanna Briggs Institute, University of Adelaide, SA, Australia The Millennium Development Goal for maternal health (MDG-5) highlights the imperative in reducing maternal mortality by three-quarters by the year 2015. As midwives, do we have a part to play in this very ambitious target? What