Abstract
Purpose
The study explored and analyzed the influential factors in the promotion or inhibition of Nurse-Midwives' practice of alternative labor and delivery position (ALP).
Methods
The study used a cross-sectional descriptive design. The participants were midwives practicing care from first to third stage of labor in the last year. Instruments were: ALP Scale and the 2003 Japanese Institute for Labour Policy, Human Resource Management Checklist for job satisfaction. Comparisons were made between midwives practicing ALP (practicing midwives) and midwives not-practicing ALP (not-practicing midwives). The influential factors were analyzed by structural equation modeling.
The Ethics Review Committee of University and Hospitals approved the study.
Results
A response rate of 71.6% yielded valid 387 midwifery responses of which 124 (32.0%) were practicing and 263 (68.0%) were not practicing midwives. Although the majority (81.1%) was positive about ALP, the majority (60.3%) also practiced the recumbent maternal position in labor, so there was a difference between midwives' awareness and actual practice. In "innovation" by Rogers (2003), "Innovator" and "Early adopter" were consisted of Innovative group, "Early majority" "Late majority" "Laggards" were consisted of Conservative group. Innovative group was significantly higher the rate of practicing midwives, belonged homogeneous maternity ward, caring almost normal or low risk labor women. The analysis of influential factors by structural equation modeling indicated that, "dislike for innovation" and "confusion about ALP midwifery skills" negatively influenced practicing ALP. "Innovation" positively influenced practicing ALP. "Homogenous maternity wards" also positively influenced practicing ALP more than mixed wards.
Conclusion
Promoting factors of ALP were midwives' "innovation" and "homogeneous maternity ward". Inhibiting factors of ALP were "dislike for innovation" and "confusion about ALP midwifery skills".
