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Full-Text Articles in Nursing Midwifery

Internet Use And Decision-Making Processes Among Pregnant Women: A Cross-Sectional Study, Ayça Balmumcu, Endam Çetinkaya Ak, Sabriye Uçan Yamaç Aug 2026

Internet Use And Decision-Making Processes Among Pregnant Women: A Cross-Sectional Study, Ayça Balmumcu, Endam Çetinkaya Ak, Sabriye Uçan Yamaç

Makara Journal of Health Research

Background: The coronavirus disease 2019 (COVID-19) pandemic restricted access to in-person health services, especially in rural areas. This increased reliance on the internet for health information and decision-making was particularly notable among pregnant women. This study aimed to investigate the role of internet use in decision-making among pregnant women.

Methods: This analytical, cross-sectional study examined 384 pregnant women living in a rural district of Turkey who attended family health centers for prenatal care. Data were collected using the Internet Decision-Making Scale in Pregnancy and a questionnaire assessing internet use patterns during the pandemic.

Results: Pregnant women demonstrated …


Poor Compliance With Private Nursing And Midwifery Practice Guidelines In Urban Settings In Uganda, Dan Muramuzi, Edson Atwine, Barbara Okiror, Mercy Muwema, Christine Nimwesiga, Laban Muteebwa May 2026

Poor Compliance With Private Nursing And Midwifery Practice Guidelines In Urban Settings In Uganda, Dan Muramuzi, Edson Atwine, Barbara Okiror, Mercy Muwema, Christine Nimwesiga, Laban Muteebwa

School of Nursing & Midwifery, East Africa

Background: Optimal compliance with private practice guidelines is one of the core components of quality improvement in nursing and midwifery professions. Private nursing and midwifery practice guidelines in Uganda were introduced in 2019. However, little has been documented about compliance with these guidelines, despite playing a crucial role in ensuring safe nursing and midwifery practice and maintenance of professional standards.  We assessed the compliance with private nursing and midwifery practice guidelines of Uganda (2019) and explored barriers to optimal compliance with these guidelines in private health facilities licensed by the Uganda Nursing and Midwifery Council (UNMC) in Kampala Metropolitan …


Breastfeeding Promotion For Infants With Neonatal Abstinence Syndrome (Nas), Olivia Czerwonka May 2026

Breastfeeding Promotion For Infants With Neonatal Abstinence Syndrome (Nas), Olivia Czerwonka

Evidence-Based Practice Project Reports

Neonatal abstinence syndrome (NAS) is the exposure in utero to drugs with the incidence in the United States increasing from 4 to 6.3 per 1000 births (Wei et al., 2023). The purpose of this quality improvement project was to implement a breastfeeding support intervention to increase breastfeeding frequency and reduce hospital length of stay of newborns with NAS. A tailored multicomponent guideline based upon the current Ten Steps to Successful Breastfeeding as established by WHO and UNICEF (2017) was implemented. Mothers of infants diagnosed with NAS were recruited using convenience sampling from a Northwest Indiana Hospital. Key stakeholders within the …


Standardizing Care: Strengthening Dka Protocol Implementation Among Emergency Department Nurses, Toni Joy Angelique Biliran Miculob Dec 2025

Standardizing Care: Strengthening Dka Protocol Implementation Among Emergency Department Nurses, Toni Joy Angelique Biliran Miculob

Master's Projects and Capstones

Objective: The objective of this project was to address the inconsistent understanding and utilization of the Diabetic Ketoacidosis (DKA) protocol in a high-acuity emergency department within a large hospital system, where baseline survey results showed that 84% of nurses found the DKA order set confusing and only 15% felt “very comfortable” applying it.

Aim: The aim was to improve nurse clarity, confidence, and consistency in using the DKA protocol to support timely, evidence-based management of this high-risk, time-sensitive condition.

Methods: The intervention consisted of brief, targeted education delivered during pre-shift huddles across day and night shifts, focusing …


Editorial – Dec 2025, Edwin Van Teijlingen, Rafat Jan Dec 2025

Editorial – Dec 2025, Edwin Van Teijlingen, Rafat Jan

Journal of Asian Midwives (JAM)

No abstract provided.


Nurses’ And Midwives’ Job Satisfaction And Retention During Covid-19: A Scoping Review, Laura Hynes, Sadie Geraghty, Sheena Mcchlery, Aisling Smyth, Reeti Brar, Karen Clark-Burg Dec 2025

Nurses’ And Midwives’ Job Satisfaction And Retention During Covid-19: A Scoping Review, Laura Hynes, Sadie Geraghty, Sheena Mcchlery, Aisling Smyth, Reeti Brar, Karen Clark-Burg

Research outputs 2022 to 2026

Background: The COVID-19 pandemic focused attention on the previously well-documented world-wide shortage of nurses and midwives. The pandemic accentuated this crisis, which resulted in nurses and midwives questioning their roles and their careers. The impact of the pandemic on job satisfaction and the intention of nurses and midwives to stay has not been adequately explored. Aim: The aim of this scoping review was to identify and map the literature that describes the intrinsic and extrinsic factors that influenced nurses’ and midwives’ job satisfaction and intent to stay or leave their employment or profession during the COVID-19 pandemic. Method: This scoping …


Measuring The Impact Of The Australian National Placement Evaluation Centre To Enhance Nursing And Midwifery Student Clinical Placements: A Multimodal Evaluation, Colleen Ryan, Robyn Cant, Areum Hyun, Debbie Procter, Louise Alexander, Dianne Bloxsome, Lynda Hughes, Fiona Bogossian, Simon Cooper Aug 2025

Measuring The Impact Of The Australian National Placement Evaluation Centre To Enhance Nursing And Midwifery Student Clinical Placements: A Multimodal Evaluation, Colleen Ryan, Robyn Cant, Areum Hyun, Debbie Procter, Louise Alexander, Dianne Bloxsome, Lynda Hughes, Fiona Bogossian, Simon Cooper

Research outputs 2022 to 2026

Aim: To evaluate the early impact of the Centre. Background: The educational quality of nursing and midwifery student clinical placement learning varies. The National Placement Evaluation Centre has a pivotal role in quality improvement by systematically collecting student and supervisor feedback on placement experiences. Design: Multimodal impact evaluation. Methods: Data were collected from website analytics and a survey shared via stakeholder registration emails and social media. The Impact Management Planning and Evaluation Ladder model was used to understand impact. Data were analysed using a sequential, hybrid inductive/deductive approach. Descriptive statistics summarised participant characteristics and qualitative data were themed. Results: Website …


A Jewel In The Crown Is Better Than Money In The Pocket": Historical Data On The Role Of Midwives In Caring For Families In Southern Appalachia, Kristen Montgomery Apr 2025

A Jewel In The Crown Is Better Than Money In The Pocket": Historical Data On The Role Of Midwives In Caring For Families In Southern Appalachia, Kristen Montgomery

Epsilon Sigma at-Large Research Conference

Background: Midwives have provided care to women since the beginning of time. Early midwives had little training but learned their craft from experienced women. Later, formal training became available. Midwives have a rich history in Appalachia.

Purpose: to explore the rich history of all types of midwives in Appalachia.

Methods: Materials from the Archives of Appalachia were reviewed. Both written and oral materials were evaluated. This included a review of the document, identification of themes, and then comparing those themes with previously identified themes. Documents were reviewed in a random order by two researchers who met to discuss results.

Results: …


“Time To Rebuild The Healthcare Workforce”: Addressing Socio-Cultural And Psychological Perspectives Of Men’S Presence In Nursing And Midwifery, Sarmad Muhammad Soomar, Salima Farooq, Sarosh Tahar Khymani, Nargis Asad Dec 2024

“Time To Rebuild The Healthcare Workforce”: Addressing Socio-Cultural And Psychological Perspectives Of Men’S Presence In Nursing And Midwifery, Sarmad Muhammad Soomar, Salima Farooq, Sarosh Tahar Khymani, Nargis Asad

Journal of Asian Midwives (JAM)

Background: There is a global scarcity of healthcare workers, particularly nurses and midwives, who make up more than half of the current workforce associated with “care”, which is the essence of nursing and midwifery in patient and family care. This is always considered as a profession for women in most of the global workforce. In a patriarchal society, nursing and midwifery limits the choice to be adopted by men. Based on male nurses and midwives’ experiences and stories, it was aimed to explore the present literature to see the citations related to this area, which have been cited to address …


Understanding Research Capacity And Culture Of Nurses And Midwives In Two Health Services In Western Australia, Carrie Janerka, Gavin D. Leslie, Olivia Gallagher, Melissa Mellan, Marguerite Lane, Fenella J. Gill Jun 2024

Understanding Research Capacity And Culture Of Nurses And Midwives In Two Health Services In Western Australia, Carrie Janerka, Gavin D. Leslie, Olivia Gallagher, Melissa Mellan, Marguerite Lane, Fenella J. Gill

Research outputs 2022 to 2026

Background: Health services with a strong research culture report better patient outcomes and organisational performance. Measuring research capacity and culture (RCC) is important for understanding baseline research capabilities of a health service and assessing the effectiveness of capacity-building and culture-improving interventions. Aim: To describe the RCC of nurses and midwives in two health services in Western Australia. Methods: A cross-sectional survey of nurses and midwives was undertaken using a previously validated RCC tool to measure RCC in individual, professional group, and organisational domains, and identify barriers, enablers, and research activity. Staff at each health service were recruited via email during …


Beyond The Classroom Walls: Stakeholder Experiences With Remote Instruction In Post Rn Baccalaureate Nursing Program During The Covid-19 Pandemic: A Qualitative Inquiry, Laila Akber Cassum, Arusa Mansoor, Saima Sachwani, Zeenar Salim, Ridah Feroz, Shanaz Cassum Apr 2024

Beyond The Classroom Walls: Stakeholder Experiences With Remote Instruction In Post Rn Baccalaureate Nursing Program During The Covid-19 Pandemic: A Qualitative Inquiry, Laila Akber Cassum, Arusa Mansoor, Saima Sachwani, Zeenar Salim, Ridah Feroz, Shanaz Cassum

School of Nursing & Midwifery

The COVID-19 pandemic led to the closure of educational campuses and the suspension of conventional classroom teaching globally and locally, and many switched overnight to an online modality. The change was experienced differently by varied audiences, given the availability of resources. The study aimed to examine stakeholders' experiences of emergency remote instructions in the Post-RN Baccalaureate Nursing Program during the COVID-19 pandemic. A qualitative descriptive exploratory design with a purposive sampling technique was used at a private nursing university in Karachi, Pakistan. Focus group discussions with students and faculty were conducted separately, while in-depth interviews with key informants were held …


Pandemic Paradox: A Mixed Methods Study Unmasking The Impact Of Covid-19 On Australia's Nursing And Midwifery Workforce Job Satisfaction And Retention, Laura Lillian Hynes Jan 2024

Pandemic Paradox: A Mixed Methods Study Unmasking The Impact Of Covid-19 On Australia's Nursing And Midwifery Workforce Job Satisfaction And Retention, Laura Lillian Hynes

Theses

Background: The COVID-19 pandemic has seen an outpouring of attention focusing on the global nursing and midwifery shortage and its damaging impact on healthcare systems worldwide. However, there is limited research, both globally and in Australia, on its impact on nurses’ and midwives’ job satisfaction and their associated intentions to stay or leave their job and/or profession, as a result. The lack of extensive research in this area highlights the importance of this Doctoral thesis. My research aimed to fill this gap by conducting a detailed study of the personal experiences of nurses and midwives who worked during the pandemic …


Over 200 Dalarna University Alumni Help Advance Education And Care In Africa And Asia: A Short Communication, Kerstin Erlandsson, Marie Klingberg Allvin Dec 2023

Over 200 Dalarna University Alumni Help Advance Education And Care In Africa And Asia: A Short Communication, Kerstin Erlandsson, Marie Klingberg Allvin

Journal of Asian Midwives (JAM)

No abstract provided.


Because Breastfeeding Is Never Done Alone, Mehtab Lalwani, Kiran Nawaz Ali Dec 2023

Because Breastfeeding Is Never Done Alone, Mehtab Lalwani, Kiran Nawaz Ali

Journal of Asian Midwives (JAM)

No abstract provided.


A Step To Improve Maternal Health In Mountain Region Of Pakistan, Rafat Jan, Farzana Yameen, Marina Baig, Sadia Karimi, Kiran Mubeen, Arusa Lakhani Jul 2023

A Step To Improve Maternal Health In Mountain Region Of Pakistan, Rafat Jan, Farzana Yameen, Marina Baig, Sadia Karimi, Kiran Mubeen, Arusa Lakhani

Journal of Asian Midwives (JAM)

No abstract provided.


Remifentanil Patient Controlled Analgesia Use In Laboring Women: A Feasibility And Acceptability Study, Joshua Carr May 2022

Remifentanil Patient Controlled Analgesia Use In Laboring Women: A Feasibility And Acceptability Study, Joshua Carr

Dissertations

Background/Purpose: Interest in remifentanil patient controlled analgesia (RPCA) as a treatment for labor pain has increased due to its unique pharmacodynamics and effectiveness on pain control among parturients. Despite its promise, RPCA remains infrequently used in the US. The purpose of this study was to 1) examine the implementation and acceptability of a new RPCA protocol in the labor and delivery ward of a mid-sized hospital, and 2) identify the attitudes and beliefs of healthcare workers in a real-world clinical setting.

Theoretical/Conceptual Framework: The holistic nature of Comfort Theory can account for the proposed mechanisms contributing to the …


Moving On After Critical Incidents In Health Care: A Qualitative Study Of The Perspectives And Experiences Of Second Victims, Melanie Buhlmann, Beverley Ewens, Amineh Rashidi Apr 2022

Moving On After Critical Incidents In Health Care: A Qualitative Study Of The Perspectives And Experiences Of Second Victims, Melanie Buhlmann, Beverley Ewens, Amineh Rashidi

Research outputs 2022 to 2026

Aims: To gain a deeper understanding of nurses and midwives' experiences following involvement in a critical incident in a non-critical care area and to explore how they have 'moved-on' from the event.

Design: An interpretive descriptive design guided inductive inquiry to interpret the meaning of moving-on.

Methods: Purposive sampling recruited 10 nurses and midwives. Data collection comprised semi-structured interviews, memos and field notes. Data were concurrently collected and analysed during 2016–2017 with NVivo 11. The thematic analysis enabled a coherent analytical framework evolving emerging themes and transformation of the data into credible interpretive description findings, adhering to the COREQ reporting …


The Effects Of Exercise And Nursing Care On Postpartum Depression, Greyson Whaley Apr 2022

The Effects Of Exercise And Nursing Care On Postpartum Depression, Greyson Whaley

Epsilon Sigma at-Large Research Conference

Abstract

Introduction and Background: According to the Centers for Disease Control and Prevention (2020), “postpartum depression is depression that occurs after having a baby which is more intense and lasts longer than those of “baby blues,” a term used to describe the worry, sadness, and tiredness many women experience after having a baby.” It also states, “1 in 8 women report symptoms of depression after giving birth, about 1 in 5 (20%) women were not asked about depression during a prenatal visit, and over half (50%) of pregnant women with depression were not treated.”

Purpose Statement: The purpose of this …


Childbirth In Incarceration And Nursing Interventions, Breanna Mauk Apr 2022

Childbirth In Incarceration And Nursing Interventions, Breanna Mauk

Epsilon Sigma at-Large Research Conference

Introduction and Background

The number of incarcerated pregnant women is increasing every day. At the same time, their quality of care is decreasing. From being treated like animals by jail staff to having unqualified staff members instructing them during labor, this has to change. Not only is the safety of the woman at risk, but most importantly her unborn baby.

Purpose Statement

Incarcerated pregnant women deserve the same healthcare as anyone else. The PICO question addressed in this paper is the following. In incarcerated pregnant women, how does ineffective health maintenance compared with effective health maintenance affect poor outcomes after …


Adolescent Mothers And Kangaroo Mother Care: A Scoping Review, Genna K. Rivers, Robin B. Dail Phd, Rn, Faan, Robin Dawson Phd, Rn, Cpnp-Pc Apr 2022

Adolescent Mothers And Kangaroo Mother Care: A Scoping Review, Genna K. Rivers, Robin B. Dail Phd, Rn, Faan, Robin Dawson Phd, Rn, Cpnp-Pc

Senior Theses

Kangaroo mother care (KMC), the practice in which mothers hold their infants skin-to-skin against their bare chest, can increase bonding and attachment between mothers and their infants. However, there is not much research on the benefits of KMC within the adolescent or teen mother population (13-19 years old). The purpose of this scoping review was to identify how common KMC is within the teen mother population, determine how KMC varies based on social determinants of health and race/ethnicity within the adolescent mother population, and how KMC impacts adolescent mothers’ maternal attachment and bonding with their infants. PubMed and CINAHL databases …


Healthcare Education Leaves The Hills: Frontier Nursing University’S Move From Appalachia, Hannah Haksgaard Jan 2022

Healthcare Education Leaves The Hills: Frontier Nursing University’S Move From Appalachia, Hannah Haksgaard

Faculty Publications

Rural communities lack maternity and childbirth services, and access is getting worse. Despite the serious need for more rural-focused childbirth services, Frontier Nursing—the most famous rural-focused childbirth healthcare provider and educator—recently left the historic rural location it had called home since its inception nearly a century ago. Frontier Nursing, established in the Appalachian Mountains in 1925, initially provided nursing and midwifery care focused on the residents of Leslie County, Kentucky, and in 1939 established a school in Leslie County to train future rural nurse-midwives. Despite success over nearly 100 years deep in the remote and rural Appalachian foothills, Frontier Nursing …


Preceptorship Practice In Healthcare Institutions In Ghana: A Situational Analysis, Ivy E. Sackey Jan 2022

Preceptorship Practice In Healthcare Institutions In Ghana: A Situational Analysis, Ivy E. Sackey

Antioch University Dissertations & Theses

Preceptors play a vital role in supporting nursing/midwifery students and new employees’ transition and assimilation into their new role. Furthermore, with the increasing focus on educating more qualified nurses and midwives to meet health-related United Nations Sustainable Development Goals, there is a need for a more standardized and coordinated approach to preceptorship training. As former Head of the Nursing/Midwifery Training Institution in Ghana, I observed first-hand that the system of preceptorship needs improvements. Published literature on preceptorship has shown that the practice plays a vital role in healthcare delivery. However, most of the existing literature preceptorship is from developed countries, …


The Influence Of Gender Bias On Male Nurses And Nursing Students In The Obstetric, Maternal, And Pediatric Nursing Profession., Julian Alvarez Dec 2021

The Influence Of Gender Bias On Male Nurses And Nursing Students In The Obstetric, Maternal, And Pediatric Nursing Profession., Julian Alvarez

The Eleanor Mann School of Nursing Undergraduate Honors Theses

This literature review analyzes if gender bias influences the disproportionate number of male nurses and male nursing students in the pediatric, maternal, and obstetric nursing fields as compared to nursing as a whole. PubMed and CINAHL databases were utilized to find 15 research articles focused on the experiences of male nurses and male nursing students. These articles were compared amongst each other to find common themes of the male experience in the nursing fields of pediatrics, maternity, and obstetrics. The three common themes found were 1) Men tend to encounter situations where their professionalism will be monitored more closely when …


Telesimulation Innovation On The Teaching Of Spikes Model On Sharing Bad News, Zohra Kurji, Azaina Aijaz, Amina Aijaz Khowaja, Zohra Asif Jetha, Shanaz Hussein Cassum Sep 2021

Telesimulation Innovation On The Teaching Of Spikes Model On Sharing Bad News, Zohra Kurji, Azaina Aijaz, Amina Aijaz Khowaja, Zohra Asif Jetha, Shanaz Hussein Cassum

School of Nursing & Midwifery

Coronavirus disease 2019 (COVID-19) brought to the world, an unprecedented emergency, which dramatically affected the face-to-face teaching in higher education academia. University faculty and students had to shift overnight to an online and remote course instruction. They were neither trained nor prepared and had limited resources and infrastructure. Palliative Care and Oncology Stream Faculty at Aga Khan University, School of Nursing and Midwifery, Pakistan, piloted an innovative academic project using telesimulation (TS). Trainee nurse interns were taught communication skills and the art of breaking bad news to palliative clients using the SPIKES model through TS. To incorporate best practices for …


Tiny Tusks Internship: Barriers To Breastfeeding, Cameron Watson May 2021

Tiny Tusks Internship: Barriers To Breastfeeding, Cameron Watson

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Tiny Tusks Breastfeeding and Infant Support Internship allows students to gain insight on breastfeeding practices through volunteering at University of Arkansas sporting events. Therefore, I chose to review prevalent barriers to breastfeeding that mothers in the United States face. These mothers were at least one of these: Hispanic, Marshallese, African American, disabled, employed, a veteran, living in a rural area, or a woman of the general American population. This topic is relevant because of the many benefits that breastfeeding provides for both the baby and the mother.


Tiny Tusks Internship: The Effect Of Health Care Providers' Education And Attitudes Toward Breastfeeding On The Mother's Decision To Breastfeed, Jocelyn Clark May 2021

Tiny Tusks Internship: The Effect Of Health Care Providers' Education And Attitudes Toward Breastfeeding On The Mother's Decision To Breastfeed, Jocelyn Clark

The Eleanor Mann School of Nursing Undergraduate Honors Theses

There is a stigma surrounding breastfeeding in the public community, places of employment, and health care facilities. This paper focuses on the impact health care workers have on the mother's decision to breastfeed her infant, and her ability to continue breastfeeding as the primary source of infant nutrition. This paper includes experiences from an internship with Tiny Tusks, which provides breastfeeding support to mothers in the Northwest Arkansas area. Tiny Tusks allows for a better understanding of the community's breastfeeding needs and provides support to breastfeeding mothers in order to reduce the stigma associated with breastfeeding. In health care environments, …


Breeching The System: An Exploration Of Women’S Experiences And Breech Care Recommendations, Sara Morris Jan 2021

Breeching The System: An Exploration Of Women’S Experiences And Breech Care Recommendations, Sara Morris

Research outputs 2014 to 2021

Aim:

This presentation reports the findings of a mixed methods study exploring women’s experiences of breech birth in Western Australia (WA) and professional recommendations for breech care.

Methods:

This pragmatic study consisted of a clinical guideline review, semi-structured interviews with women who had experienced a breech birth in WA and a multi-national e-Delphi study involving professionals with knowledge and/or experience of caring for women with a breech presenting fetus. These methods were deemed the optimal way of incorporating current clinical practice guidelines, with multi-disciplinary recommendations and consumer feedback.

Findings:

The clinical guideline review revealed similarities in antenatal care structure and …


Delegation Practices Between The Registered Nurse And The Assistant In Nursing In The Acute Care Setting In Western Australia, Carol Crevacore Jan 2021

Delegation Practices Between The Registered Nurse And The Assistant In Nursing In The Acute Care Setting In Western Australia, Carol Crevacore

Theses: Doctorates and Masters

Background:

Delegation is an essential skill that allows the Registered Nurse (RN) to allocate aspects of patient care to other team members including the unregulated Assistant in Nursing (AIN). Concerns have been raised about the activities delegated to AINs in the acute care environment.

Aim:

The aim of this research was to explore the practice of delegation between the RN and the AIN in the acute care environment. This delegation practice was examined through the lens of both the RN and the AIN.

Methodology:

This study used a mixed method explanatory sequential design. The participants were RNs and AINs working …


Lowering Antibiotic Resistance Utilizing Breastmilk, Moriah J. Harris May 2020

Lowering Antibiotic Resistance Utilizing Breastmilk, Moriah J. Harris

Honors College Theses

Antibiotic resistance is considered an emerging crisis in the healthcare world. This crisis has the potential to cause many bacterial diseases that cannot be cured using antibiotic drugs, which can lead to serious infections and death. There have been numerous studies that have found that sugars, proteins and protein-lipid complexes in breastmilk have antimicrobial properties. It has been proposed that these properties in breastmilk can help solve the antibacterial resistance crisis. This research project involved studying antibiotic resistance and how breastmilk can help solve this increasingly prevalent problem.

The implementation step of this research project involved a PowerPoint presentation detailing …


Willow Creek Women's Hospital Internship, Destinee Ross Dec 2019

Willow Creek Women's Hospital Internship, Destinee Ross

The Eleanor Mann School of Nursing Undergraduate Honors Theses

While the use of midwifery is proven to improve outcomes for low-risk mothers and infants, many healthcare providers, nurses, and patients in Northwest Arkansas continue to be skeptical about utilizing midwifery care. During my internship, I worked directly with labor and delivery nurses, physicians, and a midwife at Willow Creek Women’s Hospital and provided high-quality care to women during their birthing process. This hospital focuses entirely on women and infant care and provides gynecological, obstetric, and newborn services. Willow Creek Women’s Hospital is also one of the few hospitals in Arkansas to implement a certified nurse-midwife (CNM) and has two …