Midwives' Educational Needs in Iran: A Narrative Review.

BACKGROUND: Midwives have a major role in the improvement of health indicators in every country. In order for midwives to be able to play their role well, they must have sufficient updated knowledge. For this purpose, it is necessary to review their educational needs. The aim of the present research was to review Iranian studies that have investigated midwives' educational needs.
MATERIALS AND METHODS: In this narrative review, PubMed, Scopus, Web of Science, Google Scholar, ProQuest, Ovid, SID, and Magiran databases were searched for the full texts of Iranian studies published in Persian and English languages in the period of 2000-2018. Review, descriptive, and interventional articles consistent with the research aim were included in this study.
RESULTS: Of the 53 found articles, 23 articles that were relevant to midwives' educational needs in Iran were investigated. The findings of the studies showed that the educational needs of the midwives can be categorized into the four groups of knowledge and performance, communication skills, occupational rules/regulations, and religious rules.
CONCLUSIONS: The results showed that midwives in Iran have different educational needs. Because the midwifery practice leads to the promotion of public health, it is imperative that midwives have comprehensive knowledge and the skills necessary for providing optimal care. In order to achieve this, short-term and long-term training programs tailored to the needs of midwives are recommended. Copyright:

Introduction

One of the important recommendations of the World Health Organization (WHO) for medical groups is the identification of the needs that are relevant to their profession.[1] The needs of a profession are usually identified through need assessment. Need assessment is a method of investigating society's health problems and is the first step for upgrading the skills of personnel.[23] Moreover, the data obtained from needs assessment are utilized by efficient planners to facilitate planning and set priorities.[4]

Assessing midwives’ educational needs, and then, planning and executing educational plans based on those needs can be a positive step towards knowledge transfer and upgrading caregivers’ information. In general, promotion of the knowledge and skills of medical personnel along with optimization of healthcare services and achievement of standards corresponding to the society's needs are the goals of medical education programs.[356] In order to achieve these goals, the educational needs should be reviewed. Educational needs assessment is the process of regular data collection.[367] Since midwives play an important role in the improvement of health and enhancement of human development indicators in the society, it seems that determining and prioritizing the needs of this group and providing education for them in order to keep them up to date with the continuous scientific advances in medicine is of great importance.[89]

In a study in 2006, in Indonesia, the importance of assessment of the educational needs of midwives based on their professional duties was pointed out.[10] In recent years, the assessment of midwives’ educational needs has attracted the attention of many researchers around the world.[911] Moreover, in Iran, various studies have been performed on midwives’ general needs and this issue has been investigated from different aspects. Some of these studies have focused on midwives’ knowledge and awareness[12131415] and some others have investigated the communication skills of midwives in their interaction with pregnant women.[1617] Some researchers have focused on midwives’ knowledge of religious rules[1819] and some others have investigated midwives’ awareness of professional rules and regulations.[1618202122]

Regarding the different studies on midwives’ educational needs in Iran, each of the researches have been focused on a specific field of the needs and the studies have been performed in a special geographic region; thus, the viewpoints of a certain group of midwives have been reviewed in each study. Therefore, in order to have a comprehensive research on midwives’ educational needs in Iran and to gain a general understanding of this subject, all the available studies should be integrated into an article. Therefore, considering the importance of the issue and the lack of a review research in this regard, the researchers decided to review and summarize the studies relevant to midwives’ educational needs in Iran.

Materials and Methods

The present review of the available literatures published in Persian and English journals investigated the midwives’ educational needs in Iran. For data collection, first, library resources were reviewed. Then, by using Mesh in PubMed database, the relevant keywords for accessing the articles were selected. In the first stage, the keywords of need assessment, professional needs, educational needs, maternity care provider, pregnancy care provider, and midwife were searched separately in databases such as PubMed, Scopus, Web of Science, Google Scholar, ProQuest, Ovid, SID, and Magiran. Then, they were combined with “and” or “or” to make some new keywords or phrases. As a result, 53 Iranian articles that had the mentioned keywords in their title or abstract were extracted. The extracted articles included 4 articles from PubMed, 2 from Web of Science, 1 from Scopus, 3 from ProQuest, 6 from Ovid, 5 from SID, 6 from Magiran, and 26 from Google Scholar. The literature search was conducted from the 20th to the 30th of January 2019. The quality of the articles was assessed using standard checklists of qualitative and quantitative articles. The inclusion criteria of the study included full text Persian and English articles written by Iranian authors on midwives’ educational needs and published within the period of 2000 to 2018. The exclusion criteria of the study included abstracts and articles published as case report and letter to editor.

By entering the articles found in scientific databases into Endnote software, 8 articles were recognized as repetitive and omitted. Out of the 45 remaining articles, 22 articles the full text of which were not available or were inconsistent with the research aim were omitted. From among all the studied articles that were relevant to midwives’ educational needs in Iran, 23 quantitative and qualitative articles, which had the study inclusion criteria, were selected. These articles were studied several times by one author and reviewed by the other author to gain a deeper understanding. The process of selecting the articles is presented in Figure 1. Since the included studies were not homogeneous, data analysis was conducted through inclusive review of the articles, qualitative summarization, and writing a conclusion.

Figure 1

Flowchart of narrative review process

Ethical considerations

In this review study, the collected data were only used for scientific purposes and intellectual property was respected in the reporting and publication of the results. The study was approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences, Tehran, Iran, (IR.SBMU.REC.1397.106).

Results

In this study, of the 53 articles found in the primary search, 23 were relevant to midwives’ educational needs. They were conducted in different cities of Iran. Due to the importance of the topic and in order to provide practical results for planners, after investigating the issues related to midwives’ educational needs in Iranian studies, similar needs were assigned to a similar group and they were investigated in the four categories of knowledge and practice, communication skills, professional rules/regulations, and religious principles. Most articles assessed the knowledge and practice of nurses.

Educational needs related to midwives’ knowledge and practice

It is a known fact that high level of knowledge of health care providers can influence their attitudes and practice and lead to promotion of health and satisfaction of the health care recipients. The expressed educational needs were related to labor and childbirth,[23] evidence-based practice,[24] Sexually Transmitted Diseases (STDs),[25] infection control,[26] prenatal skills and care procedures for addicted pregnant women,[27] Cardiopulmonary Resuscitation (CPR), information technology, traditional medicine in midwifery, and hypertension in pregnancy,[9] medical history recording and pregnancy examinations,[5] pregnant women's oral and dental health,[12] HIV transmission prevention from mothers to children,[13] congenital cytomegalovirus infection,[14] maternal mortality prevention in natural disasters,[28] side effects of drugs and neonatal resuscitation,[29] non-medical treatments and sexual disorders during menopause,[30] female genital mutilation,[31] and pregnancy care.[32]

Educational needs related to respecting the rights of pregnant women and communication skills

Respecting the dignity of the patients is the basis of high-quality midwifery care and a step towards increasing women's satisfaction with the provided services. In order to respect the patients’ rights, health care providers should be aware of these rights, because observance of these rights can lead to patients’ physical and mental health and security and strengthen the communication between healthcare service providers and patients. Midwives’ educational needs in this regard were pregnant women's rights[22] and communication skills.[16]

Educational needs related to occupational rules and regulations

Findings of the researches represented midwives’ educational needs in the fields of Islamic punishment rules,[33] abortion rules,[34] professional rules,[21] and the process of judgment.[35]

Educational needs related to religious principles

Since midwives are more in contact with women during pregnancy and women consult with them, having the most recent information is necessary for them. Midwives’ educational needs related to religious principles in the present review were ethical and religious bases of gestational surrogacy[36] and professional Islamic rules.[1934] A summary of the results is presented in Table 1.

Table 1

Articles about midwives’ educational needs in Iran from 2000 to 2018

Number	Authors (Year)	Type of the study	Sample size	Population	Data collection tools	Results
1	Taghizadeh et al. (2018)[28]	descriptive	361	Midwife	questionnaire	Midwives’ skills and knowledge level regarding the prevention of maternal mortality in natural disasters was poor.
2	Faraji-Khiavi et al. (2018)[29]	cross-sectional	82	Midwife	questionnaire	Education of side effects of drugs and neonatal resuscitation were the main educational needs of midwives.
3	Malekmohammadi and Malekmohammadi (2017)[12]	descriptive-analytic	204	Midwives and gynecologists	questionnaire	There is the need to upgrade midwives’ and gynecologists’ skills and knowledge in order to achieve the best care for pregnancy period.
4	Azmoude et al. (2017)[24]	cross-sectional	98	Midwife	questionnaire	Midwives need to promote their knowledge in the field of evidence-based practice.
5	Bostani et al. (2017)[31]	descriptive study	168	Midwife	questionnaire	About one fifth of the midwives had enough knowledge on female genital mutilation.
6	Pourmarzi and Sharami (2017)[25]	cross-sectional	144	Midwife	questionnaire	Some midwives were aware of the guideline of sexually transmitted diseases.
7	Peyman et al. (2019)[35]	qualitative	14	Midwife	semi-structured interviews	Midwives did not have enough awareness of professional rules and the judgment process.
8	Mirrafiei et al. (2017)[21]	cross-sectional	115	Midwife	questionnaire	Midwives’ awareness of professional rules and regulations was low to medium.
9	Afhami et al. (2016)[34]	cross-sectional	189	Midwife	questionnaire	Awareness of most midwives on the rules of abortion was poor to medium.
10	Bahri et al. (2016)[13]	cross-sectional	133	Midwife	questionnaire	Most midwives’ educational needs were related to mother-child HIV transmission methods.
11	Masoomi et al. (2016)[22]	quasi-experimental	176	Midwife	questionnaire	Education of pregnant women’s rights was another educational need of midwives.
12	Mazaheri and Moghim (2015)[14]	cross-sectional	341	General practitioners and midwives	questionnaire	Midwives could not gain an acceptable score of awareness of congenital cytomegalovirus infection.
13	Abedian et al. (2014)[23]	cross-sectional	223	Midwife	questionnaire	The first educational need of midwives was to gain knowledge about labor and childbirth.
14	Shamaeian-Razavi et al. (2013)[36]	descriptive-analytic	175	Midwife	questionnaire	Midwives did not have enough information about the ethical, legal, and religious principles related to midwifery.
15	Sereshti et al. (2011)[9]	cross-sectional	280	Midwife	questionnaire	Midwives’ awareness in different areas was at a medium level.
16	Lotfipur et al. (2010)[5]	cross-sectional	97	Midwife	questionnaire	The educational needs of midwives were pregnancy history and examinations, risk factors for delivery, and postpartum nutrition.
17	Askarian et al. (2007)[26]	cross-sectional	273	Nurses, midwives, and students	questionnaire	Most of the midwives needed specific education on infection control.
18	Taghizadeh et al. (2007)[16]	correlational	50	Midwife	questionnaire	Midwives’ verbal and non-verbal communication skills were at a low level.
19	Tork-Zahrani et al. (2007)[30]	descriptive	97	Midwife	questionnaire	Most of the midwives’ educational needs were non-medical treatments and sexual disorders during menopause.
20	Banaian and Sereshti (2007)[19]	descriptive	151	Midwife	questionnaire	Midwives’ awareness of professional rules and regulations was low.
21	Hajifoghaha and Keshavarz (2008)[33]	cross-sectional	177	Midwife	questionnaire	Midwives’ awareness of Islamic professional punishment rules was low.
22	Mojahed et al. (2005)[27]	cross-sectional	100	Midwife	questionnaire	Midwives needed education regarding skills such as caring for addicted pregnant women, breech and twin pregnancies.
23	Khalili (2002)[32]	semi-experimental	34	Health centers’ staff in prenatal care units	questionnaire	The educational needs of prenatal care providers were significant.

Discussion

This review study was conducted to obtain and investigate the studies performed on the educational needs of midwives in Iran. The findings have shown that midwives have various educational needs.

One of their educational needs is related to their knowledge and performance. This need has been evaluated and approved in some studies.[2927] The findings of these studies were consistent with two other studies that reported midwives require training in order to provide better prenatal care and delivery.[532] In an Iranian study, midwives’ knowledge of the methods of mother-child Human Immunodeficiency Virus (HIV) transmission was investigated. This finding was consistent with the suggestions of the Royal College of Obstetricians and Gynaecologists (RCOG) which stated that since midwives play a key role in prenatal care, they should have enough knowledge about mother to child Acquired Immunodeficiency Syndrome (AIDS) transmission to be able to provide more effective care.[13] Similarly, midwife's knowledge about prevention of AIDS transmission during pregnancy was investigated in Nigeria.[37] Since women refer to gynecologists and midwives to receive prenatal care, improving the knowledge of care providers about oral and dental health was necessary to achieve better results in pregnancy and prevent undesirable side effects.[27] The review of the literature revealed that in addition to the Iranian studies, some of the studies performed in other countries also evaluated the knowledge of prenatal care providers on ultrasound in midwifery,[38] genetic screening in pregnancy,[39] immunization in pregnancy,[40] and nutrition in pregnancy.[41] The above-mentioned studies concluded that because midwives provide health care services to patients, they should constantly try to learn new diagnostic, therapeutic, and care methods. In addition, midwives have an important training role; they must have the necessary scientific knowledge and skills for teaching people. The other educational need of midwives is communication skills and respecting the rights of pregnant women. In all the stages of midwifery care, the quality of communication is the main determinant of effective communication and satisfaction of the patient with the care provider.[16] Researchers who have investigated the communication between pregnant women and midwives have mentioned this communication as the right of pregnant women and considered the observance of this right necessary. They have reported that midwives’ communication skills were poor and stated that they should be familiarized with communication skills and the rights of pregnant women from the beginning of their university education and try to observe them.[42] Although pregnant women may have no information about all their rights, performance of the treatment team in execution of the protocols, treatment interventions, and care should be consistent with ethical principles and standards.[43] These studies concluded that, in general, providing optimal health services is possible when midwives have learned the skills necessary for communicating with community members and continue to learn and improve them.

The results of the studies suggest that the promotion of knowledge of health providers regarding professional rules and regulations is necessary and it can play a significant role in decreasing medical professional errors and protecting women's health.[2144] Thus, midwives should be aware of the professional rules, because of their critical responsibility to any individual in the community. In addition, they must have sufficient information about the possible consequences of not obeying the rules. Some of the researchers claimed that midwives have little awareness of professional religious rules and regulations. Furthermore, regarding the religious culture of the Iranian people, education of ethical and religious matters related to medical sciences to maternity care providers is one of the main factors mentioned as promoting fertility status.[45] Since midwives have a close relationship with women in society, it seems necessary for them to know the religious issues of midwifery in order to respect the religious beliefs of the people and teach them to pregnant women when necessary.

It can also be noted that the results of these studies showed that the researchers focused on reviewing midwifes’ educational needs, because through strengthening the abilities and meeting the needs of maternal care providers, the spiritual and material needs of pregnant women can be met. Researchers believed that the serving and control of midwifery care should be assigned to care providers who have inclusive capabilities.[46]

In their viewpoint, acquisition of these capabilities is subject to holding regular in-service retraining courses, and revising university courses and improving the education quality in all the educational levels in the universities.[34] Nevertheless, promotion of the knowledge of pregnancy care providers requires the special attention of the authorities and planners of every country.[47]

The authors hope that the results of this research help policy makers and planners recognize midwives’ needs and adopt strategies to meet these needs and promote the quality of their services.

Lack of access to libraries and theses relevant to the research topic in universities all over the country and impossibility of reviewing their information are the limitations of this research.

Conclusion

This literature review showed that midwives have different educational needs. Because midwives play a key role in the provision of community health, it is imperative that they have comprehensive knowledge and the skills necessary for providing optimal care. Therefore, in order to achieve this, short-term and long-term training programs tailored to the needs of midwives are recommended. Moreover, meeting the educational needs of midwifery students is emphasized.

Financial support and sponsorship

Shahid Beheshti University of Medical Sciences, Tehran, Iran

Conflicts of interest

Nothing to declare.