Please use this identifier to cite or link to this item:
Appears in Collections:Faculty of Health Sciences and Sport Journal Articles
Peer Review Status: Refereed
Title: Midwives' competence: is it affected by working in a rural location?
Author(s): Hundley, Vanora
Tucker, Janet
van, Teijlingen Edwin
Kiger, Alice
Ireland, Jillian M
Harris, Fiona Margaret
Farmer, Jane
Caldow, Jan
Bryers, Helen
Contact Email:
Keywords: clinical competence
rural health services
questionnaire survey
Issue Date: Aug-2007
Citation: Hundley V, Tucker J, van Teijlingen E, Kiger A, Ireland JM, Harris FM, Farmer J, Caldow J & Bryers H (2007) Midwives' competence: is it affected by working in a rural location?, Rural and Remote Health, 7 (3), p. 764.
Abstract: Introduction – Rising health care costs and the need to consolidate expertise in tertiary services have led to the centralisation of services. In the UK the result has been that many rural maternity units have become midwife-led. A key consideration is that midwives have the skills to competently and confidently provide maternity services in rural areas, which may be geographically isolated and where the midwife may only see a small number of pregnant women each year. Our objective was to compare the views of midwives in rural and urban settings regarding their competence and confidence with respect to ‘competencies’ identified as being those which all professionals should have in order to provide effective and safe care for low-risk women. Method – This was a comparative questionnaire survey involving a stratified sample of remote and rural maternity units and an ad hoc comparison group of three urban maternity units in Scotland. Questionnaires were sent to 82 midwives working in remote and rural areas and 107 midwives working in urban hospitals with midwife-led units. Results – The response rate from midwives in rural settings was considerably higher (85%) than from midwives in the urban areas (60%). Although the proportion of midwives who reported that they were competent was broadly similar in the two groups, there were some significant differences regarding specific competencies. Midwives in the rural group were more likely to report competence for breech delivery (p=0.001), while more urban midwives reported competence in skills such as intravenous fluid replacement (p < 0.001) and initial and discharge examination of the newborn (p < 0.001). Both groups reported facing barriers to Continuing Professional Development, however, more of the rural group had attended an educational event within the last month (p < 0.001). Lack of time was a greater barrier for urban midwives (p=0.02), whereas distance to training was greater for rural midwives (p=0.009). Lack of motivation or interest was significantly higher in urban units (p=0.006). Conclusion – It is often assumed that midwives in rural areas, with fewer deliveries, will be less competent and confident in their practice. Our exploratory study suggests that the issue of competence is far more complex and deserves further attention.
Rights: Publisher statement: "© VA Hundley, JS Tucker, E van Teijlingen, A Kiger, JC Ireland, F Harris, J Farmer, JL Caldow, H Bryers, 2007. A licence to publish this material has been given to ARHEN".; First published in Rural and Remote Health [].

Files in This Item:
File Description SizeFormat 
Hundley 2007.pdf208.75 kBAdobe PDFView/Open

This item is protected by original copyright

Items in the Repository are protected by copyright, with all rights reserved, unless otherwise indicated.

If you believe that any material held in STORRE infringes copyright, please contact providing details and we will remove the Work from public display in STORRE and investigate your claim.