Journal of Korean Academy of Nursing

Opening Status of the Korea Midwifery Birthing Centers and Development of Midwifery Practice Guideline: Song, Ji Young , Park, Young-Joo; J Korean Acad Nurs 2020;50(4):583-598. Published online August 31, 2020; DOI: https://doi.org/10.4040/jkan.20032

Abstract PDF: Purpose
This study was to investigate the operational status of the midwifery birthing centers (MBCs) and midwives’ job status (Phase 1) and to develop midwifery practice guidelines (MPG) (Phase 2) in Korea.
Methods
In the first phase, the subjects were 15 midwives who operated 11 of 14 MBCs that were opened as of August 2018. The questionnaire consisted of items to measure the operational status of the MBC and midwives’ job status. In the second phase, the MPG was developed from literature review, interviews with five midwives opening their MBCs, surveys with 74 midwives, and a validity evaluation conducted by seven experts.
Results
The distribution of operating MBCs was five in Gyunggi-do, two each in Seoul and Incheon, one each in Busan, Chungcheongbuk-do, Gyeongsangbuk-do, Gyeongsangnam-do and Jeju-do. The mean age of midwives was 54.3 and all were female. In 2017, a total of 762 births including 81 homebirths were performed by midwives. The job performance was highest in the order of neonatal care 3.81, childbirth care 3.56, and postpartal care 3.53, respectively. The MPG included seven areas of prenatal care, childbirth care, postpartal care, neonatal care, primary health care, law/ ethics, and administration, with 56 tasks and 166 task elements.
Conclusion
This study provides the valid basic data for the operational status of the MBC and the midwives’ job status. The MPG describes the midwife’s job and may be used as basic data for preparing policies for the development of midwifery practice in Korea.

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Improving the Standards of Midwifery Education and Practice and Extending the Role of a Midwife in Korean Women and Children's Health Care: Kyung Hye Lee; Journal of Korean Academy of Nursing 2003;33(8):1111-1118. Published online March 28, 2017; DOI: https://doi.org/10.4040/jkan.2003.33.8.1111

Abstract PDF: Background
A midwife is a medical professional who has a nursing license, and is also licensed as a midwife with one additional year of education. In this globalization era, a midwife's role is increasing in importance for women and children's health care worldwide.
Purpose
The primary purpose was to analyze midwifery education programs in Korea and other nations. The secondary purpose was to define strategies to improve midwifery education and practice, and to extend the role of a midwife women and children's health care in Korea.
Methods & Results
1) The definition of a midwife and midwifery practice recognized internationally by World Health Organization (WHO) and International Council of Nurse Midwives (ICNM) was identified. 2) Midwifery education programs of Korea, U.S.A., Sweden, Australia, and Japan, were investigated and discussed. 3) Core competencies for the basic midwifery practice suggested by ACNM of the U.S.A. were reviewed as standard of midwifery practice. 4) As for the midwifery education system, a Masters degree program in a college of nursing is suggested. 5) The role of a midwife includes not only health care of childbirth women and newborn babies, but also a lifelong health care of women as well as her family and children.
Conclusion
An effort to extend the midwife's role and to improve service is imperative. The Laws/Acts related to midwives should be revised in regard to education, and practices, and the national examination for midwifery licensure needs revision to qualify for international approval. Also, midwifery curriculum and standards of practice need to be evaluated periodically, and an effective system needs to be established to renew midwife licenses.

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Methods and Applications to estimate the Conversion Factor of Resource-based Relative Value Scale for Nurse-Midwife's Delivery Service in the National Health Insurance: Jinhyun Kim, Yoomi Jung; J Korean Acad Nurs 2009;39(4):574-583. Published online August 31, 2009; DOI: https://doi.org/10.4040/jkan.2009.39.4.574

Abstract PDF: Purpose
This paper analyzed alternative methods of calculating the conversion factor for nurse-midwife's delivery services in the national health insurance and estimated the optimal reimbursement level for the services.
Methods
A cost accounting model and Sustainable Growth Rate (SGR) model were developed to estimate the conversion factor of Resource-Based Relative Value Scale (RBRVS) for nurse-midwife's services, depending on the scope of revenue considered in financial analysis. The data and sources from the government and the financial statements from nurse-midwife clinics were used in analysis.
Results
The cost accounting model and SGR model showed a 17.6-37.9% increase and 19.0-23.6% increase, respectively, in nurse-midwife fee for delivery services in the national health insurance. The SGR model measured an overall trend of medical expenditures rather than an individual financial status of nurse-midwife clinics, and the cost analysis properly estimated the level of reimbursement for nurse-midwife's services.
Conclusion
Normal vaginal delivery in nurse-midwife clinics is considered cost-effective in terms of insurance financing. Upon a declining share of health expenditures on midwife clinics, designing a reimbursement strategy for midwife's services could be an opportunity as well as a challenge when it comes to efficient resource allocation.

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