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Despite ongoing insecurity, Afghanistan has demonstrated improvement in health outcomes. Reasons for this success include a strategic public-private health service delivery model and investment in Afghan health care workforce development. Afghan universities have the primary responsibility for ensuring that an adequate health care workforce is available to private and public health care delivery settings. Most entry-level health care providers working in Afghanistan are educated within the country. However, university constraints, including faculty shortages and limited access to professional development, have affected both the flow of the health care workforce pipeline and the skill levels and competencies of those who do enter the workforce. Aware of these constraints and workforce needs, the administration at Kabul University of Medical Sciences (KUMS), working in collaboration with the Ministry of Higher Education, prioritized investment in strengthening technical and academic capabilities within four faculties (anesthesiology, dentistry, medical laboratory technology, and midwifery). KUMS partnered with the University of Minnesota in 2017 with United States Agency for International Development support through the University Support and Workforce Development Program. Together they established a unique training-of-trainers (TOT) faculty development program to improve faculty knowledge and skills specific to their technical expertise, as well as knowledge and skills in instructional design and research methods. In this article, we describe the successes and challenges associated with partnership development, implementation, and sustainability.

Objective: To develop and assess the reliability and validity of a new instrument used during the third trimester of pregnancy to measure women's confidence in their ability to achieve physiologic birth, the Preparation for Labor and Birth (P-LAB) instrument., Design: Two-phase instrument development study that consisted of item generation and a prospective field test., Setting: Field testing occurred in five midwestern U.S. prenatal clinics., Participants: Participants in the field test were 203 nulliparous and parous pregnant women who intended to give birth vaginally., Methods: Psychometric testing consisted of test-retest reliability testing and assessments of content validity, face validity, and construct validity. We measured construct validity using exploratory factor analysis and correlation with the Sense of Coherence Scale., Results: The 22-item P-LAB showed good content validity, good internal consistency, and stability over time. All items had content validity index scores greater than or equal to 0.8, and the total instrument content validity index was 0.95. We identified four factors related to women's confidence in their ability to achieve physiologic birth: Planned Use of Pain Medication, Relationship With Care Provider and Supportive Birth Environment, Beliefs About Labor, and Labor Support (social and professional). Cronbach's alpha coefficient for the four extracted factors were .93, .76, .73 and .74, respectively. Intraclass correlation [95% confidence interval] for the total questionnaire was .92 [.88, .94]. We found no linear association between total P-LAB scores and sense of coherence., Conclusion: Our findings demonstrate acceptable initial psychometric properties for the P-LAB instrument. Additional testing is required to evaluate the instrument's construct, convergent, and divergent validity., (Copyright © 2020. Published by Elsevier Inc.)

Introduction: A physiologic approach to labor and birth is preferred for most women. The United States spends more on birth than any other country. Cesarean rates are currently 32%, and approximately 23% of women with a singleton pregnancy experience induction or augmentation of labor. Most physiologic birth research has focused on care during labor and birth. The purpose of this study was to describe women's perceptions of the care processes, support, and information received during pregnancy that helped them feel confident for physiologic labor and birth., Methods: Using a qualitative descriptive design with 2 phases, women were recruited from an urban area and a smaller city in Minnesota. Phase 1 included focus groups with women who had given birth within the previous 6 months. They participated in a discussion about experiences that helped them feel confident for labor and birth. In Phase 2, women who had a physiologic birth, which was defined as term pregnancy, spontaneous labor, no epidural analgesia, and vaginal birth, participated in individual interviews. Focus group and individual interview recordings were transcribed and analyzed using Glaser's constant comparative approach., Results: Thirty-eight women participated in 9 focus groups. Seventeen women had a physiologic birth; 14 participated in individual interviews. Themes derived from the analysis included confidence in the face of uncertainty, belief in the normalcy of birth and the body's ability to birth, research on my own, supportive care partnership, on the same page, and sources of information and support., Discussion: Women who experienced physiologic birth believed that this was possible and expected. They sought information, including searching on their own, from maternity care providers and a broader support system. Relationships with their maternity care providers were important. Prenatal care focused on women's strengths and abilities, while also monitoring pregnancy health and safety, may help reduce unnecessary interventions, improve outcomes, and reduce costs., (© 2018 by the American College of Nurse-Midwives.)

Nurse-midwives and women's health nurse practitioners have a long history as positive change agents in health care as well as education. This article chronicles the transition of a traditional face-to-face nurse-midwife and women's health nurse practitioner graduate curriculum to a Web-based format with campus seminars and clinical laboratories. This change was made to increase access to these graduate programs. A total of 20 courses, including both graduate core and specialty courses, was converted to the Web-based format over a 3-year period. Practical considerations for implementing a similar program, including faculty development and support, student orientation and ongoing support, development of a learning community, and time management, are discussed. The importance of listening to student feedback and partnering with them as the program continues to develop is emphasized as a key element of program evaluation and improvement.