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Objective To determine the incidence of immediate, uninterrupted skin-to-skin contact and breastfeeding after birth; and which factors are associated with it. Design Cross-sectional e-survey was developed and piloted prior to distribution. Sampling was purposive and included snowball sampling. Associations between maternity care practices and the primary outcome measure were examined using logistic regression. Setting Australia. Participants Women who birthed a term baby within the previous three years, in any Australian setting (hospital, birth centre or at home), were eligible to participate. Measurements and findings 1200 postpartum women met the eligibility criteria and completed the e-survey. The primary outcome, ‘pronurturance', included: (1) immediate mother/baby holding; (2) skin-to-skin contact; (3) uninterrupted holding for at least 60 min; 4) breastfeeding in the birth setting. Of 1200 participants, 22% (n = 258) experienced pronurturance. Pronurturance was less likely following caesarean section (adjusted Odds Ratio (aOR) 0.07, 95% Confidence Interval (CI) 0.03–0.17). Pronurturance was more likely with a known midwife during labour and birth (aOR 1.89, 95% CI 1.35–2.65). Contributing to the low rate of pronurturance were lack of antenatal skin-to-skin information; babies being wrapped; women wearing clothing; and non-urgent caregiver interruptions including weighing the baby or facilitating the mother to shower. Key conclusion Health services must strategically address the institutional processes which delay and/or interrupt skin-to-skin contact and breastfeeding in birth suite and operating theatre settings. Implications for practice Midwives and midwifery students providing continuity of carer are best placed to provide pronurturance to mothers and babies. Caregivers should educate women about pronurturance antenatally, and actively support immediate, uninterrupted mother/baby skin-to-skin contact and breastfeeding after birth.

to examine the effect of skin-to-skin contact and breast feeding within 30 minutes of birth, on the rate of primary postpartum haemorrhage (PPH) in a sample of women who were at mixed-risk of PPH.retrospective cohort study.two obstetric units plus a freestanding birth centre in New South Wales (NSW) Australia.after excluding women (n=3671) who did not have opportunity for skin to skin and breast feeding, I analysed birth records (n=7548) for the calendar years 2009 and 2010. Records were accessed via the electronic data base ObstetriX.skin to skin contact and breast feeding within 30 minutes of birth.outcome measure was PPH i.e. blood loss of 500ml or more estimated at birth. Data was analysed using descriptive statistics and logistic regression (unadjusted and adjusted).after adjustment for covariates, women who did not have skin to skin and breast feeding were almost twice as likely to have a PPH compared to women who had both skin to skin contact and breast feeding (aOR 0.55, 95% CI 0.41-0.72, p0.001). This apparently protective effect of skin to skin and breast feeding on PPH held true in sub-analyses for both women at 'lower' (OR 0.22, 95% CI 0.17-0.30, p0.001) and 'higher' risk (OR 0.37 95% CI 0.24-0.57), p0.001. KEY CONCLUSIONS AND IMPLICATION FOR PRACTICE: this study suggests that skin to skin contact and breastfeeding immediately after birth may be effective in reducing PPH rates for women at any level of risk of PPH. The greatest effect was for women at lower risk of PPH. The explanation is that pronurturance promotes endogenous oxytocin release. Childbearing women should be educated and supported to have pronurturance during third and fourth stages of labour.

Background: clinical reasoning was once thought to be the exclusive domain of medicine – setting it apart from ‘non-scientific’ occupations like midwifery. Poor assessment, clinical reasoning and decision-making skills are well known contributors to adverse outcomes in maternity care. Midwifery decision-making models share a common deficit: they are insufficiently detailed to guide reasoning processes for midwives in practice. For these reasons we wanted to explore if midwives actively engaged in clinical reasoning processes within their clinical practice and if so to what extent. The study was conducted using post structural, feminist methodology. Question: to what extent do midwives engage in clinical reasoning processes when making decisions in the second stage labour? Methods: twenty-six practising midwives were interviewed. Feminist interpretive analysis was conducted by two researchers guided by the steps of a model of clinical reasoning process. Six narratives were excluded from analysis because they did not sufficiently address the research question. The midwives narratives were prepared via data reduction. A theoretically informed analysis and interpretation was conducted. Findings: using a feminist, interpretive approach we created a model of midwifery clinical reasoning grounded in the literature and consistent with the data. Thirteen of the 20 participant narratives demonstrate analytical clinical reasoning abilities but only nine completed the process and implemented the decision. Seven midwives used non-analytical decision-making without adequately checking against assessment data. Conclusion: over half of the participants demonstrated the ability to use clinical reasoning skills. Less than half of the midwives demonstrated clinical reasoning as their way of making decisions. The new model of Midwifery Clinical Reasoning includes ‘intuition’ as a valued way of knowing. Using intuition, however, should not replace clinical reasoning which promotes through decision-making that can be made transparent and be consensually validated. Refereed/Peer-reviewed

Question is using ‘transition to motherhood theory' the best way to guide midwives in providing woman-centred care? Background contemporary research about changes to women's embodied sense of self during childbearing is influenced by foundational research and theory about the transition to motherhood. Rubin and Mercer are two key nursing authors whose work on transition to motherhood theory still shapes the ways in which a woman's experience of change during childbearing is understood in midwifery. Methods using a feminist post-structural framework, Rubin and Mercer's theory and research is described, critiqued and discussed. Findings Rubin and Mercer used pre-existing theories and concepts that had the effect of finding similarities and discarding differences between women. Rubin and Mercer's theory and research is an expression of humanistic philosophy. This philosophy creates frameworks that have an assumed, disempowered role for childbearing women. Their research used a logico-empirical, quantitative approach. Qualitative interpretive or constructivist approaches offer more appropriate ways to study the highly individualised, embodied, lived experience of a woman's changing self during childbearing. Conclusion Rubin and Mercer's theory is baby-centred. Transition to motherhood theory privileges the position of experts in directing how a woman should become a mother. This has the effect of making midwives agents for the social control of women. Implications for practice Rubin and Mercer's transition to motherhood theory is a well-intentioned product of its time. The theory is inconsistent with contemporary midwifery philosophy which promotes a woman-centred partnership between the midwife and the woman. The usefulness of this outdated nursing theory in midwifery teaching, research or practice is debatable.