Search

Cesarean delivery rates are rapidly increasing in Southeastern Europe (to more than 60%), North Africa (with a rate as high as 72% in Egypt), and in urban areas in Southern Africa (a rate of over 50% in Lagos, Nigeria). Data on the background to these increases are scarce, but likely to include poor birthing facilities in general hospitals, convenience for the doctor, private medicine, fear of litigation, socioeconomic status, shortage of midwives and nurses, and disappearance of vaginal instrumental deliveries. Options to reverse cesarean delivery trends are discussed. In this context there is a need to be better informed about how women are being counseled regarding vaginal or cesarean delivery. The long-term consequences in subsequent pregnancies for mothers and children may well be largely ignored, while these risks are highest in LMICs where higher birth numbers are desired. FIGO has begun discussions with obstetric and gynecologic societies, healthcare bodies, and governments in several countries discussed in this article, to find ways to lower the cesarean delivery rate. The requests came from the countries themselves, which may prove beneficial in helping advance progress. [ABSTRACT FROM AUTHOR]

This good clinical practice paper provides an overview of the current evidence around second stage care, highlighting the challenges and the importance of maintaining high-quality, safe, and respectful care in all settings. It includes a series of recommendations based on best available evidence regarding length of second stage, judicious use of episiotomy, and the importance of competent attendants and adequate resource to facilitate all aspects of second stage management, from physiological birth to assisted vaginal delivery and cesarean at full dilatation. The second stage of labor is potentially the most dangerous time for the baby and can have significant consequences for the mother, including death or severe perineal trauma or fistula, especially where there are failures to recognize and repair. This paper sets out principles of care, including the vital role of skilled birth attendants and birth companions, and the importance of obstetricians and midwives working together effectively and speaking with one voice, whether to women or to policy makers. The optimization of high-quality, safe, and personalized care in the second stage of labor for all women globally can only be achieved by appropriate attention to the training of birth attendants, midwives, and obstetricians. FIGO is committed to this aim alongside the WHO, ICM, and all FIGO's 132 member societies. [ABSTRACT FROM AUTHOR]

Objective To understand why skilled birth attendance-an acknowledged strategy for reducing maternal deaths-has been effective in some settings but is failing in Pakistan and to demonstrate the value of a theory-driven approach to evaluating implementation of maternal healthcare interventions. Design Implementation research was conducted using an institutional ethnographic approach. Setting and population National programme and local community levels in Pakistan. Methods Observations, focus group discussions, and in-depth interviews were conducted with 38 Community Midwives ( CMWs), 20 policymakers, 45 healthcare providers and 136 community members. A critical policy document review was conducted. National and local level data were brought together. Main outcomes Alignment of programme theory with real-world practice. Results Data revealed gaps between programme theory, assumptions and reality on the ground. The design of the programme failed to take into account: (1) the incongruity between the role of a midwife and dominant class and gendered norms that devalue such a role; (2) market and consumer behaviour that prevented CMWs from establishing private practices; (3) the complexity of public-private sector cooperation. Uniform deployment policies failed to consider existing provider density and geography. Conclusions Greater attention to programme theory and the 'real-world' setting during design of maternal health strategies is needed to achieve consistent results in different contexts. [ABSTRACT FROM AUTHOR]

Aim: With high rates of trauma in the population, known links between trauma and perinatal distress, and the intimate and close nature of the nursing and midwifery roles, ensuring awareness and understandings of trauma is crucial for guiding practice. This paper aims to explore the relationship of trauma to the perinatal period, based on theory and practice, to consider on how nurses and midwives can deliver trauma‐sensitive interactions. Design and Methods: This discursive discussion draws on relevant research from the fields of trauma therapy, attachment theory and nursing and midwifery practice to consider elements of trauma‐sensitive practice in the perinatal period. Results: Nurses and midwives can foster safety for people who have experienced trauma through noticing and responding to triggers, supporting awareness of attachment and its relationships to trauma, undertaking psychosocial screening with care, supporting linearity and cohesion in narratives and developing collaborative care plans that maximise safety and agency. For nurses and midwives, understandings of the relationship between trauma, pregnancy, birth, early parenting and distress is crucial for effective care delivery. Delivering perinatal nursing or midwifery care of any kind, without universal trauma precautions risks reinforcing, misinterpreting or re‐enacting dynamics of trauma. To be trauma‐sensitive in this period requires nurses and midwives to have awareness of the dynamics of trauma in relation to pregnancy, birth and attachment. Implications for the Profession and/or Patient Care: This paper fills a gap in the translation of theory to practice for trauma‐sensitive care in the perinatal period, with a focus on the therapeutic relationship formed by nurses and midwives. The findings highlight that nurses and midwives can foster safety for people who have experienced trauma within their practice, when they hold a robust understanding of the relationship between trauma, pregnancy, birth, early parenting and distress. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Objective: Screening for intimate partner violence in the home is often challenging due to the lack of privacy. The aim of this study was to compare two different screening methods (paper‐pencil vs. tablet) for identifying intimate partner violence during perinatal home visits. Design: Randomized control trial. Sample: Pregnant women (N = 416) in perinatal home visiting programs were randomized to either paper‐pencil or computer assisted, intimate partner violence screening. Measurements: The Abuse Assessment Screen was used to screen for physical and sexual IPV and Women's Experiences with Battering for emotional intimate partner violence. Results: No significant differences in prevalence were found between the screening methods. Intimate partner violence prevalence rates for the year before and/or during pregnancy using paper‐pencil was 21.8% versus 24.5% using tablets (p =.507). There were significant differences in prevalence among the three race/ethnic groups (Caucasian, 36.9%; African American, 26.7%; Hispanics, 10.6%; p <.001) and significant differences in rates across three geographical areas: urban 16.0%; rural 27.6%, suburban women 32.3% (p <.001). Conclusions: This study provides evidence that both methods are useful for identifying intimate partner violence during perinatal home visits. [ABSTRACT FROM AUTHOR]

On September 28, 1981, Great Britain's Central Council produced a consultation paper in which certain proposals are made for election to the recently constituted National Boards for Nursing, Midwifery and Health Visiting. The purpose of the election is to elect nurses, midwives and health visitors as members of the National Boards for Nursing, Midwifery and Health Visiting in England, Scotland, Wales and Northern Ireland. It is proposed that there should be three categories of candidates--nurses, midwives and health visitors. To be eligible to stand as a candidate a person must be either a practising nurse, practising midwife or a practising health visitor.

Background: Normal physiologic birth has been shown to result in optimal maternal–infant outcomes, but the concept of physiologic birth is continually evolving. Midwives play an important role in advocating for normal physiologic birth; however, their perceptions of what this approach entails have not been systematically appraised. Objective: In this qualitative review, we aimed to examine midwives' perceived meanings of "normal physiologic birth" and to describe their experiences facilitating such births. Methods: Five electronic databases were searched, and 26 qualitative papers were included, representing a total of 433 midwives from different backgrounds (i.e., independent, home‐based, community‐based, and hospital‐based). Eligible papers were assessed for quality, and then data were coded and synthesized thematically. Results: Four highly connected themes were generated: (1) the midwife: fundamental beliefs; (2) the woman: empowerment and advocacy; (3) the environment: ambience and culture; and (4) the team: need for institutional support and recognition. The fundamental beliefs of midwives, such as their perceived role and definition of normal physiologic birth and their self‐confidence, influence practice styles and contribute to personal and professional development. Midwives often advocate for a person‐centered approach that encouraged women's and other birthing person's autonomy and involvement in shared decision‐making. The midwife–client relationship is also central. Most importantly, a conducive birthing environment and an inclusive workplace culture that encourages interprofessional support, collaboration, and recognizes midwifery practices were identified as crucial in providing optimal conditions for the facilitation of physiologic birth. Conclusions: This review provides healthcare policymakers and institutions fresh impetus to evaluate and revise as needed current workplace policies to be more inclusive and supportive of midwifery practices and physiologic birth. [ABSTRACT FROM AUTHOR]

Background: Migrant and ethnic inequalities in maternal and perinatal mortality persist across high‐income countries. Addressing social adversity and inequities across the childbirth trajectory cannot be left to chance and the good intentions of practitioners. Robust, evidence‐based tools designed to address inequity by enhancing both the quality of provision and the experience of care are needed. Methods: An inductive modelling approach was used to develop a new evidence‐based conceptual model of woman–midwife relationships, drawing on data from an ethnographic study of relationships between migrant Pakistani women and midwives, conducted between 2013 and 2016 in South Wales, UK. Key analytic themes from early data were translated into social–ecological concepts, and a model was developed to represent how these key themes interacted to influence the woman–midwife relationship. Results: Three key concepts influencing the woman–midwife relationship were developed from the three major themes of the underpinning research: (1) Healthcare System; (2) Culture and Religion; and (3) Family Relationships. Two additional weaving concepts appeared to act as a link between these three key concepts: (1) Authoritative Knowledge and (2) Communication of Information. Social and political factors were also considered as contextual factors within the model. A visual representation of this model was developed and presented. Conclusions: The model presented in this paper, along with future work to further test and refine it in other contexts, has the potential to impact on inequalities by facilitating future discussion on cultural issues, encouraging collaborative learning and knowledge production and providing a framework for future global midwifery practice, education and research. Patient or Public Contribution: At the outset of the underpinning research, a project involvement group was created to contribute to study design and conduct. This group consisted of the three authors, an Advocacy Officer at Race Equality First and an NHS Consultant Midwife. This group met regularly throughout the research process, and members were involved in discussions regarding ethical/cultural/social issues, recruitment methods, the creation of participant information materials, interpretation of data and the dissemination strategy. Ideas for the underpinning research were also discussed with members of the Pakistani community during community events and at meetings with staff from minority ethnic and migrant support charities (BAWSO, Race Equality First, The Mentor Ring). Local midwives contributed to study design through conversations during informal observations of antenatal appointments for asylum seekers and refugees. [ABSTRACT FROM AUTHOR]

Studying quasi‐experimental data from French hospitals from 2010 to 2013, we test the effects of a substantial diagnosis‐related group (DRG) tariff refinement that occurred in 2012, designed to reduce financial risks of French maternity wards. To estimate the resulting DRG incentives with regard to the choice between scheduled C‐sections and other modes of child delivery, we predict, based on pre‐admission patient characteristics, the probability of each possible child delivery outcome and calculate expected differences in associated tariffs. Using patient‐level administrative data, we find that introducing additional severity levels and clinical factors into the reimbursement algorithm had no significant effect on the probability of a scheduled C‐section being performed. The results are robust to multiple formulations of DRG financial incentives. Our paper is the first study that focuses on the consequences of a DRG refinement in obstetrics and develops a probabilistic approach suitable for measuring the expected effects of DRG fee incentives in the presence of multiple tariff groups. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic and Brexit were separate yet inter‐related developments which affected the British National Health Service (NHS). The UK's state‐funded health sector had historically relied on migrant labour and depended on a migration infrastructure designed to solve its nursing labour shortages. The analysis of primary qualitative and secondary quantitative data shows that the NHS migration infrastructure increased its orientation towards Asia to compensate for the effects of Brexit. The paper reveals how the persistent use of temporary visas along with conditional contractual arrangements has led to various exclusions for migrant nurses and midwives. These data also demonstrate how international travel restrictions associated with COVID‐19 created temporary obstacles for nurses' inflows. Alongside Brexit, this has also resulted in an increase in outflows amongst EU health workers. The article identifies the development of migrant support infrastructure amongst Filipino and Indian nurses as a major COVID‐19 linked innovation. [ABSTRACT FROM AUTHOR]

Background: In Canada, Ontario midwives provide care to sexual and gender minority (SGM) people. Published literature shows how midwives' attitudes shape the experiences of lesbians, but research examining midwives' attitudes toward SGM people is lacking. Our study measured the attitudes of Ontario midwives toward SGM clients, hypothesizing that attitudes would be positive overall and that there would be no difference in attitudes across practice settings. Methods: Paper surveys (n = 926) with an option to respond online were sent to Ontario midwifery practices. We measured midwives' attitudes toward sexual minorities (11 questions, scores ranged from 11 to 55) and gender minorities (9 questions, scores ranged from 9 to 45), with higher scores indicating more positive attitudes. Overall and subgroup analyses were performed. Results: The 268 completed surveys indicated that midwives' attitudes were positive toward both sexual (mean score 49.2, maximum possible score of 55, ie, 89.4%) and gender minorities (mean score 38.9, maximum possible score of 45, ie, 86.4%). Analyses showed that attitudes toward SGM were associated with midwives' sexual identity and route of entry into the profession (ie, university‐based vs bridging programs), but not practice setting. Conclusions: Although attitudes of this subset of midwives toward SGM clients were positive, volunteer bias could account for this finding since 32.6% of respondents identified as sexual minorities. Since the attitudes of midwives who entered the profession through the university‐based education program were significantly more positive than those who entered through international bridging programs, future research should examine how SGM‐related content is integrated into midwifery education and training curricula. [ABSTRACT FROM AUTHOR]

Background: The clitoris has long been ignored in medical literature and teaching, with the first paper describing its anatomy only published in 1993. It is essential that those working in women's health understand the anatomy of this important female sexual organ. Aims: The aim of this study was to assess the level of knowledge of the anatomy of the clitoris across five cohorts in a busy teaching maternity hospital in Ireland. Materials and Methods: A questionnaire was devised, asking ten consultants, ten non‐consultant hospital doctors (NCHDs), ten midwives, ten midwifery students and ten medical students to name the anatomical parts of a 3D model of the clitoris. Results: None of the 50 respondents could name all five labelled parts of the clitoris, and 38 of respondents could not correctly name one anatomical part. Conclusions: It is evident that there is a lack of knowledge of the anatomical parts of the clitoris among the medical staff included in this study. This reflects a lack of adequate teaching in this area in both past and recent years. Despite this, we acknowledge that women's health and sexual health awareness is improving all of the time, and we hope that this study can highlight the need for reformed teaching in this area. [ABSTRACT FROM AUTHOR]

Background: Birth companions can have a positive effect on women's experiences in labor. However, companions can feel unprepared and need professional guidance to help them feel involved and provide effective support. Methods: A convergent segregated mixed‐methods systematic review was conducted to explore women's, companions', and midwives' experiences of birth companion support and identify ways to improve the experience for women and companions. A thematic synthesis of qualitative data and a narrative summary of quantitative data were conducted followed by integration of the findings. Results: Companions who cope well in labor reported feeling involved, able to preserve women's internal focus and have a defined role, providing physical or emotional support. LBGTQ+ partners faced barriers to inclusion due to "forefronting" of their sexuality by staff and a lack of recognition in the language and processes used. The experience of birth companions can be enhanced by promoting their role as co‐parent, guardian, and coach, provision of timely information and developing a trusting relationship with care providers. Only two papers reported midwives' views on birth companions in labor. Conclusions: Women's and companions' satisfaction with birth is increased when companions can support the mother, feel supported themselves, and valued as a co‐parent. The midwives' role in information provision and guidance can maximize birth companions' experience and ability to provide positive support. LBGTQ+ families need more support to feel included and recognized. [ABSTRACT FROM AUTHOR]

Doulas are non‐medical support persons, paid for privatively by clients, who offer emotional support during pregnancy and childbirth. While doulas work alongside clinical care providers, such as physicians, midwives, and nurses, they are unregulated and typically have no formal standing in hospitals. As with other types of care work, doula practice is shaped by gendered assumptions about women's "natural" and boundless capacity to provide care. In this paper, I draw on interviews with 26 doulas practicing in Toronto, Canada, to explore the nature of doulas' caring dilemma―the tension between an altruistic motivation to provide care and a desire for greater professional autonomy and control over working conditions among care workers. I show that doulas' self‐imposed obligation to provide a specific model of care, along with their desire to fill gaps in maternity care, results in a caring dilemma that places their own needs in opposition to those of their clients. In response to their significant caring demands, some doulas attempt to alter their work to improve their working conditions. [ABSTRACT FROM AUTHOR]

Nursing and midwifery are unarguably stressful endeavors requiring high levels of psychological capital and coping strategies. The impact of the work environment on patient safety outcomes suggests that high nurse/midwife stress may be associated with more adverse patient events. The purpose of this study was to explore the psychological capital of clinical nurses and midwives and identify explanatory factors (including psychological capital, well‐being, and health‐related behaviors) contributing to attitudes to patient safety. A descriptive web‐ and paper‐based survey comprising a convenience sample of nurses and midwives in acute health facilities in Sydney, Australia, was performed (October 2018 and April 2019). Variables included psychological capital, psychological well‐being, work culture, and attitudes to patient safety. Descriptive statistics were performed and a regression model was specified (a statistical significance of P < 0.05 was set a priori). Psychological capital, depression score, and work engagement had a significant effect on patient safety perceptions when controlling for other factors. The findings suggest that nurse and midwife well‐being is an important consideration when striving to improve patient safety. [ABSTRACT FROM AUTHOR]

Background: The Birthing on Noongar Boodjar project (NHMRC Partnership Project #GNT1076873) investigated Australian Aboriginal women and midwives' views of culturally safe care during childbearing. This paper reports on midwifery knowledge of Aboriginal women's cultural needs, their perceptions of health systems issues, and their ability to provide equitable and culturally safe care. Method: A qualitative study framed by an Indigenous methodology and methods which supported inductive, multilayered analyses and consensus‐driven interpretations for two clinical midwife data groups (n = 61) drawn from a larger project data set (n = 145) comprising Aboriginal women and midwives. Findings: Midwives demonstrated limited knowledge of Aboriginal women's cultural childbearing requirements, reported inadequate access to cultural education, substituted references to women‐centered care in the absence of culturally relevant knowledge and consistently expressed racialized assumptions. Factors identified by midwives as likely to influence the midwifery workforce enabling them to provide culturally safe care for Aboriginal women included more professional development focused on improving understandings of cultural birth practices and health system changes which create safer maternal health care environments for Aboriginal women. Conclusions: Individual, workforce, and health systems issues impact midwives' capability to meet Aboriginal women's cultural needs. An imperative exists for effective cultural education and improved professional accountability regarding Aboriginal women's perinatal requirements and significant changes in health systems to embed culturally safe woman‐centered care models as a means of addressing racism in health care. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to explore the perceived benefits and challenges of online distance education and computer‐based testing (CBT) among registered nurses and midwives in a sample of government‐owned health facilities and health training institutions in Ghana. Design: Exploratory descriptive qualitative design. Methods: Individual semi‐structured interviews were conducted with 45 participants (i.e. 25 nurses and 20 midwives). The data were manually processed and analysed using Braun and Clarke's thematic analysis approach (November 2019‐February 2020). Results: Nurses and midwives prefer online distance education for three reasons: convenience, cost‐effectiveness and learning centre proximity to the workplace. The course schedule's flexibility allowed participants to work and study simultaneously. Others acknowledged online distance education as a viable option for overcoming the challenges of obtaining study leave. However, the lack of recognition of certificates by some employers, poor Internet connectivity and perceived excessive course load were noted as deterrents. Regarding the CBT, many of the participants said that it was useful. Among the advantages of CBT are: (1) a decrease in examination malpractices, (2) a decrease in examination costs and (3) a rise in students' interest in information, communication and technology (ICT). This finding emphasizes the necessity of integrating ICT into nursing and midwifery education and examinations, as well as maximizing its benefits. [ABSTRACT FROM AUTHOR]

Background: Umbilical cord clamp timing has implications for newborn health, which include increased iron stores up to 6 months of age. National and International cord clamping guidelines differ as do health professionals' practices. The rationale for differences in cord clamping practice is unclear. Aims and objective: Studies on the knowledge, attitudes, and practices of maternity health care professionals about cord clamp timing were synthesized. Similarities and differences between professional groups and understanding of the optimal timing of cord clamp timing for term newborns were compared. Methods: An integrative review was undertaken. PubMed, Scopus, MIDIRS, CINAHL, and Google Scholar were searched. Publication date limits were set between January 2007 and December 2020. Quality appraisal was undertaken using the Critical Appraisal Skills Program (CASP) tools. Results: Eighteen studies met inclusion criteria, as they included primary research studies that investigated maternity health care professionals' knowledge, attitudes, and practices about umbilical cord clamping, and were written in English. Four main subject areas were identified: a) knowledge of optimal cord clamp timing; b) attitudes and perceptions of early vs deferred cord clamping; c) cord clamping practice; and d) rationale for cord clamping practice. Conclusions: Different attitudes and practices were identified between midwifery and medical professionals in relation to cord clamp timing together with health professional knowledge and practice gaps pertaining to optimal cord clamp timing. Contemporary evidence should inform guidelines for clinical practice and be embedded into maternity health professional curricula and professional development programs. [ABSTRACT FROM AUTHOR]

There is a lack of consensus in the international scientific community with respect to the most suitable hydration strategies when attending nulliparous women during low‐risk births. This paper describes the protocol for a randomized controlled trial to compare two hydration strategies and their influence on maternal and neonatal morbidity. The study population consists of nulliparous women admitted to the obstetrics department of a University Hospital. The women are being randomized into two groups: the "optimal hydration" group, which will be guaranteed 300 ml/hr liquids (crystalloids and bottled mineral water) with a minimum diuresis of 35 ml/hr; and the "variability in hydration" group, which will receive intravenous (alternating normal saline, Ringer's lactate solution, glucose, or Voluven®) and clear (bottled mineral water or isotonic drinks [Aquarius®]) liquids, without any established perfusion rate, and without established minimum diuresis. Outcomes for mothers include duration of labor, cesarean section, fever, and dehydration. Outcomes for newborns are respiratory distress, hypoglycemia, hyponatremia, jaundice, weight loss over 48 hr, and breastfeeding difficulties. Analysis will be per‐protocol. Administering optimal hydration may improve health and safety for mothers and their newborn and reduce maternal and neonatal morbidity. The study is registered at www.clinicaltrials.gov. The project received funding by the Ministry of Health of Spain and is approved by the Research Ethics Committee. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper explores the perceptions of career progression in the NHS of a group of midwives and nurses trained in Ghana and working in the UK. It draws on semi-structured interviews with nurses, midwives and managers which were conducted as part of the Researching Equal Opportunities for Overseas trained Health Professionals project (REOH). Background. Research into overseas nurses in the UK has tended to focus on their experiences of discrimination in relationships with colleagues, managers and patients. There is limited statistical evidence indicating that migrant nurses experience slower career progression than their UK-trained counterparts. However, there is little analysis of their experiences and perceptions of the process of career progression or their understandings of the factors that could account for their limited entry into higher grades. Conclusions. This paper argues that many Ghanaian nurses and midwives can experience difficulty in progressing into senior positions because of cultural differences and gaps in knowledge. However, this paper indicates that these problems can become institutionalized and entrenched by practices on the ward, particularly support from managers being dispensed as patronage that is not given equally to all. This creates an informal system of promotion to management which is not transparent, is based on subjective and culturally specific criteria and can undermine egalitarian formal procedures and create spaces where discriminatory practices can operate. Relevance to clinical practice. These processes can lead to sectors of the workforce becoming demoralized, to the wastage of skills and other resources and problems in staff retention. [ABSTRACT FROM AUTHOR]

devane d., begley c.m. & clarke m. (2004) Journal of Advanced Nursing 47(3), 297–302 How many do I need? Basic principles of sample size estimation In conducting randomized trials, formal estimations of sample size are required to ensure that the probability of missing an important difference is small, to reduce unnecessary cost and to reduce wastage. Nevertheless, this aspect of research design often causes confusion for the novice researcher. This paper attempts to demystify the process of sample size estimation by explaining some of the basic concepts and issues to consider in determining appropriate sample sizes. Using a hypothetical two group, randomized trial as an example, we examine each of the basic issues that require consideration in estimating appropriate sample sizes. Issues discussed include: the ethics of randomized trials, the randomized trial, the null hypothesis, effect size, probability, significance level and type I error, and power and type II error. The paper concludes with examples of sample size estimations with varying effect size, power and alpha levels. Health care researchers should carefully consider each of the aspects inherent in sample size estimations. Such consideration is essential if care is to be based on sound evidence, which has been collected with due consideration of resource use, clinically important differences and the need to avoid, as far as possible, types I and II errors. If the techniques they employ are not appropriate, researchers run the risk of misinterpreting findings due to inappropriate, unrepresentative and biased samples. [ABSTRACT FROM AUTHOR]

Midwives’ perceptions of the use of technology in assisting childbirth in Northern Ireland Aim of the paper. The aim of this paper is to report a survey of midwives’ views on the use of technology in assisting births. Background. The research was designed to provide a deeper understanding of the integration of technology into midwives’ practice and to identify and examine aspects of training needs. Methods. Over 400 midwives responded to a questionnaire seeking information on their experiences and perceived competence with labour ward technology, with a particular focus on the use of cardiotocograph machines (CTGs) for electronic foetal monitoring. The survey sought views on the extent to which midwives trust the technology, their perceived levels of training and competence, their awareness of policy relating to technological intervention and the issue of women’s choice in whether the progress of their delivery is technologically monitored. Findings. The majority of midwives in this survey trust the use of technology but have concerns about issues of safety in relation to potential faults, and to their perceived lack of training in technology usage. The majority also indicated that they prefer a nontechnological birth although many point to the benefits of technological support when difficulties are encountered. The use of technology is seen as multi-professional and there was much support among the respondents for multi-disciplinary training in the use of technologies in future curricula. Conclusions. If the various findings of this sample survey were to be consolidated for midwives as a whole, they suggest that provisions for continuing professional development may need to address technological awareness and competence in a more focused manner than is discernible at present. [ABSTRACT FROM AUTHOR]

The relationship between attendance at birth and maternal mortality rates: an exploration of United Nations’ data sets including the ratios of physicians and nurses to population, GNP per capita and female literacy Background. This is the third and final paper drawing on data taken from United Nations (UN) data sets. The first paper examined the global distribution of health professionals (as measured by ratios of physicians and nurses to population), and its relationship to gross national product per capita (GNP) (). The second paper explored the relationships between the global distribution of physicians and nurses, GNP, female literacy and the health outcome indicators of infant and under five mortality rates (IMR and u5MR) (). In the present paper, the global distribution of health professionals is explored in relation to maternal mortality rates (MMRs). The proportion of births attended by medical and nonmedical staff defined as ‘attendance at birth by trained personnel’ (physicians, nurses, midwives or primary health care workers trained in midwifery skills), is included as an additional independent variable in the regression analyses, together with the ratio of physicians and nurses to population, female literacy and GNP. Aim. To extend our earlier analyses by considering the relationships between the global distribution of health professionals (ratios of physicians and nurses to population, and the proportion of births attended by trained health personnel), GNP, female literacy and MMR.

Introduction of Aims and Scope for the Journal of Advanced Nursing with emphasis on inclusiveness and diversity among nurses and midwives. Issues and innovations in nursing practice; Aspects of motherhood and maternity; Studies of diabetic populations.

Aim: To investigate nursing/midwifery students, Clinical Mentors, Link Teachers and Head Nurses experiences within "Dedicated Education Unit" model in 6 European clinical placements and analyse the necessary elements for a powerful clinical learning environment. Design: A multi‐country, phenomenological, qualitative study. Methods: Focus group interviews were performed to identify the personal and organizational factors of importance for students and nurses/midwives. Results: Data analysis produced 4 main themes (1) Clinical placement organization, (2) students' clinical knowledge and skill acquisition, (3) students, and nurses/midwives' experiences within the DEU model and (4) factors for creating an effective learning environment. Conclusions: A close educational‐service collaboration, a realistic clinical placement planning, a focus on student learning process and an investment in professionals' education and development among others, are elements to set up a powerful clinical learning environment. Implications for the profession: It is considered advisable and urgent to improve the working conditions of nurses/midwives and the learning environments of students as a strategy to alleviate the global shortage of nurses and respond to the increasingly demanding health needs of the population. Impact: Due to the close relationship between students' learning and features of the clinical environment nurse educators seek innovative models which allow students to manage patient care and their transition to professional practice. To implement new learning strategies, identifying students, nurses and midwives perceptions and suggestions is a powerful information to evaluate implementation process and outcomes. Public Contribution: Our findings could help academic and clinical managers to meet the human and organizational requirements to create a successful learning environment in every student placement. [ABSTRACT FROM AUTHOR]

Aims: To establish a comprehensive understanding of the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of postpartum haemorrhage (PPH) following normal vaginal delivery. Design: We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis for Scoping Reviews (PRISMA‐ScR) recommendations. Methods: We considered studies related to the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of PPH during vaginal delivery. We excluded guidelines, consensuses, abstracts of meetings and non‐English language studies. Databases, including the Cochrane Library, PubMed, Web of Science, Ovid, Medline, Embase, JBI EBP and BIOSIS Previews, were searched on January 1, 2023, with no time limitations. Results: We included 28 publications. Midwives play important roles in the prevention, diagnosis and management of postpartum haemorrhage during vaginal delivery. In the prevention of PPH, midwives' roles include identifying and managing high‐risk factors, managing labour and implementing skin‐to‐skin contact. In the diagnosis of PPH, midwives' roles include early recognition and blood loss estimation. In the management of PPH, midwives are involved in mobilizing other professional team members, emergency management, investigating causes, enhancing uterine contractions, the repair of perineal tears, arranging transfers and preparation for surgical intervention. However, midwives face substantial challenges, including insufficient knowledge and skills, poor teamwork skills, insufficient resources and the need to deal with their negative emotions. Midwives must improve their knowledge, skills and teamwork abilities. Health care system managers and the government should give full support to midwives. Future research should focus on developing clinical practice guidelines for midwives for preventing, diagnosing and managing postpartum haemorrhage. [ABSTRACT FROM AUTHOR]

The diagnosis of foetal distress is complex: it is influenced by a number of factors which range from the physical examination of the mother and foetus to the psychological and social world in which the mother, the midwife and other health care professionals work. The consequences of an incorrect diagnosis of normality or foetal distress are potentially serious for both mother and baby. Recent changes in the practice and delivery of midwifery care have placed more responsibility on midwives. It is therefore imperative that midwives become more aware of the complexity of the diagnosis as well as of some of the factors which can improve the quality of their diagnosis. This paper reviews the literature associated with the diagnosis of foetal distress, physiological and pathological changes during pregnancy and labour, and the usefulness and limitation of the tools readily available to midwives for the diagnosis. It also examines the limits of the relationship that exists between intra-uterine and neonatal markers. The purpose of this paper is to provide background information that would support midwives in the diagnosis of foetal distress in the hope that the false positive diagnoses can be reduced for the benefit of mothers and babies. Ultimately an improvement in outcome should be reflected in the more efficient and effective use of resources available to maternity services. [ABSTRACT FROM AUTHOR]

In the article the authors comment on the views of sociologists Rona Campbell and Sam Porter, on a paper on feminist theory and the sociology of human reproduction written by them. The authors clarify that while feminists and midwives may hold ideas in common, feminist and midwifery practice are diverse and contested fields and there is no intrinsic affinity between the two. In their earlier paper they argued that feminism is not disinterested in its response to midwifery. It is further argued that differences which have become increasingly vociferous within feminism have tended to be neglected within the sociology of health and illness, and proposed that post-structuralist approaches might provide a fruitful, although certainly not unproblematic, counterpoint to a range of modernist feminist perspectives as they relate to gender and reproduction. In response to Campbell and Porter's criticism for ignoring recent midwifery and social science research on midwifery practice, it is clarified that the authors never intended to question midwifery's credentials in working with childbearing women.

Abstract: Background: The purpose of this study was to develop assessment criteria that could be used to examine the level of integration of home birth within larger health care systems in developed countries across 11 international jurisdictions. Methods: An expert panel developed criteria and a definition to assess home birth integration within health care systems. We selected jurisdictions based on the publications that were eligible for inclusion in our systematic review and meta‐analysis on planned place of birth. We sent the authors of the included publications a questionnaire about home birth practitioners and practices in their respective health care system at the time of their studies. We searched published peer‐reviewed, non–peer‐reviewed, and gray literature, and the websites of professional bodies to document information about home birth integration in each jurisdiction based on our criteria. Where information was lacking, we contacted experts in the field from the relevant jurisdiction. Results: Home birth is well integrated into the health care system in British Columbia (Canada), England, Iceland, the Netherlands, New Zealand, Ontario (Canada), and Washington State (USA). Home birth is less well integrated into the health care system in Australia, Japan, Norway, and Sweden. Conclusions: This paper is the first to propose criteria for the evaluation of home birth integration within larger maternity care systems. Application of these criteria across 11 international jurisdictions indicates differences in the recognition and training of home birth practitioners, in access to hospital facilities, and in the supplies and equipment available at home births, which give rise to variation in the level of integration across different settings. Standardized criteria for the evaluation of systems integration are essential for interpreting planned home birth outcomes that emerge from contextual differences. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Review of Sociology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The section comments on the article "Protective Steering: A Grounded Theory Study of the Processes by Which Midwives Facilitate Informed Choices During Pregnancy," by V. Levy, which appeared in the 1999 issue of the "Journal of Advanced Nursing." It discusses the focus of the paper, which is on the relationship between the childbearing woman and the midwife. It characterizes the midwives in Levy's sample in terms of making decisions about their maternity care.

This paper examines empirically whether midwives, as an integral part of the reproductive health and family planning programs in Indonesia, are effective in advising young women to delay their first birth and also influence the decision on post-primary school attendance. Using the Indonesian Family Life Survey, I investigate the extent to which the expansion of a midwife program affects the age at first birth and the number of school years of women. My findings suggest that women who were exposed to a midwife when they have to decide on further school attendance (aged 13-20 years) delay their first birth and also stay longer in school. According to the average returns of education in Indonesia, I conclude that reproductive health services provided by midwives can generate large socioeconomic benefits by allowing young women to postpone their first birth. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In this paper, midwives' experiences of working with vulnerable pregnant women who were subject to child protection orders in New South Wales, Australia, and faced the possible removal of their baby at birth, known as 'assumption of care', are described. A qualitative descriptive approach was used to explore the experiences of ten midwives who had been involved in some 91 episodes of assumption of care. In-depth interviews were undertaken and thematic analysis was used to analyse the data-set. Four themes were elicited that demonstrated how midwives worked with vulnerable women and Community Services during the antenatal period. These were labelled: Reporting - Taking the first step; The woman-midwife relationship remains a priority; Jumping through the 'community service' hoops; and Crunch time: The decision... sometimes justifiable sometimes not? Even though the three-way relationship between the woman-midwife-Community Services could be confrontational, it was essential that midwives worked in a positive way with Community Services to improve outcomes for the woman and her unborn child. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Messages Working effectively with Community Services is essential. Sharing information and developing multidisciplinary approaches and pathways will produce the best outcomes for vulnerable newborns and their mothers whilst at the same time supporting health and community workers to work in a cohesive manner to provide quality care., Midwives need to be supported to stay 'woman centred'. Keeping the woman engaged in the system will help ensure the health of the foetus (baby)., Further research is needed to explore the perspectives of all those involved in assumption of care. [ABSTRACT FROM AUTHOR]

As preliminary research into the childbirth experience of migrants in China, this paper presents a systematic review of Chinese and English literature published between 1999 and 2011 on childbirth in migrants in China. Electronic databases were accessed and papers were found by keyword search. A total of 132 Chinese and 9 English papers were catalogued for review. These papers address migrant maternity issues concerning antenatal, intrapartum, postnatal care, institutional issues, family planning or birth control. Since China's economic reforms, the healthcare infrastructure has been inadequate for childbirth in migrants. They experience more adverse birth outcomes than local residents. This suggests that the effects of change upon childbirth and the existing urban and rural care systems cannot meet the needs of the migrants. There is a lack of research in the childbirth experience of women. Knowledge of their childbirth experience will contribute to the understanding of these needs, informing systems' reform. The medical approach results in many unnecessary interventions and higher costs. It is argued here that a midwifery model of care is most appropriate for the childbirth experience of migrant women. [ABSTRACT FROM AUTHOR]

This paper analyzes and explores varying discourses within the talk of new practitioner direct entry (DE) midwives in Aotearoa/New Zealand. In Aotearoa/New Zealand, midwifery is theorized as a feminist profession undertaken in partnership with women. Direct entry midwifery education is similarly based on partnerships between educators and students in the form of liberatory pedagogies. The context for the analysis is a large ethnographic study undertaken with a variety of differently positioned midwives based mainly in one city in New Zealand. I interviewed and observed over 40 midwives in their different practice settings in 2003. Complex and contesting forms of knowledge production are analyzed in this paper drawing on methodological insights from Foucauldian discourse analysis. New practitioners engage in techniques of self-monitoring and surveillance as they move towards becoming established practitioners. New midwifery subjectivities and forms of knowledge production which contest authoritative forms of knowledge are produced. Midwives in New Zealand are seen to inhabit a complex and liminal space of midwifery praxis. Paradoxically, they are exhorted to remain the ‘guardians of normal birth’ in a time of increasing interventions into birth both locally and internationally. Paradoxes encountered by new midwifery practitioners in New Zealand as they struggle to maintain ideals of ‘normal’ birth may be paralleled by the constraints inadvertently produced through governing discourses of emancipatory or liberatory pedagogies. The relevance of this is also highly critical for midwifery and birth practices internationally. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an integrative literature review to investigate: (a) the extent of entrepreneurial activity by nurses, midwives and health visitors in the United Kingdom and (b) the factors that influenced these activities. Background. Internationally, social and commercial entrepreneurial activity is regarded as important for economic growth and social cohesion. Methods. Seventeen bibliographic databases were searched using single and combined search terms: 'entrepreneur$', 'business', 'private practice', 'self-employ$', 'intrapreneur$' 'social enterprise$' 'mutuals', 'collectives', 'co-op' and 'social capital' which were related to a second layer of terms 'Nurs$', 'Midwi$', 'Visit$'. 'Entrepreneur$' Private Midwi$, Independent Midwi$, and 'nursing workforce'. In addition, hand searches of non-indexed journals and grey literature searches were completed. The following inclusion criteria were: (a) describing nurses, midwife and/or health visitor entrepreneurship (b) undertaken in the UK, and (c) reported between January 1996 and December 2005. Results. Of 154 items included only three were empirical studies; the remainder were narrative accounts. While quality of these accounts cannot be verified, they provide as complete an account as possible in this under-researched area. The numbers of nurses, midwives and health visitors acting entrepreneurially were very small and mirror international evidence. A categorization of entrepreneurial activity was inductively constructed by employment status and product offered. 'Push' and 'pull' influencing factors varied between types of entrepreneurial activity. Conclusion. Empirical investigation into the extent to which nurses and midwives respond to calls for greater entrepreneurialism should take account of the complex interplay of contextual factors (e.g. healthcare legislation), professional and managerial experience and demographic factors. [ABSTRACT FROM AUTHOR]

Objective To investigate midwives’ attitudes, values and beliefs on the use of intrapartum fetal monitoring. Design Qualitative, semi-structured interviews Subjects and setting Fifty-eight registered midwives in two hospitals in the North of England. Results In this paper two main themes are discussed, these are: informed choice, and the power of the midwife. Midwives favoured the application of informed choice and shared a unanimous consensus on the definition. However, the idealistic perception of informed choice, which included contemporary notions of empowerment and autonomy for women expressing an informed choice, was not reportedly translated into practice. Midwives had to implement informed choice on intrapartum fetal monitoring within a competing set of health service agendas, i.e. medically driven protocols and a political climate of actively managed childbearing. This resulted in the manipulation of information during the midwives’ interactions with women. This ultimately meant that the women often got the choice the midwives wanted them to have. Conclusions The information that a midwife imparts may consciously or subconsciously affect the woman's uptake and understanding of information. Therefore, the midwife has a powerful role to play in balancing the benefits and risk ratios applicable to fetal heart rate monitoring. However, a deeply ingrained pre-occupation with technological methods of intrapartum fetal monitoring over many years has made it difficult for midwives to offer alternative forms of monitoring. This has placed limits on the facilitation of informed choice and autonomous decision making for women. [ABSTRACT FROM AUTHOR]

'Great fleas have little fleas': Irish student midwives' views of the hierarchy in midwifery Background. Many studies have investigated the world of the student nurse, but there is little work into the lives and experiences of student midwives. Studies of Irish midwives' provision of care have demonstrated that they are not fulfilling their complete role, and research into their education was deemed to be necessary. Aim. To explore the opinions, feelings and views of student midwives as they progressed through their 2-year education programme in Ireland. Methods. Both quantitative and qualitative methods were used and the qualitative sections of the study were guided by the phenomenological approach. Ethical approval was granted. All students in the first intake of 1995 in all seven midwifery schools in Southern Ireland agreed to take part (n=125). Individual and group interviews, diary-keeping and questionnaires collected data. Results. The findings presented in this paper describe the students' views of the hierarchical structures in midwifery, and the role and behaviours of the 'Matron'. The data describes a subculture of nursing/midwifery subordination. Discussion. One reason for the hierarchical nature of the midwifery profession may be because it is an almost totally female-dominated profession, with the female hierarchy exercising control over other women within a male-based power structure. Many hospitals preferred to employ their own students as staff, ensuring a continuation of the hierarchical regime. Conclusion. The recurring nature of this problem may be because midwives now fear change more than they desire it. Further research is required to ascertain whether the reason for the strong hierarchy is because of the continuation of midwifery from the male-dominated profession of nursing, to the existence of the industrial/economic model of maternity care or to the impact of the medicalization of childbirth. [ABSTRACT FROM AUTHOR]

1. Working with women experiencing a mid-trimester termination of pregnancy is part of clinical practice in many gynaecological services. In this paper recent research with nurses working in the gynaecological area is drawn on to explore the issues for nurses working with women experiencing mid-trimester termination. Mid-trimester terminations are those carried out between approximately 12 and 20 weeks. 2. Mid-trimester termination results in the delivery of a fetus and this event requires sensitive management as it is has the potential to cause distress for the women due to the psychological and physical impact of the procedure. However, health professionals involved can also find this a distressing clinical event due to the complex nature of the management and care required. 3. Consideration of this clinical event from a feminist perspective led to my exploring the way in which feminist theory could be applied in the situation of mid-trimester termination. Using notions from feminist theory can assist in the management of this process, and feminist concepts related to the centrality of women's experience can be integrated into actual practice. 4. A series of recommendations are provided in this paper to show the way in which feminist concepts can be integrated into clinical practice. Integrating feminist principles into practice can support both the woman experiencing the abortion and the nurse whose role in the event is sustained and intimate, and result in positive outcomes for both women. This can result in an environment that is safe and supportive for all women involved in mid-trimester terminations. [ABSTRACT FROM AUTHOR]

Midwives’ attitudes to the use of the cardiotocograph machine Background. The literature would suggest that midwives’ attitudes towards the use of birth technology are mainly focused around issues of ‘trust and dependence’ yet there has been no published research to refute or substantiate these beliefs. Aim. This paper reports on an empirical study that aimed to identify midwives’ attitudes to technology usage in the labour ward and specifically the use of the cardiotocograph machine (CTG) for electronic foetal monitoring. Design. A postal survey was conducted and the questionnaire included a 25-item attitude scale, which was designed to assess attitudes towards the use of the CTG machine. All midwives (1086) on the United Kingdom Central Council register for Northern Ireland were surveyed. The data were factor analysed and compared using several categorical groupings including age, perceived skill, prior training with computers and trust in the machines. Results. The results indicate that midwives reject any notion of them being, or becoming, dependent on machines in their practice. However, midwives who trust machines are more disposed to their use and trust is affected by perceived competence. Conclusion. The paper concludes with a recommendation for the future education of midwives to develop and maintain competence based craft skills in natural birth as well as high-tech birth. [ABSTRACT FROM AUTHOR]

During the past decade, the professional journals have contained numerous papers authored by nurses and nurse -- researchers describing the gap which persists between research and clinical practice. Problems have been highlighted and challenges explored in the quest to discover ways of encouraging practitioners to become more aware of research evidence as a knowledge base for practice. Many of the identified issues may be transposed into a midwifery setting but other factors may be recognized which are specific to the practice of midwifery. This paper considers both conceptual and pragmatic issues in an attempt to explore the complexity of the influences which may affect the integration of research into midwifery practice. [ABSTRACT FROM AUTHOR]

This paper comprises essentially a discussion of the pilot of a study currently being undertaken to compare the practice styles of graduate and non-graduate nurses. The background to the main study is described and discussed, as is the methodology. The problems encountered in the planning and executing of the data collection are particularly highlighted. The paper does not present data from the pilot study, but evaluates the methodology used and considers the implications for the main study. [ABSTRACT FROM AUTHOR]

Aim: We explored midwives' experiences and challenges in providing maternity care during the period of the first surge of the COVID‐19 pandemic in Dodoma. Design: Phenomenological study design was used to explore midwives' experiences and challenges in providing maternity care during the COVID‐19 pandemic in Tanzania. Methods: We conducted interviews with a total of 23 midwives, using semi‐structured interviews and an audio recorder. Five focus group discussions (FGDs) were conducted. To analyse the data, we used interpretive phenomenological thematic data analysis with NVivo software. To analyse templates, we followed a step‐by‐step process, starting with familiarizing ourselves with the data, followed by preliminary coding, organizing themes, developing an initial coding template, using the initial template, refining the template and finally applying it to the entire dataset. Results: It was found that three themes and eight subthemes merged in the current study. The main themes were ① mental health distress, ② work environment challenges and ③ isolation of midwives by different groups. Public Contribution: Reducing risk and protecting midwives from infectious diseases will improve the workforce, reduce the number of hospital stays, reduce the cost of hospital services, improve birth outcomes and indirectly improve family, community and national economies. Conclusion: Due to the system's failure to provide psychological support, protective environment and isolation rooms for confirmed or suspected cases put midwives at a higher risk of contracting the virus and had to work in a stressful environment. In addition to having the right tools, midwives must also receive emotional and psychological support in order to be at their best. The system must ensure that midwives are ready for uncertain times, such as pandemic infectious disease outbreaks, by providing protective work place environment such as personal protective equipment, psychological support and isolation room for confirmed COVID‐19 cases. [ABSTRACT FROM AUTHOR]

Exclusive breastfeeding for the first 6 months of life offers the recommended best start in the life for a newborn baby. Yet, in Australia only a small number of babies receive breast milk exclusively for the first 6 months. Reasons for the introduction of formula milk are multi‐factorial including access to appropriate support and the woman's experience of breastfeeding. The language and practices of health professionals can impact upon how a woman feels about breastfeeding and her breastfeeding body. One aspect of breastfeeding support that has had scarce attention in the literature is the language used by health professionals to describe the behaviour of the breastfeeding infant during the early establishment phase of breastfeeding. This paper reveals some of the ways in which midwives, lactation consultants and breastfeeding women describe the newborn baby during the first week after birth. The study was conducted at two maternity units in New South Wales. Interactions between midwives and breastfeeding women were observed and audio recorded on the post‐natal ward and in women's homes, in the first week after birth. The transcribed data were analysed using discourse analysis searching for recurring words, themes and metaphors used in descriptions of the breastfeeding baby. Repeated negative references to infant personality and unfavourable interpretations of infant behaviour influenced how women perceived their infant. The findings revealed that positive language and interpretations of infant breastfeeding behaviour emerged from more relationship‐based communication. [ABSTRACT FROM AUTHOR]

Perinatal women are at risk of depression and/or suicidality. Suicide is the highest cause of indirect maternal deaths in the perinatal period. Midwives and maternal child health nurses ( MCHN), as key clinicians, need to be able to detect these mental health issues. Little is known about these clinicians' attitudes to suicide. In this paper, we report on the results of a cross-sectional study of midwives' and MCHN attitudes to suicide. A convenience sample of midwives ( n = 95) and MCHN ( n = 86) from south-eastern Victoria, Australia, was recruited into the study. Participants completed the Attitudes to Suicide Prevention Scale. The results showed that MCHN have more positive attitudes towards suicide prevention than midwives, and younger participants have more positive attitudes to suicide prevention compared to older participants. Midwives and MCHN could benefit from continuing professional education to build their knowledge and skills in assessing suicide risk for childbearing women and their families, increasing positive attitudes, improving detection, and mental health referrals. [ABSTRACT FROM AUTHOR]

Aim: To explore midwives' experiences with providing home‐based postpartum care during the COVID‐19 pandemic in Norway. Design: A descriptive and explorative qualitative study. Methods: The study is based on semi‐structured individual interviews with 11 midwives experienced in offering home‐based postpartum care. We explored their experiences of such care during the first wave of the COVID‐19 pandemic. Data collection occurred from October through November 2020. An inductive thematic analysis was performed using Systematic Text Condensation (STC) by Malterud (2012). Results: The following two main results emerged from the analyses: (1) the midwives adapted quickly to changes in postpartum care during the pandemic and (2) midwives saw the experience as an opportunity to re‐evaluate their practices. Conclusion: This study highlights midwives' resilience and adaptability during the first wave of COVID‐19 pandemic. It emphasises the crucial role of face‐to‐face interactions in postpartum care, while recognising the value of technology when direct access is limited. By shedding light on midwives' experiences, this research contributes to improving postpartum care in unforeseen circumstances. It underscores the significance of interdisciplinary integration in planning postpartum care services and the lasting influence of lessons learned on addressing future challenges. Implications for Practice: The valuable insights gained from lessons learned during the COVID‐19 pandemic may have a lasting influence on the postpartum care system, empowering it to tackle unforeseen challenges both today and in the future. Impact: The current study addressed midwives' experience with providing home‐based postpartum care during the COVID‐19 pandemic in Norway. Midwives received an opportunity to re‐evaluate their own practices and valued being included when changes were implemented. The current findings should alert policy makers, leaders and clinicians in postpartum care services when planning future practice. [ABSTRACT FROM AUTHOR]

Introduction: This study assessed views, understanding and current practices of maternity professionals in relation to impacted fetal head at cesarean birth, with the aim of informing a standardized definition, clinical management approaches and training. Material and methods: We conducted a survey consultation including the range of maternity professionals who attend emergency cesarean births in the UK. Thiscovery, an online research and development platform, was used to ask closed‐ended and free‐text questions. Simple descriptive analysis was undertaken for closed‐ended responses, and content analysis for categorization and counting of free‐text responses. Main outcome measures included the count and percentage of participants selecting predefined options on clinical definition, multi‐professional team approach, communication, clinical management and training. Results: In total, 419 professionals took part, including 144 midwives, 216 obstetricians and 59 other clinicians (eg anesthetists). We found high levels of agreement on the components of an impacted fetal head definition (79% of obstetricians) and the need for use of a multi‐professional approach to management (95% of all participants). Over 70% of obstetricians deemed nine techniques acceptable for management of impacted fetal head, but some obstetricians also considered potentially unsafe practices appropriate. Access to professional training in management of impacted fetal head was highly variable, with over 80% of midwives reporting no training in vaginal disimpaction. Conclusions: These findings demonstrate agreement on the components of a standardized definition for impacted fetal head, and a need and appetite for multi‐professional training. These findings can inform a program of work to improve care, including use of structured management algorithms and simulation‐based multi‐professional training. [ABSTRACT FROM AUTHOR]

The rise of managerialism within healthcare systems has been noted globally. This paper uses the findings of a scoping study to investigate the management of poor performance among nurses and midwives in the United Kingdom within this context. The management of poor performance among clinicians in the NHS has been seen as a significant policy problem. There has been a profound shift in the distribution of power between professional and managerial groups in many health systems globally. We examined literature published between 2000 and 10 to explore aspects of poor performance and its management. We used Web of Science, CINAHL, MEDLINE, British Nursing Index, HMIC, Cochrane Library and Pub Med. Empirical data are limited but indicate that nurses and midwives are the clinical groups most likely to be suspended and that poor performance is often represented as an individual deficit. A focus on the individual as a source of trouble can serve as a distraction from more complex systematic problems. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Senanayake H, Goonewardene M, Ranatunga A, Hattotuwa R, Amarasekera S, Amarasinghe I. Achieving Millennium Development Goals 4 and 5 in Sri Lanka. BJOG 2011;118 (Suppl. 2):78-87. Sri Lanka has an exemplary record in maternal and child health care. Provision of free education for over 60 years has helped to empower women. Medical care is accessible and provided free of charge. The maternal mortality ratio and the other indices of maternal and neonatal health have shown uninterrupted improvement since 1930. Midwives and the policy to increase their presence has been the key to success. Public health midwives provide care at the doorstep. Institutional midwives carry out the vast majority of deliveries, of which 99% occur in hospitals. Although on target with the Millennium Development Goals, some challenges that still remain are maternal death from postpartum haemorrhage and unsafe abortion, and perinatal deaths due to congenital abnormalities and prematurity. [ABSTRACT FROM AUTHOR]

Nursing and midwifery are priority professions for which there are current and future (projected) workforce shortages. This study takes a work—life perspective to examine the key workplace factors that impact on retention and well-being. Two qualitative studies are described. Study 1 explores the meaning of work—life interaction for these professionals, to inform the focus and emphasis of policy and practice initiatives. Study 2 presents an in-depth examination of five key issues: work scheduling, workload, accessing leave, child-care and casual work. It was clear that nursing and midwifery was a significant source of meaning, purpose and satisfaction in workers’ lives. However, the potential for high levels of work—life conflict and negative spillover of stress into non-work-life was very evident. The paper concludes with a summary of recommendations to improve administrative, procedural and cultural aspects of nursing and midwifery work to support and enhance work—life interaction and well-being. [ABSTRACT FROM PUBLISHER]