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Background: Given that AI-driven decision support systems (AI-DSS) are intended to assist in medical decision making, it is essential that clinicians are willing to incorporate AI-DSS into their practice. This study takes as a case study the use of AI-driven cardiotography (CTG), a type of AI-DSS, in the context of intrapartum care. Focusing on the perspectives of obstetricians and midwives regarding the ethical and trust-related issues of incorporating AI-driven tools in their practice, this paper explores the conditions that AI-driven CTG must fulfill for clinicians to feel justified in incorporating this assistive technology into their decision-making processes regarding interventions in labor. Methods: This study is based on semi-structured interviews conducted online with eight obstetricians and five midwives based in England. Participants were asked about their current decision-making processes about when to intervene in labor, how AI-driven CTG might enhance or disrupt this process, and what it would take for them to trust this kind of technology. Interviews were transcribed verbatim and analyzed with thematic analysis. NVivo software was used to organize thematic codes that recurred in interviews to identify the issues that mattered most to participants. Topics and themes that were repeated across interviews were identified to form the basis of the analysis and conclusions of this paper. Results: There were four major themes that emerged from our interviews with obstetricians and midwives regarding the conditions that AI-driven CTG must fulfill: (1) the importance of accurate and efficient risk assessments; (2) the capacity for personalization and individualized medicine; (3) the lack of significance regarding the type of institution that develops technology; and (4) the need for transparency in the development process. Conclusions: Accuracy, efficiency, personalization abilities, transparency, and clear evidence that it can improve outcomes are conditions that clinicians deem necessary for AI-DSS to meet in order to be considered reliable and therefore worthy of being incorporated into the decision-making process. Importantly, healthcare professionals considered themselves as the epistemic authorities in the clinical context and the bearers of responsibility for delivering appropriate care. Therefore, what mattered to them was being able to evaluate the reliability of AI-DSS on their own terms, and have confidence in implementing them in their practice. [ABSTRACT FROM AUTHOR]

Background/Aims In addition to the high rate of attrition among registered midwives, student midwives are increasingly likely to choose to leave their programme, decreasing the projected number of midwives who would join the NHS. The aim of this study was to understand how students experience clinical practice and if these experiences affect their decision to enter the professional register. Methods Seven student midwives who had experienced clinical placement as part of their pre-registration training were invited to attend semi-structured interviews. Data were analysed following an interpretive phenomonology approach, where descriptive, linguistic and conceptual comments on the transcripts were used to identify emergent themes. Results The 79 identified themes were categorised into five sub-themes within two super-ordinate themes: 'kindness and compassion grows future midwives and strength' and 'resolve through COVID-19 and beyond'. The overarching theme from the participants' interviews was 'I can be a good midwife when I qualify'. Conclusions Students want to feel like they will be good midwives, which will be achieved with positive attitudes and behaviours towards them from senior staff during clinical placements. Staff involved with the care of women and newborns should ensure they show students civility and patience while teaching and supporting them. Understanding the level of knowledge that students possess can make it simpler for staff to recognise what each student may or may not have been exposed to. [ABSTRACT FROM AUTHOR]

Objective: To determine impact of undertaking an international educational program during a nurse's or midwife's pre-registration program on subsequent practice, focusing on how nurses and midwives were transformed personally through participation in such programs. Background: Participation in international educational programs has been reported to enhance nursing and midwifery students' personal and professional development, however long-term impacts remain unclear. This paper presents findings drawn from a larger grounded theory study. Study design and Methods: Charmaz's grounded theory methodology was used to elicit experiences from 13 general nurses, two mental health nurses, three midwives and four dual qualified nurse/midwives across eight different countries. Data analysis led to the creation of three categories, with this paper reporting on the category of Developing as a Person. Findings: Participation in international educational programs can be transformative for nurses and midwives with long-lasting impacts, contributing positively to their personal growth and development. Discussion: The study findings underscore significant long-term impacts of international educational programs for nurses and midwives. These outcomes highlight the importance of incorporating international experiences into healthcare education. Conclusion: By providing opportunities for healthcare professionals to engage with diverse settings and populations, organisations and educational institutions can foster the development of well-rounded and globally competent practitioners. Implications for research, policy, and practice: The study's findings hold significant implications for research, policy, and practice in healthcare education. To deepen our understandings, additional longitudinal research across diverse countries is warranted. Policymakers have an opportunity to acknowledge the positive impact of these programs on the personal growth and development of nurses and midwives, potentially leading to the integration of global competency requirements into licensure programs. In order to provide comprehensive education, educational institutions should consider the inclusion of study abroad opportunities, cultural exchanges, and global clinical placements within nursing and midwifery curricula. What is already known about the topic? • International educational programs are widely used as a way of developing nursing and midwifery students' cultural understandings. • Previous studies have reported on short-term impacts of international educational programs. What this paper adds: • Long-term impacts of participation in an international educational program on nurses and midwives are described. • Personal development and subsequent transformations occur for nurses and midwives as a result of participation in international educational programs. [ABSTRACT FROM AUTHOR]

Background: Performing an episiotomy where clinically indicated is a key intervention in the Obstetric Anal Sphincter Injury Care Bundle (OASI‐CB) implemented across England and Wales to reduce the risk and increase the detection of severe perineal trauma after birth. Standards of consent provided to people in maternity care generally and for episiotomy specifically have been reported as suboptimal. Compromising birthing people's personal autonomy or sense of control has been linked to a dissatisfying birth experience, negative psychological sequelae, and litigation. Methods: This study explored experienced midwives' practice of informed consent for episiotomy during a midwife‐led birth. We sampled 43 midwives across eight NHS Trusts in England and Wales using online focus groups and telephone interviews about their experience of consent in episiotomy. Using qualitative content analysis and art‐based co‐analysis methods with eight midwives from across the research sites, we co‐analyzed and co‐constructed three themes and four practice recommendations from the data. Results: Three themes were constructed from the data: Assent rather than consent, Change in culture to support best practice, and Standardized information. These themes informed the shaping of four recommendations for best practice in episiotomy informed consent. Conclusion: This study has shown how variations in midwifery practice and culture may impact birthing people's experience of informed consent in episiotomy. Midwives may not have the knowledge or skills to conduct a detailed consent conversation, leading to variation in practice and messages for birthing people. The use of antenatal discussion aids can offer women the opportunity to become informed and fully participate in the decision‐making process. [ABSTRACT FROM AUTHOR]

Background: Choice in childbirth is not a new concept, yet it has been suggested that few service-users have a genuine choice about birth. Existing research has explored midwives' experiences of caring for service users birthing outside guidelines, but nothing is known about student midwives' experiences. This study's aim was to explore student midwives' experiences of caring for women giving birth outside the guidelines. Methods: A generic qualitative approach was used, and purposive sampling recruited five student midwives from a university in east England. Data were collected using semi-structured interviews and analysed thematically. Results: The three themes were 'contradictions', focusing on the incongruity identified in the narratives, 'the actions of clinicians' illustrated by clinician behaviour witnessed by the participants and 'punishment and judgement', which outlines the treatment of service users who gave birth outside the guidelines. Conclusions: Students can be exposed to inapt clinicians' behaviours, with the failure to protect and advocate for service users leaving them feeling anxious and potentially burnt out. Midwives should act as role models, so future midwives are aware this behaviour is not conducive to person-led care. [ABSTRACT FROM AUTHOR]

This study aimed to explore women's experiences of support and care received from maternity healthcare professionals for perinatal low mood or depression, and healthcare professionals' experiences of providing support and care for women experiencing perinatal low mood or depression. In this qualitative study, face‐to‐face individual semistructured interviews and focus groups were conducted with 15 women and 19 healthcare professionals living or working in Yorkshire and the Humber, England in 2019. Thematic analysis was used to analyze the qualitative data. The following themes were identified: (1) lack of standardization in identification and support for perinatal low mood and depression; (2) unclear and nonstandardized pathways for perinatal low mood and depression; and (3) enablers and barriers of receiving support and care for perinatal low mood and depression. Providing training opportunities for healthcare professionals, especially midwives, may be helpful for filling the gray area for women who do not need a referral to mental health services but require support from healthcare professionals. Improving the variety of psychological therapies for the treatment of perinatal depression may also be helpful to meet women's expectations of treatments. [ABSTRACT FROM AUTHOR]

Background/Aims: Understanding how midwives make decisions and what influences those decisions during labour and birth might illuminate why childbirth is straightforward for some women but needs a more interventionist route for others. The aim of this study was to explore midwifery decision-making during normal labour and birth. Methods: An interpretivist epistemology with a case-study approach was used for this study, which involved data collection at two case sites. The participants were midwives on duty at two labour suites of large regional teaching hospitals in the East Midlands. Focus group interviews, observations, diary keeping and documentary reviews were included. Results: There were five main themes. The central theme was 'the hybrid midwife'. Within this theme, midwives were found to be operating in dualistic belief systems. They were operating between woman-centred, intuitive philosophies and associated decision-making approaches, and organisation-centred, hypothetico-deductive philosophies and related decision-making strategies. From the literature review and study findings, the situated, dynamic midwifery decision-making framework 'focus on straightforward labour and birth' was developed to assist in midwifery decision-making. Conclusions: Decision-making in normal labour and birth is a complex phenomenon, influenced by many factors. Midwives have to balance decision-making strategies that are appropriate for childbearing women across all risk categories. However, they do not always appear to be fully prepared for the reality of decision-making in clinical practice. [ABSTRACT FROM AUTHOR]

Aim: To identify and describe the impact areas of a newly developed leadership development programme focussed on positioning leaders to improve the student experience of the clinical learning environment. Background: There is a need to consider extending traditional ways of developing leaders within the clinical learning in order to accommodate an increased number of students and ensure their learning experience is fulfilling and developmental. The Florence Nightingale Foundation implemented a bespoke leadership development programme within the clinical learning environment. Identifying the areas of impact will help to inform organisational decision making regarding the benefits of encouraging and supporting emerging leaders to undertake this type of programme. Method: For this qualitative descriptive study, eight health care professionals who took part in a bespoke leadership development programme were interviewed individually and then collectively. The Florence Nightingale Foundation fellowship/scholarship programme is examined to determine impact. Results: Two key themes were described in relation to impact of the programme. These were 'Personal Development' and 'Professional Impact'. The two key themes comprised several subthemes. The notion of time and space to think was subsumed within each theme. Conclusion: Data highlights that the Florence Nightingale Foundation programme had a distinct impact on participants by transforming thinking and increasing self‐confidence to enable changes to make improvements both within their organisations and at national level. Implications for Nursing Management: Health care managers must continue to invest in building leadership capacity and capability through programmes that can help position individuals to realize their potential to positively influence health outcomes and wider society. [ABSTRACT FROM AUTHOR]

Aims: To measure registered nurses', registered midwives', and nursing and midwifery students' current levels of knowledge, attitude and practices related to intimate partner violence. Background: Nurses and midwives whether registered or students need to be confident and competent in identifying and responding to intimate partner violence. Design A cross‐sectional survey. Methods: Data were collected through online surveys using the Physician Readiness to Manage Intimate Partner Violence Survey. Descriptive and inferential statistics were used to analyse the data. Results: Nursing and midwifery students were less knowledgeable and prepared than nurses and midwives. Midwives had more positive attitudes compared with nurses towards women experiencing intimate partner violence. Conclusions: Heath care institutions and regulatory bodies should provide resources and support to nursing and midwifery professionals. Personal experiences of domestic abuse and professional experience of supporting victims of domestic abuse/intimate partner violence affected practitioner's abilities to identify and manage intimate partner violence. Implications for Nursing Management: Nurse and midwifery managers can ensure that clinical and organisational policies and protocols are revisited and updated regularly and that interdisciplinary collaboration is promoted and emphasized for prompt identification and management of intimate partner violence. [ABSTRACT FROM AUTHOR]

Background: Research forms an important part of clinical practice for nurses, midwives and allied healthcare professionals (NMAHPs). However, it is known there is a lack of confidence in this community in the development and use of research skills. The 4Ps Programme is a bespoke research-training programme that focuses on four areas: place, project, person and plan., Aim: To report an evaluation of the 4Ps Programme that used a survey to record the confidence levels reported by NMAHPs., Discussion: An increase in participants' confidence was observed across all modules in the 4Ps Programme. This exceeded the standard deviation in the 'place' session, demonstrating genuine improvement. It was not possible to demonstrate a significant improvement in all cases. Low response rates affected the quality of the data obtained in the study, which would have benefitted from a more targeted approach to questions and better enabled the tracking of individuals' improvement over the course of the programme., Conclusion: Participation in bespoke, targeted training related to research could lead to an increase in NMAHPs' confidence in research-related activities. Efforts need to be made to refine the evaluation approach and improve response rates., Implications for Practice: The 4Ps Programme can improve research-related confidence. Improved and further longitudinal evaluation will assess its impact in developing future clinical academics., Competing Interests: None declared, (© 2024 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Although disgust is recognized as a common and prominent emotion in healthcare, little is known about how healthcare professionals understand, experience and conceptualize disgust. The aim of the study was to gain an in‐depth understanding of how nursing and midwifery students experience, understand and cope with disgust in their clinical work. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis (IPA). Six participants (all women: two nursing students, four midwifery students) from a university in the South of England were interviewed. Four superordinate themes with eight subthemes were identified. Overall, findings suggest that participants experience both moral and physical disgust; however, they find it difficult to talk about and use other terms to describe their experience. Findings are discussed through the lens of social identity theory, to understand the relevance of professional identity and how this might further maintain the disgust taboo. The strategies participants have developed in order to cope with disgust are explored and understood within the current healthcare climate. Future research should focus on ways of addressing the experience of disgust by healthcare professionals in order to improve the quality of care provided, especially in the climate of the COVID‐19 crisis. [ABSTRACT FROM AUTHOR]

Background High rates of poor mental health in healthcare staff threatens the quality and sustainability of healthcare delivery. Multi-factorial causes include the nature and structure of work. We conducted a critical review of UK NHS (England) data pertaining to: doctors, nurses, midwives and paramedics. Sources of data Key demographic, service architecture (structural features of work) and well-being indicators were identified and reviewed by a stakeholder group. Data searching prioritized NHS whole workforce sources (focusing on hospital and community health services staff), which were rated according to strength of evidence. Findings Key differences between professions were: (i) demographics: gender (nursing and midwifery female-dominated, doctors and paramedics more balanced); age (professions other than doctors had ageing workforces); ethnicity (greater diversity among doctors and nurses); (ii) service architecture: despite net staffing growth, turnover and retention were problematic in all professions; 41.5% doctors were consultants but smaller proportions held high grade/band roles in other professions; salaries were higher for doctors; (iii) well-being: all reported high job stress, particularly midwives and paramedics; sickness absence rates for nurses, midwives and paramedics were three times those of doctors, and presenteeism nearly double. Growing points Sociocultural factors known to increase risk of poor mental health may explain some of the differences reported between professions. These factors and differences in service architecture are vital considerations when designing strategies to improve well-being. Areas timely for developing research Multi-level systems approaches to well-being are required that consider intersectionality and structural differences between professions; together with inter-professional national databases to facilitate monitoring. [ABSTRACT FROM AUTHOR]

Background: Multidisciplinary team collaboration has been identified as a key factor in optimising intrapartum care. The way future doctors feel about their undergraduate placements with midwives is worth considering, given that this might influence their behaviour in the long term. This study aimed to investigate the experience of medical students working with midwives on NHS labour wards. Methods: Qualitative thematic analysis was done on transcripts of in-depth interviews with 10 medical students from across England. These students had clinical experiences with midwives or were seeking to work with midwives, and had experiences of training during or after 2010. Results: Midwives were described as 'gatekeepers', with the power either to open or close the labour room door to medical students. Participants described mixed feelings about midwives; some reportedly provided pivotal learning experiences, particularly regarding physiological labour and birth. Others were perceived as unsupportive. The dynamic with midwives was often linked to wider multidisciplinary team culture. Conclusions: Despite national calls to improve multidisciplinary team relations and undergraduate experiences, this sample of medical students shows that some still perceive tension with midwives. This may affect future obstetricians' exposure to physiological birth at an impressionable time and also influence their multidisciplinary team behaviour. Research into midwives' perspective is needed, given that collaboration is a key factor in providing safer, more personalised care. [ABSTRACT FROM AUTHOR]

This study explored the psychological experience of a small cohort of nursing and midwifery students who had been deployed to work in the NHS during the COVID-19 pandemic. The students were employed on band 4 contracts within an acute NHS Trust in the South of England. Overall, students found the experience of being deployed into clinical practice during a major public health emergency a valuable and unique experience that strengthened their resilience. However, students reported a significant level of personal obligation to opt-in to deployment. Working within clinical areas caused heightened anxiety and uncertainty, which was alleviated by managerial support. [ABSTRACT FROM AUTHOR]

Resilience in nursing and midwifery involves being able to manage ethically adverse situations without suffering moral distress and is key to mental wellbeing, staff retention and patient safety. The aim of this research was to ask what the psychological effects were for nursing and midwifery students who had been deployed to work in the NHS during the COVID-19 pandemic. This study looked at the incidence of burnout in a small cohort of nursing and midwifery students who were employed as band 4 aspirant nurses and midwives in acute NHS trusts in the south of England. The findings suggested that student midwives reported higher levels of emotional exhaustion and depersonalisation than student nurses but overall, both cohorts of students reported moderate levels of burnout. Part 2 will present the lived experience of deployment as described by students. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has impacted healthcare education and delivery, including both theory and practice learning. Academic staff responded rapidly to move teaching online during the first lockdown, with many returning to practice to deliver care or upskill practice staff to work in critical care. Many pre-registration students responded by becoming paid NHS employees, contributing to care delivery while remaining on their programme of study. Practice learning partners, despite the challenges of the pandemic, continued to support students to achieve their registration status. This occurred within the context of the Emergency and Recovery Standards, published by the Nursing and Midwifery Council between March 2020 and September 2021. This paper sets out the response of students, practice learning partners and higher education institutions involved in pre-registration nursing and midwifery programmes. [ABSTRACT FROM AUTHOR]

Background In the UK, simulation in midwifery education mostly relates to developing clinical skills such as managing obstetric emergencies. However, there is minimal use of neonate simulators in educating student midwives on the impact of teratogens on fetal development. There is also limited research on using neonatal simulators as a creative pedagogical tool in undergraduate midwifery education. Objectives The two main objectives of this study were to ascertain whether students could recognise the physical impact of teratogens in the early postnatal period while interacting with simulators and to explore whether midwifery students understood their role as future midwives when working with pregnant women who may be misusing substances. Methods This qualitative research involved Level 4 student midwives from south England. A taught session on protecting the unborn environment was provided and students were tasked to interact with low fidelity fetal alcohol syndrome simulators and medium fidelity drug affected simulators. Student responses to group activities, such as interacting with the simulators and considering their role as future midwives in educating pregnant women about the impact of teratogens on a fetus and newborn baby, were collected. Results The use of the simulators was a useful pedagogical tool for enhancing student knowledge around teratogenesis and fetal impact. Conclusions Neonatal simulators can be used to engage undergraduate midwifery students and enhance their learning and knowledge. [ABSTRACT FROM AUTHOR]

Background: Concerns are being expressed around the lack of diversity at higher levels of clinical academia. This study aimed to explore experiences and challenges associated with combining clinical academic careers with family life. Methods: Qualitative data were gathered from participants from 4 NHS Trusts and 2 universities in the East Midlands of England using online surveys and semi-structured interviews. Results: The survey was completed by 67 nurses, midwives and allied health professionals, and 73 medical clinical academic trainees. Interviews were conducted with 16 participants from each group including equal numbers of men and women. Caring responsibilities differed between the two study populations. Medical clinical academic trainees were younger and either had young children or were yet to start a family. In contrast, nurses, midwives and allied health professionals tended to be older when they embarked on a clinical academic career and often waited until their children were school-age or older. Similar concerns were raised regarding working part-time and childcare, and how their career prospects might be affected in terms of fulfilling promotion criteria and being able to relocate for work purposes. The occupation of their partners also featured in participants' experiences; those who shared childcare with someone who worked 'regular' hours, appeared to be better supported to combine a clinical academic career with family life. Gender stereotyping was identified in some reported experiences highlighting a need for appropriate mentorship and for positive role models who were able to demonstrate that it is possible to survive and thrive as a clinical academic with family responsibilities. Conclusions: Although people manage to find ways to successfully combine clinical academic roles with family life, findings highlight a need to identify ways of supporting and encouraging trainees with caring responsibilities to ensure that they remain on the clinical academic pathway. [ABSTRACT FROM AUTHOR]

Student midwives have to complete a demanding programme to become a midwife, and therefore it is questioned whether they need resilience to be successful. The study's aims were to explore whether resilience developed in one cohort of 25 undergraduate student midwives and what the concept of resilience meant to them. This study adopted a longitudinal case study approach in one Higher Education Institution in England during the first 18 months of their programme. The study used Wagnild and Young's (1993) (updated 2015) True Resilience Scale©, administered on three occasions. Additionally, four focus groups were conducted twice and six participants were involved in one-to-one interviews to explore issues raised in the focus group. SPSS Pairwise comparisons revealed that there were significant differences in True Resilience Scale© scores between the first and the second completion (p=0.034), and time one and time three (p=0.002); there were no significant differences between time two and time three (p=1.0). In this cohort of student midwives, the scale showed that the majority had developed their resilience during the study and this was supported in what the students reported. A conceptual model, which defines resilience for student midwives, is presented to strengthen how resilience can be supported and developed. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your awareness of the barriers that pregnant women with learning disabilities may experience in accessing maternity care • To identify reasonable adjustments that can be made to improve the care of pregnant women with learning disabilities • To learn about a service improvement initiative designed to raise healthcare professionals' awareness of the needs of women with learning disabilities during pregnancy An increasing number of women with learning disabilities are forming relationships and having children. These women are likely to have additional needs during pregnancy and to experience barriers in their access to maternity services. This article details a literature review on maternity care for women with learning disabilities during pregnancy and explains how the findings were used to inform the planning of a service improvement initiative. The literature review identified that this patient population is inconsistently and ineffectively supported by maternity services. Based on these findings, a service improvement initiative was designed to raise awareness of the needs of women with learning disabilities during pregnancy among healthcare professionals working in maternity services in Devon, England. It was decided that a one-day conference be held for up to 120 delegates in the summer of 2021. Its outcomes will be used to advance the service improvement initiative, create learning disability champions and provide practical suggestions on how reasonable adjustments can be made for women with learning disabilities during pregnancy. [ABSTRACT FROM AUTHOR]

The aim of this study was to qualitatively assess student perceived impact of a novel interprofessional approach to delivering education on sexual exploitation (SE). This article reports on research that we designed, delivered and evaluated to develop an interprofessional community of learning, enabling SE to be discussed with second-year undergraduate students. Participants came from a broad range of specialties. Following the study, students reported an increased level of awareness, understanding and confidence when working with SE. This interprofessional education session has since been incorporated into the nursing, midwifery and allied health programme in a local university and is part of a second-year undergraduate module on knowledge and skills for safe practice. [ABSTRACT FROM AUTHOR]

Background There is variation in undergraduate curriculum content related to abortion, both nationally and internationally. Aims To explore how student midwives perceived education related to abortion within a midwifery curriculum. Methods A qualitative exploratory survey design used an anonymised questionnaire to capture the perception of 60 student midwives on education related to abortion. Frequency, distribution and themes generated were synthesised using framework analysis. Results A total of 45 students responded. Overall, 16 were in first year, 15 were in second year and 14 were third year students. Of those who had received education about abortion, only five (2.25%) expressed that their learning needs about the topic had been met. A total of 40% (18) had cared for women seeking abortion while in clinical placement. There were two overarching themes that were identified: education and values. Conclusions The theory of abortion did not prepare the students for practice. Standardised midwifery content is required, covering definition, process, and legal aspects of care around abortion, on international, national and local levels. Empathy was enhanced by exposure to theory or practice and a safe, reflective, educational space is essential to explore how perceptions change after exposure to the topic. [ABSTRACT FROM AUTHOR]

Throughout the 19th century, midwives were depicted as incompetent slatterns in both popular imagery and medical literature. We examine how, between 1500 and 1800, midwifery was regulated by a combination of formal licensing by the Church and informal oversight within the community. We argue that episcopal licensing demanded that midwives demonstrate knowledge and competence in midwifery, not only that they were spiritually fit to baptise dying infants. Although episcopal licensing lacked statutory authority, the symbiosis of formal and informal systems of regulation ensured good midwifery practice and midwives were regarded as experts in all matters relating to childbirth. The Midwives Act 1902 introduced statutory regulation of midwives, restoring their 'professional status' if in a subordinate role. We show that the history of the regulation of midwives across four centuries casts light on the interplay between formal and informal regulation and matters of gender and professional status. [ABSTRACT FROM AUTHOR]

Background: Induced abortion is a common procedure. However, there is marked variation in accessibility of services across England. Accessing abortion services may be difficult, particularly for women who live in remote areas, are in the second trimester of pregnancy, have complex pre-existing conditions or have difficult social circumstances.Objective and Rationale: This article presents a two-part review undertaken for a new National Institute of Health and Care Excellence guideline on abortion care, and aiming to determine: the factors that help or hinder accessibility and sustainability of abortion services in England (qualitative review), and strategies that improve these factors, and/or other factors identified by stakeholders (quantitative review). Economic modelling was undertaken to estimate cost savings associated with reducing waiting times.Search Methods: Ovid Embase Classic and Embase, Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R), PsycINFO, Cochrane Library via Wiley Online, Cinahl Plus and Web of Science Core Collection were searched for articles published up to November 2018. Studies were included if they were published in English after 2001, conducted in Organization for Economic Co-operation and Development (OECD) countries and were: qualitative studies reporting views of patients and/or staff on factors that help or hinder the accessibility and sustainability of a safe abortion service, or randomized or non-randomized studies that compared strategies to improve factors identified by the qualitative review and/or stakeholders. Studies were excluded if they were conducted in OECD countries where abortion is prohibited altogether or only performed to save the woman's life. One author assessed risk of bias of included studies using the following checklists: Critical Appraisal Skills Programme checklist for qualitative studies, Cochrane Collaboration quality checklist for randomized controlled trials, Newcastle-Ottawa scale for cohort studies, and Effective Practice and Organization of Care risk of bias tool for before-and-after studies.Qualitative evidence was combined using thematic analysis and overall quality of the evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Confidence in the Evidence from Reviews of Qualitative Research (CERQual). Quantitative evidence was analysed in Review Manager 5.3 and overall quality of evidence was assessed using GRADE.Outcomes: Eight themes (service level barriers; financial barriers; logistical barriers; personal barriers; legal and policy barriers; privacy and confidentiality concerns; training and education; community prescribing and telemedicine introduce greater flexibility) and 18 subthemes were identified from 23 papers (n = 1016) included in the qualitative review. The quality of evidence ranged from very low to high, with evidence for one theme and seven subthemes rated as high quality. Nine studies (n = 7061) were included in the quantitative review which showed that satisfaction was better (low to high quality evidence) and women were seen sooner (very low quality evidence) when care was led by nurses or midwives compared with physician-led services, women were seen sooner when they could self-refer (very low quality evidence), and clinicians were more likely to provide abortions if training used an opt-out model (very low quality evidence). Economic modelling showed that even small reductions in waiting times could result in large cost savings for services.Wider Implications: Self-referral, funding for travel and accommodation, reducing waiting times, remote assessment, community services, maximizing the role of nurses and midwives and including practical experience of performing abortion in core curriculums, unless the trainee opts out, should improve access to and sustainability of abortion services. [ABSTRACT FROM AUTHOR]

Background: This is the second part of a series of two papers which explores the use of interpretative phenomenological analysis (IPA) within midwifery education in order to examine students' perspectives of the newborn infant physical examination (NIPE). Part one, featured in the British Journal of Midwifery volume 28, no 2, explains the background to the development of the study and explores the use of IPA within an emerging aspect of midwifery education. Part two of the series will present the research findings and implications for practice. Objectives: This study aims to explore the experiences of student midwives completing the theory and practice aspects of the NIPE within a pre-registration midwifery programme. Design: A qualitative design was utilised to analyse data collected by semi-structured interviews. Setting: A large university in the West Midlands geographical area. Participants: Five student midwives were purposively selected to participate in the study. Methods: This study was conducted using IPA. Findings: Three superordinate themes were generated: learning by doing, mentorship and transition to qualification. The findings demonstrate the significance of student midwives being exposed to the practical aspect of the NIPE during their training. Conclusions: The study findings indicate that standardisation is required within preparation to undertake the NIPE within clinical practice. Higher educational institutes must also provide greater support with regards to the mentorship of student midwife NIPE practitioners. Further research should examine the maintenance of the NIPE role within newly qualified midwives. [ABSTRACT FROM AUTHOR]

The NHS Multi-Professional Framework for Advanced Clinical Practice in England (Health Education England, 2017) sets out an expectation that all health and care professionals working at advanced clinical practice (ACP) level demonstrate a range of standard clinical academic capabilities across four pillars: clinical practice, leadership and management, education, and research. To achieve this, practitioners and employers need to work collaboratively to develop these capabilities and recognise how they contribute to improving the quality of care. However, the culture, leadership values and infrastructure of clinical practice environments limit opportunities for such clinical academic development (van Oostveen et al., 2017), resulting in a strong clinical bias amongst advanced practitioners with limited focus on research and leadership. To address this, we propose Nursing, Midwifery and Allied Health Professional (NMAHP) groups require specific development programmes that combine an academic, research and quality improvement experience grounded within clinical practice roles. In this article, we describe Western Sussex Hospitals NHS Foundation Trust Clinical Improvement Scholarship (CIS), a twelve-month programme combining work on a practice-based quality improvement project alongside education for leadership, research and quality improvement. Early indicators from the first and second cohorts suggest a significant increase in research and leadership knowledge with 'scholars' reporting increased commitment and confidence in utilising research evidence to improve care. Line managers also suggest a notable rise in professional confidence in the delivery of care and organisational competency. We therefore conclude that the CIS programme has impacted positively on professional capabilities and clinical quality within the Trust. [ABSTRACT FROM AUTHOR]

Many countries have adopted abstinence guidelines for pregnant women, due to uncertainty around the risk of harm caused by small amounts of alcohol. There is a lack of research exploring frontline midwives' attitudes towards alcohol use during pregnancy and comparisons of practices in different countries. Sixteen semi-structured interviews were conducted with midwives working in Liverpool, England (n = 7) and Örebro County, Sweden (n = 9). Data were analysed inductively, using thematic analysis with thematic networks. The findings show that all midwives believed pregnant women should be advised not to consume any alcohol during pregnancy and there is a need to tailor their approach to the individual. A key concern among midwives in both countries was how to advise about alcohol exposure that occurs before the pregnancy is known to the woman. English midwives discussed the uncertainty around the risk of consuming small amounts of alcohol, whereas Swedish midwives believed any amount of alcohol was associated with risk. Discussing alcohol was viewed as part of the health professional's role, but routine questions for all women were perceived to aid discussions about alcohol. Future research should further explore the impact of wider social and political environment on midwives' attitudes around risks with prenatal alcohol use. [ABSTRACT FROM AUTHOR]

Aim: To explore how adult, child, mental health nursing and midwifery students describe their "values journey" after completing their second year following exposure to the clinical practice environment. Background: Where student nurses and midwives are selected using multiple mini interviews, in a values‐based recruitment process, the conservancy and or development of their personal values remains unclear. Design: A hermeneutic, cross‐professional longitudinal study was commenced at one university in England in 2016 with data collection points at the end of years one (DC1), two (DC2) and three (DC3). From the 42 participants recruited in year one, 28 went on to participate in data collection at DC2 (3 adult, 6 child, 3 mental health nurses and 16 midwifery students). Methods: Four semi‐structured focus groups were conducted. Data analysis incorporated inductive and deductive approaches in a hybrid synthesis. Findings: Participants did not feel their values had changed fundamentally since year one. However, the prioritization of their values and how they were "put into practice" had changed. Key themes identified were: "changed sense of self as a healthcare practitioner"; "influences on values in practice" and "reflection on values." Conclusion: Reframing of personal values is an integral part of learning across clinical and academic settings. Critical reflective practice should be integrated into pre‐registration health education programmes to support student nurses and midwives sustain their learning around values; to maintain "good" values in the face of observed "bad" values. [ABSTRACT FROM AUTHOR]

Background: Decisions made in early labor influence the outcomes of childbirth for women and infants. Telephone assessment during labor, the current norm in many settings, has been found to be a source of dissatisfaction for women and can present challenges for midwives. The aim of this qualitative study was to explore midwives' views on the potential of video‐calling as a method for assessing women in early labor. Methods: A series of 8 midwife focus groups (n = 45) and interviews (n = 4) in the Midlands region of England and the mid‐South and Northeast regions of the United States were completed. Audio recordings were transcribed verbatim and coded using content analysis. Coding diagrams were used to help develop major themes in the data. Results: Midwives were generally positive about the potential of video‐calling in early labor and using visual cues to make more accurate assessments and to enhance trust. Some midwives expressed concerns about privacy, both for themselves and for women, and issues of accessibility. They suggested strategies for implementation and further research, such as the need for a private space in birth facilities and training for both staff and service users. Conclusions: Video‐calling was seen as a viable option for assessment of women in early labor with some particular challenges related to implementation. This research focused on midwives' views; the views of women and their families should also be considered. There is a lack of evidence on the clinical and cost effectiveness of video‐calling in maternity care and further research is warranted. [ABSTRACT FROM AUTHOR]

Abstract The objectives of this qualitative study were to describe the experiences of currently practicing newborn examiner midwives who had accessed their training post registration; explore their views on the inclusion of newborn examination in the pre-registration curriculum and invite them to identify strategies to achieve practical implementation of the inclusion of the newborn examination in pre-registration in the practice setting. Data were collected through semi-structured interviews and analysed using Thematic Analysis with an inductive approach. Three main themes were identified; experiences of the role, views of the newborn examination being incorporated into the pre-registration midwifery curriculum and practical considerations. The findings from this study show that currently practicing newborn examiner midwives accept the need for inclusion of the newborn examination in pre-registration midwifery education in order to sustain the best service for mothers and babies. The findings also indicate a need for ongoing interprofessional learning, support and investment to maximise efficiency of the service. Highlights • Newborn examination should be included in pre-registration midwifery standards. • There should be provision for interprofessional education of newborn examiners. • Service provision of newborn examiners should be reviewed to ensure sustainability. [ABSTRACT FROM AUTHOR]

Background: Literature on the management of gestational diabetes mellitus (GDM) and other pre-existing diabetic conditions in pregnancy suggest treatments that may ameliorate outcomes for both mother and neonates. Aims: To examine the effects of GDM on outcomes for mothers and neonates and the effects of maternal age, body mass index and gestational age at birth with or without induction of labour for women with GDM. Methods: Audit data of outcomes for GDM groups were analysed against outcomes for the general population of women giving birth in this unit. Descriptive statistics organised the data and inferential statistics determined the significant differences between frequencies. Findings: Most of the results were predictive when comparing women with and without GDM for mode of birth and outcomes for mothers and neonates. This included significant differences for hospital birth, induction of labour and caesarean section. Conclusion: Good glycaemic control and healthy lifestyle measures are advised to minimise development of obesity in women with GDM and diverse outcomes for both mothers and neonates. [ABSTRACT FROM AUTHOR]

Background. The newborn infant physical examination (NIPE) was previously known and described as examination of the newborn (EONB) and came under the remit of medical doctors. NIPE has now been undertaken by midwives for more than a decade, and it is time to explore the outcomes in holistic midwifery practice. Aim. To explore the factors that motivate midwives to undertake NIPE, post-registration midwifery course. Objectives. To find out whether midwives use the newly learned skills in practice; to examine factors influencing midwives' ability to integrate NIPE into holistic midwifery practice and to identify the best ways to bring about change in midwifery practice. Method. Using a grounded theory approach, 12 midwives and five heads of midwifery were interviewed. Data were collected through interviews and analysed using Strauss and Corbin's (1998) mode of grounded theory analysis. Ethical approval was obtained from the five participating NHS trusts. Findings. The substantive theory of 'integration of the examination of the newborn into holistic midwifery practice' was generated from the data encompassing four key categories: knowledge and training acquisition; change in culture, perception and practice; philosophy of midwifery; and political and financial drivers. The majority of participants believe they were delivering holistic care to mothers and babies. The participants believed that it was not necesssary to be an experienced midwife to undertake NIPE and that the training should be integral to the pre-registration midwifery curriculum. Their views indicate a belief that midwives do not need to be specialist or advanced practitioners to undertake NIPE. Conclusion. The researcher argues that this small study contributes to a greater understanding of midwives' roles and responsibilities in NIPE. It provides insight and understanding into why midwives are motivated to undertake additional training to facilitate them in providing holistic care for mothers and their newborn babies, and disputes the notion perceived by some practitioners of the need to be an advanced or specialist practitioner to undertake this role. [ABSTRACT FROM AUTHOR]

The recent 50th anniversary of the 1967 Abortion Act provides the opportunity to revisit what has been termed the ‘remarkable authority’ this Act ascribes to doctors. This paper does so using as its starting point a seminal commentary on this question by the renowned medical sociologist Sally Macintyre, published in this journal in 1973 as ‘The Medical Profession and the 1967 Abortion Act in Britain’. We revisit themes from that paper through an analysis of the findings of interviews with 14 doctors who, throughout lengthy careers, have provided abortions and led the development of the abortion service in England and Wales. We contrast our findings with Macintyre's, and argue that our interviews highlight the shifting meaning of medical authority and medical professionalism. We show that those doctors most involved in providing abortions place moral value on this work; uphold the authority of women (not doctors) in abortion decision-making; view nurses and midwives as professional collaborators; and consider their professional and clinical judgement impeded by the present law. We conclude that medical sociologists have much to gain by taking abortion provision as a focus for the further exploration of the shifting meaning of medical authority. [ABSTRACT FROM AUTHOR]

Background: There is evidence that midwives may find discussions about weight difficult with pregnant women with a raised body mass index (BMI). In previous studies, pregnant women have reported a lack of information and negative experiences. Aim: To explore the experiences of pregnant women with a raised BMI to investigate if their pregnancies were affected by their interactions with midwives and other health professionals. Methods: Women (n=11) were interviewed using an standardised framework. The discussions were recorded and then transcribed. Thematic analysis was used. Findings: Three themes emerged from the data: ‘feeling judged’, ‘knowledge gap’ and ‘doing your best’. Conclusion: Pregnant women with a raised BMI can feel judged in their communications with midwives and other health professionals. They do not have the information necessary to make informed decisions on their care but they do their best to follow guidelines and have a healthy pregnancy. [ABSTRACT FROM AUTHOR]

Abstract: Background: Most research on women experiencing stillbirth relies on online user group surveys or qualitative interviews. The objective of this study was to investigate the experience of women who are at a higher risk of stillbirth, living in areas of greatest deprivation, and are commonly not well represented. Methods: This study used birth and death registrations in 2012‐2013 to identify a sample of mothers whose babies had died as a result of stillbirth. These women were sent a survey 6‐9 months after the stillbirth. We undertook descriptive analysis of quantitative data and used binary logistic regression with the Index of Multiple Deprivation as a measure of disadvantage. We used thematic analysis to describe free text responses. Results: The survey response rate was 30% (N = 473). Ethnic minority, younger age, and single parenthood were associated with disadvantage. Women residents in the most deprived areas perceived care more negatively: during labor they were significantly less likely to be spoken to by medical staff so they could understand (73% compared with 90%, adjusted odds ratio [aOR] 0.33 [95% confidence interval {CI} 0.18‐0.65]), or treated with respect by midwives (79% compared with 90%, aOR 0.41 [95% CI 0.22‐0.77]). The qualitative themes identified were: “Difficulty in accessing care,” “More could have been done,” “Ineffective communication,” and “Cared for and not cared for” which support the quantitative findings. Conclusion: Women living in the most deprived areas reported poorer experiences of care compared with more advantaged women. All women need compassionate and sensitive care around the time of a stillbirth. [ABSTRACT FROM AUTHOR]

Background: There is compelling evidence for the benefits of exercise during pregnancy for both the mother and fetus. Aim: To investigate the attitudes and beliefs of physiotherapists and midwives in the North of England regarding the provision of recreational exercise during pregnancy and to identify the sources of information used to influence this. Method: This study used an observational cross-sectional design. A questionnaire was divided into three sections: demographic information, attitudes and beliefs about recreational exercise, and sources of information. The questionnaire was distributed to a convenience sample of 152 physiotherapists and 168 midwives in the North of England. Descriptive statistics and frequency tables were calculated. Findings: The majority of the findings were positive in relation to attitudes and beliefs about recreational exercise during pregnancy among healthcare practitioners. Conclusion: It is clear from this study that continuing professional development is required to update some healthcare professionals' knowledge base. [ABSTRACT FROM AUTHOR]

Background: The NHS Litigation Authority's ‘sign up to safety’ campaign aims to prevent undiagnosed breech birth and possible poor birth outcomes. An audit was completed following the introduction of hand-held scanning ultrasound examination. Aims: The hand-held ultrasound was used by midwives for all women in labour and before induction of labour to confirm presentation. Methods: A criterion-based retrospective audit, conducted over 6 months in 2016, with a sample of 2737 women. Findings: The audit demonstrated that 22 breech presentations were detected when using the hand-held ultrasound before induction of labour or in labour. The audit standard of 100% of women receiving an ultrasound scan was not met, and potential reasons are explored. Conclusions: The results support the use of hand-held ultrasound, as it did detect breech presentation before induction of labour or spontaneous labour and birth. Further work includes the audit of the reasons that hand-held ultrasound scanning was not used, to ensure that a targeted action plan can be created. Future research into midwifery values, cultural attitudes and the effectiveness of abdominal palpation is also needed, to develop the knowledge base on which scanning can be framed. [ABSTRACT FROM AUTHOR]

Objectives To identify the existing antenatal information provision practices for pregnant women with intellectual disabilities in England. To identify how practices between and within local supervising authorities differed, and if midwives were adapting standard antenatal information for pregnant women with intellectual disabilities, including examples of accessible information being used. Study design Cross-sectional survey. Methods All contact supervisors of midwives from acute trusts with maternity services were accessed via the local supervisor of midwives officers' databases and sent a questionnaire. Quantitative data were collated. Associations between trust size, geographical location, antenatal provision and National Institute for Health and Care Excellence guidelines alongside National policy were examined using Fischer's exact test of association. Results Contact supervisors of midwives returned a questionnaire on behalf of their trust (74, 53%). The majority worked in maternity units with more than 4000 births a year (50, 66%). Few trusts had a specialist or lead midwife in post for pregnant women with intellectual disabilities (17, 22.9%) but over half (39, 52.7%) reported that their trust had a specialist learning disability nurse in post. Only 28.3% reported availability of post registration training and even fewer (8, 10.8%) had access to written protocols. Less than half reported extra time being offered at the booking (29, 39.1%) or routine antenatal appointments (30, 40.5%). Less than a quarter (17, 22.9%) reported that their trust had routine antenatal written information available in accessible formats. Conclusion Reasonable adjustments to standard antenatal information for pregnant women with intellectual disabilities were not common practice. Most trusts did not have local guidelines in place or offer midwives post registration education to help support them in this requirement. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To explore how adult, child and mental health nursing and midwifery students, selected using multiple mini interviews, describe their ‘values journey’ following exposure to the clinical practice environment. Background: Values based recruitment (VBR) incorporates assessment of healthcare students’ personal values using approaches like multiple mini interviews. Students’ experience of adjustment to their values during their programme is conceptualized as a ‘values journey’. The impact of VBR in alleviating erosion of personal values remains unclear. Design: A cross‐professional longitudinal cohort study was commenced at one university in England in 2016 with data collection points at the end of years one, two and three. Non‐probability consecutive sampling resulted in 42 healthcare students (8 adult, 8 child and 9 mental health nursing and 17 midwifery students) taking part. Methods: Six semi‐structured focus groups were conducted at the end of participants’ Year One (DC1). Data analysis incorporated inductive and deductive approaches in a hybrid synthesis. Findings: Participants described a ‘values journey’ where their values, particularly communication, courage and wanting to make a difference, were both challenged and retained. Participants personal journeys also acknowledged the: ‘courage it takes to use values’; ‘reality of values in practice’ and ‘need for self‐reflection on values’. Conclusion: A ‘values journey’ may begin early in a healthcare student's education programme. This is important to recognize so that appropriate interventions designed to support students in higher education and clinical practice can be implemented. The values incorporated in VBR should be continually evaluated for fitness for purpose. [ABSTRACT FROM AUTHOR]

Aims and objectives: To report the findings from an evaluation of the impact of the Compassion in Practice Vision and Strategy (National Health Service England (NHSE), 2012) on nursing, midwifery and care staff. Background: The Compassion in Practice Vision and Strategy was a programme of work to highlight the importance of compassionate care following the Francis Report in 2013 into the deficits in care in an NHS Hospital Trust. It was launched by NHS England in 2012 at a time when fiscal cuts were introduced by the Department of Health in England. Design and setting: Mixed methods. Results: Inferential statistics were used to test whether there were significant differences between staff at different levels of seniority with regard to awareness and involvement in Compassion in Practice Vision and Strategy and their attitudes to it. Awareness and involvement of staff in Compassion in Practice Vision and Strategy were high amongst middle and senior management but limited at ward level. Staff involvement in Compassion in Practice Vision and Strategy was limited due to a lack of awareness. Ward level staff who were aware and involved, perceived a lack of support and communication from senior leadership to deliver the Compassion in Practice Vision and Strategy. Discussion: Results reveal professional anger, distress and resistance to the Compassion in Practice Vision and Strategy and a view of the programme as a top‐down initiative which did not sufficiently recognise structural constraints on nurses’ ability to deliver compassionate care. We discuss the implications of our findings for global nursing. Conclusion: Participants emphasised that compassion for patients is only sustainable where there is compassion for staff and many participants felt that they were not being treated with compassion. Relevance for clinical practice: National Health Service England should strongly affirm that nurses and midwives in general provide compassionate care. Trust leadership should provide support for ward level staff who deliver compassionate care in difficult circumstances. [ABSTRACT FROM AUTHOR]

This article describes the experience of one university team in developing, delivering and evaluating an online Nursing and Midwifery Council-approved mentorship programme for nurses and midwives who support pre-registration students in practice. Although the authors are confident of the quality of the educational provision, this article does not discuss this programme as an exemplar of best practice, but aims to share the learning gained from the experience of introducing a digital learning version of a mentorship course. [ABSTRACT FROM AUTHOR]

This paper outlines why experienced supervisors at a London healthcare provider received skills training so they could offer safeguarding supervision to front-line colleagues with case management responsibilities for vulnerable children and young people. It examines how supervisors use the main functions of supervision and a cycle of reflection in clinical practice with supervisees. As well as the professional issues encountered by supervisors in relation to the benefits, the challenges of providing supervision and the action required to make safeguarding supervision a part of the organisational culture are also explored. [ABSTRACT FROM AUTHOR]

Background. NICE UK guidelines (2003) recommended screening for fetal abnormalities, in particular Down syndrome, was to be universally offered to all pregnant women. Aim. To explore key aspects of women's experiences of being offered screening for fetal abnormalities. Objective. To understand the impact of the guideline recommendations on women's autonomy with a focus on non-directive/directive information-giving. Method. A qualitative study drawing upon literature and a constructivist grounded theory approach (Charmaz, 2014), using semi-structured, face-to-face interviews. Ethics. Ethical approval was granted by a national research ethics service ethics committee. Setting. An inner-city teaching hospital in north-west England. Recruitment. Women were identified by their clinical care team in the antenatal clinic and subsequently approached by the researcher when between 20 and 36 weeks' gestation. Participants. Six women of between 27 and 35 weeks' gestation took part in the study. Data saturation was the key determinant of sample size. Saturation was reached when no new issues arose. Findings. Data analysis identified five themes: the importance of reciprocal trust and familiarity in decision-making; compelled to choose; restricting options; eager to choose ; little concept of choice. The grounded theory of 'striking a balance' was generated. Conclusion. Recommendations in the guidelines should place greater emphasis on asking women questions and learning from them so as to better understand their individual needs and tailor their care accordingly. [ABSTRACT FROM AUTHOR]

Objective:The current study aimed to explore student midwives’ awareness, knowledge, and experiences of supporting women with antenatal anxiety (ANA) within clinical practice. Background:ANA is associated with negative outcomes for mother and baby. Midwives play a key role in the screening of antenatal mental health and care of women suffering from ANA. Methods:This study was conducted with student midwives at one UK university in the north-west of England. Twenty-five midwifery students completed a brief online survey informed by National Institute of Health and Care Excellence (NICE) guidelines. Of these, seven volunteered to participate in semi-structured interviews exploring the survey data. The interview topic guide was designed based on the findings of the survey. Results:Thematic analysis of the seven interviews revealed four overarching themes:Perpetuating factors,Barriers to care,Skills required in roleandSuggestions for future directions.Midwives had a varied knowledge and understanding of ANA and expressed a desire to learn more about their role in supporting women with ANA. Conclusion:Although a small study, the results highlight the need for education to be improved in order to best prepare student midwives for cases of ANA, with emphasis on integrating psychology and mental health information into teaching as well as time spent in clinical practice. Midwives are key in the screening of women for ANA and are in an ideal position to signpost for specialist care. [ABSTRACT FROM AUTHOR]

Background: For the past decade, Maternal Mortality Reports, published in the United Kingdom every three years, have consistently raised concerns about maternal observations in maternity care. The reports identify that observations are not being done, not being completed fully, are not recorded on Early Warning Score systems, and/or are not escalated appropriately. This has resulted in delays in referral, intervention and increases the risk of maternal morbidity or mortality. However there has been little exploration of the possible reasons for non-completion of maternal observations.Methods: The aim of this study was to explore midwives' experiences of performing maternal observations and escalating concerns in rural and urban maternity settings in the West Midlands of England. A qualitative design involving a series of six focus groups with midwives and Supervisors of Midwives was employed to investigate the facilitators of, and barriers to the completion of maternal observations.Results: Eighteen Midwives and 8 Supervisors of Midwives participated in a total of 6 focus groups. Three key themes emerged from the data: (1) Organisation of Maternal Observations (including delegation of tasks to Midwifery Support Workers, variation in their training, the care model used e.g. one to one care, and staffing issues); (2) Prioritisation of Maternal Observations (including the role of professional judgement and concerns expressed by midwives that they did not feel equipped to care for women with complex clinical needs; and (3) Negotiated Escalation (including the inappropriate response from senior staff to use of Modified Early Warning Score systems, and the emotional impact of escalation).Conclusions: A number of organisational and cultural barriers exist to the completion of maternal observations and the escalation of concerns. In order to address these the following actions are recommended: standardised training for Midwifery Support Workers, review of training of midwives to ensure it addresses the increasing complexity of the maternal population, identification and agreement regarding the organisation of maternal observations among staff, an emphasis on increasing the priority placed on maternal observations in all clinical settings, and clarification and reinforcement of escalation procedures for both midwives and senior clinicians. [ABSTRACT FROM AUTHOR]

In 2012, after several high-profile cases of poor quality care in England and concerns about a lack of compassion and a need to refocus on values, the Department of Health in England published a new strategy for nursing, midwifery and care staff: Compassion in Practice. The strategy included the 6Cs (care, compassion, courage, communication, competence and commitment) and in the follow-on framework, produced by NHS England in 2016, the 6Cs were included again. This article explains the background to the 6Cs and highlights the other values frameworks that nurses and midwives must work within too. Nursing theorists have studied caring extensively and the earlier set of 6Cs, produced by a Canadian nurse Sister Simone Roach, is explained in the article. The meaning of the DH’s 6Cs is then explored in detail with reference to previous research and nursing theory. [ABSTRACT FROM AUTHOR]

Following an increase in the incidence of whooping cough (pertussis) in the general population from 2011, coupled with neonatal pertussis mortality seen in 2012, a programme of maternal pertussis immunisation was introduced to the UK in the same year. The programme aims to provide passive immunity from birth, until active immunity can be provided through the routine immunisation programme from 8 weeks of age. Since its introduction, evaluation of the vaccine given in pregnancy has demonstrated its safety, efficacy and patient acceptability. Uptake of the vaccine has reached 70% and its continued use is an opportunity to protect newborn babies from a serious and sometimes fatal vaccine-preventable infection. Midwives should discuss pertussis immunisation with pregnant women and either signpost them to their GP to receive it or, if commissioned to do so, administer the vaccine themselves. [ABSTRACT FROM AUTHOR]