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Background/Aims: Midwifery degrees require students to study for 3 years, during which they are assessed both academically and in practice placements. This study's aim was to explore year-by-year associations between assessment grades and students' ethnicity as they progressed through their degree. Methods: Retrospective data collected at a single university in the UK were analysed using descriptive statistics. The cohort and variables were stratified by student ethnicity, year of study and assessment grades given for academic work and placement practice assessments. Results: While Black, Asian and minority ethnic students started with lower practice assessment grades in year 1, this improved such that there was no difference in attainment by year 3. In contrast, university academic grades were consistently lower for Black, Asian and minority ethnic versus White students, and this pattern did not change throughout the degree programme. Conclusions: The likely factor in lower final degree outcomes among Black, Asian and minority ethnic students is not from practice assessments but academic performance. Targeted interventions that recognise different learning styles and educational experiences in the university environment may address and improve this inequality in attainment. [ABSTRACT FROM AUTHOR]

Purpose: Undiagnosed urinary tract infections (UTIs) in pregnancy are associated with adverse perinatal outcome. Urine microbiology cultures reported as 'mixed bacterial growth' (MBG) frequently present a diagnostic dilemma for healthcare providers. We investigated external factors contributing to elevated rates of (MBG) within a large tertiary maternity centre in London, UK, and assessed the efficacy of health service interventions to mitigate these. Description: This prospective, observational study of asymptomatic pregnant women attending their first prenatal clinic appointment aimed to establish (i) the prevalence of MBG in routine prenatal urine microbiology cultures, (ii) the association between urine cultures and the duration to laboratory processing and (iii) ways in which MBG may be reduced in pregnancy. Specifically we assessed the impact of patient-clinician interaction and that of an education package on optimal urine sampling technique. Assessment: Among 212 women observed over 6 weeks, the negative, positive and MBG urine culture rates were 66%, 10% and 2% respectively. Shorter duration from urine sample collection to laboratory arrival correlated with higher rates of negative cultures. Urine samples arriving in the laboratory within 3 hours of collection were most likely to be reported as culture negative (74%), and were least likely to be reported as MBG (21%) or culture positive (6%), compared to samples arriving > 6 hours (71%, 14% and 14% respectively; P < 0.001). A midwifery education package effectively reduced rates of MBG (37% pre-intervention vs 19% post-intervention, RR 0.70, 95% CI 0.55 to 0.89). Women who did not receive verbal instructions prior to providing their sample had 5-fold higher rates of MBG (P < 0.001). Conclusion: As many as 24% of prenatal urine screening cultures are reported as MBG. Patient-midwife interaction before urine sample collection and rapid transfer of urine samples to the laboratory within 3 hours reduces the rate of MBG in prenatal urine cultures. Reinforcing this message through education may improve accuracy of test results. [ABSTRACT FROM AUTHOR]

The UK and Brazil both have sizable populations with significant demands on antenatal and maternity care. However, access to different healthcare professionals and knowledge regarding the importance of maternal nutrition vary widely between the two countries. This article compares the different approaches used in maternal nutrition between the UK and Brazil, seeking to share best practice and improve antenatal care. [ABSTRACT FROM AUTHOR]

Sam Foster , Executive Director of Professional Practice, Nursing and Midwifery Council, discusses the work that is progressing on nursing and midwifery student education, including simulated practice learning.

Background: Student nurses in the United Kingdom undertake field-specific pre-registration education. The implementation of the Nursing and Midwifery Council (2018) Future nurse: Standards of proficiency for registered nurses, has raised concerns that the increasingly generic component of pre-registration programmes is not adequately preparing newly qualified children's nurses to care for children safely., Objective: To investigate how the introduction of the Nursing and Midwifery Council standards in the United Kingdom has impacted the structure and field specific content of pre-registration children's nursing programmes., Settings: An online survey completed by 54 programmes, field, or professional leads linked to 76 pre-registration children's nursing programmes. This represents 80 % of higher education institutions with Nursing and Midwifery Council approved pre-registration children's nursing programmes across all four United Kingdom countries., Methods: A survey to capture the current content and changes to curricula since the introduction of the Nursing and Midwifery Council (2018) Future nurse standards. The survey included closed-ended and open-ended questions. Closed-ended questions were statistically analysed using SPSS v.28 for Windows. Open-ended questions were thematically analysed using Quircos v.2.1., Results: 50 % of respondents reported changes to theoretical content. In 27 programmes (35.5 %) there was a decrease in child-specific content. Child specific teaching methods accounted for less than 30 % of the content of all programmes whereas cross-field teaching methods (Adult, Mental Health, Learning Disability and Child learners together) accounted for over 70 % of the taught content. Analysis of qualitative data identified three themes: genericism as the focus, the challenge to achieve the standards' proficiencies, and dilution of child specific content., Conclusions: The survey responses show disparities in how United Kingdom higher education institutions have interpreted the Nursing and Midwifery Council standards highlighting academics concerns on the growing genericism within pre-registration children's nurse education nationally. These findings will inform the next stage of the project comparing the impact of greater or lesser degrees of genericism on the outcomes of the programme for newly qualified children's nurses., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier Ltd.)

In this article, Mavis Kirkham reflects on changes since she first worked in maternity care in the UK as a student midwife in 1971. She ceased clinical practice as a midwife in 2016, although still has many links with midwifery. Her analysis of the present state of midwifery and of midwifery care challenges all those who are committed to woman-centred care to step back and see what is happening to the trusting relationships that women and their families so urgently need as they prepare for and bring a new life into the world. [ABSTRACT FROM AUTHOR]

Background: Despite considerable efforts there continues to be a degree awarding gap within the United Kingdom (UK) between the proportion of White British students receiving higher classifications, compared to ethnic minority UK-domiciled students. Practice placement elements constitute approximately 50% of most health and social care programmes, yet surprisingly little research exists related to the factors which may contribute to ethnic minority student placement outcomes or experiences. This study bridges this evidence gap by exploring factors influencing differential placement outcomes of ethnic minority students from the perspectives of key stakeholders. Methods: The study followed a descriptive qualitative research design and was multi-disciplinary, with participants drawn from across nursing, midwifery, social work and the allied health professions. Participants from four stakeholder categories (ethnic minority students, academic staff, placement educators and student union advisors) were invited to join separate focus groups. Focus groups were recorded and transcribed and analysed thematically. Results: Ten separate focus groups [n = 66] yielded three primary themes: 1) recognition, which highlighted stakeholder perceptions of the issues [sub-themes: acknowledging concerns; cultural norms; challenging environments]; 2) the lived experience, which primarily captured ethnic minority student perspectives [sub-themes: problematising language and stereotyping, and being treated differently]; 3) surviving not thriving, which outlines the consequences of the lived experience [sub-themes: withdrawing mentally, feeling like an alien]. Conclusion: This study presents a rich exploration of the factors affecting differential outcomes of ethnic minority students on practice placements through the lens of four different stakeholder groups. To our knowledge this is the first study in which this comprehensive approach has been taken to enable multiple viewpoints to be accessed across a wide range of health and social care professions. The issues and challenges raised appear to be common to most if not all of these disciplines. This study highlights the urgent need to value and support our ethnic minority students to remove the barriers they face in their practice learning settings. This is a monumental challenge and requires both individuals and organisations to step up and take collective responsibility. [ABSTRACT FROM AUTHOR]

Background: Congenital cytomegalovirus (CMV) infection is a leading cause of sensorineural hearing loss and neuro-disability in childhood. In the absence of a licensed vaccine, adoption of hygiene-based measures may reduce the risk of CMV infection in pregnancy, however these measures are not routinely discussed with pregnant women as part of National Health Service (NHS) antenatal care in the United Kingdom (UK)., Methods: An exploratory qualitative study was conducted, underpinned by Normalization Process Theory (NPT), to investigate how an educational intervention comprising of a short film about CMV may best be implemented, sustained, and enhanced in real-world routine antenatal care settings. Video, semi-structured interviews were conducted with participants who were recruited using a purposive sample that comprised of midwives providing antenatal care from three NHS hospitals (n = 15) and participants from professional colleges and from organisations or charities providing, or with an interest in, antenatal education or health information in the UK (n = 15)., Findings: Midwives were reluctant to include CMV as part of early pregnancy discussions about reducing the risk of other infections due to lack of time, knowledge and absence of guidance or policies relating to CMV in antenatal education. However, the educational intervention was perceived to be a useful tool to encourage conversations and empower women to manage risk by all stakeholders, which would overcome some identified barriers. Macro-level challenges such as screening policies and lack of official guidelines to legitimise dissemination were identified., Discussion: Successful implementation of education about CMV as part of routine NHS care in the UK will require an increase in awareness and knowledge about CMV amongst midwives. NPT revealed that 'coherence' and 'cognitive participation' between service members are vital to imbed CMV education in routine practice. 'Collective action' and 'reflexive monitoring' is required to sustain service changes., (© 2024. The Author(s).)

An introduction to articles in the issue is presented on topics including literature review of autistic women's experiences, pregnancy, birth and the postpartum period and the benefits of continuity of carer for autistic women and the positive experiences of women who felt heard and respected when communicating their needs.

To present a bibliometric overview of pedagogical research from Nurse Education in Practice from its inception in 2001 up until 2023. Bibliometric methods are useful in analysing and understanding the characteristics of scientific publications in a particular field and the influence of specific journals. However, no bibliometric analysis of a nurse education journal has been undertaken to date which would highlight important research trends in this area of nursing and midwifery. A total of 2231 publications (articles and reviews only) from Nursing Education in Practice were retrieved from the Scopus database between 2001 and 2023. Several software applications including Microsoft Excel and VOSviewer were used to undertake bibliometric analysis on this dataset. Publication trends such as country analysis, author analysis, keywords analyses (cluster, content and trend analysis) were generated to help understand the volume and scope of pedagogical nursing and midwifery research in this journal. There has been a steady increase in pedagogical research from Nurse Education in Practice since its launch in 2001 up until 2018, with a dip in publications in 2022 most likely due to the impact of restrictions during the coronavirus pandemic. The most prolific institutions publishing in the journal are mainly from the United Kingdom, Australia and the United States, with over eighty countries represented demonstrating its global reach and impact. Nursing students, nursing education, simulation and learning are some of the most frequent author keywords. The diversity of pedagogies in nursing and midwifery education, clinical learning and supervision in practice environments, and competence and confidence when transitioning to practice are the most popular research areas in Nurse Education in Practice. This study informs nurse and midwife educators and scholars about the volume and scope of pedagogical research in nursing and midwifery. It also makes recommendations on how to improve aspects of scholarship in education and areas for future pedagogical research. [ABSTRACT FROM AUTHOR]

In this column, the associate editor of The Journal of Perinatal Education raises the question "Is Normal Birth Safe through critical analysis of questions raised by the Ockenden Report in the UK. The associate editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate current education and training of student and registered midwives across the UK and Spain; analysing both pelvic floor teaching and practical experience.Study Design: A cross-sectional survey was carried out by 711 student and 384 registered midwives across different universities and regions in the UK and Spain.Results: The vast majority (91.5 % n = 382) of UK students complete training without ever cutting or repairing an episiotomy. This compares to 39.4 % (n = 85) of registered midwives who did not cut an episiotomy during training. Only 20 % (n = 9) of Spanish and 10 % (n = 45) of UK registered midwives felt confident undertaking these techniques. In Spain just 15 % (n = 6) of students, compared to 54.8 % (n = 80) of registered midwives had received teaching on longer-term pelvic floor complications.Conclusion: There is a considerable deficit in the current training practices for midwives regarding episiotomies. This lack of practice and confidence may be impacting on the increased rates of perineal tears and pelvic dysfunction in post-partum women. Across registered midwives there are gaps in education regarding longer-term pelvic floor complications. Our study was limited by a smaller sample size from Spain compared to the UK. Our results show practical assessment of skills during training is desirable and could improve both the confidence and competence of midwives upon registration. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore student midwives' theoretical knowledge of intrapartum intermittent auscultation, their confidence in, and their experience of this mode of fetal monitoring., Design and Setting: An online cross-section survey with closed and open questions. Descriptive statistics were used to analyse participants' intermittent auscultation knowledge, confidence, and experience. Reflexive thematic analysis was used to identify patterns within the free text about participants' experiences., Participants: Undergraduate midwifery students (n = 303) from Nursing and Midwifery Council-approved educational institutions within the United Kingdom., Findings: Most participants demonstrated good theoretical knowledge. They had witnessed the technique being used in clinical practice, and when performed, the practice was reported to be in line with national guidance. In closed questions, participants reported feeling confident in their intermittent auscultation skills; however, these data contrasted with free-text responses., Conclusion: This cross-sectional survey found that student midwives possess adequate knowledge of intermittent auscultation. However, reflecting individual clinical experiences, their confidence in their ability to perform intermittent auscultation varied. A lack of opportunity to practice intermittent auscultation, organisational culture, and midwives' preferences have caused student midwives to question their capabilities with this essential clinical skill, leaving some with doubt about their competency close to registration., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The psycho-social, economic and political impact of COVID-19 on women and the future midwifery workforce [ABSTRACT FROM AUTHOR]

An introduction to the first issue of 2024 is presented which includes articles discussing topics related to midwifery education including research on midwifery students' experience of clinical placement and an article on how to build strong foundations for students learning leadership and management skills.

Background: The construction and performance of professional identity is significant to broader socio-cultural understandings of who 'professionals' are and what they do. Importantly, it is also implicated in the development and enactment of policy, regulation, education, and professional practice. Professional identity is linked to self-esteem, self-efficacy, professional value, confidence and success. The salience of this in relation to midwifery practice is highly significant; aspects of autonomy, confidence, competence, responsibility, and accountability are all implicated in the provision of safe and effective care., Aim: To explore how student midwives are constructed in the discourses of policy, professionalism, and learning, to provide new perspectives to inform, policy, education, and practice., Methods: An adapted critical discourse analysis of the United Kingdom (UK) Nursing and Midwifery Council's 2009 Standards for pre-registration midwifery education, using a three-step process: exploring discourse at the level of (1) discursive practice (2) linguistic features of the text, and (3) social practice., Findings/ Discussion: The discourses that relate to midwifery education and practice emerge within socio-political and historical contexts. Constructions of identity are articulated through a rule-bound framework which includes competence, confidence and 'good health and good character'. There is a requirement for midwives to 'be' responsible, accountable, autonomous, professional, competent, and confident. Regulatory power is reinforced through medico-legal discourses, with the status of midwifery discursively presented as inferior to medicine., Conclusion: According to the Standards, midwives must be a lot of things in their role and function. The Standards' discourses are authoritative, legislative and controlling, creating an ideology about professional status and agency which constructs an 'imaginary autonomy'; becoming a midwife is more automatic (with the perception of control), than agentic. All of which has significance for the social practice of midwifery., Tweetable Abstract: 'How are midwives made? Discursive constructions of student midwives' professional identities: a discourse analysis., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To evaluate caesarean section (CS) rates and moderate to severe hypoxaemic ischaemic encephalopathy (HIE) rates with other core intra-partum outcomes following reconfiguration of maternity services in Cardiff, South Wales, UK.Design: Cohort study of births from 2006 to 2015.Settings: A University tertiary referral centre for foetal and maternal medicine with 6000 births/year, University Hospital of Wales, United Kingdom.Method: Data relating to births from 1 January 2006 to 31 December 2015 were extracted from the computerized maternity database on a yearly basis. Case notes of all mothers and babies for the same duration were hand searched for documentation of HIE. HIE data was also collected prospectively by neonatologist (SC) and obstetrician (PA).Main Outcome Measures: Incidence of caesarean section births, babies with moderate to severe HIE, instrumental vaginal births, obstetric anal sphincter injuries (OASIS) associated with instrumental delivery, and major post-partum haemorrhage (MPPH) of 2500 mL or more.Results: During this 10-year period, a downward trend in emergency CS rate was seen from 15.6% in 2006 to 10.5% in 2015, reducing total CS rate from 25.5% in 2006 to 21.2% in 2015. A downward trend in the incidence of moderate and severe HIE was seen over the same period. There was an increase in operative vaginal births (OVB) from 12.8% to 15%. The rate of spontaneous vaginal births (SVB) remained stable. The incidence of OASIS remained constant and MPPH rate has fallen.Conclusions: Following amalgamation of two medium sized obstetric units and the opening of a Midwifery Led Unit (MLU), core intrapartum outcomes have improved. Contributing factors are the introduction of regular multidisciplinary training with enhanced team working, compulsory education for obstetricians and midwives on cardiotocograph (CTG) interpretation, increased consultant presence on delivery suite, robust risk management systems and broad multidisciplinary agreement on clinical guidelines promoting vaginal birth. [ABSTRACT FROM AUTHOR]

Background: Undiagnosed breech presentation in labour is associated with fetal morbidity and mortality, and may cause significant maternal anxiety. With increasing availability of scan machines, ultrasound is now widely used in UK maternity settings. Bedside presentation scans are usually undertaken by junior doctors, often leading to delays and frustration among staff and patients. Aims: To assess local practices and attitudes towards midwives scanning for presentation. Methods: A nine-question anonymous online survey was first disseminated by email locally, and then via social media. It was open to all UK non-sonographer midwives and midwifery students. A total of 870 responses were received between January and April 2018. Findings: The survey highlighted significant variation in practice across the UK. Of those who did not scan for presentation, 85.2% felt that being able to do so would improve their practice, with the majority of respondents highlighting improvements in patient safety and satisfaction as well as workflow. Conclusions: This demonstrates that demand exists for a postgraduate or accredited short course to teach midwives how to safely and accurately scan to assess fetal presentation. [ABSTRACT FROM AUTHOR]

Grading of practice has been incorporated into the Nursing and Midwifery Council's midwifery education standards since 2009. The literature identifies that grading practice can be fraught with challenges not least related to subjectivity, inconsistency, lack of transparency and grade inflation. An established group of UK-wide lead midwife educators recognised these challenges and through completing a three-phase project, developed an evidence-based practice assessment toolkit which aims to facilitate consistent, robust and objective grading of student practice. It is suggested that this toolkit may be useful to those developing practice assessment documentation or writing evidence to reflect a student's progress and achievement in practice [ABSTRACT FROM AUTHOR]

Abstract This paper presents the final phase of a national project exploring grading of practice in programmes leading to registration as a midwife in the United Kingdom. The aim was to develop a generic framework for grading practice, enhancing standardisation while enabling flexibility in application of current and new educational standards. A mixed method on-line survey considered existing practice assessment tools, factors contributing to robust and reliable assessment and perceptions of two assessment tools developed by the research team: a 'Lexicon Framework' and 'Rubric' , which were tested through scenarios. Participants included 170 midwifery and nursing academics, clinicians and students, representing 20 universities in the UK. Seven key themes emerged, from which an 'Evidence Based Model for Professional Practice Assessment' was developed. The proposed tools were overall positively evaluated and demonstrated a good level of reliability. A national tool to standardise midwifery practice assessment is recommended, and scope for transferability of our tools to all midwifery programmes and to nursing was identified. Other recommendations include engagement of key stakeholders in development of practice assessment documentation, and maintaining the professional purpose of grading practice as central to the process. A set of key principles for assessing practice is presented. Highlights • A national tool to standardise midwifery practice assessment is recommended. • Key stakeholders should engage in development of practice assessment documentation. • The professional purpose of grading practice should be central to the process. • Key principles and an evidence based model for assessing practice are presented. • A toolkit of generic resources supporting practice assessment is near completion. [ABSTRACT FROM AUTHOR]

Abstract This paper details a competency framework to help address the need for structured guidance around genetic and genomic education and training for midwives. A one-day expert panel consensus meeting was convened to review and revise a previously published joint framework for nurses, midwives and health visitors. Fifteen midwives from practice, management, education and policy and three genetic counsellors (two with midwifery backgrounds) attended. An in-depth knowledge of genetics/genomics was not a requirement. Personal narratives covering a range of experiences across the pre- and post-natal periods were used to stimulate discussion and debate. Identified themes were mapped to the original framework to identify gaps and differences. Inclusion of additional themes into the new framework was voted upon. All original competencies were found to be valid but required amendment in order to focus specifically on the role of the midwife and the needs of the mother, child and wider family. Revisions have resulted in a framework that is more directive and which addresses the time-critical nature of information-giving, decision-making, testing and referral that are crucial components of midwifery practice. Learning outcomes and practice indicators offer educators and trainers a means of developing student/staff knowledge and skills over time and with increasing experience. Highlights • Genomics is an integral component of the maternal and family health care pathway. • This is the first genomics competency framework explicitly for midwifery practice. • Learning outcomes and practice indicators develop over time and with experience. • Competencies are written to accommodate future genomic advances in midwifery. • Genomic competence can improve care, consistency and safety for women and families. [ABSTRACT FROM AUTHOR]

This paper discusses the UK Government's public consultation into the NHS bursary and the response from the Nursing and Midwifery Council. A public consultation stipulated that the current arrangements for funding, by the State, were not to be considered for discussion. Instead, the consultation only appraised views that would lead to the successful introduction of student finance loans for NHS professional education. Testimonies from nurses, midwives and nursing students expressed concern that the new funding arrangements were unaffordable, dis-incentivising and biased towards the marketisation of student loans in the UK, yet the changes went ahead. The changes to NHS bursary funding resulted from the UK Government's desire for growth in student numbers (and ostensibly not growth in financial figures), and the fact that nursing (and other healthcare) students will become more fiscally indebted, despite society's moral obligation to them. [ABSTRACT FROM AUTHOR]

Objective: To ascertain how midwives perceived attending a mindfulness course impacted on their professional practice, particularly in regard to any stress they experienced at work. Design: A qualitative study using Interpretive Phenomenological Analysis. Semi‐structured interviews were conducted with nine midwives. Setting: A large maternity Trust in the United Kingdom. Intervention: An eight‐week mindfulness course, adapted from mindfulness‐based cognitive therapy. Findings: Four superordinate themes were identified as follows: “being challenged and committing,” “containing the self,” “reconnecting” and “moving forward with confidence.” Focusing on the present moment enabled participants better to identify the boundary between self and other. This led to an increased sense of control and a reconnection with and reframing of relationships with colleagues and the women in their care. Key conclusions: Mindfulness may provide an effective way to address the high levels of stress, role dissatisfaction and workplace bullying found in midwifery, by improving both the working environment and patient care. The pivotal role of positive workplace relationships in this process resonates with other nursing research and with contemporary philosophical thought. Relevance to clinical practice: This study adds to a body of evidence which suggests investing in the well‐being of midwifery staff improves both job satisfaction and women's experiences of care. [ABSTRACT FROM AUTHOR]

Aim To provide a unique model for use in guiding global collaboration and policy to upscale nursing and midwifery partnerships. Background and introduction Nurses and midwives across nations need skills reaching beyond the bedside and unit level in today's complex, global, multifaceted healthcare milieu. Thoughtful consideration, research and concomitant development of models to guide appropriate upscaling of nurse and midwifery capacity within and between nations are needed. Discussion This article explores an integrated global approach to upscaling nurse and midwifery capacity using examples of partnerships between nursing and midwifery programmes across multiple continents. Conclusion and implications for nursing Global nurse and midwifery capacity is effectively being developed using a myriad of approaches. A new model is presented to illustrate supports, strategies and activities to achieve intermediate and long-term goals for capacity building through strong and sustainable global partnerships. Implication for nursing policy Development of global skills can focus the nurse and midwife to influence policy-level decisions. Human resource planning that can impact countrywide provision of health care begins in the preservice setting for both nurses and midwives. A global experience can be a value-added component to the well-rounded education of future nurses. Education during preparation for entry into practice is a strategic way to develop a worldview. Incorporating reflective practice can build skills and shape attitudes to prepare the new nurse to be comfortable as a global healthcare provider. An expanded world view is the springboard to more robust and informed involvement and inclusion in policy-level discussions. [ABSTRACT FROM AUTHOR]

Background. UK midwives are educated in one of two ways: non-nurses undertake 'long' (three- to four-year) programmes, and nurses complete a 'shortened' programme of study (typically 18 to 24 months). When numbers of qualified midwives are particularly low, commissioners of midwifery programmes and employers might consider increasing the number of places on the shortened programme. How students perform on the shorter programme would, therefore, seem to be a topic of some importance, though there is currently little research evidence available on this subject. Aim. In the face of staff shortages and sweeping changes to midwifery education, this paper outlines a study that set out to investigate the views of experienced midwifery lecturers about students on the shortened programmes. Method. An exploratory descriptive design using an online survey with 12 questions was used. The key concepts of interest were: the preparedness and commitment of students applying to the short programme; their numerical and writing skills; transition to the role of the midwife; transferable nursing skills; and attrition. The questionnaire was distributed via an online platform to all lead midwives for education (LMEs) throughout the UK. In total, 62 midwifery lecturers responded to the survey. A favourable ethical review was received from the university research ethics committee and gatekeeper approval was achieved via the chair of the UK LME group. The questionnaire responses were analysed with simple descriptive statistics, using numbers and percentages only. Free-text comments were analysed using simple qualitative thematic analysis. Findings. Students on the shortened programme were generally thought to be prepared for and committed to midwifery. However, there was some concern about those who left to return to nursing, and their writing and numerical skills were not generally described as excellent. The students were thought to bring valuable nursing skills with them. Nevertheless, over 50% of experienced lecturers thought that the nurses on the shortened programme were unable to challenge the status quo. Also, they were thought to be less able than expected to undertake the decision-making client-choice aspects of the midwife's role. Implications. Midwives in the UK are expected to be autonomous as lead professionals in maternity care and therefore they need to develop excellent decision-making skills to assist women to achieve their choices, even if this requires challenging traditional practices. This study may inform planning for the future of midwifery education and influence planning for research into midwifery education. [ABSTRACT FROM AUTHOR]

Despite continuity of carer being signalled in policy in 1993 (Department of Health, 1993), it remains a largely elusive aspiration in the UK. This has implications for midwives with regards to how well they can apply the Nursing and Midwifery Council (NMC) Code (NMC, 2015) and their navigation of some of its inherent tensions. From the perspective of a new student midwife, this article discusses the advantages of caseloading in applying the Code and suggests ways in which student midwives might draw from the caseload model, bringing some of its strengths into mainstream practice. [ABSTRACT FROM AUTHOR]

Background Novice midwives at one NHS Trust undertook a 12-month preceptorship programme, designed to support them to consolidate their education and develop their competence. The study was commenced following concerns voiced by new midwives about levels of support during their transition, and also because of a high rate of attrition of newly qualified midwives at the Trust. Aims The aim of the study was to evaluate the experiences of newly qualified midwives during their preceptorship at the Trust. Methods A qualitative research design was applied. A sample of eight midwives provided data collected using a process of semi-structured interviews. Findings The findings of the research demonstrated that most of the midwives felt well-supported by their colleagues. However, although a preceptorship programme was in place at the Trust, barriers to implementing the programme included staffing levels, time for consolidation, not receiving protected time with preceptors and differences to allocated supernumerary time. Conclusions Recommendations were made for practice to include effective monitoring of the programme, and the provision of a specific Trust guideline for the preceptorship of newly qualified midwives. Providing individualised preceptorship pathways with supernumerary time in each clinical area was also recommended. [ABSTRACT FROM AUTHOR]

Introduction: Smoking in pregnancy in the United Kingdom remains prevalent (11%). To encourage and support pregnant smokers to quit, midwives must be adequately trained to do so. Substantial curricular gaps have been identified in the smoking cessation training of medical, nursing, and optometry schools. This study aimed to identify the extent of smoking cessation training and assessment in UK midwifery schools.Methods: All UK undergraduate midwifery schools (n = 53) were invited to complete a web-based survey of their curricular coverage and assessment related to smoking cessation, and perceived barriers to delivering smoking cessation training.Results: Twenty-nine (55%) midwifery schools responded. Most teaching was completed in the initial year of study. All reported teaching the harmful effects of tobacco use. The majority of respondents (83%) reported training students in brief intervention delivery and ways to assist quit attempts. Only 24% of schools in this study included relapse prevention in their curriculum. The most frequently reported barriers to teaching smoking cessation were "lack of knowledge amongst staff" (17%), "no space in a crowded curriculum" (17%), and "administrative problems" (13%).Conclusions: Midwifery schools are teaching the harmful effects of smoking and providing training on brief interventions. However, in some schools student midwives are not being sufficiently trained on relapse prevention or assessed in the practical skills necessary for delivering evidence-based interventions.Implications: Midwifery schools should revise the content and delivery of smoking cessation training to ensure midwives are equipped with the necessary knowledge and skills to contribute to the challenge of smoking cessation in pregnancy. [ABSTRACT FROM AUTHOR]

Public health is now clearly defined in policy and statute as an integral part of the midwife's role and this work continues to develop as health challenges emerge and diversify. To clarify the knowledge and skills required by contemporary midwives, this article provides an overview of health promotion and public health concepts and discusses how these are embedded in midwifery policy. The approaches and processes midwives should adopt are considered and an analysis of public health learning in midwifery education highlights areas that need to be addressed. This paper concludes with recommendations for midwifery preregistration education to develop the underpinning public health knowledge and skills that midwives require for optimum practice. [ABSTRACT FROM AUTHOR]

It is recommended that students experience caseloading and continuity models of care as part of their clinical learning (Health Education England, 2013; Nursing and Midwifery Council, 2009). Student midwives from the University of Salford have the option of a placement at the Jane Crookall Maternity Unit in the Isle of Man. This article discusses student midwives' evaluation of an innovative clinical placement on the Isle of Man that facilitates this model of care. This evaluation considers the perspectives of student midwives, service users and midwives following the commencement of this placement link in an island setting that provides continuity of care. [ABSTRACT FROM AUTHOR]

Aim To reduce variations in grading of midwifery practice and enhance reliability of assessment. Background The first phase of a national project showed there to be widely ranging interpretation and application of professional educational standards in relation to grading of practice in midwifery. This raised concerns about reliability and equity of professional assessment. The second phase therefore sought to achieve consensus on a set of core principles. Methods A participatory action research process in two stages, using a Mini-Delphi approach. Educational leads from all 55 institutions delivering midwifery programmes nationally were invited to participate. Stage one : Questionnaire comprising 12 statements drawn from the findings of the initial phase of the project. Stage two: Face-to-face discussion. Findings Statements were categorised based on questionnaire responses: 1) Consensus, 2) Staged consensus, 2) Minor modifications, 4) Controversial. Consensus was achieved on 11 core principles through group discussion; only one was omitted from the final set. Recommendations All midwifery programmes nationally to incorporate the agreed core principles. Findings should be disseminated to the regulatory body to help inform changes to midwifery and nursing educational standards. The core principles may also contribute to curriculum development in midwifery and other professions internationally. [ABSTRACT FROM AUTHOR]

In 1995, all pre-registration health education moved into higher education, signalling a shift from the apprenticeship model to an academic one. Since 2008, the Nursing and Midwifery Council has required all pre-registration midwifery programmes to be offered at degree level only, with a required practice-to-theory ratio of no less than 50% practice and no less than 40% theory. Individual education institutions vary in how these requirements are met in terms of learning and teaching strategies. This article explores literature in relation to the ‘learning styles’ pedagogical approach, which advocates that all students have a particular preferred learning style and will learn best if they are allowed to learn in their preferred style. The key question is: What are the most appropriate learning and teaching strategies to support student midwives to develop the skill set required to meet the demands of contemporary practice? [ABSTRACT FROM AUTHOR]

Aims This study aimed to assess the scope of newborn infant physical examination (NIPE) education in post-registration midwifery education, determine the structure and requirements for midwives undertaking NIPE training, and explore similarities and differences in pre- and post-registration preparation requirements. Methods In early 2015, all lead midwives for education in the UK were sent a link to an online questionnaire to assess the scope and practice of NIPE education across all midwifery curricula. This is the second of a two-part report, focusing on post-registration education; part A examined the education provision for the inclusion of NIPE in the midwifery curriculum. Findings NIPE education for midwives is popular and is well established in the post-registration curriculum. Variations exist in the length, content, assessment, levels of study and credits awarded for post-registration NIPE modules. This lack of standardisation raises questions about quality assurance. Conclusion The variation in module length has implications for commissioners and self-funding students, as longer NIPE modules are more costly. There is a strong argument for a standardised NIPE programme across the UK and for providers of maternity services to fully utilise midwives who have been trained in NIPE to avoid them becoming de-skilled. [ABSTRACT FROM AUTHOR]

Aims This study aimed to assess the scope of newborn infant physical examination (NIPE) education in programmes of pre-registration midwifery education. Methods An online questionnaire was sent to all lead midwives for education in the UK. Findings are reported in two parts: part A (the current paper) examines the education provision for the inclusion of NIPE in the midwifery curriculum. Part B (a subsequent paper) explores NIPE education as a post-registration module. Findings Of 58 education institutions, 40 (68.9%) completed the questionnaire. A quarter (25.0%) stated that NIPE training is included in their pre-registration midwifery programmes; 37.5% reported plans to implement it within the next 2–5 years and 30.0% had no plans to do so. Benefits for practice partners, commissioners, students and service users were identified. Challenges were noted, particularly in relation to resources and student support in practice. Conclusion Although barriers doubtless exist, the success of the few institutions that have incorporated NIPE into their curricula is evidence that this is not only possible, but has proven benefits. [ABSTRACT FROM AUTHOR]

Background An interprofessional education initiative was developed and piloted in 2014 at Queen’s University Belfast, within the School of Nursing and Midwifery and the School of Medicine. Aims The aim of the collaboration was to introduce concepts of normal labour and birth to fourth-year medical students, led by final-year midwifery students. Methods A variety of birthing resources were available to the midwifery students to promote interactivity with the medical students, including birthing balls and birth manikins. Artistic licence in relation to planning the activities was encouraged. Significant emphasis was placed on the importance of relationship-building with women in labour, and the concept of being ‘with woman’ was core to all elements of teaching. Midwifery students undertook acting roles such as the labouring woman, partner or midwife role and acted out mini scenarios such as contacting for advice about early labour, positions for labour or positions for birth. Medical students were encouraged to participate in the role play, and the interactive workshop culminated with a hands-on simulation of childbirth. Findings Evaluation of the workshops has been extremely positive. The midwifery students reported a perceived benefit of teamwork in preparing for the workshop and also a perceived increased level of confidence. Conclusion Both schools have recognised the benefits of this form of inter-professional education and have subsequently made a commitment to embed it within their respective curricula. [ABSTRACT FROM AUTHOR]

Background: Institutional racism within the United Kingdom's (UK) Higher Education (HE) sector, particularly nurse and midwifery education, has lacked empirical research, critical scrutiny, and serious discussion. This paper focuses on the racialised experiences of nurses and midwives during their education in UK universities, including their practice placements. It explores the emotional, physical, and psychological impacts of these experiences., Methods: This paper draws on qualitative in-depth interviews with participants from the Nursing Narratives: Racism and the Pandemic project. Of the 45 healthcare workers who participated in the project, 28 participants obtained their primary nursing and midwifery education in UK universities. Interviews with these 28 participants were selected for the analysis reported in this paper. We aimed to employ concepts from Critical Race Theory (CRT) to analyse the interview data in order to deepen our understanding of the racialised experiences of Black and Brown nurses and midwives during their education., Findings: The interviews revealed that the healthcare workers' experiences coalesced around three themes: 1) Racism is an ordinary, everyday experience; 2) Racism is operationalised through power structures; and 3) Racism is maintained through denial and silencing. Experiences often touch on a series of issues, but we have highlighted stories within specific themes to elucidate each theme effectively. The findings underscore the importance of understanding racism as a pandemic that we must challenge in response to a post-pandemic society., Conclusion: The study concludes that the endemic culture of racism in nurse and midwifery education is a fundamental factor that must be recognised and called out. The study argues that universities and health care trusts need to be accountable for preparing all students to challenge racism and provide equitable learning opportunities that cover the objectives to meet the Nursing and Midwifery Council (NMC) requirements to avoid significant experiences of exclusion and intimidation., Competing Interests: Declaration of competing interest All authors declare no conflict of interest., (Copyright © 2023. Published by Elsevier Ltd.)

The purpose of this study was to identify the current LGBTQ+ health content within midwifery pre-registration programmes and identity education best practice and innovation. There have been significant developments in some countries in protecting the rights of LGBTQ+ people. LGBTQ+ people are and do become parents and require access to maternity services. Yet some report heteronormative assumptions, negative and discriminatory attitudes from midwives that results in barriers to service access and feelings of exclusion. This mixed-methods study involved a quantitative and qualitative design. The qualitative findings are reported here. All 135 Schools of Nursing and Midwifery across the United Kingdom and Ireland were invited to participate in an online survey and qualitative interview. Thematic analysis of the qualitative data from 29 survey responses and seven midwifery follow-up interviews were conducted. Three themes identified following data analysis: (i) preparing midwifery students for practice; (ii) the diverse family unit; and (iii) safety, privacy and respect. The findings provide insights into the challenges of meeting the education needs of midwifery students, with an opportunity to develop and implement a curriculum that is reflective of the needs and concerns of LGBTQ+ people within pre-registration midwifery programmes. [ABSTRACT FROM AUTHOR]

This study explored the lived experiences of racial bias for Black, Asian and Minority Ethnic students undertaking an undergraduate or post-graduate degree in nursing, midwifery and allied health courses in the United Kingdom. Previous research indicates that students from Black, Asian and Minority Ethnic groups have fewer opportunities to succeed at university and this has brought about a race awarding gap in their degree attainment. The reasons for this awarding gap are complex and multi-factorial and it is crucial that the lived experiences of racial bias are explored from the student perspective. A hermeneutic phenomenological approach was adopted to elicit individual and collective experiences in the practice environment, a mandatory component of the student's degree. A focus group and individual semi-structured interviews were conducted to collect data from sixteen participants and analysed using thematic analysis Three encompassing themes were identified which included a sense of not belonging , trauma impact on mental health and understanding covert and overt racism. Participants reported incidences of racism and appeared to be traumatised by their experiences within practice and the university. They also reported poor mental health and well-being as shared experiences and a lack of confidence in the university and practice to mitigate racial issues. Meaningful action must be taken by universities and practice partners to advance racial inequality initiatives by having robust anti-racism action plans and processes. These should be co-created with students and staff to reduce the race awarding gap. [ABSTRACT FROM AUTHOR]

To explore international experiences of using blended learning in preparing nursing and midwifery students for initial professional registration to inform future education policy. The global nursing and midwifery skills shortage and need for an expanded nursing workforce that is fit for contemporary care delivery is widely acknowledged. The immense pressure the profession was already under because of austerity, staff shortages and increasingly complex healthcare needs has been worsened by the Covid-19 pandemic. The UK is extending and evaluating the use of blended learning programmes for pre-registration nursing and midwifery students to help address these issues. This study sought to explore relevant nursing and midwifery experiences from outside the UK to help inform future health professional education policy here and elsewhere. Cross-sectional, sequential, mixed methods study Nursing/nurse education leaders from across International Council of Nurses regions Exploratory online survey (n = 32) and three follow-up case studies (March-May 2021). Participants' knowledge and experiences of blended learning were examined along with any perceived benefits for workforce development and successful strategies for addressing the challenges blended learning presents in this context. Case studies were developed inductively from survey responses and follow up telephone calls to provide more detailed information about reported successes. Participants reported flexibility, cost effectiveness, increased student/tutor and student/student communication and interaction as benefits of blended learning. Challenges included the design and use of interactive learning resources, appropriate preparation and support for staff and students, the potential of blended learning to exacerbate otherwise hidden disadvantage and the need for multi-stakeholder cost/benefit evaluation. Blended learning is used globally in the pre-registration education of nurses, midwives and other healthcare professionals. These results broadly mirror the literature regarding the benefits blended learning offers healthcare students, staff and organisations and the strategies employed to mitigate risk. As the deployment of blended learning nursing and midwifery programmes expands, further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach. These concern adequate preparation and support of students and staff, ensuring access to appropriate equipment and connectivity, exploration of student perceptions that online learning is of lesser value and comprehensive multi-stakeholder, exploratory evaluation to uncover any hidden factors and impact. Blended learning plays an effective part in the education of pre-registration nursing and midwifery students to help tackle global workforce shortages, but further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach. [ABSTRACT FROM AUTHOR]

Nursing and midwifery mentors are fundamental to the process of ensuring future practitioners are adequately prepared and supported during the practice element of their degrees. However, there is evidence to suggest that the infrastructure and support for the mentoring role is not always adequate. This article provides a review of some of the issues including the emotional labour associated with supporting pre-registration students, difficulties in accessing protected learning time for mentoring, and lack of supportive networks for mentors to develop within the role. The authors make recommendations on what is required to ensure that the mentor role is better acknowledged, supported and resourced. [ABSTRACT FROM AUTHOR]

In the UK respect, dignity and compassion are the underpinning values which must determine service user care in the National Health Service (NHS). In midwifery education it is unclear how students are being taught these values. We created a study that aimed to explore how learning about dignity and respect is facilitated and assessed within pre-registration midwifery curricula. An online survey was devised and distributed to all Lead Midwives for Education in the UK. The findings are presented under the three main themes of understanding the meaning of dignity and respect, teaching and assessment and experiences. The study concludes that, though there are some good areas of education practice there is inconsistency in how Nursing and Midwifery Council (NMC) guidelines are transferred into curricula. This leads to students receiving differing emphasis of education on the values of dignity and respect. [ABSTRACT FROM AUTHOR]

Public Health England and the Department of Health (2015) have documented that parents are requesting consistent professional advice throughout pregnancy and the early weeks following birth, as their care is transferred from midwives to health visitors. In addition, commissioners are increasingly seeking to integrate services to provide joined-up care and improve health outcomes for parents and families. This paper discusses the benefits, to both parents and health professionals, of collaborative working, together with the challenges faced by midwives and health visitors in the current climate. It explores the benefits of collaborative learning between the two disciplines in the higher education setting, with an example of a successful collaboration at the University of Central Lancashire. [ABSTRACT FROM AUTHOR]

The new system of Nursing and Midwifery Council revalidation comes into effect in April 2016, from which time all nurses and midwives will be required to demonstrate their ability to practise safely and effectively. This article describes how one emergency department has incorporated evidence collection for revalidation into its regular continuing professional development opportunities, and outlines the benefits of this for individual nurses, employers and patients. [ABSTRACT FROM AUTHOR]

Midwives have a key role in identifying women at risk of perinatal mental health problems, referring to specialist services, planning care where appropriate, and supporting women and their families. Current guidelines and standards do not place an emphasis on perinatal mental health care as central to the training of student midwives in the UK. Research has shown that midwifery students and midwives do not feel skilled in this aspect of their role. At the University of Surrey, a programme-specific perinatal mental health module was developed for student midwives in the second year of their pre-registration programme, which has been well evaluated. Service users and specialist mental health practitioners have been involved in developing and teaching the module, and the content is reviewed annually to reflect national policy drivers. [ABSTRACT FROM AUTHOR]

A four stage framework, developed by the Nursing and Midwifery Council for the preparation of nurses and midwives who support learners within practice and educational settings was implemented in the United Kingdom in September 2007. Since then the focus of debate and discussion within the literature has centred on stage 2 of the developmental framework i.e. the mentor role. The three other stages of registrant, practice teacher and teacher have received little attention. This paper argues that currently, the provisions made within the developmental framework in relation to the stage 1 registrant's role in supporting students within practice settings, has yet to be realised. The paper begins by contemplating both the pros and cons of the 'should all nurses be mentors' debate. The argument for embracing and utilising the stage 1 role more fully in practice is then presented. The paper concludes by underlining the need to recognise the stage 1 registrants as 'mentors inwaiting' and the need to support the full potential of their contribution to students' learning and assessment in practice. [ABSTRACT FROM AUTHOR]

Objective To provide a model for conducting cost-effectiveness analyses in medical education. The model was based on a randomised trial examining the effects of training midwives to perform cervical length measurement (CLM) as compared with obstetricians on patients' waiting times. ( CLM), as compared with obstetricians. Methods The model included four steps: (i) gathering data on training outcomes, (ii) assessing total costs and effects, (iii) calculating the incremental cost-effectiveness ratio ( ICER) and (iv) estimating cost-effectiveness probability for different willingness to pay ( WTP) values. To provide a model example, we conducted a randomised cost-effectiveness trial. Midwives were randomised to CLM training (midwife-performed CLMs) or no training (initial management by midwife, and CLM performed by obstetrician). Intervention-group participants underwent simulation-based and clinical training until they were proficient. During the following 6 months, waiting times from arrival to admission or discharge were recorded for women who presented with symptoms of pre-term labour. Outcomes for women managed by intervention and control-group participants were compared. These data were then used for the remaining steps of the cost-effectiveness model. Results Intervention-group participants needed a mean 268.2 (95% confidence interval [ CI], 140.2-392.2) minutes of simulator training and a mean 7.3 (95% CI, 4.4-10.3) supervised scans to attain proficiency. Women who were scanned by intervention-group participants had significantly reduced waiting time compared with those managed by the control group ( n = 65; mean difference, 36.6 [95% CI 7.3-65.8] minutes; p = 0.008), which corresponded to an ICER of 0.45 EUR minute−1. For WTP values less than EUR 0.26 minute−1, obstetrician-performed CLM was the most cost-effective strategy, whereas midwife-performed CLM was cost-effective for WTP values above EUR 0.73 minute−1. Conclusion Cost-effectiveness models can be used to link quality of care to training costs. The example used in the present study demonstrated that different training strategies could be recommended as the most cost-effective depending on administrators' willingness to pay per unit of the outcome variable. [ABSTRACT FROM AUTHOR]

All midwives are given similar training, but practice may differ based on setting. Patricia Donovan reflects on her experiences as a midwife educator in Malawi, Seychelles and the UK [ABSTRACT FROM AUTHOR]