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Background: Midwives are the largest workforce involved in caring for pregnant women and their babies, and are well placed to translate research into practice and ensure midwifery priorities are appropriately targeted in researched. Currently, the number and focus of randomised controlled trials led by midwives in Australia and New Zealand is unknown. The Australasian Nursing and Midwifery Clinical Trials Network was established in 2020 to build nursing and midwifery research capacity. To aid this, scoping reviews of the quality and quantity of nurse and midwife led trials were undertaken., Aim: To identify midwife led trials conducted between 2000 and 2021 in Australia and New Zealand., Methods: This review was informed by the JBI scoping review framework. Medline, Emcare, and Scopus were searched from 2000-August 2021. ANZCTR, NHMRC, MRFF, and HRC (NZ) registries were searched from inception to July 2021., Findings: Of 26,467 randomised controlled trials registered on the Australian and New Zealand Clinical Trials Registry, 50 midwife led trials, and 35 peer-reviewed publications were identified. Publications were of moderate to high quality with scores limited due to an inability to blind participants or clinicians. Blinding of assessors was included in 19 published trials., Discussion: Additional support for midwives to design and conduct trials and publish findings is required. Further support is needed to translate registration of trial protocols into peer reviewed publications., Conclusion: These findings will inform the Australasian Nursing and Midwifery Clinical Trials Network plans to promote quality midwife led trials., Competing Interests: Declaration of Competing Interest The authors declare their involvement in various clinical trials that have been referenced in this scoping review. Caroline Homer also declares she is the current Editor-in-Chief of Women & Birth. The Deputy Editor, Prof Linda Sweet, managed this submission and made the final decision. All other authors have no further conflicts to declare., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: To describe the history of midwifery education, present the current education programmes and explore the ways that have been undertaken to advance the midwifery profession in Indonesia., Methods: Historical and contemporary government documents were reviewed., Findings: The history of midwifery education in Indonesia shows a complex picture during and since colonisation with government, education institutes and association proposing different ways in which midwives were to be educated. Advocacy from the midwifery profession in Indonesia meant increasingly it is midwives who are determining how midwifery education is provided. Recent initiatives have resulted in a diploma, advanced diploma, bachelor's degree, and a master's degree in midwifery. The work of the midwifery profession advocating for midwifery education culminated in the Midwifery Act 2019. These changes in this Act will ensure that midwifery education meets the needs of women and their families but also lead to competent midwives who have the knowledge and skills to provide midwifery services at all levels of health provision. The history of midwifery in Indonesia illustrates the importance of the ICM pillars of association, regulation, and education., Conclusion: The history of midwifery education in Indonesia shows that for too long midwifery education was decided, determined and even regulated by authorities and disciplines other than midwifery. However, when the midwifery association and regulation inform and regulate midwifery education then there is an opportunity to provide care that will make a difference in outcomes for women and their families. The historical analysis of the story of Indonesia midwifery gives insight into what is required for quality education., Competing Interests: Conflict of interest All authors declare that we have no conflict of interest., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Problem: COVID-19 guidance from professional and health organisations created uncertainty leading to professional and personal stress impacting on midwives providing continuity of care in New Zealand (NZ). The COVID-19 pandemic resulted in massive amounts of international and national information and guidance. This guidance was often conflicting and not suited to New Zealand midwifery., Aim: To examine and map the national and international guidance and information provided to midwifery regarding COVID-19 and foreground learnt lessons for future similar crises., Methods: A systematic scoping review informed by Arksey and O'Malley's five-stage framework. A range of sources from grey and empirical literature was identified and 257 sources included., Findings: Four categories were identified and discussed: (1) guidance for provision of maternity care in the community; (2) guidance for provision of primary labour and birth care; (3) Guidance for midwifery care to women/wāhine with confirmed/suspected COVID-19 infection, including screening processes and management of neonates of infected women/wāhine (4) Guidance for midwives on protecting self and own families and whānau (extended family) from COVID-19 exposure., Conclusion: Guidance was mainly targeted and tailored for hospital-based services. This was at odds with the NZ context, where primary continuity of care underpins practice. It is evident that those providing continuity of care constantly needed to navigate an evolving situation to mitigate interruptions and restrictions to midwifery care, often without fully knowing the personal risk to themselves and their own families. A key message is the need for a single source of evidence-based guidance, regularly updated and timestamped to show where advice changes over time., (Copyright © 2021 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: One of the Indonesian Government's strategies to reduce maternal mortality rates has been to place a midwife in every village to provide midwifery care and facilitate essential primary healthcare services. To increase the numbers of midwives, the Indonesian Government began opening midwifery schools. However, Indonesia's maternal mortality rates remained high. This raises the question of the quality of midwifery education in Indonesia and how this education could be strengthened so that midwifery plays a key role in reducing maternal mortality rates., Aim of the Research: The aim of this study was to identify the barriers and enablers to strengthening midwifery education in Indonesia., Methods: A qualitative descriptive approach and in-depth interviews was the method used with 37 participants from 12 midwifery schools in eight cities situated in six provinces in Indonesia. Indonesian midwives, midwifery lecturers, midwifery students, newly graduated midwives, and obstetricians were interviewed in Bahasa Indonesia. Interviews were transcribed, translated, and thematically analysed following Braun and Clark (2006)., Findings: This article focuses on findings on "midwifery clinical experience", a theme which contained four sub-themes: "effective hands-on clinical experience", "theory-practice gap", "role of the mentor in practice", and "the system in the clinical environment"., Conclusion: This study highlights barriers to preparing midwifery students for obtaining adequate midwifery knowledge and skills during clinical placement. Quality clinical experience would improve knowledge and skills for better preparedness for students to competently meet their role as midwives, contributing to the strengthening of midwifery education in Indonesia., (Copyright © 2021 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Problem: Hospital midwives are the main care givers for women undergoing termination of pregnancy after 20 weeks. Midwives' role and potential impact of regular involvement in termination of pregnancy (TOP) are poorly understood., Setting: New Zealand., Background: TOP after 20 weeks may be performed to save a woman's life or preserve her physical and mental health. Throughout the process midwives play a key role in supporting women's complex psychological and clinical needs., Objective: To gain a deeper understanding of the role of midwives in TOP care after 20 weeks, including the support they might need and the impacts caring for women who are having a TOP may have on them., Methods: Eight midwives from two District Health Boards were interviewed about their experiences of caring for women having a TOP after 20 weeks. Transcripts were analysed by applying a hermeneutic-phenomenological lens., Findings: Three themes emerged: "A different kind of midwife", "Staying true to oneself" and "Melting an Iceberg". TOP care is a different role within midwifery as midwives facilitate death in the space of birth. Immersing themselves in women's emotional space they create meaningful connections to support their complex needs and provide a positive birth experience. Yet, midwives are unprepared for the emotional effects of repeatedly caring for women undergoing TOP. Lacking appropriate support they can experience increasing, lasting grief., Conclusion: Midwives' experiences of providing TOP care are complex, intense and have lifelong impact. Their role in the context of TOP is highly specialised and must be valued and supported., (Copyright © 2020 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

New Zealand's response to COVID-19 was go hard and go early into Level 4 lockdown on 25 th March 2020. This rapid response has resulted in low rates of infection and deaths. For New Zealand midwives, the sudden changes to how they work with women and families during pregnancy, birth and postnatally, especially in the community, required unprecedented innovation and adaptation. The volume of information coming from many different sources, and the speed with which it was changing and updating, added further stress to the delivery of a midwifery model of care underpinned by partnership, collaboration, informed choice, safety and relational continuity. Despite the uncertainties, midwives continued their care for women and their families across all settings. In the rapidly changing landscape of the pandemic, news media provided a real time account of midwives' and families' challenges and experiences. This article provides background and discussion of these events and reports on a content analysis of media reporting the impact on the maternity system in New Zealand during the initial surge of the COVID-19 pandemic. We found that the New Zealand midwife was a major influencer and initiator for relational care to occur uninterrupted at the frontline throughout the COVID-19 lockdown, despite the personal risk. The initial 5-week lockdown in March 2020 involved stringent restrictions requiring all New Zealanders, other than essential workers such as midwives, to remain at home. Midwives kept women, their families and communities central to the conversation throughout lockdown whilst juggling their concerns about keeping themselves and their own families safe. Insights gained from the media analysis suggest that despite the significant stress and upheaval experienced by midwives and wāhine/women, relational continuity facilitates quality and consistent care that honors women's choices and cultural needs even during situations of national crisis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Crowther, Maude, Bradford, Austin, Gilkison, McAra-Couper and Krisjanous.)

Problem: In countries where education programmes are assessed as meeting international standards there is limited knowledge about the challenges facing midwifery education., Background/aim: The positive impact of quality midwifery education on maternal and newborn health is acknowledged by the World Health Organisation. However, there is limited research identifying the issues faced in providing quality midwifery education. The aim of this study was to identify the challenges and determine priority projects to strengthen midwifery education across Australia and New Zealand., Methods: A two-round Delphi study with experts in midwifery education was undertaken., Findings: In round one, 85 participants identified an initial 366 issues for midwifery education. Through thematic content analysis these were categorised into 89 statements reflecting five major themes: In round two, 105 midwifery experts from Australia n=86 (79%) and New Zealand n=23 (21%) rated the 89 statements in order of priority. Across the combined data (Australia and New Zealand) a total of 19 statements gained consensus of ≥80%., Discussion: Five priority themes were identified including; (1) enabling success of First Peoples/Māori midwifery students; (2) increasing the visibility and influence of midwifery within regulation, accreditation and university governance; (3) determining how best to deliver the clinical practicum component of programmes; (4) reviewing midwifery programmes to enhance design, content and delivery; and (5) ongoing education and support for the midwifery workforce., Conclusion: In Australia and New Zealand, it is imperative that collaborative work is undertaken to design and action identified projects addressing these priorities., (Copyright © 2020 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Introduction: This research aimed to identify what supports and what hinders job autonomy for midwives in New Zealand., Methods: Registered midwives participated in an open-ended, online survey in 2019. Anonymised participants were asked to describe an incident when they felt they were using their professional judgement and/or initiative to make decisions and the resultant actions. The data was analysed thematically., Findings: The participants identified that autonomy is embedded within midwifery practice in New Zealand. Self-employed midwives who provide continuity of care as Lead Maternity Carers, identified they practice autonomously 'all the time'. The relationship with women and their family, and informed decision making, motivated the midwife to advocate for the woman - regardless of the midwife's work setting. Midwifery expertise, skills, and knowledge were intrinsic to autonomy. Collegial relationships could support or hinder the midwives' autonomy while a negative hospital work culture could hinder job autonomy., Discussion: Midwives identified that autonomous practice is embedded in their day to day work. It strengthens and is strengthened by their relationships with the woman/whanau and when their body of knowledge is acknowledged by their colleagues. Job autonomy was described when midwifery decisions were challenged by health professionals in hospital settings and these challenges could be viewed as obstructing job autonomy., Conclusion: The high job autonomy that New Zealand midwives enjoy is supported by their expertise, the women and colleagues that understand and respect their scope of practice. When their autonomy is hindered by institutional culture and professional differences provision of woman-centred care can suffer., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Continuity of midwifery care is the best maternity care model for women at any risk level, and there is a global imperative to improve access to midwifery-led care. However, diverse perspectives about how best to prepare graduates for working in midwifery continuity of care models persist. The continuity of care experience standard in Australia was anticipated to address this., Aim: To challenge the dearth of published information about the structures and processes in midwifery education programs by identifying: the educational value and pedagogical intent of the continuity of care experience; issues with the implementation, completion and assessment of learning associated with continuity of care experience; and discuss curriculum models that facilitate optimal learning outcomes associated with this experience. We discuss the primacy of continuity of care experience in midwifery education programs in Australia., Discussion: The inclusion of continuity of care experience in midwifery programs in Australia became mandatory in 2010 requiring 20, however this number was reduced to 10 in 2014. Research has shown the beneficial outcomes of continuity of care experience to both students and women. Continuity of care experience builds mutual support and nurturing between women and students, fosters clinical confidence, resilience, and influences career goals. We require curriculum coherence with both structural and conceptual elements focusing on continuity of care experience., Implications and Recommendations: Education standards that preference continuity of care experience as the optimal clinical education model with measurable learning outcomes, and alignment to a whole of program philosophy and program learning outcomes is required., (Copyright © 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: Globally there are challenges meeting the recruitment and retention needs for rural midwifery. Rural practice is not usually recognised as important and feelings of marginalisation amongst this workforce are apparent. Relationships are interwoven throughout midwifery and are particularly evident in rural settings. However, how these relationships are developed and sustained in rural areas is unclear., Aim: To study the significance of relationships in rural midwifery and provide insights to inform midwifery education., Methods/design: Multi-centre study using online surveys and discussion groups across New Zealand and Scotland. Descriptive and template analysis were used to organise, examine and analyse the qualitative data., Findings: Rural midwives highlighted how relationships with health organisations, each other and women and their families were both a joy and a challenge. Social capital was a principal theme. Subthemes were (a) working relationships, (b) respectful communication, (c) partnerships, (d) interface tensions, (e) gift of time facilitates relationships., Conclusions: To meet the challenges of rural practice the importance of relationship needs acknowledging. Relationships are created, built and sustained at a distance with others who have little appreciation of the rural context. Social capital for rural midwives is thus characterised by social trust, community solidarity, shared values and working together for mutual benefit. Rural communities generally exhibit high levels of social capital and this is key to sustainable rural midwifery practice., Implications: Midwives, educationalists and researchers need to address the skills required for building social capital in rural midwifery practice. These skills are important in midwifery pre- and post-registration curricula., (Copyright © 2018 Australian College of Midwives. All rights reserved.)

Benign bone tumors consist of a wide variety of neoplasms that do not metastasize but can still cause local complications. Historical management of these tumors has included surgical treatment for lesion resection and possible mechanical stabilization. Initial percutaneous ablation techniques were described for osteoid osteoma management. The successful experience from these resulted in further percutaneous image-guided techniques being attempted, and in other benign bone tumor types. In this article, we present the most common benign bone tumors and describe the available results for the percutaneous treatment of these lesions.

Rural practice presents unique challenges and skill requirements for midwives. New Zealand and Scotland face similar challenges in sustaining a rural midwifery workforce. This paper draws from an international multi-centre study exploring rural midwifery to focus on the education needs of student midwives within pre-registration midwifery programmes in order to determine appropriate preparation for rural practice. The mixed-methods study was conducted with 222 midwives working in rural areas in New Zealand (n = 145) and Scotland (n = 77). Midwives' views were gathered through an anonymous online survey and online discussion forums. Descriptive analysis was used for quantitative data and thematic analysis was conducted with qualitative data. 'Future proofing rural midwifery practice' using education was identified as the overarching central theme in ensuring the sustainability of rural midwives, with two associated principle themes emerging (i) 'preparation for rural practice' and (ii) 'living the experience and seeing the reality'. The majority of participants agreed that pre-registration midwifery programmes should include a rural placement for students and rural-specific education with educational input from rural midwives. This study provides insight into how best to prepare midwives for rural practice within pre-registration midwifery education, in order to meet the needs of midwives and families in the rural context., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: the complex and challenging nature of rural midwifery is a global issue. New Zealand and Scotland both face similar ongoing challenges in sustaining a rural midwifery workforce, and understanding the best preparation for rural midwifery practice. This study aimed to explore the range of skills, qualities and professional expertise needed for remote and rural midwifery practice., Design: online mixed methods: An initial questionnaire via a confidential SurveyMonkey® was circulated to all midwives working with rural women and families in New Zealand and Scotland. A follow-up online discussion forum offered midwives a secure environment to share their views about the specific skills, qualities and challenges and how rural midwifery can be sustained. Data presented were analysed using qualitative descriptive thematic analysis., Setting and Participants: 222 midwives participated in this online study with 145 from New Zealand and 77 from Scotland., Findings: underpinning rural midwifery practice is the essence of 'fortitude' which includes having the determination, resilience, and resourcefulness to deal with the many challenges faced in everyday practice and to safeguard midwifery care for women within their rural communities., Key Conclusions: rural midwives in New Zealand and Scotland who work in rural practice specifically enhance skills such as preparedness, resourcefulness and developing meaningful relationships with women and other colleagues which enables them to safeguard rural birth., Implications for Practice: findings will inform the preparation of midwives for rural midwifery practice., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Diffuse Reflectance Fourier Transform Infrared Spectroscopy (DRIFTS)-based multivariate models were developed to quantify the content of two polymorphic impurities in mixtures with the desired active pharmaceutical ingredient (API) form, with the impurities not exceeding 2% wt/wt. In addition, close attention was paid to the outlier detection criteria: Q residuals; Hotelling T 2 ; and score bi-plot. While reasonably accurate results were obtained for the relatively simple calibration models for both forms of the impurity, the predictions for "blank" samples (separately verified to be impurity-free) were apparently biased. Thus, the model training sets were augmented with spectra from calibration mixtures incorporating some of the API from batches used in the prediction. The performance of the updated models as assessed by cross-validation was somewhat degraded as a result, while predictions against independent batches of API showed a decrease in bias indicating robustness had improved. Nevertheless, the Q residuals criterion disqualified a large number of prediction samples as outliers in contrast to the other two criteria that reported no issues at all. The results here demonstrated the effectiveness of DRIFTS for quantifying low concentration polymorphic impurities, while simultaneously highlighting the variability issues that can be encountered in practice and which need to be understood and managed appropriately to ensure the success of any automated or Good Manufacturing Practice (GMP) compliant application of multivariate modeling., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Mixtures of two polymorphic impurities with one lot of the desired form of an Active Pharmaceutical Ingredient (API), mostly binary mixtures, with up to 2% wt/wt of an impurity, were used for multivariate modeling via Diffuse Reflectance Infrared Fourier Transform (DRIFT) spectra. The two obtained cross-validated models, significantly differing in accuracy, were used to predict the concentrations of these impurities in independent API lots. The predictions were found to be biased and with outliers, as revealed by the Q residuals criterion but not the other two outlier criteria. Updating the models with the spectra from the mixtures using multiple API lots produced very different calibration results: the model of the impurity with the strong IR response became noticeably worse, while the model of the impurity with less responsive IR signal changed only marginally. The updated models performed much better in the prediction as the bias for both polymorphs was reduced and the outlier-related issues mostly disappeared., (Copyright © 2017 Elsevier B.V. All rights reserved.)

The Midwifery Development Education Service was established in the Birthing Unit at Middlemore Hospital in South Auckland New Zealand in 2007. The service is unique in the New Zealand midwifery context for the way it operates as a collaboration between the education and health provider to optimise the clinical learning experience of student midwives. This paper reports on the evaluation of the Midwifery Development Education Service that was undertaken in 2015. The evaluation captured the views and experience of students and midwives who had been involved with, or had worked alongside, the service. A mixed-method approach was adopted for the evaluation study, comprising of an anonymous on-line survey, qualitative interviews and focus group discussion. Considerable satisfaction with the service was identified. This article draws attention to participants' perceptions of the service as supporting student midwives; the significance of quality time in the provision of the clinical midwifery education; the situating of the service at a unique vantage point (overseeing the needs of the university and the hospital) and its impact upon the learning culture of education within the unit. A potential tension is also identified between the provision of a supportive learning environment and the assessment of student performance., (Copyright © 2017. Published by Elsevier Ltd.)

Background: midwifery workforce issues are of international concern. Sustainable midwifery practice, and how resilience is a required quality for midwives, have begun to be researched. How these concepts are helpful to midwifery continues to be debated. It is important that such debates are framed so they can be empowering for midwives. Care is required not to conceptually label matters concerning the midwifery workforce without judicious scrutiny and diligence., Aim: the aim of this discussion paper is to explore the concepts of sustainability and resilience now being suggested in midwifery workforce literature. Whether sustainability and resilience are concepts useful in midwifery workforce development is questioned., Method: using published primary midwifery research from United Kingdom and New Zealand the concepts of sustainability and resilience are compared, contrasted and explored., Findings: there are obvious differences in models of midwifery care in the United Kingdom and New Zealand. Despite these differences, the concepts of resilience and sustainability emerge as overlapping themes from the respective studies' findings. Comparison between studies provides evidence of what is crucial in sustaining healthy resilient midwifery practice. Four common themes have been identified that traverse the different models of care; Self-determination, ability to self-care, cultivation of relationships both professionally and with women/families, and a passion, joy and love for midwifery., Conclusions: the impact that midwifery models of care may have on sustainable practice and nurturing healthy resilient behaviors remains uncertain. The notion of resilience in midwifery as the panacea to resolve current concerns may need rethinking. Resilience may be interpreted as expecting midwives 'to toughen up' in a workplace setting that is socially, economically and culturally challenging. Sustainability calls for examination of the reciprocity between environments of working and the individual midwife. The findings invite further examination of contextual influences that affect the wellbeing of midwives across different models of care., (Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.)

New Zealand's midwifery education model is intertwined with a practice model which is underpinned by autonomy and partnership. The curriculum prepares students for practice across the scope of midwifery on their own responsibility. While students have formal learning opportunities within educational institutions they spend at least half of their programme learning through authentic work experiences alongside midwives and women. Midwifery educators partner with practising midwives to support students to develop the knowledge, skills and attitudes required to practise midwifery in the New Zealand context. This paper provides an overview of New Zealand's midwifery education model and identifies how it is integrated with New Zealand's unique midwifery service., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

We have applied optical-optical-optical triple resonance spectroscopy to resolve a system of high Rydberg states in BH that serves quantitatively to characterize a fundamental example of electron-orbital-cation core rotational coupling. The third-color ionization-detected absorption spectrum originating from the photoselected 3s B1Sigma+ Rydberg state with vibrational and total angular momentum quantum numbers, v'=1 and N'=0 consists entirely of vibrationally autoionizing resonances for which final N=1 that converge in series to the BH+v+=1 rotational limits, N+=0, 1, and 2. For series with l=1 converging to N+=0 and 2, Rydberg orbital and rotational angular momenta couple to systematically perturb level energies and distribute lifetime in a well-isolated two-channel rotronic interaction that spans hundreds of wave numbers.

Background: There is inconclusive debate within the literature as to whether the best problem-based learning (PBL) tutors are subject experts or not. The debate hinges on whether knowledgeable tutors are tempted to intervene too often in PBL discussions compared to non-expert tutors, and whether the latter may not be able to sufficiently challenge the students' level of understanding., Purpose: To describe approaches used by tutors in PBL tutorials and to identify differences between tutors from medical and non-medical backgrounds., Methods: The research reported in this paper was undertaken during the academic session 1999-2000 at the University of Liverpool Faculty of Medicine. A qualitative exploratory case study method was used and two PBL groups were observed. One of these groups had a medically qualified tutor and the other had a tutor from a humanities background. The focus of the observation was the discourse between tutor and students, which was analysed using a framework drawn from linguistics. Results were fed back to both the tutors and the students to check their perceptions of the interactions., Results: Analysis of the tutorial group interaction revealed that tutors from both backgrounds used similar techniques to raise students' awareness, facilitate the group process and direct students' learning. Differences were noted between the two tutors: the medical tutor set out to raise students' awareness by using questioning techniques herself, whereas the non-medical tutor expected students to question each other. The non-medical tutor was observed to facilitate the group process more often than the medical tutor., Conclusions: Qualitative analysis of spoken discourse in PBL tutorials provides valuable insights into the processes involved in PBL, thereby generating material which is useful for both training of and giving feedback to PBL tutors.