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ABSTRACT Aims Design Methods Results Conclusion Impact Patient or Public Contribution To understand the perspectives and experiences of healthcare providers who have experience working with an enhanced recovery care after elective caesarean birth pathway with next‐day discharge and home midwifery.This study applies a qualitative study design with a pragmatic realist approach. The realist framework was used while also taking a post‐positivist philosophy.The work was conducted in South Australia, Australia between May and October 2019. Twenty‐three semi‐structured interviews were completed with 5 doctors and 18 midwives who had occupational experience working with the pathway. Interviews were analysed using following the six‐phase qualitative thematic analysis process outlined by Braun and Clarke. COREQ guidelines were followed.Four main themes and 11 sub‐themes were identified. Main themes identified were as follows: The pathway is more than just early discharge; experiences with the process; staff engagement with the pathway; and the impact of the pathway within the health system.Healthcare providers generally accepted the pathway and found enhanced recovery care to be a positive and beneficial model of care. Staff identified five main challenges with implementing the pathway: early discharge; eligible women's automatic inclusion on the pathway; engaging women; change for staff and organisational constraints and procedures. Elements that support integration include the following: education for women; reassurance and communication with women and families; prepared care and supports including home midwifery; staff education and communication of the evidence; clear guidelines and protocols; defined staff roles; enough clinical time and clinical flexibility.Knowledge from staff in this study would be useful for other health services to consider when looking to deliver similar models of care.The health service and health providers were involved with the initiation and development of the research aims and design. [ABSTRACT FROM AUTHOR]

Introduction: Screening for substance use during pregnancy is critical for enhancing maternal health and perinatal outcomes. However, disparities persist in screening and intervention rates within maternity services. This retrospective case note review explored contemporaneous practices around screening and interventions for substance use among pregnant women during routine antenatal care. Methods: A random sample of 100 sets of maternity records were reviewed. Eligible cases included any woman attending initial pregnancy assessments at one of two South Australian metropolitan Hospital‐based antenatal clinics, from July 2019–September 2020. Screening rates for past and current alcohol, tobacco and other substance use were identified and compared with data from a subset of a nationally representative survey. Intervention details and referral pathways were also assessed. Results: The final sample of eligible cases (n = 93) demonstrated prioritisation of screening for current use, over past use, across all substances (p < 0.001). Screening was most likely for tobacco and least likely for e‐cigarettes (p < 0.001). Significant underreporting of past use compared with the benchmark was identified for all substances (except tobacco, p = 0.224). Interventions typically involved written resources, which were usually declined by clients. Discussion and Conclusions: Despite longstanding recommendations, screening and intervention practices for substance use appear inconsistent. With the recent emergence of vaping, no evidence of updated approaches to identifying e‐cigarette consumption in pregnant women was found. Several opportunities for enhancing routine screening and intervention practices within antenatal clinics were identified, and will inform the development of policy directives, targeted training modules, and other resources for health professionals working in these services. [ABSTRACT FROM AUTHOR]