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Background: Midwifery practice experience is an important component of education to develop an understanding of professional identity in midwifery students. The responsibility of supporting student development in the clinical setting is predominantly undertaken by clinical midwives. There is minimal literature relating to the professional identity development of midwifery students., Aim: To explore midwifery student experiences of the positive attributes of clinical midwives who supported the professional identity development of midwifery students in the clinical practice setting., Methods: An Appreciative Inquiry approach guided this study. The setting was a university in Sydney, Australia. Participants comprised thirteen students from a postgraduate midwifery course. Data were collected via individual interviews and analysed thematically. Students had two to six months of placement in the clinical setting., Findings: Data analysis identified three themes, Putting the woman at the centre of care; Supporting a woman-centred environment and Focusing on student success., Discussion: Findings from this study revealed that extended time spent with a midwife enabled the student to observe and reflect on the nuances of midwifery practice that are not overtly shared with students. Students were able to observe a midwife's tacit way of being. This paper reveals the positive attributes and behaviours of midwives whose practice the students want to emulate., Conclusions: Midwifery students' exposure to positive clinical midwife role models on clinical placement enables them to develop a greater understanding of professional identity., Competing Interests: Declaration of Competing Interest No conflict of interest has been declared by the authors., (Copyright © 2024. Published by Elsevier Ltd.)

Problem: Despite the pressing need to grow the Australian midwifery workforce, the rising cost of living is making midwifery education programs unaffordable for many. Understanding of the financial hardships faced by Australian midwifery students is currently limited., Background: Attrition from midwifery programs is high and rising. In Australia, this is further compounded by the financial pressures brought about by the cost-of-living crisis. Attending compulsory unremunerated clinical placements and being 'on call' for continuity of care experiences contributes to the financial challenges of midwifery students., Aim: To identify and synthesise available literature addressing financial hardship faced by Australian midwifery students during their studies., Methods: Arksey and O'Malley's framework guided this scoping review. Six databases were searched between January 2020 and April 2024. The key findings of eight included papers were thematically analysed., Findings: Four themes were identified; "Attending placements and supporting COCE's as key contributors to financial hardship", "Impacts of financial hardship on midwifery students and their wider family", "Impacts upon the future growth and diversity of the profession" and "The need for universal financial support"., Discussion: The findings highlight the nature of financial challenges, causational factors and the consequences of financial hardship associated with completing midwifery programs in Australia. Appropriate universal financial support is urgently needed if we are to grow and sustain the midwifery workforce., Conclusion: With no primary studies specifically exploring financial hardship faced by Australian midwifery students, further research is required to understand the challenges they face and evaluate the efficacy of funding initiatives., Competing Interests: Conflict of Interest The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: The aim of this pilot study was to explore clinician's experience of transitioning from midwifery clinical practice into university in an academic teaching role within one jurisdiction in Australia., Background: There is a dire shortage of midwifery academics globally. In Australia the shortage is symbiotic with the persistent deficit in the midwifery clinical workforce, which is the predominant recruitment pool for universities. The midwifery workforce cannot be replenished without sufficient academics to provide education., Design: Phenomenology was selected as the most appropriate research approach for the study seeking to illuminate the lived experiences of clinicians as they transition into their new role as academics., Methods: Seven participants were recruited purposively from one jurisdiction in Australia between November 2022 and March 2023. Qualitative conversational interviews were performed facilitating each participant to share their narrative. Participants were then able to direct the conversation to share their lived experience of the transition from a midwifery clinician in practice to a midwifery academic in a university. Demographic details were collected for context., Results: Thematic analysis was used following Giorgi's four stage phenomenological process. Four themes were identified from commonalities between the participants, 'Being a drifter", 'Keeping a foot in both camps to maintain clinical credibility', 'In at the deep end: Not prepared for the reality of academia' and 'Best of both worlds'., Conclusions: The lived experiences of the participants in this study, as they transitioned from clinical midwifery practice to academia can be related to the Theory of Transition where participants navigate: Preparation, Encounter, Adjustment and Stabilisation. A new role in higher education requires adjustment to the reality of working in academia. Midwives who had experiences of being a casual staff member felt they had the best of both worlds, as they gained an insight into the role of an academic whilst remaining in clinical practice. However, many reported that mentorship would have been beneficial to facilitate stabilisation., Competing Interests: Declaration of Competing Interest The authors of this manuscript have no conflicts of interest to declare., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Background: Practical training in a birthing unit is an important part of midwifery education. Previous research on the preceptor role predominantly consists of qualitative interview studies and have not explored pedagogical models like peer learning., Objectives: The purpose of this study was to quantitatively describe midwives' experiences, conditions, and needs in their role as preceptors in a birthing unit, as well as their attitudes towards and experiences of peer-learning., Design: A cross-sectional study, using a web-survey., Settings: The survey was distributed to all midwives working in a birthing unit in Sweden., Participants: A total of 573 valid responses were obtained., Methods: A questionnaire consisting of 22 questions, which included background questions, questions to be answered on a four-point Likert scale, and open-ended questions, was sent out from November 2022 to March 2023. The collected data were analysed using descriptive statistics, Chi-square, and Mann Whitney U test analyses. The open-ended responses were analysed using quantitative content analysis., Results: Midwives with ≤10 years of experience were more hesitant about taking on the preceptor role. They also described a lack of support and found it more challenging to integrate supervision into their working hours than midwives with >10 years of experience. Time for supervision and time for reflection with midwifery students were identified as areas that could improve the quality of supervision. Of the respondents, 42.8 % had experience of peer learning. "Students learn from each other" was identified as the most common advantage of peer learning., Conclusions: Long-term experience as a midwife plays a crucial role in how midwives perceive their role as a preceptor and the conditions they experience. The midwives in this study had started supervising students earlier than they deemed advantageous. As the preceptor plays a critical role in the midwifery student's learning process, it is important to have experienced preceptors., Competing Interests: Declaration of competing interest None declared., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: To investigate nursing/midwifery students, Clinical Mentors, Link Teachers and Head Nurses experiences within "Dedicated Education Unit" model in 6 European clinical placements and analyse the necessary elements for a powerful clinical learning environment., Design: A multi-country, phenomenological, qualitative study., Methods: Focus group interviews were performed to identify the personal and organizational factors of importance for students and nurses/midwives., Results: Data analysis produced 4 main themes (1) Clinical placement organization, (2) students' clinical knowledge and skill acquisition, (3) students, and nurses/midwives' experiences within the DEU model and (4) factors for creating an effective learning environment., Conclusions: A close educational-service collaboration, a realistic clinical placement planning, a focus on student learning process and an investment in professionals' education and development among others, are elements to set up a powerful clinical learning environment., Implications for the Profession: It is considered advisable and urgent to improve the working conditions of nurses/midwives and the learning environments of students as a strategy to alleviate the global shortage of nurses and respond to the increasingly demanding health needs of the population., Impact: Due to the close relationship between students' learning and features of the clinical environment nurse educators seek innovative models which allow students to manage patient care and their transition to professional practice. To implement new learning strategies, identifying students, nurses and midwives perceptions and suggestions is a powerful information to evaluate implementation process and outcomes., Public Contribution: Our findings could help academic and clinical managers to meet the human and organizational requirements to create a successful learning environment in every student placement., (© 2024 The Author(s). Nursing Open published by John Wiley & Sons Ltd.)

Aim: To investigate the impact of ongoing workshop training of the "Helping Babies Breathe" program on the durability of midwives' knowledge and skills., Background: Implementing the Helping Babies Breathe (HBB) program is crucial as a simple protocol for neonatal resuscitation in low-resource healthcare settings to decrease the rate of asphyxia and perinatal mortality by the initial healthcare providers. In addition to training in this program, it is also essential to guarantee the retention of the acquired knowledge and skills., Design: A quasi-experimental clinical trial study with a single-group, pre-test-and-post-test design., Methods: This study was conducted throughout the year 2022, with a sample size of 61 midwives selected through a census sampling from those working in the delivery and operating rooms of X Hospital in x City. The midwives participated in 3-hour workshops. This study was performed in two stages: intervention and follow-up. The evaluation Instruments included the HBB educational package, which consisted of a questionnaire and 3 Objective Structured Clinical Exams. During the intervention phase, the HBB program training was conducted through a series of workshops held at four different time points over a span of six months. In the follow-up stage, the learners were not provided with any further training. The evaluation was done immediately after the initial training workshop of the HBB program, at the end of the final workshop in the sixth month and at the end of the follow-up period., Results: The mean knowledge score of the baseline, at six months and at twelve months after the initial workshop were documented as (17 SD1.2), (17.79 SD 0.4) and (17.73 SD 0.5), respectively. There was a statistically significant difference in the mean knowledge scores between the baseline and the six and twelve months (P<0.05), but no statistically significant difference was observed between six and twelve months (P>0.05). The mean skill scores showed a significant improvement and were maintained after six months compared with the initial assessment (P<0.05); however, there was a significant decrease in skill score twelve months later, in comparison to both the initial assessment and the first six months (P<0.05)., Conclusions: Healthcare workers can maintain their knowledge and skills by participating in ongoing training workshops. However, without continuous training, their skills may diminish. Therefore, it is essential to implement training programs that emphasize regular practice and repetition to ensure knowledge and skills retention., Registration Number: The present research was a part of the research work with the ethics ID IR.IRSHUMS.REC.1400.019., 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 Elsevier Ltd. All rights reserved.)

Introduction: Interprofessional experiences provide critical exposure to collaborative health care teams, yet medical students often lack this experience during clinical clerkships. We created a labor and delivery triage rotation exclusively staffed by certified nurse-midwives in the obstetrics and gynecology clerkship to address this gap. We sought to evaluate the clinical learning experiences of medical students rotating on this midwife-supervised collaborative team., Methods: Between 2018 and 2020, we electronically sent all medical students an evaluation after each required clerkship. Our primary outcome was the quality of teaching score, as defined by level of agreement on a 5-point Likert scale with a statement regarding teaching quality. A secondary outcome evaluated scores from the National Board of Medical Examiners (NBME) Obstetrics and Gynecology subject examination taken by all students at the end of the rotation. Evaluations and assessments were compared between students rotating on labor and delivery triage and those who did not. Evaluation comments from students rotating on labor and delivery triage were collated to identify common themes., Results: Of 374 students, 370 (98.9%) completed the end-of-clerkship course evaluation and 312 (83.4%) completed teaching evaluations. Sixty-seven students (17.9%) rotated in labor and delivery triage; of these, 52 (77.6%) completed both the course and triage rotation evaluations. There were no differences in the mean quality of teaching scores (3.9 ± 1.2 versus 3.8 ± 1.2, p = 0.54) or in NBME Obstetrics and Gynecology subject examination scores between students rotating in labor and delivery triage compared to all other rotations (79.9% ± 7.2% vs 80.2% ± 7.8%, P = 0.436). Comments from teaching evaluations highlighted student exposure to the midwifery philosophy of care model., Discussion: This work demonstrates the feasibility and benefits of this midwife-led authentic interprofessional collaborative experience for medical students. This model can serve as an example of how to implement and evaluate interprofessional collaboration experiences in the clinical setting., (© 2023 The Authors. Journal of Midwifery & Women's Health published by Wiley Periodicals LLC on behalf of American College of Nurse Midwives (ACNM).)

Introduction: Postgraduate fellowships are growing in midwifery and yet are poorly understood by the profession. These fellowships are optional for midwives interested in developing advanced skills, transitioning to specialty practice, or entering or re-entering professional practice. The purpose of this study was to explore the characteristics and outcomes of US postgraduate midwifery fellowships as described by midwifery fellowship program directors., Methods: Postgraduate midwifery fellowship programs in the United States were identified through an environmental scan and snowball sampling. Directors of these fellowship programs were invited to complete a survey and an open-ended interview to determine their program's characteristics and outcomes. Quantitative data were summarized, and thematic analysis was used to explore the qualitative data., Results: An environmental scan and snowball sampling identified 17 postgraduate midwifery fellowship programs. Thirteen fellowship program directors completed a survey (76.5%), and 11 completed an interview (64.7%). The findings identified program characteristics, including location, structure, funding, and educational offerings, of midwifery fellowship programs. The thematic analysis revealed the emergence of 3 themes highlighting the creation of support for midwives in transition, including new graduates and practicing midwives returning to practice after a hiatus or shifting to specialty practice: (1) stepping stones, (2) empowered and equipped, and (3) innovative future. Community birth practice was defined as specialty practice by these directors., Discussion: The results of this study inform the profession of the availability of fellowships and the development of future high-quality midwifery fellowships. Postgraduate midwifery fellowships should not be required for entry to practice but have a place in the work-study opportunities available to US midwives., (© 2024 by the American College of Nurse‐Midwives.)

Background: Simulation-based training has been widely used as a valuable strategy for learning and evaluating clinical skills at different levels of nursing and midwifery education. The impact of simulation training on intensive management for high-risk pregnancy in a low-resource setting has been limited., Aim: To examine the effect of simulation-based training with low-fidelity mannequins on obstetrical nurses and midwives' knowledge, attitude, and skills for high-risk pregnancy management in a low-resource setting., Method: During September 2023, twenty-five obstetrical nurses or midwives who worked in five tertiary public hospitals in Vientiane Prefecture participated in the three-day training workshops for intensive management in high-risk pregnant women and newborns that used a simulation-based training approach integrating problem-based learning. The evaluated criteria of knowledge, attitudes, and skills pre- and post-test scores were statistically compared., Findings: Workshop trainees demonstrated an increase significantly in knowledge for high-risk pregnancy management (p = 0.012), attitude toward high-risk pregnancy management (p = 0.000), and attitude toward simulation-based training design (p = 0.002). The clinical skills were used on the simulation performance checklist, and the pre-posttest gain in overall performance scores had a statistically significant difference (p = 0.000). The mean score of postpartum hemorrhage management skills was 11.48±2.23, which increased the highest score among all skills., Conclusions: The simulation-based training in high-risk pregnancy management improves the knowledge, attitude, and skills of nurses and midwives in low-resource settings. Next steps include direct observation of trainees in the clinical setting to assess their competence in ensuring patient safety, achieving positive pregnancy outcomes, and enhancing satisfaction., 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.)

Aim: The aim of the study was to evaluate a person-centred model of clinical supervision to enhance person-centredness., Design: Experimental, quantitative., Methods: One hundred and three New Graduates were supported to reflect through a person-centred lens (July-December 2020). Evaluation was undertaken at 6 months using: the Manchester Clinical Supervision Scale-26 (effectiveness of supervision) and the Person-centred Practice Inventory (measures attributes of the nurse/midwife, the care environment and person-centred processes). Due to participation difficulties, scores were calculated by attendance rates using descriptive and inferential statistics., Results: Regular attendees scored higher on the supervision's effectiveness; however, this did not reach efficacy. 'Finding time' to attend contributed to low scores. Supervision scored well on its supportive function when attended. Many New Graduates perceived a decline in their care environment. Attendance aside, New Graduates averaged an increased in their person-centred attributes and processes. Greater participation was found in those who scored higher at baseline on their person-centred attributes and processes, and this higher scoring continued at 6 months than those who attended less., Conclusion: New Graduates who perceive themselves as person-centred and reflective at baseline are more likely to attend a person-centred clinical supervision and score higher at 6 months than those who attended less often. New Graduates found support within supervision during challenging times., Implications for Practice for Professional And/or Patient Care: For successful implementation of Person-centred Clinical Supervision, New Graduates need support to attend, as attendance supports them to begin seeing value in the process., Impact: This intervention kept person-centred practice at the forefront of New Graduates reflection, in a time of extreme change. The research has implications for nursing and midwifery management with the imperative to deliver person-centred care and create the person-centred cultures for staff to feel supported and empowered., Reporting Method: Transparent Evaluation of Non-randomized Designs (TREND)., Patient of Public Contribution: No patient or public contribution., Contribution to Wider Community: New Graduates grow their person-centredness over their transitioning year; however, this can be enhanced with regular clinical supervision underpinned by person-centred theory. Clinical supervisors can provide support to New Graduates when the environment is challenged., (© 2023 John Wiley & Sons Ltd.)

Aim: To explore nurse-midwives' perceptions of safety culture in maternity hospitals., Design: A descriptive phenomenological study was conducted using focus groups and reported following the Consolidated Criteria for Reporting Qualitative Research., Methods: Data were obtained through two online focus group sessions in June 2022 with 13 nurse-midwives from two maternity hospitals in the central region of Portugal. The first focus group comprised 6 nurse-midwives, and the second comprised 7 nurse-midwives. Qualitative data were analysed using content analysis., Findings: Two main themes emerged from the data: (i) barriers to promoting a safety culture; (ii) safety culture promotion strategies. The first theme is supported by four categories: ineffective communication, unproductive management, instability in teams and the problem of errors in care delivery. The second theme is supported by two categories: managers' commitment to safety and the promotion of effective communication., Conclusion: The study results show that the safety culture in maternity hospitals is compromised by ineffective communication, team instability, insufficient allocation of nurse-midwives, a prevailing punitive culture and underreporting of adverse events. These highlight the need for managers to commit to providing better working conditions, encourage training with the development of a fairer safety culture and encourage reporting and learning from mistakes. There is also a need to invest in team leaders who allow better conflict management and optimization of communication skills is essential., Impact: Disseminating these results will provide relevance to the safety culture problem, allowing greater awareness of nurse-midwives and managers about vulnerable areas, and lead to the implementation of effective changes for safe maternal and neonatal care., Patient or Public Contribution: There was no patient or public contribution as the study only concerned service providers, that is, nurse-midwives themselves., (© 2023 John Wiley & Sons Ltd.)

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.)

Introduction: One of the targets for the third sustainable development goals is to reduce worldwide maternal mortality ratio (MMR) to less than 70 deaths per 100,000 live births by 2030. To address issues affecting women and the newborns during childbirth and postnatal period, concerted efforts from governments and their stakeholders are crucial to maximize the use of technology to enhance frontline health professionals' skills to provide the emergency obstetric and newborn care (EmONC). However, no study has garnered nurses' and midwives' perspectives regarding the application of technology-enhanced learning approach to provide on-the-job Continuous Professional Development (CPD) and factors that may influence the application of this training approach in the Rwandan context., Methods: The study collected data from nurses and midwives from forty (40) public health facilities in remote areas nationwide. The study applied a qualitative descriptive design to explore and describe nurses' and midwives' perspectives on the feasibility and acceptability of technology enhanced learning approaches such as e-learning, phone-based remote training, and other online methods to provide trainings in EmONC. Two focus group discussions with EmONC mentors, two with nurses and midwives were conducted. Twelve key informant interviews were conducted. Participants were selected purposively. In total, 54 individuals were included in this study. A thematic approach was used to analyse data., Results: Nurses and midwives highlighted the need to provide refresher trainings about the management of pre-eclampsia. Most of the EmONC trainings are still provided face-to-face and the use of technology enhanced learning approaches have not yet been embraced in delivering EmONC CPDs for nurses and midwives in remote areas. Nurses and midwives found the first developed prototype of smartphone app training of the EmONC acceptable as it met the midwives' expectations in terms of the knowledge and skills' gap in EmONC., Conclusion: Although the newly developed application was found acceptable, further research involving practical sessions by nurses and midwives using the developed application is needed to garner views about the ease of use of the application, relevance of the EmONC uploaded content on the app, and needed improvements on the app to address their needs in EmONC., Competing Interests: Authors declare that there are no competing interests. The views expressed in this paper belong to the authors and do not necessarily align the views of UNFPA or the United Nations and the authors’ affiliated institutions., (Copyright: © 2024 Uhawenimana et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The American College of Nurse-Midwives (ACNM) represents certified nurse-midwives (CNMs) and certified midwives (CMs) who are graduate-prepared advanced practice providers. They attend educational programs accredited by the American Commission for Midwifery Education (ACME) and are certified by the American Midwifery Certification Board (AMCB). Their scope of practice as defined by ACNM includes primary care, reproductive services beginning with menarche through menopause, gender-affirming services, contraception, abortion, prenatal, birth, postpartum, and care of the newborn. CNMs/CMs attend 10.9% of US births, but other high-income countries have the reverse proportion of midwives to obstetricians. The CNM/CM workforce is growing, but retirements and attrition slow the growth. Research demonstrates good outcomes from care provided by midwives, and ACNM's primary goal is to expand the midwifery workforce and increase consumer access to midwifery care to mitigate the persistent rise in maternal mortality and morbidity. Barriers to workforce expansion include restricted practice at the state level, inability to expand the number of seats in education programs due to lack of clinical preceptors, and a lack of diversity in the workforce. Strategies to address these barriers may allow the workforce to grow, increasing access to high-quality, equitable sexual and reproductive care for people in the United States., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To better understand the barriers and facilitators to precepting midwifery students from across the healthcare ecosystem in New Jersey., Background: Growing the midwifery workforce is a crucial step to alleviating disparately poor perinatal health outcomes and expanding access to care. Difficulty recruiting and retaining preceptors has been identified as a barrier to graduating more midwives., Methods: In-depth qualitative interviews were conducted with 19 individuals involved in different stages of the clinical training process: midwives, physicians, and administrators. Transcripts were coded using the tenets of qualitative description and thematic analysis. Analysis was guided by the Promoting Action on Research Implementation in Health Services framework., Results: The following themes were identified and organized within the domains identified by our conceptual framework. Evidence: (mis)understanding the benefits of midwifery care and impacts on patient care. Context: the time and energy it takes to precept and practice considerations. Facilitations: developing the next generation of healthcare providers and the quiet and ever-present role of money in healthcare., Conclusions: Findings from this study support the importance of approaching midwifery precepting as a multifaceted endeavor, one that necessitates the full support of individuals within many different roles in an organization., Implications for Practice and Research: Getting buy-in from various levels of the healthcare ecosystem requires a flexible approach but must include a targeted effort toward showing the value of midwifery care in terms of patient outcomes, satisfaction, and cost., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To explore midwives' knowledge and understanding of the law and practice of consent in the post-Montgomery world., Design: Cross-sectional online survey. Descriptive statistical analysis of midwives' survey responses., Settings: Social media: Instagram, Facebook and Twitter. Survey distribution was via the UCL Opinio survey platform., Participants: A total of 402 midwives, surveyed over a four month period between 2nd March and 2nd July 2021., Measurements: Knowledge of legal consent, 'sureness' of meeting current legal requirements and competence to gain consent., Findings: 91% of participants acknowledged correctly that consent must be voluntary. 91% reported that women must be informed of all the risks associated with their care, although 26% reported that women should be informed of some of the risks associated with their care. Most participants were 'sure' that their discussions of consent meet current legal requirements (91%). 21% rated their competence to gain consent as 'excellent', 71% rated themselves as 'very good', whilst 1% rated their competence as 'poor'. Deficiencies in fundamental knowledge of consent were noted in some participants rating themselves highest in 'sureness' of meeting legal requirements and competence to consent., Key Conclusions: Fundamental gaps in midwives' knowledge of legal consent were identified. Participants demonstrated uncertainty regarding the extent of risk disclosure and discussion of alternative care options. Participants generally rated themselves highly in their consenting practices, despite lacking in basic knowledge of legal consent, revealing a discrepancy between midwives' self-perceptions and their actual knowledge., Implications for Practice: The overconfidence displayed by some participants is concerning for clinical midwifery practice. Professional education and guidance for midwives on legal consent in keeping with Montgomery is urgently required to ensure that midwives are legally compliant in their consenting practices., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Perceptions and experiences of midwives regarding structural empowerment during practice in Saudi Arabia were explored using a qualitative, constructive, descriptive design. Data was gathered using individual semi-structured interviews with ten midwives employed in delivery rooms, and prenatal and postnatal units of governmental hospitals in Saudi Arabia's eastern province. Data was analyzed with assistance of NVivo software, Version 12. Five themes emerged from our study: the meaning of structural empowerment, ambiguous hospital policies, the insufficient numbers of midwives, midwife-physician dynamics, and continuing education and training. Structural empowerment of midwives in maternity units may be useful in improving midwifery services in Saudi Arabia and worldwide.

Objectives: Comparison of national midwife workforce data from the National Provider Identifier file determined it undercounted midwives compared to national data available from the American Midwifery Certification Board. This undercount may be due to the existence of three taxonomy categories for midwives when registering for the National Provider Identifier. The objective of this study was to obtain an accurate count of advanced practice midwives using the National Provider Identifier Data., Methods: A recode strategy was created using the NPPES Data Dissemination File for November 7, 2021. The strategy identified advanced practice midwives using education and certification information provided in the "credentials" field. The strategy was validated using the NPPES Data Dissemination File for August 7, 2022 and the gold standard was the American Midwifery Certification Board count of midwives by state for August, 2022. Validation compared the accuracy and precision of the recode to the accuracy and precision of using the advanced practice midwife taxonomy category., Results: The recode strategy improved the accuracy and precision of the count of advanced practice midwives compared to the identification of advanced practice midwives using the advanced practice midwife taxonomy category., Conclusions for Practice: Recoding the NPPES Data Dissemination File provides a more accurate and precise count of advanced practice midwives than relying on the existing advanced practice midwife taxonomy classification. Researchers can use the NPPES Data Dissemination File when studying the midwifery workforce., (© 2023. The Author(s).)

Preconception and interconception care improves health outcomes of women and communities. Little is known about how prepared and willing Australian midwives are to provide preconception and interconception care. The aim of this study was to explore midwives' knowledge, perspectives and learning needs, and barriers and enablers to delivering preconception and interconception care. We conducted a cross-sectional exploratory study of midwives working in any Australian maternity setting. An online survey measured midwives' self-rated knowledge; education needs and preferences; attitudes towards pre and interconception care; and views on barriers, enablers; and, future service and workforce planning. Quantitative data were analysed descriptively and demographic characteristics (e.g., years of experience, model of care) associated with knowledge and attitudes regarding pre- and interconception care were examined using univariate logistic regression analysis. Qualitative data were captured through open-ended questions and analysed using inductive content analysis. We collected responses from (n = 338) midwives working across all models of care (full survey completion rate 96%). Most participants (n = 290; 85%) rated their overall knowledge about pre and interconception health as excellent, above average or average. Participants with over 11 years of experience were more likely to report above average to excellent knowledge (OR 3.11; 95% CI 1.09, 8.85). Online e-learning was the most preferred format for education on this topic (n = 244; 72%). Most (n = 257; 76%) reported interest in providing pre and interconception care more regularly and that this is within the midwifery scope of practice (n = 292; 87%). Low prioritisation in service planning was the most frequently selected barrier to providing preconception and interconception care, whereas continuity models and hybrid child health settings were reported as enablers of pre and interconception care provision. Findings revealed that midwives are prepared and willing to provide preconception and interconception care. Pre and post registration professional development; service and funding reform; and policy development are critical to enable Australian midwives' provision of pre and interconception care., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Bradfield et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Online learning platforms enable students to access their lessons anywhere and at any time, gain knowledge continuously, and become lifelong learners. This study aimed to explore the effectiveness of a web-based normal birth learning support platform, and to investigate nurse-midwife students' self-directed learning and attitudes towards online learning., Methods: This study was performed using a sequential explanatory mixed methods design, with a total of 190 nurse-midwife students who voluntarily agreed to study normal birth on the web-based learning support platform. After the web-based learning, 36 students participated in focus groups to share their experience. Knowledge data were analysed using repeated measures analysis of variance, and interview data were analysed thematically., Results: Normal birth knowledge results indicated a positive significant difference between the pre-test and post-test scores. Compared with the post-test scores, no difference was found 2 weeks after the web-based learning. However, 4 weeks after the web-based learning, test scores decreased slightly, but the difference was only marginally significant compared with the scores obtained immediately post-test and 2 weeks later. Four main themes emerged from the qualitative data collection: (1) being challenging and flexible; (2) increasing confidence and positive attitudes; (3) having an interesting web-based support design; and (4) enhancing responsibility, self-directed learning and self-regulation., Key Conclusion: Learning about normal birth on the web-based learning support platform can improve nurse-midwife students' self-discipline and self-directed learning, leading to sustainable knowledge and personal development. This was particularly significant and full of implications for learning and practice during the coronavirus disease 2019 pandemic. Acquired insights about web-based learning processes can be applied in other situations to further develop nursing and midwifery instruction, enhancing the learners' ability to apply theoretical knowledge to practice and provide effective care for women during childbirth., Competing Interests: Declaration of Competing Interest None declared, (Copyright © 2023. Published by Elsevier Ltd.)

Since the US Supreme Court overturned Dobbs v Jackson, expanded access to abortion has been critical. Abortion is safe, and related complications are rare. The safety of abortion provision by advanced practice clinicians (APCs) is well documented. Despite the increase in targeted restrictions for patients and clinicians in many states post-Dobbs, in recent years there have been meaningful gains in recognition and codification of abortion as part of an expanded scope of practice for APCs. Thus, creating a formal written pathway for midwives to obtain privileges in abortion provision could also improve abortion access. In New York City's public health care system, the largest in the United States, midwives provide a significant portion of perinatal and gynecologic care. Yet, until recently, a process to privilege midwives in the provision of abortion services did not exist. In response, midwives and physicians at a large New York City hospital system sought key stakeholder support to develop a pathway for certified nurse-midwives and certified midwives, licensed midwives in New York state, to obtain the necessary training needed for independent abortion provision. This article describes the development of a midwifery-led pilot program to improve abortion access by increasing the availability of trained midwifery abortion providers, along with the results of staff meetings exploring attitudes toward abortion care by APCs. We report our safety statistics from this pilot program and share existing evidence for safety of abortion provision by midwives and other APCs., (© 2023 by the American College of Nurse-Midwives.)

Background: Few examples exist of research capacity building (RCB) in midwifery. As in other jurisdictions, at the turn of this century midwives in the Netherlands lagged in research-based practice. Dutch professional and academic organisations recognised the need to proactively undertake RCB. This paper describes how a large national research project, the DELIVER study, contributed to RCB in Dutch midwifery., Methods: Applying Cooke's framework for RCB, we analysed the impact of the DELIVER study on RCB in midwifery with a document analysis comprising the following documents: annual reports on research output, websites of national organizations that might have implemented research findings, National Institute for Public Health and the Environment (RIVM)), midwifery guidelines concerning DELIVER research topics, publicly available career information of the PhD students and a google search using the main research topic and name of the researcher to look for articles in public papers., Results: The study provided an extensive database with nationally representative data on the quality and provision of midwifery-led care in the Netherlands. The DELIVER study resulted in 10 completed PhD projects and over 60 publications. Through close collaboration the study had direct impact on education of the next generation of primary, midwifery care practices and governmental and professional bodies., Discussion: The DELIVER study was intended to boost the research profile of primary care midwifery. This reflection on the research capacity building components of the study shows that the study also impacted on education, policy, and the midwifery profession. As such the study shows that this investment in RCB has had a profound positive impact on primary care midwifery in the Netherlands., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Spelten et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Limited literature exists in India on WhatsApp use for health communication among frontline health workers like Auxiliary Nurse Midwives (ANM). We conducted this study to assess the adoption of WhatsApp among ANMs and identify factors influencing its adoption. In addition, the study explored the perceptions of ANMs on WhatsApp use for sharing health information., Methods: We employed a mixed-method sequential explanatory design. We surveyed 259 ANMs, followed by in-depth interviews with 19 purposively sampled ANMs. We conducted multinomial logistic regression to identify factors associated with WhatsApp adoption and employed thematic analysis to analyze interviews., Results: 257 ANMs responded to the survey questionnaire, of which 18.3%, 48.2%, and 33.5% had low, mid, and high levels of WhatsApp adoption, respectively. Education (AOR = 2.87 [95% CI = 1.20-6.85]), motivation (AOR = 6.31 [95% CI = 1.43-27.80]), and technical awareness (AOR = 2.91 [95% CI = 1.11-7.62]) were significantly associated with WhatsApp adoption. Thematic analysis of the interviews resulted in six themes describing perceptions and experiences of ANMs on WhatsApp use. They are: (i) a way of instant communication, (ii) provision for multimedia messaging, (iii) a quick fix tool for queries and concerns, (iv) make attendance and reporting easy (v) a way of reaching higher officials, and (vi) a cost-saving mechanism., Conclusion: WhatsApp facilitated ANMs' communication and service delivery at the grassroots level. Measures to improve motivation, technical awareness, and digital education will likely improve WhatsApp adoption among health workers.

Introduction: Midwifery leadership is vital for improving maternal health outcomes, yet limited leadership training opportunities exist. This study evaluated acceptability and preliminary outcomes of Leadership Link, a scalable online learning program that aims to increase midwives' leadership competencies., Methods: The program evaluation study enrolled early-career midwives (<10 years since certification) into an online leadership curriculum using the LinkedIn Learning platform. The curriculum consisted of 10 courses (approximately 11 hours) of self-paced, non-health care-specific leadership content supplemented with brief midwifery-specific introductions from midwifery leaders. A preprogram, postprogram, and follow-up study design was used to evaluate changes in 16 self-assessed leadership abilities, self-perception as a leader, and resilience. Data were also collected on the application of leadership skills acquired through, and career advancements attributed to, program participation., Results: A total of 186 individuals activated LinkedIn Learning accounts. Almost half (41.9%) completed the full curriculum. Satisfaction was high, with 83.3% of postprogram survey respondents reporting the program was "probably" or "definitely" worth the time invested. Seventy-six participants (40.9%) provided matched pre- and immediate postprogram survey data on at least some of the 16 self-assessed leadership abilities. All 16 abilities showed statistically significant increases in pre- to postprogram mean scores, ranging from 6.4% to 32.5%. Both self-perception as a leader and resilience scores significantly increased from baseline. More than 87% of postprogram and follow-up survey respondents reported having applied new or improved leadership abilities to at least a small degree. Fifty-eight percent of follow-up survey respondents reported at least one midwifery career advancement, of whom 43.6% attributed the advancement, at least in part, to Leadership Link., Discussion: The findings suggest that the online Leadership Link curriculum is acceptable and may be effective in improving midwives' leadership capacity, potentially enhancing career opportunities and engagement in system change., (© 2023 by the American College of Nurse-Midwives.)

Background: Tertiary level midwifery educational pathways to achieve registration as a midwife vary in Australia, with a shift from the hospital to the university sector more than 20 years ago. These pathways are often referred to in the workforce setting to distinguish midwives with different academic backgrounds., Aim: To discuss the genesis of midwifery education in the Australian setting and explore the impact of the language used to describe the educational backgrounds on the professional identity of midwives., Discussion: Strong tertiary and regulatory governance exists to support the robust development of midwifery educational programmes and to ensure a high-quality, woman-centred workforce. Once registered, all midwives have the same skill set to provide care to women and families. However, separatist language is often used to describe midwives according to their educational background which has a propensity to reduce positive midwifery identity and influence continuing workforce attrition rates., Conclusion: Positive expression of midwifery identity, using a strength discourse and an inclusive workforce have the ability to strengthen job satisfaction and intention to remain in the profession. Midwifery education can occur through several pathways; however once registered, all midwives are equal., Competing Interests: Conflict of interest Linda Sweet, as Deputy Editor of Women and Birth declares a conflict of interest in relation to this paper., (Copyright © 2022 Australian College of Midwives. All rights reserved.)

Aim: To describe the implementation and evaluation of a midwife/midwifery student-mentoring program in one Local Health District in Sydney NSW Australia., Background: Evidence suggests well designed and supported midwife/midwifery student mentorship programs can make a difference to the clinical placement experiences and attrition rates of midwifery students., Design: In the evaluation of the mentoring program, we used surveys, focus groups and individual interviews., Methods: Eighty-six participants, including midwife mentors, midwifery students, non-mentor midwives and midwifery managers participated in the evaluation. Quantitative data were analysed using descriptive statistics and qualitative data, content analysis., Results: The mentoring program increased midwives' mentoring skills and was beneficial to their professional growth and leadership skills. Students reported positive outcomes including someone to talk to, emotional support and a sense of belonging. Mentoring programs require structure, mentor training, organisational support and transparency., Conclusion: The mentoring program provided benefits to both midwifery mentors and students and demonstrated the value of a structured and supported mentoring program for midwifery students., 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.)

Aim: To explore how the early workforce experiences of new midwives influence their career plans., Background: Each year, thousands of new midwives graduate from entry-to-practice midwifery courses, gain professional registration, and enter the workforce. Despite this, the world continues to face a shortage of midwives. The first five years of clinical practice, commonly referred to as the early career period, can be highly stressful for new midwives, contributing to early attrition from the profession. Supporting the transition from midwifery student to registered midwife is vital if we are to grow the workforce. Whilst the early career experiences of new midwives have been more broadly explored; little is currently understood about how these can influence their career plans., Methods: Following Whittemore and Knafl's (2005) five-stage process, an integrative review was conducted. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Nineteen studies met the criteria for inclusion. Thematic analysis was undertaken to organise and present the findings., Findings: Thematic analysis, guided by the review question led to the identification of three overarching themes: 'the need for support', 'sustaining health and wellbeing', and 'being able to provide safe and effective midwifery care'., Conclusion: Very little research to date has specifically explored how the early career experiences of new midwives influence their career plans, particularly within the Australian context. Further research is required to better understand how the early workforce experiences of new midwives can either strengthen their commitment to the profession or contribute to the decision to leave midwifery prematurely. This knowledge would provide a basis for the development of appropriate strategies to minimise early attrition from the midwifery profession and promote career longevity., 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.)

Adverse childhood experiences have a potential lifelong impact on health. A traumatic upbringing may increase antenatal health risks in mothers-to-be and impact child development in their offspring. Yet, little is known about the identification of adverse childhood experiences in antenatal care. The objective of this study was to explore the feasibility and acceptability of the adverse childhood experiences questionnaire among midwives and factors affecting its implementation. Three Danish maternity wards participated in the study. The data consisted of observations of midwifery visits and informal conversations with midwives, as well as mini group interviews and dialogue meetings with midwives. The data were analysed using systematic text condensation. Analysis of the data revealed three main categories; "Relevance of the adverse childhood experiences questionnaire", "Challenges related to use of the adverse childhood experiences questionnaire" and "Apprehensions, emotional strain, and professional support". The findings showed that the adverse childhood experiences questionnaire was feasible to implement in Danish antenatal care. Midwives' acceptability of the questionnaire was high. Training courses and dialogue meetings motivated the midwives to work with the questionnaire in practice. The main factors affecting the implementation process were time restrictions, worries of overstepping women's boundaries, and a lack of a specific intervention for women affected by their traumatic upbringing circumstances.

Background: A necessary precursor for quality maternity care provision is high quality education. The quality of care that students are exposed to during clinical education on maternity wards shapes their competencies and professional identities. In this study, we look at the introduction of midwives educated to international standards - with facility mentorship - deployed in tertiary level teaching hospitals in Bangladesh with the intention of improving the use of World Health Organization (WHO)-recommended birth practices., Aim: To examine the outcomes of introducing midwifery services into tertiary level care facilities in Bangladesh, on the use of WHO-recommended birth practices., Methods: A retrospective review of patient register data was carried out to understand level of changes in use of WHO-recommended birth practices after the introduction of a midwifery service. Multivariate linear regression was applied using an interrupted time series analysis, with and without a delayed effect, to assess both level and trend change following the introduction of the midwifery service., Findings: A significant increase (p < 0.001) in use of WHO-recommended birth practices was found, both immediately following the midwives' introduction and after one year. Quality improvement was observed not only in births attended by midwives, but also in those attended by doctors and nurses., Conclusion: By introducing quality maternity care provision through midwives in clinical sites, especially in tertiary-level care hospitals with large numbers of students, international standard midwives can improve the quality of clinical education in maternity wards, a critical priority for maternal health worldwide., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest. The authors alone are responsible for the views expressed in this publication, which do not necessarily represent the decisions or policies of the funder., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Guidelines for clinical practice have been part of the Ministry of health's efforts to improve the quality of care for over two decades. Their benefits have been documented in Uganda. However, having practice guidelines may not always result in their use in care provision. We explored the midwives' perceptions towards the ministry of health guidelines for providing immediate postpartum care., Methods: An exploratory descriptive qualitative study was conducted in three districts in Uganda from September 2020 to January 2021. In-depth interviews with 50 midwives from 35 health centers and 2 hospitals in Mpigi, Butambala, and Gomba districts were done. Thematic analysis of data was done., Results: Three themes emerged; awareness and use of the guidelines, perceived drivers, and perceived barriers to the provision of immediate postpartum care. The subthemes for theme I included; awareness of the guidelines, variations in the postpartum care practices, variations in preparedness to manage women with complications, and varied access to continuing midwifery education. Fear of complications and litigation were the perceived drivers of guideline use. On the other hand, lack of knowledge, busy maternity units, organization of the care, and the midwives' perceptions about their clients were the barriers to guideline use. Midwives felt that new guidelines and policies regarding immediate postpartum care should be disseminated widely., Conclusion: The midwives felt that the guidelines were good for the prevention of postpartum complications but their knowledge of the guidelines for the provision of immediate postpartum care was suboptimal. They desired on-job training and mentorship to help them bridge the knowledge gaps. Variations in patient assessment, monitoring, and pre-discharge care were acknowledged and said to be due to a poor reading culture and health facility factors like patient-midwife ratios, unit setup, and prioritization of labor., (© 2023. The Author(s).)

Aim: To document current teaching methods, curriculum, and perceived educational preparation related to the teaching of life-limiting fetal conditions, termination, and perinatal palliative care to Australian student midwives., Background: Australian women receiving a diagnosis of a life-limiting fetal condition are generally offered a choice between termination of pregnancy and perinatal palliative care. Midwives are often involved with caring for these women. What Australian student midwives are being taught about life-limiting fetal conditions, termination of pregnancy, and perinatal palliative care during their entry-to-practice program is unknown., Design: This study utilised a mixed-methods descriptive approach for data collection and analysis., Methods: Academic Leads of all Australian entry-to-practice midwifery programs received a questionnaire exploring topics taught, teaching time, teacher role, and perceived effectiveness of student preparation. Data was analysed statistically and thematically., Results: Twelve of 24 Academic Leads responded (50%); only five stated their programs taught all three areas. More respondents taught about termination of pregnancy (10/12) than perinatal palliative care (7/12). On average 5.8 ( ± 2.8) total hours was spent teaching about life-limiting fetal conditions, termination of pregnancy, and perinatal palliative care during the entire midwifery program, with a range of 1 - 10 h. The free-text data identified three central themes: lack of value within the curriculum; disconnect between the university and the placement hospital; and preparation for practice. Most (10/12) Academic Leads did not believe student midwives are prepared to care for affected families., Conclusions: Entry-to-practice midwifery programs vary considerably in their education surrounding life-limiting fetal conditions, however teaching hours overall were low and most Academic leads did not feel (or know if) their students were adequately prepared. Further research is required to determine if early career midwives find their university education in life-limiting fetal conditions adequate preparation for practice, and to then remediate identified deficiencies., 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.)

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.)

Background: In 2020, in response to major maternity workforce challenges exacerbated by the COVID-19 pandemic, the Victorian Department of Health implemented a number of workforce maximisation strategies, one of which was employment of undergraduate midwifery students called 'Registered Undergraduate Student Of Midwifery' (RUSOM)., Aim: To evaluate the RUSOM model implemented in a tertiary maternity service in Melbourne, Australia., Methods: A cross-sectional online survey was distributed to all RUSOMs and midwives at the study site in August 2021., Findings: Twenty of 26 RUSOMs (77%) and 110 of 338 permanent midwives (33%) responded. Both groups considered the model to be a positive workforce strategy that contributed to work readiness of students, and increased confidence and competence to practise. RUSOMS and midwives reported positives for the organisation including improving workload for midwives on the postnatal ward, enhancing quality of care and outcomes for women and babies, and the value of RUSOMs as team members. RUSOMs felt well supported, supervised and clinically and theoretically prepared. Both groups considered RUSOMs were underutilised, and that they could undertake additional duties, and both thought that the RUSOM model should continue., Conclusion: The model was highly valued by both RUSOMs and midwives. There was strong agreement that the model should continue and that the list of duties could be expanded. Given these findings, further research should explore the expansion and sustainability of RUSOMs in the maternity workforce., (Copyright © 2022 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: The Registered Undergraduate Student of Midwifery (RUSOM) workforce model provides final year midwifery students an opportunity of paid employment and gain experience as an assistant to midwives. A RUSOM supports the work of midwives by providing care to women and their newborns. Little is known about how the RUSOM role impacts the range of stakeholders in maternity care settings., Aim: To evaluate the acceptability of the RUSOM role, how it is experienced by staff and women, and its impact on quality of care., Methods: A mixed-methods approach including 9 qualitative focus groups (n = 41) and 4 descriptive surveys (n = 135) was used., Findings: The introduction of the RUSOM role has numerous benefits for the service, midwifery staff, women, and the RUSOM themselves. The RUSOM relieved the burden on the postnatal ward, giving midwives more time to work at their higher end of scope in direct clinical care. Having a clear scope of practice for the role ensured there were clear boundaries between the RUSOM and the midwife, resulting in the positive satisfaction for the maternity services team and women in their care., Discussion: Employing RUSOM staff has both immediate and long-term benefits for maternity services. The role had the potential to improve the professional development of upcoming midwives, leading to high quality and experienced graduates that are an invaluable asset to a maternity service., Conclusion: The positive outcome from this evaluation provides evidence for the expansion of the RUSOM model which can enhance the quality of care for women., (Copyright © 2022 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Objectives: Educated and skilled midwives are required to improve maternal and newborn health and reduce stillbirths. There are three main approaches to the pre-service education of midwives: direct entry, post-nursing and integrated programmes combining nursing and midwifery. Within these, there can be multiple programmes of differing lengths and qualifications, with many countries offering numerous pathways. This study explores the history, rationale, benefits and disadvantages of multiple pre-service midwifery education in Malawi and Cambodia. The objectives are to investigate the differences in education, roles and deployment as well as how key informants perceive that the various pathways influence workforce, health care, and wider health systems outcomes in each country., Design: Qualitative data were collected during semi-structured interviews and analysed using a pre-developed conceptual framework for understanding the development and outcomes of midwifery education programmes. The framework was created before data collection., Setting: The setting is one Asian and one African country: Cambodia and Malawi., Participants: Twenty-one key informants with knowledge of maternal health care at the national level from different Government and non-governmental backgrounds., Results: Approaches to midwifery education have historical origins. Different pathways have developed iteratively and are influenced by a need to fill vacancies, raise standards and professionalise midwifery. Cambodia has mostly focused on direct-entry midwifery while Malawi has a strong emphasis on dual-qualified nurse-midwives. Informants reported that associate midwifery cadres were often trained in a more limited set of competencies, but in reality were often required to carry out similar roles to professional midwives, often without supervision. While some respondents welcomed the flexibility offered by multiple cadres, a lack of coordination and harmonisation was reported in both countries., Key Conclusions: The development of midwifery education in Cambodia and Malawi is complex and somewhat fragmented. While some midwifery cadres have been trained to fulfil a more limited role with fewer competencies, in practice they often have to perform a more comprehensive range of competencies., Implications for Practice: Education of midwives in the full range of globally established competencies, and leadership and coordination between Ministries of Health, midwife educators and professional bodies are all needed to ensure midwives can have the greatest impact on maternal and newborn health and wellbeing., Competing Interests: Declaration of Competing Interests Andrea Nove reports financial support was provided by New Venture Fund., (Copyright © 2022. Published by Elsevier Ltd.)

Aim: This study assessed a) the impact of playing the Dignity board game on participants' understanding of respectful maternal and newborn care and b) participants' perceptions of how the game influenced their subsequent practice in Malawi and Zambia., Background: Nurse-midwives' poor understanding of respectful maternal and newborn care can lead to substandard practice; thus, effective education is pivotal. Used in several disciplines, game-based learning can facilitate skills acquisition and retention of knowledge., Design: a quasi-experimental study, using mixed-methods of data collection., Methods: Data were collected between January and November 2020. Nurse-midwives (N = 122) and students (N = 115) were recruited from public hospitals and nursing schools. Completion of paper-based questionnaires, before and after game-playing, assessed knowledge of respectful care principles and perceptions around behaviours and practice. Face-to-face interviews (n = 18) explored perceived impact of engaging with the game in clinical practice. Paired and unpaired t-test were used to compare scores. Qualitative data were analysed and reported thematically., Results: The study was completed by 215 (90.7 %) participants. Post-test scores improved significantly for both groups combined; from 25.91 (SD 3.73) pre-test to 28.07 (SD 3.46) post-test (paired t = 8.67, 95 % confidence interval 1.67-2.65), indicating an increased knowledge of respectful care principles. Nurse-midwives performed better than students, both before and after. In Malawi, the COVID pandemic prevented a third of nurse-midwives' from completing post-game questionnaires. Qualitative findings indicate the game functioned as a refresher course and helped nurse-midwives to translate principles of respectful care into practice. It was also useful for self-reflection., Conclusions: The Dignity board game has the potential to enhance understanding and practice of respectful maternal and newborn care principles in low-resource settings. Integration into nursing and midwifery curricula and in-service training for students and healthcare workers should be considered., 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 © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The Indian Government has committed to educate 90,000 midwives in accordance with international norms. This goal is critical as midwives provide evidence-based, high-quality midwifery care. There is a need to explore the contextual factors influencing this new midwifery education programme. Hence, the aim of this study is to explore contextual factors influencing the implementation of the national midwifery education programme for midwifery educators and the future Nurse Practitioners in Midwifery (NPMs) in India. A qualitative research design was used, with data collected through focus group discussions (n = 8) with a total of 27 participants representing seven national and international organisations supporting the Indian Government in its midwifery initiative. Transcribed interviews were analysed using content analysis. This study on contextual factors influencing the implementation of the new midwifery education programme in India showed that organisational and administrative processes are complex and the development of midwifery educators and nurse practitioners in midwifery needs to be fast tracked. The education of educators and future midwives in India, and elsewhere in similar settings, could benefit from efforts to simplify the organisational and administration processes and, in parallel, mobilize innovative teaching and learning approaches to bridge theory and practice., (© 2022. The Author(s).)

The use of ultrasound to determine gestational age is fundamental to the optimum management of pregnancy and is recommended for all women by the World Health Organization. However, this modality remains unavailable to many women in low-income countries where trained practitioners are scarce. Although previous initiatives have demonstrated efficacy in training midwives and technicians to perform antenatal ultrasound, these programs have often been too long and too complex to be realistic within the specific constraints of this context, highlighting the need for a novel and pragmatic approach. We describe the development and piloting of a bespoke course to teach midwives 3 fundamental components of early antenatal ultrasound scanning: (1) to identify the number of fetuses, (2) to confirm fetal viability, and (3) to determine gestational age. Having established that 5 days is insufficient, we propose that the minimum duration required to train ultrasound-naive midwives to competency is 10 days. Our completed program therefore consists of one and one-half days of didactic teaching, followed by 8 and one-half days of supervised hands-on practical training in which trainees are assessed on their skills. This package has subsequently been successfully implemented across 6 sites in Malawi, where 28 midwives have achieved competency. By describing the processes involved in our cross-continental collaboration, we explain how unexpected challenges helped shape and improve our program, demonstrating the value of preimplementation piloting and a pragmatic and adaptive approach., (© 2022 by the American College of Nurse-Midwives.)

Problem: A worldwide increase of caesarean section (CS) rates has been estimated at a rate of 4% per year and numerous interventions to reduce the rates have not been successful, perhaps because they are not acceptable to clinicians., Background: A caesarean section (CS) can be a life-saving operation, but has been associated with short- and long-term risk factors and shown to affect subsequent pregnancies., Aim: To explore midwives' views on CS rates and evaluate the feasibility and acceptability of an evidence-based intervention programme (REDUCE) designed to decrease overall CS rates in Ireland by 7%., Methods: Following ethical approval, a qualitative exploratory design was used to seek midwives' views of the evidence-based intervention. A total of 28 midwives from one large tertiary maternity hospital took part in four focus group interviews. Data were analysed using thematic analysis., Findings: Five themes emerged, illustrating the midwives' views of what could be improved in the present system and how CS rates could be reduced in future. The themes included: (i) Induction of labour; (ii) Education; (iii) Auditing of practice; (iv) Clinical practice; (v) Midwife-Obstetrician collaboration., Discussion: This study noted a rising CS rate year on year, with a rate of 37% at the time of the study, and the midwives voiced their very real concerns over the increased high rates., Conclusion: The study provided support for the evidence based 'REDUCE' intervention, which now needs to be tested empirically within this Irish population., (Copyright © 2022 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: The COVID-19 pandemic has impacted the provision of maternity care worldwide. The continuation of maternity services during the pandemic is vital, but midwives have reported feeling overwhelmed in providing these services at this time. However, there are limited studies in Indonesia that have explored the experiences of midwives in providing care during the pandemic., Aim: Our study aims to explore Indonesian midwives' experiences in providing maternity care during the COVID-19 pandemic., Methods: We used a descriptive qualitative approach using in-depth interviews to explore the experiences of 15 midwives working in different level of maternity care facilities in two regions in Indonesia, Surabaya and Mataram. All interviews were conducted via WhatsApp call and were audio-recorded with permission. Data were analysed using inductive thematic analysis., Findings: Four themes were identified: 1) fear for the wellbeing of the family and herself, 2) increased workload, 3) motivation and support for midwives, and 4) challenges in providing maternity care for women., Discussion: Sense of duty and loyalty to other midwives motivated midwives to continue working despite their fears and increased workload. Inadequate protection and support and practical challenges faced by midwives should be addressed to ensure midwives' wellbeing and the continuity of maternity care., Conclusion: Our study provides insight into Indonesian midwives' experiences in providing maternity care during the COVID-19 pandemic. Adequate protection through PPE availability, effective training and support for midwives' wellbeing is needed to support midwives in providing maternity care during the pandemic. Community's adherence to COVID-19 protocols and good collaboration between primary health centres and hospitals would also benefit midwives., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: The health attributes and advantages of breastfeeding are well documented in the literature. Current research identifies the importance of comprehensive lactation knowledge among health care professionals to improve breastfeeding outcomes. Educational curricula to incorporate lactation content is necessary for student preparedness to provide competent care. Midwives are in a unique position to support, promote, and manage breastfeeding. The purpose of this study was to survey Accreditation Commission for Midwifery Education (ACME)-accredited midwifery education programs in the United States for their breastfeeding curricular content including opportunities for clinical experiences in managing and counseling breastfeeding parents., Methods: A descriptive survey was deployed online to midwifery programs listed by the American College of Nurse-Midwives, with a response completion rate of 44.7%. Data collection included program descriptors, hours of lactation content, educational topics, faculty preparation, use of simulation, and clinical breastfeeding experiences., Results: Descriptive analyses revealed differences among the midwifery education programs surveyed regarding the amount of lactation content and clinical opportunities. Two programs offer a course specific to breastfeeding, with the remaining programs providing lactation content threaded throughout their curricula; 29.4% of programs offer 3 to 4 hours of lactation content, 35.3% report 5 to 8 hours of content, and 11.8% provide at least 10 hours of content. One program reports 18+ hours of content provided in both didactic and clinical settings. All programs report providing breastfeeding clinical opportunities for students; 18% of programs offer simulation experiences. No programs report using standardized lactation clinical competencies., Discussion: Midwives play a pivotal role in breastfeeding promotion, counseling, and clinical support. Standardization of didactic lactation education will assist programs in future curriculum mapping. Given the variability of clinical settings and patient access, creating clinical competencies and providing lactation simulation experiences may offer midwifery students a broader opportunity to gain critical skills in lactation management to best support breastfeeding families., (© 2022 by the American College of Nurse-Midwives.)

Background: The RAPID-2 intervention has been developed to support women with symptoms of mild-to-moderate anxiety in pregnancy. The intervention consists of supportive discussions with midwives, facilitated discussion groups and access to self-management materials. This paper reports the development of a training programme to prepare midwives and maternity support workers to facilitate the intervention., Methods: Kern's six-step approach for curriculum development was used to identify midwives and maternity support workers training needs to help support pregnant women with anxiety and facilitate a supportive intervention. The stages of development included feedback from a preliminary study, stakeholder engagement, a review of the literature surrounding midwives' learning and support needs and identifying and supporting the essential process and functions of the RAPID intervention., Results: Midwives' reported training needs were mapped against perinatal mental health competency frameworks to identify areas of skills and training needed to facilitate specific intervention mechanisms and components. A training plan was developed which considered the need to provide training with minimal additional resources and within midwives' scope of practice. The training plan consists of two workshop teaching sessions and a training manual., Conclusion: Future implementation is planned to include a post-training evaluation of the skills and competencies required to fully evaluate the comprehensive programme and deliver the RAPID-2 intervention as planned. In addition, the RAPID-2 study protocol includes a qualitative evaluation of facilitators' views of the usefulness of the training programme., (© 2022. The Author(s).)

Aim: To explore the experiences and perceptions of midwives in the treatment of sex trafficking victims., Design: The study was qualitative with a hermeneutic-phenomenological approach, using semi-structured interviews and focus groups., Methods: Two focus groups and six interviews were carried out on 14 midwives in primary care, delivery and emergency rooms. Data were collected in three hospitals in Spain in June 2021. ATLAS.ti 9 software was used to conduct a content analysis of the focus group and interview data., Results: The results revealed two primary themes and six subthemes. The two primary themes were (i) sex trafficking: a camouflaged reality on the invisible spectrum, and (ii) a thirst for attention in the aftermath of violence. Representative quotations were used to illustrate both the main themes and the subthemes., Conclusions: This study provides new insight into midwives' experiences treating sex trafficking victims. Professionals view this type of violence as a silent issue that negatively impacts victims' health and livelihood. However, a number of different factors stand in the way of correctly identifying and treating victims. Therefore, healthcare workers must be provided with practical tools and continuous professional development on this topic., Impact: This study indicates the importance of the midwives' key role in identifying and assisting victims of sex. Not only do measures in the healthcare setting, such as on-going specific-related content training or up-to-date protocols, need to be implemented to ensure proper care for those affected by sexual exploitation, but also focusing on suspicious characteristics and reducing obstacles to patient communication will help bring the true situation to light and better respond to patients' priority needs., (© 2022 John Wiley & Sons Ltd.)

Problem: There is limited evidence regarding midwives' confidence and practices in providing sexual and reproductive health care in Australia., Background: Midwives provide important public health education to women regarding sexual and reproductive health care., Aim: The aim of this study was to explore midwives' confidence and practices around providing education to women on three key areas of sexual and reproductive health: contraception and family planning; sexual activity; and sexual health., Methods: A cross-sectional exploratory study was conducted with responses from n = 164 midwives (43.1% response rate) working in a public tertiary maternity hospital in Western Australia. The survey included items measuring confidence; method and frequency of practice. Open-ended questions captured qualitative data. Data analysis was conducted using descriptive statistics for quantitative data and content analysis for qualitative data., Findings: There was a significant association between age, years of clinical experience (p = 0.001) and work setting (p = 0.032) on the confidence to provide education on sexual activity. Most (92.1%) midwives indicated that they wanted further education. Lack of time, knowledge and language barriers were key factors preventing education., Discussion: Midwives' provision of education to women is essential for improving health literacy and health outcomes. Results reveal the necessity to include sexual and reproductive health education in entry to registration courses and the importance of continuing professional development., Conclusion: Evidence of midwives' confidence and current practices in the provision of sexual and reproductive health care offers utility for leaders and educators in midwifery to prepare and equip midwives to fulfil this important public health role., (Copyright © 2021 Australian College of Midwives. All rights reserved.)

Aim: To explore nurses' and midwives' experiences, views, perceptions and impact on their responses to out of work emergencies where first aid may be required., Design: A constructivist grounded theory study was conducted between 2012 and 2019., Methodology: In-depth, semi-structured interviews were undertaken with 16 nurses and midwives. Participants were recruited via a participant referral process with registered nurses and midwives being accessed from three NHS organizations. Data were analysed and coded using constant comparative analysis with the support of Nvivo 10 software leading to the construction of a substantive grounded theory., Results: A core enduring in vivo theme, 'The Right Thing to Do', emerged as a central conceptual reality constructed via three key in vivo themes; 'Something I've Heard', 'Am I Covered?' and 'Just Who I Am', each with several sub-themes. A pervading anxiety about responding at off-duty situations requiring first aid was persistently evident across these themes., Conclusion: The study showed a strong sense of moral agency among nurses and midwives, despite a powerful underlying feeling of anxiety surrounding broader issues of urban myth, protection and personal and professional identity. The substantive theory emerged as 'doing "The Right Thing" in a climate of anxiety'., Impact: The study illuminates an area that has previously been the subject of anecdotal debate. The substantive theory, 'doing "The Right Thing" in a climate of anxiety' illustrates the issues and tensions that exist surrounding the off-duty response. Implications and recommendations for practice and education focus on the fostering of knowledge and understanding of professional identity, position in law and scope of practice, together with potential future research directions. This work provides the first in-depth qualitative study contributing a significant new perspective both nationally and globally., (© 2022 John Wiley & Sons Ltd.)

Aim: This review aims to demonstrate the current core competencies of the Chinese midwifery workforce and to summarize the influencing factors of core competencies., Background: Midwifery core competencies are crucial to providing high-quality maternal and newborn health care, but little is known about the overall status of the core competencies of the Chinese midwifery workforce., Evaluation: A scoping review was conducted following the latest Joanna Briggs Institute (JBI) scoping review methodology and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist., Key Issues: Forty-one studies were included in this review. Regarding core competency assessment tools, the Midwife Core Competency Scale was used most frequently among 16 identified tools. Generally, the core competencies of the Chinese midwifery workforce were at a moderate or high level, but the competencies in pre-pregnancy, public health care and integrative competence were relatively inadequate. The main factors influencing the core competencies of the midwifery workforce were their working years, educational level and training experience., Conclusion: This review provides a comprehensive overview of the core competencies of the Chinese midwifery workforce at the national level. Future studies are encouraged to use objective instruments to reflect core competencies and explore the intervenable influencing factors of core competencies., Implications for Nursing Management: Core competency assessment tools can be used to select the qualified midwifery workforce. Targeted core competency enhancement programmes should be formulated based on the current core competencies level and the factors influencing core competencies., (© 2021 John Wiley & Sons Ltd.)

Introduction: This is the third national survey about the incidence of midwifery involvement in malpractice litigation, case outcome, methods of coping, and the influence of fear of liability or actual litigation on midwifery practice and professional liability insurance. Incidence of disciplinary action was also included., Methods: A link to a web-based survey was sent to all American College of Nurse-Midwives members with an active email address in January 2018. Students and associate members were excluded from analysis. Logistic regression was used to identify predictors of involvement in lawsuit., Results: Of 6199 email links sent, 880 midwives responded (14%). One-third of participants (n = 280, 32%) have been named in at least one lawsuit after a median of 7 years in practice. Claims most often involved intrapartum hospital-based care and resulted from fetal heart rate interpretation. The most common outcome of a case was settlement prior to court or arbitration (n = 117, 42%). Significant predictors of litigation included older age of the midwife and region of practice (increased in Northeastern states, decreased in Midwestern states). Midwives' most common source of emotional support was their attorney. Only 6% (n = 53) of participants experienced disciplinary action against their state license. Half of the actions by a state governing board were unrelated to a lawsuit., Discussion: Midwives may experience litigation the longer they are in practice, but there has not been a significant change in the incidence since the previous survey in 2009. More resources and education are needed for midwives to provide adequate peer support to colleagues following adverse events or when named in a lawsuit. Continued education is also needed for midwives regarding types of professional liability insurance, affordability, and how policy terms and limits influence clinical practice., (© 2022 by the American College of Nurse-Midwives.)

In 2015, accreditation system for Japanese midwives was started by Japan Institute of Midwifery Evaluation. In the present practice, midwives are not able to acquire advanced competencies. Because of Japan's declining birth rate and uneven distribution of work places for midwives, opportunities for midwives to experience midwifery practice are decreasing and proficiency cannot be enhanced easily. The Japanese Nursing Association realized the need for strategic enhancement of midwifery practice, and consequently developed the Clinical Ladder of Competencies for Midwifery Practice (CLoCMiP) to be made available wherever it was needed. Five midwifery-related associations (Japanese Nursing Association, Japanese Midwives Association, Japan Academy of Midwifery, Japan Society Midwifery Education, and Japan Institute of Midwifery Evaluation) each shared a sense of crisis that the current situation hindered the ability of midwives to improve their ability and performance, so they decided to establish a certification system based on CLoCMiP. CLoCMiP evaluates midwifery core competencies and comprises 5 levels from Novice to Level IV to provide midwifery care autonomously. To be linked to this, designation rules of midwifery education was changed by Ministry of Health, Labor and Welfare. It increases from 28 credits to 31 credits, and applied from 2022. It should be strengthened in perinatal mental health, clinical judgment skills, and comprehensive support for the child-rearing in the community. Then, we reviewed our midwifery program and created core curriculum in preferred midwifery education by Japan Society Midwifery Education. It is important for midwives to collaborate interprofessional and continuing Education.

Competing Interests: Conflict of interest None declared