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Background: Provision of contraception to women in the immediate postnatal period has been endorsed by professional bodies, to reduce the incidence of short inter-pregnancy intervals. This study examined the views of postnatal women and practising midwives regarding provision of contraceptive advice and contraceptive methods by midwives, in a region of the United Kingdom., Methods: A mixed-method approach using qualitative interviews with midwives, and a postnatal survey followed by qualitative interviews with postnatal women, in five hospitals in the East of England. Twenty-one practising midwives and ten women were interviewed. Two hundred and twenty-seven women returned a survey. Survey data was analysed descriptively, augmented by Student's t-tests and Chi-squared tests to examine associations within the data. Interviews were recorded, transcribed and analysed guided by the phases of thematic analysis., Results: Midwives and women supported the concept of increased midwifery provision of contraceptive advice, and provision of contraceptive methods in the postnatal period. Convenience and an established trusting relationship were reasons for preferring midwifery provision over visiting a doctor for contraception. The best time for detailed discussion was reported to be antenatal and community visits. The Progesterone-only-pill (POP) was the method, in which women indicated most interest postnatally. Concerns for midwives included the need for increased education on contraceptive methods and training in supplying these. Structural barriers to such provision were time pressures, low prioritisation of contraceptive training and disputes over funding., Conclusions: Women reported interest in midwives supplying contraceptive methods and expressed the view that this would be convenient and highly acceptable. Midwives are supportive of the concept of providing enhanced contraceptive advice and methods to women in their care, and believe that it would be advantageous for women. Institutional support is required to overcome structural barriers such as poor access to continuous professional development, and to allow contraceptive provision to be fully recognised as integral to the midwifery role, rather than a marginalised addition.

Medical staff shortages in the UK have provided impetus for the introduction of advanced clinical practitioners (ACPs). This case study explored the views of 22 ACPs, managers and doctors in primary and acute settings in a region of England, to understand how the role is used, and barriers and facilitators to its success. ACP roles improved the quality of service provision, provided clinical career development and enhanced job satisfaction for staff and required autonomous clinical decision-making, with a high degree of self-awareness and individual accountability. Barriers included disparate pay-scales and funding, difficulty accessing continuing education and research, and lack of agreed role definition and title, due to a lack of standardised regulation and governance, and organisational barriers, including limited access to referral systems. Facilitators were supportive colleagues and opportunities for peer networking. Regulation of ACP roles is urgently needed, along with evaluation of the cost-effectiveness and patient experience of such roles.

Objectives: To explore the attitudes and opinions of student midwives toward drug use before educational intervention. To measure the attitudes of student midwives toward substance using pregnant women before and after educational intervention. To explore the role of the education on attitude change toward pregnant drug users following educational intervention., Design: The research used case study methodology. It was conducted in 3 phases; Likert style questionnaires (Jefferson Scale of Physician Empathy and Medical Condition Regard Scale), Virtual Learning Environment discussion board analysis and semi-structured interviews., Setting: The 'case' was a single delivery of a university distance-learning module 'Substance Misusing Parents.', Participants: The participants were 48 final year student midwives across eight NHS Trusts in the UK., Findings: The general empathy levels showed no significant change (p = 0.539), but empathy toward pregnant drug users statistically improved following the education (p = 0.012). Furthermore, students' experiences of the education demonstrated the importance of sharing and reflecting on practice with peers; the mode of delivery; the experiences of drug users, both positive and negative; and making sense of these experiences, thus bridging the 'theory-practice divide,' as key in influencing this change., Key Conclusions: The study has provided new insights into, the position of student midwives in the UK in terms of their attitudes toward pregnant drug users. It has also provided insight into the required nature of education aimed at altering attitude toward drug use; demonstrating the importance of critical reflection, offering e-learning as an effective model for education design. It has furthermore, confirmed the work of others regarding stigmatisation of drug users in practice and the importance of service user input to education., Implications for Practice: This research demonstrates the positive potential of education in changing attitude and offers suggestions for effective methods of educational delivery to help reduce stigma in midwifery and other areas of practice., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

Substance misuse is a complex issue, fraught with many challenges and inequalities for those affected; most of these are as a result not of the substances themselves, but of the underlying web of socioeconomic problems associated. Whilst the literature suggests that pregnancy may be a 'window of opportunity' for substance misusing women, it also suggests that there are several barriers to women engaging with health care. One of these is the fear of being judged and stigmatised by healthcare professionals. This literature review looks at research in the field of substance misuse in pregnancy, focusing on the 'stigmatisation' of pregnant drug users by healthcare professionals, illustrating the potential impact of this upon care.