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Background: Maternal health programmes that focus on the woman alone are limiting in LMICs as pregnant women often relate to maternity services through a complex social web that reflects power struggles within the kinship and the community., Methods: A scoping review was conducted to explore the rationale for male involvement in maternal health in LMICs. This review was guided by the question: What is the current state of knowledge regarding the inclusion of men in maternal health services in LMICs? The literature search was conducted using mySearch, Bournemouth University`s iteration of the EBSCO Discovery Service (EDS) tool. The review process used the Preferred Reporting Items for Systematic Reviews to select papers for inclusion., Findings: Thirty three studies met the inclusion criteria. Findings describe the rationale for involving men in maternity care, alongside the criticisms and challenges inherent in engaging with men in maternal health. Involving men in maternity services can improve health outcomes for women and infants. Health strategies aimed at educating men are relevant in equipping men with knowledge and skills that help men to be supportive of women`s wellbeing during pregnancy and childbirth., Conclusion: Men can serve as advocates for women and reinforce their partner`s choices in accessing skilled care and infant feeding. Further research is required to examine the effect of male involvement on women`s autonomy and to assess health education interventions aimed at mitigating harmful outcomes of involving men in maternity services., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2021. Published by Elsevier Ltd.)

Objective: the Mother-Generated Index (MGI) is a validated tool to assess postnatal quality of life. It is usually administered several weeks or months after birth and correlates with indices of post partum mood states and physical complaints. The instrument had not been translated into German before or validated for use among German-speaking women, nor have the results of the tool been assessed specifically for the administration directly after birth. This paper aims to describe the systematic translation process of the MGI into German and to assess the convergent validity of the German version of the instrument directly after birth and seven weeks post partum., Design: prospective two-stage survey., Setting: two rural hospitals in the south of Germany and in the north of Switzerland., Participants: all women giving birth between 1st October and 15th December 2012 with sufficient knowledge of German and whose babies were not referred to a neonatal care unit; 226 women were eligible to participate., Measurement Instruments: two questionnaires including questions relating to socio-demographic factors and perinatal care, and incorporating the MGI, the Hospital Anxiety and Depression Scale (HADS) and the Postnatal Morbidity Index (PMI). All instruments were subjected to forward and back translation and pilot-tested; the first questionnaire was then administered in the first two days after birth and the second six weeks post partum. Parametric and non-parametric tests were computed using SPSS., Findings: 129 surveys were returned an average of three days after birth and 83 after seven weeks. Higher postnatal quality of life showed a significant correlation with a lower anxiety and depression score (p<0.01), fewer maternal physical complaints (p<0.05) and more favourable baby adjective scores (p<0.05) after birth. Significant associations were found between MGI scores and sufficient help (p=0.03) as well as ability to cope at home (p<0.01). MGI scores three days and seven weeks after birth correlated highly significantly and positively (p<0.001)., Key Conclusions: convergent validity of the MGI with the HADS and the PMI suggests that the German version of the MGI is a valid indicator of physical and emotional post partum well-being., Implication for Practice: the German version of the MGI can be used in the post partum period to identify women whose quality of life is impaired during the first days after birth, in order to initiate extended midwifery care and referral if necessary., (Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background and Objective: the professional midwife is a key person for promoting maternal and family health. Not all countries have yet reached the professional standard for midwives set by the International Confederation of Midwives (ICM) and Nepal is one of these countries. This study explores the feasibility to establish a professional midwifery cadre in Nepal that meets the global standards of competencies, and to define a strategy to reach this., Method: a mixed-methods study comprised (1) policy-review (2) interviews and (3) observations. An assessment tool was designed for data collection and analysis using variables from three sources: ICM's Global Standards, the skilled birth attendant programme in Nepal, and JHPIEGO's site assessment tool for maternal health and new-born programmes. Data were collected in a desk review of education and policy documents, interviews with stakeholders, and site assessment of five higher education institutions and their hospital-based maternity departments. The analysis resulted in a recommended strategy., Findings: six levels of education of nurse staff providing midwifery care were identified; all regulated under the Nepal Nursing Council. No legislation was in place authorising midwifery as an autonomous profession. A post-basic midwifery programme on first cycle-bachelor level was under development. A well-organised midwifery association was established consisting of nurses providing maternal health care. Four university colleges offering higher education for nurses and clinicians had a capability to run a midwifery programme and the fifth had a genuine interest in starting a midwifery programme at bachelor level. The proposed strategy includes four strategic objectives and interventions in relation to four components identified by UNFPA: Legislation and regulation; Training and education; Deployment and utilisation; and Professional associations., Conclusion and Implication for Practice: the study has delivered a proposed strategy for the Government of Nepal for effective management of the midwifery workforce in order to enhance midwives' contribution in maternity care and thus promoting improved maternal and new-born health. The developed analytical framework could be used as an assessment tool also in other countries to establish professional midwifery cadres that meets the global standards of competencies., (© 2013 Elsevier Ltd. All rights reserved.)

Objective: To explore and understand what it means to provide midwifery care in remote and rural Scotland., Design: Qualitative interviews with 72 staff from 10 maternity units, analysed via a case study approach., Setting: Remote and rural areas of Scotland., Participants: Predominantly midwives, with some additional interviews with paramedics, general surgeons, anaesthetists and GPs., Findings: Remote and rural maternity care includes a range of settings and models of care. However, the impact of rural geographies on decision-making and risk assessment is common to all settings. Making decisions and dealing with the implications of these decisions is, in many cases, done without onsite specialist support. This has implications for the skills and competencies that are needed to practice midwifery in remote and rural settings. Whereas most rural midwives reported that their skills in risk assessment and decisions to transfer were well developed and appropriate to practising in their particular settings, they perceived these decisions to be under scrutiny by urban-based colleagues and felt the need to stress their competence in the face of what they imagined to be stereotypes of rural incompetence., Conclusions: This study shows that skills in risk assessment and decision-making are central to high quality remote and rural midwifery care. However, linked to different perspectives on care, there is a risk that these skills can be undermined by contact with colleagues in large urban units, particularly when staff do not know each other well. There is a need to develop a professional understanding between midwives in different locations., Implications for Practice: It is important for the good working relationships between urban and rural maternity units that all midwives understand the importance of contextual knowledge in both decisions to transfer from rural locations and the position of midwives in receiving units. Multiprofessional CPD courses have been effective in bringing together teams around obstetric emergencies; we suggest that a similar format may be required in considering issues of transfer., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: there is an on-going debate about perceptions of risk and risk management in maternity care., Objectives: to provide a critical analysis of the risk concept, its development in modern society in general and UK maternity services in particular. Through the associated theory, we explore the origins of the current preoccupation with risk. Using Pickstone's historical phases of modern health care, the paper explores the way maternity services changed from a social to a medical model over the twentieth century and suggests that the risk agenda was part of this process., Key Conclusions: current UK maternity services policy which promotes normality contends that effective risk management screens women suitable for birth in community maternity units (CMUs) or home birth: however, although current policy advocates a return to this more social model, policy implementation is slow in practice., Implications for Practice: the slow implementation of current maternity policy in is linked to perceptions of risk. We content that intellectual and social capital remains within the medical model., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Objective: to compare data obtained from two sources, service providers and service users, regarding the maternity services in Scotland., Design: an audit of maternity services involving site visits, staff interviews and a cross-sectional survey of service users., Participants: lead professionals in every consultant-led maternity unit in Scotland and all 1639 women giving birth in Scotland during a ten-day period., Data Collection: structured group interviews with service providers and a questionnaire survey of recently delivered women., Data Analysis: professionals' and women's responses were cross-tabulated and differences in proportions were tested for statistical significance using the chi-square test., Findings: a total of 1137 women completed the questionnaire (response rate 69%). Overall, there was good agreement between professionals' and women's perceptions of the aspects of care studied. However, there were disparities in some areas. For example, staff in eight units reported mechanisms to ensure early distribution of a free national pregnancy book; however, in six of these units less than 75% of women actually received this book prior to their first hospital visit. Eighteen units reported that they offer a postnatal 'reunion meeting'; in ten of these units, less than 50% of women were aware of the reunion meeting. Eighteen units reported a policy of each woman having a lead professional or care co-ordinator; in three of these units, less than 50% of women perceived that they had a care co-ordinator and for most women, the profession (midwife, general practitioner or obstetrician) of their perceived co-ordinator differed from that expected on the basis of staff reports. There was some evidence overall that unit policies had a direct influence on women's responses., Conclusions and Implications for Practice: this study demonstrates the importance of using a range of complementary methods of data collection and of ascertaining both service users' and providers' views when assessing the quality of care. Further research is required to explore differences in service provider's and women's perceptions and how this information can be used to improve the quality of maternity care. The finding that service provision may influence women's preferences has important implications for service planning, in particular the introduction of new models of care, and this needs further exploration., (Copyright 2002 Elsevier Science Ltd.)

Objective: A survey of women's views of their care was undertaken as part of a national audit of maternity services in Scotland. The overall aim of the audit was to determine the extent to which recommendations from recent national policy documents had been adopted in practice., Design: A cross-sectional study seeking the views of all women giving birth throughout Scotland during a 10-day period in September 1998., Participants: All women giving birth in Scotland within the survey period were eligible to participate in the study. Women unable to complete the questionnaire in English, women for whom the midwife deemed it inappropriate, and women who delivered but no longer resided in Scotland by their 10th postnatal day were excluded., Data Collection: A self-complete questionnaire given to the woman by her community midwife for completion on her 10th postnatal day., Data Analysis: Analysis was carried out using the statistical package SPSS for Windows. Descriptive statistics were produced for all variables. Statistical tests of significance were not used, as this was primarily a descriptive survey., Findings: Of the 1152 questionnaires returned, 1137 were suitable for analysis. This gave a response rate of 69% of the eligible population (1639). Most women (80%) had the majority of their antenatal care in the community but only one third had a choice about this. Sixty-nine per cent of women received care from one or two people. However, only 37% had a choice about who these people were. The majority of women gave birth in hospital (99%). Sixty-one per cent felt that they had a choice about where they could have their baby. However, fewer women had a choice about having a home birth (41%) or a DOMINO delivery (23%). Just over half the women felt that it was important to be cared for by a midwife that they had met during pregnancy but only 12% of women achieved this. Sixty-two per cent of women had talked to a health professional about what happened during labour and delivery but less than half had spoken with a professional who was present during her labour or birth., Conclusions: Considerable efforts have been made to improve information and choice for women. However, it is clear that further work is needed if women are to be offered informed choice in the provision of their maternity care.