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The debate on the safety and outcomes of home versus hospital births highlights the need for evidence-based evaluations of these birthing settings, particularly in Catalonia where both options are available. To compare sociodemographic characteristics and maternal and neonatal outcomes between low-risk women opting for home versus hospital births in Catalonia, Spain. This observational cross-sectional study analysed 3,463 low-risk births between 2016 and 2018, including 2,713 hospital and 750 home births. Researchers collected sociodemographic data, birthing processes, and outcomes, using statistical analysis to explore differences between the settings. Notable differences emerged: Women choosing home births typically had higher education levels and were predominantly Spanish. They were 3.43 times more likely to have a spontaneous birth and significantly less likely to undergo instrumental births than those in hospitals. Home births were associated with higher utilization of non-pharmacological analgesia and a more pronounced tendency to iniciate breastfeeding within the first hour post birth and stronger inclination towards breastfeeding. Hospital births, conversely, showed higher use of the lithotomy position and epidural analgesia. There were no significant differences in neonatal outcomes between the two groups. Home births managed by midwives offered better obstetric and neonatal outcomes for low-risk women than hospital births. These results suggest home birth as a safe, viable option that promotes natural birthing processes and reduces medical interventions. The study supports the integration of midwife-led home birth into public health policies, affirming its benefits for maternal and neonatal health. [ABSTRACT FROM AUTHOR]

• This was the first randomised trial to assess the impact of birth-plan counselling based on shared decision making. • Birth plan counselling based on shared decisions changed women's preferences. • Midwife counselling influenced women's childbirth preferences. Midwives provide counselling for birth plans (BPs) to women during prenatal care; however, the impact of individualised BP counselling interventions based on shared decision-making (SDM) regarding women's preferences is unknown. This randomised cluster trial included four primary healthcare units. Midwives provided BP counselling based on SDM to women in the intervention group (IG) during prenatal care along with a handout about evidence-based recommendations. Women in the control group (CG) received standard BP counselling from midwives. The main outcome was preference changes concerning BPs. A total of 461 (95.5 %) pregnant women received BP counselling (IG, n = 247; CG, n = 214). Women in the IG changed their BP preferences for 13 items compared with those in the CG. These items were: using an unique space during birth (81.1 % vs 51.6 %; p < 0.001), option for light graduation (63 % vs 44.7 %; p < 0.001), listening to music (57.3 % vs 43.6 %; p = 0.006), drinking fluids during labour (84.6 % vs 93.6 %; p = 0.005), continuous monitoring (59 % vs 37.8 %; p < 0.001); desire for natural childbirth (36.6 % vs 25 %; p = 0.014), epidural analgesia (55.1 % vs 43.6 %; p = 0.023); breathing techniques (65.2 % vs 50.5 %; p = 0.003), massage (74.9 % vs 55.3 %; p < 0.001); birthing ball use (81.9 % vs 56.9 %; p < 0.001), spontaneous pushing (49.3 % vs 28.7 %; p < 0.001), choosing birth position (69.6 % vs 41.5 %) and delayed umbilical cord clamping (67.8 % vs 44.1 %; p = 0.001). SDM counselling, together with a handout about evidence-based recommendations on childbirth and newborn care, produced more changes in women's preferences expressed in the BP than standard counselling. [ABSTRACT FROM AUTHOR]

The purpose of cardiotocograph (CTG) usage is to detect any alterations in fetal heart rate (FHR) early before they are prolonged and profound. However, the use of CTG machines on a routine basis is not an evidence-supported practice. There is no Jordanian study that assesses the midwives' attitudes toward this machine. This study aimed to identify Jordanian midwives' attitudes towards the use of cardiotocograph (CTG) machines in labor units, alongside examining the relationships between midwives' personal sociodemographic characteristics and such attitudes. A descriptive research design was used to identify Jordanian midwives' attitudes towards the use of CTG machines in both public and private labor units in Jordan. Data were collected using the valid and reliable tool designed by Sinclair (2001), and these were used to identify midwives' attitudes towards CTG usage. A total of 329 midwives working in the labor units of governmental and private hospitals in the center and north of Jordan participated in the study from May to July 2022. The total mean score for the attitude scale was M = 3.14 (SD = 0.83). More than half of the sample (N = 187, 58.4 %) demonstrated a mean score greater than 3.14, however, which indicates generally positive attitudes toward CTG usage in labor units. Midwives working in private hospitals and those holding Bachelor's degrees had more positive attitudes toward the use of CTG machines. This study provides new insights into the attitudes of Jordanian midwives towards CTG use in labor units. These suggest that it is critical to conduct training courses for registered midwives to help them develop and/or regain confidence and competence with respect to various key aspects of intrapartum care, including intermittent auscultation and the appropriate use of CTG. [ABSTRACT FROM AUTHOR]

• Inconsistency in defining the term 'physiological birth' may result in a miscommunication of care, leading to unmet expectations and diminished satisfaction for women/persons experiencing labour and birth. 'Normal', 'natural' and 'physiological birth' are used interchangeably in the literature, however it is unclear what interventions (if any) are congruent with physiological birth. • There are challenges to advocating physiological birth in the hospital setting; a lack of exposure to physiological birth, medicalisation and insufficient support could contribute to a sense of uncertainty for care providers, hindering the provision of clinical care that adheres to a physiological approach. A physiological approach to labour and birth was important to women, regardless of the outcome. • If the term 'physiological birth' has become outdated, it is crucial to describe the birthing process without ambiguity and reshape midwifery standards to align with the values that women hold as important. Physiological birth was defined by the World Health Organization in 1997, however, clinical practices in childbirth have changed considerably since this time. Ambiguous terms in healthcare such as 'physiological birth' may cause confusion amongst care providers and consumers. To identify what is known about physiological birth, and how perceptions of physiological birth manifest in current literature. This review followed the Joanna Briggs Institute methodology for scoping reviews and the PRISMA-ScR checklist. Four databases were searched using keywords relating to physiological birth. Relevant studies were identified using agreed criteria, and data were extracted and synthesised. A total of 24 studies met the inclusion criteria for this review. Three connected factors were identified: (1) Physiological birth in a risk-averse system, (2) Dominant voices in birth, and (3) Lack of exposure to physiological birth. No unified universal definition of physiological birth was identified in the literature. 'Physiological birth' as a term lacks consistency. A risk-averse healthcare system could be a barrier to physiological birth. Dominant voices in the birthing space can dictate the way birth occurs. Lack of exposure to physiological birth may diminish the acquisition and maintenance of important skills and knowledge among care providers. Recognising the factors important to women could lead to a positive birth experience. Excluding a woman's subjective experience from health professionals' understanding of physiological birth increases the likelihood of risk management being the paramount objective in clinical decision-making. We propose it is timely to align clinical understanding of physiological birth with midwifery's woman-centred professional philosophy. [ABSTRACT FROM AUTHOR]

Almost all births in Finland occur in hospitals, but the concept of labor support behavior is not well-known among Finnish midwives. The primary aim was to increase perceived labor support as measured by BANSILQ. This study was tailored to evaluate the impacts of short on-the-job training interventions for midwives (n=70) in labor support given to mothers. The training was conducted at one university hospital and and one regional hospital during 2012. The trainings were carried out twice at both hospitals to reach as many miwdwives as possible to participate. Two university hospitals—one regional and one central—were selected as controls. New mothers were asked to complete the Bryanton Adaptation of the Nursing Support in Labor Questionnaire (BANSILQ) in the postpartum wards at all the selected hospitals before the intervention (n=1500) and after the intervention (n=1500). The data were linked to the Finnish Medical Birth Register (MBR). As this is an in-job training intervention study and not a trial, it has not been registered in a trial registry. The response rate was 68% (n=1020) for the pre-intervention survey and 47% (n=704) for the post-intervention survey. At the regional-level intervention hospital, the mean length of the second stage of childbirth decreased significantly. A bonding time of at least three minutes was three times more likely at both intervention hospitals. Support for breastfeeding was twice as likely at the university-level hospital after the intervention. In all the study hospitals, mothers with less education were more likely to receive tangible and informal support than highly educated mothers. This short on-the-job intervention did not increase labor support provided by Finnish midwives in its entirety, and the effect on birth outcomes was minimal. However, support for breastfeeding increased, and some types of support were targeted at those who needed it most. To improve midwifery care, both training and sufficient resources are needed. [ABSTRACT FROM AUTHOR]

• The production of breastmilk and the latch is a priority for both the midwife and the mother. • There is a more technical approach (hands – on) in breastfeeding support, mainly in the hospital setting. • Mothers expect that the midwife has the necessary knowledge to provide accurate and realistic information about breastfeeding. • Mothers need breastfeeding support tailored to their individual needs. In Flanders, Belgium, 78.2% of the women exclusively breastfeed their babies following birth. However, after three months just one third of those babies is breastfed exclusively. This is in contrast with the WHO recommendations of a minimum of six months. Studies reveal that women are not always satisfied with the breastfeeding support they receive from their midwives, which can lead to early cessation of breastfeeding. The general aim of this study is to gain an in-depth understanding of the supporting role of midwives in breastfeeding support during the first two weeks after birth and compare it to the needs of the breastfeeding women. A qualitative approach was used with an observational design and a focus group study. Two researchers performed non-participative observations in both hospital and primary healthcare settings. Midwife-mother interactions during breastfeeding support (midwives, n = 21; mothers, n = 59) were observed. Analysis of the data gathered from two focus groups with midwives (n = 10) and two focus groups with mothers (n = 9) provides an in-depth understanding of the supporting role of midwives during breastfeeding and helps to investigate whether that role corresponds to the mothers' needs both from the mothers' and the midwives' perspective. Observations and focus groups were analyzed using thematic analysis. The analysis showed that both midwives and mothers want the breastfeeding to be a success. Generally, the production of breastmilk is a priority, for both the midwives and the mothers. Overall a hands-on approach regarding breastfeeding support was observed, mainly in the hospital settings when compared with the findings from the primary healthcare settings. A hands-on approach often occurs without asking the mother's consent. During the breastfeeding support, a professional relationship between the midwife and the mother is fostered. In primary healthcare there is one – to – one support which is contrary to hospital care, resulting in a personalized relationship. Breastfeeding support is influenced by personal (e.g. negative belief in breastfeeding policies) and external context factors (e.g. time restraints). The research data revealed three topics on breastfeeding support by the midwife which were the focus, the approach and the relationship between the midwife and the mothers. The way the midwife provides this support varies due to the setting (hospital or primary health care) and due to personal convictions of midwives and mothers. The study shows the importance of providing breastfeeding support which is tailored to individual needs of the mother. [ABSTRACT FROM AUTHOR]

• Parent's autonomy should be respected regarding student presence. • The role of the student and supervisor must be clarified for parents. • Both the student and the parents can benefit from the clinical-learning situation. • Women's rights to influence their care should be prioritised above students' learning needs. • Parents should be involved in the learning situation between student and supervisor. Various student groups participate in clinical intrapartum care, but limited data are available on parents' perceptions of student presence during labour and childbirth. This study explored parents' experiences of having a student present during labour and childbirth. Qualitative study based on an analysis of 362 parents' responses to one open-ended question from a cross-sectional survey. When they experienced students as interactive and supportive, parents reacted positively to student participation. Parents displayed clear willingness to contribute to students' learning. Some parents, however, reported unexpected, uncomfortable, or inappropriate experiences that they attributed to insufficient autonomy or undergoing many vaginal examinations. Parents, clinical supervisors, and students can benefit from clinical learning situations, but women's needs must be prioritised and student involvement balanced with women's right to choose who is with them during labour and childbirth. [ABSTRACT FROM AUTHOR]

• Problem or issue Few pregnant women are sufficiently active despite international evidence-based guidelines for prenatal physical activity. • What is already known Lack of information and advice from healthcare providers (including midwives) have been identified as a barrier to prenatal physical activity. Healthcare providers rarely fulfilled their role in providing prenatal physical activity support. The mode of communication used to support individuals in adopting active behaviour is of importance; a bidirectional mode of communication should be prioritized as it involves discussion. • What this paper adds When it comes to provide prenatal physical activity support, midwives use most often an unidirectional mode of communication instead of bidirectional. provide most often general recommendations. Despite the well-known benefits of prenatal physical activity for the health of both the mother and her future child, and the existence of international Guidelines for prenatal physical activity, few pregnant women are sufficiently active. Prenatal health care providers, notably midwives, play an important role in promoting prenatal physical activity. Unfortunately, they face several challenges that hinder strategies used to support prenatal physical activity to their clients. The mode of communication used when giving advice and counselling is part of these strategies, as is the content of the information provided. However, little is known about how midwives communicate with their clients when it comes to recommendations about prenatal physical activity, whether it is general or specific recommendations, and about personal factors that may influence their recommendations. To present a comprehensive analysis of the existing literature on strategies used by midwives to support prenatal physical activity to their clients, focusing on the mode of communication used, the content of the recommendation provided, as well as personal factors that can influence their recommendations. A scoping review was conducted to retrieve original research articles on strategies used by midwives to support prenatal physical activity, published up to May 2023 and available in English and French. The search databases included CINAHL, MEDLINE, Cochrane, Scopus, PubMed, Psychology and behavioural Sciences Collection, and APA PsycINFO. Studies that fulfilled the eligibility criteria were selected for data extraction. The main findings were organized by the mode of communication used (unidirectional and bidirectional) and the type of recommendation provided (general versus specific). Midwives' knowledge, beliefs and attitudes towards prenatal physical activity were also extracted. A total of 1 307 articles were retrieved and 19 were included. The use of unidirectional mode of communication was identified in 64 %, 64 % and 14 % of the studies when it comes to provide general recommendations, specific recommendations and information on safety, respectively. The use of bidirectional mode of communication was identified in 43 %, 21 % and 7 % of the studies when it comes to provide general recommendations, specific recommendations and information on safety, respectively. Midwives had knowledge gaps about prenatal physical activity, their beliefs were not always aligned with the most recent recommendations, and they sometimes feel vulnerable in the way they support physical activity. However, they expressed the desire to improve the support they are providing. Results of this study highlight that when it comes to support prenatal physical activity, the unidirectional mode of communication is the most often used by midwives. Unfortunately, it is not considered effective as it does not allow discussing and explaining the information provided. Moreover, midwives exhibited some knowledge gaps about prenatal physical activity. Future work will be needed to better understand their challenges and needs in order to improve their initial training and clinical practice. [ABSTRACT FROM AUTHOR]

• Addresses the gap in evidence to guide the development of midwifery standards for practice. • Identifies concepts central to both clinical and non-clinical midwifery practise. • Highlights interchangeable terms that have markedly different origins. • Presents contemporary midwifery identity, legitimacy and practice as autonomous, woman-centered and focussed on continuity of care, yet often confronted by constraints on being able to work to the full scope of practice. To critically appraise and synthesise the literature regarding the role and scope of midwifery practice, specifically to inform the evidence based development of standards for practice for all midwives in Australia. A structured scoping review of the literature CINAHL Complete, MEDLINE Complete and Cochrane Libraries databases, online and grey literature databases Comprehensive searches of databases used key words and controlled vocabulary for each database to search for publications 2006–2016. Studies were not restricted by research method. There is no substantive body of literature on midwifery competency standards or standards for practice. From 1648 papers screened, twenty-eight papers were identified to inform this review. Eight studies including systematic reviews were annotated with three research papers further assessed as having direct application to this review. To inform the development of Midwife standards for practice, the comprehensive role of the midwife across multiple settings was seen to include: woman centred and primary health care; safe supportive and collaborative practice; clinical knowledge and skills with interpersonal and cultural competence. Midwifery practice is not restricted to the provision of direct clinical care and extends to any role where the midwife uses midwifery skills and knowledge. This practice includes working in clinical and non-clinical relationships with the woman and other clients as well as working in management, administration, education, research, advisory, regulatory, and policy development roles. This review articulates the definition, role and scope of midwifery practice to inform the development of contemporary standards for practice for the Australian midwife. [ABSTRACT FROM AUTHOR]

• Complications did not increase when substituting obstetricians by midwives in the care of low-risk postpartum women. • Education by midwives reinforces healthy behaviours during the puerperal period. • Key qualities of midwives are their qualification and capacity to provide care. • Midwives appear to be the most appropriate professional for the follow up of non-complicated postpartum. • Our findings open a new research line for the development of similar studies in other Spanish hospitals. The aim of this study was to evaluate changes in the frequency of visits to the hospital emergency department due to puerperal complications in low risk postpartum women attended by midwives instead of obstetricians. A quasi-experimental retrospective study with non-random allocation, comprising two groups: a control group of women attended by obstetricians and an intervention group of women attended by midwives. A level 2 hospital in Madrid (España). Low risk postpartum women attended at the maternity unit of the Fuenlabrada University Hospital between 2013 and 2015. We gathered variables to record the homogeneity of the groups and to assess for confounders and interactions. In the case of women with different behaviours and/or who generated confounders or interactions, a multivariate adjustment with logistic regression was performed. The Homer & Lemeshow goodness-of-fit test for logistic regression was used to determine the validity of the model. The intervention group comprised a total of 1308 women, whereas there were 1313 women in the control group. In the first 40-days postpartum, 33 women in the intervention group (2.5%) attended the hospital emergency department compared to 41 in the control group (3.1%). This difference was not statistically significant (p value 0.354). The relative risk of this decrease was 0.808 (95% CI 0.514; 1.270). The NNT was 167. Care by midwives of low risk postpartum women did not lead to a worsening of puerperal complications requiring emergency department care. Furthermore, care by midwives was more effective than obstetrician care with lower emergency department attendance rates. Their qualification and capacity to provide health education were determinant factors. [ABSTRACT FROM AUTHOR]

• Midwives and traditional midwives coexist in Sahrawi refugee camps. • The only refugee camp in the world where midwives can be trained are Sahrawi refugee camps. • Midwives work in spite of precarious resources that depend essentially on foreingn aid. • Midwives are committed to improviding maternal and child health in the Sahrawi population. The historical backdrop of Western Sahara has meant that, for the last 43 years, part of its indigenous population has survived in refugee camps located in the Algerian desert. International aid from abroad has become the main source of sustenance for all people living in this hostile environment. Since the beginning of this type of settlement, the Sahrawi Arab Democratic Republic has been concerned with creating the necessary infrastructures to meet the health needs of the people living in these conditions. As a result, the Ahmed Abdel-Fatah School of Nursing was created in the Sahrawi refugee camps, which began to train midwives to care for women during the stages of pregnancy, childbirth and postpartum in 2002. The aim of this paper is to provide an approach to the origin and evolution of midwifery education for the Sahrawi refugee camps, in the only school of nursing that exists worldwide in a refugee camp. [ABSTRACT FROM AUTHOR]

• Generalisations and stereotypes pose challenges in the ANC encounter. • Somali-born parents and Swedish midwives favoured ANC tailored to individual needs. • A person-centred focus in interventions for migrants may reduce stereotypes. • Group antenatal care should encompass a person-centred approach. To explore Somali-born parents' experiences of antenatal care in Sweden, antenatal care midwives' experiences of caring for Somali-born parents, and their respective ideas about group antenatal care for Somali-born parents. Eight focus group discussions with 2–8 participants in each were conducted, three with Somali-born mothers, two with fathers and three with antenatal care midwives. The transcribed text was analysed using Attride-Stirling's tool "Thematic networks". Two towns in mid-Sweden and a suburb of the capital city of Sweden. Mothers (n = 16), fathers (n = 13) and midwives (n = 7) were recruited using purposeful sampling. Somali-born mothers and fathers in Sweden were content with many aspects of antenatal care, but they also faced barriers. Challenges in the midwife-parent encounter related to tailoring of care to individual needs, dealing with stereotypes, addressing varied levels of health literacy, overcoming communication barriers and enabling partner involvement. Health system challenges related to accessibility of care, limited resources, and the need for clear, but flexible routines and supportive structures for parent education. Midwives confirmed these challenges and tried to address them but sometimes lacked the support, resources and tools to do so. Mothers, fathers and midwives thought that language-supported group antenatal care might help to improve communication, provide mutual support and enable better dialogue, but they were concerned that group care should still allow privacy when needed and not stereotype families according to their country of birth. ANC interventions targeting inequalities between migrants and non-migrants may benefit from embracing a person-centred approach, as a means to counteract stereotypes, misunderstandings and prejudice. Group antenatal care has the potential to provide a platform for person-centred care and has other potential benefits in providing high-quality antenatal care for sub-groups that tend to receive less or poor quality care. Further research on how to address stereotypes and implicit bias in maternity care in the Swedish context is needed. [ABSTRACT FROM AUTHOR]

Abstract Objective In the current Dutch maternity care system, pregnant women who have an indication for an antenatal cardiotocography (CTG) to be undertaken need to be referred from primary midwife-led care to secondary obstetric-led care. Within three different regions in the Netherlands independent primary care midwives perform antenatal CTG in primary care, introduced as a pilot project. The aim of this study was to evaluate the experiences and views of primary care midwives who perform antenatal CTG in primary care. Design Using a qualitative approach data were collected by seventeen in depth semi-structured interviews. The interview recordings were transcribed verbatim and analysed using thematic coding. Setting Three regions in the Netherlands where midwives carry out antenatal CTG in primary care during this pilot project. Participants Seventeen primary care midwives were interviewed between July and November 2017. Findings In general, midwives were satisfied with performing antenatal CTG and felt it contributed positively towards the midwife-client relationship. However, midwives experienced an increased workload, partly due to time-consuming technical difficulties. Furthermore, mixed feelings existed on whether antenatal CTG contributes to a more physiological or to a more pathological approach in midwifery practice. Most midwives believed that performing antenatal CTG contributes to the physiological process: strengthening of their gate-keeper role, increased confidence of their clients and improved midwife-client relationship. In contrast, some midwives believed it contributes to a pathological process: medicalization and relying too much on technical devices. Key conclusions This study showed an overall positive attitude of primary care midwives towards performing antenatal CTG when required, in primary midwife-led care. However, performing the antenatal CTG can be a challenge for midwives, as midwifery care within this setting is often for healthy women who have a straightforward pregnancy. For some midwives, providing antenatal CTG monitoring in the primary care setting may be seen as using a pathological approach to midwifery care. Implications for practice There seems to be a place for antenatal CTG in primary midwife-led care. However, further research is needed before this practice can be implemented widely. [ABSTRACT FROM AUTHOR]

Highlights • First study that directly reflects the experience of midwives facing late foetal death in Spain. • Midwives perceive difficulties because they are mainly trained to help during a healthy birth. • Midwives claim to be qualified to cope with late foetal death during their training period. • Several barriers (e.g. lack of guidelines) hamper the provision of adequate care. • Midwives point out that hospitals do not have appropriate areas for parents to cope with stillbirth. Abstract Aim To explore the experiences of midwives regarding the attention given during labour in late foetal death. Design Qualitative research using a hermeneutic-interpretative phenomenological approach was carried out. Data were collected through focus groups, audio-recorded, transcribed verbatim, and analyzed using the van Manen approach. Setting and Participants Three focus group with a purposive sample of 18 midwives from 10 public hospitals and 1 primary health centre in Madrid, Spain were conducted. Findings Two main themes were identified: Professionals for Life Not Death; and Organizing the Work Without Guidelines. Midwives felt there is a lack of social awareness related to the possibility of antepartum death that keeps the mourning hidden and affects the midwives´ practice during the late foetal death process. Midwives recognize difficulties in coping with a process that ends in death: organizations are not prepared for these events (not suitable rooms), there is lack of training to cope with them, and lack of continuity in the attention received by the parents when they are discharged. Conclusion Midwives need to be trained in mourning and communication skills to guarantee good practice when attending late foetal death. Intervention guidelines and support mechanisms are required, not only for the parents, but also for the healthcare professionals. [ABSTRACT FROM AUTHOR]

Highlights • This study demonstrated that a brief educations session incorporated into mandatory training increased the knowledge and confidence of midwives in delivering advice and support for healthy pregnancy weight gain. • Greatest improvements in both perceived and objective knowledge were observed in relation to dietary guidelines and nutrition. • The training was well received by midwives with 100% stating they would recommend the training to others. Abstract Objective To examine if a brief midwifery education and training session incorporated into annual mandatory training improves the knowledge and confidence of midwives to support healthy weight gain and management in pregnancy. Design An implementation evaluation using a pre-post study design was used. Midwives completed a self- administered questionnaire prior to and following completion of the training session. Objective knowledge, perceived knowledge and confidence in relation to nutrition, physical activity and healthy weight gain and management, and process measures related to the training were assessed. Participants and setting All midwives from a tertiary birthing hospital in Brisbane Australia who attended the annual mandatory training day in 2015 were invited to participate. Measurement and findings Of the 270 midwives who attended the training 154 pre and 114 post training questionnaires were returned. An increase in perceived knowledge across topic areas was reported by 70–97% of respondents, while perceived confidence increased for 83–91% of respondents across each topic area. Objective knowledge score increased from 11 pre-training to 15 post training (maximum score 17) (p < 0.001). Ninety six percent of respondents agreed the training provided practical communication strategies and 100% would recommend the training to others. Key conclusions This brief education session integrated into an existing mandatory training program, improved the knowledge and confidence of midwives in delivering advice and support for healthy pregnancy weight gain. Implications for practice This improvement is the first step in changing practice to prevent excess weight gain during the antenatal period. This program offers an innovative model to support midwives implement change across other health services. A low cost intervention that was well received by midwives can address identified barriers to the provision of best practice care that supports a healthy pregnancy weight gain in a sustainable forum. [ABSTRACT FROM AUTHOR]

The number of clinical midwives in the Netherlands has substantially increased over the last twenty years, but their role in obstetric care is not clearly defined. Our aim was to identify the type of deliveries that are usually supported by clinical midwives and whether these changed over time. National data from the Netherlands Perinatal Registry from the years 2000 to 2016 (n = 2.999.411 deliveries) were used to divide all deliveries into classes using latent class analyses based on delivery characteristics. In the primary analyses, the identified classes, type of hospital, and year of cohort were used to predict deliveries supported by a clinical midwife. In secondary analyses, the same analyses were repeated where the classes were replaced by individual level characteristics of deliveries and stratified by referral during birth. The latent class analyses identified three classes: I. referral during birth; II. Induction of labour; and III. Planned caesarian section. The primary analyses indicated that women in both class I and II were frequently supported by clinical midwives and those in the third class almost never. Therefore, only data from deliveries assigned to class I and II were used in the secondary analyses. The secondary analyses showed that clinical midwives supported deliveries with a great variety in characteristics, such as pain relief and preterm birth. Although the frequency of clinical midwives being involved in the second stage of labour increased over the years, we did not find noticeable changes in their involvement. Clinical midwives care for women with various types of deliveries with varying degrees of pathology and complexity during second stage of labour. Additional training, taking previously acquired skills and competences into account, is necessary to deal with this complexity for which clinical midwives are not always trained. [ABSTRACT FROM AUTHOR]

• The doula is a member of the interdisciplinary team that provides maternity care. • Identifying strategies which enhance collaboration between midwife and doulas has the potential to prop up the maternity system. • Cooperation between midwives and doulas constitutes an important element in the quality of perinatal care. A doula is a person who provides support to women in the perinatal period without providing medical services. During childbirth, the doula becomes a member of the interdisciplinary team. This integrative review aims to analyse the nature of the cooperation between doulas and midwives, its efficiency and challenges and ways of strengthening this cooperation. A structured integrative review of empirical and theoretical studies written in English was conducted. The literature search included MEDLINE, Cochrane, Scopus, ProQuest, Science Direct, Web of Science, and Embase Health Source: Nursing/Academic Edition databases. The analysis included papers published in 1995–2020. Dedicated documents were searched for different combinations of terms and standard logical operators. A manual search of the studies was included for additional references. Twenty-three articles from 75 full-text records were analysed. Three main themes emerged. (1) doulas are needed to prop up the system (2) barriers in collaboration between midwives and doulas; and (3) how cooperation between midwives and doulas can be strengthened. None of the articles referred directly to the impact of collaboration between midwives and doulas on the quality of perinatal care. This is the first review to analyse the impact of collaboration between midwives and doulas on the quality of perinatal care. Ensuring adequate collaboration between doulas and midwives requires effort from both of these professional groups and the health care system. However, such collaboration is supportive for birthing women and the perinatal care system. Further research in terms of the impact of this collaboration on the quality of perinatal care is needed. [ABSTRACT FROM AUTHOR]

• Limited competencies among health care professionals including midwives are pointed out as among the major contributors to the high maternal and newborn mortality in LMICs. • In response to this awareness, Tanzania Midwives Association has been implementing continuous professional development training modules to provide midwives with necessary skills to manage obstetric emergencies. • CPD training for midwives has the potential to strengthen their knowledge, abilities, and attitudes, so influencing their practice. • Effective communication creates a pleasant working environment and fosters trust and positive relationships between midwives and women. In Low- and Middle-Income Countries (LMICs), maternal and infant mortality remains a significant problem. Inadequate healthcare provider competencies, including those of midwives, are cited as one of the major contributors to the high maternal and newborn mortality rates. Thus, enhancing the skills of midwives is a prerequisite for enhancing positive maternal and newborn health outcomes. This study describes the lessons learned from a Midwifery Emergencies Skills Training (MEST) project implemented in Tanzania between 2013 and 2018. An exploratory qualitative study was used to purposefully recruit and interview twelve health facility in-charges and eighteen midwives from twelve selected health facilities in six districts of Tanzania mainland to discover their perceptions about the midwifery practice after MEST training. The data were transcribed verbatim and analysed with qualitative content analysis. Four categories were generated from the analysis (i) enhanced knowledge and skills in the provision of midwifery care and management of obstetric emergencies, (ii) improved midwives' communication skills, (iii) increased trust and support between midwives and community and (iv) transformed attitudes of midwives toward continued professional development (CPD). MEST enhanced the knowledge and skills of midwives in the management of obstetric emergencies and referral protocol practice. However, notable gaps remain in the capacity of midwives to provide human rights-based respectful maternity care. Continued professional development for nurses and midwives through training, mentorship and supervision programs is recommended for improving maternal and newborn health. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore midwives' experiences with a safe childbirth checklist used in handover situations from birth to hospital discharge. Quality of care and patient safety is highly recognised and a priority within health services globally. In handover situations, checklists have proven to reduce unwanted variation by standardising processes, which in turn contribute to increased quality of care. To improve the quality of care, a safe childbirth checklist was implemented at a large maternity hospital in Norway. We conducted a Glaserian grounded theory (GT) study. A total of 16 midwives were included. We included three midwives in one focus group and conducted 13 individual interviews. Years of experience as midwives ranged from one to 30 years. All included midwives worked in a large maternity hospital in Norway. The main concern faced by the midwives who used the checklist included no common understanding of the purpose of the checklist nor consensus on how to use the checklist. The generated grounded theory, individualistic interpretation of the checklist , involved the following three strategies that all seemed to explain how the midwives solved their main concern: 1) not questioning the checklist, 2) constantly evaluating the checklist, and 3) distancing oneself from the checklist. Experiencing an unfortunate event concerning the healthcare of both mother or newborn was a condition that could alter the midwives understanding and use of the checklist. The findings in this study showed that a general lack of common understanding and consensus on the rationale for implementing a safe childbirth checklist led to variations between midwives in how and whether the checklist was used. The safe childbirth checklist was described as long and detailed. It was not necessarily the midwife who was expected to sign the checklist who had carried out the tasks signed for. To ensure patient safety, recommendations for future practice include securing that separate sections of a safe childbirth checklist are limited to a specific time-point and midwife. Findings emphasise the importance of implementation strategies supervised by the leaders of the healthcare services. Further research should explore the understanding of organisational and cultural context when implementing a safe childbirth checklist to clinical practice. [ABSTRACT FROM AUTHOR]

Introduction Excessive gestational weight gain, regardless of initial BMI, is associated with perinatal risks for both mother and offspring and contributes to obesity in women. Studies report that healthcare professionals find it difficult to communicate about weight and pregnant women perceive healthcare professionals as unconcerned, leaving many women uninformed about weight recommendations and risks. We aimed to explore how midwives approach communication about gestational weight gain recommendations, and to characterize communication barriers and facilitators. Methods Seventeen midwives from different areas in Sweden were interviewed by a therapist using semi-structured interviews. Interviews were transcribed verbatim and analysed by three researchers using latent content analysis. Recurrent themes were identified and formulated. Results The main theme identified in the latent part of the analysis was “midwives use avoidant behaviours to cope with fear of inflicting worries, shame or feelings of guilt in pregnant women”. Avoidant behaviours include: adjusting weight recommendations, toning down risks and avoid talking about weight. Subthemes identified were (I) Conflicting responsibilities in midwives’ professional identity (II) Perceived deficiencies in the working situation. Conclusion Midwives’ empathy and awareness of weight stigma strongly affects communication about weight with pregnant women, and midwives’ use of avoidant behaviours constitutes salient information barriers. More research is needed on whether gestational weight guidelines and weighing routines for all women, resources for extra visits, training in specific communication skills and backup access to other professions can facilitate for midwives to initiate and communicate about healthy gestational weight development, enabling more pregnant women to make well-informed lifestyle choices. [ABSTRACT FROM AUTHOR]

Objective the principal objective of this study was to assess the quality of blood loss estimates by midwives and student midwives. The secondary objectives were: to assess the intraobserver agreement of visual blood estimates and the rate of underestimation of blood loss by participants, and to estimate the sensitivity, specificity, and negative likelihood ratio of these estimates for clinically pertinent blood losses (≥ 500 mL and ≥ 1000 mL). Design multicenter cross-sectional study. Setting thirty-three French maternity units and 35 French midwifery schools participated in this study. Participants volunteer French midwifery students ( n = 463) and practicing midwives ( n = 578). Intervention an online survey showed 16 randomly ordered photographs of 8 different simulated blood quantities (100, 150, 200, 300, 500, 850, 1000, and 1500 mL) with a reference 50-mL image in each photo and asked participants to estimate the blood loss. The visual blood loss estimates were compared with Fisher's exact test. Intraobserver agreement for these estimates was assessed with a weighted kappa coefficient, and the negative predictive values (probability of no hemorrhage when visual estimate was negative) were calculated from prevalence rates in the literature. Findings of the 16,656 estimates obtained, 34.1% were accurate, 37.2% underestimated the quantity presented, and 28.7% overestimated it. Analyses of the intraobserver reproducibility between the two estimates of the same photograph showed that agreement was highest (weighted kappa ≥ 0.8) for the highest values (1000 mL, 1500 mL). For each volume considered, students underestimated blood loss more frequently than midwives. In both groups, the negative predictive values regarding postpartum hemorrhage (PPH) diagnosis (severe or not) were greater than 98%. Key conclusions and implications for practice student midwives tended to underestimate the quantity of blood loss more frequently than the midwives. Postpartum hemorrhage (≥ 500 mL) was always identified, but severe postpartum hemorrhage (≥ 1000 mL) was identified in fewer than half the cases. These results should be taken into account in training both student midwives and practicing professionals. [ABSTRACT FROM AUTHOR]

Objective identify fathers’ perceptions of their role in a breastfeeding context. Setting three different geographic areas (urban, semi-urban, and rural) of Quebec, a francophone province in Canada. Participants 43 fathers whose children had been exclusively breastfed for a minimum of six months. Methods a qualitative study using semi-structured interviews was undertaken. Thematic analysis of the interviews was carried out with NVivo 11. Findings variations were identified in the role of father during breastfeeding, namely, 1) acting as partners in decision-making; 2) being responsible for the family functioning, and 3) providing emotional support to the mother. These different variants each entail challenges and tasks. Key conclusions participating fathers perceived their role as much more complex than the limited role of breastfeeding facilitator that is usually attributed to them. Fathers saw themselves as stakeholders in decision-making relating to how their child was fed and they reacted to the imbalance created by breastfeeding. Their involvement occurred at several levels: that of their child, their spouse, and their family. Implications for practice these results suggest that more attention should be given to fathers’ roles in a breastfeeding context and more investigation is required into the extent to which health professionals, such as midwives and nurses, support fathers in managing these various roles and the challenges they entail. [ABSTRACT FROM AUTHOR]

Objective to describe the experiences of midwives who graduated from the University of São Paulo's midwifery program and the characteristics of their work within the Brazilian National Health System (SUS). Design a descriptive, qualitative field study. Setting interviews were scheduled by telephone or e-mail and were held with the midwives outside their work environment. Interviews lasted for up to one hour and were recorded. Participants ten midwives who had graduated from the University of São Paulo's midwifery program and were working or had worked in the SUS at the time of the study. Ethical issues the study protocol was approved by the internal review board of the School of Arts, Sciences and Humanities, University of São Paulo. All pertinent ethical principles were followed. Measures and Findings data were collected at interviews focussing on the participants’ work and their experiences while working in the SUS. The dialogues during the interview sessions allowed the participants to build on and extend the proposed topics. After the data had been transcribed and read, the discourses were grouped in accordance with the similarity of their content, resulting in four thematic categories: the inclusion of midwives into the obstetric team ; dealing with contradictions: challenges of the profession; working in the SUS: between precariousness and guaranteeing access to health services; and making a difference . The findings provoke reflection on the challenges faced by midwives in their work within the SUS: challenges associated with the difficulties in working in the public healthcare sector, difficulties in their relationships with other healthcare professionals, difficulties related to a general lack of knowledge on this specific occupation in Brazil, the absence of a midwifery model of care, difficulty in dealing with obstetric abuse, and the dilemmas facing the midwives during their daily practice of midwifery. Key conclusion despite the difficulties encountered, the midwives consider the care they provide to be differentiated. They perceive gradual changes in the care offered to women by the healthcare facilities and by other professionals, and believe that they make a difference in their workplaces. In addition, they want to work in the SUS and are committed to transforming the quality of care provided to women in Brazil. Practical implications the experiences related by midwives reflect the midwifery scenario nationwide, highlighting the perspectives for change. The emphasis placed by midwives on their social role and their commitment to changing current midwifery care models and to consolidating the SUS is noteworthy. [ABSTRACT FROM AUTHOR]

• There is a lack of knowledge, confidence, and support for managing maternal obesity • Midwives desire a sensitive approach to discussing obesity and maternal obesity • Barriers to practices were due to lack of education, guidance, or resources • Individual and system-level changes may help overcome these challenges Maternal obesity has been related to adverse maternal and infant outcomes. It is a persistent challenge of midwifery care worldwide and can present clinical challenges and complications. This review sought to identify evidence on the practice patterns of midwives related to prenatal care of women with obesity. The databases Academic Search Premier, APA PsycInfo, CINAHL PLUS with Full Text, Health Source: Nursing/Academic Edition, and MEDLINE were searched November 2021. Search terms included weight, obesity, practices, and midwives. Inclusion criteria included quantitative, qualitative, and mixed method studies that addressed practice patterns of midwives related to prenatal care of women with obesity published in peer-reviewed journals, written in English. The recommended Joanna Briggs Institute approach to mixed methods systematic reviews was followed e.g. study selection, critical appraisal, data extraction, and a convergent segregated method of data synthesis and integration. Seventeen articles from 16 studies were included. The quantitative evidence showed a lack of knowledge, confidence, and support for midwives that would facilitate adequate management of pregnant women with obesity while the qualitative evidence revealed that midwives desire a sensitive approach to discussing obesity and the risks associated with maternal obesity. Quantitative and qualitative literature report consistent individual and system-level barriers to implementing evidence-based practices. Implicit bias training, midwifery curriculum updates, and the use of patient centered care models may help overcome these challenges. [ABSTRACT FROM AUTHOR]

Background perinatal mental health is an important public health issue and consideration must be given to care provision for effective support and care of women in the perinatal period. Aim to synthesise primary research on midwives’ perceived role in Perinatal Mental Health (PMH). Design integrative review. Methods Whittemore and Knafl's (2005) framework was employed. A systematic search of the literature was completed. Studies were included if they met the following criteria: primary qualitative, quantitative and mixed methods research studies published in peer reviewed journals between January 2006 to February 2016, where the population of interest were midwives and the outcomes of interest were their perceived role in the management of women with PMH problems. The methodological quality of studies was assessed using the relevant CASP (Critical Appraisal Skills Programmes, 2014) criteria for quantitative and qualitative research studies. Data extraction, quality assessment and thematic analysis were conducted. Findings a total of 3323 articles were retrieved and 22 papers were included in the review (15 quantitative, 6 qualitative and one mixed method study). The quality of the studies included was good overall. Two overarching themes emerged relating to personal and professional engagement. Within personal engagement four sub themes are presented: knowledge, skills, decision making and attitude. Within professional engagement four themes are presented: continuous professional development, organisation of care, referral, and support. Conclusions and implications for practice the findings indicate midwives require continuous professional development opportunities that address knowledge, attitudes to PMH, communication and assessment skills. However educational and training support in the absence of appropriate referral pathways and support systems will have little benefit. [ABSTRACT FROM AUTHOR]

Objective: the objective behind the current study was to explore the experiences and perceptions of fathers after childbirth trauma, an area of minimal research. This is part two of a two-part series conducted in 2014 researching the mental health of fathers after experiencing a perceived traumatic childbirth. Design: qualitative methodology using semi-structured interviews and reporting of qualitative questions administered in part one's online survey (Inglis, 2014). Setting: interviews conducted face-to-face at an Australian University or on Skype. Participants: sixty-nine responded to the online qualitative questions and of these seven were interviewed. Measurements: thematic analysis of verbal and written qualitative responses. Findings: thematic analysis of qualitative survey data and interviews found a global theme 'standing on the sideline' which encompassed two major themes of witnessing trauma: unknown territory, and the aftermath: dealing with it, and respective subthemes. Key Conclusions: according to the perceptions and experiences of the fathers, there was a significant lack of communication between birthing teams and fathers, and fathers experienced a sense of marginalisation before, during, and after the traumatic childbirth. The findings of this study suggest that these factors contributed to the perception of trauma in the current sample. Whilst many fathers reported the negative impact of the traumatic birth on themselves and their relationships, some reported post-traumatic growth from the experience and others identified friends and family as a valuable source of support. Implications for practice: improved communication between midwifery staff and fathers before, during and after childbirth may reduce the rates of paternal postpartum mental health difficulties and experiences of trauma. [ABSTRACT FROM AUTHOR]

The challenge is to identify pain assessment counselling that are effective and reliable to the woman during labour while also supporting appropriate management of labour pain. This study aimed to describe women's perceptions of their counselling on pain assessment and pain management during labour. A descriptive, cross-sectional study. The sample consisted of women who had given birth (n=204) at a university hospital in Finland; 250 parturients were recruited by convenience sampling. Data were collected using a questionnaire (P-PAPM) between November 2018 and February 2019. The statistical significance of observed differences was analysed using the Chi-squared test and Fischer's exact test. Eighty percent of women reported that they had received counselling on pharmacological treatments from midwives, but only 33 % received counselling on pain assessment. The non-pharmacological methods for alleviating labour pain most commonly taught by midwives were proper breathing techniques, cold/heat treatments, and trying different positions and movements. Women were less commonly counselled to try listening to music, thinking about pleasant and positive things, or concentrating their thoughts on something other than pain. The two most commonly used counselling methods were demonstrations and written material and least used Internet-based resources. The personal issue that midwives discussed most frequently during counselling was the women's individual hopes concerning pain management (91%), while the issue discussed least often was previous experiences of pain (58%). The participants' experiences of fear, age, and education were significantly associated with aspects of counselling on pain assessment and management. Women's counselling on pain assessment and management during labour varied widely. Therefore, to improve its quality, counselling should be routinely integrated into daily midwifery work. In particular, the counselling given on non-pharmacological pain relief methods during labour was inadequate. More varied counselling methods should be used in the future. Finally, the results indicate that midwives' knowledge of counselling should be increased and they should be encouraged to routinely offer counselling on pain assessment and management for parturing women. [ABSTRACT FROM AUTHOR]

Objective: supporting healthy and normal physiological birth is part of the global maternity care agenda. Rising rates of interventions have been attributed to several factors, including characteristics, attitudes and preferences of childbearing women and their care providers. In this paper, the application of a scale that measures midwives' attitudes towards supporting normal labour and birth is described as well as factors that are associated with favourable attitudes, such as general self-efficacy, years in midwifery practice, and primary practice setting. Design: in this cross-sectional study an online questionnaire was sent out via e-mail to midwives in two regions of South Germany. The questionnaire contained a validated general self-efficacy scale, a 38-item instrument that measures attitudes towards supporting normal birth among German midwives and questions about midwives' practice experiences and educational preparation. Findings: on average, participants (n = 188) were 39 years old (SD = 10.3), and had 12 years of experience caring for women during labour and birth (SD=9.6). Multivariate modelling revealed that higher general self-efficacy, working primarily in out-of-hospital settings and having provided intrapartum care for fewer years were significantly associated with midwives' favourable attitudes towards supporting physiological birth (variance explained R²=29.0%, n=184). General self-efficacy (1.4%) and years of work experience (3.3%) contributed less of the variance in the outcome than work setting (24.5%). Sources of knowledge about normal birth were not significantly associated with the outcome and reduced the overall variance explained by 0.2%. Conclusions: the study has shown that, compared to work setting, the general self-efficacy of German midwives, years providing intrapartum care and sources of knowledge about normal birth had comparatively little impact on their attitude towards supporting normal physiologic birth. Increasing exposure to out-of-hospital birth among German midwives throughout education and practice and fostering the skills and confidence necessary to support normal birth in hospital settings are important strategies to decrease unnecessary obstetric interventions. [ABSTRACT FROM AUTHOR]

Introduction: In 2003 the World Health Organization (WHO) recommended that infants should be fed exclusively with breast milk until the age of six months. However, breast feeding rates remain lower than recommended. The crucial period for breast feeding support is the first two weeks after birth. During this period breast feeding support from the midwife is needed. The aim of this paper is to gain an in-depth understanding of the role of midwives in their support of breast-feeding women, from their own perspective. Methods: Two researchers independently conducted a systematic and comprehensive literature search. Studies needed an empirical qualitative research design (1), had to focus on the role of the midwife in the support of the breast-feeding woman from the midwife's perspective (2), and had to be published between January 2005 and December 2014 (3) in order to be included. Language restrictions were English, Dutch, German and French. Eight qualitative research studies were included, using mainly focus group and in-depth interview studies, which were reported in 11 papers representing 231 midwives and 24 maternity nurses. All but one study concerned midwives working in hospital settings. A critical appraisal was performed of each study. Findings: Midwives value breast feeding education and breast feeding support as a significant part of their role as a postnatal midwife. However, the ways in which a midwife approaches and supports the breast-feeding woman vary. We distinguished two perspectives: the midwife as technical expert' and the midwife as a skilled companion'. The technical expert' midwife is mainly breast centred, focuses on techniques, uses the hands on approach and sees a woman as a novice. The 'skilled companion' midwife is woman centred, focuses on the mother - infant relationship and uses a hands off approach during the breast feeding support. The midwives working in a hospital setting face many barriers when performing breast feeding support, such as time restraints, which makes it difficult for them to carry out their preferred role as a 'skilled companion'. These barriers can influence the breast feeding support negatively. Supporting factors, such as evidence based breast feeding guidelines, have a positive influence on the breast feeding support. Conclusion: On the basis of findings of a synthesis of qualitative research studies, we conclude that the majority of the midwives provide breast feeding support as a technical expert and a minority as a skilled companion. Midwives prefer to be a skilled companion but face many barriers in their working contexts. [ABSTRACT FROM AUTHOR]

to explore the perceptions and experiences of becoming a newly qualified midwifery practitioner. focus group methodology. NHS Trust in South East of England. 8 newly qualified midwives (NQM's) and 8 third year student midwives participated in the focus groups. Some of the participants raised concerns about the emotional challenge of making the transition from senior student to newly qualified midwife, including the impact of their own and others' expectations and the support that was available to them. The participants felt that the process of moving from student midwife to newly qualified midwife presented opportunities and challenges. Whilst the participants had looked or were looking forward to becoming a midwife, they also recognised that this process had the potential to be stressful. Both the newly qualified midwives and senior students who participated in the study identified that having effective support from more senior staff and from peers would enable newly qualified midwives to have increased confidence when providing quality care to pregnant women. Effective support strategies need to be developed in order to support the transition from student to newly qualified midwife. [ABSTRACT FROM AUTHOR]

• Limited studies have explored the optimal way for new graduate midwives to transition to practice. • Our review found that in high-resource settings, new graduate midwives' value well-structured individualised transition to practice programs. • Transition to practice within Continuity of Care models in contrast to traditional nursing-based approaches, appears safe, supported, and enables mentorship. To map and synthesise the literature underpinning the transition to practice for new graduate midwives internationally, with a focus on continuity of care and traditional transition to practice models. Scoping review of the literature Relevant databases were searched to identify primary research studies. Key words, Boolean terms, and an inclusion/exclusion criterion were used to extrapolate key pieces of research. All study types and methods published in English between 2008 - May 2021 that met the inclusion criteria were considered. 20 studies met inclusion criteria. These were conducted in Australia, the United Kingdom, and New Zealand. New graduate midwives' value structured rotations and feel very supported in continuity models, where strong mentorship and support are offered. Within this context confidence was promoted as a new practitioner. Upholding woman-centred care in busy hospital environments was a key challenge. Emerging literature indicates new graduate midwives' transition optimally within a continuity model, however more research is needed. Transitioning midwives into practice within continuity of care midwifery models may address workforce attrition and enhance early career midwife confidence. [ABSTRACT FROM AUTHOR]

To understand midwives' perspectives regarding the effect of a programme of activities aimed at reducing alcohol exposed pregnancies at two NHS Trusts in Greater Manchester. The programme included new protocols for screening, a referral pathway for specialist support and alcohol training for midwives. Semi-structured interviews were conducted with 6 midwives working in antenatal care at the two Trusts over the telephone and via video conferencing. A review of the literature provided insight into contemporary midwifery practice. The Theory of Planned Behaviour was used to inform the interview schedule design. Data analysis used a Framework Approach and drew on a priori themes from the literature review. Participating midwives described objective screening practice using a validated tool on multiple antenatal occasions and were confident to discuss alcohol. Participants were cognisant of local and national policies and guidelines. Discussing alcohol was viewed as important and part of the midwife's role, beliefs which supported participants' intention to practice in line with new protocols. Maternal under-reporting and denial of alcohol consumption was a key barrier to providing effective care. The professional practice of participants was more in keeping with the Chief Medical Officer's recommendations than that reported in recent research from the UK and other high-income countries. However, from this small study it is not possible to attribute this directly to the local Reducing Alcohol Exposed Pregnancies programme. Training to prepare midwives to elicit more accurately details of maternal alcohol consumption may improve the efficacy of the programme. [ABSTRACT FROM AUTHOR]

Aim: the aim of this Western Australian study was to describe the overall labour and birth experience of partners within the context of an intrapartum transfer occurring from a low risk midwifery-led, woman-centred unit to an obstetric unit. Design: a descriptive phenomenological design was used. 15 male partners were interviewed in the first 8 weeks post partum between July and October, 2013 to explore their experience of the intrapartum transfer. Setting: a midwifery-led birth centre set on the grounds of a tertiary maternity referral hospital. Participants: partners of women who were transferred from the birth centre to the onsite tertiary hospital due to complications during the first and second stages of labour. Findings: five main themes emerged: (1) 'emotional roller coaster'; (2) 'partner's role in changing circumstances' with subthemes: 'acknowledgement for his inside knowledge of her' and 'challenges of being a witness'; (3) 'adapting to a changing model of care' with subthemes: 'moving from an inclusive nurturing and continuity model' and 'transferring to a medicalised model'; (4) 'adapting to environmental changes' with subthemes: 'feeling comfortable in the familiar birth centre', 'going to the place where things go wrong' and 'Back to comfortable familiarity afterwards' and (5) 'coming to terms with altered expectations around the labour and birth experience'. Key conclusions: partners acknowledged the benefits of midwifery continuity of care, however, noted that as partners they also provided essential continuity as they felt they knew their woman better than any care provider. Partners found it difficult to witness their woman's difficult labour journey. They found the change of environment from birth centre to labour ward challenging but appreciated that experienced medical assistance was at hand when necessary. Being able to return to the birth centre environment was acknowledged as beneficial for the couple. Following the transfer experience partners asked for the opportunity to debrief to clarify and better understand the process. Implications for practice: findings may be used to inform partners in childbirth education classes about what to expect when transfer takes place and offer the opportunity for them to debrief after the birth. Finally, themes can provide insight to maternity care professionals around the emotions experienced by partners during intrapartum transfer to enhance informed choice, involvement in care and empathetic support. [ABSTRACT FROM AUTHOR]

The use of intravenous artificial oxytocin for augmentation of labour is very common in midwifery care in Sweden. Studies have shown that oxytocin is often administered to women in labour who have no signs of labour dystocia. It was the aim of this study to examine Swedish midwives’ views on and experiences of labour augmentation in the context of normal labour. Individual interviews were carried out with 15 midwives from southern Sweden. The material was analysed using qualitative content analysis, which resulted in one theme: sense and sensibility and four main categories: permissible situations, motivating the decision, intervening in the birth process and iatrogenic awareness. The results showed that midwives expressed ambiguity about augmentation of labour. They were of the opinion that oxytocin was used very often and sometimes unnecessarily. There is awareness that interventions to augment labour can result in undesirable effects on the birth process. Despite this, deeper discussion of this problem was avoided in the interviews. Further research should focus on the process involved when midwives weigh pros and cons when deciding to augment labour. More knowledge is also needed about the barriers for optimal care in labour that are inherent in health-care systems. [ABSTRACT FROM AUTHOR]

Background: vaginal birth is often accompanied with perineal trauma that affects postpartum morbidity. There are many techniques for protecting the perineum from injury during childbirth. The Hands-On or Hands Poised (HOOP) study (McCandlish et al., 1998) was the first trial that compared different techniques of perineal protection during the second stage of labour with very little research subsequently being undertaken. Objectives: to systematically review all available literature that compares the hands-on and hands-poised techniques of perineal management during the second stage of labour. Methods: using the principles of a modified systematic literature review, quantitative, comparative and primary research studies were selected. These were assessed for quality using the Critical Appraisal Skills Programme (CASP) framework including a data extraction form. The results were reported narratively. Main results: five studies were included and outlined the importance of both techniques. The hands-poised technique appeared to cause less perineal trauma and reduced rates of episiotomy. The hands-on technique resulted in increased perineal pain after birth and higher rates of postpartum haemorrhage. Conclusion: as the five studies selected for this review have widely differing variables, comparisons that have been drawn must be viewed with caution. Evidence would suggest that the hands-poised technique is a safe and recommended technique for perineal management and discussions of such a technique should be included in all midwifery education and training programmes. The challenge for midwives is how to support women in making informed choices about perineal management during childbirth. Until there is conclusive evidence, the choice of the hands-on or hands-poised technique will ultimately be determined by the clinical judgment of the individual midwife at the time of birth. Further research is recommended. Thorough conclusions could significantly impact on reducing postpartum morbidity and improving women's sexual health and well-being in the long term, throughout the world. [ABSTRACT FROM AUTHOR]

Background: increasingly, reflection is highlighted as integral to core practice competencies but empirical research into the relationship between reflection and performance in the clinical workplace is scarce. Aim: this study investigated the relationship between reflection ability and clinical performance. Methods: we designed a cross-sectional and a retrospective-longitudinal cohort study. Data from first, second and third year midwifery students were collected to study the variables 'clinical performance' and 'reflection ability'. Data were analysed with SPSS for Windows, Release 20.0. Descriptive statistics, Pearson's Product Moment Correlation Coefficients (r) and r2 values were computed to investigate associations between the research variables. Findings: the results showed a moderate observed correlation between reflection ability and clinical performance scores. When adopting a cross-sectional perspective, all correlation values were significant (p<0.01) and above 0.4, with the exception of the third year correlations. Assuming perfect reliability in the measurement, the adjusted correlations, for year 2 and year 3 indicated a high association between reflection ability and clinical performance (>0.6). The results based on the retrospective-longitudinal data set explained a moderate proportion of the variance after correction for attenuation. Finally, the results indicate that 'reflection ability' scores of earlier years are significant related with 'clinical performance' scores of subsequent years. These results suggest that (1) reflection ability is linked to clinical performance; (2) that written reflections are an important, but not the sole way to assess professional competence and that (3) reflection is a contributor to clinical performance improvement. Conclusions: the data showed a moderate but significant relationship between 'reflection ability' and 'clinical performance' scores in clinical practice of midwifery students. Reflection therefore seems an important component of professional competence. [ABSTRACT FROM AUTHOR]

• Evidence has shown a lack of informed decision-making in maternity care leads to negative outcomes for women and midwives yet, there is a significant lack of informed decision-making occurring in current midwifery practice. • Limited research exists which explores midwives' experiences of facilitating informed decision-making, and associated barriers. • This narrative literature review identifies and discusses key barriers to informed decision-making from the midwives' perspective, highlighting the need for changes to education, policy and practice. • Key recommendations include improvements in the access of continuity of midwifery care models, improved training for midwives in terms of facilitating informed decision-making, and a consultation process with midwives when policy-makers introduce guidelines or recommendations which may impact women's care options or decision-making. Informed decision-making is a vital component of midwifery philosophy and a core recommendation of the global respectful maternity care charter; however, women and midwives report a lack of informed decision-making in actual practice. Research reveals informed decision-making improves physical and mental health outcomes for women, regardless of childbearing experience, and is a protective factor for midwives' job satisfaction. There is currently little known about midwives' experiences of facilitating informed decision-making, and associated barriers. To critically appraise and synthesize the best qualitative evidence exploring midwives' experiences of facilitating women's informed decision-making. A systematic search of key databases and grey literature for qualitative research in English language published between 2010-2019. Quality assessment followed CASP guidelines and this review is reported in accordance with PRISMA guidelines. Thirteen studies were included in the final review. Data were synthesised narratively. Midwives were shown to have a strong desire to facilitate informed decision-making, yet reported a disparity between philosophy and practice due to multiple barriers. Barriers included; lack of specific knowledge and training, fear of blame and litigation, structural constraints including lack of time and fragmented models of midwifery care, and multidisciplinary philosophical disparities. Existing literature identifies informed decision-making is the gold-standard in providing safe and respectful maternity care, yet this review demonstrates that it is not well executed in actual practice. Midwives recognise this disparity and identify barriers which require urgent education, research, policy and practice solutions. [ABSTRACT FROM AUTHOR]

Objective: two studies aimed to explore the advice Dutch midwives give and the information Dutch pregnant women and partners of pregnant women receive about alcohol consumption in pregnancy. Design: study 1 included individual semi-structured interviews with midwives. Study 2 involved focus groups and individual semi-structured interviews with pregnant women and partners. Interview content was based on the I-Change Model. Setting: study 1 was conducted nation-wide; Study 2 was conducted in the central and southern regions of the Netherlands. Participants: 10 midwives in Study 1; 25 pregnant women and nine partners in Study 2. Measurements and findings: study 1 showed that midwives intended to advise complete abstinence, although this advice was mostly given when women indicated to consume alcohol. Midwives reported to lack good screening skills and sufficient knowledge about the mechanisms and consequences of antenatal alcohol use and did not involve partners in their alcohol advice. In Study 2, the views of pregnant women and partners were congruent to the findings reported in Study 1. In addition, pregnant women and partners considered midwives as an important source of information on alcohol in pregnancy. Partners were interested in the subject, had a liberal view on antenatal alcohol use and felt ignored by midwives and websites. Pregnant women indicated to receive conflicting alcohol advice from their health professionals. Key conclusions: midwives' alcohol advice requires improvement with regard to screening, knowledge about mechanisms and consequences of antenatal alcohol use and the involvement of the partners in alcohol advice during pregnancy. Implications for practice: training should be given to Dutch midwives to increase their screening skills and their alcohol related knowledge to pregnant women. Research is needed to determine how the midwife's alcohol advice to the partner should be framed in order to optimise the partner's involvement concerning alcohol abstinence in pregnancy. More attention to the topic at a national level, for example via mass media campaigns, should also be considered to change views about alcohol use during pregnancy in all stakeholders. [ABSTRACT FROM AUTHOR]

Effective and timely management of gestational diabetes mellitus (GDM) requires early detection. However, screening rates have been shown to be relatively low in New Zealand, despite the introduction of national screening guidelines in 2014 which indicate that all pregnant women should be screened. Thus, the aim of this study was to explore the awareness of the New Zealand Ministry of Health Diabetes in Pregnancy screening guidelines by New Zealand midwives. A 24-question online survey based upon the New Zealand screening guidelines was distributed via New Zealand midwifery social media groups to explore the awareness of New Zealand midwives with regard to screening for diabetes in pregnancy. Free text comments were also allowed, these were broadly categorized and reviewed. 174 registered midwives in Aotearoa New Zealand completed the survey. All participants responded that they routinely offer glycated haemoglobin screening for detection of undiagnosed pre-gestational diabetes, and 92.9% identified that this should occur prior to 20 weeks gestation (as per the national guidelines). However, less than two thirds of midwives thought that all women should be screened for GDM, with 18.2% indicating they would only do this if immediate risk factors were present. There also appeared to be some confusion over the time period for screening for GDM with 22.9% indicating that this should occur later than the guideline-recommended timepoint of 24–28 weeks gestation. Participants who identified as Māori and community-based midwives were most likely to screen for GDM 'only if risk factors were present'. Participants practicing for more than 6 years, those aged 45–54 years, and midwives identifying as Māori were most likely to screen for GDM after 28 weeks (though these did not reach statistical significance). The New Zealand Diabetes in Pregnancy screening guidelines do not appear to be well implemented in our sample group, particularly with regard to screening for GDM. This needs to be evaluated in a larger group of midwives, as education around the timeliness and importance of screening for all women may be required. A lack of appropriate or timely screening for GDM may mean that women are not being diagnosed or managed appropriately, which in turn may have implications for both mother and child. [ABSTRACT FROM AUTHOR]

In this study we aimed to reveal midwives' distinct perspectives about midwifery support of women in their transition process during the continuum from pregnancy to one-year postpartum. A Q-methodology study, a mixed quantitative-qualitative approach, was conducted. Participants (P-set) rank-ordered 36 statements (Q-set) about how midwives provide support during the woman's transition to motherhood, followed by interviews to motivate their ranking. To extract the perspectives/factors on support during this transition process, centroid by-person factor analysis and varimax rotation was used. The transcripts of the interviews were interpreted per factor. Independent (self-employed) and employed, community and hospital-based practising midwives in Flanders, Belgium. 83 practicing midwives participated, selected on: variation in practice setting, years of experience, views on the woman's domestic role in family life, and motherhood status. Two distinct perspectives (factors) on supporting women in transition to motherhood emerged. The job-focused midwife acts according to evidence, knowledge and guidelines and adheres to the scope and tasks within the professional profile (Factor 1). The woman-focused midwife acts within a relationship of trust emphasizing the one-on-one connection while supporting transition to motherhood and the woman's needs (Factor 2). Both factors showed an explained total variance of 59% of the Q-set. Both the job-focused midwife and the woman-focused midwife represent distinct perspectives about the midwife's execution of supporting transition to motherhood, including salotugenic elements. This provides an understanding of midwives' thoughts and experiences about why and how support is given. More awareness about the subjective distinct ways of thinking about supporting transition to motherhood should be integrated in practice, midwifery education and professional development. [ABSTRACT FROM AUTHOR]

• The pandemic process affected the performance of Turkish midwives and the quality of care they provided. • During the pandemic, midwives had differences in practice, especially in postpartum care. To determine the experiences of Turkish midwives who provided care to pregnant women diagnosed with COVID-19 or suspected of having it, during labour and delivery. A phenomenological approach was used. In-depth individual interviews were conducted with 15 midwives from 15 different hospitals in various Turkish cities through video-conferencing. Data analysis was based on Graneheim and Lundman's techniques for extracting themes from qualitative data. Four themes emerged: "Measures against pandemic uncertainty," "Impairment in postpartum care," "Emotional burden of the pandemic," and "Adaptation to the results of the pandemic." Midwives stated that they tried to reduce the risk of contamination by taking self-protection measures and creating isolated areas. They carried out practices such as separating the mother and baby postpartum and not allowing breastfeeding. They experienced emotional confusion with the difficulties faced in this process, and they became professional in the management of the process. The results of this study reveal the challenges faced by Turkish midwives during the COVID-19 pandemic and the importance of the publication of evidence-based guidelines. Provision of emotional support for midwives is essential in order to sustain the continuity of the quality maintenance of midwifery care. [ABSTRACT FROM AUTHOR]

Objective: the partograph is a tool used globally to record labour progress. Although it has the potential to improve maternal and neonatal outcomes, some midwives struggle with using it in practice. Training in partograph use is limited, and the theory is often divorced from practice. Innovative ways of improving training are urgently required. We therefore aimed to determine whether the use of an e-learning tool is beneficial for learning partograph skills. Design: an uncontrolled before-and-after study was conducted, informed by Kirkpatrick's four-stage model of evaluation; we report on the first two stages. We included a cohort of third and fourth year midwifery students who were studying at one university in Nairobi. The same hypothetical case scenario was used, pre- and post-implementation of the World Health Organization partograph e-learning tool, to assess students' partograph completion ability. Views on the tool were also sought, using semi-structured questionnaires. Data were analysed using standard statistical techniques and framework analysis. Findings: 92 (88%) students participated. Students expressed positive views about the e-learning tool. However, the mean post-intervention score (27.21) was less than half of the maximum obtainable score. There was some improvement in test scores; year three mean score pre-intervention was 21.39 (SD 5.72), which increased to 25.10 (5.41) post-intervention (paired-r=3.47, p=0.001); year four mean score preintervention was 24.39 (5.98) which increased to 29.30 (6.77) post-intervention (paired r=3.85, df=91, p o 0.001). In the post-test, year four students scored higher than year three students (unpaired r=3.28, df=90, p=0.001). Students were unable to plot cervical dilatation correctly, once established labour had been confirmed. Key conclusion: e-Learning training is acceptable to student midwives and has the potential to be an effective means of teaching the practical application of the partograph. However, in this study, their inability to correctly plot transference from the latent to active phase of labour suggests that the partograph itself may be too complicated. Modifications and further evaluation of the e-learning tool would be required before any widespread implementation. Furthermore, students need the clinical support to operationalise their learning; educating qualified midwives and obstetricians to be positive role models when completing the partograph would be one potential solution. Further research is required, taking on board the recommendations from our pilot study, to investigate the impact of partograph e-learning on practice and clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: aim of this study was to investigate current knowledge and practice regarding AMTSL in midwifery practices and obstetric departments in the Netherlands. Design: web-based and postal questionnaire. Setting: in August and September 2011 a questionnaire was sent to all midwifery practices and all obstetric departments in the Netherlands. Participants: all midwifery practices (528) and all obstetric departments (91) in the Netherlands. Measurements and findings: the response was 87.5%. Administering prophylactic uterotonics was seen as a component AMTSL by virtually all respondents; 96.1% of midwives and 98.8% of obstetricians. Cord clamping was found as a component of AMTSL by 87.4% of midwives and by 88.1% of obstetricians. Uterine massage was only seen as a component of AMTSL by 10% of the midwives and 20.2% of the obstetricians. Midwifery practices routinely administer oxytocin in 60.1% of births. Obstetric departments do so in 97.6% (po0.01). Compared to 1995, the prophylactic use of oxytocin had increased in 2011 both by midwives (10-59.1%) and by obstetricians (55-96.4%) (po0.01). Key conclusions: prophylactic administration of uterotonics directly after childbirth is perceived as the essential part of AMTSL. The administration of uterotonics has significantly increased in the last decade, but is not standard practice in the low-risk population supervised by midwives. Implications for practice: the evidence for prophylactic administration of uterotonics is convincing for women who are at high risk of PPH. Regarding the lack of evidence of AMTSL to prevent PPH in low risk (home) births, further research concerning low-risk (home) births, supervised by midwives in industrialised countries is indicated. A national guideline containing best practices concerning management of the third stage of labour supervised by midwives, should be composed and implemented. [ABSTRACT FROM AUTHOR]

Abstract: Background: within childbirth there is a common and widely known explanation of labour and birth which describes and defines the birth process as stages and phases. The aim of this research was to determine whether the discourse of labour as stages and phases resonated with women who had experienced spontaneous labour and birth. Method: a critical feminist standpoint methodology was used to explore the perspectives of 18 New Zealand women through in-depth, one to one, interviews. Findings: the participants did not talk about their labour as occurring in stages or phases and often considered this description to be an abstract concept. The current descriptions of labour onset and progression did not appear to resonate with these women or provide sufficient clarity for them to understand how far they had progressed in their labour. For women who had previously laboured there was the ability to make comparisons with their previous experiences and therefore experiential knowledge was privileged over other forms of knowledge. Despite this the discourse of measurement of cervical dilatation was dominant and considered as an authoritative means of determining labour and labour progress. Conclusion and implication for practice: women considered labour to be a continuous process. If women are to be able to make sense of their experience of labour, the maternity sector needs to explore and determine descriptions of labour which resonate more fully with the woman''s experience of labour and birth. [Copyright &y& Elsevier]

Abstract: Background: the practical training in midwifery education in Germany takes place predominantly in hospital delivery wards, where high rates of intervention and caesarean section prevail. When midwives practice birth assistance at free-standing birth centres, they have to make adjustments to what they learned in the clinic to support women without the interventions common to hospital birth. Objectives: the primary aim of this study was to investigate and describe the approach of midwives practicing birth assistance at a free-standing birth centre. Methodology: a qualitative approach to data collection and analysis with grounded theory was used which included semi-structured expert interviews and participant observation. Five midwives were interviewed and nine births observed in the research period. The setting was a free-standing birth centre in a large German city with approximately 115 births per year. Findings: the midwives all had to re-learn birth assistance when commencing work outside of the hospital. However, having been trained predominantly in hospital maternity wards, they have retained many aspects characteristic of their training. The midwives use technology, although minimal, and medical discourse in combination with 1:1, woman-centred care. The birthing woman and midwife share authority at birth. The fetus is treated as an ally of the mother, suited for birth and cooperative. Through use of objective and subjective criteria, the midwives have their own approach to making physiological birth possible. Key conclusions and implications for practice: to prepare midwives to support low-intervention birth, it is necessary to include training in birth assistance with women who birth physiologically, without interventions common to hospital birth. The results of this study would also suggest that the rate of interventions in hospital could be reduced if midwives gain more experience with women birthing without the above-mentioned interventions. [Copyright &y& Elsevier]

Abstract: Background: group-based antenatal care consists of six to nine two-hour sessions in which information is shared and discussed during the first hour and individual examinations are conducted during the second hour. Groups generally consist of six to eight pregnant women. Parent education is built into the programme, which originated in the United States and was introduced in Sweden at the beginning of the year of 2000. Objective: to investigate parents'' experiences of group antenatal care in four different clinics in Sweden. Method: a qualitative study was conducted using content analysis five group interviews and eleven individual interviews with parents who experienced group-based antenatal care. An interview guide was used. Settings: the study was set in four antenatal clinics that had offered group-based antenatal care for at least one year. The clinics were located in three different areas of Sweden. Participants: the participants were women and their partners who had experienced group-based antenatal care during pregnancy. Other criteria for participation were mastery of the Swedish language and having followed the care programme. Findings: three themes emerged, ‘The care—combining individual physical needs with preparation for parenthood, refers to the context, organisation, and content of care''. Group antenatal care with inbuilt parent education was appreciated, but respondents reported that they felt unprepared for the first few weeks after birth. Their medical needs (for physical assessment and screening) were, however, fulfilled. The theme, ‘The group—a composed recipient of care’, showed the participants role and experience. The role could be passive or active in groups or described as sharers. Groups helped parents normalise their symptoms. The theme, ‘The midwife—a controlling professional’, showed midwives are ignorant of gender issues but, for their medical knowledge, viewed as respectable professionals. Key conclusions: in the four clinics studied, group-based antenatal care appeared to meet parents'' needs for physical assessment and screening. Parents identified that the groups helped them prepare for birth but not for parenthood. The group model created a forum for sharing experiences and helped participants to normalise their pregnancy symptoms. Implications for practise: the midwife''s role in facilitating group-based antenatal care demands new pedagogical strategies and approaches. [Copyright &y& Elsevier]