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In the United Kingdom (UK), a critical shortage of midwives puts pressure on the already overworked midwives working in maternity services. Considering the challenges that midwives in the UK face, this rapid review was conducted to inform a larger-scale initiative to improve the working conditions of midwives in an acute NHS Trust in the Midlands area of the UK. To describe midwives' perceptions and experiences of positive practice environments. A search strategy to identify literature about midwives' perceptions and experiences of positive practice environments was conducted in Medline, CINAHL Plus and Embase databases. Literature screening was conducted independently in two steps using an eligibility tool. The articles' quality assessment was conducted using the Mixed Method Appraisal Tool. Data were extracted using the Job Quality framework and managed using NVivo12. Seventy articles were included in this review. Midwives' working conditions can be improved in all seven areas of the Job Quality framework. Most articles in the review reported the negative aspects of midwives' working environments, making it challenging for the team to define a positive practice environment for midwives. Despite this, authors discuss that a positive practice environment is at least sustained by ensuring midwives' ability to provide care; providing good employment conditions; developing respectful organisations; and increasing team resources, such as those that improve team resilience. Midwives' working conditions are universally challenging. Failure to address the situation will compromise recruitment and retention, increasing the shortage of midwives. Provision of safe and respectful care appears to be directly linked to midwives' safe and respectful working conditions. [ABSTRACT FROM AUTHOR]

The recent change in Chilean legislation towards abortion enabled midwives to include the care of women having an induced abortion within their scope of practice. However, midwives' identity could be strained by induced abortion care provision as it is contrary to midwives' traditional role. Considering this, the aim of the study was to elucidate how Chilean midwives understand and provide abortion care. A constructivist grounded theory study was conducted using online semi-structured in-depth interviews. Midwives were purposively sampled considering maximum variation criteria and then theoretical sampling occurred. Saturation was achieved with fifteen interviews. Interviews were conducted in Spanish and then translated into English. Constant comparison analysis generated categories. Data were managed using NVivo 12. All interviewees provided their consent to be part of this study. This article reports on the experiences of nine midwives who had provided lawful induced abortion care in Chile. The experiences of these midwives were grouped into two major categories: 'Defining a position towards abortion' and 'Abortion care is emotional labour'. Midwives can successfully provide abortion care despite being challenged by certain areas of it. Considering the high demand for emotional labour in abortion care, efforts should be made to increase midwives' emotional self-regulation skills. Likewise, organisations should strengthen and implement their offer of well-being and emotional self-care support to midwives. [ABSTRACT FROM AUTHOR]

Chilean midwives have been identified as essential for successfully implementing an abortion law, a practice which could potentially be understood as contradicting their central mission. Nevertheless, to date, there has been no investigation into how Chilean midwives have incorporated induced abortion care provision into their professional identity. To elucidate how Chilean midwives understand and provide abortion care and how they have (re)defined their professional identity to include induced abortion care. This article reports the findings of the second part of this aim. This study was underpinned by a constructivist grounded theory methodology informed by a reproductive justice and feminist perspective. Midwives from Chile who have cared for women undergoing abortion were invited to participate in the study. After purposive and theoretical sampling, fifteen midwives were recruited. Midwives' identity is woman-centred, with high value placed on their role protecting life. These two aspects of midwives' identity are in contradiction when providing abortion care. Midwives' identity results from and informs midwives' practice. Midwifery regulation influences both practice and identity. The model 'Navigating a maze' explains the interaction of these three elements. Midwives' identity response to the enactment of the Chilean abortion law is an example of how professional identity must navigate regulation and practice to make sense of its purpose. In light of this study's findings, the current tension experienced in midwives' identity should be carefully attended to prevent adverse outcomes for midwives and the Chilean population. [ABSTRACT FROM AUTHOR]

A diagnosis of atopic dermatitis (AD) is common during infancy; however, it is unclear whether differential skin barrier development defines this period and signals disease onset in predisposed individuals. We sought to study (NCT03143504) and assess the feasibility of remote skin testing from birth to monitor skin barrier maturation and model association with an AD diagnosis by age 12 months. Biophysical testing and infrared spectroscopy were conducted at the maternity ward and family home. Tape stripping collected samples for desquamatory protease and natural moisturizing factor analysis. The 4 common European filaggrin risk alleles were screened. A total of 128 infants completed the study, with 20% developing mild disease. Significant changes in permeability barrier function, desquamatory protease activity, and molecular composition assessed spectroscopically were observed longitudinally, but only subtle evidence of differential skin barrier development was noted between infant subgroups. Common filaggrin risk alleles were strongly associated with early-onset disease and conferred a significant reduction in natural moisturizing factor and water content by age 4 weeks. Accounting for a family history of atopy, these parameters alongside a greater lipid/protein ratio and reduced chymotrypsin-like activity at birth were associated with AD. Measured in ambient conditions, transepidermal water loss did not signal disease risk at any stage. Skin barrier dysfunction lacked an acquired modality but was considered proportional to cohort severity and suggests that a portfolio of tests used in a community setting has the potential to improve current AD risk evaluations from birth. [ABSTRACT FROM AUTHOR]

Abstract Background Delayed pregnancy is increasingly common in many countries including the UK. There has been international interest in providing maternity care which aims to improve outcomes for mothers and babies when pregnancy occurs after the age of 35. Despite this, there is a lack of understanding of the experience of pregnancy at advanced maternal age from the woman's perspective. Objectives To explore the experience of uncomplicated pregnancy for nulliparous women aged 35 and over and determine key processes involved in their pregnancy journey. Design A two phase constructivist grounded theory study. Setting South West of England, United Kingdom. Participants 15 nulliparous women aged 35 and over, in their third trimester of pregnancy. Methods Data were collected through semi-structured, in depth interviews which were transcribed and analysed using coding, constant comparison and memo-writing. Results The core category 'It's now or never' reflects how women may experience their pregnancy. This appears to influence feelings of readiness to become a mother, anxieties about the pregnancy and their care choices. This was felt more acutely as maternal age advances towards 40 years and beyond. Conclusions Women's understanding that their future chances to have a baby may be limited can impact upon the way pregnancy is experienced. Despite having an uncomplicated pregnancy, older pregnant women may experience considerable worry throughout their pregnancy. Further research is required on how health care providers can better support women in early pregnancy and in making decisions regarding childbirth choices which are related to age. [ABSTRACT FROM AUTHOR]

Abstract This paper explores institutional drivers for developing MOOCs by juxtaposing them against the original drivers for generating MOOCs: to offer open access education. However, the original impetus for MOOC development may be shifting towards a business oriented model. Therefore, instead of contributing to corporate social responsibility and inclusivity agendas facilitating open access to education, MOOCs are akin to an institution's shop window allowing the pseudo 'purchaser' the opportunity to glimpse behind the scenes. Hence, we ask: are MOOCs merely a sophisticated form of window dressing, showing pseudo 'purchasers' what institutions want them to see enticing them to purchase more lucrative products? Notwithstanding the motivation for developing MOOCs participants must first access them. Therefore the paper examines what MOOCs actually offer participants who are likely to access them and concludes by examining how MOOCs can be developed to facilitate better completion rates and encourage wider participation from hard to access groups. [ABSTRACT FROM AUTHOR]

Objectives to identify what skin practices are important for the protection of baby skin in healthy term babies (0–6 months) and generate evidence-based conclusions to inform health professionals and parents. Design eleven databases were searched for all empirical quantitative and qualitative research published between 2000–2015 which explored baby skin care for bathing and cleansing, nappy care, hair and scalp care, management of dry skin or baby massage, for healthy term babies up to 6 months old. Papers not published in English were excluded. A total of 3062 papers were identified. Pairs of reviewers assessed all citations and extracted data independently. There were 26 included papers: 16 RCTs, 3 non-randomised experimental studies, 1 mixed-methods study and 6 qualitative studies. Primary and secondary outcome measures were analysed using meta-analysis or narrative descriptive statistics. Synthesis of qualitative data was not possible due to disparity of the evidence. Findings from the small numbers of studies with comparable data, there was no evidence of any significant differences between tested wash products and water or tested baby wipes and water. There was some evidence to suggest that daily use of full-body emollient therapy may help to reduce the risk of atopic eczema in high risk babies with a genetic predisposition to eczema; however, the use of olive oil or sunflower oil for baby dry skin may adversely affect skin barrier function. There was no evidence about hair/scalp care or baby massage. Qualitative research indicates that parents and health professionals believe that water alone is best. Key conclusions meta-analysis was restricted due to the lack of consistency of study outcome measures. Although there is considerable RCT evidence comparing the use of specific products against water alone, or another product, for bathing, cleansing and nappy care, the power of this evidence is reduced due to inconsistency of outcome measures in terms of outcome, treatment site or time-point. The development of a core outcome measure set is advocated for trials assessing skin care practices. Implications for practice this review offers health professionals best evidence available on which to base their advice. Of those studies with comparative outcomes, the evidence indicates no difference between the specific products tested and water alone; offering parents a choice in their baby skin care regimen. Protocol available: http://www.crd.york.ac.uk/PROSPEROFILES/28054_PROTOCOL_20151009.pdf [ABSTRACT FROM AUTHOR]

• Providers shape policy the implementation process. • Abortion policies implementation morally challenges many providers. • Midwives and nurses face multiple challenges when providing abortion care. • These challenges relate to beliefs about human life, women's rights, and resources. • Midwives/nurses still experience occupational stigma when providing abortion care. Policy implementation can be affected by what individuals believe to be right and wrong. When implementing abortion policies, providers' moral beliefs can be relevant in the success of the implementation process. Considering that midwives and nurses are direct providers of abortion care, exploring their experiences related to abortion policy implementation could provide helpful information to prevent policy failure. Systematic integrative review. The studies were identified through an electronic search strategy and the screening of the reference lists of all selected articles. Studies were retrieved from eight medical and social sciences databases. Thirty-one studies focused on midwives' and nurses' experiences of implementing abortion policies, irrespective of setting or age of study were included in this review. Studies included used qualitative, quantitative and mixed methods. Study quality was appraised using the Mixed Method Appraisal Tool version 2018. No study was excluded from this review based on its quality appraisal. In terms of their quality, most studies included in this review were conducted appropriately. Three superordinate themes represent the main elements that challenge midwives and nurses when providing abortion care. The first superordinate theme identified that many midwives and nurses believed fetuses are sentient beings, making them worthy of compassionate treatment. The next superordinate theme was focused on preferences and expectations about abortion care. Finally, the third superordinate theme illustrates midwives' and nurses' experiences with other team members, highlights their creativity when challenged with insufficient resources and provides a glimpse of the numerous techniques used for coping with work-related stress. Midwives and nurses worldwide face multiple challenges when providing abortion care. Guidelines aiming to support policy implementation should consider how abortion affects healthcare providers and suggest appropriate measures to reduce these and other barriers. Midwives and nurses technical and ethical competencies for abortion provision should be strengthened. [ABSTRACT FROM AUTHOR]

Abstract: The global trend towards urbanization means that over half of the world''s population now lives in cities. Cities use energy in different proportions to national energy use averages, typically corresponding to whether a country is industrialized or developing. Cities in industrialized countries tend to use less energy per capita than the national average while cities in developing countries use more. This paper looks at existing World Bank data in respect to urban energy consumption, the emissions inventory work done by New York City, and discusses how this data highlights the need for a focus on: energy policy for buildings in industrialized cities; masterplanning and new construction standards in developing cities; and how urban energy policy can become more effective in reducing urban greenhouse gas emissions. [Copyright &y& Elsevier]

Abstract: Background: There is a global trend, in high resource countries, for delayed childbearing beyond the age of 35. Women of advanced maternal age are considered to be at higher risk of poor maternal and neonatal outcomes. Women''s views and experiences of delayed childbearing are relatively unexplored. Objectives: To gain an understanding of factors influencing women''s decisions to delay childbearing and explore their experiences and perceptions of associated risks. Design: A qualitative phenomenological study. Setting: Greater Manchester, United Kingdom. Participants: Purposive sample of 18 women aged 35 and over in three groups; six women with no children who were not pregnant, six women pregnant with their first child and six women with no children attending a fertility clinic. Methods: Data were collected by in depth semi-structured interviews, managed manually and subjected to thematic analysis. Results: Three main themes were identified; the chapters of life, the need to know, and childbearing being within or beyond women''s control. Women focussed on the need for a stable relationship, being “ready” to have a baby, and acquisition of life experience. Their experiences reflected a lack of awareness of many of the risks associated with pregnancy over age 35 and disbelief that age alone necessarily increased the likelihood of poor outcomes. Women perceived a lack of choice in the timing of when to start a family. Women suggested that although they may have reached a juncture in their lives, at which they felt ready to have a baby, the circumstances in which they found themselves may not support this; factors such as relationship, financial stability, health and fertility, were often outside of their control. Conclusions: Women do not perceive that they have ultimate control when it comes to the timing of childbearing. Health professionals and the media should be aware of the complex interplay of factors surrounding women''s reasons for delaying childbearing. Sensitive information and support should be provided allowing for varying perceptions of risk status. Women may benefit from pre-conception education. [Copyright &y& Elsevier]

Objectives: To identify what factors affect women's' decisions to delay childbearing, and to explore women's' experiences and their perceptions of associated risks. Design: Systematic procedures were used for search strategy, study selection, data extraction and analysis. Findings were synthesised using an approach developed from meta-ethnography. Data sources: We included qualitative papers, not confined to geographical area (1980–2009). Databases included CINAHL, MEDLINE, EMBASE, PsycInfo, ASSIA, MIDIRS, British Nursing Index and the National Research Register. We selected qualitative empirical studies exploring the views and experiences of women of advanced maternal age who were childless or primigravidae with a singleton pregnancy or primiparous. Review methods: Twelve papers fulfilled the selection criteria and were included for synthesis. Results: Women appear to face an issue of ‘informed and uninformed decision making’; those who believe they are informed but may not be, those who are not informed and find out they are at risk once pregnant, and those who are well informed but choose to delay pregnancy anyway. Maternity services could provide information to enable informed choice regarding timing of childbearing. Conclusions: Health professionals need to be mindful of the fact that women delay childbearing for various reasons. A strategy of pre-conception education may be beneficial in informing childbearing decisions. Obstetricians and midwives should be sensitive to the fact that women may not be aware of all the risks associated with delayed childbearing. [Copyright &y& Elsevier]

• Midwifery education was affected by national regulatory changes early in the pandemic. • There was variation in how the extended placement option was implemented. • UK AEIs provided midwifery students with the majority of decisional support. • LMEs experienced both internal and external pressures to instigate rapid change. • Learning can be taken from the impact of COVID-19 on midwifery education. to assess the effect of implementation of the extended placement option available to midwifery students during the first wave of the COVID-19 pandemic. Online survey open from 2nd June 2020 to 15th July 2020. United Kingdom. Lead Midwives for Education (LMEs). A total of 38 of 55 LMEs responded (response rate 69%). The majority of Approved Education Institutions (AEIs) offered an extended placement to students, but with some variation in the choices offered, unrelated to geographical location or size of student cohort. AEIs appeared to provide the majority of decisional support for students. Many practice learning environments became unavailable, particularly community, gynaecology/medical wards and neonatal units. LMEs experienced both internal and external pressures to instigate rapid change. The impact of COVID-19 on midwifery education is significant and will need continual scrutiny to minimise future detriment. The pressures of providing midwifery education throughout the early phase of COVID-19 were substantial, but it is important that we learn from the immediate changes made, value and pursue the changes that have been beneficial, and learn from those that were not. Student learning experiences have undergone significant change during the pandemic. It is essential to assess what effect the extended placement has had on student readiness for practice, their confidence, resilience, mental health, and attrition and retention. Educators transitioned to remote working, and rapidly assimilated new skills for online education; exploration of the impact of this is recommended. [ABSTRACT FROM AUTHOR]