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Background: The increasing shortage of staff in healthcare facilities worldwide calls for a human resource planning strategy in order to ensure safe, timely and patient-centred care. The purpose of this paper is to provide an analysis and supply and demand projections of nurses, midwives, and radiographers within the labor market of the largest university hospital in the Baltic States by 2030. Methods: The staff supply was calculated on the intake and outflow of persons in the labour market annually for various factors. Projections for the demand of nurses, midwives, and radiographers took into account the different needs of the population, categorized by gender and age, for the services offered within the institution. Results: The analysis highlights significant projected shortages in the supply of nurses and radiographers by 2030, while the supply of midwives is expected to meet the demand. The projected supply of nurses in 2030 will be lower than in 2021. Projected nurses demand in 2025 according medium scenario - shortage of 59 nurses, on prospective scenario - of 331 nurses. In 2030 according medium scenario - shortage of 173 nurses on prospective - of 772 nurses. The projected supply of radiographers in 2030 will be higher than in 2021. Projected radiographers demand in prospective scenario which is the most likely in 2025 - shortage of 26 and in 2030 - shortage of 52 radiographers. The projected supply of midwives in 2030 will be higher than in 2021. The variables influencing the increase in the demand for midwives did not exceed the projected supply in the institution, indicating a balanced supply-demand scenario for midwives. Conclusions: Due to the rising demand for nurse and radiographer services from the aging population, the predicted supply of nurses and radiographers will be insufficient. To ensure the projected demand for nurses in the medium and prospective scenarios, the nurses recruited each year should increase up to 38% in the medium scenario and 69% in the prospective scenario from 2022. In the prospective demand scenario, the recruitment of radiographers should increase three-fold and the recruitment of midwives should be reduced by 30%. [ABSTRACT FROM AUTHOR]

Background: Retaining midwives and registered nurses in the Obstetrics and Gynecology department/unit (OB/GYN) is not just a matter of organizational effectiveness and financial wellness. It's a crucial aspect of ensuring quality healthcare delivery. This study aimed to discuss the degree to which midwives and nurses in OB/GYN departments are structurally empowered, resilient, and committed to remaining at the organizations and to examine whether nurses' and midwives'sense of structural empowerment and resilience is a good predictor of their decision to stay with the organization. Methods: This study employed a unique convergent parallel mixed methods approach. The research was conducted in two distinct phases. The first phase involved a cross-sectional quantitative survey with a convenience sample of 200 midwives and nurses in OB/GYN departments. The second phase was a qualitative study utilizing semi-structured, open-ended interviews. Eighteen nurses and midwives, specifically chosen as the target population, were invited to participate in individual interviews. The data collection took place at three major hospitals in Saudi Arabia, starting in January 2023 and concluding in February 2023. Results: The study results revealed that structural empowerment and resilience were statistically significant predictors of the intent to stay in the organization (F = 35.216, p < 0.001), with 26.3% variation, the structural empowerment is higher predictor (β = 0.486, p < 0.000) to intent to stay if compared to resilience (β = 0.215, p < 0.008). Five major themes emerged from the narratives of the nurses and midwives: the nurturing of the physical and physiological, the development of the psychological, the managing finances, the restructuring of the organization, and the enrichment of the professional and occupational. Conclusion: The study's findings have significant implications for healthcare organizations. They highlight the importance of cultivating a culture of empowerment and resilience, which can serve as a powerful tool to encourage registered nurses and midwives to remain in their organizations. This insight empowers healthcare administrators, human resource managers, and obstetrics and gynecology professionals to take proactive steps toward improving retention rates. [ABSTRACT FROM AUTHOR]

Background: There are recommendations based on scientific evidence on care in the second stage of labor, but it is not known to what degree the professionals comply with these recommendations. Objective: The aim of this study is to examine the variability in clinical practices among midwives during the second stage of labor, including positions, mobility, practices, and the maximum time allowed before initiating active pushing, and to assess their adherence to clinical practice guidelines. Methods: A cross-sectional observational study. A self-designed questionnaire was developed and distributed online through scientific societies. The main variables studied were professional and work environment characteristics, maternal positions and mobility, practices during this stage, maximum time to start active pushing and duration of the second stage of labor. Descriptive statistics were calculated using SPSS 24.0. Results: Regarding the woman's position during childbirth, 80.3% (245) of midwives frequently or always allow the woman to choose her birthing position. Furthermore, 44.6% (136) of professionals prefer using side-lying positions for the mother. Regarding drinking fluids during childbirth, 51.1% (156) of midwives allowed the woman to drink the amount of liquids she wanted, whereas 11.1% (34) said that they would allow them to do so however, this was against the protocol of their hospital. When inquiring about the Kristeller maneuver, it was reported to be excessively performed in 35.1% (107) of cases for fetal bradycardia, 33.1% (101) for maternal exhaustion, and 38.4% (117) to avoid instrumental birth. Finally, a great variability was observed in the time criteria used for the initiation of active pushing and the maximum duration of the second stage of labor. Conclusions: Certain practices, such as the Kristeller maneuver, are overused among midwives, with great variability in the use of certain procedures, the waiting times to initiate pushing and completion of the second stage of labor. Further training and awareness campaigns are needed for professionals to apply evidence-based care. [ABSTRACT FROM AUTHOR]

Background: Women of childbearing age feel great about giving birth, but the pain could be excruciating depending on their pain tolerances. Midwives requires obstetrical knowledge and skills such as pain management during labour and safety. We explored midwives’ perspectives on the utilisation of pharmacological pain alleviation interventions during labour in selected hospitals in Matjhabeng Municipality, Free State province, South Africa. A qualitative study was undertaken, involving a sample of ten midwives, using a semi-structured interview guide. The interviews were audio-recorded and transcribed verbatim. Tesch’s open coding data analysis method was applied to analyse the data. The midwives were restricted to use Pethidine and Phenergan prescribed by doctors for labour pain relief, which disrupted labour pain management and obliged them either to wait for a physician or follow telephone instructions. According to the midwives, women taking Pethidine and Phenergan encountered adverse effects and discomfort. Midwives identified high workload, inadequate personnel, lack of skill and knowledge, lack of medication availability, and lack of infrastructure as the primary challenges of administering pharmacological methods to women in labour. The lack of standing orders, which delays the administration of medications pending a physician’s prescription, constituted an additional difficulty. In the instance that Pethidine and Phenergan were unavailable or ineffective for some women, the midwives recommended that women be administered alternative pharmacological pain relievers. They also advocated for institutionalization of pharmacological guidelines allowing them to use their discretion when treating labour pain. Midwives can only utilise a few standardised and regulated pharmacological medications for labour pain management. The midwives’ ability to administer pharmacological pain relief during labour was hampered by a high workload burden, insufficient staff, lack of skill and understanding, drug unavailability, and inadequate infrastructure. Midwives advocated for supported guidelines that would allow them to treat labour pain at their discretion. Intersectoral stakeholders are required to improve midwife skills and attitudes. Health facilities need to train and supply analgesics to midwives. Midwives ought to be familiar with pharmacological pain relievers. [ABSTRACT FROM AUTHOR]

Context: Working with women to best meet their needs has always been central to midwifery in Quebec, Canada. The creation of birthing centres at the end of the 1990s consolidated this desire to prioritize women's involvement in perinatal care and was intended to encourage the establishment of a care and services partnership between care providers and users. The aim of this pilot study is to evaluate the perceptions of clients, midwives and birth assistants of the way in which women are involved in partnership working in Quebec birthing centres. Methods: A single qualitative case and pilot study was conducted with midwives (n = 5), birth assistants (n = 4), a manager (n = 1), clients (n = 5) and members of the users' committee (n = 2) at a birthing centre in Quebec, Canada in July and August 2023. The partnership was evaluated using the dimensions of a validated CADICEE questionnaire. Results: The women and professionals stressed that the relationship was established in a climate of trust. The caregivers also attached importance to autonomy, information sharing and decision-making, adaptation to context, empathy and recognition of the couple's expertise. The women confirmed that they establish a relationship of trust with the professionals when the latter show empathy and that they adapt the follow-up to their knowledge and life context. Key factors in establishing this kind of care relationship are the time given, a de-medicalized environment, the comprehensive care received, and professionals who are well-informed about the partnership. In addition, the birthing centre has a users' committee that can put forward ideas but has no decision-making powers. Conclusions: Both the women and the professionals at the birthing centre appear to be working in partnership. However, at the organizational level, the women are not involved in decision-making. A study of all birthing centres in Quebec would provide a more comprehensive picture of the situation. [ABSTRACT FROM AUTHOR]

Background: Possessing sensitive and multiple responsibilities in the country's health system, particularly after the implementation of the health reform in Iran, midwives must be able to optimally perform their duties in their new job as healthcare providers. This study aimed to identify the factors that predict job adjustment for Iranian midwives working in healthcare. Methods: In this cross-sectional study, 310 midwives were recruited from 209 health centers in the Iranian province of West Azerbaijan using the census method and asked to complete research questionnaires. Data were collected using job adjustment, job satisfaction, and organizational commitment scales. SPSS version 25 was used to perform ANOVA and calculate multiple linear regression coefficients for data analysis. In addition, the AMOS software was employed for path analysis and the identification of predictive variables. Results: The mean age of the participants was 37.67 ± 7.1 years. Most participants (35.5%) were interested in their occupation as a midwife, and 27.1% were very interest. They had a moderate to strong tendency (76.1%) to remain in their new profession. In addition, 58.1% of participants experienced moderate job adjustment. For healthcare midwives, "desire to remain in the midwifery profession" and "organizational commitment" were significant predictors of job adjustment. "Desire to remain in the midwifery profession" directly affected midwives' job adjustment, while "interest in the new profession" had an indirect effect. Furthermore, "adequacy of income to expenses," "job satisfaction," and "organizational commitment" through the mediating role of "desire to remain in the profession" can, directly and indirectly, influence their job adjustment. Conclusion: To better prepare midwives for their role as healthcare providers, organizational managers should focus their efforts and plan primarily on providing incentives to increase the longevity of staying in the profession of midwifery increase job adjustment, job satisfaction, and organizational commitment, thereby improving the quality-of-service delivery. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has produced widespread disruptions for healthcare systems across Canada. Perinatal care in Ontario, Canada was subject to province-wide public health restrictions, reallocation of hospital beds and human health resources. To better understand the impacts of the pandemic on Ontario perinatal care, this study explored the perspectives of perinatal care providers about their clinical COVID-19 pandemic experiences. Methods: Semi-structured key informant virtual interviews were conducted between August 2021 and January 2022 with 15 Ontario-based perinatal care providers. Recorded interviews were transcribed, and thematic content analysis used to identify major themes and subthemes. Results: Participants were mainly women, practicing in Eastern and Central Ontario as health providers (obstetricians, nurses, midwives), allied regulated health professionals (social worker, massage therapist), and perinatal support workers (doula, lactation consultant). Major themes and subthemes were identified inductively as follows: (1) Impacts of COVID-19 on providers (psychosocial stress, healthcare system barriers, healthcare system opportunities); (2) Perceived impacts of COVID-19 on pregnant people (psychosocial stress, amplification of existing healthcare barriers, influences on reproductive decision making; minor theme- social and emotional support roles); (3) Vaccine discourse (provider empathy, vaccines and patient family dynamics, minor themes- patient vaccine hesitancy, COVID-19 misinformation); and (4) Virtual pregnancy care (benefits, disadvantages, adaptation of standard care practices). Conclusions: Perinatal care providers reported significant stress and uncertainty caused by the COVID-19 pandemic and evolving hospital protocols. Providers perceived that their patients were distressed by both the pandemic and related reductions in pregnancy healthcare services including hospital limits to support companion(s). Although virtual pregnancy care impaired patient-provider rapport, most providers believed that the workflow efficiencies and patient convenience of virtual care is beneficial to perinatal healthcare. [ABSTRACT FROM AUTHOR]

Background: Restricting parturient women in healthcare facilities from choosing positions that provide the greatest comfort and benefit during labor is a global barrier. Several complex factors, including caregiver preference and medical intervention, shape the limitation. Therefore, a practical need exists to train midwives on the knowledge and skills to change this condition. Methods: The study used a parallel, single-blind, randomized controlled trial at a provincial maternity and child health hospital in Fujian, China, from June 1 to December 31, 2019. The midwives in a birth suite were selected and randomly enrolled in a one-month simulation-based hybrid training or face-to-face teaching in September 2019. The four-level Kirkpatrick's model, including reaction, learning, behavior, and results, was used to evaluate training effects before and after the program. Data were analyzed with SPSS 25.0 using Student's t-test, Spearman's correlation test, Mann–Whitney U test, Wilcoxon signed-rank test, and chi-square test analysis of variance. The significance level was set at p < 0.05. Results: Forty-two midwives were initially randomized to either the virtual simulation group or the face-to-face group. One midwife was excluded from the analysis due to intervention discontinuation, resulting in a final analysis of 41 midwives (n1 = 21, n2 = 20). Post-intervention, the virtual simulation group exhibited higher satisfaction and learning effects compared to the face-to-face group, while the rate of perineal incision in primiparas was lower (p<0.05). No significant changes or differences were observed in self-rated behavior between the two groups (p>0.05). The virtual simulation group demonstrated an increase in non-supine birth rate (p = 0.030) and a decrease in perineal incision rate among primiparas compared to pre-intervention (p = 0.035). Moreover, knowledge performance was associated with the duration of virtual simulation (r = 0.664, p = 0.001). Conclusions: Virtual simulation is a fascinating innovation that enables midwives to develop birthing positions without practicing on real pregnant women and is one solution to achieve work competency within a shortened training period. [ABSTRACT FROM AUTHOR]

Background: Woman-centered care (WCC) is the cornerstone of the midwifery profession. However, no study has been conducted on WCC provided by Iranian midwives and its associated factors. Thus, this study aimed to determine WCC and factors associated with midwives' WCC for midwives working in urban health centers and public and private hospitals in Tabriz, Iran. Methods: This cross-sectional study was the first part (i.e., the quantitative phase) of a sequential explanatory mixed-method study conducted on 575 midwives working in urban health centers and public and private hospitals in Tabriz-Iran from November 2022 to January 2023. The required data was collected by distributing a socio-demographic and job characteristics questionnaire and woman-centered care scale-midwife self-report (WCCS-MSR). To determine the factors associated with WCC, an independent t-test or one-way analysis of variance (ANOVA) was used in bivariate analysis, and a general linear model (GLM) was employed in multivariate analysis to control possible confounding variables. Results: The statistical population consisted of 575 midwives, with a response rate of 88.2%. According to the GLM, the total mean WCCS-MSR score of single [β (95% CI) 23.02 (7.94 to 38.10)] and married [β (95% CI) 21.28 (6.83 to 35.72)] midwives was significantly higher than that of divorced midwives after adjusting their demographic and job characteristics. Also, the total mean WCCS-MSR score of midwives with sufficient income was significantly higher than those with insufficient income [β (95% CI) 8.94 (0.12 to 17.77). In addition, the total mean WCCS-MSR score of midwives with < 5 years of work experience [β (95% CI) − 7.87 (− 14.79 to − 0.94)], and midwives with official-experimental employment status [β (95% CI) − 17.99 (− 30.95 to − 5.02)], was significantly lower than those with more than 5 years of work experience and contractual employment status. Conclusions: The findings indicate that marital status, level of income, years of practice, and employment status were significantly related to WCC provided by midwives. Focusing only on the midwifery community is insufficient to ensure the improved quality of WCC. However, arrangements should be made at three levels, including policy-makers, managers, and health care provider (midwives). Plain Language Summary: As the cornerstone of the midwifery profession, WCC represents a universal, integrated, and synonymous concept with practice, which implies focusing on women as individuals. This cross-sectional study determined WCC and its associated factors of midwives working in urban health centers and public and private hospitals in Tabriz, Iran. A sample size of 575 midwives was used to determine the factors associated with WCC. The required data was collected by distributing a socio-demographic and job characteristics questionnaire and woman-centered care scale-midwife self-report (WCCS-MSR). A generalized linear model (GLM) was used to determine the factors associated with WCC. Midwives obtained the highest total mean score in the Works in Partnership with the Woman (WP-W) subscale and the lowest total mean score in the Ensures Midwifery Philosophy Underpins Practice within the Context of the Maternity Service (EMPUP-MS) subscale in the obtainable scores, which ranged from 0 to 100. Our study found that the total mean WCCS-MSR score of single and married midwives was significantly higher than that of divorced midwives. Also, the total mean WCCS-MSR score of midwives with sufficient income was significantly higher than those with insufficient income. In addition, the total mean WCCS-MSR score of midwives with < 5 years of work experience, and midwives with official-experimental employment status, was significantly lower than those with more than 5 years of work experience and contractual employment status. The findings indicated that marital status, level of income, years of practice, and employment status were significantly related to WCC provided by midwives. Therefore, to improve the quality of WCC, identifying the mentioned factors will help policy-makers to consider facilitating measures, providing practical solutions, and designing future interventions. [ABSTRACT FROM AUTHOR]

Background: Uncertainty around the risk of COVID-19 to pregnant women and their babies prompted precautionary restrictions on their health and care during the pandemic. Maternity services had to adapt to changing Government guidance. Coupled with the imposition of national lockdowns in England and restrictions on daily activities, women's experiences of pregnancy, childbirth and the postpartum period, and their access to services, changed rapidly. This study was designed to understand women's experiences of pregnancy, labour and childbirth and caring for a baby during this time. Methods: This was an inductive longitudinal qualitative study, using in-depth interviews by telephone with women in Bradford, UK, at three timepoints during their maternity journey (18 women at timepoint one, 13 at timepoint two and 14 at timepoint three). Key topics explored were physical and mental wellbeing, experience of healthcare services, relationships with partners and general impact of the pandemic. Data were analysed using the Framework approach. A longitudinal synthesis identified over-arching themes. Results: Three longitudinal themes captured what was important to women: (1) women feared being alone at critical points in their maternity journey, (2) the pandemic created new norms for maternity services and women's care, and (3) finding ways to navigate the COVID-19 pandemic in pregnancy and with a baby. Conclusions: Modifications to maternity services impacted significantly on women's experiences. The findings have informed national and local decisions about how best to direct resources to reduce the impact of COVID-19 restrictions and the longer-term psychological impact on women during pregnancy and postnatally. [ABSTRACT FROM AUTHOR]

Background: In Australia, maternity care services provide care for pregnant and postpartum women and their newborns. The COVID-19 pandemic forced these services to quickly adapt and develop policies and procedures for dealing with transmission in health care facilities, as well as work under public health measures to counter its spread within the community. Despite well-documented responses and adaptations by healthcare systems, no studies have examined the experiences of maternity service leaders through the pandemic. This study aimed to explore the experiences of maternity service leaders, to understand their perspectives on what happened in health services and what was required of a leader during the COVID-19 pandemic in one Australian state. Methods: A longitudinal qualitative study collected data from 11 maternity care leaders during the pandemic in the state of Victoria. Leaders participated in a series of interviews over the 16-month study period, with a total of 57 interviews conducted. An inductive approach to developing codes allowed for semantic coding of the data, then a thematic analysis was conducted to explore patterned meaning across the dataset. Results: One overarching theme, 'challenges of being a maternity service leader during the pandemic', encompassed participant's experiences. Four sub-themes described the experiences of these leaders: (1) needing to be a rapid decision-maker, (2) needing to adapt and alter services, (3) needing to filter and translate information, and (4) the need to support people. At the beginning of the pandemic, the challenges were most acute with slow guideline development, rapid communications from the government and an urgent need to keep patients and staff safe. Over time, with knowledge and experience, leaders were able to quickly adjust and respond to policy change. Conclusion: Maternity service leaders played an important role in preparing and adapting services in accordance with government directives and guidelines while also developing strategies tailored to their own health service requirements. These experiences will be invaluable in designing high quality and responsive systems for maternity care in future crises. [ABSTRACT FROM AUTHOR]

Background: The mother-infant relationship is complex and dynamic, informing the psychological development of the infant through bonding and attachment. Positive early interactions influence the quality of this relationship. Midwives are well placed to support the developing relationship between the mother and baby, yet there has been limited research exploring the role of the midwife in this context. Aim: To explore interventions that have been provided by the midwife which support the development of the maternal-fetal or mother-infant relationship amongst a low-risk population from pregnancy, and up to six weeks postnatal. The review also sought to understand the types of interventions developed, format and delivery, outcomes measured and if cultural considerations had been incorporated. Methods: A scoping review of the research literature was undertaken using the Joanna Briggs Institute framework. Five online databases were searched for relevant articles published in English from 2000 to 2021. Findings: Sixteen articles met the inclusion criteria. Three themes emerged: (1) viewing the fetus as separate from the mother, (2) focused activities on the maternal-infant relationship and (3) targeted educational interventions. Discussion: Providing focused activities and targeted education during the pre and postnatal periods support the development of the mother-infant relationship. Significantly, there was insufficient research that considered the influence of culture in supporting the mother-infant relationship. Conclusion: Further research is required to develop interventions that include a diverse sample to ensure culturally appropriate activities can be integrated into care during pregnancy and/or the postnatal period provided by midwives. [ABSTRACT FROM AUTHOR]

Background: Midwives and nurses are crucial in breastfeeding support. Few studies have explored appropriate language for nursing education on breastfeeding. We assessed the impact of the language used on breastfeeding attitudes among midwives and nurses. Methods: A quasi-experimental study was conducted online in Japan among 174 midwives and nurses who had work experience in obstetrics or pediatrics. Participants were allocated to three groups to receive different text messages as the intervention (the benefit of breastfeeding for Group 1; the risk of formula feeding for Group 2; the importance of childcare for Group 3 as the comparison). The Japanese version of the Iowa Infant Feeding Attitude Scale (IIFAS-J) was used to assess breastfeeding attitudes before and after reading the texts. Also, participant reactions to the text were assessed by their responses to three statements. ANOVA, the chi-square test, and the t-test were used for outcome assessments. Results: The post-test IIFAS-J score was significantly higher than the pre-test score only for Group 1 (p < 0.01). The percentage of participants who agreed with the content of the text was 70.7% in Group 1 and 48.3% in Group 2. The percentage of participants who reported discomfort with the text was 34.5% in Group 1 and 55.2% in Group 2. No significant difference among groups existed regarding interest in the text. In all three groups, participants who agreed with the text had a higher post-test IIFAS-J score than those who disagreed with the text (6.85 points higher, p < 0.01 in Group 1; 7.19 points higher, p < 0.01 in Group 2; 8.00 points higher, p < 0.02 in Group 3). Discomfort with the text and interest in the text were associated with a significantly higher post-test IIFAS-J score in Group 1 and Group 2 but not in Group 3. Conclusions: "Benefits of breastfeeding" language, which conveys the information in a positive manner, appears to be more appropriate than "risks of infant formula" language for creating a positive attitude toward breastfeeding in nursing education. Trial registration: This study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000023322). Registered 05/08/2016. [ABSTRACT FROM AUTHOR]

Background: Episiotomy is a surgical solution to relieve perineal stress, resulting in an easily repairable incision, in comparison to the risks of serious vaginal trauma during delivery. The midwife typically adopts such a clinical decision, on experience and subjective judgment. However, the association between perineal stress and episiotomy is poorly characterized. Our aim was to identify a threshold value for perineal stress leading to episiotomy, which eventually may be employed as a clinical tool for assessing whether an episiotomy is required or not.Methods: In total, 245 nulliparous women were investigated for perineal stress during non-instrumental vaginal delivery in Ningbo Women & Children's Hospital. During the second stage of labor, a flexible membrane stress sensor was placed between the fetal head and perineal wall above the anal fissure. Once the entire fetal head pressed against the sensor, real-time perineal stress was measured, and the peak value was recorded. Cases were divided into non-episiotomy group (n = 173) and episiotomy group (n = 72). The correlations between perineal stress and episiotomy was assessed through logistic regression with adjustment for maternal age, estimated birthweight, duration of second stage of labor, maternal body mass index, and presence of analgesia. Midwives were blinded to all stress measurement values. The predictive value of perineal stress on performing episiotomy was evaluated, together with the ideal cut-off perineal stress value for performing episiotomy. A ROC analysis was also performed.Results: The episiotomy group had significantly higher levels of perineal stress in comparison to the non-episiotomy group (140.50 ± 16.03 N versus 118.37 ± 19.21 N, p < 0.01). The episiotomy group was linked to significantly higher perineal stress in comparison to the non-episiotomy group (140.50 ± 16.03 VS 118.37 ± 19.21 N, p < 0.01). ROC analysis between perineal stress and episiotomy revealed a high area under the curve (AUC 0.81, 95% CI 0.75-0.86) and a cut-off value for perineal stress of 124.49 N was identified for episiotomy decision.Conclusion: The level of perineal stress was an independent predictor of performing episiotomy in nulliparous women during non-instrumental vaginal delivery. Perineal stress exceeding 124.49 N was identified as the cut-off prompting midwives to perform episiotomy. [ABSTRACT FROM AUTHOR]

Background: The present qualitative study was conducted to explain the experiences of secondary traumatic stress (STS) and its related factors in midwives working in maternity wards. Methods: Data were collected using semi-structured interviews with 11 midwives working in the maternity wards of hospitals in Urmia, Iran, through in-depth interviews with open-ended questions. Data were analyzed using the conventional content analysis approach. Results: The results of data analysis led to the extraction of three themes, seven main categories, and 18 subcategories. The first theme was "STS stimuli," with the two categories of "Discriminatory approach to midwifery" and "The nature of the midwifery profession". The second theme was "Traumatic outcomes", which included the subcategories of "Psychological-emotional trauma", "Physical trauma" and "Social trauma". The third theme was "Risk management", which had the two subcategories of "Reactive approach" and "Proactive approach". Conclusions: The results showed that, in addition to the traumatic nature of events that midwives experience during work as the secondhand victims, factors such as governance-organizational structure, unbalanced distribution of power, and poor supportive laws undermine their professional role and provide conditions conducive to STS. Therefore, avoiding traumatic situations and scientific and skill self-empowerment were the most important strategies adopted by the midwives in this study to prevent risky situations and cope with the consequences of STS. The participation of midwifery stakeholders in policy-making and adopting supportive legislation in redefining the position and role of midwives can play a major role in reducing STS and sustaining their role and position in maternal care. [ABSTRACT FROM AUTHOR]

Background: In low and middle-income countries, nurses and midwives are the frontline healthcare workers in obstetric care. Insights into experiences of these healthcare workers in managing obstetric emergencies are critical for improving the quality of care. This article presents such insights, from the nurses and midwives working in Rwandan district hospitals, who reflected on their experiences of managing the most common birth-related complications; postpartum hemorrhage (PPH) and newborn asphyxia. Rwanda has made remarkable progress in obstetric care. However, challenges remain in the provision of high-quality basic emergency obstetric and newborn care (BEmONC). This study is a qualitative part of a broader research project about implementation of an mLearning and mHealth decision support tool in BEmONC services in Rwanda. Methods: In this exploratory qualitative aspect of the research, four focus group discussions (FGDs) with 26 nurses and midwives from two district hospitals in Rwanda were conducted. Each FGD was made up of two parts. The first part focused on the participants' reflections on the research results (from the previous study), while the second part explored their experiences of delivering obstetric care services. The research results included: survey results reflecting their knowledge and skills of PPH management and of neonatal resuscitation (NR); and findings from a six-month record review of PPH management and NR outcomes, from the district hospitals under study. Data were analyzed using hybrid thematic analysis. Results: The analysis revealed three main themes: (1) reflections to the baseline research results, (2) self-reflection on the current practices, and (3) contextual factors influencing the delivery of BEmONC services. Nurses and midwives felt that the presented findings were a true reflection of the reality and offered diverse explanations for the results. The participants' narratives of lived experiences of providing BEmONC services are also presented. Conclusion: The insights of nurses and midwives regarding the management of birth-related complications revealed multi-faceted factors that influence the quality of their obstetric care. Even though the study was focused on PPH management and NR, the resulting recommendations to improve quality of care could benefit the broader field of maternal and child health, particularly in low and middle-income countries. [ABSTRACT FROM AUTHOR]

In the spring of 2020, the SARS-CoV-2 virus caused the Covid-19 pandemic, bringing with it drastic changes and challenges for health systems and medical staff. Among the affected were obstetricians and midwives, whose close physical contact with pregnant women, women who recently gave birth, and their children was indispensable. In the obstetric setting, births cannot be postponed, and maternity staff had to adapt to assure obstetric safety while balancing evidence-based standards with the new challenges posed by the pandemic. This scoping review gives a comprehensive overview of the effecs the Covid-19 pandemic had on maternity staff. We followed the evidence-based approach described by Arksey & O'Malley: we searched several databases for English and German articles published between January 2020 and January 2021 that discussed or touched upon the effects the pandemic had on maternity staff in OECD countries and China. We found that structural challenges caused by the crisis and its subjective effects on maternity staff fell into two main topic areas. Structural challenges (the first main topic) were divided into five subtopics: staff shortages and restructuring; personal protective equipment and tests; switching to virtual communication; handling women with a positive SARS-CoV-2 infection; and excluding accompanying persons. The pandemic also strongly affected the staff's mental health (the second main topic.) Attempting to meet challenges posed by the pandemic while afraid of contamination, suffering overwork and exhaustion, and struggling to resolve ethical-moral dilemmas had severe negative subjective effects. Several studies indicated increased depression, anxiety, stress levels, and risk of post-traumatic stress symptoms, although the crisis also generated strong occupational solidarity. Care for pregnant, birthing, and breast-feeding women cannot be interrupted, even during a pandemic crisis that requires social distancing. Maternity staff sometimes had to abandon normal standards of obstetric care and were confronted with enormous challenges and structural adjustments that did not leave them unscathed: their mental health suffered considerably. Researchers should study maternity staff's experiences during the pandemic to prepare recommendations that will protect staff during future epidemics. [ABSTRACT FROM AUTHOR]

Background: Midwives are well placed to promote vaccination awareness throughout a women's pregnancy and strengthen childhood vaccination demand following hospital discharge. In Perth, Western Australia, Aboriginal children experience some of the lowest vaccination coverage rates across the nation. To identify factors preventing greater vaccination uptake amongst the target population, a theory-based study was conducted with midwives across two Perth maternity hospitals to explore behavioural attributes, knowledge, attitudes and beliefs surrounding vaccination provision and the vaccines administered to Aboriginal children.Methods: A purpose-designed questionnaire was distributed to midwives working in two Perth public maternity hospitals. The proximal constructs of The Theory of Planned Behavior were used to frame the questionnaire to enable the barriers to greater vaccination coverage to be identified and behaviourally situated. Descriptive statistics described the demographics of the study sample. Chi-square and the Fisher's exact test were used to identify associations between midwife characteristics and awareness of the coverage rates. Significance was set at α = 0.05.Results: Of the 58 midwives who completed the study questionnaire, 77.2% were unaware of the sub-optimal vaccination coverage in Perth's Aboriginal children. Level of education (p = 0.53) and years worked as a practising midwife (p = 0.47) were not found to be associated with an awareness of the coverage rates. Approximately, 50% of midwives reported some concern over the efficacy of childhood vaccines, 44.4% did not feel confident with their knowledge of vaccines, while 33.3% do not routinely discuss childhood vaccinations with parents prior to hospital discharge.Conclusions: Key findings in the study identified that a range of educational, leadership and system-based issues are affecting midwives' capacity to play a more substantial role in influencing vaccination coverage in Perth's Aboriginal children. [ABSTRACT FROM AUTHOR]

Background: Mentoring is a recognized, but still underutilized strategy for effective clinical training of midwifery students. The success of formally recognized course-embedded mentoring depends on adequate preparation of clinical teacher to act as mentors and effective developing of their mentoring skills. The aim of this study was to evaluate a Mentor Training Program for midwives, the first of its kind in Poland. Methods: Twenty-one midwives who completed a dedicated Mentor Training Program organized by the Medical University of Warsaw (12–14 June 2017) participated in this study. In Stage 1, 7 days prior to the training course, the participants completed an online questionnaire that identified their motivations and expectations. In Stage 2, they assessed the training program they had completed as well as described any perceived needs of further mentor training. Subsequently a qualitative study of the data was performed using content analysis. Results: In Stage 1, the participants expressed their interest in the Mentor Training Program mostly expecting to develop skills allowing them to implement mentoring in clinical training of student midwives. They were aware of the potential benefits of mentoring for hands-on instruction on the wards and wanted to gain knowledge of this strategy. In Stage 2, the overall satisfaction with the program was high, but the participants assessed their preparedness to act as midwifery mentors as inadequate. The results suggest that the Mentor Training Program should be further refined and expanded while the outcomes need to be evaluated in more detail by both new mentors and their trainers over a longer period of time, possibly after the participants have gained actual experience of mentoring in the clinical setting. Conclusion: The participants described the Mentor Training Program as innovative, valuable and largely meeting their expectations. They gained knowledge of the concept of mentoring and its potential application in clinical training of midwifery students in Poland. Future mentor training programs should be expanded with a greater focus on developing, strengthening and applying mentoring skills in the clinical setting. [ABSTRACT FROM AUTHOR]

Background: The information on birth plan (BP) usage in Spanish hospitals is scant.Aim: To identify the percentage of pregnant women presenting a BP at five hospitals in Spain, the reasons why some women failed to do so and how BP presentation relates to obstetric outcomes and selected pain relief methods.Methods: In this descriptive, multi-centre study, data were retrospectively collected. During the postpartum visits at primary healthcare centres in various health districts in Barcelona (Catalonia, Spain), a data collection sheet about obstetric outcomes and analgesia was administered to 432 mothers who had completed a BP during their pregnancies. The main outcome was the rate of BP presentation to the hospital. The sociodemographic and obstetric characteristics and pain relief measures were compared to identify any differences between mothers who presented a BP and those who did not.Results: A total of 422 (99.7%) women were studied; 51.2% of women (95% confidence interval (CI): 46.4-55.9) had presented a BP. The main reason for not presenting a BP was because the hospital midwives did not request them (61.2%). No differences were observed in BP presentation according to age, the country of origin, education, employment or hospital. Mothers who presented a BP were more likely to start breastfeeding in the birthing room (82.4% vs. 73.3%; p = 0.024). Epidural analgesia was the most common method used for pain relief (88.9%), and women who presented a BP attempted to use concomitant non-pharmacological methods more often (50.5% vs. 38.8%; p = 0.012).Conclusion: Almost half of the mothers failed to present a BP, usually because midwives did not request it. [ABSTRACT FROM AUTHOR]

Background: Enhanced parenting self-efficacy (PSE) contributes to positive parenting and future parental-child health. First-time parents, in particular, are in need of support since the pregnancy until post-delivery to strengthen their early PSE. However, there is a lack of effective and sustainable relevant programmes in the community. The Community-enabled Readiness for first 1000 Days Learning Ecosystem (CRADLE) aims to develop a self-learning eco-community throughout the pregnancy and early childhood to promote PSE among first-time parents. We apply choice architecture strategy using behavioural nudges and midwife-led continuity care during the first 1000 days, and test their effects on PSE and mother-child health for first-time families in Singapore.Methods: This three-arm randomised controlled trial will recruit up to 750 pregnant women from the KK Women's and Children's Hospital, Singapore. Participants will be randomly assigned to receive: (1) standard routine care; (2) behavioural nudges (text messages) along with the use of a social media platform; or (3) midwife-led continuity care involving individualised teleconferencing sessions, during pregnancy and post-delivery. Using web-based questionnaires, participants will be assessed for baseline socio-demography and health status in the first visit, with follow-up assessments in the third trimester, at birth, 6-week (primary end-point), 6-, 12-, 18- and 24-month post-delivery. The primary outcome is PSE. Secondary outcomes include health and birth experience, mental wellness, feeding practice, maternal and child nutritional status. Intention-to-treat and per-protocol analyses will be performed using general linear models to test the effects of interventions across three arms. Recruitment has begun in June 2020 and is estimated to complete in September 2022.Discussion: This study may identify a sustainable effective strategy in the community by helping first-time parents to have a positive experience during the pregnancy, childbirth and parenthood, leading to an enhanced PSE and health outcomes for both mother and child. Findings from this study will provide insight into the implementation of early parenting and mother-child care programmes.Trial Registration: ClinicalTrials.gov NCT04275765 . Registered on 19 February 2020. [ABSTRACT FROM AUTHOR]

Background: Low risk pregnancy ending in a vaginal birth is best served and guided by a midwife. Utilizing a midwife in such cases offers many emotional and economic advantages and does not increase the risks for mother or neonate. However, women's experience and satisfaction of midwife-led maternity care is rarely reported in China. The primary objective of this study is to describe the experience of Chinese women receiving midwife-led maternity care, and to report their satisfaction level of the experience.Methods: The study is a cross-sectional survey of 4192 women who had natural birth from March-June 2019 in a maternity care center, Shanghai, China. We used a self-administered questionnaire addressing items related to women's experience during childbirth, as well as their satisfaction with midwife-led maternity care. We also included demographic and perinatal characteristics of each participant. Descriptive statistics and correlations analysis between groups of different experience and satisfaction were used.Results: In this sample, 87.7% of women had a Doula and a family member present during childbirth. Epidural anesthesia was used in 75.6% and episiotomy was needed in 23.2%. Free positioning during the first stage of labor and free positioning during the second stage of labor and delivery were adopted in 84.3 and 67.9% of the cases, respectively. Moderate to severe perineal pain and moderate to severe perineal edema were reported in 43.1 and 12.2% of the participants, respectively. High satisfaction level was found when there was midwife-led prenatal counseling and presence of Doula and family member, Lamaze breathing techniques, warm perineal compresses, epidural anesthesia, free positioning during the first stage of labor, and midwifes' postpartum guidance. Negative satisfaction was seen with perineal pain and edema.Conclusion: Women in this survey generally had high satisfaction with midwife-led maternity care. This satisfaction is probably felt because of the prenatal counseling by the midwife and allowing a Doula and a family member in the room during childbirth. Other intangible factors to improve the satisfaction level were Lamaze breathing techniques, warm perineal compresses, epidural anesthesia, free positioning during first stage of labor, and early skin to skin contact. [ABSTRACT FROM AUTHOR]

Background: Childbirth remains a uniquely multifaceted, mental-cognitive and a major life experience to women. It is composed of a variety of psycho social and emotional aspects and creates memories, sometimes bad experiences and unmet expectations which leaves the mother with lasting scars. Therefore, this study aimed at exploring post-caesarean section delivered mothers experiences of midwifery care in a public hospital in Ghana.Methods: This descriptive exploratory qualitative research used an interpretative approach to explore mothers' experiences of midwifery care immediately before and after caesarean section (CS). The study employed a purposive sampling technique in recruiting 22 participants who had knowledge of the phenomenon under study. Data collection was guided by an interview guide, which involved face to face individual interviews and focus group discussion at the postnatal ward and clinic. All interviews were audio-recorded and lasted 30-40 min. Audio recordings were transcribed verbatim and inductive thematic data analysis employed.Results: Four major themes emerged from the analysis of participants' transcripts: Support by Midwives (physical and psychological, and attitude towards patients' pain management); Protection of mothers (provision of privacy, confidentiality and physical environment); Provision of information/communication (before caesarean section, and before a minor task) and midwives' attitude (attitude towards delivery care).Conclusion: Mothers delivered by caesarean section had varied experiences of midwifery care which were both positive and negative ones. Provision of psychological support and adequate pain management were positive experiences. The challenges experienced were related to provision of information, privacy, and physical support. Participants, who underwent emergency CS in particular, were dissatisfied with the provision of information concerning the surgical procedure. Provision of privacy and physical support were also issues of great concern. We therefore, recommend supportive and sensitive midwifery care particularly for mothers undergoing emergency CS. Documenting women's diverse experiences of midwifery care before and after CS delivery is important to healthcare providers, hospital managers and policy makers as the feedback garnered can be used to improve maternity services and inform decisions on midwifery care. [ABSTRACT FROM AUTHOR]

Background: Antenatal care (ANC) provides healthcare services to pregnant women in an attempt to ensure, the best possible pregnancy outcome for women and their babies. Healthcare providers' understanding of their patient's behaviour and reasons for engagement in care and their response to this insight can influence patient-provider interactions and patient demand for ANC early in pregnancy. We examined the insight of healthcare providers into women's reasons for starting ANC later than the South African National Department of Health's recommended 20 weeks gestation. We also looked at the impact of late ANC presentation on overall healthcare providers' work experiences and their response in their interactions with patients.Methods: In-depth interviews were conducted with 10 healthcare providers at Maternal Obstetrics Units (MOU) and Primary Healthcare Centres (PHC) in Gauteng, South Africa. Healthcare providers were selected with the assistance of the facility managers. Data analysis was conducted using the qualitative analysis software NVivo 11, using a thematic approach of pinpointing, examining, and recording patterns within the data.Results: Healthcare providers were aware of patients need for secrecy in the early stages of pregnancy because of fears of miscarriage and women's preference for traditional care. Women with prior pregnancies presumed to know about stages of pregnancy and neglected to initiate ANC early. Barriers to early ANC initiation also include, women's need to balance income generating activities; travel cost to the clinic and refusal of care for coming after the daily patient limit has been reached. Healthcare providers encounter negative attitudes from un-booked patients. This has a reciprocal effect whereby this experience impacts on whether healthcare providers will react with empathy or frustration.Conclusions: Timing of ANC is influenced by the complex decisions women make during pregnancy, starting from accepting the pregnancy itself to acknowledging the need for ANC. To positively influence this decision making for the benefit of early ANC, barriers such as lack of knowledge should be addressed prior to pregnancy through awareness programmes. The relationship between healthcare providers and women should be emphasized when training healthcare providers and considered as an important factor that can affect the timing of ANC. [ABSTRACT FROM AUTHOR]

Background: In New South Wales (NSW) Australia, women at low risk of complications can choose from three birth settings: home, birth centre and hospital. Between 2000 and 2012, around 6.4% of pregnant women planned to give birth in a birth centre (6%) or at home (0.4%) and 93.6% of women planned to birth in a hospital. A proportion of the woman in the home and birth centre groups transferred to hospital. However, their pathways or trajectories are largely unknown.Aim: The aim was to map the trajectories and interventions experienced by women and their babies from births planned at home, in a birth centre or in a hospital over a 13-year period in NSW.Methods: Using population-based linked datasets from NSW, women at low risk of complications, with singleton pregnancies, gestation 37-41 completed weeks and spontaneous onset of labour were included. We used a decision tree framework to depict the trajectories of these women and estimate the probabilities of the following: giving birth in their planned setting; being transferred; requiring interventions and neonatal admission to higher level hospital care. The trajectories were analysed by parity.Results: Over a 13-year period, 23% of nulliparous and 0.8% of multiparous women planning a home birth were transferred to hospital. In the birth centre group, 34% of nulliparae and 12% of multiparas were transferred to a hospital. Normal vaginal birth rates were higher in multiparous women compared to nulliparous women in all settings. Neonatal admission to SCN/NICU was highest in the planned hospital group for nulliparous women (10.1%), 7.1% for nulliparous women planning a birth centre birth and 5.1% of nulliparous women planning a homebirth. Multiparas had lower admissions to SCN/NICU for all thee settings (hospital 6.3%, BC 3.6%, home 1.6%, respectively).Conclusions: Women who plan to give birth at home or in a birth centre have high rates of vaginal birth, even when transferred to hospital. Evidence on the trajectories of women who choose to give birth at home or in birth centres will assist the planning, costing and expansion of models of care in NSW. [ABSTRACT FROM AUTHOR]

Background: Health professionals may advise women to either stop breastfeeding or drug treatment due to restrictive advice in drug monographs. Regional medicines information and pharmacovigilance centres in Norway (RELIS) provide free and industry-independent answers to questions about drugs and breastfeeding documented in a full-text, searchable database (RELIS database). We used the RELIS database to describe which health care practitioners sought information about medication safety in lactation, most common drugs involved, advice provided and which resources were used to provide the advice. Methods: A random selection of 100 question-answer pairs (QAPs) from the RELIS database indexed with "BREASTFEEDING" in the period from January 2011 to December 2015 was analysed. Inclusion criteria were queries from health professionals about drugs. Questions about herbal supplements and other exposures not classified as drugs were excluded. The QAPs were manually analysed for compatibility of one or several drugs with breastfeeding, health care profession and workplace of enquirer in addition to advice and search strategy used. Results: In the 100 QAPs there were enquires about 152 drugs. Seventy-four questions concerned a single drug, but the number of drugs evaluated varied between 1 and 16. Fifty-nine questions were from physicians, 34 from nurses or midwives, two from pharmacists and two from other health professionals. Questions from physicians contained 93 drug evaluations (61%), nurses or midwives 47 (31%) and pharmacists seven (5%). The most frequent categories of drugs were antidepressants, antiepileptics and immunosuppressants. The most asked about drugs were lamotrigine, codeine, quetiapine and escitalopram. Fifty-nine percent of the drugs were deemed safe while breastfeeding, 16% if precautions were taken and 12% not recommended. Thirty-nine percent of the drug evaluations used an advanced literature search strategy, and this was significantly (p < 0.05) more likely when the enquirer was a physician. Conclusions: This analysis of questions to Norwegian medicines information centres about medicine use in breastfeeding indicates the need for communication about safety of drugs affecting the nervous system, primarily to medical doctors and midwives. In the majority of cases the medicine information centre can reassure about the safety of breastfeeding while taking a drug. [ABSTRACT FROM AUTHOR]

Background: Although midwives make clinical decisions that have an impact on the health and well-being of mothers and babies, little is known about how they make those decisions. Wide variation in intrapartum decisions to refer women to obstetrician-led care suggests that midwives' decisions are based on more than the evidence based medicine (EBM) model - i.e. clinical evidence, midwife's expertise, and woman's values - alone. With this study we aimed to explore the factors that influence clinical decision-making of midwives who work independently.Methods: We used a qualitative approach, conducting in-depth interviews with a purposive sample of 11 Dutch primary care midwives. Data collection took place between May and September 2015. The interviews were semi-structured, using written vignettes to solicit midwives' clinical decision-making processes (Think Aloud method). We performed thematic analysis on the transcripts.Results: We identified five themes that influenced clinical decision-making: the pregnant woman as a whole person, sources of knowledge, the midwife as a whole person, the collaboration between maternity care professionals, and the organisation of care. Regarding the midwife, her decisions were shaped not only by her experience, intuition, and personal circumstances, but also by her attitudes about physiology, woman-centredness, shared decision-making, and collaboration with other professionals. The nature of the local collaboration between maternity care professionals and locally-developed protocols dominated midwives' clinical decision-making. When midwives and obstetricians had different philosophies of care and different practice styles, their collaborative efforts were challenged.Conclusion: Midwives' clinical decision-making is a more varied and complex process than the EBM framework suggests. If midwives are to succeed in their role as promoters and protectors of physiological pregnancy and birth, they need to understand how clinical decisions in a multidisciplinary context are actually made. [ABSTRACT FROM AUTHOR]

Background: Clinical fetal weight estimation is a common practice in obstetrics. This study aims to evaluate the accuracy of fetal weight estimation by midwives, and to identify factors that may lead to overestimation or underestimation of fetal weight.Methods: A cohort prospective study in a Lebanese university hospital, included weight estimation of singleton pregnancies above 35 weeks. Multiple pregnancies, unclear dating, growth retardation, malformations and stillbirths cases are excluded. The estimated fetal weight is recorded by midwives in a sealed envelope and compared to true weight later. The effects of BMI, weight gain, parity, diabetes, hypertension, neonate's sex and weight, uterine contractions, rupture of membranes and daytime or nighttime shift on these estimations were assessed.Results: One hundred and sixty-six patients were included. Mean birth weight was 3246 ± 362 g. Mean absolute percentage error of weight estimation was 8.5 ± 6.7% (0-30.9%). Estimation was within the correct range of ±10% in 63% of cases. Maternal and fetal factors did not significantly change weight estimation. Fetuses with birth weights more than 4000 tended to be underestimated by midwives. Estimation improved over time (nonsignificant).Conclusions: Maternal and fetal factors, except for macrosomia, have limited impact on estimation of fetal birth weight. Macrosomia is challenging because of a consistent tendency of underestimation by midwives. [ABSTRACT FROM AUTHOR]

Background: The health and wellbeing of midwives are important considerations for workforce retention and quality care. The occurrence and relationships among mental health conditions such as burnout and depression have received little attention. We investigated the prevalence of burnout, depression, anxiety and stress in Australian midwives.Methods: An online survey was conducted in September 2014. Participants were recruited through the Australian College of Midwives and professional networks. The survey sought personal and professional details. Standard measures included the Copenhagen Burnout Inventory (CBI) (Personal, Work and Client subscales), and Depression, Anxiety, and Stress Scale (DASS). The sample was collapsed into two groups according to DASS clinical cut-offs (normal/mild versus moderate/severe/extreme). Effect size statistics were calculated and judged according to Cohen's guidelines.Results: One thousand thirty-seven surveys were received. Respondents were predominantly female (98%), with an average age of 46.43 years, and 16.51 years of practice. Using a CBI subscale cut-off score of 50 and above (moderate and higher), 64.9% (n = 643) reported personal burnout; 43.8% (n = 428) reported work-related burnout; and 10.4% (n = 102) reported client-related burnout. All burnout subscales were significantly correlated with depression, anxiety and stress, particularly personal and work-related burnout with Spearman's rho correlations ranging from .51 to .63 (p < .001). Around 20% of midwives reported moderate/ severe/ extreme levels of depression (17.3%); anxiety (20.4%), and stress (22.1%) symptoms. Mann-Whitney U tests revealed significant differences between groups with depression (r = .43), anxiety (r = .41) and stress (r = 48) having a medium size effect on burnout.Conclusion: Prevalence of personal and work-related burnout in Australian midwives was high. The physical and psychological exhaustion associated with the different types of burnout were reflected in symptoms of depression, anxiety and stress symptoms. Further research is needed to support the personal well-being of midwives and minimize workplace burnout by developing short and long term strategies. [ABSTRACT FROM AUTHOR]

Background: Adolescent mothers are at a much higher risk for maternal mortality compared to mothers aged 20 years and above. Newborns born to adolescent mothers are also more likely to have low birth weight, with the risk of long-term effects such as early onset of adult diabetes than newborns of older mothers. Few studies have investigated the determinants of adequate quality maternal and child healthcare services to pregnant adolescents. This study was conducted to gain an understanding of nurses' and midwives' intentions to provide maternal and child healthcare and family planning services to adolescents in South Africa. Methods: A total of 190 nurses and midwives completed a cross-sectional survey. The survey included components on demographics, knowledge of maternal and child healthcare (MCH) and family planning (FP) services, attitude towards family planning services, subjective norms regarding maternal and child healthcare and family planning services, self-efficacy with maternal and child healthcare and family planning services, and intentions to provide maternal and child healthcare and family planning services to adolescents. Pearson's correlation analysis was conducted to determine the association between knowledge, attitude, subjective norms, self-efficacy, and intention variables for FP and MCH services. A 2-step linear regression analysis was then conducted for both FP and MCH services to predict the intentions to provide FP and MCH services to adolescents. Results: Self-efficacy to conduct MCH services (β = 0.55, p < 0.01) and years of experience as a nurse- midwife (β = 0.14, p < 0.05) were associated with stronger intentions to provide the services. Self-efficacy to provide FP services (β = 0.30, p < 0.01) was associated with stronger intentions to provide FP services. Conclusions: Self-efficacy has a strong and positive association with the intentions to provide both MCH and FP services, while there is a moderate association with attitude and norms. There is a need to improve and strengthen nurses' and midwives' self-efficacy in conducting both MCH and FP services in order to improve the quality and utilization of the services by adolescents in South Africa. [ABSTRACT FROM AUTHOR]

Background: The participation of nurses and midwives in vaginal birth care is limited in Brazil, and there are no national data regarding their involvement. The goal was to describe the participation of nurses and nurse-midwives in childbirth care in Brazil in the years 2011 and 2012, and to analyze the association between hospitals with nurses and nurse-midwives in labor and birth care and the use of good practices, and their influence in the reduction of unnecessary interventions, including cesarean sections. Methods: Birth in Brazil is a national, population-based study consisting of 23,894 postpartum women, carried out in the period between February 2011 and October 2012, in 266 healthcare settings. The study included all vaginal births involving physicians or nurses/nurse-midwives. A logistic regression model was used to examine the association between the implementation of good practices and suitable interventions during labor and birth, and whether care was a physician or a nurse/nurse-midwife led care. We developed another model to assess the association between the use of obstetric interventions during labor and birth to the personnel responsible for the care of the patient, comparing hospitals with decisions revolving exclusively around a physician to those that also included nurses/nurse-midwives as responsible for vaginal births. Results: 16.2 % of vaginal births were assisted by a nurse/nurse-midwife. Good practices were significantly more frequent in those births assisted by nurses/nurse-midwives (ad lib. diet, mobility during labor, non-pharmacological means of pain relief, and use of a partograph), while some interventions were less frequently used (anesthesia, lithotomy position, uterine fundal pressure and episiotomy). In maternity wards that included a nurse/nurse-midwife in labour and birth care, the incidence of cesarean section was lower. Conclusions: The results of this study illustrate the potential benefit of collaborative work between physicians and nurses/nurse-midwives in labor and birth care. The adoption of good practices in managing labor and birth could be the first step toward more effective obstetric and midwifery care in Brazil. It may be easier to introduce new approaches rather than to eliminate old ones, which may explain why the reduction of unnecessary interventions during labor and birth was less pronounced than the adoption of new practices [ABSTRACT FROM AUTHOR]

Background: The aim of this Western Australian study was to describe the overall labour and birth experience of women who were transferred during the first and second stages of labour from a low risk woman-centred, midwifery-led birth centre to a co-located tertiary maternity referral hospital.Methods: Using a descriptive phenomenological design, fifteen women were interviewed up to 8 weeks post birth (July to October, 2013) to explore their experience of the intrapartum transfer. Giorgi's method of analysis was used.Results: The following themes and subthemes emerged: 1) The midwife's voice with subthemes, a) The calming effect and b) Speaking up on my behalf; 2) In the zone with subthemes, a) Hanging in there and b) Post birth rationalizing; 3) Best of both worlds with subthemes a) The feeling of relief on transfer to tertiary birth suite and b) Returning back to the comfort and familiarity of the birth centre; 4) Lost sense of self; and 5) Lost birth dream with subthemes a) Narrowing of options and b) Feeling of panic. Women found the midwife's voice guided them through the transfer experience and were appreciative of continuity of care. There was a sense of disruption to expectations and disappointment in not achieving the labour and birth they had anticipated. There was however appreciation that the referral facility was nearby and experts were close at hand. The focus of care altered from woman to fetus, making women feel diminished. Women were glad to return to the familiar birth centre after the birth with the opportunity to talk through and fully understand their labour journey which helped them contextualise the transfer as one part of the whole experience.Conclusions: Findings can inform midwives of the value of a continuity of care model within a birth centre, allowing women both familiarity and peace of mind. Maternity care providers should ensure that the woman remains the focus of care after transfer and understand the significance of effective communication to ensure women are included in all care discussions. [ABSTRACT FROM AUTHOR]

Background: Approaches to addressing the shortage of midwives are a great need especially in Sub-Saharan Africa including Tanzania. The midwifery shortage in Tanzania consists of two major causes; the first is the shortage of pre-service nursing training and the second is the low rate of retention as it is difficult to sustain midwives' career motivations. Lack of opportunities for career development, is one of the most related problems to keep midwives motivated. Continuing education as an approach to career development can heighten midwives' motivation and cultivate more skilled midwives who can educate other midwives or students and who could raise the status of midwives. Effective continuing education is ongoing, interactive, contextually relevant and based on needs assessment, however there is very limited research that describes Tanzanian midwives perspective of expectations for career development; hence this research is significant for revealing important and meaningful professional desires of midwives in Tanzania. Methods: This was a preliminary qualitative study, using snowball sampling to recruit 16 midwives in Tanzania. The researchers used a semi-structured interview including probing questions with both a focus group and several individuals. The data were collected from July to December 2013 and coded into categories and sub-categories. Results: There were 14 midwives in the focus group interview and two midwives in the individual interviews. Through data analysis, four major categories (with subcategories) emerged: (1) motivation for learning (to achieve the MDGs, and to raise reproductive health), (2) knowledge is power (to provide good practice based on knowledge, to be a role model, knowledge gives higher position and courage, and knowledge enables one to approach to the government), (3) there is no end to learning (hunger for learning, and ripple effect). Conclusions: From findings, four major categories plainly showed midwives' desire for learning, however they experienced a number of barriers to access further education. Continuing education is one of the most important and effective ways to cultivate and retain midwives. In order to respond to the midwives expectations and challenges to overcome the barriers inherent in providing more continuing education, it will be necessary to increase accessible opportunities for career development in Tanzania. [ABSTRACT FROM AUTHOR]

Background: Maternal smoking is a key cause of poor outcomes for mothers, babies and children and Wales has higher rates of smoking in pregnancy than any other UK country. Despite various improvements within the NHS Stop Smoking Service to strengthen the intervention for pregnant women, referrals and successful quit attempts for this group have continued to remain extremely low. A key element of UK national guidance for smoking cessation during pregnancy is to provide a flexible and tailored service to help increase levels of engagement. This study aims to test the effectiveness of three different models of service delivery to address the gap in the evidence base about how to deliver a flexible, tailored smoking cessation service to pregnant women. Methods: This study will adopt a quasi-experimental design over a 12 month period. The setting is four of Wales’ seven Health Boards using an integrated approach between maternity services, local public health teams and the NHS Stop Smoking Service. Core recommendations from UK public health guidance are being implemented across intervention and usual care sites. Stop smoking support for pregnant women in intervention sites is being delivered more flexibly than in usual care sites. Both qualitative and quantitative approaches will be adopted to capture important contextual information and consider multiple perspectives. A health economic analysis will be undertaken using a cost-consequences analysis approach. The primary outcome measure is engagement with stop smoking services (defined as having at least one face-to-face therapeutic contact with a clinician). Discussion: Supporting pregnant women to stop smoking is a challenging area of public health. The proposed study will address several areas where there are key evidence gaps relating to smoking cessation interventions for pregnant women. Specifically, how best to encourage pregnant women to attend a specialist stop smoking support service, how to deliver the service and who should provide it. [ABSTRACT FROM AUTHOR]

Background: The continuous rise in caesarean rates across most European countries raises multiple concerns. One factor in this development might be the type of care women receive during childbirth. 'Supportive care during labour' by midwives could be an important factor for reducing fear, tension and pain and decreasing caesarean rates. The presence and availability of midwives to support a woman in line with her needs are central aspects for 'supportive care during labour'. To date, there is no existing research on the influence of effective 'supportive care' by German midwives on the mode of birth. This study examines the association between the attendance and workload of midwives with the mode of birth outcomes in a population of low-risk women in a German multicentre sample. Methods: The data are based on a prospective controlled multicentre trial (n = 1,238) in which the intervention 'midwife-led care' was introduced. Four German hospitals participated between 2007 and 2009. Secondary analyses included a convenience sample of 999 low-risk women from the primary analyses who met the selection criterion 'low-risk status'. Participation was voluntary. The association between the mode of birth and the key variables 'attendance of midwives' and 'workload of midwives' was assessed using backward logistic regression models. Results: The overall rate of spontaneous delivery was 80.7% (n = 763). The 'attendance of midwives' and the 'workload of midwives' did not exhibit a significant association with the mode of birth. However, women who were not satisfied with the presence of midwives (OR: 2.45, 95% CI 1.54-3.95) or who did not receive supportive procedures by midwives (OR: 3.01, 95% CI 1.50-6.05) were significantly more likely to experience operative delivery or a caesarean. Further explanatory variables include the type of hospital, participation in childbirth preparation class, length of stay from admission to birth, oxytocin usage and parity. Conclusion: Satisfaction with the presence of and supportive procedures by midwives are associated with the mode of birth. The presence and behaviour of midwives should suit the woman's expectations and fulfil her needs. For reasons of causality, we would recommend experimental or quasi-experimental research that would exceed the explorative character of this study. [ABSTRACT FROM AUTHOR]

Background: In industrialized countries, improvements have been made in both maternal and newborn health. While attention to antenatal care is increasing, excessive medicalization is also becoming more common. The aim of this study is to compare caesarean section (CS) frequency and ultrasound scan utilization in a public model of care involving both midwives and obstetricians with a private model in which care is provided by obstetricians only. Methods: Design: Observational population-based study. Setting: Reggio Emilia Province. Population: 5957 women resident in the province who delivered between October 2010 and November 2011. Main outcome measures: CS frequency and ultrasound scan utilization, stillbirths, and other negative perinatal outcomes. Women in the study were searched in the public family and reproductive health clinic medical records to identify those cared for in the public system. Outcomes of the two antenatal care models were compared through multivariate logistic regression adjusting for maternal characteristics and, for CS only, by stratifying by Robson's Group. Results: Compared to women cared for in private services (N = 3,043), those in public service (N = 2,369) were younger, less educated, more frequently non-Italian, and multiparous. The probability of CS was slightly higher for women cared for by private obstetricians than for those cared for in the public system (31.8% vs. 27.1%; adjusted odds ratio: 1.10; 95% CI: 0.93-1.29): The probability of having more than 3 ultrasound scans was higher in private care (89.6% vs. 49.8%; adjusted odds ratio: 5.11; 95% CI: 4.30-6.08). CS frequency was higher in private care for all Robson's classes except women who underwent CS during spontaneous labour. Among negative perinatal outcomes only a higher risk of pre-term birth was observed for pregnancies cared for in private services. Conclusions: The public model provides less medicalized and more guidelines-oriented care than does the private model, with no increase in negative perinatal outcomes. [ABSTRACT FROM AUTHOR]

Background: Continuous support in labour has a significant impact on a range of clinical outcomes, though whether the quality and quantity of support behaviours affects the strength of this impact has not yet been established. To identify the quality and quantity of support, a reliable means of measurement is needed. To this end, a new computerised systematic observation tool, the 'SMILI' (Supportive Midwifery in Labour Instrument) was developed.The aim of the study was to test the validity and usability of the 'Supportive Midwifery in Labour Instrument' (SMILI) and to test the feasibility and acceptability of the systematic observation approach in the clinical intrapartum setting.Methods: Systematic observation was combined with a postnatal questionnaire and the collection of data about clinical processes and outcomes for each observed labour.The setting for the study was four National Health Service maternity units in Scotland, UK. Participants in this study were forty five midwives and forty four women.The SMILI was used by trained midwife observers to record labour care provided by midwives. Observations were undertaken for an average of two hours and seventeen minutes during the active first stage of labour and, in 18 cases, the observation included the second stage of labour. Content validity of the instrument was tested by the observers, noting the extent to which the SMILI facilitated the recording of all key aspects of labour care and interactions. Construct validity was tested through exploration of correlations between the data recorded and women's feelings about the support they received. Feasibility and usability data were recorded following each observation by the observer. Internal reliability and construct validity were tested through statistical analysis of the data.Results: One hundred and four hours of labour care were observed and recorded using the SMILI during forty nine labour episodes.Conclusion: The SMILI was found to be a valid and reliable instrument in the intrapartum setting in which it was tested. The study identified that the SMILI could be used to test correlations between the quantity and quality of support and outcomes. The systematic observational approach was found to be an acceptable and feasible method of enquiry. [ABSTRACT FROM AUTHOR]

Background: The use of complementary and alternative medicine (CAM) and complementary and alternative therapies (CAT) during pregnancy is increasing. Scientific evidence for CAM and CAT in the field of obstetrics mainly covers pain relief in labor. Midwives are responsible for labor and delivery care: hence, their knowledge of CAM and CAT is important. The aims of this study are to describe the professional profile of midwives who provide care for natural childbirth in Catalan hospitals accredited as centers for normal birth, to assess midwives' level of training in CAT and their use of these therapies, and to identify specific resources for CAT in labor wards. Methods: A descriptive, cross-sectional, quantitative method was used to assess the level of training and use of CAT by midwives working at 28 hospitals in Catalonia, Spain, accredited as public normal birth centers. Results: Just under a third of midwives (30.4%) trained in CAT after completion of basic training. They trained in an average of 5.97 therapies (SD 3.56). The number of CAT in which the midwives were trained correlated negatively with age (r = - 0.284; p < 0.001) and with their time working at the hospital in years (r = - 0.136; p = 0.036). Midwives trained in CAT considered that the following therapies were useful or very useful for pain relief during labor and delivery: relaxation techniques (64.3%), hydrotherapy (84.8%) and the application of compresses to the perineum (75.9%). The availability of resources for providing CAT during normal birth care varied widely from center to center. Conclusions: Age may influence attitudes towards training. It is important to increase the number of midwives trained in CAM for pain relief during childbirth, in order to promote the use of CAT and ensure efficiency and safety. CAT resources at accredited hospitals providing normal childbirth care should also be standardized. [ABSTRACT FROM AUTHOR]

Background: Risky drinking in pregnancy by UK women is likely to result in many alcohol-exposed pregnancies. Studies from the USA suggest that brief intervention has promise for alcohol risk reduction in antenatal care. However, further research is needed to establish whether this evidence from the USA is applicable to the UK. This pilot study aims to investigate whether pregnant women can be recruited and retained in a randomized controlled trial of brief intervention aimed at reducing risky drinking in women receiving antenatal care. Methods: The trial will rehearse the parallel-group, non-blinded design and procedures of a subsequent definitive trial. Over 8 months, women aged 18 years and over (target number 2,742) attending their booking appointment with a community midwife (n = 31) in north-east England will be screened for alcohol consumption using the consumption questions of the Alcohol Use Disorders Identification Test (AUDIT-C). Those screening positive, without a history of substance use or alcohol dependence, with no pregnancy complication, and able to give informed concent, will be invited to participate in the trial (target number 120). Midwives will be randomized in a 1:1 ratio to deliver either treatment as usual (control) or structured brief advice and referral for a 20-minute motivational interviewing session with an alcohol health worker (intervention). As well as demographic and health information, baseline measures will include two 7-day time line follow-back questionnaires and the EuroQoL EQ-5D-3 L questionnaire. Measures will be repeated in telephone follow-ups in the third trimester and at 6 months postpartum, when a questionnaire on use of National Health Service and social care resources will also be completed. Information on pregnancy outcomes and stillbirths will be accessed from central health service records before the follow-ups. Primary outcomes will be rates of eligibility, recruitment, intervention delivery, and retention in the study population, to inform power calculations for a definitive trial. The health-economics component will establish how cost-effectiveness will be assessed, and examine which data on health service resource use should be collected in a main trial. Participants' views on instruments and procedures will be sought to confirm their acceptability. Discussion: The study will produce a full trial protocol with robust sample-size calculations to extend evidence on effectiveness of screening and brief intervention. Trial Registration: Current Controlled Trials ISRCTN43218782 [ABSTRACT FROM AUTHOR]

Background: Maternity care providers, particularly midwives, have a window of opportunity to influence pregnant women about positive health choices. This aim of this paper is to identify evidence of effective public health interventions from good quality systematic reviews that could be conducted by midwives. Methods: Relevant databases including MEDLINE, Pubmed, EBSCO, CRD, MIDIRS, Web of Science, The Cochrane Library and Econlit were searched to identify systematic reviews in October 2010. Quality assessment of all reviews was conducted. Results: Thirty-six good quality systematic reviews were identified which reported on effective interventions. The reviews were conducted on a diverse range of interventions across the reproductive continuum and were categorised under: screening; supplementation; support; education; mental health; birthing environment; clinical care in labour and breast feeding. The scope and strength of the review findings are discussed in relation to current practice. A logic model was developed to provide an overarching framework of midwifery public health roles to inform research policy and practice. Conclusions: This review provides a broad scope of high quality systematic review evidence and definitively highlights the challenge of knowledge transfer from research into practice. The review also identified gaps in knowledge around the impact of core midwifery practice on public health outcomes and the value of this contribution. This review provides evidence for researchers and funders as to the gaps in current knowledge and should be used to inform the strategic direction of the role of midwifery in public health in policy and practice. [ABSTRACT FROM AUTHOR]