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Background Worldwide midwifery educators are passionate about educating the next generation of midwives and prepare them to contribute to public health and the midwifery profession. A redesign and transformation of midwifery education may be needed, focusing on the longterm impact on mothers, families and communities. To meet these challenges, midwifery students are expected to acquire competences in all fields of midwifery according to both national and European legislation and the International Confederation of Midwives (ICM) Global Standards for midwifery education1. The landscape of Higher Education initiated a transparent and easily comparable system of academic degrees in Europe. In 1999, an educational system in three cycles was established (Bachelor’s, Master’s and Doctorate level), by the so called Bologna process2. In recent years, midwifery educational reforms shifted from vocational training to academic education in Europe, which enhanced opportunities for mobility, employability and research. A recent study (2019) confirmed that, in most European countries, midwifery education took place at university (19 at Bachelor’s and in seven at Master’s level). Only four countries still offered vocational diploma level programs3. Nevertheless, midwives from different countries have uneven levels of proficiency, scope of practice, and education. While variation exists, some countries face challenges operating in a European context where midwifery is regulated, measured and documented in a similar way enabling comparison and impact4.

Introduction This paper is a report of a systematic review to identify and analyze studies of the measurement of empathy in midwives and other health professionals. Empathy has been recognized as an important factor in patient care, with positive outcomes for both patients and health professionals. There is a debate on the definition of empathy, on its measurement and on the possibility of improvement. Methods Searches were made of the CINAHL, SCOPUS, PubMed and PsychINFO databases using the terms empathy, clinical, midwifery, nursing, medical students, measurement, and health professionals, singly or in combination, to identify literature published in English between 2002-2015. The included papers were critically reviewed and a narrative synthesis was conducted. Results In all, 22 papers met the inclusion criteria by studies that were conducted to measure the levels of empathy in a variety of health professionals and students. Their scores were analyzed in correlation with their sociodemographic factors. Conclusions Despite numerous studies, many correlations but also differences exist, indicating the complexity of empathy and the need to further study it.

INTRODUCTION Maternal smoking constitutes a significant risk to the fetus and is associated with multiple adverse pregnancy outcomes. Despite this, an estimated 6–19% of women in Europe smoke during pregnancy. We conducted a pilot study to examine the feasibility and effectiveness of the clinical practice recommendations of the 2017 Tobacco Cessation Guidelines for High-Risk Groups (TOB-G) for pregnant and postpartum women in an outpatient obstetrics setting. METHODS The guideline recommendations were tested on a sample of 67 pregnant women recruited from obstetrics outpatient visits. Pregnant women who smoked received three behavioural counselling sessions through a combination of face-toface and telephone consultations by a midwife trained in the TOBG tobacco treatment recommendations. Smoking status was assessed at 1 month and at 6 months follow-up via self-report. RESULTS Seventy-one per cent of pregnant smokers screened agreed to participate in the counselling intervention. Pregnant women participants (mean age, M=31.73 years, SD±6.09) smoked for an average of 12.2 (SD±6.55) years. Women reported smoking an average of 4.82 (SD±4.14) cigarettes per day with 51% reporting smoking within 30 minutes of waking, an indicator of higher levels of nicotine addiction. Rates of smoking abstinence among pregnant women undergoing the counselling intervention were 43.9% and 45.6% at the 1 month and at 6 months follow-up, respectively. Replacing those participants with missing data as smokers, the quit rates were 26.9% and 38.8% at the 1 month and 6 months follow-up, respectively. CONCLUSIONS The counselling intervention delivered to pregnant women who smoke was feasible to implement in a manner that was consistent with the TOB-G guideline recommendations in an outpatient obstetrics setting. Future work should focus on increasing uptake of evidence-based tobacco treatment recommendations in outpatient obstetrics settings.

Introduction It is observed that delivery does not completely eliminate the risk of developing symptoms of preeclampsia, as well as its impending complications. The postpartum period is often associated with a high risk of developing preeclampsia, eclampsia and HELLP syndrome. Yet, there is neither an established standard, nor specific guidelines for peripartum fluid management. Our purpose is to study during the first four days of the postpartum period the differences in fluid balance on: normal pregnancies, pregnancies with preeclampsia and pregnancies with oedema and proteinuria. Methods The setting was the Gaia private maternity clinic in Athens, where 100 women in the postpartum period took part in the study and were requested to fill in a data collection-sheet, specially developed for the study. They were recruited between January 2014 and November 2014 and were divided into three groups. Group I consisted of all normal pregnancies, Group II those with oedema and proteinuria, and Group III those with preeclampsia. The demographic and clinical characteristics of the women and fetuses were initially recorded. Subsequently, daily records of fluid balance, as well as body weight, were kept for four days after labor. Descriptive statistics were used to analyze the demographic data of the sampled women. We compared the fluid balances among the three groups using t-test association and one-way Anova. Results The mean age of the women was 32.48±4.38 years. Out of a total of 100 women, 59 of them had a normal pregnancy (Group I), 24 developed oedema and proteinuria (Group II) and 17 developed preeclampsia (Group III). All three groups had a positive fluid balance on the first day postpartum and only the first group had a negative cumulative fluid balance from the second day postpartum and onwards. The second group despite having started to discard a small volume of fluid, from the second day postpartum, the balance remained positive throughout the next two days. The third group however, had a negative fluid balance only during the fourth day after labor. Conclusions ur results indicate a difference in the kinetics of fluids in women with preeclampsia, compared to those that had a normal pregnancy and postpartum period. Consequently, there appears to be a need for more rational management and follow up on fluid balance throughout labor.

Introduction The Birth Satisfaction Scale (BSS) is an important screening instrument that is used with mothers during the postpartum period for the identification of postnatal birth satisfaction. The purpose of this study was to validate and adapt the Greek version of the BSS to test its sensitivity, specificity and predictive values. Methods Childbearing women (n=310) were recruited from the perinatal care registers of the Maternity Departments of 3 Hospitals of Athens municipality (public Maternity Departments) in 2014. Inclusion criteria included fluency in spoken and written Greek language, within 1-4 postpartum days, and delivery of a healthy infant. Exploratory Factor Analysis (EFA) on the 30-items on the BSS revealed 7 orthogonal factors (KMO measure of sampling adequacy=0.856 and Bartlett’s test of sphericity=2999.806, df=435, p