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In March 2020, the World Health Organisation named the severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2), which causes corona virus disease 2019 (COVID -19), as a pandemic. Pregnant women were considered at increased risk of developing severe COVID-19 after viral infection. In response maternity services reduced face-to-face consultations with high-risk pregnant women by supplying blood pressure monitors for supported self-monitoring. This paper explores the experiences of patients and clinicians of the rapid roll-out of supported self-monitoring programme in Scotland during the first and second wave of the COVID-19 pandemic. We conducted semi-structured telephone interviews with high-risk women and healthcare professionals who were using supported self-monitoring of blood pressure (BP) In four case studies during the COVID-19 pandemic. 20 women, 15 midwives and 4 obstetricians took part in the interviews. Interviews with healthcare professionals showed that while implementation occurred at pace and at scale across the National Health Service (NHS) in Scotland, implementation differed locally, resulting in mixed experiences. Study Participants observed several barriers and facilitators to implementation. Women value the simplicity of use and convenience of the digital communications platforms while health professionals were more interested in their impact on reducing workload for both women and health professionals largely found self-monitoring acceptable, with only a few exceptions. These results show that rapid change can occur in the NHS at a national level when there is a shared motivation. While self-monitoring is acceptable to most women, decisions regarding self-monitoring should be made jointly and on an individual basis.

Additional file 1. Interview Schedule for Pregnant Women Participants. The interview schedule used with pregnant women in the study.

Additional file 2. URCHOICE calculator example results shown to healthcare professionals and women (high risk and low risk only) participants at interview/focus groups. The examples of the URCHOICE calculator that were used during interviews with pregnant women and health care professionals.

Additional file 3. Interview Schedule for Healthcare Professionals. The interview schedule used with health care professionals in the study.

Objective Smoking during pregnancy causes risks to mother and infant health. We investigated the feasibility and likely success of SKIP-IT, a narrative and picture-based smoking cessation intervention delivered via text messages. Methods A feasibility and pilot trial. We aimed to recruit 70 pregnant women who smoked, randomised to usual care alone or usual care and the SKIP-IT intervention between 12 weeks of pregnancy and 6 weeks post due-date. Outcomes assessed were recruitment, retention, acceptability of, and engagement with the intervention, smoking behaviour, intentions, perceived risk, and self-efficacy. Results Of 312 women initially approached by smoking cessation services only 54 (17%) agreed to be contacted by the research team. Twenty were then either ineligible or uncontactable and 28 (82%) participated. Most women reported texts to be entertaining and helpful. The proportion of women not smoking at follow-up was lower in the intervention group, but numbers were too small to draw conclusions about effectiveness. Conclusion The intervention was acceptable, but difficulty in making initial and follow-up contacts meant our methods were unfeasible for a larger trial. Practice implications Digital Storytelling interventions could help women quit smoking, but further research is required to identify alternative methods for studies with pregnant women who smoke.

Study 1 Interview Topic guide. (DOCX 19 kb)

COREQ checklist. (DOCX 18 kb)

Study 1 table of midwives view statements table. (DOCX 18 kb)

Study 1 table of midwives HePPBe strategies. (DOCX 16 kb)

Prototype testing. Guide for workshops to gain staff feedback on the PRAM model. (PDF 328 kb)

EBD questionnaire. Copy of questionnaire for Experience Based Design exercise relating mothersâ experiences of postnatal care to key steps in the pathways. (PDF 360 kb)

Exploring assumptions. Guide for workshops and individual staff interviews checking the pathways and possible redesign actions. (PDF 575 kb)

Postnatal care survey. Copy of questionnaire capturing more specific data describing mothersâ experiences of postnatal care. (PDF 474 kb)

Developing pathways. Guide for workshops and individual interviews collecting information to develop pathways. (PDF 107 kb)

NHS Scotland Maternity Care Survey. Copy of questionnaire capturing mothersâ experiences of maternity care in general. (PDF 1525 kb)

PRAM evaluation. Guide for interviews collecting staff experiences with the use of PRAM. (PDF 87 kb)

Background and rationale. The latent phase of labour is recognised as a period of uncertainty for women and midwives. There is evidence from the literature of considerable variation in labour definitions and practice. Stimulated by discussion at an international maternity research conference, the authors set out to explore opinions regarding the need for labour-stage definitions. Aim. To identify health professionals’ views on the need for a definition of the onset and the end of the latent phase of labour. Methods. This was an opportunistic, semi-structured, online survey of attendees at a maternity care research conference, which included midwives, other clinicians, academics, advocates and user representatives. Attendees (approximately 100) were invited to participate through a single email invitation sent by the conference committee and containing a link to the survey. Consent was sought on the landing page. Ethical approval was obtained from Bournemouth University’s research ethics committee. Quantitative questions were analysed using simple descriptive statistics using IBM SPSS Statistics Version 24. Open questions were analysed using content analysis and where participants gave a more detailed answer, these were analysed using a thematic approach. Findings. Participants in the survey (n=21) came from 12 countries. Most of the participants thought that there was a need to define the onset of the latent phase (n=15, 71%). Common characteristics were cited, but the main theme in the open comments referred to the importance of women’s perceptions of labour onset. Most participants (n = 18, 86%) thought that there was a need to define the end of the latent phase. This was felt necessary because current practice within facilities is usually dictated by a definition. The characteristics suggested were also not unexpected and there was some consensus; but the degree of cervical dilatation that signified the end of the latent phase varied among participants. There was significant debate about whether a prolonged latent phase was important; for example, was it associated with adverse consequences. Most participants thought it was important (n=15, 71%), but comments indicated that the reasons for this were complex. Themes included the value that women attached to knowing the duration of labour and the need to support women in the latent phase. Implications for practice. The findings from this small, opportunistic survey reflect the current debate within the maternal health community regarding the latent phase of labour. There is a need for more clarity around latent phase labour (in terms of both the definition and the support offered) if midwives are to provide care that is both woman centred and evidence-based. The findings will inform the development of a larger survey to explore attitudes towards labour definitions.

Summary Objective Vaginal examinations (VEs) in labour are a routine part of intrapartum care. Current UK guidelines recommend that VEs are offered to women at regular intervals of not less than 4 h and only performed when justifiably necessary. However, justification may be interpreted differently by different midwives. This study aimed to investigate (i) the number of VEs performed in relation to length of labour and (ii) the reasons given by midwives for performing the VE. Methods This study recruited a group of women (n = 144) admitted in either spontaneous labour or for induction of labour from one NHS hospital in Scotland. The number of VEs performed, the reason provided by the midwife for its need and the length of labour were all recorded. Findings The number of VEs carried out (mean 2.9, SD 1.5, range 1–7) increased as length of time in labour in hospital increased. Approximately half the sample (52%) had 3 or more VEs during labour. Almost 70% of women had more VEs than expected when the criteria of 4 hourly VEs was applied. The most common reason given by midwives for performing a VE was to assess labour progress and to assess the commencement of labour. Conclusions Despite maternity care policy to limit interventions in normal labour, we found that a substantial number of women received more VEs than was consistent with adherence to guidelines. However, until further research is conducted to validate other measures of labour progress, the number of VEs undertaken during labour is unlikely to decrease.

OBJECTIVE: to use realist evaluation to describe and explain how and in what circumstances screening and alcohol brief interventions work in routine antenatal care.DESIGN: a realist evaluation incorporating systematic reviews and qualitative data.SETTING: NHS Lothian, which is one of the 14 Scottish health boards.PARTICIPANTS: participants were recruited from two maternity units. In phase one, interviews were conducted with four participants responsible for policy implementation. These data were supported by two systematic reviews. In phase two, 17 pregnant women and 15 midwives participated in interviews, with a further six midwifery team leaders involved in a focus group.FINDINGS: training and resources provided to midwives as part of the programme acted as facilitating mechanisms that improved their skills and confidence to screen and deliver alcohol brief interventions. The programme elicited positive change in attitudes to drinking in pregnancy and possibly stimulated drinking behaviour change amongst pregnant women. However, the small numbers of pregnant women being identified for alcohol brief interventions meant delivery was infrequent and resulted in the programme not working as anticipated. The findings also revealed contextual issues around midwife-pregnant woman relationship and the challenges of negotiating the timing of screening and alcohol brief interventions delivery.CONCLUSIONS: Drinking in pregnancy is an emotive issue, therefore delivering alcohol brief interventions at the first antenatal appointment when they are more likely to achieve the most benefits poses challenges. When training midwives to screen and deliver alcohol brief interventions, special attention is needed to improve person-centred communication skills to overcome barriers associated with discussing sensitive prenatal alcohol use and enhance early identification and delivery of alcohol brief interventions at the first antenatal appointment.