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BACKGROUND: The Australian Health Practitioners Registration Agency (AHPRA) records 98.7% of the 32,000 registered midwives as female. In 2021, Australia recorded 309,996 births, and one in three women experienced birth trauma. While the exact proportion of midwives who have given birth is unknown, it is likely the majority. As a consequence, 5,000–11,000 midwives may have experienced primary birth trauma (PBT). Little is known about midwives' personal experience of birth trauma and its relationship to factors that affect their experience of the maternity workplace setting. AIMS: This study aimed to explore mental health morbidity and factors associated with the severity of PBT in Australian midwives and the relationships between these factors and professional quality of life. METHODS: Australian registered midwives 12 months post birth trauma experience and having returned to the maternity workplace without restrictions to their AHPRA registration were included. Data were collected via an online survey with four validated tools and general demographic information. FINDINGS: Midwives who have experienced PBT have symptomology for posttraumatic stress disorder, depression, anxiety, and burnout. Midwives with these symptomologies work within maternity settings with little known about the implications of accumulative symptoms, their impact on care provision or clinical decision-making, and overall long-term personal and professional well-being and health. CONCLUSION: This study found that midwives experience psychological, professional, and personal issues and trauma symptomology associated with their own primary birth trauma. Further research exploring simplified symptomatology identification and appropriate interventions both inside and outside the work environment is required to improve midwives' mental health, rates of retention in the workplace, and job satisfaction. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue, including one by Jacqueline van Swet and colleagues on the role of critical friendship in students who are doing action research practices, one by Tim McMahon and Elaine Jefford on the assessment of action research projects inside formal academic programmes, and one by Eduardo Flores-Kastanis on the claim regarding the participatory action research's (PAR) representation of a dialectic model of change.

Background: Early warning systems (EWS) are used across health care settings as a tool for the early identification of clinical deterioration and to determine the need to escalate care. Early detection of clinical deterioration and appropriate escalation of care in maternity settings is critical to the safety of pregnant women and infants; however, underutilization of EWS tools and reluctance to escalate care have been consistently reported. Little is known about midwives' use of EWS in the Australian context. Methods: Using a cross‐sectional approach, we elicited the attitudes, beliefs, and behaviors of a purposive sample of Australian midwives (n = 87) with respect to the Maternal Early Warning Trigger Tool (MEWT). Participants answered a 25‐question Likert scale survey and one open‐ended question. Qualitative answers were analyzed using consensus coding. Results: Midwives reported positive attitudes toward the MEWT, describing it as a valuable tool for identifying clinical deterioration, especially when used as an adjunct to clinical judgment. However, midwives also identified training gaps; 25% had received no training, and only half of those who had received training felt it was effective. In addition, professional tension can create a significant barrier to the effective use of the MEWT. Midwives also reported feeling influenced by their peers in their decision‐making with respect to use of the MEWT and being afraid they would be chastised for escalating care unnecessarily. Conclusions: Although the MEWT is valued by Australian midwives as a useful tool, barriers exist to its effective use. These include a lack of adequate, ongoing training and professional tension. Improving interdisciplinary collaboration could enhance the use of this tool for the safety of birthing women and their infants. [ABSTRACT FROM AUTHOR]

Introduction: Physiological signs of clinical deterioration are known to occur in the hours preceding a serious adverse event. As a result, track and trigger systems known as early warning systems (EWS) were introduced and routinely implemented as patient observation tools to trigger an alert in the presence of abnormal vital signs. Objective: The objective aimed to explore the literature pertaining to EWS and their utilisation in rural, remote and regional health care facilities. Design: The Arksey and O'Malley's methodological framework was used to guide the scoping review. Only studies reporting on rural, remote and regional health care settings were included. All four authors participated in the screening, data extraction and analysis process. Findings Our search strategy yielded 3869 peer‐reviewed articles published between 2012 and 2022, with six studies ultimately included. Collectively, the studies included in this scoping review examined the complex interaction between patient vital signs observation charts and recognition of patient deterioration. Discussion: Whilst rural, remote and regional clinicians use EWS to recognise and respond to clinical deterioration, noncompliance dilutes the tool's effectiveness. This overarching finding is informed by three contributing factors: documentation, communication and challenges specific to the rural context. Conclusion: The success of EWS relies on accurate documentation and effective communication within the interdisciplinary team to support appropriate responses to clinical patient decline. More research is required to understand the nuances and complexities of rural and remote nursing and to address challenges associated with the use of EWS in rural health care settings. [ABSTRACT FROM AUTHOR]

Aim/objective: To establish midwives' perceptions of the value of workshops designed to empower their decision‐making and leadership skills using validated midwifery clinical reasoning frameworks and appreciative inquiry methods. Background: The medical lens of childbirth can disempower women and midwives. Midwives often face challenges navigating their role as autonomous practitioners and advocates for shared decision‐making, particularly when there is tension between women's wishes, governance frameworks and organisational requirements. This can lead to 'Midwifery Abdication' and/or the midwifery voice being silenced. Design/Methods: Appreciative inquiry, involving qualitative analysis of 31 midwives' personal reflections during 'Empowering Midwives' Decision‐Making' workshops. Standards for reporting qualitative research (SRQR criteria) guided the preparation of this manuscript. Results: Decision‐making tools and 'appreciative' strategies can strengthen leadership attributes, enhance feelings of empowerment and deepen understanding. Reflecting on 'Midwifery Abdication' was perceived as confronting. Workshop activities offered understanding the reasons why 'Midwifery Abdication' may or may not occur. One overarching, key theme was identified: 'Finding my midwifery voice'. This theme encompassed three sub‐themes: 'I am not alone', 'Using leadership to promote collaboration to effect change' and 'An onward journey of enlightenment and empowerment'. Conclusion: Midwives need to find their voice and develop skills in both clinical reasoning and transformative reflection. Workshops, using Appreciative Inquiry approaches, that focused on reflection, clinical decision‐making and 'Midwifery Abdication', facilitate this and may create feelings of reunification in midwives and rejuvenate inherent passion for the profession. Relevance to clinical practice: Sharing feelings around providing care in the often‐contested space that is advocating for women using midwifery philosophy may provide relief from moral distress and a sense of shared identity desperately sought after by midwives struggling to navigate the increasingly complex terrain of maternity care. Findings encourage the need for further discussions around strengthening midwifery leadership which may be achievable using Appreciative Inquiry frameworks and approaches. [ABSTRACT FROM AUTHOR]

BACKGROUND: This review builds upon previous work exploring the concept of Midwifery Abdication, within the national midwifery literature. This article focuses on Australian legal literature, court/tribunal decisions and coronial or coroner's court findings. OBJECTIVE: To explore Midwifery Abdication and whether it is evident within Australian caselaw. DATA SOURCES: Australian Legal literature, coronial findings, and court/tribunal decisions reported by the Australian Health Practitioner Regulation Agency, during 2005–2020. ELIGIBILITY CRITERIA: 1,246 cases were located using the presented search terms. Use of exclusion criteria resulted in the inclusion of 41 cases. METHODS: While there are no validated tools to appraise caselaw, this review followed a robust protocol that guides the preparation and reporting of systematic reviews. Midwifery Abdication was identified using previously validated, interrelated constructs. RESULTS: Midwifery Abdication occurred in 41 cases; that included one or more previously identified constructs. In line with the associated integrative review, a midwife's professional identity, environmental hierarchy and associated culture of social obedience are all shown to act as influencing factors in Midwifery Abdication. LIMITATIONS: Rigorous and reproducible processes were used; however, limited search functionality of some data sources may have resulted in inadvertent omission of cases. While this review relates to case law in one high-income country it provides a platform for further international research. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Acknowledging Midwifery Abdication in Australian caselaw may serve to strengthen the midwifery voice and encourage an enhanced educational and reflective focus on midwifery philosophy and decision-making. Midwifery education must empower midwives to embrace their autonomous status while enhancing their abilities to optimize informed decision-making within a woman-centered midwifery philosophy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Stress urinary incontinence (SUI) is a globally pervasive health condition that is often first experienced during pregnancy and may well continue beyond pregnancy. Yet, definitive numbers of prevalence are uncertain due to multiple factors including embarrassment. This study compares differences and similarities between Chinese and American women's experiences of SUI and health-seeking behaviors during pregnancy. METHODOLOGY: This study used a cross-sectional design to explore health-seeking behaviors of primigravida women within the first 5 days following birth in China (n = 178) and the United States of America (n = 178) who experienced SUI using the Impact of Incontinence Questionnaire short form (IIQ-SF). RESULTS: While more Chinese women experienced SUI (p =.049), American women who experienced SUI experienced it earlier in their pregnancy (p =.003) and more frequently (p <.0001) than the Chinese women. Therefore, it can be assumed that although less American women experienced SUI, the impact was greater on their daily living activities. Irrespective of ethnicity, only 14% (n = 18) of women who described having SUI sought medical aid. CONCLUSION: The disconnect between high incidence and low rates of seeking treatment needs future exploration to develop interventions tailored to educate women about SUI and its role during pregnancy. [ABSTRACT FROM AUTHOR]

Background: People with diabetes need to make regular choices that influence their long-term morbidity and mortality. Patient decision aids are validated tools and when used collaboratively between healthcare professionals, patients and carers, can help guide value-based discussions which encourage choices that are well informed and personally relevant. Objective: To explore the use and effect of patient decision aids in the management of diabetes. Method: A scoping review design was used. Medline, ProQuest, PsycINFO, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases were searched for peer-reviewed articles published between January 1998 and December 2018. Results: Patient decision aids are not commonly or widely used in diabetes management. They offer a suitable adjunct to practice within the domains of healthcare knowledge, active participation, and communication, and shared decision-making between patients and healthcare professionals. Conclusion: Patient decision aids can offer a simple and easy-to-use method to potentially improve diabetes health literacy, through the process of shared decision-making and two-way conversations. However, there are current limitations on using them to positively influence clinical outcomes or long-term changes in self-care behaviors within the management of diabetes. Further research to explore the validity of using patient decision aids long term in these areas is required. [ABSTRACT FROM AUTHOR]

BACKGROUND: Behavioral and medical science is currently in the grip of a "replication crisis," circumscribed by the failure to replicate a large proportion of key studies and a consequential impact on confidence in the veracity of the scientific method. Given the contemporary nature of the debate it is surprising that the psychometric properties of commonly used outcome measures have not been evaluated in this context, despite the obvious potential for the measurement characteristics of the measures themselves to be a source of error within a study. The current investigation sought to replicate the original validation study of the Australian version of the 10-item Birth Satisfaction Scale—Revised (A-BSS-R) with respect to key psychometric aspects and the issues of replicability. METHODS: A replication study of all quantitative aspects of Jefford et al. (2018) with an increased sample size. Participants were a purposive sample of Australian postnatal women (n = 445). RESULTS: Most key quantitative aspects of the original validation study were found to be replicable and consistent with Jefford et al. (2018), the A-BSS-R was found to have excellent psychometric properties fundamentally mirroring the measurement characteristics observed previously. However, a small number of instances of nonreplicability were found. CONCLUSIONS: The A-BSS-R is a valid and reliable measure of birth satisfaction. Replicability, at least in part, is influenced by participant group characteristics, statistical power and sample size. More focus is required on the influence of self-report measures themselves on the germane aspects of successful study replication. [ABSTRACT FROM AUTHOR]

BACKGROUND: Confidential inquiries into maternal deaths have reported that recognition and timely interventions can reduce maternal morbidity and mortality. Although research has been undertaken that examines factors impacting registered nurses recognition of and response to the deteriorating patient, there is less literature identifying the factors impacting midwives' recognition of and response to the deteriorating maternal patient in the clinical context. OBJECTIVE: To identify, summarize, and critically evaluate peer-reviewed studies that explored factors impacting clinical practice of Australian midwives in relation to maternal deterioration. DESIGN: Reviewers searched Maternity and Infant Care, EBSCOhost, Medline, CINAHL, SCOPUS, EMCARE, and EMBASE for published literature reporting on factors impacting Australian registered midwives' ability to recognize and respond to maternal deterioration. FINDINGS: Of the articles identified and screened (n = 2,412), no studies met the inclusion criteria. This review revealed a lack of published research examining factors impacting Australian midwives' capability to recognize and respond to the deteriorating maternal patient. CONCLUSION AND IMPLICATIONS FOR PRACTICE: While research shows, for registered nurses, that high workloads and poor skill mix can negatively impact capability to respond to the deteriorating patient, little is known of registered midwives' capability during similar health events. This review highlights a major gap in current knowledge regarding Australian registered midwives' experiences surrounding the recognition of and response to the deteriorating maternal patient. Increasing understanding in this area can inform and support the Australian midwifery education, practice, and National health policies to improve health outcomes for childbearing women. Further research in this area is therefore required. [ABSTRACT FROM AUTHOR]

Research has identified midwifery as key to improving maternal and child health globally. Consequently, increasing the numbers, access, and quality of midwives is paramount as attention, funding, education, and support increases. Yet what a midwife and midwifery are is often misunderstood. The terms midwife and midwifery are often used interchangeably. Other cadres such as nurses, doulas, Skilled Birth Attendant, traditional birth attendant, and nurses with obstetric/perinatal experience are often referred to as midwives or providers of midwifery care. As health systems work to integrate midwives and midwifery, global clarity and understanding must exist on what midwives are and what they are not, and what midwifery is and is not. As the first step to establishing clarity; we undertook a critical comparison of existing different countries, 'not for profit and professional organizations' definitions and interpretation of a midwife and midwifery philosophy. The International Confederation of Midwives' definition of a midwife and midwifery philosophy, and their Global Standards for Midwifery Education acted as the baseline. A global consensus and commitment to educational systems and culture that teaches the midwifery model and the philosophy behind that care can positively impact and improve outcomes for women and babies. [ABSTRACT FROM AUTHOR]

Abstract: Despite decades of considerable economic investment in improving the health of families and newborns world‐wide, aspirations for maternal and newborn health have yet to be attained in many regions. The global turn toward recognizing the importance of positive experiences of pregnancy, intrapartum and postnatal care, and care in the first weeks of life, while continuing to work to minimize adverse outcomes, signals a critical change in the maternal and newborn health care conversation and research prioritization. This paper presents “different research questions” drawing on evidence presented in the 2014 Lancet Series on Midwifery and a research prioritization study conducted with the World Health Organization. The results indicated that future research investment in maternal and newborn health should be on “right care,” which is quality care that is tailored to individuals, weighs benefits and harms, is person‐centered, works across the whole continuum of care, advances equity, and is informed by evidence, including cost‐effectiveness. Three inter‐related research themes were identified: examination and implementation of models of care that enhance both well‐being and safety; investigating and optimizing physiological, psychological, and social processes in pregnancy, childbirth, and the postnatal period; and development and validation of outcome measures that capture short and longer term well‐being. New, transformative research approaches should account for the underlying social and political‐economic mechanisms that enhance or constrain the well‐being of women, newborns, families, and societies. Investment in research capacity and capability building across all settings is critical, but especially in those countries that bear the greatest burden of poor outcomes. We believe this call to action for investment in the three research priorities identified in this paper has the potential to achieve these benefits and to realize the ambitions of Sustainable Development Goal Three of good health and well‐being for all. [ABSTRACT FROM AUTHOR]

Introduction: Many of the risk factors for perineal trauma are modifiable, and midwives are in an ideal position to mitigate such risks. To date, no investigation using a midwifery-specific decision-making tool has sought to determine how midwives make decisions within a midwifery philosophy/context or identify the factors that may contribute to that decision making about perineal management. We sought to apply such a tool to midwives’ narratives and explore their clinical reasoning and midwifery practice when managing a woman’s perineum in labor. Methods: A qualitative interview-based study with practicing midwives in one regional Australian maternity unit was conducted. The decision-making matrix specified by a psychometrically robust and validated measure of clinical decision making and midwifery practice-guided analysis. Results: Effective clinical decision making in response to perineal trauma is contingent on a heuristic and individualized “working hypothesis” that combines distinct elements of an optimal clinical decision-making process. Midwives’ narratives highlighted their ability to engage in some form of clinical reasoning. Some elements of midwifery practice was lacking within several midwives’ narratives, thus resulting in them abdicating their professional role. Conclusion: The manner and processes by which midwives engage effectively with perineal management are complex. However, a significant influence on this process appears to be recollections from original training in perineal management, which appears to be largely rote and taught by example. We recommend balance between practical experience and synthesis with current evidence within a midwifery philosophy to optimize perineal care and risk modification. [ABSTRACT FROM AUTHOR]

Objective and background: The 10-item Birth Satisfaction Scale-Revised (BSS-R) has recently been endorsed by international expert consensus for global use as the birth satisfaction outcome measure of choice. English-language versions of the tool include validated UK and US versions; however, the instrument has not, to date, been contextualised and validated in an Australian English-language version. The current investigation sought to develop and validate an English-language version of the tool for use within the Australian context. Methods: A two-stage study. Following review and modification by expert panel, the Australian BSS-R (A-BSS-R) was (Stage 1) evaluated for factor structure, internal consistency, known-groups discriminant validity and divergent validity. Stage 2 directly compared the A-BSS-R data set with the original UK data set to determine the invariance characteristics of the new instrument. Participants were a purposive sample of Australian postnatal women (n = 198). Results: The A-BSS-R offered a good fit to data consistent with the BSS-R tridimensional measurement model and was found to be conceptually and measurement equivalent to the UK version. The A-BSS-R demonstrated excellent known-groups discriminant validity, generally good divergent validity and overall good internal consistency. Conclusion: The A-BSS-R represents a robust and valid measure of the birth satisfaction concept suitable for use within Australia and appropriate for application to International comparative studies. [ABSTRACT FROM AUTHOR]

A list of the peer reviewers of the "British Journal of Midwifery" in 2021 is presented including Laura Abbott, Jonathan Cliffe, and Eleftheria Taousani.

Aim To present an adaptation of interpretive interactionism that incorporates and honours feminist values and principles. Background Interpretive interactionism as described by Denzin can be useful when examining interactive processes. It is especially useful when events affect turning points in people's lives. When issues of power and power imbalances are of interest, a critical post- structural lens may be of use to the researcher. The authors planned to examine the interactions between midwives and women at the 'epiphaneal' points of decision making during second-stage labour. It became clear that it was necessary to honour and thus incorporate feminist principles and values in their methodology. Data sources This paper draws on a recently completed PhD project to demonstrate the application of post-structural feminist interpretive interactionism. Twenty six midwives representing each state and territory across Australia who were representative of every model of midwifery care offered in Australia were interviewed to gauge their experiences of what they believed represented good and poor case examples of decision making during second-stage labour. Review methods The authors critique the philosophical underpinnings of interpretive interactionism, and then modify these to acknowledge and incorporate post- structural and feminist ideologies. Discussion Interpretive interactionism is a useful methodology when the research question is best addressed by examining Interactional processes and the meanings people make of them, especially if these occur at turning points in people's lives. Interpretive interactionism methodology can and should be improved by taking account of issues of power, feminism and post-structural values. Conclusion Post-structural feminist interpretative interactionism has much to offer healthcare researchers who want to develop methodologically robust findings. Implications for practice/research Post-structural feminist interpretive interactionism enables the researcher to be more cognisant of the complex social political and historical context of midwifery. Researchers using feminist and post-structural ideologies will enhance research findings when these tools are applied consciously and reflexively. [ABSTRACT FROM AUTHOR]

An action-research account of a successful improvement to practice presented for assessment within a taught MA in education was given a fail grade. The student's challenge to this decision led the university assessor to re-evaluate and change his own practice in assessment in much the same way as the student had in the original report. The narrative of this event is used to explore the central dilemma of assessing action-research reports inside academic programmes; namely, the competing needs of the action-researcher to follow the investigation wherever it leads and the need for the student to meet pre-set criteria for assessment. Following an introduction, Part 2 of the paper presents an extract from the original action-research account while Part 3 presents the story of the assessment and notes how it exemplifies some of the key issues relating to the way action-research can and should be assessed within credentialed academic programmes. Part 4 explores these issues further and suggests that Elliott's formulation of quality criteria can resolve the central dilemma of marking action-research reports within credentialed programmes of study. [ABSTRACT FROM AUTHOR]

Many midwives routinely perform a vaginal examination during birth to check for the nuchal cord. Such an invasive procedure would only be consistent with midwifery philosophy if it was common to find a nuchal cord so tight that the only alternative is to cut in order to allow the birth of the baby. A tight nuchal cord, however, seems to be rare. So how did it happen that the invasive procedure of checking for the nuchal cord vaginally became a ritualized practice in contemporary midwifery? The historical literature on the significance of finding a nuchal cord is reviewed in this article. Checking for the nuchal cord has been advocated by medical textbooks. The call to make this procedure routine for all women was not made in medical texts until the late 17th century onwards. Through an exploration of the historical origins of the procedure it is demonstrated that the arguments used act as a model for the way in which all aspects of birth have been medicalized through fear. It is hypothesized that when the midwife avoids routine invasive checking for the cord and instead makes individual clinical decisions for each particular woman and baby this may be a marker of her willingness to practice as an autonomous decision maker and not just of follower of ritual. [ABSTRACT FROM AUTHOR]

A list of peer reviewers for the "British Journal of Midwifery" in 2018 is presented, including Sadie Geraghty, Alison Cooke, and Hazel Hughes.