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LGBTQ+ people experience significant physical and psychosocial health issues and concerns, and encounter barriers when accessing healthcare services. We conducted a mixed-methods research study across all Schools of Nursing and Midwifery in the United Kingdom and Ireland using a survey and qualitative interviews. This was to identify the current content within nursing and midwifery pre-registration programmes in relation to LGBTQ+ health and to identity best practice and education innovation within these programmes. The survey was completed by 29 academics, with 12 selected to participate in a follow-up in-depth qualitative interview. Analysis of the data from the survey and interviews identified five themes: there is variable programme content, academics are developing their own programmes with no clear consistency, LGBTQ+ health is being linked to equality and diversity, there are barriers to education provision, and these is some evidence of best practice examples. The findings of the study support the need to develop and implement a curriculum for LGBTQ+ health in nursing and midwifery pre-registration programmes with learning aims and outcomes. Academics need support and tools to prepare and deliver LGBTQ+ health content to nurses and midwives as they ultimately have the potential to improve the experiences of LGBTQ+ people when accessing healthcare.

RationaleThe concept of birth satisfaction embraces many factors, which include for example perceived quality of care provision, stress experienced, and personal coping strategies. A woman’s birth experience has the power to affect her mental health, decisions surrounding future birth planning, and quality of relationships with her partner and family. The UK-Birth-Satisfaction-Scale-Revised (UK-BSS-R) is currently recommended as the tool of choice by the International Consortium for Health Outcome Measures (ICHOM) for measuring women’s experiences of childbirth. It was therefore considered important to translate and validate this scale for use in a Brazilian context.ObjectiveTo translate and culturally adapt the UK-BSS-R into Brazilian (Portuguese) and validate its key measurement properties.MethodsA repeated-measures survey was conducted for the purpose of examining factor structure, validity and reliability of the Brazilian (Portuguese)-BSS-R.ParticipantsData was gathered from (n = 101) Brazilian Portuguese-speaking postnatal women.ResultsThe initial measurement characteristics of the Brazilian (Portuguese)-BSS-R in terms of Intraclass Correlational Coefficient, Standard Error of Measurement and minimal detectable change were found to be excellent.ConclusionThe Brazilian (Portuguese)-BSS-R is now considered to be a valid and reliable multidimensional psychometric instrument for measuring birth satisfaction in a Brazilian Portuguese population of postnatal women. This translation was found to be conceptually consistent with the original English-language version (UK-BSS-R) and to have an excellent initial measurement characteristics profile. The direction of future research is indicated, specifically to undertake a thorough psychometric evaluation of the Brazilian (Portuguese)-BSS-R in a larger sample.

Introduction The 11th revision of the WHO International Classification of Diseases (ICD-11) has identified Complex PTSD (CPTSD) as a new condition. Aim To explore whether the new diagnosis of CPTSD (ICD11) is relevant to women who have experienced perinatal bereavement and to advance knowledge about the acceptability, feasibility and perceived impact of delivering an innovative flexible Compassionate Focused Therapy (CFT) informed treatment package to alleviate symptoms of this condition. Methods A mixed methods study using survey and interviews was conducted. Participants first completed the International Trauma Questionnaire (ITQ) to assess if they met the criteria for PTSD or CPTSD (n=72), and subsequent semi-structured interviews (n=12) identified participants’ views about different treatment approaches. Participants A convenience sample of women who had experienced perinatal bereavement were recruited from one geographical region in Scotland. Data collection Information was gathered about trauma experiences related to perinatal bereavement; participants’ levels of PTSD or CPTSD using the ITQ; and views regarding the features of treatment options. In-depth interviews with women (n=12) and a focus group with staff (n=5) were also conducted. Findings Of 74 participants (n=74) who fully completed the ITQ, 10.8% (n=8) met the criteria for PTSD and 29.7% (n=22) for CPTSD, equating to a total of 40.5% of participants experiencing traumatic stress. Results suggest that CPTSD is a more common condition than PTSD in people with perinatal bereavement, with qualitative data suggesting that CFT and EMDR can be useful and acceptable interventions for this population group. Conclusion A feasibility study is recommended next to evaluate acceptability of trial processes in preparation for a definitive randomised controlled trial of a new flexible CFT informed treatment package to address PTSD and CPTSD in people with perinatal bereavement. Recommendations for practice Routine assessment of ICD-11 CPTSD is recommended in this population group.

Screening for antenatal depression (AND) is clinically important, with any form of depression impacting upon women’s relationships with her partner and infant postpartum. Surprisingly, screening for AND has received relatively little attention, compared with screening for postnatal depression (PND). Nonetheless, research-informed observations indicate that the impact of AND can be as significant as PND. Screening for AND can be readily undertaken using short self-report questionnaires, which have known validity characteristics and harmonized threshold cut-off scores. Contemporary practice in the UK involves an initial short two-question screening (Whooley Questions), which if post-completion indicates depression may be present, a further short 10-item depression inventory is issued (e.g., EPDS or PHQ-9). Although this system is highly effective for initial recognition of possible depression, a number of conceptual and pragmatic issues are important when applying these measures in everyday clinical practice.

This is an educational paper which aims to inform midwives of tools available to help them make appropriate provisional diagnosis of perinatal depression. A second aim of the paper is to increase midwives' awareness of the relatively newer diagnosis of antenatal depression (AND). Of additional clinical importance, midwives need to recognise that postnatal depression (PND) may be a continuation of AND. To date, screening for AND has received relatively little attention compared with PND, with the evidence-base supporting that the impact can be as severe. It is important for midwives to know that screening for AND can be undertaken using valid and reliable psychometric self-report depression screening questionnaires which have known validity characteristics and threshold cut-off scores. There are several of these tools available to help midwives make the decision about whether or not to refer the women to the mental health team. Current practice in the UK involves the midwife asking an initial short two-item ‘Whooley Question’ screen which, if indicates depression, can be followed up by the women completing a self-report depression screening questionnaire. To highlight their availability, a selection of valid and reliable psychometric self-report depression screening questionnaires are discussed herein, with it being important for midwives to develop a toolkit that can be given to women at clinics, in pamphlets, online or embedded into mobile applications.

BackgroundMaternal childbirth dissatisfaction has short- and long-term negative effects on the mothers’ health and life, as well as on relation with her child and family. Due to lack of studies in Iran and other counties, we aimed to determine pre- and during- labour predictors of low birth satisfaction.MethodsSeven hundred women with low risk singleton pregnancy participated in this prospective analytical study. The participants were hospitalized for vaginal delivery with fetus in cephalic presentation and gestational age of 370–416at two teaching centers in Tabriz (Iran). Woman characteristics, anxiety state (using Spielberger inventory) and dehydration were assessed at cervical dilatation of 4–6 cm. Iranian (Persian) birth satisfaction scale-revised was applied 12–24 h after birth. Multiple linear regression was used to determine the predictors.ResultsExcluding 26 women who were outliers, 674 women were analyzed. The mean birth satisfaction score was 23.8 (SD 6.5) from an attainable score of 0–40. The during-labour predictors of low birth satisfaction score were severe and moderate anxiety, labour dystocia, insufficient support by staff, vaginal birth with episiotomy and tear, emergency cesarean section, labour induction and labour augmentation with oxytocin, and woman dehydration. The pre-labour predictors included being primiparous, sexual and emotional violence during pregnancy, gestational age of 400–416, preference for cesarean section, no attendance at pregnancy classes, and insufficient household income. The proportion of the variance explained by the during-labour variables was 75%, by pre-labour variables was 14% and by overall was 76%.ConclusionsThe controllable during-labour predictors explains most of the variance of the satisfaction score. It seems that responding to women’s physical and psychological needs during labour and applying less interventions could improve women’s childbirth satisfaction.

Background Good quality midwifery care saves the lives of women and babies. Continuity of midwife carer (CMC), a key component of good quality midwifery care, results in better clinical outcomes, higher care satisfaction and enhanced caregiver experience. However, CMC uptake has tended to be small scale or transient. We used realist evaluation in one Scottish health board to explore implementation of CMC as part of the Scottish Government 2017 maternity plan. Methods Participatory research, quality improvement and iterative data collection methods were used to collect data from a range of sources including facilitated team meetings, local and national meetings, quality improvement and service evaluation surveys, audits, interviews and published literature. Data analysis developed context-mechanism-outcome configurations to explore and inform three initial programme theories, which were refined into an overarching theory of what works for whom and in what context. Results Trusting relationships across all organisational levels are the context in which CMC works. However, building these relationships during implementation requires good leadership and effective change management to drive whole system change and foster trust across all practice and organisational boundaries. Trusting relationships between midwives and women were valued and triggered a commitment to provide high quality care; CMC team relationships supported improvements in ways of working and sustained practice, and relationships between midwives and providers in different care models either sustained or constrained implementation. Continuity enabled midwives to work to full skillset and across women’s care journey, which in turn changed their perspective of how they provided care and of women’s care needs. In addition to building positive relationships, visible and supportive leadership encourages engagement by ensuring midwives feel safe, valued and informed. Conclusion Leadership that builds trusting relationships across all practice and organisational boundaries develops the context for successful implementation of CMC. These relationships then become the context that enables CMC to grow and flourish. Trusting relationships, working to full skill set and across women’s care journey trigger changes in midwifery practice. Implementing and sustaining CMC within NHS organisational settings requires significant reconfiguration of services at all levels, which requires effective leadership and cannot rely solely on ground-up change.

There is a growing need and demand to redesign neonatal services to place a focus on family-centered care provided locally. Early discharge training programs that prepare parents to tube-feed and care for their preterm infant at home may offer a viable option, but these are understudied. A narrative review of relevant literature was undertaken. The key findings highlighted that within the discharge programs there was no increase in readmission rates caused through home tube-feeding, infant weight gain was adequate and parental satisfaction was reported as high when 24-hour access to staff was available. Further, an increased duration of breastfeeding was associated with a reduced risk of readmission. The review highlights the potential of this service as an alternative to in-patient care for infants requiring short-term tube-feeding during their transition to full oral-feeding.

Objective: Birth Satisfaction Scale-Revised Indicator (BSS-RI) is a short selfreport instrument designed to measure satisfaction of the childbearing women’s experiences of labour and its outcomes. The aim of this study was to examine the reliability and validity of the Persian version of BSS-RI in Iranian mothers.Methods: This cross-sectional study was conducted on 396 mothers in Tehran, Iran, between July and September 2017. The mothers were administered the BSS-RI, and a demographic questionnaire. Internal consistency of the BSS-RI was examined with Cronbach’s alpha, construct validity was evaluated via exploratory factor analysis (EFA), and divergent validity was examined by correlating the BSS-RI with gestational age.Results: The EFA results demonstrated a two-factor structure corresponding to the Stress of Childbearing and Quality of Care domains of the structure proposed by provider. The Cronbach’s alpha for Stress of Childbearing and Quality of Care subscales and total BSS-RI were 0.665, 0.847, and 0.563, respectively. The mean of BSS-RI total score was 6.16 (SD = 2.60), and the Stress of Childbearing and Quality of Care subscales were 2.71 (SD = 2.39), and 3.45 (SD = 1.11), respectively. The BSS-RI showed no significant correlation with the gestational age, confirming divergent validity.Conclusion: Like the original English version, the Persian version of the BSS-RI is a reliable and valid instrument for measuring birth satisfaction in Iranian mothers. It can also be used as short and easy to administer tool for assessment of birth satisfaction in large sample survey research.

Palliative care refers to treatment and care delivered when the disease/illness is not responsive to curative treatment. The World Health Organization defines palliative care as ‘an approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of an early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual’ (WHO 2004). Palliative care and treatment strategies can also be used to manage the side effects of intrusive treatments within curative treatment. Often associated in the mind as being related to oncology and cancer, palliative care can be delivered to people experiencing any form of life-threatening illnesses such as chronic heart failure, respiratory disease, and neurological disorders such as motor neurone disease and multiple sclerosis. Palliative care can also be distinguished from end-of-life care. In the UK end-of-life care is written into clinical pathways concerned with the final days and hours of a person’s life (DoH 2008; LCP 2008). The key aims of these care pathways are to improve quality of care of the dying in the last hours and days of life and to improve knowledge related to the process of dying.

Background In 2016, the World Health Organization (WHO) labelled 13% of the world's adult population as obese. This increase in obesity is accompanied by mortality and morbidity problems, with maternal obesity and its accompanying risk for mother and infant requiring to be carefully managed. Aim To explore childbearing women with a high BMI (>35 kg/m2) perceptions of risk and its potential impacts upon pregnancy and outcome. Method Qualitative Interpretative Phenomenological Analysis (IPA) was used to gain deeper understanding of the lived experiences of childbearing women with a BMI>35 kg/m2 and perceptions of their risk and potential pregnancy outcome. Findings One of the superordinate themes that emerged was (1) Risk or no risk, and its associated three subthemes of (1a) Emotional consequences of her risky position, (1b) Recognition of high-risk complicationsfinally sinking in, and (1c) Accepting the risk body. Recommendations for practice In general, health care professionals are uncomfortable about discussing obesity-associated risks with pregnant women. The participants in this study did not classify themselves as obese, with this absence of acknowledgement and 'risky talk' leaving participants' unaware of their obesity-associated risk. This downplaying of obesity related talk requires to be corrected, simply because women in denial will perceive no need to engage with health promotion messages. In response, directives are required to be embedded into policy and practice. Conclusion Specific training is required to teach maternity care professionals how to have difficult, sensitive conversations about obesity related risks with childbearing women with high BMI's. In addition, this risk information needs to be accompanied by relevant advice and support.

Background: Prolonged deficiency in self-care strategies puts counsellors and psychotherapists at risk of burnout and compassion fatigue. Aim: To measure associations between self-compassion, compassion fatigue, wellbeing and burnout in student counsellors and student cognitive behavioural psychotherapists. Method: A quantitative survey using four validated data collection instruments: (1) Professional Quality of Life Scale; (2) Self-Compassion Scale; (3) short Warwick and Edinburgh Mental Well-being Scale; (4) Compassion For Others scale, was used to measure relationships between self-compassion, compassion fatigue, well-being and burnout. Participants: A mixed sample of student counsellors and student cognitive behavioural psychotherapists (n = 54) in their final year of study. Results: This preliminary study shows that student counsellors and student cognitive behavioural psychotherapists who reported high on measures of self-compassion and well-being also reported less compassion fatigue and burnout. Implications for practice: Compassion fatigue and burnout are found in many modern-day, highly stressful healthcare professions. The practice of self-compassion could help student practitioners manage these symptoms and subsequently improve their professional quality of life.

Background: ‘Birth Satisfaction’ is a term that encompasses a woman’s evaluation of her birth experience. The term includes factors such as her appraisal of the quality of care she received, a personal assessment of how she coped, and her reconstructions of what happened on that particular day. Her accounts may be accurate or skewed, yet correspond with her reality of how events unfolded. Objective: To evaluate properties of an instrument designed to measure birth satisfaction in a Greek population of postnatal women. Study design: We assessed factor structure, internal consistency, divergent validity and known-groups discriminant validity of the 30-item Greek Birth Satisfaction Scale – Long Form (30-item G-BSS-LF) and its revised version the 10-item Greek-BSS-Revised (10-item-G-BSS-R), using survey data collected in Athens. Participants: A convenience sample of healthy Greek postnatal women (n = 162) aged 22–46 years who had delivered between 34 and 42 weeks’ gestation. Results: The 30-item-G-BSS-LF performed poorly in terms of factor structure. The short-form 10-item-G-BSS-R performed well in terms of measurement replication of the English equivalent version as a multidimensional instrument. The short-form 10-item-G-BSS-R comprises three subscales which measure distinct but correlated domains of: (1) quality of care provision (4 items), (2) women’s personal attributes (2 items), and (3) stress experienced during labour (4 items). Key conclusions: The 10-item-G-BSS-R is a valid and reliable multidimensional psychometric instrument for measuring birth satisfaction in Greek postnatal women.

Background The current study sought to develop a short birth satisfaction indicator utilising items from the Birth Satisfaction Scale-Revised (BSS-R) for use as a brief measure of birth satisfaction and as a possible key performance indicator for perinatal service delivery evaluation. Building on the recently developed BSS-R, the study aimed to develop a simplified version of the instrument to assess birth satisfaction easily that could work as a short evaluative measure of clinical service delivery for labour and birth that is consistent with policy documents, placing women at the centre of the birth experience. Methods The six item Birth Satisfaction Scale-Revised Indicator (BSS-RI) was embedded within the 2014 National Maternity Survey for England. A random selection of mothers who had given birth in a two week period in England were surveyed three months after the birth. Using a two-stage design and split-half dataset, exploratory factor analysis, confirmatory factor analysis, internal consistency, convergent, divergent and known-groups discriminant validity evaluation were conducted in a secondary analysis of the survey data. Results Using this large population based survey of recent mothers the short revised measure was found to comprise two distinct domains of birth satisfaction, ‘stress and emotional response to labour and birth’ and ‘quality of care’. The psychometric qualities of the tool were robust as were the indices of validity and reliability evaluated. Conclusion The BSS-RI represents a short easily administered and scored measure of women’s satisfaction with care and the experience of labour and birth. The instrument is potentially useful for researchers, service evaluation and policy makers.

Post Traumatic Stress Disorder-Post Childbirth (PTSD-PC) is a powerful pathophysiological reaction that occurs in response to experiencing a traumatic birth and affects between1-6% of women. Regardless of its trigger, PTSD-PC causes significant impairment to women’s social interactions, capacity to work, and daily life. A key symptom of PTSD-PC is re-experiencing the birth in the form of nightmares, flashbacks, continual replay, intrusive thoughts, and images. When these symptoms persist beyond ‘one month’ (DSM-V definition), a diagnosis of PTSD-PC should be considered. In full awareness that there are additional mental health problems that a childbearing woman could encounter, we have elected to focus on two of the more commonly experienced diagnoses; specifically PTSD and Post Natal Depression (PND). It is important for midwives to be able to differentiate between PTSD-PC and Post Natal Depression (PND), because diagnoses and treatments differ. Generally PND is treated with antidepressants and Cognitive Behavioural Therapy (CBT), whilst PTSD is treated with Eye Movement Desensitisation and Reprocessing (EMDR) therapy or Emotional Freedom Technique (EFT). Also, there is potential for a women to develop a dual diagnosis, with partner and family affected also. Clarity surrounding the differences between PND and PTSD are key to accessing appropriate diagnosis, referral, and treatment.

Background The 30-Item-Birth-Satisfaction-Scale (30-item-BSS) was developed to evaluate women's experiences of childbirth. Objective To thematically analyse the qualitative responses to questions comprising the 30-item BSS questionnaire, to identify whether the qualitative responses are in anyway harmonized with experiences reported within the quantitative portion of the 30-item-BSS. Study design The focus of our enquiry was the analysis of secondary data from (n = 115) completed 30-item-BSS questionnaires in which respondents provided textual comments to the quantitative questions in order to draw separate qualitative analysis of birth satisfaction. Line-by-line thematic coding was conducted to classify each written comment into a theme. Themes representing birth satisfaction were subsequently analysed using constant comparative analysis to differentiate birth satisfaction classifications that range from high to low, Exceptional, Good, Satisfactory, Unsatisfactory. Participants The completed questionnaires (30-tem-BSS) from a convenience sample of postnatal women (< 10 days postpartum) who had delivered a healthy term infant. Findings The experiences for childbirth were ultimately classified as Exceptional for 4 women, Good for 39 women, Satisfactory for 55 women, and Unsatisfactory for 17 women. Key conclusions We found that qualitative data synchronized favorably with data from the quantitative aspect of the BSS. Implications for practice Two versions of the BSS are available: (1) The psychometrically valid and reliable 10-item-BSS from which scores can be correlated with other validated measures, and (2) The 30-item-BSS designed to assess individual women's experiences prior to in-depth qualitative work. Both scales are available from the second author.

The most recent Confidential Enquiry into Maternal Deaths (CMACE, 2011) identified human errors, specifically those of midwives and obstetricians/doctors as a fundamental component in contributing to maternal death in the U.K. This paper discusses these findings and outlines a project to provide training in Maternal-Acute Illness Management (M-AIM) to final year student midwives. Contents of the program are designed to educate and simulate AIM skills and increase confidence and clinical ability in early recognition, management and referral of the acutely ill woman. An outline of the Maternal-AIM program delivered at the University of Salford (Greater Manchester, UK) is presented to illustrate how this particular institution has responded to a perceived need voiced by local midwifery leaders. It is proposed that developing this area of expertise in the education system will better prepare student midwives for contemporary midwifery practice.

Background: The NMSF (2009) reported that 74 Trusts (40%) in the UK lack expertise in delivering maternity based bereavement care. In response, 3 midwifery lecturers were issued with a small grant from NHS Scotland to devise and evaluate an interactive workbook intended to develop student midwives understanding of how to deliver high quality bereavement care. \ud Aim: To develop a workbook called - an interactive workbook to shape bereavement care for midwives in clinical practice - and evaluate it for effectiveness at delivering learning objectives developed from the literature and from prior written lesson plans.\ud Method: An evaluative audit was carried out using a scored questionnaire -Understanding Bereavement Evaluation Tool (UBET) - to gather data before and post workbook completion. The UBET was purposely designed to gather data about participants’ perceived level of learning before and post workbook completion. Participants were student midwives (n=179) in their second/third year of study on a 3 year midwifery degree program at one of 3 universities. \ud Findings: The mean pre-workbook UBET score equalled 16.04 (SD = 3.81) and post-intervention 26.45 (SD = 2.16). A significant main effect of observation point was observed (p < 0.001), with post-intervention scores considerably higher than pre-intervention.\ud Discussion: Findings demonstrate that the workbook is an effective method for teaching bereavement care to student midwives (it is available from the first author).

Purpose – The purpose of this paper is to gain insight into nurses' understandings of what constitutes suitable footwear for older people in care homes. Design/methodology/approach – An exploratory descriptive qualitative survey was carried out of 20 registered nurses employed in six Scottish care homes for older people. Data were collected using a semi-structured questionnaire that included five open-ended questions. Content analysis was used to theme footwear perceptions. Findings – Participants had several views about what encompasses safe footwear; some were erroneous. The link between inappropriate footwear and falls was recognised by 80 per cent of respondents, but some were unclear about the features that effect or inhibit safety. No UK or international standardised guidelines were identified that advise nurses about appropriate footwear for older people. Practical implications – It is unknown whether respondents represent the nurse population because findings are restricted by a small sample size. Nonetheless, the group showed variable understanding of what constitutes safe footwear for older people and links with fall prevention. Improved nurse-education about what comprises safe footwear and the links with falls prevention in older people is required. Structured guidelines to direct nurse educators about what to teach student nurses about appropriate footwear for older people may work towards reducing falls. Originality/value – No guidelines to direct nurses about appropriate footwear for older people in care homes have been written. Key points have been developed.

Objective: to explore the prevalence of birth satisfaction for childbearing women planning to birth in their home or birth centers in the United States. Examining differences in birth satisfaction of the home and birth centers; and those who birthed in a hospital using the 30-item Birth Satisfaction Scale (BSS) and the 10-item Birth Satisfaction Scale-Revised (BSS-R). Study design: a quantitative survey using the BSS and BSS-R were employed. Additional demographic data were collected using electronic linkages (Qualtrics™). Participants: a convenience sample of childbearing women (n=2229) who had planned to birth in their home or birth center from the US (United States) participated. Participants were recruited via professional and personal contacts, primarily their midwives. Results: the total 30-item BSS score mean was 128.98 (SD 16.92) and the 10-item BSS-R mean score was 31.94 (SD 6.75). Sub-scale mean scores quantified the quality of care provision, women's personal attributes, and stress experienced during labour. Satisfaction was higher for women with vaginal births compared with caesareans deliveries. In addition, satisfaction was higher for women who had both planned to deliver in a home or a birth centre, and who had actually delivered in a home or a birth center. Key conclusions: total and subscale birth satisfaction scores were positive and high for the overall sample Implications for practice: the BSS and the BSS-R provide a robust tool to quantify women's experiences of childbirth between variables such as birth types, birth settings and providers.

Backgound: Perinatal Mental Illness (PMI) is a key cause of maternalmortality and morbidity in the UK, with one goal of midwives toidentify those at risk during pregnancy. At present, the system ofpreliminary identification of existing PMI in the UK involves themidwife asking pregnant women the Whooley questions at theantenatal booking interview. Aim: To explore midwives experiencesof asking the Whooley questions with pregnant women. Method: Aqualitative interpretive study explored midwives’ (n = 8) experiencesof asking the Whooley questions in one maternity unit in England (UK).Data were gathered through semistructured interviews and analysedusing Framework Analysis (FWA). Findings: Themes and subthemesidentified included: (1) no clear understanding of purpose, (1a)discomfort when disclosure occurs, (2) feeling pressurised for time,(3) resultant dissatisfaction and frustration; (3a) lack of knowledge andhow to refer, (3b) lack of training around PMI, (3c) relying on experienceand use of intuition. Discussion: The development and evaluationof an education curriculum to prepare midwives to effectively usecase-finding instruments such as the Whooley questions to identifypregnant women at risk is required

Chronic fatigue syndrome (CFS) is a severe, systemic, acquired illness which presents with overpowering tiredness that cannot be relieved by rest and is deteriorated through physical and mental activity. Due to the window of prevalence (20–40 years), some women diagnosed with CFS become pregnant. Given that CFS targets women in their reproductive years, responsibility is placed upon midwives to educate, support and provide families with advice. To equip midwives with knowledge about CFS, the objectives of this paper are to provide an overview of: how CFS impacts on reproductive health; the effects of pregnancy on CFS symptoms; CFS-related pregnancy complications; intrapartum management of women with CFS, and postpartum recovery of women with CFS. To date, only a handful of studies have explored the relationships between CFS and childbearing, and associated complications. A greater understandings of CSF interactions with physical, psychological and social reproductive processes are required.

Quality of life measures can be used by health professionals to assess effectiveness of nutritional interventions administered to palliative care patients. Stabilizing, maintaining and attempting to increase weight in palliative care patients through the support of oral feeding, and provision of artificial feeding, has been shown to mediate the metabolic and physical wasting effects of the disease process and improve general comfort. A quality of life instrument is a multi-dimensional questionnaire that health professionals can use to measure domains relating to physical, psychological and social aspects of living, and health and disease outcomes. There are three instruments specifically designed to assess quality of life in patients receiving palliative care. These are: The Palliative Care Quality of life Instrument, The Assessment of Quality of Life at the End of Life (AQEL), and The Spitzer Quality of Life Index (SQLI). General use quality of life measures are multifaceted; however, for use with palliative care patients, they have added dimensions of spirituality, existential issues (purpose and meaning of life), family members' perceptions of quality of care, symptom control and family support. Use of quality of life scales provides health professionals and organizations with an ideal measure for planning, targeting and evaluating health interventions.

Midwives are required to develop effective and constructive communication skills for use within the workplace. When a student is on placement, the Nursing and Midwifery Council (NMC) essential skills clusters for care, compassion and communication are the first skills students are required to demonstrate to their mentor. Communication is an idiom that both students and staff sometimes find difficult to assimilate, with communication problems identified in vague terms. Accordingly, methods of clearly defining and assessing attainment are commonly requested of midwifery lecturers. To facilitate students, midwives, managers and lecturers with an instrument to assess good communication, the technique of transactional analysis (TA) is proposed.

A demographic survey of London sex-workers established age, nationality, alcohol/drug use, physical/mental health concerns and whether trafficked or optionally migrated into the industry. There are overt differences between sex-workers—implications for police, health and social workers are that welfare services tailor care to meet individual needs within this population.

AIM: While contraceptive methods increased in number the number of abortions has remained stable. The aim of this study was to estimate the satisfaction of women toward a contraceptive implant (Implanon((R))) available in France in order to clarify prescription. METHOD: The survey concerned 127 women who visited Angers and Nantes family planning centres between January2009 and January2010 in two implant prescription contexts (postabortion or not). They agreed to answer a first questionnaire describing the reasons for their choice. A second questionnaire was sent six months after to assess its tolerance. RESULTS: In our study 82% of patients were using a contraceptive method prior to implant (68% in postabortion and 88% in the other group). The first reason for choosing the implant was the fear of forgetting - it was more important in the postabortion group (88% vs. 61%). The main side effects were amenorrhea (50%) weight gain (30%) and mood disorders (19%). More than one in two women (54%) was very satisfied by the implant. It should be noted that in one quarter of cases women seek early withdrawal of the contraceptive implant (23% in postabortion and 21% in the other group) a rate that is 39% in patients under 25years and 47% in patients who reported a mood disorder. CONCLUSION: There is a tendency to better tolerance of the implant out of a context of abortion. Furthermore mood disorders appear to be poorly tolerated. These elements encourage greater caution in prescribing the contraceptive implant in postabortion situation in which patients have already psychological disorders and even more among younger patients. Copyright (c) 2010 Elsevier Masson SAS. All rights reserved.

The aim was to develop a scale—the Birth Participation Scale (BPS)—which midwives can use to measure fathers' attitudes and needs in relation to birth participation. The objectives were to use the BPS to: detect whether fathers genuinely want to be present at the birth; identify localized perceptions and fears fathers may have about birth participation; and ascertain whether being present at the birth was a rewarding experience. A quantitative survey was carried out with data collected from York District Hospital Maternity Unit (UK). The participants were a stratified sample of first-time (n= 42) and second-time fathers (n= 36). Measurements and findings: the BPS was issued at two observation points: prior to birth participation and post birth participation. Difference in scores between conditions assessed the fathers' attitudes towards birth participation in a positive or negative direction. Scores post birth showed a small shift in attitude in a positive direction for first-time (p= 0.01) and second-time fathers (p= 0.02) with only 4% finding birth partnering more difficult than they had anticipated. Key conclusions are that midwives are facilitating the majority of fathers towards a positive birth experience. Implications for practice are that the BPS may prove useful for: identifying whether fathers genuinely want to be present at the birth; ascertaining fathers' personal concerns in relation to birth participation; and tailoring birth preparation to meet fathers individualized needs.

Summary Background: Equipping student midwives with confidence to deliver bereavement care to childbearing women is a challenge for midwifery lecturers. Objective: To explore qualitative data provided by student midwives who evaluated the workbook Bereavement care for childbearing women and their families (Hollins Martin & Forrest, 2013) to explore their views of potential teaching strategies that could build their confidence to deliver real bereavement care. Method: An exploratory qualitative thematic analysis was used to provide, analyse and report themes identified within data collected in a prior study. Participants: Participants were student midwives (n=179) in their second/third year of a midwifery degree program at 1 of 3 universities in the UK were included in the study. Data collection/analysis: Data to evaluate effectiveness of the bereavement workbook as a teaching method was collected using a survey instrument. It was the comments written under questions by participants that were analysed in the present study. Findings: Three themes emerged: (1) increasing classroom interaction, (2) the importance of reflecting on emotions, and (3) need for experience. Discussion: Although this study has addressed delivery of education that relates to midwives, the findings are cross transferable to other healthcare educators, practitioners, and students. Several solutions are proposed that could potentially build student confidence to deliver bereavement care: lecturers should (1) encourage group discussion in the classroom to help build student confidence to emotionally cope during real bereavement events; (2) ensure students gain exposure by encouraging qualified midwives to include them in real bereavement events early on in their training, and (3) develop packages of perinatal bereavement scenarios for simulation and rehearsal in the clinical skills laboratory. Post-implementation, it is recommended that these teaching strategies be evaluated.

The document Changing Childbirth produced by the Department of Health (1993) requests provision of more choice, continuity and control for women during pregnancy and childbirth. In this context this study considers whether midwives'decisions are influenced by a senior midwife. A simple, valid and reliable scale—the Social Influence Scale for Midwifery (SIS-M)—was devised to measure and score midwives' private anonymous responses to 10 clinical decisions. The SIS-M was initially administered as a self-completed postal survey by 209 midwives. Following a 9-month time gap, a stratified sample of 60 (20 E, F, G grade midwives) were invited for interview in which a senior midwife attempted to influence SIS-M responses in a conformist direction. Overall, a 3 × 2 (E, F, G grade midwives x private and interview SIS-M scores) analysis of variance (ANOVA) revealed midwives were significantly more conformist when influenced by a senior midwife, in comparison to private anonymous responses. No significant interaction between groups was found. These findings indicate that there is influence of a senior midwife on clinical decisions that should be woman-centred, according to Changing Childbirth (1993). The implication is that this influence may remove choice from women.

Background: female genital mutilation/cutting (FGM/C) is the procedure of removing healthy external genitalia from girls/women for socio-cultural reasons. There is much scientific literature on the adverse physical health complications that can result from having FGM/C, but little is known about its psychological impact and treatment. Objective: to identify psychological problems that may follow from a woman having FGM/C and success of treatment herein, and relate findings to the role of the maternity care professional.Study design: a structured narrative review, which identified 10 studies, was carried out.Findings: eight of ten studies reported psychological consequences, such as post-traumatic stress disorder (PTSD) and affective disorders. Also identified were socio-cultural differences in the meaning of perceived consequences for different individuals. Two studies reported inconclusive results regarding the psychological impact of FGM/C on women’s lives.Key conclusion: while these findings provide an indication of adverse psychological effects of women/girls having FGM/C, more studies are needed. In particular, studies that focus on the role that cutting extent, circumstances surrounding the cutting, and girls’ level of knowledge of what was going to take place, and their relationships to psychological outcomes.Implications for practice:raising awareness of the risk of negative psychological consequences is important, with maternal health care professionals requiring training on how to treat and care for women/girls who are suffering problems that result from having FGM/C.

Objective: To assess factor structure, validity and reliability of the Birth Satisfaction Scale (BSS) and to develop a short-form version of the tool. Design: A quantitative design focused on evaluating psychometric properties of the BSS using factor structure, internal consistency, divergent reliability and known groups validity. Setting: Ayrshire Maternity Unit community midwife bases that serve the obstetric population of Ayrshire, Scotland (UK). Participants: A convenience sample of healthy women (n=228)

Therapeutic effects of music are well recognised within the literature, with benefits for a variety of health problems documented. This narrative review summarises benefits in terms of reducing stress, anxiety, labour pain and depression in childbearing women. For neonates, music has been shown to reduce number of days to discharge, reduce pain response behaviours, increase weight gain, improve Brazelton scores, improve parent/infant intimacy, improve oxygen saturation, increase formula intake, stabilize vital signs and increase parental reports of calmed infants. The main criticism of the studies reviewed is lack of categorisation of the particulars of the variables within the music that directly influenced outcome variables. A recommendation is made that a music package be developed and relationships with variables rigorously evaluated. The validated product may then be made available for use. Since evidence supports advantages from listening to music, it is suggested that maternity professionals use it in more creative ways.

This paper addresses the issue of social attitudes. The purpose is to facilitate understanding of attitude structures and the application of this knowledge to midwifery practice. Attitudes have been defined and their development within individuals described. The above information has been applied to midwifery practice emphasizing the issue of respect for a client's attitudes and opinions which may differ considerably from our own. Attitude change has been addressed in relation to helping women change behaviours which promote obstetric damage. An explanation has been given to assist midwives’ understanding of why women continue with damaging behaviour.

The reproductive cycle in women is complex and can be considered to begin with epigenetic programming and ending with menopause. Intervening steps involve a variety of processes, including the cellular development of the sex organs, menarche, episodic endocrine cycles, menstruation, ovulation and conception. These processes can be influenced by diet and nutrition and vice versa. Body composition has an impact on the menstrual cycle and periconception and these factors in turn also influence body composition. Similarly, either food deprivation, dietary excess or obesity can result in marked changes in the menstrual cycle with a concomitant effect on fertility. This handbook is the first scientific source that provides a comprehensive overview of the relationship of diet and nutrition with puberty, menarche and menstrual cycle, conception and fertility and infertility. The handbook of diet and nutrition in the menstrual cycle, conception and fertility will benefit dieticians, nutritionists, gynaecologists, endocrinologists, obstetricians, paediatricians and those concerned with women's health in general.

The objective was to explore young mothers’ experiences of seeking and accessing health services, specifically maternity care. Study design: a phenomenological approach underpinned by the work of Husserl and guided by the framework offered by Giorgi. Participants: a purposive sample of seven young mothers took part in audio-recorded unstructured interviews in either the young mother’s home or in a private room at their GP practice. Findings: six themes emerged from the initial thematic analysis: (1) feeling abandoned, (2) information is vital, (3) feeling judged, (4) family and friends, (5) interference, (6) younger mothers need additional support. After ‘bracketing’ the preconceptions evident in the initial analysis, essential themes describing the young mothers’ experience of accessing healthcare were identified: (1) the need for support and information; (2) fear of stigmatisation and stigmatisation of self. Conclusions: the young mothers in this study experienced a need for support and information, which reflects the findings of previous studies. This study has added to the knowledge base as it also found that these young mothers were hindered from obtaining or making use of available support and information through fear or expectation of stigmatisation and self-stigmatisation. There is a need to improve availability of support and information for young mothers, who may benefit from one-to-one education to help them gain confidence to deal with pregnancy and parenthood issues. Further research on young mothers’ perceptions of maternity service provision will advance understanding of young mothers’ help and support needs during pregnancy, birth and the postnatal period.

Background: Interprofessional Learning (IPL) is an educational process intended to equip health and social care students with appropriate knowledge, skills, and attitudes for effective interprofessional working. By and large, the literature review highlighted in this article has shown that IPL is a worthwhile pursuit, with some studies highlighting conflicts over best teaching methods to use. In response, the aim of this exploratory research was to improve understandings of teaching strategies perceived by IPL lecturers to enhance students' formulation of multidisciplinary roles.Methods: An exploratory qualitative study was carried out. Semi-structured interviews were conducted, with a purposive sample of 4 consenting IPL lecturers. The objectives of the study were to extend understandings of strategies believed to enhance or inhibit students' accurate assimilation of Allied Health Professional (AHP) roles, to nurture awareness of potential obstacles that may inhibit successful delivery of IPL, to promote insight into what constitutes quality delivery of IPL, and to identify potential topics for further research.Findings: Five themes emerged from the data: (1) IPL lecturers hold contrasting viewpoints about the need for IPL; (2) improved understanding of roles is directly proportional to time spent with AHPs; (3) perspectives differ about when and where IPL should be taught; (4) stereotyping and negative attitudes inhibit accurate role construction; and (5) positive role modelling by lecturers is important.Conclusions: This article acts in a conscience-raising manner and highlights five key areas of lecturers' understandings about how to effectively deliver IPL. This nurtured awareness will be used to develop and evaluate new implementations in IPL and education.

Women in western countries generally lie semi-recumbent during first stage of labour, when perhaps it is more natural to move around. Consequently carers are unaware of what constitutes instinctive behaviours and their outcomes. With this in mind, a structured narrative review of the literature identified what prior research has shown about the impact of maternal movement upon length of first stage; results are ambiguous, with 11 studies reporting no alteration to length and 7 reporting shortening. These studies fail to adequately detail time spent mobilising and what in fact constituted walking, squatting, upright, lying lateral, supine or semi-recumbent, and their direct effects upon progress of first stage. Advancements in knowledge are required to progress understanding about maternal activity during labour and its outcomes.

Nutrition and Diet in Menopause is a single comprehensive source that will provide readers with an understanding of menopause. Holistic in its approach, this volume is divided into five sections covering psychological, endocrine and lifestyle factors, metabolism and physiology, bone and nutrition, cancer and nutrition, cardiovascular factors and dietary supplements in menopause. In-depth chapters review the potential long term consequences of menopause on the overall health of women, not only at the physical level including hot flushes (flashes), alterations to the genitourinary system, skin changes, decreased cardiovascular functions, hypertension, headache, back pain, and constipation. Written by international leaders and trendsetters, Nutrition and Diet in Menopause is essential reading for endocrinologists, cardiologists, nutritionists and all health care professionals who are interested in women’s health.

Background This paper reports original research that embraces childbearing women's views about the importance of education in preparation for childbirth. A survey was carried out using the Birth Satisfaction Scale developed by Hollins Martin and Fleming (2011). All of the items in the questionnaire include a space where the women can add their own comments to allow them to document what is important to them. This paper reports the analysis of this qualitative data. Methods The qualitative data collected in the survey was analysed using Braun and Clarke's (2006) method for undertaking a thematic analysis. Participants Participants were a convenience sample of postnatal women from a maternity unit in the West of Scotland (UK) ( n = 228) who had an uncomplicated pregnancy at term (37–42 weeks). Those with a medical diagnosis, poor obstetric history, prematurity ( 42 weeks), younger than ( 50) of age, had a history of stillbirth, perinatal or neonatal death were excluded from participating in the study. Results Three themes emerged from the data: ‘Better to be prepared', ‘Prepared through previous experience' and ‘In labour nothing goes to plan'. Conclusion The participants in this study were variable in their reports about the importance of education in preparation for childbirth, with some clearly presenting a perception of no need. For the midwife, importance lies in providing women with educational opportunities and choice and control in relation to uptake. Recommendations Women may perceive more value in education when they evaluate it as critical to their outcomes. For example, providing information about: (a) how to identify risk factors before and after birth, (b) strategies that can work towards improving maternal and fetal health, (c) how to improve fetal growth and wellbeing, (d) how to improve nutritional and dietary status, (e) optimising pregnancy outcomes. In relation to delivery of education, midwives require to make purpose and links clear.

Background and aim: measuring women’s satisfaction with their birth experience has been problematic. Recently, an attempt has been made to capture birth satisfaction’s generalised meaning and incorporate it into an evidenced-based tool. Standard procedures for validation have limitations. Qualitative techniques such as domain analysis offer an alternative and assist in better understanding the importance of each item. This article examines the parsimony of the Birth Satisfaction Scale (BSS), which is a 30-item questionnaire designed to measure satisfaction with childbirth, with women’s actual experience of childbirth. Methods: primary free text data collected from 207 women who originally tested the BSS was concurrently analysed with first-hand accounts of birth satisfaction collected from 19 qualitative papers. Results: the domain analysis confirmed three explanatory items within the BSS: ‘being in control’, ‘things going as planned’, and ‘being supported’. Conclusions: the BSS accounts for all the analysed data, suggesting it is a robust measure of satisfaction in childbirth. Strengths and limitations of the method are discussed, as are implications for practice. With further development, the instrument could be used to establish correlates with other psychometric measures, i.e. self-efficacy, anxiety, depression, locus of control and bonding; and evaluate models or care systems as a standalone instrument, or as a screening test prior to detailed qualitative work.

Background: the NMSF (2009) survey reported that bereavement midwife care was inadequate in a numberof UK NHS Trusts. Using a small grant from the Scottish government, 3 experienced midwifery lecturers designed an interactive workbook called “shaping bereavement care for midwives in clinical practice” for the purpose of improving delivery of bereavement education to student midwives. An instrument called the understanding bereavement evaluation tool (UBET) was designed to measure effectiveness of the workbook at equipping students with essential knowledge.Aim: to assess validity and reliability of the UBET at measuring midwives' self-perceptions of knowledge surrounding delivery of bereavement care to childbearing women, partners and families who have experiencedchildbirth related bereavement.Method: an evaluative audit using the UBET was undertaken to explore student midwives' (n=179) self perceived knowledge levels before and after the workbook intervention. Validity tests have shown that theUBET, (6-item version), could be considered a psychometrically robust instrument for assessing students'knowledge gain. PCA identified that the UBET comprised two sub-scales (theoretical knowledge base — Q 1,2 & 3 and psychosocial elements of care delivery — Q 4, 5 & 6).Discussion: data has shown that the easy to administer and short 6-item UBET is a valid and reliable tool foreducators to measure success at delivering education using the “shaping bereavement care for midwives inclinical practice” work book.

At present in Yemen the neonatal mortality rate stands at 12%. A contributing factor is that when abnormalities arise during labour in rural areas, there is an absence of trained medical staff to manage complications. Consequently, childbearing women are expected to travel long distances to hospitals to receive Essential Obstetric Care (EOC). This paper presents a debate over whether vacuum delivery should be introduced into the education curriculum of community midwifery courses in Yemen. It is proposed that this fundamental change to both the educational system and the community midwives role could facilitate a reduction in maternal and neonatal mortality and morbidity figures in Yemen.

At present there is lack of information about CMV transmission given to midwives, general practitioners, neonatal pediatricians and nurses, with intrauterine transmission having profound consequences in terms of outcomes for the infected neonate. To identify one particular group of midwives knowledge about CMV, the research question surveyed midwives' knowledge of CMV. A quantitative electronic survey was the research method utilized in this study. To assess midwives knowledge about CMV, the first author emailed colleagues in Hannover and was in receipt of 40 completed questionnaires. Results showed that midwives have gaps in their knowledge about CMV and that an educational program is necessary to enlarge their understandings. Given the catastrophic consequences to the neonate of contracting congenital CMV, it is imperative that both health care professionals and women receive the educational message about prevention. In response an education program for lecturers has been proposed, which consists of eleven learning objectives.

Background This paper reports original research on choice and control in childbirth. Eight women were interviewed as part of a wider investigation into locus of control in women with pre-labour rupture of membranes at term (PROM) [1]. Methods The following study uses concurrent analysis to sample and analyse narrative aspects of relevant literature along with these interviews in order to synthesise a generalisable analysis of the pertinent issues. The original PROM study had found that women experienced a higher degree of control in hospital, a finding that appeared at odds with contemporary notions of choice. However, this paper contextualises this finding by presenting narratives that lucidly subscribe to the dominant discourse of hospital as the safest place to give birth, under the premise of assuring a live healthy baby irrespective of their management type. Results This complex narrative is composed of the following themes: 'perceiving risk', 'being prepared', 'reflecting on experience', maintaining control' and relinquishing control'. These themes are constructed within and around the medical, foetocentric, risk averse cultural context. Primary data are presented throughout to show the origins and interconnected nature of these themes. Conclusions Within this context it is clear that there is a highly valued role for competent health professionals that respect, understand and are capable of facilitating genuine choice for women.

PurposeThe purpose of this paper is to develop a psychometric scale – the birth satisfaction scale (BSS) – for assessing women's birth perceptions.Design/methodology/approachLiterature review and transcribed research‐based perceived birth satisfaction and dissatisfaction expression statements were converted into a scored questionnaire.FindingsThree overarching themes were identified: service provision (home assessment, birth environment, support, relationships with health care professionals); personal attributes (ability to cope during labour, feeling in control, childbirth preparation, relationship with baby); and stress experienced during labour (distress, obstetric injuries, receiving sufficient medical care, obstetric intervention, pain, long labour and baby's health).Research limitations/implicationsWomen construct their birth experience differently. Views are directed by personal beliefs, reactions, emotions and reflections, which alter in relation to mood, humour, disposition, frame of mind and company kept. Nevertheless, healthcare professionals can use BSS to assess women's birth satisfaction and dissatisfaction. Scores measure their service quality experiences.Social implicationsScores provide a global measure of care that women perceived they received during labour.Originality/valueFinding out more about what causes birth satisfaction and dissatisfaction helps maternity care professionals improve intra‐natal care standards and allocate resources effectively. An attempt has been made to capture birth satisfaction's generalised meaning and incorporate it into an evidence‐based measuring tool.

The aim of this article is to relate basic findings from research papers to identify the effects that valsalva manoeuvre (‘purple pushing’) has upon maternal and fetal wellbeing. Analysis of 16 papers revealed four main consequences from purple pushing. These include: an increase in fetal distress; maternal distress; and perineal trauma, when compared with spontaneous pushing. Valsalva manoeuvre also makes little difference to length of second stage. Key conclusions from this literature review are that women should be encouraged to push instinctively, which often embraces natural vocalization. Restrictions of time should not be imposed when mother and fetus are well. Awaiting instinctive behaviour reduces the incidence of urinary system, pelvic floor and perineal trauma. These findings should facilitate midwives to critically understand research that underpins the Royal College of Midwives (2007) second stage of labour guidelines.

If women are to be empowered to make choices for childbirth, it is important that midwives explore and discuss their wishes and feelings about the delivery options available. Providing practical and sensible information should facilitate women with constructing a more accurate picture from which realistic hopes, fears and expectations can be formulated about impending labour. To facilitate midwives with this process, a flexible framework for a birth plan has been proposed. This easy to complete template can be used to assist childbearing women with assimilating their ambitions and desires regarding labour. Birth planning is important, since studies that compare women's expectations of childbirth with actual experience present contrasting accounts, with disappointment, guilt and failure compared with delight, pride and success. Since experiences differ it is recommended that midwives audit birth satisfaction against women's birth plans. Results would inform auditors of whether there is satisfaction with a woman's birth experience and the quality of care that she perceived she received. Women's articulated wishes about birth would facilitate understanding of why satisfaction/dissatisfaction occurs.

PurposeWithin maternity hospitals midwives are expected to follow the protocol‐driven culture and orders issued by senior staff. Simultaneously, midwives are expected to follow social policy documents and the Midwives Rules and Standards that advocate choice provision for childbearing women. Quality assurors and auditors of clinical practice need to be aware that these two directives sometimes clash. Allegiance to a hierarchical system driven by protocols and orders from the top down, at the same time as providing “woman‐centred” care is often unattainable. In order for a midwife to action the woman's choice, resourceful thinking may be required. This paper aims to examine this issue.Design/ methodology/approachA descriptive interview study set out to discover strategies which midwives use to resolve conflict produced from competing directives. An appraisal of 20 midwives' views were gained from semi‐structured interviews conducted in seven maternity units in the UK. Taking a post‐positivist approach, inductive thematic analysis was used to interpret the data.FindingsThree main categories represented resourceful ways of pleasing both authority and the childbearing woman. Midwives occasionally: are economical with the truth; circumvent face‐to‐face confrontation with senior staff; and persuade women to refuse what they perceive are unnecessary and invasive interventions.Originality/valueThis paper offers unique insights into methods that midwives use to resolve conflicts in direction issued by management. It is important that auditors are aware that midwives sometimes struggle to support the preferences of healthy childbearing women. This reduces job satisfaction, delivery of care and consequently requires address.

Background: ‘Birth satisfaction’ is important since experience of labour can influence women’s post-natal adjustment. Objective: To explore: (1) childbearing women’s experiences of ‘birth satisfaction’ and (2) identify contexts in which it is more appropriate to use the 30-item Birth Satisfaction Scale (BSS) or the 10-item BSS-Revised (BSS-R). Study design: A quantitative survey was conducted using the 30-item BSS. As a function of completing the 30-item BSS, participants also completed the short-form 10-item BSS-R. Participants: A convenience sample of post-natal women (n=228) attending for National Health Service (NHS) care at the Ayrshire Maternity Unit in the West of Scotland (UK) participated. Participants were within their first 10 post-natal days. Results: The 30-item BSS mean scores = 115.84 (SD 14.05). The thematically determined subscale mean scores of quality of care provision (BSS-QC; 8-items), women’s personal attributes (BSS-WA; 8-items) and stress experienced during labour (BSS-SL;14-items) subscales, were 32.2 (4.09), 31.9 (4.16) and 51.73 (8.04) respectively. Women experienced greater ‘birth satisfaction’ when they had a Spontaneous Vertex Delivery compared with a complicated delivery. Primigravidas were generally less ‘birth satisfied’ than multiparous women. Key conclusions: Overall assessment of care was complimentary, with g lobal levels of ‘birth satisfaction’ generally high. In response to psychometric tests, the 30-item BSS has been trimmed down to a statistically robust, valid and reliable 10-item BSS-R. Implications for practice: Now that a valid and reliable 10-item BSS has been developed to measure women’s experiences of childbirth, it can be used to assess differences between variables such as home and hospital birth, or to establish correlates with other valid measures. We advance our study as an important contribution to person-centered maternal healthcare.