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Having a baby is one of the most profound events in a woman and couple’s life. For the woman, it is intensely physical as her body responds to the changing hormones and all body systems accommodate her growing fetus. For the couple, it marks a significant change in roles and in the relationship. While practices vary across cultures, as a society we recognize the importance of this event with rites of passage like for example “baby showers. ”In other words, having a baby is as much social as it is physical.

BACKGROUNDStress 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.METHODOLOGYThis 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).RESULTSWhile 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.CONCLUSIONThe 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.

Background: Emancipation and self-determination are critical elements of midwifery care and therefore should be explicit in midwifery education. If not, the woman-centred midwife with her trust in women and birth may become a thing of the past, and the patriarchal, technocratic medical model of maternity care, with its trust in machines and misguided interventions will continue to dominate childbearing practices. The optimal time for exposure to feminist principles within the midwifery educational journey, however, is unknown, despite recognition that teaching feminist theory and related concepts positively impacts the way students value women centredness in midwifery practice. Objective: To understand midwifery student's perspectives of assimilating feminist theory and midwifery philosophy. Design: A qualitative approach using reflective journals was used to explore student midwives understanding of midwifery as a feminist profession. Setting: One regional Australian University that teaches midwifery at two campuses, one of which straddles a state border. Participants: First session, first-year midwifery students undertaking a unit of study focusing on “what is midwifery” and how at its core, midwifery is a feminist emancipatory political discipline. Methods: Data from weekly reflective journals were analysed to produce themes. Findings: Three themes were identified ‘Midwifery: Past and Present’, ‘What is this ‘F’ word? – feminism revisited’, and ‘Midwifery-feminism dyads’. These themes demonstrated transformative learning had occurred as participants appeared to value understanding feminism as the essence of midwifery philosophy early in their midwifery studies. Conclusion: Students embarking on their journey appear to value assimilation of feminist theory as a core tenet of midwifery philosophy. Feminist principles, particularly the protection of women's rights to informed choice, trusted relationships, dignity, and control throughout their childbearing journey appear to illustrate the emancipatory nature, and importance of, truly ‘woman-centred, partnership-based midwifery care’. Recommendations for practice and further research: Whilst the findings of this study relate to midwifery students, the findings point to a need to explore ways to strengthen midwives' assimilation with feminist theory, and their ability to promote feminism and provide woman-centred, partnership-based approaches. Refereed/Peer-reviewed

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. Refereed/Peer-reviewed

Objective: To examine and summarise available literature on maternity care practitioners having experienced primary trauma during their childbirthing journey and whether this impacts their mental well-being and/or care provision when subsequently caring for childbearing women. Background: Birth trauma affects 1 in 3 women; 1 in 20 women show post-traumatic stress disorder symptoms by 12 weeks after birth. However, what is not known is what percentage of these women are maternity care providers experiencing or having experienced personal trauma during their child birthing journey. This scoping review aims to examine and summarise available literature on maternity care practitioners having experienced primary trauma during their childbirthing journey and whether this impacts their mental well-being and/or care provision when subsequently caring for childbearing women. Methods: Arksey and O'Malley (2005) six-stage scoping review framework was revised and utilised. A search of the relevant databases (MEDLINE Embase, CINAHL, APA PsycInfo, Scopus) was undertaken with several keywords related to trauma and personal experience. Reference lists were also searched of studies identified for reading the full text. Findings: The search strategy identified 2983 articles. The studies excluded were considered to be unrelated to the topic directly. A total of 352 articles were reviewed by abstract, and 29 additional studies were identified from reference lists; 32 were reviewed by full text. A total of 0 studies met the inclusion criteria for the scoping review. Conclusions and implications for practice: The scoping review identified a gap in the literature as maternity care practitioners personal experience of trauma during the child birthing journey has not been researched. Research is needed to explore and conceptualise the experiences of maternity care practitioners having experienced trauma and the ongoing implications this may have on their personal and professional lives. Refereed/Peer-reviewed

Background A key element in the provision of safe and competent midwifery care is how learning experiences are construed and translated into practice. This process can be supported through clinical/professional mentoring. What constitutes ‘good mentorship’ has been the topic of much debate. While research exploring mentorship exists, there is less research exploring co-created perceptions of mentorship by the mentee and mentor. Objectives To explore student and registered midwives' co-created perspectives of what matters, what is valued and what is important in mentorship. Design An adapted Appreciative Inquiry methodology guided this study with thematic analysis used for data analysis. Settings One regional Australian university. Participants A convenience sampling, from a population of 39 third-year Bachelor of midwifery students and 39 registered midwives providing clinical supervision for students enrolled in a specific unit of study and concurrently undertaking midwifery practice experience were recruited into this study. Methods Following the four-step process of Appreciative Inquiry; Appreciate, Envision, Co-create and Embed, imagery cards were provided, and participants selected the image that resonated with their understanding of mentorship. Shared understandings were cultivated to co-create what worked well and what was valued in facilitating a positive learning experience. Results Trust developed over time is a valued component of mentorship relationships. Similarly valued is the sense of belonging and feeling safe, elements reliant on the establishment of effective and respectful communication. Conclusion What matters, what is valued and what is important in midwifery mentorship is a mutually respectful relationship between mentee and mentor. This requires time and trust and the creation of a space where the student can develop a sense of professional belonging and feel safe to learn. Further research is needed to explore ways to co-create safe learning environments. Appreciative Inquiry is a method suited to studying this area.

This chapter explores the aim of facilitating the midwife to provide information when engaging in a shared decision-making approach with women. Stress urinary incontinence (SUI) is defined as the involuntary loss of urine on effort or physical exertion, or on sneezing or coughing. For women around the world, SUI is more common than urgency incontinence. Approximately 80% of pregnant women, primigravidae and multigravidae, experience increased micturition frequency at some time during pregnancy. In general, incontinence in women is typically related to dysfunction of the bladder or pelvic floor muscles. Such dysfunction often arises during pregnancy or childbirth, or during menopause. A model of decision-making that might help facilitate this is the Three-Talk Model for Shared Decision-Making. Women need to be the final decision-makers in their care, and to enable these midwives need to engage in shared decision-making and provide evidence-informed information so an informed choice can be made.

© 2018 Wiley Periodicals, Inc. 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.

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 dataset with the original UK dataset 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 tri-dimensional 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.

Background: clinical reasoning was once thought to be the exclusive domain of medicine – setting it apart from ‘non-scientific’ occupations like midwifery. Poor assessment, clinical reasoning and decision-making skills are well known contributors to adverse outcomes in maternity care. Midwifery decision-making models share a common deficit: they are insufficiently detailed to guide reasoning processes for midwives in practice. For these reasons we wanted to explore if midwives actively engaged in clinical reasoning processes within their clinical practice and if so to what extent. The study was conducted using post structural, feminist methodology. Question: to what extent do midwives engage in clinical reasoning processes when making decisions in the second stage labour? Methods: twenty-six practising midwives were interviewed. Feminist interpretive analysis was conducted by two researchers guided by the steps of a model of clinical reasoning process. Six narratives were excluded from analysis because they did not sufficiently address the research question. The midwives narratives were prepared via data reduction. A theoretically informed analysis and interpretation was conducted. Findings: using a feminist, interpretive approach we created a model of midwifery clinical reasoning grounded in the literature and consistent with the data. Thirteen of the 20 participant narratives demonstrate analytical clinical reasoning abilities but only nine completed the process and implemented the decision. Seven midwives used non-analytical decision-making without adequately checking against assessment data. Conclusion: over half of the participants demonstrated the ability to use clinical reasoning skills. Less than half of the midwives demonstrated clinical reasoning as their way of making decisions. The new model of Midwifery Clinical Reasoning includes ‘intuition’ as a valued way of knowing. Using intuition, however, should not replace clinical reasoning which promotes through decision-making that can be made transparent and be consensually validated. Refereed/Peer-reviewed

What are the strengths and limitations of existing Decision-Making Theories as a basis for guiding best practice clinical decision-making within a framework of midwifery philosophy? Each theory is compared in relation with how well they provide a teachable framework for midwifery clinical reasoning that is consistent with midwifery philosophy. Hypothetico-Deductive Theory, from which medical clinical reasoning is based; intuitive decision-making; Dual Processing Theory; The International Confederation of Midwives Clinical Decision-Making Framework; Australian Nursing and Midwifery Council Midwifery Practice Decisions Flowchart and Midwifery Practice. Best practice midwifery clinical Decision-Making Theory needs to give guidance about: (i) effective use of cognitive reasoning processes; (ii) how to include contextual and emotional factors; (iii) how to include the interests of the baby as an integral part of the woman; (iv) decision-making in partnership with woman; and (v) how to recognize/respond to clinical situations outside the midwife's legal/personal scope of practice. No existing Decision-Making Theory meets the needs of midwifery. Medical clinical reasoning has a good contribution to make in terms of cognitive reasoning processes. Two limitations of medical clinical reasoning are its reductionistic focus and privileging of reason to the exclusion of emotional and contextual factors. Hypothetico-deductive clinical reasoning is a necessary but insufficient condition for best practice clinical decision-making in midwifery.

Summary Background Clinical decision-making was initially studied in medicine where hypothetico-deductive reasoning is the model for decision-making. The nursing perspective on clinical decision-making has largely been shaped by Patricia Benner's ground breaking work. Benner claimed expert nurses use humanistic-intuitive ways of making clinical decisions rather than the ‘rational reasoning’ as claimed by medicine. Clinical decision-making in midwifery is not the same as either nursing or medical decision-making because of the woman–midwife partnership where the woman is the ultimate decision-maker. Method CINHAL, Medline and Cochrane databases were systematically searched using key words derived from the guiding question. A review of the decision-making research literature in midwifery was undertaken where studies were published in English. The selection criteria for papers were: only research papers of direct relevance to the guiding research question were included in the review. Findings Decision-making is under-researched in midwifery and more specifically birth, as only 4 research articles met the inclusion criteria in this review. Three of the studies involved qualified midwives, and one involved student midwives. Two studies were undertaken in England, one in Scotland and one in Sweden. The major findings synthesised from this review, are that; (1) midwifery decision-making during birth is socially negotiated involving hierarchies of surveillance and control; (2) the role of the woman in shared decision-making during birth has not been explored by midwifery research; (3) clinical decision-making encompasses clinical reasoning as essential but not sufficient for midwives to actually implement their preferred decision. Conclusion We argue that existing research does not inform the discipline of the complexity of midwifery clinical decision-making during birth. A well-designed study would involve investigating the clinical reasoning skills of the midwife, her relationship with the woman, the context of the particular birthing unit and the employment status of the midwife. The role of the woman as decision-maker in her own care during birth also needs careful research attention.

No good evidence exists to support the practice of routinely checking for the nuchal cord, yet it is a common medical intervention in birth. Some evidence shows damage to the baby because the practice more frequently leads to premature cord-cutting and the vaginal examination, required by such routine checking, may be physically and/or emotionally damaging to the women. Our objective was to learn what training midwives have received and what their current practice is in relation to a possible nuchal cord at birth?Questions about nuchal cord at birth were posted to two online midwifery discussion forums and responses were invited. Twenty-six midwives from 10 countries responded to questions on nuchal cord practices.The teaching and practice of routinely checking for the nuchal cord at birth is widespread, according to at least some participants from all 10 countries. Other midwives from the same countries argued that, although they were aware that the procedure is the dominant midwifery practice, many midwives neither teach it nor perform it routinely.In the absence ofclear evidence, firmly entrenched positions are being argued for and against routine checking. The debate is infused with high emotion. Those arguing for routine checking cite safety for the baby as their main concern. Those arguing against checking cite the need to keep birth normal and the well-being of the baby as their primary concerns. There is a need to reconsider how the possibility of nuchal cord at birth should be conceptualised from a midwifery perspective to ensure woman-centred decision-making.

Background The ability to act on and justify clinical decisions as autonomous accountable midwifery practitioners, is encompassed within many international regulatory frameworks, yet decision-making within midwifery is poorly defined. Decision-making theories from medicine and nursing may have something to offer, but fail to take into consideration midwifery context and philosophy and the decisional autonomy of women. Using an underpinning qualitative methodology, a decision-making framework was developed, which identified Good Clinical Reasoning and Good Midwifery Practice as two conditions necessary to facilitate optimal midwifery decision-making during 2nd stage labour. This study aims to confirm the robustness of the framework and describe the development of Enhancing Decision-making Assessment in Midwifery (EDAM) as a measurement tool through testing of its factor structure, validity and reliability. Method A cross-sectional design for instrument development and a 2 (country; Australia/UK) x 2 (Decision-making; optimal/sub-optimal) between-subjects design for instrument evaluation using exploratory and confirmatory factor analysis, internal consistency and known-groups validity. Two ‘expert’ maternity panels, based in Australia and the UK, comprising of 42 participants assessed 16 midwifery real care episode vignettes using the empirically derived 26 item framework. Each item was answered on a 5 point likert scale based on the level of agreement to which the participant felt each item was present in each of the vignettes. Participants were then asked to rate the overall decision-making (optimal/sub-optimal). Findings Post factor analysis the framework was reduced to a 19 item EDAM measure, and confirmed as two distinct scales of ‘Clinical Reasoning’ (CR) and ‘Midwifery Practice’ (MP). The CR scale comprised of two subscales; ‘the clinical reasoning process’ and ‘integration and intervention’. The MP scale also comprised two subscales; women’s relationship with the midwife’ and ‘general midwifery practice’. Conclusion EDAM would generally appear to be a robust, valid and reliable psychometric instrument for measuring midwifery decision-making, which performs consistently across differing international contexts. The ‘women’s relationship with midwife’ subscale marginally failed to meet the threshold for determining good instrument reliability, which may be due to its brevity. Further research using larger samples and in a wider international context to confirm the veracity of the instrument’s measurement properties and its wider global utility, would be advantageous. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0882-3) contains supplementary material, which is available to authorized users.