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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.

The aim of this paper was to present a comprehensive picture of characteristics within a maternity hospital which promote obedient behaviour from midwives. The overall objective was to assess midwives’ views about their own acquiescent behaviour. A sensitive qualitative analysis appraised midwives’ views gained from semi-structured interviews conducted within the seven maternity units of North Yorkshire in the UK. Participants included a stratified sample of 20 (7E, 7F, 6G grade) practicing midwives aged between 21–60 years. Taking a post-positivist approach, inductive thematic analysis was used to interpret the data. Two themes of “situational factors that promote obedient behaviour” were derived; “an obligation to follow hospital policies” and “fear of consequences from challenging senior staff”. The key conclusion is that midwives are frequently placed in unenviable positions of relative powerlessness. It was clear that some actions and strategies that midwives use serve to reinforce the fundamental power structures and “status quo”. Quite clearly, midwives are sometimes presented with conflict between a drive to agree with authority and supporting the safe, evidence-based choices of childbearing women in their care. Raising awareness of the processes involved in obedient behaviour and exercising sharing of power may be helpful to midwives in asserting not only their own professional capacity to influence, but also the autonomy of the women they seek to empower.

This special edition offers unique insight into concepts of education within midwifery practice. One of the aims of delivering midwifery education is to advance the evidence-base and improve the quality of maternity care provided by midwives. In addition, childbearing women require accurate, accessible, evidence-based information from which to make decisions about their care. Pivotal to this approach is providing accurate information on which midwives can base their clinical decisions.

Background Pregnant women consume caffeine daily. The aim of this study was to examine the association between maternal caffeine intake from different sources and (a) gestational length, particularly the risk for spontaneous preterm delivery (PTD), and (b) birth weight (BW) and the baby being small for gestational age (SGA). Methods This study is based on the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health. A total of 59,123 women with uncomplicated pregnancies giving birth to a live singleton were identified. Caffeine intake from different sources was self-reported at gestational weeks 17, 22 and 30. Spontaneous PTD was defined as spontaneous onset of delivery between 22+0 and 36+6 weeks (n = 1,451). As there is no consensus, SGA was defined according to ultrasound-based (Marsal, n = 856), population-based (Skjaerven, n = 4,503) and customized (Gardosi, n = 4,733) growth curves. Results The main caffeine source was coffee, but tea and chocolate were the main sources in women with low caffeine intake. Median pre-pregnancy caffeine intake was 126 mg/day (IQR 40 to 254), 44 mg/day (13 to 104) at gestational week 17 and 62 mg/day (21 to 130) at gestational week 30. Coffee caffeine, but not caffeine from other sources, was associated with prolonged gestation (8 h/100 mg/day, P

Background:Up to 39% of women who experience perinatal bereavement proceed to develop Post-Traumatic-Stress-Disorder (PTSD), with this large proportion meriting treatment. Before setting-up a treatment service for postnatal women who are experiencing psychological trauma, it is important to identify what therapies have been used in-the-past to address this problem.Aim:To scope for research that has implemented therapies to treat psychological trauma post perinatal bereavement, for potential inclusion in a flexible treatment package.Method:A scoping review mapped coverage, range, and type of research that has reported on prior therapies used to treat psychological trauma post perinatal bereavement.Findings:Due to the dearth of papers that directly addressed perinatal bereavement, we widened the scope of the review to view what treatments had been used to treat psychological trauma post-childbirth. Out of 23 studies that report on effectiveness of therapies used to treat psychological trauma post-childbirth, only 4-focused upon treating PTSD post perinatal bereavement (3 effective/1 ineffective). Successful treatments were reported by Kersting et al. (2013), who found CBT effective at reducing PTSD symptoms post-miscarriage, termination for medical reasons, and stillbirth (n = 33 & n = 115), and Navidian et al. (2s017)) found that 4-sessions of grief-counselling reduced trauma symptoms post-stillbirth in (n = 50) women. One study by Huberty et al. (2020found on-line yoga to be ineffective at reducing PTSD symptoms post-stillbirth.Conclusions:A dearth of research has explored effectiveness of therapies for treating psychological trauma post perinatal bereavement and post-childbirth, with need to develop and test a research informed flexible counselling package.

BackgroundSatisfaction with the birth experience has been established to be critical for the wellbeing of the mother. The Birth Satisfaction Scale-Revised (BSS-R) is a brief and psychometrically robust multi-dimensional self-report tool designed to assess birth experience. The current investigation sought to translate and validate a Czech Republic version of the BSS-R (CZ-BSS-R).MethodsFollowing translation psychometric assessment of the CZ-BSS-R was undertaken using a cross-sectional design. A between-subjects design was incorporated in order to evaluate known-groups validity evaluation of the translated measure. Four hundred and sixty-five Czech-speaking women within the Czech Republic took part in the study. Confirmatory factor analysis was undertaken and divergent and convergent validity and internal consistency characteristics also evaluated.ResultsThe CZ-BSS-R was observed to have excellent psychometric properties and conceptually and measurement faithful to the original English-language measure. Consistent with previous investigations using the BSS-R significant differences were found in scores as a function of delivery type.ConclusionsThe CZ-BSS-R is a valid, robust and reliable measure of birth experience and suitable for use with Czech-speaking women in the Czech Republic. The study highlighted that instrument and emergency Caesarean section were associated with a lower level of birth satisfaction compared to vaginal delivery.

Extensive study of possible causes of wound sepsis revealed that the two most common were virulent staphylococci in nasal carriers among operating room team personnel and airborne pathogens in the operating room. If a surgeon finds he has an epidemic of infections, he should first of all consider himself as a possible source. A special mask patterned after the oxygen mask used by airmen is useful if the surgeon is found to be a source of infection. Ultraviolet light was found of value for air sterilization but not for skin sterilization. Studies showed that benzalkonium swabbing of the skin leaves much to be desired, but the patient's skin, in 182 cases observed, appeared to play only an insignificant role in wound sepsis under the given conditions. More efficient masking of the operating room personnel and general measures to insure maximum cleanliness are suggested as means for decreasing the frequency of surgical infections.