Search

Critical to maternal outcome and development of a healthy and relationship between mother and baby, is the woman's perception of her birth experience. The Birth Satisfaction Scale-Revised (BSS-R) has been demonstrated to be psychometrically robust, easily administered, and scored self-report measure of birth experience. Aim of the study was to translate the UK-BSS-R into Hindi, collect data, and psychometrically validate an Indian (Hindi)-BSS-R.Psychometric assessment of the Indian (Hindi)-BSS-R was undertaken following translation using a cross-sectional design. Evaluation of known-groups validity was undertaken using an embedded between-subjects component. Data were collected from (n = 312) postnatal Hindi speaking women in India. Measurement characteristics were assessed using confirmatory factor analysis, divergent validity and internal consistency analysis.The measurement properties of the Indian (Hindi)-BSS-R were observed to be equivocal, with the established tri-dimensional measurement model not achieving best fit to data. Instead, an alternative two-factor model offered an excellent fit to data. Significant differences were observed between Indian (Hindi)-BSS-R scores and family type and gestation term status, which highlights the relevance of these contextual aspects to the Indian birth experience. Internal consistency was observed to be low on some sub-scales, indicating the potential need for future revision.The Indian (Hindi)-BSS-R is a measure of birth experience, which accepting some measurement caveats, is acceptable for use with Hindi speaking women in India. Further research is required to determine if modification of some of the items is required to improve internal consistency.

The use of ultrasound to determine gestational age is fundamental to the optimum management of pregnancy and is recommended for all women by the World Health Organization. However, this modality remains unavailable to many women in low-income countries where trained practitioners are scarce. Although previous initiatives have demonstrated efficacy in training midwives and technicians to perform antenatal ultrasound, these programs have often been too long and too complex to be realistic within the specific constraints of this context, highlighting the need for a novel and pragmatic approach. We describe the development and piloting of a bespoke course to teach midwives 3 fundamental components of early antenatal ultrasound scanning: (1) to identify the number of fetuses, (2) to confirm fetal viability, and (3) to determine gestational age. Having established that 5 days is insufficient, we propose that the minimum duration required to train ultrasound-naive midwives to competency is 10 days. Our completed program therefore consists of one and one-half days of didactic teaching, followed by 8 and one-half days of supervised hands-on practical training in which trainees are assessed on their skills. This package has subsequently been successfully implemented across 6 sites in Malawi, where 28 midwives have achieved competency. By describing the processes involved in our cross-continental collaboration, we explain how unexpected challenges helped shape and improve our program, demonstrating the value of preimplementation piloting and a pragmatic and adaptive approach.

BACKGROUNDSatisfaction with the birth experience is increasingly recognized as critical to the well-being of mother and baby and thus accurate assessment of this key dimension is essential. The Birth Satisfaction Scale-Revised (BSS-R) has been shown to be a robust, valid, and reliable measure of birth experience. The current study sought to develop an Urdu version of the measure to be used in Pakistan.METHODSFollowing translation, a cross-sectional design was used to examine the measurement properties of the Pakistan (Urdu)-BSS-R (P-BSS-R). Participants were a purposive sample of Pakistani postnatal women (n = 200). Key psychometric properties were examined using Confirmatory Factor Analysis (CFA), internal consistency evaluation, and known-groups discriminant validity testing.RESULTSThe majority of measurement parameters for clinical application of the P-BSS-R were found to be acceptable with good known-groups discriminant validity and data fit to the tri-dimensional theoretical model of the BSS-R observed. However, some idiosyncratic observations were highlighted, including unexpected low internal consistency.CONCLUSIONSThe P-BSS-R was found to be a generally valid and reliable measure of the experience, a caveat being low internal consistency warranting further investigation.

Background In several countries, midwifery students undertake continuity of care experiences as part of their pre-registration education. This is thought to enable the development of a woman-centred approach, as well as providing students with the skills to work in continuity models. A comprehensive overview of factors that may promote optimal learning within continuity experiences is lacking. Aim To identify barriers and facilitators to optimal learning within continuity experiences, in order to provide a holistic overview of factors that may impact on, modify and determine learning within this educational model. Methods An integrative literature review was undertaken using a five-step framework which established the search strategy, screening and eligibility assessment, and data evaluation processes. Quality of included literature was critically appraised and extracted data were analysed thematically. Findings Three key themes were identified. A central theme was relationships, which are instrumental in learning within continuity experiences. Conflict or coherence represents the different models of care in which the continuity experience is situated, which may conflict with or cohere to the intentions of this educational model. The final theme is setting the standards, which emerged from the lack of evidence and guidance to inform the implementation of student placements within continuity experiences. Conclusion The learning from continuity experiences must be optimised to prepare students to be confident, competent and enthusiastic to work in continuity models, ultimately at the point of graduation. This will require an evidence-based approach to inform clear guidance around the intent, implementation, documentation and assessment of continuity experiences.

This paper considers use of Compassionate Mind Training (CMT) to help midwives cope with traumatic clinical incidents. In this context, CMT is taught to cultivate compassion and teach midwives how to care for themselves as they would women, family and friends. The need to build midwives’ resilience is recognized by the UK Nursing and Midwifery Council (NMC), who advocate that mental health coping strategies be embedded into midwifery curriculum. In this respect, CMT can be used as a resilience building method designed to help the midwife respond to self-criticism and threat-based emotions with compassion. The underpinnings of CMT involves understanding that people can develop cognitive biases or unhelpful thinking patterns co-driven by an interplay between genetics and the environment. Within this paper, the underpinning theory of CMT is outlined and how it can be used to balance the psychological threat, drive, and soothing systems. The 3-way flow of compassion is further discussed, which involves: (1) delivering compassion to others, (2) accepting compassion from others, and (3) providing compassion to self. To stabilize emotions and create self-soothing, CMT activities have been described that are designed to improve ability to cope and reduce perceptions of threat and danger. To contextualize application to midwifery practice, a traumatic incident has been used to illustrate how CMT can improve a midwife’s compassion for self, quality of work life, and mental well-being. Overall, teaching CMT has potential to improve professional quality of life, reduce midwives’ sickness rates, and potential attrition from the profession.

Birth satisfaction relates to women's perceptions of their childbirth experience, with importance placed on the midwife to improve standards of the intranatal care provided. With evaluating intranatal care in mind, this paper aims to educate midwives about one particular method of measuring women's experiences of labour, which involves using the valid and reliable Birth Satisfaction Scale-Revised (BSS-R). The BSS-R is a 10-item self-report valid and reliable measure, which is recommended by the International Consortium for Health Outcomes Measurement (ICHOM) as the ‘method of choice’ for evaluating women's ‘birth experience’. Since the ICHOM began recommending the BSS-R as part of its pregnancy and childbirth standard set, the scale (at time of print) has been used in 39 countries and 134 sites around the world.

The Birth Satisfaction Scale-Revised is a short but valid and reliable robust measure of different aspects of birth satisfaction. This study aimed to test factor structure, validity and reliability of the Croatian version of the Birth Satisfaction Scale-Revised. In the cross-sectional study, a convenient online sample of 552 women completed questionnaires in the first year postpartum. The Birth Satisfaction Scale-Revised, subscale Satisfaction with Delivery from the Childbirth Perception Questionnaire, and a set of questions on demographic and obstetric data were administered. The results showed the excellent fit of both the three-factor model (Stress experienced during labour, Women's personal attributes, Quality of care) and two-factor model (with Stress and Women's attributes combined into one factor), with no significant difference between the two models. Furthermore, bi-factor modeling revealed a general factor of childbirth experience, which explains the variance of items from Stress and Women's attributes subscales. The internal consistency was high for the total scale and Quality of care, while acceptable for the other two subscales. Convergent and divergent validity was high. Known-group discriminant validity showed that women who gave birth by unassisted vaginal birth and planned caesarean section reported higher levels of birth satisfaction. In conclusion, both empirical findings and theoretical background suggest a three-factor model as the better solution for the Birth Satisfaction Scale-Revised conceptualization. As the Croatian version of the Birth Satisfaction Scale-Revised was shown to be valid and reliable, it is recommended for use to measure birth satisfaction both for research and practical purposes.

Background Recent observations suggest birth satisfaction may be significantly associated with postpartum post-traumatic stress disorder (PP-PTSD). The Birth Satisfaction Scale-Revised (BSS-R) is increasingly used Internationally as a short, valid and reliable multi-dimensional measure of birth experience. The current study sought to develop a Dutch version of the BSS-R (D-BSS-R) for clinical and research application in the Netherlands. Methods Post-translation, a cross-sectional design with an embedded between-subjects component was used to evaluate key indices of validity and reliability of the D-BSS-R in a purposive sampled cohort of 244 Dutch-speaking women in the Netherlands. Confirmatory factor analysis, divergent, convergent and known-groups discriminant validity were evaluated as was the internal consistency of the measure. Results The D-BSS-R was found to be a generally valid and reliable measure of birth experience with the key measurement characteristics of the original English-language measure transferring well to the Dutch context. Statistically significant negative correlations were observed between all D-BSS-R sub-scales and a validated measure of PTSD. Conclusions The D-BSS-R represents a valid and reliable measure of birth experience suitable and appropriate for use in the Netherlands. The study corroborates previous suggestions of linkage between birth satisfaction and PP-PTSD using a robust and diagnostically valid measure of trauma.

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.

To translate and validate a Spanish-language version of the Birth Satisfaction Scale-Revised (BSS-R) and describe key measurement properties.A cross-sectional instrument validation design examining factor structure, validity and reliability.Three public hospital sites in Spain.202 women who had given birth within the past four weeks provided complete questionnaire data for analysis.Measures included the Spanish version of the BSS-R (S-BSS-R) and the Perceived Stress Scale (PSS). The tri-dimensional measurement model of the BSS-R was found to offer a good fit to Spanish data. Known-groups discriminant validity was found to be excellent with women experiencing a non-intervention delivery having higher S-BSS-R scores (p 0.05) compared to those having an intervention. Women who had no pain control were found to have greater S-BSS-R total and S-BSS-R women's attributes and stress experienced sub-scale scores compared to those who received pain control (p 0.05). Total scale internal reliability was also found to be acceptable. Evidence for good divergent and convergent validity was also found across total and sub-scale S-BSS-R scores.The S-BSS-R was found to have generally good to excellent psychometric properties and represents a valid and reliable translation of the original version of the BSS-R for use in Spanish-speaking populations. The development of the S-BSS-R enables comparison of birth satisfaction with international study data where the BSS-R is used.The relationship of both delivery type and pain control to birth satisfaction represent important areas for further research.

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.

Objective: To validate the Italian-language version of the Birth Satisfaction Scale-Revised (BSS-R) and report key measurement properties of the tool. To evaluate the impact of antenatal class attendance on BSS-R assessed birth satisfaction. Background: Maternal satisfaction is one of the standards of care defined by the World Health Organisation (WHO) to improve the quality of services. The BSS-R is a multi-dimensional self-report measure of the experience of labour and birth. Methods: Cross-sectional instrument evaluation design examining factor structure and key aspects of validity and reliability. Embedded between-subjects design to examine known-group discriminant validity and the impact of antenatal class attendance on BSS-R sub-scale and total scores as dependent variables. After giving birth, 297 women provided data for analysis. Results: The Italian version of the BSS-R (I-BSS-R) was the key study measure. The established three-factor and bi-factor models of the BSS-R were found to offer an excellent fit to the data. Comparison of the tri-dimensional measurement model and the bi-factor model of the BSS-R found no significant differences between models. Women who attended antenatal classes had significantly lower stress experienced during childbearing sub-scale scores (I-BSS-RSE), compared to those who did not. Good convergent, divergent validity and known-groups discriminant validity were established for the I-BSS-R. Internal consistency observations were found to be sub-optimal in this population. Conclusions: On all key psychometric indices, with the exception of internal consistency that requires further investigation, the I-BSS-R was found to be a valid translation of the original BSS-R. The impact of antenatal classes on birth satisfaction warrants further research.

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.

Childbirth satisfaction may positively affect maternal intention to have a future pregnancy and preference to have a cesarean. We translate the UK-Birth-Satisfaction-Scale-Revised (UK-BSS-R) into Persian and validate an Iranian-BSS-R for future use in this population. In total, 784 mothers who were hospitalized in postpartum wards completed the Persian version of the BSS-R. The confirmatory factor analysis on 10-items scale confirmed the conventional three-factor structure. The Cronbach’s alpha of the Iranian-BSS-R subscales and the total score were within the range of 0.53-0.76. Our findings provide further evidence that the BSS-R is an internationally reliable and valid instrument to measure birth satisfaction.

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.

The 10-item Birth Satisfaction Scale - Revised (BSS-R) is increasingly being used internationally as the instrument of choice for the assessment of birth satisfaction. There remains conjecture over the most appropriate way to score the instrument; subscale scores overall total score, or both approaches. The current study sought to clarify this issue by examining the measurement characteristics of the United States version of the BSS-R from a large data set.Secondary analysis of a data matrix from a large sample US BSS-R validation study (N = 2116) using structural equation modelling.A bi-factor model revealed an excellent fit to data (χConsistent with the recommendations of the original BSS-R validation study, the current investigation found robust empirical evidence to support the use of both the subscale scoring system and the total score. Researchers and clinicians can therefore select either approach (or both) with confidence.

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

Following a change in UK legislation, the Nursing and Midwifery Council (NMC) model of statutory supervision for midwives ceased in 2017. In response, the Scottish Government (SG) and NHS Education for Scotland (NES) worked with the NHS Health Boards to develop a new employer-led model of clinical supervision. The aim of this new model is to help midwives provide improved services, safer care and improved outcomes for childbearing women and infants in keeping with professional regulation. The new Scottish Clinical Supervision Model is also designed to increase midwives personal wellbeing and help them deal with everyday challenges of clinical practice. This design of supervision is a radical departure from the prior NMC model, given that it incorporates facilitation and coaching methods which teach midwives to respond, reflect, and restore self, and through doing so reduce stress and increase resilience. In an attempt to improve nurturing leadership, the key components of this new model are underpinned by a person-centred approach, during which the supervisor provides unconditional positive regard and empathy towards the supervisee. Equipping midwives to develop contemporary supervision is supported by NES through online education that can be accessed at: https://www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/maternity-care/about-us/clinical-supervision.aspx

Background Around 4% of women develop Post Traumatic Stress Disorder Post Childbirth (PTSD-PC). During childbirth a woman's perception of her care provider's interpersonal verbal and nonverbal relationship behaviours, termed ‘Quality of Provider Interaction' are significantly associated with the development of PTSD-PC. Aims To understand how women who develop PTSD-PC and midwives, experience their interactions during care provision. In particular, how they feel during their interactions and what this means to them. Methods The qualitative method of Interpretative Phenomenological Analysis that incorporates a reflective approach, was used to gain deep understanding of the lived experience of care provider interaction. Six women who met full diagnostic criteria for PTSD-PC and six midwives who provided intrapartum care, participated in individual face-to-face interviews. Results Two key findings were identified: 1) Failing to recognise and meet the human needs of both women and midwives, results in poor quality interactions from midwives and poor perception of care provider interaction by women; 2) The study groups of women and midwives both identified the quality of their relationship as central to positive interactions. Recommendations for practice (1) Raise the status of psychological wellbeing for childbearing women and make it of equal importance to physical wellbeing, with clear focus upon care provider interaction; (2) Create a midwife centred system that enables midwives to provide optimal care provider interaction and improve relationship-based care; and (3) Challenge underlying toxic cultures that currently persist in the maternity services system, which undermine the work of midwives and consequently the experience of women. Conclusion Failure to recognise and meet the human and relationship needs of both childbearing women and midwives contributes to poor care provider interactions offered by midwives and negative perceptions of care provider interactions by women. In response, NHS maternity services need to highlight the importance of the quality of care provider interaction alongside perinatal psychological wellbeing. This requires improved working environments for midwives, so they can optimise their quality of interaction with childbearing women. This will in turn impact upon the incidence and levels of trauma and PTSD-PC experienced by women.

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.

Objective and background: The Birth Satisfaction Scale-Revised (BSS-R) is a multi-dimensional measure which is recommended by international clinical guidelines for global use as the birth satisfaction outcome measure of choice. The current investigation sought to develop a Hebrew version of the BSS-R for use in the Jewish-Israeli context and examine the relationship between BSS-R domains and the perception of the experience of labour as traumatic.Methods: Following review, translation, and back-translation for linguistic equivalence, a Hebrew version of the BSS-R (H-BSS-R) was prepared and psychometrically evaluated using key indices of validity and reliability. Complete multivariate normal data from 288 first-time Jewish Israeli mothers within two years after childbirth was entered into the analysis.Results: The H-BSS-R was found to have a good fit to the BSS-R tridimensional measurement model, excellent internal consistency, divergent and known-group discriminant validity. Moreover, women who experienced their labour as traumatic had significantly lower H-BSS-R subscale scores than women who reported that their birth experience was non-traumatic.Conclusion: The H-BSS-R is a robust and valid measure suitable for use with Jewish-Israeli women, as well as for investigating the relationship between traumatic labour and birth satisfaction.

Background: A continued absence of strategies that promote self-care puts midwives at risk of experiencing symptoms of stress, empathic distress fatigue, burnout, and compassion fatigue, all of which can affect midwives' performance and the level of compassion they show to others. Aims: The objective of this paper is to outline a possible education strategy for student midwives that has the potential to affect the level of compassion that the individual can show both to him/herself and others in times of suffering. Suggested approach: Compassionate mind training (CMT) has been found to be beneficial in clinical populations with individuals who report symptoms of primary trauma, low levels of self-compassion, and who are self-critical. Student midwives bear witness to the traumas of others, so it is important to consider an intervention to help student midwives who may experience symptoms of secondary trauma, self-criticism, or low levels of self-compassion while in training. Conclusion: Incorporating CMT into undergraduate midwifery degree programmes may help student midwives become sensitive to their own suffering, and could potentially help them cope with emotional demands, placement anxieties and organisational pressures.

Background: Compassion fatigue and burnout can impact on performance of nurses. This paper explores the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life, and wellbeing among community nurses.\ud Aim: To measure associations between self-compassion, compassion fatigue, wellbeing, and burnout in community nurses.\ud Method: Quantitative data were collected using standardised psychometric questionnaires: (1) Professional Quality of Life Scale; (2) Self-Compassion Scale; (3) short Warwick Edinburgh Mental Wellbeing Scale; (4) Compassion For Others Scale, used to measure relationships between self-compassion, compassion fatigue, wellbeing, and burnout. \ud Participants: A cross sectional sample of registered community nurses (n=37) studying for a postgraduate diploma at a University in the North of England took part in this study.\ud Results: Results show that community nurses who score high on measures of self-compassion and wellbeing, also report less burnout. Greater compassion satisfaction was also positively associated with compassion for others, and wellbeing, whilst also being negatively correlated with burnout. \ud Conclusion: High levels of self-compassion were linked with lower levels of burnout. Furthermore when community nurses have greater compassion satisfaction they also report more compassion for others, increased wellbeing, and less burnout. The implications of this are discussed alongside suggestions for the promotion of greater compassion. \ud \ud Key words: burnout, compassion fatigue, district nurses, compassion, self-compassion, wellbeing

Background: Compassion fatigue and burnout can impact on the performance of midwives, with this quantitative paper exploring the relationship between self-compassion, compassion fatigue, self-judgement, self-kindness, compassion for others, professional quality of life and well-being of student midwives. Method: A quantitative survey measured relationships between self-compassion, compassion fatigue, well-being, and burnout using questionnaires: (1) Professional Quality of Life Scale; (2) Self-Compassion Scale; (3) Short Warwick and Edinburgh Mental Well-being Scale; (4) Compassion For Others Scale. Participants: A purposive and convenience sample of student midwives (n=103) studying at university participated in the study. Results: Just over half of the sample reported above average scores for burnout. The results indicate that student midwives who report higher scores on the self-judgement sub-scale are less compassionate towards both themselves and others, have reduced well-being, and report greater burnout and compassion fatigue. Student midwives who report high on measures of self-compassion and well-being report less compassion fatigue and burnout. Conclusion: Student midwives may find benefit from ‘being kinder to self’ in times of suffering, which could potentially help them to prepare for the emotional demands of practice and study. Implications: Developing, creating and cultivating environments that foster compassionate care for self and others may play a significant role in helping midwives face the rigours of education and clinical practice during their degree programme.

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.

Objective: To review primary research from within the literature regarding PTSD Post-Childbirth (PTSD-PC), that focussed on Quality of Provider Interaction (QPI) from either the perspective of women who have developed PTSD-PC, or midwives.Background: Up to 45% of women find childbirth traumatic. PTSD-PC develops in 4% of women (18% in high-risk groups). The woman’s subjective experience of her childbirth has been shown to be the most important risk factor in the development of PTSD-PC, within which perceived QPI is key. Methods: A systematic search was performed for PTSD-PC literature. Papers that focussed on either women’s subjective experiences of childbirth, particularly QPI, or midwives’ perspectives on QPI, were included. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) tools, and a narrative synthesis of findings produced.Results: 14 studies met inclusion criteria. Three overarching features of QPI contribute towards developing PTSD-PC: (1) interpersonal factors; (2) midwifery care factors; and (3) lack of support. The importance of ‘how care is provided’ is emphasised over ‘what happens’. Conclusion: QPI is a significant factor in the development of PTSD-PC and the identified key features of QPI have potential to be modified by midwives. The development of guidelines for midwives needs to be grounded on evidence highlighted in this review, along with further high quality qualitative research exploring QPI from the perspective of women with PTSD-PC, but also midwives’ knowledge and needs regarding their role within QPI.

Background: The Birth Satisfaction Scale – Revised (BSS-R) is a valid and reliable scale designed to assess women’s experiences of labour and childbirth. Objective: To assess factor structure, validity, and reliability of the Turkish Birth Satisfaction Scale – Revised (T-BSS-R) using data collected from a Turkish population. Setting: Istanbul Ministry of Health Zeynep Kamil Women’s and Children’s Training and Research Hospital. Participants: A convenience sample of healthy child-bearing women (n = 120) who had experienced a spontaneous vertex delivery at full term. Method: A survey was conducted post backtranslating the T-BSS-R, with survey data analysed using confirmatory factor analysis. Results: Factor modelling found three subscales embedded in the T-BSS-R, which indicated a good model fit, χ2 = 44.67, CFI = .94; MSEA = .057; SRMR = .075. A Chi-square value of 1.33 also indicated a good fit. Means for the T-BSS-R subdimensions (1) Stress Experienced (T-BSS-SE-R) = 6.86 ± 3.10, (2) Women’s Attributes (T-BSS-WA-R) = 2.84 ± 1.89, (3) Quality of Care (T-BSS-QC-R) = 10.69 ± 3.19 and total scale = 20.39 ± 5.98. The Cronbach alpha coefficient for total scale = 0.71 and for subdimensions T-BSS-SE-R= 0.55, T-BSS-WA-R = 0.44 and T-BSS-QC-R = –0.74.Conclusion: Data analysis determined that the T-BSS-R is a valid andreliable instrument to measure birth satisfaction in a population of Turkish women. The T-BSS-R is available for use from c.hollinsmartin@napier.ac.uk.

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: Postnatal Depression (PND) is a key cause of maternal morbidity, with current systems of initial recognition in the UK detecting only 50% of cases. In attempts to predict those potentially at risk, this review suggests a novel approach. Aim: Implementing the concept of ‘ideal mother’ versus ‘real mother’, and asking the woman to compare their ‘ideal self’ against ‘existent self’, the aim of this instrument development review was to determine themes from the literature that relate to women’s perceptions of self as a mother, and from this identification develop questions for inclusion within a proposed new measure entitled the Self-Image as Mother Scale (SIMS). Method: A scoping review of the literature was carried out to: (1) identify themes considered to affect perception of self as mother, and from this identification, evidence-based questions for inclusion in the SIMS were developed. Findings: Themes identified included (1) marital dissatisfaction, (2) inadequate partner support, (3) lack of family support, (4) socio-economic status and associated poverty, (5) concern about infant, (6) antenatal/postnatal complications, (7) acceptance of infant gender, (8) history of mental health problems, (9) unplanned pregnancy.Conclusions: From this scoping review 18 questions were developed for inclusion in the SIMS, which will then be evaluated for psychometric properties, scale refinement and validation.

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.

Introduction: There is limited understanding of the type and extent of maternal postures that midwives should encourage or support during labor. The aims of this study were to identify a set of postures and movements commonly seen during labor, to develop an activity monitoring system for use during labor, and to validate this system design. Methods: Volunteer student midwives simulated maternal activity during labor in a laboratory setting. Participants (N = 15) wore monitors adhered to the left thigh and left shank, and adopted 13 common postures of laboring women for 3 minutes each. Simulated activities were recorded using a video camera. Postures and movements were coded from the video, and statistical analysis conducted of agreement between coded video data and outputs of the activity monitoring system. Results: Excellent agreement between the 2 raters of the video recordings was found (Cohen’s κ = 0.95). Both sensitivity and specificity of the activity monitoring system were greater than 80% for standing, lying, kneeling, and sitting (legs dangling). Discussion: This validated system can be used to measure elected activity of laboring women and report on effects of postures on length of first stage, pain experience, birth satisfaction, and neonatal condition. This validated maternal posture-monitoring system is available as a reference and for use by researchers who wish to develop research in this area.

Midwifery continuity of carer (MCC) models result in better clinical outcomes for women and offer midwives a superior way of working when compared to other models of maternity care. Implementing a MCC model, a key recommendation of the Scottish Government Maternity and Neonatal Strategy Best Start, requires significant restructuring of maternity services and changes to midwives' roles. Careful evaluation is therefore required to monitor and understand how the policy affects care providers and users. Realist evaluation is an appropriate methodology for evaluating programmes of change set within complex social organisations, such as health services, and can help to understand variations in outcomes and experiences. This paper presents the approach taken using the principles of realist evaluation to identify key programme theories, which then informed an evaluation framework and a midwives' evaluation tool. The comprehensive survey-tool developed for midwives has the potential to be used more widely to evaluate comparable strategic change in this area.

Introduction: The 10-item Birth Satisfaction Scale-Revised (BSS-R) is a theoretically anchored and easy to administer multidimensional measure of the birth satisfaction construct. The use of the BSS-R Internationally has led to an increasing number of translation and validation studies being conducted. An important onsideration for any validation/translation study of the measure concerns sample size. However, sample size estimations for validation studies are invariably based on ‘rules of thumb’ that are insensitive to the dynamics of the measure under scrutiny and may consequently lead to underpowered investigations. The current study sought to determine empirically the minimum sample size for a validation study of the BSS-R. Methods: A Monte Carlo simulation study was conducted using the parameter specifications of the original BSS-R validation study as the input model. An extensive series of simulations were conducted to estimate statistical power and simulation quality for a range of sample sizes (N = 50 to N = 1000). Sample sizes from published BSS-R studies were also included in the simulations conducted. Results: Monte Carlo simulations revealed the minimum sample size for a validation study of the BSS-R to be N = 175. The original BSS-R development study and the US validation study were found to be adequately powered and satisfied all quality criteria for the simulations. Two published BSS-R studies had insufficient sample size to assure confidence in avoiding type 1 error. Conclusion: Sample size estimation for validation studies should be empirically informed to avoid type 1 error and ensure an adequately powered investigation.

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.

Objective: This research sought to test the measurement invariance of the Birth Satisfaction Scale-Revised (BSS-R) across United States (US) and United Kingdom (UK) samples. Multiple-group measurement was tested and latent means analysis compared levels of birth satisfaction across the samples. Method: Using Confirmatory Factor Analysis (CFA), data previously collected from 409 mothers (181 US mothers; 228 UK mothers) were used to examine the multiple-group measurement invariance of the BSS-R across US and UK samples. Results: A correlated factors BSS-R model demonstrated partial measurement invariance. US mothers had significantly lower birth satisfaction levels on the three BSS-R subscales. Conclusions: This research demonstrates that the BSS-R is a robust tool that can be used to reliably measure women’s birth satisfaction within and across the US and UK.

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.