Search

Background: Increasing the numbers of Indigenous health professionals is an international priority to enhance health outcomes for Indigenous communities. It is also incumbent on academics to ensure all graduates are culturally safe to work with Indigenous Peoples, and that accredited health degrees contain appropriate Indigenous content, improving the cultural competence of the registered health workforce. However, little current research investigates Indigenous tertiary students' experiences of learning about Indigenous health., Aim: To explore Indigenous students' experiences of being taught Indigenous health., Design: This study employed an online survey (16 % response rate) developed to evaluate student's beliefs, attitudes and learning experiences following operationalisation of a university Indigenous Graduate Attribute. An Aboriginal researcher also conducted Yarning Circles with Indigenous students as a culturally appropriate means to deepen insight into their experiences of studying Indigenous health topics alongside non-Indigenous peers., Setting: A large urban Australian university., Participants: Twelve Indigenous students from four health disciplines completed the anonymous survey. Five Indigenous midwifery students participated in a Yarning Circle., Methods: Survey data were analysed descriptively using SPSS version 27. Qualitative data from Yarning Circle transcripts were analysed thematically from an inductive Indigenous standpoint., Results: Results from the survey demonstrated unanimous agreement that all health students should learn about Indigenous Peoples' health and cultures. However, most participants agreed that there needed to be more content on Indigenous knowledges, derived from Indigenous authors, researchers, and community presenters. The Yarning Circle yielded rich discussion of students' experiences, explored across three key themes and associated sub-themes. Themes were: When your culture is content; Being an Indigenous student; and Sources of strength and support as Indigenous students., Conclusions: Findings indicate the importance of framing Indigenous content, incorporating Indigenous knowledge into curricula, ensuring Cultural Safety in classrooms with both Indigenous and non-Indigenous students, and supporting Indigenous students to excel., Competing Interests: Declaration of competing interest The authors have no declaration of conflict., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: To explore Australian and New Zealand nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices., Design: A cross-sectional survey design., Methods: An online survey was sent to Australian and New Zealand nursing and midwifery educators across the 45 Schools of Nursing and Midwifery between July and September 2023. The online survey consisted of 29 open- and closed-ended questions about nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices., Results: There was a total of 127 responses to the first open-ended question. A total of 97 nursing and midwifery educators then completed the remaining questions. While educators had mostly positive views about integrating planetary health into their teaching, they lacked the knowledge and/or confidence to do so effectively., Conclusion: Australian and New Zealand nursing and midwifery educators acknowledge that planetary health should be included in nursing and midwifery curricula, but most reported a deficit in knowledge and/or confidence to integrate these complex concepts into their teaching. When considering planetary health, most educators focussed on climate change, which demonstrates their limited understanding of the concept of planetary health., Implications for the Profession: All nurses and midwives need to understand how the health of the planet and human civilization are interconnected and be prepared to address complex global health challenges now and in the future. Across the world, key healthcare organizations have called upon nursing and midwifery educators to prepare the healthcare workforce to practice in a more sustainable way, including supporting decarbonization of healthcare. However, our study has demonstrated that nursing and midwifery educators do not feel ready to respond due to a lack of required knowledge and/or confidence., Reporting Method: We used the Consensus-Based Checklist for Reporting of Survey Studies (CROSS)., Patient or Public Contribution: No patient or public contribution., (© 2024 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Aim: To achieve consensus on the knowledge and skills that undergraduate/pre-licensure nursing students require to steward healthcare towards a more sustainable future., Design: A two-phase real-time Delphi study., Methods: Phase 1 included the generation of Planetary Health, climate change and sustainability knowledge and skill statements based on a review of relevant literature. Phase 2 consisted of a real-time Delphi survey designed to seek consensus on the proposed statements from a panel of 42 international experts., Results: Of the 49 survey statements, 44 (90%) achieved ≥75% consensus and 26 (53%) achieved ≥80% consensus. Three were removed and 32 were modified to improve clarity of language., Conclusion: The knowledge and skills statements that emerged through this Delphi study can serve as a guide for incorporating Planetary Health, climate change and sustainability into nursing education programs., Implications for the Profession: Incorporating Planetary Health and climate change education into nursing programs has the potential to produce more environmentally conscious and socially responsible nurses., Impact: The absence of consensus on the essential knowledge and skills expected of nursing students has hindered the advancement of curricula and impacted educators' confidence in teaching Planetary Health and climate change. This study has resulted in a meticulously crafted framework of knowledge and skill statements that will be beneficial to educators, the future nursing workforce, and, ultimately, the individuals and communities whom nurses serve., Reporting Method: This paper adheres to the Conducting and REporting DElphi Studies (CREDES) reporting guideline., Patient or Public Contribution: No patient or public contribution., (© 2024 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Problem: Antenatal care guidelines used in Australia are inconsistent in their recommendations for childbirth and parenting education (CBPE) classes for preparation of women and parents for pregnancy, childbirth, and early parenting., Background: Clinical practice guidelines in maternity care are developed to assist healthcare practitioners and consumers to make decisions about appropriate care. The benefit of such guidelines relies on the translation and quality of the evidence contained within them. In the context of antenatal care guidelines, there is a potential evidence-practice gap with regard to CBPE., Aims: This review aims to appraise the quality of Australian antenatal care guidelines in their recommendations for CBPE for women and partners., Methods: Publicly available Australian antenatal care guidelines were identified including local health district websites and professional organisations pertaining to maternity care. Guidelines were reviewed independently, and the quality was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool., Findings: Five guidelines were included in the review and appraised using AGREE II. With the exception of the Department of Health Pregnancy Care Guidelines, guidelines scored poorly across all six domains. When appraised according to specific CBPE recommendations for rigour of development, presentation, and applicability; all guidelines received low scores., Discussion: Prenatal services remain largely unregulated across the board, with no systematic approach to make recommendations for CBPE and guidelines lacking in rigour with regard to CBPE., Conclusion: Within the guidelines reviewed there was a lack of evidence-based recommendations provided for educators or consumers regarding childbirth and parenting education., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: To scope and synthesise literature around the job satisfaction of early career midwives - those in their first five years of post-qualification practice - including the effect on their career aspirations and intention to leave the profession., Design: Scoping review., Methods: Relevant databases were searched for published research studies and grey literature. Literature were selected through adherence to pre-set inclusion and exclusion criteria to ensure relevance. Literature was included that was published from 2012. Selected literature were tabled and common themes were mapped to look for similarities and differences in findings., Findings: Ten papers were included - seven original research studies, a fact sheet, a non peer-reviewed article, and a conference paper. Negative themes - lack of support, workload stress, and job dissatisfaction, and positive themes - passion for midwifery, collegial relationships, and autonomy - were found across many of the included papers., Key Conclusions: Many midwives are considering leaving their profession due to the stress of their work, role dissatisfaction, and a lack of support. This is more common amongst early career midwives. There were some protective factors such as having pride in the midwifery profession. More research is needed to identify and address the needs specific to early career midwives., (Copyright © 2023 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Problem: Given the current rate of burnout and attrition among nurses and midwives globally, there is a need to understand the effectiveness of supportive strategies to help retain this workforce., Background: Clinical supervision can help to ensure that nurses and midwives are supported and have the capacity to cope with their job demands. Yet there are no metasyntheses that provide a collective understanding of their experiences with clinical supervision., Aim: To synthesise the experiences of nurses and midwives who have accessed clinical supervision., Methods: A metasynthesis was conducted by systematically searching academic databases for relevant publications; assessing their quality using an established checklist; extracting and analysing qualitative content; and synthesising key findings about the experiences of nurses and midwives regarding clinical supervision., Findings: Themes and subthemes were identified from 12 papers, including: optimal logistics; support; safety and confidentiality; improving practice through reflection; and trust in the group., Discussion: For clinicians to feel comfortable discussing their practice and workplace with the facilitator and colleagues, nurses and midwives needed to feel safe during clinical supervision and trust the process and their peers. Despite common difficulties of finding time for the sessions, clinical supervision can enhance collaboration and communication in the workplace., Conclusion: Clinical supervision that adheres to group rules can provide professional support within a safe, confidential space. Having trust in peers and facilitators at the sessions can help staff develop confidence, provide personal development and professional sustenance., Competing Interests: Declaration of Competing Interest The authors have declared no conflict of interest., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)

Objectives: By 2030, 60% of the global population is expected to live in urban areas. Exposure to urban environments during the first 2000 days of life can have positive or negative health outcomes across the life course. Understanding the types of urban exposures that influence health outcomes is needed to guide research priorities for public health and urban planning. This review aims to summarise the published research examining the health outcomes of all urban environmental exposures during the first 2000 days of life, identify the quantity and characteristics of research in this area, methods used, and knowledge gaps., Methods: We conducted a scoping review using the JBI methodology for scoping reviews. Eight databases were searched for peer-reviewed primary studies. Inclusion criteria were studies that measured maternal, infant and child exposure to everyday urban environment features and conditions in cities/metropolitan areas during the first 2000 days of life and reported offspring health outcomes across the life course, including embryo, fetal/newborn, infant, child, adolescent, and adult outcomes. We used Covidence software for data screening and extraction. Study characteristics and findings were summarised using tables and narrative synthesis., Results: We reviewed 235 articles, which included studies conducted across 41 countries, the majority in the US (n = 63). A broad range of environmental exposures were studied, spanning seven categories: air pollution; energy-based pollution; atmosphere, chemical and metal exposure; neighbourhood-built and natural environment features; neighbourhood community conditions; and residential living conditions. Air pollution was the most studied exposure type (n = 153 studies). Health outcomes were reported for all life stages except adults, with fetal/newborn outcomes the most studied life stage (n = 137)., Conclusions: We found that most research investigating urban environmental exposures in the first 2000 days and health outcomes across the life course focused on air pollution exposures and fetal/newborn health outcomes, using correlational retrospective cohort designs. Few studies included multiple environmental exposures. There is a clear need for more longitudinal research to determine the health impacts of multiple urban environmental exposures across the life course. This will assist in developing urban design and planning strategies and population health to mitigate health risks across the life course., Competing Interests: Authors CC and AH served on the executive committee of the funding organisation.

Problem: Implementation of woman-centred care in evidence-based maternity practice requires clinicians to be skilled in shared decision-making, yet there is limited training or research into such interventions., Background: Shared decision-making enables women to make informed decisions in partnership with clinicians where there are varied clinical options in relation to indications for and timing of planned birth., Aim: We aimed to develop a shared decision-making training intervention and evaluate its feasibility and acceptability to midwives and obstetricians., Methods: The intervention was co-designed by midwifery and medical clinician-researchers, and a consumer representative. Online training and demonstration videos were distributed to midwives and obstetricians in three Sydney hospitals, followed by two online workshops in 2021 and 2022 where participants practised shared decision-making in roleplaying scenarios tailored to timing of birth. Training was evaluated using post-workshop and post-training surveys and semi-structured qualitative interviews., Findings: The training workshop format, duration and content were well received. Barriers to the uptake of shared decision-making were time, paternalistic practices and fear of repercussions of centring women in the decision-making process., Discussion: The intervention enabled midwifery and medical colleagues to learn communication repertoires from each other in woman-centred discussions around timing of birth. Roleplay scenarios enabled participants to observe and provide feedback on their colleagues' shared decision-making practices, while providing a space for collective reflection on ways to promote, and mitigate barriers to, its implementation in practice., Conclusion: Shared decision-making training supports maternity clinicians in developing skills that implement woman-centred care in the timing of planned birth., Competing Interests: Declaration of Competing Interest This manuscript is not being considered elsewhere. There are no conflicts of interests in relation to any commercial products, consultancies, stock ownership or other equity interests or patent-licensing arrangements. This work was supported as part of the Timing of Birth study by Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Competing Interests: The authors have declared that no competing interests exist.

Problem: Over one third of women report their birth experience as psychologically traumatic. Psychological birth trauma has been associated with perinatal mental illness and post-traumatic stress disorder., Background: Midwifery continuity of care provides improved outcomes for mothers and babies as well as increased birth satisfaction. Some women who have experienced psychological birth trauma will seek out midwifery continuity of care in their next pregnancy. The aim of this study was to explore women's experiences of midwifery continuity of care following a previous traumatic birth experience in Australia., Methods: A qualitative descriptive approach was undertaken. Eight multiparous women who self-identified as having psychological birth trauma were interviewed. Data were analysed using thematic analysis to discover how participants subsequently experienced care in a midwifery continuity of care model., Findings: Seven out of eight participants had care from a private midwife following birth trauma. Four themes were discovered. The nightmare lives on: despite a positive and/or healing experience in midwifery continuity of care, women still carry their traumatic birth experiences with them. Determination to find better care: Women sought midwifery continuity of care following a previous traumatic birth in their desire to prevent a similar experience. A broken maternity system: women described difficulties accessing these models including financial barriers and lack of availability. The power of continuity: All reported a positive experience birthing in a midwifery continuity of care model and some reported that this had a healing effect., Conclusion: Offering midwifery continuity of care models to women with a history of psychological birth trauma can be beneficial. More research is necessary to confirm the findings of this small study, and on ways women who have psychological birth trauma can be prioritised for midwifery continuity of care models in Australia., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)

Background: Breastfeeding protects against a range of conditions in the infant, including sudden infant death syndrome (SIDS), diarrhoea, respiratory infections and middle ear infections [1, 2]. The World Health Organization (WHO) recommends exclusive breastfeeding until six months of age, with continued breastfeeding recommended for at least two years and other complementary nutritious foods [3]. The 2017-18 National Health Survey (NHS) and 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) reported that the proportion of breastfeeding in Aboriginal and Torres Strait Islander infants (0-2 years) were less than half that of non-Indigenous infants (21.2% vs. 45%, respectively)[4]. There is a lack of research on interventions supporting Aboriginal women to breastfeed, identifying an evaluation gap related to peer support interventions to encourage exclusive breastfeeding in Aboriginal women., Methods: We will evaluate the effect of scheduled breastfeeding peer support for and by Aboriginal women, on breastfeeding initiation and the prevalence of exclusive breastfeeding. This MRFF (Medical Research Future Fund) funded project is designed as a single-blinded cluster randomised controlled trial recruiting six sites across New South Wales, Australia, with three sites being randomised to employ a peer support worker or undertaking standard care. Forty pregnant women will be recruited each year from each of the six sites and will be surveyed during pregnancy, at six weeks, four and six months postnatally with a single text message at 12 months to ascertain breastfeeding rates. In-depth interviews via an Indigenous style of conversation and storytelling called 'Yarning' will be completed at pre- and post-intervention with five randomly recruited community members and five health professionals at each site" [5]. Yarns will be audio recorded, transcribed, coded and thematic analysis undertaken. Health economic analysis will be completed to assess the health system incremental cost and effects of the breastfeeding intervention relative to usual care., Discussion: Evidence will be given on the effectiveness of Aboriginal peer support workers to promote the initiation and continuation of breastfeeding of Aboriginal babies. The findings of this study will provide evidence of effectiveness and cost-effectiveness of including peer support workers in postnatal care to promote breastfeeding practices., Trial Registration: ACTRN12622001208796 The impact of breastfeeding peer support on nutrition of Aboriginal infants., (© 2023. The Author(s).)

Background: All women require access to quality maternity care. Continuity of midwifery care can enhance women's experiences of childbearing and is associated with positive outcomes for women and infants. Much research on these models has been conducted with women with uncomplicated pregnancies; less is known about outcomes for women with complexities., Aim: To explore the outcomes and experiences for women with complex pregnancies receiving midwifery continuity of care in Australia., Methods: This integrative review used Whittemore and Knafl's approach. Authors searched five electronic databases (PubMed/MEDLINE, EMBASE, CINAHL, Scopus, and MAG Online) and assessed the quality of relevant studies using the Critical Appraisal Skills Programme (CASP) appraisal tools., Findings: Fourteen studies including women with different levels of obstetric risk were identified. However, only three reported outcomes separately for women categorised as either moderate or high risk. Perinatal outcomes reported included mode of birth, intervention rates, blood loss, perineal trauma, preterm birth, admission to special care and breastfeeding rates. Findings were synthesised into three themes: 'Contributing to safe processes and outcomes', 'Building relational trust', and 'Collaborating and communicating'. This review demonstrated that women with complexities in midwifery continuity of care models had positive experiences and outcomes, consistent with findings about low risk women., Discussion: The nascency of the research on midwifery continuity of care for women with complex pregnancies in Australia is limited, reflecting the relative dearth of these models in practice., Conclusion: Despite favourable findings, further research on outcomes for women of all risk is needed to support the expansion of midwifery continuity of care., Competing Interests: Conflict of Interest All authors declare no conflict of interest in this study., (Copyright © 2023 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Midwives have a pivotal role in screening for risk factors for mental illness and psychosocial vulnerabilities in women during the perinatal period. They also have a key responsibility to provide women with the appropriate resources to support their mental wellbeing. Midwives can lack confidence and/or feelings of competence regarding these skills. Care of women in the context of their perinatal mental health is a core midwifery skill that deserves practical learning during pre-registration education, just as the more 'hands on' skills such as abdominal palpation, labour and birth support or newborn examination. However, there is limited opportunity for students to gain clinical placement experiences that are specific to perinatal mental health (PMH). This discussion paper describes an innovative teaching and learning project that aimed to improve confidence in students' ability to conduct screening, support, and referral of women experiencing mental ill health. The project involved the development of an Objective Structured Clinical Examination (OSCE) and audio visual resources to support learning and teaching and clinical placement. Feedback was collected to inform the refinement of the first OSCE, and to assist in the design of the audio visual resources that are now displayed publicly on the Australian College of Midwives website at https://www.midwives.org.au/Web/Web/Professional-Development/Resources.aspx?hkey=12c2360e-d8b9-4286-8d0a-50aeaeca9702., (Copyright © 2023 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Problem: Eligibility criteria for publicly-funded homebirth models are strict and, as such, many women who initially plan a homebirth later become excluded., Background: Fifteen publicly-funded homebirth programs are operating in Australia, offering eligible women the opportunity to give birth at home at no cost, with the care of a hospital-employed midwife., Aim: To explore the experiences of women who planned a publicly-funded homebirth and were later excluded due to pregnancy complications or risk factors., Methods: A qualitative descriptive approach was taken. Recruitment was via social media sites specifically related to homebirth in Australia. Data collection involved semi-structured telephone interviews. Transcripts were thematically analysed., Findings: Thirteen women participated. They were anxious about 'Jumping through hoops' to maintain their low-risk status. After being 'Kicked off the program', women carefully 'negotiated the system' in order to get the birth they wanted in hospital. Some women felt bullied and coerced into complying with hospital protocols that did not account for their individual needs. Maintaining the midwife-woman relationship was a protective factor, decreasing negative experiences., Discussion: Women plan a homebirth to avoid the medicalised hospital environment and to gain access to continuity of midwifery care. To provide maternity care that is acceptable to women, hospital institutions need to design services that enable continuity of the midwife-woman relationship and assess risk on an individual basis., Conclusion: Exclusion from publicly-funded homebirth has the potential to negatively impact women who may feel a sense of loss, uncertainty or emotional distress related to their planned place of birth., Competing Interests: Conflict of interest None declared., (Copyright © 2023 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: The social support offered to women in the perinatal period can buffer against depression and anxiety. The sources and types of support that reduce maternal levels of depression and anxiety are not well understood., Aims: To investigate the effects of structural and functional support on depression and anxiety in women in the perinatal period, and to explore the experiences of women around support during the perinatal period., Method: A comprehensive search of six electronic databases was undertaken. Relevant studies published from January 2010 to April 2020 were included (PROSPERO reference number: CRD42020194228). Quantitative and qualitative studies were eligible if they reported the effects of, or had themes related to receiving functional or structural support in the perinatal period on women's levels of depression or anxiety. Qualitative data was synthesised using a thematic synthesis method. Quantitative data could not be pooled due to the lack of comparable RCTs or cohort studies and was thus presented in a narrative form., Results: Fifty-one articles (41 quantitative and 10 qualitative studies) were included. Analysis of quantitative studies demonstrated that insufficient support from partner, friends and family was associated with greater risk of symptoms of depression and anxiety. Distance-delivered interventions (via internet or telephone) diminished levels of depression and anxiety. Qualitative data revealed three overarching themes: appreciating all forms of support in the perinatal period, recognising appropriate and inappropriate support from health professionals and services, and having barriers to mobilising functional and structural support., Limitations: Grey literature was not explored and search strategies only included English, Spanish and Portuguese language articles. The reviewed studies were heterogeneous and for this reason, quantitative assessments were not feasible., Conclusion: Support from specific sources such as family members, friends who are also mothers, health professionals, neighbours, supervisors, co-workers and online communities still need to be further investigated. Implications for health professionals involved in the care of women in the perinatal period are discussed., Competing Interests: Declaration of competing interest All authors have no conflicts/competing interests to declare., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: The COVID-19 pandemic has caused isolation, fear, and impacted on maternal healthcare provision., Aim: To explore midwives' experiences about how COVID-19 impacted their ability to provide woman-centred care, and what lessons they have learnt as a result of the mandated government and hospital restrictions (such as social distancing) during the care of the woman and her family., Methods: A qualitative interpretive descriptive study was conducted. Twenty-six midwives working in all models of care in all states and territories of Australia were recruited through social media, and selected using a maximum variation sampling approach. Data were collected through in-depth interviews between May to August, 2020. The interviews were recorded, transcribed verbatim, and thematically analysed., Findings: Two overarching themes were identified: 'COVID-19 causing chaos' and 'keeping the woman at the centre of care'. The 'COVID-19 causing chaos' theme included three sub-themes: 'quickly evolving situation', 'challenging to provide care', and 'affecting women and families'. The 'Keeping the woman at the centre of care' theme included three sub-themes: 'trying to keep it normal', 'bending the rules and pushing the boundaries', and 'quality time for the woman, baby, and family unit'., Conclusion: Findings of this study offer important evidence regarding the impact of the pandemic on the provision of woman-centred care which is key to midwifery philosophy. Recommendations are made for ways to preserve and further enhance woman-centred care during periods of uncertainty such as during a pandemic or other health crises., (Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.)

Problem: Aspects of the midwifery workplace culture have previously been measured as negative with limited leadership or support. Support for midwives is essential for them to face the complexity and workloads in Australian maternity units., Background: Understanding the culture of the midwifery workplace is important to develop strategies to stem workforce attrition and to optimise care of women and their families., Aims: This study aimed to assess midwives' perceptions of workplace culture in two maternity units in Sydney, Australia, and compare the results with a national study using the same validated instrument., Method: This study reports results using the Australian Midwifery Workplace Culture instrument (n = 49 midwives) and stakeholder groups (n = 10). Simple descriptive statistics were used, and the qualitative responses were analysed thematically., Findings: Compared to the national sample, participants rated their workplace more favourably, especially their relationships with managers and colleagues. Over one-third (36.7%) considered that their workplace had a positive culture, compared with 27.9%. However, they rated their workplaces more negatively on time constraints and staff resources, and reported limited autonomy. Workplaces were highly medicalised which impacted their philosophy of woman-centred care and their ability to work autonomously., Discussion: Factors related to collegiality in the workplace, relationship with managers, midwives' intention to leave the profession and time constraints are discussed in comparison to the national study, as well as other relevant research. Conclusion Workplace collaboration, support, respect and understanding were extremely important to midwives, as were adequate staffing levels, teamwork and opportunities for further education., (Copyright © 2021 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: There are major shortfalls in the midwifery workforce which has been exacerbated by the COVID 19 pandemic. Midwives have high levels of burnout and many, often early career midwives, are planning to leave the profession. There are reports of a poor workplace culture in maternity units, including bullying. Support is essential for the welfare of the workforce to be able to cope with the demands of their jobs. Supportive strategies, such as Clinical Supervision, a recognised approach in healthcare, enable reflection in a facilitated, structured way, and can enhance professional standards. The purpose of this research is to study burnout levels in midwives, those exiting their workplace and perceptions of workplace culture in relation to access to, and attendance of, monthly Clinical Supervision., Methods: This study will be a cluster randomised controlled trial of maternity sites within Sydney and the surrounding districts. Twelve sites will be recruited and half will receive monthly Clinical Supervision for up to two years. Midwives from all sites will be requested to complete 6-monthly surveys comprising validated measurement tools: the Copenhagen Burnout Inventory (CBI), the Australian Midwifery Workplace Culture (AMWoC) tool and the Clinical Supervision Evaluation Questionnaire (CSEQ) (the latter for intervention sites only). Primary outcomes are the levels of burnout in midwives (using the CBI). Secondary outcomes will be the quality of the intervention (using the CSEQ), perceptions of workplace culture (using the AMWoC tool) and midwives' intention to stay in their role/profession, as well as sick leave rates and numbers of exiting staff. We will also determine the dose effect - ie the impact in relation to how many Clinical Supervision sessions the midwives have attended, as well as other supportive workplace strategies such as mentoring/coaching on outcomes., Discussion: Through attending monthly Clinical Supervision we hypothesise that midwives will report less burnout and more positive perceptions of workplace culture than those in the control sites. The potential implications of which are a productive workforce giving high quality care with the flow-on effect of having physically and psychologically well women and their babies., Trial Registration: The ACTRN Registration number is ACTRN12621000545864p , dated 10/05/2021,., (© 2022. The Author(s).)

Background: Having a known midwife throughout pregnancy, birth and the early parenting period improves outcomes for mothers and babies. In Australia, midwifery continuity of care has been recommended in all states, territories and nationally although uptake has been slow. Several barriers exist to implementing midwifery continuity of care models and some maternity services have responded by introducing modified models of continuity of care. An antenatal and postnatal continuity of care model without intrapartum care is one example of a modified model of care that has been introduced by health services., Objectives: The aim of this study was to explore the value and acceptability of an antenatal and postnatal midwifery program to women, midwives and obstetricians prior to implementation of the model at one hospital in Metropolitan Sydney, Australia., Methods: A qualitative descriptive methodology was undertaken to discover the value and acceptability to the implementation of the model. Data was collected via focus groups and one to one interviews from the service users (pregnant women and two partners) and service providers (midwives and obstetricians). We also collected demographic data to demonstrate the diversity of the setting. The Quality Maternal Newborn Care (QMNC) Framework was used to guide the focus groups and analyse the data., Findings: Four themes emerged from the data that were named feeling safe and connected, having more quality time and being confident, having a sense of community and respecting cultural diversity. The findings were analysed through the lens of the quality components of the QMNC framework. The final findings demonstrate the value and acceptability of implementing this model of care from women's, midwives and obstetrician's perspective., Conclusions/implications: Providing midwifery continuity of care through the antenatal and postnatal period without intrapartum care, is being implemented in Australia without any research. Using the QMNC framework is a useful way to explore the qualities of a new emerging service and the values and acceptability of this model of care for service providers and service users., (Copyright © 2021 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

While the value of ethnography in health research is recognized, the extent to which it is used is unclear. The aim of this review was to map the use of ethnography in maternity care, and identify the extent to which the key principles of ethnographies were used or reported. We systematically searched the literature over a 10-year period. Following exclusions we analyzed 39 studies. Results showed the level of detail between studies varied greatly, highlighting the inconsistencies, and poor reporting of ethnographies in maternity care. Over half provided no justification as to why ethnography was used. Only one study described the ethnographic approach used in detail, and covered the key features of ethnography. Only three studies made reference to the underpinning theoretical framework of ethnography as seeking to understand and capture social meanings. There is a need to develop reporting guidelines to guide researchers undertaking and reporting on ethnographic research., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Background: In Australia, perinatal care is provided through a mix of government and private funding. Women who give birth in a private hospital are less likely to receive depression screening and psychosocial assessment and are less likely to access parenting services that support mental health outcomes, compared to women who give birth in a public hospital., Aim: The aim of this study was to determine the risk of one outcome of perinatal mental illness - hospital admission - for women who gave birth in private hospitals compared to women who gave birth in public hospitals., Methods: This population-based cohort study employed binary regression analysis of state government data. Linkage of the Perinatal Data Collection, Registry of Births, Deaths and Marriages, and Admitted Patients Data Collection (2003-2009) has provided comparative information on women admitted to any hospital during the first year after birth with a primary diagnosis of mental illness., Results: In the first year after birth, women who gave birth in private hospitals were more likely to be admitted to a hospital with a primary diagnosis of mental illness (rate = 2.54%, 95% CI = 2.40-2.68%) than women who gave birth in public hospitals (rate = 1.68%, 95% CI = 1.61-1.75%)., Conclusion: The increased likelihood of admission for postnatal mental illness may indicate increased risk of developing a mental illness for women who gave birth in a private hospital., (© 2020 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Objective: The aim of the study was to explore hospital-based midwives' experiences of providing publicly-funded homebirth services in Australia., Design: A qualitative descriptive study using a constructivist grounded theory methodology was undertaken., Setting: Five different states or territories of Australia where publicly-funded homebirth services were operating., Participants: Interviews were conducted with 21 midwives and midwifery managers from eight different public hospitals who had recent experience of working in, or with, publicly-funded homebirth models., Findings: Witnessing undisturbed birth in the home setting transformed midwives' attitudes towards birth. Following exposure to homebirth, many midwives felt they were seeing undisturbed birth for the first time. This led them to question their current understanding of physiological birth and develop a new awareness of the powerful influence that the environment has on labouring women. This new understanding resulted in changes to their practice., Key Conclusions: For midwives accustomed to working in hospital settings, exposure to homebirth deepened their understanding of physiological birth, resulting in a perspective transformation and subsequent shift in practice., Implications for Practice: Exposure to homebirth may motivate midwives to alter their practice in both home and hospital settings in order to shift the power dynamic between women and caregivers and protect women from unnecessary disturbance during labour., Competing Interests: Conflict of Interest The authors have no conflict of interest to declare., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Problem: The midwifery workforce in Australia is impacted by shortages and attrition. Workplace culture affects midwives' intentions to stay in the profession and their capacity to provide woman-centred care for mothers and infants., Background: Staff attrition in maternity services often relates to midwives' workplace experiences and negative perceptions of organisational culture. Broad-based data are essential to fully understand midwifery workplace culture., Aim: This study aimed to examine Australian midwives' perceptions of workplace culture, using a specifically developed instrument., Methods: A national online survey of Australian midwives, within a wider project on maternity workplace culture. Quantitative data were analysed descriptively. Qualitative data were analysed using content analysis., Findings: Overall, 322 eligible midwives rated workplace culture and 150 provided further qualitative responses. Themes included 'the ability to be a midwife', 'support at work' and 'bullying'. Less than a third of midwives thought their workplace had a positive culture. Many respondents felt disengaged and unsupported by managers and described an inability to use all their midwifery knowledge in medically-dominated environments. Many attributed poor workplace culture to limited resources, poor communication, time pressure and a lack of leadership in their workplaces. Inadequate staffing levels and poor management left many midwives feeling disempowered and despondent about their workplace. Others, however, described highly positive workplace cultures and inspiring role models., Conclusion: The survey captured a snapshot of Australian midwifery workplace culture. Findings on leadership, workloads, management support and other aspects of workplace culture can inform future workforce planning and policies. A larger study of the midwifery workplace culture is needed., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

Background: In Thailand, maternal complications and poor neonatal outcomes are common in pregnant adolescents. There are attempts to improve outcomes for this group through specialised antenatal clinics, however, neither the way in which these clinics are provided nor the attitudes of healthcare professionals to pregnant adolescents are known. The aim of this study was to understand the experiences of healthcare professionals in caring for pregnant adolescent women in Thailand., Methods: A qualitative descriptive design was used. Semi-structured interviews were conducted with 21 healthcare professionals involved in caring for pregnant adolescents across three public hospitals in Bangkok, Thailand. All interviews were analysed thematically., Results: The core concept 'recognising the challenges of providing care for young Thai pregnant women' explained the provision of care. This concept contained three main themes: 1) having an awareness of the political and societal contexts and environment of care; 2) being aware of attitudes and the need to develop psychosocial skills in caring for adolescent women; and 3) having different approaches to caring for pregnant adolescents. A lack of continuity of care was a significant barrier in terms of structure and process. Effective communication was important to provide quality care., Conclusion: Healthcare professionals recognised that there were barriers to providing effective care for adolescent women. These findings may inform healthcare professionals and policymakers in Thailand in relation to the systems of care required and addressing the needs of pregnant adolescents. This would enable Thailand to meet the goal in providing a positive pregnancy experience for all women., (Copyright © 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)