Search

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.

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.

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.

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.

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.

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

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.

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.

Abstract 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 stra

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.

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

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.

Background

Objectives

Methods

Findings

Conclusions/implications

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.

Background The proportion of women undergoing induction of labour (IOL) has risen in recent decades, with significant variation within countries and between hospitals. The aim of this study was to review research supporting indications for IOL and determine which indications are supported by evidence and where knowledge gaps exist. Methods A systematic scoping review of quantitative studies of common indications for IOL. For each indication, we included systematic reviews/meta-analyses, randomised controlled trials (RCTs), cohort studies and case control studies that compared maternal and neonatal outcomes for different modes or timing of birth. Studies were identified via the databases PubMed, Maternity and Infant Care, CINAHL, EMBASE, and ClinicalTrials.gov from between April 2008 and November 2019, and also from reference lists of included studies. We identified 2554 abstracts and reviewed 300 full text articles. The quality of included studies was assessed using the RoB 2.0, the ROBINS-I and the ROBIN tool. Results 68 studies were included which related to post-term pregnancy (15), hypertension/preeclampsia (15), diabetes (9), prelabour rupture of membranes (5), twin pregnancy (5), suspected fetal compromise (4), maternal elevated body mass index (BMI) (4), intrahepatic cholestasis of pregnancy (3), suspected macrosomia (3), fetal gastroschisis (2), maternal age (2), and maternal cardiac disease (1). Available evidence supports IOL for women with post-term pregnancy, although the evidence is weak regarding the timing (41 versus 42 weeks), and for women with hypertension/preeclampsia in terms of improved maternal outcomes. For women with preterm premature rupture of membranes (24-37 weeks), highquality evidence supports expectant management rather than IOL/early birth. Evidence is weakly supportive for IOL in women with term rupture of membranes. For all other indications, there were conflicting findings and/or insufficient power to provide definitive evidence. C

Nurses and midwives of Australia now is the time for change! As powerfully placed, Indigenous and non-Indigenous nursing and midwifery professionals, together we can ensure an effective and robust Indigenous curriculum in our nursing and midwifery schools of education. Today, Australia finds itself in a shifting tide of social change, where the voices for better and safer health care ring out loud. Voices for justice, equity and equality reverberate across our cities, our streets, homes, and institutions of learning. It is a call for new songlines of reform. The need to embed meaningful Indigenous health curricula is stronger now than it ever was for Australian nursing and midwifery. It is essential that nursing and midwifery leadership continue to build an authentic collaborative environment for Indigenous curriculum development. Bipartisan alliance is imperative for all academic staff to be confident in their teaching and learning experiences with Indigenous health syllabus. This paper is a call out. Now is the time for Indigenous and non-Indigenous nurses and midwives to make a stand together, for justice and equity in our teaching, learning, and practice. Together we will dismantle systems, policy, and practices in health that oppress. The Black Lives Matter movement provides us with a ‘now window’ of accepted dialogue to build a better, culturally safe Australian nursing and midwifery workforce, ensuring that Black Lives Matter in all aspects of health care.

© 2020 Informa UK Limited, trading as Taylor & Francis Group. Nurses and midwives of Australia now is the time for change! As powerfully placed, Indigenous and non-Indigenous nursing and midwifery professionals, together we can ensure an effective and robust Indigenous curriculum in our nursing and midwifery schools of education. Today, Australia finds itself in a shifting tide of social change, where the voices for better and safer health care ring out loud. Voices for justice, equity and equality reverberate across our cities, our streets, homes, and institutions of learning. It is a call for new songlines of reform. The need to embed meaningful Indigenous health curricula is stronger now than it ever was for Australian nursing and midwifery. It is essential that nursing and midwifery leadership continue to build an authentic collaborative environment for Indigenous curriculum development. Bipartisan alliance is imperative for all academic staff to be confident in their teaching and learning experiences with Indigenous health syllabus. This paper is a call out. Now is the time for Indigenous and non-Indigenous nurses and midwives to make a stand together, for justice and equity in our teaching, learning, and practice. Together we will dismantle systems, policy, and practices in health that oppress. The Black Lives Matter movement provides us with a ‘now window’ of accepted dialogue to build a better, culturally safe Australian nursing and midwifery workforce, ensuring that Black Lives Matter in all aspects of health care.

BACKGROUND: The proportion of women undergoing induction of labour (IOL) has risen in recent decades, with significant variation within countries and between hospitals. The aim of this study was to review research supporting indications for IOL and determine which indications are supported by evidence and where knowledge gaps exist. METHODS: A systematic scoping review of quantitative studies of common indications for IOL. For each indication, we included systematic reviews/meta-analyses, randomised controlled trials (RCTs), cohort studies and case control studies that compared maternal and neonatal outcomes for different modes or timing of birth. Studies were identified via the databases PubMed, Maternity and Infant Care, CINAHL, EMBASE, and ClinicalTrials.gov from between April 2008 and November 2019, and also from reference lists of included studies. We identified 2554 abstracts and reviewed 300 full text articles. The quality of included studies was assessed using the RoB 2.0, the ROBINS-I and the ROBIN tool. RESULTS: 68 studies were included which related to post-term pregnancy (15), hypertension/pre-eclampsia (15), diabetes (9), prelabour rupture of membranes (5), twin pregnancy (5), suspected fetal compromise (4), maternal elevated body mass index (BMI) (4), intrahepatic cholestasis of pregnancy (3), suspected macrosomia (3), fetal gastroschisis (2), maternal age (2), and maternal cardiac disease (1). Available evidence supports IOL for women with post-term pregnancy, although the evidence is weak regarding the timing (41 versus 42 weeks), and for women with hypertension/preeclampsia in terms of improved maternal outcomes. For women with preterm premature rupture of membranes (24-37 weeks), high-quality evidence supports expectant management rather than IOL/early birth. Evidence is weakly supportive for IOL in women with term rupture of membranes. For all other indications, there were conflicting findings and/or insufficient power to provide definitive eviden

© 2019 John Wiley & Sons Australia, Ltd Aim: To develop and psychometrically test the Australian Midwifery Workplace Culture instrument. Background: Workplace culture is critical within midwifery settings. Culture determines not only the well-being and continued retention of maternity staff and managers but it also affects the quality and ultimate safety of the care they provide to women, infants and families. Several studies have identified cultural problems within maternity services. Relatively few instruments take account of the unique aspects of these workplaces and the relationship between midwives and women. Design: Three-stage instrument development involved item generation (based on the Culture of Care Barometer), expert content validation and a pilot test. Methods: During 2016, 38 midwifery experts reviewed the initial items, and 322 midwives then pilot-tested the draft instrument. We used exploratory factor analysis to identify key domains and to refine the instrument. Results: The refined instrument contained 22 items in three distinct domains: relationship with managers, empowerment and collegiality. Conclusion: The instrument can contribute to understanding important dimensions of the culture in maternity workplaces and thus to examining problematic attitudes and practices. The instrument requires further development and testing with larger and more diverse samples of midwives and validation in specific midwifery settings and models of care.

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.

© 2019 Australian College of Midwives 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.

© 2019 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.

© 2018 Background: The ability of midwives to provide empathic care that is culturally appropriate is critical for women to feel accepted by the midwives who support them. Australia is a culturally diverse society, yet there is evidence of poorer maternity outcomes for some women and infants, related to their cultural background. Objectives: This study's objective was to evaluate the effectiveness of an education program for student midwives. The program was intended to increase the cultural empathy of future midwives, to help ensure greater cultural safety and optimal maternity outcomes across all sections of Australian society. Design: This quantitative study compared pre- and post-intervention measures of students’ empathy. Setting: The health faculty of a large urban university in Australia. Participants: Fifty-five students from all three years of an undergraduate midwifery program participated. Methods: The study examined students’ scores on the Jefferson Scale of Empathy for health profession students, measured before and immediately after the education program, and again after four weeks. Results: The midwifery students had a high mean baseline score on the empathy scale. Scores increased significantly after the education program. Students with lower pre-test scores recorded significantly greater increases in their empathy levels than those who were more empathic initially. Empathy scores declined one month after the program, but remained higher than baseline levels. Conclusions: Several studies have explored empathy levels amongst current and future health professionals. However, few studies of health professional students have evaluated the impact of specific education interventions addressing cultural empathy. This study found that midwifery students tended to have higher empathy scores than students in other health disciplines. The education workshop further increased participants’ scores.

© 2018 Elsevier Ltd Objective: first year midwifery students learn early in semester about situations in midwifery where a high level of emotion is expressed, such as taking a sexual history, being faced with the body image changes of pregnancy and working with women in the extreme pain of labour. Commencing students usually have not had exposure to the realities of studying and working in midwifery, and often have an idealised view of midwifery that may lead to attrition from the course. We aimed to equip students with personal and professional tools to discuss sensitive issues in midwifery and promote self-care through the development of two workshops. The first workshop focussed on sensitive issues in midwifery and the second on self-care strategies. Design: quantitative and qualitative data were collected pre and post workshops using a survey. Setting: the workshops were developed at one university in New South Wales, Australia. Participants: Beginning first year midwifery students Measurements: feeling more comfortable, confident and knowledgeable was measured using a paired t-test from the responses on a pre and post workshop survey. Content analysis was performed on the qualitative survey responses. Findings: there were significant increases in the students feeling more comfortable to discuss sensitive issues in midwifery following the first workshop. They found meeting new people, respecting opinions, normalizing confronting topics to be valuable and useful. The second workshop found significant differences in being more confident and knowledgeable to access and try new self-care strategies in both their personal and professional life. Students discussed learning to be more mindful in order to prepare for stressful situations. They became aware of their feeling and thoughts when under stress and said they would practice techniques including meditation. Conclusion: the workshops assisted the students to develop peer support, self-care strategies and coping me

© 2017 Background: In some countries, up to 30% of women are exposed to intrapartum antibiotic prophylaxis for prevention of early-onset group B Streptococcal infection. Intrapartum antibiotic prophylaxis aims to reduce the risk of neonatal morbidity and mortality from this infection. The intervention may adversely affect non-pathogenic bacteria which are passed to the newborn during birth and are considered important in optimising health. Since many women are offered intrapartum antibiotic prophylaxis, effectiveness and implications of this intervention need to be established. This review considers clinical trials and observational studies analysing the effectiveness of intrapartum antibiotic prophylaxis. Methods: An integrative literature review was conducted. One systematic review, three clinical trials and five observational studies were identified for appraisal. Findings: Randomised controlled trials found intrapartum antibiotic prophylaxis effective but all retrieved randomised clinical trials had significant methodological flaws. High quality observational studies reported high rates of effectiveness but revealed less than optimal adherence to screening and administration of the prophylaxis. Scant consideration was given to short term risks, and long-term consequences were not addressed. Discussion: Studies found intrapartum antibiotic prophylaxis to be effective. However, evidence was not robust and screening and prophylaxis have limitations. Emerging evidence links intrapartum antibiotic prophylaxis to adverse short and longer-term neonatal outcomes. Conclusion: Our review found high quality evidence of the effectiveness of intrapartum antibiotic prophylaxis was limited. Lack of consideration of potential risks of the intervention was evident. Women should be enabled to make informed decisions about GBS management. More research needs to be done in this area.

© 2016 Australian College of Midwives Background Over the past two decades, 14 publicly-funded homebirth models have been established in Australian hospitals. Midwives working in these hospitals now have the opportunity to provide homebirth care, despite many having never been exposed to homebirth before. The transition to providing homebirth care can be daunting for midwives who are accustomed to practising in the hospital environment. Aim To explore midwives’ experiences of transitioning from providing hospital to homebirth care in Australian public health systems. Methods A descriptive, exploratory study was undertaken. Data were collected through in-depth interviews with 13 midwives and midwifery managers who had recent experience transitioning into and working in publicly-funded homebirth programs. Thematic analysis was conducted on interview transcripts. Findings Six themes were identified. These were: skilling up for homebirth; feeling apprehensive; seeing birth in a new light; managing a shift in practice; homebirth—the same but different; and the importance of mentoring and support. Discussion Midwives providing homebirth work differently to those working in hospital settings. More experienced homebirth midwives may provide high quality care in a relaxed environment (compared to a hospital setting). Midwives acceptance of homebirth is influenced by their previous exposure to homebirth. Conclusion The transition from hospital to homebirth care required midwives to work to the full scope of their practice. When well supported by colleagues and managers, midwives transitioning into publicly-funded homebirth programs can have a positive experience that allows for a greater understanding of and appreciation for normal birth.

© 2016 International Council of Nurses Aim: The Australian Award Fellowship Program aimed to strengthen nursing and midwifery leadership and capacity in developing countries in the Pacific. Background: It is necessary to build an optimal global health workforce, and leadership and mentorship are central to this need. This is especially important in small island states such as the Pacific who have limited capacity and resources. Introduction: This health system strengthening program addressed quality improvement in education, through the mentorship of potential nursing and midwifery leaders in the South Pacific Region. Methods: Program participants between 2013 and 2015 were interviewed. Data were audio-taped, transcribed and analysed thematically using an inductive process. Results: Thirty-four nurses and midwives from 12 countries participated. There were four main themes arising from the data which were: having a country-wide objective, learning how to be a leader, negotiating barriers and having effective mentorship. Discussion: Our study showed that participants deemed their mentorship from country leaders highly valuable in relation to completing their projects, networking and role modelling. Similar projects are described. Limitations: The limitation of this study was its small size. There is a need to continue to build the momentum of the program and Fellows in each country in order to build regional networks. Conclusions and implications for nursing and midwifery: The Program has provided beneficial leadership education and mentorship for nurses and midwives from Pacific countries. It has provided a platform to develop quality improvement projects in line with national priorities. Implications for health policy: Global aid programs and the recipients of the program would benefit from comparable health strengthening approaches to nursing and midwifery in similar developing countries.

© 2016 Australian College of Midwives Issue Indigenous women in many countries experience a lack of access to culturally appropriate midwifery services. A number of models of care have been established to provide services to women. Research has examined some services, but there has not been a synthesis of qualitative studies of the models of care to help guide practice development and innovations. Aim To undertake a review of qualitative studies of midwifery models of care for Indigenous women and babies evaluating the different types of services available and the experiences of women and midwives. Methods A meta-synthesis was undertaken to examine all relevant qualitative studies. The literature search was limited to English-language published literature from 2000–2014. Nine qualitative studies met the inclusion criteria and literature appraisal – six from Australia and three from Canada. These articles were analysed for coding and theme development. Findings The major themes were valuing continuity of care, managing structural issues, having negative experiences with mainstream services and recognising success. Discussion The most positive experiences for women were found with the services that provided continuity of care, had strong community links and were controlled by Indigenous communities. Overall, the experience of the midwifery services for Indigenous women was valuable. Despite this, there were still barriers preventing the provision of intrapartum midwifery care in remote areas. Conclusion The expansion of midwifery models of care for Indigenous women and babies could be beneficial in order to improve cultural safety, experiences and outcomes in relation to pregnancy and birth.