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Background Newborn bloodspot screening identifies presymptomatic babies who are affected by genetic or congenital conditions. Each year, around 10,000 parents of babies born in England are given a positive newborn bloodspot screening result for one of nine conditions that are currently screened for. Despite national guidance, variation exists regarding the approaches used to communicate these results to families; poor communication practices can lead to various negative sequelae. Objectives Identify and quantify approaches that are currently used to deliver positive newborn bloodspot screening results to parents (phase 1). Develop (phase 2), implement and evaluate (phase 3) co-designed interventions for improving the delivery of positive newborn bloodspot screening results. Quantify the resources required to deliver the co-designed interventions in selected case-study sites and compare these with costs associated with current practice (phase 3). Design This was a mixed-methods study using four phases, with defined outputs underpinned by Family Systems Theory. Setting All newborn bloodspot screening laboratories in England (n = 13). Participants Laboratory staff and clinicians involved in processing or communicating positive newborn bloodspot screening results, and parents of infants who had received a positive or negative newborn bloodspot screening result. Interventions Three co-designed interventions that were developed during phase 2 and implemented during phase 3 of the study. Main outcome measure Acceptability of the co-designed interventions for the communication of positive newborn bloodspot screening results. Results Staff were acutely aware of the significance of a positive newborn bloodspot screening result and the impact that this could have on families. Challenges existed when communicating results from laboratories to relevant clinicians, particularly in the case of congenital hypothyroidism. Clinicians who were involved in the communication of positive newborn bloodspot screening results were committed to making sure that the message, although distressing for parents, was communicated well. Despite this, variation in communication practices existed. This was influenced by many factors, including the available resources and lack of clear guidance. Although generally well received, implementation of the co-designed interventions in practice served to illuminate barriers to acceptability and feasibility. The interventions would not influence NHS expenditure and could be cost neutral when delivered by teleconsultations. Limitations Participants with a pre-existing interest in this topic may have been more likely to self-select into the study. The researchers are experienced in this field, which may have biased data collection and analysis. COVID-19 hindered implementation and related data collection of the co-designed interventions. Conclusions There was variation in the processes used to report positive newborn bloodspot screening results from newborn bloodspot screening laboratories to clinical teams and then to families. The various practices identified may reflect local needs, but more often reflected local resource. A more consistent ‘best practice’ approach is required, not just in the UK but perhaps globally. The co-designed interventions represent a starting point for achieving this. Future work Future work should include a national evaluation study with predefined outcomes, accompanied by an economic evaluation, to assess the acceptability, feasibility and usability of the co-designed interventions in practice nationally. Trial registration This trial is registered as ISRCTN15330120. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 19. See the NIHR Journals Library website for further project information.

We examined interprofessional working in a newly implemented parent-infant mental health service team supporting families experiencing bonding and attachment difficulties. The aim was to identify forms of interprofessional work undertaken, barriers and facilitators of this work, and families’ and healthcare professionals’ perceptions of it. Semi-structured interviews were carried out with 21 stakeholders (5 parents, 4 team clinicians, 9 service referrers, 3 service commissioners) and were analyzed thematically. Interprofessional activities identified included building the service team’s cohesion and shared practice, building partner networks, interagency communication, coordination of roles, and raising awareness of infant mental health and parent-infant relationship needs. Enablers and barriers to interprofessional working were broadly consistent with findings from previous studies of related services, but with additional emphasis on consultative work as an enabler. Healthcare professionals reported benefiting from the case consultations and training on infant mental health provided by the service team. Parents reported that good interprofessional working enhanced satisfaction and engagement with the service. Findings indicate the centrality of interprofessional working for parent-infant mental health teams, with implications for future service implementation, service development, and understanding of mechanisms by which such services may influence family outcomes.

BackgroundPatient and public involvement (PPI) has become increasingly important in the development, delivery and improvement of healthcare. PPI is used in healthcare innovation; yet, how it is used has been under-reported. The aim of this scoping review is to identify and map the current available empirical evidence on the role of PPI during different stages of healthcare innovation.MethodsThe scoping review was conducted in accordance with PRISMAScR and included any study published in a peer-reviewed journal between 2004 and 2021 that reported on PPI in healthcare innovation within any healthcare setting or context in any country. The following databases were searched: Medline, EMBASE, CINAHL, PsycInfo, HMIC and Google Scholar. We included any study type, including quantitative, qualitative and mixed-method studies. We excluded theoretical frameworks, conceptual, scientific or grey literature as well as discussion and opinion papers.ResultsOf the 87 included studies, 81 (93%) focused on or were conducted by authors in developed countries. A wide range of conditions were considered, with more studies focusing on mental health (n = 18, 21%) and cancer care (n = 8, 9%). The vast majority of the studies focused on process and service innovations (n = 62, 71%). Seven studies focused on technological and clinical innovations (8%), while 12 looked at both technological and service innovations (14%). Only five studies examined systems innovation (5%) and one study looked across all types of innovations (1%). PPI is more common in the earlier stages of innovation, particularly problem identification and invention, in comparison to adoption and diffusion.ConclusionHealthcare innovation tends to be a lengthy process. Yet, our study highlights that PPI is more common across earlier stages of innovation and focuses mostly on service innovation. Stronger PPI in later stages could support the adoption and diffusion of innovation.Patient or Public ContributionOne of the coauthors of the paper (S. S.) is a service user with extensive experience in PPI research. S. S. supported the analysis and writing up of the paper.

Background Postpartum women are at higher risk of depression compared to the general population. Despite the mental health benefits an active lifestyle can provide, postpartum women engage in low physical activity and high screen time. Very little research has investigated the social ecological (i.e. individual, social and physical environmental) influences on physical activity and screen time amongst postpartum women, particularly amongst those with depressive symptoms. Therefore, this study sought to examine the influences on physical activity and screen time amongst postpartum women with heightened depressive symptoms. Methods 20 mothers (3–9 months postpartum) participating in the Mums on the Move pilot randomised controlled trial who reported being insufficiently active and experiencing heightened depressive symptoms participated in semi-structured telephone interviews exploring their perceptions of the key influences on their physical activity and screen time across various levels of the social ecological model. Strategies for promoting physical activity and reducing screen time were explored with participants. Thematic analyses were undertaken to construct key themes from the qualitative data. Results Findings showed that postpartum women with depressive symptoms reported individual (i.e. sleep quality, being housebound, single income), social (i.e. childcare, social support from partner and friends) and physical environmental (i.e. weather, safety in the local neighbourhood) influences on physical activity. Postpartum women reported individual (i.e. screen use out of habit and addiction, enjoyment) and social (i.e. positive role modelling, social isolation) influences on screen-time, but no key themes targeting the physical environmental influences were identified for screen time. Strategies suggested by women to increase physical activity included mother’s physical activity groups, home-based physical activity programs and awareness-raising. Strategies to reduce screen time included the use of screen time tracker apps, increasing social connections and awareness-raising. Conclusions Amongst postpartum women with heightened depressive symptoms, influences on physical activity encompassed all constructs of the social ecological model. However, screen time was only perceived to be influenced by individual and social factors. Intervention strategies targeting predominantly individual and social factors may be particularly important for this high-risk group. These findings could assist in developing targeted physical activity and screen time interventions for this cohort.

Purpose of review The aim of this review was to summarise recent evaluations of healthcare professional training regarding gestational weight gain and provide recommendations for future training. Recent findings A number of evaluated healthcare professional training sessions regarding gestational weight gain show promising results in terms of increased participant confidence and knowledge and impact on women’s outcomes. It is clear that the interventions which have also implemented resources in the practice environment to support training are the ones most likely to influence gestational weight gain. Summary Support from healthcare professionals are key to influence pregnant women’s weight gain and should be offered within the standard curriculum and through mandatory training. Factors influencing this support include women’s and healthcare professional characteristics, interpersonal and healthcare system and policy factors. All of these need to be considered when developing healthcare professional training to support women with their gestational weight gain.

Objective: Breast cancer survivors who are physically active have lower recurrence and all-cause mortality. Breast cancer survivors often struggle to initiate and maintain physically active lifestyles. Barriers include psychosocial, environmental, and musculoskeletal factors. An individualised physical activity intervention, informed by physiotherapy and behaviour change principles, may comprehensively address these barriers. This study tests the feasibility of this intervention.\ud \ud Methods: Following ethical approval and informed consent, stage-I and stage-II breast cancer survivors within 18 months of diagnosis were recruited from a secondary care NHS breast cancer unit. The intervention used tools combining musculoskeletal dysfunction, self-efficacy measurement and the COM-B model to allow personal tailoring of intervention techniques. The feasibility of recruitment, retention, acceptability and practicality of delivery of the physical activity intervention was tested using a single arm study.\ud \ud Results: Nine of 36 (25%) potential participants were recruited. Seven (77%) were retained to the study end. All participants reported that the intervention was acceptable. Eight would recommend the intervention and reported that their physical activity level increased due to the intervention. The intervention was practical to deliver within routine physiotherapy appointments.\ud \ud Conclusions: This small feasibility study has promising findings and will now need to be tested with more participants.

Maternity policy in England has recommended the establishment of Community Hubs, where health-care professionals who care for women during and after pregnancy are co-located and can provide care collaboratively. The aim this paper is to explore midwives,' health visitors' and postnatal women's experiences and views of co-location of midwifery and health visiting services and collaborative practice. In total 15 midwives, 17 health visitors, and 29 mothers participated in a semi-structured interview, either via phone or face-to-face. Transcripts were analyzed thematically. Participants reported how care is currently provided in numerous settings, with home visits especially well liked. Co-location was perceived to be of benefit, however some mothers were not convinced of its necessity, suggesting that integrated services are more important than co-located services. Health-care professionals recognized that co-location aids but does not automatically improve interprofessional collaboration. These findings highlight the need for careful consideration before implementing co-located maternity services. Community Hubs may be apromising strategy to improve care for women and their families but to provide interprofessional care and collaboration appropriate managerial and organizational support is needed. With this support, midwives and health visitors have the potential to deliver the best care possible for women and their families.

In some countries, including the United Kingdom, young mothers’ pregnant and postnatal bodies remain an area of concern for policy and practice, with interventions developed to support improved health behaviours including diet and physical activity. This article explores what young women themselves think and feel about eating and moving during and after pregnancy. Semi-structured interviews with 11 young mothers were conducted within two voluntary organisations. Data were analysed using thematic analysis with the theoretical lens of embodiment, which provided an understanding of how young women’s eating and moving habits related to how they felt about their bodies in the world. Four themes situated in different experiences of being and having a body were identified: pregnant body, emotional body, social body and surveilled body. Stress and low mood impacted eating habits as young women responded to complex circumstances and perceived judgement about their lives. Food choices were influenced by financial constraints and shaped by the spaces and places in which young women lived. Whilst young women were busy moving in their day-to-day lives, they rarely had the resources to take part in other physical activity. Holistic approaches that focus on how women feel about their lives and bodies and ask them where they need support are required from professionals. Interventions that address the structural influences on poor diet and inequalities in physical activity participation are necessary to underpin this. Approaches that over-focus on the achievement of individual health behaviours may fail to improve long-term health and risk reinforcing young women’s disadvantage.

BACKGROUND Each year in England, almost 10,000 parents are informed of their child’s positive newborn bloodspot screening result around 2-8 weeks after birth, depending on the condition. Communication of positive newborn bloodspot screening results is a subtle and skilful task, which demands thought, preparation and evidence to minimise potentially harmful negative sequelae. Evidence exists of variability in the content and the way the result is currently communicated which has the potential to lead to increased parental anxiety and distress. OBJECTIVE The main objective was to co-design interventions to improve delivery of positive newborn bloodspot screening results to families. METHODS The principles of Experience-based Co-design were used with seventeen health care professionals employed in three National Health Service Trusts in England and 21 parents; 13 mothers and 8 fathers of 14 children recruited from the same three National Health Service Trusts. Staff experiences were gathered via semi-structured interviews. Filmed, narrative interviews with parents were developed into a composite film. These data were used to identify priorities for improving communication of positive newborn bloodspot screening results to parents during firstly, separate parent and heath care professionals feedback events followed by joint parent and heath care professionals feedback events. Following this, parents and heath care professionals worked together via online co-design working groups to develop co-designed solutions and additions to existing processes. RESULTS Themes identified from the parent’s interviews included: impact of initial communication; parental reactions; attending the first clinic appointment; impact of staff communication strategies and skills; impact of diagnosis on family and friends; improvements to the communication of positive NBS results; and parents views of NBS. Themes identified from the staff interviews included: communication between health care professionals; process of communicating with the family; parent and family- centred care; availability of resources and challenges to effective communication. Three online co-design working groups were developed, each attended by 12-18 participants who had taken part in the parental or health care professionals’ interviews. The priorities included: changes to the NBS card; standardised laboratory proformas; standardised communication checklists; and an email / letter for providing reliable up to date condition specific information for parents following communication of the positive NBS result. CONCLUSIONS Variation in communication practices for positive NBS results continues to exist. This was influenced by many factors and has the potential to lead to negative sequelae from a parental perspective. Parents and health care professionals were able to successfully work together to identify priorities and develop potential solutions to improve communication of positive NBS results to parents. The adaptation of EBCD to include virtual methods could reduce costs associated with this methodology while also enabling the approach to be more responsive to health care professionals’ and patients’/parents’ busy schedules. CLINICALTRIAL ISRCTN 15330120 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s40814-019-0487-5

ObjectiveTo implement and evaluate co-designed interventions to improve communication of positive newborn bloodspot screening results and make recommendations for future research and practice.DesignA process evaluation underpinned by Normalisation Process Theory.SettingThree National Health Service provider organisations in England.ParticipantsTwenty-four healthcare professionals (7 newborn screening laboratory staff and 24 clinicians) and 18 parents were interviewed.InterventionsThree co-designed interventions were implemented in practice: standardised laboratory proformas, communication checklists and an email/letter template.Primary outcome measuresAcceptability and feasibility of the co-designed interventions.ResultsAuditing the implementation of these interventions revealed between 58%–76% of the items on the laboratory proforma and 43%–80% of items on the communication checklists were completed. Interviews with healthcare professionals who had used the interventions in practice provided positive feedback in relation to the purpose of the interventions and the ease of completion both of which were viewed as enhancing communication of positive newborn bloodspot screening results. Interviews with parents highlighted the perceived benefit of the co-designed interventions in terms of consistency, pacing and tailoring of information as well as providing reliable information to families following communication of the positive newborn bloodspot screening result. The process evaluation illuminated organisational and contextual barriers during implementation of the co-designed interventions in practice.ConclusionVariations in communication practices for positive newborn bloodspot screening results continue to exist. The co-designed interventions could help to standardise communication of positive newborn screening results from laboratories to clinicians and from clinicians to parents which in turn could improve parents’ experience of receiving a positive newborn bloodspot screening result. Implementation highlighted some organisational and contextual barriers to effective adoption of the co-designed interventions in practice.Trial registration numberISRCTN15330120.

Background Behaviour change techniques (BCTs) employed within PA intervention for pregnant women with a healthy body mass index (BMI) have been previously identified, however, these BCTS may differ for other weight profiles during pregnancy. The aim of this current review was to identify and summarise the evidence for effectiveness of PA interventions on PA levels for pregnant women with overweight and obesity, with an emphasis on the BCTs employed. Methods A systematic review and meta-analysis of PA intervention studies using the PRISMA statement was conducted. Searches were conducted of eight databases in January 2019. Strict inclusion/exclusion criteria were employed. The validity of each included study was assessed using the Cochrane Collaboration’s tool for assessing risk of bias. The primary outcome measure was change in PA levels, subjectively or objectively measured, with physical fitness as a secondary outcome. All intervention descriptions were double coded by two authors using Michie’s et al’s BCT taxonomy V1. Meta-analyses using random effect models assessed the intervention effects on PA. Other PA outcomes were summarised in a narrative synthesis. Results From 8389 studies, 19 met the inclusion criteria 13 of which were suitable for inclusion in a meta-analysis. The remaining 6 studies were described narratively due to insufficient data and different outcome measures reported. In the meta-analysis, comparing interventions to a control group, significant increases were found in the intervention group for metabolic equivalent (SMD 0.39 [0.14, 0.64], Z = 3.08 P = 0.002) and physical fitness (VO2 max) (SMD 0.55 [0.34, 0.75], Z = 5.20 P = p = 0.002). ‘Self-monitoring of behaviour’ was the most frequently used BCTs (76.5%), with ‘social support’ being newly identified for this pregnant population with overweight or obesity. Conclusions This review identified a slight increase in PA for pregnant women with overweight and obesity participating in interventions. However, due to the high risk of bias of the included studies, the results should be interpreted with caution. PA measures should be carefully selected so that studies can be meaningfully compared and standardised taxonomies should be used so that BCTs can be accurately assessed.

Teenage pregnancy is more prevalent in areas of high obesity, compared to areas where obesity levels are low. Risks associated with maternal obesity in pregnant teenagers include pre-eclampsia and caesarean delivery. To reduce these risks, pregnant teenagers need to be supported to gain a healthy weight in pregnancy. This includes encouraging these women to eat healthily through providing appropriate information including online or smartphone apps in conjunction with face-to-face support. These young women also need encouragement to be physically active. This support must be tailored to the teenage population considering their specific barriers and facilitators to behaviour change. Midwives with the aid of a multidisciplinary team play a key role in encouraging these healthy behaviours.

Background Pregnant women’s stress, mental and physical health, and health behaviours can have important implications for maternal and child health outcomes. Aim To examine pregnant women’s levels of stress, mental and physical health, and health behaviours during the COVID-19 pandemic. Methods A cross-sectional survey was conducted online, with recruitment and data collection occurring between 16/6/20 and 17/7/20. Participants were pregnant women recruited via online pregnancy/parenting communities. Participants self-reported their levels of general stress, pregnancy-specific stress and COVID-19 related stress, mental and physical health, general health behaviours, and COVID-19 related health behaviours. Findings 573 pregnant women participated in the survey. Participants were most commonly resident in the United States (42.6%, n = 243), Ireland (41.2%, n = 235) or the United Kingdom (10%, n = 57). The majority (80.0%, n = 457) were married and educated to degree level or above (79.3, n = 453). Pregnant women reported high levels of pregnancy-specific and COVID-19-related stress, and low levels of mental and physical health, during the pandemic. Encouragingly, pregnant women in this study generally reported high levels of adherence to public health advice and pregnancy health behaviours. Stress and general mental health outcomes were best predicted by well-being factors (including stress and social support). Health impairing behaviours (e.g. poor diet) were predicted by both well-being and demographic factors. Discussion Interventions targeting pregnancy- and pandemic-specific stress at the population level will be essential to support mental health and minimise adverse outcomes for women and children during the pandemic.

Background: The COVID-19 pandemic has impacted on maternity care, supports and women's mental health. \ud \ud Aim: The aim of this study was to assess pregnant women's satisfaction with antenatal care and social support and to examine stress-reduction strategies women used during the pandemic. \ud \ud Methods: An online survey was conducted between June and July 2020. Pregnant women, aged over 18 years were recruited. The survey included closed and open-ended questions to assess women's perceptions and satisfaction with their antenatal care, social support, and stress-reduction strategies. Descriptive statistics and multivariate analysis were used for quantitative analyses; qualitative content analysis was used for open-ended questions. \ud \ud Findings: 573 pregnant women completed the survey. Women reported low levels of social support which was predicted by women's mental health and demographic factors and was related to public health and maternity service restrictions. Women reported that restrictions implemented in the maternity services limited their face-to face interactions with healthcare professionals and meant their partners could not attend antenatal appointments or support them in the postpartum period in the maternity setting. The lack of information on COVID-19 and pregnancy meant women had greater uncertainty about pregnancy and birth. \ud \ud Discussion: Our findings indicate how the lack of access to antenatal care and reduced perceived social support as a result of the restrictions implemented in response to the COVID-19 pandemic, potentially intensifies pregnancy specific stress. \ud \ud Conclusions: There is a need for the provision of supportive care, both formally and informally, particularly with women who may be more vulnerable during a pandemic.

Objective:Early-life nutrition plays a key role in establishing healthy lifestyles and preventing chronic disease. This study aimed to (1) explore healthcare professionals’ (HCP) opinions on the acceptability of and factors influencing the delivery of interventions to promote healthy infant feeding behaviours within primary care and (2) identify proposed barriers/enablers to delivering such interventions during vaccination visits, to inform the development of a childhood obesity prevention intervention.Design:A qualitative study design was employed using semi-structured telephone interviews. Data were analysed using qualitative content analysis; findings were also mapped to the Theoretical Framework of Acceptability (TFA).Setting:Primary care in IrelandParticipants:Twenty-one primary care-based HCP: five practice nurses, seven general practitioners, three public health nurses, three community dietitians and three community medical officers.Results:The acceptability of delivering interventions to promote healthy infant feeding within primary care is influenced by the availability of resources, HCP’s roles and priorities, and factors relating to communication and relationships between HCP and parents. Proposed barriers and enablers to delivering interventions within vaccination visits include time constraints v. opportunistic access, existing relationships and trust between parents and practice nurses, and potential communication issues. Barriers/enablers mapped to TFA constructs of Affective Attitude, Perceived Effectiveness and Self-Efficacy.Conclusions:This study provides a valuable insight into HCP perspectives of delivering prevention-focused infant feeding interventions within primary care settings. While promising, factors such as coordination and clarity of HCP roles and resource allocation need to be addressed to ensure acceptability of interventions to HCP involved in delivery.

Physical activity is known to decline during pregnancy and the postnatal period, yet physical activity is recommended during this time due to the significant health benefits for mothers and their offspring. As a result of the COVID-19 pandemic and the restrictions imposed to reduce infection rates, pregnant and postnatal women have experienced disruption not just to their daily lives but also to their pregnancy healthcare experience and their motherhood journey with their new infant. This has included substantial changes in how, when and why they have engaged with physical activity. While some of these changes undoubtedly increased the challenge of being sufficiently active as a pregnant or postnatal woman, they have also revealed new opportunities to reach and support women and their families. This commentary details these challenges and opportunities, and highlights how researchers and practitioners can, and arguably must, harness these short-term changes for long-term benefit. This includes a call for a fresh focus on how we can engage and support those individuals and groups who are both hardest hit by COVID-19 and have previously been under-represented and under-served by antenatal and postnatal physical activity research and interventions.

ObjectiveTo explore health professionals’ experiences of communicating positive newborn bloodspot screening (NBS) results, highlight differences, share good practice and make recommendations for future research.DesignQualitative exploratory design was employed using semi-structured interviewsSettingThree National Health Service provider organisations in EnglandParticipantsSeventeen health professionals involved in communicating positive newborn bloodspot screening results to parents for all nine conditions currently included in the newborn bloodspot screening programme in England.ResultsFindings indicated variation in approaches to communicating positive newborn bloodspot screening results to parents, largely influenced by resources available and the lack of clear guidance. Health professionals emphasised the importance of communicating results to families in a way that is sensitive to their needs. However, many challenges hindered communication including logistical considerations; difficulty contacting the family and other health professionals; language barriers; parental reactions; resource considerations; lack of training; and insufficient time.ConclusionHealth professionals invest a lot of time and energy trying to ensure communication of positive newborn bloodspot screening results to families is done well. However, there continues to be great variation in the way these results are communicated to parents and this is largely influenced by resources available but also the lack of concrete guidance. How best to support health professionals undertaking this challenging and emotive task requires further exploration. We recommend evaluation of a more cohesive approach that meets the needs of parents and staff while being sensitive to the subtleties of each condition.Trial registration numberISRCTN15330120

Background\ud The COVID-19 pandemic and related restrictions can adversely impact antenatal maternal well-being and health behaviours.\ud \ud Aim\ud To examine antenatal stress and stress-reduction strategies, social support, and health behaviours between women pregnant before and during the pandemic in Ireland.\ud \ud Methods\ud 210 pregnant women were recruited online and in the antenatal department of a tertiary maternity hospital before the pandemic, and 235 women recruited online during the pandemic. Only women resident in Ireland were included in this study. Women completed measures of stress, social support, health-behaviours, and self-reported stress-reduction strategies. Differences in outcomes were examined between women pregnant before and during the pandemic, and between Phase 2 and Phase 3 of the Irish Government COVID-19 restrictions.\ud \ud Findings\ud Women pregnant during the pandemic reported lower perceived social support, including support from a significant other, friends and family, than women pregnant before the pandemic. There were no significant differences in stress in health behaviours but women reported higher stress and less physical activity during the pandemic. Women reported a range of comparable stress-reduction strategies before and during the pandemic. No differences were observed between phases of pandemic-related restrictions for any outcome.\ud \ud Discussion\ud Our findings highlight negative impacts of the pandemic on social support, stress, and physical activity, which can have implications for maternal and child health. Lack of differences between restriction phases suggests on-going negative effects for antenatal well-being and behaviours.\ud \ud Conclusion\ud Development of supports for pregnant women during the pandemic should include social-support and stress-reduction components.

Background Physical activity (PA) is a modifiable risk factor for postnatal depression (PND) and programs are needed to enhance PA amongst women at risk of PND. Key stakeholder involvement in informing development and implementation of such programs is vital. However, little research demonstrates key stakeholder insights to inform development and implementation of PA programs for improving PND. The aim of this study was to explore key stakeholder perspectives on the design and delivery of a home-based PA program for mothers with PND symptoms to inform future real-world implementation and scale-up.Methods In September to November 2019, representatives from various key stakeholder organisations involved in postnatal PA and/or mental health, public health and policy in Australia (n = 11) participated in semi-structured interviews exploring their perceptions on the design and delivery of a home-based PA program for mothers with PND symptoms. The interview schedule was informed by both the Consolidated Framework for Implementation Research (CFIR) and the PRACTical planning for Implementation and Scale-up (PRACTIS) guide. Thematic analyses were used for qualitative data.Results The relative priority of PND and PA was high for most organisations involved, although none implemented PA programs supporting women at risk of PND. Most stakeholders perceived the program as appealing due to addressing barriers to postnatal PA, although identified some feasibility issues regarding funding and delivery mechanisms. Suggestions for program adaptations included an equity focus (e.g. providing socioeconomically disadvantaged women with a greater program dose; translating web-app based content into various languages). Planned components of the program were suggested to align (i.e. relative advantage) with existing initiatives (e.g. equipment hire for nurseries scheme) and screening systems for PND (timing of referral). Perceived barriers to scale-up included logistics/cost of equipment, organisational capacity demands and safety risks/liability. Perceived enablers to scale-up included linking the program with ‘adjunct’ programs and services.Conclusions While the program was appealing and most organisations could see a role in endorsing and/or referring to the program, funding and delivery mechanisms still need to be identified.

Health professionals require education and training to implement obesity management guidelines and ultimately impact on the health outcomes experienced by their patients. Therefore, a systematic review of systematic reviews that evaluated interventions designed to change the practice of health professionals when addressing diet and physical activity with their patients was conducted. MEDLINE Complete; Cochrane database of systematic reviews; PsycINFO; CINAHL Complete; Global Health; Embase; INFORMIT: Health Subset; Health System Evidence and RX for change were searched in March 2019, with no date or language limits. Identified references underwent screening, full-text analyses and data extraction in duplicate. The search identified 15 230 references. Five systematic reviews that provided a narrative syntheses of a combined 38 studies were included. Health professional participants generally reported being satisfied with the training interventions. Heterogeneity between and within included reviews, non-controlled designs of individual studies and low quality of evidence at an individual study level and review level made it difficult to draw firm conclusions regarding what interventions are most effective in changing health professionals’ knowledge, skills, self-efficacy, attitudes and practice. However, similar gaps in the literature were identified across included reviews. Key areas that could be addressed in future interventions including organization and system-level barriers to providing advice, health professionals’ attitudes and motivation and weight stigma have been highlighted. Health professionals and patients could be more involved in the planning and development of interventions that work towards improving diet and physical activity advice and support provided in healthcare.

Background Postnatal women are commonly physically inactive, and, when coupled with depressive symptoms, barriers to physical activity can be heightened. This study aimed to 1) examine the feasibility and acceptability of a multi-component home-based physical activity intervention delivered to mothers at risk of postnatal depression, and 2) examine changes in health behaviours (physical activity, sedentary behaviour, sleep, diet) and indicators of mental health. Methods Sixty-two mothers (3 – 9 months postpartum) who at baseline were insufficiently active and experiencing heightened depressive symptoms were recruited into a 12-week randomised controlled trial in 2018. Participants were randomised into either a) Intervention group (receiving a theoretically underpinned multi-component program including free exercise equipment at home, access to smartphone web-app, and an online forum); or b) Control group (usual routine). Primary outcomes were program feasibility and acceptability. Secondary outcomes included self-reported and accelerometer-assessed physical activity and sedentary behavior, sleep, diet, determinants of physical activity, and mental health (depressive and anxiety symptoms), measured at baseline and follow-up (12-weeks), with self-reported physical activity, sedentary behaviour and depressive symptoms also measured at weeks 4 and 8. Qualitative data was analysed following inductive content analysis, and quantitative data using linear mixed models. Results Exercise equipment use in the home was shown to be a feasible strategy to re-engage postnatal women in physical activity. Other components of the program (e.g. web-app, online forum) had low compliance. The program had high acceptability, predominately due to its accessibility, flexibility and ability to overcome key barriers to physical activity. The program resulted in improvements in short-term self-reported physical activity (increased 162min/week at 4 weeks, 95% CI: 37.7, 286.2), behavioural skills (B=0.4, 95% CI: 0.0, 0.8) and perceived barriers to physical activity. However, accelerometer measured physical activity decreased in the intervention group, compared to control group at week 12 (B=-1.3, 95% CI:-2.5, -0.1). There were no changes in other outcomes. Conclusions A home-based physical activity program involving free exercise equipment is acceptable and feasible amongst women experiencing heightened postnatal depressive symptoms. Such programs may be effective in increasing engagement in physical activity, yet additional strategies may be needed to enhance maintenance of physical activity and improvements in mental health.

Background: Childhood overweight and obesity is a major public health issue. Responsive feeding has been identified as having a protective effect against child overweight and obesity, and is associated with healthy weight gain during infancy. Responsive feeding occurs when the caregiver recognises and responds in a timely and developmentally appropriate manner to infant hunger and satiety cues. Despite its benefits, responsive feeding is not ubiquitous. To better support caregivers to engage in responsive feeding behaviours, it is necessary to first systematically identify the barriers and enablers associated with this behaviour. This mixed-methods systematic review therefore aims to synthesise evidence on barriers and enablers to responsive feeding using the COM-B model of behavioural change. Methods: 7 electronic databases will be searched (Maternal and Infant Care, CINAHL, Cochrane, PubMed, Medline, PsycINFO, EMBASE). Studies examining factors associated with parental responsive and non-responsive feeding of infants and children ( Ethics and dissemination: Ethical approval is not required for this review as no primary data will be collected, and no identifying personal information will be present. The review will be disseminated in a peer reviewed journal. PROSPERO registration: CRD42019144570 (06/08/2019)

Understanding women’s experiences of pregnancy is imperative to provide them with the most appropriate maternity services. This chapter summarizes the evidence regarding pregnant women with obesity’s experiences of maternity services, with a specific focus on obesity stigma. Most of women’s experiences are negative, including feelings of guilt, discomfort, and embarrassment. The emerging evidence of how this obesity stigma may influence the care women are offered is also discussed. This chapter also outlines the negative attitudes held by health-care professionals’ who care for pregnant women with obesity and the clinical context in which they work. Finally, recommendations for how to reduce obesity stigma within maternity services are provided.

In the UK, there is a clear remit for midwives and health visitors to work collaboratively to care for pregnant women and new mothers. This study evaluated a clinical placement for midwifery students with health visitor mentors. The evaluation explored the experience of mentors and students during the placement, the effect on their understanding of the different roles and the potential effect on collaborative working in the future. Results indicated that students developed their knowledge of the health visitor role and learned transferable skills to take back to midwifery. They saw little collaborative practice, but identified ways to incorporate interprofessional working into their practice once qualified. Mentors were positive about sharing health visiting practice and the potential impact on relationships in the future.

Objective: This study aimed to explore health visitors’ (HVs) views on the acceptability and potential implementation of internet-based postpartum anxiety interventions in their practice.\ud \ud Background: Internet-based self-help has been shown to be effective and acceptable for postpartum depression. Recently, an internet-based intervention has been developed for postpartum anxiety. Before implementing new anxiety interventions in postpartum care, it is important to determine the acceptability and ways of implementing such interventions. This study therefore explored HVs’ views on this, as they are the some of the key healthcare professionals supporting women postpartum.\ud \ud Methods: Semi-structured interviews were conducted with 13 HVs across the UK. Audio-recorded interviews were transcribed verbatim and analysed using thematic analysis.\ud \ud Results: Five themes emerged – suitability; benefits; concerns; importance of one-to-one support; implementation. Internet-based interventions were seen as suitable as an additional option for a sub-group of postpartum women. Identified benefits included increased availability of a treatment tool for postpartum anxiety and treatment anonymity and flexibility. Reported concerns were the women’s state of mind, decreased human and professional contact, as well as IT access and literacy and language skills. HVs considered the most feasible way to implement internet-based interventions would be to have flyers for HVs to include with other information provided after birth or to hand out and discuss during their visits. The need for sufficient evidence of treatment efficacy and appropriate training was highlighted.\ud \ud Conclusion: This study highlights the opportunities and challenges that need to be considered before implementing internet-based interventions for postpartum anxiety in the postpartum care.

Anxiety is common among postpartum women and can have adverse effects on mother's and child's somatic and psychological health if left untreated. In the UK, nurses or midwifes with a specialisation in community public health nursing, also called health visitors (HVs), work with families who have children younger than 5 years of age and are therefore in a key position to identify and support women with postpartum mental health issues. Until recently, postpartum mental health support provided by HVs mainly focused on identifying and managing depression, but the updated clinical guidance by the National Institute for Health and Care Excellence also includes guidance regarding screening and psychological interventions for perinatal anxiety. This study therefore aimed to explore HVs' experiences of supporting women with postpartum anxiety and their views on currently available care. Using a qualitative approach, in-depth semi-structured interviews were conducted with 13 HVs from the UK between May and October 2015. Participants were interviewed in person at their workplace or on the phone/Skype. Using thematic analysis, four main themes emerged: identification and screening issues; importance of training; service usage; and status of current service provision. Women with postpartum anxiety were commonly encountered by HVs in their clinical practice and described as often heavily using their or other related healthcare services, which puts additional strain on HVs' already heavy workload. Issues with identifying and screening for postpartum anxiety were raised and the current lack of perinatal mental health training for HVs was highlighted. In addition, HVs described a current lack of good perinatal mental health services in general and specifically for anxiety. The study highlights the need for HV perinatal mental health training in general and postpartum anxiety specifically, as well as better coverage of specialist mental health services and the need for development of interventions targeted at postpartum anxiety.

The journey from pregnancy to caring for a new infant is a significant experience for many women and crucial period for obesity prevention. During this time, a large portion of care is allocated to midwives and maternal and child health nurses (MCHN). These professions have the potential to play a crucial role in supporting women with weight management across pregnancy and postpartum; however, both midwives and MCHNs report barriers to doing this. Upskilling achieved through midwifery and MCHN education that equips midwives and MCHNs with the skills and knowledge to provide evidence-based advice for weight management could assist in addressing some of these barriers. Interprofessional collaboration should be fostered so healthy lifestyle messages and support are reinforced consistently by midwives and MCHNs throughout pregnancy and postpartum.

Objectives\ud Female genital mutilation (FGM) is a worldwide problem associated with severe health risks. In the UK, preventative public health campaigns have been developed to eradicate FGM. The aim of the present study was to elicit the views about FGM public health campaigns from the perspective of a UK Somali community.\ud \ud Study design\ud Three focus groups and one interview were conducted with 16 community members.\ud \ud Methods\ud Using posters and leaflets focused on UK FGM prevention, photo-elicitation was used to encourage participants to discuss the usefulness and implications for national public health messages aimed at eradicating FGM. Data were subjected to inductive thematic analysis.\ud \ud Results\ud Participants were positive about the aims of the campaigns presented within the research, believing such campaigns were necessary and increased awareness of FGM. However, participants felt the campaigns also carried risks of enhancing stereotypes in terms of ethnicity, gender and religion. For example, some images were perceived to suggest that FGM was only relevant to Sub-Saharan women, although it is also prevalent in other populations. Some fathers reported feeling unfairly targeted in campaigns that focused on the role of mothers in protecting daughters from FGM. Participants were also concerned that some poster images may suggest that FGM was associated with Islam and perceived as a religious issue, rather than a cultural one. Fears were identified that this could lead to stigmatisation and hostility towards those affected.\ud \ud Conclusions\ud The research findings suggested that actively working with affected communities to develop messaging that counters negative stereotyping and associated hostility should be a priority.

Aim The aim of this study was to identify and summarise the effectiveness of physical activity (PA) interventions on PA levels for pregnant women with overweight and obesity, with a specific emphasis on the behaviour change techniques (BCTs) employed. Methods A systematic review and meta-analysis of PA intervention studies using the PRISMA statement was conducted. Searches were conducted of eight databases in January 2018. Strict inclusion/exclusion criteria were employed. Primary outcome measures included change in PA levels, subjectively or objectively measured with physical fitness as a secondary outcome. The BCT taxonomy V1 was used to identify BCTs. Meta-analyses using random effect models assessed the intervention effects on PA. Other PA outcomes were summarised in a narrative synthesis. Results From 8024 studies, 17 met the inclusion criteria. Of these, 11 studies provided data suitable for inclusion in a meta-analysis. Significant increases were found for metabolic equivalent (SMD 0.38 [0.07, 0.70], Z=2.40 P=0.02) and physical fitness (VO2 max) (SMD 0.55 [0.34, 0.75], Z=5.20 P= Discussion This review revealed a slight increase in PA for pregnant women with overweight and obesity. However, these conclusions are tentative because of the poor methodological quality of the included studies. A range of BCTs clusters that could be used to help improve physical activity levels during pregnancy was identified, including: ‘goals and planning’, ‘feedback and monitoring’ and ‘shaping knowledge’ with ‘social support’ being unique to this population. Future studies should consider PA measures carefully so that studies can be meaningfully compared and intervention developers need to use recognised and standardised taxonomies so that BCTs can be accurately assessed.

Straightforward transfer of care from pregnancy to the postpartum period is associated with health benefits and is desired by women worldwide. Underpinning this transfer of care is the sharing of information between healthcare professionals and the provision of consistent information to women. In this qualitative study, two aspects of continuity of information were examined; first the information passed on from midwife to health visitor regarding a woman and her baby before the health visitor meets the woman postnatally and second, the consistency of information received by women from these two healthcare professionals (the main healthcare providers during and after pregnancy in England). To be eligible for the study, women had to have had a baby in England within 12 months prior to the interview. Participants also needed to be able to read and speak English and be over 18 years old. Recruitment of participants was via word of mouth and social media. Twenty-nine mothers were interviewed of whom 19 were first time mothers. The interviews took place in the summer and autumn of 2016 and were transcribed verbatim and analysed using Framework Analysis. Two overarching themes were identified: not feeling listened to and information inconsistencies. Women reported little experience of midwives and health visitors sharing information about their care, forcing women to repeat information. This made women feel not listened to and participants recommended that healthcare professionals share information; prioritising information about labour, mental health, and chronic conditions. Women had mixed experiences regarding receiving information from midwives and health visitors, with examples of both consistent and inconsistent information received. To avoid inconsistent information, joint appointments were recommended. Findings from this study clearly suggest that better communication pathways need to be developed and effectively implemented for midwives and health visitors to improve the care that they provide to women.

Background Research suggests that collaboratively delivered maternity care can positively impact health outcomes. However, women’s perspectives on models of care involving interprofessional collaboration between midwives and health visitors are not well understood. Accounts of women’s maternity care experiences are key to improving maternity services. This study considered women’s views and experiences of maternity care as collaboratively provided by midwives and health visitors in England. Methods A qualitative focus group study with an exercise exploring women’s ideal maternity care pathway was conducted. Three focus groups were conducted in London, England between June and August 2017 with women who had had a child within 18 months prior to the study. The participants (n = 12) were recruited from two Children’s Centres in London, England. Data were analysed using thematic analysis. Results Four themes were identified: ‘Women’s experiences of maternity care from midwives and health visitors’, ‘Midwife-health visitor communication’, ‘Midwife-health visitor collaboration for tailored care’, and ‘Women’s ideal maternity care pathway’. Regarding women’s experiences of interprofessional collaboration between midwives and health visitors, this was rarely encountered, but welcomed by women. Women’s observations of limited tailored care and co-ordination led to several suggestions to improve maternity care, including secure, shared medical recordkeeping systems, clarity on midwives’ and health visitors’ roles, as well as increased communication. Conclusions Maternity care that is collaboratively delivered by midwives and health visitors, from the perspectives of the women in this study, is not routinely provided. However, women recognise the potential benefits of midwife-health visitor collaboration. Future research should explore service configurations that support integrated maternity care pathways, and evaluate the impact of midwife-health visitor collaboration on health and service outcomes. Electronic supplementary material The online version of this article (10.1186/s12884-018-2127-0) contains supplementary material, which is available to authorized users.

Aim: To explore recent mothers’ views of the health visiting antenatal contact in England. Background: English health visitors are mandated to be in contact with all women in the third trimester of pregnancy. The aim of this antenatal contact is to assess the needs of the family before the birth and support preparation for parenthood. Recent data show that this contact is provided fragmentarily and not always face-to-face. More information on how women view this contact could inform service provision. Methods: Twenty-nine mothers with a baby less than 1 year old were recruited via social media and word of mouth. Having had antenatal contact with a health visitor was not a requirement to participate in the study. Women took part in face-to-face or phone interviews and all recordings were transcribed verbatim. Data were analysed using systematic thematic analysis. Findings: Eleven women had contact with a health visitor during pregnancy: nine through a home visit, one via a letter and one via a phone call. The remaining 18 women were asked about what they would have wanted from an antenatal contact. Three themes were identified: relationship building, information provision, and mode and time of contact. Some participants who had experienced a home visit reported building rapport with their health visitor before the postnatal period, but not everyone had this experience. Women reported requesting and receiving information about the health visiting service and the role of the health visitor. Finally, women suggested different modes of contact, suggesting a letter or that the information about health visiting could be provided by a midwife. A few women preferred a home visit. These study findings show women were unclear regarding the aim of the health visitor antenatal contact. As such, the contact is unlikely to reach its full potential in supporting parents-to-be.

ObjectiveTo explore current communication practices for positive newborn screening results from the newborn bloodspot screening (NBS) laboratory to clinicians to highlight differences, understand how the pathways are implemented in practice, identify barriers and facilitators and make recommendations for future practice and research.DesignA qualitative exploratory design was employed using semi-structured interviews.SettingThirteen NBS laboratories in England.ParticipantsSeventy-one clinicians; 22 NBS laboratory staff across 13 laboratories and 49 members of relevant clinical teams were interviewed.ResultsAssurance of quality and consistency was a priority for all NBS laboratories. Findings indicated variation in approaches to communicating positive NBS results from laboratories to clinical teams. This was particularly evident for congenital hypothyroidism and was largely influenced by local arrangements, resources and the fact individual laboratories had detailed standard operating procedures for how they work. Obtaining feedback from clinical teams to the laboratory after the child had been seen could be challenging and time-consuming for those involved. Pathways for communicating carrier results for cystic fibrosis and sickle cell disease could be ambiguous and inconsistent which in turn could hamper the laboratories efforts to obtain timely feedback regarding whether or not the result had been communicated to the family. Communication pathways for positive NBS results between laboratories and clinical teams could therefore be time-consuming and resource-intensive.ConclusionThe importance placed on ensuring positive NBS results were communicated effectively and in a timely fashion from the laboratory to the clinical team was evident from all participants. However, variation existed in terms of the processes used to report positive NBS results to clinical teams and the people involved. Variant practice identified may reflect local needs, but more often reflected local resources and a more consistent ‘best practice’ approach is required, not just in the UK but perhaps globally.Trial registration numberISRCTN15330120.

OBJECTIVES: Interprofessional collaboration between midwives and health visitors working in maternal and child health services is widely encouraged. This systematic review aimed to identify existing and potential areas for collaboration between midwives and health visitors; explore the methods through which collaboration is and can be achieved; assess the effectiveness of this relationship between these groups, and ascertain whether the identified examples of collaboration are in line with clinical guidelines and policy.\ud \ud DESIGN: A narrative synthesis of qualitative and quantitative studies.\ud \ud DATA SOURCES: Fourteen electronic databases, research mailing lists, recommendations from key authors and reference lists and citations of included papers.\ud \ud REVIEW METHODS: Papers were included if they explored one or a combination of: the areas of practice in which midwives and health visitors worked collaboratively; the methods that midwives and health visitors employed when communicating and collaborating with each other; the effectiveness of collaboration between midwives and health visitors; and whether collaborative practice between midwives and health visitors meet clinical guidelines. Papers were assessed for study quality.\ud \ud RESULTS: Eighteen papers (sixteen studies) met the inclusion criteria. The studies found that midwives and health visitors reported valuing interprofessional collaboration, however this was rare in practice. Findings show that collaboration could be useful across the service continuum, from antenatal care, transition of care/handover, to postnatal care. Evidence for the effectiveness of collaboration between these two groups was equivocal and based on self-reported data. In relation, multiple enablers and barriers to collaboration were identified. Communication was reportedly key to interprofessional collaboration. \ud \ud CONCLUSIONS: Interprofessional collaboration was valuable according to both midwives and health visitors, however, this was made challenging by several barriers such as poor communication, limited resources, and poor understanding of each other's role. Structural barriers such as physical distance also featured as a challenge to interprofessional collaboration. Although the findings are limited by variable methodological quality, these were consistent across time, geographical locations, and health settings, indicating transferability and reliability.

BackgroundMidwives are increasingly expected to promote healthy behaviour to women and pregnancy is often regarded as a ‘teachable moment’ for health behaviour change. This view focuses on motivational aspects, when a richer analysis of behaviour change may be achieved by viewing the perinatal period through the lens of the Capability-Opportunity-Motivation Behaviour framework. This framework proposes that behaviour has three necessary determinants: capability, opportunity, and motivation.Aim To outline a broader analysis of perinatal behaviour change than is afforded by the existing conceptualisation of the ‘teachable moment’ by using the Capability-Opportunity-Motivation Behaviour framework. Findings Research suggests that the perinatal period can be viewed as a time in which capability, opportunity or motivation naturally change such that unhealthy behaviours are disrupted, and healthy behaviours may be adopted. Moving away from a sole focus on motivation, an analysis utilising the Capability-Opportunity-Motivation Behaviour framework suggests that changes in capability and opportunity may also offer opportune points for intervention, and that lack of capability or opportunity may act as barriers to behaviour change that might be expected based solely on changes in motivation. Moreover, the period spanning pregnancy and the postpartum could be seen as a series of opportune intervention moments, that is, personally meaningful episodes initiated by changes in capability, opportunity or motivation.DiscussionThis analysis offers new avenues for research and practice, including identifying discrete events that may trigger shifts in capability, opportunity or motivation, and whether and how interventions might promote initiation and maintenance of perinatal health behaviours.

Walking groups are often enjoyed by postnatal women, but little is known about what makes them an acceptable activity to this group. This study aimed to investigate the acceptability of a postnatal walking group using the Theoretical Framework of Acceptability (TFA). Seventeen postnatal women took part in a walk-along interview during a walking group session. Semi-structured interviews were based on the TFA and findings were analysed deductively onto the seven TFA components. Overall, the walking group was found to be acceptable. Benefits included meeting other mothers and walking in an accessible and convenient location. Women understood the group aim of supporting new mothers and thought it achieved this aim. Most women reported that attending the group was little effort, although for some the timing did not fit well with their baby&rsquo, s schedule. Participants stated that meeting other mothers and being physically active aligned with their value system. In conclusion, the acceptability of the walking group was found to be multifaceted, of which enjoyment was one part. These findings can be used when advertising other walking groups or physical activities for the postnatal population.

Young mothers under the age of 20 often have poor nutrition and low levels of physical activity, adversely affecting outcomes for themselves and their babies. The aim of this qualitative study was to explore the experiences of healthcare professionals in supporting young women around eating and moving during and after pregnancy. Seventeen semi-structured interviews were conducted with midwives, family nurse practitioners and health visitors involved in the care of pregnant and post-natal mothers under the age of 20 in England and Wales. Data were analysed using thematic analysis and coded within the theoretical framework of the COM-B model to three areas of capability, motivation and opportunity. For capability, participants were broadly divided between those who had specialist knowledge and training in communication skills to support health behaviours in this population and professionals reliant on tacit knowledge. For opportunity, having enough time was seen as critical because young women's difficult social contexts meant supporting improved health behaviours required relationships of trust to be built. For motivation, participants reported that supporting young women with eating and moving was part of their role. However, the decision to prioritise this support sometimes related to perceived need based on BMI and this was complicated as young women were still growing. Motivation was additionally connected to professionals' own body experiences and health behaviours. Moving habits were less frequently discussed than eating as professionals described how young women tended to walk a lot in their daily lives or found that young women were not interested. Results suggest that to support eating and moving behaviours with young women, professionals need to be trained in communication techniques, enabled with the time to hold space for young women and be able to reflect on their own attitudes and beliefs to support a rounded model of health and wellbeing.

Objective: The prevalence of pregnant women with high body mass index is increasing worldwide. High body mass index is associated with health risks for mother and baby and supporting healthy gestational weight gain is important. Midwives play an important role in supporting women to engage in behaviours such as healthy eating and physical activity. The aim of this study was to explore how midwives’ support pregnant women with high body mass index to establish a healthy lifestyle with emphasis on nutrition and physical activity in order to minimise gestational weight gain.\ud \ud \ud Methods: Semi-structured interviews were conducted with 16 midwives working in antenatal health care in Sweden. Interviews were conducted shortly after new guidelines on care for pregnant women with high body mass index had been introduced. The interviews were recorded, transcribed and analysed by thematic analysis.\ud \ud \ud Results: Three main themes were identified; use a conscious approach, invite to participate and have a long-term health perspective. Midwives built a relationship with a woman through identifying her concerns and circumstances, before sensitively discussing weight. Some midwives used Motivational Interviewing to help women identify their own resources. To reach long-term health benefits, midwives set achievable goals with the women.\ud \ud \ud Conclusion: These study findings provide practical examples of how midwives can support women with weight management during pregnancy. Through being sensitive when developing a relationship, midwives enabled the women to identify their own resources and achievable goals. Support after the baby is born is needed subsequently to help women maintain their healthy behaviour changes.

Objective The aim of this study was to explore midwifery students and health visitor practice mentors experiences of a health visiting placement for midwifery students, focusing on the student-mentor relationship. Design Interview study Setting East London, United Kingdom Participants Eighteen students and eighteen mentors were invited to take part in an interview. Ten midwifery students (55.5%) and fifteen health visitor practice mentors (83.3%) took part in interviews or provided information via email. Thematic analysis was used to analyse findings. Findings The main study finding was that students reported valuing practice mentors who took the time to get to know them, were welcoming and enthusiastic and planned their time in advance. The mentors in turn spoke highly of the students who were keen and enthusiastic about the placement, but noted that not all students had appeared interested. Key conclusions The findings from this small interview study show that taking time to make the students feel welcome was important to facilitate a student-mentor relationship. Another important factor in whether a student enjoyed their placement was the mentors' advance planning.

Background:\ud Midwifery‐led birth settings have been recommended as the most cost‐effective birthplaces for healthy women experiencing uncomplicated pregnancies. However, midwives complete most of their training in obstetric units where birth interventions are common. To prepare for working in a midwifery‐led setting training is a key priority. This study evaluated a postgraduate‐level midwifery module on Optimum Birth (defined as birth which supports physiology and empowerment, avoiding unnecessary intervention) designed to prepare midwives for supporting women in midwifery‐led settings.\ud \ud Methods:\ud A mixed‐methods design was employed. Pre‐module and post‐module questionnaires measured attitudes, knowledge, confidence, and learning outcomes. Qualitative data collection included a final‐day focus group and 8‐ to 10‐week follow‐up interviews. The target for recruitment was 15 postgraduate midwives. Fifteen midwives practicing in three London boroughs enrolled of whom 14 completed the module. Pre‐total and post‐total scores were analyzed with paired‐sample t tests. Qualitative data were analyzed using thematic analysis.\ud \ud Results:\ud Quantitative and qualitative data indicated that the module increased participants’ self‐reported skills, knowledge, and confidence in practicing Optimum Birth. Qualitative data indicated ways in which midwives were implementing changes to promote Optimum Birth in their place of work. Attitudes were highly positive pre‐module and post‐module.\ud \ud Conclusions:\ud The Optimum Birth module provided appropriate training for preparing midwives for the shift toward working in midwifery‐led settings. Midwifery leaders and managers should implement strategies to develop midwives’ philosophy, knowledge, and skills to increase their readiness to work in midwifery‐led birth settings.

This multi-method evaluation assessed the perceived impact of interprofessional workshops targeting enhanced collaboration between healthcare professionals who care for women during and after pregnancy. Current policy recommends partnership working to improve care for women and babies, however, there is little interprofessional education in this area. Five one-day workshops were delivered to 18 healthcare professionals (47.4% of the 38 healthcare professionals registered). The workshop was evaluated through questionnaires before and after the workshop measuring attitudes and willingness towards collaboration; observations of the workshops by a researcher and follow-up interviews 2 months' post-workshop to explore changes in practice. Workshops were attended by midwives, health visitors (trained nurses specialising in community care for children 0-5 years), dietitians, nurses, a general practitioner and a breastfeeding specialist. Attitudes and willingness to participate in interprofessional collaborative practice improved after the workshop. Observations made at the workshop included engaged participants who reported numerous barriers towards collaboration. Follow-up contact with 12 participants identified several examples of collaboration in practice resulting from workshop attendance. These findings suggest that the workshops influenced attendees to change their practice towards more collaborative working. Future work needs to confirm these results with more participants.