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Maternity care organisations have a responsibility to ensure the health and welfare of their staff. Rates of burnout are high in midwifery compared to other professionals. Therefore, exploring how it can be reduced is imperative.To explore with midwives the contributors to burnout and how best to reduce burnout in a maternity hospital in Ireland.A Participatory Action Research study involving Co-operative Inquiry meetings (n = 5) with practising midwives (n = 21) between October 2018 and March 2019, in a large, urban teaching maternity hospital in Ireland. The transcribed data were analysed using Thematic Network Analysis.Several recommendations were made for maternity organisations, to reduce or prevent burnout. These include improving workplace culture, increasing support and acknowledgement, offering time and space for debriefing and reflection and regular rotation of staff. Consistent staff shortages are, however, a barrier to adhering to these recommendations.This study is the first of its kind to offer an in-depth exploration with midwives into the main contributors of burnout and what can be done at an organisational level to reduce burnout among midwives. The findings of this study highlighted the importance of working relationships. Additionally, owing to the nature of midwifery practice, time and space need to be created for midwives to debrief and reflect. However, there is an urgent need for healthcare systems to combat staffing shortages in order for these strategies to be successful.

Midwives are ideally placed to promote physiological birth and improve women's birth experiences. Freedom of movement in labor is highly recommended as it reduces a need for obstetric interventions in labor and prevents and corrects labor complications, such as poor progress and malposition of the fetus. The Labour Hopscotch Framework (LHF) provides women and midwives with a visual depiction of the steps they can undertake to remain active and, in this way, support physiological birth processes. The objective of this study was to explore midwives' experiences of supporting women during labor with the Labour Hopscotch Framework and identify any improvements necessary to the Labour Hopscotch Framework.A two phased mixed-method sequential explanatory design study consisting of a survey (women, n=809 and partners, n=759) and focus group (n=8 midwives) was completed to evaluate the LHF following its implementation. This article presents the findings reporting midwives' perceptions of using the Labour Hopscotch Framework with women and their birthing partners. The setting was a large urban teaching maternity hospital in Dublin, Ireland, where eight midwives practiced in the following areas: labor suite, antenatal unit, and community midwifery.The Labour Hopscotch Framework was described as beneficial in promoting physiological birth, using a creative, attractive visual depiction to guide women in, and before, labor. The Labour Hopscotch Framework was deemed helpful in increasing midwifery students and newly qualified midwives' confidence to provide women with tangible, supportive assistance during labor and increased partners' involvement in the labor process.Labour Hopscotch Framework should be more widely promoted to all women attending the hospital for maternity care and a clear explanation of each step given and demonstrated to increase women's understanding of the steps within. Labour Hopscotch training should be included in midwifery education programs.

Background Pathways to dedicated clinics for women in Ireland who experience morbidity during the antenatal, intrapartum or postnatal periods are lacking. In view of this, a postnatal morbidity clinic was set up and an evaluation was conducted with clinic attendees with the aim of improving the service by using the results to guide the expansion and improvements. Methods A survey was developed using two validated questionnaires of women who were discharged from the clinic over 6 months. Surveys were self-completed and returned by 92 women, then analysed using descriptive statistics for quantitative data and thematic analysis for qualitative data. Results Several areas were highlighted for improvement, such as expanding debriefing services, making a more precise plan of action upon discharge and improving continuity of care. Conclusions Postnatal morbidities exert a considerable toll on new mothers. Listening to women's experiences of attending the clinic guided the successful expansion of advanced midwife practitioner-led supports and improved efficiencies within the clinic as well as highlighting the importance of such a service for all women.

Background There has been a shift in maternity care over the past decade. The changes encountered by postnatal ward staff and the impact of these changes on women postnatally requires exploration. This study aimed to ascertain midwives' and healthcare assistants' perspectives of the changes in postnatal care and challenges to providing care in the current context. Methods This was a qualitative study involving two focus groups of 15 midwives and healthcare assistants from an Irish urban maternity hospital. The participants' responses were analysed thematically. Results Changes in women's clinical characteristics, including increased comorbidities and caesarean section rates, were highlighted as creating additional care needs. Furthermore, additional midwifery tasks and clinical protocols as well as shorter hospital stays leave little time for high-quality, woman-centred care. Participants highlighted a negative impact on maternal health from limited follow-up midwifery care in the community. Conclusions With additional midwifery duties and a reduction in time to complete them, additional community midwifery care is key to providing high-quality follow-on care after postnatal discharge from hospital.

Background: Many staff supports, such as the internationally accredited Schwartz Center Rounds were suspended worldwide during the Covid-19 restrictions, at a time when they were most needed. Schwartz Rounds are multi-disciplinary forums where staff can discuss the emotional, social and ethical challenges of care in a confidential and safe environment, intending to improve staff well-being and patient care. In a bid to improve staff support after the suspension of full Schwartz Rounds, virtual, then blended (limited spaces for socially distanced in-person attendance and virtual access) Rounds were initiated.Purpose: This study aimed to evaluate Schwartz Rounds in a maternity setting in Ireland and compare full-in person Rounds with virtual and blended Rounds.Methods: Standard Schwartz Rounds evaluation forms were completed by Rounds attendees. Data were analysed using SPSS (Version 24). Respondents were invited to include a comment at the end of the form, and these free-text comments were analysed thematically.Results: Six Rounds were evaluated (2 full in-person Rounds attended before the pandemic, 1 virtual, 3 blended) and a total of 115 evaluation forms were completed. The Rounds were rated extremely high. Some, but not all aspects of the Rounds were rated more positively from the full in-person Rounds. Some technical difficulties were a barrier to fully experiencing the Round when attending remotely.Conclusion: Schwartz Rounds are attended by staff in over 560 healthcare organisations, internationally and have been reported to improve staff well-being and teamwork. The pandemic saw Schwartz Rounds being suspended in most organisations due to social distancing guidelines. Virtual and blended Rounds are recommended as an effective replacement for full Schwartz Rounds while social distancing and infection control measures are in place. However, in order to improve post-panellist discussion and gain the full Schwartz Round experience, recommencement of full, in-person Rounds are recommended as soon as public health measures allow

The emotional nature of midwifery practice has been described by several researchers and midwives have reported extremely high burnout levels. Burnout is dynamic and effects individual midwives differently, depending on individual coping abilities and demographic and contextual factors. However, midwives themselves can reduce burnout at an individual level.This study aimed to explore the concept of burnout with midwives and to ascertain their perspectives on how burnout can be reduced. This paper presents findings in relation to individual midwives' responsibilities for the reduction of burnout.This was a Participatory Action Research study. A total of 5 co-operative inquiry meetings were held with practising midwives (n = 21) over a six-month period (October 2018 - March 2019), in a large, urban teaching maternity hospital in Ireland. Data was analysed using Thematic Network Analysis.Midwives explored in detail the emotional nature of midwifery practice and how this contributes upon midwives' burnout levels. Recommendations were made for individuals to reduce their own burnout levels. These include self-awareness and basic self-care skills. Some specific individual characteristics were suggested as increasing the risk of burnout such as younger, less experienced midwives.Midwives require high levels of self-awareness to identify external demands, which make them more susceptible to burnout, and utilise their own positive coping mechanisms. Basic self-care is also necessary for midwife well-being. However, without commitment from healthcare systems to reduce chronic excessive workload, burnout levels will remain high, which impacts negatively on midwives and the women in their care.

Background Due to the coronavirus infection, visitors to all hospitals were greatly restricted in the UK. In maternity hospitals, only partners of women in labour were permitted to attend the hospital. Aims This study aimed to gain an understanding of women's experiences of visiting restrictions imposed due to COVID-19. Methods Women who attended the hospital for outpatient appointments and who were inpatients on the antenatal or postnatal ward during a two-week period were asked to complete an anonymous survey. Findings A total of 422 surveys were completed. The majority of women (97.6%) agreed that the hospital made adequate preparations for them to feel safe. Most women reported that the restrictions are a good thing and several advantages were identified. Women cited not having their partner with them as the main negative consequence to the restrictions. Conclusions Although women miss having their partner for support during scans and to help after the baby is born, during the COVID-19 pandemic, the safety aspect of the restrictions and the support received from staff is considered by women when making recommendations to a maternity hospital about whether, or how, to ease restrictions on visiting.

Concerns have been expressed globally about the decline in rates of physiological birth and rising intervention rates during labor and birth. The 'Labour Hopscotch' Framework, a visual depiction of steps required to remain active during labor was implemented in a large tertiary maternity hospital in Ireland. The aim of this study was to evaluate the steps of the Labour Hopscotch women found most useful, examine the use of non-pharmacological and pharmacological methods of pain relief used during labor and finally to investigate the labor and birth outcomes of women who used 'Labour Hopscotch' during labor.A descriptive cross-sectional study was conducted using a study specific questionnaire.A total of 809 women completed the questionnaire. The Labour Hopscotch Framework was positively evaluated. Mobilizing, the birthing ball, birthing stool, and water therapy were found to be the most useful steps. Primiparous women were more likely to use non-pharmacological methods of pain relief. Pharmacological methods used by women were entonox (67.5%), pethidine (8%) and epidural analgesia (38.5%). Primiparous women were more likely to have epidural analgesia than multiparous women (p0.00001). Women that attended either private (p=0.004) or public-led obstetric (p=0.005) antenatal care were more likely to have epidural analgesia in labor. Women attending the community midwives were least likely to receive epidural analgesia during labor. The rates of spontaneous vaginal birth, assisted birth and cesarean section, were 77.1%, 14% and 8.7%, respectively.Our study findings contribute to the increasing national and international evidence that initiatives such as Labour Hopscotch can promote and advocate for women to be active and mobile during labor to support physiological birth.

The rates of obstetric interventions, particularly caesarean section during childbirth, continues to rise in Ireland. This is reflective of international trends with concerns that societal confidence for physiological labour is declining. In response to such concerns, a community midwife designed and produced a framework entitled Labour Hopscotch which aims to support physiological birth and evidence-based midwifery practice in Ireland.

Introduction In depth exploration of the burnout phenomenon among midwives is sparse. The concept has been extensively studied, but predominantly reports rates and evaluates interventions to reduce burnout. A definition has yet to be offered in the literature from a midwifery perspective. Aims To explore midwives’ understandings of burnout, professionally and personally, in the context of contemporary maternity care in Ireland. Methods This was a Two-phase Participatory Action Research study. Five co-operative inquiry meetings were held with practising midwives (n = 21) over a six-month period between October 2018 and March 2019, in a large, urban teaching maternity hospital in Dublin, Ireland. Findings We found that multiple factors contributed to midwives’ perceptions and understandings of the concept of burnout. Midwives defined burnout as persistent stress and exhaustion, with an associated reduction of their individual coping abilities, motivation, empathy and/or efficacy, is unique to the individual and is primarily, in the midwifery context, caused and inextricably linked to excessive workload. Conclusion Burnout is a complex concept with many entities and its significance and impact within the midwifery profession highlights the importance of its exploration and understanding. This study is the first of its kind to explore, with midwives, the concept of burnout. The elements of stress and exhaustion in the definition mirror existing definitions in the literature.

Objective The overall aim of this study was to collate information to inform the updating of a perineal management educational programme for midwives. This paper explores midwives' confidence and educational needs in managing the woman's perineum during the second stage of labour, focusing on future quality initiatives to improve midwives' experiences and expertise in the prevention of perineal trauma during birth. Design A mixed-methods sequential exploratory design was used. Participants and Setting Midwives and clinical midwife managers assisting with births in the labour ward of a large urban university stand-alone maternity hospital in the Republic of Ireland with approximately 9,000 births per year participated in the study. Measurements A questionnaire and two focus groups were used to collect the data. Findings Fifty-two midwives from a total of 64 eligible labour ward midwives completed the questionnaire, a response rate of 81.2%. Midwives indicated that perineal management workshops did not cover prevention of perineal trauma, and mainly focused on suturing and repair of the perineum. The majority of midwives (85%) indicated that they would like further education on the prevention of perineal trauma. Higher levels of confidence in making a decision to perform an episiotomy, infiltrating the perineum and at performing an episiotomy were reported in experienced midwives. Midwives want improved and additional education in the management of women's perinea during the second stage of labour and made various recommendations regarding the content, format, timing and frequency of the workshop. Suggestions for further education included techniques for preventing perineal trauma during labour and birth and how to perform an episiotomy. Key conclusions This study provides key insights into midwives' confidence and educational needs in relation to managing the woman's perineum during the second stage of labour. The findings from this study demonstrates the appetite of midwives for additional education in the area of perineal management, particularly prevention strategies. Implications for practice Midwives play an essential role in reducing the rates of perineal trauma through regular education. It is therefore important that midwives keep up to date with the best available evidence. Updating existing perineal management educational programmes that are tailor made to midwives' needs could not only improve clinical skills and perineal protection techniques but also midwives' confidence in decision making. The overall aim is to reduce perineal trauma in women having a spontaneous vaginal birth.

Background Clinical training should be efficient, intellectually rigorous, and integrated into practice. This interactive workshop was developed to support student midwives in bereavement care. Aims To improve student midwives' confidence in providing bereavement care to parents after pregnancy loss and perinatal death. Methods Two focus groups were held, where students' (n=12) discussed their experiences of attending the workshop, barriers and facilitators to gaining confidence, and any further education needs. Findings All students agreed that the workshop increased their confidence, and said that role-plays were the most beneficial aspect of the day. Lack of exposure and support from mentors and senior staff was seen as the largest barrier to gaining further confidence. Conclusions The results suggest that all students could benefit from a workshop to increase confidence in bereavement care. The content of this workshop can be used in other maternity settings in Ireland and is recommended for all staff members caring for parents after perinatal bereavement or pregnancy loss.

To improve the confidence in student Midwives to provide bereavement careto parents following pregnancy loss and perinatal death.The one-day interactive Educational Training Workshop in Bereavement Care (ETWBC) was developed for student midwives in their final year of their B.Sc. Midwifery Degree Programme and those completing a Higher Diploma in Midwifery to help improve their confidence to provide bereavement care in clinical practice.A longitudinal sequential mixed-methods design was used to evaluate the outcome and processes of participation in the Workshop. This paper reports on the outcome evaluation.Participants completed the study questionnaires at all 3 time points: pre/post workshop and 3 month follow-up. Thirty nine of the 41 student midwives (Higher Diploma and 4th year B.Sc.) participated in the workshop. 97.44% (n = 38) of the participants completed all the questionnaires.Participation in the ETWBC increased student's midwives confidence (measured using knowledge and skills scales); Bereavement support skills [F(2,72) = 21.150, p .000, partial eta squared = 0.370] and Bereavement support knowledge [F(1.6,60) = 48.460, p .000, partial eta squared = 0.567]to provide bereavement care. Improvement in Student Midwives' level of self-awareness of the needs of bereaved parents [F(2,72 )= 20.311, p .000, partial eta squared = 0.361] and of their own personal needs [F (1.7, 61) = 30.387, p .000, partial eta squared = 0.458] in relation to providing bereavement support were also found.Participation in the Education Training Workshop on Bereavement Care helped increase student midwives confidence to provide bereavement care to grieving parents and to increase their self-awareness around their clinical practice in this area. The ETWBC is recommended as a brief effective educational intervention for inclusion in Midwifery curricula which could be modified for use with other relevant professional groups.

Signs of riboflavin deficiency require many months to develop in patients placed on riboflavinrestricted diets (1-6). The demonstrations that riboflavin deficiency induced by dietary restriction or riboflavin antagonists resulted in regression of rodent tumors (7-13) prompted several efforts in this laboratory to produce riboflavin deficiency in patients with neoplastic disease (14, 15). Riboflavin antagonists were used in these studies with the objective of producing the deficiency state rapidly, since a regimen requiring many months of dietary restriction would not lend itself to therapeutic evaluation in patients with metastatic cancer. These earlier investigations did not result in the production of clinical evidences of riboflavin deficiency or in objective demonstrations of tumor regression. The administered riboflavin antagonists, selected on the basis of their effectiveness in rats, were shown to be metabolized differently in man. The most active of these agents against rat tumors, 6,7-dimethyl-9- (2'-acetoxyethyl) -isoalloxazine, was rapidly and almost completely hydrolyzed in man, although a significant amount of the absorbed drug was excreted unchanged by rats. With the objective of producing human riboflavin deficiency, an analog was sought that would be an effective riboflavin antagonist in rodents and would be metabolized similarly in rodents and in man.