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Clinical decision-making is integral to contemporary healthcare. Midwives support and advocate for primarily healthy women throughout a life-altering transition, as set out in the code. They provide safe, evidence-based, compassionate and individualised care in partnership with women, to promote choice and shared decision-making. This critical reflection analyses a tripartite clinical decision, focusing on the hypothetico-deductive and dual processing models. This is an opportune time to reflect upon one's own practice, particularly in light of the Ockenden report, to ensure high professional standards are maintained collaboratively across all parties involved in a clinical decision.

Experts are growing increasingly concerned about the sustainability of the midwifery workforce, with unfilled vacancies in the thousands, an ageing workforce with many taking early retirement, and difficulty retaining newly qualified midwives. Staffing studies have focussed on the quality of care in labour, with fewer studies looking at staffing levels in relation to postnatal care. This Evidence Brief describes a cross-sectional analysis of women’s responses to the Maternity Survey 2018 linked to midwifery staffing levels in each Trust. Researchers at the University of Southampton aimed to understand whether the experience of care on postnatal wards varies according to the number of midwives available. They have focused on experiences of postnatal care while in hospital, as this is an area where families have expressed dissatisfaction.

This guide presents recommendations for midwives and obstetricians on the subject of wound healing; in relation to surgical site infections (SSI) post-caesarean section (CS) using negative pressure wound therapy (NPWT) for at-risk groups. Background It is well documented that there has been a steady growth in CS rates since the 1980s (Betrán et al, 2016), despite the World Health Organization's ([WHO], 2015) reiteration in 1985 of an 'ideal' CS rate globally of 10%–15%. Bragg et al (2010) asserts a CS increase in England from 9% in 1980 to 24.6% by 2008–2009. The National Maternity and Perinatal Audit ([NMPA], 2019) Project Team reports a birth rate of 700 000 during 2016–2017 in the NHS across England, Wales and Scotland, of which approximately 1 in 4 women were delivered by CS (Bhatia et al, 2021); a statistic reiterated within the National Institute for Health and Care Excellence ([NICE], (2021) caesarean birth guidance. The WHO (2015) affirms that when medically necessary, CS prevents maternal and newborn mortality (Boerma et al, 2018; Sandall et al, 2018). There are many speculated reasons for this increase, such as rising maternal age at first.

Staffing levels have been implicated in cases of adverse maternity events, near misses and sub-optimal outcomes such as unwell new-borns or still births. Care that is missed due to high workload can affect the detection of deterioration in mothers and babies, and delay appropriate management. A national shortage of midwives has resulted in increased reliance on support workers but the possible effect of skill-mix changes on outcomes has not been assessed.This Evidence Brief describes a systematic scoping review to explore evidence on the association between inpatient midwifery staffing levels, skill mix and outcomes for mothers and babies. Researchers at the University of Southampton aimed to understand the amount and strength of the available evidence, the direction of relationships established, and to highlight gaps for future research.

This article is the first in a two-part series exploring decision-making (DM) in contemporary midwifery practice. This first part considers the role and nature of DM, and critiques two DM tools, while the second proposes a midwifery-specific DM tool in the context of a tripartite clinical decision, incorporating broader perspectives and ethical issues in DM. DM is an integral part of midwifery practice, and is formally introduced to third-year student midwives at the University of Southampton in an Autonomous Practice academic module that incorporates both DM and carrying a student caseload, with the aim of supporting the transition from student to newly qualified midwife. The taught component of the module occurs over a one-week period, introducing students to the complexities and challenges encountered in clinical DM within midwifery practice. The module culminates in a written assignment exploring and critiquing DM theories and models, and applying a DM model to a tripartite clinical decision. As stated throughout the module and through research, most learning in reality occurs once qualified and a change in professional responsibility has been realised (Kitson-Reynolds 2010; Kitson-Reynolds et al 2014).