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Introduction: The initial COVID-19 lockdown in Aotearoa New Zealand (Aotearoa NZ) in 2020, likely resulted in significant disruption to maternity care and midwifery education. Therefore, we asked the question, “What was the experience of student midwives studying and providing maternity care during the COVID-19 pandemic in Aotearoa NZ?” Aim: Our aim was to explore the impact of the 2020 lockdown phase of the COVID-19 pandemic for student midwives in Aotearoa NZ. Method: This qualitative descriptive study used semi-structured interviews to explore the impact of alert levels 3 and 4 COVID-19 lockdowns in 2020. Inductive thematic analysis was used to identify codes and generate themes and sub-themes from the interview transcripts. Findings: Seven midwifery students described their experiences from which two overall themes were identified. The first of these was Uncertainty in which participants described insecurity, loss of control, isolation and constant worry. On the positive side they described Flexibility and Resilience – the ability to be flexible as they moved to more frequent use of online platforms, which provided connection with their peers; and resilience where the pandemic was considered beneficial by some for the future as it built their ability to face unanticipated challenges in their midwifery practice. Conclusion: During a pandemic, anxiety, isolation and insecurity are common and our participants felt additional institutional support for student midwives was required. We concluded that it is essential to acknowledge the anxiety and individual needs of all students and check in with them regarding their physical and mental wellbeing. Setting up online platforms and facilitating connections between tutors and peers may provide more structural support.

Background: In Aotearoa New Zealand pertussis and influenza vaccinations are available free-of-charge during pregnancy, although uptake varies between District Health Board areas. Aims: This study was designed to assess the knowledge of, attitudes towards, and infrastructural access to, these vaccines for birthing people in an area of Auckland (Counties Manukau) where uptake has been low. Methods: A mixed methods research design was used involving interviews (n = 7), two focus groups (n = 9) and a paper-based survey (n = 121). Interviews and focus groups were semi-structured and analysed using thematic analysis. The survey comprised of a 20-item Likert scale. Findings: Participants displayed support for maternal vaccinations. Concerns remain regarding potential adverse effects. Awareness of the existence of vaccines in pregnancy is not universal, and 36% of survey participants were unaware that the vaccines are free-of-charge. Appreciation was expressed for trusted healthcare relationships within which people feel supported to make decisions about maternal vaccination, and for immunisation services that are easily accessible. Conclusion: The research contributes to growing evidence on the significance of health professionals providing information about immunisation in pregnancy. Also highlighted is the importance of: culturally safe knowledge sharing; information being tailored to meet individual needs; and continuity of health and maternity care to facilitate that.

Introduction: In Aotearoa New Zealand the COVID-19 pandemic in 2020 resulted in a four-week lockdown in March and April of 2020 with ongoing restrictions for several weeks. Aim: To explore the experiences of women who were pregnant, giving birth and/or managing the early weeks of motherhood during the 2020 COVID-19 alert levels 3 and 4 in Aotearoa New Zealand. Method: This qualitative study used semi-structured interviews to explore childbirth experiences during the COVID-19 alert level restrictions. Reflexive, inductive, thematic analysis was used to identify codes, subthemes and themes. Findings: Seventeen women participated in the study. Analysis of the qualitative interviews revealed four themes. The first of these was: Relationship with my midwife, in which participants described the importance of the midwifery continuity of care relationship, with midwives often going above and beyond usual care and filling the gaps in service provision. In the Disruption to care theme the participants described feeling anxious and uncertain, with concerns about the hospital restrictions and changing rules. The participants also described their Isolation during postnatal care in a maternity facility due to separation from their partners/whānau; they describe receiving the bare necessities of care, feeling they were on their own, and working towards their release home; all of which took an emotional and mental toll. The final theme, Undisturbed space, describes the positive aspects of the lockdown of being undisturbed by visitors, being better able to bond with the baby and being able to breastfeed in peace. Conclusion: Midwifery continuity of care appears to have supported these women and their families/whānau during the service restrictions caused by the COVID-19 lockdown. The partner, or other primary support person, and whānau should be considered essential support and should not be excluded from early postpartum hospital care.

Background/Aims The extension of termination of pregnancy services in the Republic of Ireland represents a significant change to practice. Education is required so that nurses and midwives can fulfil their expanded role. The aim of this study was to provide an evaluation of a national termination of pregnancy education programme for midwives and nurses in the Republic of Ireland. Methods Kirkpatrick's framework for evaluation was used to create an online questionnaire that captured nurses' and midwives' reactions to a training experience at a termination of pregnancy education programme and their self-assessed knowledge before and after training. Results Participation in the training programme increased the participants' knowledge and confidence in caring for women having a termination. Participants reported that the training was relevant, met their expectations and new knowledge would be used. Recommendations for programme enhancement were also received. Conclusions Participants were satisfied with the education that they received. The positive impact that a short educational intervention had on participants' knowledge and confidence in providing care for women choosing termination of pregnancy was demonstrated.

Background/Aims Adolescent pregnancy is a significant health problem that can lead to adverse effects for the health of both adolescent mothers and their babies. Little is known about adolescent pregnancy from the perspective of adolescents, especially in developing countries, including Iran. The present study's aim was to explore Iranian adolescent women's perspectives of pregnancy. Methods This study was a thematic analysis conducted from November 2018 to October 2019 in north Iran. Data were collected through 24 unstructured, face-to-face in depth interviews which were transcribed and analysed using coding, constant comparison and memo writing. Results The experiences were categorised into five themes: ‘skeptical confronting pregnancy’, ‘intelligent self-care’, ‘embracing the pregnancy’, ‘effective support from others’ and ‘mixed perceptions of pregnancy’. Conclusions This study could improve healthcare professionals' adaptation of care for pregnant adolescent women and inspire them to tailor their care specifically to adolescents' needs.

Background/Aims Significant weight loss during early life can be of serious concern and assessing weight is key in decisions regarding supplementation. However, supplementation is a significant risk factor for early breastfeeding cessation. Recognising differential causes of weight loss supports identification of genuinely unwell infants and targets practices that support exclusive breastfeeding appropriately. This study's aim was to identify whether maternal fluid balance/load is associated with neonatal weight loss. Methods The databases CINAHL, MEDLINE, EMBASE, EMCARE were searched for relevant literature. Data were extracted using a structured form based on the Cochrane handbook. Meta-analysis was not possible because of the heterogeneity of all aspects of study design and outcome definitions. Results Eight studies presented original data. Four reported an association between maternal intravenous fluid intake and neonatal weight loss, and four did not. No two studies collected the same outcome data at the same time, using the same comparator or intervention. Conclusions Further research is required to clarify the relationship between maternal fluid intake and neonatal weight loss in a clinically useful way.

Background/Aims Midwives are often the only professionals to examine a women after a vaginal birth. Therefore, it is important that they are trained in the detection and management of obstetric perineal trauma. This study's aim was to establish midwives' current knowledge and training in post-birth perineal trauma, including obstetric anal sphincter injuries, in the UK. Methods An online national validated survey was distributed to UK midwives. There were 58 questions to assess midwives' knowledge and training. Univariable and multivariable analyses were conducted. Results A total of 149 midwives participated. Only 50.3% had received training in obstetric tears. Midwives were better at classifying 3a (98.0% and 87.9% respectively) than 3b tears (79.2%, 85.9% and 84.6%) from images and descriptive text. Those who had training (P=0.02) and were a higher banding (P=0.003) were better at identifying tears. Conclusions Although midwives' knowledge of obstetric tears was good, there was room for improvement and midwives stated that they would like more training.

Background/Aims A short interpregnancy interval is associated with several maternal and neonatal complications. In Oman, the incidence of short interpregnancy interval is well documented in the annual health report, but evidence is lacking on its impact on adverse pregnancy outcomes. This study examined short interpregnancy interval, its risk factors and its association with the prevalence of adverse pregnancy outcomes among Omani pregnant women. Methods A retrospective matched case–control design was adopted. Data were collected from medical records between January and December 2020. A total of 597 pregnant women from two tertiary care hospitals in Oman were included. Results There was a significant relationship between interpregnancy interval and the prevalence of adverse maternal and perinatal outcomes, including postpartum haemorrhage, iron deficiency anemia, preterm birth and low birth weight. Significant risk factors for a short interpregnancy interval were advanced maternal age, young age at first birth, low parity and previous perinatal loss. Conclusions Encouraging acceptance of birth spacing through the use of contraception would signify a notable change in cultural values that can act as a barrier to birth spacing. This would therefore improve pregnancy outcomes.

Funding Information: A special remark for the late Professor João Luís Baptista PhD MD—AV research co-supervisor—a great man who was a thinker and a fighter for Sao Tome and Príncipe improvement of public health. We are indebted to all the women who participated in the study. The authors would like to thank the 1) medical team and nurses of Hospital Ayres de Menezes Maternity for their support, especially to the chief-nurse Paulina Oliveira, and 2) Ana Sequeira, Rita Coelho, Ana Margalha, Ana Castro, Alexandra Coelho, and Inês Gomes for field support. We would like to acknowledge Instituto Camões, I.P. for the logistic support in Sao Tome & Principe. Funding Information: AV was supported by the Fundação para a Ciência e Tecnologia (FCT) ( https://www.fct.pt/index.phtml.pt/ ), grant number SFRH/BD/117037/2016. The funder had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. Publisher Copyright: © 2023, The Author(s). Background: Sao Tome & Principe (STP) has a high peri-neonatal mortality rate and access to high-quality care before childbirth has been described as one of the most effective means of reducing it. The country has a gap in the coverage-content of antenatal care (ANC) services that must be addressed to better allocate resources to ultimately improve maternal and neonatal health. Therefore, this study aimed to identify the determinants for adequate ANC utilization considering the number and timing of ANC contacts and screening completion. Methods: A hospital based cross-sectional study was undertaken among women admitted for delivery at Hospital Dr. Ayres de Menezes (HAM). Data were abstracted from ANC pregnancy cards and from a structured face-to-face interviewer-administered questionnaire. ANC utilization was classified as partial vs adequate. Adequate ANC utilization was defined as having ANC 4 or more contacts, first trimester enrolment plus one or more hemoglobin tests, urine, and ultrasound. The collected data were entered into QuickTapSurvey and exported to SPSS version 25 for analysis. Multivariable logistic regression was used to identify determinants of adequate ANC utilization at P-value < 0.05. Results: A total of 445 mothers were included with a mean age of 26.6 ± 7.1, an adequate ANC utilization was identified in 213 (47.9%; 95% CI: 43.3–52.5) and a partial ANC utilization in 232 (52.1%; 95% CI: 47.5–56.7). Age 20–34 [AOR 2.27 (95% CI: 1.28–4.04), p = 0.005] and age above 35 [AOR 2.5 (95% CI: 1.21–5.20), p = 0.013] when comparing with women aged 14–19 years, urban residence [AOR 1.98 (95% CI: 1.28–3.06), p < 0.002], and planned pregnancy [AOR 2.67 (95% CI: 1.6–4.2), p < 0.001] were the determinants of adequate ANC utilization. Conclusion: Less than half of the pregnant women had adequate ANC utilization. Maternal age, residence and type of pregnancy planning were the determinants for adequate ANC utilization. Stakeholders should focus on raising awareness of the importance of ANC screening and engaging more vulnerable women in earlier utilization of family planning services and choosing a pregnancy plan, as a key strategy to improve neonatal health outcomes in STP. publishersversion published

Claire Leader discusses the three-year delivery plan for maternal and neonatal services in England, focusing on the goal to grow the maternity workforce

Background/Aims Self-rated health before, during and after pregnancy is important for women's quality of life and promotes bonding between mother and child. However, diverse aspects of care models influence women's experiences during pregnancy. This study aimed to investigate low-risk women's self-rated health during the perinatal period in relation to different models of care in Sweden. Methods A retrospective study was conducted of computerised obstetric data from 167 523 women with low-risk pregnancies during 2010–2015. Descriptive analysis was used, as well as group comparisons and ordinal regression analysis, to establish links between self-rated health before, during and after pregnancy and sociodemographic characteristics. Results The majority of women, regardless of model of care, rated their health as very good or good before, during and after pregnancy. During pregnancy, primiparous women, those who attended Conclusions Women attending private healthcare services tended to rate their health as better. Vulnerable groups of women need special attention from healthcare authorities.

Background/Aims Maternal cytomegalovirus infection can result in congenital cytomegalovirus, with neonatal and childhood sequalae including sensorineural deafness, visual impairment, and neurological abnormalities. This study's aim was to explore midwives' and women's level of awareness and knowledge of cytomegalovirus infection, and its impact during pregnancy. Methods A systematic review of the literature was carried out. Seven papers met the criteria for inclusion, and data were analysed for a total of 370 registered midwives and 1717 women. Results Participating midwives and childbearing women experienced significant levels of inadequate knowledge of cytomegalovirus infection. Midwives exhibited restricted recognition of viral transmission, maternal and neonatal symptoms and antenatal prevention, and childbearing women documented limited awareness and understanding of cytomegalovirus infection and congenital cytomegalovirus. Conclusions Pregnant women need to be provided with information about cytomegalovirus, including how it may affect the fetus and how to reduce the risk of exposure during pregnancy. Midwives require additional education to increase their knowledge and understanding of cytomegalovirus.

Background/Aims Surveys are a popular method of collecting data to explore factors associated with midwives' emotional wellbeing. However, existing survey instruments lack consideration of how working practices may influence outcomes. This study aimed to test the face and content validity of a new instrument by assessing midwives' comprehension of bespoke survey items. Methods A total of 24 cognitive interviews were conducted with midwives working across the UK. A framework matrix method facilitated descriptive and explanatory analysis of the interpretation of survey items. Interviews were followed by a discussion group with midwifery academics to help identify optimal wording of one problematic survey question. Results A range of potential comprehension and response problems were identified, resulting in modifications and the addition of new survey items. Conclusions Cognitive interviews can be an effective method to confirm the relevance and usability of bespoke survey items and offer opportunities to improve wording to reduce potential sources of error, thus enhancing the face and content validity of surveys.

Background/Aims In the last decade, simulation has become a key pedagogical tool in midwifery education. The purpose of this study was to undertake a scoping review of the literature to explore the integration and application of simulation in midwifery education. Methods A search was carried out using the online database PUBMED, for articles published between 2011 and 2021. After screening and quality assessment, n=44 articles were included in the review. Results The number of articles published on this topic increased from three published in 2011–2012 to seven published in 2020–2021. A total of 44 articles were included, and assessed based on their main aims and objectives. These were development and evaluation of a simulation, description and/or comparison of fidelity, description of a simulation via screens/remotely, exploring student midwives' experiences, the impact on student midwives, and assessing student midwives' satisfaction in a simulation. Conclusions This review explored the existing literature on simulation and midwifery education. It allows an assessment of the current state of midwifery education and opens up avenues for further development.

Background Recurrent miscarriage is defined as three recurrent first trimester pregnancy losses. The Tender Loving Care Clinic is a specialist clinic for women during the first trimester of a pregnancy following recurrent miscarriages. This study's aim was to review cases of those who attended the tender loving care clinic for antenatal care. Methods A retrospective chart review was conducted using anonymous data, collected from the electronic records of women who attended the clinic over a 1-year period. Results A total of 103 women attended the clinic during the study period. The majority (90.3%) were prescribed medication while attending. Pregnancy outcomes for women attending the clinic were good; 69.2% of women went on to have a live birth. Conclusions Pregnancy outcomes following recurrent miscarriages are reassuring with supportive antenatal care. This review highlights the importance of psychological care and reassurance in a pregnancy following recurrent miscarriages.

Breastfeeding has multiple positive impacts on infants, mothers, and the economy.However, the global breastfeeding rates fall short of the World Health Organization's recommendations. Telelactation interventions have been shown to improve breastfeeding outcomes, yet this field has not been systematically reviewed.This mixed-studies systematic review aims to consolidate and synthesize findings on the available evidence of telelactation interventions on breastfeeding outcomes, uptake of these interventions, and provide recommendations for future lactation interventions.A literature search was conducted in six electronic databases (PubMed, EMBASE, CINAHL, PsycINFO, Cochrane, and Scopus) and one gray literature (Mednar) from their inception date to October 2021. Thirteen articles met the selection criteria, and thematic synthesis was conducted to consolidate and synthesize findings from the included studies.Three themes and nine subthemes were identified: (1) Attributes and receptivity of telelactation interventions, (2) Benefits associated with telelactation interventions, and (3) Recommendations and improvement opportunities.Telelactation interventions were well-received by stakeholders (mothers, fathers, and healthcare providers), and receptivity was found to be influenced by primiparity and the perceived usefulness of telelactation consultations (extrinsic motivation). These interventions showed promising improvement in the provider-user relationship and breastfeeding outcomes. Future studies should make telelactation user-friendly, secure their telelactation platforms, increase communication options and built-in functions, and improve care continuity.This review highlighted the advantages, recommendations, and future considerations for telelactation interventions. More research is needed to pilot telelactation interventions in various regions and obtain longitudinal data with different time points.

International guidelines recommend intrapartum cardiotocograph (CTG) monitoring for women at risk for poor perinatal outcome. Research has not previously addressed how midwives and obstetricians enable or hinder women's decision-making regarding intrapartum fetal monitoring and how this work is structured by external organising factors.To examine impacts of policy and research texts on midwives' and obstetricians' work with labouring women related to intrapartum fetal monitoring decision-making.We used a critical feminist qualitative methodology known as Institutional Ethnography (IE). The research was conducted in an Australian tertiary maternity service. Data collection included interviews, observation, and texts relating to midwives' and obstetricians' work with the fetal monitoring system. Textual mapping was used to explain how midwives' and obstetricians' work was organised to happen the way it was.CTG monitoring was initiated predominantly by midwives applying mandatory policy. Midwives described reluctance to inform labouring women that they had a choice of fetal monitoring method. Discursive approaches used in a national fetal surveillance guideline, a Cochrane systematic review, and the largest randomised controlled trial regarding CTG monitoring in labour generated and reproduced assumptions that clinicians, not labouring women, were the appropriate decision-maker regarding fetal monitoring in labour.Guidelines structured midwives' and obstetricians' work in a manner that undermined women's participation in decisions about fetal monitoring method. Intrapartum fetal monitoring guidelines should be critically reviewed to ensure they encourage and enable midwives and obstetricians to support women to make decisions about intrapartum care.

Nyoman Anita Damayanti, Ratna Dwi Wulandari, Ilham Akhsanu Ridlo Department of Health Policy and Administration, Faculty of Public Health, Unversitas Airlangga, Surabaya, IndonesiaCorrespondence: Nyoman Anita Damayanti, Department of Health Policy and Administration, Faculty of Public Health, Unversitas Airlangga, St. Ir. Soekarno, Kampus C, Surabaya, East Java, 60115, Indonesia, Tel +62818518232, Fax +62315920948, Email nyoman.ad@fkm.unair.ac.idPurpose: Maternal mortality is one problem that still affects countries like Indonesia and others globally. The World Health Organization (WHO) notes that Southeast Asian countries have a high MMR. Indonesia’s maternal mortality ranks third highest in Southeast Asia, with a 177 maternal mortality rate per 100,000 live births in 2017. In 2018, the maternal mortality rate reached 91.45 per 100,000 live births. Pregnant women’s deaths can be caused inadequate medical care due to how frequently they seek treatment. This study intends to identify and analyze how knowledge, education, and myths affect pregnant women’s attitudes toward seeking health services.Materials and Methods: The study involved 175 pregnant and postpartum women who visited 10 health public centers in two cities in East Java by accidental sampling. Data regarding intrapersonal, interpersonal, and local wisdom were collected through surveys with structured instruments and in-depth interviews. Data statistics used pathway analysis with a p-value of > 0.05.Results: Intrapersonal, interpersonal, and local wisdom variables have a significant direct or indirect effect on utilizing health services. Knowledge was the variable with the greatest influence (t-value, 27.96).Conclusion: Myth and culture as local wisdom and intrapersonal factors significantly affect the pattern of utilizing health services.Keywords: healthcare utilization, maternal mortality, human and health, pregnancy, sociocultural

Maternity policy and guidelines increasingly recommend or stipulate the increased provision of midwifery continuity of carer as a priority model of care. The scale up and sustainability of this model will require that student midwives are competent to provide continuity of carer at the point of qualification. Guidance relating to how to optimally prepare student midwives to work within continuity models is lacking.To explore perspectives and experiences of working within and learning from student placement within continuity models of care.An online mixed methods survey aimed at midwifery students and qualified midwives with experience of working within or providing education relating to continuity models. Quantitative results were analysed through descriptive statistics while free text responses were brought together in themes.Benefits and challenges to placement within continuity models were identified. These provide recommendations that will enhance learning from and skill development within continuity models of care.There is a need for continuity of mentorship and strong relationships between education and practice, and the provision of flexible curriculum content around this to enable students to prioritise appointments with women in their care. System level evaluation and support is needed to guide the optimal provision of continuity models, so that they are effective in improving outcomes and experiences. Foregrounding woman centred care as foundational to education and facilitating the critical deconstruction of dominant discourses that conflict with, and may prevent this form of practice, will promote the provision of care that is integral to these models.

Helina Abebe Kurbi,1,2 Solomon Mekonnen Abebe,3 Nestanet Worku Mengistu,3 Tadesse Awoke Ayele,1 Alemayehu Teklu Toni4 1Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Kotebe Metropolitan University, Menelik II Health Science College, Department of Mental Health, Addis Ababa, Ethiopia; 3Department of Nutrition institute of public health, college of medicine and health sciences, university of Gondar, Gondar, Ethiopia; 4Department of Pediatrics and School of Medicine, Institute of Public health, college of Medicine and health sciences, university of Gondar, Gondar, EthiopiaCorrespondence: Helina Abebe Kurbi, Email helusimren@gmail.comBackground: The prevalence of prenatal common mental disorders afflicting the global community, including Ethiopia, is thriving. Therefore, a time-efficient and valid screening tool is required. This study aimed to culturally adapt and validate the self-reporting questionnaire-20 tool developed by the World Health Organization among pregnant mothers in Ethiopia.Methods: A total of 310 pregnant women completed the questionnaire at two selected health centers in the regional state of Amhara. The World Health Organization’s Self Reporting Questionnaire-20 tool was first translated into Amharic by two experts. The back translation was done by two English experts. Internal consistency and reliability were assessed using Cronbach’s alpha. Convergent and discriminant validity were assessed using composite reliability and extracted mean variance. SRQ-20 was tested for reliability and validity using principal components analysis and the Kaiser-Meyer-Olkin measure of sample adequacy with a cutoff value of 0.50 for each item.Results: The Kaiser-Meyer-Olkin measure (KMO = 0.733) for sample adequacy and the Bartlett’s sphericity test for the identity matrix indicated that the data were amenable to exploratory factor analysis. Principal components analysis identified six factors that explained 64% of the variation in the self-report questionnaire 20. Cronbach’s alpha was 0.817 for the entire scale and the extracted mean variance was greater than 0.5 for all factors, indicating convergent validity. The extracted mean variance, composite reliability, and factor loadings were all greater than 0.75 for all factors in this study, indicating that convergent validity was satisfactory and that discriminatory validity was also satisfied. The composite factor reliability scores ranged from 0.74 to 0.84, and the square roots of the mean variances were greater than the factor correlation scores.Conclusion: The interview-based, culturally-adapted 20-item Amharic version of the SRQ-20 tool demonstrated good cultural adaptation and was also found to be valid and reliable in the present context.Keywords: antenatal common mental disorders, cultural adaptation, factor analysis, SRQ-20, Ethiopia

Obstetric triage is usually undertaken by a midwife and involves conducting a physical assessment to identify a woman's presenting problem. The Birmingham Symptom-specific Obstetric Triage System (BSOTS) was developed in the United Kingdom (UK) to overcome challenges associated with triaging women by standardising the maternity triage process. The Australian study site is the first hospital outside the UK to implement this approach.To evaluate the implementation of the BSOTS in an Australian tertiary maternity service.A multi-method approach including pre-implementation BSOTS education evaluations (n = 26), post-implementation clinical data audit (n = 660), and staff focus groups (n = 9) was undertaken. Participants included midwives who worked in the Maternity Assessment Centre. Data of women who had attended the service during BSOTS implementation was analysed in the audit component.Staff valued the BSOTS standardised approach to maternity triage, particularly for midwives new to the role. The retrospective audit showed that time to triage and time to care outcomes for women improved from pre-implementation audits and were mostly adhering to auditable standards. Lack of knowledge amongst staff (especially medical staff) regarding the BSOTS was considered a barrier to the effective flow of care of women through the centre.The BSOTS is a useful approach for prioritising women's care. Ensuring that all staff are aware of the system and its benefits is likely to enhance implementation and improve triage outcomes.The BSOTS is an innovative midwife led practice change that is applicable to the Australian context, and benefits women, midwives, and the maternity service.