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Abstract Background Guidelines for clinical practice have been part of the Ministry of health’s efforts to improve the quality of care for over two decades. Their benefits have been documented in Uganda. However, having practice guidelines may not always result in their use in care provision. We explored the midwives’ perceptions towards the ministry of health guidelines for providing immediate postpartum care. Methods An exploratory descriptive qualitative study was conducted in three districts in Uganda from September 2020 to January 2021. In-depth interviews with 50 midwives from 35 health centers and 2 hospitals in Mpigi, Butambala, and Gomba districts were done. Thematic analysis of data was done. Results Three themes emerged; awareness and use of the guidelines, perceived drivers, and perceived barriers to the provision of immediate postpartum care. The subthemes for theme I included; awareness of the guidelines, variations in the postpartum care practices, variations in preparedness to manage women with complications, and varied access to continuing midwifery education. Fear of complications and litigation were the perceived drivers of guideline use. On the other hand, lack of knowledge, busy maternity units, organization of the care, and the midwives’ perceptions about their clients were the barriers to guideline use. Midwives felt that new guidelines and policies regarding immediate postpartum care should be disseminated widely. Conclusion The midwives felt that the guidelines were good for the prevention of postpartum complications but their knowledge of the guidelines for the provision of immediate postpartum care was suboptimal. They desired on-job training and mentorship to help them bridge the knowledge gaps. Variations in patient assessment, monitoring, and pre-discharge care were acknowledged and said to be due to a poor reading culture and health facility factors like patient-midwife ratios, unit setup, and prioritization of labor.

Background: Guidelines for clinical practice have been part of the Ministry of health's efforts to improve the quality of care for over two decades. Their benefits have been documented in Uganda. However, having practice guidelines may not always result in their use in care provision. We explored the midwives' perceptions towards the ministry of health guidelines for providing immediate postpartum care. Methods: An exploratory descriptive qualitative study was conducted in three districts in Uganda from September 2020 to January 2021. In-depth interviews with 50 midwives from 35 health centers and 2 hospitals in Mpigi, Butambala, and Gomba districts were done. Thematic analysis of data was done. Results: Three themes emerged; awareness and use of the guidelines, perceived drivers, and perceived barriers to the provision of immediate postpartum care. The subthemes for theme I included; awareness of the guidelines, variations in the postpartum care practices, variations in preparedness to manage women with complications, and varied access to continuing midwifery education. Fear of complications and litigation were the perceived drivers of guideline use. On the other hand, lack of knowledge, busy maternity units, organization of the care, and the midwives' perceptions about their clients were the barriers to guideline use. Midwives felt that new guidelines and policies regarding immediate postpartum care should be disseminated widely. Conclusion: The midwives felt that the guidelines were good for the prevention of postpartum complications but their knowledge of the guidelines for the provision of immediate postpartum care was suboptimal. They desired on-job training and mentorship to help them bridge the knowledge gaps. Variations in patient assessment, monitoring, and pre-discharge care were acknowledged and said to be due to a poor reading culture and health facility factors like patient-midwife ratios, unit setup, and prioritization of labor. [ABSTRACT FROM AUTHOR]

Background: Women of non-white British ethnicity have a higher maternal mortality risk for reasons not yet fully understood, and report significant concerns about stereotypes, racism and overall dissatisfaction in care. This study aimed to examine what midwives perceive to be contributing factors to ethnic disparity in maternity care. Methods: A systematic search of the literature was conducted to find contemporaneous, relevant studies which were appraised for inclusion and quality. Four qualitative studies were included. Results: Midwives spoke about practical, cultural and logistical concerns that contribute to health inequalities; none mentioned racism. Three themes emerged: relationship barriers, logistical barriers and a sense of us vs them. Three areas of us vs them were explored: 'incongruent expectations', 'structural racism, stereotypes and implicit bias' and 'culture vs professional accountability'. Conclusions: Further research into the impact of implicit bias is needed to adequately address health inequalities for non-white British women. A national strategy could be used to set expectations for women accessing UK maternity services early in pregnancy. Midwives need to be empowered and supported to thoroughly document women's choices so that their professional responsibilities are met. [ABSTRACT FROM AUTHOR]

This paper reports on research that explores the experience of the ward based midwife, as research suggests workplace balance is problematic. To explore the processes and practices around ward based clinical engagement and its impact in an Australian public tertiary obstetric unit. A qualitative descriptive study was undertaken. Focus groups were used to gather data. Groups were audio recorded and transcribed verbatim. Thematic analysis was continued until data saturation was achieved. Seven focus groups involving 40 midwives were conducted. Midwives' voices suggested tensions arose when their aspirations around core professional values and camaraderie were compromised by the practice realism of the ward. Furthermore, they described frustration with imposed restrictions which governed their working environment. These occurred outside the ward, had a direct impact on how it functioned, and were perceived to be out of the midwives' control. Midwives experiencing emotional distress revealed they were carrying a burden. Two burdens were described: disengagement and what have I missed? Thought must be given to how the art of midwifery is practiced on the ward. Ignoring the growing body of literature on this subject will be problematic for both midwives and women, as midwives will be disempowered to foster women's capabilities through tailored, supportive and respectful care. [ABSTRACT FROM AUTHOR]

• Women's mobile phone use impacts the midwife-woman relationship in birth suite. • Midwives were concerned about granting permission for their image to be recorded. • Mobile phones enabled others not present to access women and influence decision making. Women's use of mobile phones while in birth suite has been recognised as a common occurrence. However, no evidence has been reported around midwives' perceptions of how women's mobile phone use impacts midwifery care in birth suite. To explore midwives' perceptions of women's mobile phone use and impact on care in the labour and birth environment. A qualitative descriptive study was undertaken. Transcriptions from focus groups were subjected to thematic analysis. Ten focus groups involving 63 Australian midwives were conducted. Four key themes and corresponding subthemes were identified: 'considering consent' which encompassed the subthemes 'establishing boundaries' and 'taken by surprise'; 'competing with the phone' encompassing 'missing the experience' and 'delaying care'; 'being with woman' encompassing 'affecting relationships' and 'not my right to deny'; and finally 'bringing others into the room' with subthemes of 'keeping in touch' and 'seeking a second opinion'. This is the first study to explore midwives perceptions of women's mobile phone use and the impact on a midwife's ability to provide care in birth suite. Findings suggest that women's mobile phone use can influence the relationship between the midwife and the woman and contributes to delays in providing care. Midwives shared how they experienced tensions around their right to grant permission for their image to be recorded. Finally, mobile phones have allowed others not present in the birth suite to access women and influence their decision making. It is widely recognised women are bringing their mobile phones into the labour and birth environment. Therefore, it is important we explore midwives perceptions around the tensions and concerns that exist, so they can be addressed. [ABSTRACT FROM AUTHOR]

In the present study a preliminary enquiry was made into midwives’ perceptions of cultural issues in prenatal care. 23 midwives completed a questionnaire in a formal setting. Comprehension is identified as the most preferred cultural component in midwifery practice. Significant perceived positive associations were obtained among a number of sociocultural variables and prenatal care. The findings of this study suggest that midwifery practice needs to be informed by cultural practices in pregnancy. [ABSTRACT FROM AUTHOR]

Mental health disorders are estimated to affect between 10% and 20% of women who access maternity services and can be defined as a public health issue due to the potential consequences for women, children and families. Detecting problems early in pregnancy can significantly improve outcomes for women and their families. However, mental health problems are not being consistently identified in routine midwifery practice and little is known from current literature about midwives' practice in relation to current national guidelines or the impact models of care have on assessing maternal mental health. To identify midwives' views about barriers and facilitators to screening for mental health in pregnancy using current UK guidelines. Nine community midwives from a single district general hospital in the south of England were recruited to take part in focus groups. Thematic analysis was used to extract key themes from the data. Three key themes were identified from the focus groups and included system factors, social factors and trust. Barriers and facilitators to screening maternal mental health were associated with the initial 'booking' appointment' and differences in models of care. Barriers to screening were defined as high workload, poor continuity, and a lack of trust between women and midwives. This study highlights key barriers and facilitators associated with mental health screening during pregnancy, including issues of trust and uncertainty about women's willingness to disclose mental health conditions. Further research is required to evaluate the relationship between women and midwives in contemporary practice and the influence this may have on maternal mental health. [ABSTRACT FROM AUTHOR]