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Getting a PhD is the highest possible education qualification which only a small proportion of all students achieve. As a consequence, examining PhD research in the form of a doctoral thesis is specialist work. This paper highlights the different options that are available for PhD examiners. There are four general options: (1) pass, (2) rewrite and resubmit; (3) lower degree, with or without resubmission; and (4) fail the PhD. However, from our experience, of both being examined for our own PhDs and examining others at a range of different universities, we have noted a considerable variety in detail within these common options. This paper outlines a variety of outcomes of a PhD examination, followed by four short case studies, each reflecting on a particular aspect /differences we experienced as examinees or as examiners. This paper further aims to alert PhD candidates and examiners to study the examination rules set by the awarding university, as the details of the PhD examination outcome, and hence the options available to both examiners and the students may differ more than one might expect.

Introduction: This article presents research into the professionalisation of midwifery in Slovenia. Since recognition by related occupations is important for professions, this comparative study asked doctors and nurses in Slovenia about their perceptions of the status of midwifery. Method: A questionnaire survey was conducted with 300 Slovenian midwives, 666 nurses and 416 obstetricians. The questionnaire included statements covering traditional sociological notions of the profession (ethics, theory, power), and three notions based on new elements of professionalism (reflective practice, interdisciplinary working and partnership with clients). Results: Results suggest that nurses perceived themselves to be less autonomous than midwives, and this partly explains why most nurses thought that midwifery should be a specialised course of study, after the general nursing diploma. Obstetricians claimed to support midwives, however they did not give midwives credit for basic midwifery competencies and did not feel midwifery to be equal to their profession. Midwives revealed not to feel autonomous; they felt that nursing and obstetrics is jeopardizing independent midwifery practice. Discussion with conclusion: Slovenian midwifery was poorly evaluated in some attributes of professionalism, especially knowledge and autonomy. Even midwives themselves consider midwifery more occupation than profession. The autonomy of midwifery will be hard to achieve in the institutions of medical dominance. The study revealed that participants of all three groups are in a competitive relation and are poorly aware of the roles and competencies of other two professions. Therefore, partially joined education might be beneficial in order to promote interprofessional collaboration in the future.

First paragraph: The Final Report of the Ockenden Review examined the care of 1486 families who experienced adverse outcomes in one hospital Trust in England, the majority of whom received care between 2000 and 2020 (Ockenden 2022). It describes the damaging outcomes and experiences caused by poor care for women and babies in pregnancy, labour and birth. Multiple individual actions recommended by the report are resulting in immediate and extensive changes across the maternity services in England. The report findings are relevant across the whole UK, and to international efforts to improve safety and quality in maternal and newborn care systems.

Objective: To evaluate whether a slow and deep breathing (SDB) intervention is acceptable to pregnant women.\ud \ud Methods: The trial aims to recruit 67 pregnant women who have developed pregnancy-induced hypertension (clinicaltrials.gov: NCT04059822). SDB will be undertaken daily for 10 min using a video aid and women will self-monitor blood pressure (BP) daily. At 36-weeks gestation women will complete an online questionnaire. Adherence, recruitment rates, and acceptance of the intervention will be evaluated.\ud \ud Conclusion: The findings from this trial will evaluate if women accept SDB as a treatment method. Initial analysis will evaluate if BP and/or obstetric interventions reduce following SDB intervention.

Many traditional scientific journals carry an editorial at the start of each issue or perhaps in most issues. The more recently established online journals seemed to have discontinued this tradition, for example there is no editorial in Sociological Research Online or many of the online journals in the BMC stable, such as BMC Pregnancy & Childbirth or BMC Public Health. Over the past two decades we have published close to fifty editorials between us. We would like to highlight some of their specific features to offer advice and encouragement to would-be editorial writers, and, more generally, promote the writing and publishing of editorials. This paper includes an overview of the eight most recent editorials, all focusing on the hot topic of COVID-19, published in this scientific journal.

BACKGROUND: Admission to hospital in the latent phase of labour is associated with a cascade of unnecessary intervention. Women who seek early hospital admission may have heightened fear and anxiety in relation to pain routed in their pre-pregnancy experiences. OBJECTIVE: To determine the prevalence of pain catastrophising in a healthy non-pregnant population and explore previous pain experiences and fear of childbirth as characteristics that might predict pain catastrophising. DESIGN: Prospective observational study across two higher education institutions in Scotland and England using a semi-structured survey administered through Bristol Online Surveys. Four validated questionnaires were used to identify the prevalence of pain catastrophising and fear of childbirth in nulliparous women of reproductive age. RESULTS: The survey was completed by 122 women undertaking an undergraduate degree and aged between 18 and 23 years. A high prevalence of pain catastrophising was found: a cut-off score of 20 and above = 47.5% (58/122 participants), a cut-off score of 30 and above = 21.3% (26/122). Fear of pain (β = 0.14, t = 4.21, p

Background Maternal health programmes that focus on the woman alone are limiting in LMICs as pregnant women often relate to maternity services through a complex social web that reflects power struggles within the kinship and the community. Methods A scoping review was conducted to explore the rationale for male involvement in maternal health in LMICs. This review was guided by the question: What is the current state of knowledge regarding the inclusion of men in maternal health services in LMICs? The literature search was conducted using mySearch, Bournemouth University`s iteration of the EBSCO Discovery Service (EDS) tool. The review process used the Preferred Reporting Items for Systematic Reviews to select papers for inclusion. Findings Thirty three studies met the inclusion criteria. Findings describe the rationale for involving men in maternity care, alongside the criticisms and challenges inherent in engaging with men in maternal health. Involving men in maternity services can improve health outcomes for women and infants. Health strategies aimed at educating men are relevant in equipping men with knowledge and skills that help men to be supportive of women`s wellbeing during pregnancy and childbirth. Conclusion Men can serve as advocates for women and reinforce their partner`s choices in accessing skilled care and infant feeding. Further research is required to examine the effect of male involvement on women`s autonomy and to assess health education interventions aimed at mitigating harmful outcomes of involving men in maternity services.

Previous research highlights that disabled women have less choice, control and respect of their dignity during pregnancy, childbirth and parenting. The experience of dignity and respect during pregnancy and childbirth for those with physical and sensory disability in the UK and Ireland is explored.Narrative, semi-structured telephone and Skype interviews were conducted with ten disabled women in the UK and Ireland. Interviews were audio-recorded and transcribed verbatim. Intra- and inter-thematic analysis was undertaken, beginning with a process of open coding. As themes developed, a process of constant comparison was used.The key finding is that effective communication with women was perceived to best respect the women's dignity in childbirth. This meant enabling women to feel heard, enabling women to make informed decisions about their care and providing individualized care. The single most important factor that enabled this communication was continuity of carer.The factor that most promoted maternity care that was perceived to be respectful was effective communication. This is not so different in other parts of the world, or for non-disabled women, however care providers should be particularly careful to enable good communication with disabled women.

Background Paper-based charts remain the principal means of documenting the vital signs of hospitalised pregnant and postnatal women. However, poor chart design may contribute to both incorrect charting of data and clinical responses. We decided to identify design faults that might have an adverse clinical impact. Methods One hundred and twenty obstetric early warning charts and escalation protocols from consultant-led maternity units in the United Kingdom and the Channel Islands were analysed using an objective and systematic approach. We identified design errors that might impede their successful use (e.g. generate confusion regarding vital sign documentation, hamper the recognition of maternal deterioration, cause a failure of the early warning system or of any clinical response). Results We found 30% (n=36/120) of charts contained at least one design error with the potential to confuse staff, render the charts difficult to use or compromise patient safety. Amongst the most common areas were inadequate patient identification, poor use of colour, illogical weighting, poor alignment and labelling of axes, and the opportunity for staff to ‘game’ the escalation. Conclusions We recommend the urgent development of an evidence-based, standardised obstetric observation chart, which integrates ‘human factors’ and user experience. It should have a clear layout and style, appropriate colour scheme, correct language and labelling, and the ability for vital signs to be documented accurately and quickly. It should incorporate a suitable early warning score to guide clinical management.

The aim of this study was to investigate the association between stress and diet quality/patterns among women of reproductive age in UK. In total, 244 reproductive aged women participated in an online survey consisting of the European Prospective into Cancer and Nutrition food frequency questionnaire in addition to stress, depression, physical-activity, adiposity, and socioeconomic questions. An a-priori diet quality index was derived by assessing the adherence to Alternate Mediterranean Diet (aMD). A-posteriori dietary-patterns (DPs) were explored through factor analysis. Regression models were used to assess the predictors of the DPs. Participants mainly had medium (n = 113) aMD adherence. Higher stress levels were reported by participants with low aMD adherence. Participants with high aMD adherence were of normal BMI. Factor analysis revealed three DPs: fats and oils, sugars, snacks, alcoholic-beverages, red/processed meat, and cereals (DP-1), fish and seafood, eggs, milk and milk-products (DP-2), and fruits, vegetables, nuts and seeds (DP-3). Regression models showed that DP-1 was positively associated with stress (p = 0.005) and negatively with age (p = 0.004) and smoking (p = 0.005). DP-2 was negatively associated with maternal educational-level (p = 0.01) while DP-3 was negatively associated with stress (p &lt, 0.001), BMI (p = 0.001), and white ethnicity (p = 0.01). Stress was negatively associated with healthy diet quality/patterns among reproductive aged women.

Objective:To validate the European Prospective Investigation into Cancer (EPIC) FFQ in Lebanon.Design:Validation of the EPIC FFQ was done against three 24-h recalls (24-HR). Unadjusted and energy-adjusted correlations, Bland–Altman plots and weighed kappa statistics were used to assess the agreement between the two methods.Setting:Lebanon.Participants:119 adults (staff and students) at a Lebanese University.Results:Good unadjusted and energy-adjusted correlation coefficients were found between data from the two methods which ranged from –0·002 (vitamin A) to 0·337 (carbohydrates) and were all statistically significant except for vitamin D, vitamin E, vitamin A, Se and niacin. Slight/fair agreement was reported through weighed kappa estimates for unadjusted data ranging from –0·05 (vitamin C) to 0·248 (Mg) and for energy-adjusted data ranging from –0·034 (vitamin A) to 0·203 (P). Individuals were categorised into exact and adjacent quartiles with an average of 78 % for unadjusted data and 70 % for energy-adjusted data, indicating a very good agreement between the EPIC FFQ and the average of the 24-HR data. The visual inspection of the Bland–Altman plots revealed an overestimation of energy, carbohydrates, protein and fat intakes by the FFQ method.Conclusion:Overall, when all tests were taken into consideration, the current study demonstrated an acceptable agreement of the EPIC FFQ with the 24-h dietary recall method and significantly good correlations between dietary intakes. Therefore, the EPIC FFQ can be considered a valid tool for assessing diet in epidemiological studies among Lebanese adults.

In 1972, two landmark papers in this journal described the partograph,1,2 a chart designed to provide finite referral criteria for midwives working in peripheral clinics who needed to refer women in labour to Harare Hospital, Zimbabwe (then Rhodesia). This innovation coincided with influential reports from the National Maternity Hospital in Dublin of the ‘active management of labour’ (early amniotomy, proactive use of oxytocin and one‐to‐one nursing care) with the objective of achieving birth within a limited time frame.3 The partograph was globally adopted, and has been used as part of the assessment of labour progress for nearly half a century. It was recommended by the World Health Organization (WHO) in the early 1990s as a routine tool for displaying the progress of labour. Despite its global acceptance, utilization and correct completion rates as low as 31% and 3% respectively, have been reported.

Poor diet quality is a major cause of maternal obesity. We aimed to investigate a priori and a-posteriori derived dietary patterns in childbearing-aged women in UK. An online survey assessed food intake, physical activity (PA), anthropometry and socio-demographics. An a priori defined diet quality was determined via Mediterranean diet (MD) adherence score and Exploratory Factor Analysis (EFA) derived dietary patterns (DPs). Multiple linear regression explored associations between DPs with anthropometric measures, PA and socio-demographics. Participants (n = 123) had low-to-medium MD adherence (average MD-score: 4.0 (2.0)). Age was positively associated with higher MD adherence (X2 (2) = 13.14, p = 0.01). EFA revealed three DPs: &lsquo, fruits, nuts, vegetables and legumes&rsquo, (&ldquo, Vegetarian-style&rdquo, DP), &lsquo, sweets, cereals, dairy products and potatoes&rsquo, Dairy, sweets and starchy foods&rdquo, and &lsquo, eggs, seafood and meats&rsquo, Protein-rich&rdquo, DP). &ldquo, DP was positively associated with higher maternal educational level (p &lt, 0.01) and PA (p = 0.01), but negatively with white ethnicity (p &lt, 0.01). &ldquo, DP was positively associated with white ethnicity (p = 0.03) and negatively with age (p = 0.03). &ldquo, DP was positively associated with age (p &lt, 0.001) and negatively with PA (p = 0.01). A poor diet quality was found among childbearing-aged women, notably in the younger age category, those of white ethnicity, that were more physically inactive and with a lower socioeconomic background.

Introduction There are many mobile telephone apps to help women self-monitor aspects of pregnancy and maternal health. This literature review aims to understand midwives' perspectives on women self-monitoring their pregnancy using eHealth and mHealth, and establish gaps in research. Methods MEDLINE, PubMed, Scopus, CINAHL and PsycINFO were systematically searched on midwifery, eHealth/mHealth and perspectives. Qualitative, quantitative and mixed-methods studies published in English were considered for inclusion in the review, without geographical limitations. Relevant articles were critically appraised and narrative synthesis was conducted. Results Twelve relevant papers covering midwives' perspectives of the use of eHealth and mHealth by pregnant women were obtained for inclusion in this review. Seven of these publications focused on midwives' views of eHealth, and five on their perspectives of mHealth interventions. The studies included demonstrate that midwives generally hold ambivalent views towards the use of eHealth and mHealth technologies in antenatal care. Often, midwives acknowledged the potential benefits of such technologies, such as their ability to modernise antenatal care and to help women make more informed decisions about their pregnancy. However, midwives were quick to point out the risks and limitations of these, such as the accuracy of conveyed information, and negative impacts on the patient-professional relationship. Conclusions Post-COVID-19, where technology is continuously developing, there is a compelling need for studies that investigate the role of eHealth and mHealth in self-monitoring pregnancy, and the consequences this has for pregnant women, health professionals and organisations, as well as midwifery curricula.

OBJECTIVE: The Obstetric Anal Sphincter Injuries (OASI) Care Bundle is designed to reduce the incidence of obstetric anal sphincter injuries. However, introducing behavioural change requires an understanding of current practice. This study aims to establish midwives practise at the time of birth, and the factors that influence this. DESIGN: Quantitative research - a national online survey. SETTING: Nationwide - United Kingdom (UK). Participants 563 midwives from across the UK. METHODS: An online survey of midwives' practice. Midwives were invited to participate through the Supervisor of Midwives network. Consent was sought on the landing page. Data analysis using descriptive and inferential statistics, with sub group analyses were used to explore variations in practice. Measurements Number of midwives using "hands on" the perineum and the influences on midwives' perineal practice at the time of birth. FINDINGS: Most midwives preferred to use "hands on" the perineum at the time of birth (61.4%). "Hands on" practise was significantly associated with where midwives worked (p

Poor diet quality is a major cause of maternal obesity and associated with adverse metabolic effects for mother and offspring. Psychological stress can increase intake of unhealthy dietary choices (e.g. highly palatable, energy dense diet), but no study has investigated the association between stress and diet quality in women of childbearing age.This systematic review of the association between psychological stress and diet quality used the PEO (Population, Exposure, and Outcome) model.Medline, CINAHL, Scopus, Cochrane Library, Web of Science, and Sciencedirect were searched (October 2018 - January 2019). From 139,552 hits, 471 papers were screened, but only 8 studies met our inclusion criteria: English language, stress (exposure) measured in combination with diet quality (outcome), healthy women (18–49 years of age (population). Data extraction was determined by the PEO. Quality assessment used CASP tool for Cohort studies.The review included eight studies from USA (n = 6), Egypt (n = 1), and Iran (n = 1). The six cross-sectional and two longitudinal studies were published between 2011 and 2017 and had a total of 3,982 participants. Studies were heterogeneous in methods: three used food frequency questionnaires to assess dietary intake while the others used 24-hour dietary recalls. Diet quality was measured using different indices: Alternate Healthy Eating Index (n = 2), Healthy Eating Index (n = 2), Dietary Approach to Stop Hypertension (DASH) Diet Index (n = 2), Dietary Quality Index- Pregnancy (n = 2), and Dietary Guideline Adherence Index (n = 1). Only one study used three diet quality indices. No study explored dietary patterns using factor analysis and other statistical techniques. Most studies used the perceived stress scale to measure stress; however, there were differences regarding the use of this scale to form a continuous or categorical variable (with varying cut-off scores) perceived stress, whereas no study reported biological response to stress. Outcomes also varied in direction of association; no association (n = 4), negative association (n = 3), mixed results (n = 1).This review is the first to systematically examine association between stress and diet quality in women of childbearing age; there was heterogeneity in measures of diet quality and study designs. Future studies that explore diet quality/patterns should include both diet indices and factor analysis and additionally measure biological markers of both dietary intake and stress.

Introduction Birthing centres (BC) in Nepal are mostly situated in rural areas and provide care for women without complications. However, they are often bypassed by women and their role in providing good quality maternity services is overlooked. This study evaluated an intervention to increase access and utilisation of perinatal care facilities in community settings. Methods This longitudinal cross-sectional study was conducted over five years in four villages in Nepal and included two BCs. An intervention was conducted in 2014–2016 that involved supporting the BCs and conducting a health promotion programme with local women. Population-based multi-stage sampling of women of reproductive age with a child below 24 months of age was undertaken. Household surveys were conducted (2012 and 2017) employing trained enumerators and using a structured validated questionnaire. The collected data were entered into SPSS and analysed comparing pre- and post-intervention surveys. Results The intervention was associated with an increase in uptake in facility birth, with an increase in utilisation of perinatal services available from BCs. The post-intervention survey provided evidence that women were more likely to give birth at primary care facilities (OR 5.60, p-value

Little is known about the physiology of labour onset at term, and there is a debate about what signs and symptoms should be used to define it. In low resource settings and, particularly, for remote and rural communities, delay in recognising labour onset may mean a delay in seeking a skilled birth attendant. This chapter presents the most recent evidence about the physiology of labour onset, including the complex neuro-hormonal, biophysical, psychological and emotional factors that contribute. The symptoms of labour onset are explored from the perspective of both pregnant women and service providers in a range of sociocultural contexts. Early labour presents challenges for pregnant women, their families, communities and health care professionals. The chapter discusses how maternity care services should be designed, and delivered to ensure that women get the optimum advice and care at the beginning of labour.

More than half of women in developed countries are overweight or obese. Studies show that 20–25% of women in the UK enter pregnancy as obese. Healthy diet patterns such as the Mediterranean diet (MD) are linked with lower adiposity among women of childbearing age. However there is evidence that maternal diet in the UK is poor and stress increases the consumption of saturated-fat, sweets, and energy-dense foods. There is limited evidence on dietary patterns and stress among women of childbearing age, therefore this study aimed to investigate the association.This was an anonymous online survey of female university students. The survey included: socio-demographic characteristics, physical activity, self-reported BMI and waist circumference. Dietary assessment was done via a validated 100-food item food frequency questionnaire and perceived stress via the Perceived Stress Scale (PSS). The dietary data were compared to the a priori defined Mediterranean Diet Score (MDS) and scored according to eight components (vegetables, legumes, fruit and nuts, cereals, fish, dairy products, meat and meat products, and the ratio of unsaturated to saturated fat). The scores ranged from 0 to 8 with MDS adherence groups being 0–3 low, 4–5 medium, and 6–8 high. Factor analysis was also applied on 11 food components (g/d) (the eight above plus eggs, potatoes, sweets and drinks) to reveal the latent major dietary patterns (DP) in the studied cohort.Negative binomial regression was used to examine the association between stress and the diet patterns, controlling for the socioeconomic factors, physical activity, marital status, BMI, and waist.One hundred twenty-three students (mean age 27.7 (SD 7.3)) participated. Participants had medium (n = 49) or low MD adherence (n = 48), with fewer participants having high adherence (n = 26). Stress was not significantly associated with MD adherence, but was positively associated with sweets intake (p = 0.03). The scree plot of Factor analysis showed that the number of factors generated by the analysis is three.Using minimum loading cut-off of 0.4, factor analysis revealed three latent diet patterns; the first (DP-1) contained: cereals, sweets and potatoes (comfort foods), DP-2 consisted: eggs, fish and meat (high protein) and DP-3 consisted of: vegetables, fruits, nuts, and legumes (vegan). Results showed a significant positive association between stress and DP-1 (p < 0.01). No association was found between other diet patterns and any other psychosocial and physical variables.Future well designed randomised controlled trials are needed to investigate further the relationship between perceived stress and dietary patterns in women of childbearing age.

Background\ud Despite the increasing number of women with disability globally becoming pregnant, there is currently limited research about their experiences. A national survey of women’s experience of dignity and respect during pregnancy and childbirth raised concerns about the possibility of women with disability having unequal care with overall less choice and control. To address this further we conducted a study to explore the experiences of dignity and respect in childbirth of women with disability.\ud \ud Methods\ud The study involved a self-selecting, convenience sample of 37 women who had given birth in the United Kingdom and Ireland and had completed an internet-based survey. Women were identified through online networks and groups of and for disabled parents and for people with specific medical conditions. Data were collected using an online survey tool. Survey data were analysed using descriptive statistics. Thematic analysis was used for open questions.\ud \ud Results\ud Despite generally positive responses, just over half of the group of women expressed dissatisfaction with care provision. Only 19% thought that reasonable adjustments or accommodations had been made for them (7/37). When reasonable adjustments were not in place, participants’ independence and dignity were undermined. More than a quarter of women felt they were treated less favourably because of their disability (10/37, 27%). At all points in the pregnancy continuum more than a quarter of women felt their rights were either poorly or very poorly respected; however this was greatest in the postnatal period (11/35, 31%). In addition, more than half of the women (20/36, 56%) felt that maternity care providers did not have appropriate awareness of or attitudes to disability.\ud \ud Conclusions\ud Women’s experiences of dignity and respect in childbirth revealed that a significant proportion of women felt their rights were poorly respected and that they were treated less favourably because of their disability. This suggests that there is a need to look more closely at individualised care. It was also evident that more consideration is required to improve attitudes of maternity care providers to disability and services need to adapt to provide reasonable adjustments to accommodate disability, including improving continuity of carer.

Objective the aim of the study was to explore Slovenian midwives' views of their professional status. The influence of participants' educational background on their views was also examined, since higher education is related to professionalism. Design this was a quantitative descriptive survey, using postal data collection. The questionnaire comprised of six elements crucial for professionalism – three elements distinctive of ‘old' professionalism (power, ethics, specific knowledge) and three characteristics of ‘new' professionalism (reflective practice, inter-professional collaboration and partnership with users). Participants a total of 300 midwives who were registered in a national register of nurses and midwives at the time of the study. The response rate was 50.7% (152 returned the questionnaire). Participants that were on a probationary period were excluded, leaving 128 questionnaires for analysis (43%). Some 40.9% participants had secondary midwifery education, 56.7% had higher midwifery education and only few (2.4%) finished postgraduate education. Findings the majority of participants did not consider midwifery to be a specific profession. Midwives with secondary education were more likely to consider practical skills to be important than theoretical midwifery knowledge. In general midwives did not feel enabled to practice autonomously; and this caused them to face ethical dilemmas when aiming to fulfil women's wishes. All participants with midwifery secondary school education thought that obstetrics jeopardises midwifery scope of practice, but only half of the BSc participants thought this. One-fifth of all participants estimated that midwifery is also threatened by nursing. The respondents reported feeling a lack of control over their professional activity and policy making; however the majority of midwives claimed that they were willing to take on more responsibility for independent practice. Key conclusions Slovenian midwifery cannot be considered to be a profession yet. It faces several hindrances, due to its historical development. Implications for practice in order to develop a specific professional identity for midwives, the content and structure of education should be analysed and changed in order to improve socialisation and professionalism. In clinical settings, the scope of midwifery practice and responsibilities, as defined by EU directives, should be agreed by all professional groups.

The role of the journal editor may not be well known by authors. The purpose of this article is to explain the role in order to encourage future participation in reviewing and publication. Illustration is provided of the publishing process.

Aims and objectives To identify how nurse leaders view and experience the opportunities offered by one of the largest global nursing organisations Sigma Theta Tau International. Background Worldwide, nursing leadership is challenged with addressing the complex issues impacting on care delivery. International nursing organisations are a means to bring together individuals to promote leadership and scholarship for nursing practice to promote patient safety and quality care. The newly established all-England chapter of Sigma Theta Tau International is a recent addition to the society in terms of nurse leadership in Europe, as such faces challenges as it establishes its identity and seeks to interpret the organisational vision: to advance world health through nursing leadership and scholarship. Moving forward, members views were sought on the goals of the chapter and how they may be enacted. Design In July 2013, all chapter members at that time had been nominated on the basis of achievement in nurse leadership; all were invited to participate in an online survey. The online questionnaire contained a series of closed and open questions. Results Most respondents joined because they believed in the vision and networking opportunities Sigma Theta Tau International provides. Three themes were extracted from the data: the value of networking and communication, leadership and the development of culturally sensitive organisations and the need for shared scholarship for nursing practice. Conclusion Findings indicate the growth of effective leadership at all levels of nursing could be harnessed through successful collaboration and keen support for robust connections between practice and education to promote quality care. Relevance to clinical practice Whilst challenging, globalisation presents an opportunity for a nursing society such as Sigma Theta Tau International to work collaboratively to address healthcare issues. A nursing society that explores and resolves its own complex issues by actively promoting leadership and collaborative scholarship reveals a potential to empower the profession to share our collective solutions towards enhancing clinical practice.

On reading the title of an article the reader can sometimes wonder what the author is trying to say, as the title seems so far removed from the research covered in the article. Do such authors forget that many readers of health and medical journals browse the list of contents (in a paper or electronic format) and use titles to select the article that attracts attention? Academic authors are often not clear enough in the titles of their articles, and hence may not attract as large a readership as possible. Any author would want their article to be read and cited, and to stand out in a crowded Table of Contents or a list of papers found in a search on electronic databases.DOI: http://dx.doi.org/10.3126/nje.v4i1.10138 Nepal Journal of Epidemiology 2014;4 (1): 344-347

Health Renaissance, January-April 2013; Vol. 11 No.1; 1-5 DOI: http://dx.doi.org/10.3126/hren.v11i1.7592

Historically, women have learned about childbirth from their mothers and sisters, and from seeing childbirth in the family or community. In the more recent past, women would have gone to books for advice. Today, we see that women are turning to media to learn about what the experience of childbirth is like. This poses an interesting dilemma for midwives who support mothers during their pregnancy. This chapter will discuss the findings from two closely linked research projects that speak to midwives about their experience with women who are allegedly influenced by the media in their decisions about childbirth. The chapter will explore how midwives understand their profession to be depicted in the media and will also explore how midwives engage with the media. We will provide some suggestions for midwives moving forward who wish to create more positive representations of childbirth and early labour in the media.

Background Antenatal care models vary widely around the world, reflecting local contexts, drivers and resources. Randomised controlled trials (RCTs) have tested the impact of multi-component antenatal care interventions on service delivery and outcomes in many countries since the 1980s. Some have applied entirely new schemes, while others have modified existing care delivery approaches. Systematic reviews (SRs) indicate that some specific antenatal interventions are more effective than others; however the causal mechanisms leading to better outcomes are poorly understood, limiting implementation and future research. As a first step in identifying what might be making the difference we conducted a scoping review of interventions tested in RCTs in order to establish a taxonomy of antenatal care models. Methods A protocol-driven systematic search was undertaken of databases for RCTs and SRs reporting antenatal care interventions. Results were unrestricted by time or locality, but limited to English language. Key characteristics of both experimental and control interventions in the included trials were mapped using SPIO (Study design; Population; Intervention; Outcomes) criteria and the intervention and principal outcome measures were described. Commonalities and differences between the components that were being tested in each study were identified by consensus, resulting in a comprehensive description of emergent models for antenatal care interventions. Results Of 13,050 articles retrieved, we identified 153 eligible articles including 130 RCTs in 34 countries. The interventions tested in these trials varied from the number of visits to the location of care provision, and from the content of care to the professional/lay group providing that care. In most studies neither intervention nor control arm was well described. Our analysis of the identified trials of antenatal care interventions produced the following taxonomy: Universal provision model (for all women irrespective of health state or complications); Restricted ‘lower-risk’-based provision model (midwifery-led or reduced/flexible visit approach for healthy women); Augmented provision model (antenatal care as in Universal provision above but augmented by clinical, educational or behavioural intervention); Targeted ‘higher-risk’-based provision model (for woman with defined clinical or socio-demographic risk factors). The first category was most commonly tested in low-income countries (i.e. resource-poor settings), particularly in Asia. The other categories were tested around the world. The trials included a range of care providers, including midwives, nurses, doctors, and lay workers. Conclusions Interventions can be defined and described in many ways. The intended antenatal care population group proved the simplest and most clinically relevant way of distinguishing trials which might otherwise be categorised together. Since our review excluded non-trial interventions, the taxonomy does not represent antenatal care provision worldwide. It offers a stable and reproducible approach to describing the purpose and content of models of antenatal care which have been tested in a trial. It highlights a lack of reported detail of trial interventions and usual care processes. It provides a baseline for future work to examine and test the salient characteristics of the most effective models, and could also help decision-makers and service planners in planning implementation. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1186-3) contains supplementary material, which is available to authorized users.

It has been recognised that the media can affect our perceptions, views and tastes on a wide-range of issues. The mass media in it various forms (newspapers, television & radio, the internet and Twitter) and formats, have a far reaching influence through, for example news programmes, documentaries, advertising and entertainment. At the same time the media can also be seen as a channel for agencies responsible for public health to get their messages across to the population. Public health agencies are always searching for ways to disseminate health information and messages to their intended audiences. These are, of course, global concerns, but as both public health and the media are part of the society in which they operate there will be locally specific issues and considerations. To date most of the research into the media and public health has been conducted in high-income countries, and there has been very little research in Nepal on the interaction of public health and health promotion with the media.This overview paper highlights some of the key issues that public health practitioners, media editors and journalists, health policy-makers and researchers could consider.Journal of Manmohan Memorial Institute of Health Sciences Vol. 2 2016 p.70-75

Background Obstetric early warning systems are recommended for monitoring hospitalised pregnant and postnatal women. We decided to compare: (i) vital sign values used to define physiological normality; (ii) symptoms and signs used to escalate care; (iii) type of chart used; and (iv) presence of explicit instructions for escalating care. Methods One-hundred-and-twenty obstetric early warning charts and escalation protocols were obtained from consultant-led maternity units in the UK and Channel Islands. These data were extracted: values used to determine normality for each maternal vital sign; chart colour-coding; instructions following early warning system triggering; other criteria used as triggers. Results There was considerable variation in the charts, warning systems and escalation protocols. Of 120 charts, 89.2% used colour; 69.2% used colour-coded escalation systems. Forty-one (34.2%) systems required the calculation of weighted scores. Seventy-five discrete combinations of ‘normal' vital sign ranges were found, the most common being: heart rate=50–99beats/min; respiratory rate=11–20breaths/min; blood pressure, systolic=100–149mmHg, diastolic ≤89mmHg; SpO 2 =95–100%; temperature=36.0–37.9°C; and Alert-Voice-Pain-Unresponsive assessment=Alert. Most charts (90.8%) provided instructions about who to contact following triggering, but only 41.7% gave instructions about subsequent observation frequency. Conclusion The wide range of ‘normal' vital sign values in different systems suggests a lack of equity in the processes for detecting deterioration and escalating care in hospitalised pregnant and postnatal women. Agreement regarding ‘normal' vital sign ranges is urgently required and would assist the development of a standardised obstetric early warning system and chart.

Background Implementing effective antenatal care models is a key global policy goal. However, the mechanisms of action of these multi-faceted models that would allow widespread implementation are seldom examined and poorly understood. In existing care model analyses there is little distinction between what is done, how it is done, and who does it. A new evidence-informed quality maternal and newborn care (QMNC) framework identifies key characteristics of quality care. This offers the opportunity to identify systematically the characteristics of care delivery that may be generalizable across contexts, thereby enhancing implementation. Our objective was to map the characteristics of antenatal care models tested in Randomised Controlled Trials (RCTs) to a new evidence-based framework for quality maternal and newborn care; thus facilitating the identification of characteristics of effective care. Methods A systematic review of RCTs of midwifery-led antenatal care models. Mapping and evaluation of these models’ characteristics to the QMNC framework using data extraction and scoring forms derived from the five framework components. Paired team members independently extracted data and conducted quality assessment using the QMNC framework and standard RCT criteria. Results From 13,050 citations initially retrieved we identified 17 RCTs of midwifery-led antenatal care models from Australia (7), the UK (4), China (2), and Sweden, Ireland, Mexico and Canada (1 each). QMNC framework scores ranged from 9 to 25 (possible range 0–32), with most models reporting fewer than half the characteristics associated with quality maternity care. Description of care model characteristics was lacking in many studies, but was better reported for the intervention arms. Organisation of care was the best-described component. Underlying values and philosophy of care were poorly reported. Conclusions The QMNC framework facilitates assessment of the characteristics of antenatal care models. It is vital to understand all the characteristics of multi-faceted interventions such as care models; not only what is done but why it is done, by whom, and how this differed from the standard care package. By applying the QMNC framework we have established a foundation for future reports of intervention studies so that the characteristics of individual models can be evaluated, and the impact of any differences appraised.

BACKGROUND: There is a need for studies evaluating maternal health interventions in low-income countries. This paper evaluates one such intervention designed to promote maternal health among rural women in Nepal. METHODS AND RESULTS: This was a five-year controlled, non-randomised, repeated cross-sectional study (2007, 2010, 2012) of a participatory community-based maternal health promotion intervention focusing on women's groups to improve maternal health services uptake. In total 1,236 women of childbearing age, who had their last child

BACKGROUND: Considerable debate surrounds the influence media have on first-time pregnant women. Much of the academic literature discusses the influence of (reality) television, which often portrays birth as risky, dramatic and painful and there is evidence that this has a negative effect on childbirth in society, through the increasing anticipation of negative outcomes. It is suggested that women seek out such programmes to help understand what could happen during the birth because there is a cultural void. However the impact that has on normal birth has not been explored. METHODS: A scoping review relating to the representation of childbirth in the mass media, particularly on television. RESULTS: Three key themes emerged: (a) medicalisation of childbirth; (b) women using media to learn about childbirth; and (c) birth as a missing everyday life event. CONCLUSION: Media appear to influence how women engage with childbirth. The dramatic television portrayal of birth may perpetuate the medicalisation of childbirth, and last, but not least, portrayals of normal birth are often missing in the popular media. Hence midwives need to engage with television producers to improve the representation of midwifery and maternity in the media.

Objective to synthesise implementation lessons regarding birth kits in terms of the context, the user, requirements for use and the logistics of supplying kits. Design the scoping review was informed through a systematic literature review; a call for information distributed to experts in maternal and child health, relevant research centres and specialist libraries; a search of the web sites of groups working in the area of maternal and child health; and data extraction from DHS surveys. Data synthesis involved the production of a simple descriptive summary of the state of knowledge regarding birth kits. Participants the 28 articles included in the review described a total of 21 birth kits used in 40 different countries and in many cases the kits were part of a package of interventions. Findings although birth kits are available in more than 50 low resource countries, evidence regarding implementation is limited. Levels of birth kit use vary considerably (8–99%); with higher levels being reported where birth kits are distributed free as part of a research programme. Identifying the user of the birth kit was difficult in most reports and the evidence regarding training requirements for birth kit use was conflicting. Limited information exists regarding facilitators and barriers to birth kit use, and how birth kits fit within the wider service delivery of maternal and child health. Conclusion despite widespread use of birth kits, implementation lessons are hard to identify. The fact that birth kits are predominantly used in non-facility settings, and probably by non-skilled attendants, poses further challenges in synthesising the evidence. It would seem logical that government run programmes would increase utlisation rates; however in these countries national level data are not yet available. Such data are crucial to identifying how women obtain and use birth kits. The importance of context cannot be over emphasised, and better descriptive methods are needed to capture contextual factors that may impact on the implementation process. Implications for practice birth kits are a promising technology to achieve MDG 5, however further research is needed before making recommendations to scale up mother held birth kits or to expand kit contents.

BACKGROUND: In the United Kingdom, general practitioner (GP) involvement in maternity care has declined significantly over the past decade. This is particularly so in remote and rural areas where midwives have stepped up and taken over units to ensure that women in these areas continue to have a service. A recent report by the King’s Fund argues for a greater role for the GP in maternity care provision; however, this raises questions about whether GPs have the skills and training to provide such care.AIM: To explore the views of GPs on the skills and training required to deliver safe and appropriate local intrapartum services in remote and rural settings.METHODS: Mixed-method study consisting of qualitative interviews with a purposive sample of GPs in six remote and rural sites. To triangulate the interview findings and identify features that might have been missed in the interviews, a questionnaire was developed using initial key themes identified.FINDINGS: Maternity care accounted for less than 10% of most remote and rural GPs’ workload, yet interviewees reported that their role required them to be competent in a wide range of procedures. This was seen as a major barrier to recruitment and retention in rural areas. Although self-reported competence and confidence was high, several GPs felt de-skilled and felt that they were fighting a losing battle to maintain skills. GPs regarded isolation, need for comprehensive expertise, limited resources, and transportation difficulties as factors affecting the decline in their contribution to remote and rural maternity care.CONCLUSION: Although rural GPs and midwives might traditionally have been in competition, providing a woman-centered service in remote areas may be easier to achieve through collaborative working. However, if GPs are to play a greater role, then they will need to be prepared to make a strategic commitment to the maintenance of remote and rural maternity care. This will require innovative methods of training, special consideration of educational needs, and incentives for practitioners to settle in rural areas, but it may already be too late for GPs to have a substantial input into maternity care.

Background: The latent phase of labor can vary greatly in duration, and many women are uncertain about when to contact the maternity unit. The aim of this study was to elicit and value women’s preferences for some aspects of labor management. Methods: A questionnaire was sent to 1,251 women who had recently given birth to their first child at one of 14 maternity units in Scotland. Discrete choice questions were used to measure women’s preferences for five attributes of care: number of visits (assessments) before admission to the labor ward, time spent on the labor ward before delivery, mobility during labor, pain relief required, and mode of delivery. Responses were analyzed for the sample as a whole and for subgroups defined by recent experiences of labor. Results: A total of 730 (58.4%) questionnaires were returned and analyzed. Women expressed a preference for fewer visits before admission, shorter times on the labor ward before delivery, mobility during labor, normal vaginal deliveries, and moderate forms of pain relief (Entonox and opiates). Subgroup analysis suggests that women’s preferences for pain relief are influenced by their recent labor experience. The elicited preference values provide a means for estimating the tradeoffs women are willing to make between attributes of labor management. Conclusions: Women appear to dislike being turned away from the labor ward before admission for delivery. Extra visits before admission only appear to be a price worth paying if they result in reductions in the duration of time spent on the labor ward, reductions in the chance of being immobilized in hospital during labor, or a lower chance of requiring an instrumental or operative delivery. (BIRTH 38:1 March 2011)

A considerable amount of research has focused on interventions in pregnancy to promote health in current and future generations. This has yielded inconsistent results and focus has turned towards improving health in the preconception period. Promotion of healthy dietary patterns similar to a Mediterranean diet in the preconception years has been suggested as a dietary strategy to prevent maternal obesity and optimize offspring health. However, it is uncertain whether adoption is acceptable in women of childbearing age. This qualitative study aims to investigate the perceived barriers to following a Mediterranean diet in women of childbearing age. Semi-structured focus groups were used to generate deep insights to be used to guide the development of a future intervention. Nulliparous women aged between 20 and 47 years were recruited (n = 20). Six focus groups were digitally audio recorded and transcribed verbatim by the researcher. Thematic analysis was used to analyze data, which occurred in parallel with data collection to ascertain when data saturation was reached. Five core themes were identified: Mediterranean diet features, perceived benefits, existing dietary behavior and knowledge, practical factors, and information source. The present study highlights that a Mediterranean diet is acceptable to childbearing-aged women, and the insights generated will be helpful in developing an intervention to promote Mediterranean diet adoption.

Background: Post-natal depression affects approximately 10–15% of women. The literature suggests that midwives and nurses are key professionals in dealing with post-natal mood disorders. However, this would be a new role in Slovenia for which it is not clear whether midwives and nurses are prepared. Aim: This study explored Slovenian midwives' and nurses' knowledge of, and attitudes towards, post-natal mood disorders. Methods: Two focus groups were conducted, each with five participants, working in the maternity hospital and in the community centre in Postojna. Findings: Data were grouped into three main themes – knowledge of post-natal mental health disorders, role in the management of these issues, and perceived problems and possible solutions in the health care of post-natally depressed women. Participants lacked knowledge on post-natal mental health and did not consider its management to be their role. They saw the main obstacle to caring for these women as being a lack of continuity of carer. Conclusion: Slovenian midwives and nurses should be appropriately educated regarding this subject in order to become more capable of managing post-natal mental health. Continuous relationships with women should be encouraged. Limitations: Further investigation is required and a questionnaire survey involving a larger sample of midwives and community nurses is planned on the basis of the findings of this study.

Obesity and excess gestational weight gain (EGWG) in pregnancy increase the risk for adverse maternal and infant outcomes. Along with careful monitoring of weight gain during pregnancy, early identification of a maladaptive response to the changes of pregnancy may help to avoid adverse outcomes. Simple physiologic markers such as resting heart rate (HR), heart period (HP), and blood pressure (BP) may be powerful predictors of cardiovascular adaptation to pregnancy. This article summarizes the current state of the science regarding the effect of obesity (body mass index [BMI] ! 30 kg/m2) and EGWG in pregnant women at rest in laboratory settings. The impact of differences in weight gain (kg and BMI) on pregnancy outcomes is also examined. A search was conducted for articles published from 1985 to 2006 reporting data on body weight and HR or HP at rest from randomized controlled trials or controlled trials conducted in laboratory settings involving pregnant women at low or high risk for adverse pregnancy outcomes who were obese or had EGWG. A meta-analysis was conducted on the 23 studies meeting inclusion criteria to explore the relation of BMI to HR, HP, and physiologic parameters. Autonomic responsiveness was found to be diminished in obese women with a BMI > 30 kg/m2and in women with high risk for adverse pregnancy outcomes, which may indicate a maladaptive autonomic response that is imbalanced and disorganized and that reduces adaptation to environmental demands.