A satisfação da grávida com os cuidados das enfermeiras obstétricas durante a pandemia COVID-19 / Pregnant women's satisfaction with the care provided by nurse midwives during the COVID-19 pandemic / Satisfacción de las embarazadas con la atención de las enfermeras obstétricas durante la pandemia de COVID-19

Resumo Enquadramento: Em tempo de pandemia, as consultas de enfermagem de vigilância da gravidez sofreram alterações, nomeadamente na restrição de acompanhantes. Por esse motivo, é importante a avaliação da satisfação das grávidas com a assistência de enfermagem durante este contexto pandémico. Objetivo: Avaliar a satisfação da grávida com a assistência das enfermeiras obstétricas nas consultas de vigilância da gravidez durante o contexto de pandemia COVID-19. Metodologia: Estudo transversal descritivo de natureza quantitativa, com uma amostra de 196 grávidas. Aplicado a Escala de Satisfação dos Pacientes com a Assistência de Enfermagem (General Practice Nurse Satisfaction Scale - GPNS), constituída pelas dimensões: relacionamento interpessoal e comunicação, confiança, credibilidade e dedicação. Resultados: As grávidas apresentam-se em média mais satisfeitas na dimensão relacionamento interpessoal e comunicação e menos satisfeitas na dimensão dedicação. Conclusão: As grávidas apresentam-se satisfeitas com a assistência de enfermagem percecionando a sua importância. Tal reforça a pertinência das consultas serem realizadas por um Enfermeiro Especialista em Enfermagem de Saúde Materna e Obstétrica.

Abstract Background: Prenatal nursing appointments underwent changes during the COVID-19 pandemic, namely in the restriction of companions. For this reason, it is important to assess pregnant women's satisfaction with nursing care during this period. Objective: To assess pregnant women's satisfaction with nurse midwife-led prenatal appointments during the COVID-19 pandemic. Methodology: A qualitative descriptive cross-sectional study was conducted with a sample of 196 pregnant women. The Portuguese version of the General Practice Nurse Satisfaction Scale (Escala de Satisfação dos Pacientes com a Assistência de Enfermagem) was administered to the sample. The tool consists of the following dimensions: interpersonal relationship and communication, confidence, credibility, and dedication. Results: Pregnant women are, on average, more satisfied in the interpersonal relationship and communication dimension and less satisfied in the dedication dimension. Conclusion: Pregnant women are satisfied with nursing care and acknowledge its importance. This finding reinforces the importance of nurse midwife-led consultations.

Resumen Marco contextual: En tiempos de pandemia, las citas de enfermería para el seguimiento del embarazo cambiaron, sobre todo la restricción de acompañantes. Por esta razón, es importante evaluar la satisfacción de las mujeres embarazadas con los cuidados de enfermería durante este contexto pandémico. Objetivo: Evaluar la satisfacción de las mujeres embarazadas con la atención prestada por las enfermeras obstétricas en las consultas de seguimiento del embarazo durante la pandemia de COVID-19. Metodología: Estudio descriptivo transversal de carácter cuantitativo, con una muestra de 196 mujeres embarazadas. Se aplicó la Escala de Satisfacción de los Pacientes con Asistencia de Enfermería (General Practice Nurse Satisfaction Scale - GPNS), compuesta por las siguientes dimensiones: relaciones interpersonales y comunicación, confianza, credibilidad y dedicación. Resultados: Las mujeres embarazadas están, de media, más satisfechas en la dimensión relaciones interpersonales y comunicación, y menos satisfechas en la dimensión dedicación. Conclusión: Las embarazadas se mostraron satisfechas con los cuidados de enfermería y se dieron cuenta de su importancia. Esto refuerza la pertinencia de que las consultas sean realizadas por una enfermera especializada en Enfermería de Salud Materna y Obstétrica.

Tanzanian midwives' clinical practices and experiences in caring for women with antepartum hemorrhage: a critical incident technique study.

BACKGROUND: Antepartum hemorrhage (APH) is an obstetric emergency that complicates pregnancy worldwide and continues to lead to hemorrhagic conditions in parts of Tanzania. Midwifery education received by midwives consists theoretical knowledge on the subject but with no or minimal practical skills in the laboratory, which may reduce their practical capacity as graduated midwives. This study therefore aimed to explore midwives' clinical actions and experiences regarding the care of women with APH in Mwanza region. METHOD: Qualitative, inductive approach with critical incident technique was used. Data were analysed using the critical incident technique, and a question guide consisting of eleven open-ended questions was used to collect data from 44 out of 60 midwives who graduated not less than one year. A total of 522 critical incidents, with 199 actions and 323 experiences, were identified and categorized into five main areas. Ethical approval was obtained. RESULTS: Midwives' clinical actions and experiences in caring for women with APH are affected by the knowledge and skills obtained during training at school. They have insufficient theoretical knowledge and practical skills, leading to inadequate identification of the problem and the implementation of care. A need for additional preventive care is described and structural issues, such as co-operation, referral to other instances, access to equipment and relevant treatments need to be improved. CONCLUSION: The actions taken to provide care for women with APH were related to their ability to identify problems, implement care and carry out structural initiatives. However, the midwives' experience was influenced by an attempt to understand the seriousness of the situation and the existence of an organizational challenge. The results can provide knowledge and tools to improve midwives' education and clinical practice and in the long run, prevent complications, improves health and minimize suffering in women with APH.

A seesaw of equilibrium, midwives' experiences of infection prevention and control guideline adherence: A qualitative descriptive study.

Background: Infection prevention and control guidelines play a key role in preventing infections which can impact mothers and their newborn's quality of life. Despite the presence of evidenced-based infection prevention and control guidelines, midwives' adherence can be suboptimal internationally. The identification of facilitators and barriers to infection prevention and control guidelines can support practice and facilitate midwifery care. Aim: To understand midwives' experiences of the barriers and facilitators when adhering to infection prevention and control guidelines. Methods: A qualitative descriptive study using semi-structured interviews with 10 midwives from February to March 2022. The interviews were audio recorded, transcribed verbatim, and analysed utilising Braun and Clarke's thematic analysis framework involving the six steps of becoming familiar with the data, generating initial codes, generating themes, reviewing themes, defining and naming the themes, and presenting themes. Findings: Two themes developed; seesaw for equilibrium and back to basics: learning on your feet. Midwives experienced conflicting emotional motivators in the need for professional integrity towards infection prevention and control guideline adherence. The work environment impacts on midwives' ability to adhere to guidelines and communication and education have a vital role to play in infection prevention and control guideline adherence. Conclusions: While midwives have a strong sense of protection of professional integrity, work conditions such as environment, organisational structures, and management systems affect midwives' adherence to infection prevention and control guidelines. Effective education, training, and communication are required to promote infection prevention and control guideline adherence.

Supporting healthcare professionals from ethnic minority backgrounds to 'Step Into' a clinical academic career.

Background: There is a need to develop research focussed healthcare professionals with the clinical experience and academic skills to meet the needs of a diverse population. Yet, healthcare professionals from ethnic minority backgrounds are often faced with personal, structural or organisational barriers, which prevent them from accessing and applying for development opportunities. Aim: To undertake an evaluation of the Step into Clinical Academic Careers' programme. The programme was designed specifically for nurses, midwives and allied healthcare professionals (NMAHPs) working in NHS organisations, from ethnic minority backgrounds, who had the ambition to pursue a research or clinical academic career. Methods: Qualitative individual interviews and online evaluations were conducted to identify the views, perspectives and experiences of participants who undertook the programme. Participants were also followed up after 6 months. Results: Participants provided insights into four key areas relating to outcomes of the programme. These were (1) increased confidence, (2) increased motivation, (3) developing networks and (4) inspiring people. Conclusions: Organisations must work purposefully and collaboratively to realise equitable support for individuals from ethnic minority backgrounds, through targeted mentoring and leadership development training. Failure to do this will result in a continuation of limited diversity amongst clinical academic and clinical research leaders.

Predictors of Pregnant Women's Decision to Opt for Cesarean Section in Romania.

INTRODUCTION: In Romania, the latest official report indicates that more than half of the births (80,890 cases, representing 52.88% of the total) are performed by cesarean, a rate significantly higher than the World Health Organization (WHO) recommendation of 15-20%. This study aims to identify the predictors associated with women's decisions to opt for cesarean in Romania. MATERIALS AND METHODS:  An analytical cross-sectional observational study was conducted in the general population of Romania. The study was carried out over the course of 2023, with a total duration of four months. During this period, researchers targeted pregnant women from various regions of the country, regardless of their place of residence, age, or education level. The primary data collection tool was a self-administered online questionnaire, distributed via Google Forms, an accessible and efficient platform that allows for automatic response collection. The questionnaire was distributed online, particularly on social media platforms frequented by pregnant women, such as Facebook, Instagram, and TikTok. RESULTS: A total of 1,301 participants were validated. Socio-demographic and clinical factors significantly influence women's decisions to give birth by cesarean. Among these participants, 435 expressed a preference for cesarean delivery. Key predictors include fear of pain and concern for the child's health. Fear of pain at birth is the first predictor in Romanian women to choose cesarean (OR=2.09; 95% CI: 1.62-2.68). Concerns about the child's health do not increase the likelihood of opting for a cesarean. CONCLUSION:  By utilizing valuable resources such as midwives and implementing strategies like birth plans, significant contributions can be made toward reducing the cesarean rate and improving the childbirth experience for women worldwide.

Midwives' Knowledge and Attitudes Regarding Perinatal Care for Women With Disabilities.

INTRODUCTION: Women with disabilities (WWD) face significant barriers to accessing quality perinatal care, resulting in adverse outcomes for mothers and newborns. Midwives are crucial in providing this care, but their knowledge and attitudes can impact the quality of services delivered. This study aims to examine midwives' knowledge and attitudes toward perinatal care for WWD and identify factors influencing these aspects. METHODS: A cross-sectional study was conducted from January to April 2023, involving 149 midwives from various healthcare settings. Data were collected using a self-administered questionnaire addressing demographics, knowledge, attitudes, and perceived barriers related to perinatal care for WWD. Descriptive statistics and non-parametric tests were used for analysis, with a significance level set at 0.05. RESULTS: The sample comprised predominantly female midwives (146, 98%), with a mean age of 33.7 years and a mean of 9.8 years of work experience. Only 48 (32.2%) reported workplaces equipped for perinatal care for WWD. Most participants rated the perinatal care services in Greece for WWD as moderate (87, 58.4%) and believed that the medical staff's knowledge in this area was insufficient (148, 99.3%). The mean knowledge score was 35 points out of 100, indicating a low level of knowledge. Key barriers included the lack of adapted services (148, 99.3%) and insufficient infrastructure (143, 96%). Despite these challenges, 142 (95.3%) midwives supported the right of WWD to have children. Significant correlations were found between higher knowledge scores and less specialized attitudes, while more perceived barriers correlated with a greater need for further education. CONCLUSIONS: This study highlights the urgent need for improved education and training programs for midwives to enhance their knowledge and attitudes toward perinatal care for WWD. Addressing educational and structural barriers is essential to provide equitable and high-quality care. Policymakers should prioritize creating inclusive healthcare environments and support ongoing professional development for midwives.

The handling of hazardous medications by nurses and midwives: A retrospective cohort study.

BACKGROUND: Occupational exposure of healthcare workers to hazardous medications can be potentially harmful. Hazardous medications can be carcinogenic, developmentally toxic, reproductively toxic, genotoxic and/or toxic to organs at low doses. These hazardous medications can be used in many healthcare settings, but published research of occupational exposure has focused almost exclusively on cancer services. AIM: To identify the healthcare settings where nurses and midwives are responsible for the administration of hazardous medications. METHOD: A retrospective cohort study was undertaken of all medication administration events occurring during a two-week period at a public metropolitan health service in 2023. All medication administration events from six hospital sites were identified using the electronic (Oracle Health-Cerner-Millennium®) and paper (Chemotherapy Chart) medication administration records. From all of the medications administered, the subset of medications classified as hazardous were identified based on the Victorian Therapeutics Advisory Group Framework for Handling of Hazardous Medicines (2021) and other guidelines. Poisson regression modelling was used to explore associations between the number of hazardous medications and the healthcare area where they were administered (p < 0.001). RESULTS: Of the 121,567 administration events, 6054 (5.0 %) involved hazardous medications. The healthcare areas with the highest rate of hazardous medication administration events, as a proportion of all medication administration events, were outpatient cancer service (301/695, 43.3 %), birth suite (13/86, 15.1 %) and mental health (404/4011, 10.1 %) areas. During the two-week period, 6054 hazardous medication administration events occurred, involving 117 different medications. The greatest number of these events took place in the medical (1729/6054, 28.6 %) and geriatric (1579/6054, 26.1 %) inpatient healthcare areas. A total of 1258 nurses and midwives were directly involved in either administering, or checking and witnessing the administration of hazardous medications to 996 patients (25.2 % of the total 3958 patients). Most hazardous medications administered to patients were in an oral dosage form (5426/6054, 89.6 %). CONCLUSION: Hazardous medications were administered in all healthcare areas, with the exception of endoscopy services. Nurses and midwives were at risk of occupational exposure from hazardous medications.

Newly qualified nurses' and midwives' experience with continuing professional development during transition: A cross-sectional study.

AIM: To explore newly qualified nurses and midwives' experience of continuing professional development (CPD) and factors associated with CPD participation during newly qualified nurses and midwives' transition, such as job satisfaction and intention to leave. BACKGROUND: Newly qualified nurses and midwives find it difficult to make the transition to their first registered post. During the transition, professional support through CPD is essential to build competence and confidence and increase job satisfaction and retention. DESIGN: A cross-sectional study. METHODS: This study was conducted from September 2021 to October 2022. The online survey, consisting of 83 items, included: the Questionnaire of Professional Development of Nurses (Q-PDN), the McCloskey/Mueller Satisfaction Scale, three questions about Intention to Leave and two open-ended questions. The analysis was conducted by combining the results from the three European countries. Descriptive and logistic regression analyses were performed. The participants were Newly qualified nurses and midwives from Ireland, Italy and Croatia RESULTS: A total of 476 Newly qualified nurses and midwives completed the survey. Of these, 32 % (n=152) were satisfied with opportunities to participate in CPD activities and 54.8 % (n=261) had participated in a formal CPD programme. Most newly qualified nurses and midwives (89.1 %, n=424) agreed that they would like to participate in a formal CPD programme. Almost half of the participants (46.4 %, n=219) had thought of leaving the profession in the previous 12 months. We found that 'having participated in a programme to support newly qualified nurses (OR=0.29; p<.001), 'participating in mandatory CPD activities' (OR=0.76; p=0.016) and 'working in the clinical area of community' (OR=0.31; p<.001) or in maternity (OR=0.46; p=0.040) were positively associated with better job satisfaction. CONCLUSIONS: Participation in support programs during the transition period contributes to increasing job satisfaction for newly qualified nurses and midwives. During their transition, newly qualified nurses and midwives need more support from their institution managers, in terms of ensuring a better learning environment, as well as formal and informal supports.

Nutrition education in the midwife consultation room. A cross sectional survey in Spain.

BACKGROUND: Diet during pregnancy is a key factor in the success of pregnancy. However, several studies have found pregnant women have low adherence to dietary recommendations. The midwife is a key health professional to provide nutrition education for pregnant women. Thus, it is important to know in detail her role in this respect. AIM: To explore how Spanish midwives undertake nutrition education in order to assess the need for specific interventions aimed at improving the health of pregnant women. METHODS: A cross-sectional descriptive observational study was undertaken using an online questionnaire (466 responses). FINDINGS: Spanish midwives recognise the importance of nutrition in pregnancy and that advising pregnant women in this regard is part of their role. In fact, all community midwives discuss nutrition to pregnant women, although they recognise that they do not feel particularly comfortable in dealing with certain topics, which could be related to a lack of mastery of the subjects. Midwives (56.5 %) rated the nutrition training their received as poor. CONCLUSION: In order to guarantee the quality in the nutrition education provided by Spanish midwives to promote the health of pregnant women, our results demonstrate the importance of strengthening both the nutrition content of midwives' training programmes and the ongoing support they receive throughout their professional life.

ICP: A midwifery perspective.

Background: ICP is a liver condition specific to pregnancy affecting 0.5-0.6% of pregnancies in Australia. Aims: to review the SOMANZ guidelines and extrapolate information relevant to midwives proving care for women with ICP. Findings: Multidisciplinary input is essential in caring for women with ICP and their families. Non-fasting TSBA samples ≥19 µmol/L are diagnostic in the presence of pruritus. Peak TSBA denotes the severity of the disease. Increased risk of stillbirth is small when peak TSBA ≥100 µmol/L. Conclusion: Midwives play an essential role in supporting women with ICP helping them navigate complex appointments and manage the pruritus and concomitant issues.

Traumatic experiences, quality of life, and organizational commitment among midwives: A cross-sectional study.

BACKGROUND: The work of midwives is emotionally challenging. Midwives share moments of joy, when a baby is born, and attend complex events of loss and trauma. Exposure to childbirth complications, emergencies, and loss can affect their professional quality of life and functioning. This aspect of midwives' practice has not been sufficiently researched. AIM: To examine the associations between exposures to traumatic events, post-traumatic symptoms, and personal resilience with professional quality of life and organizational commitment among hospital midwives. METHODS: Participants in this cross-sectional study conducted in 2020 included 131 midwives from three large hospitals in central Israel. Data were collected using a structured self-administered questionnaire that examined socio-demographic characteristics, exposure to traumatic events during childbirth, personal resilience, post-traumatic symptoms, professional quality of life, and organizational commitment. RESULTS: The three most traumatic events for midwives were: neonatal death or feared death, maternal death or feared death, and stillbirth. The more frequent the exposure to traumatic events, the more numerous and intense the post-traumatic symptoms. The more numerous and intense the post-traumatic symptoms, the higher the level of professional burnout and compassion fatigue and the lower the compassion satisfaction. Higher compassion satisfaction and lower professional burnout were associated with higher organizational commitment. Personal resilience, country of birth, post-traumatic symptoms, and organizational commitment predicted compassion satisfaction. CONCLUSIONS: Midwives' exposure to traumatic events is associated with the onset of post-traumatic symptoms, impaired professional quality of life, and reduced organizational commitment, and is accompanied by burnout and compassion fatigue. There is a need to address this issue in training programs and to develop organizational support and policies to improve midwives' well-being and quality of care.

Nutrition knowledge and practice of midwives in Botswana.

Background: The roles and responsibilities of midwives include providing adequate nutrition assessment, nutrition and health education, counselling, and support to pregnant women. Aim: This study aims to assess midwives' nutrition knowledge and to what extent they integrate maternal nutrition in services provided at health facilities. Setting: This study included hospitals and clinics within the three selected districts in Botswana. Methods: A cross-sectional study design with an analytical component was employed. Direct observation through a checklist and a structured interviewer-administered questionnaire were used. Data were analysed using SPSS IBM version 26. Results: A sample of 102 midwives participated, resulting in a response rate of 82%. Most of the participants were females (89.2%). Maternal nutrition knowledge was found to be variable but decreased with midwives' age. A statistically significant correlation coefficient of p < 0.005 at r = -0.278 was observed between maternal nutrition knowledge and age. Similarly, there was a statistically significant negative correlation between maternal nutrition knowledge, practices and maternal nutrition course attended using Pearson correlation (r = -0.217 p < 0.028). Conclusion: Midwives had adequate to variable but declining maternal nutrition knowledge and practices with age. There is a need to provide midwives with refresher courses, as their nutrition knowledge and practices were related with courses attended. Contribution: The study contributes to provide the literature concerning nutrition knowledge and practices of midwives. The results will assist in addressing the gaps encountered and lead to the improvement of maternal nutrition and pregnancy outcomes.

" I carry their stories home ": experiences of nurses and midwives caring for perinatal adolescent mothers in primary health care settings in Rwanda.

INTRODUCTION: Adolescent mothers require trauma- and violence-informed care during the perinatal period due to trauma histories and ongoing violence as a result of pregnancy. Nurses and midwives play a critical role in caring for adolescent mothers in primary healthcare settings in Rwanda in the perinatal period. PURPOSE: To explore the experiences of nurses and midwives working with adolescent mothers in selected primary healthcare settings in Rwanda to inform the delivery of trauma- and violence- informed care. METHODS: This study utilized an interpretive description qualitative approach and was conducted in eight primary healthcare settings in Rwanda. Twelve nurses and midwives working in perinatal services and four heads of health centers participated in in-depth individual interviews. Data were analyzed thematically. RESULTS: The analysis revealed four main themes and 11 (sub-themes): (a) relational practice (being creative and flexible, "lending them our ears"); (b) individual challenges of providing care to adolescent mothers (lack of knowledge to provide care related to gender-based violence, and gendered experience); (c) factors contributing to workarounds (inflexible guidelines, lack of protocol and procedures, lack of nurses' and midwives' in service training, and the physical structure of the perinatal environment); and (d) vicarious trauma (living the feelings, "I carry their stories home," and hypervigilance in parenting). CONCLUSION: Nurses and midwives find caring for adolescent mothers challenging due to their unique needs. These needs require them to be creative, adaptable, and attentive listeners to better understand their challenges. These practitioners face difficulties such as insufficient specific knowledge related to, for example, gender-based violence, inflexible guidelines, and a lack of protocols and training. Additionally, in the perinatal environment attention to the needs of practitioners in those settings is often lacking, and many nurses and midwives report experiencing vicarious trauma. Consequently, there is a pressing need for guidelines and protocols specifically tailored for the care of adolescent mothers. Ongoing trauma- and violence- informed care training and professional education should be provided to enhance the ability of nurses and midwives to care for adolescent mothers and prevent re-traumatization and mitigate vicarious trauma effectively.

Nurses' and Midwives' Stress of Conscience and Its Correlation With Selected Sociodemographic and Work-Related Variables.

AIM: To assess the level of stress of conscience experienced by Polish nurses and midwives and its determinants. DESIGN: Descriptive cross-sectional study. METHODS: The study was conducted from March 2019 to December 2020 and included convenience sampling of nurses and midwives working in hospitals in south-eastern Poland. An adapted version of the stress of the conscience questionnaire was used. RESULTS: A total of 476 nurses and midwives completed the survey. The stress of conscience mean value was 67.57. There were no differences in stress of conscience between nurses and midwives. There were five predictors of stress of conscience for nurses: additional job, place of residence, care for patients over 65 years of age, satisfaction with one's salary and having specialised courses, for midwives: social status, work mode and postgraduate studies. CONCLUSION: With the knowledge of predictors of stress of conscience, educational institutions, policymakers and hospital managers should focus their interventions on the factors that lead to a higher level of stress of conscience. It is essential to provide psychological support, building positive relationships between colleagues and focusing on organisational conditions. IMPLICT: Further research in this area is therefore encouraged, along with pre- and postgraduate training in coping with challenging situations such as the death of a patient and caring for elderly patients with dementia or multiple diseases. The study identifies predictors of stress of conscience and problems that can influence their appearance. Factors that increase the stress of conscience, such as organisational conditions and caring after patients are over age 65, should receive special attention in clinical education and result in the provision of an increased level of support from supervisors. Policymakers should also direct their future actions towards the ageing population, staff shortages, the resignation from the profession by improving working conditions and reducing the stress of conscience. REPORTING METHOD: STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Midwives' perspectives and perceptions in relation to perinatal psychotic-like experiences: a qualitative study.

BACKGROUND: Psychotic-like experiences (PLEs) refer to subclinical experiences consistent with psychosis that may include hearing, feeling or seeing things that others cannot, or experiencing unusual beliefs. These experiences appear to be more common during the perinatal period. There appear to be barriers which make it difficult for midwives to support mothers with mental health difficulties. However, it is important that midwives can provide support with PLEs. AIM: This study aimed to explore UK midwives' perspectives and perceptions relating to mothers' psychotic-like experiences in the perinatal period. METHODS: A qualitative study using semi-structured interviews with ten midwives recruited online was conducted. Transcripts were analysed using thematic analysis. RESULTS: Four themes were developed: (1) Identifying psychotic-like experiences would be complicated; (2) Psychotic-like experiences can feel overwhelming for women and midwives; (3) This is my responsibility: I'll do what I can to support women even if it's hard; and (4) The system feels unsafe and insecure which makes the anticipated role in supporting psychotic-like experiences harder. CONCLUSION: Midwives described their motivation to support mothers with PLEs but articulated many factors that made this difficult. The results emphasise the importance of training and guidance for midwives to support them being able to offer support and information to mothers. The findings also highlight the importance of systemic safety for midwives alongside support through supervision and reflective practice.

Embodiment and the technologies of induction of labour.

OBJECTIVE: To critically engage with the body project of induction of labour. DESIGN: A nested, qualitative study that formed part of a feasibility Random Controlled Trial investigating different methods of outpatient induction of labour. The data reported in this article were gathered via interview with women and midwives involved in the trial. All the participants who took part in the trial presented as cisgender women. FINDINGS: Analysis of 27 interview transcripts suggested that the expansion in choice of when, how and where to start labour can change the way decisions about labour onset is understood. The space needed for a new body project is emerging where distinctions between medicalised labour and spontaneous labour are less clear. CONCLUSION: The embodiment of the new technologies of induction for those involved in this study was both a facet of increased freedom and autonomy and a gendered discourse where the normative function of routine intervention appeared more complete.

Responding to Domestic Violence and Abuse during COVID-19 through Remote Interventions: An Evaluation of the Identification and Referral to Improve Safety (IRIS) Service.

Aim: To explore the perspectives of patients/service users receiving specialist domestic violence and abuse (DVA) support from the Identification and Referral to Improve Safety (IRIS) service during the coronavirus disease 2019 (COVID-19) pandemic. Design: A qualitative approach was used to conduct this study. Methods: Thematic analysis of data collected via in-depth individual interviews with 11 patients/service users who received DVA support following their disclosure of abuse to a health-care professional in general practice (GP) and subsequent referral to the IRIS service. Findings: Six themes were identified-experience of DVA during COVID-19; awareness of the IRIS service; pathway to care; accessibility, safety, and remote consultations; adequacy of telephone support; and impact of IRIS support. Participants reported feeling supported by the GP team and the DVA specialists from the IRIS service. Conclusion: The pandemic had a significant impact on health care and specialist DVA service providers. The swift shift to remote consultations proved to be an effective way to identify DVA, determine the support needs of those experiencing DVA from their own perspective, and make appropriate referrals for specialist support. Further research is needed to understand the views of health-care professionals and those working in the IRIS service to explore factors affecting their ability to provide remote services. The study highlighted the need for health-care professionals other than doctors (including nurses, midwives, and others) to build knowledge, confidence, and competence in asking about DVA.

Exploring birth experience of mothers, based on comfort theory.

Objectives: To analyse the phenomenon of "giving birth" on the basis of the lived experiences of women and midwives. METHODS: The qualitative study was conducted in the delivery room of a mother-friendly hospital in western Turkey from March 1 to December 30, 2019, and comprised primiparous women aged 18-35 years having a spontaneous vaginal birth, and midwives who delivered the babies. Data was collected through indepth interviews that were audiorecorded. Additionally, women's written birth stories and researcher's observation regarding the participants were used. Data was subjected to content analysis using NVIVO 12 Pro software. RESULTS: Of the 28 subjects 15(53.6%) were lay women with mean age 24.2±3.87 years (range: 18-30 years), and 13(46.4%) were midwives with mean age 42.61±4.50 years (range: 37-50 years). The most referred conceptual themes in Kolcaba's Theory of Comfort were "enhanced comfort", "mother-friendly hospital policy", and "midwives' comforting interventions." Under the theme of "Increasing Comfort", women cared about psychological and environmental comfort. Women had the most psychospiritual comfort and environmental comfort as well as physical and sociocultural comfort. Women cared about psychological and environmental comfort that facilitated birth. CONCLUSIONS: The mother-friendly hospital policy increased and contributed to the support and comfort provided to women. Kolcaba's Comfort Theory was an appropriate and working theory for birth and midwifery care, indicating that women's comfort should be ensured in the psychospiritual, environmental, physical and sociocultural contexts.

Historical Study of the Graduates of the Tuskegee School of Nurse-Midwifery, a Program for Black Nurses.

OBJECTIVE: To increase awareness of the contributions of Black nurses to midwifery and to provide an understanding of how initiatives in the past address racial disparities in maternal health that are still relevant today. DESIGN: Historical research. SETTING: The Tuskegee School of Nurse-Midwifery. DATA SOURCES: Thirty-one Black nurse-midwives who graduated from the Tuskegee School of Nurse-Midwifery and oral histories of two of these graduates. METHODS: Historical research that involved locating and analyzing primary and secondary sources about the graduates of the Tuskegee School of Nurse-Midwifery from 1941 to 1946; the oral histories conducted with two graduates are examples of primary sources. RESULTS: The Tuskegee School of Nurse-Midwifery opened September 15, 1941, in Tuskegee, Alabama. The purpose of the school was to educate Black nurses in midwifery to address maternal health in the Black communities where the maternal and infant mortality rates were greatest. By the end of the second year of the program, the maternal mortality rate declined from 8.5 per 1,000 live births to 0, and the infant mortality rate decreased from 45.9 per 1,000 to 14 among the women served in Macon County. However, the school closed in 1946 after graduating 31 Black nurse-midwives. CONCLUSION: The history of early Black nurse-midwives is relevant to the disciplines of nursing, midwifery, and public health. The Tuskegee graduates obtained an education in a relatively new and evolving profession during a time when racism and discrimination in education, financial opportunity, and housing profoundly affected the health and well-being of Black communities. These factors continue to contribute to racial disparities in maternal health and create barriers for those in the Black community who want to become nurses or midwives. The challenges and successes Black nurse-midwives experienced are significant to the present day, but their stories are often not told.

Thirty Years of Midwifery Education in the Rural and Diverse State of New Mexico.

The purpose of this article is to discuss the evolution of the University of New Mexico (UNM) Nurse-Midwifery Education Program, its impact on New Mexico communities, and the vision moving forward for the program in a rural and culturally diverse state. New Mexico has a rich history of community-based midwifery and the UNM Nurse-Midwifery Education Program, founded in 1991, is rooted in this tradition. Graduates are prepared to practice in rural and underserved communities, advance birth equity, and decrease perinatal health disparities. Faculty have advanced the program mission to improve the health and well-being of New Mexico families through diversifying the midwifery workforce, growing community collaboration, and engaging in research and scholarship activities aimed at promoting access to care. Program faculty recognize the critical need to address factors underpinning the rising maternal morbidity and mortality crisis, including rurality, poverty, and structural racism. These efforts have yielded positive results, with 60% of program graduates serving New Mexico communities and increasingly diverse midwifery student cohorts (70% of currently enrolled students). Efforts to support midwifery student success are bolstered through a recently awarded Health Resources and Services Administration Maternity Care Nursing Workforce Expansion grant. Through such endeavors, the program will continue to strive toward social justice and human dignity.