Obesity in women giving birth in Victoria, 2010-2019: a retrospective cohort study.

OBJECTIVE: To assess the prevalence of obesity in pregnant women in Victoria, 2010-2019. STUDY DESIGN: Retrospective cohort study; analysis of Victorian Perinatal Data Collection data. SETTING, PARTICIPANTS: Women who gave birth in seventeen Victorian Department of Health areas (eight metropolitan, nine regional), 2010-2019. MAIN OUTCOME MEASURES: Proportions of births to women with obesity (body mass index ≥ 30 kg/m2), by Department of Health area and year. RESULTS: A total of 710 364 births with records that included the mothers' BMI were recorded in Victoria during 2010-2019. The proportion of births to women with obesity rose from 19.6% (95% confidence interval [CI], 19.3-19.9%) in 2010 to 21.5% (95% CI, 21.2-21.8%) in 2019; the proportion of births to women with normal weight declined from 49.0% (95% CI, 48.6-49.4%) to 46.8% (95% CI, 46.4-47.1%). In metropolitan areas, the proportion of births to women with obesity rose from 17.7% (95% CI, 17.7-17.8%) to 19.4% (95% CI, 19.3-19.4%); in regional areas, it increased from 25.0% (95% CI, 25.0-25.1%) to 29.1% (95% CI, 29.0-29.2%). The increase in prevalence of obesity was greater among women living in the lowest socio-economic standing (Index of Relative Socio-Economic Disadvantage) quintile than for those residing in the quintile of least disadvantage (adjusted rate ratio, 2.16; 95% CI, 2.12-2.20). CONCLUSION: The proportion of births to Victorian women with obesity rose during 2010-2019, particularly in regional areas. Ensuring that regional health services are adequately resourced to meet the needs of the increasing number of women at risk of obesity during pregnancy is vital.

Association between pregnancy intention and completion of newborn and infant continuum of care in Sub-Saharan Africa: systematic review and meta-analysis.

BACKGROUND: The newborn and infant continuum of care such as essential newborn care, early initiation and exclusive breastfeeding, and immunisation are highly recommended for improving the quality of life and survival of infants. However, newborn and infant mortality remains high across Sub-Saharan African countries. While unintended pregnancies are associated with adverse newborn and infant health outcomes, there is inconclusive evidence on whether pregnancy intention influences newborn and infant continuum of care completion. Therefore, this review aimed to pool findings reported in the literature on the association between pregnancy intention and newborn and infant health care across the continuum of care in Sub-Saharan Africa. METHODS: We searched MEDLINE Complete, EMBASE, CINAHL Complete, and Global Health databases for studies potentially eligible for this systematic review and meta-analysis. Two researchers independently screened the identified articles by abstract and title, and then full-text using Covidence. We used the Newcastle-Ottawa Scale to assess the quality of the included studies. The Cochran's Q test and I2 were executed to detect and quantify the presence of statistical heterogeneity in the studies. Meta-analysis was done for each outcome when more than one original study reported relevant data, using Stata statistical software version 18. RESULTS: Eleven studies were included from a total of 235 articles identified by the search. The odds of completing essential newborn care (pooled odds ratio: 3.04, 95% CI: 1.56, 5.90), early initiation of breastfeeding (pooled odds ratio: 1.30, 95% CI: 1.13, 1.52), exclusive breastfeeding (pooled odds ratio: 2.21, 95% CI: 1.68, 2.89), and being fully immunised (pooled odds ratio: 2.73, 95% CI: 1.16, 6.40) were higher among infants born to women with intended pregnancies as compared to women with unintended pregnancies. CONCLUSION: Intended pregnancy was positively associated with essential newborn care completion, early initiation and exclusive breastfeeding, and full immunisation of infants in SSA countries. Thus, policy-makers and stakeholders should strengthen the provision of quality family planning services to prevent unintended pregnancy. Furthermore, follow-up of women with unintended pregnancies is needed to increase women's opportunity to access essential newborn health care services that further reduce the risk of newborn and infant morbidity and mortality. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42023409148.

An innovative low-cost breast pump-hire program to enhance breastfeeding rates in a neonatal intensive care unit.

AIM: To evaluate the outcomes of a low-cost hospital-grade breast pump hire program for women experiencing financial hardship with infants in neonatal intensive care. DESIGN: A multi-method evaluation including data audits and surveys. METHODS: Twenty-four electric breast pumps were purchased and rented to mothers at a cost of $1/day. To be eligible, mothers needed to have given birth to an infant <32 weeks and/or <1500 g and self-identified as experiencing financial hardship. Data were collected by (1) a retrospective audit to evaluate infant feeding and clinical outcomes at hospital discharge; (2) prospective telephone surveys to evaluate women's satisfaction with the program; and (3) analysis of the breast pump register to determine any loss or damages. RESULTS: Twenty-four mothers of 26 infants participated in the program. More than half of the infants were exclusively breastmilk fed at hospital discharge, and more than three-quarters were fed a combination of breastmilk and formula. Women who intended to formula feed were supported to provide breastmilk to their infants in the first few weeks of life. Most participants were highly satisfied with the program. Women reported that accessibility to a hospital-grade breast pump improved their ability to provide expressed breastmilk to their infants. Most participants were 'extremely satisfied' with the performance of the breast pump. One-quarter of the women reported that they would have exclusively formula-fed if they did not have access to the breast pump hire program. The audit of the equipment register showed no reported technical issues, loss or damages. CONCLUSION: The findings suggested that the low-cost breast pump hire program supported equitable care, increasing women's ability to provide expressed breastmilk for their infants. IMPACT: Providing access to low-cost hospital-grade breast pumps to mothers of vulnerable infants is likely to prevent poor infant clinical outcomes and improve women's care satisfaction. PUBLIC OR PATIENT CONTRIBUTION: Nil.

Satisfaction with maternity triage following implementation of the Birmingham Symptom-Specific Obstetric Triage System (BSOTS): Perspectives of women and staff.

AIM: To explore the satisfaction and experiences of women and staff with the BSOTS in an Australian hospital. DESIGN: Cross-sectional descriptive survey. METHODS: Surveys were distributed to women and staff between February and May 2022. Survey questions reflected satisfaction with triage and provision of care under the BSOTS system (for women) and confidence in using the BSOTS system and its impact on triage-related care (for staff). Survey data were summarized using descriptive statistics, and qualitative responses were analysed using content analysis. RESULTS: There were 50 women and 40 staff (midwives and doctors) survey respondents. Most women were satisfied with triage wait times, the verbal information they received and the time it took for them to receive care. Nearly all midwife participants indicated they had high knowledge and confidence in using the BSOTS. Most staff indicated that the BSOTS supported the accurate assessment of women and had benefits for women, staff and the hospital. CONCLUSION: The findings showed that women and staff were satisfied with receiving and providing care in a maternity triage setting under the BSOTS system. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Implementing standardized maternity triage approaches such as the BSOTS in health settings delivering care to pregnant women is recommended for improving flow of care and perceptions of care quality by women. IMPACT: Quality of maternity triage processes is likely to impact the satisfaction of women attending services and the staff providing care. The BSOTS was shown to improve maternity triage processes and was associated with satisfaction of women and staff. Maternity settings can benefit from implementing triage approaches such as the BSOTS as it standardizes and justifies the care provided to women. This is likely to result in satisfaction of women and staff engaged in maternity triage and improve the birth outcomes of women and babies. REPORTING METHOD: The reporting of this paper has followed SQUIRE guidelines. PATIENT OR PUBLIC CONTRIBUTION: Women engaged with maternity services were participants in the study but did not contribute to the design, conduct or publication of the study.

PRECeDe Pilot: Prevention of neonatal respiratory distress with antenatal corticosteroids before elective caesarean section in women with diabetes - a feasibility randomised trial.

OBJECTIVE: The PRECeDe Pilot Trial was designed to determine the feasibility of undertaking a multicentre, randomised controlled trial (RCT) to assess the efficacy of antenatal corticosteroids administration within 7 days before elective caesarean section (CS) in women with pre-gestational diabetes (PGDM) or gestational diabetes (GDM). DESIGN: Triple blind, parallel group, placebo-controlled, pilot RCT. SETTING: Single-centre tertiary maternity hospital in Melbourne, Australia. POPULATION: Pregnant women with PGDM (type 1 or type 2 diabetes) or GDM booked for a planned CS scheduled between 35+0 and 38+6 weeks of gestation. METHODS: Eligible participants were randomised to receive two injections of either betamethasone 11.4 mg or normal saline placebo, 24 hours apart within 7 days before CS scheduled between 35+0 and 38+6 weeks of gestation. MAIN OUTCOME MEASURE: The proportion of eligible women who consented and were randomised. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12619001475134. RESULTS: Of 537 women eligible, 182 were approached and 47 (26%) were recruited. Of these, 22 were allocated to the betamethasone group and 25 were allocated to the placebo group. There were no serious adverse events related to participation. CONCLUSION: It is feasible to undertake a triple-blind, placebo-controlled RCT investigating the efficacy of antenatal corticosteroids in preventing respiratory morbidity in infants of women with PGDM or GDM who are undergoing an elective CS between 35+0 and 38+6 weeks.

Pregnant women with diabetes and their clinician's experience of participating in a pilot randomised controlled trial of corticosteroid administration in late pregnancy: A qualitative study.

BACKGROUND: Little research exists to support the administration of corticosteroids to pregnant women with diabetes. Pregnant women are often excluded from clinical trials due to concerns of harm to the foetus. AIM: This study aimed to understand the experiences of women and clinicians of participating in the Prevention of neonatal Respiratory distress with antenatal corticosteroids before Elective Caesarean section in women with Diabetes pilot randomised controlled trial to determine the acceptability of the study protocol. METHODS: Women and clinicians participating in the pilot trial were invited to complete a telephone interview regarding their experiences of participating. Qualitative data were collected and subsequently analysed using thematic analysis. RESULTS: A total of 13 women and nine clinicians were recruited between June 2020 and May 2022 for a telephone interview. Participating in the study was deemed acceptable by women and clinicians. Women chose to participate in the study due to the perceived low risk of harm associated with the intervention and for altruistic reasons. The high level of clinical support and information provided for the duration of the pilot trial was valued by women and clinicians. All clinicians highlighted the importance of conducting the trial to inform evidence-based practice. CONCLUSIONS: Pregnant women are more likely to participate in clinical trials when perceived risks are low and they are well-informed during decision-making. Clinicians will support clinical trials when they perceive a benefit to practice and feel assured that women receive extensive monitoring and support. Incorporating these factors into study protocols is more likely to be successful in recruiting pregnant women and maintaining the engagement of clinical staff for the duration of clinical trials. PATIENT OR PUBLIC CONTRIBUTIONS: Patients were invited to be participants in this study. A consumer has been included in the planning and oversite of the large multicentre trial.

The Green Maternity project: A midwife-led initiative to promote correct waste segregation on an Australian postnatal ward.

AIMS: Healthcare waste production is a significant contributor to carbon emissions, negatively impacting the environment. Ineffective healthcare waste disposal results in greater measures to manage it which is costly to both the environment and healthcare organizations. This study aimed to improve waste management in a tertiary maternity hospital. Specifically, the impact of a midwife-led intervention to improve waste segregation, staff knowledge and attitudes and waste management-related costs was investigated. DESIGN: A multi-method study including pre- and post-intervention staff waste management knowledge and attitude surveys and waste audits of bins located on the postnatal ward. METHODS: The intervention included education sessions, posters and signage by waste bins and monthly newsletters distributed throughout 2021 to raise staff awareness of correct waste segregation processes. Pre- and post-intervention surveys were distributed in early 2021 and early 2022, respectively. The waste audits occurred on three occasions, January, July and December of 2021. The waste audit included total waste in kilograms (kg), waste in kg by segregation and identification of correct and incorrect segregation. Waste audit and quantitative staff survey data were analysed using descriptive statistics and chi square. Qualitative data from the staff surveys were analysed using content analysis. RESULTS: Knowledge and attitudes to waste management were similar across pre- and post-intervention staff surveys. Knowledge of accurate allocation of specific items to waste streams was variable with errors identified in both the pre- and post-surveys. Waste audit data showed reductions in clinical waste at each measurement, with a 71.2% decrease in clinical waste from baseline to the final audit. Accuracy of waste segregation also improved from the baseline to final audit, resulting in a 48% reduction in waste management costs. CONCLUSION: The midwife-led initiative improved waste segregation and achieved the associated waste management cost reduction. IMPACT: A midwifery-led initiative to address waste production and segregation on a maternity ward had a positive impact on waste segregation practices and associated waste management costs. The existence of change champions along with in-service sessions, posters and newsletters to raise awareness of correct waste segregation resulted in a 71% reduction of incorrect items being placed in clinical waste bins. Challenges such as COVID-19 pressures and workload made it difficult for midwives to engage in waste management education and effective waste segregation. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Implementing clinician-led waste management interventions across hospital wards while addressing workload issues are likely to have significant cost benefits for organisations and minimise the environmental impacts of healthcare settings.

Rural maternity and media discourse analysis: Framing new narratives.

INTRODUCTION: Continued rural maternity closure across Australia has seen impacts on women and families such as financial pressures, quality and safety concerns, and emotional pressure. This review aimed at understanding how media coverage of rural maternity and closure are presented and what impact this may have on maternity service sustainability. OBJECTIVE: This research seeks to examine media discourse and characteristics of online newspaper articles related to rural maternity services. DESIGN: A narrative review was conducted using thematic discourse analysis to examine online newspaper content published in Victoria, Australia from 2010 to June 2021. FINDINGS: Local maternity services were a source of community interest for rural people. Coverage of negative outcomes for mothers and babies was highlighted by rural newspapers; however, increased content over the last 12-month period focused on community support for the sustainability of rural maternity services. Recent community support in newspaper articles coincided with maternity services reviews and retaining some of these rural services. DISCUSSION: Community support in media may provide a protective social pressure, leading rural health services to consider this when reviewing the sustainability or closure of rural maternity services. CONCLUSION: Media attention about sustaining local maternity services by highlighting issues and representing community voices may influence health executive to consider opportunities to remodel and sustain high-quality and safe maternity care in rural settings. Knowing how rural health executives consider media, community pressure, and how it impacts expediency of maternity service closure decisions is unknown and an important gap in knowledge to explore and understand.

Australian women's experiences of receiving maternity care during the COVID-19 pandemic: A cross-sectional national survey.

BACKGROUND: The COVID-19 pandemic has led to multiple changes in maternity services worldwide. Systems rapidly adapted to meet public health requirements aimed at preventing transmission of SARS-CoV-2, including quarantine procedures, travel restrictions, border closures, physical distancing and "stay-at-home" orders. Although these changes have impacted all stakeholders in maternity services, arguably the women at the center of this care have been most affected. This study aimed to explore women's experiences of receiving maternity care during the COVID-19 pandemic in Australia. METHODS: A national cross-sectional online survey, including fixed choice and open-ended questions, was conducted during the first wave of the COVID-19 pandemic in Australia; pregnant and postnatal women were recruited through social media networks. RESULTS: The survey was completed by 3364 women. Women felt distressed and alone due to rapid changes to their maternity care. Limited face-to-face contact with health practitioners and altered models of care often required women to accommodate significant changes and to coordinate their own care. Women felt that they were often "doing it alone," due to public health restrictions on support people and visitors, both within and outside health services. Women described some benefits of visitor restrictions, such as, more time for rest, breastfeeding establishment, and bonding with their baby. CONCLUSIONS: This large nationwide Australian study provides unique data on women's experiences of receiving maternity care during the COVID-19 pandemic. Lessons learned provide an opportunity to rebuild and reshape the maternity sector to best meet the needs of women and their families during current and future public health crises.

A dedicated antenatal clinic for pregnant women with morbid and super-obesity: Patient characteristics, outcomes, perceptions and lessons learnt from establishing the DIAMOND clinic.

BACKGROUND: The DIAMOND antenatal clinic was established to provide multidisciplinary continuity of care to pregnant women living with morbid (body mass index (BMI) ≥40 kg/m2 ) or super-obesity (BMI ≥50 kg/m2 ). AIM: The aim was to describe clinic processes, demographics, clinical outcomes and women's perceptions of the clinic. METHODS: Women who received antenatal care in the clinic between 2016 and 2019 (n = 257) had routine data collected for retrospective analysis. A patient satisfaction survey was conducted for women who received care in 2019 (n = 89). RESULTS: The median BMI was 49 kg/m2 (max = 81 kg/m2 ). The mean age was 32 years. The largest proportion of women (27.6%) resided in the most disadvantaged suburbs of the region. Primipara comprised 29.6%, and 4.7% of women identified as Aboriginal or Torres Strait Islander. Diabetes was present in 47.5%, and 9.3% developed pre-eclampsia. Half (49.4%) had their labour induced (49.8% required cervical ripening), and 37% had an elective caesarean section. Almost a quarter (24.1%) of women underwent emergency caesarean section. One in six women had a measured blood loss of more than 1000 mL. The unadjusted stillbirth rate was 0.8%. Blood transfusions were required by 3.9%, and 1.9% of women required intensive care admission. Survey responses showed women valued the clinic for the enhanced surveillance, continuity, care coordination and respectful care. Improvements to waiting times were recommended. CONCLUSIONS: Establishing a dedicated clinic for women living with high BMI provides a well-liked environment for a high-risk cohort of women. Our review identified opportunities for improvement in clinic processes. We plan to assess overall impact on perinatal outcomes.

Covid-19 changes to maternity care: Experiences of Australian doctors.

BACKGROUND: The COVID-19 pandemic meant rapid changes to Australian maternity services. All maternity services have undertaken significant changes in relation to policies, service delivery and practices and increased use of personal protective equipment. AIMS: The aim of this study was to explore and describe doctors' experiences of providing maternity care during the COVID-19 pandemic in Australia. METHODS: A national online survey followed by semi-structured interviews with a cohort of participants was conducted during the first wave of the COVID-19 pandemic in Australia (May-June 2020). Participants were recruited through social media networks. Eighty-six doctors completed the survey, and eight were interviewed. RESULTS: Almost all doctors reported rapid development of new guidelines and major changes to health service delivery. Professional colleges were the main source of new information about COVID-19. Most (89%) doctors felt sufficiently informed to care for women with COVID-19. Less than half of doctors felt changes would be temporary. Doctors described workforce disruptions with associated personal and professional impacts. The ability to access and process up-to-date, evidence-based information was perceived as important. Doctors acknowledged that altered models of care had increased pregnant women's anxiety and uncertainty. All doctors described silver linings from sector changes. CONCLUSIONS: This study provides unique insights into doctors' experiences of providing maternity care during the COVID-19 pandemic in Australia. Findings have immediate relevance to the maternity sector now and into the future. Lessons learnt provide an opportunity to reshape the maternity sector to better prepare for future public health crises.

Food taboos and nutrition-related pregnancy concerns among Ethiopian women.

AIMS AND OBJECTIVES: To discuss Ethiopian food taboos during pregnancy and their relation to maternal nutritional status and pregnancy outcomes. BACKGROUND: Recent waves of migration have seen large groups of Ethiopian refugees moving to countries around the globe. This is of concern as Ethiopian women are at risk of a number of medical and pregnancy complications. Health is further compromised by poor diet and adherence to cultural food beliefs and taboos. In refugee women, many of these factors correspond with significantly higher rates of pregnancy complications and poor birth outcomes. DESIGN: This is a discussion paper informed by a literature review. METHODS: A search of the Scopus, PubMed, Web of Science and Academic Search Premier databases for the keywords Ethiopian, pregnancy, food and taboos was conducted in the research literature published from 1998-2015. This time is contingent with Ethiopian migration trends. RESULTS: Ethiopian migrant women are at risk of inadequate nutrition during pregnancy. Risks include cultural factors associated with food taboos as well as issues associated with low socioeconomic status. Consequently, Ethiopian women are more likely to have nutritional deficiencies such as anaemia which have been associated with a range of pregnancy complications. CONCLUSIONS: There are many serious consequences of poor diet during pregnancy; however, most of these can be avoided by greater awareness about the role of nutrition during pregnancy and by adopting a balanced diet. RELEVANCE TO CLINICAL PRACTICE: There is an urgent unmet need for nutrition education among Ethiopian women. Research indicates that Ethiopian women are receptive to nutritional advice during pregnancy and also that pregnant women are generally motivated to act in the baby's interest. These factors suggest that this high-risk group would be amenable to culturally appropriate nutrition education, which would provide much-needed meaningful support in pregnancy.

Breastfeeding and pre-pregnancy bariatric surgery: A scoping review.

BACKGROUND: Bariatric surgery is a procedure for people with class II and III obesity who are unable to lose weight using traditional methods. The incidence rate of bariatric surgery in reproductive-age women is increasing rapidly, so the number of women who become pregnant after bariatric surgery is rising. AIM: To collate and synthesise available literature regarding breastfeeding following bariatric surgery. METHODS: This review was reported by the preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews (PRISMA-Scr). The review included peer-reviewed research studies and research-based conference abstracts on breastfeeding outcomes in mothers who have undergone bariatric surgery before pregnancy. Health databases were searched from 1990 to December 2023. Included studies were analysed using a narrative synthesis. FINDINGS: From 1506 abstracts, 16 papers were identified. Three themes emerged from the analysis: challenges in exclusive breastfeeding, nutritional composition in breast milk, and breastfeeding experience. There was a tendency for lower breastfeeding rates and shorter durations in mothers who had bariatric surgery. Most studies focussed on the nutritional composition of breast milk however these results were mixed. Only three articles were qualitative, and their findings showed that women wanted more information and support about breastfeeding following bariatric surgery. DISCUSSION: Our review indicates breastfeeding challenges in post-bariatric surgery mothers and reduced breastfeeding rates. It is unclear whether bariatric surgery impacts the nutritional quality of breast milk due to inconsistent study outcomes. CONCLUSION: Future research is essential, specifically on understanding the breastfeeding concerns and experiences of women who have undergone bariatric surgery.

Barriers and facilitators of access to maternity care for African-born women living in Australia: a meta-synthesis of qualitative evidence.

BACKGROUND: Adverse perinatal health outcomes are notably high among African-born women living in Australia. This problem is partly attributed to their lower engagement in maternity care services as compared to Australian-born women. Various barriers might limit African-born women's access to and use of services; however, these barriers are not well documented. Therefore, this review aimed to synthesise current qualitative evidence on barriers and facilitators of access to maternity care for African-born women living in Australia. METHODS: The search was conducted in MEDLINE, CINAHL, Embase, PsychInfo, and Maternity and Infant Care databases on 16 April 2023. All articles retrieved were meticulously screened for eligibility by two independent reviewers with any disagreements resolved through discussion. The quality of the included articles was evaluated using the Mixed Methods Appraisal Tool. Studies were screened in Covidence and analysed in NVivo. The findings were organised and presented using Levesque's framework of healthcare access. RESULTS: Out of 558 identified papers, 11 studies comprising a total of 472 participants met the eligibility criteria. The review highlighted provider-side barriers such as shortage of information, unmet cultural needs, long waiting times, low engagement of women in care, discrimination, and lack of continuity of care. User-side barriers identified include communication issues, difficulty navigating the health system, and lack of trustful relationships with healthcare providers. In contrast, the review pinpointed provider-side facilitators including positive staff attitudes, service availability, and the proximity of facilities to residential homes, while user-side facilitators such as cultural assimilation and feeling valued by healthcare providers were noted. CONCLUSIONS: This review identified barriers and facilitators of access to maternity care for African-born women living in Australia. Empirical evidence that would inform potential changes to policy and practice to address African-born women's unique health needs was highlighted. Designing and implementing a culturally safe service delivery model could remove the identified access barriers and improve African-born women's engagement in maternity care. Moreover, reinforcing factors associated with positive healthcare experiences is essential for improving maternity care access for this priority population. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023405458.

Development of the essential learning outcomes for the midwifery student continuity of care learning model: A Delphi study.

BACKGROUND: In Australia, midwifery students are required to undertake at least ten Continuity of Care Experiences (CoCE) during their education. The learning outcomes of this experience have never been explicit or standardised resulting in inconsistent assessment. AIM: To develop and identify standardised learning outcomes for the CoCE. METHODS: A modified Delphi survey was conducted with an expert panel. Intended learning outcome statements were developed, reflecting the learning objectives identified in a previous study. Bloom's taxonomy levels of thinking complexities guided the wording of the outcomes. Participants were asked to rank and rate their level of agreement with each statement over two survey rounds. FINDINGS: Round one was completed by 32 participants, with 92.5% of the 40 statements reaching consensus. The second round was completed by 23 participants, with 70.7% of the 33 statements reaching consensus. Content analysis of participant comments from each round identified duplicates that were removed and informed refining the wording of some statements. A final set of 15 learning outcomes were agreed upon. The outcomes were broadly grouped within the themes of accountability, advocacy, and autonomy. DISCUSSION: This study has identified agreed learning outcomes for midwifery students undertaking CoCE. The consensus agreement of experts reinforced the learning model enables the development of woman-centred practice that is underpinned by accountability, advocacy, and autonomy. CONCLUSION: Purposeful learning outcomes for the CoCE have been developed, informing how the model can be embedded in curricula, guide student learning and assessment to standardise the pedagogy of the model to prepare future midwives.

Sustainability of rural Victorian maternity services: 'We can work together'.

BACKGROUND: Rural maternity service closures and service level reductions are continually increasing across Victoria. There is limited understanding of how rural board members and executives make decisions about their maternity service's operations and sustainability. AIM: To examine perspectives of rural Victorian board members and executives on the sustainability of rural maternity services. METHODS: This was a qualitative study. Interviews were conducted via Zoom™ with 16 rural Victorian hospital board members and executives. Data were thematically analysed. FINDINGS: Severe shortages in the rural maternity workforce, primarily midwives, have contributed to service sustainability decisions. Challenges in offering midwifery workforce incentives cause difficulty in overcoming workforce shortages. A rural maternity workforce strategy harnessing connection with regional services was called for. Innovative models of maternity care were often actioned at the point of service suspension or closure. Participants requested a government policy position and funding for innovative, safe, and sustainable models of care in rural settings. DISCUSSION: There is an opportunity for workforce planning to occur between regional and rural services to ensure the development of sustainable maternity models such as midwifery group practice and incentivise the workforce to address current deficits and sustain service provision. CONCLUSION: Models of care developed with rural communities, in collaboration with regional services, have the potential to strengthen the delivery of safe, sustainable maternity services. Workforce modelling and centralised government policies aimed at arresting workforce deficits are suggested to provide rural health service leaders with strategic and operational directions to support the delivery of safe, sustainable maternity services.

Barriers and enablers to antenatal care attendance for women referred to social work services in a Victorian regional hospital: A qualitative descriptive study.

BACKGROUND: Women referred to social work services during pregnancy are more likely to experience social disadvantage than those who are not, resulting in reduced antenatal care attendance. Lack of antenatal care engagement leads to poor identification and management of concerns that can have immediate and long-term health consequences for women and their babies. Identifying the barriers and enablers to antenatal care attendance for women referred to social work services is important for designing models of care that promote effective engagement. AIMS: This study aimed to explore the barriers and enablers to antenatal care attendance by women referred to social work services from the perspectives of women, and clinicians who provide antenatal healthcare. METHODS: A qualitative descriptive study using constructivist grounded theory methods was undertaken. Ten women referred to social work services and 11 antenatal healthcare providers were purposively recruited for interviews from a regional maternity service in Victoria, Australia. FINDINGS: Continuity of care and healthcare providers partnering with women were central to effective engagement with antenatal care services. Three interrelated concepts were identified: 1) experiences of the hospital environment and access to care; 2) perceptions of care influence engagement, and 3) motivations for regularly attending services. CONCLUSIONS: Continuity of care is essential for supporting women referred to social work services to attend antenatal appointments. Women are better equipped to overcome other barriers to antenatal service attendance when they have a strong partnership with clinicians involved in their care.

The introduction of registered undergraduate students of midwifery in a tertiary hospital: Experiences of staff, supervisors, and women.

BACKGROUND: The Registered Undergraduate Student of Midwifery (RUSOM) workforce model provides final year midwifery students an opportunity of paid employment and gain experience as an assistant to midwives. A RUSOM supports the work of midwives by providing care to women and their newborns. Little is known about how the RUSOM role impacts the range of stakeholders in maternity care settings. AIM: To evaluate the acceptability of the RUSOM role, how it is experienced by staff and women, and its impact on quality of care. METHODS: A mixed-methods approach including 9 qualitative focus groups (n = 41) and 4 descriptive surveys (n = 135) was used. FINDINGS: The introduction of the RUSOM role has numerous benefits for the service, midwifery staff, women, and the RUSOM themselves. The RUSOM relieved the burden on the postnatal ward, giving midwives more time to work at their higher end of scope in direct clinical care. Having a clear scope of practice for the role ensured there were clear boundaries between the RUSOM and the midwife, resulting in the positive satisfaction for the maternity services team and women in their care. DISCUSSION: Employing RUSOM staff has both immediate and long-term benefits for maternity services. The role had the potential to improve the professional development of upcoming midwives, leading to high quality and experienced graduates that are an invaluable asset to a maternity service. CONCLUSION: The positive outcome from this evaluation provides evidence for the expansion of the RUSOM model which can enhance the quality of care for women.

Advocacy, accountability and autonomy; the learning intention of the midwifery student continuity of care experience.

PROBLEM: The Continuity of Care Experience is a mandated inclusion in midwifery education programs leading to registration as a midwife in Australia. The practice-based learning experience has evolved over time, yet there remains no standardised learning intentions, objectives, or outcomes for the model. AIM: To identify the key learning intentions of the Continuity of Care Experience by an expert panel to support the development of learning outcomes. METHODS: A descriptive qualitative study with two focus groups were conducted with an expert panel (n = 15). Participants were midwifery education subject matter experts on the Continuity of Care Experience with backgrounds in academia, policy development, curriculum design, accreditation, or clinical education. The discussions were transcribed and thematically analysed. FINDINGS: Three main themes and six sub-themes describe the learning intentions of the Continuity of Care Experience. The main themes were: (1) advocacy for women; (2) accountability of care; and (3) autonomy in practice. DISCUSSION: The education model of continuity of care enables students to develop midwifery practice that involves advocating for women, being accountable for their care and being autonomous in practice. We have established that during the experience students practice in partnership with women and are exposed to the full scope of midwifery care. Importantly students learn holistic woman-centred practice. CONCLUSION: The learning intentions of the Continuity of Care Experience reflects woman-centred practice. Having identified a common understanding of the learning intention, these can now be used to design learning, and assessment, through the development of measurable learning outcomes.

Language used to describe the Australian midwifery workforce: A change opportunity to improve professional identity.

BACKGROUND: Tertiary level midwifery educational pathways to achieve registration as a midwife vary in Australia, with a shift from the hospital to the university sector more than 20 years ago. These pathways are often referred to in the workforce setting to distinguish midwives with different academic backgrounds. AIM: To discuss the genesis of midwifery education in the Australian setting and explore the impact of the language used to describe the educational backgrounds on the professional identity of midwives. DISCUSSION: Strong tertiary and regulatory governance exists to support the robust development of midwifery educational programmes and to ensure a high-quality, woman-centred workforce. Once registered, all midwives have the same skill set to provide care to women and families. However, separatist language is often used to describe midwives according to their educational background which has a propensity to reduce positive midwifery identity and influence continuing workforce attrition rates. CONCLUSION: Positive expression of midwifery identity, using a strength discourse and an inclusive workforce have the ability to strengthen job satisfaction and intention to remain in the profession. Midwifery education can occur through several pathways; however once registered, all midwives are equal.