Embracing the continuity of care experience: A new Australian graduate entry master of midwifery course with a student caseload of 15 women per year.

BACKGROUND: Women receiving continuity of midwifery care have increased satisfaction and improved outcomes. Preparation of midwifery students to work in continuity models from the point of graduation may provide an ongoing midwifery workforce that meets rising demand from women for access to such care. AIM OF THE PAPER: The aim of this paper is to describe an innovative midwifery course based on a continuity model, where students acquire more than 50 % of clinical hours through continuity of care experiences. Additional educational strategies incorporated in the course to enhance the CCE experience within the philosophy of midwifery care, include a virtual maternity centre, case-based learning and the Resources Activities Support Evaluation (RASE) pedagogical model of learning. DISCUSSION: Australian accredited midwifery courses vary in structure, format and philosophy; this new course provides students with an alternative option of study for those who have a particular interest in continuity of midwifery care. CONCLUSION: A midwifery course which provides the majority of clinical hours through continuity of care may prepare graduates for employment within midwifery group practice models by demonstrating the benefits of relationship building, improved outcomes and the reality of an on-call lifestyle.

Midwives' and registered nurses' role and scope of practice in acute early pregnancy care services in Australia: a scoping review protocol.

OBJECTIVE: The objective of this review is to review and synthesize what is documented on the role and scope of practice of midwives and registered nurses working in acute early pregnancy care settings in Australia. INTRODUCTION: Women experiencing complications before 20 weeks of pregnancy may need to attend an acute care service, often a hospital emergency department. Midwives and registered nurses provide care for women with early pregnancy complications, and it is important that their role and scope of practice is documented. This review will explore the literature relating to acute early pregnancy care in Australia to better understand how midwives' and registered nurses' roles and scope are currently described in this setting. INCLUSION CRITERIA: Any literature that explores the role and scope of practice of midwives and registered nurses who care for women who present to acute care services in Australia with early pregnancy complications will be considered for inclusion in the review. METHODS: A 3-step review process will involve a preliminary search of MEDLINE and ProQuest, followed by a more detailed search of a larger selection of databases, using identified keywords and phrases from the initial search. Reference lists of retrieved literature will then be examined for relevant citations. Literature in English will be considered, including relevant gray literature. Search results will be imported into reference and review support software. Data that align with the inclusion criteria will be organized into tabulated and narrative formats for presentation. DETAILS OF THIS REVIEW PROJECT ARE AVAILABLE AT: Open Science Framework https://osf.io/5bnqz.

'They follow the wants and needs of an institution': Midwives' views of water immersion.

BACKGROUND: A midwife's ability to fully support women's autonomy and self-determination with respect to midwifery care is often challenging. This is particularly true of water immersion for labour and birth. However, the woman's agency over what happens to her body and that of her unborn baby should be key considerations for maternity care provision. OBJECTIVES: A three phased mixed-methods study was undertaken to examine how water immersion policies and guidelines are informed. Phase three of this study captured the knowledge and experiences of Australian midwives, their support for water immersion and their experiences of using policies and guidelines to inform and facilitate the practice. METHODS: Critical, post structural, interpretive interactionism was used to examine more than 300 responses to three open-ended questions included in a survey of 233 midwives. Comment data were analysed to provide further insight, context and meaning to previously reported results. FINDINGS: Findings demonstrated a complex, multidimensional interplay of factors that impacted on both the midwife's ability to offer and the woman's decision to use water immersion under the themes 'the reality of the system', 'the authoritative 'others'' and 'the pseudo decision-makers'. Multiple scaffolded levels were identified, each influenced by the wider macro-socio-political landscape of Australian midwifery care. CONCLUSIONS: The insight gained from examining midwives' views and opinions of water for labour and birth, has aided in contextualising previously reported results. Such insight highlights the importance of qualitative research in challenging the status quo and working towards woman-centred practice and policy.

What are the benefits? Are they concerned? Women's experiences of water immersion for labor and birth.

OBJECTIVE: The objective of this study was to explore the views, experiences, perceptions of and access to water immersion for labor and birth in Australia. DESIGN: A sequential exploratory mixed methods study commenced in 2016. The first phase involved an online survey. The second phase is due to commence in 2019 and will involve focus groups and interviews. This paper presents a subset of results from phase one that asked women to self-rate the benefits and risks associated with water use on Likert-scales and for those who had a previous birth not involving water, how the two experiences compared. PARTICIPANTS: A total of 740 Australian women who had used water immersion for labor and/or birth rated the benefits against 7-point Likert scales and 736 responded to 5-point Likert scales relating to commonly cited concerns surrounding the option. RESULTS: Women highly rated water immersion against all benefits. Benefits that were most highly rated (by numbers of 'entirely agree' on 7-point Likert scales) included sense of safety (80.14%), an alert baby (75.00%), a positive birth experience (72.70%), water as soothing (72.03%) and freedom of movement (71.35%). Women were most concerned (by selecting 'somewhat' to 'extremely concerned' on 5-point Likert scales) about being told to get out of the water when they did not want to (n = 120/736, 16.30%), their contractions going away (n = 76/736, 10.33%) and unsupportive staff (n = 65/736, 8.83%). More than 90% (n = 682/740) of women mostly to entirely agreed that they would recommend water immersion to others. Women rated water immersion as more comfortable, more satisfying and more relaxing when compared to previous births that they had that did not involve water. KEY CONCLUSIONS: Women value water immersion for labor and birth. They have very little to no concern for the most common adverse events as documented in the literature. IMPLICATIONS FOR PRACTICE: The results add to the growing evidence base surrounding water immersion for labor and birth. Whilst there remains ongoing debate about the safety of water immersion, women's experiences should be considered alongside outcome data. The results of this study may assist policy makers and clinicians in their advocacy and support of women who choose water immersion. ETHICAL CONSIDERATIONS: The Human Research Ethics Committee of the University of South Australia approved the research.

Tertiary education regarding stillbirth for student midwives: The tears 4 SMS project.

PROBLEM: Undergraduate education for midwives in the area of stillbirth may be lacking. BACKGROUND: When a baby dies the families are usually cared for, at some stage in their pregnancy or birth journey, by midwives, however, midwives may not be adequately prepared to care for them. AIM: The aim of this study was to investigate the current content of stillbirth education in undergraduate midwifery curricula in Australia. METHODS: Nineteen midwifery program leaders from each of the Australian Universities that deliver undergraduate midwifery education were invited to respond to an online survey regarding content related to stillbirth risk, prevention and/or bereavement care. There were 10 complete surveys. Quantitative survey data were analysed and described using percentages, and data from the free text comments collected verbatim. FINDINGS: Responses indicated that there is a diverse inclusion of material relating to the topic of stillbirth, with different approaches to teaching the content and the amount of time devoted to the topic is relatively small. DISCUSSION: This small study in scoping curricula from participating Australian Universities indicated that more could be done to strengthen stillbirth related content. Stillbirth is a complex issue and therefore it is important for midwives to understand not only bereavement care but also the physiological underpinnings of issues that could be an antecedent cause or precursor for stillbirth. CONCLUSION: There is room to improve and standardise appropriate stillbirth curriculum nationally. It is imperative that midwives are able to provide sensitive and knowledgeable care to all women and their families.

Practitioner accreditation for the practice of water immersion during labour and birth: Results from a mixed methods study.

BACKGROUND: Water immersion for labour and birth is an option that is increasingly favoured by women. Australian water immersion policies and guidelines commonly specify that practitioners, such as midwives, must undertake further education and training to become accredited. METHOD: A three-phase mixed methods approach was used. Phase one used critical discourse analysis to determine who or what informs policies and guidelines related to water immersion for labour and/or birth. Phase two examined policy and guideline informants' experiences of the development of policies/guidelines, whilst phase three surveyed Australian midwives' views and experiences of water immersion and their use of and/or involvement in the development of policies and guidelines. FINDINGS: Practitioner accreditation for the facilitation of water immersion was a common finding across all phases of the study. An examination of policies and guidelines found that practitioners, namely midwives, were required to meet additional training requirements to facilitate water immersion. Participants of phases two and three identified and discussed accreditation as a significant challenge to the option of water immersion, particularly where there were inconsistencies across documents and in the interpretation of their content. CONCLUSION: The need for practitioners to be accredited to facilitate water immersion was identified as a major barrier to availability and therefore, women's ability to access the option. Given these findings, the need for accreditation should be challenged.

Australian midwives views and experiences of practice and politics related to water immersion for labour and birth: A web based survey.

BACKGROUND: There is little published research that has examined practitioners' views and experiences of pain relieving measures commonly used during labour and birth, particularly for non-pharmacological measures such as water immersion. Furthermore, there is minimal published research examining the process of policy and guideline development, that is, the translation of published research to usable practice guidance. AIMS: The aims of phase three of a larger study were to explore midwives knowledge, experiences and support for the option of water immersion for labour and birth in practice and their involvement, if any, in development of policy and guidelines pertaining to the option. METHODS: Phase three of a three phased mixed methods study included a web based survey of 234 Australian midwives who had facilitated and/or been involved in the development of policies and/or guidelines relating to the practice of water immersion. FINDINGS: Midwives who participated in this study were supportive of both water immersion for labour and birth reiterating documented benefits of reduced pain, maternal relaxation and a positive birth experience. The most significant concerns were maternal collapse, the difficulty of estimating blood loss and postpartum haemorrhage whilst barriers included lack of accredited staff, lifting equipment and negative attitudes. Midwives indicated that policy/guideline documents limited their ability to facilitate water immersion and did not always to support women's informed choice. CONCLUSION: Midwives who participated in this study supported the practice of water immersion reiterating the benefits documented in the literature and minimal risk to the woman and baby. ETHICAL CONSIDERATIONS: The Human Research Ethics Committee of the University of South Australia approved the research.

Fetal movements: What are we telling women?

PROBLEM: Information that women receive about the importance of monitoring fetal movements and what to do if there are changes is inconsistent and may not be evidence based. BACKGROUND: This paper reports a summary of the kind of messages a group of South Australian midwives (n=72) currently give pregnant women. METHODS: Comment data from two questions in a larger survey asking (1) what information midwives routinely provide to women about fetal movements and (2) their practice regarding advice they give to women reporting reduced fetal movements. Data were analysed using summative content analysis. FINDINGS: Four main recurring words and phrases were identified. With respect to information midwives give all women about monitoring fetal movements, recurring words were "10", "normal", "kick charts" and "when to contact" their care-provider. Recurrent words and phrases arising from answers to the second question about advice midwives give to women reporting reduced fetal movement were "ask questions," "suggest fluids," "monitor at home and call back" or "come in for assessment". DISCUSSION: These findings suggest that a group of South Australian midwives are providing pregnant women with inconsistent information, often in conflict with best practice evidence. CONCLUSION: As giving correct, evidence based information about what to do in the event of an episode of reduced fetal movement may be a matter of life or death for the unborn baby it is important that midwives use existing guidelines in order to deliver consistent information which is based on current evidence to women in their care.

Talking to pregnant women about stillbirth: Evaluating the effectiveness of an information workshop for midwives using pre and post intervention surveys.

OBJECTIVE: The project aimed to establish the level of knowledge a group of midwives had about risk factors for stillbirth and identify their current willingness to raise and discuss stillbirth with pregnant women during standard antenatal care. DESIGN: Surveys were administered pre and post an education intervention. The intervention consisted of a half day education workshop. A change in knowledge pre and post intervention was measured as a means to determine the effectiveness of the workshop. SETTINGS: The workshop first provided participants with up-to-date information about modifiable and preventative risk factors for stillbirth and then provided them with the opportunity to practice a range of strategies to assist them to becoming confident in raising and discussing the topic of stillbirth. PARTICIPANTS: Three workshops were offered and a total of 109 qualified midwives attended. METHODS: In order to explore the level of knowledge increase and retention of knowledge about stillbirth as well as participants willingness to discuss stillbirth with pregnant women, comparisons were made between the pre workshop survey responses and those given to the two follow-up surveys immediately following and 3 months after the workshop. RESULTS: There was a statistically significant improvement in knowledge about stillbirth as well as in participant willingness to engage the pregnant women in their care in a conversation about stillbirth. KEY CONCLUSIONS: Providing a workshop on stillbirth for registered midwives is quite effective in raising their awareness about stillbirth. However, before substantial changes can be made in stillbirth awareness, ways and means to sensitively promote public awareness of stillbirth need to be explored and anxieties and taboos addressed. Research could explore whether or not a stillbirth awareness message actually does make women anxious, and if so the nature of this anxiety and how this anxiety might best be ameliorated.

The effect of "hands on" techniques on obstetric perineal laceration: A structured review of the literature.

OBJECTIVE: The purpose of this structured review was to review current evidence of "hands on" and "hands off" techniques as it relates to rates of perineal laceration in order to provide direction for future research in this important area of midwifery practice. METHOD: A structured literature search using all identified keywords and index terms was undertaken in MEDLINE, EMBASE Joanna Briggs Institute, CINAHL, TRIP, and OVID nursing database. FINDINGS: A total of 24 papers were identified from the initial searches as potentially relevant to the review questions. Of these a total of nine papers were considered relevant for this review. These nine included one systematic review with meta-analysis, four randomised controlled trials (RCTs), one quasi-experimental study and three cohort studies. CONCLUSION: "Hands on" techniques have been traditionally used but not been well defined in the literature, therefore it is currently unclear as to whether or not "hands on" technique can reduce perineal laceration. More studies are required to test the effectiveness of a standardised "hands on" technique and also to determine what part other factors such as maternal position, visualisation and use of water might play in perineal laceration rates.

Open the VALT™: Creation and application of a visually authentic learning tool.

This paper describes the process of creating and applying a Visually Authentic Learning Tool (VALT™) in an undergraduate midwifery program. The VALT was developed to facilitate learning in the topic "bleeding in pregnancy". The VALTs objective is to open the mind of the student to facilitate learning via the visual representation of authentic real life simulations designed to enhance and bring to life the written scenario. Students were asked for their feedback of the VALTs. A descriptive analysis was performed on the collated results to determine how the students rated the VALTS in terms of satisfaction and meeting their learning needs. Overall the students seemed to value the VALTs as they present an engaging and unique opportunity to promote learning whilst acknowledging and valuing different learning style within the student group.

Assertiveness training for undergraduate midwifery students.

Assertiveness can be defined as an interpersonal behaviour that promotes the fact all people in a relationship are equally important. All health professionals including midwives must work with and care for people. At times this will include facilitating interactions that require skilful negotiation and assertiveness. Yet embedding assertiveness education into undergraduate midwifery curricula has not been widely adopted. This paper explores one method of delivering assertiveness training in an undergraduate midwifery course and provides comment on the effectiveness of this strategy in developing assertiveness skills in a cohort of undergraduate midwifery students. We used an assertiveness survey which was administered immediately before and 3-4 months after an assertiveness training workshop. All students (n = 55) attending the training day were invited to participate. Of these 41 (77% response) chose to participate in the pre intervention survey and 32 participated (9 students lost to follow-up) in the follow up survey. There was an overall improvement in self-perceived assertiveness scores following the assertiveness training workshop. These findings provide encouraging evidence that educational institutions that offer specific and targeted assertiveness education will be rewarded with more assertive graduates.

Access, boundaries and confidence: The ABC of facilitating continuity of care experience in midwifery education.

BACKGROUND: To register as a midwife in Australia, students must complete minimum requirements of clinical experiences throughout their programme. This includes following women through their childbirth journey in order to gain continuity of care experience. Research suggests that women and students find the continuity of care experience (COCE) valuable. Nevertheless, students cite difficulty in achieving these experiences. Aim This project sought to explore the challenges and identify supportive strategies for midwifery students undertaking the COCE. METHODS: This project adopted an action research approach incorporating the four stages of planning, action, observation and reflection. This paper specifically reports the findings from the planning stage in which a focus group with education providers, facilitator and students was conducted and a survey with students (n=69) was undertaken. Key themes were identified through thematic analysis and a number of actions were proposed. FINDINGS: Three main themes, 'access', 'boundaries' and 'confidence' were identified as challenges for students undertaking the COCE. Students raised concern regarding lack of access to women for COCE. They identified a need to establish clear professional and personal boundaries in managing the COCE. Students also highlighted the significance of confidence on the success of their experience. Throughout the study students identified strategies that could assist in the COCE. CONCLUSION: There is a need for clarity and support around the COCE for all stakeholders. Placing the COCE within a Service Learning model is one response that ensures that this experience is understood as being symbiotic for women and students and enables supportive actions to be developed and implemented.

Bearing witness: midwives experiences of witnessing traumatic birth.

BACKGROUND: Traumatic birth is a phenomenon that has been identified in women's birthing experiences, yet there has been no primary research conducted into midwives experiences of witnessing traumatic birth. Traumatic stress from witnessing and working with traumatised clients has been identified in other caring professionals such as nurses, social workers and emergency department personnel. This includes evidence of posttraumatic stress disorder, secondary traumatic stress, vicarious traumatisation and compassion fatigue. A distinct gap in the literature about midwives experiences of witnessing traumatic birth and the effects of working with potentially traumatised women formed the basis for this research. RESEARCH DESIGN AND METHOD: A descriptive qualitative study was used to explore midwives experiences of witnessing traumatic birth. The aim of this research was to enable midwives to describe their experiences and to determine if they are at risk of negative psychological sequalae similar to those in other caring professions. Ten currently or previously Registered Midwives with varying amounts of experience were interviewed, and transcripts of those interviews formed the raw data for the study. The data were independently thematically analysed by the two authors to identify common themes used to describe the experience of witnessing traumatic birth. RESULTS: 'Stuck between two philosophies', 'What could I have done differently', and 'Feeling for the woman', emerged as the main themes from the research. The participants described their emotional distress from feeling 'stuck' between wishing they could practice according to their midwifery philosophy, and the reality of working within a medical model of care. Feelings of responsibility for women and babies' outcomes, and repeatedly questioning what they could have done differently to prevent a traumatic birth was also reported. Feeling for the woman emerged as a major factor in midwives' experiences of witnessing traumatic birth. CONCLUSIONS: As far as we can determine this is the first study to explicitly examine the phenomenon of midwives witnessing traumatic birth from the midwives point of view. While it was anticipated that midwives might describe being emotionally distressed by their experiences, the extent of their empathy and feelings of being stuck between two philosophies provide new knowledge into what affects midwives when working with birthing women. Further research into these areas is warranted. Better understanding of how witnessing traumatic birth impacts on midwives and what kind of support after these experiences is required to ensure midwives are equipped to cope when witnessing traumatic birth.

Using online roleplay in undergraduate midwifery education: a case-study.

Online roleplay i.e. role play which occurs using an online asynchronous discussion board, can be effectively utilised to teach a variety of skills to midwifery students. This paper will discuss the design and implementation of an online roleplay for a small (n = 19) class of final year undergraduate Midwifery students. It briefly describes the design of the online roleplay and outlines the expected learning outcomes of the activity. It then outlines evaluative survey results for student evaluation of the online role play. Results focus on student opinion of communication and collaboration skills developed through participation in the roleplay. Students considered that the online roleplay provided them with a means to allow communication skills to be developed and practiced. They also believed that the roleplay enable them to practice collaboration in an authentic real world setting. Finally implications for use of this method of teaching in nurse/midwife education are discussed.

An innovative strategy in evaluation: using a student engagement framework to evaluate a role-based simulation.

Online role-play has the potential to actively engage students in authentic learning experiences and help develop their clinical reasoning skills. However, evaluation of student learning for this kind of simulation focuses mainly on the content and outcome of learning, rather than on the process of learning through student engagement. This article reports on the use of a student engagement framework to evaluate an online role-play offered as part of a course in Bachelor of Nursing and Bachelor of Midwifery programs. Instruments that measure student engagement to date have targeted large numbers of students at program and institutional levels, rather than at the level of a specific learning activity. Although the framework produced some useful findings for evaluation purposes, further refinement of the questions is required to be certain that deep learning results from the engagement that occurs with course-level learning initiatives.

Much ado about the flu: design and implementation of an e-role play for a large class of undergraduate students.

Role play in a face-to-face setting is becoming widely accepted as a useful pedagogy in nurse education. However, online e-role play i.e. role play which occurs using an electronic medium, is less well used, particularly with large classes. This paper will discuss the design and implementation of an online e-role play for a large class (n = 414) of undergraduate Nursing and Midwifery students. It describes the rationale for the use of this method and the expected learning outcomes followed by detail about how the e-role play was designed. It also discusses challenges faced in implementing this learning activity with a large group of students and then outlines student and staff evaluation of the e-role play. Finally lessons learned and implications for using this pedagogy in nurse education are considered.

Using simulation to promote nursing students' learning of work organization and people management skills: a case-study.

Simulation is becoming widely used in nurse education. However, reports concerning its use focus almost exclusively on describing experiences with high-fidelity manikin simulation used to teach students a range of psychomotor skills and clinical procedures. Simulation has enormous potential as a learning tool and can provide much more than just a basis for safely learning clinical skills. This paper gives a case-study of use of a simulation exercise that is designed to develop nursing students' work organization and people management skills. It also discusses student evaluation of the simulation exercise. Student engagement with this type of simulation and their feedback suggest that skills obtained during the simulation are transferable into and valuable for their clinical placements.