World Health Organization Chief Nursing Officer Elizabeth Iro in interview: the COVID-19 pandemic, and nursing and midwifery challenges and qualities.

In an interview, World Health Organization Chief Nursing Officer Elizabeth Iro reflected on nursing during the COVID-19 pandemic and how nurses have risen to the challenges they have faced. Despite the cancellation of virtually all the activities planned to mark 2020 as the International Year of the Nurse and Midwife, she believes that nurses' leadership, courage, compassion, commitment and expertise have been revealed to the world like never before. However, it is critical to nurture and support the next generation of nurses so that they can help to bring about the necessary reforms for health systems around the world.

Midwifery and Nursing Strategies to protect against COVID-19 During the Third Trimester of Pregnancy.

OBJECTIVE: The rapid pace of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic (COVID-19) presents significant challenges to midwives and nurses. This study aimed to explore midwifery and nursing interventions to limit the transmission of COVID-19 among women in their third trimester of pregnancy, to reduce the incidence of nosocomial infection and promote safety of care for women and their infants. METHOD: We completed a retrospective review of medical records from 35 women in their third trimester of pregnancy with SARS-CoV-2, admitted to one hospital in Wuhan, China in January and February 2020. We investigated the clinical characteristics of the COVID-19 infection in pregnancy, and the individualized midwifery and nursing care offered, including environmental protection, prevention of nosocomial infection, maternal observations, monitoring of signs and symptoms of COVID-19, and psychological care. RESULT: Thirty-one women had a caesarean section, and four had vaginal births. Retrospective analysis of midwifery and nursing strategies implemented to care for these women showed no maternal complications or nosocomial infections. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The care strategies we implemented could prevent complications and nosocomial infection in the third trimester of pregnancy, thus ensuring the safety of women and their infants. Further research needs to determine treatment priorities for women infected with COVID-19 during pregnancy and the postnatal period.

Good clinical practice advice for the management of pregnant women with suspected or confirmed COVID-19 in Nigeria.

The impact on healthcare services in settings with under-resourced health systems, such as Nigeria, is likely to be substantial in the coming months due to the COVID-19 pandemic, and maternity services still need to be prioritized as an essential core health service. The healthcare system should ensure the provision of safe and quality care to women during pregnancy, labor, and childbirth, and at the same time, maternity care providers including obstetricians and midwives must be protected and prioritized to continue providing care to childbearing women and their babies during the pandemic. This practical guideline was developed for the management of pregnant women with suspected or confirmed COVID-19 in Nigeria and other low-resource countries.

The forgotten link between sexual health and pregnancy.

Women presenting to midwives in pregnancy have one forgotten risk factor: sexually transmitted infections (STIs). Pregnant women have had unprotected sexual intercourse at least once. Statistics highlight the increasing prevalence of STIs, with women aged under 25 being at high risk due to reasons identified by the Department of Health (DH) (2012; 2013). Focusing on chlamydia in pregnancy, the risks to the neonate are severe. There are no health campaigns about safe sex in pregnancy, so women cannot access this information. The screening and education around STIs could be dramatically improved; women should be screened for chlamydia at booking, with this repeated if they have a new partner (which is a strong possibility as 50 per cent of pregnancies are unplanned). To increase awareness of this issue, further education for midwives is essential by collaborating with sexual health services and developing a referral pathway. Antenatal education about safe sex in pregnancy can then be introduced and health campaigns developed.

Rethinking bugs. Part 2.

Bacteria seem to be getting mentioned everywhere at the moment, and could even be said to be 'trending'. In this second instalment of a two-part article, I argue that we need to re-think the care and treatment we offer to women for a number of reasons. Using the example of group B strep disease, I argue that avenues other than the current treatment pathway are worthy of exploration, and with antibiotic resistance an increasing problem, this may be the best way forward. I conclude that, because the need for reconsideration of some elements of maternity care is so great, the current focus on bacteria and the potential that this has to throw new light onto old areas may be very helpful.

Maternal and neonatal outcomes of Hepatitis C positive women attending a midwifery led drug and alcohol service: A West Australian perspective.

BACKGROUND: the Women and Newborn Drug and Alcohol Service (WANDAS) is a specialist, midwifery-led service providing pregnancy care to women dealing with alcohol and other drug (AOD) use, at the sole tertiary maternity hospital in Western Australia. AIM: to assess the antenatal, intrapartum and neonatal outcomes of women with Hepatitis C (HCV) who attended the WANDAS service between 2009 and 2012. DESIGN: this retrospective cohort study used data obtained from computerised midwifery records. Univariate comparisons between those who were HCV positive and those who were not, were performed. Multivariable logistic regression was utilised to investigate the simultaneous factors associated with being HCV positive and an opiate user. FINDINGS: the incidence of HCV in this cohort was 37% (213 of 570). Compared to those who were HCV negative those who were positive were more likely to: be older (P<0.001); use opioids in pregnancy (P<0.001); be an intravenous drug user (P<0.001); engage in polysubstance use (P<0.001); and receive an induction of labour (P=0.036). There were no intrapartum characteristics found to be significant at a multivariate level associated with being HCV positive and an opiate user, but there were a couple of neonatal complications. These were having a baby admitted to Special Care Nursery (OR 1.95, 95% CI 1.33-2.88, P<0.001) and a baby at increased risk of being diagnosed with neonatal abstinence syndrome (OR 3.40, 95% CI 2.24-5.15, P<0.001). CONCLUSION: our findings highlight the complexity of caring for pregnant women who are HCV positive, they also highlight that all pregnant women who are AOD users are an at risk population. IMPLICATIONS FOR PRACTICE: these results improve our understanding of the obstetric and midwifery issues associated with caring for pregnant women who are HCV positive and the value of provision of specialist care from a multidisciplinary team, led by a consultant midwife.

Who safeguards mothers?

While routine screening for group B streptococcus is not recommended in the UK, women are sometimes coincidentally found to be carrying these bacteria during investigations of symptoms in pregnancy. If such women decide to decline intravenous antibiotics for themselves in labour, they can seek support from midwives in appropriate roles. But once the woman's baby is born, the situation changes somewhat, as the legal context changes and the issue of safeguarding may be raised. This article considers the issues that arise in such scenarios and raises questions about who is there to support women who experience pressure to consent to their healthy newborn baby having prophylactic intravenous antibiotics.

Midwives' perspectives on male participation in PMTCT of HIV and how they can support it in Lusaka, Zambia.

OBJECTIVE: the purpose of this study is to describe midwives' perspectives on (1) male participation in Prevention of Mother-To-Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) and (2) the methods that could be used to improve male participation in the Lusaka District, Zambia. DESIGN: a qualitative descriptive study. Data were collected using 10 open-ended questions. SETTING: 25 public antenatal clinics in the Lusaka District, Zambia. PARTICIPANTS: midwives (n=45). FINDINGS: content analysis highlighted that a male partner can prevent his wife and his infant from being exposed to HIV by preventive behaviour in their intimate relationship and by utilising health-care services. Several barriers to male participation were identified. These were linked to the male partner himself, to health-care services and to society. Stigma as a multifaceted barrier was considered to permeate every level. The sources of the resources that a male partner needs to prevent Mother-To-Child Transmission (MTCT) were the male partner himself, health-care services and society. The methods that midwives can use to improve male participation were the following: first, influencing individuals, the community, employers and health personnel; second, intervening in risk behaviour; and third, providing disease intervention services. KEY CONCLUSION: male participation in PMTCT of HIV is diverse, not only in HIV testing at the beginning of pregnancy, and it is influenced by various dimensions. Midwives' methods to improve male participation were broad, extending outside the antenatal clinic. A shortage of midwives and other typical issues of limited resources of developing countries pose challenges to male participation in PMTCT of HIV. IMPLICATION FOR PRACTICE: the study showed that cultivating a male-friendly approach in antenatal care is urgent to protect infants.

Group B streptococcus infection: risk and prevention.

Group B Streptococcus (group B Strep or GBS) is the UK's commonest cause of severe early-onset (up to six days) infection in babies. GBS is a normal body commensal, colonising the gut and vagina. GBS may pass to babies around childbirth; although most are unaffected, some develop severe infection. GBS is also a recognised cause of stillbirth and puerperal sepsis. Most GBS infection in babies is of early onset and most of these infections are highly preventable with the targeted use of intrapartum antibiotic prophylaxis. This article reviews current UK guidelines and prevention strategies.

The microbiota battle.

Antibiotic prophylaxis for laboring women with the intent of protecting newborns from group B strep (GBS) infection carries substantial risks and ethical shortcomings. GBS has been proven to be developing resistance to erythromycin and clindamycin. We are now seeing evidence of its resistance to penicillin, the recommended drug used in the prophylactic protocol. Bacterial resistance to antibiotics is linked to increased virulence of the bacteria. Considering the fact that robust bacterial flora throughout the body is essential to the health and well-being of new mothers and the bacterial colonization of their babies, perhaps the prophylactic use of antibiotics needs to be reconsidered.

Enhancing postnatal perineal care: Part 2.

Maternal physical and psychological wellbeing during the postnatal period can be significantly impaired by perineal trauma sustained during childbirth. Current literature emphasises preventative measures, yet there is a lack of a systematic, evidence based approach to postnatal perineal care. This is concerning as the eighth 'Saving mothers' lives' report (CMACE 2011) identifies genital tract sepsis for the first time as the leading cause of maternal deaths. The aim of this article is therefore to develop a systematic approach to improve postnatal perineal care with a focus on assessment and treatment of perineal pain as well as recovery of pelvic floor function.

HIV and pregnancy: challenges in practice.

Midwives face great challenges in practice in caring for women with multiple medical, social and psychological needs. This article highlights the issues such as extreme grief reaction, fear of abandonment and stigma and prejudice that women face when they are diagnosed HIV positive during pregnancy. The article also discusses the importance of communication and a multi-agency approach in providing safe antenatal care for vulnerable women and their families.

Blood tests for investigating maternal wellbeing. 5. Testing for sexually transmitted infections in pregnancy.

This article explores the issues surrounding blood testing for the presence of sexually transmitted infections (STIs) during pregnancy. The aim is to provide an overview of the blood tests required and also of some of the wider issues around STIs in pregnancy. It considers aspects of physiology, pathology, the impact on the fetus and neonate of these infections and provides information about the blood tests themselves. It also considers the current NICE guidelines in relation to testing for STIs in pregnancy, as well as other relevant sources of evidence in relation to the management of these conditions. The article finishes with a consideration of the midwife's role in relation to providing information to women and for supporting them in their decision-making for testing for STIs.