Defining woman-centred care: A concept analysis.

PROBLEM: In midwifery a shared definition of woman-centred care is lacking, and this remains an identified gap in the evidence underpinning midwifery practice. BACKGROUND: Woman-centred care is an underpinning philosophy used in midwifery practice both nationally and internationally. AIM: To analyse the practice of woman-centred care to clarify its meaning and comprehension and subsequently advance an evidence-based definition of the concept. METHODS: Using an adapted theoretical and colloquial evolutionary model a three-stage concept analysis was conducted to identify attributes, antecedents, and consequences of woman-centred care and subsequently construct an evidence-based, internationally informed definition. FINDINGS: Antecedents of woman-centred care are education, models of care and midwife characteristics. Attributes are choice and control, empowerment, and relationships. Consequences are shared and informed decision making which supports the woman in navigating complex health systems, and improved health outcomes. Whilst important to midwifery practice and midwifery-led models of care, continuity of care is not a core essential element of woman-centred care. DISCUSSION: Analysis, synthesis, and re-examination of the data on woman-centred care facilitated deep immersion, exploration and clarification of this concept that underpins midwifery philosophy and practice. The constructed definition can be used to inform health policy, midwifery research, education, and clinical practice. CONCLUSION: An evidence-based definition of woman-centred care is necessary for conversion of this essential concept to practice. Regardless of model of care all women should receive woman-centre care improving the health outcomes of both the woman and neonate.

Factors associated with spontaneous vaginal birth in nulliparous women: A descriptive systematic review.

PROBLEM: Spontaneous vaginal birth (SVB) rates for nulliparous women are declining internationally. BACKGROUND: There is inadequate understanding of factors affecting this trend overall and limited large-scale responses to improve women's opportunity to birth spontaneously. AIM: To undertake a descriptive systematic review identifying factors associated with spontaneous vaginal birth at term, in nulliparous women with a singleton pregnancy. METHODS: Quantitative studies of all designs, of nulliparous women with a singleton pregnancy and cephalic presentation, who experienced a SVB at term were included. Nine databases were searched (inception to October 2022). Two reviewers undertook quality appraisal; Randomised Controlled Trials (RCTs) with high risk of bias (ROB 2.0) and other designs with (QATSDD) scoring ≤ 50% were excluded. FINDINGS: Data were abstracted from 90 studies (32 RCTs, 39 cohort, 9 cross-sectional, 4 prevalence, 5 case control, 1 quasi-experimental). SVB rates varied (13%-99%). Modifiable factors associated with SVB included addressing fear of childbirth, low impact antenatal exercise, maternal positioning during second-stage labour and midwifery led care. Complexities arising during pregnancy and regional analgesia were shown to decrease SVB and other interventions, such as routine induction of labour were equivocal. DISCUSSION: Antenatal preparation (low impact exercise, childbirth education, addressing fear of childbirth) may increase SVB, as does midwifery continuity-of-care. Intrapartum strategies to optimise labour progression emerged as promising areas for further research. CONCLUSION: Declining SVB rates may be improved through multi-factorial approaches inclusive of maternal, fetal and clinical care domains. However, the variability of SVB rates testifies to the complexity of the issue.

Achieving international consensus on the concept of woman-centred care: A Delphi study.

PROBLEM: There is no internationally-informed understanding of how midwives perceive woman-centred care and use it in practice. BACKGROUND: Woman-centred care is integral to the role of the midwife and to determining standards of practice. Few empirical studies have explored the meaning of woman-centred care, and those that have are limited to country specific research. AIM: To gain an in-depth understanding and consensus on the concept of woman-centred care from an international perspective. METHODS: A three round Delphi study was conducted, with surveys distributed online to a group of international expert midwives to draw consensus on the topic of woman-centred care. FINDINGS: A panel of 59 expert midwives representing 22 countries participated. Fifty-nine statements about woman-centred care, of which 63% of statements reached the 75% a priori agreement level, were developed and categorised under four emergent themes: defining characteristics of woman-centred care (n = 17), the role of the midwife in woman-centred care (n = 19), woman-centred care and systems of care (n = 18), woman-centred care in education and research (n = 5). DISCUSSION: Participants agreed that woman-centred care should be provided by any health care professional in any health care setting. Systems of maternity care should provide holistic care tailored for the individual woman rather than subject her to routine practices and policies. Although continuity of care is important to midwifery practice, it was not reported as a core characteristic of woman-centred care. CONCLUSION: This is the first study to investigate the concept of woman-centred care as it is experienced globally by midwives. The findings of this study will be used to contribute to the development of an internationally informed evidence-based definition of woman-centred care.

Australian midwives and clinical investigation: Exploration of the personal and professional impact.

BACKGROUND: The purpose of regulation of health professionals is public protection. Concerns regarding professional conduct or midwifery care can lead to clinical investigation. Midwifery literature reveals midwives feel ill-equipped and unprepared for clinical investigation and experience stress and abreaction. AIM: To explore the lived experience of clinical investigation and identify the personal and professional impact on Australian midwives. METHOD: Semi-structured interviews of a purposive sample of Australian midwives. Data analysis was informed by a phenomenological conceptual framework derived from Husserl, Heidegger and Merleau-Ponty. FINDINGS: Twelve midwives were interviewed, with seven under current investigation. Discussion involved personal and professional experiences of three or more investigations each, over a period of three to five years. Most investigations were instigated by hospitals with two complaints from women. Seven participants were alleged negligent following adverse neonatal outcomes and five had misconduct allegations. Midwives were employed or in private practice and half provided homebirth services. Themes included being safe, being connected, time and being, perception and well-being. DISCUSSION: The investigative process involves different health services, state and national bodies using varying powers and processes over protracted time periods. Participants discussed aspects such as disrespect, inequity, powerlessness, silence and ostracization. Midwives who successfully navigated clinical investigation developed resilience through reflection on clinical practice in a culture of safety. CONCLUSION: The process of regulating midwives, designed to protect the Australian public, may be harming investigated midwives. Understanding the personal and professional impact of clinical investigation needs to underpin midwifery education, clinical practice, inform policy and regulatory reform.

Experiences of women, hospital clinicians and general practitioners with gestational diabetes mellitus postnatal follow-up: A mixed methods approach.

PROBLEM: Postnatal screening rates to detect type two diabetes following gestational diabetes are low. The quality of communication is an important element to consider in developing targeted strategies that support women in completing recommended follow-up care. AIMS: To explore the communication perspectives, practices and preferences of women, hospital clinicians and general practitioners, to determine strategies that may promote completion of recommended postnatal GDM follow-up, in Queensland Australia. METHOD: We used an exploratory, three-phase, mixed-methods approach, interpreted through intergroup communication theory. Phase one: convergent interviews explored perspectives of the communication experience in GDM care among new mothers (n = 13), hospital clinicians (n = 13) and general practitioners (n = 16). Phase two: a retrospective chart audit assessed current practice in postnatal discharge summaries of women (n = 86). Phase three: an online survey identified the preferences of general practitioners and hospital clinicians who provide maternity care in Queensland. Triangulation of the findings from the interviews, audit and surveys was used to clarify results and increase the robustness of the findings. RESULTS: Three themes: Seeking information, Written hospital discharge summary (discharge summary) and Clarity of follow-up requirements, provide direction for pragmatic strategies to promote follow-up. Practical recommendations include continued discussion about care with women from the point of GDM diagnosis into the postnatal period; discharge summaries that give primacy to diagnosis and ongoing treatment; and provision of explicit directions for recommended testing and timing. IMPLICATIONS: This research informs seven practical recommendations to help promote completion of recommended postnatal GDM follow-up.

Midwives and clinical investigation: A review of the literature.

BACKGROUND: An allegation of negligence or an adverse outcome during childbirth can lead to clinical investigation of a midwife's practice. Anecdotal evidence suggests midwives find this stressful and disturbing. AIM: Synthesise the evidence relating to midwives' experiences of investigation and the effects on clinical practice and personal wellbeing. METHODS: Two database searches were conducted between 2015 and 2016 to identify primary research published between 1990 and 2016. Studies were evaluated for quality using standard instruments. FINDINGS: Despite numerous references to 'litigation' in peer-reviewed journals, little substantive research related specifically to midwives. 11 inclusions comprised three qualitative studies (one with two publications), reporting litigation experiences of midwives and seven quantitative studies (four research groups), identifying risk liability through cyclic surveys of midwives and law reports. Failure to identify deterioration in foetal well-being was a common finding among researchers examining reasons for litigation. Experienced midwives were at highest risk of litigation. Researchers found high levels of distress and abreaction among participants who either stopped working in birth suite or left midwifery. They also identified a level of ambiguity around defensive practices associated with fear of litigation. CONCLUSION: There is little research regarding experiences of midwives and clinical investigation. Midwives under investigation need appropriate support. Continuing to work during prolonged investigative processes is stressful as reported by midwives who described being "ill-equipped" and "unprepared." Midwives in the review preferred the support of colleagues over counsellors. Educators, employers and regulators need to work collaboratively and incorporate reflective practice in targeted support.

The Pituri Learning Circle: central Australian Aboriginal women's knowledge and practices around the use of Nicotiana spp. as a chewing tobacco.

INTRODUCTION: Tobacco smoking has a range of known and predictable adverse outcomes, and across the world sustained smoking reduction campaigns are targeted towards reducing individual and public risk and harm. Conversely, more than 87 million women, mostly in low- and middle-income countries, use smokeless tobacco, yet the research examining the effect of this form of tobacco exposure on women is remarkably scant. In central Australia, the chewing of wild Nicotiana spp., a tobacco plant, commonly known as pituri and mingkulpa, is practised by Aboriginal groups across a broad geographical area. Until recently, there had been no health research conducted on the effects of chewing pituri. METHODS: This article reports on one component of a multidimensional pituri research agenda. A narrative approach utilising the methodology of the Learning Circle was used to interview three key senior central Australian Aboriginal women representative of three large geographical language groupings. The participants were selected by a regional Aboriginal women's organisation. With the assistance of interpreters, a semistructured interview, and specific trigger resources, participants provided responses to enable an understanding of the women's ethnobotanical pituri knowledge and practices around the use of pituri within the context of Aboriginal women's lives. Data were transcribed, and by using a constant comparison analysis, emergent themes were categorised. The draft findings and manuscript were translated into the participants' language and validated by the participants. RESULTS: Three themes around pituri emerged: (a) the plants, preparation and use; (b) individual health and wellbeing; and (c) family and community connectedness. The findings demonstrated similar participant ethnobotanical knowledge and practices across the geographical area. The participants clearly articulated the ethnopharmacological knowledge associated with mixing pituri with wood ash to facilitate the extraction of nicotine from Nicotiana spp., the results of which were biochemically verified. The participants catalogued the pleasurable and desired effects obtained from pituri use, the miscellaneous uses of pituri, as well as the adverse effects of pituri overdose and toxicity, the catalogue of which matched those of nicotine. The participants' overarching pituri theme was related to the inherent role pituri has in the connectiveness of people to family, friends and community. CONCLUSIONS: Central Australian Aboriginal women have a firmly established knowledge and understanding of the pharmacological principles related to the content of Nicotiana spp. and the extraction of nicotine from the plant. Widespread use of Nicotiana spp. as a chewing tobacco by Aboriginal populations in the southern, central and western desert regions of Australia is attested to by participants who assert that everyone uses it, with girls in these remote areas commencing use between 5 and 7 years of age. Central Australian Aboriginal people who chew Nicotiana spp. do not consider it to be a tobacco plant, and will strongly refute that they are tobacco users. Central Australian Aboriginal people do not consider that the Western health information regarding tobacco (as a smoked product) is applicable or aligned to their use of pituri. Nicotiana spp. users will deny tobacco use at health assessment. There is a requirement to develop and provide health information on a broader range of tobacco and nicotine products in ways that are considered credible by the Aboriginal population. Health messages around pituri use need to account for the dominant role that pituri occupies in the context of central Australian Aboriginal women's lives.
Information for readers: A consultative organisation of Aboriginal women has as a strategic intent and operational agenda the improvement of Aboriginal women's and children's health across the research region. The group seeks opportunities to enhance their knowledge based on legitimate collaborative research; accordingly, they sought to participate in a range of research activities regarding the use of pituri and women's health outcomes. Of particular note, the group's participants chose to be identified by name in the publication of this research activity. In this article, the term 'Aboriginal' has been chosen by the central Australian women to refer to both themselves and the Aboriginal people in their communities; 'Indigenous' has been chosen to refer to the wider Australian Aboriginal and Torres Strait Islander people. The term Nicotiana spp. is used when referring to the plants from a Western perspective; pituri is used when referring to the plants, the tobacco quid, and the practice of chewing from a general Aboriginal perspective; and mingkulpa is used when the participants are voicing their specific knowledge and practices.

A critical and interpretive literature review of birthing women's non-elicited pain language.

BACKGROUND: Standardised pain assessment i.e. the McGill Pain Questionnaire provide an elicited pain language. Midwives observe spontaneous non-elicited pain language to guide their assessment of how a woman is coping with labour. This paper examined the labour pain experience using the questions: What type of pain language do women use? Do any of the words match the descriptors of standardised pain assessments? What type of information doverbal and non-verbal cues provide to the midwife? METHODS: A literature search was conducted in 2013. Studies were included if they had pain as the primary outcome and examined non-elicited pain language from the maternal perspective. A total of 12 articles were included. FINDINGS: The analysis revealed six categories in which labour pain can be viewed: 'positive', 'negative', 'physical', 'emotional', 'transcendent' and 'natural'. Women's language comprised i.e. prefixes and suffixes, which indicate the qualities of pain, and figurative language. Language indicated location of pain, gave insight into other life phenomena i.e. death, and shared similarities with standardised pain assessmentdescriptors. Labour cues were 'functional', 'dysfunctional,' or 'neutral' (part of the physiological childbirth process), and were verbal, non-verbal, emotional, psychological, physical behaviour or reactions, or tactile. CONCLUSION: Labour can bring about a spectrum of sensations and therefore emotions from happiness and pleasure to suffering and grief. Spontaneous pain language comprises verbal language and non-verbal behaviour. Narratives are an effective form of pain communication in that they provide details regarding the quality, nature and dimensions of pain, and details notcaptured in quantitative data.

Development and piloting the Woman Centred Care Scale (WCCS).

PROBLEM/BACKGROUND: In midwifery we espouse a woman centred care approach to practice, yet in midwifery education no valid instrument exists with which to measure the performance of these behaviours in midwifery students. AIM: To develop and validate an instrument to measure woman centred care behaviours in midwifery students. METHOD: We identified four core concepts; woman's sphere, holism, self-determination and the shared power relationship. We mapped 18 individual descriptive care behaviours (from the Australian National Competency Standards for the Midwife) to these concepts to create an instrument to articulate and measure care behaviours that are specifically woman centred. Review by expert midwifery clinicians ensured face, content and construct validity of the scale and predictive validity and reliability were tested in a simulated learning environment. Midwifery students were video recorded performing a clinical skill and the videos were reviewed and rated by two expert clinicians who assessed the woman centred care behaviours demonstrated by the students (n=69). FINDINGS/DISCUSSION: Test and re-test reliability of the instrument was high for each of the individual raters (Kappa 0.946 and 0.849 respectively p<0.001). However, when raters were compared there were differences between their scores suggesting variation in their expectations of woman centred care behaviours (Kappa 0.470, p<0.001). Midwifery students who had repeated exposures to higher levels of simulation fidelity demonstrated higher levels of woman centred care behaviours. CONCLUSION: The WCCS has implications for education and the wider midwifery profession in recognising and maintaining practice consistent with the underlying philosophy of woman centred care.

Examining the nexus of labour pain and culture using an applied social science framework

Birthing women can convey a cultural response to pain. The greater the cultural distance between a woman and her midwife, the greater the chance of misinterpretation of her labour experience. This paper examines childbirth beliefs, influences and practices, which contribute to cross-cultural understandings of pain. A literature search was conducted in April 2013. Studies were included if they had pain as the primary outcome and examined non-elicited pain language from the maternal perspective. Twelve articles were included. The language findings were reported in a companion paper. The present paper reported the cultural findings using an applied social science framework to reflect upon the nexus of pain and culture within pain communication and the development of culturally sensitive practice. The studies depicted shared childbirth beliefs and practices across African, Asian, European, North American and South American cultures, which in part is attributed to common physiological factors of childbirth. Childbirth may be impacted upon by 'internal' factors: pain reactions and attitudes, religion and spirituality, pain definition and meaning, anxiety, pain acceptance and tolerance, conceptualisation of motherhood, psychology, and societal beliefs; external factors may include the environment (physical setting or context of childbirth) and the model of care. The interpretation of these beliefs may be influenced by the midwife's development of their cultural competence.Viewing cultural patterns provides a cultural lens for midwives across care models (e.g. technocratic, humanistic, and holistic) to better understand women's experiences of pain, to reflect upon cross-cultural interpretation of pain and to develop cross-cultural competence.

Mujeres que dan a luz pueden transmitir una reacción cultural al dolor. Cuanto más distancia cultural hay entre una mujer y su matrona mayores la posibilidad de una interpretación errónea de su experiencia del dolor de parto. Este artículo examina las creencias, influencias y prácticas del parto que contribuyen al entendimiento transcultural del dolor. Se realizó una búsqueda de la literatura en abril de 2013. Fueron incluidos doce estudios lo cuales tuvieron el dolor como un resultado principal y examinaron el idioma del dolor no provocado (es decir, el idioma natural que no está obtenido por la evaluación estandarizada del dolor) de la perspectiva materna. Los resultados lingüísticos fueron presentados en otro artículo anterior. En cambio, este artículo presenta los resultados culturales usando un marco de ciencia social aplicada para reflexionar sobre el nexo del dolor y la cultura dentro de la comunicación del dolor y el desarrollo de una práctica culturalmente sensible. Los estudios representaron creencias y prácticas del parto compartidos por la cultura africana, asiática, europea, norteamericana y sudamericana que está atribuido ­en parte ­a los factores fisiológicos comunes del parto. El parto puede estar impactado por los factores 'internos': las reacciones y actitudes del dolor, la religión y espiritualidad, las definiciones y significaciones del dolor, la ansiedad, la aceptación y tolerancia del dolor, la conceptualización de la maternidad, la psicología, y las creencias sociales; los factores externos pueden incluir el ambiente (entorno físico u contexto del parto) y el modelo de atención. La interpretación de estas creencias puede estar influenciada por el desarrollo de competencia cultural de la matrona. Observarlos patrones culturales ofrece a las matronas unos lentes culturales, a través, de los modelos de atención(ej. tecnocrático, humanista, holístico) para entender mejor la experiencia del dolor de la mujer, para reflexionar sobre la interpretación transcultural del dolor y para desarrollar la competencia transcultural.

The effectiveness of varied levels of simulation fidelity on integrated performance of technical skills in midwifery students--a randomised intervention trial.

BACKGROUND: Simulation as a pedagogical approach is used in health professional education to address the need to safely develop effective clinical skills prior to undertaking clinical practice, in complex healthcare environments. Evidence for the use of simulation in midwifery is largely anecdotal, and research evaluating the effectiveness of different levels of simulation fidelity is lacking. OBJECTIVES: To evaluate the effectiveness of varying levels of fidelity on simulated learning experiences and identify which best contributes to integrated and global clinical skills development in midwifery students. DESIGN: Randomised three arm intervention trial. PARTICIPANTS: Midwifery students who had yet to receive theoretical instruction in the performance of the clinical skill of vaginal examination. METHODS: Midwifery students (n=69) received theoretical instruction in the performance of vaginal examination following random allocation into one of three intervention arms. Participants were recorded performing the procedure using low fidelity (part task trainer only), medium fidelity (part task trainer and life sized poster of a pregnant woman) or progressive fidelity (part task trainer and a simulated standardised patient). Senior midwifery students were recruited to act in the role of standardised patients. RESULTS: There was a statistically significant difference in the mean total Global Rating Scale score between at least two of the three groups (p=0.009). The progressive fidelity group revealed as different from both the low fidelity group (p=0.010) and medium fidelity group (p=0.048). There was a statistically significant difference in the mean total Integrated Procedural Performance Instrument score between at least two of the three groups (p=0.012). The progressive fidelity group revealed as different from both the low fidelity group (p=0.026) and medium fidelity group (p=0.026). CONCLUSIONS: Progressive and medium fidelity simulation yields better outcomes than low fidelity simulation and where resources are constrained medium fidelity equipment, such as a life sized poster can produce effective learning experiences for midwifery students.

A review of interventions to prevent Type 2 Diabetes after Gestational Diabetes.

BACKGROUND: Gestational Diabetes Mellitus (GDM) during pregnancy is a risk factor for the development of Type 2 Diabetes (T2DM) within 15 years, and prevention programmes have been problematic. QUESTION: The aim of the study is to identify effective strategies and programmes to decrease the risk of T2DM in women who experience GDM, the barriers to participation, and the opportunities for midwives to assist women in prevention. METHODS: English language, peer reviewed and professional literature published between 1998 and 2013 were searched. A systematic review of the literature was undertaken, included studies were then appraised for quality and finally findings of the studies were thematically analysed. FINDINGS: This review identified that there are interventions that are effective, however most lifestyle changes are difficult to translate into everyday life. As the incidence of GDM is expected to rise, midwives' role in promoting long-term health behaviours requires further review. CONCLUSIONS: Women need to overcome barriers and be supported in making the behavioural changes necessary to prevent T2DM following GDM. Midwives as the primary carers for women in pregnancy and childbirth are ideally positioned to educate women and engage them in lifestyle and behaviour programmes that prevent the onset of Type 2 Diabetes.

The prevalence of work-related neck, shoulder, and upper back musculoskeletal disorders among midwives, nurses, and physicians: a systematic review.

With the global shortage of health care workers predicted to worsen, attrition from the work force must be minimized. This review examined the incidence or prevalence of neck, shoulder, and upper back musculoskeletal disorders, a possible source of attrition, among midwives, nurses, and physicians. Four electronic databases were systematically searched for publications meeting inclusion criteria. Reference lists of retrieved articles were hand searched for additional articles. After eliminating articles that did not meet inclusion criteria, the remaining articles were assessed for quality and prevalence or incidence data were extracted. Twenty-nine articles published between 1990 and 2012 were included and assessed for quality. Median annual prevalence rates were 45% (neck), 40% (shoulder), and 35% (upper back). Methodological concerns included small sample size, inconsistency of outcome measures, likelihood of non-response bias, and low response rates. Midwives, who have not been well studied, demonstrated prevalence somewhat lower than that of nurses and physicians.

A protocol for evaluating progressive levels of simulation fidelity in the development of technical skills, integrated performance and woman centred clinical assessment skills in undergraduate midwifery students.

BACKGROUND: Simulation as a pedagogical approach has been used in health professional education to address the need to safely develop effective clinical skills prior to undertaking clinical practice. However, evidence for the use of simulation in midwifery is largely anecdotal, and research evaluating the effectiveness of different levels of simulation fidelity are lacking.Woman centred care is a core premise of the midwifery profession and describes the behaviours of an individual midwife who demonstrates safe and effective care of the individual woman. Woman centred care occurs when the midwife modifies the care to ensure the needs of each individual woman are respected and addressed. However, a review of the literature demonstrates an absence of a valid and reliable tool to measure the development of woman centred care behaviours. This study aims to determine which level of fidelity in simulated learning experiences provides the most effective learning outcomes in the development of woman centred clinical assessment behaviors and skills in student midwives. METHODS/DESIGN: Three-arm, randomised, intervention trial.In this research we plan to:a) trial three levels of simulation fidelity - low, medium and progressive, on student midwives performing the procedure of vaginal examination;b) measure clinical assessment skills using the Global Rating Scale (GRS) and Integrated Procedural Performance Instrument (IPPI); andc) pilot the newly developed Woman Centred Care Scale (WCCS) to measure clinical behaviors related to Woman-Centredness. DISCUSSION: This project aims to enhance knowledge in relation to the appropriate levels of fidelity in simulation that yield the best educational outcomes for the development of woman centred clinical assessment in student midwives. The outcomes of this project may contribute to improved woman centred clinical assessment for student midwives, and more broadly influence decision making regarding education resource allocation for maternity simulation.

An interpretive review of women's experiences of gestational diabetes mellitus: proposing a framework to enhance midwifery assessment.

BACKGROUND: Gestational diabetes mellitus (GDM) affects almost 5% of pregnancies in Australia, and within 15 years, 25% of affected women will go on to develop Type 2 Diabetes Mellitus (T2DM). The adoption of preventive health behaviours may be influenced by women's experiences of GDM. QUESTION: This review sought to understand women's beliefs, values, perceptions and experiences following diagnosis of GDM. METHODS: Peer reviewed and professional journals were searched for primary research, published between January 1991 and December 2011 that explored the beliefs, values, perceptions and experiences of peripartum or postpartum women with a diagnosis or history of GDM. FINDINGS: Nineteen studies met the inclusion criteria and the majority of these studies were qualitative (n=15). Each study was reviewed and synthesis revealed three emergent themes and core concepts related to each theme: Responses (initial reaction to GDM diagnosis, negative thoughts following diagnosis, struggle to manage GDM, feelings of 'loss of control', changes to identity and adapting to change), Focus of Concern (concern for baby's health, mother's concern for her own health, perceived seriousness of GDM, perceived fear of T2DM) and Influencing Factors (cultural roles and beliefs, social stigmas, social support, professional support, adequate and appropriate information, social roles and barriers to self-care). CONCLUSION: The experiences of women with GDM are unique and personal however this review highlights common experiences evident in the existing research. The proposed framework may be used by midwives in clinical assessment and care of women diagnosed with GDM.

Helping women but hurting ourselves? Neck and upper back musculoskeletal symptoms in a cohort of Australian Midwives.

OBJECTIVE: To determine the prevalence of neck and upper back musculoskeletal symptoms in a group of Australian midwives and explore individual characteristics and workplace exposures associated with these symptoms. DESIGN: cross-sectional, using data from the Nurses and Midwives e-Cohort Study, a longitudinal, electronic survey of midwives and nurses in Australia, New Zealand and the United Kingdom. SETTING: data were collected via an online survey in 2006-2008. PARTICIPANTS: qualified Australian midwives aged 23-70 years. MEASUREMENTS AND FINDINGS: We undertook descriptive analysis of the sample, calculated prevalence and examined associations between individual and workplace variables and neck and upper back musculoskeletal symptoms. Variables achieving p<0.1 in bivariate analysis were entered simultaneously into logistic regression models. Overall prevalence rates were 48.8% for neck and 28.2% for upper back musculoskeletal symptoms; work-related prevalence was 40.8% (neck) and 24.5% (upper back), comparable to reported rates among nurses and physicians. Presence of symptoms in the adjacent area was associated with greater than a fourfold increased risk for neck and upper back symptoms. Participants with care responsibility for an adult dependent were 36% more likely to report neck symptoms. Current shift work and total physical activity were associated with decreased likelihood of neck and upper back symptoms, respectively. Psychological job demands were only weakly associated with upper back symptoms, possibly because the survey tool could not capture a sufficiently broad range of psychosocial exposures to present a complete picture. A striking finding was that work in awkward postures conferred an increased risk of 35% for neck and nearly 50% for upper back symptoms. KEY CONCLUSIONS: neck and upper back musculoskeletal symptoms were prevalent in this sample. Both individual and workplace factors were significantly associated with neck and/or upper back symptoms. Psychological job demands and work in awkward postures are potentially modifiable exposures that deserve further examination. IMPLICATIONS FOR PRACTICE: midwives who are or may become carers for adult dependents should be aware of a possible increased risk for neck symptoms. It may be prudent for midwives and those who employ/supervise them to monitor and, where possible, jointly develop strategies to mitigate psychological job demands. The potential hazard posed by work in awkward postures warrants consideration of how midwives may minimize time spent working in these postures.

A cross-sectional analysis of the association between night-only or rotating shift work and overweight/obesity among female nurses and midwives.

OBJECTIVE: To examine the associations between shift work types and overweight/obesity among female nurses and midwives. METHODS: A cross-sectional study. Measurement included exposure variables: rotating shift work and night-only shift work; outcome variables: overweight and obesity; and potential confounding and associated variables: modifiable lifestyle factors, general health status, menopausal status, and work pattern. RESULTS: Among the 2086 participants, almost 60% were overweight/obese (31.7% overweight; 27.1% obese). After we adjusted the selected confounders, we found that rotating shift workers were 1.02 times more likely to be overweight/obese than day workers (P = 0.007; 95% confidence interval [95% CI], 1.004 to 1.03; and P = 0.02; 95% CI: 1.004 to 1.04, respectively). Night-only shift work was found to be significantly associated with obesity only (P = 0.031; relative risk, 1.02; 95% CI, 1.002 to 1.04). CONCLUSIONS: Rotating shift work was associated with both overweight and obesity; and night-only shift work was associated with obesity, not overweight.

Does maintaining or changing shift types affect BMI? A longitudinal study.

OBJECTIVES: To examine the impact of maintaining or changing shift work status on body mass index (BMI) among female nurses and midwives. METHODS: A longitudinal study. Measurements included day work maintainers, shift work maintainers, day to shift changers and shift to day changers, changes in BMI, and potential confounders selected from baseline survey. Repeated measures analysis of covariance was employed. RESULTS: The shift to day changers had decreased in BMI over the follow-up period (mean, -3.02; SD, 5.45; P < 0.001). In contrast, the shift work maintainers and the day to shift changers had increased in BMI over follow-up period (mean, 0.56; SD, 5.47; P = 0.01 and mean, 0.13; SD, 5.64; P = 0.04, respectively). CONCLUSIONS: The analysis suggests that shift work could increase BMI.