Let's talk aspirin: A survey of barriers and facilitators faced by midwives when engaging in conversations about aspirin with women at risk of pre-eclampsia.

OBJECTIVE: Adherence to low-dose aspirin is key in preventing pre-eclampsia. Midwives are well positioned to support women to take aspirin as prescribed. This study aimed to understand the barriers and facilitators that midwives face during consultations with pregnant women about prophylactic aspirin. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, UK-wide, quantitative and qualitative study of midwives was conducted between November 2020 and April 2021 using social media platforms. The survey was designed using the Theoretical Domains Framework by a team of researchers experienced in using it. An open-ended question was embedded in the survey to allow midwives to expand on matters related to the study subject. FINDINGS: Out of 160 responders, 37.5 % indicated inadequate engagement in conversations with women about aspirin prophylaxis. Domains 'Knowledge' (OR 13.7, 95 %CI 5.7-32.7, p < 0.001), 'Professional role and Identity' (OR 15.3, 95 %CI 6.4-36.7, p < 0.001) and 'Beliefs about capabilities' (OR 13.6, 95 %CI 6.1-30.6, p < 0.001) were most prominently associated with effective engagement. Best fit model was comprised of 'Beliefs about Capabilities', 'Social/professional role and identity', and 'Knowledge'. Midwives' comments focused on barriers within 'environmental context' related to 'conflicting views' and 'deficit in resources' that compromise positive reinforcement of aspirin use. Responders also provided helpful 'Top tips' that streamline their daily practice. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Beliefs about Capabilities, Social/professional role and identity, Knowledge, and Environmental Context and resources are key domains related to midwives' engagement in conversations about aspirin in pregnancy. Clear, up-to date information for midwives and the public should be available in an easy access format to allow provision of unequivocal advice related to the use of aspirin in pregnancy.

How is high quality research evidence used in everyday decisions about induction of labour between pregnant women and maternity care professionals? An exploratory study.

OBJECTIVE: To explore the use of high quality research evidence in women's and maternity care professionals' decisions about induction of labour (IOL). METHODS: A qualitative study underpinned by a social constructionist framework, using semi-structured interviews and generative thematic analysis. SETTING: A large tertiary referral maternity unit in northern England in 2013/14. PARTICIPANTS: 22 randomly selected health care professionals involved in maternity care (midwives, obstetricians, maternity service managers), and 16 postnatal women, 3-8 weeks post-delivery, who were offered IOL in their most recent pregnancy. FINDINGS: Three themes were identified in the data; (1) the value of different forms of knowledge, (2) accessing and sharing knowledge, and (3) constrained pathways and default choices. Findings echo other evidence in suggesting that women do not feel informed about IOL or that they have choices about the procedure. This study illuminates potential explanatory factors by considering the complex context within which IOL is discussed and offered (e.g. presentation of IOL as routine rather than a choice, care pathways that make declining IOL appear undesirable, blanket use of clinical guidelines without consideration of individual circumstances and preferences). KEY CONCLUSIONS: This study suggests that organisational, social, and professional factors conspire towards a culture where (a) IOL has become understood as a routine part of maternity care rather than an intervention to make an informed choice about, (b) several factors contribute to demotivate women and health care practitioners from seeking to understand the evidence base regarding induction, and (c) health care professionals can find themselves ill-equipped to discuss the relative risks and benefits of IOL and its alternatives. IMPLICATIONS FOR PRACTICE: It is important that IOL is recognised as an optional intervention and is not presented to women as a routine part of maternity care. When IOL is offered it should be accompanied by an evidence informed discussion about the options available to support informed decision making. Health care professionals should be supported to understand the evidence base and our findings suggest that any attempt to facilitate this needs to acknowledge and tackle complex organisational, social and professional influences that contribute to current care practices.