'I might have cried in the changing room, but I still went to work'. Maternity staff balancing roles, responsibilities, and emotions of work and home during COVID-19: An appreciative inquiry.

PROBLEM: Knowing how to help staff thrive and remain in practice in maternity services. BACKGROUND: A chronic shortage of staff in maternity services in the United Kingdom and high levels of stress and burnout in midwifery and medical staff. PURPOSE: To understand how to support and enhance the wellbeing of staff in a small UK maternity service. METHODS: An appreciative inquiry using interviews with n = 39 maternity staff and n = 4 group discussions exploring meaningful experiences, values and factors that helped their wellbeing. RESULTS: Staff members were highly motivated, managing a complex melee of emotions and responsibilities including challenges to professional confidence, mental health, family situation, and conflict between work-life roles. Despite staff shortages, a demanding workload, professional and personal turmoil, and the pandemic participants still found meaning in their work and relationships. DISCUSSION: A 'whole person' approach provided insight into the multiple stressors and emotional demands staff faced. It also revealed staff resourcefulness in managing their professional and personal roles. They invested in relationships with women but were also aware of their limits - the need to be self-caring, employ strategies to switch-off, set boundaries or keep a protective distance. CONCLUSION: Staff wellbeing initiatives, and research into wellbeing, would benefit from adopting a holistic approach that incorporates home and family with work. Research on emotion regulation strategies could provide insights into managing roles, responsibilities, and the emotional demands of working in maternity services. Emotion regulation strategies could be included in midwifery and obstetric training.

Identifying the factors that influence midwives' perineal practice at the time of birth in the United Kingdom.

OBJECTIVE: The Obstetric Anal Sphincter Injuries (OASI) Care Bundle is designed to reduce the incidence of obstetric anal sphincter injuries. However, introducing behavioural change requires an understanding of current practice. This study aims to establish midwives practise at the time of birth, and the factors that influence this. DESIGN: Quantitative research - a national online survey. SETTING: Nationwide - United Kingdom (UK). Participants 563 midwives from across the UK. METHODS: An online survey of midwives' practice. Midwives were invited to participate through the Supervisor of Midwives network. Consent was sought on the landing page. Data analysis using descriptive and inferential statistics, with sub group analyses were used to explore variations in practice. Measurements Number of midwives using "hands on" the perineum and the influences on midwives' perineal practice at the time of birth. FINDINGS: Most midwives preferred to use "hands on" the perineum at the time of birth (61.4%). "Hands on" practise was significantly associated with where midwives worked (p<0.001), risk factors for OASI (p<0.001), and the approach that they were taught in their midwifery training (p<0.01). Midwives expressed lack of confidence in some areas with a third unsure that they could identify the third degree tear category b (38.2%) or c (34.3%). KEY CONCLUSIONS: There has been a growth in the number of midwives using "hands on" at the time of birth but midwives feel that they require additional training in regards to identifying an OASI. The study should be repeated following the roll out of the OASI care bundle, to identify its impact on midwives' perineal practice. IMPLICATIONS FOR PRACTICE: The study identified that there needs to be an improvement in the recognition of OASI by midwives, and in future repeating the study would identify whether the OASI care bundle has influenced midwives' practice.

A study to evaluate the introduction of the Newborn Infant Physical Examination knowledge and skills into an undergraduate pre-registration midwifery education programme.

Newborn Infant Physical Examination is recommended between six to 72 h from birth and the midwife is ideally placed to undertake this screening examination. In the United Kingdom only a small percentage of midwives are competent to undertake this screening, and is usually taught once qualified. The aim of this qualitative study was to explore the experiences of student midwives in relation to the impact and effectiveness of introducing the theory of Newborn Infant Physical Examination into an undergraduate midwifery curriculum and the opportunity to apply the skills in practice. Two focus groups with final year student midwives (n = 11) were undertaken. The transcribed interviews were reviewed by the researchers and thematically analysed. Three themes emerged: i) timing of the theoretical content, ii) applying theory to practice iii) holistic care. Recommendations include the importance of incorporating the theoretical elements into the programme even if students do not have the opportunity to become competent in the required skills. Most students favoured the theory elements to be threaded throughout the three year programme rather than having a single dedicated module. Students identified that when midwives completed the newborn examination, holistic care was improved.

National survey: Developing a common approach to grading of practice in pre-registration midwifery.

This paper presents the final phase of a national project exploring grading of practice in programmes leading to registration as a midwife in the United Kingdom. The aim was to develop a generic framework for grading practice, enhancing standardisation while enabling flexibility in application of current and new educational standards. A mixed method on-line survey considered existing practice assessment tools, factors contributing to robust and reliable assessment and perceptions of two assessment tools developed by the research team: a 'Lexicon Framework' and 'Rubric', which were tested through scenarios. Participants included 170 midwifery and nursing academics, clinicians and students, representing 20 universities in the UK. Seven key themes emerged, from which an 'Evidence Based Model for Professional Practice Assessment' was developed. The proposed tools were overall positively evaluated and demonstrated a good level of reliability. A national tool to standardise midwifery practice assessment is recommended, and scope for transferability of our tools to all midwifery programmes and to nursing was identified. Other recommendations include engagement of key stakeholders in development of practice assessment documentation, and maintaining the professional purpose of grading practice as central to the process. A set of key principles for assessing practice is presented.

Core principles to reduce current variations that exist in grading of midwifery practice in the United Kingdom.

AIM: To reduce variations in grading of midwifery practice and enhance reliability of assessment. BACKGROUND: The first phase of a national project showed there to be widely ranging interpretation and application of professional educational standards in relation to grading of practice in midwifery. This raised concerns about reliability and equity of professional assessment. The second phase therefore sought to achieve consensus on a set of core principles. METHODS: A participatory action research process in two stages, using a Mini-Delphi approach. Educational leads from all 55 institutions delivering midwifery programmes nationally were invited to participate. Stage one: Questionnaire comprising 12 statements drawn from the findings of the initial phase of the project. Stage two: Face-to-face discussion. FINDINGS: Statements were categorised based on questionnaire responses: 1) Consensus, 2) Staged consensus, 2) Minor modifications, 4) Controversial. Consensus was achieved on 11 core principles through group discussion; only one was omitted from the final set. RECOMMENDATIONS: All midwifery programmes nationally to incorporate the agreed core principles. Findings should be disseminated to the regulatory body to help inform changes to midwifery and nursing educational standards. The core principles may also contribute to curriculum development in midwifery and other professions internationally.

A scoping study to explore the application and impact of grading practice in pre-registration midwifery programmes across the United Kingdom.

Grading of practice is a mandatory element of programmes leading to registration as a midwife in the United Kingdom, required by the Nursing and Midwifery Council. This validates the importance of practice by placing it on an equal level with academic work, contributing to degree classification. This paper discusses a scoping project undertaken by the Lead Midwives for Education group across the 55 Higher Education Institutions in the United Kingdom which deliver pre-registration midwifery programmes. A questionnaire was circulated and practice tools shared, enabling exploration of the application of the standards and collation of the views of the Lead Midwives. Timing and individuals involved in practice assessment varied as did the components and the credit weighting applied to practice modules. Sign-off mentor confidence in awarding a range of grades had increased over time, and mentors seemed positive about the value given to practice and their role as professional gatekeepers. Grading was generally felt to be more robust and meaningful than pass/refer. It also appeared that practice grading may contribute to an enhanced student academic profile. A set of guiding principles is being developed with the purpose of enhancing consistency of the application of the professional standards across the United Kingdom.

Humanising midwifery care.

Since the publication of the Francis Report (2013), providing care that is kind and compassionate is high on the agenda of all NHS services, including maternity. This article introduces the humanising values framework that explores aspects of what it is to be human and offers practical examples of how it can be incorporated into midwifery care. Susan Way and Janet Scammell consider the advantages of woman-centred care, highlighting the benefits of humanising care.

Parent Reports of Exclusive Breastfeeding After Attending a Combined Midwifery and Chiropractic Feeding Clinic in the United Kingdom: A Cross-Sectional Service Evaluation.

This service evaluation investigated an interdisciplinary allied professional health care strategy to address the problem of suboptimal breastfeeding. A clinic of midwives and chiropractors was developed in a university-affiliated clinic in the United Kingdom to care for suboptimal feeding through a multidisciplinary approach. No studies have previously investigated the effect of such an approach. The aim was to assess any impact to the breastfeeding dyad and maternal satisfaction after attending the multidisciplinary clinic through a service evaluation. Eighty-five initial questionnaires were completed and 72 (85%) follow-up questionnaires were returned. On follow-up, 93% of mothers reported an improvement in feeding as well as satisfaction with the care provided. Prior to treatment, 26% of the infants were exclusively breastfed. At the follow-up survey, 86% of mothers reported exclusive breastfeeding. The relative risk ratio for exclusive breastfeeding after attending the multidisciplinary clinic was 3.6 (95% confidence interval = 2.4-5.4).

Midwives making a difference: a conference organised by and for student midwives.

The midwifery council at Bournemouth University, each year, is set the objective to organise and deliver a conference for student midwives. It is a very lengthy task that requires a lot of dedication from the students who make up the council; they work tirelessly to arrange speakers for the day. Previous speakers at the conferences have included Michel Odent, Milli Hill and representatives from charities. Although time consuming, the day is highly valued by the students and it equips each council member with organisational, public-speaking and time-management skills that are essential for midwifery practice today.

Would a student midwife run postnatal clinic make a valuable addition to midwifery education in the UK?--a systematic review.

BACKGROUND: There is growing evidence in the UK that some National Health Service improvements, particularly in the postnatal period, are having an impact on the quality and variety of student midwives' clinical experiences, making it challenging for them to meet the standards set by the regulatory body for midwives and receive a licence to practice. A possible solution to this may be the introduction of a Student Midwife integrated Learning Environment (SMiLE) focusing upon the delivery of postnatal care (PN) through a student run clinic. OBJECTIVE: To identify the current state of knowledge, regarding the educational outcomes of students who engage with student run clinics (SRC) and the satisfaction of clients who attend them. Search strategy--BNI, CINAHL, EMBASE, and MEDLINE were searched for articles published until April 2014. SELECTION CRITERIA: Studies, nationally and internationally, were carried out on healthcare students running their own clinics. Outcome measures were the evaluation of educational outcomes of students and client satisfaction were included. DATA COLLECTION AND ANALYSIS: Data were extracted, analysed and synthesised to produce a summary of knowledge, regarding the effectiveness of SRCs. MAIN RESULTS: 6 studies were selected for this review. AUTHORS' CONCLUSIONS: The findings that SRC can offer advantages in improving educational outcomes of students and provide an effective service to clients are encouraging. However, given the limited number of high-quality studies included in this review, further research is required to investigate the effectiveness of SRC.

A qualitative study exploring women's personal experiences of their perineum after childbirth: expectations, reality and returning to normality.

OBJECTIVE: to explore the feelings, perceptions and experiences of women in relation to their perineum following childbirth in the early postnatal period. DESIGN: a qualitative study using grounded theory. Data were collected using diaries and interviews and analysed using constant comparative method. SETTING: hospital and community setting in the South of England. PARTICIPANTS: women (n=11) aged 20-42 years who had a vaginal birth. FINDINGS: one core category, 'Striving for normality' and five major categories emerged: (1) 'preparing for the unknown', (2) 'experiencing the unexpected', (3) 'adjusting to reality', (4) 'getting back to normal' and (5) 'recovery of self'. 'Striving for normality' was where women wanted to be able to do normal things and feel like their normal selves soon after the birth of their baby. Much of what the women described doing during the early postnatal period was related to achieving this goal. KEY CONCLUSIONS: the initial impact of childbirth on the perineum and surrounding area meant that in the first few postnatal days women largely concentrated on managing the effects of this. The impact however, went beyond the immediacy of coping with bodily functions extending into other daily activities in terms of managing and completing them. Examples of daily living activities in this context include bathing, eating, walking as well as completing household chores. Returning to normal following childbirth is significant for women and successfully achieving daily living activities is part of this process. However, women in this study seemed unprepared for the reality of this experience. IMPLICATIONS FOR PRACTICE: women may be poorly prepared for the impact that perineal pain and discomfort can have on their lives especially related to successfully completing daily living activities in the early postnatal period. Consideration should be given to finding different ways of communicating the impact to women such as in the early postnatal period, rather than during pregnancy. The underpinning philosophy of care for the postnatal period should encapsulate a holistic approach, where physical symptoms of perineal pain and discomfort experienced by women are not tackled in isolation from any psychosocial impact this may also have.