Midwifery educators' knowledge of antenatal exercises in selected Nigerian midwifery schools.

BACKGROUND:  Exercise during pregnancy is beneficial to both the pregnant woman and the foetus. Midwifery educators play a crucial role in ensuring that midwifery students receive the knowledge and training needed to demonstrate antenatal exercises. To ensure that their students understand and deliver adequate antenatal care, midwifery educators should be highly knowledgeable in pregnancy-related exercises. OBJECTIVES:  The study was conducted to determine the knowledge of midwifery educators about antenatal exercise. METHOD:  A descriptive cross-sectional study was conducted of the knowledge about antenatal exercises by midwifery educators. A purposive total population of 54 midwifery educators from three midwifery schools in Cross River State, Nigeria, was included in the study. Questionnaires were used for data collection, and Statistical Package for Social Sciences (SPSS) version 27 was used for data analysis. Ethical issues and rigour were maintained. RESULTS:  The study revealed that antenatal exercises are included in the midwifery curriculum and exercise demonstration were mainly done by midwifery educators and clinical instructors. The majority (n = 34, 66.7%) of the respondents were knowledgeable about World Health Organization (WHO) guidelines for exercise during pregnancy and had an average knowledge of the ideal antenatal exercises. CONCLUSION:  Midwifery educators have average knowledge of the ideal antenatal exercises, which prompts the development of an exercise programme to guide midwifery training and practice. Midwifery educators should collaborate with exercise specialists to teach and demonstrate antenatal exercises.Contribution: The study highlighted the need for midwifery educators to obtain more information on antenatal exercises to adequately prepare midwifery students for evidence-based exercise care for pregnant women.

Enhancing the competencies of obstetrical nurses and midwives in high-risk pregnancy management through simulation-based training in Lao people's democratic republic: A pilot study.

BACKGROUND: Simulation-based training has been widely used as a valuable strategy for learning and evaluating clinical skills at different levels of nursing and midwifery education. The impact of simulation training on intensive management for high-risk pregnancy in a low-resource setting has been limited. AIM: To examine the effect of simulation-based training with low-fidelity mannequins on obstetrical nurses and midwives' knowledge, attitude, and skills for high-risk pregnancy management in a low-resource setting. METHOD: During September 2023, twenty-five obstetrical nurses or midwives who worked in five tertiary public hospitals in Vientiane Prefecture participated in the three-day training workshops for intensive management in high-risk pregnant women and newborns that used a simulation-based training approach integrating problem-based learning. The evaluated criteria of knowledge, attitudes, and skills pre- and post-test scores were statistically compared. FINDINGS: Workshop trainees demonstrated an increase significantly in knowledge for high-risk pregnancy management (p = 0.012), attitude toward high-risk pregnancy management (p = 0.000), and attitude toward simulation-based training design (p = 0.002). The clinical skills were used on the simulation performance checklist, and the pre-posttest gain in overall performance scores had a statistically significant difference (p = 0.000). The mean score of postpartum hemorrhage management skills was 11.48±2.23, which increased the highest score among all skills. CONCLUSIONS: The simulation-based training in high-risk pregnancy management improves the knowledge, attitude, and skills of nurses and midwives in low-resource settings. Next steps include direct observation of trainees in the clinical setting to assess their competence in ensuring patient safety, achieving positive pregnancy outcomes, and enhancing satisfaction.

National Nursing and Midwifery Commission Act, 2023 in India: Issues and the Way Forward.

With the recent enactment of the National Nursing and Midwifery Commission (NNMC) Act, 2023, significant changes are anticipated in the scope of practice and autonomy for registered nurses and midwives in India. However, alongside these anticipated advancements, concerns have emerged regarding various aspects of the Act, necessitating critical examination. In this article, we aim to explore expected changes in nursing education and service and concerns about the NNMC Act, providing insights into the implications of the NNMC Act on the regulation and advancement of the nursing and midwifery profession in India. The Act is anticipated to introduce uniform standards, implement entry and exit examinations, recognize midwifery as a distinct discipline, and determine the scope of practice for nurses and midwives. Moreover, the implementation of the Nurse Practitioner Program and guidelines for its limited prescribing authority is anticipated. Concerns exist regarding the composition of the commission and board members, adequate stakeholder representation, lacking provisions for ensuring continued competence, working conditions of nurses and midwives, nomenclature, integrating new terms, and clearly defining roles. These concerns emphasize the need for viable career pathways, uniform cadres, and a streamlined registration system, crucial for advancing nursing and midwifery profession in India. The coexistence of concerns and anticipation highlights the complexity of enacting regulatory reforms in nursing and midwifery. Policymakers can lay the foundation for a comprehensive, inclusive regulatory system that promotes excellence in nursing and midwifery practice, ultimately benefiting both healthcare providers and patients.

Development of a Quality Assurance Assessment Tool to meet accreditation standards for midwifery education: A Delphi study.

BACKGROUND: Ensuring the quality of midwifery education is critical for producing a qualified and competent midwifery workforce for sexual, reproductive, maternal, and newborn care services. While global standards advocate for quality enhancement and accreditation systems, challenges persist, particularly in low-income countries like Bangladesh. AIM: To validate and culturally adapt a Quality Assurance Assessment tool aligned with global midwifery education standards for application in Bangladesh. The goal of the tool is to guide and assess an internal quality education assurance process tailored to meet the national accreditation standards. METHODS: A modified Delphi technique was conducted with a panel of 55 experts, including educators, principals, and researchers from Bangladesh, India, and Sweden. The study underwent three rounds: tool development, field testing, and consensus building. RESULTS: The first round was completed by 25 workshop panel members, the second was completed by 30 participants during field testing, and the third was completed by the 25 workshop panel members from the first round. The developed Quality Assurance Assessment Tool demonstrated face and content validity through expert consultation and field testing, aligning with both global education and national accreditation standards. Minor revisions enhanced clarity and feasibility. CONCLUSION: The Delphi rounds resulted in a validated Quality Assurance Assessment Tool that offers a robust framework for assessing and enhancing midwifery education quality, aiding progress towards meeting national accreditation standards. This study provides a valuable resource for countries seeking to develop similar tools aligned with global and national education priorities.

Endorsed midwife prescribing in Australia: "[For] the women, more than anything".

PROBLEM: Prescribing by Endorsed Midwives has existed in Australia for more than ten years. Significant barriers exist in the bureaucracy surrounding prescribing and state and territory legislation which further constrain midwives capacity to prescribe required medications. BACKGROUND: Current evidence indicates Endorsed Midwives improve timely access to medications and can experience both enablers and barriers to prescribing. AIM: To explore Endorsed Midwives' lived experiences of medication prescribing, including which medications are being prescribed, how this affects the women in their care, midwives' practice, and perspectives on the future of midwifery prescribing. METHODS: A descriptive qualitative approach was used. Data collection occurred through semi-structured interviews (n=10) of Endorsed Midwives from varied Australian practice contexts and locations. Data analysis followed Reflexive Thematic Analysis. FINDINGS: Four themes were developed: Medication prescription as essential healthcare; Prescribing optimises midwifery practice; External structures can both promote and inhibit the capacity to prescribe; The future of prescribing. DISCUSSION: Endorsed Midwife prescribing has the potential to positively impact women's maternity care and enable midwives to fulfil their scope of practice. However, limitations to prescribing need to be addressed to capitalise on these benefits. CONCLUSION: Significant reform of health service policy, state and territory legislation and further development of the Pharmaceutical Benefits Scheme are required to fully embrace and capitalise on the full scope of Endorsed Midwives in the Australian Healthcare system.

"A safe space"; A statewide evaluation of Midwifery Antenatal and Postnatal Service (MAPS) using the quality maternal newborn care, evidence informed framework.

BACKGROUND: The World Health Organization recommends Midwifery Continuity of Care (MCoC) due to the consistent improvements in outcomes for mothers and babies. Surveys from the United Kingdom and Australia reported large numbers of midwives are unable to commit to the on call component required to provide MCoC across the continuum. To address this challenge a modified MCoC model called Midwifery Antenatal and Postnatal Services (MAPS) has been introduced. The aim of this study was to evaluate MAPS services in six sites across one State in Australia. METHODS: A multi-site qualitative descriptive study was undertaken framed by the Quality Maternal Newborn Care (QMNC) Framework. The QMNC framework was used to develop focus group questions for data collection, and as a lens for analysing data. Data were collected via focus groups from midwives and women at six sites ranging from metropolitan to regional and rural settings and thematically analysed. FINDINGS: Participants (n=80) included women (n=28), midwives (n=44) and MAPS managers (n=8). This paper reports the findings from the women and midwives, presented under three themes: Getting onto the program, Knowing the story and Building confidence by sharing information. Each theme had subthemes and the findings were aligned either positively or negatively with the QMNC framework. CONCLUSION: This study found the MAPS model aligns in positive ways with the QMNC quality care framework with some recommendations to improve quality care. Midwives want to provide continuity of care and MAPS is a useful model for providing continuity through the antenatal and postnatal periods.

Education of postpartum hemorrhage management clinical skills among midwifery students in Malawi: A qualitative study.

BACKGROUND: Unskilled health professionals in healthcare systems are contributing to the high numbers of maternal mortality in Malawi. It is therefore essential that midwifery students acquire postpartum hemorrhage management clinical skills, especially in view of high maternal mortality, with postpartum hemorrhage being the leading cause. However, there is limited evidence on how the teaching is conducted with regard to students' learning of postpartum hemorrhage management clinical skills. PURPOSE: This study aimed to describe the current teaching of postpartum hemorrhage management clinical skills in undergraduate nursing and midwifery program in Malawi. METHODS: The study applied a qualitative exploratory descriptive design. Data were collected through ten individual interviews with lecturers and three focus group discussions with twenty-four students in a midwifery education program in Malawi. The data were analyzed using thematic analysis. RESULTS: Two themes emerged from the data analysis: (1) there are various teaching and learning approaches for postpartum hemorrhage management in use and (2) unpreparedness of midwifery students in postpartum hemorrhage management for patient care. CONCLUSION: The present study demonstrated that teaching of postpartum hemorrhage management clinical skills in an undergraduate nursing and midwifery programme in Malawi focuses on theoretical knowledge rather than practical skills, leaving midwifery students unprepared for postpartum hemorrhage management during clinical practice. The findings from the present study may provide knowledge guiding revision of the curriculum for the undergraduate nursing and midwifery programme in Malawi to consider global standards of midwifery education; enhance the lecturer to student ratio to provide the students with appropriate supervision; and to employ innovative teaching and learning strategies that promote peer education and skills practice among midwifery students. In addition, to conduct more research related to various teaching approaches in nursing and midwifery educational programs and among qualified midwives in Malawi. STATEMENT OF SIGNIFICANCE: Postpartum hemorrhage management education in undergraduate nursing and midwifery programme in Malawi focuses more on theory than clinical skills. Improving midwifery students' acquisition of postpartum hemorrhage management clinical skills is needed to ultimately help lower Malawi's maternal mortality ratio.

Complexities of midwifery care delivered to perinatal women in prison: A qualitative study.

PURPOSE: To provide insight into the challenges faced by imprisoned perinatal women in accessing appropriate information, support, and care and the importance of the midwife's role in this context. METHOD: This paper draws on two studies conducted in one United Kingdom (UK) women's prison over two separate time points (2019, 2021). In both qualitative evaluative studies that were descriptive in nature, semi-structured interviews were conducted with perinatal women and professionals involved in their care. PARTICIPANTS: 17 women participated across the two qualitative studies, six were pregnant, nine were on the Mother and Baby Unit (MBU) and two had given birth in the last 12 months but were not on the MBU. 12 professionals participated across the two studies. RESULTS: The studies highlight the specific challenges that perinatal women in prison face compared to their community counterparts in being able to access reliable information on pregnancy, birth, and parenting; having access to appropriate and reliable peer support and mental health support not only in terms of provision but also in terms of accessibility; and in being able to advocate for themselves or having people that can advocate for them. CONCLUSION: These challenges arguably heighten the importance of, as well as the pressure on the midwife in this context. The authors therefore highlight the need for consideration of three factors for midwifery in this context: (1) Resourcing (2) Information provision to, and information sharing between, midwives to increase awareness of challenges faced by this cohort, and (3) Strengthening the midwife's position to support and advocate for women's perinatal mental health in prison.

Midwifery hurdles: Navigating tuberculosis screening challenges in South Africa.

BACKGROUND:  In South Africa, screening for tuberculosis during pregnancy is a serious challenge. Tuberculosis is one of the leading indirect causes of mortality in pregnant women. OBJECTIVES:  The objective of the study was to explore the challenges experienced by midwives regarding tuberculosis in pregnant women. METHOD:  A qualitative exploratory research method was used to conduct the study. The study population comprised midwives who worked at primary healthcare clinics in the selected local area, Capricorn District, Limpopo province. Purposive non-probability sampling was used to select 10 participants. Data from participants were acquired using in-depth individual semi-structured interviews. Data analysis was carried out using manual thematic analysis following Tesch's technique. RESULTS:  The outcomes of this study included midwives knowing their roles regarding tuberculosis screening among pregnant women. They further highlighted their challenges while screening tuberculosis in pregnant women, such as shortage of screening tools, withholding of tuberculosis information, and language barrier. CONCLUSION:  Midwives should have the necessary equipment and be trained in various languages used in the province to improve tuberculosis screening among all pregnant women.Contribution: Infected pregnant women and their unborn children's health can be improved by tuberculosis screening.

Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model: A Sequential Explanatory Mixed-Methods Study.

BACKGROUND: In recent decades, medical supervision of the labor and delivery process has expanded beyond its boundaries to the extent that in many settings, childbirth has become a medical event. This situation has influenced midwifery care. One of the significant barriers to midwives providing care to pregnant women is the medicalization of childbirth. So far, the policies and programs of the Ministry of Health to reduce medical interventions and cesarean section rates have not been successful. Therefore, the current study aims to be conducted with the purpose of "Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model". METHODS/DESIGN: The current study is a mixed-methods sequential explanatory design by using the MAP-IT model includes 5 steps: Mobilize, Assess, Plan, Implement, and Track, providing a framework for planning and evaluating public health interventions in a community. It will be implemented in three stages: The first phase of the research will be a cross-sectional descriptive study to determine the attitudes and preferences towards establishing a midwifery-led birthing center focusing on midwives and women of childbearing age by using two researcher-made questionnaires to assess the participants' attitudes and preferences toward establishing a midwifery-led birthing center. Subsequently, extreme cases will be selected based on the participants' average attitude scores toward establishing a midwifery-led birthing center in the quantitative section. In the second stage of the study, qualitative in-depth interviews will be conducted with the identified extreme cases from the first quantitative phase and other stakeholders (the first and second steps of the MAP-IT model, namely identifying and forming a stakeholder coalition, and assessing community resources and real needs). In this stage, the conventional qualitative content analysis approach will be used. Subsequently, based on the quantitative and qualitative data obtained up to this stage, a midwifery-led birthing center program based on the third step of the MAP-IT model, namely Plan, will be developed and validated using the Delphi method. DISCUSSION: This is the first study that uses a mixed-method approach for designing a midwife-led maternity care program based on the MAP-IT model. This study will fill the research gap in the field of improving midwife-led maternity care and designing a program based on the needs of a large group of pregnant mothers. We hope this program facilitates improved eligibility of midwifery to continue care to manage and improve their health easily and affordably. ETHICAL CODE: IR.MUMS.NURSE.REC. 1403. 014.

In recent decades, medical management of the labor and delivery process has extended beyond its limitations to the extent that in many settings, childbirth has become a medical event. This situation has influenced midwifery care. The global midwifery situation indicates that one in every five women worldwide gives birth without the support of a skilled attendant. One of the significant barriers to midwives providing care to pregnant women is the medicalization of childbirth. In industrialized countries, maternal and infant mortality rates have decreased over the past 60 years due to medical or social reasons. So far, the policies and programs of the Ministry of Health to diminish medical interventions and cesarean section rates have not been successful. Midwifery models in hospital care contain midwives who support women's choices and diverse ideas about childbirth on the one hand, and on the other hand, they must adhere to organizational guidelines as employees, primarily based on a medical and pathological approach rather than a health-oriented and midwifery perspective. Therefore, the current study aims to be conducted with the purpose of "Designing a midwifery-led birth centered maternity program based on the MAP-IT model". It is a Model for Implementing Healthy People 2030, (Mobilize, Assess, Plan, Implement, Track), a step-by-step method for creating healthy communities. Using MAP-IT can help public health professionals and community changemakers implement a plan that is tailored to a community's needs and assets.

FIGO good practice recommendations on optimizing models of care for the prevention and mitigation of preterm birth.

The global challenge of preterm birth persists with little or no progress being made to reduce its prevalence or mitigate its consequences, especially in low-resource settings where health systems are less well developed. Improved delivery of respectful person-centered care employing effective care models delivered by skilled healthcare professionals is essential for addressing these needs. These FIGO good practice recommendations provide an overview of the evidence regarding the effectiveness of the various care models for preventing and managing preterm birth across global contexts. We also highlight that continuity of care within existing, context-appropriate care models (such as midwifery-led care and group care), in primary as well as secondary care, is pivotal to delivering high quality care across the pregnancy continuum-prior to conception, through pregnancy and birth, and preparation for a subsequent pregnancy-to improve care to prevent and manage preterm birth.

Examining the validity and reliability of the COMcareSS (Continuity of Midwifery Care Satisfaction Survey).

BACKGROUND: Continuity of midwifery care has been proven to show an improvement in clinical outcomes for women and greater maternal satisfaction with maternity care. Several questionnaires have been developed to measure satisfaction with maternity services although few are suitable for continuity of midwifery maternity care models, and many have not been validated. AIMS: The purpose of this study was to test the reliability and validity of the newly developed Continuity of Midwifery Care Satisfaction Survey (COMcareSS) with a cohort of women who have recently experienced continuity of midwifery care. METHODS: The COMcareSS was distributed to women in Australia who had experienced a live birth within a continuity model of midwifery care and were up to two months postpartum. Factor analysis was conducted, and Cronbach's alpha coefficient calculated for the 34-item scale. FINDINGS: In total 272 completed responses were recorded. Cronbach's alpha coefficient for the scale was 0.96 suggesting some redundancy in items. There was a lack of variation in responses. In factor analysis, only one factor could feasibly be attempted. This accounted for 76 % of variation in responses. CONCLUSION: The COMcareSS scale is the first to be developed to measure maternal satisfaction with continuity of midwifery led care. The 34-item scale has good internal consistency. The scale may be unidimensional though the lack of variation in responses means that other possible latent constructs, were not able to be detected. Use of a standardised scale such as the COMcareSS will facilitate benchmarking between services and, comparison and meta-analysis in research studies.

Impact of the Nursing and Midwifery Council (2018) future nurse: Standards of proficiency for registered nurses on children's nursing curriculum - A cross-sectional study.

BACKGROUND: Student nurses in the United Kingdom undertake field-specific pre-registration education. The implementation of the Nursing and Midwifery Council (2018) Future nurse: Standards of proficiency for registered nurses, has raised concerns that the increasingly generic component of pre-registration programmes is not adequately preparing newly qualified children's nurses to care for children safely. OBJECTIVE: To investigate how the introduction of the Nursing and Midwifery Council standards in the United Kingdom has impacted the structure and field specific content of pre-registration children's nursing programmes. SETTINGS: An online survey completed by 54 programmes, field, or professional leads linked to 76 pre-registration children's nursing programmes. This represents 80 % of higher education institutions with Nursing and Midwifery Council approved pre-registration children's nursing programmes across all four United Kingdom countries. METHODS: A survey to capture the current content and changes to curricula since the introduction of the Nursing and Midwifery Council (2018) Future nurse standards. The survey included closed-ended and open-ended questions. Closed-ended questions were statistically analysed using SPSS v.28 for Windows. Open-ended questions were thematically analysed using Quircos v.2.1. RESULTS: 50 % of respondents reported changes to theoretical content. In 27 programmes (35.5 %) there was a decrease in child-specific content. Child specific teaching methods accounted for less than 30 % of the content of all programmes whereas cross-field teaching methods (Adult, Mental Health, Learning Disability and Child learners together) accounted for over 70 % of the taught content. Analysis of qualitative data identified three themes: genericism as the focus, the challenge to achieve the standards' proficiencies, and dilution of child specific content. CONCLUSIONS: The survey responses show disparities in how United Kingdom higher education institutions have interpreted the Nursing and Midwifery Council standards highlighting academics concerns on the growing genericism within pre-registration children's nurse education nationally. These findings will inform the next stage of the project comparing the impact of greater or lesser degrees of genericism on the outcomes of the programme for newly qualified children's nurses.

Midwife-led obstetric triage to increase providers' knowledge and improve timeliness of care: A pre and posttest design.

BACKGROUND: Research in low- and middle-income countries has shown that maternal mortality is directly related to inadequate or absent obstetric (OB) triage systems. Standard triage systems and knowledge on triaging for obstetric emergencies are often absent or lacking in most healthcare systems in Liberia. OBJECTIVE: The objective of this research was to address the third delay defined as receiving adequate, quality care when a facility is reached by increasing knowledge through the establishment of a midwife-led, hospital-based OB triage system to stratify care based on risk and imminence of birth and to improve timely assessment at two district referral hospitals. METHODS: A quasi-experimental study design using a pre/post survey was employed for a midwife-led OB triage training course. Using a train-the-trainer model, five midwives were trained as champions, who in turn trained an additional 62 providers. Test results were analyzed with the R statistical software using paired sample t-test and descriptive statistics. RESULTS: Pretest results revealed a knowledge and practice gap among OB providers on key components of the standard triage package. However, post-test mean scores were significantly higher (M = 79.6, SD = 2.32) than pre-test mean scores (M = 59.0, SD = 2.30) for participants following a 2-day training (p = <0.001). DISCUSSION: Following a structured OB triage training, participants showed significant improvement in post-test OB triage scores. CONCLUSION: Standard OB triage protocols incorporated into the policies and procedures of obstetric wards have the potential to improve knowledge and practice, addressing the third delay and reducing preventable, obstetrics-related deaths.

Perceptions of quality of care in Midwife-led Birth Centres (MLBCs) in Uganda: Why do women choose MLBCs over other options?

BACKGROUND: Midwife-led birth centres (MLBCs) are associated with reduced childbirth interventions, higher satisfaction rates, and improved birth outcomes. The evidence on quality of care in MLBCs from low and middle-income countries (LMIC) is limited. AIM: This study aimed to explore the perceptions of women and midwives regarding the quality of care in four MLBCs in Uganda. METHODS: A qualitative study was conducted in four MLBCs in Uganda. We conducted interviews with women and midwives in the MLBCs to explore their perceptions and experiences related to care in the MLBCs. The study obtained ethical approval. Deductive thematic analysis was used for data analysis. RESULTS: Three key themes were identified regarding the perceptions of women and midwives about the quality of care in the MLBCs: providing respectful, and dignified care; a focus on woman-centred care; and reasons for choosing care in the MLBC. Women valued the respectful and humane care characterised by dignified and non-discriminatory care, non-abandonment, privacy, and consented care. The woman-centred care in the MLBC involved individualised holistic care, providing autonomy and empowerment, continuity of care, promoting positive birth experience, confidence in the woman's own abilities, and responsive providers. Women chose MLBCs because the services were perceived to be available, accessible, affordable, with comprehensive and effective referral mechanisms. CONCLUSION: Women perceived care to be respectful, woman-centred, and of good quality. Global attention should be directed to scaling up the establishment of MLBCs, especially in LMIC, to improve the positive childbirth experience and increase access to care.

Assessment of the psychometric properties of the italian version of the midwifery student evaluation of practice (MIDSTEP-IT): A validity and reliability study.

BACKGROUND: Clinical learning is a crucial component of the midwifery education program, necessary to support the acquisition of professional abilities through the integration of theoretical and practical learning experiences. Evaluating Bachelor of Midwifery students' perception of their clinical learning experiences is important to improve midwifery educational programs. AIM: the objective of this study was the translation, cultural adaptation, and validation of the Midwifery Student Evaluation of Practice (MidSTEP) in a group of Italian midwives' students. METHODS: "Translation and Cultural Adaptation of Patient Reported Outcomes Measures - Principles of Good Practice" guidelines were adopted to achieve the MidSTEP Italian version. Exploratory Factor Analysis was performed. Internal consistency for reliability was assessed using Cronbach's alpha reliability coefficient (α) and Omega coefficient (ω), while Intraclass Correlation Coefficients (ICC) were used to determine if the tool was stable over time. FINDINGS: The Italian version of MidSTEP (MidSTEP-IT) has good internal consistency: considering the Clinical Learning Environment Scale, Cronbach's α was 0.839 (for the "Skill Development" subscale α was equal to 0.739 and for the "Philosophy of Midwifery Practice" subscale α was equal to 0.825) while considering the Midwifery Preceptor Scale, Cronbach's α was 0.920. Factor analysis does not fully reflect the factorial analysis of the original version. CONCLUSION: The MidSTEP-IT had been proven to be a valid and reliable tool, easy and fast to administer, that could be effectively helpful for investigating and measuring the Italian midwifery students' perception of their clinical learning experiences, according to the setting and impact of mentors on their professional growth. It is an innovative tool, valuable in both clinical practice and research to highlight the importance of encouraging a supportive clinical learning environment and an efficient preceptorship.

Organization and quality of care in childbirth in private for-profit maternity units in France: Risks of the deprofessionalization of midwives.

OBJECTIVE: In France, in 2007-2009, the risk of peripartum maternal mortality, especially the one due to hemorrhage, was higher in the private for-profit maternity units than in university maternity units. Our research, a component of the MATORG project, aimed to characterize the organization of care around childbirth in these private clinics to analyze how it might influence the quality and safety of care. MATERIAL AND METHODS: We conducted a qualitative survey in 2018 in the maternity units of two private for-profit clinics in the Paris region, interviewing 33 staff members (midwives, obstetricians, anesthesiologists, childcare assistants and managers) and observing in the delivery room for 20 days. The perspective of the sociology of organizations guided our data analysis. FINDINGS/RESULTS: Our study distinguished three principal risk factors for the safety of care in maternity clinics. The division of labor among healthcare professionals threatens the maintenance of midwives' competencies and makes it difficult for these clinics to keep midwives on staff. The mode of remuneration of both midwives and obstetricians incentivizes overwork by both, inducing fatigue and decreasing vigilance. Finally the clinical decision-making of some obstetricians is not collegial and creates conflicts with midwives, who criticize the technicization of childbirth. Some demotivated midwives no longer consider themselves responsible for patients' safety. CONCLUSIONS: The organization of work in private maternity units can put the safety of care around childbirth at risk. The division of labor, staff scheduling/planning, and a lack of collegiality in decision-making increase the risk of deprofessionalizing midwives.