The lived experience of midwives' transitioning from a clinical role into teaching in higher education in one jurisdiction of Australia: A pilot study.

AIM: The aim of this pilot study was to explore clinician's experience of transitioning from midwifery clinical practice into university in an academic teaching role within one jurisdiction in Australia. BACKGROUND: There is a dire shortage of midwifery academics globally. In Australia the shortage is symbiotic with the persistent deficit in the midwifery clinical workforce, which is the predominant recruitment pool for universities. The midwifery workforce cannot be replenished without sufficient academics to provide education. DESIGN: Phenomenology was selected as the most appropriate research approach for the study seeking to illuminate the lived experiences of clinicians as they transition into their new role as academics. METHODS: Seven participants were recruited purposively from one jurisdiction in Australia between November 2022 and March 2023. Qualitative conversational interviews were performed facilitating each participant to share their narrative. Participants were then able to direct the conversation to share their lived experience of the transition from a midwifery clinician in practice to a midwifery academic in a university. Demographic details were collected for context. RESULTS: Thematic analysis was used following Giorgi's four stage phenomenological process. Four themes were identified from commonalities between the participants, 'Being a drifter", 'Keeping a foot in both camps to maintain clinical credibility', 'In at the deep end: Not prepared for the reality of academia' and 'Best of both worlds'. CONCLUSIONS: The lived experiences of the participants in this study, as they transitioned from clinical midwifery practice to academia can be related to the Theory of Transition where participants navigate: Preparation, Encounter, Adjustment and Stabilisation. A new role in higher education requires adjustment to the reality of working in academia. Midwives who had experiences of being a casual staff member felt they had the best of both worlds, as they gained an insight into the role of an academic whilst remaining in clinical practice. However, many reported that mentorship would have been beneficial to facilitate stabilisation.

A survey of students' experiences of returning to midwifery studies after maternity leave: A pilot survey.

AIM: To identify the barriers and facilitators having an impact on the progression and completion of studies for students who give birth during their midwifery program. BACKGROUND: Balancing the demands of pregnancy and new motherhood with the rigorous academic requirements of a tertiary-level midwifery program is challenging for students wishing to progress and complete their studies. Understanding the barriers and facilitators students face when resuming midwifery studies following birth can assist universities in providing educational environments that support students in achieving their midwifery education. DESIGN: Social media online Qualtrics survey with closed and open questions. METHOD: Participants were Australian midwifery students who gave birth and returned to their midwifery studies within the past 5 years. Responses from 35 students were descriptively analysed. RESULTS: For students who commenced pregnancy during their midwifery degree, 40 % chose to take leave from their studies at term (37-40 weeks gestation) or continue their studies without leave. Almost half of the students (n=17) chose to return to their studies before six weeks post birth (68 % (n=24) opting for a part-time pathway). Most of the childcare was undertaken by the student's partner (n=9) or other family members (n=8). Work integrated learning, rostering of shifts and being on call for Continuity of Care Experience relationships accounted for the most significant number (n=19) of responses when identifying barriers to resuming midwifery studies. CONCLUSIONS: The greatest barrier for students is work integrated learning while juggling the transition to parenthood. Universities must work closely with maternity services to support students in completing their studies.

An analysis of legislation and policies that guide maternity leave decision making in Australian midwifery students.

Objective There are no guidelines to assist midwifery academics or students in determining the optimal time to return to their educational programs following pregnancy. Rather, students need to navigate balancing new motherhood with the pressures of returning to their clinical midwifery placement and completing their statutory requirements to meet the Australian Midwife Accreditation Standards before the end of their program. The aim of this study was to seek best practice information that provides guidance to academics supporting midwifery students returning to study after maternity leave. Methods An analysis of contemporary Australian legislation, workforce guidelines, professional association statements, and university policies was undertaken to determine what guidance is available to assist midwifery academics in providing advice to midwifery students about the optimal time to return to their studies following birth. This document analysis was performed during 2021-2022 and followed Altheide and Schneider's 12 step process divided into five stages to clarify best practice advice for midwifery academics to provide guidance to students returning to study after maternity leave. Results Policy documents that refer to pregnancy confirm women have legal rights, and there is clear guidance on maternity leave; however, advice for midwifery students on the optimum time to return to study and clinical placements after birth is missing from the result of this document analysis search. Conclusion Transition to motherhood during the postnatal period is an important time. Clear national guidelines are needed to provide support and recommendations regarding a safe and optimal time to return to study and placement.

The impact of abortion doulas on women and providers' outcomes: An integrative review of the evidence.

The aim of this integrative review is to map the literature on the impact of abortion doulas on women and abortion care providers. This review followed a modified Whittemore and Knafl framework and PRISMA guidelines. Electronic databases (Medline, PubMed, CINAHL, the Cochrane Library, Scopus, Proquest, EMBASE, and PsycINFO) were searched using key terms: abortion and doula. Search was limited by date (2012-2022), type (primary research only), and language (English only). Of the 99 papers found, only 4 met inclusion criteria. The four papers - drawn from 2 studies - were analysed using NICE Appraisal checklists. In total, data from 328 participants (n = 314 women, n = 5 physicians, n = 5 staff members, n = 4 abortion doulas) was analysed. Of the 314 women, 160 women received doula support and 154 did not. Two qualitative papers showed women and abortion providers reported a beneficial impact of abortion doulas, but the two quantitative (RCTs) papers showed null impact for a doula support intervention vs. usual care on women's physical and psychological outcomes. Women reported wanting support during the abortion; however, the evidence is not yet clear on whether a doula is required to address this need for women undergoing a surgical abortion in clinic. It may be that abortion support is important in ways that are difficult to measure.

How do nurses use early warning system vital signs observation charts in rural, remote and regional health care facilities: A scoping review.

INTRODUCTION: Physiological signs of clinical deterioration are known to occur in the hours preceding a serious adverse event. As a result, track and trigger systems known as early warning systems (EWS) were introduced and routinely implemented as patient observation tools to trigger an alert in the presence of abnormal vital signs. OBJECTIVE: The objective aimed to explore the literature pertaining to EWS and their utilisation in rural, remote and regional health care facilities. DESIGN: The Arksey and O'Malley's methodological framework was used to guide the scoping review. Only studies reporting on rural, remote and regional health care settings were included. All four authors participated in the screening, data extraction and analysis process. FINDINGS: Our search strategy yielded 3869 peer-reviewed articles published between 2012 and 2022, with six studies ultimately included. Collectively, the studies included in this scoping review examined the complex interaction between patient vital signs observation charts and recognition of patient deterioration. DISCUSSION: Whilst rural, remote and regional clinicians use EWS to recognise and respond to clinical deterioration, noncompliance dilutes the tool's effectiveness. This overarching finding is informed by three contributing factors: documentation, communication and challenges specific to the rural context. CONCLUSION: The success of EWS relies on accurate documentation and effective communication within the interdisciplinary team to support appropriate responses to clinical patient decline. More research is required to understand the nuances and complexities of rural and remote nursing and to address challenges associated with the use of EWS in rural health care settings.

Midwives' recognition and response to maternal deterioration: A national cross-sectional study.

BACKGROUND: Early warning systems (EWS) are used across health care settings as a tool for the early identification of clinical deterioration and to determine the need to escalate care. Early detection of clinical deterioration and appropriate escalation of care in maternity settings is critical to the safety of pregnant women and infants; however, underutilization of EWS tools and reluctance to escalate care have been consistently reported. Little is known about midwives' use of EWS in the Australian context. METHODS: Using a cross-sectional approach, we elicited the attitudes, beliefs, and behaviors of a purposive sample of Australian midwives (n = 87) with respect to the Maternal Early Warning Trigger Tool (MEWT). Participants answered a 25-question Likert scale survey and one open-ended question. Qualitative answers were analyzed using consensus coding. RESULTS: Midwives reported positive attitudes toward the MEWT, describing it as a valuable tool for identifying clinical deterioration, especially when used as an adjunct to clinical judgment. However, midwives also identified training gaps; 25% had received no training, and only half of those who had received training felt it was effective. In addition, professional tension can create a significant barrier to the effective use of the MEWT. Midwives also reported feeling influenced by their peers in their decision-making with respect to use of the MEWT and being afraid they would be chastised for escalating care unnecessarily. CONCLUSIONS: Although the MEWT is valued by Australian midwives as a useful tool, barriers exist to its effective use. These include a lack of adequate, ongoing training and professional tension. Improving interdisciplinary collaboration could enhance the use of this tool for the safety of birthing women and their infants.

Two parts of an indivisible whole - Midwifery education and feminism: An exploratory study of 1st year students' immersion into midwifery.

BACKGROUND: Emancipation and self-determination are critical elements of midwifery care and therefore should be explicit in midwifery education. If not, the woman-centred midwife with her trust in women and birth may become a thing of the past, and the patriarchal, technocratic medical model of maternity care, with its trust in machines and misguided interventions will continue to dominate childbearing practices. The optimal time for exposure to feminist principles within the midwifery educational journey, however, is unknown, despite recognition that teaching feminist theory and related concepts positively impacts the way students value women-centredness in midwifery practice. OBJECTIVE: To understand midwifery student's perspectives of assimilating feminist theory and midwifery philosophy. DESIGN: A qualitative approach using reflective journals was used to explore student midwives understanding of midwifery as a feminist profession. SETTING: One regional Australian University that teaches midwifery at two campuses, one of which straddles a state border. PARTICIPANTS: First session, first-year midwifery students undertaking a unit of study focusing on "what is midwifery" and how at its core, midwifery is a feminist emancipatory political discipline. METHODS: Data from weekly reflective journals were analysed to produce themes. FINDINGS: Three themes were identified 'Midwifery: Past and Present', 'What is this 'F' word? - feminism revisited', and 'Midwifery-feminism dyads'. These themes demonstrated transformative learning had occurred as participants appeared to value understanding feminism as the essence of midwifery philosophy early in their midwifery studies. CONCLUSION: Students embarking on their journey appear to value assimilation of feminist theory as a core tenet of midwifery philosophy. Feminist principles, particularly the protection of women's rights to informed choice, trusted relationships, dignity, and control throughout their childbearing journey appear to illustrate the emancipatory nature, and importance of, truly 'woman-centred, partnership-based midwifery care'. RECOMMENDATIONS FOR PRACTICE AND FURTHER RESEARCH: Whilst the findings of this study relate to midwifery students, the findings point to a need to explore ways to strengthen midwives' assimilation with feminist theory, and their ability to promote feminism and provide woman-centred, partnership-based approaches.

Giving midwives a voice - Qualitative perspectives of an 'empowering decision-making workshop'.

AIM/OBJECTIVE: To establish midwives' perceptions of the value of workshops designed to empower their decision-making and leadership skills using validated midwifery clinical reasoning frameworks and appreciative inquiry methods. BACKGROUND: The medical lens of childbirth can disempower women and midwives. Midwives often face challenges navigating their role as autonomous practitioners and advocates for shared decision-making, particularly when there is tension between women's wishes, governance frameworks and organisational requirements. This can lead to 'Midwifery Abdication' and/or the midwifery voice being silenced. DESIGN/METHODS: Appreciative inquiry, involving qualitative analysis of 31 midwives' personal reflections during 'Empowering Midwives' Decision-Making' workshops. Standards for reporting qualitative research (SRQR criteria) guided the preparation of this manuscript. RESULTS: Decision-making tools and 'appreciative' strategies can strengthen leadership attributes, enhance feelings of empowerment and deepen understanding. Reflecting on 'Midwifery Abdication' was perceived as confronting. Workshop activities offered understanding the reasons why 'Midwifery Abdication' may or may not occur. One overarching, key theme was identified: 'Finding my midwifery voice'. This theme encompassed three sub-themes: 'I am not alone', 'Using leadership to promote collaboration to effect change' and 'An onward journey of enlightenment and empowerment'. CONCLUSION: Midwives need to find their voice and develop skills in both clinical reasoning and transformative reflection. Workshops, using Appreciative Inquiry approaches, that focused on reflection, clinical decision-making and 'Midwifery Abdication', facilitate this and may create feelings of reunification in midwives and rejuvenate inherent passion for the profession. RELEVANCE TO CLINICAL PRACTICE: Sharing feelings around providing care in the often-contested space that is advocating for women using midwifery philosophy may provide relief from moral distress and a sense of shared identity desperately sought after by midwives struggling to navigate the increasingly complex terrain of maternity care. Findings encourage the need for further discussions around strengthening midwifery leadership which may be achievable using Appreciative Inquiry frameworks and approaches.

A scoping review of maternity care providers experience of primary trauma within their childbirthing journey.

OBJECTIVE: To examine and summarise available literature on maternity care practitioners having experienced primary trauma during their childbirthing journey and whether this impacts their mental well-being and/or care provision when subsequently caring for childbearing women. BACKGROUND: Birth trauma affects 1 in 3 women; 1 in 20 women show post-traumatic stress disorder symptoms by 12 weeks after birth. However, what is not known is what percentage of these women are maternity care providers experiencing or having experienced personal trauma during their child birthing journey. This scoping review aims to examine and summarise available literature on maternity care practitioners having experienced primary trauma during their childbirthing journey and whether this impacts their mental well-being and/or care provision when subsequently caring for childbearing women. METHODS: Arksey and O'Malley (2005) six-stage scoping review framework was revised and utilised. A search of the relevant databases (MEDLINE Embase, CINAHL, APA PsycInfo, Scopus) was undertaken with several keywords related to trauma and personal experience. Reference lists were also searched of studies identified for reading the full text. FINDINGS: The search strategy identified 2983 articles. The studies excluded were considered to be unrelated to the topic directly. A total of 352 articles were reviewed by abstract, and 29 additional studies were identified from reference lists; 32 were reviewed by full text. A total of 0 studies met the inclusion criteria for the scoping review. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The scoping review identified a gap in the literature as maternity care practitioners personal experience of trauma during the child birthing journey has not been researched. Research is needed to explore and conceptualise the experiences of maternity care practitioners having experienced trauma and the ongoing implications this may have on their personal and professional lives.

What matters, what is valued and what is important in mentorship through the Appreciative Inquiry process of co-created knowledge.

BACKGROUND: A key element in the provision of safe and competent midwifery care is how learning experiences are construed and translated into practice. This process can be supported through clinical/professional mentoring. What constitutes 'good mentorship' has been the topic of much debate. While research exploring mentorship exists, there is less research exploring co-created perceptions of mentorship by the mentee and mentor. OBJECTIVES: To explore student and registered midwives' co-created perspectives of what matters, what is valued and what is important in mentorship. DESIGN: An adapted Appreciative Inquiry methodology guided this study with thematic analysis used for data analysis. SETTINGS: One regional Australian university. PARTICIPANTS: A convenience sampling, from a population of 39 third-year Bachelor of midwifery students and 39 registered midwives providing clinical supervision for students enrolled in a specific unit of study and concurrently undertaking midwifery practice experience were recruited into this study. METHODS: Following the four-step process of Appreciative Inquiry; Appreciate, Envision, Co-create and Embed, imagery cards were provided, and participants selected the image that resonated with their understanding of mentorship. Shared understandings were cultivated to co-create what worked well and what was valued in facilitating a positive learning experience. RESULTS: Trust developed over time is a valued component of mentorship relationships. Similarly valued is the sense of belonging and feeling safe, elements reliant on the establishment of effective and respectful communication. CONCLUSION: What matters, what is valued and what is important in midwifery mentorship is a mutually respectful relationship between mentee and mentor. This requires time and trust and the creation of a space where the student can develop a sense of professional belonging and feel safe to learn. Further research is needed to explore ways to co-create safe learning environments. Appreciative Inquiry is a method suited to studying this area.

Patient decision aids in clinical practice for people with diabetes: a scoping review.

BACKGROUND: People with diabetes need to make regular choices that influence their long-term morbidity and mortality. Patient decision aids are validated tools and when used collaboratively between healthcare professionals, patients and carers, can help guide value-based discussions which encourage choices that are well informed and personally relevant. OBJECTIVE: To explore the use and effect of patient decision aids in the management of diabetes. METHOD: A scoping review design was used. Medline, ProQuest, PsycINFO, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases were searched for peer-reviewed articles published between January 1998 and December 2018. RESULTS: Patient decision aids are not commonly or widely used in diabetes management. They offer a suitable adjunct to practice within the domains of healthcare knowledge, active participation, and communication, and shared decision-making between patients and healthcare professionals. CONCLUSION: Patient decision aids can offer a simple and easy-to-use method to potentially improve diabetes health literacy, through the process of shared decision-making and two-way conversations. However, there are current limitations on using them to positively influence clinical outcomes or long-term changes in self-care behaviors within the management of diabetes. Further research to explore the validity of using patient decision aids long term in these areas is required.

'A match made in midwifery': Women's perceptions of student midwife partnerships.

PROBLEM: Little is known regarding experiences of childbearing women participating in a Continuity of Care Experience. BACKGROUND: Continuity of Care immersion is considered a vital component of undergraduate education in Australia. A student midwife follows a woman's childbearing journey regardless of the woman's individual needs or chosen model of care. QUESTION: What do women value in their student-woman continuity experience, and does this vary with model of care provision? METHODS: Qualitative analysis was conducted on open-text box responses from 946 mothers enrolled in one regional university Continuity of Care program between 2014-2018. FINDINGS: This qualitative descriptive study identified three overarching themes: 'Known student midwife'; 'Knowledge'; and, 'Professionalism'. The 'Known Student Midwife' was strongly associated with provision of support and advocacy for the woman and her partner/family. Women's responses were overwhelmingly positive, however, when some partnerships terminated, a negative impact was reported. Themes were often interlinked, suggesting when women valued one key attribute the others were somewhat related. Although rare, from some responses it was unclear if students had over-stepped professional boundaries, prompting the need for ongoing education. DISCUSSION: This study provides compelling evidence for the perceived value of the Continuity of Care Experience in Australian midwifery curricula, as well as possible areas of concern regarding the nature of professional behaviour. CONCLUSIONS: Continuity of Care immersion plays a significant role in Australian midwifery education programs and is predominantly well received by childbearing women. Development of reflexive practice skills in undergraduate curricula may further enhance this experience for women.

Nurses and midwives teaching in the academic environment: An appreciative inquiry.

BACKGROUND: The past two decades has seen significant change in nursing and midwifery education in Australia. Although, regulatory documents explicate expectations of teaching, and supervising in the context of being a nurse or midwife, the move from hospital-based to higher education learning nessitated a change in how students receive their education and who provides it. The quality of teaching by nurse or midwife academics is subject to the academic's ability to transition from a clinical educator to academic. OBJECTIVE: To explore the experiences of nurse and midwife academics teaching in the academic environment. DESIGN: Appreciative Inquiry (AI) was used to explore the experiences of academics teaching final year nursing and midwifery students. SETTING: Two regional universities in Australia. PARTICIPANTS: Seven nursing and midwifery academics teaching a unit of study focusing on mentorship, leadership and teaching. METHODS: Narrative data from interviews conducted using AI were collected, transcribed and analysed to produce themes. RESULTS: Three key themes were identified; 'Feeling valued', 'Feeling safe' and 'Having connections'. These themes and related subthemes impacted teaching experiences and role transition from experienced clinician to academic. CONCLUSION: Nursing and midwifery academics would benefit from organisational support in their role transition from clinician to academic. Further research is crucial regarding initiatives that can support academics to feel safe, valued and connected when teaching the next generation of nurses and midwives.

Asking different questions: A call to action for research to improve the quality of care for every woman, every child.

Despite decades of considerable economic investment in improving the health of families and newborns world-wide, aspirations for maternal and newborn health have yet to be attained in many regions. The global turn toward recognizing the importance of positive experiences of pregnancy, intrapartum and postnatal care, and care in the first weeks of life, while continuing to work to minimize adverse outcomes, signals a critical change in the maternal and newborn health care conversation and research prioritization. This paper presents "different research questions" drawing on evidence presented in the 2014 Lancet Series on Midwifery and a research prioritization study conducted with the World Health Organization. The results indicated that future research investment in maternal and newborn health should be on "right care," which is quality care that is tailored to individuals, weighs benefits and harms, is person-centered, works across the whole continuum of care, advances equity, and is informed by evidence, including cost-effectiveness. Three inter-related research themes were identified: examination and implementation of models of care that enhance both well-being and safety; investigating and optimizing physiological, psychological, and social processes in pregnancy, childbirth, and the postnatal period; and development and validation of outcome measures that capture short and longer term well-being. New, transformative research approaches should account for the underlying social and political-economic mechanisms that enhance or constrain the well-being of women, newborns, families, and societies. Investment in research capacity and capability building across all settings is critical, but especially in those countries that bear the greatest burden of poor outcomes. We believe this call to action for investment in the three research priorities identified in this paper has the potential to achieve these benefits and to realize the ambitions of Sustainable Development Goal Three of good health and well-being for all.

Development and validation of the Australian version of the Birth Satisfaction Scale-Revised (BSS-R).

OBJECTIVE AND BACKGROUND: The 10-item Birth Satisfaction Scale-Revised (BSS-R) has recently been endorsed by international expert consensus for global use as the birth satisfaction outcome measure of choice. English-language versions of the tool include validated UK and US versions; however, the instrument has not, to date, been contextualised and validated in an Australian English-language version. The current investigation sought to develop and validate an English-language version of the tool for use within the Australian context. METHODS: A two-stage study. Following review and modification by expert panel, the Australian BSS-R (A-BSS-R) was (Stage 1) evaluated for factor structure, internal consistency, known-groups discriminant validity and divergent validity. Stage 2 directly compared the A-BSS-R data set with the original UK data set to determine the invariance characteristics of the new instrument. Participants were a purposive sample of Australian postnatal women (n = 198). RESULTS: The A-BSS-R offered a good fit to data consistent with the BSS-R tridimensional measurement model and was found to be conceptually and measurement equivalent to the UK version. The A-BSS-R demonstrated excellent known-groups discriminant validity, generally good divergent validity and overall good internal consistency. CONCLUSION: The A-BSS-R represents a robust and valid measure of the birth satisfaction concept suitable for use within Australia and appropriate for application to International comparative studies.

Midwifery abdication - is it acknowledged or discussed within the midwifery literature: An integrative review.

INTRODUCTION: In this review we explore the concept of Midwifery Abdication and whether it is acknowledged or discussed within the midwifery literature. METHODS: A modified Whittemore and Knafl integrative review framework of 2005 enabled consideration of quantitative and qualitative literature. A total of 1508 papers were located. Duplicate records were removed, leaving 1197 records. All titles, abstracts, or case facts were reviewed using a framework derived from the definition of Midwifery Abdication. Three qualitative studies were selected for analysis; the NICE Quality Appraisal Checklist was used to determine study quality. RESULTS: Midwifery Abdication occurs, as reported within the wider midwifery literature, and indicated in three studies from different countries. However, the original constructs need to be widened to include: 'external perceptions of midwifery practice' and 'how can reflection facilitate change'. The extent of philosophy in these environments leads to the adoption of midwifery philosophy failure. Such an environment impacts on a midwife's ability to fully exercise autonomy, and to advocate for normality and women. This renders Midwifery Abdication almost inevitable or at least very difficult to prevent. A midwife's professional identity, environmental hierarchy and associated culture of social obedience, acceptance and finding one's place, all act as influencing factors in abdication. CONCLUSIONS: Midwifery education needs to ensure that midwives are prepared and able to embrace their professional status as independent practitioners. Promotion of reflexive practice to facilitate personal and professional change is warranted. Practice policies that are not supportive of a midwife's professional autonomy and scope of practice reinforce the technocratic work environment.

Determining the psychometric properties of the Enhancing Decision-making Assessment in Midwifery (EDAM) measure in a cross cultural context.

BACKGROUND: The ability to act on and justify clinical decisions as autonomous accountable midwifery practitioners, is encompassed within many international regulatory frameworks, yet decision-making within midwifery is poorly defined. Decision-making theories from medicine and nursing may have something to offer, but fail to take into consideration midwifery context and philosophy and the decisional autonomy of women. Using an underpinning qualitative methodology, a decision-making framework was developed, which identified Good Clinical Reasoning and Good Midwifery Practice as two conditions necessary to facilitate optimal midwifery decision-making during 2nd stage labour. This study aims to confirm the robustness of the framework and describe the development of Enhancing Decision-making Assessment in Midwifery (EDAM) as a measurement tool through testing of its factor structure, validity and reliability. METHOD: A cross-sectional design for instrument development and a 2 (country; Australia/UK) x 2 (Decision-making; optimal/sub-optimal) between-subjects design for instrument evaluation using exploratory and confirmatory factor analysis, internal consistency and known-groups validity. Two 'expert' maternity panels, based in Australia and the UK, comprising of 42 participants assessed 16 midwifery real care episode vignettes using the empirically derived 26 item framework. Each item was answered on a 5 point likert scale based on the level of agreement to which the participant felt each item was present in each of the vignettes. Participants were then asked to rate the overall decision-making (optimal/sub-optimal). FINDINGS: Post factor analysis the framework was reduced to a 19 item EDAM measure, and confirmed as two distinct scales of 'Clinical Reasoning' (CR) and 'Midwifery Practice' (MP). The CR scale comprised of two subscales; 'the clinical reasoning process' and 'integration and intervention'. The MP scale also comprised two subscales; women's relationship with the midwife' and 'general midwifery practice'. CONCLUSION: EDAM would generally appear to be a robust, valid and reliable psychometric instrument for measuring midwifery decision-making, which performs consistently across differing international contexts. The 'women's relationship with midwife' subscale marginally failed to meet the threshold for determining good instrument reliability, which may be due to its brevity. Further research using larger samples and in a wider international context to confirm the veracity of the instrument's measurement properties and its wider global utility, would be advantageous.

Midwives׳ clinical reasoning during second stage labour: Report on an interpretive study.

BACKGROUND: clinical reasoning was once thought to be the exclusive domain of medicine - setting it apart from 'non-scientific' occupations like midwifery. Poor assessment, clinical reasoning and decision-making skills are well known contributors to adverse outcomes in maternity care. Midwifery decision-making models share a common deficit: they are insufficiently detailed to guide reasoning processes for midwives in practice. For these reasons we wanted to explore if midwives actively engaged in clinical reasoning processes within their clinical practice and if so to what extent. The study was conducted using post structural, feminist methodology. QUESTION: to what extent do midwives engage in clinical reasoning processes when making decisions in the second stage labour? METHODS: twenty-six practising midwives were interviewed. Feminist interpretive analysis was conducted by two researchers guided by the steps of a model of clinical reasoning process. Six narratives were excluded from analysis because they did not sufficiently address the research question. The midwives narratives were prepared via data reduction. A theoretically informed analysis and interpretation was conducted. FINDINGS: using a feminist, interpretive approach we created a model of midwifery clinical reasoning grounded in the literature and consistent with the data. Thirteen of the 20 participant narratives demonstrate analytical clinical reasoning abilities but only nine completed the process and implemented the decision. Seven midwives used non-analytical decision-making without adequately checking against assessment data. CONCLUSION: over half of the participants demonstrated the ability to use clinical reasoning skills. Less than half of the midwives demonstrated clinical reasoning as their way of making decisions. The new model of Midwifery Clinical Reasoning includes 'intuition' as a valued way of knowing. Using intuition, however, should not replace clinical reasoning which promotes through decision-making can be made transparent and be consensually validated.