The National COVID-19 Clinical Evidence Taskforce: pregnancy and perinatal guidelines.

INTRODUCTION: Pregnant women are at higher risk of severe illness from coronavirus disease 2019 (COVID-19) than non-pregnant women of a similar age. Early in the COVID-19 pandemic, it was clear that evidenced-based guidance was needed, and that it would need to be updated rapidly. The National COVID-19 Clinical Evidence Taskforce provided a resource to guide care for people with COVID-19, including during pregnancy. Care for pregnant and breastfeeding women and their babies was included as a priority when the Taskforce was set up, with a Pregnancy and Perinatal Care Panel convened to guide clinical practice. MAIN RECOMMENDATIONS: As of May 2022, the Taskforce has made seven specific recommendations on care for pregnant women and those who have recently given birth. This includes supporting usual practices for the mode of birth, umbilical cord clamping, skin-to-skin contact, breastfeeding, rooming-in, and using antenatal corticosteroids and magnesium sulfate as clinically indicated. There are 11 recommendations for COVID-19-specific treatments, including conditional recommendations for using remdesivir, tocilizumab and sotrovimab. Finally, there are recommendations not to use several disease-modifying treatments for the treatment of COVID-19, including hydroxychloroquine and ivermectin. The recommendations are continually updated to reflect new evidence, and the most up-to-date guidance is available online (https://covid19evidence.net.au). CHANGES IN MANAGEMENT RESULTING FROM THE GUIDELINES: The National COVID-19 Clinical Evidence Taskforce has been a critical component of the infrastructure to support Australian maternity care providers during the COVID-19 pandemic. The Taskforce has shown that a rapid living guidelines approach is feasible and acceptable.

Clinical care of pregnant and postpartum women with COVID-19: Living recommendations from the National COVID-19 Clinical Evidence Taskforce.

To date, 18 living recommendations for the clinical care of pregnant and postpartum women with COVID-19 have been issued by the National COVID-19 Clinical Evidence Taskforce. This includes recommendations on mode of birth, delayed umbilical cord clamping, skin-to-skin contact, breastfeeding, rooming-in, antenatal corticosteroids, angiotensin-converting enzyme inhibitors, disease-modifying treatments (including dexamethasone, remdesivir and hydroxychloroquine), venous thromboembolism prophylaxis and advanced respiratory support interventions (prone positioning and extracorporeal membrane oxygenation). Through continuous evidence surveillance, these living recommendations are updated in near real-time to ensure clinicians in Australia have reliable, evidence-based guidelines for clinical decision-making. Please visit https://covid19evidence.net.au/ for the latest recommendation updates.

The development of National ACMI Standards for the accreditation of three-year Bachelor of Midwifery programs.

Prior to 2002 Australians who wished to become midwives were expected to complete and undergraduate nursing degree and then apply for admission to a university-based post-nursing program in midwifery, usually requiring an additional year of study. Graduates were, therefore, qualified to practice in either profession. Many organisations, coalitions and individuals have contributed to the arduous struggle to ensure that midwives are educated in ways that allow them to confidently and competently fulfill their role as the World Health Organisation defines it. Indeed, in some states, universities and Nurses Boards recognising the need for multiple routes of entry to practice have introduced three-year undergraduate midwifery degrees. So far this has taken place in South Australia and Victoria but other states intend to follow this initiative. In this paper the background to the development of the ACMI National Bachelor of Midwifery Taskforce and the midwifery Program Standards will be discussed. A brief description of the Program Standards is presented to show how they can be used to ensure that 21st century midwives are capable of competently and confidently responding to the changing needs of maternity service providers and consumers. Finally, the authors argue that it is crucial that employers and clinicians have access to a standardised, objective means to evaluate midwifery programs, and believe that the Standards provide the means to do this.