In what ways does maternity care in Australia align with the values and principles of the national maternity strategy? A scoping review.

Australia's national maternity strategy Woman-centred care: strategic directions for Australian maternity services (the Strategy) was released by the federal government in November 2019. It was developed to provide national guidance on the effective provision of woman-centred maternity care. The Strategy is structured around four values of safety, respect, choice, and access, and underpinned by twelve principles of woman-centred care. By examining previous research, this review aims to provide a baseline understanding of how maternity care provision is being met in relation to these core values. A systematic search of Australian literature was undertaken via four databases using the Strategy's values and 41 articles met the selection criteria. Include articles were predominantly published pre-2019, providing a baseline understanding of Australian maternity care provision prior to the Strategy's publication. Findings suggest that the four values align with those of women; however, women were not always receiving care in accordance with the values, particularly among women from priority populations. Women prioritised safety for themselves and their babies, articulated the need for respectful relationships with maternity care providers, wanted autonomy to make their own decisions, and desired access to appropriate, local, maternity services. Additionally, while pockets of appropriate care do exist, these are more likely to occur at a single-service level than more broadly at a population level. This implies the Strategy is needed, and its operationalisation must be prioritised through a coordinated national response to better meet the maternity care needs of Australian women. Further research is warranted to determine the Strategy's effectiveness.

Barriers and enablers for midwives to use the Nursing and Midwifery Board of Australia's Endorsement for scheduled medicines for midwives.

BACKGROUND: In 2010, the Nursing and Midwifery Board of Australia introduced a new registration standard: Endorsement for scheduled medicines for midwives. The endorsement enables midwives to provide women with Medicare-rebatable care, prescribe relevant medications, and order relevant Medicare-rebatable diagnostics. Translating endorsement education into clinical midwifery practice has been slow, indicating the presence of barriers affecting midwives' ability to use this standard, despite it increasing their scope for service provision. AIM: To discover the mechanisms affecting midwives' ability to work to full scope of practice after completing a programme of study leading to endorsement. METHODS: An observational (non-experimental) design was used. Midwives who had completed an education programme leading to endorsement were invited to complete a survey. Descriptive statistics were used to analyse the quantitative questions and content analysis was conducted on the qualitative data. FINDINGS: Results indicated that barriers - such as the limitations of Medicare provisions for endorsed midwives and a general lack of support for the role - restrict endorsed midwives' ability to provide quality maternity services. Having some form of support for the role may act as an enabler, in addition to midwives having personal determination and confidence in their ability to use the endorsement. Recommendations to strengthen the endorsed midwife's role include facilitating endorsement use in the public sector, relaxing Medicare Benefit Schedule and Pharmaceutical Benefit Scheme restrictions, raising awareness of the role and scope, and improving midwives' pre-endorsement preparation. CONCLUSION: This study highlights the need for an all-of-system approach to support and develop the endorsed midwife's role.

Barriers and enablers for midwives using endorsement for scheduled medicines: A literature review.

PROBLEM: There are currently 429 midwives in Australia who hold the Nursing and Midwifery Board of Australia's Endorsement for scheduled medicines for midwives. Little is known about how midwives are using the endorsement and what factors impact on its use. OBJECTIVE: To critically examine the literature to discover what the barriers and enablers are for midwives to use the endorsement. METHOD: A search was undertaken examining literature published since 2004. Due to a lack of articles specific to midwifery, the search was widened to include literature related to similar non-medical health professions. The search was divided into two streams: accessing the Medicare Benefits Schedule and accessing the Pharmaceutical Benefits Scheme and prescribing. Twenty-six primary articles from 2009 onward met the review criteria. FINDINGS: Although singular barriers and enablers to both streams were identified, many of the themes act as both enabler and barrier. Themes common to both the Medicare Benefits Schedule focus and the Pharmaceutical Benefits Scheme and prescribing focus are that of medical support, scope of practice, ongoing support from health care consumers and management, and endorsement processes. Barriers occur approximately three times more frequently than enablers. CONCLUSION: Barriers and enablers occur for various reasons including legislative, regulatory, organisational, and the individual's support for and attitude towards these roles. To overcome barriers and facilitate the success of emerging non-medical extended practice roles, significant buy-in and investment is needed across all levels of the health system. The review highlights a significant gap in knowledge about the endorsement's use in midwifery.