'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.

Let's talk early labour: The L-TEL randomised controlled trial.

BACKGROUND: Women without complications have lower obstetric intervention if they remain at home in early labour but many women report dissatisfaction in doing this. Using self-efficacy theory as an underpinning framework, a web-based intervention was co-created with women who had previously used maternity services. The intervention provides early labour advice, alongside the videoed, real experiences of women. METHOD: The pragmatic, randomised control trial aimed to evaluate the impact of the web-based intervention on women's self-reported experiences of early labour. Low-risk, nulliparous, pregnant women (140) were randomised. The intervention group (69) received the web-based intervention antenatally to use at their own convenience and the control group (71) received usual care. Data were collected at 7-28 days postnatally using an online version of the Early Labour Experience Questionnaire (ELEQ). The primary outcome was the ELEQ score. Secondary, clinical outcomes such as labour onset, augmentation and mode of birth were collected from the existing hospital system. RESULTS: There were no statistically significant differences in the ELEQ scores between trial arms. Women in the intervention group were significantly more likely to progress spontaneously in labour without the need for labour augmentation (39.1 %) compared to the control group (21.1 %) (OR 2.41, CI 95 %; 1.14-5.11). CONCLUSION: Although the L-TEL Trial found no statistically significant differences in the primary outcome, the innovative intervention to support women during latent phase labour was positively received by women. Web-based resources are a cost effective, user-friendly and accessible way to provide women with education. A larger trial is needed to detect differences in clinical outcomes.

The Experience of Women From Underrepresented Groups With Urinary Incontinence: A Systematic Review.

INTRODUCTION: Urinary incontinence (UI) in women is a global public health issue. However, there is a limited understanding of the experience of women from underrepresented groups suffering from UI. The purpose of this systematic review was to examine current evidence regarding the experience of women with UI from these groups. METHODOLOGY: A systematic search was undertaken to retrieve research studies that answered the research question. Four qualitative research studies were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this review. RESULTS: Four themes emerged from this review: the perceived origin of UI, the physical, psychological, and social impact of UI, the impact of culture and religion on UI, and vice versa, and the interaction of women with health services. DISCUSSION: Social determinants of health, such as religion and culture, need to be considered by professionals providing care if women from underrepresented groups experiencing UI are to receive optimal care.

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.

Midwives' views towards women using mHealth and eHealth to self-monitor their pregnancy: A systematic review of the literature.

INTRODUCTION: There are many mobile telephone apps to help women self-monitor aspects of pregnancy and maternal health. This literature review aims to understand midwives' perspectives on women self-monitoring their pregnancy using eHealth and mHealth, and establish gaps in research. METHODS: MEDLINE, PubMed, Scopus, CINAHL and PsycINFO were systematically searched on midwifery, eHealth/mHealth and perspectives. Qualitative, quantitative and mixed-methods studies published in English were considered for inclusion in the review, without geographical limitations. Relevant articles were critically appraised and narrative synthesis was conducted. RESULTS: Twelve relevant papers covering midwives' perspectives of the use of eHealth and mHealth by pregnant women were obtained for inclusion in this review. Seven of these publications focused on midwives' views of eHealth, and five on their perspectives of mHealth interventions. The studies included demonstrate that midwives generally hold ambivalent views towards the use of eHealth and mHealth technologies in antenatal care. Often, midwives acknowledged the potential benefits of such technologies, such as their ability to modernise antenatal care and to help women make more informed decisions about their pregnancy. However, midwives were quick to point out the risks and limitations of these, such as the accuracy of conveyed information, and negative impacts on the patient-professional relationship. CONCLUSIONS: Post-COVID-19, where technology is continuously developing, there is a compelling need for studies that investigate the role of eHealth and mHealth in self-monitoring pregnancy, and the consequences this has for pregnant women, health professionals and organisations, as well as midwifery curricula.

Applying interprofessional education to the practice setting.

Interprofessional education is a key requirement identified in various professional and regulatory body education standards in the UK. However, recent high-profile investigatory reports into adverse incidents in NHS organisations have demonstrated failures of translating interprofessional education into practice. This paper explores how a university in the south of England uses service improvement projects to address this. Working with key senior clinicians, small groups of students from a variety of professional backgrounds collaborate to address an identified problem in practice to bring about better, safer practice to benefit patients. This style of learning enables students to acquire essential attributes in preparation for employment, such as critical thinking, teamworking, ethical practice and leadership.

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.