Strategies used by midwives to enhance knowledge and skill development in midwifery students: an appreciative inquiry study.

BACKGROUND: Midwifery practice experience for midwifery students is an important component of education to enhance knowledge and skill development. Practicing midwives provide student support in the clinical setting, there is minimal literature relating to strategies midwives use to support students. OBJECTIVE: To explore midwifery student experiences of the strategies used by midwives to facilitate knowledge and skill development in the clinical practice setting. METHODS: Qualitative approach based on Appreciative Inquiry. The setting is one University in Australia. Participants, thirteen Graduate Diploma in Midwifery students. Individual interviews followed by thematic analysis. RESULTS: Data analysis identified six themes, Willingness to share knowledge and develop skills; The positive use of questioning; Moderating support; Teaching through the woman; Learning through problematisation and Providing constructive affirmation. CONCLUSIONS: Midwives incorporated varied strategies to support student development in the clinical setting. For an equitable clinical experience, all midwives need support to develop skills and confidence in facilitating student learning.

Application of the Childbirth Supporter Study to Advance the Birth Unit Design Spatial Evaluation Tool.

OBJECTIVE: Translational research to advance design criteria and apply the Childbirth Supporter Study (CSS) findings to practice. BACKGROUND: The physical design of birth environments has not undergone substantial improvements in layout or ambiance since the initial move to hospitals. Cooperative, continuously present childbirth supporters are beneficial and are an expectation for most modern birth practices, yet the built environment does not offer support for the supporter. METHODS: To advance design criteria, we use a comparative case study approach to create translational findings. Specifically, CSS findings were used as indicators to advance the Birth Unit Design Spatial Evaluation Tool (BUDSET) design characteristics in pursuit of better support for childbirth supporters in the built hospital birth environment. RESULTS: This comparative case study provides eight new BUDSET design domain suggestions to benefit the supporter-woman dyad, and subsequently the baby and care providers. CONCLUSIONS: Research-informed design imperatives are needed to guide the inclusion of childbirth supporters as both a supporter and as an individual in the birth space. Increased understanding of relationships between specific design features and childbirth supporters' experiences and reactions are provided. Suggestions to enhance the applicability of the BUDSET for birth unit design facility development are made, specifically ones that will better accommodate childbirth supporters.

Examining the transformation of midwifery education in Australia to inform future directions: An integrative review.

BACKGROUND: Integral to quality midwifery practice is the education of midwives. Like other countries, Australia faces ongoing challenges in delivering midwifery education programs. Reasons include escalating program costs, challenges in securing meaningful clinical experiences, subsumption of midwifery with nursing, and associated loss of identity in some institutions. AIM: To critically examine the literature exploring the historical and current drivers, supports and impediments for entry-to-practice midwifery programs to identify strategies to strengthen midwifery education in Australia. METHODS: A structured integrative literature review using Whittemore and Knafl's five-stage framework was undertaken; 1) problem identification, 2) literature search, 3) data evaluation, 4) data analysis, and 5) presentation of results. FINDINGS: The literature search identified 50 articles for inclusion. The thematic analysis identified four key themes: i. a commitment to educational reform, ii. building a midwifery workforce, iii. quality maternity care through midwifery education, and iv. progressing excellence in midwifery education. DISCUSSION: Extensive literature describes the evolution of midwifery education in Australia over the last 30 years. Through collaboration and amidst opposition, quality midwifery education has been established in Australia. Identification of midwifery as a distinct profession and transformative leadership have been integral to this evolution and must be grown and sustained to prevent a decline in standards or quality. CONCLUSION: There is a need to address priorities in midwifery education and for the evaluation of midwifery programs and pedagogy. The provision and maintenance of quality education and practice require shared responsibility between education providers and health care services.

Experiences of Maternity Healthcare Professionals Returning to Work Following a Personal Perinatal Loss: A Scoping Review of the Literature.

BACKGROUND: In Australia, midwives care closely for women during pregnancy and birth and the immediate postnatal period. This scoping review aimed to explore the experiences of female maternity healthcare professionals when they return to work following a personal pregnancy loss or neonatal death.Methodology: A scoping review was carried out on published and unpublished research and grey literature looking at how maternity healthcare professionals who have had a personal perinatal loss experience working in a maternity setting following the loss. A search of the literature was performed between October and December 2018, with no set limitations. A search for relevant references from included papers was also carried out. The literature was analysed thematically. The types of perinatal loss were defined as per Australian guidelines. RESULTS: 10 articles were included in this scoping review. Four themes emerged from the literature and these were: 1) Impact of being asked, "have you got children?"; 2) Impact on professional practice; 3) Impact of pre-existing professional knowledge; 4) Importance of collegial support on return to work. CONCLUSIONS: Return to work in a maternity setting following a personal perinatal loss is emotionally challenging and requires a range of supports. Further research is needed in this area.

Midwives providing woman-centred care during the COVID-19 pandemic in Australia: A national qualitative study.

BACKGROUND: The COVID-19 pandemic has caused isolation, fear, and impacted on maternal healthcare provision. AIM: To explore midwives' experiences about how COVID-19 impacted their ability to provide woman-centred care, and what lessons they have learnt as a result of the mandated government and hospital restrictions (such as social distancing) during the care of the woman and her family. METHODS: A qualitative interpretive descriptive study was conducted. Twenty-six midwives working in all models of care in all states and territories of Australia were recruited through social media, and selected using a maximum variation sampling approach. Data were collected through in-depth interviews between May to August, 2020. The interviews were recorded, transcribed verbatim, and thematically analysed. FINDINGS: Two overarching themes were identified: 'COVID-19 causing chaos' and 'keeping the woman at the centre of care'. The 'COVID-19 causing chaos' theme included three sub-themes: 'quickly evolving situation', 'challenging to provide care', and 'affecting women and families'. The 'Keeping the woman at the centre of care' theme included three sub-themes: 'trying to keep it normal', 'bending the rules and pushing the boundaries', and 'quality time for the woman, baby, and family unit'. CONCLUSION: Findings of this study offer important evidence regarding the impact of the pandemic on the provision of woman-centred care which is key to midwifery philosophy. Recommendations are made for ways to preserve and further enhance woman-centred care during periods of uncertainty such as during a pandemic or other health crises.

The river of postnatal psychosis: A qualitative study of women's experiences and meanings.

OBJECTIVE: This paper reports findings from a study about women's experience of postpartum psychosis which affects 1-2 women in 1000 in the first four to six weeks following childbirth. Previous research reports many women are relucent to disclose symptoms of mental ill health to healthcare professionals, although they are most likely to discuss symptoms and concerns with a health professional known to them. DESIGN: A qualitative interpretive study using semi-structured interviews. PARTICIPANTS: Ten women in Australia who had recovered from postpartum psychosis in the last ten years were interviewed. DATA ANALYSIS: Data were analysed thematically by three researchers to enhance trustworthiness. RESULTS: The women described their overall experience as traumatic and described what they saw as contributing factors such as a previous history of mental illness or a significant life event that was present before or during pregnancy; the women described how they made meaning of the symptoms they experienced, such as a lack of sleep or changes in their thoughts or behaviours; and the difficulties they experienced during recovery. The women also identified novel ways to support themselves and each other as they recovered. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Midwives require further education to recognise the symptoms of postpartum psychosis, to ask further probing questions to identify postpartum psychosis in its early stages and to support women as they recover from this illness.

Developing and conducting appreciative inquiry interviews.

BACKGROUND: The appreciative inquiry (AI) interview follows a specific format and needs to be planned and developed before implementation. AI questions are designed to draw on the interviewee's experiences, commencing with general questioning and progressing to more focused questioning. AIM: To explain how to plan and undertake AI interviews, and to discuss issues that nurse researchers might encounter. DISCUSSION: This article is based on the first author's experience of undertaking an AI doctoral study. The primary method of collecting data for the study was AI interviews. The more focused questioning related to participants' experiences of positive actions or behaviours. Although questioning was positive in nature and participant-centric, conducting the interviews was more problematic than the first author anticipated. Some participants struggled to recall positive memories to share. CONCLUSION: The unexpected response to the interview questions required the first author to examine her practices, as well as beliefs and judgements relating to AI. This reflexivity assisted in implementing changes to the study's process, resulting in a more positive experience for her and the participants. IMPLICATIONS FOR PRACTICE: Researchers using the AI interview require the capacity to be self-critical and change the process if necessary to enrich the outcome.

Appreciative inquiry as an intervention to improve nursing and midwifery students transitioning into becoming new graduates: An integrative review.

OBJECTIVE: To identify, critique and synthesise the evidence about the impact of Appreciative Inquiry on improving nursing and midwifery students as they transition into becoming new graduates. DESIGN: An integrative review. DATA SOURCES: The databases were: Pubmed, Ovid Medline, Cumulative Index of Nursing and Allied Health and Scopus. REVIEW METHODS: A Whittemore and Knafl's (2005) five stage approach was used to appraise the primary literature related to nursing and midwifery students transitioning into becoming new graduates. RESULTS: A total of 805 articles were retrieved and six studies met the inclusion criteria and included in this review. These studies have shown that Appreciative Inquiry as an intervention can be used to improve nursing and midwifery students' experiences as they transition into becoming new graduates. Three overarching themes were identified: caring, connecting and nurturing, transforming the workplace and work practices and appreciating and enabling nurses and midwives as a profession. CONCLUSION: Appreciative Inquiry offers a creative, exploratory and compassionate method to improve positive change for nursing and midwifery students as they transition into becoming new graduates. The impact of caring, nurturing nurses and midwives who mentor nursing and midwifery students makes a difference in increasing the likelihood that graduates will remain in the profession and establish fulfilling relationships with both colleagues and people.

Implementing and evaluating the effectiveness of an oral health module for the bachelor of midwifery program at an Australian university.

OBJECTIVE: Although guidelines recommend antenatal care providers such as midwives promote oral health during pregnancy, oral health training is not routinely provided in undergraduate midwifery curricula. The aim of this study was to implement an oral health module into an Australian undergraduate midwifery program, and evaluate its effectiveness in improving the oral health knowledge and confidence of midwifery students. DESIGN: Pre-test post-test study (2015-2017). SETTING: An undergraduate midwifery program within an Australian university. PARTICIPANTS: All first-year undergraduate midwifery students enrolled in two core units at the above university (N = 56). METHODS: Oral health modules were implemented into each of the two core units within the first year of the Bachelor of Midwifery course. Changes in knowledge and confidence were measured using a standardised questionnaire, administered at baseline, immediately following module completion, and at 2 and 3 years following module completion. RESULTS: 44 students participated in the baseline survey (79% response rate), of which 41 completed the first post-module questionnaire, 21 completed the second post-questionnaire, and 24 completed the third post-questionnaire. Knowledge scores significantly increased from baseline (mean 13.12) to follow-up (mean 17.78, p < 0.001), with increases being retained through to the 3-year mark (mean 18.29, p < 0.001). Confidence scores also showed a sustained increase following the module, particularly regarding introducing oral health in the first antenatal appointment (62.1% increase, p < 0.001) and referring pregnant women to a dentist (48.2% increase, p < 0.001). However, the 48.2% increase (p < 0.001) in confidence in conducting a visual mouth check on a pregnant woman following the module was not sustained at subsequent time points, reducing to a 31.5% increase (p = 0.118) by the third year post-module. CONCLUSIONS: The module is effective in improving and sustaining the knowledge and confidence of midwifery students to promote maternal oral health. Ongoing updates may be required to keep confidence high regarding visual mouth checks.

It's okay to breastfeed in public but .

Background: Decisions about infant feeding are embedded and are continuously made within a woman's social and cultural context. Despite the benefits of breastfeeding to both women and infants, and government policies and laws to protect and promote breastfeeding, breastfeeding in public remains a controversial issue. The purpose of this paper is to present findings from an Australian study that explored the perceptions and beliefs held by first time expectant mothers and their family and social networks towards breastfeeding in public. Methods: This study collected data through fifteen family conversations to explore the views and beliefs of first time mothers and those in her social network towards breastfeeding. Breastfeeding in public was discussed in nine of the family conversations with 50 individual people contributing. We used a process of a descriptive contextual analysis drawing out specific elements of the family conversations to identify an underlying ideology around breastfeeding in public within these groups. Results: The analysis focused on four key elements of the conversations. These included the descriptions of the event, the actions, the locations and feelings of the dominant players. Descriptions of the event outlined different beliefs and feelings related to breastfeeding in public and whether it should occur at all. Suggestions for not breastfeeding in public were timing your outings so feeding could take place at home, expressing breastmilk or using the dummy. When breastfeeding in public was considered acceptable, there were requisite social norms. Breastfeeding in public requires women to be discrete and covered-up, so as not to expose her breast. She is also required to feed in an appropriate place to avoid discomforting others, guard against judgement, and to protect herself from the unwanted male gaze. Conclusions: Our findings suggest that controversy remains as to whether breastfeeding should occur in public at all. Even where breastfeeding in public is seen as a woman's choice, there are social rules that govern how it should be undertaken to make it an 'appropriate' activity. As a result, women need to take responsibility for others feelings, minimise the discomfort of others and 'keep themselves safe' if and when they breastfeed in public spaces.

Place of sanctuary: an appreciative inquiry approach to discovering how communities support breastfeeding and parenting.

Background: Significant efforts by governments at a global and national level have not resulted in a significant increase in the duration of breastfeeding to six months. The views of family and social networks, and community attitudes particularly around breastfeeding in public, influence infant feeding decisions. Yet many interventions designed to increase breastfeeding focus on the individual woman and have not been developed from the 'ground up' in consultation with women and communities. This study aimed to identify the key components of Mother Infant Caring Communities that promote and support breastfeeding and early parenting. Methods: Appreciative Inquiry was used to facilitate a 'Community Conversation' workshop in two local councils in Australia. Thirty-five participants attended the community conversation workshops including new parents, grandparents, children's services, local government, and representatives from maternity and child health services. In addition, one focus group discussion was conducted with six retail business owners or managers. Qualitative content analysis was used to analyse data. This paper presents the findings of the first phase (the Discovery phase) of the study. Results: Four major themes emerged: "PLACE - A community for everyone"; "A PLACE for children and families"; "Sometimes a PLACE to breastfeed" and "The parent room: a hidden and unsafe PLACE to breastfeed". Participants described the characteristics of communities that provided a sanctuary and fostered well-being for parents and infants including, open green spaces, safe playgrounds, walking tracks and community hubs. Shopping centres were described as having the potential to be the 'village'. Community-based services to support breastfeeding and parenting were highly valued. Yet in both sites, participants stated that breastfeeding was rarely observed in public and bottle feeding was more evident. Conclusion: Breastfeeding and parenting are embedded in the places where women and families live. Community spaces including shopping centres, should be designed to include infants and young children and offer appropriate facilities such as safe and clean parenting rooms. Health services must work with local government, businesses, and diverse community members to identify what parents' value about their community and design and implement innovative local strategies to support breastfeeding.

Birthplace in Australia: Antenatal preparation for the possibility of transfer from planned home birth.

OBJECTIVE: The aim of the study was to explore how women and midwives prepare, during the antenatal period, for the possibility of intrapartum transfer from planned home birth. DESIGN: A Constructivist Grounded Theory approach was taken in order to focus upon the social interactions and processes that emerged. SETTING: Urban and regional areas in four states of south eastern Australia. PARTICIPANTS: Thirty-one semi-structured interviews were conducted with women and midwives. FINDINGS: There were three sub-categories relating to preparation for the possibility of transfer. These were 'Building the midwife-woman partnership', 'Fostering professional connections' and 'Reducing uncertainty'. The reciprocal trust inherent in the midwife-woman partnership helped women feel safe in relation to the possibility of intrapartum transfer to hospital. Midwives who had positive transfer experiences spoke about their commitment to fostering professional connections with hospitals and health professionals as a part of building the capacity for collaboration if, and when, a transfer occurred. Reducing uncertainty involved preparation that included not only providing information and emotional support to the woman around the possibility of transfer, but also arranging for her to book in to a back-up hospital.

Workplace culture and the practice experience of midwifery students: A meta-synthesis.

AIM: To describe midwifery students' practice experience and to explore facilitators and barriers to positive clinical learning experiences. BACKGROUND: Practice experience is a vital component of every midwifery course. Course dissatisfaction and attrition of midwifery students has been attributed to sub-optimal practice experiences. Events or actions experienced by midwifery students that trigger dissatisfaction and attrition need to be identified. EVALUATION: A meta-synthesis was based on that developed by Noblit and Hare. KEY ISSUES: Students perceive workplaces as poorly prepared for their arrival and subsequent support. Students' experience in the practice setting is influenced by the existing workplace culture. Workplace culture influences institutional functioning and individuals within the culture. Enculturation of students into the midwifery culture and subsequent learning is affected by the support received. CONCLUSIONS: The practice experience of midwifery students was profoundly influenced by workplace culture. Students tended to have polarized accounts of their experience that were predominantly negative. IMPLICATIONS FOR NURSING (MIDWIFERY) MANAGEMENT: To provide an optimal environment for midwifery students; midwifery managers and individual midwives need to be aware of the facilitators and barriers to midwifery student development in the practice setting.

Birthplace in Australia: Processes and interactions during the intrapartum transfer of women from planned homebirth to hospital.

OBJECTIVE: the aim of the study was to explore the views and experiences of women, midwives and obstetricians on the intrapartum transfer of women from planned homebirth to hospital in Australia. DESIGN: a Constructivist Grounded Theory approach was taken, to conceptualise the social interactions and processes grounded in the data. SETTING: urban and regional areas in four states of south-eastern Australia. PARTICIPANTS: semi-structured qualitative interviews were conducted with 36 women, midwives and obstetricians who had experienced an intrapartum homebirth transfer within three years prior to the interview. Interviews were audio recorded and transcribed verbatim. FINDINGS: women who were transferred to hospital from a planned homebirth made physical and psychological journeys out of their comfort zone, as they faced the uncertainty of changing expectations for their birth. The trusting relationship between a woman and her homebirth midwife was crucial to women's sense of safety and well-being in hospital. Midwives and obstetricians, when congregating in the hospital birthing rooms of transferred women, also felt out of their comfort zones. This was due to the challenges of converging with others who possessed conflicting paradigms of safety and risk in birth that were at odds with their own, and adapting to different routines, roles and responsibilities. These differences were derived from diverse professional, social and personal influences and often manifested in stereotyping behaviours and 'us and them' dynamics. When midwife-woman partnerships were respected as an inclusive part of women's care, collaboration ensued, conflict was ameliorated, and smooth transfers could be celebrated as successes of the maternity care system. KEY CONCLUSIONS: supporting woman centred care in homebirth transfers means acknowledging the social challenges of collaborating in the unique context of a transferred woman's hospital birthing room. Understanding the power of the midwife-woman partnership, and its value to the health and well-being of each woman and her baby, is key to facilitating a successful transfer. IMPLICATIONS FOR PRACTICE: the midwife-woman partnership played a central role in providing the necessary support and advocacy for women transferred out of their comfort zone. When midwives worked together in an integrated system to provide the necessary care and support for women who were transferred, greater levels of collaboration emerged and women's perceptions of their quality of care was high. In practice, this meant health professionals respecting each other's roles, responsibilities and expertise, and ameliorating 'us and them' dynamics.

Media Representations of Breech Birth: A Prospective Analysis of Web-Based News Reports.

INTRODUCTION: Recent research has demonstrated that the media presentation of childbirth is highly medicalized, often portraying birth as risky and dramatic. Media representation of breech presentation and birth is unexplored in this context. This study aimed to explore the content and tone of news media reports relating to breech presentation and breech birth. METHODS: Google alerts were created using the terms breech and breech birth in online English-language news sites over a 3-year period from January 1, 2013, to December 31, 2015. Alerts were received daily and filed for analysis, and data were analyzed to generate themes. RESULTS: A total of 138 web-based news reports were gathered from 9 countries. Five themes that arose from the data included the problem of breech presentation, the high drama of vaginal breech birth, the safe option of cesarean birth versus dangers of vaginal breech birth, the defiant mother versus the saintly mother, and vaginal breech birth and medical misadventure. DISCUSSION: Media reports in this study predominantly demonstrated negative views toward breech presentation and vaginal breech birth. Cesarean birth was portrayed as the safe option for breech birth, while vaginal breech birth was associated with poor outcomes. Media presentations may impact decision making about mode of birth for pregnant women with a breech fetus. Health care providers can play an important role in balancing the media depiction of planned vaginal breech birth by providing nonjudgmental, evidence-based information to such women to facilitate informed decision making for birth.

The fact and the fiction: A prospective study of internet forum discussions on vaginal breech birth.

BACKGROUND: Women with a breech baby late in pregnancy may use the internet to gather information to assist in decision-making for birth. The aim of this study was to examine how women use English language internet discussion forums to find out information about vaginal breech birth and to increase understanding of how vaginal breech birth is perceived among women. METHOD: A descriptive qualitative study of internet discussion forums was undertaken. Google alerts were created with the search terms "breech birth" and "breech". Alerts were collected for a one-year period (January 2013-December 2013). The content of forum discussions was analysed using thematic analysis. RESULTS: A total of 50 forum discussions containing 382 comments were collected. Themes that arose from the data were: Testing the waters-which way should I go?; Losing hope for the chance of a normal birth; Seeking support for options-who will listen to me?; Considering vaginal breech birth-a risky choice?; Staying on the 'safe side'-caesarean section as a guarantee; Exploring the positive potential for vaginal breech birth. CONCLUSION: Women search online for information about vaginal breech birth in an attempt to come to a place in their decision-making where they feel comfortable with their birth plan. This study highlights the need for clinicians to provide comprehensive, unbiased information on the risks and benefits of all options for breech birth to facilitate informed decision-making for the woman. This will contribute to improving the woman's confidence in distinguishing between "the fact and the fiction" of breech birth discussions online.

Using video in childbirth research.

BACKGROUND: Conducting video-research in birth settings raises challenges for ethics review boards to view birthing women and research-midwives as capable, autonomous decision-makers. AIM: This study aimed to gain an understanding of how the ethical approval process was experienced and to chronicle the perceived risks and benefits. RESEARCH DESIGN: The Birth Unit Design project was a 2012 Australian ethnographic study that used video recording to investigate the physical design features in the hospital birthing space that might influence both verbal and non-verbal communication and the experiences of childbearing women, midwives and supporters. Participants and research context: Six women, 11 midwives and 11 childbirth supporters were filmed during the women's labours in hospital birth units and interviewed 6 weeks later. Ethical considerations: The study was approved by an Australian Health Research Ethics Committee after a protracted process of negotiation. FINDINGS: The ethics committee was influenced by a traditional view of research as based on scientific experiments resulting in a poor understanding of video-ethnographic research, a paradigmatic view of the politics and practicalities of modern childbirth processes, a desire to protect institutions from litigation, and what we perceived as a paternalistic approach towards protecting participants, one that was at odds with our aim to facilitate situations in which women could make flexible, autonomous decisions about how they might engage with the research process. DISCUSSION: The perceived need for protection was overly burdensome and against the wishes of the participants themselves; ultimately, this limited the capacity of the study to improve care for women and babies. CONCLUSION: Recommendations are offered for those involved in ethical approval processes for qualitative research in childbirth settings. The complexity of issues within childbirth settings, as in most modern healthcare settings, should be analysed using a variety of research approaches, beyond efficacy-style randomised controlled trials, to expand and improve practice-based results.

Messages to new mothers: an analysis of breast pump advertisements.

The mass media is replete with all kinds of advice, products and ideas about 'motherhood' with advertising being a major source of information on the latest products and consumer trends. Advertising is a key means of promoting ideas about infant feeding, and yet, there has been little in the way of critical analyses of breast pump advertisements in order to reveal the kinds of messages they convey about this method of feeding. This article makes an important step towards addressing this gap through analysing three advertisements for breast pumps from a popular Australian magazine for mothers. We utilize a social semiotic framework to investigate not just what choices are made in the design of the ads but also what those choices mean in terms of the overall message of the ads. Our analysis identifies three core messages: 'breastfeeding and breast pumping are the same with the purpose being to produce breast milk only', 'using breast pumps facilitates quality time with the baby' and 'mothers need outside expertise (including breast pumps) to ensure baby's development'. We believe it is important for those who provide information and support for breastfeeding women to be aware of the subtle, naturalized messages that ads convey so that they may better understand what may be underlying women's decisions regarding methods of infant feeding. © 2016 John Wiley & Sons Ltd.

Birth room images: what they tell us about childbirth. A discourse analysis of birth rooms in developed countries.

OBJECTIVE: this study examined images of birth rooms in developed countries to analyse the messages and visual discourse being communicated through images. DESIGN: a small qualitative study using Kress and van Leeuwen's (2006) social semiotic theoretical framework for image analysis, a form of discourse analysis. SETTING/PARTICIPANTS: forty images of birth rooms were collected in 2013 from Google Images, Flickr, Wikimedia Commons and midwifery colleagues. The images were from obstetric units, alongside and freestanding midwifery units located in developed countries (Australia, Canada, Europe, New Zealand, United Kingdom and the United States of America). MAIN FINDINGS: findings demonstrated three kinds of birth room images; the technological, the 'homelike', and the hybrid domesticated birth room. The most dominant was the technological birth room, with a focus on the labour bed and medical equipment. The visual messages from images of the technological birth room reinforce the notion that the bed is the most appropriate place to give birth and the use of medical equipment is intrinsically involved in the birth process. Childbirth is thus construed as risky/dangerous. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: as images on the Internet inform and persuade society about stereotypical behaviours, the trends of our time and sociocultural norms, it is important to recognise images of the technological birth room on the Internet may be influential in dictating women's attitudes, choices and behaviour, before they enter the birth room.

Childbirth Supporters' Experiences in a Built Hospital Birth Environment: Exploring Inhibiting and Facilitating Factors in Negotiating the Supporter Role.

OBJECTIVE: To explore inhibiting and facilitating design factors influencing childbirth supporters' experiences. BACKGROUND: Birthing women benefit from the continuous, cooperative presence of supporters. However, little research has investigated how birth room design facilitates or inhibits supporters' role navigation. METHODS: We conducted an exploratory video ethnographic single case study of childbirth supporters' experiences, within an Australian hospital birth environment. Video, field notes, and video-cued reflexive interviews with the woman, her midwives, and supporters were thematically analyzed using ethnographic/symbolic interactionist perspectives to frame supporters' understandings. RESULTS: Findings suggest supporters' experiences are complex, made more complicated by sparse understanding or accommodation of their needs in the built environment. Supporters' presence and roles are not facilitated by the physical space; they experience "an unbelonging paradox" of being needed, yet uncertain and "in the way" during "tenuous nest-building" activities. CONCLUSIONS: Suggested design guidelines to facilitate supporters' well-being and their roles in designed hospital birth spaces are provided.