Midwives' experiences of cultural competency training and providing perinatal care for migrant women a mixed methods study: Operational Refugee and Migrant Maternal Approach (ORAMMA) project.

BACKGROUND: The number of international migrants continues to increase worldwide. Depending on their country of origin and migration experience, migrants may be at greater risk of maternal and neonatal morbidity and mortality. Having compassionate and culturally competent healthcare providers is essential to optimise perinatal care. The "Operational Refugee and Migrant Maternal Approach" (ORAMMA) project developed cultural competence training for health professionals to aid with providing perinatal care for migrant women. This presents an evaluation of ORAMMA training and explores midwives' experiences of the training and providing care within the ORAMMA project. METHODS: Cultural competence was assessed before and after midwives (n = 35) received ORAMMA compassionate and culturally sensitive maternity care training in three different European countries. Semi-structured interviews (n = 12) explored midwives' experiences of the training and of caring for migrant women within the ORAMMA project. RESULTS: A significant improvement of the median score pre to post-test was observed for midwives' knowledge (17 to 20, p < 0.001), skills (5 to 6, p = 0.002) and self-perceived cultural competence (27 to 29, p = 0.010). Exploration of midwives' experiences of the training revealed themes of "appropriate and applicable", "made a difference" and "training gaps" and data from ORAMMA project experiences identified three further themes; "supportive care", "working alongside peer supporters" and "challenges faced". CONCLUSIONS: The training improved midwives' knowledge and self-perceived cultural competence in three European countries with differing contexts and workforce provision. A positive experience of ORAMMA care model was expressed by midwives, however clearer expectations of peer supporters' roles and more time within appointments to assess the psychosocial needs of migrant women were desired. Future large-scale research is required to assess the long-term impact of the ORAMMA model and training on practice and clinical perinatal outcomes.

Breast cancer and social relationship coping efficacy: validation of the Greek version.

The Social Relationship Coping Efficacy scale (SRCE) was designed to assess cancer patients' efficacy for maintaining social support and social relationships. The purpose of the study was to confirm the psychometric quality and utility of a Greek-language version of the (SRCE) scale. The study included 116 women with breast cancer, who underwent surgery at a public hospital In Greece. The SRCE scale was translated using standard procedures and then culturally adapted for use in Greece. Psychometric evaluation of the SRCE-Greek scale included reliability, structural validity and convergent validity analyses. The SRCE-Greek scale demonstrated strong internal consistency (Cronbach a 0.87), and split-half reliability (Spearman-Brown, 0.747; Guttman, 0.742). The structural construct validity was confirmed with factor analysis using principal axis factor analysis. Construct validity was further supported with convergent validity with the Family Crisis Oriented Personal Evaluation Scales (F-COPES) (Acquiring Social Support, Reframing) and Family Support scale. The Greek language SRCE has strong internal consistency reliability and construct validity, as well as satisfactory convergent validity. Results provide support for the use of the SRCE-GR as a research and clinical instrument for the assessment of breast cancer patient's self-efficacy with regard to maintaining and enhancing close social relationships and social support.

Psychosocial factors associated with conflicts among health professionals in the operating room in a Greek sample.

AIM: The purpose of this study is to investigate conflicts and identify the factors that cause the creation of conflicts in the operating room as well as coping strategies for conflict resolution. BACKGROUND: The operating room is a special and changeable working environment, which is constantly evolving, and requires interdisciplinary team collaboration. Therefore, it is an environment that may cause conflict among employees. METHOD: The study was conducted at three Public Hospitals of Athens, during the period from 1 April 2018, to 15 June 2018. The research tool used to conduct the research was the questionnaire of Kontogianni et al. (2011). The questionnaire consisted of four sections dealing with conflict issues and their management. The sample consisted of 185 nurses and medical staff. The level of statistical significance was set equal to .05. The questions were analysed through the statistical package SPSS 20. RESULTS: Τhe majority of participants had conflicts with colleagues (79%), with doctors (69.5%) and with nurses (43.7%). Τhe majority of the sample was unaware of conflict management strategies (60%). One of the important factors that intensify the conflicts is the burdensome workload in combination with the unsatisfactory salary. Avoidance is the preferred conflict management strategy (64.7%), followed by mutual benefit trading (55.4%.) Acceptance is the least appropriate strategy (10.9%). CONCLUSIONS: In order to deal with conflicts in the operating room effectively, it is necessary for nurses and physicians to be trained in conflict management. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should support the training of nurses in conflict management in order to create a climate of cooperation and reduce conflicts.

Validity and reliability of the Greek version of Wijma delivery expectancy/experience questionnaire (Version A) among low-risk pregnant women.

BACKGROUND: Fear of childbirth is a frequent health issue for pregnant women. The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) is a widely used instrument to measure the fear of childbirth during the antenatal period. The aim of the study was to assess the psychometric properties of the W-DEQ (version A) in a sample of Greek pregnant women. METHODS: Low-risk pregnant women in the second or third trimester of pregnancy (N = 201) were invited to participate in the study and to complete a booklet of questionnaires including the Greek versions of W-DEQ-A, State-Trait Anxiety Inventory (STAI), Coping Orientations to Problems Experienced (Brief COPE), Perceived Stress Scale (PSS-10) and Edinburgh Postnatal Depression Scale (EPDS). Exploratory (EFA) and confirmatory factor analysis (CFA) was performed. RESULTS: The mean age of participants was 34.2 years (SD = 4.3 years). EFA yielded six factors ("Lack of self-efficacy", "Lack of positive anticipation", "Lack of feeling lonely", "Concerns about delivery and losing control", "Calmness", and "Concern for the child") of 33 items of W-DEQ-A. CFA confirmed the multidimensionality of the instrument. All Cronbach's alpha were over 0.7, indicating acceptable reliability of the factors. All factors were significantly correlated with each other, and convergent validity was demonstrated by a significant association with stress, anxiety, and depression among low-risk pregnant women. CONCLUSION: The Greek version of W-DEQ-A proved to be a valid and reliable instrument of fear of childbirth among Greek low-risk pregnant women.

Tocophobia: Risk Factors, Consequences and Management - A Systematic Review of the Literature.

OBJECTIVE: As far as childbirth is concerned, it is well known that it constitutes a major life process for every woman. Many women experience negative emotions during pregnancy because of the normal hormonal changes. However, if fear becomes severe, it gives rise to a specific pathology termed tocophobia. Especially, tocophobia adversely affects women's pregnancy and childbirth, including increased caesarean sections. Consequently, midwives need to detect women with tocophobia in order to support them. The aim of the present systematic review was to analyze the risk factors for tocophobia, the impact of this health condition on caesarean sections and the midwife's role. MATERIALS AND METHODS: The present systematic review comprised 32 full-text cross-sectional, qualitative, experimental studies and cohort studies published in English between 2017 and 2022, that were obtained from PubMed and Google Scholar databases, and it was conducted according to the PRISMA guideline. RESULTS: The present analysis found that sociodemographic, obstetric and psychological factors were associated with tocophobia. Moreover, women with severe fear had increased obstetric interventions, particularly caesarean sections. Studies have also shown that psycho-education, preparation classes and specific counselling by trained midwives are effective methods in reducing tocophobia. CONCLUSIONS: Midwives should be aware of the risk factors for tocophobia in order to detect women with fears and support them in the attempt to avoid non-urgent obstetric interventions. Antenatal and intrapartum care should be offered to women with tocophobia to reduce their fear as well as the prevalence of caesarean section and to promote vaginal birth with a positive experience.

European Association of Perinatal Medicine (EAPM), European Board and College of Obstetricians and Gynaecologists (EBCOG), European Midwives Association (EMA). Joint position statement: Substandard and disrespectful care in labour - because words matter.

Substandard or disrespectful care during labour should be of serious concern for healthcare professionals, as it can affect one of the most important events in a woman's life. Substandard care refers to the use of interventions that are not considered best-practice, to the inadequate execution of interventions, to situations where best-practice interventions are withheld from patients, or there is lack of adequate informed consent. Disrespectful care refers to forms of verbal and non-verbal communication that affect patients' dignity, individuality, privacy, intimacy, or personal beliefs. There are many possible underlying causes for substandard and disrespectful care in labour, including difficulties in modifying behaviours, judgmental or paternalistic attitudes, personal interests and individualism, and a human tendency to make less arduous, less difficult, or less stressful clinical decisions. The term "obstetric violence" is used in some parts of the world to describe various forms of substandard and disrespectful care in labour, but suggests that it is mainly carried out by obstetricians and is a serious form of aggression, carried out with the intent to cause harm. We believe that this term should not be used, as it does not help to identify the underlying problem, its causes, or its correction. In addition, it is generally seen by obstetricians and other healthcare professionals as an unjust and offensive term, generating a defensive and less collaborative mindset. We reach out to all individuals and institutions sharing the common goal of improving women's experience during labour, to work together to address the underlying causes of substandard and disrespectful care, and to develop common strategies to deal with this problem, based on mutual comprehension, trust and respect.

Assessing the burden of caregivers of patients with mental disorders: translating and validating the involvement evaluation questionnaire into Greek.

BACKGROUND: The changes in the organization of mental health care services have made the role of the family even more important in caring for patients with mental disorders. Caring may have serious consequences for family caregivers, with a great impact on the quality of family life. This study reports on the translation, cultural adaptation, and validation of the Involvement Evaluation Questionnaire-European Union (IEQ-EU) into the Greek language. METHODS: Caregivers of patients with major mental disorders were interviewed to test a modified version of the IEQ-EU questionnaire. Psychometric measurements included reliability coefficients, exploratory factor analysis and confirmatory analysis by linear structural relations. To measure the concurrent validity we used the Nottingham Health Profile (NHP). RESULTS: Most caregivers were female (83%), mainly mothers living with the patient (80%), with quite a high level of burden. The Greek version of the IEQ-EU (G-IEQ-EU) demonstrated a good reliability with high internal consistency (α = 0.88), Guttman split-half correlation of 0.71, high test-retest reliability (ICC = 0.82) and good concurrent validity with the NHP. A four-factor structure was confirmed for the G-IEQ-EU, slightly different from the original IEQ. The confirmatory factor analysis demonstrated that the four-factor model offered modest fit to our data. CONCLUSIONS: The G-IEQ-EU is a reasonably valid and reliable tool for use in both clinical and research contexts in order to assess the burden of caregivers of patients with mental disorders.

Breastfeeding During Pregnancy: A Systematic Review of the Literature.

Objectives: Breastfeeding during pregnancy has unintended repercussions that have yet to be determined. Previous research employed various approaches and reached varied outcomes, with some emphasizing on advantages and others focusing on hazards. With this study we aim at shedding light on the effects of breastfeeding during pregnancy on the outcome of pregnancy and the risk of miscarriage. Materials and methods: We conducted a systematic review of relevant papers which have been published in English between 2014 and 2022 by using the PubMed, Scopus and Google Scholar search engines. Databases identified 257 records, which were checked for their relatedness to the topic (title and abstract), and compliance with the selection criteria. Only 10 records met all requirements and were included in the present review. Results:The results revealed that breastfeeding during pregnancy appeared to be unrelated to pregnancy outcome and miscarriage risk, notwithstanding the need for caution in women at risk of preterm birth and high-risk pregnancies. Conclusion:All studies recognized the high nutritional requirements of lactating pregnant women as well as the importance of proper nutrition for a safe breastfeeding for both the mother and child (children). Further research, with larger samples and adequate methodology, is expected to lead to safer conclusions for breastfeeding during pregnancy.

Pregnancy during the pandemic: The psychological impact of COVID-19 on pregnant women in Greece.

INTRODUCTION: The COVID-19 outbreak has affected the overall health of people worldwide. Historically, pandemics pose a challenge to psychological resilience, causing heightened stress levels. This study aimed to investigate the impact of the COVID-19 pandemic on the psychological state of pregnant women in Greece. METHODS: A survey study was conducted on a sample of 149 pregnant women in late 2020, including the 'fear of COVID-19' scale, a self-report instrument that assess fear of COVID-19 among the general population and the State-Trait Anxiety Inventory (STAI) scale which measures state and trait anxiety. RESULTS: Pregnant women with a mental health history tended to score higher on the 'fear of COVID-19' scale (mean ± SD: 19.48 ± 4.35) compared to pregnant women who had never had mental health problems before (17.12 ± 5.27). Moreover, pregnant women with anxiety as part of their personality tended to also score higher on the 'fear of COVID-19' scale. In all, 48.3% of pregnant women reported that their psychological state had been severely affected by the COVID-19 outbreak. CONCLUSIONS: Pregnant women were highly affected by the COVID-19 pandemic. A significantly increased 'fear of COVID-19' scale score was associated with self-reported pre-existence mental health conditions. Pregnant women with higher levels of 'trait anxiety' tended to report higher scores on the 'fear of COVID-19' scale.

Can the Day of the Week and the Time of Birth Predict the Mode of Delivery According to Robson Classification?

Worldwide, the cesarean section rate has steadily increased from 6.7% in 1990 to 21.1% in 2018 and is expected to rise even more. The World Health Organization propose the adoption of the Robson classification system as a global standard for monitoring, evaluating, and comparing delivery rates. The purpose of the current study is to use the Robson classification system to investigate how, independently of medical factors, the day of the week and time of delivery may be related to the mode of birth. In the sample analysis, we included the records of 8572 women giving birth in one private health facility in Greece. Over 60% of deliveries during the study period were performed by cesarean section, 30.6% by vaginal delivery, and 8.5% of deliveries were performed by operative vaginal delivery. The results of this study indicate that the lowest birth rates are observed on Monday, Saturday, and Sunday. Nulliparous women with no previous cesarean delivery, with a singleton in cephalic presentation ≥37 weeks with spontaneous labor (group 1) are 73% more likely to deliver by cesarean section between 08:00 A.M. and 03:59 P.M. compared to those who give birth between 12:00 A.M. and 07:59 A.M. Also, multiparous women with a single cephalic term pregnancy and one previous cesarean section (group 5.1) are 16.7 times more likely to deliver by cesarean section in the morning compared to overnight deliveries. These results point out two non-clinical variables that influences the CS rate. The Robson classification system was a useful tool for the above comparisons.

Implementation of the Robson Classification in Greece: A Retrospective Cross-Sectional Study.

Cesarean sections have become the most commonly performed operations around the world. The World Health Organization recommended the use of the Robson classification system as a universal standard to establish a joint control system in healthcare facilities. The aim of this study was to implement the Robson classification for the first time in Greece to identify trends in cesarean births and examine the groups of women who are the main contributors to the increasing rates. Moreover, the indicators for cesarean sections will be evaluated as per the Robson classification. In the sample analysis, we included the records of 8572 women giving birth in one private health facility in Greece. A total of 8572 women gave birth during the study period, of which 5224 (60.9%) were cesarean section births and 3348 (39.1%) were vaginal births. In our study, according to the Robson classification, the largest contributors to the overall CS rate were as follows: (a) nulliparous women with a single cephalic term pregnancy, who were either labor induced or delivered by cesarean section before labor-Group 2 (34.6%); (b) multiparous women with a single cephalic term pregnancy and at least one previous cesarean section-Group 5 (30.7%); (c) women with a single cephalic preterm pregnancy-Group 10 (11.7%); (d) women with multiple pregnancies-Group 8 (7.0%). Our study is expected to assist policymakers in Greece in planning further interventions for each subgroup of women in order to reduce the overall CS rate and unnecessary CSs.

Social determinants of health and vaccine uptake during the first wave of the COVID-19 pandemic: A systematic review.

Social determinants of health significantly impact population health status. The aim of this systematic review was to examine which social vulnerability factors or determinants of health at the individual or county level affected vaccine uptake within the first phase of the vaccination program. We performed a systematic review of peer-reviewed literature published from January 2020 until September 2021 in Medline and Embase (Bagaria et al., 2022) and complemented the review with an assessment of pre-print literature within the same period. We restricted our criteria to studies performed in the EU/UK/EEA/US that report vaccine uptake in the general population as the primary outcome and included various social determinants of health as explanatory variables. This review provides evidence of significant associations between the early phases of vaccination uptake for SARS-CoV-2 and multiple socioeconomic factors including income, poverty, deprivation, race/ethnicity, education and health insurance. The identified associations should be taken into account to increase vaccine uptake in socially vulnerable groups, and to reduce disparities in uptake, in particular within the context of public health preparedness for future pandemics. While further corroboration is needed to explore the generalizability of these findings across the European setting, these results confirm the need to consider vulnerable groups and social determinants of health in the planning and roll-out of SARS-CoV-2 vaccination programs and within the context of future respiratory pandemics.

Validation of the Greek maternal adjustment and maternal attitudes scale for assessing early postpartum adjustment.

The Maternal Adjustment and Maternal Attitudes Scale is a self- administered scale, designed for use in primary care settings to identify postpartum maternal adjustment problems regarding body image, sex, somatic symptoms, and marital relationships. Women were recruited within four weeks of giving birth. Responses to the Maternal Adjustment and Maternal Attitudes Scale were compared for agreement with responses to the Edinburgh Postnatal Depression Scale as a gold standard. Psychometric measurements included: reliability coefficients, explanatory factor analysis, and confirmatory analysis by linear structural relations. A receiver operating characteristic analysis was carried out to evaluate the global functioning of the scale. Of 300 mothers screened, 121 (40.7%) were experiencing difficulties in maternal adjustment and maternal attitudes. Scores on the Maternal Adjustment and Maternal Attitudes Scale correlated well with those on the Edinburgh Postnatal Depression Scale. The internal consistency of the Maternal Adjustment and Maternal Attitudes Scale, Greek version-tested using Cronbach's alpha coefficient-was 0.859, and that of Guttman split-half coefficient was 0.820. Findings confirmed the multidimensionality of the Maternal Adjustment and Maternal Attitudes Scale, demonstrating a six-factor structure. The area under the receiver operating characteristic curve was 0.610, and the logistic estimate for the threshold score of 57/58 fitted the model sensitivity at 68% and model specificity at 64.6%. Data confirmed that the Greek version of the Maternal Adjustment and Maternal Attitudes Scale is a reliable and valid screening tool for both clinical practice and research purposes to detect postpartum adjustment difficulties.

A fuzzy intelligent system to assess midwives' burnout conditions.

INTRODUCTION: Midwives' burnout affects their effectiveness and the quality of the services they provide to pregnant women as well as the quality of the collaboration with medical staff. The burnout depends on a number of factors that can exhibit high variability over time. This creates the necessity of introducing intelligent approaches that assess changes in behavior, environmental factors, working conditions, and to make decisions to optimize the physical and mental health of midwives. The aim of this study was to employ fuzzy logic to design a Fuzzy Intelligent or Inference System (FIS) that assesses midwives' burnout level by emulating the reasoning of human experts. METHODS: The proposed FIS addresses the assessment of midwives' burnout comprehensively since it incorporates findings following a thorough analysis of the relevant literature, as well as assimilates experts' knowledge elicited through semi-structured interviews. Additionally, fuzzy rules are more intuitive and thus easier to understand and modify by human users than dealing and translating numerical results. The FIS performance is compared and evaluated against experienced midwives. RESULTS: Findings confirm the ability of the proposed FIS to produce judgments that are closer to experts' consensus, as expressed by their aggregated assessment. CONCLUSIONS: The proposed FIS is evaluated by comparing its results with judgments made by experts, suggesting that fuzzy logic allows precise and personalized assessment of midwives' burnout levels. The proposed FIS can be used to evaluate burnout, support organizations to develop burnout policies as well as used as a research instrument to investigate interrelationships of burnout factors.

Which classification system could empower the understanding of caesarean section rates in Greece? A review of systematic reviews.

INTRODUCTION: Worldwide there is an alarming increase in the caesarean delivery rate which has become a controversial topic. However, the reasons for this tendency are not clear. For example, in Greece alone, rates increased by almost 50% from 1983 to 1996. In order to better understand the causes of this phenomenon, we need to examine closely what groups of women undergo caesarean section (CS). To achieve this, it is essential to use a system that will enable us to monitor and compare caesarean delivery rates. Such a classification system should be easily adopted by obstetricians, midwives, and public health services. METHODS: A review search of electronic databases concerning medical care was held from December 2020 to January 2021 in order to find systematic reviews which describe either theoretical or practical CS classification systems. RESULTS: The most common classification systems fall into three main categories based on indication, urgency and maternal-based characteristics. According to users the highest rated classification system was women-based classifications in general. In particular the Robson Ten Group Classification System was considered to be the most valid to meet current local and international standards. The Robson classification system is praised for its robustness, simplicity, flexibility, and reproducibility. CONCLUSIONS: The right implementation of the Robson Ten Group Classification System can facilitate an in-depth analysis of the main groups that increase CS rates and can be used to both review and monitor delivery practices both in Greece and abroad.

Intelligent systems in obstetrics and midwifery: Applications of machine learning.

INTRODUCTION: Machine learning is increasingly utilized over recent years in order to develop models that represent and solve problems in a variety of domains, including those of obstetrics and midwifery. The aim of this systematic review was to analyze research studies on machine learning and intelligent systems applications in midwifery and obstetrics. METHODS: A thorough literature review was performed in four electronic databases (PubMed, APA PsycINFO, SCOPUS, ScienceDirect). Only articles that discussed machine learning and intelligent systems applications in midwifery and obstetrics, were considered in this review. Selected articles were critically evaluated as for their relevance and a contextual synthesis was conducted. RESULTS: Thirty-two articles were included in this systematic review as they met the inclusion and methodological criteria specified in this study. The results suggest that machine learning and intelligent systems have produced successful models and systems in a broad list of midwifery and obstetrics topics, such as diagnosis, pregnancy risk assessment, fetal monitoring, bladder tumor, etc. CONCLUSIONS: This systematic review suggests that machine learning represents a very promising area of artificial intelligence for the development of practical and highly effective applications that can support human experts, as well the investigation of a wide range of exciting opportunities for further research.

Identifying intimate partner violence (IPV) during the postpartum period in a Greek sample.

Research has highlighted the wide impact of intimate partner violence (IPV) and the public health role of community health professionals in detection of victimized women. The purpose of this study was to identify postpartum emotional and physical abuse and to validate the Greek version of the Women Abuse Screening Tool (WAST) along with its sensitivity and specificity. Five hundred seventy-nine mothers within 12 weeks postpartum were recruited from the perinatal care registers of the Maternity Departments of two public hospitals in Athens, Greece. Participants were randomly selected by clinic or shift. The WAST and the Partner Violence Screen (PVS) surveys were administered in random order to the mothers from September 2007 to January 2008. The WAST was compared with the PVS as a criterion standard. Agreement between the screening instruments was examined. The psychometric measurements that were performed included: two independent sample t tests, reliability coefficients, explanatory factor analysis using a Varimax rotation, and Principal Components Method. Confirmatory analysis-also called structural equation modeling-of principal components was conducted by Linear Structural Relations. A receiver operating characteristic (ROC) analysis was carried out to evaluate the global functioning of the scale. Two hundred four (35.6%) of the mothers screened were identified as experiencing IPV. Scores on the WAST correlated well with those on the PVS; the internal consistency of the WAST Greek version-tested using Cronbach's alpha coefficient-was found to be 0.926 and that of Guttman's split-half coefficient was 0.924. Our findings confirm the multidimensionality of the WAST, demonstrating a two-factor structure. The area under ROC curve (AUC) was found to be 0.824, and the logistic estimate for the threshold score of 0/1 fitted the model sensitivity at 99.7% and model specificity at 64.4%. Our data confirm the validity of the Greek version of the WAST in identifying IPV. The validated Greek WAST scale could be used for screening purposes in both clinical practice and research.

Migrant women's experiences of pregnancy, childbirth and maternity care in European countries: A systematic review.

BACKGROUND: Across Europe there are increasing numbers of migrant women who are of childbearing age. Migrant women are at risk of poorer pregnancy outcomes. Models of maternity care need to be designed to meet the needs of all women in society to ensure equitable access to services and to address health inequalities. OBJECTIVE: To provide up-to-date systematic evidence on migrant women's experiences of pregnancy, childbirth and maternity care in their destination European country. SEARCH STRATEGY: CINAHL, MEDLINE, PubMed, PsycINFO and Scopus were searched for peer-reviewed articles published between 2007 and 2017. SELECTION CRITERIA: Qualitative and mixed-methods studies with a relevant qualitative component were considered for inclusion if they explored any aspect of migrant women's experiences of maternity care in Europe. DATA COLLECTION AND ANALYSIS: Qualitative data were extracted and analysed using thematic synthesis. RESULTS: The search identified 7472 articles, of which 51 were eligible and included. Studies were conducted in 14 European countries and focused on women described as migrants, refugees or asylum seekers. Four overarching themes emerged: 'Finding the way-the experience of navigating the system in a new place', 'We don't understand each other', 'The way you treat me matters', and 'My needs go beyond being pregnant'. CONCLUSIONS: Migrant women need culturally-competent healthcare providers who provide equitable, high quality and trauma-informed maternity care, undergirded by interdisciplinary and cross-agency team-working and continuity of care. New models of maternity care are needed which go beyond clinical care and address migrant women's unique socioeconomic and psychosocial needs.

A survey for the readiness of Greek midwives for the adoption of evidence-based practice (EBP).

INTRODUCTION: The holistic approach of healthcare practice in midwifery demands the use of evidence-based practice (EBP) in all aspects of clinical care. Applying EBP in every day healthcare practice by midwives offers various significant benefits. The aim of the present study was to investigate and assess the knowledge and awareness of midwives in Greece with regard to EBP. METHODS: Data collection took place from October 2012 to January 2013 among midwifery staff within two national 'urban' healthcare hospitals of Athens and the department of midwifery in the Athens Technological Institute. The sample consisted of 209 participants of which 109 were midwives and 100 student midwifes. Both were invited to complete a questionnaire specifically designed for the study. RESULTS: Only 43.5% of midwives declared awareness of the term EBP, while 36.4% had to search for general evidence about twice a month in order to support their role. The first source of information to support clinical practice was found to be 'asking colleagues' (52.2%) followed by 'internet search in general' (48.8%), but not in the EBP databases. In addition, 61.2% of respondents stated that EBP would definitely contribute to the provision of better quality midwifery care. CONCLUSIONS: For a successful implementation of EBP, it is required initially to train personnel to develop their abilities, to provide information on the way to use different data sources and encourage midwifery personnel to take initiatives and be part of the decision-making process.

Improving pregnancy and birth experiences of migrant mothers: A report from ORAMMA and continued local impact.

INTRODUCTION: Migration is a growing phenomenon affecting many European countries, with many migrants being of childbearing age. Depending on the country of origin, poorer pregnancy and birth outcomes amongst migrant women have been reported. Providing appropriate culturally sensitive perinatal services is of paramount importance. METHODS: The Operational Refugee And Migrant Mothers Approach (ORAMMA) was a three-site multidisciplinary collaborative research project, designed to develop and test implementation of a high-quality maternity care model including peer supporters for migrant women who have recently arrived in European countries. Community-based activities were undertaken to ensure ongoing local impact for maintaining supportive interactions amongst peer supporters and recently arrived migrant women in the UK. RESULTS: The women who volunteered to become maternity peer supporters were motivated by their own experiences of being newly arrived migrants in the past or a sense of altruism. Forging links with multiple local community groups enabled the continuation of the support provided by maternity peer supporters, including during the COVID-19 pandemic. CONCLUSIONS: Engagement of maternity peer supporters in supporting newly arrived mothers has multiple advantages of addressing social isolation and marginalisation of migrant communities, with potential benefits of improving access and enhancing health literacy and health outcomes amongst recently arrived migrant women as well as creating a self-supporting network for peer supporters themselves.