In brief

Research shows that while inhaling gas and air (Entonox) in labour is safe for mothers and babies, long-term cumulative exposure may carry health risks. Work notice The right to strike The UK government's Strikes (Minimum Service Levels) Bill is, at the time of going to press, at the committee stage in the House of Lords (the first chance for line-by-line examination). Visit bit.ly/ Clementine-register Working mums Maternity leave Careers After Babies research has found that of 848 mothers interviewed, 98% want to return to work after having a child but just 13% can make it work full-time, citing the cost of childcare and lack of flexibility from businesses as the reason. Find out more at hegenbergermedical.com/training Research Healthy eating support Researchers at the University of Hertfordshire are calling for better information on diet and nutrition to be made available to expectant parents.

Learning throughout the storm

Newly qualified midwives highlight the lessons they learnt during their final year of training during the global pandemic

Designated antenatal clinic for pregnant women with COVID in the fifth wave of pandemic

We report our experience in setting up a designated antenatal clinic in the Kowloon East Cluster during the fifth wave of COVID pandemic for infected pregnant women.

From branch to board

Members' needs drive the RCM's actions at every level, from local branches to the governing board, individual matters to strategic direction. There are a few RCM committees chaired by board members - for example, looking at audit and risk or the information services for members - and all of those also feed back into the board for oversight. Keelie Barrett MSW MEMBER OF THE RCM BOARD I was the first MSW member of the RCM board, elected in 2019 when MSWs became eligible. Because of this, I feel it's important for me to be a role model to show other MSWs what's possible and encourage them to put themselves forward too. Having been on a board of governors at a school I had an insight into that - but I wasn't aware of all the sub-committees board members get involved in, such as the Investment Committee that I currently chair, all of which feeds back into the whole board meetings every other month.

Care and repair

Better Births followed on the heels of the Kirkup report (2015), which found "avoidable harm" had caused the deaths of 11 babies and one mother at University Hospitals of Morecambe Bay NHS Foundation Trust, at a time when England had higher maternal and infant mortality rates than both the EU and OECD averages (Papanicolas et al, 2019). Deteriorating conditions Following the Better Births report, change was incremental but positive: between 2016 to 2019, the CQC (2021) found "year-on-year improvement" for women giving birth. At local level, workplace reps will be able to access toolkits and resources through the RCM website, and the RCM will provide training that will empower them to ask for changes in their workplaces. "With our experience from the start of Caring for You in 2016 - the issues that it's raised, the conversations we've had, the improvements we've seen - it really will lead us onto improving actual working conditions."

Knowledge, attitudes, and practices related to the COVID-19 pandemic among pregnant women in Bangkok, Thailand

Background Pregnancy is associated with increased risk for severe COVID-19. Few studies have examined knowledge, attitudes, and practices (KAP) related to pregnancy during the pandemic. This study investigated the association between socio-demographic characteristics and KAP related to COVID-19 among pregnant women in an urban community in Thailand. Methods A cross-sectional online survey was distributed among pregnant women in Bangkok, Thailand from July–August 2021. Binary logistic regression was conducted to test the association between socio-demographic characteristics and KAP related to COVID-19, and a Spearman’s analysis tested correlations between KAP scores. Results A total of 150 pregnancy survey responses were received. Most participants were third trimester (27–40 weeks gestation;68.0%). Pregnancy had never been risked contracting COVID-19 (84.7%). Most expressed concerns about being infected with COVID-19 during pregnancy and following birth (94.0 and 70.0%, respectively). The results of binary logistic regression analysis found associations between knowledge and marital status (OR = 4.983, 95%CI 1.894–13.107). In addition, having a bachelor’s degree or higher was associated with higher attitude scores (OR = 2.733, 95%CI 1.045–7.149), as was being aged 26–30 (OR = 2.413 95%CI 0.882–6.602) and 31–35 years of age (OR = 2.518–2.664, 95%CI 0.841–8.442). Higher practice scores were associated with having a bachelor’s degree or higher (OR = 2.285 95%CI 1.110–6.146), and income ≥15,001 bath (OR = 4.747 95%CI 1.588–14.192). Correlation analysis found a weak positive correlation between knowledge and practice scores (r = 0.210, p-value = 0.01). Conclusion Participants overall had high KAP scores. This study can guide public health strategies regarding pregnant women and COVID-19. We recommend that interventions to improve and attitude and practice scores. Knowledge on pregnancy and COVID-19 should focus on reducing fear and improving attitudes toward the care of patients as well as the promotion of preventive practices.

Editorial

Women’s health continues to make headline news both in the UK and globally. There is increasing data on the safety of COVID-19 vaccinations in pregnancy, with benefits not just for the pregnant woman but also her yet-to-be-born baby (with decreased infant admission for COVID-19 in the first 6 months of life for those born to vaccinated mothers). In my practice, the message seems to be getting through, but we must still listen to those who are worried by vaccination and explore their fears individually.

100 years of progress

The 2030 Agenda for Sustainable Development, adopted by all United Nations member states in 2015, provides a blueprint for the wellbeing of people and the planet. Te crises in Ukraine, Syria and Afghanistan demonstrate the challenges of providing high-quality sexual, reproductive, maternal and newborn healthcare in areas of confict and mass human migration;women (including midwives), adolescent girls and newborns are especially vulnerable in humanitarian emergencies. Te ICM's Push Campaign aims to accelerate progress on reducing maternal and neonatal mortality, advance sexual and reproductive health rights, address key barriers to women's leadership in the global health workforce, and shift underlying gender norms that undervalue women's rights, lives and work.

On your side

Workplace reps – stewards, health and safety, learning and MSW advocates – are the RCM's front line, supporting, advising, representing, sharing information and caring whileworking alongside members Midwife Mary Ann Gillan has been a steward for the RCM Fife Branch for five years My motivation is getting people a fair deal and advocating for them. [...]over the past two years we've had a huge issue in Fife with staff not being paid correctly for annual leave dating back to 2008 – but, working with other unions, we were able to come to an agreement for the back pay owed. With help from the regional offi cer, we were able to get them to delay implementation and go back to the beginning, work more with midwives and follow the right processes. Recently we were able to get funding from the Welsh Union Learning Fund for a training course run by the charity Birthrights focusing on facilitating a woman's right to informed choice and consent;we're currently off ering an aromatherapy course in collaboration with another Welsh RCM branch.

Resumption of Elective Surgery Following COVID-19 Outbreak, Guideline for Female Pelvic Medicine and Surgery

Division of Female Pelvic Medicine and Surgery, Department of Obstetrics and Gynecology, Emam Khomeini Hospital, Tehran University of medical sciences proposed a clinically relevant algorithm to guide appropriate decision making based on underlying risk stratification and resource utilization in order to resume elective surgeries, following COVID-19 pandemic crisis. The consequence of standardized decision-making factors and transparency of the principles will provide more assurance, consistency, and reliability on both sides, care providers and the patient. It also will decrease ethical dilemmas and moral criticism for surgeons. Eventually, this approach is applicable in any other disaster preparedness as a logical stratification of surgical indications for the female pelvic floor surgical procedures.

Social media minefield

National news headlines such as - 'Mental Health Nurse struck off for Facebook posts' and 'Nurses sanctioned for improper use of social media' - do not help either. [...]we know that seven NMC registrants were struck off between 2017 and 2019 after allegations involving social media. Research, such as Dr Rose McCarthy's 'Facemums' project, shows how small-scale social media projects involving pregnant women and midwives have been beneficial to both groups. Research It could be proposed that providing in-depth training may be the answer to bridging the gap on social media between women and midwives, but without research into the area to provide training content, it is hard to know where to start.

Working for you

Jacqueline Dunkley-Bent, NHS England's chief midwife, and Dr Matthew Jolly, the national clinical director for maternity, wrote to maternity units telling them to "stop using caesarean section rates [for] performance management" and to stop pursuing "normal births", with the targets described as potentially "unsafe" and clinically inappropriate. Even though multiple structures are in place to support staff in raising issues, including the Nursing and Midwifery Council's duty of candour and NHS whistleblowing policies, staff are too often still being ignored and stifled when trying to raise concerns. The RCM guidelines outline situations in which staff should speak up to their line managers and employers, including when staffing levels are unsafe, where leadership support is reduced and when there is pressure to overlook staff concerns. Dr Mary Ross-Davie, RCM director for professional midwifery, urged unvaccinated pregnant women to: "go to trusted, evidence-based sources such as the RCM, RCOG and government websites and talk to healthcare k professionals, including your midwife.