Clinicians' perspectives and experiences of providing cervical ripening at home or in-hospital in the United Kingdom.

Induction of labour, or starting labour artificially, is offered when the risks of continuing pregnancy are believed to outweigh the risks of the baby being born. In the United Kingdom, cervical ripening is recommended as the first stage of induction. Increasingly, maternity services are offering this outpatient or 'at home', despite limited evidence on its acceptability and how different approaches to cervical ripening work in practice. There is also a paucity of literature on clinicians' experiences of providing induction care in general, despite their central role in developing local guidelines and delivering this care. This paper explores induction, specifically cervical ripening and the option to return home during that process, from the perspective of midwives, obstetricians and other maternity staff. As part of a process evaluation involving five case studies undertaken in British maternity services, interviews and focus groups were conducted with clinicians who provide induction of labour care. The thematic findings were generated through in-depth analysis and are grouped to reflect key points within the process of cervical ripening care: 'Implementing home cervical ripening', 'Putting local policy into practice', 'Giving information about induction' and 'Providing cervical ripening'. A range of practices and views regarding induction were recorded, showing how the integration of home cervical ripening is not always straightforward. Findings demonstrate that providing induction of labour care is complex and represents a significant workload. Home cervical ripening was seen as a solution to managing this workload; however, findings highlighted ways in which this expectation might not be borne out in practice. More comprehensive research is needed on workload impacts and possible lateral effects within other areas of maternity services.

Evaluation of the effect of a midwife-led online program using cognitive behavioral therapy for pregnant women at risk for anxiety disorder in Japan: A pilot randomized controlled trial.

AIM: This study aimed to conduct a pilot randomized controlled trial (RCT) to examine the appropriateness and feasibility of a midwife-led cognitive behavioral therapy (CBT)-based, three-session program delivered remotely to pregnant women at risk for anxiety disorders. METHODS: The study design was a pilot RCT. Outcome was the difference between the two groups in the change in generalized anxiety disorder-7 (GAD-7), Kessler6 (K6) and Edinberg Postnatal Depression Scale (EPDS) etc. Recruitment was conducted from August 2020 to July 2021 in clinics and web-based survey monitors in Japan, with follow-up through November 2021. RESULTS: This program involving 63 pregnant women were administered. Although the intervention was remote, a total of three sessions was completed during pregnancy. The change in GAD-7 scores from pre- to 1 month postpartum, was mean -1.77 in the intervention group and mean -0.97 in the control group, with a p-value of .521, indicating no significant difference between the two groups, although GAD-7 scores were lower in the intervention group. The change in K6 score from pre- to 1 month postpartum, was mean -3.55 in the intervention group and mean -1.62 in the control group, with a p-value of .168, indicating no significant difference between the two groups, although the intervention group showed a greater decrease. In particular, in primiparas, the change in GAD-7 scores in the intervention group was large, and some expressed a desire for a postpartum session, suggesting that a follow-up session after delivery may be effective. In multiparas, the control group showed an increase in both GAD-7 and K6 scores from late pregnancy to 1 month postpartum, while the intervention group showed a decrease in scores. CONCLUSION: The program was implemented using CBT conducted by midwife, anxiety decreased in primiparas. In future RCTs, it was suggested that additional postpartum sessions may be effective. TRIAL REGISTRATION: UMIN Clinical trial registry ID: UMIN000040304.

Barriers and facilitators to the provision of maternal health services at community health centers during the COVID-19 pandemic: Experiences of midwives in Indonesia.

OBJECTIVE: To explore the experiences of midwives in Indonesia on the provision of maternal health services during the COVID-19 pandemic. DESIGN AND METHODS: A qualitative descriptive study using focus group discussions was undertaken. A conventional content analysis was used to analyze the data. Coding categories were generated from the transcripts. SETTING AND PARTICIPANTS: Twenty-two midwives from five community health centers of three regions in the Province of Jambi, Indonesia were included. FINDINGS: The interviewees shared similar barriers and facilitators in delivering the services, including the unavailability of adequate protective equipment, the limitation of the number of services, and dealing with the new public health measures related to the COVID-19. Overall, midwives demonstrated a continued commitment to provide maternal health services during the pandemic. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Significant changes in service delivery have been made to comply with pandemic related restrictions. Despite the unprecedentedly difficult working environment, the midwives continue to provide adequate services to the community by implementing a strict health protocol. Findings from this study contribute to a better understanding of how the quality of the services changed, as well as how new challenges can be addressed and positive changes can be reinforced.

The commitment to a midwifery centre care model in Bangladesh: An interview study with midwives, educators and students.

BACKGROUND: Midwifery-led care is a key factor in reducing maternal and new-born mortality globally. In Bangladesh, only a third of births are attended by professionals and almost 70% of births occur outside healthcare facilities. Midwifery is a relatively new profession in Bangladesh and a midwifery centre care model has only recently been introduced. This study aims to explore the willingness within the healthcare system to support a greater role for midwifery centres in maternity services. METHODS: Data were collected through individual semi-structured interviews with 55 midwives, midwifery educators and final year midwifery students. Two of the midwifery educators were principals of nursing institutes involved in the government's midwifery leadership and considered as experts in the midwifery care system. The data was analysed using qualitative content analysis. The transcribed interviews comprised 150 pages. The study received ethical approval from the Directorate General of Nursing and Midwifery in Bangladesh. RESULTS: One main category emerged from the study: "The foundations of a midwifery centre care model need to be strengthened for the sustainable implementation of midwifery centres in Bangladesh to continue". Five additional categories were identified: 1) The midwifery centre care model is inaccessible for communities, 2) Striving for acceptable standards of care within a midwifery centre care model is not a priority 3) Respectful, woman-centred care is weak, 4) Community engagement with the midwifery centre care model is insufficient, and 5) The midwifery centre care model is not integrated into the healthcare system. These categories were supported by the identification of 11 sub-categories. CONCLUSION: The willingness to commit to a midwifery centre care model is not yet in place in Bangladesh. Advocacy, information, and education about the benefits of normal birth assisted by professional midwives is needed at all levels of Bangladeshi society.

Mothers' and Midwives' Experiences of Maternal and Child Health Services during the COVID-19 Pandemic in Banggai, Indonesia: A Qualitative Study.

Background: Maternal and child health (MCH) services have been affected by the Coronavirus disease (COVID-19) pandemic in all countries, including Indonesia. Information regarding the impact of COVID-19 on MCH service access and provision is limited, particularly in the context of rural Indonesian communities. This study aimed to explore the experiences of Indonesian mothers and midwives from a rural regency regarding MCH services delivery during the pandemic. Methods: This study was a sub-study of a pre-existing cohort study conducted in four sub-districts in Banggai, Indonesia, as the qualitative research. This study was conducted from November 2020 to April 2021, involving 21 mothers and six midwives. We selected the participants using snowball sampling. In-depth interviews were conducted in Bahasa. The study used both deductive and inductive approaches for analysis. Data analysis was performed using NVivo v.12. Results: The study identified three themes and eight sub-themes from the analysis incorporating the midwives' and mothers' data. The themes included health service change, perceived barriers to service delivery, and family impact. This study highlights health service changes due to the pandemic, such as relocating the MCH services. Mothers perceived barriers to accessing health services, including distance reasons and fear of COVID-19. Only the shortages of staff affected the midwives in providing optimal services. Conclusion: The pandemic triggered health service changes and caused some barriers to service delivery. This study recommends that the local government and stakeholders should pay more attention to the health service changes according to the mothers' experiences and address barriers to optimize access to MCH services during the pandemic.

Using Collaborative Online International Learning to Support Global Midwifery Education.

BACKGROUND AND LOCAL PROBLEM: The COVID-19 pandemic created a gap in global health learning, requiring creative solutions to bridge the divide. Collaborative online international learning (COIL) is a program between universities located in different geographic areas that aims to build cross-cultural learning and collaboration. INTERVENTION: Faculty members from Uganda and the United States worked collaboratively to plan a 2-session COIL activity for nursing and midwifery students. Twenty-eight students from the United States and Uganda participated in the pilot quality improvement project. MEASURES: Students completed a 13-question REDCap survey measuring satisfaction, time commitment for the activity, and increase in knowledge about differently resourced healthcare systems. Students also were asked to provide qualitative feedback in that survey. RESULTS: Survey results indicate a high level of satisfaction and an increased understanding of a new healthcare system. The majority of students wanted more scheduled activity times, the opportunity to meet face to face, and/or more robust sessions in the future. CONCLUSION: This COIL activity between students in the United States and Uganda was a no-cost activity that provided global health learning opportunities for students during the global pandemic. The COIL model is replicable, adaptable, and customizable for a variety of courses and time spans.

Changes to Birth Plans Due to COVID-19: A Survey of Utah Midwives and Doulas.

INTRODUCTION: This study seeks to understand the experiences of Utah midwives and doulas caring for patients during the recent coronavirus disease 2019 (COVID-19) pandemic. Specifically, the goal of the study was to describe the perceived impact on the community birth system and explore differences in the access and use of personal protective equipment (PPE) between in- and out-of-hospital births. METHODS: This study used a cross-sectional, descriptive study design. A 26-item survey developed by the research team was sent via email to Utah birth workers, including nurse-midwives, community midwives, and doulas. Quantitative data were collected during December 2020 and January 2021. Descriptive statistics were used in the analysis. RESULTS: Of the 409 birth workers who were sent a link to the survey, 120 (30%) responded: 38 (32%) CNMs, 30 (25%) direct-entry or community midwives, and 52 (43%) doulas. The majority (79%) reported changes to clinical practice during the COVID-19 pandemic. Community midwives (71%) who responded indicated practice volume increased. Survey participants reported an increased patient preference for home births (53%) and birth center births (43%). Among those with one or more patient transfers to the hospital, 61% experienced a change in the process. One participant reported that it took 43 minutes longer to transfer to the hospital. Community midwives and doulas reported poor access to a regular source of PPE. DISCUSSION: Survey participants reported changes to planned birth locations during the COVID-19 pandemic. When necessary, transfers to hospitals were reported to be slower. Community midwives and doulas reported having insufficient access to PPE and reported limited knowledge about COVID-19 testing resources and resources for educating patients on COVID-19. This study adds an important perspective to the existing literature on COVID-19 by indicating that policymakers should include community birth partners in community planning for natural disasters and future pandemics.

Suicide, self-harm, and suicide ideation in nurses and midwives: A systematic review of prevalence, contributory factors, and interventions.

BACKGROUND: Nurses have been identified as an occupational group at increased risk of suicide. This systematic review examines the prevalence of, and factors influencing, suicide and related behaviours among nurses and midwives (PROSPERO pre-registration CRD42021270297). METHODS: MEDLINE, PsycINFO, and CINAHL were searched. Articles published from 1996 onwards exploring suicidal thoughts and behaviours among nurses and midwives were included. Quality of included studies was assessed. Articles were subjected to narrative synthesis informed by suicide data examined, study design, and quality. PRISMA guidelines were followed. RESULTS: A total of 100 studies were eligible for inclusion in the review. Articles examining suicide exclusively among midwives were absent from the literature. Several studies confirmed that nursing professionals, especially female, are at increased risk of suicide, particularly by self-poisoning. Factors contributing to risk include psychiatric disorders, alcohol and substance misuse, physical health problems, and occupational and interpersonal difficulties. In studies of non-fatal suicidal behaviours, including during the COVID-19 pandemic, psychiatric, psychological, physical and occupational factors were contributory. There has been little investigation of interventions for prevention of suicide in nurses. LIMITATIONS: Only articles published in English language were reviewed. CONCLUSIONS: The findings highlight the risk of suicide in nurses. They also show a combination of factors contribute to suicide and non-fatal suicidal behaviour in nurses, with psychiatric, psychological, physical health, occupational and substance misuse (especially alcohol) problems being particularly important. The limited evidence regarding prevention measures indicates a major need to develop primary and secondary interventions for this at-risk occupational group, for example, education regarding enhancing wellbeing and safe alcohol use, alongside accessible psychological support.

Volunteering in an emergency project in response to the COVID-19 pandemic crisis: the experience of Italian midwives.

OBJECTIVES: During the first wave of the COVID-19 pandemic, the Region of Lombardy in Italy and its Regional Emergency Service (Azienda Regionale Emergenza Urgenza [AREU]) created a dedicated 24/7 free phone service to help the Lombard population. After an invitation from their professional order, local midwives collaborated on the AREU project as volunteers to address the needs of women from antenatal to postnatal periods. The aim of this article was to explore the experiences of midwives who volunteered in the AREU project. STUDY DESIGN: This was a qualitative study using an interpretative phenomenological approach (IPA). METHODS: The experiences of midwives volunteering in AREU (N = 59) were explored using audio diaries. Written diaries were also offered as an alternative. Data collection took place between March and April 2020. Midwives were provided with semistructured guidance that indicated the main areas of interest of the study. The diaries were thematically analysed following a temporal criterion; a final conceptual framework was created from emerging themes and subthemes. RESULTS: The following five themes were identified: (1) choosing to join the volunteer project, (2) the day-to-day difficulties, (3) strategies to cope with the unexpected, (4) professional relationships and (5) reflecting on the personal experience. CONCLUSIONS: This is the first study to investigate the experiences of Italian midwives who volunteered in a public health project during a pandemic/epidemic. According to participants, taking part in the volunteer activities was informed by and impacted on both their professional and personal lives. Overall, the experiences of midwives who volunteered in AREU were positive and of humanitarian value. Providing midwifery services within a multidisciplinary team for the benefit of public health represented both a challenge and personal/professional enrichment.

Antenatal care experiences of uninfected pregnant women during the COVID-19 pandemic: A qualitative systematic review.

BACKGROUND: There is a limited understanding of pregnant women's antenatal care experiences during the COVID-19 pandemic. PURPOSE: To review and synthesize qualitative studies on uninfected pregnant women's antenatal care experiences during the COVID-19 pandemic. METHODS: Five databases were searched for qualitative studies published between January 2020 and January 2023. This study used a thematic synthesis of qualitative evidence and was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Furthermore, this review was registered with PROSPERO and a quality appraisal was assessed. RESULTS: Nine published qualitative studies were included in this review. The studies were conducted in eight countries and included 3,709 participants. Five themes were identified: (a) disruptions of normal antenatal care services, (b) feelings of uncertainty, (c) desire for sufficient spousal support, (d) coping strategies, and (e) trust in health care providers. DISCUSSION AND CONCLUSION: The themes can be utilized to reform current interventions for pregnant women by nurse-midwife managers and by health care policymakers to improve current practice and direct new research to prepare for future pandemics.

Identification of factors influencing core competence promotion among professional nurses and midwives: A qualitative study using the COM-B model.

AIM: To identify factors influencing a behaviour of improving core competencies among nurses and midwives in the Maternity and Child Health Care Hospital using the capability, opportunity, motivation and behaviour (COM-B) model. BACKGROUND: With the increasing number of women with pregnancy complications and the COVID-19 pandemic, nurses and midwives are being challenged and enhancing their core competencies is imperative to ensure high-quality care. To develop effective intervention strategies, it is essential to systematically explore what influences nurses and midwives to improve their core competencies. To this end, this study applied the COM-B model of behavioural change. DESIGN: Qualitative study using the COM-B model. METHODS: This qualitative descriptive study was conducted in 2022 using face-to-face interviews, including 49 nurses and midwives. Topic guides for the interviews were developed based on the COM-B model. Transcribed verbatim interviews were analysed using deductive thematic analysis. RESULTS: The COM-B model captures several factors. Capability factors included clinical knowledge and self-directed learning abilities. Opportunity factors included professional education covering necessary clinical skills, adequate clinical practice, personalised training, available time, insufficient clinical learning resources, absence of scientific research resources and support from leadership. Motivational factors were access to long-term work, incentive policies based on individuals' work values and responses to upward social comparison. CONCLUSIONS: The findings of this study suggested that prior to developing intervention strategies to enhance the core competencies of nurses and midwives, processing barriers to nurses' and midwives' capabilities, opportunities and motivation can facilitate the implementation of interventions.

Digitally augmented learning: a qualitative study on the perception of nurses and midwives in the Master's degree during the SARS-CoV-2 pandemic in Italy. / La didattica aumentata digitalmente: studio qualitativo sulla percezione di infermieri e ostetriche del corso di Laurea magistrale durante la pandemia SARS-CoV-2 in Italia.

BACKGROUND: The SARS-CoV-2 pandemic has necessitated a rapid transition to digitally augmented education, generating a phenomenon that is unprecedented in the history of university education of healthcare professionals. The purpose of this study is to understand the effects of online teaching on the learning of students of the Master's Degree, to collect the significant elements of their experience and stimulate reflection on teaching practices. OBJECTIVE: To describe perceptions and experiences of nurses and midwives in the Master's degree on digitally augmented learning during the SARS-CoV-2 pandemic. METHODS: A descriptive qualitative study was performed on a proactive sample of 34 nurse practitioners, pediatric nurses and midwives. The data was collected in January-February 2021 through an online form, built ad hoc. The answers were analyzed with deductive content analysis. RESULTS: 4 main categories emerge from the analysis of the texts: educational impact, time management, disadvantages of online teaching, distance learning-teaching. The results partly confirm what is reported in the literature about virtual learning, with better time management and the usefulness of video recordings. However, learning is strongly conditioned by the difficulties of interaction and communication between the students and between the teachers and the students. CONCLUSION: The digitally augmented learning allowed the continuation of the training course of health professionals engaged during the SARS-CoV-2 emergency. However, distance learning if used exclusively for a long time is a limited tool as it modifies the didactic processes preventing the development of meaningful relationships, dialogue and educational relationships which are important and essential outcomes in the master's course.

Personal protective equipment availability and accessibility among nurses and midwives in selected urban general hospitals in Lusaka, Zambia: a cross-sectional study.

Introduction: the World Health Organization (WHO) declared COVID-19 a pandemic in January 2020, which has spread to many countries, including Zambia. Zambia has had challenges in providing personal protective equipment (PPEs) to nurses and midwives. The study's objective was to assess the availability and accessibility of PPEs among nurses and midwives caring for women in the general hospitals in Lusaka, Zambia. Methods: a cross-sectional analytical study design was conducted at five general hospitals in Lusaka on 162 nurses and midwives between February and April 2021, selected by purposive sampling of study sites and simple random sampling to select the participants. Data was collected using a semi-structured self-administered questionnaire and analyzed in STATA version 13. Chi-square and Fisher's exact test were used to test associations between the independent variables and the outcome, and a multivariable logistic regression was used to investigate the predictors of accessing PPEs. Results: out of the 162 who participated in the study, 48.8% were nurses, while 51.2% were midwives. Only 10% (16/160) of the participants reported having enough PPEs at work. Age, marital status, PPE use, employment duration, and protection confidence were associated with accessibility (P<0.05). Conclusion: overall, there was an inadequate provision of PPEs in the health facilities putting the nurses and midwives at a high risk of acquiring COVID-19. Policymakers need a deliberate move to make the availability and accessibility of PPEs a reality during the pandemic.

Experiences of teleconsultation by French liberal midwives during the COVID-19 crisis / Expériences de la téléconsultation par les sages-femmes libérales françaises pendant la crise du COVID-19

CONTEXT: In the context of the COVID-19 pandemic, the French government has authorized the practice of teleconsultations for midwives since March 20th. A questionnaire survey of 1491 liberal midwives reported that 88.5% of them had implemented this practice. We therefore wished to explore their motivations and the way in which they have integrated this new practice modality into their practice. METHODS: We conducted 22 semi-structured interviews with liberal midwives who had implemented teleconsultations since their authorization. The study was conducted between May and July 2020 and ended when saturation of the results was reached. A content analysis was used to identify recurrences and exceptions in the discourse. RESULTS: The main motivations of the liberal midwives for offering teleconsultations were to maintain access to care for women and their own professional activity. They pointed to a number of limitations, including the issue of professional secrecy and guaranteed confidentiality, and inequality of access to care in relation to the digital divide. The integration of teleconsultation into their practice has made it possible to highlight and enhance the support work carried out by midwives, which until now has not been very visible or recognized. CONCLUSION: Midwives quickly adopted teleconsultations, which have been made permanent since the confinement. This tool helps to ensure continuity of care but also raises new questions about equal access to care.

Contexte: Dans le contexte de la pandémie COVID-19, le gouvernement français a autorisé la pratique des téléconsultations pour les sages-femmes à partir du 20 mars 2020. Une enquête par questionnaire menée auprès de 1 491 sages-femmes libérales a rapporté que 88,5 % d'entre elles avaient mis en œuvre cette pratique. Nous avons donc souhaité explorer leurs motivations et la façon dont elles ont intégré cette nouvelle modalité d'exercice dans leur pratique. Méthodes: Nous avons mené 22 entretiens semi-directifs auprès de sages-femmes libérales ayant mis en place des téléconsultations depuis leur autorisation. L'étude, réalisée entre mai et juillet 2020, a pris fin lorsque la saturation des résultats a été atteinte. Une analyse de contenu a permis de dégager les récurrences et les exceptions dans le discours. Résultats: Les principales motivations des sages-femmes libérales à proposer des téléconsultations étaient de maintenir l'accès aux soins pour les femmes et préserver leur propre activité professionnelle. Elles pointaient un certain nombre de limites, parmi lesquelles la question du secret professionnel et de la garantie de la confidentialité, ou encore l'inégalité d'accès aux soins en lien avec la fracture numérique. L'intégration de la téléconsultation dans leur pratique a permis de mettre en lumière et valoriser le travail d'accompagnement réalisé par les sages-femmes jusqu'à présent peu visible et reconnu. Conclusion: Les sages-femmes se sont rapidement approprié les téléconsultations qui ont, depuis le confinement, été pérennisées. Cet outil permet une aide à la continuité des soins, mais pose également de nouvelles questions d'égalité d'accès aux soins.

Prevalence and factors associated with academic burnout risk among nursing and midwifery students during the COVID-19 pandemic: A cross-sectional study.

AIM: The aim of the study was to assess the prevalence of academic burnout (AB) and its associated factors among nursing and midwifery students during the COVID-19 pandemic. DESIGN: A correlational cross-sectional study. METHODS: An online survey was distributed from November to December 2020 to nursing and midwifery students in Belgium. The risk of AB was assessed using the MBI-SS Academic Burnout Inventory scale. Factors associated with AB were related to the personal life and level of education of the student and to the COVID-19 pandemic. RESULTS: The prevalence of overall AB risk was 50.0% (95% CI 48.5-53.1). Factors significantly associated with higher risk of AB were having a child, having a job, the level of academic training, working overtime, insufficient personal protective equipment against viral contamination during the last internship, work overload due to the pandemic, personal proven or possible SARS-CoV-2 infection and having a relative who died related to COVID-19.

Personal protective equipment: Analysis of supply among midwives during the COVID-19 pandemic in Peru.

OBJECTIVE: To report the details of provision of personal protective equipment to midwives during the COVID-19 pandemic in Peru METHODS: This is a non-experimental, descriptive, cross-sectional study. An online survey of 679 midwives working at public healthcare centres was conducted via questionnaires. The following aspects were outlined: method of supply and frequency of delivery of personal protective equipment, type of personal protective equipment provided by the institution, and self-purchase. Furthermore, features of the midwives' workplace were described. For statistical analysis, absolute frequencies and relative proportions were used for categorical variables, and mean and standard deviation were used for numerical variables. MEASUREMENTS AND FINDINGS: The most important finding of this study is that a large proportion of midwives (66.6%) did not receive new personal protective equipment for each shift; 41.9% of midwives who received personal protective equipment during each shift exclusively provided services in the COVID-19 ward, whereas 27.6% did not. The least received supplies were of N95 respirator masks (41.7%) and disposable isolation suit gown (50.5%). Only a certain proportion of midwives (38.6%) were trained by their own institutions on the use of personal protective equipment. KEY CONCLUSIONS: The provision of personal protective equipment to midwives and training on personal protective equipment were insufficient at all workplaces. Therefore, measures must be taken to increase the supply of this material to midwives who are essential workers in reproductive health.

[Digital midwifery care during the COVID-19 pandemic in Germany-acceptance of mothers]. / Digitale Hebammenbetreuung in der COVID-19-Pandemie in Deutschland ­ Akzeptanz bei Müttern.

BACKGROUND: To ensure outpatient midwifery care during the COVID-19 pandemic, digital midwifery services were enabled for the first time in Germany in March 2020. The aim of the survey "Digital midwifery care in the context of the Covid-19 pandemic" was to conduct an initial evaluation of the newly introduced digital services from the perspective of the midwives and the users. This publication presents the results of the mothers' survey. METHOD: In February and March 2021, a cross-sectional study with an online survey was conducted. Women insured with BARMER who gave birth to a healthy child between May and November 2020 were surveyed anonymously throughout Germany using an exploratively developed online questionnaire on the utilization, satisfaction, and potential of digital midwifery care in pregnancy and the postpartum period. RESULTS: Feedback was provided by 1821 mothers. Around one third of the responding women had used digital midwifery services during pregnancy and/or the postpartum period and rated these services positively by over 80%. From the respondents' point of view, courses and counselling are very well suited whereas postpartum care often requires the midwife's presence. Advantages were seen in infection control and in saving time and travel. CONCLUSION: The COVID-19 pandemic has become a catalyst for digitalization in midwifery care. The digital services were quickly implemented by freelance midwives and well accepted by women and can usefully complement the care provided in the presence of the midwife. The opportunity to utilize and further develop these offers should be taken.

An international exploration of blended learning use in pre-registration nursing and midwifery education.

AIM: To explore international experiences of using blended learning in preparing nursing and midwifery students for initial professional registration to inform future education policy. BACKGROUND: The global nursing and midwifery skills shortage and need for an expanded nursing workforce that is fit for contemporary care delivery is widely acknowledged. The immense pressure the profession was already under because of austerity, staff shortages and increasingly complex healthcare needs has been worsened by the Covid-19 pandemic. The UK is extending and evaluating the use of blended learning programmes for pre-registration nursing and midwifery students to help address these issues. This study sought to explore relevant nursing and midwifery experiences from outside the UK to help inform future health professional education policy here and elsewhere. DESIGN: Cross-sectional, sequential, mixed methods study PARTICIPANTS/SETTINGS: Nursing/nurse education leaders from across International Council of Nurses regions METHODS: Exploratory online survey (n = 32) and three follow-up case studies (March-May 2021). Participants' knowledge and experiences of blended learning were examined along with any perceived benefits for workforce development and successful strategies for addressing the challenges blended learning presents in this context. Case studies were developed inductively from survey responses and follow up telephone calls to provide more detailed information about reported successes. RESULTS: Participants reported flexibility, cost effectiveness, increased student/tutor and student/student communication and interaction as benefits of blended learning. Challenges included the design and use of interactive learning resources, appropriate preparation and support for staff and students, the potential of blended learning to exacerbate otherwise hidden disadvantage and the need for multi-stakeholder cost/benefit evaluation. CONCLUSIONS: Blended learning is used globally in the pre-registration education of nurses, midwives and other healthcare professionals. These results broadly mirror the literature regarding the benefits blended learning offers healthcare students, staff and organisations and the strategies employed to mitigate risk. As the deployment of blended learning nursing and midwifery programmes expands, further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach. These concern adequate preparation and support of students and staff, ensuring access to appropriate equipment and connectivity, exploration of student perceptions that online learning is of lesser value and comprehensive multi-stakeholder, exploratory evaluation to uncover any hidden factors and impact. TWEETABLE ABSTRACT: Blended learning plays an effective part in the education of pre-registration nursing and midwifery students to help tackle global workforce shortages, but further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach.