The challenges and opportunities for implementing group antenatal care ('Pregnancy Circles') as part of standard NHS maternity care: A co-designed qualitative study.

OBJECTIVE: To identify the challenges and opportunities for rolling out a bespoke model of group antenatal care called Pregnancy Circles (PC) within the National Health Service: what kind of support and training is needed and what adaptations are appropriate, including during a pandemic when face-to-face interaction is limited. DESIGN: Exploratory qualitative study (online focus group). Study co-designed with midwives. Data analysed thematically using an ecological model to synthesise. SETTING: Five maternity services within the National Health Service. PARTICIPANTS: Seven midwives who facilitated PCs. Three senior midwives with implementation experience participated in the co-design process. FINDINGS: Three themes operating across the ecological model were identified: 'Implementing innovation', 'Philosophy of care' and 'Resource management'. Tensions were identified between group care's focus on relationships and professional autonomy, and concepts of efficiency within the NHS's market model of care. Midwives found protected time, training and ongoing support essential for developing the skills and confidence needed to deliver this innovative model of care. Integrating Pregnancy Circles with continuity of carer models was seen as the most promising opportunity for long-term implementation. Midwives perceived continuity and peer support as the most effective elements of the model and there was some evidence that the model may be robust enough to withstand adaptation to online delivery. KEY CONCLUSIONS: Midwives facilitating group care enjoyed the relationships, autonomy and professional development the model offered. Harnessing this personal (micro-level) satisfaction is key to wider implementation. Group care is well aligned with current maternity policy but the challenges midwives face (temporal, practical and cultural) must be anticipated and addressed at macro and meso level for wider implementation to be sustainable. The PC model may be flexible enough to adapt to online delivery and extend continuity of care but further research is needed in these areas. IMPLICATIONS FOR PRACTICE: Implementation of group care in the NHS requires senior leadership and expertise in change management, protected time for training and delivery of the model, and funding for equipment. Training and ongoing support, are vital for sustainability and quality control. There is potential for online delivery and integrating group care with continuity models.

Induction of labour during the COVID-19 pandemic: a national survey of impact on practice in the UK.

BACKGROUND: Induction of labour (IOL) is one of the most commonly performed interventions in maternity care, with outpatient cervical ripening increasingly offered as an option for women undergoing IOL. The COVID-19 pandemic has changed the context of practice and the option of returning home for cervical ripening may now assume greater significance. This work aimed to examine whether and how the COVID-19 pandemic has changed practice around IOL in the UK. METHOD: We used an online questionnaire to survey senior obstetricians and midwives at all 156 UK NHS Trusts and Boards that currently offer maternity services. Responses were analysed to produce descriptive statistics, with free text responses analysed using a conventional content analysis approach. FINDINGS: Responses were received from 92 of 156 UK Trusts and Boards, a 59% response rate. Many Trusts and Boards reported no change to their IOL practice, however 23% reported change in methods used for cervical ripening; 28% a change in criteria for home cervical ripening; 28% stated that more women were returning home during cervical ripening; and 24% noted changes to women's response to recommendations for IOL. Much of the change was reported as happening in response to attempts to minimise hospital attendance and restrictions on birth partners accompanying women. CONCLUSIONS: The pandemic has changed practice around induction of labour, although this varied significantly between NHS Trusts and Boards. There is a lack of formal evidence to support decision-making around outpatient cervical ripening: the basis on which changes were implemented and what evidence was used to inform decisions is not clear.

Doppler-derived velocity of blood flow across the cardiac valves in the normal dog.

Doppler echocardiography is a relatively new procedure used to assess certain cardiovascular disorders in the dog. The objectives of this study were to determine the range of values for the maximal peak velocity of blood flow across each of the four cardiac valves in a sample population of normal adult dogs, using duplex continuous wave Doppler echocardiography, and to determine the optimal tomographic planes to use for an adequate continuous wave Doppler evaluation of the canine heart. Twenty normal dogs were examined to obtain values for peak transvalvular velocity for each of the four cardiac valves. The mean values +/- 1 SD, in cm/s were: 98.1 +/- 9.4 for the pulmonary valve imaged from the left side of the chest, 95.5 +/- 10.3 for the pulmonary valve imaged from the right side of the chest (n = 19), 118.1 +/- 10.8 for the aortic valve, 86.2 +/- 9.5 for the mitral valve and 68.9 +/- 8.4 for the tricuspid valve. Regurgitation was detected across the pulmonic valve in 14 of the 20 dogs, and across the tricuspid valve in ten dogs. The analysis of the tomographic images confirmed that for a complete assessment of a given intracardiac valve, the valve must be examined from all possible directions to obtain maximum values for peak velocity.