Antenatal cardiotocography in primary midwife-led care: a budget impact analysis.

OBJECTIVES: In many countries, the healthcare sector is dealing with important challenges such as increased demand for healthcare services, capacity problems in hospitals and rising healthcare costs. Therefore, one of the aims of the Dutch government is to move care from in-hospital to out-of-hospital care settings. An example of an innovation where care is moved from a more specialised setting to a less specialised setting is the performance of an antenatal cardiotocography (aCTG) in primary midwife-led care. The aim of this study was to assess the budget impact of implementing aCTG for healthy pregnant women in midwife-led care compared with usual obstetrician-led care in the Netherlands. METHODS: A budget impact analysis was conducted to estimate the actual costs and reimbursement of aCTG performed in midwife-led care and obstetrician-led care (ie, base-case analysis) from the Dutch healthcare perspective. Epidemiological and healthcare utilisation data describing both care pathways were obtained from a prospective cohort, survey and national databases. Different implementation rates of aCTG in midwife-led care were explored. A probabilistic sensitivity analysis was conducted to estimate the uncertainty surrounding the budget impact estimates. RESULTS: Shifting aCTG from obstetrician-led care to midwife-led-care would increase actual costs with €311 763 (97.5% CI €188 574 to €426 072) and €1 247 052 (97.5% CI €754 296 to €1 704 290) for implementation rates of 25% and 100%, respectively, while it would decrease reimbursement with -€7 538 335 (97.5% CI -€10 302 306 to -€4 559 661) and -€30 153 342 (97.5% CI -€41 209 225 to -€18 238 645) for implementation rates of 25% and 100%, respectively. The sensitivity analysis results were consistent with those of the main analysis. CONCLUSIONS: From the Dutch healthcare perspective, we estimated that implementing aCTG in midwife-led care may increase the associated actual costs. At the same time, it might lower the healthcare reimbursement.

The Relationship Between Restrictive Regulation of Midwives, Practice Environment, and Professional Burnout: A 7-State Mixed-Methods Comparison of Autonomous and Restrictive State Regulation.

PURPOSE: The purpose of the study was to investigate the relationship between state regulation of the midwifery workforce, practice environment, and burnout. BACKGROUND: Burnout threatens the US midwifery workforce, with over 40% of certified nurse-midwives meeting criteria. Burnout can lead to poorer physical and mental health and withdrawal from the workforce. Burnout in midwives has been associated with lack of control and autonomy. In the United States, midwives' autonomy is restricted through state-level regulation that limits scope of practice and professional independence. METHODS: A mixed-methods study was conducted using an explanatory sequential approach. Quantitative and qualitative data were collected by online surveys and analyzed in a 2-stage process, followed by data integration. RESULTS: State regulation was not found to be independently associated with burnout (n = 248; P = .250); however, mediation analysis showed a significant association between state regulation, practice environment, and burnout. Qualitative analysis mirrored the importance of practice environment and expanded on its features. CONCLUSION: For midwives, unrestrictive practice regulation may not translate to burnout prevention without supportive practice environments. IMPLICATIONS FOR PRACTICE AND RESEARCH: Interventions should focus on promoting job flexibility, realistic demands, and professional values. While midwives' commitment to patients and the profession can help bolster the workforce, it can also amplify negative experiences of the practice environment.

Women's expectations, preferences and needs in midwifery care - results from the qualitative Midwifery Care (MiCa) study: Childbirth and early parenthood.

OBJECTIVE: The main goals of our study were (I) the investigation of expectations and preferences as well as (II) the determination of needs of women in regard to midwifery care. DESIGN: Descriptive phenomenology was used to investigate the ways in which women experienced childbirth and early parenthood. A descriptive qualitative research design was chosen, using focus groups. SETTING: ix online focus groups were carried out with 19 women for this part of the Midwifery Care (MiCa) study, mainly from the north of Germany. PARTICIPANTS: Women shortly after birth, in puerperium and the first year after childbirth were recruited in Germany. A purposeful strategy according to maximum variation sampling was applied to reach diversity in the sample regarding age and previous children. Data were analysed using qualitative content analysis, according to Mayring, with support of the qualitative data analysis software MAXQDA 2022. FINDINGS: Six main categories were derived for both childbirth and early parenthood: (a) involvement of family, (b) need for information, (c) physical and psychological aspects and (d) orientation in the healthcare system. In each group, one main category about provision of healthcare was developed: (e) care around childbirth and (f) midwifery care in early parenthood. Women attached great importance to the communication with midwives and favoured the involvement of their partners in the childbirth process and during parenting. Based on different experiences and inconsistency of information, women would prefer consistency in staff and communication as well as standardised information. CONCLUSIONS: From the user's perspective, midwifery care is crucial during childbirth and the child's first year of life. Current health care during and after childbirth and early parenthood lacks individualised care models, emotional support, adequate and professional communication between different health care providers, and consistency in midwifery care. Our findings should be translated into health care delivery with effective interprofessional teamwork within the continuity of midwifery care. Further quantitative research should analyse the individual healthcare situations of women in the reproductive phase of their life as well as of the applied healthcare models in order to personalise care and to improve healthcare quality.

Midwives' approach to the prevention and repair of obstetric perineal trauma in Spain.

AIM: Different clinical practice guidelines include recommendations on how to prevent and repair obstetric perineal trauma, as well as the use of episiotomy. To evaluate the variability in midwives' professional practices for preventing and repairing perineal trauma, as well as the professional factors that may be associated with the restrictive use of episiotomy. DESIGN: Observational cross-sectional study. METHODS: Three hundred five midwives completed an anonymous questionnaire developed by the authors and distributed across various midwifery scientific societies. The main outcomes measured were the frequencies of adopting specific practices related to perineal injury prevention and repair, episiotomy technique and restrictive episiotomy use (<10%). Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals were estimated. RESULTS: Intrapartum perineal massage was not normally used by 253 (83%) of midwives, and 186 (61%) applied compresses soaked in warm water to the perineum. Regarding episiotomy, there was a great deal of variability, noting that 129 (42.3%) adopted a restrictive use of this procedure, 125 (41%) performed it between 10% and 20%, while 51 midwives (16.7%) performed it in more than 20% of cases. In addition, 165 (54.1%) midwives followed an incision angle of 60º. Concerning tears, 155 (50.8%) usually sutured first-degree tears and 273 (89.5%) always sutured second-degree tears. Midwives attending home births (aOR = 6.5; 95% CI: 2.69-15.69), working at a teaching hospital (aOR = 3.69; 95% CI: 1.39-9.84), and the ones who recently completed their professional training (aOR = 3.58; 95% CI: 1.46-8.79) were significantly more likely to adopt a restrictive use of episiotomy. CONCLUSIONS: There is a significant variability in Spanish midwives' practices for preventing and repairing perineal tears. Moreover, the restrictive use of episiotomy is associated with midwives attending home births, working in teaching hospitals and having recent professional training. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

UK student midwives' theoretical knowledge, confidence, and experience of intermittent auscultation of the fetal heart rate during labour: An online cross-sectional survey.

AIM: This study aimed to explore student midwives' theoretical knowledge of intrapartum intermittent auscultation, their confidence in, and their experience of this mode of fetal monitoring. DESIGN AND SETTING: An online cross-section survey with closed and open questions. Descriptive statistics were used to analyse participants' intermittent auscultation knowledge, confidence, and experience. Reflexive thematic analysis was used to identify patterns within the free text about participants' experiences. PARTICIPANTS: Undergraduate midwifery students (n = 303) from Nursing and Midwifery Council-approved educational institutions within the United Kingdom. FINDINGS: Most participants demonstrated good theoretical knowledge. They had witnessed the technique being used in clinical practice, and when performed, the practice was reported to be in line with national guidance. In closed questions, participants reported feeling confident in their intermittent auscultation skills; however, these data contrasted with free-text responses. CONCLUSION: This cross-sectional survey found that student midwives possess adequate knowledge of intermittent auscultation. However, reflecting individual clinical experiences, their confidence in their ability to perform intermittent auscultation varied. A lack of opportunity to practice intermittent auscultation, organisational culture, and midwives' preferences have caused student midwives to question their capabilities with this essential clinical skill, leaving some with doubt about their competency close to registration.

The sustainability of midwifery group practice: A cross-sectional study of midwives and managers.

PROBLEM: Although there is robust evidence for the benefits of midwifery group practice (MGP) caseload care, there are limited opportunities for women to access this model in Australia. There is also limited knowledge on how to sustain these services. BACKGROUND: MGP can benefit childbearing women and babies and improve satisfaction for women and midwives. However, sustainability of the model is challenging. While MGPs are often supported and celebrated, in Australia some services have closed, while others struggle to adequately staff MGPs. AIM: To investigate midwives and managers opinions on the management, culture, and sustainability of MGP. METHODS: A national survey of MGP midwives and managers was distributed (2021 and 2022). Quantitative data were analysed using descriptive statistics, and qualitative data were analysed using content analysis. RESULTS: A total of 579 midwives and 90 managers completed the survey. The findings suggest that many MGPs do not support new graduates and students to work in MGP. Over half (59.8%) the participants (midwives and managers) reported that the women and families were the best aspect about working in MGP, while 44.3% said the effects on midwives' lifestyle and families were the worst aspect. DISCUSSION: The relationship with women remains the major motivator for providing MGP care. However, work-life imbalance is a deterrent, exacerbated by staffing shortages. Staffing might be improved by adequate renumeration, strengthening orientation, and attracting new graduates and students through experience in MGP. CONCLUSIONS: There is a need to attract midwives to MGP and improve work-life balance and sustainability.

Midwives' attitudes toward the use of cardiotocograph (CTG) machines in labor units: A study in Jordan.

BACKGROUND: The purpose of cardiotocograph (CTG) usage is to detect any alterations in fetal heart rate (FHR) early before they are prolonged and profound. However, the use of CTG machines on a routine basis is not an evidence-supported practice. There is no Jordanian study that assesses the midwives' attitudes toward this machine. This study aimed to identify Jordanian midwives' attitudes towards the use of cardiotocograph (CTG) machines in labor units, alongside examining the relationships between midwives' personal sociodemographic characteristics and such attitudes. METHODS: A descriptive research design was used to identify Jordanian midwives' attitudes towards the use of CTG machines in both public and private labor units in Jordan. Data were collected using the valid and reliable tool designed by Sinclair (2001), and these were used to identify midwives' attitudes towards CTG usage. A total of 329 midwives working in the labor units of governmental and private hospitals in the center and north of Jordan participated in the study from May to July 2022. RESULTS: The total mean score for the attitude scale was M = 3.14 (SD = 0.83). More than half of the sample (N = 187, 58.4 %) demonstrated a mean score greater than 3.14, however, which indicates generally positive attitudes toward CTG usage in labor units. Midwives working in private hospitals and those holding Bachelor's degrees had more positive attitudes toward the use of CTG machines. CONCLUSION: This study provides new insights into the attitudes of Jordanian midwives towards CTG use in labor units. These suggest that it is critical to conduct training courses for registered midwives to help them develop and/or regain confidence and competence with respect to various key aspects of intrapartum care, including intermittent auscultation and the appropriate use of CTG.

The importance of recovery and staffing on midwives' emotional wellbeing: A UK national survey.

BACKGROUND: There is currently a gap in the evidence on how working practices, such as the ability to take rest breaks, finish on time or intershift recovery influence outcomes. AIM: The aim of this study was to explore the association of individual characteristics, work-related factors and working practices on emotional wellbeing outcomes of UK midwives. METHODS: An online cross-sectional survey collated data between September and October 2020. Outcomes explored were work-related stress, burnout, being pleased with their standard of care, job satisfaction and thoughts about leaving midwifery. Univariate analysis identified the explanatory variables to be investigated using multivariable logistic regression. FINDINGS: A total of 2347 midwives from the four UK nations completed the survey. No standard approach in monitoring safe staffing or in-shift or intershift recovery was found. There were high levels of work-related stress, burnout and thoughts about leaving midwifery, and low levels of job satisfaction, with just half of midwives reporting they were satisfied with the standard of care they could provide. Multivariable regression revealed that working practices variables, generally related to impeded recovery or compounded by staffing issues, had a significant association with poorer emotional wellbeing outcomes. CONCLUSION: This research has demonstrated an association between impeded recovery, including a lack of formal methods to monitor this, and poorer emotional wellbeing outcomes, and that staffing levels are highly influential in determining outcomes. There is a need to re-evaluate current approaches to job design and how midwives are expected to work.

Care and services partnership in Quebec birthing centres: myth or reality?

CONTEXT: Working with women to best meet their needs has always been central to midwifery in Quebec, Canada. The creation of birthing centres at the end of the 1990s consolidated this desire to prioritize women's involvement in perinatal care and was intended to encourage the establishment of a care and services partnership between care providers and users. The aim of this pilot study is to evaluate the perceptions of clients, midwives and birth assistants of the way in which women are involved in partnership working in Quebec birthing centres. METHODS: A single qualitative case and pilot study was conducted with midwives (n = 5), birth assistants (n = 4), a manager (n = 1), clients (n = 5) and members of the users' committee (n = 2) at a birthing centre in Quebec, Canada in July and August 2023. The partnership was evaluated using the dimensions of a validated CADICEE questionnaire. RESULTS: The women and professionals stressed that the relationship was established in a climate of trust. The caregivers also attached importance to autonomy, information sharing and decision-making, adaptation to context, empathy and recognition of the couple's expertise. The women confirmed that they establish a relationship of trust with the professionals when the latter show empathy and that they adapt the follow-up to their knowledge and life context. Key factors in establishing this kind of care relationship are the time given, a de-medicalized environment, the comprehensive care received, and professionals who are well-informed about the partnership. In addition, the birthing centre has a users' committee that can put forward ideas but has no decision-making powers. CONCLUSIONS: Both the women and the professionals at the birthing centre appear to be working in partnership. However, at the organizational level, the women are not involved in decision-making. A study of all birthing centres in Quebec would provide a more comprehensive picture of the situation.

Association of personal and systemic factors on intrapartum risk perception and obstetric intervention rates: a cross-sectional study.

BACKGROUND: Risk perception is fundamental to decision-making; therefore its exploration is essential to gaining a comprehensive understanding of the decision-making process for peripartum interventions. The aim of this study was to investigate associations between personal and systemic factors of the work setting and the risk perception of obstetric healthcare professionals, and in turn how this might influence decisions regarding obstetric interventions. METHODS: Case vignettes were used to measure risk perception. A quantitative cross-sectional online survey was performed within an exploratory sequential mixed-methods design, and an intervention readiness score created. Associations were calculated using location and dispersion measures, t-tests and correlations in addition to multiple linear regression. RESULTS: Risk perception, as measured by the risk assessment score, was significantly lower (average 0.8 points) for midwives than for obstetricians (95%-CI [-0.673; -0.317], p < .001). Statistically significant correlations were found for: years of experience and annual number of births in the current workplace, but this was not clinically relevant; hours worked, with the groups of participants working ≥ 30,5 h showing a statistically significant higher risk perception than participants working 20,5-30 h (p = .005); and level of care of the current workplace, with the groups of participants working in a birth clinic (Level IV) showing a statistically significant lower risk perception than participants working in Level I hospital (highly specialised obstetric and neonatal care; p = .016). The option of midwife-led birthing care showed no correlation with risk perception. The survey identified that risk perception, occupation, years in the profession and number of hours worked (i.e. full or part time) represent significant influences on obstetric healthcare professionals' willingness to intervene. CONCLUSIONS: The results of the survey give rise to the hypothesis that the personal and systemic factors of professional qualification, occupation, number of hours worked and level of acuity of the workplace are related to the risk perception of obstetric healthcare professionals. In turn, risk perception itself made a significant contribution to explaining differences in willingness to intervene, suggesting that it influences obstetricians' and midwives' decision-making. Overall, however, the correlations were weak and should be interpreted cautiously. The significant variations in the use of interventions must be addressed in order to provide the highest quality and best possible care for childbearing women and their families. To this end, developing strategies to improve interdisciplinary relationships and collaboration is of great importance. TRIAL REGISTRATION: German Clinical Trials Register DRKS00017172 (18.06.2019).

Midwives' Intercultural Effectiveness Levels and Influencing Factors.

INTRODUCTION: Due to globalization, countries around the world are starting to notice diversity in their populations. It is crucial that midwives be able to communicate effectively with women from a variety of cultures to provide them with culturally effective health care. METHOD: This cross-sectional study was conducted with 394 midwives who work in seven different regions of Türkiye. Data on the intercultural effectiveness and intercultural communication competence of midwives were collected. Data analysis was performed using descriptive statistics, t-tests, analysis of variance, and regression analysis. RESULTS: Midwives' intercultural effectiveness was influenced by their foreign language proficiency, experiences abroad, having friends from different cultures, following social media platforms in different languages and cultures, providing care to individuals from diverse cultures, and their willingness to do so. DISCUSSION: Findings suggest that exposure to different cultures enhances the level of intercultural effectiveness. Consequently, it is recommended to make plans to support midwives to have positive experiences with different cultures.

Midwives' experiences of performing obstetric ultrasounds in antenatal care in eastern Ethiopia: Qualitative exploratory study.

BACKGROUND: In 2016, the World Health Organization recommended inclusion of an ultrasound scan as part of routine antenatal care to improve pregnancy outcomes. However, most rural women in Ethiopia do not have access to ultrasound scanning as part of their routine antenatal care. Recently, ultrasonography services were introduced at health centers in Harar, Kersa, and Haramaya districts in Eastern Ethiopia. This expoloratory study aimed to examine experiences of pregnancy surveillance midwives in the Child Health and Mortality Prevention Surveillance (CHAMPS) who performed ultrasonography at health centers that are in the catchment area of Health and Demographic Surveillance Systems, in Eastern Ethiopia. OBJECTIVE: To explor midwives' experiences across 14 health centers in Eastern Ethiopia, located in the Kersa, Haramaya, and Harar Health and Demographic Surveillance Systems from February to April 2022. DESIGN: Exploratory qualitative study. METHODS: The methods used were based on the Standards for Reporting Qualitative Research framework. Purposeful sampling was used to explore experiences of midwives who performed ultrasonography at selected health centers. The Midwives are recurited, trained and stationed at the health ceners to do ultrasound scanning and other activities by the Child Helath and Mortality Prevention Surveillance (CHAMPS) pregancny surveillance activities. Among 17 midwives who had undergone ultrasonography training and who were actively involved in ultrasound scanning at health centers in Kersa, Haramaya, and Harar Health and Demographic Surveillance Systems, three midwives who worked at health centers with no power or near a hospital were excluded. Using tape recordings and note-taking, data were collected through in-depth interviews based on a semi-structured interview guide. Thematic analysis used for data categorization, and the trustworthiness of data was kept throughout the procedure using credibility, dependability, confirmability, and transferability. RESULTS: In this study, we identified five main themes: Ultrasonography positively impacts midwives trained as sonographers; performing ultrasound scans enhances the skills and confidence of midwives, improving their professional development, Individual perception of self-efficacy; midwives' belief in their abilities to perform ultrasound scans effectively influences their job satisfaction and motivation, Provision of care; integrating ultrasound into antenatal care enhances the quality, therapeutic communication, and personalized nature of care provided to pregnant women, Barriers to providing ultrasonography services; challenges such as shortage of ultrasonography-trained staff and workload can hinder the delivery of ultrasound services in rural areas, Community acceptance; the level of community understanding, trust, and support towards ultrasound technology and midwives as sonographers impacts the successful implementation and sustainability of ultrasound services. CONCLUSION: Ultrasonography performed by midwives at rural health centers had a considerable impact on antenatal care services and incareased confidence of midwives.

Midwives' Experiences with Ultrasound Scans for Pregnant WomenThe World Health Organization recommends that pregnant women undergo at least four antenatal care (now eight times) visits during their pregnancy. The goal is to reduce feto-maternal complications. Recently, ultrasonography services are introduced in Harar, Kersa and Haramaya districts, Eastern Ethiopia.Midwives who performed ultrasonography at selected health centers were part of this exploaroty study. The information were generated through code, categories, and themes.Five themes were identified. Ultrasonography positively impacts midwives trained as sonographers, individual perception of self-efficacy, provision of care, barriers to providing ultrasonography services, and community acceptance.Ultrasonography performed by midwives at rural health centers had a considerable impact on antenatal care services and midwives confidence.

Norwegian community midwives' experience of interdisciplinary collaboration in care of pregnant women with vulnerabilities.

AIM: The aim of this study was to investigate Norwegian community midwives(CMs) experience of collaboration when caring for pregnant women with vulnerabilities. We wanted to determine which professionals and services are considered important and with whom they have written agreements and good lines of communication. Furthermore, which tools are used in collaboration and if any background factors enhance collaboration. BACKGROUND: Vulnerable pregnant women may require more than standard antenatal care, involving interdisciplinary collaboration. Outcomes can improve if vulnerable pregnant women are offered additional support. The introduction of multi-disciplinary teams in Norway has shown promising results, as in many other countries. A Norwegian report concluded that there is need for more research to improve the quality and availability of interdisciplinary care. METHODS: A cross-sectional, descriptive study, using data from a questionnaire that approximately 700 CMs in Norway were invited to answer online from May-August 2020. Data were analysed using the statistical software SPSS 26. RESULTS: One third (257) of the invited CMs participated in the survey. They reported that professionals involved in standard antenatal care, such as those at the maternity unit and PHNs, were the most important collaborative partners when caring for vulnerable pregnant women. The CMs reported poor communication with general practitioners, child welfare-, drug welfare- and mental health-services. The most frequent methods for accessing collaboration were phoning and electronically through patient record systems, while there was limited use of the personal care plan, patient coordination meetings and regular meetings with collaborative partners/services. CMs with more than ten years as a CM and "Early Start" training were more frequently involved in patient coordination meetings and counselling and debriefing sessions compared to inexperienced CMs who had not attended a special training program. CONCLUSION: Experience and completed the Early Start education/training increased the use of interprofessional collaborating meetings including CMs. This study suggests interdisciplinary training programmes to improve collaboration, which are expected to benefit vulnerable pregnant women, their babies and families. IMPLICATION FOR PRACTICE AND RESEARCH: We recommend education and training in both the educational system and among involved professionals in communities to improve collaboration in the care of vulnerable women. In order to measure the effectiveness of collaboration in the care of vulnerable pregnant women, both the targeted group and the collaborating professionals should be asked to provide feedback. More research on communication and collaboration is needed.

Comadronas ixiles: el eslabón entre las embarazadas, la familia y la comunidad / Ixil midwives: the link between pregnant women, the family and the community

Este documento presenta una recopilación de buenas prácticas adoptadas por las comadronas y los servicios de salud, tras haber participado en los cinco diálogos interculturales realizados durante el año 2023 en la región Ixil, de los cuales tres estuvieron enfocados en salud reproductiva y dos en nutrición. Estos diálogos se realizaron como parte de la implementación de la Guía de Diálogos Interculturales en Salud, elaborada y oficializada por el Ministerio de Salud Pública y Asistencia Social, con la cooperación técnica de OPS/OMS y el apoyo financiero de la Unión Europea. A partir de la experiencia, se recogieron buenas prácticas y lecciones aprendidas que dan cuenta de mujeres y niños que son acompañadas por comadronas y personal de salud durante la ventana de los primeros mil días de vida, lo que deriva en niños más sanos, mejor nutridos y la prevención de la mortalidad materna. La metodología de diálogos interculturales en salud se basa en el Plan de Acción 2021-2025 de la Política de Comadronas de los Cuatro Pueblos de Guatemala 2015-2025 y consta de seis capítulos que fueron elaborados por la Unidad de Atención en Salud de los Pueblos Indígenas y la Dirección de Promoción y Educación en Salud.

Women's experiences with planned singleton upright breech birth - A phenomenological study.

OBJECTIVE: To explore the experience of primi- and multiparous women with planned singleton upright breech births. METHOD: We conducted face-to-face, in-depth interviews with five primiparous and five multiparous women who underwent a physiological breech birth at one hospital in Norway and analyzed the data using Giorgi's descriptive phenomenological method. RESULTS: The phenomenon of women's experiences with physiological breech birth yielded four main constituents: "Mental preparedness and control", "The importance of shared decision-making and sufficient information", "Trust and the many 'faces' of birthing staff", and "'I actually did it!': Coping and control in the upright breech position". The significance of readiness, the influence of previous experiences and information, and the establishment of trust in midwives and gynecologists emerge as dominant themes. The sense of co-determination, control, and mastery is also highlighted. CONCLUSIONS: Our findings underscore the pivotal role of personal attributes in fostering mental preparedness when confronted with unforeseen aspects of childbirth. Notably, women's experiences with upright breech birth vary; while some perceive it as an ideal birth, others find it more challenging. Factors such as unpreparedness, lack of information, diminished co-determination, and loss of control negatively impact birth experiences. This study's findings underscore the significance of tailoring maternity care to individual needs and improving information sharing. These measures are paramount for optimizing women's experience during upright breech births.

Navigating a maze: Midwives' identity response to the enactment of an abortion law in Chile.

BACKGROUND: Chilean midwives have been identified as essential for successfully implementing an abortion law, a practice which could potentially be understood as contradicting their central mission. Nevertheless, to date, there has been no investigation into how Chilean midwives have incorporated induced abortion care provision into their professional identity. OBJECTIVE: To elucidate how Chilean midwives understand and provide abortion care and how they have (re)defined their professional identity to include induced abortion care. This article reports the findings of the second part of this aim. METHODS: This study was underpinned by a constructivist grounded theory methodology informed by a reproductive justice and feminist perspective. Midwives from Chile who have cared for women undergoing abortion were invited to participate in the study. After purposive and theoretical sampling, fifteen midwives were recruited. FINDINGS: Midwives' identity is woman-centred, with high value placed on their role protecting life. These two aspects of midwives' identity are in contradiction when providing abortion care. Midwives' identity results from and informs midwives' practice. Midwifery regulation influences both practice and identity. The model 'Navigating a maze' explains the interaction of these three elements. CONCLUSION: Midwives' identity response to the enactment of the Chilean abortion law is an example of how professional identity must navigate regulation and practice to make sense of its purpose. In light of this study's findings, the current tension experienced in midwives' identity should be carefully attended to prevent adverse outcomes for midwives and the Chilean population.

Midwives' views about the effects of climate change on maternal and child health: A qualitative study.

BACKGROUND: Midwives have important responsibilities to protect the health of mothers and children from the negative effects of climate change. AIM: This research was conducted to determine how midwives perceived climate change, the effects of climate change on maternal and child health, and what midwives could do to combat these effects. METHODS: The research was designed as a case study, one of the qualitative research designs. The research sample consisted of 11 midwives selected by snowball sampling, which is one of the non-random sampling methods. FINDINGS: The data obtained were collected under five main themes. The themes were determined as "(I) the causes of climate change, (II) concerns about the consequences of climate change, (III) the effects of climate change on mother-child health, (IV) measures to mitigate the effects of climate change, and (V) midwives' role in protecting mother-child health against the effects of climate change." CONCLUSION: Midwives are knowledgeable about climate change. They are aware of the effects of climate change on maternal and child health and they are doing some practices in this regard (breastfeeding, promoting the regulation of fertility and adequate/balanced nutrition, etc.). Midwives are aware of the importance of the midwifery profession in raising awareness of the individual and society, in addressing the effects of climate change on human health and in reducing the negative effects of climate change on health, and they want to take action at the national level (with the support of the midwifery organization and the state) for the sustainability of health.

Continuity of Clinician Type and Intrapartum Experiences During the Perinatal Period in California.

INTRODUCTION: Continuity of care with an individual clinician is associated with increased satisfaction and better outcomes. Continuity of clinician type (ie, obstetrician-gynecologist or midwife) may also impact care experiences; however, it is unknown how common it is to experience discontinuity of clinician type and what its implications are for the birth experience. We aimed to identify characteristics associated with having a different clinician type for prenatal care than for birth and to compare intrapartum experiences by continuity of clinician type. METHODS: For this cross-sectional study, data were from the 2017 Listening to Mothers in California survey. The analytic sample was limited to individuals with vaginal births who had midwifery or obstetrician-gynecologist prenatal care (N = 1384). Bivariate and multivariate analysis examined characteristics of individuals by continuity of clinician type. We then examined associations of clinician type continuity with intrapartum care experiences. RESULTS: Overall, 74.4% of individuals had the same type of clinician for prenatal care and birth. Of individuals with midwifery prenatal care, 45.1% had a different birth clinician type, whereas 23.5% of individuals who had obstetrician-gynecologist prenatal care had a different birth clinician type. Continuity of clinician type was positively associated with having had a choice of perinatal care clinician. There were no statistically significant associations between clinician type continuity and intrapartum care experiences. DISCUSSION: Findings suggest individuals with midwifery prenatal care frequently have a different type of clinician attend their birth, even among those with vaginal births. Further research should examine the impact of multiple dimensions of continuity of care on perinatal care quality.

Midwives' Experiences of Intact Cord Resuscitation in Nonvigorous Neonates After Vaginal Birth in Sweden.

OBJECTIVE: To describe midwives' experiences of intact cord resuscitation close to the mother for nonvigorous neonates after vaginal birth. DESIGN: Descriptive qualitative. SETTING: Four labor wards in Sweden. PARTICIPANTS: Midwives (N = 13) currently or previously employed in labor wards where the Sustained Cord Circulation and Ventilation (SAVE) study was conducted. METHODS: We analyzed semistructured interviews using reflexive thematic analysis. RESULTS: Participants' experiences are presented in an overarching theme: Midwives balance knowledge with doing the right thing in a challenging work environment during intact cord resuscitation. Three primary themes emerged: A New Workflow, Zero Separation: The Big Advantage, and The Midwife: Guardian of Childbirth. CONCLUSION: The participants were keen to keep the umbilical cord intact even for nonvigorous neonates. They wanted to work with the neonate close to the mother to facilitate zero separation and family participation. Ventilation with an intact umbilical cord was considered a routine to be implemented in the future, but the participants identified certain difficulties with the design of the SAVE study.

Consensus-based recommendations for the care of women with a breech presenting fetus.

OBJECTIVE: To establish consensus related to aspects of breech presentation and care. DESIGN: A multinational, three round e-Delphi study. PARTICIPANTS: A panel of 15 midwives, four obstetricians and an academic with knowledge and/or experience of caring for women with a breech presenting fetus. METHODS: An initial survey of 45 open-ended questions. Answers were coded and amalgamated to form 448 statements in the second round and three additional statements in the third round. Panellists were asked to provide their level of agreement for each statement using a 5-point Likert scale. Consensus was deemed met if 70% of panellists responded with strongly agree to somewhat agree, or strongly disagree to somewhat disagree after the second round. FINDINGS: Results led to the development of a consensus-based care pathway for women with a breech presenting fetus and a skills development framework for clinicians. KEY CONCLUSIONS: A cultural shift is beginning to occur through the provision of physiological breech workshops offered by various organisations and may result in greater access to skilled and experienced clinicians for women desiring a vaginal breech birth, ultimately improving the safety of breech birth. IMPLICATIONS FOR PRACTICES: The care pathway and skills development framework can be used by services wishing to make changes to their current practices related to breech presentation and increase the level of skill in their workforce.