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Pregnancy provides motivation for women to improve their diets and increase their physical activity. Opportunistic brief interventions delivered as part of routine primary care have produced improvements in patients' health behaviour. Consequently, there have been calls for midwives to use contacts during pregnancy in this way. This study explored the experiences of pregnant women and research midwives/nurses of a brief intervention called Healthy Conversation Skills (HCS) being delivered as part of a randomised control trial, assessing the acceptability and feasibility of including this intervention in routine maternity care. Three research questions were addressed using mixed methods to produce four datasets: face‐to‐face interviews with participants, a focus group with the HCS‐trained midwives/nurses, case reports of participants receiving HCS and audio‐recordings of mid‐pregnancy telephone calls to the women which produced midwife/nurse HCS competency scores. Midwives/nurses used their HCS to support women to make plans for change and set goals. Women welcomed the opportunity to address their own health and well‐being as distinct from that of their baby. Midwives/nurses were competent in using the skills and saw healthy conversations as an effective means of raising issues of diet and physical activity. Recent extension of maternity appointment times provides ideal opportunities to incorporate a brief intervention to support behaviour change. Incorporating HCS training into midwifery education and continuing professional development would facilitate this. HCS is a scalable, brief intervention with the potential to improve the diets and physical activity levels of women during pregnancy, and hence the health of themselves and their babies.

Objectives: This study aimed to examine the attitudes and awareness of Iranian clinical nurses and midwives towards telenursing and telehealth also referred to as e-health. Methods: The cross-sectional study was conducted from February to August 2019 in Iran. Nurses and midwives were randomly recruited from hospitals affiliated with Mashhad University of Medical Sciences in Mashhad, Iran using a stratified cluster random sampling method. Data were collected using a reliable and valid Persian-language questionnaire consisting of 32 close-ended survey items to examine Internet/computer access, daily Internet use and awareness of and general attitude towards telehealth and telenursing; statistical analyses were performed. Results: A total of 523 nurses and midwives were included in this study (response rate: 94.4%). The mean age and duration of clinical practice were 33.36 ± 7.46 and 8.88 ± 6.73 years, respectively. The majority of participants recognised the definition of telenursing (66.7%) and telehealth (80.1%). A positive attitude towards telenursing and telehealth was reported by 73.0% of the participants. Clinical nurses and midwives with a master's degree were more aware of the definition of telehealth compared to those with undergraduate bachelor degrees (P = 0.03). Additionally, midwives significantly more frequently presented a positive attitude towards telehealth and telenursing compared to nurses (86.2% versus 71.2%; P = 0.01). Conclusion: The positive attitude of the current participants was an important factor in the promotion of telenursing and telehealth. The implementation of educational and infrastructure developmental programs can help speed up executional processes in these fields.

Access to Caesarean section (C-section) remains inadequate for some groups of women while others have worryingly high rates. Understanding differential receipt demands exploration of the socio-cultural, and political economic, characteristics of the health systems that produce them. This extensive institutional ethnography investigated under- and over-receipt of C-section in two rural districts in Pakistan – Jhelum and Layyah. Data were collected between November and July 2013 using semi-structured interviews from a randomly selected sample of 11 physicians, 38 community midwives, 18 Lady Health Visitors and nurses and 15 Traditional Birth Attendants. In addition, 78 mothers, 35 husbands and 23 older women were interviewed. The understandings of birth by C-section held by women and their family members were heavily shaped by gendered constructions of womanhood, patient–provider power differentials and financial constraints. They considered C-section an expensive and risky procedure, which often lacked medical justification, and was instead driven by profit motive. Physicians saw C-section as symbolizing obstetric skill and status and a source of legitimate income. Physician views and practices were also shaped by the wider health care system characterized by private practice, competition between providers and a lack of regulation and supervision. These multi-layered factors have resulted in both unnecessary intervention, and missed opportunities for appropriate C-sections. The data indicate a need for synergistic action at patient, provider and system levels. Recommendations include: improving physician communication with patients and family so that the need for C-section is better understood as a life-saving procedure, challenging negative attitudes and promoting informed decision-making by mothers and their families, holding physicians accountable for their practice and introducing price caps and regulations to limit financial incentives associated with C-sections. The current push for privatization of health care in low-income countries also needs scrutiny given its potential to encourage unnecessary intervention.

Abstract Objective To investigate the accuracy of interpretation of probabilistic screening information by different stakeholder groups and whether presentation as frequencies improves accuracy. Design Between participants experimental design; participants responded to screening information embedded in a scenario. Setting Regional maternity service and national conferences and training days. Participants 43 pregnant women attending their first antenatal appointment in a regional maternity service; 40 companions accompanying the women to their appointments; 42 midwives; 41 obstetricians. Participation rates were 56%, 48%, 89%, and 71% respectively. Measures Participants estimated the probability that a positive screening test result meant that a baby actually had Down's syndrome on the basis of all the relevant information, which was presented in a scenario. They were randomly assigned to scenarios that presented the information in percentage (n = 86) or frequency (n = 83) format. They also gave basic demographic information and rated their confidence in their estimate. Results Most responses (86%) were incorrect. Obstetricians gave significantly more correct answers (although still only 43%) than either midwives (0%) or pregnant women (9%). Overall, the proportion of correct answers was higher for presentation as frequencies (24%) than for presentation as percentages (6%), but further analysis showed that this difference occurred only in responses from obstetricians. Many health professionals were confident in their incorrect responses. Conclusions Most stakeholders in pregnancy screening draw incorrect inferences from probabilistic information, and health professionals need to be aware of the difficulties that both they and their patients have with such information. Moreover, they should be aware that different people make different mistakes and that ways of conveying information that help some people will not help others.

Quality of care is essential for further progress in reducing maternal and newborn deaths. The integration of educated, trained, regulated and licensed midwives into the health system is associated with improved quality of care and sustained decreases in maternal and newborn mortality. To date, research on barriers to quality of care for women and newborns has not given due attention to the care provider's perspective. This paper addresses this gap by presenting the findings of a systematic mapping of the literature of the social, economic and professional barriers preventing midwifery personnel in low and middle income countries (LMICs) from providing quality of care. A systematic search of five electronic databases for literature published between January 1990 and August 2013. Eligible items included published and unpublished items in all languages. Items were screened against inclusion and exclusion criteria, yielding 82 items from 34 countries. 44% discussed countries or regions in Africa, 38% in Asia, and 5% in the Americas. Nearly half the articles were published since 2011. Data was extracted and presented in a narrative synthesis and tables. Items were organized into three categories; social; economic and professional barriers, based on an analytical framework. Barriers connected to the socially and culturally constructed context of childbirth, although least reported, appear instrumental in preventing quality midwifery care. Significant social and cultural, economic and professional barriers can prevent the provision of quality midwifery care in LMICs. An analytical framework is proposed to show how the overlaps between the barriers reinforce each other, and that they arise from gender inequality. Links are made between burn out and moral distress, caused by the barriers, and poor quality care. Ongoing mechanisms to improve quality care will need to address the barriers from the midwifery provider perspective, as well as the underlying gender inequality.

Background Anaemia is a common health problem among pregnant women and a contributing factor with a major influence on maternal mortality in Indonesia. The Four Pillars Approach is a new approach to anaemia in pregnancy, combining four strategies to improve antenatal and delivery care. The primary objective of this study is to measure the effectiveness of the Four Pillars Approach. The barriers, the facilitators, and the patients’ as well as the midwives’ satisfaction with the Four Pillars Approach will also be measured. Methods/Design This study will use a cluster randomised controlled trial. This intervention study will be conducted in the Public Health Centres with basic emergency obstetric care in Yogyakarta Special Province and in Central Java Province. We will involve all the Public Health Centres (24) with emergency obstetric care in Yogyakarta Special Province. Another 24 Public Health Centres with emergency obstetric care in Central Java Province which have similarities in their demographic, population characteristics, and facilities will also be involved. Each Public Health Centre will be asked to choose two or three nurse-midwives to participate in this study. For the intervention group, the Public Health Centres in Yogyakarta Special Province, training on the Four Pillars Approach will be held prior to the model’s implementation. Consecutively, we will recruit 360 pregnant women with anaemia to take part in part in the study to measure the effectiveness of the intervention. The outcome measurements are the differences in haemoglobin levels between the intervention and control groups in the third trimester of pregnancy, the frequency of antenatal care attendance, and the presence of a nurse-midwife during labour. Qualitative data will be used to investigate the barriers and facilitating factors, as to nurse-midwives’ satisfaction with the implementation of the Four Pillars Approach. Discussion If the Four Pillars Approach is effective in improving the outcome for pregnant women with anaemia, this approach could be implemented nationwide and be taken into consideration to improve the outcome for other conditions in pregnancy, after further research. Trial registration Current Controlled Trials ISRCTN35822126 .

The actual effect of the use of simulations on clinical decision making is inconclusive. This pilot study used a posttest design to determine the effect of a simulation strategy on the clinical decision-making process of midwifery students. Thirty-six graduate diploma students volunteered and were randomly assigned to two groups, with the experimental group receiving two simulation sessions (normal labor and physiological jaundice), and the control group receiving the two usual lectures. The main findings were that students who received the simulation strategy collected more clinical information, revisited collected clinical information less, made fewer formative inferences, reported higher confidence levels, and for the posttest normal labor simulation, reached a final decision more quickly. Such effects are reasonable for this type of intervention with the existent variability in each group. Further research with a larger sample size and more rigorous data collection strategies is required.

Background The health and wellbeing of midwives are important considerations for workforce retention and quality care. The occurrence and relationships among mental health conditions such as burnout and depression have received little attention. We investigated the prevalence of burnout, depression, anxiety and stress in Australian midwives. Methods An online survey was conducted in September 2014. Participants were recruited through the Australian College of Midwives and professional networks. The survey sought personal and professional details. Standard measures included the Copenhagen Burnout Inventory (CBI) (Personal, Work and Client subscales), and Depression, Anxiety, and Stress Scale (DASS). The sample was collapsed into two groups according to DASS clinical cut-offs (normal/mild versus moderate/severe/extreme). Effect size statistics were calculated and judged according to Cohen’s guidelines. Results One thousand thirty-seven surveys were received. Respondents were predominantly female (98%), with an average age of 46.43 years, and 16.51 years of practice. Using a CBI subscale cut-off score of 50 and above (moderate and higher), 64.9% ( n  = 643) reported personal burnout; 43.8% ( n  = 428) reported work-related burnout; and 10.4% ( n  = 102) reported client-related burnout. All burnout subscales were significantly correlated with depression, anxiety and stress, particularly personal and work-related burnout with Spearman’s rho correlations ranging from .51 to .63 ( p  < .001). Around 20% of midwives reported moderate/ severe/ extreme levels of depression (17.3%); anxiety (20.4%), and stress (22.1%) symptoms. Mann-Whitney U tests revealed significant differences between groups with depression ( r  = .43), anxiety ( r  = .41) and stress ( r  = 48) having a medium size effect on burnout. Conclusion Prevalence of personal and work-related burnout in Australian midwives was high. The physical and psychological exhaustion associated with the different types of burnout were reflected in symptoms of depression, anxiety and stress symptoms. Further research is needed to support the personal well-being of midwives and minimize workplace burnout by developing short and long term strategies.

Background Stress is one of the factors that damage the mental health of nurses, part of which can likely be offset by individual personality characteristics and coping styles, and the degree of stress is related to some differences in marriage, night shift, department and so on. The purpose of this study is to investigate the situation and influencing factors of stress-load among nurses and midwives in obstetrics and gynaecology. Methods From February 2023 to March 2023, a cross-sectional study was carried out involving 540 obstetric and gynaecological nurses and midwives from 21 hospitals in Guangdong Province, using the Chinese Big Five Personality Inventory (CBF-PI-B), Trait Coping Style Questionnaire (TCSQ), and Chinese version of Stress Load Scale (SOS). A bootstrap method was used to analyse the mediating effect of positive coping and negative coping between personality traits and stress load. Results The survey achieved a response rate of 92.31% and a total effective rate of 78.89%. The stress load of obstetric and gynaecologic nurses and midwives was moderate, with a total score of 65.30 ± 17.27 points. The most common personality characteristics of the nurses and midwives was conscientiousness. There were significant positive correlations between neuroticism, negative coping, event load, and individual vulnerability ( p  < 0.01). Conscientiousness, openness, and positive coping were significantly negatively correlated with negative coping and individual vulnerability ( p  < 0.01). 45.4% of the difference can be explained by positive coping ( R 2  = 0.454, F  = 352.873, p  < 0.001), indicating a prominent contribution. Positive coping partially played a mediating role in the relationship between agreeableness ( ab =-0.076, 95% CI: -0.145 to -0.020) and event load, while it fully mediated in the relationship between conscientiousness ( ab  = 0.219, 95% CI: -0.328 to -0.120) and openness ( ab  = 0.176, 95% CI: -0.277 to -0.091) and individual vulnerability. Negative coping partially played a mediating role in the association between neuroticism and event load ( ab  = 0.206, 95% CI: 0.151 to 0.269) and individual vulnerability ( ab  = 0.287, 95% CI: 0.215 to 0.355), while fully played a mediating role in the association between conscientiousness ( ab =-0.176, 95% CI: -0.310 to -0.056) and openness ( ab =-0.161, 95% CI: -0.261 to -0.063) and individual vulnerability, agreeableness ( ab  = 0.132, 95% CI: 0.023 to 0.251) and event load. Conclusion At present, the stress load of obstetrics and gynaecological nurses and midwives is moderately high. Both positive coping and negative coping plays a mediating effect between neuroticism, conscientiousness, openness, agreeableness and stress load of nurses.

Midwives work in a high-stress, high-risk, and high-intensity delivery room environment, which exposes them to significant emotional challenges. Understanding the factors influencing midwives' professional quality of life (ProQoL) is crucial for maintaining their well-being. Although the nursing work environment plays a significant role in ProQoL, a gap in understanding how the nursing work environment and traumatic stress affect midwives' ProQoL remains, especially in Chinese midwives. The purpose of this study was to identify how the nursing work environment and traumatic stress are related to ProQoL in Chinese midwives. An online questionnaire was administered to 232 midwives working in the delivery room of 59 hospitals in Henan Province, China. The participants were selected via a convenience sampling approach between November and December 2023. The data collection tools used were the Demographic and professional characteristics Questionnaire, Traumatic Stress Scale for Midwives (TSSM) (consisting of frequency and impact), Nursing Work Environment Scale (NWES), and ProQoL (consisting compassion satisfaction, burnout, and secondary traumatic stress). The data were analyzed via the Mann-Whitney U test, the Kruskal-Wallis H test, Spearman's correlation, and multiple linear regression. The study revealed that midwives reported moderate levels of compassion satisfaction (35.18 ± 7.703) and burnout (25.33 ± 4.334), alongside a low level of secondary traumatic stress (21.50 ± 5.464). Results showed that the nursing work environment was positively correlated with compassion satisfaction (r = 0.610) and negatively correlated with burnout (r = -0.390) and secondary traumatic stress (r = -0.296). Midwives' scores on the frequency and impact of traumatic stress were positively related to burnout (r = 0.254, r = 0.452) and secondary traumatic stress (r = 0.281, r = 0.380) but negatively related to compassion satisfaction (r = -0.145, r = -0.383). Multiple regression analysis results revealed that the nursing work environment, the impact of traumatic stress, major shifts, health condition and the frequency of traumatic stress predicted compassion satisfaction. The impact of traumatic stress, health condition, and the nursing work environment predicted burnout. The impact of traumatic stress, the nursing work environment and frequency of night shifts per month predicted secondary traumatic stress. The associations we identified among the nursing work environment, traumatic stress, and ProQoL suggest the potential importance of implementing a supportive nursing work environment and developing strategies such as trauma-informed care education and trauma management for midwives. These strategies are vital in improving midwives' ProQoL, thereby promoting their health and well-being.