Experiences Of Midwives Research Articles

Midwives’ experiences regarding recordkeeping during intrapartum care in Limpopo Province healthcare facilities

Background: South Africa has experienced an increase in litigations because of poor recordkeeping. The quality of maternal healthcare necessitates quality recordkeeping. All midwives’ interventions should be documented in the maternity case record as an instrument to highlight the quality of intrapartum care offered.Objectives: The purpose of the study was to determine and describe the experiences of midwives regarding recordkeeping during intrapartum care in Limpopo province and to make recommendations to improve recordkeeping.Method: A qualitative, explorative and descriptive design was adopted. Midwives were selected purposively to participate in focus group discussions. Data were thematically analysed with the help of the independent transcriptionist and coder.Results: The findings revealed the themes: perceptions of midwives regarding recordkeeping and the challenges and enablers that influence recordkeeping during intrapartum care.Conclusion: Quality recordkeeping requires timely, detailed, comprehensive and accurate recording. The study recommended the availability of updated guidelines, in-service training, monitoring and evaluation of recordkeeping, peer review, record auditing, proper time management among midwives and appointment of staff in line with the staffing needs of the unit to enhance recordkeeping.Contribution: Quality recordkeeping has a positive impact on the provision of quality healthcare to mothers during intrapartum care and reduces litigations related to maternity cases.

The Experience of Birth Professionals Who Witness Obstetric Violence During Childbirth

Research The experience of obstetric violence is well documented. However, the impact on and experience of doulas and midwives who witness OV deserves more attention. The research questions that guided this study were: What types of harm are doulas and midwives witnessing, what factors influence their decision to intervene, and what impact does this experience have on their professional career and well-being? Methods This exploratory study used semi-structured qualitative interviews to understand how doulas and midwives navigate the experience of witnessing OV. The data analysis included reflexive thematic analysis. Feminist standpoint theory was employed to center the lived experiences of women and other individuals from marginalized groups in the research and in the knowledge acquisition process. Key contributions This study found that independent birth professionals like doulas and midwives are struggling with how to navigate their roles in the obstetric system. They find creative ways to advocate yet are often met with mistreatment themselves. This work is a call to action to the field of social work to engage in issues related to perinatal health and reproductive justice.

Women and midwives’ experiences of an audio-visual enhanced hospital birth environment: An interview study

ProblemMost hospital birth environments remain clinical in appearance and are not attuned to the neurohormonal processes that orchestrate labour and birth. Hospital environments are therefore not aligned with the innate needs of a woman to feel safe and secure in the place where she gives birth. BackgroundResearch has suggested that audio-visual effects such as nature images and sounds may help promote physiological labour in women at low risk of complications. This study aimed to explore the experiences of women labouring in a hospital birth environment enhanced with audio-visual technology, regardless of pregnancy complexity and use of interventions. Experiences of midwives providing one-to-one midwifery care in this environment were also explored. MethodsTranscripts of semi-structured interviews conducted with thirty-two women and six midwives were analysed thematically. FindingsUniversally, women reported that access to audio-visual imagery and soundtracks in the birth environment positively influenced their experience of labour. Nature images and sounds during labour helped create serenity and calmness within the woman and her surroundings, allowing her to relax and focus inwards. Midwives used this technology to create a calm and psychologically safe environment for women giving birth in the hospital. Projecting nature images and sounds became a medium for midwives to create ambience and instil calmness in the clinical environment. Midwives also reported observing positive impacts on the behaviours of other clinicians entering the room. ConclusionAudio-visual enhancement of the hospital birth environment was found to enhance women’s birth experiences and support midwives providing woman-centred care.

Discrimination at Health Center: Experiences of Tribal Women and Midwives in Jharkhand, India

The pivotal concern of this study is to investigate how age, social status, language, and cultural background interact to affect women’s control over and susceptibility to disrespect during birth setting in Jharkhand, India. Women, particularly, belonging from tribal community were directly impacted by disrespect during birth settings, which happens during pregnancy, labor, and the first few weeks following delivery. Hence, the article aims to uncover the effects of disrespect during birth setting on patient’s trust in birth setting facilities and health care teams. Besides, this study also adds to challenge the culture of silence that currently surrounds this issue. The study was conducted in the Sisai block of Jharkhand’s Gumla district, where focus group discussion (FGD) with the assistance of 18 public health midwives (PHMs) and 24 individuals with prior parturition experience were involved. The qualitative data was categorized and analyzed using an intersectional framework, which facilitated the identification of significant themes and patterns. The results show that power dynamics and repressive institutions associated with gender, ethnicity, social, linguistic, and cultural inequality were intertwined with disrespect during birth setting, especially with tribal women. In conclusion, the standard of birthing treatment in India needs to be improved, especially in tribal regions.

Simulation as a method in a supervision course, experiences of midwives and specialist nurses: A qualitative study

AimTo explore supervisors’ experience of simulation in a student supervision course BackgroundThe relationship between student and supervisor is crucial for the students’ learning and quality of education. The supervisors have an important role in facilitating a good start and the best learning opportunities for students in clinical placement. Supervision can be demanding and there is a need to strengthen supervisors in their role. An interprofessional supervision course was designed, using simulation as a method. Simulation is frequently used for acute situations to improve patient safety but is less common in student supervision. In our supervision course, simulation was introduced in the digital component and practiced in the physical component. The 4–6 members of the interprofessional simulation groups were assigned roles as either participants or active observers. They were guided by a facilitator, who constructed student-supervisor scenarios, allocated roles and facilitated reflection. DesignA qualitative, explorative design involving focus groups and written reflections. MethodsTwo focus groups (n=9) were conducted following a pilot course in addition to written reflections (n= 80) after four courses. After revising the course and the interview guide, two additional focus groups (n =10) were held and a further 43 written reflections received. The empirical data were analyzed using thematic analysis by Braun and Clarke. ResultsThe three themes.1. Interprofessional simulation provides a wider perspective on the student- supervisor relationship.The participants experienced being active in different roles, followed by subsequent joint reflection. They expressed increased relational understanding as well as the importance of verbal and nonverbal communication in supervision through learning from other interprofessional supervisors.2. Simulation provides realism by entering into the situation. Simulation fostered activation of the senses that improved the supervisor’s ability to be attentive to the student’s needs.3.Challenging to simulate the role of supervisor. Most participants were willing to force themselves out of their comfort zone to learn. However, quite a few felt uncomfortable participating in simulation on communication and preferred observing others. ConclusionThe participants experienced simulation as valuable for strengthening their awareness of their ability to influence students’ learning and relational understanding. The results showed the value of reflective observation in addition to participating in simulation. Simulation might contribute to improved supervision, although different experiences that inhibit learning outcomes must be acknowledged.

Exploring clinical practice education for student midwives: Hospital and community opportunities and challenges

Understanding the experiences of student midwives during clinical training is crucial amid evolving midwifery practices in the Philippines. This training is a vital component of their education, offering real-world experience in hospital and community settings. Although existing literature covers various aspects of midwifery training, detailed accounts of the specific challenges and opportunities faced by Filipino student midwives are limited. This study explores the experiences of student midwives across different levels of training in public and private institutions, focusing on the opportunities and challenges they encountered. A qualitative descriptive research design was conducted with 26 purposively selected student midwives. Data collected through in-depth interviews were analyzed to identify recurring themes. Key themes included the importance of a supportive learning environment, exposure to diverse cases, and the acquisition of practical skills. Challenges such as hierarchical barriers and communication challenges, role confusion, resource limitations and adaptation struggles, balancing autonomy and supervision, emotional toll of challenging situations and limited community experiences were highlighted. The findings stress the need for a more supportive and resourceful training environment. Addressing these challenges through targeted interventions could enhance the learning experience and better prepare student midwives for their professional roles. Collaborative efforts with other healthcare professionals and continuous learning opportunities are also essential for their development. This study offers valuable insights for educators and healthcare institutions to optimize midwifery training programs, ultimately fostering the holistic growth of future midwives.

“… I carry their stories home …”: experiences of nurses and midwives caring for perinatal adolescent mothers in primary health care settings in Rwanda

IntroductionAdolescent mothers require trauma- and violence-informed care during the perinatal period due to trauma histories and ongoing violence as a result of pregnancy. Nurses and midwives play a critical role in caring for adolescent mothers in primary healthcare settings in Rwanda in the perinatal period.PurposeTo explore the experiences of nurses and midwives working with adolescent mothers in selected primary healthcare settings in Rwanda to inform the delivery of trauma- and violence- informed care.MethodsThis study utilized an interpretive description qualitative approach and was conducted in eight primary healthcare settings in Rwanda. Twelve nurses and midwives working in perinatal services and four heads of health centers participated in in-depth individual interviews. Data were analyzed thematically.ResultsThe analysis revealed four main themes and 11 (sub-themes): (a) relational practice (being creative and flexible, “lending them our ears”); (b) individual challenges of providing care to adolescent mothers (lack of knowledge to provide care related to gender-based violence, and gendered experience); (c) factors contributing to workarounds (inflexible guidelines, lack of protocol and procedures, lack of nurses’ and midwives’ in service training, and the physical structure of the perinatal environment); and (d) vicarious trauma (living the feelings, “I carry their stories home,” and hypervigilance in parenting).ConclusionNurses and midwives find caring for adolescent mothers challenging due to their unique needs. These needs require them to be creative, adaptable, and attentive listeners to better understand their challenges. These practitioners face difficulties such as insufficient specific knowledge related to, for example, gender-based violence, inflexible guidelines, and a lack of protocols and training. Additionally, in the perinatal environment attention to the needs of practitioners in those settings is often lacking, and many nurses and midwives report experiencing vicarious trauma. Consequently, there is a pressing need for guidelines and protocols specifically tailored for the care of adolescent mothers. Ongoing trauma- and violence- informed care training and professional education should be provided to enhance the ability of nurses and midwives to care for adolescent mothers and prevent re-traumatization and mitigate vicarious trauma effectively.

O40 - Experiences of midwives when they return to work in a maternity unit following a personal pregnancy loss or neonatal death: A hermeneutic phenomenological study

O40 - Experiences of midwives when they return to work in a maternity unit following a personal pregnancy loss or neonatal death: A hermeneutic phenomenological study

Domestic, family and sexual violence polyvictimisation and health experiences of Australian nurses, midwives and carers: a cross-sectional study

BackgroundDomestic, family and sexual violence is a prevalent health and social issue. Nurses may be exposed to higher rates of this violence in their personal lives compared to the community, but little is known about their polyvictimisation experiences or health and well-being impacts.MethodsAn online descriptive, cross-sectional survey of women nurses, midwives and carer members of the Australian Nursing and Midwifery Federation (ANMF) (Victorian Branch) (response rate: 15.2% of nurses sent an invitation email/28.4% opened the email). Violence survey measures included: intimate partner violence (Composite Abuse Scale); child abuse and sexual violence (Australian Bureau of Statistics Personal Safety Survey items). Health measures included: Short Form-12; Fast Alcohol Screening Test; Patient Health Questionnaire-4; Short Screening for DSM-IV Posttraumatic Stress Disorder; well-being measures included: Connor-Davidson Resilience Scale, social support, and financial stress. Proportions were used to describe the prevalence of violence by sociodemographic characteristics and health and well-being issues; logistic regression predicted the odds of experiencing overlapping types of violence and of experiencing health and well-being outcomes.Results5,982 participants (from a parent study of 10,674 nurses, midwives and carers) had experienced at least one type of lifetime violence; half (50.1%) had experienced two or three types (polyvictimisation). Survivors of child abuse were three times more likely to experience both intimate partner violence and non-partner adult sexual assault. Any violence was associated with poorer health and well-being, and the proportion of affected participants increased as the types of violence they had experienced increased. Violence in the last 12-months was associated with the poorest health and well-being.ConclusionsFindings suggest a cumulative, temporal and injurious life course effect of domestic, family and sexual violence. The polyvictimisation experiences and health and well-being associations reported by survivor nurses, midwives and carers underscores the need for more accessible and effective workplace interventions to prevent and mitigate psychosocial ill health, especially in the recent aftermath of violence.

Working in smaller teams in community midwifery practices to foster continuity of carer: Midwives’ experiences – A qualitative study in the Netherlands

BackgroundMidwife-led continuity of carer (MLCC) improves health outcomes and increases pregnant women’s satisfaction. Working in smaller teams in community midwifery practices is one of the ways to promote continuity of carer. AimTo gain insight into the experiences of Dutch community midwives regarding working in smaller teams, by identifying motivators and barriers. MethodsA qualitative study was conducted using individual, semi-structured interviews (n=9). The sample was purposively selected. The interviews were analysed using the Abbreviated Grounded Theory. FindingsFour themes were identified: 1) Ideal implementation of working in smaller teams, 2) Best care for pregnant women, 3) Conflicts with the current maternity care system, 4) Personal interests of the midwife. The core concept connecting all themes was midwives’ experiences of an 'inner conflict' regarding working in smaller teams. ConclusionA strong motivation for working in smaller teams is the wish to provide the best care for pregnant women through offering more continuity of carer. The structure of maternity care, financially and organisationally, acts as a barrier in the transition to working in smaller teams. How community midwives manage these motivators and barriers depends on their personal interests, vision, and personal life. The balance between the motivators and barriers can create an inner conflict among the midwives. This inner conflict encompasses an ethical issue: what is the best care and what is it worth? A discussion within the professional group concerning the practical and ethical aspects of working in smaller teams is needed to find ways to reduce the inner conflict of community midwives who wish to work in smaller teams, thereby promoting the implementation of MLCC.

Midwives' support for parents following stillbirth: How they practise and resources they need from a phenomenological perspective.

To explore the perceptions and experiences of midwives caring for couples who experience a stillbirth. Qualitative study based on Gadamer's hermeneutic phenomenology. This study was conducted with midwives (n = 18) at the birth unit of a third-level public hospital in Jaén (Spain) in 2023. Personal semi-structured interviews were recorded in audio for later transcription by two researchers following steps described by Fleming. Two themes were identified as important aspects of the practise of midwives in a situation of the birth of a stillborn child: (1) the importance of each action of the midwife, and (2) the availability of resources determines the care provided. Having a stillbirth is a very complex experience, in which the psychological support and human and material resources involved are the basic tool for the care of these families. Acknowledging limitations of the available resources, the assistance and care provided by midwives are in line with the clinical practice guidelines, which can have an emotional impact on them. The care to be provided in stillbirth requires appropriate human and material resources for these families. Midwifery and nursing professionals are in a unique position for acting in cases of families with a stillbirth, updated protocols and, in general, the coordination of the different agents involved within the healthcare system. WHAT PROBLEM DID THE STUDY ADDRESS?: The midwives´ experiences in cases which end with the delivery of a stillborn. WHAT WERE THE MAIN FINDINGS?: Each action of the midwife is as important as the availability of resources to offer the most appropriate care. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: In each woman who receives the care of a midwife who attends the birth of a stillborn. COREQ checklist. No patient or public contribution occurred for this study as this research focused on exploring staffs' perspectives from the specific viewpoint of their personal experience.

Midwifery experiences in rural Southern Aotearoa New Zealand: insights into pre-eclampsia management

aim: This study investigated the experiences of rural midwives in the Southern region of Aotearoa New Zealand, focussing on practices and challenges in caring for pregnant individuals displaying signs of pre-eclampsia (PE). method: Conducted as part of the University of Otago’s Trainee Intern Healthcare Evaluation Project, investigating the efficacy of the soluble FMS-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio test, this exploratory study employed qualitative research methods. Twenty-three midwives from nine locations across the Southern region were interviewed by trainee intern doctors (TIs) using a semi-structured interview protocol. Thematic analysis was applied to the data. results: The study highlighted the challenging context of rural midwifery, emphasising diverse working conditions, geographic complexities and the impact of the midwifery shortage. Midwives’ decision making about PE depended on location, experience, scientific evidence, holistic model of care and the constant concern about PE. A model illustrating midwifery decision making in PE management was developed. conclusion: Rural midwives in Aotearoa New Zealand’s Southern region managing PE cases face complex challenges. The model derived from this study illustrates the delicate balance that rural midwives navigate, emphasising the need for strategies to support their practice and preserve Aotearoa New Zealand’s distinctive maternity care model.

Community-based health programme for nurses and midwives: A mixed methods evaluation.

To evaluate a community-based psychological health and well-being programme for nurses and midwives. Mixed methods programme evaluation. Four studies were included: observational descriptive study (cross-sectional survey) of the health, well-being and experiences of previous programme participants (Study 1); observational exploratory prospective cohort study (longitudinal survey) of health, well-being and experiences of participants who engaged in the programme from 2020 to 2023 (Study 2); qualitative descriptive study (interviews) of experiences and perceptions of nurses and midwives who have engaged with the programme as participants or clinicians (Study 3); observational descriptive study (cross-sectional survey) of experiences and perceptions of programme stakeholders (Study 4). Surveys included validated measures. Data were collected online. Descriptive, repeated measures and thematic analyses were conducted. One-hundred and fifteen participants completed Study 1: 20% (n = 23) reported stress in the severe-to-extremely severe category; 22% (n = 25) reported psychological distress in the moderate-to-severe category. Thirty-one programme participants were followed in Study 2: the effect of the programme on participant well-being over time was not significant. Sixteen programme participants and eight programme clinicians were interviewed (Study 3). Experiences of nurses and midwives engaging with the programme were highly positive and strong attributes of the programme included (1) shared professional experience of clinicians and participants which supported a common language and facilitated understanding, and (2) effective programme leadership, and autonomy and flexibility in the clinicians' role which enabled and supported a positive working experience. Thirty-nine broader stakeholders participated in a cross-sectional survey (Study 4). All stakeholders reported high satisfaction with the programme. Participants considered the programme being 'by nurses and midwives, for nurses and midwives' critical to the programme's success and value. The community-based psychological health and well-being programme developed, led and delivered by nurses and midwives, for nurses and midwives, was a highly valued resource. Levels of stress and burnout in the health workforce are high. A community-based psychological health and well-being programme for nurses and midwives was found to be an important and highly valued resource for nurses and midwives. A programme delivered by nurses and midwives, for nurses and midwives, was considered critical to programme success. Programme leadership, and autonomy and flexibility in the programme clinicians' roles, facilitated and supported a positive working experience for programme clinicians. Quality and safety in patient care is directly impacted by the well-being of nurse and midwives. A community-based psychological health and well-being programme for nurses and midwives was found to be an important and highly valued resource for nurses and midwives. Survey findings were reported according to STROBE (von Elm etal. in Lancet, 370:1453-1457, 2007) and qualitative findings according to COREQ (Tong etal. in International Journal for Quality in Health Care, 19(6):349-357, 2007). No patient or public contribution.

Exploring birth experience of mothers, based on comfort theory.

To analyse the phenomenon of "giving birth" on the basis of the lived experiences of women and midwives. The qualitative study was conducted in the delivery room of a mother-friendly hospital in western Turkey from March 1 to December 30, 2019, and comprised primiparous women aged 18-35 years having a spontaneous vaginal birth, and midwives who delivered the babies. Data was collected through indepth interviews that were audiorecorded. Additionally, women's written birth stories and researcher's observation regarding the participants were used. Data was subjected to content analysis using NVIVO 12 Pro software. Of the 28 subjects 15(53.6%) were lay women with mean age 24.2±3.87 years (range: 18-30 years), and 13(46.4%) were midwives with mean age 42.61±4.50 years (range: 37-50 years). The most referred conceptual themes in Kolcaba's Theory of Comfort were "enhanced comfort", "mother-friendly hospital policy", and "midwives' comforting interventions." Under the theme of "Increasing Comfort", women cared about psychological and environmental comfort. Women had the most psychospiritual comfort and environmental comfort as well as physical and sociocultural comfort. Women cared about psychological and environmental comfort that facilitated birth. The mother-friendly hospital policy increased and contributed to the support and comfort provided to women. Kolcaba's Comfort Theory was an appropriate and working theory for birth and midwifery care, indicating that women's comfort should be ensured in the psychospiritual, environmental, physical and sociocultural contexts.

The lived experience of midwives’ transitioning from a clinical role into teaching in higher education in one jurisdiction of Australia: A pilot study

AimThe aim of this pilot study was to explore clinician’s experience of transitioning from midwifery clinical practice into university in an academic teaching role within one jurisdiction in Australia. BackgroundThere is a dire shortage of midwifery academics globally. In Australia the shortage is symbiotic with the persistent deficit in the midwifery clinical workforce, which is the predominant recruitment pool for universities. The midwifery workforce cannot be replenished without sufficient academics to provide education. DesignPhenomenology was selected as the most appropriate research approach for the study seeking to illuminate the lived experiences of clinicians as they transition into their new role as academics. MethodsSeven participants were recruited purposively from one jurisdiction in Australia between November 2022 and March 2023. Qualitative conversational interviews were performed facilitating each participant to share their narrative. Participants were then able to direct the conversation to share their lived experience of the transition from a midwifery clinician in practice to a midwifery academic in a university. Demographic details were collected for context. ResultsThematic analysis was used following Giorgi’s four stage phenomenological process. Four themes were identified from commonalities between the participants, ‘Being a drifter”, ‘Keeping a foot in both camps to maintain clinical credibility’, ‘In at the deep end: Not prepared for the reality of academia’ and ‘Best of both worlds’. ConclusionsThe lived experiences of the participants in this study, as they transitioned from clinical midwifery practice to academia can be related to the Theory of Transition where participants navigate: Preparation, Encounter, Adjustment and Stabilisation. A new role in higher education requires adjustment to the reality of working in academia. Midwives who had experiences of being a casual staff member felt they had the best of both worlds, as they gained an insight into the role of an academic whilst remaining in clinical practice. However, many reported that mentorship would have been beneficial to facilitate stabilisation.

Understanding attrition of early career midwives in Australia

ProblemThere is a lack of understanding of the experiences of early career midwives which lead to workforce attrition. BackgroundIn the Australian midwifery setting, workforce attrition in conjunction with the ageing profile of the workforce is of increasing concern. Midwives in the earliest stages of their career are most vulnerable to career attrition, however limited research specifically engages with this cohort. AimTo understand the professional and social circumstances that led early career midwives to leave clinical practice, how their midwifery background influenced career trajectories, and what would compel them to return to clinical practice. MethodsSemi-structured interviews were conducted with 11 early career midwives who had left the profession within 5 years of qualification. Transcripts underwent thematic analysis. FindingsThree themes described early career midwives’ experiences: transition to professional practice, an untenable workplace culture, mental health impacts of early clinical midwifery practice. Two further themes emerged about experiences post-midwifery careers: influence of midwifery on subsequent career, and conditions for re-entry. DiscussionChallenges with transitioning to professional midwifery practice in conjunction with untenable workplace culture led to such deterioration in wellbeing that remaining within the profession became unfeasible for early career midwives. Desire to remain within health care was apparent, however re-entry to the profession was deemed by most to be out of the question. ConclusionEarly workforce retention strategies should be the focus of future workforce planning and policy. Larger scale inquiry foregrounding early career midwives is necessary to inform strategies for midwifery workforce retention in Australia.

‘It was horrible to watch, horrible to be a part of’: Midwives’ perspectives of obstetric violence

BackgroundObstetric violence, including unconsented interventions, coercion and disrespect, violates human rights; impacting the physical and psychosocial health of women. The perspective and experience of midwives related to obstetric violence have been explored in low and middle-income countries, with limited research into the experience of midwives in high income nations. AimTo explore Australian midwives’ perspectives of obstetric violence. MethodsThematic analysis of qualitative in-depth interviews with 15 midwives experienced in supporting women during birth. Critical feminist theory underpinned each stage of the research. FindingsInterviews with 15 Australian midwives from diverse care settings were analysed thematically. Four key themes were developed from the data: ‘the operationalisation of obstetric violence’, ‘the impact of obstetric violence’ ‘the historical and situational context’ and ‘hope for the future’. Midwives considered entrenched patriarchal structures and gender inequity as fundamental to the occurrence of obstetric violence. This societal scaffold is intensified within health care systems where power imbalances facilitate maternal mistreatment through coercion and grooming women for compliance in the antenatal period. Fragmented care models expose women to mistreatment with continuity models being protective only to a point. Midwives experience their own trauma, as a result of what they have witnessed, and due to the lack of support they receive when advocating for women. ConclusionsObstetric violence occurs in Australian maternity systems with unconsented interventions, overmedicalisation, coercion, and disrespect observed by midwives. Care-related trauma impacts on the mental health of midwives, raising workforce concerns for policy makers, consumer advocates and professional bodies.

Nurses under fire: Insights from testimonies of community nurses and midwives in nonhospital settings in the southern Israel conflict zone.

Nurses-with or without prehospital care training-may find themselves delivering immediate care to injured individuals outside a healthcare facility, sometimes even in situations where their own life is at risk. This study explores the experiences of community nurses and midwives who provided immediate care during the Hamas militant movement's attack in southern Israel. The researchers collected and analyzed eight nurse and midwife survivors' testimonies published in digital media to gain a deeper understanding of their perspectives. Through qualitative content analysis, common themes, patterns, and insights were identified. The study aimed to contribute valuable knowledge in this field and followed the Consolidated Criteria for Reporting Qualitative Research (COREQ)checklist for methodological rigor. Two themes emerged from the testimonies, focusing on the nurses' swift realization of necessary action under fire and resilience and ingenuity in practice. Despite lacking training and resources, the nurses professionally assessed the situation and improvised creative solutions to care for the wounded. Although they had no prehospital emergency care background, community nurses and midwives were able to respond effectively, providing lifesaving care. The findings highlight the nurses' resilience, adaptability, and dedication in unprecedented situations. However, the study also emphasizes the importance of providing all nurses with baseline prehospital care training and structured planning of this care to empower them to deliver optimal patient care in uncertain and dangerous conditions, especially in and around conflict and disaster zones.

Assessing the Gap Between Women's Expectations and Perceptions of the Quality of Intrapartum Care in Jordan: A Two-Stage Study Using the SERVQUAL Model.

Although Jordan has made significant progress toward expanding the utilization of facility-based intrapartum care, prior research highlights that poor service quality is still persistent. This study aimed to identify quality gaps between women's expectations and perceptions of the actual intrapartum care received, while exploring the contributing factors. Utilizing a pre-post design, quality gaps in intrapartum care were assessed among 959 women pre- and postchildbirth at a prominent tertiary hospital in northern Jordan. Data were gathered using the SERVQUAL scale, measuring service quality across reliability, responsiveness, tangibles, assurance, and empathy dimensions. The overall mean gap score between women's expectations and perceptions of the quality of intrapartum care was -0.60 (±0.56). The lowest and highest mean gap scores were found to be related to tangibles and assurance dimensions, -0.24 (±0.39) and -0.88 (±0.35), respectively. Significant negative quality gaps were identified in the dimensions of assurance, empathy, and responsiveness, as well as overall service quality (p < 0.001). The MLR analyses highlighted education (β = 0.61), mode of birth (β = -0.60), admission timing (β = -0.41), continuity of midwifery care (β = -0.43), physician's gender (β = -0.62), active labour duration (β = 0.37), and pain management (β = -0.33) to be the key determinants of the overall quality gap in intrapartum care. Our findings underscore the importance of fostering a labour environment that prioritizes enhancing caregivers' empathetic, reassuring, and responsive skills to minimize service quality gaps and enhance the overall childbirth experience for women in Jordan. This paper is a collaborative effort involving women with lived experiences of childbirth, midwives, and obstetrics and gynaecologist physicians. The original idea, conceptualization, data generation, and coproduction, including manuscript editing, were shaped by the valuable contributions of stakeholders with unique perspectives on intrapartum care in Jordan.

CONTINUITY OF CARER: WHAT DOES IT MEAN AND DOES IT MATTER TO MIDWIVES AND BIRTHING WOMEN?

This paper discusses key themes from a large-scale, long-term multi-perspective evaluation of caseload midwifery practice in the United Kingdom (UK). Caseload practice was introduced in several UK settings, on a pilot scale, following the publication of Changing Childbirth intended to put into practice its core principles of continuity, choice and control for women.1 A range of new midwifery practices were piloted and evaluated across the UK. Relatively little attention was given to defining and exploring the nature and meanings of the new models of practice, or to midwives in this new practice context. This has led to difficulty in comparing the impact of different models of practice. We draw on two aspects of our work – an ethnographic study of the experiences of midwives (with and without caseloads) and a study of the women's experiences and responses to care – to explore in greater depth the concepts involved in the caseload model and their meaning for women and for midwives in practice. Interviews were conducted with 40 women and 36 caseload midwives. Other forms of data collection, including questionnaires and observation were used and were analysed thematically using grounded theory principles. Themes emerging included autonomy, confidence, reciprocity and relationship: the idea of knowing and being known. On this basis we have argued that continuity is not an end in itself but an important means towards the end of women-centred care and should be considered in relation to other key themes such as autonomy and environment.