Midwifery Experience Research Articles

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.

Midwifery and nursing honours programs in Australia and New Zealand: A scoping review of contemporary challenges and opportunities

ProblemContemporary resources that identify the challenges and experiences of Midwifery and Nursing honours students and providers within Australia and New Zealand are lacking. BackgroundThe establishment and development of accredited, tertiary education for Midwifery and Nursing has enhanced professionalism and opportunity. However, the progression from registration pathway programs to Higher Degrees by Research remain limited. AimTo undertake a scoping review of Australian and New Zealand honours programs and synthesise student and provider perspectives. MethodsA scoping review was undertaken. Publicly available grey literature and relevant database searched. English language, peer-reviewed publications were identified from the past 10-years. FindingsWithin Australia, 16 universities, and 2 in New Zealand, offer a Midwifery and/or Nursing honours program. Within Australia, the majority of programs were offered in both Midwifery and Nursing streams, however only Nursing in New Zealand. Four studies met inclusion criteria and described strengths and challenges of the current offerings. DiscussionChallenges included: logistical issues related to low/decreasing enrolments and resource. Students identified burdens associated with student driven research and balancing the multiple demands of clinical roles. Opportunities were seen in terms of providers professional interactions between academic and clinical sites. Students viewed honours programs as an opportunity to actively partake in research and determine their commitment to further research training including Doctor of Philosophy (PhD). ConclusionProgressing the professional status of both Midwifery and Nursing is based on discrete professional research and evidence. Honours programs provide a research focused degree to prepare nurses and midwives, but challenges are present.

Midwifery Experiences During Two Major Earthquakes in Türkiye: Challenges and Lessons Learned - A Qualitative Study.

This study aims to identify midwives' post-earthquake caregiving experiences. A phenomenological study was undertaken in May-June 2023. The participants of the study consisted of 15midwives who were included in the study with the purposeful sampling method and volunteered to provide care during the earthquake. Data were collected by an in-depth interview method using a demographic information form and a semi-structured interview form. Thematic analysis was conducted on interview transcripts. The research identified 2main themes: difficulties in managing midwifery care and the psychological impact of the earthquake on midwives. Challenges included issues with disaster organization, management, and coordination; communication gaps; insufficient medical supplies; harsh environmental conditions; inability to fulfill basic needs; lack of disaster-related knowledge and experience among midwives; and the overall survival conditions of disaster victims. The disaster caused several psychological effects on midwives, including shock, surprise, sadness, confusion, feelings of inadequacy, insomnia upon returning from the disaster area, nightmares, difficulty adapting, guilt about returning, feelings of helplessness, and experiences of loss and mourning. This study detailed midwives' experiences during disasters, difficulties, and barriers to effective care. It is crucial to record midwives' experiences during disasters and use this information and solutions to prepare for future disasters. Disaster preparedness training for midwives should be planned to increase physical and emotional resilience.

Evaluating the long-term impact of large-scale trainings: an exposure based cross-sectional study on female genital mutilation-related knowledge, attitudes and practices among Sudanese midwives in Khartoum State

ObjectivesTo examine the long-term impact of large-scale training targeting midwives in a setting where they are the main female genital mutilation (FGM) practitioners. We hypothesised that trained midwives would have...

A survey of Australian midwives: Experts in nitrous oxide administration within the peripartum setting

ProblemThere is little documented evidence of midwives’ perspectives regarding the use of nitrous oxide in the peripartum period. BackgroundNitrous oxide is an inhaled gas used widely in the peripartum period; usually offered and managed by midwives. AimExplore midwives’ knowledge, perceptions, and practices of facilitating women’s use of nitrous oxide in the peripartum period. MethodsAn exploratory cross-sectional survey design was used. Quantitative data were analysed using descriptive and inferential statistics; open-ended responses underwent template analysis. FindingsMidwives (n = 121) working in three Australian settings reported regularly recommending the use of nitrous oxide and high levels of knowledge and confidence supporting its use. There was a significant association between midwifery experience, and perspectives on women’s capacity to use nitrous effectively (p = 0.004); and desire for refresher education (p < 0.001). Midwives working in continuity models were more likely to support women using nitrous oxide in any situation (p = 0.039). DiscussionMidwives demonstrated expertise in facilitating nitrous oxide use, citing utility to relieve anxiety and distract women from pain or discomfort. Nitrous oxide was identified as an important adjunct to the provision of supportive care requiring midwifery therapeutic presence. ConclusionThis study provides novel insight into midwives’ support of nitrous oxide use in the peripartum setting revealing high levels of knowledge and confidence. Recognition of this unique expertise held by midwives is important to ensure transfer and development of professional knowledge and skills and emphasises the need for midwifery leadership in clinical service provision, planning and policy.

The Relationship Between Midwifery Practical Skills Evaluation and Midwifery Experience Among Young Midwives Working at Perinatal Medical Centers in Japan

The Relationship Between Midwifery Practical Skills Evaluation and Midwifery Experience Among Young Midwives Working at Perinatal Medical Centers in Japan

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

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

'A tool we need': Midwives' descriptions and recommendations of an ideal obstetric triage tool.

The obstetric triage tool (OBTT) is used to record the clinical findings following obstetric triage (OBT). The recorded OBTT provides midwives with clinical information leading to diagnosis of existing and potential maternal and foetal problems that may lead to intrapartum complications, planning of specific midwifery care and communication among the midwifery team about the woman in labour. This study aimed to explore and describe midwives' experiences of the OBTT used during admission of women in labour in the Bojanala district. This study was conducted in the two selected facilities in Bojanala district in North West province. This study is a derivative of a major study, entitled 'Midwives' experiences of OBT by midwives in the Bojanala district'. A qualitative, explorative and descriptive research design was followed. Nine purposefully sampled midwives with over 5 years of clinical midwifery experience, employed in the Bojanala district, attended a semistructured interview. Data obtained were analysed using Colaizzi's descriptive method of data analysis according to the themes and categories which emerged. One central theme with 10 subthemes emerged. Midwives verbalised their dissatisfaction with the current OBTT and made recommendations for the revision of the tool. The study highlighted midwives' experiences of the OBTT and recommendations for an ideal tool based on their knowledge of admission of a woman in labour. This study provides a new OBTT from midwives' perspectives that could be useful in improving pregnancy and labour outcomes in clinical midwifery practice.

Developing Conflict Resolution Strategies and Building Resilient Midwifery Students: Protocol for a Mixed Methods Research Study.

BackgroundWorkplace bullying and violence (WBV) are well-documented issues in the midwifery profession. Negative workplace culture, conflict, and bullying are the most common forms of workplace violence experienced by midwives. Workplace violence increases the risk of midwives experiencing burnout, compassion fatigue, psychological trauma, poor mental health, absenteeism, loss of passion for the midwifery profession, job dissatisfaction, and poor job retention. Midwifery students describe workplace violence in the form of physical, emotional, or verbal abuse, and bullying. Therefore, there is a justification to develop conflict resolution strategies and resilience in midwifery students prior to graduation.ObjectiveOur aim is to develop and facilitate a bespoke education program for South Australian midwifery students to enable them to develop skills in conflict resolution, build resilience, and identify self-care strategies.MethodsThis study will undertake a preparatory phase summarizing the body of literature on midwifery students’ knowledge, understanding, and experiences of WBV. Following this, a 3-phase sequential mixed methods research design study will be undertaken. In Phase 1, quantitative data will be collected via a semistructured questionnaire and a validated conflict measurement tool, before and after attending an education workshop, and will be analyzed using descriptive and inferential statistics. Results from Phase 1 will inform and guide the development of an interview schedule for Phase 2. In Phase 2, qualitative data will be gathered by facilitating one-to-one interviews and a thematic analysis will be undertaken to gain a deeper understanding of midwifery students’ experiences of WBV. In Phase 3, data integration using triangulation will be undertaken and meta-inferences will be developed via the integration of results and findings from Phases 1 and 2.ResultsThe preparatory phase will commence in October 2021. Phase 1 will commence in 2022 with analysis of pre- and posteducation results anticipated to be completed by December 2022. Phase 2 will be developed from findings of the preparatory phase and results of Phase 1. An interpretation of verbatim interview transcripts is estimated to be undertaken by April 2023. Phase 3 of the study is expected to commence in May 2023, and this will involve the analysis of collective evidence gathered from Phases 1 and 2. The anticipated completion date for the study is December 2023.ConclusionsThe outcomes of this research will provide insights into the prevalence and impact of WBV experienced by midwifery students. The findings of the research will report on levels of knowledge, skills, and confidence, and will assess the impact of a bespoke conflict resolution and resilience education workshop for midwifery students in managing WBV.International Registered Report Identifier (IRRID)PRR1-10.2196/35558

Intentions to leave and actual turnover of community midwives in the Netherlands: A mixed method study exploring the reasons why

BackgroundIn the Netherlands, the turnover of midwives of relatively young age is high. This is concerning since a lack of midwifery experience can negatively affect the quality of maternity care. AimTo study the rate and the reasons for intending to leave, and to explore the reasons for leaving midwifery jobs in the Netherlands. MethodsWe used a mixed-methods design including a quantitative survey (N = 726) followed by qualitative interviews (N = 17) with community midwives. FindingsAlmost one third of the respondents considered leaving the profession. The decision to actually leave the job was the result of a process in which midwives first tried to adapt to their working conditions, followed by feelings of frustration and finally feelings of decreased engagement with the work. The reasons for leaving midwifery practice are an accumulation of job demands, lack of social resources and family responsibilities. DiscussionCompared to international figures, we found a lower rate of midwives who considered leaving the profession. This could be explained by the differences in the organisation of midwifery care and the relatively high job autonomy of midwives in the Netherlands. Nevertheless, changes must be made in terms of decreasing the demands of the job and creating more job resources. ConclusionInnovations in the organisational structure that focus on continuity of care for pregnant individuals, job satisfaction for midwives and building a sustainable workforce may result in an increase in the retention of midwives. These innovations would ensure that women and their babies receive the best care possible.

Client experiences of expertise in midwifery care in New Brunswick, Canada

ObjectiveThis study contextualizes client experiences of midwifery in New Brunswick within the broader literature on midwifery in Canada and contributes to understandings of how midwifery care fits into the landscape of reproductive healthcare in the province. DesignSemi structured interviews with 32 clients and supportive others of the New Brunswick midwifery program were carried out in 2019 and 2020, and transcripts were analysed using general thematic analysis. SettingN New Brunswick, Canada ParticipantsClients of midwifery care provided by the Fredericton Midwifery Centre, as well as their supportive others (partners and spouses, family members, friends) FindingsParticipants in this study reported a high degree of satisfaction with midwifery services and identified several approaches to practice that they felt contributed to high quality midwifery care. These include competence and expertise, time and access as abundance rather than scarcity, attention to the familial context, trauma informed care and attention to mental and emotional health, postpartum care, and supporting agency and autonomy. In short, participants’ responses indicate that midwifery care in New Brunswick meets the criteria for respectful maternity care, as outlined by Shakibazadeh et al. (Shakibazadeh et al., 2018) and Butler et al. (Butler et al., 2020). Our findings are in line with research on midwifery care in other settings, although there is a significant emphasis on the medical expertise and training of midwives amongst our participants which is less evident in the scholarly literature. Key conclusionsIn a province where reproductive health care has been systematically underfunded, clients celebrate the expertise and competence of midwives, challenging the narrative which constructs midwifery as ‘traditional’ care, and hospital-based obstetrics as expert care. Instead, midwives are recognized as highly specialized evidence-based practitioners, and this is particularly prized by clients in relation to processes of information sharing.

Experience of midwives in providing care to labouring women in varied healthcare settings: A qualitative study.

BackgroundMidwives are essential to timely, effective, family-centred care. In South Africa, patients have often expressed dissatisfaction with the quality of midwifery care. Negative interpersonal relationships with caregivers, lack of information, neglect and abandonment were consistent complaints. Less is known about how midwives experience providing care.AimThis research explored and described the experiences of midwives in providing care to labouring women in varied healthcare settings.SettingMidwives practicing in the Gauteng province, South Africa, in one of three settings: private hospitals, public hospitals or independent maternity hospital.MethodsA convenience sample of midwives (N = 10) were interviewed. An exploratory and descriptive design, with individual semi-structured interviews conducted, asked a primary question: ‘How is it for you to be a midwife in South Africa?’ Transcribed interviews were analysed using thematic coding.ResultsFive themes were found: proud to be a midwife, regulations and independent function, resource availability, work burden and image of the midwife.ConclusionMidwives struggle within systems that fail to allow independent functioning, disallowing a voice in making decisions and creating change. Regardless of practice setting, midwives expressed frustration with policies that prevented utilisation consistent with scope of practice, as well as an inability to practice the midwifery model of care. Those in public settings expressed concern with restricted resource appropriation. Similarly, there is clear need to upscale midwifery education and to establish care competencies to be met in providing clinical services.ContributionThis research provides evidence of the midwifery experience with implications for needed health policy change.

Challenges and needed reforms in midwifery and nursing regulatory systems in India: Implications for education and practice.

BackgroundIn India, nursing regulation is generally weak, midwifery coexists with nursing, and 88% of nursing and midwifery education is provided by the private health sector. The Indian health system faces major challenges for health care provision due to poor quality, indeterminate regulatory functions and lack of reforms.MethodsWe undertook a qualitative investigation to understand midwifery and nursing education, and regulatory systems in India, through a review of the regulatory Acts, and an investigation of the perceptions and experiences of senior midwifery and nursing leaders representing administration, advocacy, education, regulation, research and service provision in India with an international perspective.ResultsThere is a lack of importance accorded to midwifery roles within the nursing system. The councils and Acts do not adequately reflect midwifery practice, and remain a barrier to good quality care provision. The lack of required amendment of Acts, lack of representation of midwives and nurses in key governance positions in councils and committees have restrained and undermined leadership positions, which have also impaired the growth of the professions. A lack of opportunities for professional practice and unfair assessment practices are critical concerns affecting the quality of nursing and midwifery education in private institutions across India. Midwifery and nursing students are generally more vulnerable to discrimination and have less opportunities compared to medical students exacerbated by the gender-based challenges.ConclusionsIndia is on the verge of a major regulatory reform with the National Nursing and Midwifery Commission Bill, 2020 being drafted, which makes this study a crucial and timely contribution. Our findings present the challenges that need to be addressed with regulatory reforms to enable opportunities for direct-entry into the midwifery profession, improving nursing education and practice by empowering midwives and nurses with decision-making powers for nursing and midwifery workforce governance.

Geçmişten Günümüze Geleneksel Ebelik: Amasya, Tokat Örneği

Objective: This research aims to determine the views of traditional midwives in Amasya and Tokat regions about their past midwifery experiences. Material and Methods: The research is a qualitative one and a content analysis was conducted in line with the aims. A digitization concern was not aroused from the qualitative data obtained. The research was carried out in the central villages of Amasya and Turhal district villages of Tokat province. The data were collected by using in-depth interviews with 7 women who had been midwives in the past. The interviews were conducted by a single researcher. Results: Traditional midwives gave information about their practices about the profession, family planning, pregnancy, birth and postpartum period. It contains information about how they started their profession, where they learned midwifery and why they did this profession. They said that they learned by themselves and even had this experience at their first birth. They mostly made explanations about birth. Statements are common for the birthing position, although they mention different practices regarding the practices they perform during childbirth. They stated that they gave birth in sitting, squatting and semi-sitting positions. One of the important data is that only the traditional midwife who went to school until the 3rd grade at that time kept a record book. Conclusion: It is seen that women expressed that they do this job to help women. Traditional midwives, respecting the physiological natural process of labor, express that they give birth in upright positions such as squatting, especially during delivery. However, unlike current midwifery services, traditional midwives seem to focus only on childbirth.

Women's lived experience of compassionate midwifery: Human and professional

ObjectiveTo develop an understanding of women's lived experience of compassionate midwifery DesignA qualitative study using the principles of Interpretive Phenomenological Analysis (IPA). Data was collected during interviews with 17 women who identified themselves as having received compassionate midwifery care. FindingsWomen participants' experience of compassionate care from midwives was experienced through a sense of a midwife Being With them, Being in Relationship with them and Empowerment. Women were also aware of the way midwives were able to Balance potentially conflicting aspects of their work, in order to provide compassionate care.Two other themes which emerged through extensive analysis of the data related to how women set their experience of compassion in the context of their personal suffering and that compassion made a difference. These themes will be reported separately. Conclusion and implications for practiceThe unique contribution of this study was to provide a window into the nature of women's lived experiences of compassionate midwifery and thus building, understanding around the qualities of compassionate midwifery and its impact on women. The findings are important because they challenge assumptions that compassion is ill-defined and therefore difficult to teach. On the contrary, compassionate midwifery was easily identified by women participants and had the features of an effective intervention for relieving their suffering. A dynamic model of Compassionate Midwifery in Balance has been proposed, providing a much-needed tool to inform practice, education and policy. Further research will build on this work by focussing on women in varied circumstances, environments and cultures and on understanding the lived experience of compassionate midwifery from the midwife's perspective.

Midwifery student's perceptions of completing a portfolio of evidence for initial registration: A qualitative exploratory study

The Australian Nursing and Midwifery Accreditation Council (ANMAC) has set regulatory standards, that require midwifery students to verify how they have met ANMAC standard 8.11 requirements prior to registration as a midwife. The most common formats for recording achievement of the ANMAC requirements are paper-based or electronic portfolios. Research was conducted to compare student's experiences of completing their university portfolio format. Focus group interviews were held at two south east Queensland universities. This study has found that there is disparity between universities in the level of detail documenting evidence of midwifery experiences. The paper-based portfolio was criticised for not having sufficient space for the students to explain the extent of their experiences, in contrast students completing the ePortfolio felt their reflective entries were excessive.Some students felt the portfolio was not being used to its full potential with suggestions that all experiences that fall within the midwife scope of practice should be recorded as evidence of practice experiences. Students felt the current ANMAC Standard 8.11 requirements limit the range of experiences and are repetitive in requiring up to 100 recordings for some experiences. No nationally agreed format exists of how students are required to document their required ANMAC experiences.

Scoping review of the impact of birth trauma on clinical decisions of midwives.

The psychological and emotional impact of a traumatic birth experience on clinicians is well-established. It is also known that emotions can generally influence decisions. However, it is not clear whether experiencing a birth trauma can affect the professional behaviour and decision-making of clinicians. This study explores the impact of birth trauma on clinical decision-making of midwives. Four databases (Medline, Scopus, CINAHL and ProQuest) were searched to identify English language studies published from 1990 to 2018. Due to the lack of studies with specific focus on clinical decision-making after birth trauma, we defined two main domains for our literature search. To be included, studies had to focus on either traumatic birth experience or clinical decision-making in midwifery. The findings of the two domains were then integrated. Of a total 2104 studies identified, 70 received full-text screening with 40 included in the review. Twenty-two articles were about traumatic birth events and 18 examined decision-making in midwifery. Information were extracted on each article's purpose, study design, data collection, participants, definitions of birth trauma and the context in which clinical decisions were made. Thematic analysis was conducted. The impact of birth trauma on midwives could be categorized into the following themes: psychological issues; professional concerns; changes in practice and positive impact. Review of literature indicated that clinical decision-making could be influenced through all these themes. Decision-making can be impacted by the midwife's affective state related to previous experience of birth trauma. The continuum of impact may vary from increased defensiveness to increased personal and professional growth. Being aware of this impact can help midwives to better manage their emotions while making decision after traumatic birth experiences.

Implementation of reproductive life planning (RLP) in primary health care supported by an evidence-based website

Objectives: The aims of the study were to evaluate how well the reproductive life plan (RLP) tool was implemented in practice and explore the utility of the website www.reproduktivlivsplan.se for patient counselling.Methods: A cross-sectional study was conducted in 2018, in which 73 midwives in primary health care were asked to use the RLP tool and the website in their daily practice. Three months later, participants answered a questionnaire, based on normalisation process theory (NPT), about their implementation experience.Results: The response rate was 73% (n = 53). The mean length of midwifery experience was 15 years. Almost all respondents (89%) reported a positive attitude towards the tool and the website and their ability to use them in practice. The majority agreed to all statements about implementation of the RLP, according to NPT. Use of the RLP also made it easier for midwives to support clients in forming reproductive goals (85%, n = 45), give family planning advice (81%, n = 43), give advice about how to improve health before pregnancy (85%, n = 45) and give advice about how to preserve fertility (89%, n = 47). Nine out of ten respondents said they would recommend the website to other midwives.Conclusion: The RLP was well implemented among the respondents and the majority considered the website to be a useful tool. Long-term studies are needed to further elucidate the effects of the RLP on changes in health behaviour and pregnancy outcomes.

Sharing experiences of military midwifery

High-quality family planning services help women to achieve their preferred family size and birth spacing, which in turn leads to improved health outcomes and better quality of life. This study investigates whether women have access to a 1-year supply of oral contraceptives (OCs) on site when they receive care at community health centers and whether states require coverage for a 1-year supply.This study used a concurrent, mixed-methods approach, with a single phase of quantitative research (survey of health centers) and two phases of qualitative research (50-state policy environment scan and in-depth interviews).Only three states require coverage for a 1-year supply of OCs under all Medicaid and private insurance coverage mechanisms; the majority of states limit it through at least one mechanism. The survey found that 50.9% of health centers provided OCs on site, and of these, only 29.9% offered up to a 1-year supply at a time. An analysis of interviews revealed that clinician and pharmacist preferences and the organization's overall approach to family planning played a role in these practices.This study finds that that only a minority of health centers provide a 1-year supply on site and that a minority of states have rules requiring coverage for a 1-year supply of OCs. To remedy these gaps, change is needed at multiple levels, including health center practices, clinician knowledge and beliefs, federal agency guidance, and state-level insurance policy.

Implementation and upscaling of midwifery continuity of care: The experience of midwives and obstetricians

ProblemDespite high quality evidence supporting midwifery continuity of care, access to this model is limited in many parts of Australia and internationally. BackgroundThe models of care provided to women have a strong influence on their perinatal experience and clinical outcomes. Midwifery Continuity of Care (CoC) is arguably the most significant factor in enhancing women’s clinical outcomes during child-bearing and facilitating a positive childbirth experience. Health system change is required, yet little literature has detailed the actualisation of this in the context of upscaling midwifery CoC. Research question/aimThis study aimed to explore the perceptions and experiences of midwifery and obstetric staff during the implementation and upscaling of midwifery CoC within a regional hospital and health service in coastal Queensland, Australia. MethodsA single-site, qualitative enquiry. Obstetricians and midwives participated in semi-structured interviews or focus groups at two-time points: within 2 months of introduction of the CoC service (obstetricians n=6; midwives n=15); and 2-years after implementation (obstetricians n=5; midwives n=17). Data were analysed thematically. FindingsFour key themes and several categories were generated from the data: hopes and expectations; clinical and practice changes; organisational and structural change; and, future directions. DiscussionOrganisational culture, structural change, communication processes and collaborative relationships can be used to inform future scale-up and sustain midwifery caseload care. Specifically, communication, inter-disciplinary collegial relationships, and managerial support are crucial to the sustainability and ultimate upscaling of caseload midwifery care. ConclusionSystem change is challenging, but in order to improve access to midwifery CoC is necessary.