Background: There are high levels of consumer demand for homebirth in Australia, however access is limited due to a wide range of factors, including associated costs of a private midwife and the limited number of publicly funded homebirth models. Homebirth with a qualified midwife, networked into a health system, is a safe option for women with a low-risk pregnancy. This paper has two aims. The first is to describe the implementation of a publicly funded homebirth service with an employed mentor. The second is to provide the outcomes from a matched cohort of women who received care from the same Midwifery Group Practice [MGP] who gave birth at home, compared with those who gave birth in hospital. Methods: The retrospective comparative cohort study used routinely collected perinatal data from the hospital's electronic database (eMaternity) from July 2018 ¿ October 2021. The cohort of interest were women who received care through MGP. They were identically matched by parity, age, Body Mass Index (BMI), spontaneous labour and gestation of 37¿42 weeks. A description of the employed midwifery mentor to implement this model of care is also provided. Findings: 100 women gave birth at home during the study period. They were more likely to have a physiological birth (p < 0.001), intact perineum (p < 0.0001), and less likely to have a postpartum haemorrhage (p < 0.0001) compared to the matched cohort of women who birthed in hospital. There were less assisted births and caesarean section births for women who transferred from home to hospital (p < 0.0001). No statistical differences were seen between groups for postpartum haemorrhage, and Apgar score of < 7 at 5 minutes. Conclusion: This study demonstrated favourable outcomes for women receiving MGP who planned to birth at home compared to those women who chose a hospital birth. This is consistent with the existing literature that place of birth makes a difference. A description of the role of a mentor in supporting the sustainability of a publicly funded homebirth program is provided. Further research is recommended to evaluate the mentor's role in implementing and sustaining the model.

Problem: Evidence suggests new midwifery graduates are leaving the profession prematurely during the initial graduate years due to workplace stress. Background: Graduate midwives are essential to provide a future midwifery workforce. Support for new graduates in the initial years of practice is essential in retaining them in the midwifery profession. Aim: The aim of this study was to explore midwives' perspectives of the support they provide new graduates within existing midwifery graduate programs, and their experiences and perceptions of the health service processes to support midwifery graduates. Methods: A cross-sectional study was undertaken with a purposive sample of Australian midwives. Descriptive statistics were used to analyse frequencies and percentages of responses. Spearman's correlational analyses were used to determine associations between the variables. Responses to open-ended questions were analysed by content analysis. Findings: In total, 167 midwives responded to the survey. Just over a third (34.1 %) of midwives felt they had sufficient resources to support a midwifery graduate. Half (50.9 %) of the midwives engaged in reflective practice with midwifery graduates. The majority (97 %) of midwives reported that they felt it was important for midwifery graduates to have a mentor. Discussion: A lack of protected time to provide mentoring opportunities and support new graduates to gain further experience and education was identified. These findings support the need for a formal mentorship program to be introduced. Conclusion: This study offers insights into the perspective of midwives dealing with the realities of striving to support midwifery graduates in their initial years of practice.

Background: Global and national frameworks for midwifery education recognise and prioritise the provision of midwifery continuity of care. Previous studies report that learning is enhanced when students have professional experience placements within these models, however there remains wide variation in midwifery students' access to placements within these models in Australia. Aim: To evaluate Bachelor of Midwifery students' experiences in midwifery continuity of care models within two local health districts in New South Wales, Australia. Method: A mixed methods design was used: qualitative data collected through interviews, and quantitative data collected via an online survey using the Midwifery Student Evaluation of Practice (MidSTEP) tool. Thematic analysis of qualitative data and descriptive analysis of quantitative data was undertaken. Results: Sixteen students responded, four students were interviewed, and 12 students completed the survey. The MidSTEP mean scores for all sub-scales rated above 3.0/4.0. Participants rated 'work across the full scope of midwifery practice' and five out of eight subscales of Philosophy of Midwifery Practice at 100 %. 'Experiences prepare me to be a change agent for maternity service reform' rated the lowest (67 %). Three qualitative themes emerged: care versus carer model; learning experience; and future career as a caseload midwife. Conclusion: A mixed method approach using a validated tool to measure student experiences, contributes to the evidence that students value professional experience placements within midwifery continuity of care models. Currently this is not an option for all midwifery students and as midwifery continuity of care models expand, these findings will inform further implementation of student professional experience placement within these models.

Background: The World Health Organization recommends Midwifery Continuity of Care (MCoC) due to the consistent improvements in outcomes for mothers and babies. Surveys from the United Kingdom and Australia reported large numbers of midwives are unable to commit to the on call component required to provide MCoC across the continuum. To address this challenge a modified MCoC model called Midwifery Antenatal and Postnatal Services (MAPS) has been introduced. The aim of this study was to evaluate MAPS services in six sites across one State in Australia. Methods: A multi-site qualitative descriptive study was undertaken framed by the Quality Maternal Newborn Care (QMNC) Framework. The QMNC framework was used to develop focus group questions for data collection, and as a lens for analysing data. Data were collected via focus groups from midwives and women at six sites ranging from metropolitan to regional and rural settings and thematically analysed. Findings: Participants (n=80) included women (n=28), midwives (n=44) and MAPS managers (n=8). This paper reports the findings from the women and midwives, presented under three themes: Getting onto the program, Knowing the story and Building confidence by sharing information. Each theme had subthemes and the findings were aligned either positively or negatively with the QMNC framework. Conclusion: This study found the MAPS model aligns in positive ways with the QMNC quality care framework with some recommendations to improve quality care. Midwives want to provide continuity of care and MAPS is a useful model for providing continuity through the antenatal and postnatal periods.

There is growing concern that maternity research trends have enabled the proliferation of medically orientated research methods. While this trend has helped demonstrate the safety and quality of midwifery care, it has also enabled a culture of valuing medical research approaches, over more critical, creative and explorative qualitative research. Consequently, a serious imbalance exists within maternity evidence, the majority focusing on treatment of maternity complications rather than what would benefit the mainstream of low-risk women - perpetuating a culture of medically-led maternity care as the prevailing option. Constructivist grounded theory is one approach that can help address current maternity research limitations. This paper highlights capacity within its processes to ask different questions, embracing diverse ways of knowing and unpacking the importance of research remaining woman-centred. There is a need to prioritise such research approaches, raising the perspectives of maternity users and identifying what matters most to women and birthing people themselves.

Background: Recent research highlights the impact of the COVID-19 pandemic on maternity services, although none to date have analysed the association between continuity of carer and how women felt about the changes to pregnancy care and birth plans. Aim: To describe pregnant women's self-reported changes to their planned pregnancy care and associations between continuity of carer and how women feel about changes to their planned care. Methods: A cross-sectional online survey of pregnant women aged over 18 years in their final trimester of pregnancy in Australia. Findings: 1668 women completed the survey. Most women reported at least one change to pregnancy care and birthing plans. Women receiving full continuity of carer were more likely to rate the changes to care as neutral/positive (p<.001) when compared with women who received partial or no continuity. Discussion: Pregnant women experienced many changes to their planned pregnancy and birth care during the COVID-19 pandemic. Women who received full continuity of carer experienced fewer changes to care and were more likely to feel neutral/positive about the changes than women who did not receive full continuity of carer.

Background: Midwifery curricula in Australia incorporate 'Continuity of care experiences' (CoCE) as an educational strategy based on an assumption that midwifery students will learn skills and knowledge about woman-centred care that they may not learn in the typical fragmented care system. However, exactly what skills and knowledge they are expected to 'learn' and how these can be assessed have never been specifically identified. Aim: To explore midwifery students' continuity of care learning experiences within pre-registration midwifery education. Methods: Focus groups were conducted with first, second and third year Bachelor of Midwifery students (n = 12), who were undertaking CoCE in rural and regional tertiary hospitals in NSW, Australia. Findings: The overarching theme, 'Learning through relationships', was made up of three interrelated themes: Meeting women and making connections, Being known, and Understanding holistic care. Discussion: The findings from this study contribute to understanding the educational effects of CoCE. The CoCE relationship provided safety and freedom to learn which was seen as foundational for midwifery students' vision of their future practice and can be seen as a self-determined transformational approach to learning. Conclusion: This study adds insight into midwifery students' experience of CoCE, and demonstrates that transformative learning occurs through developing a relationship with both the woman and the midwife. For midwifery to develop as a profession and maintain its focus on woman-centredness, it is important that this aspect of midwifery education remains embedded within midwifery program philosophies and learning outcomes.

Background: Having a known midwife throughout pregnancy, birth and the early parenting period improves outcomes for mothers and babies. In Australia, midwifery continuity of care has been recommended in all states, territories and nationally although uptake has been slow. Several barriers exist to implementing midwifery continuity of care models and some maternity services have responded by introducing modified models of continuity of care. An antenatal and postnatal continuity of care model without intrapartum care is one example of a modified model of care that has been introduced by health services. Objectives: The aim of this study was to explore the value and acceptability of an antenatal and postnatal midwifery program to women, midwives and obstetricians prior to implementation of the model at one hospital in Metropolitan Sydney, Australia. Methods: A qualitative descriptive methodology was undertaken to discover the value and acceptability to the implementation of the model. Data was collected via focus groups and one to one interviews from the service users (pregnant women and two partners) and service providers (midwives and obstetricians). We also collected demographic data to demonstrate the diversity of the setting. The Quality Maternal Newborn Care (QMNC) Framework was used to guide the focus groups and analyse the data. Findings: Four themes emerged from the data that were named feeling safe and connected, having more quality time and being confident, having a sense of community and respecting cultural diversity. The findings were analysed through the lens of the quality components of the QMNC framework. The final findings demonstrate the value and acceptability of implementing this model of care from women's, midwives and obstetrician's perspective. Conclusions/implications: Providing midwifery continuity of care through the antenatal and postnatal period without intrapartum care, is being implemented in Australia without any research. Using the QMNC framework is a useful way to explore the qualities of a new emerging service and the values and acceptability of this model of care for service providers and service users.

Nurses and midwives of Australia now is the time for change! As powerfully placed, Indigenous and non-Indigenous nursing and midwifery professionals, together we can ensure an effective and robust Indigenous curriculum in our nursing and midwifery schools of education. Today, Australia finds itself in a shifting tide of social change, where the voices for better and safer health care ring out loud. Voices for justice, equity and equality reverberate across our cities, our streets, homes, and institutions of learning. It is a call for new songlines of reform. The need to embed meaningful Indigenous health curricula is stronger now than it ever was for Australian nursing and midwifery. It is essential that nursing and midwifery leadership continue to build an authentic collaborative environment for Indigenous curriculum development. Bipartisan alliance is imperative for all academic staff to be confident in their teaching and learning experiences with Indigenous health syllabus. This paper is a call out. Now is the time for Indigenous and non-Indigenous nurses and midwives to make a stand together, for justice and equity in our teaching, learning, and practice. Together we will dismantle systems, policy, and practices in health that oppress. The Black Lives Matter movement provides us with a 'now window' of accepted dialogue to build a better, culturally safe Australian nursing and midwifery workforce, ensuring that Black Lives Matter in all aspects of health care.

Objective: 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. Data Sources: 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. Study Selection: 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. Data Extraction: 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. Results: 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. Conclusion: 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.

An innovative blended learning resource for undergraduate nursing and midwifery students was developed in a large urban Australian university, following a number of concerning reports by students on their experiences of bullying and aggression in clinical settings. The blended learning resource included interactive online learning modules, comprising film clips of realistic clinical scenarios, related readings, and reflective questions, followed by in-class role-play practice of effective responses to bullying and aggression. On completion of the blended learning resource 210 participants completed an anonymous survey (65.2% response rate). Qualitative data was collected and a thematic analysis of the participants' responses revealed the following themes: 'Engaging with the blended learning resource'; 'Responding to bullying' and 'Responding to aggression'. We assert that developing nursing and midwifery students' capacity to effectively respond to aggression and bullying, using a self-paced blended learning resource, provides a solution to managing some of the demands of the clinical setting. The blended learning resource, whereby nursing and midwifery students were introduced to realistic portrayals of bullying and aggression in clinical settings, developed their repertoire of effective responding and coping skills for use in their professional practice.

Objectives: Breastfeeding mothers returning to work undertake multiple conflicting roles at home and work that can result in high levels of stress. Exploring coping skills amongst these mothers can help in planning useful programmes to promote family wellbeing. This study aims to explore the experiences of working breastfeeding mothers and their coping mechanism against high levels of daily stress. Methods: In this qualitative study, we described the experiences of 20 Iranian breastfeeding mothers through in-depth and semi-structured interviews. All interviews were recorded, transcribed and analysed using thematic analysis. Results: Two main themes emerged as follows: 1) self-management with subthemes of a) attitude reconstruction, b) order and planning, c) creating a boundary between work and family and d) reprioritising life affairs; and 2) seeking help with subthemes of a) family member support, b) childcare facilities and c) spirituality. Conclusions: Findings suggest that women need support from family members and family-friendly policies at the workplace. Breastfeeding mothers may benefit from educational programmes that focus on effective coping strategies.

Objective: Shoulder dystocia (SD) is an obstetric emergency which if not carefully diagnosed and managed, can contribute to lifelong neonatal morbidities. Despite current guidelines on the definition of SD (impaction of the fetal shoulder behind the maternal symphysis pubis and need for ancillary manoeuvres or head-body delivery interval (HBDI) >60 s) its accurate diagnosis requires clinical expertise as well as overall consideration of feto-maternal condition. Based on the literature available, our study aims to determine (1) the range of HBDI as an indicator of SD and (2) the neonatal complications occurring following prolonged HBDI in normal or SD-complicated births. Study design: A comprehensive literature search will be conducted in the following databases MEDLINE, CINAHL and Scopus (Elsevier) as well as international obstetric guidelines to find English language published data since 1970 that evaluate HBDI, prolonged HBDI and associated neonatal outcomes. Retrospective/prospective observational studies and randomized controlled trials will be recruited. As heterogeneity in definitions of SD among studies is expected, we will categorize our results according to the following two definitions: 1-Bony obstruction of fetal shoulder behind the maternal symphysis pubis or less commonly, posterior shoulder on sacral promontory and need for ancillary manoeuvres or 2- Head-body delivery interval (HBDI)> 60 s). Two reviewers will independently identify eligible studies, assess risk of bias and extract data based on predefined checklists. Outcomes of interest will be the HBDI in normal and SD-complicated births and associated neonatal consequences. Discussion: Findings of this systematic review will provide reliable information regarding (1) the interval between birth of the head and birth of the shoulders and (2) neonatal outcomes attributed to either true SD or prolonged HBDI. Our findings will add to the knowledge of whether prolonged HBDI is an appropriate definition for SD and whether/what level of prolongation of HBDI results in adverse neonatal outcomes. This increased understanding will better inform the clinical practice of midwives and obstetricians.