Associate Professor Michelle Gray

Aim: This study aimed to assess the specific clinical and non-clinical training needs of midwives and determine their preferred approach to enhancing performance. Background: Pre-eclampsia remains one of the leading causes of maternal deaths in low and middle-income countries. Pre-eclampsia-related deaths may be due to reduced midwifery knowledge and inadequate management. Therefore, a training needs assessment is vital in identifying gaps in practice, especially, in poorly resourced settings for maximal use of training resources. Design: A hospital-based cross-sectional study. Setting: The largest tertiary hospital in Ghana. Methods: An online version of the validated WHO Hennessy-Hicks Training Needs Analysis questionnaire was used to assess midwives' training needs on the management of pre-eclampsia. The tool has good psychometric properties and was used to assess 1) midwives' confidence in performing tasks, 2) the importance of the task to their role and 3) their preferred performance improvement approach. Data analysis adhered to the guidelines specified in the Hennessy-Hicks Training Needs Analysis Questionnaire and the priority training requirements of the midwives were assessed through descriptive statistics and a series of independent t-tests. Results: Among the 250 midwives who responded, most possessed 1¿5 years of experience (74.7 %). All 28 tasks were viewed by midwives as essential responsibilities in pre-eclampsia management. Midwives had the greatest need for training in research/audit and clinical skills domains respectively (p < 0.001, 95 % confidence interval: 1.08¿1.47, Cohen's-D = 1.27; and p < 0.001, 95 % confidence interval: 0.69¿1.06, Cohen's-D = 0.87). The foremost primary training necessity, as recognised by midwives, was undertaking health promotion activities, including antenatal health education (MD= 0.43, 95 % confidence interval: 0.29¿0.57). Training courses were identified as the preferred approach to address training needs and improve overall proficiency. Conclusion: Midwives in Ghana require comprehensive training covering research and clinical-based competencies to improve pre-eclampsia management. Considering the pivotal role of Ghanaian midwives in safeguarding maternal well-being, there is a compelling need to enhance the calibre of midwifery services. These findings can guide stakeholders in countries with comparable healthcare contexts in creating effective, resource-efficient training programs that avoid counterproductivity, ultimately supporting national initiatives to enhance pre-eclampsia management and the quality of care.

Problem: Like other low- and middle-income countries, Ghana has high maternal mortality stemming from pre-eclampsia. Ghanaian midwives are frontline service providers of emergency care in obstetric complications and have the greatest potential to maximise pre-eclampsia outcomes. Little is known about the potential barriers and challenges to midwives' capacity to provide quality care in pre-eclampsia in Ghana. Therefore, we aimed to explore and gain insights into midwives' experiences of pre-eclampsia care including their knowledge, skills, and psychological aspects such as midwives' resilience. Background: There is a rising global incidence of pre-eclampsia. Quality midwifery care in inter-professional collaborative practice is crucial to reducing pre-eclampsia-related morbidity and mortality. Methods: A qualitative descriptive exploratory study. In-depth semi-structured interviews (n = 35) were performed in 2021 and analysed by thematic analysis. Findings: There were three main themes. 1) Competence and Confidence in care; midwives provided timely and appropriate care based on sound knowledge and skills; they explained how pre-eclampsia care was organised within a multidisciplinary context and described collaborative working amongst midwives for mutual learning and support. 2) Emotional concerns and empathy; midwives' described fulfillment in achieving positive pre-eclampsia outcomes. In contrast, maternal loss was distressing and traumatic. 3) Call for improved care resources for pre-eclampsia; midwives recommended expansion of continuing professional development opportunities, appropriate infrastructure, resources, tailored public education, and a review of pre-service education to support their participation in pre-eclampsia care. Conclusion: To improve the quality of care in pre-eclampsia, midwives should be capacitated, systems should promptly address barriers, and prioritise midwives' emotional well-being.

Aim: The 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. Background: There 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. Design: Phenomenology 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. Methods: Seven 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. Results: Thematic 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'. Conclusions: The 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.

Objective: The aim of this review was to examine the literature to identify what is known about midwives' experiences as academics and their perspectives of transition from clinical practice to university. Introduction: Literature on health care practitioners, particularly nurses' transition from clinical experts to novice teachers suggests the transition to academia is challenging.Challenges reported by research studies have identified stress, uncertainty, and lack of a supportive and structured transition. There was a dearth of primary research evidence of midwives' perspectives. Methods: A scoping review using the Johanna Briggs Institute three step approach was employed. First, an initial limited search of Google Scholar and CINAHL was undertaken to identify articles on the topic. Second, the text words contained in the titles and abstracts of relevant articles and the index terms used to describe the articles were used to develop a complete search strategy in databases: EMBASE, MIDIRS, Scopus and PubMed. Finally, a manual search of the reference lists of all included sources of evidence was manually searched for additional studies. Results: Ten papers that included midwives as the participants were located from Australia, The United Kingdom (UK) and the United States of America (USA) between 2006 and 2022. Analysis of the findings led to three themes: Theme 1: Challenges associated with the transition; Theme 2: Dichotomy of identity; and Theme 3: Fear of losing clinical credibility. Conclusion: In most studies midwives formed a subset of the sample meaning that the voices of midwifery academics are minimised by the experiences of other health practitioners. However, in depth details were located from four personal reflections which identified that transition from clinical practice to academia can result in a duality of roles while individuals come to terms with their new reality and overcome their fear of losing credibility as clinicians. New academics from health tend to hold onto their identity as clinicians rather than adopting their new persona as academics. Fear of losing credibility stems from the need to maintain competence for continued professional registration as clinicians. Further research is needed which focuses on midwives as the target sample to validate the research evidence from this scoping review.

This study applies an action learning research (ALR) methodology to develop and implement an electronic portfolio (ePortfolio) for learning and assessment in clinical placements of undergraduate nursing students for the first time in Morocco. Alpha, beta, and gamma systems of ALR were adopted. Twenty-two action learning groups (ALG) was established, and a total of 108 nursing students and 9 nurse educators were involved. To evaluate the implementation process and generate actionable knowledge qualitative data were generated through individual interviews and focus groups from the Higher Institute of Nursing Professions and Health Techniques of Morocco. ALR was found to be an effective method to implement ePortfolio in nursing education where the key element was the ALG allowing participants' reflections on their actions. The benefits and challenges of ePortfolio use were highlighted. ePortfolio is accepted as an adequate educational tool to pedagogically support students' learning and assessment in clinical placement.

Problem: Limited opportunity exists for new graduates in Australia to be employed in continuity of care midwifery models. Aim: To explore the perspectives of midwifery mentors supporting new graduate midwives employed in continuity of care models. Methods: An interpretive, qualitative study was conducted. Semi-structured interviews and focus groups with senior midwifery staff who mentored new graduate midwives during their transition to practice within a continuity of care model were undertaken. Digitally recorded and transcribed verbatim, data were thematically analysed. Data collection ceased once theoretical saturation had been achieved. NVIVO software was used to assist with coding and data management. Findings: Twelve mentors participated. Mentors provided valuable feedback to optimise the supportive mechanisms to enable the success of the rotation of new graduate midwives in continuity of care models during their transition to practice period. Three key themes were constructed, including: Getting it right in the first place; Nurturing our new midwives; and The cultural void. Discussion: Consistent with the wider literature, effective implementation, sound support structures and wider acceptance of new graduate midwives transitioning to practice within continuity of care models is crucial to its success and sustainability. Conclusion: Mentors are responsible to nurture, respect and guide new midwives through this crucial period, as they transition from midwifery student to registered midwife. Mentors believe in the transition of new graduate midwives in continuity of care models.

Introduction In low-resource settings, midwives are the first contact for women with preeclampsia and lead the coordination of care. Unfavourable preeclampsia outcomes create a burden for women, families, and the health system. It is therefore important to understand the unique context of midwives' practice and the complex factors that influence the delivery of maternal healthcare. Aim This qualitative study explored the perspectives of key stakeholders in a tertiary hospital in Ghana regarding the facilitators and barriers influencing midwives' provision of preeclampsia care using a socioecological model. Methods Semi-structured interviews were conducted with 42 participants comprising senior managers (n = 7) and hospital midwives (n = 35) in 2021. Thematic analysis used Braun and Clarke's six-step method, and the findings were organised within four levels of the socioecological model: individual, interpersonal, organisational, and public policy. Results Two main themes were identified: 1) Facilitators of preeclampsia management, and 2) Barriers to preeclampsia management. Facilitators were identified at three levels (individual, interpersonal, and organisational) and included midwives' knowledge of preeclampsia; midwives' self-efficacy; midwives' skillset to enhance preeclampsia care; collaborative practice; and strategies for preeclampsia care quality improvement. At the individual level, the barriers were inadequate pre-service preparation, lack of evidence-based midwifery care, and colleagues' work attitudes. Hierarchical decision-making and staff views of women's risk perceptions were identified as barriers at the interpersonal level. At the organisational level, the barriers were: scarce resources and staff shortages, and a lack of midwifery-specific guidelines. Two barriers were identified within the public policy level: the high cost of preeclampsia care and issues with the referral system. Conclusion Multi-faceted factors play a significant role in midwives' management of preeclampsia. Hence context-specific multi-level interventions have the potential to improve the quality-of-care women in Ghana receive.

Problem: Complex physiological processes are often difficult for midwifery students to comprehend when using traditional teaching and learning approaches. Online resources for midwifery education are limited. Background: Face to face instructional workshops using simulation have had some impact on improving understanding. However, in the 21st century new technologies offer the opportunity to provide alternative learning approaches. Virtual and artificial realities have been shown to increase confidence in decision making during clinical practice. Aim: Explore the impact of using three-dimensional (3D) visualisation in midwifery education, on student's application, when educating women about the birth of the placenta, and membranes. Methods: Face to face individual interviews were performed, to collect deep, meaningful experiences of students, learning about the third stage of labour. Findings: Prior clinical experiences impacted on student's ability to articulate how they would discuss birth of the placenta and membranes, and the process of haemostasis with women. Discussion: The narrative findings of this pilot study identified ways that students traditionally learn midwifery, through theory, and clinical practice. Interview narratives illustrated how midwifery students who had previous experiences of witnessing birth, had superior ability to discuss the third stage of labour with women. While students with limited birth experiences, found the 3DMVR assisted them in their understanding of the physiology of the third stage of labour. Conclusion: In an environment of increasing technological advances, clinical placements remain an essential component of midwifery education.

Objective: To map and synthesise the literature underpinning the transition to practice for new graduate midwives internationally, with a focus on continuity of care and traditional transition to practice models. Design: Scoping review of the literature Methods: Relevant databases were searched to identify primary research studies. Key words, Boolean terms, and an inclusion/exclusion criterion were used to extrapolate key pieces of research. All study types and methods published in English between 2008 - May 2021 that met the inclusion criteria were considered. Findings: 20 studies met inclusion criteria. These were conducted in Australia, the United Kingdom, and New Zealand. New graduate midwives' value structured rotations and feel very supported in continuity models, where strong mentorship and support are offered. Within this context confidence was promoted as a new practitioner. Upholding woman-centred care in busy hospital environments was a key challenge. Key Conclusions: Emerging literature indicates new graduate midwives' transition optimally within a continuity model, however more research is needed. Implications for practice: Transitioning midwives into practice within continuity of care midwifery models may address workforce attrition and enhance early career midwife confidence.

Background: Preeclampsia is a global issue that causes significant morbidity and mortality in low- and middle-income countries (LMICs). The care women with preeclampsia receive in LMICs is below the standard experienced by women in westernised countries due to multiple interacting factors. A review of policy factors influencing the management of preeclampsia in Ghana is needed. Aim: This study focuses on the midwife's role and scope of practice concerning preeclampsia management. The study aimed to explore the congruence between Ghanaian preeclampsia guidelines and international best practice recommendations for midwifery practice. The study also aimed to describe how recommendations are incorporated into Ghanaian guidelines. Method/design: This study was a qualitative document analysis of national and tertiary hospital policies related to midwives' scope of practice in Ghana. Altheide's five-step process (sampling, data collection, data coding and organisation, data analysis and report) was used to systematically source and analyse the content of written documents. Results: The findings illustrated several recommendation shortcomings in Ghanaian documents at the national and tertiary hospital levels. The content of Ghanaian preeclampsia management guidelines was not comprehensive, contained conflicting information, and was not backed by research evidence. The standards of practice for midwives were consistent at both the national and tertiary hospital levels. Midwives had limited roles in detection, management, stabilisation, and referral of women with preeclampsia. Conclusion: Uniform guidelines incorporating international recommendations are urgently needed to improve multi-professional collaboration, solidify midwives' roles, and optimise maternal and fetal outcomes.

Background: Well-developed critical thinking skills are required to provide midwifery care that is safe, evidence-based, and woman-centred. A valid, reliable tool to measure is required the application of critical thinking in midwifery practice. The Carter Assessment of Critical Thinking in Midwifery (CACTiM) has previously been psychometrically assessed using classical methods at a single site. This study aims to further evaluate the properties of CACTiM tools using Rasch analysis in a diverse group of midwifery students and preceptors. Methods: The CACTiM tools were completed by undergraduate midwifery students studying at three Australian universities and their preceptors. Midwifery students' critical thinking was evaluated separately through student self-assessment and preceptor assessment and then matched. Rasch analysis was used to evaluate the validity of the tools. Results: Rasch analysis confirmed both the preceptor and student CACTiM tools demonstrated good reliability and unidimensionality. The items can differentiate between students' ability to apply critical thinking in midwifery practice. Person reliability and item reliability were above.92 for both scales indicating excellent reliability and internal consistency. Several improvements were identified to the tools, including enhanced wording to some items, and reduction to a 5-point Likert scale. Through analysis of lower-scoring items, midwifery programs can identify curricula enhancements. Conclusion: The CACTiM student and preceptor tools are valid and reliable measures of critical thinking in midwifery practice. The tools can assess students' critical thinking abilities and identify areas for development for individuals and across student cohorts through curricula enhancements.

Background: Complex physiological processes are often difficult for midwifery students to comprehend when using traditional teaching and learning approaches. Face to face instructional workshops using simulation have had some impact on improving understanding. However, in the 21st century new technologies offer the opportunity to provide alternative learning approaches. Aim: To investigate the impact of using three-dimensional (3D) visualisation in midwifery education on student's experience of learning, and retention of knowledge at three points in time. Design: A pilot study involving a two-armed parallel Randomised Controlled Trial (RCT) comparing the retention of knowledge scores between the control and intervention groups. Setting: An Australian University in the Northern Territory. Participants: The sample included second year Bachelor of Midwifery students (n = 38). All received traditional midwifery education before being randomly allocated to either the intervention (n = 20) or control (n = 18) group. Methods: A new immersive virtual environment was introduced to complement existing traditional midwifery education on the third stage of labour. This intervention was evaluated using a demographic survey and multiple-choice questionnaire to collect baseline information via Qualtrics. To measure change in knowledge and comprehension, participants completed the same multiple-choice knowledge questionnaire at three time points; pre, immediately post and at 1 month post intervention. In addition, the intervention group completed a 3D student satisfaction survey. Results: Baseline knowledge scores were similar between the groups. A statistically significant increase in knowledge score was evident immediately post intervention for the intervention group, however there was no significant difference in knowledge score at one month. Conclusions: The results support the creation of further three-dimensional visualisation teaching resources for midwifery education. However, a larger randomised controlled study is needed to seek generalisation of these findings to confirm enhanced student learning and retention of knowledge post 3DMVR, beyond the immediate exposure time.

Objective: The objective of this scoping review was to map and identify existing literature that described online learning and teaching approaches used in midwifery education. Design: An extensive search of multiple databases and gray literature was undertaken following the JBI standards, using predefined selection criteria and following the PRISMA guidelines. Methods: This scoping review included studies published in English between 2010 and 2020 that explored the online approaches to learning and teaching for undergraduate midwifery students. The articles were reviewed by three reviewers and content analysis was undertaken. Results: Twenty-seven articles were included in the review. Results suggest that student engagement is one of the main components of effective teaching in online midwifery education. Online learning resources need to engage the student and promote two-way communication that facilitates and motivates learning. Conclusions: Adequate training and support for academic staff and students is essential for the online delivery of midwifery education.

Problem: National professional standards dictate that all practitioners should provide mentorship to students, however students often report a lack of interest from many mentors while on placement. Background: It is important that academic researchers investigate issues that can inform us of how the student/mentor relationship is facilitated and supported. Aim: The aim of the project was to explore the perspectives of midwifery mentors who had experienced challenges with mentoring students, to determine what the challenges are, and what support they need, as mentors. Methods: An online anonymous survey containing qualitative questions was used to identify the challenges faced by mentors, and asked them to provide recommendations for improving their delivery of mentorship. Three themes emerged; challenges of providing mentorship ¿ student related; challenges of providing mentorship ¿ work related; and what needed to be done to improve mentoring. Discussion: Mentors shared their experiences of mentoring students and the issues they had faced. Conclusions: Recommendations are made that acknowledges the important role of midwifery mentorship and suggest the introduction of preparation for mentorship training for midwives working with students.

Background: Pre-eclampsia is a multi-organ disease affecting pregnant women from the second trimester onwards resulting in multiple adverse outcomes. Sub-optimal treatment of pre-eclampsia is linked with unfavorable outcomes. It is critical for midwives as primary providers to be competent in the diagnosis and management of pre-eclampsia especially in low-and middle-income countries. Aim: To identify what midwives' around the world know about pre-eclampsia management. Methods: A scoping review using the JBI three-step search strategy was used to identify relevant research articles and grey literature on the subject. Database searches in PubMed, CINAHL, Cochrane Databases, Web of Science, and Scopus yielded twenty papers in addition to nine guidelines from Google Scholar. The findings were synthesised using a metasynthesis approach and presented as themes. Findings: Four themes were identified from the extracted data: Foundational knowledge of pre-eclampsia; Knowledge and management of a woman with pre-eclampsia according to guidelines; Knowledge of being prepared for emergency procedures and management of emergencies; Factors influencing knowledge. The first three themes addressed diagnosis and management whilst the last theme described how contextual factors led to either increased or decreased knowledge of pre-eclampsia. Conclusion: Worldwide, practicing midwives lack knowledge on several aspects of pre-eclampsia diagnosis and care. Policies on in-service training should be oriented to include innovative non-traditional methods that have the potential to increase midwives' knowledge.

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.

Midwifery learning and teaching resources have remained unchanged for decades. At a regional Queensland university, a 3D visualization resource was introduced in addition to books, lectures, and clinical skills laboratory sessions to enhance students' conceptual understanding of the physiological processes related to the birth of the placenta and hemostasis. Fourteen second-year midwifery students volunteered to participate in pilot evaluation. This study included an eight-item questionnaire using Likert scale rankings followed by three open-ended questions, to evaluate the 3D midwifery visualization resource (3DMVR) and its use with midwifery students. All participants believed the 3D visualization resource enabled them to gain a greater depth of understanding about the anatomy and physiology of the uterus and birth of the placenta and understanding of the processes of hemostasis. Research is needed to assess if students' learning and retention of knowledge is improved using this new technology.

Portfolios are used in midwifery education to provide students with a central place to store their accumulative evidence of clinical experience for initial registration in Australia. Portfolio formats can be paper-based or electronic. Anecdotal discussion between midwifery students in Queensland debated the best format to document the requirements for the Australian Nursing and Midwifery Accreditation Council (ANMAC) standard 8.11. Midwifery students using paper-based portfolios envisioned that an ePortfolio would be streamline, simple, safe to use, and able to be used anywhere with WIFI, while some students using an ePortfolio expressed a desire to have a paper-based portfolio as a hard copy. This situation called for evidence of a comparison to resolve the debate. The aim of this study was to investigate midwifery students' experiences of the benefits and challenges between paper-based and ePortfolios when compiling evidence to meet the requirements for initial registration as a midwife in Australia (ANMAC, 2014).

Aim: A theoretical discussion using categorisation theory to discuss the final analysis of findings from research which investigated midwives' responses to the changed registration-renewal requirements in Australia after the introduction of national registration. Background: In 2010 the Health Practitioner Regulation National Law Act introduced national registration to standardise the regulation of health professionals in Australia. Annual registration-renewal standards required all health professionals to meet the same standards of clear police check, insurance for scope of practice, Continuing Professional Development (CPD) and Recency of Practice (ROP). Question: How did dual registered midwives respond to the changed registration-renewal requirements when national registration was introduced? Methods: A longitudinal single case study was conducted in two phases between 2011¿2013 with a purposive sample of 24 midwives from five states of Australia to perform individual or group interviews. Findings: Participants used inclusion and exclusion criteria to create boundaries around practice to illustrate how they met the registration-renewal standards. Accentuation (exaggeration) of practice helped them define their separate professional registrations. Boundaries included the type of person being cared for, practice activities. and place of practice. Conclusion: The theory of categorisation helped explain the dual registrants' behaviour and rationalise their midwifery responses.

Background contemporary knowledge related to the experiences of new midwifery practitioners is limited to countries that run hospital-based transition to practice programmes within an employment contract arrangement, such as the United Kingdom, and Australia. Less is known of the experiences of New Midwifery Practitioners (NMPs) who transition into autonomous private practice in New Zealand, Canada and the Netherlands. Purpose the purpose of this paper is to report on a scoping review of the way NMPs are transitioned to practice in the first year of registered practice across the selected countries. Methods this review accessed literature and government and professional sites to make comparisons between the transition to practice processes within five countries, and discusses the benefits and issues, associated with public hospital employment programs versus community based government funded midwifery group practices. Findings comparison of the way in which NMPs are transitioned to practice in the first year of registered practice between the selected countries shows important differences based on occupational organisation. Funding of maternity services influences how NMPs in each country are orientated and supported in their transition to registered practice. Direct comparisons between countries were difficult. More research is recommended to investigate NMPs' experiences of transition to practice in private practice.

Background: In June 2010 the Australian Health Practitioner Agency unified the national registration of health professionals in Australia and introduced a separate register for midwives. Standard registration renewal requirements aimed to provide safe, competent practitioners. These new conditions created the impetus for practitioners to consider how they meet the re-registration standards for either their nurse or midwifery register/s. Question: How are midwives responding to the changed re-registration conditions for registration renewal? Methods: Longitudinal case study design. A purposive sample of 24 midwives from five states was recruited. 20 took part in individual interviews over two re-registration periods. 4 midwives were interviewed in a focus group to verify the findings. Findings: Three themes captured issues and tensions about registration and midwifery practice. They are Rotation, Restriction and Extension. Conclusion: This paper has shown how the re-registration conditions and standards post 2010 have generated discourse around registration renewal. The simultaneous introduction of regulatory and legislative changes has resulted in the construction of categories within contemporary midwifery practice that do not necessarily align with the Nursing and Midwifery Board of Australia (NMBA) requirements for re-registration. Further research is recommended to examine the continuing influence and impact of the changes on the Australian midwifery workforce.