JMIR nursingMariana Luisa Firmiano, Ana Paula Assunção Moreira, Flaviana Vely Mendonça Vieira, Carla Sa-Couto, Alexandrina Cardoso
BACKGROUND: Technologies such as virtual reality (VR) and augmented reality (AR) have been increasingly incorporated into nursing education to support the development of cognitive, psychomotor, and behavioral competencies. In midwifery, immersive environments offer opportunities to simulate high-risk or low-frequency clinical scenarios, strengthening students' confidence and preparedness for professional practice. However, there is still significant variability in how VR and AR are pedagogically implemented, with limited understanding of their theoretical grounding, instructional design, and educational outcomes. OBJECTIVE: This systematic review aimed to synthesize and critically evaluate the characteristics of educational programs using VR and AR to develop competencies among nursing and midwifery students and professionals. METHODS: This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 and Synthesis Without Meta-Analysis (SWiM) guidelines and was registered in PROSPERO (International Prospective Register of Systematic Reviews). A comprehensive search was conducted in August 2024 across PubMed, Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Eligible studies were experimental, quasi-experimental, or observational, and involved undergraduate or postgraduate students in nursing, obstetric nursing, or midwifery, as well as certified midwives or nurse-midwives. Two independent reviewers conducted screening, data extraction, and quality appraisal using Joanna Briggs Institute (JBI) tools and the Medical Education Research Study Quality Instrument (MERSQI) scale. Data were synthesized narratively according to predefined thematic categories. RESULTS: Four studies published between 2021 and 2024 met the inclusion criteria, encompassing 634 participants (360 midwifery students and 274 midwives or nurse-midwives). Two randomized controlled trials and 2 quasi-experimental studies were included. Interventions used VR in 3 studies and AR in one, simulating scenarios such as normal and complicated childbirth, neonatal resuscitation, and emergency obstetric procedures. Most interventions focused on developing technical competencies, while one also addressed teamwork and communication. Only 2 studies explicitly reported theoretical or pedagogical frameworks, and 2 mentioned alignment with the INACSL Healthcare Simulation Standards of Best Practice. Structured briefing or debriefing was rarely described. All studies assessed learning outcomes (Kirkpatrick level 2), and 3 included participants' satisfaction (level 1). Methodological quality, measured by MERSQI, ranged from 10.0 to 14.5, with a mean score of 12.9 (SD 2.0), indicating moderate to high quality. CONCLUSIONS: Evidence suggests that VR and AR can enhance learning in obstetric nursing and midwifery education by providing safe, experiential, and interactive learning environments. However, the limited use of theoretical frameworks and structured instructional design highlights the need for more pedagogically grounded interventions. Future research should prioritize the integration of learning theories, validated assessment tools, and best-practice simulation standards to strengthen the educational impact and curricular integration of immersive technologies in nursing and midwifery education.
The Australian & New Zealand journal of obstetrics & gynaecologyWee Ming Wong, Ching Mei Loo, Susan Roberts, Grace Branjerdporn
BACKGROUND: Suicide in the peripartum is a leading cause of death in Australia. Appropriate screening and response to self-harm and suicidality during antenatal appointments is key to reducing the risk of suicide. AIM: The study explores the knowledge, confidence and behavioural changes resulting from an educational intervention for midwives in assessing and making appropriate referrals based on self-harm and suicide risks in antenatal women, as screened by question ten of the Edinburgh Postnatal Depression Scale (EPDS) eliciting thoughts of self-harm in the previous 7 days. MATERIALS AND METHODS: Educational workshops aimed at improving midwives' confidence and capabilities in conducting suicide risk assessments, developing safety plans and understanding referral pathways were completed. Changes to medical documentation in relation to risk assessment and follow-up actions were reviewed pre- and post- the education sessions. RESULTS: Midwives' (N = 115) self-reported knowledge and confidence increased from pre- to post-education. Pre-intervention, 86 (5.87%) antenatal women answered question ten positively on the EPDS. Medical documentation revealed that more midwives were able to screen for the frequency and persistence of suicidal thoughts following the training. CONCLUSION: While education enhanced knowledge and confidence as well as resulted in improvements to some risk assessment practices, further systemic and organisational support may be necessary to achieve consistent and comprehensive risk assessments and adherence to recommended follow-up actions in clinical practice. The study underscores the critical role of continuous training for midwives in self-harm/suicide assessment, particularly given the significant maternal mortality associated with suicide.
Journal of evaluation in clinical practiceRecep Yücel, Şebnem Yücel, Hacer Alan Dikmen, Havva Tokgöz Kekeç
AIM: This study aimed to examine the associations between exposure to physical and verbal workplace violence and post-traumatic stress disorder (PTSD) symptoms as well as professional quality of life among midwives. DESIGN: Descriptive and correlational study. METHODS: A descriptive and correlational study was conducted with 341 midwives working in public healthcare institutions in Turkey between February and June 2024. Data were collected online using the Personal Information Form, the PTSD Brief Scale, and the Professional Quality of Life Scale. Independent samples t-tests and linear regression analyses were performed. RESULTS: Among the participants, 22.9% reported exposure to physical violence and 85.0% to verbal violence in the workplace. Exposure to verbal violence was significantly associated with higher PTSD symptom levels (p = 0.004), whereas physical violence was not (p = 0.082). Both physical (p = 0.046) and verbal violence (p = 0.049) were significantly associated with higher compassion satisfaction. Regression analysis showed that verbal violence explained 2.1% of the variance in PTSD symptoms (Adjusted R2 = 0.021), while physical and verbal violence together explained 1.9% of the variance in compassion satisfaction (Adjusted R2 = 0.019). CONCLUSION: Workplace violence against midwives is highly prevalent and is associated with variations in psychological well-being and professional quality of life. Due to the cross-sectional correlational design, causal relationships cannot be established. Nevertheless, these findings highlight the importance of institutional strategies, respectful workplace policies, and supportive interventions to address workplace violence and promote midwives' mental health and professional well-being.
JMIR research protocolsTshepo Kabelo Mohale, Wilma Ten Ham-Baloyi, Olivia Baorapetsi Baloyi, Emelda Zandile Gumede
BACKGROUND: Virtual reality (VR) is increasingly used in health care training and nursing education to address clinical skills gaps and provide immersive learning experiences. While multiple systematic reviews have synthesized primary research on VR effectiveness, no umbrella review has comprehensively evaluated and integrated findings from existing systematic reviews specifically focused on nursing and midwifery education. OBJECTIVE: This umbrella review aims to systematically identify, critically appraise, and synthesize findings from published systematic reviews and meta-analyses examining the use of VR in nursing and midwifery education, with particular emphasis on clinical skills training. METHODS: This protocol will follow the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015 statement and is registered with PROSPERO (CRD420261303572). Nine databases will be searched, including PubMed, CINAHL, Scopus, Web of Science, ERIC, PsycInfo, Cochrane Library, African Journals Online, and SciELO. Two independent reviewers will conduct screening, data extraction, and methodological appraisal using AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews, version 2). The overlap of primary studies across reviews will be calculated using the corrected covered area (CCA) method, and decision rules for managing overlap will be applied. Narrative synthesis will follow Synthesis Without Meta-Analysis guidance. Certainty of evidence will be assessed using an adapted GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach with a prespecified framework for downgrading based on AMSTAR 2 ratings, overlap, heterogeneity, imprecision, and indirectness. RESULTS: The review search and screening commenced in July 2026 and are ongoing as of August 2026. Full-text screening and data extraction are scheduled for September to October 2026, followed by methodological appraisal, overlap assessment, and evidence synthesis from October to December 2026. Manuscript preparation is planned for November to December 2026, with the review findings expected to be submitted for publication in early 2027. CONCLUSIONS: This umbrella review will provide the first comprehensive, high-level synthesis of evidence on the use of VR in nursing and midwifery clinical training. By systematically appraising and grading the certainty of existing systematic reviews, it will identify the most robust findings while exposing critical evidence gaps. The resulting evidence gap map and summary of findings will offer clinicians, policymakers, and researchers a clear roadmap for evidence-based decision-making and prioritization of future primary research.
BMJ openJessica Thomas, Eleri Owen-Jones, Mariya Kovalenko, Anna Clark, Sana Usman, Suzanne Beattie-Jones, Danielle Thornton, Jayanta Banerjee, Neelam Heera-Shergill, …
INTRODUCTION: Around 4% of babies are in breech presentation at the end of pregnancy but up to 43% of these are missed by abdominal palpation alone. Since women in the UK without additional risk factors do not routinely receive a scan in the third trimester, around 1%-2% of women present with undiagnosed breech presentation in labour, which is associated with poorer outcomes for both mothers and babies. Research suggests a point-of-care ultrasound (PoCUS) scan in late pregnancy could improve the rate of breech presentation detection. The Sono-breech study aims to determine the diagnostic accuracy and acceptability of handheld scans performed by midwives for fetal presentation at 36 weeks and how cost-effective this would be to implement in routine antenatal care in the National Health Service (NHS). METHODS AND ANALYSIS: Prior to delivering the study, midwives receive training for the detection of presentation and fetal heart rate using handheld ultrasound equipment.The study will take place in at least 10 NHS Trusts across England selected to ensure a diverse participant population and to include under-researched settings. Between 35+0 and 36+6 weeks' gestation, women who consent to the study will receive a scan for fetal presentation performed by a midwife using a handheld PoCUS device alongside routine antenatal checks, including palpation. Before the end of the next day, they will receive a conventional ultrasound scan performed by a practitioner deemed already competent at obstetric scanning. This scan will be considered the gold standard for presentation. All results will be recorded in the Sono-breech REDCap database. Women with babies in non-cephalic presentations will be referred to their local NHS Trust pathway for further management. Diagnostic accuracy (sensitivity and specificity) will be computed from the comparison between findings at the midwife-performed scan and the conventional ultrasound scan.Birth outcome data will be collected from the participants' medical notes after they have given birth. Aggregate birth data regarding the rate of undiagnosed non-cephalic births will be collected from all women who deliver at each site.Midwives who take part in the study will be invited to participate in focus groups or interviews about the implementation of the scan into routine care. Non-participant observation will take place during midwife training sessions and antenatal clinics in specific participating trusts.6-12 weeks after birth, some women will be invited to take part in an interview to explore their experience with the handheld scan.6 weeks after birth, all women will be sent two questionnaires by email. These questionnaires will be used in combination with the birth outcome data and NHS tariffs to calculate the cost-effectiveness of introducing the handheld scan into routine antenatal care in the NHS.Study registration ISRCTN11748052. ETHICS AND DISSEMINATION: The study has obtained approval from the West Midlands-South Birmingham Research Ethics Committee and was approved by the Health Research Authority and Health and Care Research Wales. Publication will be in line with the National Institute of Health and Care Research (NIHR) Open Access policy.
Women and birth : journal of the Australian College of MidwivesElysse Prussing, Jenni Doust, Frances Guy, Olivia Tierney
BACKGROUND: Climate change is an escalating concern for maternal and newborn health. Maternity care, particularly through high-intervention, hospital-based practices, generates substantial environmental waste. Midwifery Continuity of Care (MCC) models are known to reduce unnecessary interventions and improve safety and satisfaction of care, whilst suggesting potential reduction in environmental impacts. However, limited evidence exists evaluating the carbon footprint of MCC compared with standard medically led care. AIM: To evaluate whether a Midwifery Group Practice (MGP) model generates lower carbon emissions than medically led standard maternity care in an Australian regional setting. METHODS: A quantitative retrospective analysis was conducted using de-identified routinely collected clinical data from 2024 to 2025 at one regional maternity service. Carbon footprint estimates (kgCO₂e) using validated calculations from Spil et al. (2024), were applied to key clinical outcomes; including mode of birth, analgesia use, suturing, and postnatal length of stay. The kgCO₂e for women receiving MGP were compared with those receiving standard care. FINDINGS: Data from 210 MGP and 129 standard care participants showed consistently lower emissions in the MGP cohort. The mean estimated emissions per episode of care were lower in the MGP cohort compared with the standard care cohort (52.87 kgCO₂e vs 99.51 kgCO₂e), representing approximately half the carbon footprint. CONCLUSION: Episodes of care in the MGP cohort were associated with substantially lower estimated carbon emissions than those in the standard-care cohort within this regional maternity services. These findings suggest MGP as an effective low-carbon maternity care strategy aligned with national sustainability and net-zero targets.
Women and birth : journal of the Australian College of MidwivesFrida Berg, Kerstin Erlandsson, Noor Islam Pappu, Helena Wigert, Joy Kemp, Pronita Raha, Rabeya Basri, Paridhi Jha, Malin Bogren
BACKGROUND: High-quality maternal and newborn care relies on competent midwives, placing high demands on midwifery education. Continuous internal quality assurance is essential for meeting accreditation standards yet remains understudied, particularly in low- and middle-resource settings. AIM: The aim of this study was to identify contextual factors preparing for implementation of an internal quality assurance process in midwifery education in Bangladesh. METHODS: A qualitative inductive design, guided by process evaluation principles for complex interventions. Data was collected through focus group discussions (n = 10) with a total of 76 midwifery faculty across Bangladesh. Transcribed discussions were analysed using qualitative content analysis. FINDINGS: This study identified several contextual factors that influence how systematic internal quality assurance is implemented in midwifery education: governance and national leadership culture, institutional constraints and navigating individual engagement. CONCLUSION: Internal quality assurance in midwifery education requires more than technical tools. Trust-based leadership, psychological safety and integration into institutional routines and national policies are essential. Aligning national quality goals with local capacity and faculty values supports sustainable quality improvement in low- and middle-income settings.
Revista da Escola de Enfermagem da U S PSerap Öner, Eylül Tutar
OBJECTIVE: To examine midwifery students' knowledge and perceptions of quality assurance and accreditation, and to identify factors associated with accreditation perception. METHOD: This cross-sectional study was conducted with 253 undergraduate midwifery students. Data were collected using a Personal Information Form, a Quality and Accreditation Knowledge Questionnaire, and the Accreditation Perception Scale. Descriptive statistics, t-tests, ANOVA, and multiple linear regression analysis were used. RESULTS: Students demonstrated a moderate level of accreditation perception (mean = 3.42 ± 1.11). Knowledge of accreditation (β = 0.618, p < 0.001) and willingness to participate (β = 0.476, p = 0.002) were significant predictors, explaining 17.3% of the variance (R2 = 0.173). Year of study and participation in scientific activities were not significant (p > 0.05). CONCLUSION: Accreditation perception is mainly influenced by knowledge and engagement rather than academic progression. Integrating structured education on quality assurance and accreditation into curricula may enhance student awareness and support the development of a sustainable quality culture.
BMJ openOludayo Adeyemi Olosunde, Oswald Zion N Onunwa, Oluwasuen B Osundina, Adebisi O Olosunde, Temitope O Olajubu, Charity E Odufu, Florence Pamilerin
OBJECTIVE: To assess traditional birth attendant (TBA) service utilisation and associated factors among women of reproductive age in Ife Central Local Government Area, Osun State, Nigeria. DESIGN: A community-based cross-sectional study guided by Andersen's Behavioural Model. SETTING: Community settings in Ife Central Local Government Area, Osun State, Nigeria. PARTICIPANTS: Women who had delivered within the preceding 24 months were selected using a multistage sampling technique involving the selection of wards, households, and one eligible woman per household. The calculated minimum sample size was 369 after adjusting for a 10% non-response rate. Of the 366 questionnaires distributed, 316 were completed and analysed, giving a response rate of 86.3%. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was self-reported ever use of TBA services. Secondary measures comprised associations between TBA service utilisation and prespecified sociodemographic, healthcare access and sociocultural factors. These associations were assessed using χ² tests and multivariable logistic regression at a 5% significance level. RESULTS: Of the 316 respondents, 61.4% reported ever using TBA services. In bivariate analyses, TBA service utilisation was significantly associated with inadequate transportation access, a non-positive experience with facility-based maternal services, previous denial of services, exclusion from maternal healthcare decision-making, community approval of TBA use and cultural accommodation by TBAs (all p<0.05). In the fully adjusted model, seven factors remained independently associated with TBA service utilisation: age 27-38 years compared with 15-26 years (adjusted OR (AOR)=3.62, 95% CI 1.62 to 8.07), tertiary education compared with no formal or primary education (AOR=0.17, 95% CI 0.04 to 0.65), adequate transportation access (AOR=0.41, 95% CI 0.17 to 0.97), health insurance covering maternity services (AOR=0.24, 95% CI 0.08 to 0.68), a positive experience with facility-based maternal services (AOR=0.21, 95% CI 0.09 to 0.50), previous denial of care (AOR=2.47, 95% CI 1.17 to 5.24) and community approval of TBA use (AOR=2.38, 95% CI 1.06 to 5.36). The model demonstrated acceptable calibration (Hosmer-Lemeshow χ²(8)=7.839, p=0.449), good discrimination (area under the receiver operating characteristic curve=0.836) and no substantial multicollinearity (all variance inflation factors <3.6). CONCLUSIONS: TBA service utilisation was associated with maternal age, educational attainment, transportation access, health insurance coverage for maternity services, experiences with facility-based maternal services, previous denial of care and community approval of TBA use. These findings highlight the need to improve access to acceptable facility-based maternal healthcare, address barriers to receiving care and incorporate culturally responsive approaches into maternal health services.
PloS oneJakia Sultana Mim, Md Shihab Mostafa, Bodrunnahar Barna, Ahmed Nuzat Sadia, Raisul Islam, Abdullah Al Islam
BACKGROUND: Bangladesh has achieved notable progress in maternal and child health; however, maternal and neonatal mortality remain high, partly due to inadequate access to skilled birth attendants (SBA) during delivery. This study aims to identify key socioeconomic and demographic factors influencing SBA utilization in Bangladesh. METHODS: Data were obtained from the 2022 Bangladesh Demographic and Health Survey (BDHS), a nationally representative cross-sectional survey which was conducted from June 27 to December 12, 2022. The outcome variable was skilled birth attendants during delivery, defined as attendants provided by a doctor, nurse, or midwife. Descriptive statistics and chi-square tests were used for initial analysis, followed by binary logistic regression to identify significant determinants. Additionally, the inclusion of machine learning models provides an additional classification framework that improves classification performance and helps identify important predictors, complementing traditional regression analysis. RESULTS: From the study, 67.94% of women utilized skilled birth attendants during childbirth. Higher maternal education, household wealth, antenatal care utilization, and urban residence were significantly associated with greater SBA utilization. Women with higher education had substantially higher odds of using SBA than those with no education (AOR = 4.10, 95% CI: 1.94-8.66, p < 0.001), while rural women had lower odds than urban women (AOR = 0.64, 95% CI: 0.47-0.88, p = 0.006). Women who attended four or more ANC visits were also more likely to use SBA than those with no ANC visits (AOR = 2.92, 95% CI: 1.72-4.96, p < 0.001). Women from the richest households had higher odds of SBA utilization compared with those from the poorest households (AOR = 1.77, 95% CI: 1.11-2.81, p = 0.016). Among the machine-learning models, Random Forest achieved the highest numerical accuracy (0.82). CONCLUSION: Education, economic status, ANC utilization, and place of residence were identified as key factors associated with skilled birth attendants during delivery in Bangladesh using the binary logistic regression model. Moreover, the machine learning models were used separately to classify SBA. Targeted interventions focusing on disadvantaged and rural populations can help improve equitable access to maternal healthcare. However, differences related to religion and region should be interpreted cautiously, as they may reflect broader socioeconomic and cultural factors rather than direct effects.
OBJECTIVES: To establish a James Lind Alliance (JLA) Priority Setting Partnership to identify research priorities for midwifery practice and maternity care. DESIGN: Using standard JLA methodology, participants were invited to complete an online survey asking for evidence gaps and information about areas of importance to them. Out of scope data were removed and the data analysed to develop uncertainties or priority areas. Following an evidence check to establish if any of the uncertainties had already been answered, a second online survey was developed, in which the priority areas were ranked in importance by respondents. An in-person workshop was held to decide the final top 10 based on the ranked priorities from the second survey. SETTING: The UK maternity services. PARTICIPANTS: Midwives, midwifery students, maternity support workers, women, birthing people and their families and supporters. RESULTS: 977 respondents provided 3272 lines of data. Analysis resulted in the creation of 68 priority topics. Following a review of the evidence, one uncertainty was found to have already been answered. The remaining 67 uncertainties were then ranked by 548 respondents using an online survey. The final top 10 priorities were agreed by consensus at an in-person workshop and include a range of topics across clinical care, as well as those affecting staff well-being and midwifery education. CONCLUSIONS: Researchers who undertake midwifery and maternity research should consider these priorities when deciding on the focus of studies and applying for funding. Funders should also consider these priority areas when deciding which studies to support.
Archives of women's mental healthMichelle L Miller, Kylie L Willams, Tiffany R Williams, Cara Berg Raunick, Sarah A Greenwell, Maggie Sullivan, Russell J Ledet, Camila Arnaudo, Kundai Crites, …
BACKGROUND: Traumatic birth experiences are common and negatively affect the health and wellbeing of the birthing person. Interactions between patients and providers are an important risk factor for experiencing birth as traumatic. The current study investigated both patient and provider perceptions of birth. METHODS: Participants (N = 146) were recruited from a mother-baby postpartum recovery unit and asked about birth satisfaction, if they found their birth traumatic (using DSM-5 Diagnostic Criteria for PTSD), and if their providers debriefed with them post-birth. Providers (N = 95, including obstetricians and midwives) were also asked if the birth was traumatic. RESULTS: There were 60 participants (41.1%) that experienced birth trauma, yet only two thirds received a debrief from their providers (n = 40, 66.7%). Only 65.9% of providers accurately endorsed their patient's birth as traumatic. Participants who endorsed birth trauma reported significantly lower satisfaction with their birth experience than those who did not (mean difference = 2.881, t = 7.217 (144), p<.001, CI [2.092, 3.670]). Most participants endorsed that they wanted to be asked whether their birth experience was traumatic, especially those that had experienced birth trauma (81.8%). CONCLUSION: There is a mismatch between how patients and providers are viewing the same birth experience. Obstetric providers are working with patients when they may be recovering from a traumatic event, creating an ideal opportunity for trauma-informed care. A universal workflow should include briefly discussing birth experiences, especially if the experience was traumatic, with future research focusing on patient and provider outcomes associated with improved conversations.
JMIR research protocolsLucille Kelsall-Knight, Jennifer M Goldberg, Kelvin McMillan, Elizabeth K Darling, Charlene Downing
BACKGROUND: Sexual and gender diverse populations experience inequities in health and health care access, as well as gaps in health professional education. Preregistration nursing and midwifery education represents a critical formative stage for developing inclusive and affirming practice; however, the integration of sexual and gender diversity within curricula remains variable and inconsistently described. Mapping how inclusive pedagogical practices address sexual and gender diversity in preregistration nursing and midwifery education will clarify current approaches and identify gaps in the literature. OBJECTIVE: This study aims to map how sexual and gender diversity is addressed through inclusive pedagogical practices in preregistration nursing and midwifery education globally. METHODS: This protocol follows the Joanna Briggs Institute (JBI) guidance for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting checklist and will be reported in accordance with PRISMA-ScR guidance. We will search the CINAHL, MEDLINE, PubMed, Scopus, and Web of Science databases, as well as targeted gray literature. Two reviewers will independently screen titles and abstracts, followed by full-text screening, and extract data using a piloted form through Covidence. Prior to formal screening, reviewers will pilot-test the inclusion criteria on a sample of titles and abstracts to ensure consistency. Agreement will be discussed, and the eligibility criteria will be refined as required. Data extraction will include pedagogical practices addressing sexual and gender diversity (teaching strategies, curriculum content, simulation, and assessment), theoretical or conceptual frameworks; outcomes and indicators (knowledge, attitudes, skills, confidence, and learning environment), and any identified equity considerations (attention to gender identity and sexual orientation and intersectionality). Synthesis and presentation of findings will be completed using the Patterns, Advances, Gaps, Evidence for Practice, and Research Recommendations (PAGER) framework. RESULTS: The scoping review was initiated in May 2026 following protocol registration with the Open Science Framework. Preliminary searches conducted in November 2025 informed the final search strategy. The final searches were conducted in May 2026 across 5 databases. At the time of manuscript submission, screening and data extraction were in progress. Data charting and synthesis are expected to be completed by October 2026, with findings anticipated for dissemination in December 2026. CONCLUSIONS: This review is expected to identify diverse but inconsistently applied inclusive pedagogical practices, which show a predominance of short-term outcome evaluations and limited theoretical underpinning. It will also highlight key gaps, particularly in the inclusion of gender diverse populations, midwifery-specific evidence, and rigorously evaluated interventions. This review will provide a comprehensive map of inclusive pedagogical practices addressing sexual and gender diversity in preregistration nursing and midwifery education, identify gaps in the evidence base, and inform curriculum development and educator training. TRIAL REGISTRATION: Open Science Framework 10.17605/OSF.IO/8GHVD; https://osf.io/8ghvd. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/93408.
European journal of psychotraumatologyNienke S W M Bosma, Hannah W de Klerk, Iva A E Bicanic, Lisa Zuidema, Jaklien Leemans, Jacques W M Maas, Marieke Dewitte, Fleur Aben, Marlies Y Bongers, Peggy …
Background: Sexual assault (SA) can have serious consequences for physical, mental, social, and reproductive health. Worldwide, about one in three women report experiencing physical SA. Despite this high prevalence, previous research shows only a minority of healthcare providers (HCPs) consistently inquire about SA during initial consultations.Objective: This study aims to establish how gynaecologists and midwives can best address SA by exploring women's preferences with disclosing their experience of SA.Method: An explorative qualitative research design was used with a web-based questionnaire among women who disclosed their SA to a gynaecologist or midwife. The questionnaire was distributed via the Dutch Sexual Assault Center, social media channels and outpatient clinics. A reflexive thematic analysis was conducted.Results: Based on 147 responses, we generated three themes: (1) women need empathy and understanding of trauma response in HCPs. This entailed a non-emotional stance, authenticity, validation after disclosure and sufficient time for a conversation. (2) Women need HCPs to take the lead in addressing SA. This entailed inquiring about SA proactively, informing women about possible connection between SA and symptoms, addressing needs and options, and proving follow-up care. (3) Women need control over the narrative and care pathway. This entailed control over the level of detail women wish to share, the terminology used, medical records, and who is present during consultations.Conclusions: The results can be used to inform education and trauma-informed guidelines on how gynaecologists and midwives can best support SA disclosures. This way, negative responses and re-traumatisation can be avoided and the ongoing recovery process of SA survivors can be supported in gynaecological and midwifery care.
Revista da Escola de Enfermagem da U S PŞeyma Çatalgöl, Eda Can
OBJECTIVE: This study aims to determine the views of midwives working in family health centers regarding vaccine hesitancy and refusal, as well as the solution strategies they propose for this issue. METHOD: This descriptive cross-sectional study was conducted with 81 midwives working in family health centers in the province of Uşak, Türkiye, between March 24 and May 18, 2021. Data were collected via Google Forms using a structured questionnaire developed based on the literature. The data were analyzed using descriptive statistics, including frequencies and percentages. RESULTS: According to midwives' reports, the most frequently cited factors contributing to vaccine hesitancy and refusal include exposure to anti-vaccine websites (90.1%), concerns about vaccine ingredients (70.4%), the influence attributed to community leaders (66.7%), and religious beliefs (65.4%). Other reported factors include past vaccination experiences (56.8%), distrust of vaccine manufacturers (44.4%), and distrust of healthcare workers and the healthcare system (38.3%). An analysis of vaccine information sources revealed that patients most frequently used the internet (37.0%), their social environment (30.9%), healthcare institutions (24.7%), and television (7.4%). 65.4% of midwives reported encountering anti-vaccine individuals. The most frequently recommended strategies include: presenting television content supporting vaccination (70.4%), broadcasting public service announcements via television and the internet (67.9%), and providing information about vaccines through healthcare workers (58.0%). CONCLUSION: Midwives' field observations suggest that vaccine hesitancy and refusal may be associated with digital misinformation, trust-related concerns, and sociocultural factors. Strengthening education initiatives led by healthcare workers and media-based information strategies could potentially contribute to increasing vaccine acceptance.
Women's health (London, England)Sandra Olivia Frans, Ariane Utomo, Linda Rae Bennett
BackgroundIndonesia has the highest rates of cervical cancer mortality in Southeast Asia, mainly due to poor access to and low uptake of cervical screening. Indonesian midwives are primarily responsible for conducting cervical screening, yet there is very limited research on their relevant knowledge, training and capacity to provide screening.ObjectiveThis study explored midwives' experiences of cervical screening training and their knowledge related to CC, cervical screening using Visual Inspection with Acetic Acid (VIA), and Human Papillomavirus (HPV) DNA testing in East Nusa Tenggara, Indonesia.DesignA qualitative study design was employed, based on primary data collected through fieldwork using semi-structured interviews and supplemented by a knowledge assessment questionnaire.MethodsTwenty-four midwives across two districts, one semi-urban and one rural, participated. Qualitative data were analysed using a codebook thematic analysis approach, and questionnaire data were descriptively analysed.ResultsMidwives' mean knowledge score was 75%, with midwives trained in cervical screening scoring higher than untrained midwives. Our findings highlighted inequitable access to training, with midwives in the more urban district having more access to training and higher knowledge. Midwives emphasised that adequate training and continuous practice of the VIA were crucial to building confidence in service delivery. Key knowledge gaps included poor understanding of the relationships between HPV infection, pre-cancer lesions, cervical cancer and its prevention. Midwives' poor knowledge of cervical cancer aetiology and asymptomatic pre-cancer lesions resulted in only recruited women who came with associated symptoms.ConclusionsGeographical inequality in human resource investment in remote areas limits women's access to quality cervical screening and impedes progress towards cervical cancer elimination. Supporting midwives through thorough and up-to-date training, including HPV DNA testing, is essential to increase screening access and uptake, and for the transition to HPV DNA testing.
Global health actionMengstu Melkamu Asaye, Getie Mihret Aragaw, Kihinetu Gelaye Wudineh, Eden Bishaw Taye, Kerstin Erlandsson
BACKGROUND: Midwife-led continuous labour support is a woman-centered approach that has been shown to improve childbirth outcomes. Despite strong global recommendations, it has yet been implemented in Ethiopia. OBJECTIVE: This study aimed to explore the experiences of primiparous women with midwife-led continuous labour support in northwest Ethiopia. METHODS: A qualitative exploratory design was used from July to December 2024. In-depth interviews were conducted with 16 primiparous women who received midwife-led continuous labour support in four primary hospitals. Interviews were audio-recorded, transcribed verbatim, translated into English, and analyzed using latent content analysis. RESULTS: Four sub-categories emerged: emotional empowerment and mindset transformation; compassionate, respectful, and welcoming care; physical and informational support enabling coping and comfort; and a desire for expanded support and system strengthening. Participants considered this model superior to routine care for achieving a positive birth experience, and they advocated its wider adoption, family involvement, and investment in midwives. CONCLUSION: Midwife-led continuous labour support fostered positive birth experiences and strengthened relationships between women and midwives. As the mothers reported, the support enhanced their confidence, emotional empowerment, and development of strategies to cope with labor pain. This approach has clear clinical and policy implications for improving maternal and newborn care. This approach is superior to routine care and is strongly recommended by these mothers as standard practice, offering opportunities for family involvement and institutional investment in midwives.
Asia-Pacific psychiatry : official journal of the Pacific Rim College of PsychiatristsLucy Charlotte Broughton, Natalie Hughes, Jiaxu Zeng, Alesha Smith
PURPOSE: Perinatal mood disorders are associated with adverse maternal and neonatal outcomes and affect 15%-20% of pregnant people. Guidelines recommend SSRIs when non-pharmacological therapies are ineffective, yet antenatal depression remains undertreated. This study aimed to assess the attitudes, knowledge, and practices of general practitioners (GPs) and midwives on SSRI use in pregnancy. METHODS: A knowledge, attitudes, and practice survey was developed in QualtricsXM and distributed to New Zealand-registered GPs and midwives between May 2023 and October 2024 using convenience sampling. RESULTS: Responses from 119 GPs and 62 midwives were analyzed. Discomfort managing antenatal depression was reported by 11% of GPs and 36% of midwives. Knowledge of SSRI risks in pregnancy varied among respondents. Average concern regarding the use of SSRIs in pregnancy and the risk of adverse outcomes was low, but there was considerable variation. In the case vignette, recommended actions differed: 53% advised maintaining treatment, 13% suggested dose reduction, and 24% recommended switching antidepressants. Patient counseling was limited, and appropriate written patient information was rarely provided. CONCLUSIONS: This study highlights variability in knowledge, attitudes, and practices among GP's and midwives regarding SSRIs during pregnancy. Further training, improved access to patient information, and decision aids could enhance patient-centered care and ensure pregnant people receive balanced, evidence-based guidance on SSRI use.
AIM: This study aimed to determine whether midwifery students' awareness of global climate change is associated with their attitudes and behaviours toward medical waste management. DESIGN: This study employed a descriptive cross-sectional design. METHODS: The study was conducted during the 2025-2026 academic year at Atatürk University. The sample consisted of volunteer midwifery students enrolled across all academic years. Data were collected using a sociodemographic questionnaire, the Global Climate Change Awareness Scale and the Medical Waste Attitude and Behaviour Scale. Data were analysed using descriptive statistics, independent samples t-tests, one-way ANOVA with Bonferroni post hoc tests and Pearson correlation analysis. RESULTS: Participants demonstrated high levels of climate change awareness (74.60 ± 8.21) and generally positive attitudes toward medical waste management (96.91 ± 12.10). Fourth-year students had significantly higher awareness scores than students in lower academic years (p < 0.05). Students who perceived climate change as a professional responsibility and believed that it affected health had significantly higher climate change awareness scores. A moderate positive correlation was identified between climate change awareness and medical waste attitudes (r = 0.392, p < 0.001). IMPLICATIONS FOR NURSING PRACTICE: Nurse educators should integrate climate change, environmental sustainability and medical waste management into undergraduate nursing and midwifery curricula using evidence-based educational strategies. Strengthening students' environmental competencies may promote sustainable healthcare practices, improve waste management behaviours and prepare future healthcare professionals to address the environmental challenges associated with climate change. NO PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
Sociology of health & illnessJennifer M Goldberg, Amaya Perez-Brumer, Lori E Ross
Queer, transgender and nonbinary (QTNB) people access midwifery services, yet little is known about their experiences of midwifery care. Our qualitative study used critical narrative inquiry to examine how QTNB midwifery service-users in Ontario, Canada, experience cisheteronormativity in healthcare. Drawing on in-depth interviews with 14 participants, our analysis examines the effects of biomedicalisation on QTNB people who navigate these systems. Our findings show that QTNB people access and participate in technologies of pregnancy surveillance, which deploy information-seeking practices that collect information about the genetic makeup of the baby, conception and paternity. These 'lines of inquiry' present in mundane but insidious ways, embedded within cisheteronormative assumptions about paternity and conception. Stemming from broader biomedical discourse that views sex and gender as one and the same, genetically determined and binary, the discursive effects of lines of inquiry render invisible QTNB identities, family building processes and kinship structures. We explore this tension, showing how lines of inquiry have unequal effects of surveillance across queer family building, kinship and identity, and how QTNB resist dominant discourse around sex, gender and sexuality. Findings can be used by perinatal health professionals to better care for QTNB perinatal service-users as they navigate technologies of surveillance during pregnancy.
International nursing reviewSayed Ibrahim Ali, Mostafa Shaban
AIM: To synthesise and critically appraise empirical evidence on midwives' climate change awareness and planetary health literacy, the psychological attributes underpinning their readiness for climate-related maternal and newborn risks, the educational interventions targeting these attributes, and the systemic factors shaping their preparedness. BACKGROUND: Climate change threatens maternal and newborn health through extreme heat, flooding, and disruption of services. Midwives are well positioned to deliver climate-responsive care, yet the constructs used to describe their preparedness-awareness, literacy, resilience, and readiness-are inconsistently defined and measured, and no prior systematic review has synthesised and appraised this evidence with explicit attention to what individual studies actually assessed. METHODS: A systematic review was conducted according to PRISMA 2020 and registered with PROSPERO (CRD420251135183). Six databases (PubMed/MEDLINE, Embase, Web of Science, Scopus, PsycINFO, and CINAHL) were searched for primary empirical studies published between January 2000 and July 2025 involving practising midwives, student midwives, or midwifery academics. The Capability-Opportunity-Motivation-Behaviour (COM-B) model guided the synthesis. Constructs and instruments were extracted exactly as reported and mapped transparently to review domains. Risk of bias was assessed with RoB 2 and Joanna Briggs Institute tools. RESULTS: Six studies met the eligibility criteria: two randomised controlled trials, three qualitative studies, and one consensus study, together involving 333 midwives, student midwives, and midwifery academics in Türkiye, Australia, and the Democratic Republic of the Congo. No study directly measured planetary health literacy with a validated instrument, and none measured psychological readiness as a defined construct; the available evidence comprised proxy indicators, principally climate change awareness, resilience, and perceived stress. Interactive climate change education significantly improved midwifery students' awareness, and resilience-based training improved practising midwives' resilience and reduced stress. Qualitative evidence indicated that midwives recognise climate-related threats to mothers and newborns but respond through improvised strategies in the absence of formal training, protocols, and institutional support. Both trials were rated at low risk of bias; the four non-randomised studies carried some concerns. CONCLUSION: Direct evidence on midwives' planetary health literacy and psychological readiness does not yet exist. A small, geographically concentrated body of evidence on related proxy constructs suggests that educational and resilience-focused interventions are promising, while systemic supports remain largely absent. Construct-explicit measurement, validated instruments, and system-level preparedness research are priorities. IMPLICATIONS FOR NURSING: Educators and professional-development providers can draw on validated curricular competency content and two trial-tested pedagogies-interactive climate change education and resilience-based training-while recognising that transfer to clinical practice remains untested. IMPLICATIONS FOR NURSING POLICY: Policy should prioritise the development and validation of measurement instruments for planetary health literacy and psychological readiness in midwifery, the integration of climate-related competencies into curricula and accreditation, and investment in the institutional protocols and supports whose absence this review consistently identified.
International nursing reviewBarry McBrien, Frances O' Brien, Shobha Rani Shetty, Sinead Keogh, Jessica Eustace-Cook, Gobnait Byrne
AIM: To map the available evidence on the assessment of migrant nurse and midwife workplace integration in global healthcare settings. BACKGROUND: Globally, migrant nurses and midwives are important resources in mitigating workforce shortages. Existing evidence focuses on the orientation stages of migrant nurse and midwife transition into the healthcare setting rather than their long-term workplace integration. DESIGN/METHODS: The nine databases searched were CINAHL, Medline, Web of Science, Embase, PsycINFO, ASSIA, SicELO, Maternity & Infant Care and Global Index Medicus. An initial search was performed in December 2021 and updated in December 2025. RESULTS: A total of 91 articles were included, comprising qualitative (n = 48), quantitative (n = 13), mixed-methods (n = 6), others (n = 23) and one book chapter. Multiple definitions of workplace integration were found, and 23 tools were identified. CONCLUSIONS: Workplace integration, a multidimensional, time-dependent process, requires collaboration among stakeholders. A standard definition will help to clarify their responsibilities. Key factors ensuring successful integration include promoting effective communication, supporting knowledge advancement, facilitating career development and skill utilisation. The development of standardised interventions with flexibility for local adaptation will support successful workplace integration. IMPLICATIONS FOR NURSING/HEALTH POLICY: Findings highlight the need for policy developers to support migrant nurses and midwives with interventions focused on linguistic challenges, cultural competence and differing care models, that are key to successful integration. Future research must include host stakeholders' perspectives to fully understand the dynamics of workplace integration.
International nursing reviewKazumi Kubota, Yoko Shimpuku
AIM: To examine how the Midwives' Data Hub can function as workforce policy intelligence to support staffing, workforce well-being and equity. BACKGROUND: Midwifery shortages, maldistribution and unsustainable workloads threaten equitable maternity care. Policymakers need midwifery-specific information that connects workforce indicators with education, deployment, retention, regulation, service design and financing. POLICY CONTEXT: Global workforce monitoring has improved visibility of health workforce challenges, but aggregate indicators may obscure midwifery-specific risks. In settings such as Japan, demographic change, regional service variation and workforce constraints create a need for context-sensitive planning. DESCRIPTION OF INNOVATION: The Midwives' Data Hub is framed as an enabling layer of workforce policy intelligence, not as a direct staffing intervention. It can organise indicators across workforce distribution, education, regulation, scope of practice, metadata and service context to support policy deliberation. KEY OUTCOMES: The analysis proposes a policy logic in which data visibility supports problem definition, stakeholder interpretation, selection of policy packages, implementation monitoring and policy revision. Potential policy levers include education planning, deployment support, retention measures, scope-of-practice optimisation, work design and financing. Governance risks include incomplete data, weak comparability, punitive dashboard use and insufficient professional participation. CONCLUSION: Hub-informed planning may support better workforce decisions only when linked to resources, leadership, professional judgement and accountable implementation. IMPLICATIONS FOR NURSING: Workforce data should strengthen dialogue about workload, supervision, rostering, continuing professional development and midwives' professional voice, rather than replace local judgement. IMPLICATIONS FOR HEALTH POLICY: Policymakers should embed the Midwives' Data Hub in participatory governance that connects indicators to financing, education, retention, service equity, workforce equity and policy revision. This approach treats workforce intelligence as a basis for accountable action rather than simple performance comparison.
The journal of pastoral care & counseling : JPCCM-N Bélanger-Lévesque, S Crowther
This article offers an original comparative analysis of spiritual care providers and midwives using two theoretical models, the "art of midwifery practice" and "practiced spirituality". The analysis draws on interview data from ten New Zealand midwives. Focusing on presence, guardianship, intuition, confidence/courage, and human relationship. The analysis reveals shared yet distinct ways of enacting care, illuminating overlooked dimensions of spiritual care practice, and opening new avenues for interdisciplinary reflection.
JMIR nursingIsabella Garti, Nadyen Shikpup, Ophelia Tonto, Michelle Gray, Halima Musa Abdul, Awwal Mohammed Ladan
BACKGROUND: Midwifery education in Nigeria is undergoing a transformation in pedagogical approach. Existing traditional teaching materials are being supplemented by digital technology-enhanced learning resources; however, educators' limited pedagogical capacity may hinder their adoption. Thus, train-the-trainer (TTT) workshops were implemented to build capacity among midwifery educators to prepare them for the implementation of a digital learning platform across 20 institutions in Nigeria. OBJECTIVE: This study aimed to describe the development and qualitative evaluation of a TTT program to support the implementation of a technology-enhanced learning platform within preservice midwifery education in Nigeria. We aimed to evaluate participants' perceptions of the training and their preparedness to implement their learning. METHODS: The workshop was developed using the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) instructional design model. A 3-day TTT program was delivered in 2 cohorts in July 2025 to a purposive sample of 80 institution-nominated midwifery educators and information and communication technology officers from 20 pilot institutions. A qualitative descriptive study was conducted to explore participants' perceptions of the training and their readiness to implement and support the technology-enhanced learning platform within their institutions. Data were analyzed using qualitative content analysis. RESULTS: Pre-workshop responses demonstrated varying levels of prior exposure to and use of digital technologies, as well as differing expectations of the training. Four themes emerged from the post-workshop evaluation. Participants perceived improvements in their understanding of pedagogical and technology-enhanced learning approaches; reported greater readiness to support implementation and knowledge transfer within their institutions; highlighted infrastructure and technical support barriers to implementation; and emphasized the need for ongoing capacity building, monitoring, and support to promote long-term sustainability. CONCLUSIONS: Rather than evaluating educational outcomes, this study provides early evidence of educator readiness, implementation considerations, and sustainability requirements for technology-enhanced learning in preservice midwifery education in low-resourced settings such as Nigeria. A multifaceted approach combining capacity building, ongoing support, technical requirements, and institutional commitment to continuous improvement is needed. Future phases of this implementation research will evaluate educational, implementation, and institutional outcomes associated with the digital learning platform.
Revista da Associacao Medica Brasileira (1992)Selma Sen, Sezer Er Güneri, Huriye Akkale
OBJECTIVE: We conducted this study to examine the attitudes and metaphorical perceptions of violence against women among midwifery students. METHODS: This Convergent Mixed-Methods study involved 383 midwifery students enrolled in a health sciences department during the 2024-2025 academic year. Data were collected using the Student Information Form, the Scale of Attitude Toward Violence Against Women, and the Metaphor Identification Form on Violence Against Women. RESULTS: Of the midwifery students, 21.5% reported exposure to at least one form of violence, with emotional and verbal violence being the most commonly reported. A substantial proportion of midwifery students remained silent when exposed to violence. The total mean attitude score for violence against women was 27.32±6.46, indicating non-traditional and non-myth-supporting attitudes. The metaphor analysis yielded eight overarching themes. CONCLUSION: The findings suggest that midwifery students hold contemporary and critical attitudes toward violence against women; however, their help-seeking behaviors remain limited due to sociocultural barriers. The metaphors produced reflect a deep understanding of the destructive, cyclical, and structurally oppressive nature of violence. Overall, our findings demonstrate that midwifery students possess a multidimensional and detailed understanding of violence against women; however, persistent barriers to help-seeking behavior indicate that sociocultural norms remain powerful.
INTRODUCTION: The Objective Structured Clinical Examination (OSCE) is a well-known clinical skill evaluation tool that has been applied worldwide to teach and assess learners' competencies in healthcare disciplines. Poor implementation of OSCE can lead to inaccurate assessments and ultimately result in the production of incompetent professionals. However, there is no evidence of the implementation status and factors that limit the much-needed OSCE practice in the study area. OBJECTIVE: To assess OSCE implementation among midwifery and nursing educators in the South and Central region of Ethiopian universities, 2023. METHODS: An institution-based cross-sectional study with a mixed approach was used among 269 midwifery and nursing educators and 15 key informants from 8 May to 10 June 2023. All midwifery and nursing educators were included from randomly selected 4 universities in southern and central Ethiopia. Quantitative data were collected using pretested self-administered questionnaires and were analyzed using descriptive statistics and logistic regression. With a p-value of less than 0.05, which denotes statistical significance, a corresponding 95% confidence interval (CI) was calculated. Qualitative data was collected through in-depth interviews and analyzed using open-code software Version 4.02, and findings were used to support quantitative findings. RESULTS: A total of 260 (97%) educators participated in this study, and 43.5% (95% CI 37.4-49.5) of them had a good OSCE implementation. Training in OSCE (AOR = 2.07, 95% CI 1.03-4.17), having an OSCE checklist (AOR = 1.89, 95% CI 1.05-3.42), having equipment (AOR = 2.36, 95% CI 1.03-5.39) and negative perceptions toward OSCE (AOR = 0.53, 95% CI 0.31-0.92) were significantly associated, and poor organization and planning, perceptions towards OSCE, shortage of resources and insufficient number and duration of the station were found by qualitative study. CONCLUSIONS: Less than half of educators have had a good OSCE implementation. Training, equipment, checklists, and perceptions highlight issues such as poor organization and planning, resource, and time allocation stations found as influencing factors. In addition to improving in-service and ongoing OSCE training, it is preferable to ensure the availability and accessibility of resources in the facilities to improve OSCE implementation.
OBJECTIVE: To determine the rate of obstetric referral and explore contextual factors influencing referral practices in public health centres of Addis Ababa, Ethiopia. DESIGN: Explanatory sequential mixed-methods study. SETTING AND PERIOD: Fifty public health centres in the Addis Ababa City Administration, January-April 2021. METHODS: Delivery and referral registers from 50 health centres were reviewed retrospectively for 12 months (8 July 2019-7 June 2020). Facility observations and interviews with maternity unit heads were conducted in all selected centres. In-depth interviews were conducted with 20 midwives and 13 health centre managers. Quantitative data were analysed descriptively, and qualitative data were analysed thematically using Colaizzi's method. RESULTS: Only 13 (26%) of the 50 health centres have met all eight standards assessed for functionality of the referral system. The main gaps of the referral system were a lack of ambulance (12%), absence of formal agreement with referral centers, and lack of timely case-by-case feedback from referral centers(64%). The overall obstetric referral rate was 32%, with substantially higher referral rates in health centers without caesarean section (CS) services compared with those providing CS (39% vs 21%). Qualitative findings indicated that high referral rates were associated with limitations in the predictive capacity of the partograph, variability in providers' clinical skills, and risk-averse practices driven by accountability concerns related to maternal and perinatal outcomes. CONCLUSION: Improving functionality of referrals and reducing unnecessarily high referrals requires adopting and training providers on the new WHO labour guide and partograph, improving referral feedback, and clarifying accountability mechanisms.
Women's health (London, England)Christiana MacDougall, Krista Johnston, Adrienne Gulliver, Samantha Fowler, Madeline Levesque
BackgroundAccess to midwifery care in New Brunswick, Canada is limited, with services concentrated in a single urban clinic and unmet demand across the province.ObjectivesThis study examined public knowledge, awareness, and experiences of midwifery services in New Brunswick.DesignA cross-sectional survey was administered between August 2023 and January 2024. The survey assessed familiarity with reproductive healthcare providers and knowledge of midwifery services.MethodsAn online survey was completed by 282 New Brunswick residents who were current or potential service users of midwifery care. Descriptive statistics, correlations, t-tests, and ANOVAs were used to analyze differences in knowledge across demographic groups.ResultsParticipants expressed strong support for expanding midwifery care, with 96.8% agreeing it should be available to all who want it and 90.8% supporting home birth as an option. However, few participants reported direct access to midwifery services, with many placed on waitlists or deemed ineligible due to the restricted catchment area for the clinic. Knowledge scores were significantly higher among residents in the city where the clinic is located and 2SLGBTQIA+ participants. Awareness around the profession's prescribing rights, laboratory orders, and public funding was limited.ConclusionIn addition to addressing structural barriers and expanding services into rural and Francophone communities, the findings of this study indicate a need for targeted public education campaigns to ensure equitable, culturally responsive, and sustainable maternity care across the province. Our findings suggest that the lack of knowledge about midwifery may reflect the incomplete integration of regulated midwifery care into the provincial healthcare system.
Biomedica : revista del Instituto Nacional de SaludÖznur Tiryaki
INTRODUCTION: Healthcare professionals, particularly midwives and nurses, have played a fundamental role in global immunization efforts by acting as the primary providers responsible for vaccine administration. OBJECTIVE: This study aims to determine whether there is a statistically significant difference in Childhood Vaccination Advocacy Scale scores before and after vaccine advocacy awareness training. MATERIALS AND METHODS: Data were collected using a questionnaire on demographic characteristics and knowledge regarding vaccine administration, developed by the researcher in accordance with the literature, as well as the Vaccine Advocacy Scale for Childhood Vaccines. This research was designed as a single-group, pre-test and post-test quasi-experimental study. Pre-test and post-test scores were compared using the Wilcoxon signed-rank test. A significance level of p < 0.05 was considered statistically significant. RESULTS: The study was conducted with 249 midwives and/or nurses. The mean age of the participants was 39.40 ± 7.43 years, with an average of 18.01 ± 7.99 years of profesional experience. The mean total score on the Vaccine Advocacy Scale for Childhood Vaccines was 45.19 ± 2.85 before the training and 46.95 ± 1.99 after the training. A Wilcoxon signed-rank test revealed that the increase in post-training scores was statistically significant (p = 0.000). CONCLUSION: The findings indicate that participants had relatively high levels of vaccine advocacy even prior to the training. However, the statistically significant improvement in scores post-training clearly demonstrates the effectiveness of the educational intervention.
South African family practice : official journal of the South African Academy of Family Practice/Primary CareMpho Mdakane, Xolani Dlamini, Tshiamo N Ramalepa
BACKGROUND: Adolescent pregnancy remains a public health concern in South Africa, with adolescent primigravidae often facing barriers to antenatal care (ANC) access and continuation. Their first encounter with ANC services is pivotal in shaping future engagement, yet many report uncertainty, stigma and poor communication. This study explored the experiences of adolescent primigravidae during their first ANC visit in the Ekurhuleni East sub-district, Gauteng province. METHODS: A qualitative, exploratory, and descriptive design was utilised. Sixteen adolescent primigravidae between the ages of 10 and 19 years were purposively chosen from designated ANC clinics and a district hospital in the Ekurhuleni East sub-district of Gauteng Province. Data were gathered through semi-structured interviews, transcribed verbatim and analysed using Creswell's six-step content analysis framework. RESULTS: Five themes emerged: (1) Initial ANC clinic visits and uncertainty; (2) negative and positive interactions with the midwives; (3) age-related concerns in the ANC settings; (4) long waiting times; and (5) information and education gaps. While many participants felt hopeful and intended to continue ANC visits, some expressed uncertainty, influenced by judgement and social stigma within the ANC setting. CONCLUSION: The first ANC is a critical window for engagement. The experiences shared emphasised the significance of respectful interactions with providers, effective communication, and an environment that is adolescent friendly and supportive in shaping their views on ANC and utilisation.Contribution: The study offers insight into adolescent-centred ANC improvements and informs recommendations for midwifery practice, health education, and policy development.
Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany))Sonja Sponsel, Larissa Pfaller, Linda Karrer, Oliver Schöffski, Matthias Wilhelm Beckmann, Alexander Mocker
BACKGROUND: Womens health literacy before, during and after childbirth is of considerable public health importance. As midwives frequently serve as primary care providers and first professional contacts during this critical stage of life, they are strategically positioned to support and enhance women's health literacy. The effective fulfilment of this role, however, requires a well-developed level of professional health literacy among midwives themselves. Empirical evidence on this construct remains limited. The aim of this study was to provide a systematic assessment of professional health literacy among midwives in Bavaria. METHODS: A cross-sectional design was applied using data from a standardised online survey conducted within the HELPER study. Between November 2023 and May 2024, 668 midwives practising in Bavaria participated. Professional health literacy was assessed using the PROF-HL-Q, a 34-item instrument covering four competency domains. Data were analysed through descriptive and inferential statistics, including independent samples t-tests and correlation analysis. RESULTS: Mean scores across the four competency domains ranged from 48.6 to 78.0 (scale range: 0-100). Patient-centred communication achieved the highest mean scores and was perceived as the least challenging domain. In contrast, professional digital health literacy showed the lowest mean scores and was rated as the most challenging. CONCLUSION: The findings underline the pivotal role of midwives as providers of health-related information and guidance through-out the perinatal period. Simultaneously, domain-specific competency gaps were identified, indicating a need for curricular refinement in both pre-registration education and continuing professional development. Targeted measures, particularly in the areas of digital competencies, evidence-informed practice, and advanced communication skills, appear warranted.
International journal of environmental research and public healthCladious Verenga, Shalote Chipamaunga-Bamu, Farai D Madzimbamuto, Sunanda C Ray
BACKGROUND: Limited access to trained providers remains a barrier to basic obstetric ultrasound use in low-resource antenatal care settings. This study aimed to explore trainer and trainee experiences of Zimbabwe's six-week Basic Obstetric Ultrasound Short Course (BOUSC) and its perceived relevance to promoting healthy pregnancy through antenatal risk recognition and referral readiness. METHODS: A qualitative study using transcendental phenomenology was conducted in the Fetal Medicine Units of Sally Mugabe Central Hospital and Parirenyatwa Group of Hospitals. Sixteen semi-structured interviews were conducted between September and October 2023 with eight trainers and eight trainees purposively selected from course records. Interviews were audio-recorded, transcribed verbatim, and analysed using Moustakas' approach, including bracketing, horizontalisation, clustering of significant statements, and theme synthesis. RESULTS: Thematic saturation was achieved. Four themes emerged: interactive and clinically situated teaching; confidence and basic skill development through supervised scanning; interprofessional learning that reduced hierarchy; and sustainability concerns related to equipment, mentorship, refresher training, and post-training practice. The most salient finding was that midwives trained as advanced obstetric sonographers were perceived as credible trainers for doctors and other cadres when operating within a supervised fetal medicine governance structure. CONCLUSIONS: Participants perceived the BOUSC as a practical and collaborative training model for basic obstetric ultrasound. The study does not demonstrate clinical outcome effects, but suggests that supervised basic ultrasound training may help promote healthy pregnancy when embedded within clear competency limits, quality assurance, and referral pathways.
PROBLEM: Continuity of care (CoC) improves maternal health, yet midwifery students encounter obstacles in digital communication, including a lack of standardised instruction. BACKGROUND: Digital technology is essential for facilitating CoC, but students lack sufficient exposure to telehealth protocols to foster meaningful clinical partnerships. QUESTION: What are the digital communication needs of midwifery students, and how might a mobile application be implemented to enhance continuity of care practices? METHODS: A mixed-methods exploratory sequential design was used. Phase 1 involved Focus Group Discussions (FGDs) with 40 midwifery students in West Java, Indonesia. Phase 2 utilised a survey of 97 students to confirm the communication model through Confirmatory Factor Analysis (CFA). FINDINGS: Qualitative analysis revealed eight themes, including Communicator, Channel, and Effect. The quantitative validation of the communication model questionnaire exhibited robust reliability across all aspects (Cronbach's alpha reaching 0.977), affirming its validity and reliability for application in Indonesian midwifery education. Significant quantitative results indicated that the Message dimension had the highest mean score (5.45), whereas the Communicator dimension had the lowest (5.07). DISCUSSION: The components of the application-based digital communication model can be used by clinical educators in CoC-oriented learning activities to help midwifery students develop digital communication competencies. However, this framework is still exploratory and has not been implemented or tested in a real-life clinical setting. CONCLUSION: The principal contribution of this study is a newly validated digital communication model framework. The application-based digital communication model has produced a valid and reliable questionnaire incorporating these quantitatively validated components, so that it can be used for the implementation of the application-based digital communication model in midwifery education in Indonesia.
BACKGROUND: Maternal healthcare is an integral part of the public health system, yet the mental well-being of pregnant women is often overlooked in lower- to middle-income countries (LMICs). Midwives, as frontline workers, can provide psychological care to pregnant women, yet their experiences in this role remain unexplored. The study aimed to explore community midwives' experiences of delivering the Safe Motherhood Accessible Resilience Training (SM-ART) resilience intervention and its perceived impact on their practice and on women's perinatal mental health. METHOD: A qualitative exploratory design was used. A sample was recruited using purposive sampling. A focus group discussion (FGD) was conducted in Urdu with all five community midwives who had delivered the intervention at a midwifery-led clinic in Karachi, Pakistan. The data were transcribed and then translated into English. Manual coding was independently performed by two researchers. Words and phrases were first coded, then grouped by similarity into categories, and finally aggregated into themes, which were iteratively reviewed to represent participants' experiences. Rigor and trustworthiness were ensured through regular check-ins and reflective journals. RESULTS: Thematic analysis revealed four themes: "SM-ART" leading towards impacting personality, "SM-ART"- a way towards empowerment, growth, and change, Operational feasibility of SM-ART intervention, and Integration of SM-ART intervention in the community midwives' curriculum. Overall, the study findings revealed that midwives experienced positive changes in their behavior, gained confidence, and enhanced their knowledge of mental health and resilience. They found the intervention feasible and recommended it be embedded in their Midwifery Education. CONCLUSION: The study signifies the voices of midwives, reflecting the SM-ART module's capacity to foster resilience among health care professionals.
Journal of psychosomatic obstetrics and gynaecologyBirgitta Larsson, Margareta Johansson, Danielle Eld, Linn Hirsch, Hanna Fahlbeck
BACKGROUND: Midwifery continuity models of care have been associated with positive health outcomes and positive childbirth experiences. Such models may be beneficial for women with fear of birth but remain uncommon in Sweden. AIM: To explore thoughts and perceptions of midwifery continuity of care among women with fear of birth and describe their experiences of fragmented maternity care. METHOD: A qualitative research design in which semi-structured telephone interviews were conducted during pregnancy and postpartum with women scoring above 70 on the Fear of Birth Scale. Data was analyzed using reflexive thematic analysis. RESULTS: Two themes were identified: A desire for knowing and being known and Unheld in the hands of many. These illustrate women's desire to feel secure and their belief that a trusting relationship with a known midwife throughout pregnancy, childbirth and the postpartum period could reduce their fear. Fragmented standard care was perceived as stressful, and all women expressed interest in midwifery continuity of care. CONCLUSION: Women with fear of birth believed that relational continuity with a known midwife could foster trust, guidance and reduce fear. The fragmented standard care was perceived as uncertain, contributing to emotional distress. These findings highlight the need for personalized and relational midwifery care.
MidwiferyIngegerd Hildingsson, Klockar Linda Nääs, Ingela Wiklund, Margareta Johansson
BACKGROUND: Antenatal care plays a vital role in preparing women for childbirth and the postpartum period. Midwifery continuity models may enhance the quality of antenatal care. AIM: To explore women's experiences regarding the organisation and content of antenatal care among participants in a midwifery continuity of care (MCoC) project. METHODS: a prospective cohort study of 142 women experiencing fear of birth or depressive symptoms. This project offered two alternatives for antenatal care: 'full continuity' with the MCoC midwives (Model A), or a mixed option with health check-ups with a local midwife and digital contacts with the MCoC midwives (Model B). Counselling, parent education and birth preparation were provided online for all women. Data was collected through online questionnaires during pregnancy and postnatally, measuring perceived reality (PR) and subjective importance (SI) of antenatal care. FINDINGS: Fifty women opted for the 'full continuity model' (Model A), while 92 chose the mixed alternative (Model B). No differences in background characteristics were observed between the groups. Statistically significant discrepancies emerged between perceived reality and subjective importance, especially regarding information. Overall satisfaction with antenatal care was high. Women in Model A rated midwife support and partner involvement higher compared to those in Model B. Deficiencies were noted regarding information on breastfeeding and postpartum care in Model B. CONCLUSION: The quality of antenatal care was perceived as satisfactory; however, information regarding breastfeeding and the postpartum period requires enhancement. The model with 'full continuity' was associated with stronger midwifery support and greater partner involvement.
British journal of nursing (Mark Allen Publishing)Kevin Hambridge, Matthew Carey, Francis Thompson, Halil Kaya
BACKGROUND: Healthcare personnel worldwide are exposed to violence and aggression within the workplace. This is despite legislation, policies and guidelines to protect healthcare workers. This violence and aggression also includes healthcare students including nursing and midwifery students. There is limited evidence available regarding the experiences and thoughts of nursing and midwifery students about this phenomenon. AIM: To explore student nurse and midwife experiences of violence when in the placement setting. METHODS: A mixed-methods cross-sectional questionnaire survey was conducted involving preregistration nursing and midwifery students in a university in the UK. The research study was planned and reported based on the CROSS checklist. The survey was distributed to 1681 students and 369 responded, giving a response rate of 22%. There were 364 qualitative responses within the survey. This article reports only on the qualitative comments drawn from two open-ended questions, which were thematically analysed based on Braun and Clarke's six-step process. FINDINGS: Two themes emerged, 'Experiences of sustaining and witnessing violence and aggression' and 'Training, education and measures to prevent violence and aggression'. CONCLUSIONS: It is imperative that students receive the most effective and evidence-based education and training to help to prevent and manage violence and aggression while on their programme. It is also imperative that nursing and midwifery students are aware of the importance of reporting episodes of violence and aggression to ensure that students receive the appropriate support and follow up to prevent and help lessen the emotional impact.
This study evaluated the effectiveness of synchronous online simulation compared with face-to-face instruction in teaching episiotomy repair skills to midwifery students. It also assessed learning satisfaction and self-confidence. A randomized controlled study was conducted with undergraduate students enrolled in a childbirth course. Participants were randomly assigned to either a synchronous online or face-to-face training group. Both groups received structured instruction using standardized simulation models. Outcomes were measured using the Student Satisfaction and Self-Confidence in Learning Scale and the Episiotomy Skill Evaluation Form. Both training formats resulted in similarly high levels of skill performance. The online group demonstrated significantly higher self-confidence and overall learning satisfaction, while skill outcomes were comparable between groups. No significant associations were found between demographic characteristics and study outcomes. Synchronous online simulation is a feasible and effective alternative to face-to-face training for developing procedural skills while also enhancing learner confidence and satisfaction.
African journal of reproductive healthMxolisi W Ngwenya, Livhuwani Muthelo, Melitah M Rasweswe, Tshepo A Ntho, Nyanisi Mhlongo, Tebogo M Mothiba
During childbirth, no woman should lose a child. However, perinatal mortality remains a global concern. The recent South African Saving Mothers and Babies report revealed a notable 20% increase in perinatal mortality in Mpumalanga province. This excess of perinatal mortality was due to hypertensive disorders and unexplained causes. Thus, this paper explores and describes the voices of midwives on the causes of perinatal mortality in the resource-limited setting of the Mpumalanga province. A qualitative, exploratory and descriptive design was carried out to explore the views and perceptions of midwives on the causes of perinatal mortality. Purposive sampling was adopted to select midwives with experience in midwifery care, and data saturation was reached with the 20th participant. The data was collected through semi-structured interviews and analysed using thematic analysis. The study revealed that issues such as delayed interventions and poor monitoring by healthcare personnel, lack of triaging, shortage of staff, variations in implementation of health education and compliance were the concerning issues contributing to perinatal mortality. The study highlights that health education is a crucial element in the prevention of perinatal mortality. Therefore, more initiatives should be directed at educating patients about the importance of antenatal care, treatment adherence, and the use of unsafe traditional medicines for the induction of labour.