Supporting students and qualified staff to provide care during perinatal bereavement is a challenge. In UK culture, death remains a taboo, while the death of a child is considered even more difficult to come to terms with. Conversely, pregnancy loss is often minimised. Bringing the expertise of experience to bear as part of educational approaches to supporting learners ensures that perinatal loss is viewed as a human life event, not simply a theoretical or clinical practice issue.

As midwives we claim the right and obligation to strive to reinvent midwifery as a profession, value-system and system of knowledge through restorative justice, claiming and co-creating a decolonised intellectual heritage and removing knowledge hierarchies. This article provides a definition of key concepts associated with decoloniality/decolonisation and discusses the project of ‘Decolonisation’ as a means of addressing – and countering – racism, ethnocentrism, orientalism, sexism and oppression, through reparative knowledge exchange, restorative justice and practical applications of global human rights.

Reproductive technologies have enabled millions of couples and individuals to build or expand their families. These medical procedures are generally ethically acceptable, but as technological capabilities expand, so does the need to address ethical considerations. The basic principles of beneficence, nonmaleficence, autonomy, and justice serve as a framework when considering the ethics of most clinical procedures. This chapter discusses considerations for the number of embryos to transfer, the use of donor gametes, how to proceed when treatment seemed futile, aneuploidy testing of embryos, as well as a discussion of the ethical cautions in newer techniques such as gene-editing. The aforementioned core principles can serve as guidance when ascertaining the ethical status of current and future reproductive technologies. In discussing the ethics of informed consent in childbearing, the chapter highlights the need to address the systematic inequalities and injustices that prevent women and birthing people from exercising true autonomy in reproductive decision making. The focus on relational care and increasing awareness of inequalities and of the rights of birthing people would help to change the landscape and move our systems away from dehumanization and medicalization and toward true informed decision making.

Pregnancy is a time when many women might be focusing on their health, perhaps to a greater degree than previously. Pregnancy, as every other personal experience, must be viewed holistically. Women and pregnant people often experience increased levels of stress due to fear, partly compounded by medicalized systems of maternity care. These systems can make depersonalize the experience of pregnancy. Wellbeing, although hard to define, incorporates an understanding of the intersections between mind, body and self: mood, emotion, thought and embodied experience are all part of wellbeing and this is particularly relevant during pregnancy. Too often, biomedical approaches to pregnancy care overlook emotional wellbeing and Complementary therapies such as aromatherapy, music and acupuncture offer an adjunct to conventional maternity care and the chance to optimize bio-psycho-social wellbeing throughout pregnancy, and support pregnant people to address the emotional changes and challenges of this period of growth and becoming. This chapter focuses on some ways to use complementary therapies such as aromatherapy, music, and acupuncture to enhance a person's sense of emotional wellbeing during pregnancy. It touches on some of the psychological, personal, emotional, and physical challenges associated with the pregnancy journey, and considers ways that women and childbearing people can take charge of their own emotional state and enhance their ability to adapt to the changing landscape of body, mind, and personal world during this time of transition.

Energy field therapies build on two different disciplines—a spiritual discipline which involves faith in the existence of a universal life-force or energy, and a system based in the principles of physics. The fundamental nature of humanity is to express itself through touch, and historically, touch therapies have been used within traditional medicine/healing systems almost universally. This chapter covers a range of biofield and manipulative therapies to promote fertility and to support holistic wellbeing during pregnancy, including Reiki, therapeutic touch, osteopathy, chiropractic, and others.

Physiological and hormonal changes in pregnancy can contribute towards sleep disordered breathing in pregnant women (SDBP). When present, SDBP increases the risk of several adverse maternal and fetal outcomes independent of factors such as age, weight and pre-existing maternal comorbidities. SDBP is underdiagnosed and may be hard to recognise because the presentation can be difficult to differentiate from normal pregnancy and the severity may change over the course of gestation. Timely intervention seems likely to help reduce adverse outcomes, but the relative benefits of intervention are still unclear. The definition of what constitutes a sleep-related breathing "disorder" in pregnancy may be different to the general population and so traditional thresholds for intervention may not be relevant in pregnancy. Any modifications to the disease definition in this group, or implementation of more intensive screening, may result in overdiagnosis. Further research is needed to help clinicians evaluate the balance of benefits and harms in this process. Until this is clearer there is a strong imperative for shared decision making in screening and treatment decisions, and screening programmes should be monitored to assess whether improved outcomes can be achieved at the healthcare system level.Untreated sleep disordered breathing in pregnancy poses risks to maternal and fetal wellbeing, but it is underdiagnosed.Careful approaches to screening could improve rates of diagnosis, but thresholds for and benefits of intervention are unclear.Clinical guidelines and screening programmes for sleep disordered breathing in pregnancy need to consider the potential harms of overdiagnosis and should involve shared decision making and careful monitoring of outcomes relevant to the individual.Explore current knowledge of the prevalence of sleep disordered breathing in the pregnant population.Explore the relationship between sleep disordered breathing and adverse outcomes.Understand the approaches to diagnosis and management of sleep disordered breathing in pregnancy.Explore issues around screening, underdiagnosis and overdiagnosis in the context of sleep disordered breathing in pregnancy.

Physiological and hormonal changes in pregnancy can contribute towards sleep disordered breathing in pregnant women (SDBP). When present, SDBP increases the risk of several adverse maternal and fetal outcomes independent of factors such as age, weight and pre-existing maternal comorbidities. SDBP is underdiagnosed and may be hard to recognise because the presentation can be difficult to differentiate from normal pregnancy and the severity may change over the course of gestation. Timely intervention seems likely to help reduce adverse outcomes, but the relative benefits of intervention are still unclear. The definition of what constitutes a sleep-related breathing "disorder" in pregnancy may be different to the general population and so traditional thresholds for intervention may not be relevant in pregnancy. Any modifications to the disease definition in this group, or implementation of more intensive screening, may result in overdiagnosis. Further research is needed to help clinicians evaluate the balance of benefits and harms in this process. Until this is clearer there is a strong imperative for shared decision making in screening and treatment decisions, and screening programmes should be monitored to assess whether improved outcomes can be achieved at the healthcare system level.

Background: in 2015, NHS Wales introduced a national standardised approach to aseptic non-touch technique (ANTT). This approach aims to standardise practice and promote better clinical outcomes. Aim: to provide insight into the challenges faced by clinical staff adopting ANTT during intravenous therapy. Methods: focused ethnography across two paediatric wards in NHS Wales. Data collection included participant observation, audit questionnaires and semi-structured interviews. Data were analysed according to Wolcott's (1994) process and emerging themes were reflected upon against the theoretical framework of Kirkpatrick's (1994) model of training evaluation. Findings: absence of feedback following training, individual preference, lack of opportunity to practise the ANTT technique, lack of clarity and standardisation and expectations of parents/medical staff are all challenges faced by registered nurses. Implications of the study: the findings may be used by NHS managers to support national initiatives within staff training and development programmes, and to improve infection prevention initiatives. Organisational culture is a modifier of healthcare worker behaviour and requires further attention locally and nationally. Quality assurance in the adoption of standardised best practice must take into account staff training and development needs, and workplace culture.

Introduction Gestational obstructive sleep apnoea (G-OSA) affects around one in four pregnant women,1 and is associated with poor maternal and foetal outcomes.2–4 G-OSA therefore represents a potentially modifiable risk-factor for perinatal outcomes, but more intensive screening risks overdiagnosis due to a lack of research into i) optimal intervention thresholds, and ii) the preferences and experiences service users.5 Method This project aims to explore the perceptions, concerns, and values of service users regarding screening and diagnosis of G-OSA, using qualitative semi-structured interviews with thematic analysis. This study has received research ethics committee approval. Results At the time of writing interviews are ongoing. Preliminary analysis suggests that, while pregnant women would likely see screening for, or research into G-OSA as being desirable, there are concerns: Women might not perceive sleep problems as being a risk–factor for adverse outcomes. Increased knowledge of G–OSA would therefore represent an additional perceived 'risk' in pregnancy. Women may feel offended if they felt that their behaviour or lifestyle was a factor in whether screening was offered. Women may find diagnostic equipment scary and would need reassurance that it would not harm their baby. Despite the practical burden of screening or treatment for G–OSA, women may feel obliged to take part due to societal pressures. Women may feel guilty or distressed if they were unable to tolerate continuous positive airway pressure. Discussion We expect to develop these themes further with more interviews and analysis, but the results so far promise that the research will offer insight into how clinical and research programs might be designed in order to minimise distress and optimise service user participation. This adds to the debate around the risk-benefit analysis of increasing the screening burden faced by women in pregnancy. References Pien GW, Pack AI, Jackson N, et al. Risk factors for sleep-disordered breathing in pregnancy. Thorax 2014;69:371–7. doi:10.1136/thoraxjnl-2012–202718 Li L, Zhao K, Hua J, et al. Association between Sleep-Disordered Breathing during Pregnancy and Maternal and Fetal Outcomes: An Updated Systematic Review and Meta-Analysis. Front Neurol 2018;9:91. doi:10.3389/fneur.2018.00091 Brown NT, Turner JM, Kumar S. The intrapartum and perinatal risks of sleep-disordered breathing in pregnancy: a systematic review and metaanalysis. Am J Obstet Gynecol 2018;219:147–161.e1. doi:10.1016/j.ajog.2018.02.004 Bourjeily G, Danilack VA, Bublitz MH, et al. Obstructive sleep apnea in pregnancy is associated with adverse maternal outcomes: a national cohort. Sleep Med 2017;38:50–7. doi:10.1016/j.sleep.2017.06.035 Perkins A, Einion A. Pregnant pause: should we screen for sleep disordered breathing in pregnancy?Breathe 2019;15:36–44. doi:10.1183/20734735.0343–2018

Report review runs alongside Guideline Commentary and the other Evidence Series articles, examining local, national and international reports that have implications directly or indirectly for midwives. It helps readers to understand what reports mean for midwifery practice and to place report recommendations into context. As with all our evidence series articles, report reviews support you to critique recommendations and implications for your own practice.

The Evidence Series attempts to make research practices and findings accessible to midwives. In this article, Alys Einion describes a scoping study which is being used to test a potential theory about the impact of ‘reality tv’ birth programmes on how women make sense of birth.

AIM:to investigate emotional intelligence (EI) and its relationship to nursing leadership.BACKGROUND:strong, effective leadership is core to organisational competency and significantly influences care quality. EI is the ability to understand one's own feelings and to assess and respond to the feelings of others. It is linked to self-awareness, self-management, social awareness and social skills, all of which are vital in leadership roles. However, insufficient research explores EI in nursing leadership from the perspective of nurse leaders.DESIGN:a qualitative study employed interpretive phenomenological analysis methods, using a purposive sample of band 7 sisters/charge nurses/team managers (n=5) from one Welsh health board. Semistructured interviews were recorded and analysed in four stages.FINDINGS:four clusters of themes were identified, each with two to three subthemes. These were: sensing others-the empathetic leader; experiencing the affected sense of self; strategies employed to build the team; and reading the flux of the organisation.CONCLUSION:although the nurse leaders were unfamiliar with the concept of EI, their narratives reflected some core values of EI. However, significant barriers around time, pressure and staffing levels impeded their potential to use EI to become more effective leaders. Nurse leaders should harness the power of emotions to influence others to achieve excellent care.

Guideline commentary aims to help readers make sense of published guidelines by offering a detailed appraisal of a guideline or a specific section of a guideline, in a careful and considered manner. In doing so, we can advance our knowledge and understanding of reviewing guidelines and guidance to inform our practice. This process is designed to assess the usefulness of the guideline and underpinning evidence, in terms of decision-making and implications for practice.

Research unwrapped is a popular series to help readers make sense of published research by undertaking a detailed appraisal of an article in a careful and considered manner. In doing so, we can advance our knowledge and understanding of a research topic and apply it to our practice. This process is designed to assess the usefulness of the evidence in terms of decision-making and application to practice.

This article is part of a series that aims to highlight Cochrane Systematic Reviews of relevance to pregnancy and childbirth and to stimulate discussion on the relevance and implications of the review for practice. The Cochrane Collaboration is an international organisation that prepares and maintains high quality systematic reviews to help people make well-informed decisions about health care and health policy. A systematic review tries to search for, appraise and bring together existing research to answer a specific research question. The Cochrane Database of Systematic Reviews (CDSR) is published monthly online. Residents in countries with a national license to The Cochrane Library, including the UK and Ireland, can access the Cochrane Library online, free of charge, through www.thecochranelibrary.com

Symposium Summary runs alongside Guideline Commentary and the other evidence series articles; it examines local, national and international conferences that have implications directly or indirectly for midwives. It helps readers to understand the value of conferences and symposiums for midwifery practice and to place conference research recommendations into context. As with all our evidence series articles, Symposium summary supports you to critique recommendations and implications for your own practice. In this review, Alys Einion and Louise Hunter examine the Helsinki symposium in order to assess its key messages and its impact.

The Objective Structured Clinical Examination (OSCE) in Swansea University's midwifery course began life as a clinical skills/obstetric emergencies assessment with a pass/fail outcome, and segued into a graded, summative assessment as part of the redevelopment and revalidation of the undergraduate curriculum. An evaluation of the first iteration of the OSCE identified key learning points around preparation, learning, resources, lecturer input and skills practice, which were then used to improve the second iteration of the module/assessment. The need to provide ample opportunities for practice, the value of simulation as a ‘safe’ place to learn critical clinical skills and the stress associated with this kind of examination were identified as issues. The provision of immediate peer and lecturer feedback during practice sessions was highly valued. Future work on the OSCE needs to consider the need to tailor learning experiences to the context and to the learner.