Aim: to explore recruitment to UK midwifery programmes from the perspective of applicants from Black, Asian and Minority Ethnic (BAME) groups and describe the perceptions and experiences of the application process for these applicants and those from white backgrounds.Background: Midwifery in the Global North is an overwhelmingly white profession. This lack of diversity has been cited as a factor in the poorer outcomes experienced by women from non-white backgrounds. There is a need for midwifery programmes to recruit and support more ethnically and racially diverse cohorts if this situation is to be addressed. Very little is currently known about the recruitment experiences of midwifery applicants.Design: A mixed methods study comprising a survey and individual interview or focus group. The study was conducted between September 2020 and March 2021 in three universities in South East England. Participants comprised 440 applicants to midwifery programmes and 13 current or recently qualified BAME midwifery students.Findings: Although many survey findings in respect to choosing a midwifery programme were broadly similar between candidates from BAME and non-BAME backgrounds, some trends were noted. More BAME applicants cited school/college rather than family as encouraging. More BAME applicants also indicated that they would consider issues of diversity when selecting a place of study, and BAME respondents appeared less likely to consider location and university life. Survey and focus group findings combined may indicate deficits in social capital available to BAME midwifery applicants. Focus group findings in particular suggest multiple experiences of challenge and inequity at all stages of the application process, together with a perception that midwifery is a niche and white profession. Applicants value proactive support from universities and would appreciate increased diversity, opportunities for mentorship and an individualised approach to recruitment. Conclusions: BAME applicants to midwifery can face additional challenges which have an impact on their ability to secure a place. There is a need to reposition midwifery as an inclusive and welcoming option for people from all backgrounds and to develop equitable recruitment processes that value a range of skills and life experiences.

IntroductionResearch to understand factors associated with normal physiologic birth (unassisted vaginal birth, spontaneous labor onset without epidural analgesia, spinal, or general anesthetic, without episiotomy) is required. Laboring and/or giving birth in water has been shown to be associated with a high proportion of physiologic birth but with little understanding of factors that may influence this outcome. This study explored factors associated with normal physiologic birth for women who labored in water.MethodsWe conducted a secondary analysis of a UK‐based prospective observational study of 8064 women at low risk of childbirth complications who labored in water. Consecutive women were recruited from birth settings in England, Scotland, and Northern Ireland. Planned place of birth, maternal characteristics, intrapartum events, and maternal and neonatal outcomes were measured. Univariable and multivariable logistic regression modelling explored factors associated with normal physiologic birth.ResultsIn total, 5758 (71.4%) of women who labored in water had a normal physiologic birth. Planned birth in the community (adjusted odds ratio [aOR], 2.58; 95% CI, 2.22‐2.99) or at an alongside midwifery unit (aOR, 1.21; 95% CI, 1.04‐1.41) was positively associated with normal physiologic birth compared with planned birth in an obstetric unit. Duration of second stage (aOR, 0.66; 95% CI, 0.62‐0.70), duration in the pool [aOR, 0.93; 95% CI, 0.90‐0.96), and birth weight of the neonate (aOR, 0.74; 95% CI, 0.65‐0.85) were negatively associated with normal physiologic birth. Parity was not associated with normal physiologic birth in multivariate analyses.DiscussionOur findings largely reflected wider research, both in and out of water. We found midwifery‐led birth settings may increase the likelihood of normal physiologic birth among healthy women who labor in water, irrespective of parity. This association supports growing evidence demonstrating the importance of planned place of birth on reducing intervention rates and adds to research on labor and birth in water.

Globally, 5–30% of children have eczema which could be partly attributable to skin cleansing routines. Evidence-based international guidance on this topic is lacking and dated national UK guidelines may not reflect best practices. We conducted a mixed method, UK-wide (England, Scotland, Northern Ireland and Wales) cross-sectional survey to investigate parental cleansing of their newborn's skin; 973 responses were suitable for inclusion. Sixty percent (60%) of participants delayed the first cleansing after birth for 48 h and 79.4% of participants cleansed their newborn's nappy area with each change. Participants from Scotland were more likely to cleanse their newborn within the first 48 h (X22 = 29.3, p < 0.001) and then cleanse more frequently (X24 = 14.51, p < 0.006) than those in England and Wales. 59.7% of participants used water alone for cleansing their newborn's body. Further research is needed into the appropriateness and effectiveness of parents' newborn skin cleansing practices and influences on their decision-making.

Introduction and hypothesis Obstetric anal sphincter injury (OASI) during childbirth is associated with urino-genital pain and dysfunction. Waterbirth is a popular birth choice for women, but controversy remains around the risk of OASI during waterbirth. This study reports on the incidence of OASI, and factors associated with OASI, for a cohort of women who gave birth in water. Methods This secondary analysis used prospectively collected data from 2,908 women who gave birth in water in a hospital setting. The incidence of OASI was calculated. Univariable and multivariable logistic regression analysis evaluated factors associated with OASI. Results The incidence of OASI was 1.9% (95% confidence interval (CI) 1.4, 2.4) for all women. In nulliparae it was higher (3.2%, 95% CI 2.3, 4.3) than in multiparae (0.9%, 95% CI 0.5, 1.4). In the multivariable analysis, two variables were associated with OASI; multiparity was negatively associated with OASI (adjusted odds ratio [aOR] 0.24, 95% CI 0.12, 0.50, p < 0.001), and birth weight was positively associated with OASI (aOR 1.001, 95% CI 1.000, 1.002, p = 0.02). A "hands-on" technique was used during only 13% of births. A birth position supporting a flexible sacrum did not influence OASI risk. Conclusions A low incidence of OASI was found for this cohort of women. The low proportion of midwives using a hands-on technique suggests that it may not be required in waterbirth.

We assessed whether the sex ratio of nestling Marsh Tits (Poecile palustris) varied with habitat fragmentation by sampling broods from two British woodland areas with contrasting patch size, and comparing the data with published results from an extensive forest in Poland. We found no evidence for manipulation of offspring sex ratios, supporting findings from Poland, and suggesting that this trait may be typical of the species. The results are important in helping to understand the origin of biased sex ratios observed among adult Marsh Tits in the declining population in Britain.

Capsule Marsh Tits were strongly associated with both the amount and species diversity of woodland understorey; Blue Tits were associated with large trees and deadwood.Aims To gather quantitative information on the habitat requirements of Marsh Tits, in comparison with those of Blue Tits, across a large number of sites in England and Wales, and secondly to evaluate the range of habitat conditions likely to encourage the presence, and increase the abundance of, each species.Methods Counts of birds were made at each of 181 woods across England and Wales, and habitat data were collected from the same locations in each woodland. Marsh Tit and Blue Tit presence and abundance were related to habitat characteristics, interspecific competition and deer impact.Results Shrub cover and species diversity were important for the presence and abundance of Marsh Tits, across their geographical range in Britain. Blue Tits were associated with large trees and deadwood.Conclusion Our results support the hypothesis that changes in woodland management, leading to canopy closure and a decline in the understorey available, could have had an impact on Marsh Tits, and may have led to the observed population decline. These same changes were also consistent with population increase in Blue Tits.

Ageing and sexing Marsh Tits Poecile palustris presents some difficulties for ringers. Wing length has previously been found to be useful for sexing English Marsh Tits, although the replacement of all juvenile rectrices and greater coverts by first‐year birds made ageing difficult. We examined Marsh Tits of known age and sex and found that 93.5% of birds could be sexed correctly using wing lengths of ≤ 62 mm for females and ≥ 63 mm for males. Wing length was also an indicator of age: many first‐years had shorter wings, but most also retained some juvenile rectrices and greater coverts after the post‐juvenile moult, and could be readily aged using these features. We found a primary moult period of 67 days for adult Marsh Tits, with a mean onset of 27 May.

Ageing and sexing Marsh Tits Poecile palustris presents some difficulties for ringers. Wing length has previously been found to be useful for sexing English Marsh Tits, although the replacement of all juvenile rectrices and greater coverts by first‐year birds made ageing difficult. We examined Marsh Tits of known age and sex and found that 93.5% of birds could be sexed correctly using wing lengths of ≤ 62 mm for females and ≥ 63 mm for males. Wing length was also an indicator of age: many first‐years had shorter wings, but most also retained some juvenile rectrices and greater coverts after the post‐juvenile moult, and could be readily aged using these features. We found a primary moult period of 67 days for adult Marsh Tits, with a mean onset of 27 May.

The Marsh Tit Poecile palustris is a small, hole‐nesting woodland passerine whose national population in the UK has declined by more than 50% in the last 25 years. To investigate possible causes for the species long‐term decline, we examined habitat selection by Marsh Tits at three scales. For individual foraging birds, winter time budgets and foraging behaviour, recorded using instantaneous sampling, differed little between Marsh and Blue Tits Cyanistes caeruleus, but Marsh Tits spent more time in the understorey and more time lower down in both the woodland canopy and the understorey. At the scale of breeding territories, the characteristics (numbers by size class, vegetation density, species richness) of trees and shrubs were compared using 100 × 10‐m sample transects of ten territories in each of four woods. The characteristics of the trees differed significantly between woods whilst those of the shrubs did not, suggesting that the characteristics of shrubs were more important in territory selection by Marsh Tits than were those of trees. Furthermore, in one of the four woods (Wytham Woods, Oxfordshire), Marsh Tits were largely absent from areas with dense tree canopy, but poor shrub cover. On a national scale, using data from 157 of the woodlands surveyed by the RSPB/BTO Repeat Woodland Bird Survey, Marsh Tit abundance in 2003/04 was found to be positively related to vegetation cover at heights corresponding to the shrub layer, especially at 2–4 m. These relationships were not apparent in data for the same woods for the 1980s, but shrub cover had increased substantially by 2003/04 and Marsh Tit abundance had increased in woods with the most cover in 2003/04. Thus, factors damaging the shrub layer, such as overgrazing by deer, shading out by canopy closure and managed clearance of shrub cover, may reduce the suitability of woodland for Marsh Tits. Habitat use by a closely related species, Willow Tit Poecile montanus, is also discussed.