Background Midwifery professional practice experience (MPE) is critical to student learning. Midwifery education standards in Australia prescribe that students must complete midwifery continuity of care experiences across pregnancy, birth and postnatally for ten women. Midwifery Professional Experience (MPE) can occur in partnering health facilities and in midwifery continuity of care models. Aim To compare the MPE experiences of midwifery students in public hospital maternity and continuity of midwifery care models using the validated Midwifery Students' Experience of Practice (MidSTEP) Tool. Methods Recruitment was via university learning management systems. Data were collected via REDCap using the validated MidSTEP tool. Demographics, program information and 26 Likert-style responses were included. Categorical data were analysed using descriptive statistics, Likert responses were dichotomised and compared between public hospital maternity care and midwifery continuity of care using McNemar’s test (significance 0.05). Open text questions were thematically analysed. Findings 92 responses were received, 96.7 % MPE was in public maternity models of care and 3.3 % in a midwifery continuity of care model. Midwifery student responses to the MidSTEP scale favoured learning experiences through midwifery continuity of care. Open text responses were coded into four themes, culture, implicit values of the maternity service, support for students and experiences with midwifery continuity of care models. Conclusion This study demonstrates learning in MPE is optimised when students are embedded within continuity of midwifery care models. Prioritising student feedback using the MidSTEP tool aligns with midwifery philosophy and should be prioritised.

Background: Thousands of graduate registered nurses (GRNs) enter the Australian acute hospital workforce annually, and many participate in transition to practice programs (TPPs). The benefits of these programs have been poorly evaluated. Aim: This study explores the experiences of GRNs who completed a 12-month TPP at two Australian acute metropolitan hospitals and whether they believe their clinical competence increased. Methods: A qualitative hermeneutic phenomenological approach was adopted to explore experiences of 14 registered nurses who completed a TPP at two Australian metropolitan hospitals during the years 2021-2023. Focus groups were used to explore the experiences of GRNs. NVivo software was used in data collation, analysis, and synthesis. Findings: Three themes were identified: support - including clinical support from graduate nurse educators and clinical facilitators, as well as GRN expectations of support versus reality in practice; education - including directed and self-directed learning; and clinical competence - how it develops and how the TPP impacted views on clinical competence. Themes identified that GRNs believe they require clinical support in their first year of practice to assist in a successful transition to practice. Participants believed education should be tailored to match individual needs and adapt as their skill level progresses. Participants also identified that they had unrealistic expectations of the support that would be provided through TPPs. Conclusion: While the outcomes of this study reflect existing GRN transition literature, they also identify that expectations of TPP clinical support should be explicitly outlined in detail at orientation to avoid unrealistic expectations of clinical support. (c) 2025 The Authors. Published by Elsevier Ltd on behalf of Australian College of Nursing Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

INTRODUCTION:Labor is both a physiological and physical activity that requires energy expenditure by the woman. Despite this, women are often fasted in labor, with hydration requirements addressed predominantly by intravenous therapy. Little is known about how best to manage this in nulliparous women undergoing induction of labor, who can be prone to lengthy labors. Therefore, we undertook a systematic review and meta-analysis to determine the effects of intravenous hydration regimens on nulliparous women undergoing induction of labor. MATERIAL AND METHODS:A systematic review and meta-analysis were conducted. Databases searched were PubMed, CINAHL, Embase, Cochrane, Scopus, and Web of Science using the search strategy combination of associated key concepts for intravenous therapy and nulliparous laboring women. The primary outcome was excessive neonatal weight loss. Meta-analyses for categorical outcomes included estimates of odds ratio (OR) and their 95% confidence intervals (CI) calculated; and for continuous outcomes the standardized mean difference, each with its 95% CI. Heterogeneity was assessed visually and by using the χ2 statistic and I2 with significance being set at p < 0.10. RESULTS:A total of 1512 studies were located and following screening, three studies met the eligibility criteria. No studies reported excessive neonatal weight loss. Increased rates of intravenous therapy (250 mL/h vs. 125 mL/h) during labor were not found to reduce the overall length of labor (mean difference -0.07 h, 95% CI -0.27 to 0.13 h) or reduce cesarean sections (OR 0.74, 95% CI 0.45-1.23), when women were not routinely fasted. CONCLUSIONS:Our review found no significant improvements for nulliparous women who received higher intravenous fluid volumes when undergoing induction of labor and were not routinely fasted. However, data are limited, and further research is needed.

PROBLEM:In midwifery a shared definition of woman-centred care is lacking, and this remains an identified gap in the evidence underpinning midwifery practice.BACKGROUND:Woman-centred care is an underpinning philosophy used in midwifery practice both nationally and internationally.AIM:To analyse the practice of woman-centred care to clarify its meaning and comprehension and subsequently advance an evidence-based definition of the concept.METHODS:Using an adapted theoretical and colloquial evolutionary model a three-stage concept analysis was conducted to identify attributes, antecedents, and consequences of woman-centred care and subsequently construct an evidence-based, internationally informed definition.FINDINGS:Antecedents of woman-centred care are education, models of care and midwife characteristics. Attributes are choice and control, empowerment, and relationships. Consequences are shared and informed decision making which supports the woman in navigating complex health systems, and improved health outcomes. Whilst important to midwifery practice and midwifery-led models of care, continuity of care is not a core essential element of woman-centred care.DISCUSSION:Analysis, synthesis, and re-examination of the data on woman-centred care facilitated deep immersion, exploration and clarification of this concept that underpins midwifery philosophy and practice. The constructed definition can be used to inform health policy, midwifery research, education, and clinical practice.CONCLUSION:An evidence-based definition of woman-centred care is necessary for conversion of this essential concept to practice. Regardless of model of care all women should receive woman-centre care improving the health outcomes of both the woman and neonate.

BACKGROUND:While consent is an integral part of respectful maternity care, how this is obtained during labour and birth presents conflicting understandings between midwives' and women's experiences. Midwifery students are well placed to observe interactions between women and midwives during the consent process.AIM:The purpose of this study was to explore the observations and experiences of final year midwifery students of how midwives obtain consent during labour and birth.METHODS:An online survey was distributed via universities and social media to final year midwifery students across Australia. Likert scale questions based on the principles of informed consent (indications, outcomes, risks, alternatives, and voluntariness) were posed for intrapartum care in general and for specific clinical procedures. Students could also record verbal descriptions of their observations via the survey app. Recorded responses were analysed thematically.FINDINGS:225 students responded with 195 completed surveys; 20 students provided audio recorded data. Student's observations suggested that the consent process varied considerably depending on the clinical procedure. Discussions of risks and alternatives during labour were frequently omitted.DISCUSSION:The student's accounts suggest that in many instances during labour and birth the principles of informed consent are not being applied consistently. Presenting interventions as routine care subverted choice for women in favour of the midwives' preferences.CONCLUSIONS:Consent during labour and birth is invalidated by a lack of disclosure of risks and alternatives. Health and education institutions should include information in guidelines, theoretical and practice training on minimum consent standards for specific procedures inclusive of risks and alternatives.

Problem: There is no internationally-informed understanding of how midwives perceive woman-centred care and use it in practice. Background: Woman-centred care is integral to the role of the midwife and to determining standards of practice. Few empirical studies have explored the meaning of woman-centred care, and those that have are limited to country specific research. Aim: To gain an in-depth understanding and consensus on the concept of woman-centred care from an international perspective. Methods: A three round Delphi study was conducted, with surveys distributed online to a group of international expert midwives to draw consensus on the topic of woman-centred care. Findings: A panel of 59 expert midwives representing 22 countries participated. Fifty-nine statements about woman-centred care, of which 63% of statements reached the 75% a priori agreement level, were developed and categorised under four emergent themes: defining characteristics of woman-centred care (n = 17), the role of the midwife in woman-centred care (n = 19), woman-centred care and systems of care (n = 18), woman-centred care in education and research (n = 5). Discussion: Participants agreed that woman-centred care should be provided by any health care professional in any health care setting. Systems of maternity care should provide holistic care tailored for the individual woman rather than subject her to routine practices and policies. Although continuity of care is important to midwifery practice, it was not reported as a core characteristic of woman-centred care. Conclusion: This is the first study to investigate the concept of woman-centred care as it is experienced globally by midwives. The findings of this study will be used to contribute to the development of an internationally informed evidence-based definition of woman-centred care.

Woman-centred care is a fundamental concept used in national and international healthcare and midwifery practice. However, there is not an internationally-informed definition of woman-centred care, and this remains an identified gap in the evidence. The aim of this study was to develop an evidence-based definition of woman-centred care informed by empirical literature and international midwifery practice for use in midwifery clinical practice, maternity services, education, and research. A three-stage concept analysis was undertaken using an adapted theoretical and colloquial evolutionary model. Stage-1 examined the empirical literature on woman-centred care and identified theoretical attributes, antecedents, and consequences. Stage-2 examined the colloquial language of international midwives in our recent Delphi study to identify the colloquial attributes, antecedents, and consequences of woman-centred care. Both theoretical (Stage-1) and colloquial (Stage-2) understandings of the concept were used in Stage-3 to construct an evidence-based, internationally informed midwifery definition of the concept of woman-centred care. Antecedents of woman-centred care are education, models of care and the midwife characteristics. Attributes of woman-centred care are choice and control, empowerment, and relationships. Consequences are shared and informed decision making which supports the woman in navigating complex health systems and improves the health outcomes of both the woman and neonate. The use of a shared unambiguous evidence-based international definition of woman-centred care is essential for translation of this fundamental concept to practice. The emergent evidence informed definition of woman-centred care will be presented on conclusion of this presentation.

INTRODUCTION Many women use pharmacological or non-pharmacological pain management (NPPM) during childbirth, however, evidence shows the usage rates of pharmacological pain management are increasing. The shift towards a biomedical approach to birth care opposes the enduring midwifery philosophy of trusting the woman and her body. Identifying midwives’ beliefs and attitudes towards perceived and actual barriers to offering NPPM as an initial option will provide insight into the factors that affect this. METHODS This review of the literature sought to understand midwives’ beliefs and attitudes towards the barriers to offering NPPM as an initial option for laboring women. Peer-reviewed journals were searched for primary research that met the inclusion criteria and explored midwives’ beliefs and attitudes towards the barriers to offering NPPM as an initial option for laboring women. Included studies were evaluated for quality according to the Critical Appraisal Skills Programme (CASP) checklists. RESULTS Thirteen qualitative studies met the inclusion criteria and four main themes of barriers to midwives offering NPPM emerged: health system-related, health facility-related, health practitioner-related, and health consumer-related barriers. CONCLUSIONS The review of the literature highlighted there are barriers that prevent or delay the initial utilization of non-pharmacological methods of pain management in labor by midwives. These findings can be used as a platform to inform further research into this topic.

Woman-centred care is integral to the role of the midwife and to determining standards of practice. Few empirical studies have explored the meaning of woman-centred care, and its relationship to maternity services, how midwives perceive this concept and use it in practice, and this remains an identified gap in the evidence base. The aim of this study was to investigate the concept of woman-centred care in the context of international midwifery practice. A three round Delphi study with an international panel of expert midwives was used to gain an in-depth understanding and consensus of woman-centred care in the context of international midwifery clinical practice, maternity services, education, and research. A panel of 59 expert international midwives representing 22 countries participated in the Delphi study. A total of 59 statements about woman-centred care were developed using qualitative data obtained from the expert midwives and these statements categorised under four emergent themes. A total of 37 (63%) statements relating to woman-centred care reached the a priori consensus level of 75%. This presentation will report on those elements of woman-centred care that reached international consensus and highlight those that did not. Drawing on an international expert midwifery panel, this is the first study to investigate the concept of woman-centred care as it is experienced globally by midwives in clinical practice, maternity services, education, and research. The findings of this study will be used to contribute to the development of an internationally informed evidence-based definition of woman-centred care.

Australian midwives are regulated under the National Registration and Accreditation Scheme. Unregistered birth workers may provide midwifery services at homebirths without any regulatory oversight. To address this issue, several states have passed legislation enabling prohibition orders to be made (negative licensing) against unregistered health practitioners who fail to comply with a statutory code of conduct developed for those not covered by the National Scheme.To explore the consequences for the availability of birth choices for women that arise from the introduction of negative licensing.An analysis of the regulatory framework and recent cases of unregistered birth workers attending homebirths reveals problems with equitable access to homebirth support, arising from issues with professional indemnity insurance, geography, and poor integration with hospitals and the wider healthcare system. These problems contribute to women choosing to employ the services of unregistered birth workers.Negative licensing provides a useful additional tool for improving the safety of homebirths for mothers and babies, but it does not address the issues leading expectant parents to choose an unregistered birth worker to attend their births, and may contribute to an increase in high-risk behaviours, such as freebirthing.

Objective: The objective of this review is to explore, review and synthesize the empirical literature that reports on the concept of woman centred care. Design: Integrative review of the empirical literature on the concept of woman centred care. Data sources: A comprehensive search strategy was conducted using the phrase 'woman-centred care' 'women-centred care' (and all associated spelling variants) in the relevant databases including PubMed, Cumulative Index to Nursing and Allied Health, Intermid, Scopus, lnformit and Web of Science. A concurrent search using the phrase 'patient-centred care' (and associated spelling variants) was also conducted, to ensure all studies about care of a woman in pregnancy, labour and postpartum were captured. Review method: A comprehensive five stage integrative review methodology was used to review primary studies which addressed woman-centred care as either an intervention or an outcome. The quality of included studies was assessed using the appropriate Critical Appraisal Skills Programme tool. Results: Initial searching located 1205 papers. Seventeen studies met the inclusion criteria (qualitative n=12 and quantitative n=5). The studies were conducted in Australia (n=5), Ireland (n=1), Japan (n=2), Netherlands (n=2), New Zealand (n=1), South Africa (n=1), Sweden (n=1), Switzerland (n=1), United Kingdom (n=1), and the United States of America (n=2). The quality of the studies varied. NVivo software was employed to abstract and synthesize the data. Analysis revealed 10 subthemes synthesized under three pre-determined main themes of clinical practice (choice and control, empowerment, protecting normal birth, relationships and the individual midwife), maternity service (model of care, continuity of care and maternity care systems) and education (registered practitioners and student midwives). Conclusions: This review integrates the empirical literature to illuminate the concept of woman-centred care as it currently applies to clinical practice, maternity service, and education. The concept of woman centred care is intertwined in the themes and subthemes identified in the studies. There is wide variation in how woman-centred care is interpreted and this contributes to the confusion and tokenism with which it is discussed in health policy documents and frameworks. Further research is also warranted in the development of a universal definition of woman-centred care and in how woman-centred care behaviours are developed in practitioners. (C) 2019 Elsevier Ltd. All rights reserved.

Problem/background: In midwifery we espouse a woman centred care approach to practice, yet in midwifery education no valid instrument exists with which to measure the performance of these behaviours in midwifery students.Aim: To develop and validate an instrument to measure woman centred care behaviours in midwifery students.Method: We identified four core concepts; woman's sphere, holism, self-determination and the shared power relationship. We mapped 18 individual descriptive care behaviours (from the Australian National Competency Standards for the Midwife) to these concepts to create an instrument to articulate and measure care behaviours that are specifically woman centred.Review by expert midwifery clinicians ensured face, content and construct validity of the scale and predictive validity and reliability were tested in a simulated learning environment. Midwifery students were video recorded performing a clinical skill and the videos were reviewed and rated by two expert clinicians who assessed the woman centred care behaviours demonstrated by the students (n = 69).Findings/discussion: Test and re-test reliability of the instrument was high for each of the individual raters (Kappa 0.946 and 0.849 respectively p < 0.001). However, when raters were compared there were differences between their scores suggesting variation in their expectations of woman centred care behaviours (Kappa 0.470, p < 0.001). Midwifery students who had repeated exposures to higher levels of simulation fidelity demonstrated higher levels of woman centred care behaviours.Conclusion: The WCCS has implications for education and the wider midwifery profession in recognising and maintaining practice consistent with the underlying philosophy of woman centred care. (C) 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

BACKGROUND:Simulation as a pedagogical approach is used in health professional education to address the need to safely develop effective clinical skills prior to undertaking clinical practice, in complex healthcare environments. Evidence for the use of simulation in midwifery is largely anecdotal, and research evaluating the effectiveness of different levels of simulation fidelity is lacking. OBJECTIVES:To evaluate the effectiveness of varying levels of fidelity on simulated learning experiences and identify which best contributes to integrated and global clinical skills development in midwifery students. DESIGN:Randomised three arm intervention trial. PARTICIPANTS:Midwifery students who had yet to receive theoretical instruction in the performance of the clinical skill of vaginal examination. METHODS:Midwifery students (n=69) received theoretical instruction in the performance of vaginal examination following random allocation into one of three intervention arms. Participants were recorded performing the procedure using low fidelity (part task trainer only), medium fidelity (part task trainer and life sized poster of a pregnant woman) or progressive fidelity (part task trainer and a simulated standardised patient). Senior midwifery students were recruited to act in the role of standardised patients. RESULTS:There was a statistically significant difference in the mean total Global Rating Scale score between at least two of the three groups (p=0.009). The progressive fidelity group revealed as different from both the low fidelity group (p=0.010) and medium fidelity group (p=0.048). There was a statistically significant difference in the mean total Integrated Procedural Performance Instrument score between at least two of the three groups (p=0.012). The progressive fidelity group revealed as different from both the low fidelity group (p=0.026) and medium fidelity group (p=0.026). CONCLUSIONS:Progressive and medium fidelity simulation yields better outcomes than low fidelity simulation and where resources are constrained medium fidelity equipment, such as a life sized poster can produce effective learning experiences for midwifery students.