Our Updates

Epidural analgesia for labour: An update on labour, birth and perinatal outcomes

The use of epidural analgesia for labour is common, with just over 40% of Queensland women making use of it (Queensland Health, 2020). Epidural analgesia is widely considered to be a safe option. Transforming Maternity Care Collaborative researcher Dr Elizabeth Newnham led a team of researchers who recently examined outcomes for women who did, and did not, make use of epidural analgesia for labour (Newnham et al., 2020).

Data were collected as part of the Maternal health and Maternal Morbidity in Ireland (MAMMI) study which prospectively explored the health of women giving birth for the first time, between 2012 and 2017 in Ireland. Women who gave birth by caesarean section prior to the onset of labour were not included. Care was taken to statistically control for the effects of age, body mass index, and maternity care pathway (public or private care). Data from the birth through to three months postpartum were available for 1,221 women in total.

Women giving birth for the first time who used epidural analgesia were more likely to give birth with vacuum assistance (22.1% without epidural, 25.5% with epidural use) or forceps assistance (4.2% without epidural, 17.4% with epidural). This finding probably relates to the longer duration of the second stage of labour (average of 35 mins without epidural vs 213 mins with epidural). Caesarean section rates were much higher in women who used epidural analgesia (3.4% without epidural, 32.2% with epidural). Seventy percent of women who laboured without an epidural had a spontaneous vaginal birth, while only 24.9% of women with epidural analgesia did so.

Intravenous oxytocin and antibiotics were more commonly used in labour for women using epidural analgesia. The use of antibiotics possibly relates to the higher rate of fever during labour in women using epidural analgesia (0.8% without epidural analgesia, 9.1% with epidural analgesia). Rate of perineal trauma or postpartum haemorrhage were no different between the two groups.

No differences in Apgar scores (either at 1 min or 5 mins), or in the rate of admission to the neonatal intensive care nursery were found. Breastfeeding rates were lower at three months for women who has used epidural analgesia (63.1% without epidural analgesia, 47.5% with epidural analgesia).

The findings of this research reflect that found in previous research about epidural use. Given the nature of this type of research, it is not possible to claim that the outcomes seen were a direct consequence of epidural use. The information set out in the study  provides a useful starting point for obstetricians and midwives as they work with women to support them to make informed decisions about their care.

References

Newnham, E. C., Moran, P. S., Begley, C. M., Carroll, M., & Daly, D. (2020, Sep 11). Comparison of labour and birth outcomes between nulliparous women who used epidural analgesia in labour and those who did not: A prospective cohort study. Women Birth, in press. https://doi.org/10.1016/j.wombi.2020.09.001

Queensland Health. (2020). Queensland Perinatal Statistics 2019. Interim Report. https://www.health.qld.gov.au/hsu/peri/peri2019/queensland-perinatal-statistics-2019

Access to midwifery continuity of care for childbearing women in the Australian health system

Equitable access to high quality maternity care is a critical priority for all health systems (Koblinsky et al. 2016; United Nations 2019). Strong evidence show that continuity of care delivered by a known midwife is safe, confers significant health benefits for women and babies, and results in higher reported satisfaction with care (Forster et al. 2016; Sandall et al. 2016). Not only is continuity of midwifery care linked to improved outcomes in general populations of childbearing women and those with social risk factors, studies also demonstrate the model meets the triple aims of health system improvement – improved satisfaction, better health care, and cost effectiveness (APPGGH 2016; Berwick 2008).

Despite this evidence, only a small proportion of women have access to continuity of midwifery care.  Scaling up access for women in vulnerable groups presents additional challenges (Renfrew et al. 2019). It’s important to know where families have or do not have access to high quality maternity care across birth settings, so that solutions can be found. A team of researchers from the Transforming Maternity Care Collaborative, led by Dr Rosalyn Donnellan-Fernandez have recently used modelling to provide a snapshot of the progress that is being made in Queensland towards providing universal access to publicly funded models of care (Donnellan-Fernandez et al., 2020).

2017 data for Queensland health services provided information about the number of services offering a midwifery continuity of carer model and the number of full-time equivalent midwives employed in such models. Assuming that each full-time equivalent midwife provided care to 35 women annually formed the basis of the model.

Almost 40,000 births occurred in public hospitals (excluding the Mater) in 2017. Overall, 18% of Queensland women who gave birth that year would have had access to a midwifery continuity of care model. When comparing hospitals by the number of births, geographical location, and whether they operated as a tertiary referral service, significant variations were present. Hospitals with a birth rate of 500 – 2000 births had the lowest estimated access to midwifery continuity of care at 11%. 11,830 women gave birth in these hospitals, almost 30% of the births in 2017.

Three large tertiary hospitals were the site of another 30% of the births. 17% of women giving birth in these facilities were estimated to have access to midwifery continuity of care. Five remote hospitals (providing birth care for 2%) had the highest rate of access at 77%, however this rate was noted to not reflect the full picture for these services. High rates of both planned and emergent antenatal and intrapartum transfer (from 30 to 90%) have been reported for these services. The estimated rates of access to midwifery continuity of carer include women who received antenatal and / or postnatal care in these five hospitals, but who gave birth elsewhere, therefore providing an artificially high estimate.

The authors concluded:

“scaling-up continuity of midwifery care models remains an important public health strategy to address equitable service access and disparate maternal and infant health outcomes.”

References
All Party Parliamentary Group on Global Health (APPGGH). (2016). Triple Impact Report. How developing nursing will improve health, promote gender equality and support economic growth. 

Berwick, D.M., Nolan, T.W., & Whittington, J. (2008). The triple aim: Care, health, And cost. Health Affairs, 27(3), 759-769.

Donnellan-Fernandez, R. E., Creedy, D. K., Callander, E. J., Gamble, J., & Toohill, J. (2020, Aug 28). Differential access to continuity of midwifery care in Queensland, Australia. Australian Health Review, in press. https://doi.org/10.1071/AH19264

Forster D.A., McLachlan, H.L., Davey, M.A., et al. (2016). Continuity of care by a primary midwife (caseload midwifery) increases women’s satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial. BMC Pregnancy Childbirth, 28, 2016.

Koblinsky, M., Moyer, C., Calvert, C., Campbell, J., Campbell, O., Feigl, A., Graham, W., Hatt, L. Hodgins, S., Matthews, Z., McDougall, L., Moran, A., Nandakumar, A., Langer, A. (2016). Quality maternity care for every woman everywhere: a call to action. Lancet, 388, 2307-2320.

Renfrew, M., Ateva, E., Dennis-Antwi, J., Davis, D., Dixon, L., Johnson, P., Powell Kennedy, H., Knutsson, A., Lincetto, O., McConville, F., McFadden, A., Taniguchi, H., Ten Hoope Bender, B., Zeck, W. (2019). Midwifery is a vital solution—What is holding back global progress? Birth, 46, 396-399.

Sandall, J., Soltani, H., Gates, S., Shennan, A., Devane, D. (2016). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, CD004667.

United Nations. (2019). The Sustainable Development Goals Report 2019. Department of Economic and Social Affairs: UN. New York.

Psychological trauma regarding birth and helpful responses – Podcast

This week is Birth Trauma Awareness week. There is increasing recognition that a significant proportion of women describe some aspect of their birth as traumatic. This week provides an opportunity to focus on what can be done to prevent, and respond appropriately to, women’s experiences of their births as a form of psychological trauma.

Professor Jenny Gamble, Director of Transforming Maternity Care, recorded a podcast with Annalee Atia from Pregnancy Birth and Beyond earlier this week. In the podcast Professor Gamble explained that women may experience their birth as traumatic if they feel that there was threat to their life or safety or their baby’s (or babies’) life or safety. About 30% of Australian women report that their birth was traumatic and have some trauma symptoms at 4-6 weeks after birth.

All women should be asked about their birth experience and provided with sufficient time and empathy to be able to talk about it. The process of care is key to whether women experienced birth as traumatic. Technically poor care, failures of communication, care with coercion and without consent, and excluding the woman from decision making contribute to experiencing the birth as traumatic.

Human intent in the harm or threat experienced is significant in the development of traumatic stress and PTSD. If women feel their trust was betrayed or that they received treatment with callous disregard they are more likely to experience birth as traumatic.

The podcast explains helpful early responses for maternity care providers and others. For some women, following the trauma and the struggle to cope and work through the impact of their birth experience, report positive change and growth. These women are beacons of hope and often an empathetic ‘home’ for others experiencing adversity.

You can listen to the Podcast here. Other events held during Birth Trauma Awareness week are hosted on the Facebook page of the Maternal Mental Health Matters Australia 2020 group, along with helpful resources for people who have been affected by birth trauma.

Mental health screening during pregnancy and after birth is even more important right now

Professor Debra Creedy 

Up to 15% of pregnant women in Australia, and 21% of mothers of infants up to four months of age will experience depression. The presence of anxiety, which frequently co-exists with depression, is estimated to also be as high as 20%. Depression during pregnancy and/or the postpartum period can have profound effects on not only a woman’s long-term health and well-being but can also adversely affect her relationship with the baby and her partner.

We currently don’t know the impact of life changes and restrictions related to COVID 19 on the emotional wellbeing of childbearing women. A systematic review of clinical outcomes of 3559 hospitalised patients (in 72 different studies) was published in the Lancet (18th May, 2020). Rogers and colleagues concluded that if the pattern for COVID 19 follows that of similar pandemics (such as SARS in 2002) many admitted patients will experience confusion, acute depression, anxiety, and sleep difficulties. After the illness, 32.2% patients from these combined studies reported post-traumatic stress, and around 15% reported symptoms of depression and anxiety. This data highlights the importance of assessing the emotional wellbeing of not only people with COVID19 but for members of the community who may be at risk, such as pregnant women. However, the approach to screening for depression and/or anxiety during pregnancy and the postpartum varies a great deal.

In an effort to promote common approaches to assessment and measurement of patient outcomes and experiences, core outcome sets are being developed for a range of conditions and used in practice. A core outcome set is an agreed set of outcomes that should be measured and reported. In 2016 the International Consortium for Health Outcomes Measurement (ICHOM) published a core outcome set to evaluate value in maternity care. Acknowledging mental health as an outcome important to women, the ICHOM Working Party included the Patient Health Questionnaire (PHQ-2) and the Edinburgh Postnatal Depression Scale (EPDS) to measure symptoms of perinatal depression.

Currently in Australia, United States, and Canada clinical guidelines recommend that all women should be screened during pregnancy and at least once in the postpartum using the Edinburgh Depression Scale (EPDS). Whereas in the United Kingdom, health professionals undertake selective screening using two brief questions similar to the PHQ-2 – During the past 2 weeks, have you been bothered by (1) ‘feeling down, depressed or hopeless’; and (2) ‘little interest or pleasure in doing things’. If a woman says ‘yes’ (been bothered for several days =1; more than half the days = 2; or nearly every day =3) to one or both questions, then she is asked to complete the EPDS (10 questions). Subsequently, ICHOM recommended using the 2-item PHQ-2 to screen all women, followed by the EPDS if a woman obtains a score of 3 or more (known as a ‘positive’ screen). But the extent to which the PHQ-2 could correctly identify and not miss childbearing women at risk of depressive symptoms had not been tested and further research was needed.

We aimed to compare the screening accuracy of the PHQ-2 to identify women at risk of probable depression during pregnancy and the postpartum. We recruited 309 pregnant women who completed the PHQ-2 and EPDS (at their booking-in appointment around 36-weeks) and postpartum (at 6 and 26-weeks) 4.

The accuracy of the PHQ-2 was tested using two methods (1) scored cut-points >2 and >3, and (2) dichotomous yes/no (positive response to either question) against EPDS cut-points for probable major and probable minor depression. We were interested in the ‘sensitivity’ of the tool – that is, the ability of the PHQ-2 to correctly identify women with depression (known as the true positive rate), and ‘specificity’ – the ability of the PHQ-2 to correctly identify those women who do not have depression (true negative rate).

Our analysis revealed that the dichotomous yes/no (positive response to either question) had the highest sensitivity (81 – 100%). While specificity was low (60 – 74%) we felt that this shortcoming was outweighed by the ability of the PHQ-2 to correctly identify those women at risk for depression.

COVID19 will challenge the mental health of many people in our community, so we shouldn’t stop mental health screening. Our research highlights the importance of supporting women’s mental health through pregnancy and the first year post birth, and why having screening tools that are simple, easy to use tools, and ‘fit for purpose’ in the face of changes to care provision are important. Women receiving continuity of care from a known midwife throughout pregnancy and up to 6 weeks postpartum are more likely to be screened for depression and are more likely to confide in their midwife about concerns and worries.

Towards value-based maternity care: Validation of the ICHOM Standard Set for Pregnancy and Childbirth

Valerie Slavin, PhD candidate, Midwife, Transforming Maternity Care Collaborative, Griffith University & Gold Coast University Hospital

Professor Jenny Gamble, Transforming Maternity Care Collaborative, Griffith University

Professor Debra Creedy, Transforming Maternity Care Collaborative, Griffith University

Maternity services aim to provide high quality and high value care that women want to access. A challenge lies in how to measure the quality and value of maternity care. In Australia, evidence of widespread variation in maternity care, costs, and outcomes suggests over-use of services for some women and under-use for others. Unexplained variation raises concerns regarding the equity, effectiveness, and efficiency of care.

Traditional maternity measures used to report on the quality of maternity care are limited and generally focus on outcomes such as mortality, mode of birth, post-partum haemorrhage, and severe perineal trauma; or processes such as induction of labour, postnatal readmission, or length of stay. Although these are important outcomes, in isolation they reveal little about performance, quality, or value of maternity care.

Having tools that can reliably report on a range of outcomes over time, and that are important to childbearing women, care providers, and healthcare funding bodies, provides a means to inform real-time clinical decision-making, monitor and benchmark performance, and drive quality improvement activities.

PROMs and PREMs

Person-reported outcome/experience measures (PROMs/PREMs) can supplement traditional measures by assessing the efficacy of maternity care and interventions from the woman’s perspective. Without consistent use of the same questions however, data generated from PROMs and PREMs are of limited value.

Standardised outcome measures

Standard Sets are collections of standardised outcomes and instruments. They represent the missing link to measure the quality and value of care but must be developed using rigorous methods. Since 2012 the International Consortium for Health Outcomes Measurement (ICHOM) has been developing global Standard Sets including outcomes, measurement tools, time-points, and risk adjustment factors to improve value-based healthcare. In 2016 ICHOM developed a Standard Set to measure the value of maternity care which included measures of health-related quality of life, incontinence, emotional wellbeing, pain during sex, birth experience, breastfeeding experience and self-efficacy, and mother infant bonding. To be implemented in practice, maternity services must have confidence that the outcomes and measures included in the Set were developed using rigorous methods and that the measures are valid and reliable in childbearing women. Until recently, the quality of the set had not been evaluated.

Ensuring the validity of PROMs in maternity care

As a group of researchers from the Transforming Maternity Care Collaborative we evaluated the quality and feasibility of the ICHOM Standard Set for Pregnancy and Childbirth. Firstly, we conducted two systematic reviews to assess the quality of the Standard Set development process (manuscript currently under review), and the quality and suitability of the PROMs included in the Set. While the Set was developed using rigorous methods, five included PROMs had not been previously been validated in childbearing women.

We conducted a program of work to evaluate the psychometric performance of these unvalidated PROMs in childbearing women. We conducted a study with 309 consecutive women from one large tertiary hospital in Queensland and collected survey data at five time-points as prescribed by ICHOM (at booking, and 36 weeks of pregnancy and one, six and 26 weeks after birth). We also collected electronic hospital data at six weeks following birth. We provided women with the option of using a tablet device while attending an antenatal care visit, electronic survey completion on their own device, or to complete the survey by phone with the research midwife. The ICHOM Standard Set was acceptable to women. Almost all women invited agreed to participate (95%), and response rates were high at all time-points; being highest at booking (92%) and lowest at 26-weeks post birth (71%).

We conducted psychometric analysis on five PROMs and developed recommendations and/or refinement of the tools to measure health related quality of life (Slavin, Gamble, Creedy, Fenwick, & Pallant, 2019), urinary and anal incontinence (Slavin, Gamble, Creedy, & Fenwick 2019; Slavin, Creedy, & Gamble, 2019), depression symptoms (Slavin, Creedy & Gamble, 2020a), and social support (Slavin, Creedy and Gamble, 2020b).

Our findings support the implementation of the revised Standard Set for Pregnancy and Childbirth to measure value of maternity care. If your health service is interested in using the ICHOM Standard Set and you would like assistance designing methods for women to report their experiences, our study team can assist you.

References
Slavin, V., Gamble, J., Creedy, D. K., Fenwick, J., & Pallant J. (2019). Measuring physical and mental health during pregnancy and postpartum in an Australian childbearing population – validation of the PROMIS Global Short Form. BMC Pregnancy and Childbirth, 19, 370.

Slavin, V., Gamble, J., Creedy, D. K., & Fenwick, J. (2019). Perinatal incontinence: Psychometric evaluation of the International Consultation on Incontinence Questionnaire –Urinary Incontinence Short Form and Wexner Scale. Neurology and Urodynamics, 38(8), 2209-2223.

Slavin, V., Creedy, D. K., & Gamble, J. (2019). Benchmarking outcomes in maternity care: Perinatal incontinence–a framework for standardised reporting. Midwifery, 102628, 1-11.

Slavin, V., Creedy, D. K., & Gamble, J. (2020a). Comparison of screening accuracy of the Patient Health Questionnaire–2 using two case-identification methods during pregnancy and childbirth. BMC Pregnancy and Childbirth, 20, 211.

Slavin, V., Creedy, D. K., & Gamble, J. (2020b). Single Item Measure of Social Supports: Evaluation of construct validity during pregnancy. Journal of Affective Disorders, 272, 91-97.

Transforming maternity care requires the full contribution of the midwifery profession

Adjunct Professor Jocelyn Toohill PhD

Midwives play a critical role in healthcare. Unfortunately, most health leaders, and many health professionals have little understanding of what midwives can do. As a consequence, we have a significantly under-recognised and underutilized midwifery workforce relative to their scope of practice. For communities to have access to the highest standard of maternity care, and for health services to deliver world-class care we must have a midwifery workforce who are supported to work to full scope of practice.

Why is this important?

The “State of the World’s Midwifery” report is the 3rd international report to be published with a global focus to improving availability, accessibility, acceptability, and quality midwifery care. Importantly the report will demonstrate that “Power Comes from the Womb” and will be published by the United Nations Population Fund in 2021. This report will outline the 60-fold benefit that will come from investing in midwifery and highlight the impact midwifery can achieve through adopting a lifetime approach to care. Eighty-seven percent of all essential sexual, reproductive, maternal and newborn healthcare can be provided by midwives. Fifty-six maternal and neonatal outcomes are improved through midwifery practice alone. If we want a first-class health system, we must begin by acknowledging the value of midwives in saving lives and preventing lifetime morbidity, and midwives must be ready to meet this welcome but long overdue recognition.

Acknowledge

To make use of the all the opportunities quality midwifery care might provide for Queensland communities, we need to begin by knowing our existing midwifery workforce. Midwifery is relatively invisible within workforce systems, and is confused within a career structure not designed for the profession . We need to develop and articulate more clearly midwifery position description and generic level statements, that describe what it is that midwives do, when they do it, and where they do it.

Midwives are regulated to provide woman-centred care, and to promote normal physiology for women, both with and without complexities. When a woman has physical, medical, or psycho-social challenges her care does and will include members of the multidisciplinary team and will be guided by the Australian College of Midwives National Consultation and Referral Guidelines. Often health professionals have little understanding of the education preparation or lifesaving skills and knowledge midwives have and this lack of understanding of the scope of a midwife contributes to fragmented care for the woman and disrupts away from providing relationship based care within midwifery continuity. As such the professional role of the midwife must be articulated and embedded in human resource management systems, so that workforce numbers and workforce planning are focused to achieve best practice models where every woman has access to her own midwife. To promote and progress this, midwives must be included in all discussions to have a voice with executive health staff relating to the importance of midwives and of midwifery care.

Innovate

To innovate maternity care, midwifery continuity of carer models need to be scaled up. Despite overwhelming evidence of benefit, few women have access to this model of midwifery care. By tapping into the benefits to women and their families of consistent professional support from midwives during the first 1,000 days of life, we can provide a continuum of connected care and a professional career pathway for midwives that is integrated with child health. We recognise that a consistent and trusted carer means that psychosocial health needs, such as postnatal depression and domestic and family violence, are more likely to be identified earlier and addressed.

Home birth

Queensland is one of only two Australian jurisdictions without publicly funded homebirth. Homebirth is safe and provides improved outcomes in the right population of women. Queensland has strong consumer interest for home birth. During COVID-19 private midwives have reported a 35% increase in homebirths, and higher levels of demand than they can meet. There are concerning reports suggesting that women are giving birth without a midwife or doctor because they cannot afford a private midwife and are fearful of birthing in a hospital. Public health messaging of the safety of birth in hospital has not diminished the numbers of women continuing to seek out this choice. Equity of access to maternity and birth care that is physically and psychologically safe is important. Identifying opportunities for how homebirth could be facilitated remains a significant gap, with ‘hospital in the home’ arrangements perhaps an option.

Birthing on Country

Actioning and embedding culturally appropriate care and acknowledging the importance of birthing on country to Aboriginal and Torres Strait Island women is paramount in providing a world class health system and achieving sustainable development goals. Scaling up midwifery continuity of care with Aboriginal and Torres Strait Island women is vital. A major contributor to poor outcomes for Aboriginal and Torres Strait Island women is preterm birth, and we know that this is reduced by 50% where mothers receive midwifery continuity of care. Through implementing recommendations of the Queensland Rural Taskforce Report, maternity care can be provided closer to home and build continuity models. Technology will be a major conduit for midwives to connect women living rurally with specialist services.

Transform

Transforming maternity care will only come from the realisation of the full capacity of the midwifery profession. Currently, there are few midwives who have graduated in the past 12 years from a Bachelor of Midwifery program holding leadership roles. In 2018 surveys showed that contemporary midwifery education and practice remain poorly understood, with significant numbers of midwives indicating they were restricted from working to their full scope of practice. For those in leadership roles, a clear understanding of the differences between nursing and midwifery is necessary to grow and show the benefits of the midwifery workforce. Upon graduation midwives should be articulated directly to continuity models rather than restricted to and deskilled in historical and fragmented graduate programs. Ensuring culturally appropriate support is in place to attract and retain Aboriginal and Torres Strait Islander midwives is also key to building an equitable and inclusive workforce.

Additionally, through ensuring all women have access to a midwife – and specifically within a relationship-based continuity model where they are working to full scope – will assist in addressing the one in three women who have trauma symptoms from a poor birth experience or from feelings of having been treated disrespectfully. The protective factor for women is having a known midwife who understands her needs. Trust builds over time through cumulative education, information sharing, and decision-making, where the woman can feel confident in her midwife’s advocacy of her needs. Through this support – and regardless of birth or maternity outcome – the woman’s feelings of safety and control are likely to result in improved perinatal mental health, adaption to early parenting and greater capacity to meet the developmental needs of her child. Women who receive midwifery care are more likely to feel empowered, experience shared decision making and be more satisfied with their care.

Summary

For ongoing improvements in maternity care to be achieved we need to make the best use of our existing workforce by expanding opportunities for midwives to provide continuity of care. We need to be ready for the recommendations coming from the State of the World’s Midwifery report.

All midwives – regardless of the model they choose to work – in are vital to promoting the profession and to achieving a world class maternity system. Midwives are potent, and we must ensure that how midwives are educated and regulated to work is supported, translated to practice, and for women to have increased access. It has been said previously, that if midwifery were a pill, everyone would be prescribed it. I commend all midwives to primarily advocate for women, but fundamentally understand that universal access to best practice midwifery continuity is dependent on us all.

While our profession is predominantly women, all midwives, regardless of gender must safeguard gender equality. We must call out poor care or inequity. To be effective we must continue to strengthen our profession and stand united so women know, our communities know, and our governments know who we are, what we do and why midwifery is so fundamentality important to women, to strong communities and to generational health. Without this commitment the usefulness of the 2021 State of the World’s Midwifery report to our profession may be lost.

New research from the Transforming Maternity Care Collaborative Team

Collectively, the Transforming Maternity Care Collaborative generate a large volume of high quality, impactful research. This week has seen the publication of five new papers from our team members in the Women and Birth journal. You can access the full text of each of these via the links below. Settle in with a cuppa and enjoy getting up to date.

Intrapartum CTG monitoring does not improve perinatal outcomes.

Authors: Dr Kirsten Small, Associate Professor Mary Sidebotham, Professor Jennifer Fenwick, Professor Jenny Gamble.

This systematic literature review identified all randomised controlled trials and non-experimental evidence which has examined whether the use of CTG monitoring during labour rather than intermittent auscultation reduces perinatal mortality or cerebral palsy rates in babies born to women considered to be at high risk. No improvement in mortality was found, while an increase in the cerebral palsy rate was noted when CTG monitoring was used during preterm labour.

“High-quality research is urgently required to identify which women, if any, obtain a perinatal benefit from intrapartum CTG monitoring.”

Access this paper here.

Measuring midwifery students’ experiences of learning in clinical practice environments.

Authors: Ms Marnie Griffiths, Professor Jennifer Fenwick, Professor Jenny Gamble, Professor Debra Creedy.

Learning in a clinical environment is a key component of a comprehensive midwifery education program. Being able to measure how well specific learning environments support midwifery students as they develop the knowledge and skills required for professional practice is important. This paper reports on the development and testing of the MidSTEP tool which offers a robust way to capture students’ perceptions of the clinical practice component of their degree. Students indicated high level support for the statements that the clinical environment supported their learning, enabled them to work across the full scope of practice, and fostered a self-directed approach to learning.

Access this paper here.

Placing students in the driver’s seat.

Authors: Ms Valerie Hamilton, Professor Kathleen Baird, Professor Jennifer Fenwick

This research reports on students’ experiences of learning to provide midwifery care in a student-led midwifery clinic providing antenatal and postnatal care. Students who were on-call for individual women were supported to provide antenatal and postnatal care under the supervision and guidance of their university practice lecturer. “Being in the driver’s seat” was the major theme of the findings, with students reporting a sense of being in control and feeling like “a real midwife”. Students described growing in confidence over time and feeling competent to step into practice.

Access this paper here.

Stepping from student to employment through simulated employment interviews.