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BACKGROUND: Whilst most women desire to birth vaginally, research highlights reducing rates of normal physiological birth worldwide. Previous studies have focussed largely on clinical practices associated with vaginal birth however health care professionals' intentions are also known to effect behaviour; a factor not well understood within the context of midwifery and normal physiological birth. QUESTION/AIM: To explore factors influencing midwives' intentions to facilitate normal physiological birth. METHODS: A qualitative study using individual interviews was conducted. The Theory of Planned Behaviour was used to develop a semi-structured interview guide to gather perceptions, thoughts, knowledge, and experience of normal physiological birth from participants. Data were analysed thematically within the theoretical constructs: attitudes, subjective norms, and perceived behavioural control. FINDINGS: Fourteen midwives from various practice settings, models, and locations in Australia were interviewed. Major factors influencing midwives' intentions to facilitate normal physiological birth were influenced by workplace culture, values and influence of leaders, the need to prioritise collaborative interdisciplinary relationships and support autonomy in midwifery. DISCUSSION: Factors influencing the midwives' intentions of facilitating normal physiological birth were multifaceted. Some influences are more obvious and observable through practice, while others were rooted in underlying beliefs and attitudes that were hidden in the subconscious of those involved. However, all contributing influences ultimately shape midwives' intentions and the way in which they facilitate normal physiological birth. CONCLUSIONS: Midwives intend to support normal physiological birth; however multiple factors influence their intentions over time. Prioritising collaborative interdisciplinary relationships and supporting autonomy in midwifery could address known barriers.

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BACKGROUND: The Family Community-based Assistance Resourcing and Education Program (FCP) is a nurse home visiting program that was introduced in Queensland two decades ago to redress health inequalities for infants from families experiencing specific social stressors. Locally adapted versions of this home visiting program are still in use, but have not been evaluated. This study examined child health nurse perceptions of the adapted FCP in one regional Queensland health service. METHODS: A qualitative descriptive exploratory study using two focus groups (conducted May 2019) with Child Health Nurses who delivered the FCP was conducted. Transcripts of digital recordings were analysed using Braun and Clarke's (2006) six-step framework for guided thematic analysis. RESULTS: A total of 16 Child Health Nurses participated in the study, with a mean of 10years' experience with the program. Data analysis generated 12 themes organised under three domains: 'Establishing the relationship with families', 'What works in practice' and 'We could do it better'. Participants cited flexibility, expert input and in-home delivery as key program benefits. However, narrow eligibility criteria, poor screening for perinatal anxiety and resourcing constraints were identified as limitations. CONCLUSIONS: This study is the first to measure Child Health Nurses' perceptions of an adapted FCP. It sheds light on their 'practice wisdom', including the program's ability to meet the needs of families with social vulnerabilities. The study supports prior calls for home visiting programs to be evaluated against clearly stated program intentions. Participant insights have been shared to inform practice and program implementation both locally and as part of Queensland's First 2000Days health service delivery reform agenda.

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PROBLEM: Spontaneous vaginal birth (SVB) rates for nulliparous women are declining internationally. BACKGROUND: There is inadequate understanding of factors affecting this trend overall and limited large-scale responses to improve women's opportunity to birth spontaneously. AIM: To undertake a descriptive systematic review identifying factors associated with spontaneous vaginal birth at term, in nulliparous women with a singleton pregnancy. METHODS: Quantitative studies of all designs, of nulliparous women with a singleton pregnancy and cephalic presentation, who experienced a SVB at term were included. Nine databases were searched (inception to October 2022). Two reviewers undertook quality appraisal; Randomised Controlled Trials (RCTs) with high risk of bias (ROB 2.0) and other designs with (QATSDD) scoring ≤ 50% were excluded. FINDINGS: Data were abstracted from 90 studies (32 RCTs, 39 cohort, 9 cross-sectional, 4 prevalence, 5 case control, 1 quasi-experimental). SVB rates varied (13%-99%). Modifiable factors associated with SVB included addressing fear of childbirth, low impact antenatal exercise, maternal positioning during second-stage labour and midwifery led care. Complexities arising during pregnancy and regional analgesia were shown to decrease SVB and other interventions, such as routine induction of labour were equivocal. DISCUSSION: Antenatal preparation (low impact exercise, childbirth education, addressing fear of childbirth) may increase SVB, as does midwifery continuity-of-care. Intrapartum strategies to optimise labour progression emerged as promising areas for further research. CONCLUSION: Declining SVB rates may be improved through multi-factorial approaches inclusive of maternal, fetal and clinical care domains. However, the variability of SVB rates testifies to the complexity of the issue.

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PROBLEM: Limited opportunity exists for new graduates in Australia to be employed in continuity of care midwifery models. AIM: To explore the perspectives of midwifery mentors supporting new graduate midwives employed in continuity of care models. METHODS: An interpretive, qualitative study was conducted. Semi-structured interviews and focus groups with senior midwifery staff who mentored new graduate midwives during their transition to practice within a continuity of care model were undertaken. Digitally recorded and transcribed verbatim, data were thematically analysed. Data collection ceased once theoretical saturation had been achieved. NVIVO software was used to assist with coding and data management. FINDINGS: Twelve mentors participated. Mentors provided valuable feedback to optimise the supportive mechanisms to enable the success of the rotation of new graduate midwives in continuity of care models during their transition to practice period. Three key themes were constructed, including: Getting it right in the first place; Nurturing our new midwives; and The cultural void. DISCUSSION: Consistent with the wider literature, effective implementation, sound support structures and wider acceptance of new graduate midwives transitioning to practice within continuity of care models is crucial to its success and sustainability. CONCLUSION: Mentors are responsible to nurture, respect and guide new midwives through this crucial period, as they transition from midwifery student to registered midwife. Mentors believe in the transition of new graduate midwives in continuity of care models.

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INTRODUCTION: Implementation of interprofessional education (IPE) is recognised as challenging, and well-designed programs can have differing levels of success depending on implementation quality. The aim of this review was to summarise the evidence for implementation of IPE, and identify challenges and key lessons to guide faculty in IPE implementation. METHODS: Five stage scoping review of methodological characteristics, implementation components, challenges and key lessons in primary studies in IPE. Thematic analysis using a framework of micro (teaching), meso (institutional), and macro (systemic) level education factors was used to synthesise challenges and key lessons. RESULTS: Twenty-seven primary studies were included in this review. Studies were predominantly descriptive in design and implementation components inconsistently reported. IPE was mostly integrated into curricula, optional, involved group learning, and used combinations of interactive and didactic approaches. Micro level implementation factors (socialisation issues, learning context, and faculty development), meso level implementation factors (leadership and resources, administrative processes), and macro level implementation factors (education system, government policies, social and cultural values) were extrapolated. Sustainability was identified as an additional factor in IPE implementation. CONCLUSION: Lack of complete detailed reporting limits evidence of IPE implementation, however, this review highlighted challenges and yielded key lessons to guide faculty in the implementation of IPE.

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OBJECTIVE: To map and synthesise the literature underpinning the transition to practice for new graduate midwives internationally, with a focus on continuity of care and traditional transition to practice models. DESIGN: Scoping review of the literature METHODS: Relevant databases were searched to identify primary research studies. Key words, Boolean terms, and an inclusion/exclusion criterion were used to extrapolate key pieces of research. All study types and methods published in English between 2008 - May 2021 that met the inclusion criteria were considered. FINDINGS: 20 studies met inclusion criteria. These were conducted in Australia, the United Kingdom, and New Zealand. New graduate midwives' value structured rotations and feel very supported in continuity models, where strong mentorship and support are offered. Within this context confidence was promoted as a new practitioner. Upholding woman-centred care in busy hospital environments was a key challenge. KEY CONCLUSIONS: Emerging literature indicates new graduate midwives' transition optimally within a continuity model, however more research is needed. IMPLICATIONS FOR PRACTICE: Transitioning midwives into practice within continuity of care midwifery models may address workforce attrition and enhance early career midwife confidence.

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AIMS: The aim of this study was to examine the potential association of family-centred care as perceived by parents during a NICU stay with parents' depressive symptoms at discharge and at 4 months corrected for infant age. DESIGN: A longitudinal, multicentre cohort study was conducted from 2018 to 2020 in 23 NICUs across 15 countries. METHODS: Parents (n = 635 mothers, n = 466, fathers) of infants (n = 739) born before 35 weeks of gestation and admitted to the participating NICUs were enrolled to the study during the first weeks of their infants' hospitalizations. They responded to Digi-FCC daily text messages inquiring about their perception of family-centred care provided by NICU staff. In addition, they completed a questionnaire assessing their overall perception of family-centred care at discharge. Parents' depressive symptoms were measured by the Edinburgh Postnatal Depression Scale at discharge and again after discharge when their infants were at 4 months corrected for age. RESULTS: The mothers' and the fathers' perceptions of family-centred care were associated with their depressive symptoms at discharge and at 4 months corrected age, controlling for gestational age, multiple birth, parent education and relationship status. Parents' participation in infant care, care-related decisions and emotional support provided to parents by staff explained the variation in the parents' perceptions of family-centred care. The factors facilitating the implementation of family-centred care included unlimited access to the unit for the parents and for their significant others, as well as amenities for parents. CONCLUSIONS: Our study shows that family-centred NICU care associates with parents' depressive symptoms after a NICU stay. IMPACT: Depression is common in parents of preterm infants. The provision of family-centred care may protect the mental well-being of parents of preterm infants.

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Minimal research has examined psychological processes underpinning ultra-marathon runners' performance. This study examined the relationships between mental toughness and self-efficacy with performance in an elite sample of ultra-marathon runners competing in the 2019 Hawaiian Ultra Running Team's Trail 100-mile endurance run (HURT100). The Mental Toughness Questionnaire (SMTQ) and the Endurance Sport Self-Efficacy Scale (ESSES) were completed by 56 elite ultra-marathon runners in the HURT100 (38 males, 18 females; Mage = 38.86 years, SDage = 9.23). Findings revealed mental toughness and self-efficacy are highly related constructs (r(54) = 0.72, p < 0.001). Mental toughness and self-efficacy did not significantly relate to ultra-marathon performance (mental toughness and self-efficacy with Ultra-Trail World Tour (UTWT) rank F(2, 53) = 0.738, p = 0.483; mental toughness and self-efficacy with likelihood would finish the HURT100 χ2 = 0.56, p = 0.756; mental toughness and self-efficacy with HURT100 placing and time F(2, 53) = 1.738, p = 0.186 and F(2, 30) = 2.046, p = 0.147, respectively). However, participants had significantly and meaningfully higher mental toughness (M = 45.42, SD = 4.26, medium and large effect sizes) than athletes from other sports previously published. Our interpretation is that these results taken in conjunction, suggest a threshold of mental toughness that performers require to be of the standard needed to be able to prepare for and compete in elite ultra-marathon events such as the HURT100; once this mental toughness threshold is met, other factors are likely to be more influential in determining elite level ultra-marathon performance.

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BACKGROUND: Physical and emotional parent-infant closeness activate important neurobiological mechanisms involved in parenting. In a neonatal care context, most research focuses on physical (parental presence, skin-to-skin contact) aspects; insights into emotional closeness can be masked by findings that overemphasise the barriers or challenges to parenting an infant during neonatal care. AIM: To explore existing qualitative research to identify what facilitates and enables parents' experiences of emotional closeness to their infants while cared for in a neonatal unit. STUDY DESIGN: A systematic review using meta-ethnographic methods. Search strategy involved searches on six databases, author runs, and backward and forward chaining. Reciprocal translation was used to identify and compare key concepts of parent-infant emotional closeness. RESULTS: Searches identified 6992 hits, and 34 studies from 17 countries that involved 670 parents were included. Three overarching themes and associated sub-themes were developed. 'Embodied connections' describes how emotional closeness was facilitated by reciprocal parent-infant interactions, spending time as a family, and methods for parents to feel connected while physically separated. 'Inner knowing' concerns how knowledge about infant and maternal health and understanding the norms of neonatal care facilitated emotional closeness. 'Evolving parental role' relates to how emotional closeness was intertwined with parental identities of contributing to infant health, providing direct care, and being acknowledged as a parent. CONCLUSION: Parent-infant closeness evolves and is facilitated by multifaceted biopsychosocial factors. Practice implications include creating private and uninterrupted family time, strategies for parents to maintain an emotional connection to their infant when separated, and neurobiology education for staff.

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PROBLEM: Despite high quality evidence supporting midwifery continuity of care, access to this model is limited in many parts of Australia and internationally. BACKGROUND: The models of care provided to women have a strong influence on their perinatal experience and clinical outcomes. Midwifery Continuity of Care (CoC) is arguably the most significant factor in enhancing women's clinical outcomes during child-bearing and facilitating a positive childbirth experience. Health system change is required, yet little literature has detailed the actualisation of this in the context of upscaling midwifery CoC. RESEARCH QUESTION/AIM: This study aimed to explore the perceptions and experiences of midwifery and obstetric staff during the implementation and upscaling of midwifery CoC within a regional hospital and health service in coastal Queensland, Australia. METHODS: A single-site, qualitative enquiry. Obstetricians and midwives participated in semi-structured interviews or focus groups at two-time points: within 2 months of introduction of the CoC service (obstetricians n=6; midwives n=15); and 2-years after implementation (obstetricians n=5; midwives n=17). Data were analysed thematically. FINDINGS: Four key themes and several categories were generated from the data: hopes and expectations; clinical and practice changes; organisational and structural change; and, future directions. DISCUSSION: Organisational culture, structural change, communication processes and collaborative relationships can be used to inform future scale-up and sustain midwifery caseload care. Specifically, communication, inter-disciplinary collegial relationships, and managerial support are crucial to the sustainability and ultimate upscaling of caseload midwifery care. CONCLUSION: System change is challenging, but in order to improve access to midwifery CoC is necessary.

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