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Background: Despite global support for midwifery leadership investment, there is a notable lack of scientific evaluations of leadership programmes worldwide for midwives. The Government of India's Midwifery Initiative launched the Midwifery Leadership Programme to enhance the leadership capacity of state-level midwifery leaders. Aim: To evaluate the Midwifery Leadership Programme in India using implementation science as a framework. Methods: A qualitative research design using the UK Medical Research Council guidance for process evaluation of a 12-week midwifery leadership programme in India. Data were collected through focus group discussions (n=6) with midwives and medical doctors, who have responsibility in maternal and child health services, midwifery education, practice and regulation, and individual interviews (n=3) with programme directors and a government representative, resulting in an individual participant total of 22. Transcribed discussions were analysed guided by an evaluation framework, using content analysis. Results: The midwifery leadership programme was successfully implemented in terms of fidelity, dose, and reach, with continuous adaptations. Having the programme's design, structure, and content tailor-made for the Indian context was valued highly. Easy-to-follow assignments led to state-level action plans, while participants’ motivation and improved communication skills enhanced leadership capacity. Conclusions: This study demonstrates the utility of a process evaluation framework in evaluating midwifery education programmes, using the Midwifery Leadership Programme in India as an example. It is recommended that future research on evaluating midwifery education initiatives adopt implementation science frameworks to evaluate both the implementation process and the mechanisms driving programmes' impact for change, thereby informing the design and delivery of effective midwifery education programmes. © 2024 The Authors

The World Health Organization and the International Confederation of Midwives emphasize the importance of accreditation to enhance quality in midwifery education. In midwifery education programmes, internal self-assessments are used to meet accreditation criteria. However, research on this topic is scarce. Therefore, this paper describes how we plan to conduct an evaluation of an internal quality assurance process in midwifery education aimed at achieving national accreditation standards in Bangladesh. This study has a longitudinal exploratory design and will be guided by the principles of process evaluation of complex interventions. An internal quality assurance self-assessment intervention will be introduced at 31 private and public education institutions in Bangladesh. To ensure a sustainable implementation, the Plan-Do-Study-Act cycle will be introduced. Data will be collected using self-administered questionnaires and focus group discussions with midwifery faculty and final-semester students. Descriptive statistics and regression models will be performed for the quantitative data, and the qualitative data will be analysed using content analysis. It is anticipated that, without internal quality assurance of midwifery education programmes, accreditation alone is unlikely to enhance quality. We aspire for this research project to illustrate a process that the midwifery institutes can implement themselves for sustainable transformation towards high-quality midwifery education in countries where such internal quality assurance processes have not yet been integrated into the education system.Trial registration: The study was registered retrospectively with the ISRCTN registry on 26 August 2024. The registration number is: ISRCTN14492910.

BACKGROUND: Globally, the quality of maternal and newborn care remains inadequate, as seen through indicators like perineal injuries and low Apgar scores. While midwifery practices have the potential to improve care quality and health outcomes, there is a lack of evidence on how midwife-led initiatives, particularly those aimed at improving the use of dynamic birth positions, intrapartum support, and perineal protection, affect these outcomes.

OBJECTIVE: To explore how the use of dynamic birth positions, intrapartum support, and perineal protection impact the incidence of perineal injuries and the 5-min Apgar score within the context of a midwife-led quality improvement intervention.

METHODS: A cohort of 630 women with uncomplicated full-term pregnancies was recruited from a hospital in Uganda. Observations and questionnaires assessed birth positions, intrapartum support, perineal protection, health outcomes and maternal characteristics. Primary outcomes included perineal injuries and the 5-min Apgar scores. The primary outcomes were analysed using descriptive data, with trends visualised through a run chart to assess changes during the midwife-led Quality Improvement intervention. Secondary outcomes included postpartum haemorrhage, admission to neonatal intensive care, newborn resuscitation, skin-to-skin care, and breastfeeding initiation.

RESULT: A statistically significant association was found between women having intact perineum (i.e., no perineal injuries) and giving birth in a dynamic birth position [AOR; 0.6 (95% CI 0.4 - 0.90)], receiving intrapartum support [AOR; 0.9 (95% CI 0.9 - 1.0)], and using perineal protection measures [AOR; 0.3 (95% CI 0.2 - 0.5)]. Newborns with an Apgar score below seven at five minutes were significantly associated with intrapartum support [AOR; 0.8 (95% CI 0.7 - 1.0)] and perineal protection [AOR; 0.3 (95% CI 0.1 - 0.8)]. However, after adjustment, no significant association was found between Apgar score and birth positions [AOR; 0.5 (95% CI 0.2 - 1.5)]. Perineal injuries and low Apgar scores significantly decreased (p < 0.001) during the Midwife-led Quality Improvement intervention period.

CONCLUSION: This study demonstrates that low 5-min Apgar scores and perineal injuries decreased during a midwife-led Quality Improvement intervention focusing on dynamic birth positions, intrapartum support, and perineal protection strategies.

CLINICAL TRIAL: This study is registered on ClinicalTrials.gov as of 14th February 2022, under registration number NCT05237375.

BACKGROUND: The purpose of this study was to compare the effects of two caregiving models on full-term healthy infants' wakefulness, rooting and sucking reflexes, initiation of breastfeeding, and physiological parameters when reunited with their mothers after a mother-infant separation of 130 min after elective cesarean birth.

METHODS: Ninety-five mother-infant pairs participated in a randomized controlled trial, in which full-term healthy infants were allocated to be either dressed in their mothers' arms (n = 56) or skin-to-skin with their mother (n = 39) when reunited with the mother within 130 min after cesarean birth. Data were collected by the Neonatal Behavioral Assessment Scale (NBAS) to assess the infants' wakefulness and prebreastfeeding behaviors. Physiological parameters were assessed at 15 min intervals, from 130 to 205 min after birth. Time to first breastfeed was measured in minutes from the reunion with the mother.

RESULTS: The primary finding was that physiologic parameters did not differ but time for initiation of breastfeeding after the reunion with the mother was significantly faster in the skin-to-skin group compared to the infants in the mothers' arms group (p = 0.005). Over the full study period, a more relaxed state and drowsy were found in the skin-to-skin group compared to the infants in the mothers' arms group.

CONCLUSION: Healthy full-term infants born by elective cesarean, who were cared for by their mothers when reunited within 130 min of separation and cared for by their fathers during the mother-infant separation, initiated breastfeeding successfully and showed stable physiological patterns.

Integrating Sexual Reproductive Health and Rights (SRHR) into educational programs and healthcare services supports the EU Eastern Partnership and the UN's Agenda 2030. A Swedish Institute (SI)-funded project empowers undergraduate students in medicine, psychology, and social work to support SRHR among youth and young adults in wartime and post-war Ukraine by incorporating the subject into university curricula. In August 2024, a study tour to Sweden was conducted by managers and faculty from Ukrainian universities, during which the visitors to Sweden identified the need to establish Youth Clinics at Ukrainian universities to address the SRHR needs of the war-affected youth population.

OBJECTIVE: The aim of this study is to explore the impact of barriers and facilitators on the quality of midwifery care in The Gambia, from the perspectives of clinical midwives, midwifery students, educators, and leaders.

METHODS: A qualitative study based on focus group discussions with 29 clinical midwives, midwifery students, educators and leaders analysed with content analysis. The study was conducted in The Gambia.

RESULTS: The analyses led to three main categories outlining barriers and facilitators for the quality of midwifery care: 1) the gap between theory and practice, 2) working in a harsh environment and 3) facilitating factors that can pave ways forward. The results are described in generic categories: 1a) national plans and facility-based guidelines, 1b) midwifery education, 1c) becoming a skilled midwife, 2a) scarcity of resources, 2b) encountering community barriers, 2c) midwives - a passionate but demotivated profession, 3a) positive assets for quality midwifery care, 3b) women in leadership as a tool for a motivated midwifery workforce and 3c) teamwork.

CONCLUSIONS: Addressing the gaps between theory and practice, and strengthening the incentives for midwives to remain in their profession are central for improved quality of midwifery care in The Gambia. Guaranteed employment after completing education, equal opportunities for men and women to become midwives and the significance of passion are assets which need to be carefully maintained within the health care system.

AIM: To explore the readiness of Bachelor in Midwifery graduates in Nepal to provide midwifery care aligned with the definition competently on graduation and to identify barriers affecting their practice.

BACKGROUND: Nepal has introduced an internationally standardised BSc midwifery education programme designed to enable midwives to work competently and independently in midwifery care on entering the profession.

DESIGN: A qualitative interview study was conducted and analysed using inductive content analysis.

METHODS: Individual interviews were conducted with 8 midwives, 5 educators and 5 students using a guide based on ICM competencies. Participants were recruited from various institutions and universities across Nepal and ethical approval was obtained.

RESULTS: Possibilities and challenges in applying programme content include seven sub-categories: Preparation before clinical education, Midwifery care, The bridging role of midwifery educators, Clinical supervision, Use of evidence-based, respectful and culturally sensitive midwifery practice, independent midwifery practice and Being a role model. The findings indicate that while the BSc programme provides strong theoretical preparation, significant challenges persist in translating this into practice.

CONCLUSIONS: While the BSc midwifery programme theoretically prepares students to work competently and independently in midwifery practice, practical challenges hinder its implementation. Addressing these issues, such as improving clinical support, recruiting qualified midwifery educators and establishing a deployment strategy, can enhance midwives' ability to work independently in midwifery care, ultimately improving health outcomes for women, families and communities.

BACKGROUND: Childbirth in healthcare facilities has increased in South-East Asia and the focus on quality of childbirth care has increased in the region. Without a deeper understanding of women's experience of giving birth in healthcare facilities, the quality of care cannot be improved. The aim of this study was to synthesise available qualitative research from India that explores women's experiences of giving birth in healthcare facilities.

METHOD: A qualitative systematic literature review was conducted in February 2023, using the databases PubMed, CINAHL, and Scopus. We used an inductive content analysis.

FINDINGS: The search identified 6316 articles, 16 of which were included. The overall categories were Lack of dignity and respect, Adequacy of supportive care, and Limited hospital infrastructure and cleanliness, and these were cited by the women to be a deterrent from having their future births at a hospital.

CONCLUSION: There is an urgent need for comprehensive measures to eliminate mistreatment during childbirth, ensure cost-free access to healthcare, and enhance the quality of maternal care. These efforts are essential for improving maternal and neonatal outcomes and promoting positive childbirth experiences for women in India and in other similar settings.

Galkayo University, in an ongoing partnership with Benadir University and the Karolinska Institutet, reports on the co-creation of a mentorship program for midwifery educators at Galkayo University. This program was initiated in Spring 2023 with the aim of sharing experiences on midwifery education between educators from Sweden and Somalia—both countries with long traditions of midwifery care. By leveraging the expertise of Swedish and Somali midwifery educators, the mentorship program seeks to bridge gaps in knowledge and skills, ultimately contributing to better midwifery education and care in both Somalia and Sweden. This commentary describes the significance of the program and its potential for impact if scaled up after contextualization.

BACKGROUND: The maternity continuum of care plays a vital role in improving maternal and neonatal outcomes. However, its uptake remains low in Ethiopia, highlighting the need to identify challenges within the primary health care system to inform practice. Hence, this study aimed to explore the challenges of the maternity continuum of care within the primary health care system in northwest Ethiopia.

METHODS: An interpretive description approach was employed from March 3, 2022, to November 27, 2022, within the primary health care system in northwest Ethiopia. Maximum variation sampling was utilized, comprising 28 in-depth interviews, three focus group discussions with 29 participants, and four key informant interviews. The reflexive thematic analysis method was applied, and the results were mapped onto the constructs of the socio-ecological model.

RESULTS: The analysis identified four main themes: low maternity healthcare-seeking behavior (intrapersonal level), lack of peer and family support (interpersonal level), cultural influences on maternity care and low community responsiveness (community level), and inadequate health system readiness and response (health facility/system level). Some of the sub-themes include low health literacy and self-efficacy and misconceptions regarding maternity care at the intrapersonal level; peer and family pressure against seeking maternity care, low autonomy, and intimate partner violence at the interpersonal level; cultural influences on pregnancy disclosure and postnatal care and low social accountability at the community level; and delays in accessing ambulance services, long waiting times for maternity care, shortages of essential healthcare supplies, poor coordination of care, inadequate monitoring and evaluation, disrespectful maternity care, and dissatisfaction among healthcare workers at the health facility/system level.

CONCLUSION: Intrapersonal, interpersonal, community, and health facility- and system-level challenges have influenced the maternity continuum of care within the primary health care in northwest Ethiopia. Since these challenges are interdependent, considering a holistic approach within primary health care could lead to an improved maternity continuum of care.