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Women who experience fear of birth during pregnancy are more likely to report negative birth experiences. Fear of birth and depressive symptoms may negatively influence women's birth experiences. Midwifery continuity of care (MCoC) models have been shown to improve satisfaction and may help mitigate fear and mental health challenges. To identify profiles of women based on birth experiences and emotional wellbeing after childbirth within MCoC models, and to examine associations with background characteristics, attitudes, and birth outcomes. A longitudinal cohort study was conducted in rural Sweden, including 378 women participating in MCoC models, with high priority on women with fear of birth. Data were collected via questionnaires in mid-pregnancy and two months postpartum. A k-means cluster analysis was performed using the Childbirth Experience Questionnaire (CEQ), Fear Of Birth Scale (FOBS), and Edinburgh Postnatal Depression Scale (EPDS). Three distinct profiles of women emerged based on the instruments included in the cluster analysis. The clusters differed in self-reported health, fear of birth, prenatal attitudes, continuity of care, and mode of birth. Women's attitudes and operative births were the strongest predictors of cluster membership. Continuity with a known midwife distinguished profiles characterised by elevated fear of birth and depressive symptoms. Women's birth experiences and emotional wellbeing cluster into distinct profiles shaped by psychological, relational, and contextual factors. Attitudes during pregnancy and mode of birth are key determinants, while continuity with a known midwife enhances the perception of professional support. Tailoring MCoC models to these profiles may promote more individualized, equitable, and positive care for diverse groups of women.
Pregnant women are increasingly exposed to various sources of information that shape their perceptions of modes of birth. While it is essential to support women's informed decision-making regarding childbirth, particularly where caesarean section (CS) rates are rising, women's perceptions on modes of birth remain poorly understood. To assess women's perceptions of the benefits of vaginal birth and caesarean section. A cross-sectional survey was conducted among a representative sample of postpartum women in 32 participating hospitals in Argentina, Burkina Faso, Thailand, and Viet Nam. The survey included four open-ended questions asking women to list the perceived advantages and disadvantages of planned CS and vaginal birth (VB), which were analysed descriptively. Among the 3127 women included, the most frequently perceived benefits of VB were faster recovery and shorter hospital stay (85.7% of participants) and improved postpartum mobility (55.7%), while few women mentioned its clinical benefits. Women mainly perceived CS as a way of avoiding the disadvantages of VB, namely labour pain (49.2%), emergency CS (26%), or instrumental birth (22.4%). Few women mentioned the benefits of CS itself, such as greater convenience for time management. Vaginal birth is valued by women for practical reasons related to social and domestic imperatives surrounding childbirth. At the same time, they perceive CS as a way to avoid the experience of vaginal birth, which may be considered negative. This study highlights the need to enhance access to effective labour pain management, strengthen psychosocial support, and provide comprehensive information to pregnant women. The QUALI-DEC trial is registered on the Current Controlled Trials website (https://www.isrctn.com/) under the number ISRCTN67214403.
HypnoBirthing is a birth preparation course combining physiological birth information and hypnosis techniques. There is little evidence demonstrating the effect of HypnoBirthing on pharmacological analgesia use or mode of birth. To investigate if the use of HypnoBirthing during labour affects the likelihood of epidural analgesia, other analgesia use, and birth mode. A retrospective cohort design provided data for women with a singleton pregnancy planning a vaginal birth from January 2011 to June 2024. Propensity score matching was used to create equally sized groups based on use of HypnoBirthing. The primary outcome was use of epidural analgesia. The associations with outcomes of interest were estimated in the matched cohort using multivariable analysis and stratified by parity. Following propensity score adjustment of 1322 pairs (885 paired nulliparous; 437 paired multiparous) HypnoBirthing was associated with a significant reduction in epidural analgesia use in nulliparous (OR. 0.50 [95% CI 0.41-0.63]) and multiparous women (OR 0.48 [95% CI 0.35-0.67]). In nulliparous and multiparous women, the use of HypnoBirthing was also associated with a significant reduction in odds of caesarean section birth (nulliparous OR 0.93 [95% CI 0.55-0.88]; multiparous OR 0.41 [95% CI 0.26-0.67]). Use of water immersion increased significantly in both parities. HypnoBirthing is associated with a significant reduction in the use of epidural analgesia, greater use of water immersion, and decreased odds of caesarean section. Our study suggests that the use of HypnoBirthing during labour can further support women's aspirations to avoid pharmacological analgesia and achieve an unassisted vaginal birth.
There are several maternity care models in Australia providing varying levels of continuity of care in the private and public maternity system. These were disrupted to varying degrees during the pandemic. To examine the impact of the five main maternity care models in Australia on perinatal outcomes for women who gave birth during the COVID-19 pandemic and their babies. A national survey, was conducted from March to December 2020, and again from August 2021 to March 2022. A weighted sample of 3682 postnatal women provided information on birthing outcomes. Survey tabulations of prevalence and weighted logistic regressions examined associations between five models of maternity care and perinatal outcomes. Compared with standard care, continuity of care in both public (MWCOC) and private midwife (PPM) models was associated with higher odds of: spontaneous labour (MWCOC AOR 1.66; CI 1.35-2.04; PPM AOR 11.01; CI 0.6.29-19.28), spontaneous vaginal birth (MWCOC AOR 1.84; CI 1.49-2.28; PPM AOR 3.14; CI 2.08-4.73), postnatal midwife visits at home, feeling supported postnatally, feeling the care provider showed commitment, and feeling known by the care provider; as well as lower odds: of induction, elective and emergency caesarean section, augmentation with oxytocin, perceived traumatic birth (MWCOC AOR 0.57; CI 0.45-0.73; PPM AOR 0.49; CI 0.31-0.77), fetal distress, and infant admission to special/neonatal intensive care. Compared to standard care, private obstetric care was associated with lower rates of postpartum haemorrhage, perceived traumatic birth (AOR 0.56; CI 0.45-0.69), spontaneous labour (AOR 0.45; CI 0.37-0.54), spontaneous vaginal birth (AOR 0.54; CI 0.45-0.65), postnatal home visits from a midwife, and higher rates of elective caesarean section (AOR 2.65; CI 2.12-3.30). Continuity of midwifery care models are associated with lower intervention rates and birth trauma compared to standard care. However, for women who seek, or are not concerned about increased obstetric intervention, private obstetric care also leads to lower rates of birth trauma when compared to standard care. Continuity of care models should be prioritised in future disaster events.
Experiencing complications in pregnancy and birth is often associated with poor postpartum health outcomes and can have lasting consequences for women. Understanding women's subjective experiences of pregnancy and/or birth complications and how they feel such experiences impact their current mental health is essential to better inform supports and resources. To explore how women experience and describe their mental health following pregnancy and birth complications in Ireland. We conducted semi-structured interviews with 21 women from February to May 2024. Participants were purposively sampled. Eligible women were ≥ 18 years of age and had been between 12 months and 5 years since experiencing a pregnancy and/or birth complication. Reflexive thematic analysis was used to develop themes and subthemes. We developed four main themes: 1) 'Expectations versus reality' highlighted the disconnect between women's hopes for pregnancy and birth, and the unexpected nature of their actual experiences. 2) 'Unresolved consequences' reflected women's ongoing psychological and mental health challenges, particularly regarding anxiety and concerns for future pregnancies. 3) 'Perception of healthcare experiences' highlighted the importance of effective communication with healthcare providers, 4) 'Support and systems' described interpersonal and structural supports, and networks important to women. Women's experiences of mental health following pregnancy and birth complications are impacted by multiple factors throughout their pregnancy and birth journey. To improve the mental health experiences of women who have pregnancy and/or birth complications, access to information, resources, and supports at interpersonal and structural levels is needed.
There is a growing concern about shortages of midwives. While limited research found motivational factors for staying in the profession, it remains unclear how these factors differ by experience level or work setting. This study aims to determine the proportion of midwives at two levels of professional experience working in community and hospital settings in the Netherlands who intend to stay in the profession, to explore their reasons why, and to identify associated factors. A cross-sectional quantitative survey was conducted among 984 midwives working in community or hospital settings. Participants were grouped by years of experience (≤15 and >15 years). Descriptive statistics, chi-square tests and logistic regression analyses were conducted. Seventy-one percent (n = 542) of community midwives and sixty-eight percent (n = 148) of hospital midwives intended to stay in the profession, and this intention did not differ significantly between experience groups. Reasons for this intention included passion for midwifery, job satisfaction and job variety. Community midwives emphasised autonomy and working with women, whereas hospital midwives highlighted collaboration with colleagues. Across experience levels, intention to stay factors included alignment with midwifery ideology, a positive work-life balance, and psychological resources. Professional relationships, autonomy, and psychological resources (optimism and hope) varied by setting and experience level and should guide the design and organisation of maternity care. Seventy percent of Dutch midwives intend to stay in the profession, driven by passion, professional values, and work-life balance, with setting-specific differences in the importance of autonomy, relationships with women and teamwork.
Stillbirth can have deep and lasting emotional, spiritual, and psychological effects on parents, families, and all those connected to birth. Although respectful, culturally appropriate care after stillbirth is critical, it often varies across settings and population groups. First Nations women in Australia continue to experience higher rates of stillbirth, particularly in remote communities. However, the unique strengths, experiences, and perspectives of these women and communities remain under-researched. To build an understanding of the lived experience of First Nations women whose baby was stillborn in Cape York by documenting the stories of First Nations Elders and health professionals who had provided care and/or support to grieving families. Qualitative study with one-on-one or group interviews using a yarning methodology. Data were analysed via reflexive thematic analysis. Thirty-three participants were engaged (health professionals=28; community members=5), most identified as First Nations and had experience of stillbirth in their own family. The findings highlighted the power of yarning in offering insights into the lived experience of stillbirth in Cape York. Identified themes were: (1) Historical and cultural context of healthcare in Cape York; (2) Ceremony, ritual, and the importance of family; (3) The language of loss; (4) The journey of grief; and (5) Providing support. Historical, cultural, interpersonal, and psychosocial factors interact to shape the experience of stillbirth among First Nations people in Cape York. Findings can inform service improvements to maximise culturally responsive care after stillbirth in Cape York and similar regions.
The mistreatment and abuse of women during childbirth in Nigeria is pervasive, contributing greatly to the high maternal mortality and morbidity rates. Although the prevalence and patterns of obstetric violence have been well studied, there is little insight into the gendered drivers of obstetric violence. This study aims to explore the gender inequalities in the Nigerian healthcare system and how it contributes to obstetric violence in Nigeria. The feminist phenomenological research approach was employed in this study. Specifically, in-depth interviews were conducted with 10 medical doctors, 33 midwives and 8 community health officers in eight public health facilities in Nigeria. The qualitative data were coded using the Dedoose software for analysis and thematically analyzed. The study revealed enormous gender inequalities embedded in the healthcare system. They include gender gaps in leadership positions, devaluation of midwifery, intra-professional inequalities, disparities in resources and conditions of service, and discriminatory practices. The inequalities have resulted in poor rapport with women, leading to more authoritative care, agitation and abandonment of women, intentional negligence and physical abuse. The inequalities also fuel discontentment among midwives and this is transferred to the labouring women through constant yelling and shouting. The poor treatment of midwives also contributes to the mass emigration of female health workers, resulting in increased workload and burnout of midwives, which leads to poor care and abuse in the maternity wards. Dealing with obstetric violence requires structural changes that focus on dismantling the patriarchal patterns embedded in the healthcare system in Nigeria.
Despite evidence supporting benefits of upright and flexible sacral positions during labour, most women continue to birth in supine positions. Historically, women have laboured and birthed in positions that optimise gravity, encouraging physiological birth. However, many women birth in supine positions, even though upright positions are associated with shorter duration of second stage and favourable outcomes. To observe the proportion of time nulliparous women spent in upright and supine positions during the active second stage of labour, and to explore associations with birth outcomes. This prospective observational study included term nulliparous women who were planning a vaginal birth. Midwives recorded commencement of, and all position changes during second stage. Data were analysed using descriptive statistics and regression modelling. Of 330 participants, 216 (65%) birthed physiologically, 114 (35%) had an instrumental birth. Women who birthed physiological more frequently adopted all-fours position or used a birth stool, whereas those who had an instrumental birth were more often in semi-recumbent or lithotomy positions. For every 10% increase in time spent in upright positions during the active second stage, the likelihood of physiological birth increased by 26%. Conversely, each 10% increase in time spent in a supine position there was a 30% increased likelihood of instrumental birth. Findings indicate a clear association between upright positioning during the active second stage of labour and increased rates of physiological birth. Nulliparous women may benefit from being actively supported to adopt upright positions during the second stage of labour.
Emotional intelligence (EI) is the ability to identify and manage one's own emotions, as well as the emotions of others and within other healthcare disciplines EI is considered an essential attribute of an effective practitioner. Midwifery is emotionally challenging work meaning midwifery students require more than just the cognitive ability to learn the requisite midwifery knowledge and competence at performing practical midwifery skills. The knowledge and skills that midwives require intersect with and are influenced by a wide range of emotions and emotional experiences. To develop an understanding of midwifery students' perceptions of EI and its relationship to midwifery to inform education and support of midwifery students. A qualitative methodology, phenomenography, was used to gain a collective understanding of midwifery students' perceptions and experiences of EI and its relationship to midwifery. In-depth interviews were conducted with 16 Australian midwifery students. Phenomenographic analysis was used to identify categories of description (the phenomenographic equivalent of themes) revealing the different ways midwifery students conceptualised EI and its relationship to midwifery. The findings of this research offer a unique midwifery perspective on the nature of EI highlighting how EI is an integral part of midwifery practice and a necessary attribute that midwifery students require to support their practice in an emotionally challenging profession. Becoming a midwife is an inherently emotion filled experience that requires midwifery students to not only master the skills and competencies required for midwifery practice but to learn how to navigate the nuances and complexities of often-intense emotional experiences.These findings have implications for all those who support midwifery students within both academic and clinical spaces, to better prepare midwifery students to deal with the emotional load of midwifery and support the development of EI.
Midwifery continuity of care improves perinatal outcomes, yet implementing these models can be challenging, particularly in regional and rural settings. Midwives express a preference for working within these models of care however historically opportunities are often restricted to full‑time employment. Most women have limited knowledge of how to access midwifery continuity. Evaluating the prevalence and accessibility of midwifery continuity of care models, and how midwives provide this care remains a complex task. The aim of this study was to nationally map Australian midwifery continuity of care models, identifying which women could gain access and how midwives provide the care. A cross-sectional study design with an online survey was undertaken. Quantitative analyses included descriptive statistics. Midwifery group practice (MGP) was offered by 73.1% (n = 79/108) of respondents (responding services), 45.6% (n = 36/79) of respondents offering MGP made it available to women with risk factors. Pre-existing diabetes 48.1% (n = 38/79), vaginal birth after caesarean section 87.3% (n = 69/79) and psychosocial risk factors 89.9% (n = 71/77). Access was also reported for women under 18 years 88.5% (n = 69/78), migrant/refugee women 93.6% (n = 73/78) and Aboriginal and Torres Strait Islander women 94.9% (n = 75/79). Over a third 35.2% (n = 38/108) of respondents were from regional, rural or remote areas. Homebirth was available in 23.4% (n = 18/77) of respondents. Almost all respondents supported midwives to work part-time 90.9% (n = 70/77) and 64.1% (n = 50/78) did not require midwives to have a minimum number of years' experience. Australian midwifery continuity is provided through various models. Survey responses identified women with pregnancy risk factors can access midwifery continuity. Midwives were offered flexible work options with opportunities for early career midwives to provide continuity.
There is limited research on women's perception of risk regarding pregnancy after caesarean. Interpregnancy interval alters risk in the next pregnancy and birth following a caesarean. Interpregnancy interval is a potentially modifiable risk that health care providers need to consider when counselling women about future pregnancy plans. What is women's experience of decision making regarding interpregnancy interval after caesarean birth? Twelve women participated in in-depth interviews; these were analysed thematically assisted by the use of NViVO software. The overarching theme identified was "Finding my way through the confusion to make informed decisions". Women are receiving confusing biased information delivered at varying time points. This is not meeting women's information needs leading them to seek knowledge through other sources, including online peers, to make sense of the confusion. They gather their own knowledge in order to advocate for themselves, make pregnancy spacing decisions that fit with their expectations and maximise the chances of having the birth they want. Consistent evidence based information is lacking in the current maternity care environment regarding interpregnancy interval. This creates barriers to making informed decisions for next pregnancy and birth planning. Women are looking for evidence based information to make individualised decisions. This requires women to seek knowledge outside of the maternity care system to empower themselves to navigate the system and make decisions rather than following prescriptive directives. There is a need to provide evidence based pregnancy planning resources to women that facilitate informed shared decision making.
Midwives in the Netherlands face sustainability challenges, with 40 % leaving the profession within 15 years after graduation. Dissatisfaction with maternity care organisation, on-call demands, and work-life balance are reasons to leave, and one third of midwives intended to leave the job. This study explores the well-being of midwives in both community and hospital settings and identifies contributing factors. A cross-sectional survey was conducted among 995 practicing midwives using an online questionnaire. Nearly 40 % of Dutch midwives reported high work engagement. Compared to hospital midwives, community midwives reported equal levels of work engagement, higher levels of work- and personal-related burnout, and significantly lower levels of client-related burnout. Hope and work-life balance were identified as significant factors in both mitigating burnout symptoms and enhancing work engagement among community and hospital midwives. Determinants contributing to work engagement and burnout were largely similar between community and hospital midwives and included hope, passion for midwifery, high work variety and balancing work with private life. Dutch midwives reported relatively low levels of burnout and high work engagement compared to international data. Midwives' well-being while working in a community or a hospital setting differed slightly but not significantly. Community midwives showed significantly lower client-related burnout than hospital midwives, although higher levels of work- and personal-related burnout. The findings underscore the importance of supporting midwives in balancing their professional and personal lives in different phases of their career, particularly through flexible working conditions, fostering hope, and working with passion according to their ideologies.
Few midwives are given the opportunity to provide continuity of midwife care despite the suggested benefits. Translating evidence into practice remains challenging, particularly in low-income settings where workforce limitations, structural constraints, and leadership capacity influence implementation. Although continuity of care models have gained increasing attention globally, little is known about how midwives in low-income countries perceive their readiness and capacity to initiate and sustain such models. To explore how midwives experience and perceive their capacity to implement and lead continuity of midwife care in Ethiopia. A qualitative exploratory design was used. Twenty-one midwives providing continuity of midwife care participated in semi-structured individual online in-depth interviews. The data were analysed using reflexive thematic analysis. The overarching theme, "Opening the door to the full scope of midwifery practice," captured how continuity of midwife care enabled midwives to utilise their full professional capacity. Four interrelated themes described this capacity: 1) clinical competence and autonomy, 2) individualised care and trustful relationships, 3) motivation, commitment and professional pride, and 4) teamwork and structural support. The findings suggest that midwives' capacity was shaped not only by individual competence and motivation, but depended on organisational conditions that enabled autonomy, responsibility, and continued professional development. Continuity of midwife care can function as a liberating structure that releases midwives' existing capacity, when recognised and supported by the system. Enabling midwives to fully exercise their professional role is foundational to delivering respectful, equitable, and effective maternity care in Ethiopia and similar settings worldwide.
Perineal trauma, including obstetric anal sphincter injury (OASI), is a significant adverse outcome of vaginal birth. Although perineal care skills are acquired during midwifery clinical placement, limited evidence examines whether student involvement or stage of preregistration experience influences perineal outcomes. To examine whether perineal outcomes differ between spontaneous vaginal births in which a supervised student midwife was recorded as the primary accoucheur and births attended by a registered midwife, and to assess whether OASI risk varies across stages of preregistration student experience. This retrospective cohort study included term, singleton, cephalic spontaneous vaginal births across three public hospitals in New South Wales, Australia (2018-2024). Cohort A comprised all eligible births attended by registered midwives or student midwives (n = 34,235). Cohort B included postgraduate student midwives with complete ascertainment of 30 student-attended births (n = 3930), categorised as ≤ 10, 11-20 and 21-30 births. Modified Poisson regression with robust variance estimation was used to estimate risk ratios (RRs) for OASI. In Cohort A, student midwife involvement was not independently associated with OASI (aRR 1.07, 95% CI 0.93-1.22). In Cohort B, experience category was not associated with OASI risk in the overall adjusted model. However, compared with the ≤ 10 birth group, the 21-30 birth group demonstrated a higher adjusted OASI risk (aRR 1.61, 95% CI 1.02-2.55), while no difference was observed for the 11-20 birth group. Student midwife involvement was not associated with OASI risk. A modest increase in risk in the highest experience group warrants further investigation. Perineal outcomes were more strongly influenced by maternal and intrapartum factors than by cumulative birth exposure.
Midwifery is a relatively new profession in Bangladesh, formally established in 2013. While emerging research has begun to document the advancements and the challenges midwives face, there remains limited understanding of the experiences of those practising in rural settings in rural Bangladesh. This study aimed to explore the lived experiences of midwives working in rural Bangladesh. A qualitative descriptive study was used. Seventeen midwives with at least six months of rural experience participated in semi-structured interviews conducted Zoom or WhatsApp with an interpreter present when required to facilitate communication. Data was analysed inductively using Braun and Clarke's six phase process of thematic analysis, supported by Atlas.ti software. Trustworthiness was established through member checking, reflexivity, and use of Lincoln and Guba's criteria for rigour. Five overarching themes were identified including Community Perceptions and Trust in Midwifery, Climate and Environmental Pressures on Rural Midwifery Care, Infrastructure, System and Resource Constraints, Professional Identity, Motivation and Scope of Practice and Supports Needed to Strengthen the Rural Midwifery Workforce. Midwives demonstrated resilience and professional pride despite facing resource shortages, limited recognition, and cultural and structural barriers. The importance of community awareness, continued education, government investment, and system level support to enhance midwifery care in rural areas were highlighted in this study. Addressing these needs could improve both workforce strength and sustainability and health outcomes. Midwives in rural Bangladesh demonstrate strong commitment to woman-centred care despite systemic barriers. Strengthening support, education, and policy investment is essential to sustain this vital workforce.
First Nations women often experience harmful, inequitable maternity care, shaped by intergenerational trauma and culturally unsafe care. Historical forced removal of First Nations children has created enduring trauma that influences pregnancy and birthing experiences. In the Australian Capital Territory, maternity care is provided through Western biomedical systems, where increasing child protection interventions and fear of surveillance affect women's engagement with care. The aim of this study was to explore the maternity care experiences of First Nations women and families in the Australian Capital Territory, and to understand participants' perspectives of culturally safe models of care. This study used Kapati Time Yarning, an Indigenous Research Method based on relational storytelling. Fourteen First Nations women, partners, and family members participated between October 2024 and March 2025. Data were analysed using reflexive thematic analysis. Intergenerational trauma was identified as a key theme, with participants describing a persistent fear of child removal, race-based surveillance, and mistrust within maternity services. Pregnancy and birth were experienced as instances of heightened scrutiny, prompting hypervigilance, embodied protective behaviours, and care-avoidance, reinforcing cycles of trauma across generations. Many First Nations people are birthing away from their ancestral Country. The articulation of Birthing with Country offers a pathway to reframe maternity care by bringing Country, cultural authority, and relational care into the maternity space. Intergenerational trauma linked to forced child removals is actively reproduced within maternal health services. First Nations-led, culturally safe models such as Birthing with Country are essential to disrupt fear and surveillance, build trust, and support wellbeing.
The political instability in the West Bank, stemming from Israeli occupation characterized by violence, and movement restrictions, simultaneously hinders access to maternal and childbirth services. Midwives are the first respondent during humanitarian crises, wars, and acute situations, delivering vital care and support to mothers and newborns. To explore the competencies and challenges faced by Palestinian midwives in delivering childbirth services to women with limited access to hospitals, particularly during violence and closure in the West Bank. A qualitative study was conducted through in-depth, face-to-face interviews with a purposive sample of 20 Palestinian midwives from the West Bank, utilizing an interview guide. Thematic analysis was employed to identify key themes and sub themes. This study reveals two key themes: the competence of midwives and the challenges they face in providing childbirth services amid closures and violence in the West Bank. Midwives are driven to deliver lifesaving care to women who have limited access to hospitals, including assisting with births. However, they encounter several obstacles, such as intrapersonal factors, political and safety concerns, issues related to competency and available resources, geographic and infrastructure limitations, social pressures, psychological barriers, and policies within the healthcare system. Empowering midwives is vital to ensuring that women have safe childbirth services in areas with limited access to hospitals. Empowerment can be achieved by strengthening their skills, providing legal protections, and ensuring access to medical instruments. Furthermore, midwives should be provided with support and guidance to enhance their mental and emotional well-being.
There is little known about the maternal and fetal outcomes of planned homebirths versus hospital births in Türkiye. The place where women give birth has an impact on their postpartum experiences and maternal and fetal outcomes. This study aimed to compare women who experienced homebirth and hospital birth in terms of traumatic birth perception levels. An unmatched case-control study was conducted with 215 mothers, including 97 cases and 118 controls, in Istanbul province. Participants were asked to complete an online survey which includes a personal information form about childbirth and postpartum experiences, and the Traumatic Birth Perception Scale. The responses received from 215 participants in the case and control groups were subjected to statistical evaluation. The comparison between the categorical characteristics of the homebirth and hospital birth groups was made using a chi-square analysis, and the comparison between continuous variables was made with an independent groups analysis. The homebirth group perceived childbirth as less traumatic. The feeling of safety during birth was significantly higher in the homebirth group than in the hospital birth group. Our results are consistent with high-quality evidence regarding the biomedical safety of home birth. Home could be an important place to decrease traumatic childbirth perception.
Continuity of midwifery care (CoMC) is associated with significantly improved outcomes for mothers and babies yet is not universally accessible to Australian women. Globally, implementation of this model has been slow and variable. In Australia, the proportion of maternity services providing CoMC models in the public sector varies across jurisdictions. To explore the structural and contextual factors contributing to the provision of public CoMC models in Australia. The Policy Triangle framework was adapted to analyse publicly available data from three Australian states that report use of CoMC: Victoria, Western Australia and Queensland. Structural and contextual factors impacting provision of CoMC were compared: 1) types of pre-registration midwifery education, 2) proportion of endorsed midwives, 3) industrial arrangements, 4) professional association membership, 5) midwifery leadership, and 6) State policy. In 2023, 19.7% of women in Queensland received CoMC, compared with 9.6% in Western Australia and 5.3% in Victoria. Compared to Victoria, Queensland and Western Australia had more endorsed midwives as a proportion of births, higher annual leave loading for midwives working in CoMC models, and a higher proportion of professional association membership. Victoria offered predominantly combined nursing/midwifery pre-registration degrees. Only Queensland had a clear, direct policy statement. There was limited data in relation to midwifery leadership. This narrative review provides insights into the socio-political, policy, cultural and industrial ecosystem impacting provision of CoMC. Comprehensive, multilevel strategic interventions are needed to address these barriers to advance women's access to publicly funded CoMC models.