The importance of recognizing factors contributing to the poor mental health of women in the perinatal period has been highlighted both nationally and internationally. As such there is a need for enhanced midwifery services and education provision in perinatal mental health, which has been advocated by practitioners, educationalists, service providers and government documents. Following the publication of the Scottish Perinatal Mental Health Curricular Framework, a national education package was developed and delivered to a cohort of multi-professionals which included midwives. This innovative course was developed by a multidisciplinary team producing educational material that ensured cultural and discipline specific relevance in relation to the learning outcomes of the curricular framework. The team identified key clinicians and educationalists to contribute to each learning outcome. A blended learning approach using workshops and e-learning and the use of inter-professional mentoring was implemented. The development, implementation, evaluation and future plans are presented here.

There is insufficient evidence to support definitive conclusions regarding the efficacy of any included intervention. A number of limitations, such as non-probability sampling, lack of blinding, and insufficient follow-up weaken the evidence. The inclusion of fathers in only three studies reflects the overall neglect of men in research regarding the prenatal relationship. Further in-depth study of the nature of the maternal/paternal-fetal relationship may be needed in order to allow for the identification of interventions that are consistently beneficial and worthwhile.

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The decision-making power base in maternity care has altered in the last century with recent government documents suggesting that it be more women-centred. Those midwives who do not use evidenced-based practice and who teach, support and demonstrate ritualistic practices without reference to the substantial research available, are limiting women's choice(s) in maternity care. In a trial (Fleming et al, 2001), investigating whether routine suturing of perineal lacerations is required, the researchers concluded that midwives appeared to have attempted to influence the outcome because of their own deep-held beliefs about suturing. The rationale for this behaviour is not always easy to understand and it is examined here to determine what concepts are influencing these practices. First, is this behaviour a way of raising the midwife's profile as an expert or are midwives in fact feeling less the expert of normal childbirth as their role is eroded by other disciplines? Second, are midwives trying to regain autonomy by controlling women as a response to the control of this speciality by the medical and nursing professions? Finally, could it be that midwives' lack of support for women in making informed choice(s) is an ethical misunderstanding that they have between beneficence and autonomy? Unfortunately, whatever the rationale, the practice observed suggests that some midwives appear to be demonstrating the paternalistic attitudes previously associated with the medical profession.

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