Despite decades of considerable economic investment in improving the health of families and newborns world-wide, aspirations for maternal and newborn health have yet to be attained in many regions. The global turn toward recognizing the importance of positive experiences of pregnancy, intrapartum and postnatal care, and care in the first weeks of life, while continuing to work to minimize adverse outcomes, signals a critical change in the maternal and newborn health care conversation and research prioritization. This paper presents "different research questions" drawing on evidence presented in the 2014 Lancet Series on Midwifery and a research prioritization study conducted with the World Health Organization. The results indicated that future research investment in maternal and newborn health should be on "right care," which is quality care that is tailored to individuals, weighs benefits and harms, is person-centered, works across the whole continuum of care, advances equity, and is informed by evidence, including cost-effectiveness. Three inter-related research themes were identified: examination and implementation of models of care that enhance both well-being and safety; investigating and optimizing physiological, psychological, and social processes in pregnancy, childbirth, and the postnatal period; and development and validation of outcome measures that capture short and longer term well-being. New, transformative research approaches should account for the underlying social and political-economic mechanisms that enhance or constrain the well-being of women, newborns, families, and societies. Investment in research capacity and capability building across all settings is critical, but especially in those countries that bear the greatest burden of poor outcomes. We believe this call to action for investment in the three research priorities identified in this paper has the potential to achieve these benefits and to realize the ambitions of Sustainable Development Goal Three of good health and well-being for all.

The A-BSS-R represents a robust and valid measure of the birth satisfaction concept suitable for use within Australia and appropriate for application to International comparative studies.

BACKGROUND: Good clinical reasoning in midwifery is essential for the safety and quality of the care for women and babies. Midwives, as autonomous practitioners, are held legally and professionally accountable for their clinical reasoning, decisions, and the care they provide. Yet there is contested space between being accountable to the woman (and her birth experience) and being accountable to legal and professional frameworks and regulations. This places the midwife in a vulnerable position. This vulnerability is explored in this article.METHODOLOGY: The narratives of 6 midwives who were interviewed as part of a larger study were subjected to an inductive thematic analysis. Trustworthiness and rigor of the study was assured by careful monitoring of the research process and data checking.RESULTS: Although potentially unpalatable to the midwifery profession, we feel it is important to acknowledge that a concept called Midwifery Abdication does perhaps exist. Our assertion is underpinned by 3 key themes: “internalized perceptions of midwifery practice,” “knowing but failing to act,” and “prioritization of the woman’s needs.” Although this may be an unconscious act, it may be part of a conscious thought process which is influenced by internal and external factors. The result is loss of one’s professional voice. Midwifery Abdication introduces a level of risk, in changing clinical situations, which require a reconsideration and potential renegotiation of maternal choices and decisions.CONCLUSION: Some midwives appear to abdicate their professional decision-making role. Midwives must practice within their country’s legislative framework, which is complemented by their regulatory authority codes of professional conduct, standards, and ethics. Midwifery Abdication undermines the safety and efficacy of midwifery practice and thus destabilizes our right to claim professional autonomy.

Jefford E, Fahy K, Sundin D. International Journal of Nursing Practice 2011; 17: 246–253 Decision‐Making Theories and their usefulness to the midwifery profession both in terms of midwifery practice and the education of midwives What are the strengths and limitations of existing Decision‐Making Theories as a basis for guiding best practice clinical decision‐making within a framework of midwifery philosophy? Each theory is compared in relation with how well they provide a teachable framework for midwifery clinical reasoning that is consistent with midwifery philosophy. Hypothetico‐Deductive Theory, from which medical clinical reasoning is based; intuitive decision‐making; Dual Processing Theory; The International Confederation of Midwives Clinical Decision‐Making Framework; Australian Nursing and Midwifery Council Midwifery Practice Decisions Flowchart and Midwifery Practice. Best practice midwifery clinical Decision‐Making Theory needs to give guidance about: (i) effective use of cognitive reasoning processes; (ii) how to include contextual and emotional factors; (iii) how to include the interests of the baby as an integral part of the woman; (iv) decision‐making in partnership with woman; and (v) how to recognize/respond to clinical situations outside the midwife's legal/personal scope of practice. No existing Decision‐Making Theory meets the needs of midwifery. Medical clinical reasoning has a good contribution to make in terms of cognitive reasoning processes. Two limitations of medical clinical reasoning are its reductionistic focus and privileging of reason to the exclusion of emotional and contextual factors. Hypothetico‐deductive clinical reasoning is a necessary but insufficient condition for best practice clinical decision‐making in midwifery.

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