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Aim: This study explored Australian midwives' experience and practice of performing an episiotomy.Background: Evidence underpins the recommended angle and length of episiotomy to avoid morbidity for the woman, yet there is limited research regarding midwives' episiotomy knowledge, skill and attitudes.Methods: A cross-sectional anonymous survey of Australian midwives with current birthing experience was employed. The survey contained items modified from validated instruments with Likert scales, a diagram, categorical responses and open ended responses. Data was analysed using descriptive statistics and thematic analysis.Results: A total of 360 surveys responses were analysed. Approximately half (46%) midwives were in senior clinical positions. Experience varied considerably, with approximately half of the midwives (55.6%) having undertaken <4 episiotomies independently and 20% 'very confident' in the procedure. Only 28% midwives identified the episiotomy length correctly while 73% midwives identified the angle correctly. Two thirds of participants (n = 236) identified the correct angle on the pictorial representation. Overall, only 15% of midwives identified the three characteristics of a correctly performed episiotomy.The three most common clinical reasons for performing an episiotomy were fetal distress, perineal 'buttonhole' and previous severe perineal trauma. Analysis of attitudes revealed themes such as lack of confidence and experience, fear, and limited evidence supporting episiotomy explaining midwives' use/non-use of episiotomy.There was significant variation in health service requirements to establish a midwife's competence to perform episiotomy. Most midwives (75%, n = 270) wanted further education regarding episiotomy, with face-to-face workshops as the preferred format for education.Implications: Knowledge and practice gaps demonstrated the need for continuing professional development to translate evidence to practice and promote optimal outcomes for women. Many midwives are inexperienced with the procedure and simulation in workshops may assist midwives feel more confident to perform an episiotomy when is clinically indicated.

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In-service granular activated carbon (GAC) may transform into biological activated carbon (BAC) and remove contaminants through both adsorption and biodegradation, but it is difficult to determine its biodegradative capacity. One approach to understand the GAC biodegradative capacity is to compare the performance between unsterilized and sterilized GAC, but the sterilization methods may not ensure effective microbial inhibition and may affect adsorption. This study identified the 14C-glucose respiration rate as the best metric to evaluate the effectiveness of three sterilization methods: sodium azide addition, autoclaving, and γ irradiation. The sterilization protocols were refined, including continuously feeding 300 mg/L of sodium azide, three cycles of autoclaving, and 10–12 kGy of γ irradiation. Parallel minicolumn tests were conducted to identify sodium azide addition as the most broadly effective sterilization method with an insignificant effect on adsorption in most cases, except for the adsorption of anionic compounds under certain conditions. Nevertheless, this problem was solved by decreasing the azide dosage as long as it is still sufficient to provide effective microbial inhibition. This study helps to develop an approach that differentiates adsorption and biodegradation in GAC, which could be used by future studies to advance our understanding of BAC filtration.

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AimTo explore the satisfaction and experiences of women and staff with the BSOTS in an Australian hospital.DesignCross‐sectional descriptive survey.MethodsSurveys were distributed to women and staff between February and May 2022. Survey questions reflected satisfaction with triage and provision of care under the BSOTS system (for women) and confidence in using the BSOTS system and its impact on triage‐related care (for staff). Survey data were summarized using descriptive statistics, and qualitative responses were analysed using content analysis.ResultsThere were 50 women and 40 staff (midwives and doctors) survey respondents. Most women were satisfied with triage wait times, the verbal information they received and the time it took for them to receive care. Nearly all midwife participants indicated they had high knowledge and confidence in using the BSOTS. Most staff indicated that the BSOTS supported the accurate assessment of women and had benefits for women, staff and the hospital.ConclusionThe findings showed that women and staff were satisfied with receiving and providing care in a maternity triage setting under the BSOTS system.Implications for the Profession and/or Patient CareImplementing standardized maternity triage approaches such as the BSOTS in health settings delivering care to pregnant women is recommended for improving flow of care and perceptions of care quality by women.ImpactQuality of maternity triage processes is likely to impact the satisfaction of women attending services and the staff providing care. The BSOTS was shown to improve maternity triage processes and was associated with satisfaction of women and staff. Maternity settings can benefit from implementing triage approaches such as the BSOTS as it standardizes and justifies the care provided to women. This is likely to result in satisfaction of women and staff engaged in maternity triage and improve the birth outcomes of women and babies.Reporting MethodThe reporting of this paper has followed SQUIRE guidelines.Patient or Public ContributionWomen engaged with maternity services were participants in the study but did not contribute to the design, conduct or publication of the study.