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Control and empowerment are crucial aspects of contemporary midwifery. Enabling a labouring woman to be in control is believed to aid the normal physiological process. To date no studies have explicitly considered individual control over environmental variables and its association with satisfaction levels. This second results paper presents data from a questionnaire survey of 559 mothers and 227 ward-based staff. While most mothers felt they could control the lighting within the birthing room, this was not the case in all the units surveyed; few acknowledged that they could adjust temperature or ventilation within the room. Staff attitudes towards this varied: 24% of midwives believed that such control should not be given to labouring or postnatal women. A perceived lack of control over environmental variables was common among midwives. Adverse comments about oppressive heating and lighting were common. Environmental noise was an irritant for some and was also cited as a factor in reducing work effectiveness.

Purpose This review presents the evidence on the prevalence of visual impairments in children and adults with Autism Spectrum Disorder (ASD), and the similar behavioural traits associated with both visual impairment and autism. Method A systematic literature review was conducted using online databases. Results Seven studies explored the incidence of visual impairments in people with ASD and found a higher incidence of strabismus (squint) (8.3%) than in a comparable child population (1.5 to 5.3%). Eleven studies identified behavioural traits common to both autistic and visually impaired populations. The majority were small-scale screening studies using varied methodologies, constituting an emerging field of research. Conclusion Further large-scale, multicentre studies are required to accurately identify prevalence rates of ophthalmic conditions in people with ASD. There is a small but evolving evidence base that establishes behavioural and linguistic traits common to both visual impairment and autism.

Design and use of space are critical features of contemporary healthcare facilities, but there is often pressure on available space. The drive to minimize the ‘institutional’ feel of maternity units has led to the move to make them more ‘homely’. This first of three results papers presents findings from a three-year nine-site study in England examining maternity unit design and its impact on women giving birth there. Data from a questionnaire survey of 559 mothers and 227 ward-based staff are augmented by analysis of follow-up focus groups. For mothers perceptions of spaciousness were strongly associated with overall satisfaction with surroundings and facilities (p<.01), as well as with care received (p<.01). Mothers' perceived ability to move themselves or room furniture around during labour varied across units and was not associated with overall room size. Among midwives the belief that they provided good quality care was moderately correlated with positive responses concerning ward layout (p<.01) and a comfortable working environment (p<.01).

Staff wellbeing is a recognized feature of workplace effectiveness. This final results paper presents data on staff attitudes from a multi-site study in England examining maternity unit design. Two hundred and twenty-seven midwives completed questionnaires relating to their workplace; follow-up focus groups provided further insights. Adequate and clean facilities for rest, uniform changing and washing appear not to be available in many units. While most midwives felt that the clinical area was spacious enough, those working in midwife-led units (MLUs) were more likely to say that ward layout facilitated observation of mothers and babies (p<.001) and promoted positive staff interaction (p<.001). Midwives in obstetric-led units (OLUs) were more likely to indicate that ward layout made maintaining cleanliness more difficult (p=.01). Poor air quality and oppressive lighting were the most commonly cited environmental sources of potential health problems. Midwives' workstations were frequently cramped with inadequate space for computer and other electronic equipment. At times this was felt to compromise confidentiality.

The design of buildings, particularly interior design, is acknowledged to have an effect on those who live and work there. Within the context of health care, a number of studies have attempted to identify what works best and least well. The outcomes measured include clinical outcomes, and patient and staff wellbeing. However to date there has been limited research examining the role of design in maternity units. This paper provides the background to a three-year multi-method/multi-site study examining the impact of maternity unit design on satisfaction levels, and of staff perceptions of work performance. Results are given in three accompanying papers. This article provides details of the participants: women who had recently given birth (n=559), and staff (n=227) working within the units. Methods included questionnaire survey, focus group, individual interview and on-site design evaluation.

Since these mothers' self-rated risk level was none or low, some comparability of outcomes is permissible. It appears that models of care are significantly different in obstetric-led units compared with midwife-led units, leading to greater likelihood of intrapartum intervention, need for analgesia, and assisted or operative delivery. A randomized controlled trial examining such units would permit a conclusive examination of these outcomes.

Background Evidence suggests that people with learning disabilities are less likely to have an up‐to‐date eye examination as sight loss is characteristically underdiagnosed in people with complex needs. Method A retrospective study of records from 576 Service Users of RNIB UK Vision, learning disability and Complex Needs Services was carried out. Results The record review found a higher prevalence of spectacle prescription in a learning disability (LD) population in agreement with findings from other LD studies. There was a higher prevalence of severe myopia in people with LD compared with a general adult population. Conclusion This study found a higher prevalence of spectacle prescription in people with learning disabilities compared to a general adult population, which has implications for people with learning disabilities to ensure that they have access to eye care and regularly attended eye tests. It also has implications for healthcare professionals working with people with complex needs to ensure they have access to eye care.