Midwifery最新文献

{"title":"Beyond the observed: Postpartum posttraumatic stress symptoms and mother-child bonding in Ghana","authors":"Sheriffa Mahama ,&nbsp;Justina Aba Ackom ,&nbsp;Buruwaa Adomako Agyekum ,&nbsp;Crossby Osei Tutu ,&nbsp;David Kwame Kumador ,&nbsp;Justice Owusu-Bempah","doi":"10.1016/j.midw.2025.104470","DOIUrl":"10.1016/j.midw.2025.104470","url":null,"abstract":"<div><h3>Background</h3><div>The birth of a child is considered positive in almost all cultures; however, research suggests that 20–40 % of women find childbirth psychologically traumatic, with some of these women developing posttraumatic stress disorder. Despite its potential illness burden, postpartum posttraumatic stress disorder is not routinely screened for in Ghana and, therefore unlikely to be diagnosed and treated.</div></div><div><h3>Aim</h3><div>This study investigated the incidence and risk factors of postpartum posttraumatic stress disorder among mothers and its association with the mother-child bond.</div></div><div><h3>Method</h3><div>Quantitative data were collected from 150 mothers with infants aged 1 – 12 months across five health centres in the Sekondi-Takoradi Metropolis in Ghana.</div></div><div><h3>Findings</h3><div>The findings show that 119 mothers presented various posttraumatic stress disorder symptoms after childbirth, and the total incidence of full postpartum posttraumatic stress disorder among this sample was 3.3 %. Parity, previous trauma and dissociation were the significant predictors of postpartum posttraumatic stress disorder. The development of posttraumatic stress symptoms after childbirth was found to be significantly associated with mother-child bonding.</div></div><div><h3>Conclusion</h3><div>Based on the findings, it is recommended that screening for posttraumatic stress disorder symptoms during prenatal and early postnatal periods be done for timely intervention.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"148 ","pages":"Article 104470"},"PeriodicalIF":2.6,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the impact of Australian Health Practitioner Regulation Agency notifications on midwives’ wellbeing, midwifery practise, and career: A qualitative study","authors":"Fiona Gordon ,&nbsp;Laura Y Whitburn ,&nbsp;Michelle Newton","doi":"10.1016/j.midw.2025.104471","DOIUrl":"10.1016/j.midw.2025.104471","url":null,"abstract":"<div><h3>Background</h3><div>Limited evidence exists about the impact of regulatory complaints processes on registered midwives and the wider midwifery profession within the Australian context.</div></div><div><h3>Aim</h3><div>To understand the broader impact of the Australian Health Practitioner Regulation Agency (AHPRA) notifications process on midwives’ wellbeing, midwifery practise and career, and explore supports that midwives use and need.</div></div><div><h3>Methods</h3><div>A contextualist qualitative approach using semi-structured, in-depth interviews with a purposive sample of eleven Australian midwives. Data were analysed through reflexive thematic analysis.</div></div><div><h3>Findings</h3><div>Three themes derived from the data were: ‘Profound personal and professional impacts’, ‘A fundamentally flawed process’, and ‘Finding strength in support’. Midwives subject to a notification report high levels of distress and inadequate support, resulting in devastating personal and professional impacts. During investigations midwives were dissatisfied with the AHPRA’s communication and timelines, their health and wellbeing were negatively impacted, lost confidence in practise, and questioned their self-identity.</div></div><div><h3>Discussion</h3><div>Midwives subject to notification processes through the AHPRA find this stressful and protracted with negative impacts on health, wellbeing and professional practise. Midwives impacted by notifications need adequate supports from peers and a range of organisations within the industry. Improvements to streamline regulation processes and access to support mechanisms within organisations and the wider profession is urgently needed.</div></div><div><h3>Conclusion</h3><div>The current regulatory complaints process of midwives in Australia warrants urgent review and reform. With present midwifery workforce shortages, midwives impacted by notification processes need adequate support to remain in the profession.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"148 ","pages":"Article 104471"},"PeriodicalIF":2.6,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What does existing research tell us about the factors impacting non-serving military spouse mothers’ perinatal mental health experiences? A systematic review with textual narrative synthesis","authors":"Lyndsay M.H. Spencer ,&nbsp;Elizabeth A. Barley ,&nbsp;Ann Robinson ,&nbsp;Hilary Davies-Kershaw","doi":"10.1016/j.midw.2025.104468","DOIUrl":"10.1016/j.midw.2025.104468","url":null,"abstract":"<div><div>Perinatal mental health disorders affect 1 in 5 mothers, with military life introducing unique stressors that may exacerbate these conditions. Non-serving military spouse mothers may be particularly vulnerable, yet their specific needs remain underexplored. Understanding factors affecting their mental health is crucial, given its impact on both individual wellbeing and military personnel retention in the U.K.</div><div>This review systematically examines the factors influencing perinatal mental health in non-serving military spouse mothers, identifying key stressors and research gaps. A comprehensive search of eight electronic databases—ProQuest, MEDLINE, PsycINFO, PsycArticles, CINAHL, EMBASE, and Web of Science—was conducted in April 2024, with relevant data extracted. Due to heterogeneity among studies, a textual narrative synthesis was applied.</div><div>Seven U.S-based studies met inclusion criteria, though all were of limited quality. No studies focused on European non-serving military mothers. Deployment emerged as a primary stressor, with perceived risk and timing of deployments in relation to pregnancy affecting mental health outcomes. However, broader perinatal experiences were largely unexamined.</div><div>Findings suggest military-specific factors, particularly spousal deployment, influence non-serving spouse mothers’ perinatal mental health. However, existing research is low quality, overly focused on deployment, U.S-centric, and limited in scope within the perinatal period.</div><div>Future research should explore the U.K Armed Forces context, consider factors beyond deployment, and encompass the entire perinatal period. These insights are essential for healthcare professionals and policymakers to develop targeted interventions and military-informed perinatal care.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"148 ","pages":"Article 104468"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International News August 2025","authors":"Elizabeth Duff (International News Editor)","doi":"10.1016/j.midw.2025.104465","DOIUrl":"10.1016/j.midw.2025.104465","url":null,"abstract":"","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"147 ","pages":"Article 104465"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the hesitations of pregnant women towards COVID-19 vaccines during the pandemic: A mixed methods approach","authors":"Sena Dilek Aksoy ,&nbsp;Suna Uysal Yalçın ,&nbsp;Resmiye Kaya Odabaş","doi":"10.1016/j.midw.2025.104469","DOIUrl":"10.1016/j.midw.2025.104469","url":null,"abstract":"<div><h3>Background</h3><div>Various reasons stemming from direct vaccine concerns, individual factors, and sociocultural and environmental factors contribute to vaccine hesitancy among pregnant women regarding COVID-19 vaccines.</div></div><div><h3>Aims</h3><div>The study described and compare pregnant women’s perspectives on COVID-19 vaccination during the pandemic and to identify barriers and facilitators.</div></div><div><h3>Findings</h3><div>A mixed-methods research design was adopted to integrate quantitative and qualitative descriptive methods. At a state hospital in the western region of Turkey, 249 pregnant women attending the maternity clinic from March to August 2022 were surveyed using questionnaires, and in-depth individual interviews were conducted with 17 of them. The interview topics were based on the participants’ perceptions and attitudes toward COVID-19 vaccines. A mixed-methods research design was adopted, using quantitative purposive sampling to describe and compare their COVID-19 vaccination status and qualitative purposive sampling to identify their hesitations regarding COVID-19 vaccines, analyzed through content analysis. Reporting followed the GRAMMS guidelines.</div></div><div><h3>Discussion</h3><div>Sixty-six percent of pregnant women had not received the COVID-19 vaccine. Those with advanced age, lower education levels, and lower income exhibited higher levels of vaccine hesitancy. The hesitations of pregnant women toward COVID-19 vaccines revealed three main themes: direct vaccine-related hesitation, hesitation arising from individual factors, and hesitation stemming from socio-cultural and environmental factors.</div></div><div><h3>Conclusion</h3><div>Vaccine hesitancy, which emerged during the COVID-19 pandemic, was a significant cause for concern. This hesitancy was explained by three main themes: vaccine hesitancy arising from the vaccine itself, vaccine hesitancy due to individual factors, and vaccine hesitancy stemming from socio-cultural and environmental factors. Additionally, sub-themes such as perceptions related to the management of the vaccination program, personal and infant-related risk-benefit assessments, the influence of anti-vaccine activists on social media, and political factors were also identified as playing a significant role in vaccine hesitancy.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"148 ","pages":"Article 104469"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“I felt so alone in the process:” Experiences of Indigenous women with maternal medical travel in the Canadian Arctic and opportunities for improvement","authors":"Fariba Kolahdooz ,&nbsp;Se Lim Jang ,&nbsp;Priya Patel ,&nbsp;Claire Manning ,&nbsp;Sarah Deck ,&nbsp;Anahat Juneja ,&nbsp;Debbie DeLancey ,&nbsp;André Corriveau ,&nbsp;Stephanie Irlbacher-Fox ,&nbsp;Marie Tarrant ,&nbsp;Sarah Cook ,&nbsp;Adrian Wagg ,&nbsp;Sangita Sharma","doi":"10.1016/j.midw.2025.104466","DOIUrl":"10.1016/j.midw.2025.104466","url":null,"abstract":"<div><h3>Problem</h3><div>Indigenous women face unique challenges during pregnancy/birth-related medical travel due to systemic barriers, cultural differences, and geographic isolation.</div></div><div><h3>Background</h3><div>In Canada, Indigenous women frequently travel substantial distances for pregnancy care and birth. Many pregnant women in Northwest Territories (NWT) are mandated to travel to urban centres with secondary/tertiary hospitals between 36–38-weeks gestation.</div></div><div><h3>Question/Hypothesis/Aim</h3><div>What are the experiences of Indigenous women in NWT regarding pregnancy and birth-related medical travel? How do cultural and community-specific, culturally informed, and accessible healthcare practices influence the experiences of Indigenous women during pregnancy-related medical travel?</div></div><div><h3>Methods</h3><div>Across three NWT communities, 156 self-identifying Indigenous women who were pregnant or who had given birth in the previous three years completed a semi-structured interviewer-administered questionnaire. Qualitative data were analyzed using reflexive thematic analysis in NVivo.</div></div><div><h3>Findings</h3><div>Of the 55 women who travelled for pregnancy care, 68.5 % felt prepared for medical travel and 57.4 % had a positive experience. Of the 52 women who travelled for birth, the mean length of stay after birth was 11 days (ranges from 1 to 90 days), with 63.5 % staying ≤ one week.</div></div><div><h3>Participants highlighted three themes</h3><div>Travel experiences, experiences with prenatal care and childbirth, and suggestions for improvement. The experiences involved loneliness, nervousness, logistical challenges, and communication and resource issues.</div></div><div><h3>Discussion</h3><div>Suggestions included improving cultural competency, expanding community healthcare, and incorporating Elder knowledge sharing.</div></div><div><h3>Conclusion</h3><div>While many women reported positive experiences, improvements in medical travel and care access are needed to guide Indigenous maternal healthcare policy and planning.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"148 ","pages":"Article 104466"},"PeriodicalIF":2.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of midwife-led counseling for women who have experienced traumatic childbirth: A clinical trial","authors":"Simin Shaeri ,&nbsp;Mouloud Agajani Delavar ,&nbsp;Fatemeh Bakouei ,&nbsp;Alireza Azizi ,&nbsp;Maria Karbalaeizadeh","doi":"10.1016/j.midw.2025.104467","DOIUrl":"10.1016/j.midw.2025.104467","url":null,"abstract":"<div><h3>Background</h3><div>Given high traumatic births, post-traumatic stress, anxiety, and depression, more research is needed for counseling frameworks for healthcare professionals. This study aims to assess midwife-led counseling impact on women who have experienced traumatic childbirth.</div></div><div><h3>Method</h3><div>This study employed a controlled clinical trial conducted at Imam Ali Hospital from June 2023 to January 2024. Ninety-six eligible women who had experienced traumatic childbirth were stratified into two groups, namely the postpartum midwifery counseling group (n=48) and the control group (n=48), utilizing random block allocation. The counseling group received standard postpartum care supplemented with face-to-face counseling based on the Gamble model within 72 h after childbirth, followed by two telephone counseling sessions in the fourth and eighth weeks post-delivery. Conversely, the control group received solely routine postpartum care. Women's anxiety during the postpartum period was assessed as a secondary outcome. Statistical analysis was conducted using IBM SPSS Statistics version 20, with a significance level set at less than 0.05.</div></div><div><h3>Results</h3><div>Significant differences were observed between the counseling and control groups regarding changes in Acute Stress Disorder (ASD) scores from baseline to 12 weeks post-intervention (-18.32; 95 % CI, -12.52 to -24.13; P&lt; 0.001). Additionally, notable disparities were noted between the groups in terms of changes in Post-Traumatic Stress Disorder (PTSD) scores based on the Impact of Event Scale – Revised (IES-R) (-14.49; 95 % CI, -11.63 to -17.34; P&lt; 0.001) and the CheckList – Civilian (PCL) (-11.10; 95 % CI, -8.42 to -13.60; P&lt; 0.001) from baseline to post-intervention. Furthermore, a significant difference was observed in changes in anxiety scores from baseline to post-intervention (-19.49; 95 % CI, -15.28 to -3.69; P&lt; 0.001). The relative risk (RR) of developing PTSD based on both scales was over 60 % lower in the counseling group compared to the control group.</div></div><div><h3>Conclusion</h3><div>In conclusion, this study shows midwife-led counseling effectively reduces psychological distress after traumatic childbirth. It improves ASD, PTSD symptoms, and anxiety. Integrating such counseling into postpartum care can mitigate PTSD risk. Lower relative risk underscores its potential in promoting maternal mental health. Future research should explore long-term effects.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"148 ","pages":"Article 104467"},"PeriodicalIF":2.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144205778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stress-coping styles of midwives providing maternity care to Ukrainian migrant women in Poland after the outbreak of the full-scale war in Ukraine","authors":"Beata Szlendak ,&nbsp;Barbara Baranowska ,&nbsp;Ilona Nenko ,&nbsp;Nina Sahraoui ,&nbsp;Urszula Tataj-Puzyna ,&nbsp;Anna Durka ,&nbsp;Maria Węgrzynowska","doi":"10.1016/j.midw.2025.104464","DOIUrl":"10.1016/j.midw.2025.104464","url":null,"abstract":"<div><h3>Problem</h3><div>The type of the stress-coping styles used by the healthcare providers is associated with their level of stress, health outcomes and risks of work-related burnout.</div></div><div><h3>Background</h3><div>The war in Ukraine and following it increased migration has led to an increased workload for health professionals in Poland, both due to the increased number of women seeking care and the additional time needed to care for migrant women.</div></div><div><h3>Aim</h3><div>The aim of this study was to describe the stress-coping styles used by midwives in Poland in while carrying for Ukrainian migrant women.</div></div><div><h3>Methods</h3><div>Five focus group interviews with a total of 32 midwives who cared for migrants from Ukraine after the outbreak of the full-scale war were conducted between March and June 2023.</div></div><div><h3>Findings</h3><div>In order to cope with the difficulties, midwives took actions that fit into the task-oriented style of coping with stress, including 1. mobilization and participation in aid; 2. striving for effective communication and 3. providing support and education.</div></div><div><h3>Discussion</h3><div>Midwives who participated in the study experienced stress due to increased workload, which was intensified by a feeling of lack of system support. The empathy enabled them to effectively cope with the emotional challenges in this challenging situation. .</div></div><div><h3>Conclusion</h3><div>Midwives’ ability to effectively cope with stress, mainly through a task-oriented style increased their chances of offering high-quality maternity care. These underscore the importance of support for medical personnel and the need for further research to develop effective strategies for coping with stress in crisis situations.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"148 ","pages":"Article 104464"},"PeriodicalIF":2.6,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The support provision and self-support journey of partners in high-risk pregnancies with comorbidities: A meta-synthesis analysis","authors":"Zeyi Zhang ,&nbsp;Longshan Yang ,&nbsp;Heng Cao ,&nbsp;Feng Li","doi":"10.1016/j.midw.2025.104463","DOIUrl":"10.1016/j.midw.2025.104463","url":null,"abstract":"<div><h3>Aims</h3><div>To explore the support provision and self-support journey of partners in high-risk pregnancies with comorbidities by integrating qualitative findings.</div></div><div><h3>Methods</h3><div>This is a meta-synthesis of qualitative studies. We systematically reviewed six electronic databases for relevant studies published from inception to January 2025. Inductive thematic analysis was used for data analysis. We created a journey map to illustrate the experiences of partners throughout the key timepoints during the high-risk pregnancies complicated by comorbidities.</div></div><div><h3>Results</h3><div>18 studies were included. Totally 13 analytic themes with 31 descriptive themes emerged from the four-phase (prenatal screening period, treatment during pregnancy, delivery, and postpartum) journey. Examples for analytic themes included Multiple Factors Shaping Partners’ Caregiving Readiness and Role Definition, Self-support void, Engagement in High-Risk Pregnancy Healthcare Involves Both Reassurance and Challenges.</div></div><div><h3>Conclusion</h3><div>Role of partners in supporting women with high-risk pregnancies complicated by comorbidities and their involvement in self-care across full journey was highlighted.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"148 ","pages":"Article 104463"},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Working to support cultures of safety in maternity and neonatal services: a qualitative interview study with service leaders and unit/safety leads","authors":"Nicola Mackintosh ,&nbsp;Sarah Chew ,&nbsp;Natalie Armstrong ,&nbsp;Phil Duncan ,&nbsp;Matt Hill ,&nbsp;Tony Kelly ,&nbsp;Liz Sutton ,&nbsp;Janet Willars ,&nbsp;Carolyn Tarrant","doi":"10.1016/j.midw.2025.104461","DOIUrl":"10.1016/j.midw.2025.104461","url":null,"abstract":"<div><h3>Background</h3><div>Recent inquiries have demonstrated the significance of safety cultures within maternity and neonatal services. Research has highlighted the benefits of shifting attention away from safety incidents and towards learning about how the mundane, ‘normal’ accomplishments of safety are shaped by local cultures. However, we still have much to learn about the role of different staff groups in creating conditions that nurture and sustain local safety cultures.</div></div><div><h3>Aims</h3><div>To explore how staff in middle-management positions worked to influence safety cultures at local maternity and neonatal unit and service level.</div></div><div><h3>Methods</h3><div>We used a qualitative design, starting with scores obtained from a safety culture survey to identify high-performing organisations in England, in line with a positive deviance approach. Thirteen service leads and 23 unit/safety leads participated in interviews. Analysis used the constant comparative approach, combined with a theoretically-focused coding framework.</div></div><div><h3>Findings</h3><div>Our research revealed how service and unit/safety leads influenced their local cultures of safety: through working across boundaries between the executive board and frontline practice on maternity and neonatal safety priorities; engaging with the service user voice, bringing this into the boardroom and the ward; and using horizon-scanning and political connections to manage the interface between policy initiatives and local practice.</div></div><div><h3>Conclusions and implications</h3><div>Staff in middle-management roles play an important role in nurturing and sustaining local cultures of safety, through boundary working within and outside the organisation and with different stakeholders. This demonstrates the importance of supporting staff in such roles, in efforts to develop local safety cultures.</div></div><div><h3>Statement of significance: Problem</h3><div>problematic cultures/sub-cultures are acknowledged as a contributing factor to failures within healthcare services</div><div>What is already known: research has highlighted the benefits of shifting attention away from safety incidents and ‘extraordinary events’, and towards learning how the mundane, ‘normal’ accomplishments of safety are shaped by local cultures</div><div>What this paper adds: this paper highlights the important boundary work that staff in middle-management positions undertake to create the conditions that nurture and sustain local safety cultures</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"148 ","pages":"Article 104461"},"PeriodicalIF":2.6,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}