Partnering with the woman who declines recommended maternity care: Development of a statewide guideline in Queensland, Australia.

Background: Choice, a fundamental pillar of woman-centred maternity care, depends in part on the right to decline recommended care. While professional guidance for midwives and obstetricians emphasises informed consent and respect for women's autonomy, there is little guidance available to clinicians or women about how to navigate maternity care in the context of refusal.

Aim: To describe the process and outcomes of co-designing resources to support partnership between the woman who declines recommended maternity care and the clinicians and health services who provide her care.

Partnering with consumers and practising clinicians to establish research priorities for public hospital maternity services.

Objective An innovative approach by two Queensland health services was taken to establish a shared maternity services' research agenda by partnering with consumers and clinicians. The objective was to set the top five research priorities to ensure that the future direction of maternity research was relevant to end-user and organisational needs. Methods A modified James Lind Alliance (JLA) methodology was applied between August 2022 and February 2023 across two south-east Queensland Health Services which included five participating maternity units and involved partnership with consumers, healthcare professionals and clinician researchers.

A pre-post implementation study of a care bundle to reduce perineal trauma in unassisted births conducted by midwives.

Problem: The perineal-bundle is a complex intervention widely implemented in Australian maternity care facilities.

Background: Most bundle components have limited or conflicting evidence and the implementation required many midwives to change their usual practice for preventing perineal trauma.

Aim: To measure the effect of perineal bundle implementation on perineal injury for women having unassisted births with midwives.

Bringing researchers to the consumer table: The process and outcomes of a consumer roundtable on telehealth.

Introduction: Despite the significant expansion and rapid uptake of telehealth services as a COVID-19 response, the pandemic restricted opportunities to involve health consumers in telehealth research. Authentic consumer and community involvement in research begins with engagement in priority-setting. We report here on the process and outcomes of a consumer-led event intended to support involvement of consumers, from early in the research process.

The impact of a perineal care bundle on women's birth experiences in Queensland, Australia: A qualitative thematic analysis.

Unlabelled: A care bundle was introduced into 28 Australian hospitals in 2018 with the aim of reducing severe perineal tears. There has been limited research regarding the impact of this bundle on women's birth experiences.

Question: How does the introduction of a perineal care bundle impact on women's birth experiences in Queensland maternity hospitals?

Methods: We recruited 18 women who had birthed in five Queensland hospitals where the bundle had been implemented.

Termination of pregnancy in Queensland post-decriminalisation: a content analysis of client records from an all-options pregnancy counselling organisation.

Background: Termination of pregnancy (ToP) was decriminalised in Queensland, Australia, in December 2018. Although approximately 14 000 terminations are performed in Queensland annually, decriminalisation had addressed a known barrier to ToP access by supporting the legal right to access and enabling safe and regulated public pathways to ToP care. The post-decriminalised ToP experience in Queensland is unknown.

Validating a scale to measure respectful maternity care in Australia: Challenges and recommendations.

Objective: Respectful maternity care is a pervasive human rights issue, but little is known about its realisation in Australia. Two scales, developed in North America, measure key aspects of respectful maternity care: the Mothers on Respect Index and Mothers Autonomy in Decision Making scale. This study aimed to validate these two scales in Queensland, Australia, and to determine the extent to which women currently experience respectful maternity care and autonomy in decision making.

Women's unmet needs in early labour: Qualitative analysis of free-text survey responses in the M@NGO trial of caseload midwifery.

Objective: to analyse women's experiences of early labour care in caseload midwifery in Australia.

Design: this study sits within a multi-site randomised controlled trial of caseload midwifery versus standard care. Participant surveys were conducted at 6-weeks and 6-months after birth.

Does introducing a dedicated early labour area improve birth outcomes? A pre-post intervention study.

Problem: Women increasingly present to hospital in early labour, but admission before active labour contributes to overuse of interventions, poorer clinical and psychological outcomes, and higher healthcare costs.

Background: Innovative models of early labour care have so far not improved birth outcomes.

Aim: To examine if reconfiguring the early labour service in a large Australian maternity service improved (1) the birth outcomes of women who presented in early labour and (2) alleviated bed blockages by decreasing length of stay in the Pregnancy Assessment and Observation Unit.

Is the Birthing Unit Design Spatial Evaluation Tool valid for diverse groups?

Background: Awareness of the impact of the built environment on health care outcomes and experiences has led to efforts to redesign birthing environments. The Birth Unit Design Spatial Evaluation Tool was developed to inform such improvements, but it has only been validated with caseload midwives and women birthing in caseload models of care.

Aim: To assess the content validity of the tool with four new participant groups: Birth unit midwives, Aboriginal or Torres Strait Islander women; women who had anticipated a vaginal birth after a caesarean; and women from refugee or culturally and linguistically diverse backgrounds.

Refusal of recommended maternity care: Time to make a pact with women?

Background: The right to refuse medical treatment can be contentious in maternity care. Professional guidance for midwives and obstetricians emphasises informed consent and respect for patient autonomy, but there is little guidance available to clinicians about the appropriate clinical responses when women decline recommended care.

Objectives: We propose a comprehensive, woman-centred, systems-level framework for documentation and communication with the goal of supporting women, clinicians and health services in situations of maternal refusal.

The experiences of women, midwives and obstetricians when women decline recommended maternity care: A feminist thematic analysis.

Background: pregnant women, like all competent adults, have the right to refuse medical treatment, although concerns about maternal and fetal safety can make doing so problematic. Empirical research about refusal of recommended maternity care has mostly described the attitudes of clinicians, with women's perspectives notably absent.

Design: feminist thematic analysis of in-depth, semi-structured interviews with women's (n=9), midwives' (n=12) and obstetricians' (n=9) about their experiences of refusal of recommended maternity care.

Primary Maternity Units in rural and remote Australia: Results of a national survey.

Background: Primary Maternity Units (PMUs) offer less expensive and potentially more sustainable maternity care, with comparable or better perinatal outcomes for normal pregnancy and birth than higherlevel units. However, little is known about how these maternity services operate in rural and remote Australia, in regards to location, models of care, service structure, support mechanisms or sustainability. This study aimed to confirm and describe how they operate.

Women's, midwives' and obstetricians' experiences of a structured process to document refusal of recommended maternity care.

Problem/background: Ethical and professional guidance for midwives and obstetricians emphasises informed consent and respect for patient autonomy; the right to refuse care is well established. However, the existing literature is largely silent on the appropriate clinical responses when pregnant women refuse recommended care, and accounts of disrespectful interactions and conflict are numerous. Policies and processes to support women and maternity care providers are rare and unstudied.

Maternity Care Plans: A retrospective review of a process aiming to support women who decline standard care.

Background: All competent adults have the right to refuse medical treatment. When pregnant women do so, ethical and medico-legal concerns arise and women may face difficulties accessing care. Policies guiding the provision of maternity care in these circumstances are rare and unstudied.

Effect of a maternity consumer representative training program on participants' confidence and engagement.

Objective: This paper describes the effects of a maternity consumer representative training program on participants' confidence to fulfil this role and engagement in representative activities.

Methods: The present study was a descriptive, pre-post evaluation design with a 3-month follow-up. Fifty-eight people completed the program and 55 agreed to participate in the evaluation.

Maternity services and the discharge process: a review of practice in Queensland.

Background: Efforts to increase postnatal support available to women and families are hampered by inadequate referral mechanisms. However, the discharge process in maternity services has received little research attention.

Aim: To review current discharge practices in Queensland, in order to identify mechanisms to minimise fragmentation in the care of women and families as they transition from hospital-based postnatal care to community-based health and other services.

Maternity care providers' perceptions of women's autonomy and the law.

Background: Like all health care consumers, pregnant women have the right to make autonomous decisions about their medical care. However, this right has created confusion for a number of maternity care stakeholders, particularly in situations when a woman's decision may lead to increased risk of harm to the fetus. Little is known about care providers' perceptions of this situation, or of their legal accountability for outcomes experienced in pregnancy and birth.