Nursing Midwifery Commons^™

Co-Design And Feasibility Testing Of A Midwife-Led Birth Debrief: An Implementation Science Project, Kate Buchanan, Phoebe Backhouse, Leanne Graham, Amy O’Meagher, Sara Bayes

Research outputs 2022 to 2026

Background: The period spanning pregnancy, birth and postpartum is characterised by psychosocial as well as physiological changes: many women experience new or worsening mental ill-health during the perinatal period. Midwives play a critical role in supporting and promoting psychosocial health by providing mental health education, counselling and screening. Often this includes a post-birth conversation, guided reflection, or debrief. Information about the effectiveness and experiences of specific and structured midwife-led birth debrief is scant. Aim: Our study aimed to assess the perceived effectiveness, experiences and implementability of a midwife-led birth debriefing intervention in one Australian maternity unit. Methods: A Type II …

Digital Teaching In Midwifery Education Since 2021: A Literature Review Of Trends, Technological Advancements And Challenges, Michelle Gray, Kristina Vogel, Annette Bernloehr, Terri Downer, Melanie Welfare, Nicola H. Bauer

Research outputs 2022 to 2026

Aim: To produce an updated synthesis of digital learning and teaching approaches in midwifery education since 2021. Background: Globally, there is an increasing trend towards using digital technologies in midwifery education with little examination of trends, terminology or impact by midwifery academics. Design: A comprehensive literature review. Methods: Ten databases were searched (2021–March 2025) guided by JBI methodology and PRISMA-ScR reporting, resulting in 36 empirical studies focusing on digital technologies used with midwifery students. The review mapped recent technological developments, associated benefits and emerging challenges. Results: Digital innovations were in 15 countries and ranged from immersive virtual reality, augmented and …

Maternal Prenatal Anxiety And Risk Of Preterm Birth And Low Birthweight: Evidence From A Cumulative Meta-Analysis With Stability Thresholds, Bereket Duko, Desta, Biniyam Sahiledengle, Yohannes Tekalegn Efa, Tenaw Tiruye, Lisa Whitehead, Gavin Pereira, Amanuel Tesfay Gebremedhin

Research outputs 2022 to 2026

Background: We conducted cumulative meta-analyses to quantify the degree to which maternal prenatal anxiety impacts preterm birth (PTB) and low birthweight (LBW), and to identify when findings reached stability, enabling confident recommendations for early interventions. Methods: Following PRISMA guidelines, we systematically searched PubMed/MEDLINE, PsycINFO, Scopus, EMBASE, CINAHL (EBSCO), ProQuest, and the Cochrane Library from database inception to May 7, 2025. The methodological quality of included studies was assessed using the Newcastle–Ottawa Scale. Inverse variance weighted random-effects cumulative meta-analysis was performed to pool adjusted odds ratios (AORs) with sequential inclusion of newly published studies. Stability thresholds were computed to assess sufficiency …

Factors Impacting Western Australian Midwives' Intention To Stay: A Mixed Methods Study, Christine Atkinson, Dianne Bloxsome, Zoe Bradfield, Kate Buchanan, Sarah Dawson, Frances Finch, Sadie Geraghty, Sara Bayes

Research outputs 2022 to 2026

Problem Midwifery workforce sustainability remains a critical concern for maternity services. Existing literature predominantly focuses on burnout and attrition, offering limited insight into what influences midwives’ decisions to remain within specific workplaces. Background Midwives consistently report strong professional commitment alongside growing workforce instability. National data indicate that uncertainty about current roles does not necessarily reflect disengagement from the profession. Understanding workplace-level influences on retention is therefore essential for targeted workforce strategy. Aim To examine how workplace stress and satisfaction with the practice environment are associated with Western Australian midwives’ intention to stay in their current job and in the profession. …

The Effect Of Midwife-Led Continuous Labor Support Care On Delivery Mode And Timely Initiation Of Breastfeeding In Primigravida Women In Northwest Ethiopia: A Hybrid Type I Implementation Study, Mengstu Melkamu Asaye, Aragaw, Eden Bishaw Taye, Kihinetu Gelaye Wudineh, Sara Bayes

Research outputs 2022 to 2026

Midwife-led continuous labor and childbirth support reduces the episiotomy rate and increases the rates of vaginal delivery and early initiation of breastfeeding. However, no studies have yet been conducted in Ethiopia. This study aimed to evaluate the effect of midwife-led continuous labor and childbirth support. A quasi-experimental study involving 419 primigravida women compared an intervention given by trained midwives at two hospitals to routine at two others. Data were collected from July to December 2024 through interviews and record reviews. The McNemar test was used to compare changes, with a p-value of less than 0.05. Midwife-led continuous labor support increased …

Reimagining Peer-Led Support In Doctoral Nursing And Midwifery Education: A Collaborative Autoethnographic Case Study, Gideon U. Johnson, Sachini Thennakoon, Mayumi Kumarage, Emy Toutountzis, Lisa Whitehead

Research outputs 2022 to 2026

Aim: To explore how peer-led initiatives can enhance connection, belonging and sustainability within higher degree by research (HDR) nursing and midwifery programmes. Background: HDR study can be an isolating experience, often characterised by fragmented support and limited opportunities for structured peer learning. While institutions provide formal mechanisms for supervision and progress, less attention has been given to student-led approaches that cultivate inclusive scholarly communities and sustained peer engagement. Design: Collaborative autoethnographic case study. Methods: HDR student representatives and academic staff at Edith Cowan University, Australia (2022–2024), reflected collaboratively on the design, implementation and impact of peer-led initiatives, including monthly hybrid …

Intrapartum Experiences Of Gestational Surrogates And Intended Parents In Australia: A Qualitative Study, Jutharat Attawet, Leo Ng, Evie Kendal, Yunjing Qiu, Myles Ojabo, Sarah Jefford, Micah D.J. Peters

Research outputs 2022 to 2026

Background Gestational surrogacy is an increasingly visible, though tightly regulated, pathway to parenthood in Australia, yet intrapartum care remains under-examined. Existing maternity models are grounded in woman-centred care and offer limited guidance for births involving surrogates and intended parents within a triadic care relationship. Objectives To describe the intrapartum experiences of gestational surrogates and intended parents in Australia and to identify care processes that support or hinder respectful, inclusive practice. Methods A descriptive qualitative study was conducted with purposive sampling. Seventeen participants took part between December 2024 and May 2025, comprising nine gestational surrogates and eight intended parents who had …

Midwifery Students' Definitions Of Normal Labor And Birth: A Study From Five Countries, Jalana Lazar, Juliet Wood, Jane Fry, Barbara Baranowska, Urszula Tataj-Puzyna, Debora Dole, Emma Ritchie, Clare Davison, Cindy L. Farley, Felicity Agwu Kalu, Maria Healy, Maria Węgrzynowska

Research outputs 2022 to 2026

Introduction: Internationally, many women and birthing people are receiving maternity care interventions as a routine with no medical indication for their use. This medicalized environment influences midwives' practice and, by extension, midwifery students' clinical learning experiences, gaining knowledge and confidence in facilitating normal labor and birth. To educate midwifery students in the provision of high-quality maternal and newborn care, it is important to explore their understanding of normal labor and birth, as this underpins their philosophy of care and will inform their future practice. Methods: An online survey was developed from a review of current evidence. Following ethical approval, the …

Quantifying Nurse And Midwife-Led Research Impact: Retrospective Application Of The Framework To Assess The Impact From Translational Health Research (Fait) Model On Two Exemplar Randomised Controlled Trials, Kim Neylon, Rouen, Lisa Whitehead, Greg Sharplin, Kathleen Baird, Marion Eckert

Research outputs 2022 to 2026

Background: Nurse- and midwife-led clinical trials are underrepresented in Australia and New Zealand, despite their potential to improve health outcomes and deliver economic value. Demonstrating the broader impact of such research is essential to inform policy and funding decisions. Aim: To assess the utility of the Framework to Assess the Impact from Translational health research (FAIT) in capturing the translational impact of nurse- and midwife-led randomised controlled trials through retrospective application to two exemplar studies. Methods: FAIT was retrospectively applied to the RSVP (nurse-led) and DAME (midwife-led) trials using three components: Modified Payback, Economic Analysis, and Narrative. Program Logic Models …

Research Publication Performance Of The Australian And New Zealand Nursing And Midwifery Professoriate, Lisa Mckenna, Fiona Bogossian, Simon Cooper, Tracy Levett-Jones, Philippa Seaton

Research outputs 2022 to 2026

Aim: To analyse research publication performance of Australian and New Zealand professors and associate professors of nursing and midwifery, and compare with 2016 data. Methods: A search of university websites was conducted to identify all nursing and midwifery professoriate in Australia and New Zealand. Each individual was then searched in the Scopus database to identify individual total citations, h-index, number of publications, first author Field Weighted Citation Impact (FWCI) and overall FWCI. Comparisons with 2016 data were also undertaken. Results: A total of 304 academics were included, comprising 270 from Australia and 34 from New Zealand, and 169 full professors …

The Development Of A Midwifery Specific Tool To Identify The Barriers And Enablers To Change Within The Midwifery Setting, Sara Davis

Theses: Doctorates and Masters

Despite being well-positioned to identify service gaps and propose improvements, many midwives lack the knowledge, skills, confidence, or tools to effect practice change. Implementation science (IS) offers a structured approach to moving evidence-based innovations into practice; however, existing IS theories, models, and frameworks do not reflect the unique context of midwifery practice. The first step in the intentional implementation of an evidence-based practice innovation is to conduct a context assessment to identify factors that may facilitate or impede its uptake. There are numerous evidence-based checklists for this, but none capture all the influences on midwifery practice environments.

In this study, …

Midwife-Led Birth Debrief: A Concept Analysis, Kate Buchanan, Elliesha O'Reilly, Georgia Wilcox, Sara Bayes, Lauren Kearney, Linda Sweet, Hazel Keedle

Research outputs 2022 to 2026

Background: Psychological birth trauma (PBT) affects approximately 19 % of postnatal women, making its prevention a global priority. Midwives are responsible for providing psychosocial care during the postnatal period to foster the mother-infant relationship, provide education and screening and support positive transitions to parenting. However, the specific attributes of a birth debrief and the role of the midwife in a supporting a woman to review their birth experience is less well documented in regulatory frameworks or scientific literature. This has created significant ambiguity in both clinical practice among health professionals and in research contexts. The lack of a clear understanding …

Nurses’ And Midwives’ Job Satisfaction And Retention During Covid-19: A Scoping Review, Laura Hynes, Sadie Geraghty, Sheena Mcchlery, Aisling Smyth, Reeti Brar, Karen Clark-Burg

Research outputs 2022 to 2026

Background: The COVID-19 pandemic focused attention on the previously well-documented world-wide shortage of nurses and midwives. The pandemic accentuated this crisis, which resulted in nurses and midwives questioning their roles and their careers. The impact of the pandemic on job satisfaction and the intention of nurses and midwives to stay has not been adequately explored. Aim: The aim of this scoping review was to identify and map the literature that describes the intrinsic and extrinsic factors that influenced nurses’ and midwives’ job satisfaction and intent to stay or leave their employment or profession during the COVID-19 pandemic. Method: This scoping …

Delivering Optimal Weight Gain Advice To Pregnant Women By Lead Maternity Carer Midwives In A Real-World Setting To Optimise Health Outcomes (Dot Study): A Case Study Protocol, Kirsten J. Coppell, Nicole Mcgrath, Beverley Lawton, Kendall Stevenson, H. Mel Rackham, Katrina J. Sharples, Trudy Sullivan, Rosemary M. Hall, Helen Paterson

Research outputs 2022 to 2026

Background: Excess gestational weight gain (GWG) occurs in up to 70% of women who birth. Excess GWG increases the risk of adverse outcomes in both mother and baby including gestational diabetes, pre-eclampsia, postpartum weight retention, large for gestational age babies, and adiposity among children. Antenatal lifestyle interventions can limit excess GWG. However, successful translation of interventions into routine antenatal care are seldom, and interventions involving midwives are uncommon. Following a successful feasibility study, the main aims of this study are to determine if the Delivering Optimal weighT gain advice in pregnancy (DOT) intervention is acceptable to midwives, acceptable and accessible …

Women’S Experiences Of Declining Recommended Or Routine Maternity Care: A Systematic Review, Ilyana Mohamed Hussain, Kate Buchanan, Linda Sweet, Sara Bayes

Research outputs 2022 to 2026

Background Women have the right to decline recommended or routine maternity care. While informed choice is increasingly emphasised in maternity care, the experiences of women who decline recommended or routine care remain underexplored. Aims To synthesise evidence on women’s experiences of declining recommended or routine aspects of maternity care. Methods A systematic review was conducted using a structured approach informed by Joanna Briggs Institute (JBI) principles for qualitative synthesis. Eight studies were appraised using the Critical Appraisal Skills Programme (CASP) checklist. Data were analysed through a narrative synthesis process, developing categories and dimensions that were synthesised into overarching themes. Results …

Woman-Centred Ethical Grid For Midwifery Education: A Content Analysis, Kate Buchanan, Darcie Bygraves, Emma Ritchie, Krystyl Toneycliffe, Sara Bayes, David Seedhouse

Research outputs 2022 to 2026

Background: Midwives across the world are required to practice in accordance with an internationally agreed set of ethical principles. Midwifery education for many students includes ethics theory content, but this does not necessarily provide them with the skills toward ethical competence in practice. Aim: To understand students' perception of ethical issues and to use these findings as foundational information with which to create an ethical deliberation tool for practice. Methods: Qualitative Content Analysis was used for this study. Purposive sampling provided twenty-one ethics-focused reflective assignments from one Western Australian university. Ethical considerations: Institutional review board approval was obtained. Findings: Three …

Global Perspectives Of Midwifery Ethics: Crucial Features For Practice Via An International Delphi Study, Kate Buchanan, Sara Bayes, Elizabeth Newnham, Mavis Kirkham, Marianne Nieuwenhuijze

Research outputs 2022 to 2026

Background: Practising ethically as a midwife is essential for providing high quality care during pregnancy, childbirth, and the postpartum period. Whilst midwives may have theoretical knowledge of ethics, applying ethical care in practice may be challenging. There is a gap in the literature that describes how midwives themselves conceptualise, interpret, and apply ethics in their practice. Aim: To describe midwives’ perceptions, and experiences of ethics in midwifery practice, and to determine the crucial features of midwifery ethics. Methods: Fifty participants from 21 countries participated in the study. A two-round Delphi approach was employed. Round Two required participants to enter the …

Co-Designing A Resilience-Based Mentoring Program For Novice Midwives: A Participatory Action Research Approach, Dianne Bloxsome, Tracy Martin, Kaoru Nosaka, Sara Bayes

Research outputs 2022 to 2026

Aim: To co-design a resilience-based mentoring program for novice midwives in Western Australia, informed by the experiences of past midwifery graduates and the perspectives of midwives in senior roles. Background: Effective workforce planning and retention strategies are essential in preventing the continued loss of midwives and in attracting newly qualified midwives to healthcare organisations. Transitioning from student to registered midwife is a known period of vulnerability that requires structured, evidence-informed support. Design: A Participatory Action Research (PAR) approach was adopted to collaboratively develop a mentoring program tailored to the transition needs of newly qualified midwives. Methods: Fourteen participants contributed to …

A Five-Country Comparison Of Midwifery Students' Confidence In Facilitating Normal Labor And Birth, Juliet Wood, Jalana Lazar, Barbara Baranowska, Clare Davison, Debora Dole, Cindy L. Farley, Jane Fry, Maria Healy, Felicity Agwu Kalu, Urszula Tataj-Puzyna, Emma Ritchie, Maria Wegrzynowska

Research outputs 2022 to 2026

Introduction: Midwifery students need confidence in recognizing and supporting normal birth, the backbone of the midwifery professional role. Developing this confidence in the face of decreasing rates of physiological birth worldwide is a critical challenge. Midwife researchers from Australia, England, Northern Ireland, Poland, and the USA investigated midwifery student confidence for supporting normal birth and explored enhancing and detracting factors. Methods: A cross-sectional survey design was undertaken with 570 midwifery students at 8 academic midwifery programs across 5 countries The Student Confidence for Supporting Normal Birth Questionnaire with free text and Likert-type questions on a 1 (least influential) to 4 …

Work While You Learn: Evaluating A Paid Employment Model For Postgraduate Midwifery Students In Diverse Contexts, Sadie Geraghty, Kirstie Balding, Sheena Mcchlery, Sarah Hay

Research outputs 2022 to 2026

Background: Postgraduate midwifery student employment models are lacking robust evaluation of how the paid employment model serves as a workforce strategy in Western Australia. Aim: The aim of this study was to evaluate a paid employment model for postgraduate midwifery students, that was implemented in metropolitan, rural, and regional areas in a Western Australian context. Methods: A convergent parallel design collected both quantitative and qualitative data. This study used a survey design with quantitative and qualitative questions within a well-established process evaluation framework. Results: All midwifery students reported benefits of the paid model of employment, which included financial stability while …

Measuring The Impact Of The Australian National Placement Evaluation Centre To Enhance Nursing And Midwifery Student Clinical Placements: A Multimodal Evaluation, Colleen Ryan, Robyn Cant, Areum Hyun, Debbie Procter, Louise Alexander, Dianne Bloxsome, Lynda Hughes, Fiona Bogossian, Simon Cooper

Research outputs 2022 to 2026

Aim: To evaluate the early impact of the Centre. Background: The educational quality of nursing and midwifery student clinical placement learning varies. The National Placement Evaluation Centre has a pivotal role in quality improvement by systematically collecting student and supervisor feedback on placement experiences. Design: Multimodal impact evaluation. Methods: Data were collected from website analytics and a survey shared via stakeholder registration emails and social media. The Impact Management Planning and Evaluation Ladder model was used to understand impact. Data were analysed using a sequential, hybrid inductive/deductive approach. Descriptive statistics summarised participant characteristics and qualitative data were themed. Results: Website …

Compassionate Self-Care For Nurses And Midwives: A Sequential Explanatory Mixed Methods Study, Mary Steen, Shwikar Othman, Jennifer Fereday, Annette Briley, Qunyan Xu, Rachael Vernon

Research outputs 2022 to 2026

Background: Awareness of being kind and compassionate to yourself is often overlooked despite emerging evidence that high levels of self-compassion decrease levels of anxiety and improves well-being. Aim: To explore what being compassionate to yourself means to nurses and midwives and increase knowledge and understanding of how self-compassion may enhance well-being. Methods: Mixed methods study design was utilised to investigate and explore the influence of self-compassion on nurses and midwives' well-being. Phase 1 involved quantitative data collection and analysis. Phase 2 qualitative data were collected to expand on quantitative results. Results: Fifty-four participants responded to a pre-workshop questionnaire, 55 completed …

Midwifery Students' Evaluation Of Midwifery Practice Experiences In Australia: A National Survey, F. Bogossian, A. Hyun, D. Bloxsome, A. Brown, S. Cooper, S. Hunter, L. Kearney

Research outputs 2022 to 2026

Aim: To report the findings of the first 12 months of a national survey of midwifery students’ evaluation of midwifery practice experiences in Australia. Background: Accreditation standards for midwifery programs globally and in Australia, require evidence of monitoring and evaluation of student midwifery practice experiences. In 2022 the National Placement Evaluation Centre was commissioned to measure and enhance the quality of nursing and midwifery practice experiences. Design: Survey Methods: A national survey of midwifery students who completed midwifery practice experience in Australia between 1 July 2023 and 30 June 2024. Results: Midwifery practice experiences (n = 871) were evaluated; most …

Transformative Learning In Homebirth Settings: A Reflexive Thematic Analysis Of Midwifery Students' Experiences, Kate Buchanan, Sara Morris, Sara Bayes, Clare Davison

Research outputs 2022 to 2026

Background: The homebirth setting provides opportunities for midwifery students to witness autonomous midwifery practice, but these experiences are limited. Factors that limit practicum placement in the home birth setting are either logistical, with less than one percent of women having a homebirth in Australia or related to university governance, whereby approval is not granted for midwifery students attending homebirth. Objectives: To explore midwifery students' experiences in the homebirth setting and to determine how this has influenced understandings of the role and scope of practice the midwife. Methods: Qualitative methods were chosen to inform this study. Setting: A University that offers …

Indirect Evidence Of Sex-Selective Abortion Practices To The Imbalanced Sex Ratio At Birth In Australian Migrant Populations, Amanuel Tesfay Gebremedhin, Gizachew A. Tessema, Ravisha Srinivasjois, Judith A. Daire, Kevin A. Chai, Bereket Duko, Kalayu Brhane Mruts, Gavin Pereira

Research outputs 2022 to 2026

A skewed sex ratio at birth (SRB), commonly observed in countries with high son preference can be attributed to prenatal sex-selective abortion. However, the possibility of sex selection among migrants in high-income countries has received little attention. Our study aims to identify the indirect evidence of sex-selective abortion practices to the SRB imbalance in a large Australian cohort. Our study aims to identify the indirect evidence of sex-selective abortion practices to the SRB imbalance in a large Australian cohort. In this population-based study, perinatal data were obtained from all registered births in Western Australia (WA) and New South Wales (NSW) …

What Do Safety And Risk Mean To Women Who Choose To Birth At Home? A Systematic Review, Candice Chauncy, Kate Dawson, Sara Bayes

Research outputs 2022 to 2026

Introduction: Despite clear evidence to support the safety and efficacy of homebirth, the concept challenges the almost universal belief that hospital is the safest place to give birth. Homebirth remains largely unsupported around the world due to prevailing beliefs and constructs surrounding risk and safety. Despite barriers to access, women continue to choose home as a place to birth. Methods: A systematic review of qualitative research was conducted to explore and understand women's views on what constitutes risk and safety in labour and birth for those who choose to birth at home. All studies were evaluated for quality and relevance. …

Confirming The Validity And Reliability Of The Placement Evaluation Tool To Evaluate Midwifery Practice Placements (Pet-Midwifery), Fiona Bogossian, Dianne Bloxsome, Angela Brown, Robyn Cant, Susan Hunter, Lauren Kearney, Lesley Kuliukas, Carolyn Ross, Simon Cooper

Research outputs 2022 to 2026

Problem: In Australia, program accreditation requirements include that education providers monitor and evaluate teaching and learning environments and provide evidence of outcomes being used to inform program quality improvement. Yet, closing this loop has proven challenging. Background: The Australian National Placement Evaluation Centre (NPEC) functions to measure the quality of placements through student evaluations. One measure the Placement Evaluation Tool (PET) had not been tested in midwifery student cohorts. Aim: To confirm the validity and reliability of the Placement Evaluation Tool (PET) for midwifery. Design: Survey instrument development. Methods: A three-phase, sequential study involving seven Australian universities and students enrolled …

Midwives Experience Of Working With Maternity Assistants: A Qualitative Study, Carol Crevacore, Annie De Leo, Peta Fisher, Sara Bayes

Research outputs 2022 to 2026

Introduction: The midwifery workforce is essential for delivering safe, high-quality maternity care, however, global staffing shortages pose significant challenges. To address these issues, incorporating midwifery assistants, including undergraduate midwifery students into the model of care has been proposed as a strategy to support midwives and maintain effective service delivery. Aim: This study explores the Registered Midwives' experiences working with Midwifery Assistants (MAs) in an Australian tertiary maternity service. Methods: This study employed a qualitative exploratory design and was conducted using semi-structured interviews with 9 midwives who had experienced working with MAs in the tertiary maternity care setting. Results: The discussion …

A Qualitative Analysis Of Australian Midwifery Students’ Perspectives Of Midwifery Practice Experience: Characteristics That Enhance Or Diminish Clinical Education Placements, L. Kearney, Dianne Bloxsome, S. Hunter, A. Brown, Simon Cooper, F. Bogossian

Research outputs 2022 to 2026

Background: Midwifery education in Australia faces challenges in combining theoretical and practical experiences, with reports of inconsistent support and supervision during Midwifery Practice Experience (MPE), alongside significant financial and personal costs to students. National evaluation and improvement initiatives are essential to ensure that midwifery students receive effective and high-quality clinical learning opportunities. Aim: This study aimed to answer two research questions: 1) How do midwifery students describe their Midwifery Practice Experiences? 2) What are the characteristics of Midwifery Practice Experiences that enhance or diminish midwifery student learning? Methods: National midwifery student survey data, collected through the National Placement Evaluation Centre. …

How Valuable Is An Implementation Toolkit For Midwives? An Exploratory Study, Annemarie (Annie) De Leo, Linda Sweet, Peter Palamara, Dianne Bloxsome, Sara Bayes

Research outputs 2022 to 2026

Background: Incorporating evidence-based approaches in maternity care throughout the entire trajectory from pregnancy through to the postnatal phase is integral to good public health. Yet, despite developing theories, frameworks, and models to guide midwives’ implementation efforts, implementing new evidence-based practices in midwifery practice settings remains challenging. Methods: An exploratory study design was used to conduct an initial assessment of the appeal and suitability of an implementation ‘how to’ Toolkit for Australian change-leader midwives. We aimed to determine the effectiveness of the intervention by evaluating midwives’ experience of using the Toolkit, and report on the usability of the Toolkit in maternity …