Sally Pezaro

The 2025 revision of Ireland's midwifery education standards marks the first comprehensive update since 2012 and includes an important step forward in acknowledging trans and gender diverse (TGD) people as recipients of midwifery care. However, despite this progress, the standards remain constrained by gender‐exclusive language and a lack of substantive integration of TGD perspectives across curricula. Drawing on international literature and recent evidence on TGD pregnancy experiences, this commentary argues that recognition without structural embedding risks tokenism and perpetuates inequity. Situating the discussion within a human rights framework, it highlights the relevance of the International Confederation of Midwives' Philosophy and Bill of Rights, which centers on self‐determination, bodily autonomy, justice and equity, principles that align directly with trans inclusion. The commentary calls for consistent inclusive terminology, explicit competencies in TGD health, and leadership education that equips midwives to advocate for equity and human rights. It also underscores the need to foster safe, affirming environments for trans and non‐binary midwives, ensuring that the profession itself embodies the inclusivity it promotes in care.

Integrating research and evidence into teaching promotes critical thinking, problem solving and innovation, but challenges remain in identifying the most effective methods. The Research Inspired Online/Offline Teaching (RIOT) framework presents a solution for midwifery and nursing education, but its applicability and feasibility must first be tested. This study investigated factors influencing the implementation of the RIOT framework and proposed solutions for overcoming barriers. Semi-structured interviews and qualitative surveys were conducted with academic staff, and educational managers and leaders in a university in the United Kingdom between February and June 2024. Twenty-four interviews and six qualitative survey responses were analysed using framework and thematic analysis. Framework analysis identified barriers and solutions at five levels: individual, interpersonal, organisational, institutional and societal. Thematic analysis formed four overarching themes: (1) understanding the relevance of research, (2) knowledge, skills, tools and confidence to apply research into teaching, (3) establishing a collaborative research culture and (4) overcoming challenges impacting the ability to maintain teaching excellence. The 4M Model for Promoting Research Inspired Teaching in Midwifery and Nursing Education was developed from the findings to provide a foundation for facilitating research integration via the RIOT framework. The 4M model emphasises the necessity for collaboration, optimisation of research impact, cultivation of a collaborative research culture, and maintenance of teaching excellence.

The COVID-19 pandemic profoundly impacted nurses and other healthcare professionals, underscoring a need to capture and share their experiences, especially amid persistent negative perceptions of nursing. This research aimed to understand the experiences of those who worked during the pandemic, translate them into audio artworks, and understand how their resulting exhibition was experienced. Utilizing arts-based inquiry, nurses ( n = 4) and other healthcare specialists ( n = 4) were involved in an arts-based workshop fostering a deep exploration of their experiences, and revealing themes such as uncertainty, the complexities of navigating professional identity within widespread “hero narratives”, human connection and the powerful sense of catharsis and community found in sharing their experiences. Inspired by these insights, an artist created the audio artwork “Boats on an ocean”. Six other audio artworks were subsequently created in the same way. A survey ( n = 18) and in two hybrid workshops ( n = 6) were then undertaken to understand how audiences experienced the exhibited artwork. Audiences consistently described the exhibition as “profoundly moving”. This research marks the first instance of using arts-based methods to both qualitatively capture and artistically disseminate healthcare professionals’ COVID-19 experiences. It serves as a historic record, preserving accounts for future generations.

Aims: With respect to midwives and nurse‐midwife populations (1) measure and (2) explore professional identity and (3) explore how the midwifery profession may be best represented in the public realm. Design: Convergent Parallel Mixed‐Methods Design. Methods: A web‐based survey was used to collect data from 860 midwives and nurse‐midwives from 102 countries between February and July 2022. Qualitative data were analysed inductively via reflexive thematic analysis. Statistical analysis was performed using SPSS. Results: Nurse‐midwives had a statistically significant higher professional identity score than midwives. Subthemes included pride and passion in midwifery and nurse‐midwifery; motivational religiosity; celebrating role diversity and a call for the separation of nursing and midwifery. Subthemes outlining barriers to the development of a healthy professional identity related to lack of professional recognition in society and lack of respect from other professions. Subthemes related to the representation of midwifery included (1) imagery (e.g., real midwives) and (2) mediums (e.g., statues). Diminished professional identity and the conflation of midwifery with nursing were negatively associated with the recruitment and retention of midwives. Conclusion: This is the first study to measure and investigate the professional identity of midwives and nurse‐midwives concomitantly and explore how midwifery may be best represented in the public realm. Public monuments highlighting both the art and science of midwifery along with the separation of midwifery from the nursing profession and enhanced role diversity may boost the professional identity of midwives overall. Implications for the Profession: Midwives' professional identity, status and recognition in society are key to improved perinatal outcomes, recruitment and retention. Findings will inform interventions designed to enhance the professional identity and public representation of midwives worldwide. Impact: This research demonstrates midwives diminished professional identity. Findings will be used to bolster the midwifery profession to improve perinatal outcomes, along with the recruitment and retention of midwives to the benefit of childbearing people and their families worldwide. Patient or Public Contribution: Global webinars were used to engage midwives and nurse‐midwives in shaping the design and direction of this research. Reporting Method: The Good Reporting of a Mixed Methods Study (GRAMMS) checklist was used to guide reporting.

Background and aim Preconceptional care aims to improve health and is influenced by various factors including health literacy. Considering the importance and necessity of high quality preconceptional care, this study aimed to determine the predictors of receiving care and folic acid supplementation prior to pregnancy. Methods This cross-sectional study included 693 participants with pregnancies of less than 14 weeks gestation referred to health centers and gynecologists in Shiraz city, Iran. Multi-stage sampling occurred from May 2021 to February 2022 in 18 comprehensive urban health centers and 20 gynecology offices via the proportional allocation method. Data was collected using a questionnaire consisting of 3 parts: 1) individual and fertility characteristics, 2) information related to the components of preconceptional care and 3) health literacy. This was completed by individual participants who self-reported their responses. Results Examining the frequency of the variables related to individual characteristics revealed that the mean age of participants in the study was 30.32 with a standard deviation of 5.29 years and more than half (59.3%) had a university level education. The receipt of pre-conceptual care was found to have a statistically significant relationship with the following: level of education, employment status, length of marriage, number of pregnancies, week of pregnancy and whether it was planned or not, along with health literacy (P < 0.05). Folic acid supplementation was found to have a statistically significant relationship with the following: level of education, financial status of the family, length of marriage, number of pregnancies and current pregnancy status (P < 0.05). In examining the predictive effect of individual variables and health literacy in the logistic regression model with the outcome of receiving preconceptional care and folic acid supplementation, length of marriage, health literacy, occupational status, and pregnancy planning status variables remained in the model following analysis. Conclusion Several factors had a statistically significant relationship with receiving pre-conceptual care and folic acid supplementation. In order to improve pre-conceptual care and increase folic acid supplementation, special attention must be paid to improving health literacy, increasing levels of education and reducing unplanned pregnancies.

Effective communication in relation to pregnancy and birth is crucial to quality care. A recent focus in reproductive healthcare on “sexed language” reflects an ideology of unchangeable sex binary and fear of erasure, from both cisgender women and the profession of midwifery. In this paper, we highlight how privileging sexed language causes harm to all who birth—including pregnant trans, gender diverse, and non‐binary people—and is, therefore, unethical and incompatible with the principles of midwifery. We show how this argument, which conflates midwifery with essentialist thinking, is unstable, and perpetuates and misappropriates midwifery's marginalized status. We also explore how sex and gender essentialism can be understood as colonialist, heteropatriarchal, and universalist, and therefore, reinforcing of these harmful principles. Midwifery has both the opportunity and duty to uphold reproductive justice. Midwifery can be a leader in the decolonization of childbirth and in defending the rights of all childbearing people, the majority of whom are cisgender women. As the systemwide use of inclusive language is central to this commitment, we offer guidance in relation to how inclusive language in perinatal and midwifery services may be realized.

Objective: To co-create expert guidelines for the management of pregnancy, birth, and postpartum recovery in the context of hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD). Design: Scoping Review and Expert Co-creation. Setting: United Kingdom, United States of America, Canada, France, Sweden, Luxembourg, Germany, Italy, and the Netherlands. Sample: Co-creators (n = 15) included expertise from patients and clinicians from the International Consortium on the Ehlers-Danlos syndromes and Hypermobility Spectrum Disorders, facilitated by the Ehlers-Danlos Society. Methods: A scoping review using Embase, Medline, the Cochrane Central Register of Controlled Trials and CINHAL was conducted from May 2022 to September 2023. Articles were included if they reported primary research findings in relation to childbearing with hEDS/HSD, including case reports. No language limitations were placed on our search, and our team had the ability to translate and screen articles retrieved in English, French, Spanish, Italian, Russian, Swedish, Norwegian, Dutch, Danish, German, and Portuguese. The Mixed Methods Appraisal Tool was used to assess bias and quality appraise articles selected. The co-creation of guidelines was based on descriptive evidence synthesis along with practical and clinical experience supported by patient and public involvement activities. Results: Primary research studies (n = 14) and case studies (n = 21) including a total of 1,260,317 participants informed the co-creation of guidelines in four overarching categories: 1) Preconceptual: conception and screening, 2) Antenatal: risk assessment, management of miscarriage and termination of pregnancy, gastrointestinal issues and mobility, 3) Intrapartum: risk assessment, birth choices (mode of birth and intended place of birth), mobility in labor and anesthesia, and 4) Postpartum: wound healing, pelvic health, care of the newborn and infant feeding. Guidelines were also included in relation to pain management, mental health, nutrition and the common co-morbidities of postural orthostatic tachycardia syndrome, other forms of dysautonomia, and mast cell diseases. Conclusions: There is limited high quality evidence available. Individualized strategies are proposed for the management of childbearing people with hEDS/HSD throughout pregnancy, birth, and the postpartum period. A multidisciplinary approach is advised to address frequently seen issues in this population such as tissue fragility, joint hypermobility, and pain, as well as common comorbidities, including dysautonomia and mast cell diseases.