Discovery of a Possibly Relict Outbreeding Morphotype of Sparrow's-egg Lady's-slipper Orchid, Cypripedium passerinum, in Southwestern Yukon

An outbreeding morphotype of Cypripedium passerinum with separate anthers and stigma was discovered in the Beringian region of southwestern Yukon. The occurrence of this breeding system in Beringia is attributed to the persistent advantage of outbreeding over hundreds of thousands of years in this unglaciated area, whereas the widespread occurrence of exclusively self-pollinating races elsewhere in Canada is attributed to advantages in colonization of recently deglaciated territory which first became available less than 10,000 years ago, and/or to a changing and more forested habitat

Building nursing and midwifery leadership capacity in the Pacific

© 2016 International Council of Nurses Aim: The Australian Award Fellowship Program aimed to strengthen nursing and midwifery leadership and capacity in developing countries in the Pacific. Background: It is necessary to build an optimal global health workforce, and leadership and mentorship are central to this need. This is especially important in small island states such as the Pacific who have limited capacity and resources. Introduction: This health system strengthening program addressed quality improvement in education, through the mentorship of potential nursing and midwifery leaders in the South Pacific Region. Methods: Program participants between 2013 and 2015 were interviewed. Data were audio-taped, transcribed and analysed thematically using an inductive process. Results: Thirty-four nurses and midwives from 12 countries participated. There were four main themes arising from the data which were: having a country-wide objective, learning how to be a leader, negotiating barriers and having effective mentorship. Discussion: Our study showed that participants deemed their mentorship from country leaders highly valuable in relation to completing their projects, networking and role modelling. Similar projects are described. Limitations: The limitation of this study was its small size. There is a need to continue to build the momentum of the program and Fellows in each country in order to build regional networks. Conclusions and implications for nursing and midwifery: The Program has provided beneficial leadership education and mentorship for nurses and midwives from Pacific countries. It has provided a platform to develop quality improvement projects in line with national priorities. Implications for health policy: Global aid programs and the recipients of the program would benefit from comparable health strengthening approaches to nursing and midwifery in similar developing countries

Examining the content validity of the Birthing Unit Design Spatial Evaluation Tool (BUDSET) within a woman-centred framework.

Introduction: The environment for birth influences women in labor. Optimal birthing environments have the potential to facilitate normal labor and birth. The measurement of optimal birth units is currently not possible because there are no tools. An audit tool, the Birth Unit Design Spatial Evaluation Tool (BUDSET), was developed to assess the optimality of birthing environments. The BUDSET is based on 4 domains (fear cascade, facility, aesthetics, support), each comprising design principles that are further differentiated into specific assessable design items. In the process of developing measurement tools, content validity must be established. The aim of this study was to establish the content validity of the BUDSET from the perspective of women and midwives. Methods: This was a mixed-methods study with a survey assessing agreement with BUDSET items and in-depth interviews. Survey results were analyzed using an item-level content validity index and a survey-level validity index. Interview data were analyzed using a directed content analysis approach. The study was conducted in 2 locations¿a major maternity hospital and a midwifery research center, both in Australia. Study participants were 10 women and 2 midwifery academics. Results: The survey revealed that content-related validity varied according to the BUDSET domain, with the domains of facility and support established as content valid by most participants. The domains of the fear cascade and aesthetic were less strong, particularly among pregnant women. Interview data analysis provided content validity evidence of both the fear cascade and aesthetic domains. A further 4 subthemes of fear cascade also were identified: foreign space, medical-hospital-emergency, being sterile/clinical, and protecting the woman from the environment. Content validity evidence for facility and support domains also was established. Discussion: This study has established that the BUDSET is content valid for assessing the optima ity of birthing environments. Some further refinement of the tool is now possible

Maternal mortality in Australia: Learning from maternal cardiac arrest

Cardiac arrest in pregnancy is fortunately a rare event that few midwives will see during their career. The increase in maternal age, the Body Mass Index, cesarean sections, multiple pregnancies, and comorbidities over recent years have increased the probability of cardiac arrest. The early warning signs of impending maternal cardiac arrest are either absent or go unrecognized. Maternal mortality reviews highlight the deficiencies that maternity care providers have in managing cardiac arrest in pregnancy. The aim of this article is to address the knowledge deficiencies of health professionals by reviewing the physiological changes in pregnant women that complicate the management of cardiopulmonary resuscitation, using a case scenario. There are key differences in the management of pregnant women, when compared to standard adult resuscitation. The outcome is dependent on the speed of the response and the consideration of a number of crucial pregnancy-specific interventions. Staff members need to be adequately trained in order to deal with maternal cardiac arrest and have access to training packages and in-service education programs. As cardiac arrest in pregnancy is a rare event, emergency drill simulations are an important component of ongoing education. © 2011 Blackwell Publishing Asia Pty Ltd.

‘Stress, anger, fear and injustice’: An international qualitative survey of women's experiences planning a vaginal breech birth

© 2016 Elsevier Ltd Objective the outcomes of the Term Breech Trial had a profound impact on women's options for breech birth, with caesarean section now seen as the default method for managing breech birth by many clinicians. Despite this, the demand for planned vaginal breech birth from women does exist. This study aimed to examine the experiences of women who sought a vaginal breech birth to increase understanding as to how to care for women seeking this birth option. Design an electronic survey was distributed to women online via social media. The survey consisted of qualitative and quantitative questions, with the qualitative data being the focus of this paper. Open ended questions sought information on the ways in which woman sourced a clinician skilled in vaginal breech birth and the level of support and quality of information provided from clinicians regarding vaginal breech birth. Thematic analysis was used to analyse and code the qualitative data into major themes. Findings in total, 204 women from over seven countries responded to the survey. Written responses to the open ended questions were categorised into seven themes: Seeking the chance to try for a VBB; Encountering coercion and fear; Putting the birth before the baby?; Dealing with emotional wounds; Searching for information and support; Traveling across boundaries; Overcoming obstacles in the system. Key conclusions for women seeking vaginal breech birth, limited system and clinical support can impede access to balanced information and options for care. Recognition of existing evidence on the safety of vaginal breech birth, as well as the presence of clinical guidelines that support it, may assist in promoting vaginal breech birth as a legitimate option that should be available to women

This baby is not for turning: Women's experiences of attempted external cephalic version

© 2016 The Author(s). Background: Existing studies regarding women's experiences surrounding an External Cephalic Version (ECV) report on women who have a persistent breech post ECV and give birth by caesarean section, or on women who had successful ECVs and plan for a vaginal birth. There is a paucity of understanding about the experience of women who attempt an ECV then plan a vaginal breech birth when their baby remains breech. The aim of this study was to examine women's experience of an ECV which resulted in a persistent breech presentation. Methods: A qualitative descriptive exploratory design was undertaken. In-depth semi-structured interviews were conducted and analysed thematically. Results: Twenty two (n = 22) women who attempted an ECV and subsequently planned a vaginal breech birth participated. Twelve women had a vaginal breech birth (55 %) and 10 (45 %) gave birth by caesarean section. In relation to the ECV, there were five main themes identified: 'seeking an alternative', 'needing information', 'recounting the ECV experience', 'reacting to the unsuccessful ECV' and, 'reflecting on the value of an ECV'. Conclusions: ECV should form part of a range of options provided to women, rather than a default procedure for management of the term breech. For motivated women who fit the safe criteria for vaginal breech birth, not being subjected to a painful experience (ECV) may be optimal. Women should be supported to access services that support vaginal breech birth if this is their choice, and continuity of care should be standard practice

Supporting Women Planning a Vaginal Breech Birth: An International Survey

© 2016 Wiley Periodicals, Inc. Objective: The aim of this study was to explore the experiences of women who planned a vaginal breech birth. Method: An online survey was developed consisting of questions regarding women's experiences surrounding planned vaginal breech birth. The survey was distributed between April 2014 and January 2015 to closed membership Facebook groups that had a consumer focus on vaginal breech birth. Results: In total, 204 unique responses to the survey were obtained from women who had sought the option of a vaginal breech birth in a previous pregnancy. Most women (80.8%) stated that they were happy with the birth choices they made, and a significant proportion (89.4%) would attempt a vaginal breech birth in subsequent pregnancies. Less than half of women were formally referred to a clinician skilled in vaginal breech birth when their baby was diagnosed breech (41.8%), while the remainder sourced a clinician themselves. Half of the women felt supported by their care provider (56.7%) and less than half (42.3%) felt supported by family and friends. Conclusion: The women who responded to this international survey sought the option of a vaginal breech birth, were subsequently happy with this decision, and would attempt a vaginal breech birth in their next pregnancy. Access to vaginal breech birth is important for some women; however, this choice may be challenging to achieve. Consistent information and support from clinicians is important to assist decision-making

Effects of the COVID-19 lockdown on mental health in a UK student sample

BACKGROUND: The COVID-19 pandemic and the resulting restrictions placed upon society have had a profound impact on both physical and mental health, particularly for young people. AIMS: The current study assesses the impact of COVID-19 on student mental health. METHOD: Four hundred and thirty four first year Undergraduate students completed a battery of self-report questionnaires (PHQ-P, GAD-7 and SAS-SV) to assess for depression, anxiety and mobile phone addiction respectively with data being collected over a 2 year period. The data from each year was compared (216 and 218 students respectively). RESULTS: A MANOVA revealed that COVID-19 had a significant impact on self-reported levels of depression, anxiety and smartphone addiction—which all significantly increased from the 2020 to the 2021 group. The percentage of students who had a score which warranted a classification of clinical depression increased from 30 to 44%, and for anxiety increased from 22 to 27%—those students who showed a comorbidity across the two rose from 12 to 21%. Smartphone addiction levels rose from 39 to 50%. Correlational analysis showed a significant relationship between Smartphone usage and depression and anxiety. CONCLUSIONS: This research suggests that COVID-19 has had a major impact upon student mental health, and smartphone addiction. The importance of identifying predictive factors of depression and anxiety is emphasised, and suggestions for intervention are discussed