Insight into how nurse prescribers feel about prescriptive authority. Highlights the advantages and disadvantages of this extended scope of practice. RNPs describe how to overcome some of the barriers they have encountered with useful suggestions being made for practice development and further research.

Introduction Type 1 diabetes mellitus occurs in one in every 275 pregnancies and can result in increased morbidity and mortality for both mother and baby. Several pregnancy complications can be reduced or prevented by attendance at pre‐pregnancy care (PPC). Despite this, less than 40% of pregnant women with pre‐gestational diabetes receive formal PPC. The aim of this scoping review is to identify the barriers to PPC attendance among women with type 1 diabetes. Methods We conducted a scoping review by searching five databases (Ebsco, Embase, Ovid and PubMed for literature and the ProQuest for any grey/unpublished literature) for studies in English between 2000 and 2022. Studies that evaluated attendance at PPC for women with type 1 diabetes were included. Results There are multiple barriers to PPC attendance, and many of these barriers have been unchanged since the 1990s. Identified barriers can be grouped under patient‐centered and clinician‐centered headings. Patient factors include knowledge and awareness, unplanned pregnancies, negative perceptions of healthcare and communication issues, unclear attendance pathways and logistical issues including time off work and childcare. Clinician factors include physician knowledge, time constraints and lack of comfort discussing pregnancy/contraception. Conclusion This review highlights the ongoing problem of poor attendance at PPC and identifies key barriers to be addressed when developing and implementing PPC programs for women with type 1 diabetes.

Background Following a shortage of Prostin gel in 2015, an alternative method of inducing labour was required. The Propess® pessary was sourced, a guideline adapted for local use and the method introduced into the local unit. There was a perception that this means of induction took longer than the traditional Prostin but with a higher vaginal birth rate. Aims To evaluate the effectiveness and safety of Propess® as a method of induction compared with Prostin. Methods A retrospective audit to compare the labour and mode of birth of all women who were induced in the Directorate over a specific time period. The NICE Clinical Guideline no. 70 (2008) was used as the audit standard. Findings Only 28.5% women in the Propess® group required the use of oxytocin to artificially initiate contractions, versus 43% in the Prostin group. The Prostin group took slightly longer overall from the start of the induction process to the birth of the baby. There was a similar vaginal birth rate in both groups and similar clinical outcomes for the babies. Conclusions Propess® is a safe, effective means to induce labour with its use to be continued locally. Results have been disseminated within the wider hospital group and a new audit planned for 2017.

As rates of anxiety, tocophobia and post-traumatic stress syndrome increase, there is a need for health professionals to reflect, review and rethink how women could be better prepared for labour and birth. Women need to fully understand the choices available and to have the support to enable them to deal with the pain and challenges of labour. All pregnant women should be helped to understand the physiology of labour and birth so that they are aware of what is happening to their bodies and what they and their midwife might do or avoid to keep birth normal. Information must incorporate discussions on both pharmacological and non-pharmacological methods of pain relief, which must be current, contemporary and evidence-based to enhance the woman's ability to make informed choices about her intrapartum care. How the woman copes with this process depends on not only the confidence she has in her own body but also on the support of her caregivers. The care setting, as well as any pre-existing fears, previous experiences and expectations all heavily influence a woman's positive or negative birth experience.