https://www.um.edu.mt/library/oar/handle/123456789/342 Fri, 10 Apr 2026 09:42:45 GMT 2026-04-10T09:42:45Z https://www.um.edu.mt/library/oar/handle/123456789/145398 Title: Midwives’ attitudes towards the development and implementation of birth plans Abstract: Birth plans are written documents that outline women’s preferences for labour, birth, and the postpartum period. Despite their recognised benefits in supporting woman-centred care, birth plans are not currently implemented in Malta, and local research on midwives’ attitudes is lacking, with limited quantitative evidence in international literature. This highlights the need for this study to inform practice and policy development. This study aimed to assess Maltese midwives’ attitudes towards developing and implementing birth plans, addressing the research question: What are midwives’ attitudes towards the development and implementation of birth plans in Malta? Its objectives were to explore their views and attitudes, perceived challenges, and strategies to support readiness for its implementation into practice. A primarily quantitative, non-experimental, cross-sectional, descriptive design was adopted, using a self-administered, self-designed online questionnaire supplemented by qualitative open-ended questions. Content validity was established via expert review, with indices indicating excellent item- and scale-level content validity, and inter-rater agreement. Reliability and feasibility were confirmed through a pilot study. Convenience sampling was employed, where 281 midwives practising at Mater Dei Hospital and Gozo General Hospital were invited to participate. 128 completed questionnaires were received, yielding a 45.55% response rate. Quantitative data were analysed using descriptive and inferential statistics, and qualitative data were analysed using reflexive thematic analysis (Braun & Clarke, 2022). The findings revealed generally positive views and attitudes towards birth plans, with midwives recognising their value for woman-centred care, informed decision-making, and communication. Midwives also identified practical challenges that may affect birth plan development and implementation and suggested strategies to facilitate adoption. The Theory of Planned Behaviour helped shed light on these findings, suggesting that midwives’ positive attitudes may strengthen intentions to implement birth plans, while perceived challenges can influence perceived behavioural control and subjective norms. This study indicates that overall, Maltese midwives view birth plans positively but require organisational support, education, and structured processes for effective implementation. These findings can inform policy development, enhance woman-centred care, and help align Maltese maternity services with international standards of respectful, evidence-based maternity care. Description: M.Sc.(Melit.) Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/145398 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/145397 Title: The influence of the birth environment on childbirth experiences : a quantitative study of midwives’ perspectives Abstract: Purpose: In recent decades, the institutionalisation of childbirth has led to increasingly medicalised maternity settings, with growing recognition of the impact this has on childbirth experiences. However, research has largely explored women’s perspectives and the physical aspects of the birth environment using qualitative methods. This study addresses these gaps by quantitatively investigating midwives’ perspectives on how various dimensions of the hospital birth environment shape the childbirth experience. Aim: To examine midwives’ views on the impact of the birth environment on the woman’s childbirth experience. Objectives: To identify midwives’ perceptions of physical factors in the birth environment that influence the woman’s childbirth experience; to assess midwives’ perceptions of psychological and emotional factors in the birth environment that influence the woman’s childbirth experience and to evaluate midwives’ reported practices in utilising the birth environment to enhance the woman’s childbirth experience. Methodology: A quantitative, non-experimental, cross-sectional design was employed using a self-designed online questionnaire distributed to midwives working in selected maternity settings within the main public hospital. Purposive sampling recruited 141 participants from a total population of 213 midwives, representing a 66.2% response rate. Quantitative findings were evaluated through descriptive and inferential statistical methods, whereas qualitative responses were examined using content analysis. The study was guided by the Birth Territory Theory (Fahy et al., 2008) and the Theory of Supportive Birth Settings (Maxwell et al., 2024), which provided the theoretical lens for interpreting findings. Results: Midwives highlighted key physical factors of the birth environment, including privacy, lighting and availability of birthing aids, while a calm and supportive atmosphere was recognised as crucial for psychological and emotional wellbeing. Novel findings included concerns about the delivery bed quality and functionality, the impact of swinging doors on privacy and soundproofing, and the anxiety-inducing presence of large wall clocks opposite delivery beds. Midwives identified various practices used to enhance the birth environment, however, institutional barriers were often reported to limit these efforts. Conclusion: This study contributes to the existing body of knowledge by providing quantitative evidence of midwives’ perspectives, a group previously underrepresented, and by extending focus beyond the physical to the psychological and emotional factors of the birth environment. Findings underscore the need for a balanced approach integrating environmental design, professional empowerment and institutional support to enhance childbirth experiences. The study provides a foundation for future research on broader dimensions of the birth environment and the factors that facilitate or hinder improvements in maternity care settings. Description: M.Sc.(Melit.) Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/145397 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/145396 Title: Midwifery models of care in practice : a national survey of midwives' knowledge and practice patterns Abstract: Purpose: The World Health Organization (2024) identifies that midwifery-led care as an effective strategy for reducing maternal and neonatal morbidity and mortality. In Malta, however, the maternity system remains predominantly obstetric-led, limiting midwives’ autonomy and constraining the implementation of midwifery-led models. This study explored Maltese midwives’ perceptions, knowledge, and practices of midwifery models of care, and examined opportunities for reform towards more womancentred, continuity-based care. Methods: A descriptive, cross-sectional quantitative survey was conducted among practising midwives working across public and private sectors in Malta, including Gozo. The research instrument was developed following an in-depth literature review to ensure comprehensive coverage of relevant domains, and it was validated for content validity, demonstrating good internal consistency and reliability. In Malta, approximately 260 midwives are actively employed in clinical practice (estimated from recent national reports; EMA Malta, 2025). All practising midwives were invited to participate, and 174 (n=67%) completed questionnaires were returned. This represents a high response rate among the active midwifery workforce, providing robust national coverage and exceeding the requirement for a 95% confidence level with a 5% margin of error. The survey explored midwives’ knowledge, practice patterns, autonomy, professional satisfaction, and perceived barriers to midwifery-led care. Quantitative data were analysed using descriptive and inferential statistics, while optional open-text comments were analysed using a simple inductive qualitative content analysis approach (Elo & Kyngäs, 2008) to contextualise quantitative findings Results: Midwives reported greatest familiarity with team-based hospital models, while continuity of care and community-based approaches were cited less frequently. Midwifery-led care were typically limited to low-risk women. One-to-one care was mostly achievable during labour, particularly in smaller units such as Gozo. Participants valued holistic, woman-centred care and continuity, however, they reported barriers including medical dominance, staff shortages, time constraints, and limited autonomy. Leadership from midwifery managers and the Ministry of Health was viewed as essential for system-level reform, although midwives acknowledged their own role in advocating for change. Conclusion: This study provides locally grounded quantitative evidence supporting the expansion of midwifery-led care in Malta. Strengthening midwifery education, autonomy, and policy support for continuity-of-care models has the potential to enhance maternal and neonatal outcomes and to further empower the midwifery profession. Recommendations for practice, education, policy, and research are proposed. Description: M.Sc.(Melit.) Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/145396 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/145395 Title: Exploring the influence of social media on adolescent mothers’ experiences of early motherhood Abstract: In an era where social media permeates nearly every aspect of daily life, particularly among adolescents, its influence has become particularly profound during the early stages of motherhood. This study aimed to explore how adolescent mothers experience and interpret the influence of social media during their transition to early motherhood. To achieve this purpose, this study was guided by three objectives: (1) to explore adolescent mothers’ perceptions of how social media portrays early motherhood (2) to explore how adolescent mothers make sense of their lived experiences of early motherhood in the context of social media use, and (3) to interpret adolescent mothers’ reflections on whether social media use has supported or hindered their transition to motherhood. Adopting a constructivist paradigm and guided by Interpretative Phenomenological Analysis (IPA) methodology, this research sought to capture the depth and complexity of participants’ lived experiences. Eight Maltese adolescent mothers aged 18 and 19 years, each between five and seven months postpartum, were recruited by the intermediary through purposive sampling from the two main general hospitals in Malta and Gozo. Data were gathered through semi-structured, audio-recorded, face-to-face interviews. All audio-recording were transcribed verbatim and analysed following Smith et al.’s (2022) eight-stage IPA framework. This study was also guided by the Social Comparison Theory. Ethical clearance was obtained and the principles of the Belmont Report (1979) were adhered to. Three group experiential themes emerged. Theme 1: The Double-Edged Nature of Social Media revealed that while digital platforms provided reassurance, advice, and connection, they also fuelled comparison, guilt, and anxiety. Theme 2: Making Sense of Social Media: Trust and Self-Efficacy at Stake demonstrated how participants wrestled with misinformation and conflicting opinions, often questioning their confidence before gradually learning to trust their instincts. Theme 3: Navigating Responsibility and Perception captured their frustration at being labelled “children raising children”, which motivated them to prove their competence in digital spaces. Collectively, these findings depict social media as both a lifeline and a liability - a source of belonging and guidance, yet also a mirror that amplifies vulnerability. The study highlights the need for professional support and digital literacy initiatives that help adolescent mothers engage critically with online content while fostering compassion, validation, and empowerment during their transition to motherhood. Moreover, adopting a longitudinal design, could highlight a clearer insight into the long-term effects of digital interactions on maternal identity and mental health. Description: M.Sc.(Melit.) Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/145395 2026-01-01T00:00:00Z