Midwives’ and registered nurses’ role and scope of practice in acute early pregnancy care services: a scoping review
Authors: Freeman Nicole , Warland Jane , Cheney Kate , Bradfield Zoe 
Published: May 2024

Objective:
The objective of this scoping review was to investigate and describe what is reported on the role and scope of practice of midwives and registered nurses providing care for women with pregnancy complications prior to 20 weeks’ gestation in acute clinical settings in Australia.

Introduction:
In many high-income countries, women experiencing unexpected complications in early pregnancy attend an acute care service, such as an emergency department, rather than a maternity or obstetric unit. This service structure can impact the care women receive and determine who provides it. Women and their partners, who are often experiencing emotional distress, have reported difficult experiences when accessing acute services, particularly emergency departments, which are not traditionally staffed by midwives. The role and scope of practice of both midwives and registered nurses providing acute early pregnancy care in most high-income countries, including Australia, is poorly reported. Documenting this area of practice is an important first step in facilitating ongoing research in this important aspect of pregnancy care.

Inclusion criteria:
Published and gray literature that described the role and scope of practice of midwives and/or registered nurses providing care in acute early pregnancy settings in Australia were considered for this review.

Methods:
A scoping review of the literature was conducted following JBI methodological guidance and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A 3-step search strategy was conducted to explore evidence from databases and search engines, gray literature sources, and selected reference lists. The search was limited to sources published from 2005 until October 2023. The databases searched included MEDLINE (Ovid), MIDIRS (Ovid), JBI Evidence-based Practice Database (Ovid), CINAHL Ultimate (EBSCOhost), ProQuest Central, Web of Science Core Collection, Scopus, and Cochrane Library. Google and Google Scholar were also used to identify published studies. After screening, data were extracted from records selected for the final review, mapped, and analyzed using content analysis.

Results:
A total of 23 sources were selected for inclusion in the review, and these included primary research studies, conference abstracts, and gray literature, such as clinical guidance documents, academic theses, and websites, from January 2008 to October 2023. The most common setting for care provision was the emergency department. Midwives’ and registered nurses’ role and scope of practice in acute early pregnancy care in Australia can be categorized into 4 areas: physical care, psychosocial support, care coordination, and communication. Women’s access to midwifery care at this time in pregnancy appears to be limited. Registered nurses, usually employed in emergency departments, have the most prominent role and scope in the provision of care for women with acute early pregnancy complications. Descriptions of midwives’ practice focus more on psychosocial support and follow-up care, particularly in early pregnancy assessment service models.

Conclusions:
This review highlights the inconsistency in midwives’ and registered nurses’ role and scope in acute early pregnancy in Australia, a finding which is relevant to other international settings. Both professions could further fulfill role and scope capacity in the provision of supportive, individualized, and timely care for women and families accessing a range of acute early pregnancy services. Emergency departments are the usual practice domain of registered nurses who may be limited in terms of the scope of care they can provide to women with early pregnancy complications. Leaders of the midwifery profession should conduct further research into innovative service models that embed a role for midwives in all settings that provide care for pregnant women, regardless of stage of pregnancy.

Review registration:
Open Science Framework https://osf.io/7zchu/