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Professor Nicky Leap

Biography

Current positions: Adjunct Professor of Midwifery, Faculty of Nursing Midwifery and Health UTS
Visiting Professor, Florence Nightingale School of Nursing and Midwifery, Kings College, London
2010-2012 International Francine Gooris Chair for Midwifery, University College Arteveldehogeschool, Ghent, Belgium

For over twenty-five years, Nicky has worked across midwifery research, education and practice in both the UK and Australia. She was integrally involved in the development and implementation of the Australian Bachelor of Midwifery programs in South Australia and at UTS and has had a leadership role in developing national standards for midwifery education and practice in Australia. Nicky has played a pivotal role in both Australia and the UK in the development and evaluation of midwifery continuity of care models, including the implementation of NSW's first publicly funded homebirth program. Nicky led a two year pilot study to develop, implement and test Centering Pregnancy®, an innovative program combining antenatal care, education and support for pregnant women in small groups.

Nicky was the Professor of Midwifery Practice Development and Research for South East Sydney and Illawarra Area Health Service from 2006 – 2010 (Director of Midwifery Practice 2002 – 2006 in the same area health service)

Nicky completed her Professional Doctorate in Midwifery at UTS, her dissertation examining the role and culture of rhetorical innovations and intentional strategies in the development of Australian midwifery.

Nicky has held a visiting researcher position at Kings College London since 2005. Her research activities at Kings include a Department of Health (UK) funded study with Professor Jane Sandall to develop and evaluate interactive learning resources and workshops for midwifery and medical students and maternity staff, with an aim to promote normal birth and a positive experience for women.

Professional

Involved in various research and education activities in CMFH and Kings College London

Supervision of Masters and doctoral students and examination of theses

Member, Australian College of Midwives, Royal College of Midwives (UK)
Editorial Board: International Journal of Childbirth; Women and Birth
2010 Invited International Visitor – University of Maastricht – public workshops and seminars with students

Consultant to the Pregnancy and Parents Centre, Edinburgh, Scotland

Invited speaker and workshop facilitator at International Conferences: Australia, New Zealand, UK, Canada, USA, Belgium, the Netherlands, Italy.

With two colleagues, Nicky led the introduction to Australia and New Zealand of the Advanced Life Support in Obstetrics (ALSO) multi-disciplinary course and was an Inaugural Board member.

Image of Nicky Leap
Casual Academic, University Casual Academics
MSc, Doctor of Midwifery
Member, Australian College of Midwives
 

Research Interests

Introduction of CenteringPregnancy® to Australia?and group antenatal care
Midwifery Perspectives on Pain in Labour?
Developing community based midwifery, midwifery caseload practice and publicly funded home birth services
Midwifery practice development
Development of interactive learning packages using video ethnography and multi-media resources

Research projects
Research Projects
Project Coordinator - Sowing the Seeds of Innovation in the Prevention of Child Abuse and Neglect: Midwifery and Child and Family Health Nursing. Development of an interactive learning package: curriculum materials and stimulus DVD clips addressing risk and protective factors for nurturing and protecting children. Commissioned by the University of South Australia and funded by the Ian Potter Foundation.

Development of stimulus video clips for learning activities. UTS Teaching and Learning Grants.

Senior research assistant: Theorising the relationship between birth unit design and the communication patterns of labouring women and their maternity care providers. Australian Research Council grant

Introduction of CenteringPregnancy® to Australia – Initial funding: Telstra Foundation grant. ?
Understanding transitions of care from midwives to child and family health nurses - NMRB of NSW grant ?
Normal Birth Matters - Development and field testing of a training package for maternity staff to improve support for women to have a normal birth: Department of Health UK.
Supporting women to have a normal labour and birth: development of a multi-media, interactive workshop package for student midwives and medical students: Kings College London Teaching Innovations Award.

Can supervise: Yes
Registered Level 1. PhD and Masters students, examiner of PhD and masters theses.

Midwifery - undergraduate and postgraduate

Chapters

Leap, N., Dahlen, H.G., Brodie, P.M., Tracy, S.K. & Thorpe, J. 2011, 'Relationships - the glue that holds it all together' Midwifery continuity of care and sustainability' in Davies, L., Dallenbach, R. & Kensington, M. (eds), Sustainability, Midwifery and Birth, Routledge, London, UK, pp. 61-74.
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In late December 2009, four midwifery leaders sat around a kitchen table in Sydney and audio-recorded a conversation about experiences of developing midwifery models of care. With this chapter in mind, we focussed on what we saw as features of sustainable models that enable women to develop a trusting relationship with their midwives through pregnancy, labour and the early weeks of new motherhood. Mostly we reflected on our experiences of setting up midwifery group practices in the Australian public health system where midwives are employed, but some of us also drew on our experiences in the United Kingdom (UK) and New Zealand (NZ); this included our involvement in models where midwives are self-employed and working either privately or as part of the public health system.
Homer, C.S., Brodie, P.M. & Leap, N. 2008, 'Getting started: What is midwifery continuity of care? (Chapter 1)' in Homer, C., Brodie, P. & Leap, N. (eds), Midwifery continuity of care: A practical guide, Churchill Livingstone Elsevier, Sydney, Australia, pp. 1-24.
Sandall, J., Page, L.A., Homer, C.S. & Leap, N. 2008, 'Midwifery continuity of care: What is the evidence? (Chapter 2)' in Homer, C., Brodie, P. & Leap, N. (eds), Midwifery continuity of care: A practical guide, Churchill Livingstone Elsevier, Sydney, pp. 25-46.
Leap, N., Homer, C.S. & Brodie, P.M. 2008, 'Introducing continuity of care in mainstream maternity services: Building blocks for success (Chapter 4)' in Homer, C., Brodie, P. & Leap, N. (eds), Midwifery continuity of care: A practical guide, Churchill Livingstone Elsevier, Sydney, pp. 67-88.
Homer, C.S., Brodie, P.M. & Leap, N. 2008, 'Midwifery continuity of care for specific communities (Chapter 10)' in Homer, C., Brodie, P. & Leap, N. (eds), Midwifery continuity of care: A practical guide, Churchill Livingstone Elsevier, Sydney, Australia, pp. 181-194.
Homer, C.S., Brodie, P.M. & Leap, N. 2008, 'Midwifery continuity of care: The future (Chapter 12)' in Homer, C., Brodie, P. & Leap, N. (eds), Midwifery continuity of care: A practical guide, Churchill Livingstone Elsevier, Sydney, Australia, pp. 215-219.
Brodie, P.M. & Leap, N. 2008, 'From ideal to real: the interface between birth territory and the maternity service organization' in Fahy, K., Foureur, M. & Hastie, C. (eds), Birth Territory and Midwifery Guardianship, Elsevier, Oxford, UK, pp. 149-167.
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Leap, N. 2006, 'Promoting Physiological Birth' in Pairman, Pincombe, Thorogood, Tracy & Livingstone, C. (eds), MIdwifery Preparation for Practice, Elsevier, London, pp. 280-294.
This chapter forms an important contribution to midwifery textbooks and the dissemination of knowledge and research in national and international arenas
Edwards, N. & Leap, N. 2006, 'The politics of involvingwomen in decision making' in Page, L.A. & McCandish, R. (eds), The New Midwifery: Science and Sensitivity in Practice 2nd edition, Churchill Livingstone, Edinburgh UK, pp. 97-124.
Leap, N. & Anderson, T.A. 2004, 'The role of pain and the empowerment of women' in Downe, S. (ed), Normal Childbirth: Evidence and Debate, Churchill Livingstone, Edinburgh UK, pp. 1-10.
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This chapter forms an important contribution to midwifery text books and the dissemination of knowledge and research in national and international arenas

Conferences

Hoang, D.B., Lawrence, E.M., Ahmad, N., Balasubramanian Appiah, V., Homer, C.S., Foureur, M. & Leap, N. 2008, 'Assistive Care Loop with Electronic Maternity Records', 2008 10th IEEE International Conference on e-Health Networking, Applications and Services, International Conference on e-Health Networking, Applications and Services, IEEE, Biopolis, Singapore, pp. 118-123.
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Surprisingly women-held pregnancy health records (paper based) are still predominantly used in most hospitals in Australia. These records are not standardized as each hospital or state has a slightly different version. Early efforts have been made to standardize pregnancy records and make them available electronically. Electronic record systems do not allow dynamic interaction between users and they are not accessible when users are mobile. This paper describes an assistive maternity care (AMC) system that addresses a number of important issues: 1) transforming a women-held paper-based record for pregnancy care into an electronic maternity record (EMR); 2) investigating mechanisms to make the record active; 3) creating a system whereby details of the pregnant women and their carers can be recorded, updated over wired and wireless networks; and 4) creating a pregnancy care loop over which midwives and doctors and pregnant women under their care can communicate effectively anywhere, anytime for the duration of pregnancy.
Davis, D.L., Homer, C.S., Foureur, M., Leap, N. & Forbes, I. 2008, 'Birthing units: Designing homely delivery spaces to promote natural birth', Health Facilities Design and Development 2008, Brisbane, Australia.

Journal articles

Harte, J.D., Homer, C.S., Sheehan, A., Leap, N. & Foureur, M. 2016, 'Using video in childbirth research: Ethical approval challenges.', Nursing ethics.
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Conducting video-research in birth settings raises challenges for ethics review boards to view birthing women and research-midwives as capable, autonomous decision-makers.This study aimed to gain an understanding of how the ethical approval process was experienced and to chronicle the perceived risks and benefits.The Birth Unit Design project was a 2012 Australian ethnographic study that used video recording to investigate the physical design features in the hospital birthing space that might influence both verbal and non-verbal communication and the experiences of childbearing women, midwives and supporters.Six women, 11 midwives and 11 childbirth supporters were filmed during the women's labours in hospital birth units and interviewed 6 weeks later.The study was approved by an Australian Health Research Ethics Committee after a protracted process of negotiation.The ethics committee was influenced by a traditional view of research as based on scientific experiments resulting in a poor understanding of video-ethnographic research, a paradigmatic view of the politics and practicalities of modern childbirth processes, a desire to protect institutions from litigation, and what we perceived as a paternalistic approach towards protecting participants, one that was at odds with our aim to facilitate situations in which women could make flexible, autonomous decisions about how they might engage with the research process.The perceived need for protection was overly burdensome and against the wishes of the participants themselves; ultimately, this limited the capacity of the study to improve care for women and babies.Recommendations are offered for those involved in ethical approval processes for qualitative research in childbirth settings. The complexity of issues within childbirth settings, as in most modern healthcare settings, should be analysed using a variety of research approaches, beyond efficacy-style randomised controlled trials, to expand and improve practice-b...
Mondy, T., Fenwick, J., Leap, N. & Foureur, M. 2016, 'How domesticity dictates behaviour in the birth space: Lessons for designing birth environments in institutions wanting to promote a positive experience of birth.', Midwifery, vol. 43, pp. 37-47.
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BACKGROUND: limited efforts have been made to understand the complex relationships between women's experiences of birth and the influence of the design and environment of a birth space. Domestic aesthetics in a birth space are believed to be an important aspect of optimal birth unit design. AIM: to explore the concept of domesticity within the birth space. The specific objectives were to explore, describe and compare birth spaces with different domestic characteristics and subsequently, how laboring women worked within these spaces during the labour process. This project was situated within a larger ongoing body of work exploring birth unit design. METHOD: a qualitative approach, using the techniques of video ethnography and reflexive interviewing, was used. Video data consisted of films of the labours of six Australian women who gave birth in 2012. Filming took place in two different tertiary hospitals in Sydney NSW (n=5 women), as well as a stand-alone Birth Centre (n=1 woman). Video footage of a woman labouring at home was used to compare and contrast women's experiences. Latent content analysis was used to analyse the data set. In addition there were 17 one-hour video-reflexive interviews that were audio-taped and fully transcribed (nine interviews with women and/or their support people and eight with midwives). Field note data accompanied both the video recording as well as the reflexive interviews. FINDINGS: in general, women labouring in conventional hospital labour and birth rooms acted and interacted with the environment in a passive way. The spaces clearly did not resemble homely or 'domestic' spaces. This forced women to adapt to the space. In essence all but one of the women labouring and birthing in these spaces took on the role of a 'patient'. One participant responded quite differently to the conventional hospital space. 'Domestication of the space' was the mechanism this woman used to retain a sense of ownership within the birth space. In contrast...
Catling, C., Medley, N., Foureur, M., Ryan, C., Leap, N., Teate, A. & Homer, C.S.E. 2015, 'Group versus conventional antenatal care for women', Cochrane Database of Systematic Reviews.
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Harte, J.D., Leap, N., Fenwick, J., Homer, C.S. & Foureur, M. 2014, 'Methodological insights from a study using video-ethnography to conduct interdisciplinary research in the study of birth unit design', International Journal of Multiple Research Approaches, vol. 8, no. 1, pp. 36-48.
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Gray, J.E., Leap, N., Sheehy, A.D. & Homer, C.S. 2013, 'Students' perceptions of the follow-through experience in 3 year bachelor of midwifery programmes in Australia', Midwifery, vol. 29, no. 4, pp. 400-406.
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Background: providing opportunities for students to participate in midwifery continuity of care experiences is a challenge in many midwifery education programmes. The `follow-through experience' was a deliberate strategy introduced into midwifery education programmes in Australia to ensure that students experienced midwifery continuity of care.
Homer, C.S., Ryan, C.L., Leap, N., Foureur, M., Teate, A. & Catling, C. 2012, 'Group versus conventional antenatal care for women (Review)', The Cochrane Database of Systematic Reviews, no. 11, pp. 1-59.
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The primary and secondary outcomes were pre-determined as described. The included trials measured a number of outcomes that were non-pre-speci?ed. As these were important for the populations studied in the trials, these were included post hoc. For example, the Ickovics 2007a trial targeted young women and the outcomes included sexual and behavioural outcomes including HIV risk behaviour and STDs. The Kennedy 2011 trial included family healthcare readiness. In addition, inadequate antenatal care was included as a non-pre-speci?ed outcome as it was used as a measure of quality of care
Gray, J.E., Leap, N., Sheehy, A.D. & Homer, C.S. 2012, 'The 'follow-through' experience in three-year Bachelor of Midwifery programs in Australia: A survey of students', Nurse Education in Practice, vol. 12, no. 5, pp. 258-263.
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The follow-through experience in Australian midwifery education is a strategy that requires midwifery students to follow a number of women through pregnancy, labour and birth and into the parenting period. The experience was introduced by the Australian College of Midwives as part of national standards for the three-year Bachelor of Midwifery programs. Anecdotally, the introduction caused considerable debate. A criticism was that these experiences were incorporated with little evidence of their value. An online survey was undertaken to explore the follow-through experience from the perspectives of current and former students. There were 101 respondents, 93 current students with eight recent graduates. Participants were positive about developing relationships with women. They also identified aspects of the follow-through experience that were challenging. Support to assist with the experience was often lacking and the documentation required varied. Despite these difficulties, 75% felt it should be mandatory as it facilitated positive learning experiences. The follow-through experience ensured that students were exposed to midwifery continuity of care. The development of relationships with women was an important aspect of learning. Despite these challenges, there were significant learning opportunities. Future work and research needs to ensure than an integrated approach is taken to enhance learning.
Shaban, I. & Leap, N. 2012, 'A review of midwifery education curriculum documents in Jordan', Women and Birth, vol. 25, no. 4, pp. 47-55.
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Background There is worldwide recognition that midwives are specialists in normal pregnancy, labour and birth and the postnatal period and that they should be educated to be primary providers of maternity care. In Jordan midwives currently have limited opportunities to fulfil this role. Since the mid-1980s, two public community colleges have offered three-year diploma midwifery education programmes in two major cities in Jordan. In 2002 the first and only four-year bachelor of midwifery education programme was established in one public university. Aim A review to describe the design and content of midwifery education programmes in Jordan and address the question: Does the design of midwifery education programmes in Jordan encourage confidence that graduates will be competent to practise to the full capacity of the internationally defined role and scope of practice of the midwife and undertake the role of primary maternity care providers for women with low-risk pregnancies?
Foureur, M., Leap, N., Davis, D.L., Forbes, I. & Homer, C.S. 2011, 'Testing the birth unit design spatial evaluation tool (BUDSET) in Australia: a Pilot Study', Health Environments Research & Design Journal, vol. 4, no. 2, pp. 36-60.
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Objective: To pilot test the Birth Unit Design Spatial Evaluation Tool (BUDSET) in an Australian maternity care setting to determine whether such an instrument can measure the optimality of different birth settings. Background: Optimally designed spaces to give birth are likely to influence a woman's ability to experience physiologically normal labor and birth. This is important in the current industrialized environment, where increased caesarean section rates are causing concerns. The measurement of an optimal birth space is currently impossible, because there are limited tools available. Methods: A quantitative study was undertaken to pilot test the discriminant ability of the BUDSET in eight maternity units in New South Wales, Australia. Five auditors trained in the use of the BUDSET assessed the birth units using the BUDSET, which is based on 18 design principles and is divided into four domains (Fear Cascade, Facility, Aesthetics, and Support) with three to eight assessable items in each. Data were independently collected in eight birth units. Values for each of the domains were aggregated to provide an overall Optimality Score for each birth unit. Results: A range of Optimality Scores was derived for each of the birth units (from 51 to 77 out of a possible 100 points). The BUDSET identified units with low-scoring domains. Essentially these were older units and conventional labor ward settings. Conclusion: The BUDSET provides a way to assess the optimality of birth units and determine which domain areas may need improvement. There is potential for improvements to existing birth spaces, and considerable improvement can be made with simple low-cost modifications. Further research is needed to validate the tool.
Teate, A., Leap, N., Rising, S. & Homer, C.S. 2011, 'Women's Experiences Of Group Antenatal Care In Australia-The Centeringpregnancy Pilot Study', Midwifery, vol. 27, no. 2, pp. 138-145.
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Objective: to describe the experiences of women who were participants in the Australian CenteringPregnancy Pilot Study. CenteringPregnancy is an innovative model of care where antenatal care is provided in a group environment.
Dahlen, H., Homer, C.S., Leap, N. & Tracy, S.K. 2011, 'From social to surgical: historical perspectives on perineal care during labour and birth', Women and Birth, vol. 24, no. 3, pp. 105-111.
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A review of key historical texts that mentioned perineal care was undertaken from the time of Soranus (98138 A.D.) to modern times as part of a PhD into perineal care. Historically, perineal protection and comfort were key priorities for midwives, most of whom traditionally practised under a social model of care. With the advent of the Man-Midwife in the seventeenth and eighteenth century, the perineum became pathologised and eventually a site for routine surgical intervention most notably seen in the widespread use of episiotomy. There were several key factors that led to the development of a surgical rather than a social model in perineal care. These factors included a move from upright to supine birth positions, the preparation of the perineum as a surgical site through perineal shaving and elaborate aseptic procedures; and the distancing of the woman from her support people, and most notably from her own perineum. In the last 30 years, in much of the developed world, there has been a reemergence of care aimed at preserving and protecting the perineum. A dichotomy now exists with a dominant surgical model competing with the re-emerging social model of perineal care. Historical perspectives on perineal care can help us gain useful insights into past practices that could be beneficial for childbearing women today. These perspectives also inform future practice and research into perineal care, whilst making us cautious about political influences that could lead to harmful trends in clinical practice.
Foureur, M., Davis, D.L., Fenwick, J.H., Leap, N., Iedema, R.A., Forbes, I. & Homer, C.S. 2010, 'The Relationship Between Birth Unit Design And Safe, Satisfying Birth: Developing A Hypothetical Model', Midwifery, vol. 26, no. 5, pp. 520-525.
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Recent advances in cross-disciplinary studies linking architecture and neuroscience have revealed that much of the built environment for health-care delivery may actually impair rather than improve health outcomes by disrupting effective communication an
Foureur, M., Leap, N., Davis, D.L., Forbes, I. & Homer, C.S. 2010, 'Developing The Birth Unit Design Spatial Evaluation Tool (Budset) In Australia: A Qualitative Study', Health Environments Research & Design Journal, vol. 3, no. 4, pp. 43-57.
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Objective: To develop a tool known as the Birth Unit Design Spatial Evaluation Tool (BUDSET), to assess the optimality of birth unit design. Background: The space provided for childbirth influences the physiology of women in labor. Optimal birth spaces a
Leap, N., Sandall, J., Buckland, S.S. & Huber, U. 2010, 'Journey To Confidence: Women'S Experiences Of Pain In Labour And Relational Continuity Of Care', Journal of Midwifery and Women's Health, vol. 55, no. 3, pp. 234-242.
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Introduction: An evaluation carried out at King's College Hospital Foundation National Health Service Trust in London identified that women who received continuity of carer from the Albany Midwifery Practice were significantly less likely to use pharmaco
Smith, R.M., Leap, N. & Homer, C.S. 2010, 'Advanced midwifery practice or advancing midwifery practice?', Women and Birth, vol. 23, no. 3, pp. 117-120.
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Advanced midwifery practice is a controversial notion in midwifery, particularly at present in Australia. The proposed changes in legislation around access to the publicly funded Medical Benefits Scheme (MBS) and the Pharmaceutical Benefits Scheme (PBS) in 20092010 have meant that the issue of advanced midwifery practice has again taken prominence. Linking midwifery access to MBS and PBS to a safety and quality framework that includes an `advanced midwifery credentialling framework is particularly challenging. The Haxton and Fahy paper in the December 2009 edition of Women and Birth is timely as it enables a reflection upon these issues and encourages debate and discussion about exactly what is midwifery, what are we educating our students for and is working to the full scope of practice practising at advanced level? This paper seeks to address some of these questions and open up the topic for further debate.
Homer, C.S., Passant, L., Brodie, P.M., Kildea, S.V., Leap, N., Pincombe, J. & Thorogood, C. 2009, 'The role of the midwife in Australia: Views of women and midwives', Midwifery, vol. 25, no. 6, pp. 673-681.
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Objective to research the role of midwives in Australia from the perspectives of women and midwives. This study was part of a commissioned national research project to articulate the scope of practice of Australian midwives and to develop national competency standards to assist midwives to deliver safe and competent midwifery care. Design a multi-method approach with qualitative data collected from surveys with women and interviews with midwives. Setting participants represented each state and territory in Australia. Participants midwives who were randomly selected by the regulatory authorities across the country and women who were consumers of midwifery care and involved in maternity activism. Key conclusions midwives and women identified a series of key elements that were required of a midwife. These included: being woman centred; providing safe and supportive care; and working in collaboration with others when necessary. These findings were consistent with much of the international literature. Implications for practice a number of barriers to achieving the full role of the midwife were identified. These included a lack of opportunity to practice across the full spectrum of maternity care, the invisibility of midwifery in regulation and practice, the domination of medicine, workforce shortages, the institutional system of maternity care, and the lack of a clear image of what midwifery is within the wider community. These barriers must be addressed if midwives in Australia are to be able to function according to the full potential of their role.
Homer, C.S., Henry, K., Schmied, V., Kemp, L., Leap, N. & Briggs, C.J. 2009, ''It looks good on paper': Transitions of care between midwives and child and family health nurses in New South Wales', Women and Birth, vol. 22, no. 2, pp. 64-72.
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Background The way in which women and their babies transition from maternity services to the care of child and family health nurses differs across Australia. The aim of the study was to understand the transition of care from one service to another and how to promote collaboration in the first few weeks after the birth. Method A descriptive study was undertaken. All midwifery, child and family health and Families NSW managers in NSW were invited to participate by completing a questionnaire. Results There was a wide range of transition of care models. These varied by setting, geography, context and history. Three main models emerged from the analysis. These were as follows: 1. Structured, non-verbal communication system that relied on paper-based or computerised systems. This included either centralised referral or centre-based referral processes. 2. Liaison person model which was similar to purposeful contact, but with everything vested in one clinician who is responsible for the coordination and organisation. 3. Purposeful contact model which was mostly for identified at-risk women and included continuity of care with formal networks and face to face contact.
Leap, N., Sandall, J., Grant, J., Bastos, M.H. & Armstrong, P. 2009, 'Using video in the development and field-testing of a learning package for maternity staff: Supporting women for normal childbirth', International Journal of Multiple Research Approaches, vol. 3, no. 3, pp. 302-320.
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This paper discusses methodological issues relating to the use of video technology to develop and field test educational resources. Research to develop and field test a learning package for National Health Service (UK) maternity staff used video to observe and describe exemplary practice and to elicit video clips for the purpose of stimulating interactive workshop activities and interprofessional learning. The project aimed to enhance the knowledge, skills and self-efficacy of maternity staff to support women to have a normal birth. Data from filmed observations of midwifery interactions, interviews and group discussions with a range of women, their partners, midwives and doctors, contributed to understandings of positive influences on women's experiences of childbirth. This data informed the development of learning outcomes for workshop activities and the selection of stimulus video clips. The rationale for using video in this way, the research process that was undertaken and some of the ethical and practical challenges encountered are discussed.
Leap, N. 2009, 'Woman-centred or women-centred care: does it matter?', Birtish Journal of Midwifery, vol. 17, no. 1, pp. 12-16.
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The concept of woman-centred care is fundamental to midwifery and underpins the philosophy statements of midwifery professional organizations. It has also been used as a framework in a range of policy documents and standards related to midwifery and maternity service provision, notably in the UK and Australia. This discussion article questions the conceptual and practical implications of substituting `women-centred care for `womancentred care in terms of addressing womens individual needs and shifting the locus of control away from the institution and professionals towards the woman herself. Contested meanings of woman-centred care and empowerment are explored in relation to conceptual interpretations and the development of projects involving midwifery continuity of care.
Forbes, I., Homer, C.S., Foureur, M. & Leap, N. 2008, 'Birthing Unit Designs', World Health Design, vol. 1, no. 3, pp. 47-53.
Homer, C.S., Passant, L., Kildea, S.V., Pincombe, J., Thorogood, C., Leap, N. & Brodie, P.M. 2007, 'The development of national competency standards for the midwife in Australia', Midwifery, vol. 23, no. 4, pp. 350-360.
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OBJECTIVE: to develop and validate national competency standards for midwives in Australia. This study was part of a commissioned national research project to articulate the scope of practice of Australian midwives and to develop national competency standards to assist midwives to deliver safe and competent midwifery care. DESIGN: a multi-method, staged approach was used to collect data through a literature review, workshop consultations, interviews, surveys and written submissions in order to develop national competency standards for Australian midwives. Subsequently, direct observation of practice in a range of settings ensured validation of the competencies. SETTING: maternity-care settings in each state and territory in Australia. PARTICIPANTS: midwives, other health professionals and consumers of midwifery care. FINDINGS: The national competency standards for the midwife were developed through research and consultation before being validated in practice. KEY CONCLUSIONS: the national competency standards are currently being implemented into education, regulation and practice in Australia. These will be minimum competency standards required of all midwives who seek authority to practise as a midwife in Australia. It is expected that all midwives will demonstrate that they are able to meet the competency standards relevant to the position they hold. IMPLICATIONS FOR PRACTICE: the competency standards establish a national standard for midwives and reinforce responsibility and accountability in the provision of quality midwifery care through safe and effective practice. In addition, individual midwives may use the competency standards as the basis of their ongoing professional development plans.
Leap, N., Barclay, L. & Sheehan, A. 2003, 'Results of the Australian Midwifery Action Project Education Survey. Paper 2: Barriers to effective midwifery education as identified by midwifery course coordinators', Australian Midwifery Journal, vol. 16, no. 3, pp. 6-11.
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Leap, N., Barclay, L. & Sheehan, A. 2003, 'Results of the Australian Midwifery Action Project Education Survey. Paper 3: Workforce issues', Australian Midwifery, vol. 16, no. 3, pp. 12-17.
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This paper is the third in a series reporting on the findings of the AMAP Education Survey of the 27 Australian universities providing a program for initial authorisation to practise as a midwife. Workforce issues were identified by this research, such as the potential number of places in courses, attrition rates, and the number of graduates from midwifery education programs who seek and obtain employment in midwifery. The findings pose serious challenges to the development and sustainability of the Australian midwifery workforce.
Leap, N. 2002, 'Identifying the Midwifery Practice Component of Australian Midwifery Education Programs', Australian Journal of Midwifery, vol. 15, no. 3, pp. 14-23.
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Leap, N. 2002, 'Identifying the midwifery practice component of Australian Midwifery Education Programs. Results of the Australian Midwifery Action Project (AMAP) Education Survey.', Australian journal of midwifery : professional journal of the Australian College of Midwives Incorporated, vol. 15, no. 3, pp. 15-23.
This paper is the first in a series of papers reporting on the findings of the AMAP Education Survey of the 27 universities providing a program for initial authorization to practise midwifery. It concentrates on issues related to the practice component of courses. Subsequent papers will present findings related to workforce issues and the barriers to effective midwifery education as identified by the midwifery course coordinators. Serious concerns are raised about the standards of Australian midwifery education, particularly when international comparisons are made, in terms of the length of courses, clinical practice requirements and the opportunities for students to engage with contemporary midwifery practice across community and acute settings.
Leap, N. 1999, 'The introduction of `direct entry' midwifery courses in Australian universities: Issues, myths and a need for collaboration', Women and Birth, vol. 12, no. 2, pp. 11-16.
Roseveare, P., Allen, K., Cheal, C., Clark, B., Leap, N., Robinson, D., Sewell, E., Sikorski, J. & Thomas, S.P. 1992, 'Provision Of Home Births', British Medical Journal, vol. 304, no. 6841, pp. 1569-1569.
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Reports

Brodie, P.M., Barclay, L., Lane, K., Leap, N., Reiger, K. & Tracy, S.K. Australian College of Midwives 2003, Results of the Australian Midwifery Action Project Education Survey, Australian Journal of Midwifery, pp. 1-33, Canberra, Australia.