bluuebunny/crossref_metadata_2025 huggingface dataset:
Work-based studies: one small step for the individual, a giant leap for the NHS
Authors: Birch Linda , McLaughlin Andrea , Somerville David
Published: May 2014

Midwives are under increasing pressure to access higher education. Likewise, the NHS is under pressure to offer educational opportunities to staff and adopt a culture of life-long learning. The organisation of traditional post-registration midwifery education may be prohibitive to many employees. Personal beliefs, home circumstances, entry requirements and practical issues can make access to higher education very difficult. Work-based learning allows knowledge, skills and experience within the NHS to be combined with those from Higher Education Institutions to broaden access to further study.
Now wash your hands please
Authors: Flint Caroline
Published: May 2014

Well alright, of course I'll wash my hands. Thank you for the little pictures showing me how to wash my hands. They are very descriptive and if I had spent my whole life until this moment living in the Sahara desert with no water I might find the little pictures very useful. That one is especially instructive, the one which shows you washing the back of your hands and that one, the one which shows you rubbing the pad of flesh at the base of your thumbs – very good, thank you. I'll bear those parts in mind when I next wash my hands, when I get out of this hospital and am able to wash my hands again. When I wash my hands at home, or in the mother's home, or in our little Birth Centre, those places where there is not just running water of a pleasant temperature but soap (usually liquid soap, pleasantly scented) and even towels – great ideas for hand washing.
Maternity services for women in prison: a descriptive study
Authors: Price Sally
Published: May 2014

Historically, maternity care for women in prison has been poor, with little attention paid to the specific needs of pregnant women in the policy literature. However prison health care is undergoing a modernisation programme with a requirement that prisoners receive health care to the same standard as those not imprisoned. This two-part article describes the findings of a research study into the maternity services for women in prison. Part one provides a background to the project and describes the pregnant prison population, and the current services available to them. What is evident from the findings is that the standard of care for women in prison is variable, dependent upon the establishment in which they reside. As a disenfranchised group, with high risk factors for pregnancy and birth, women in prison and midwives who care for them face many challenges in the provision of equitable care that is accessible and effective.
Incontinence and the effects of childbirth on the pelvic floor
Authors: Logan Karen
Published: May 2014

Incontinence is a common problem for women, affecting their long term health. Pregnancy and childbirth are cited as the primary cause of this condition. Unfortunately many women do not seek help for this problem and those that do often wait until symptoms are very severe. Exercizing the pelvic floor muscles is recognized as way of preventing and treating symptoms of stress incontinence and pelvic floor weakness. if offered to women, these exercises can be used to promote continence and prevent the longer term problems that women encounter. This article looks at prevalence of incontinence after childbirth, the resulting pelvic floor damage and discusses implications for practice. It also suggests options for service developments to help women at risk of developing incontinence.
The use of complementary therapies in maternity services: A survey
Authors: Mitchell Mary , Williams Julie , Hobbs Emily , Pollard Katherine
Published: May 2014

The aim of this study was to establish the extent of use of complementary therapies in the maternity services in England and to determine the views of heads of midwifery to the integration of these therapies into midwifery practice. The questionnaire was sent to 221 heads of midwifery in all NHS maternity units in England. A response rate of 75% was achieved. Sixty four percent of the maternity units who responded provided a complementary therapy service in a variety of combinations to mothers, babies and staff. However, only 9% provided a service to all three groups. The four therapies offered most widely were massage, aromatherapy, reflexology and acupuncture. Attitudes were positive with 70% of respondents convinced of the benefits and 94% believing it important for them to be available in the NHS. Respondents felt that complementary therapies had an important role, particularly in relation to increasing consumer satisfaction, promoting normal childbirth, decreasing medical intervention and increasing midwives’ job satisfaction.
Everybody's business: managing midwifery complaints
Authors: Sidgewick Chris
Published: May 2014

Complaints about the NHS in general and midwifery in particular have been steadily rising over recent years. The Office of the Parliamentary and Health Service Ombudsman (PHSO) is the final rung on the complaints ladder once the NHS complaints procedure has been exhausted. It is a good idea to try to settle complaints at the earliest possible stage and to avoid escalation to this level. This paper identifies a change in culture and how the effects of complaints can be resolved as early as possible by all staff acknowledging their corporate responsibility coupled with good proactive management. Four common roots of complaints are identified, the role of the PHSO described and a conclusion drawn that complaints are everybody's business.
Social support in pregnancy: Midwives have a crucial role to play
Authors: Magill-Cuerden Julia
Published: May 2014

Although Oakley's (1998) seminal work on the role of social support in pregnancy is referred to frequently by midwives, the long term influence of the midwife on the family is not well evidenced. Little is really known about the impact of a midwife's care on the future health of the mother, the father, the baby or even siblings. For example, if the midwife, at birth, encourages interaction between siblings and newborn could this set the scene for reducing the level of sibling rivalry in the family? Or, if a midwife talks to parents about their role in helping each other to avoid postnatal exhaustion could this lead to a better understanding between parents?
Are third degree tears unavoidable? The role of the midwife
Authors: Bedwell Carol
Published: May 2014

Currently the incidence of third and fourth degree tears is reported to be between 0.5 and 2.5% (Byrd et al 2005). Although occurring relatively infrequently, third degree tears are associated with high levels of morbidity. They are the commonest cause of faecal incontinence in women, with women also suffering from dysparunea and perineal pain. Women who have suffered a third degree tear also have a slightly increased risk (4.5%) of a repeat at subsequent births. (Byrd et al, 2005) As well as physical problems, women also suffer psychologically, feeling isolated and fearful of future pregnancies, which may affect relationships with both partner and baby. (Williams et al, 2005).
Seeking to explore what matters to women about postnatal care
Authors: Wray Julie
Published: May 2014

It is already known that for many women hospital postnatal care is the least satisfying and valued part of their maternity care provision (Audit Commission, 1997). Furthermore, it continues to be reported that research in the area of postnatal care has been neglected leading to an insufficient body of knowledge and evidence to support postnatal care (MacArthur et al 1991; Bick et al 2001; Wray 2002). There are major issues in relation to the content and organisation of postnatal care, yet there has been limited revision to service delivery, which is struggling to cope when faced with a shortage of midwives. This local study sought to involve service users, notably newly delivered mothers and an established users group in a participatory manner to explore mothers’ experiences of postnatal care. A number of important factors emerged that provide further insights into what matters to women after birth. Postnatal care at home was highly regarded and valued by mothers in this study, but concerns continued to be raised about postnatal hospital care. Fundamental components of service delivery in hospital such as cleanliness and hygiene, visiting arrangements, noise, rest and support for infant feeding and baby care were key findings. This paper presents an overview of the study, discussing aspects of the hospital stay and reflections on the study.
The value of clinical practice to senior lecturers in higher education
Authors: Cook Angela
Published: May 2014

The integration of Midwifery Education into Higher Education in the UK was completed in 1996. Since this transition, Salvoni (2001) states that concerns have been raised regarding the usefulness of theoretical knowledge in practice. This research aimed to explore seven senior lecturers’ perceptions of the value of clinical practice as midwifery educationalists based in a Higher Education setting. A phenomenological approach was adopted with information being obtained through a focus group interview. The findings indicated that a transition process occurred as the Senior Lecturers withdrew from clinical practice similar to feelings of loss. Those Senior Lecturers involved in clinical practice perceived it to be valuable in terms of informing teaching activities and increasing confidence as opposed to those not directly involved. Future research is recommended to elicit the perceptions of other midwifery lecturers in the United Kingdom. This may impact upon the future provision of midwifery education.
Ten common pitfalls to avoid when conducting qualitative research
Authors: Baker Lisa
Published: May 2014

Qualitative research offers rich, profound and exhaustive data that has an important and valuable contribution to make to midwifery practice. This article lists the ten common pitfalls faced by those embarking on qualitative research, the first of these being the misconception that this form of research is an easy option. Researchers must pay attention to their method of data collection, the depth of the data collected, data checking and ethical considerations.
The trouble with size 0…
Authors: Bainbridge Jane
Published: May 2014

The rise of the size 0 woman, or even 00, is surely not a trend that adult woman should aspire to, especially in view of a recent study which found that women with a BMI below 18.5 are prone to miscarry.
Challenges of twin pregnancy
Authors: Khalil Asma , O'Brien Pat
Published: May 2014

The incidence of twins is traditionally quoted as 1 in 80 but it varies widely across the world. Fertility treatment is responsible for a significant increase over the past two decades but recently the Human Fertilisation and Embryology Authority has suggested measures to reduce the occurrence of twins after IVF. Twin pregnancy is associated with increased risks for both mother and her babies; the main concerns are pre-eclampsia, prematurity, growth restriction and twin to twin transfusion (TTTS). Preterm delivery is five times more likely in twins than in singleton; while prediction has improved, preventative strategies are still ineffective. Growth restriction occurs in up to a third of twins and is more difficult to monitor clinically. TTTS can now be managed by laser ablation of the communicating placental vessels. Overall the perinatal mortality rate is almost five times greater in twins. Recent research has shown an increased risk of death of the second twin from anoxia or trauma when delivered vaginally compared with caesarean section.
Narratives from the Blackburn West caseholding team: building up
Authors: Fleming Anita , Downe Soo
Published: May 2014

The first paper in this series described the development and early set-up of a caseloading group midwifery practice in East Lancashire Hospitals NHS Trust in 2004. This second paper details the processes that took place after the team leader was appointed, including an analysis of the changes that took place in the first two years in staffing organization and on-call arrangements. Intervention rates were markedly lower in the caseholding team when compared to both the local hospital and a local midwifery team with a similar demographic profile and rates of normal birth without intervention being particularly high. The paper identifies and expands on nine key factors that appear to be important in promoting the effectiveness of the group practice. These were: continuity of carer; visibility in the community; multi-agency involvement; inter-disciplinary collaboration; leadership; strategic partnership; ability to be innovative and flexible; involvement of local community and individuals; and shared group philosophy.
Getting ready for birth: impending fatherhood
Authors: Wöckel Achim , Schfer Eberhard , Beggel Anna , Abou-Dakn Michael
Published: May 2014

Fathers-to-be, who would like to support their partner while they give birth often feel poorly prepared for the situation at birth in spite of attending preperation classes with the mother-to-be. Is there a way to enhance preparation by having men participate in an additional class lead by a male obstetrician? In a randomized prospective trial men who took part in preparation classes together with their partner were separated into two groups. The men in the intervention group were given additional training without their partners to prepare them for the delivery room. The men in the control group were not given extra training and only attented the preparation course with their partners. Data were collected at the end of the course and three months after birth by questionnaire. In the intervention group the participants felt better prepared and judged the experience of birth more positively. The training lead to an intensified feeling of having helped their partner adequately during birth. The women whose partners had attended the training felt that the support of their partners was much better, compared with the control group. Special classes for men enhanced the contentment of both partners at birth.
Maternity unit design: background to multi-site study in England
Authors: Symon Andrew , Paul Jeanette , Butchart Maggie , Carr Val , Dugard Pat
Published: May 2014

The design of buildings, particularly interior design, is acknowledged to have an effect on those who live and work there. Within the context of health care, a number of studies have attempted to identify what works best and least well. The outcomes measured include clinical outcomes, and patient and staff wellbeing. However to date there has been limited research examining the role of design in maternity units. This paper provides the background to a three-year multi-method/multi-site study examining the impact of maternity unit design on satisfaction levels, and of staff perceptions of work performance. Results are given in three accompanying papers. This article provides details of the participants: women who had recently given birth (n=559), and staff (n=227) working within the units. Methods included questionnaire survey, focus group, individual interview and on-site design evaluation.
Reactive arthritis in pregnancy: a case study
Authors: Hastings-Tolsma Marie , O Burton Abby , Morales Christine
Published: May 2014

Reactive arthritis is an infectious disease found around the world. An inflammatory disease that can follow enteric or venereal infection, reactive arthritis is common in third world countries and can also be found in the developed world. Little has been written about the impact of this infectious disease on pregnancy. This case report details presentation of enteral infection and subsequent diagnosis of reactive arthritis in a 23-year-old primigravida who had previously traveled and lived in sub-Saharan Africa. Difficult to diagnose, reactive arthritis has an unclear etiology and diagnosis in pregnancy is often delayed as symptoms can mimic those commonly found in pregnancy. While a normal infant can be expected, medical management during pregnancy must be attentive to the potential impact of treatment on the developing fetus.
Parents' experiences of feeding a baby with cleft lip and palate
Authors: Owens Janine
Published: May 2014

Childbirth and breastfeeding have become medicalized due to a variety of factors over the past century and support with breastfeeding is a concept that is recently being revisited with initiatives such as the ‘breast buddy’ campaign. While current research addresses the breastfeeding hopes, desires and experiences of mothers with children with no feeding impairments, there has been no research to date which explores the lived feeding experiences of mothers of children born with cleft lip and palate. There are many difficulties with feeding a child with cleft lip and palate. The Clinical Standards Advisory Group's (CSAG, 1998) proposal for the care pathways and location of care recommends that specialist cleft lip and palate nurses visit new mothers of babies with cleft lip and palate within 24 hours with the aim of assisting midwifery units by offering specialist feeding advice and support. This small scale study explores the lived experiences of parents of children with cleft lip and palate. It suggests that the implementation of CSAG's proposals have been problematic and that there needs to be greater collaboration between midwifery units and specialist cleft lip and palate nurses.
Truth, virtue, beauty and childbirth
Authors: Walsh Denis
Published: May 2014

What constitutes truth, virtue and beauty are the three fundamental questions of the ancient discipline of philosophy. A wonderful article by Parker and Gibb (1998) discuss their relevance to midwifery, reminding us that the mother of Socrates, the great Greek philosopher, was a midwife. Socrates drew parallels between what he did as a philosopher, nurturing the getting of wisdom in others with his mother's ‘midwifing’ of the new mother and new baby. I want to share some reflections on these three great questions about truth, virtue and beauty in relation to childbirth today.
Antenatal classes: women can't think beyond labour
Authors: Wiener Andrew , Rogers Cathy
Published: May 2014

There is interest in refocusing NHS antenatal classes to support parents in the transition to parenthood. However anecdotal reports suggest many midwives believe women in antenatal classes cannot focus on postnatal issues. This study set out to evaluate the prevalance of this view, with a postal survey of 144 midwives in a Hospital NHS Trust. There was a 58% return rate. 48% of respondants thought that women were not interested in postnatal topics. Midwives thought women were unable or unwilling to be realistic about the changes and difficulties a baby brings.

Discussion focuses on a comparison of the client-centred/facilitative approach to antenatal education with the traditional directive/lecture type approach. It is argued that a facilitative approach enables women to discuss fears and anxieties about the transition to parenthood more openly. It is suggested that group facilitation training should be an integral part of midwifery training.
Maternity unit design study part 2: perceptions of space and layout
Authors: Symon Andrew , Paul Jeanette , Butchart Maggie , Carr Val , Dugard Pat
Published: May 2014

Design and use of space are critical features of contemporary healthcare facilities, but there is often pressure on available space. The drive to minimize the ‘institutional’ feel of maternity units has led to the move to make them more ‘homely’. This first of three results papers presents findings from a three-year nine-site study in England examining maternity unit design and its impact on women giving birth there. Data from a questionnaire survey of 559 mothers and 227 ward-based staff are augmented by analysis of follow-up focus groups. For mothers perceptions of spaciousness were strongly associated with overall satisfaction with surroundings and facilities (p<.01), as well as with care received (p<.01). Mothers' perceived ability to move themselves or room furniture around during labour varied across units and was not associated with overall room size. Among midwives the belief that they provided good quality care was moderately correlated with positive responses concerning ward layout (p<.01) and a comfortable working environment (p<.01).
Maternity unit design study part 3: environmental comfort and control
Authors: Symon Andrew , Paul Jeanette , Butchart Maggie , Carr Val , Dugard Pat
Published: May 2014

Control and empowerment are crucial aspects of contemporary midwifery. Enabling a labouring woman to be in control is believed to aid the normal physiological process. To date no studies have explicitly considered individual control over environmental variables and its association with satisfaction levels. This second results paper presents data from a questionnaire survey of 559 mothers and 227 ward-based staff. While most mothers felt they could control the lighting within the birthing room, this was not the case in all the units surveyed; few acknowledged that they could adjust temperature or ventilation within the room. Staff attitudes towards this varied: 24% of midwives believed that such control should not be given to labouring or postnatal women. A perceived lack of control over environmental variables was common among midwives. Adverse comments about oppressive heating and lighting were common. Environmental noise was an irritant for some and was also cited as a factor in reducing work effectiveness.
The lived experience of newly qualified midwives: a qualitative study
Authors: van der Putten Deirdre
Published: May 2014

This study evaluated the issues important to newly qualified midwives by asking them individually about their experiences of this time in practice. A qualitative approach using Heideggerian phenomenology was chosen for the study and data were collected using formal semi-structured interviews. Analysis and interpretation of the data were achieved using Colaizzi's Analysis Framework. The description of the experience is unique to each participant midwife, however, commonalities were observed and core themes presented. The main findings revealed six major themes that describe the meaning of clinical practice for newly qualified midwives. These were as follows: reality shock; feeling prepared; living up to expectations; theory–practice gap; clinical support and mentorship; and continuous professional education. Midwifery educators need to address these issues when reviewing and amending midwifery curricula education programmes and preparing student midwives for transition to practice. Recommendations and implications for midwifery education are discussed.
Decision making capacity does not arrive with puberty
Authors: Griffith Richard
Published: May 2014

A recent report by the National Children's Bureau showed that some 29% of secondary schools in England now have sexual health clinics with one in 20 providing children with prescriptions for a variety of contraceptives (Emmerson, 2008). Condoms, pregnancy tests and morning-after pills are being offered in schools to hundreds of thousands of children, some as young as 11, without their parents being informed. The services are open access and confidential and therefore rely on the child to consent to the advice and treatment they receive. Do such services suggest that a child's ability to make treatment decisions simply arrives with puberty or does the law impose a higher standard of capacity for children under sixteen?
Helping a woman meet her stillborn baby while it is soft and warm
Authors: Rådestad Ingela , Christoffersen Line
Published: May 2014

For the first 30 minutes, a stillborn baby feels soft and warm, just like a live baby. The time immediately after birth can be seen as an “acute” situation – a time that can never be relived. After just 30 minutes, the baby will grow cold, and its colour will change. Following stillbirth, parents are in a state of shock, and asking whether they want to see and hold their baby may suggest that it is not obvious that they would want to do so. This creates doubt, and for many the spontaneous reaction may be to reply with a refusal they later regret. Not seeing the baby immediately after delivery also means not holding the baby immediately afterwards. Parents who have both seen and held the baby during the first 30 minutes describes this as the most valuable time they had with their baby.
Building capacity to care: learning for maternity support workers
Authors: Griffin Richard , Dunkley-Bent Jacqueline , Malhotra Gita
Published: May 2014

Maternity support workers (MSW) are an increasingly important part of the maternity workforce. This article describes the results of an extensive study of the reasons why maternity units in London introduced MSWs, the service areas they work in, the duties they undertake and it explores views on effective training and development for the role. The study found that MSW is a reasonably established role in London; typically one MSW is employed for every qualified midwife and works across all care settings. Maternity services introduced the role for a wide range of reasons. There is a pressing need to develop a single accredited learning programme for MSWs to overcome problems with transferability. The study identified the features heads of midwifery would like to see learning programmes address.
Student midwives' experiences of hospital-based postnatal care
Authors: Kroll Debra , Ahmed Shamoly , Lyne Michelle
Published: May 2014

This mixed method study explored whether concerns raised by student midwives about the quality of their mentorship and teaching in the postnatal ward environment enabled them to meet the Nursing and Midwifery Council standards of proficiency for postnatal care, to qualify as a midwife. Some concerns were supported and it was found that effective, supportive teaching and mentorship was affected by many factors owing to the physical environment and the competing demands placed on mentors.

The primary findings were that students felt less valued on the wards and better supported in the community. There was recognition that some skills could only be learnt in the hospital setting. There was no significant difference between the needs of students on long or shortened pre-registration programmes. Students will therefore continue to need teaching and mentorship in the hospital setting and trusts have an obligation to actively support this commitment.
Community midwives and the safer management of controlled drugs
Authors: Griffith Richard
Published: May 2014

The case of Harold Shipman, a doctor convicted of some 15 murders, mainly through the use of lethal injections of controlled drugs, highlights the need to ensure that procedures are in place to monitor the storage, recording and use of controlled drugs by health professionals including midwives (R v Shipman [2000]).
New hope for women struggling to conceive
Authors: Clift-Matthews Victoria
Published: May 2014

Time and again we hear stories in the press about teenagers getting pregnant and rising birth rates in the younger population but there are some women who might consider these young girls lucky; these women are the ones struggling to conceive and who are more likely to be at the other end of the age spectrum. What must it feel like to read stories about people who become pregnant accidentally or within one or two cycles, almost as soon as the decision to start a family is made, when you have been trying yourself. Some may have been trying for years and might have spent thousands on failed cycles of IVF. So they didn't try to have children in their twenties and only felt the time was right in their thirties, perhaps through career choices, financial circumstances or other commitments. Perhaps they didn't meet a man they could have children with until they reached the grand old age of forty. Indeed, should they be fortunate enough to experience the joy of a yearned-for positive pregnancy test result, they would end up being labelled as ‘older mothers’. It must be difficult as the months go by, turning into years, to feel your chances of conceiving are dimishing by the day, especially if repeated IVF attempts or even just the one are beyond your budget.
Afghan custom prevents access to health services
Authors: Daniel Lincia
Published: May 2014

The shortage of female health professionals in Afghanistan and its custom of only allowing women to go out when accompanied by a male escort means women are having difficulties accessing midwifery services.
Disability in Pregnancy and Childbirth
Authors: Moore Denyse
Published: May 2014

As a basic textbook about the needs of disabled women during pregnancy and childbirth Disability in Pregnancy and Childbirth is a suitable read for everyone. The advice ranges from essential care of the woman and her family, to assessing ward suitability, scoping the necessary improvements and planning how to obtain the needed resources. I felt that much of the advice given in this textbook should be standard practice with all clients; not merely those who are disabled. The information is applicable and suitable for ward managers, the woman and her family and everyone in between.
Headaches in pregnancy: warning signs for other problems
Authors: Bainbridge Jane
Published: May 2014

Migraines are common in women of childbearing age but women should watch out if they suffer during pregnancy as such headaches could be warnings signs for more serious problems such as pre-eclampsia.
Controversy over breastfeeding doll: is this a step too far?
Authors: Bainbridge Jane
Published: May 2014

Mixed attitudes towards breastfeeding mean mothers quickly learn which public places are best avoided, but the launch of a breastfeeding doll has challenged even the most determined breastfeeding supporter.
Book Reviews
Authors: Lee Elaine
Published: May 2014

Published by the Royal College of Obstetricians and Gynaecologists, this book discusses a relatively new outpatient, ‘one-stop’ approach to gynaecological treatments; an approach originating in the USA. The aim of ambulatory gynaecology is to reduce costs in the treatment of women with common gynaecological complaints, while at the same time increasing satisfaction through the reduction of waiting times and inpatient hospital stays. Using established care pathways, national guidelines and good practice it is argued that setting up ambulatory gynaecological services would be reasonably simple and cost-effective. This patient-centred, cost-conscious approach to service delivery fits well with targets across all of the devolved government areas in the UK.
Flexible care for pregnant teenagers
Authors: Clift Matthews Victoria
Published: May 2014

What a time of change we're going through with the coalition government proposing public health cuts at every turn. Of the nearly 200 quangos to be abolished, two on the list that stood out to me were the Human Fertilization and Embryology Authority (HFEA) and the Teenage Pregnancy Independent Advisory Group (Daily Telegraph, 2010). Thousands of couples rely on the HFEA to guide them through the difficult process of assisted conception and it seems a little unfair to abolish it when, in the main, it is funded by the patients themselves and not the taxpayer. Providing fertility treatment is a life-changing service and important area of research, which needs independent and careful monitoring. It is only worth abolishing the HFEA if this service can be provided more cheaply for patients, as well as responsibly, which is unlikely.
Book Reviews
Authors: Jones Shirley R
Published: May 2014

I offered to review this book the day after watching an American film with the same title. As films usually follow the publication of books, I was surprised to find that it was the same story. The original book had been published in the USA in 1997 and has just been published in the UK for the first time, with the film being made between times. Therefore, I read the book with knowledge of the story and visualization of the characters, as portrayed in the film.
Reasons behind the decision to terminate the contract with Albany
Authors: Yiannouzis Katie
Published: May 2014

As head of midwifery at King's College Hospital, I would like to take this opportunity to explain why we have terminated our contract with the Albany Midwifery Practice.
Support needs of women who continue to smoke in pregnancy
Authors: Lagan Briege M , Casson Karen
Published: May 2014

This article reports the findings from an exploratory, descriptive survey to assess pregnant smokers' awareness, attitudes and behaviour in relation to smoking in pregnancy and the support needed to help them stop. One hundred and fifty women attending antenatal clinics within an acute health-care trust hospital in Northern Ireland and who continued to smoke in pregnancy were asked to complete a questionnaire. One hundred and twenty-three women participated. Findings identified smoking habits were established in early teenage years. Most women were not aware of many of the dangers associated with continuing to smoke in pregnancy. Having a partner who smoked was negatively associated with women's cessation of smoking in pregnancy. The findings also suggest that once the smoking habit is established addiction makes it more difficult for women to quit. Therefore, if smoking prevalence among pregnant women is to be reduced preventive and early intervention programmes must start early in school life. For those women whose partner also smokes, interventions are required to encourage both the woman and her partner to quit together.
Student midwives' satisfaction with enquiry-based learning
Authors: Tully Susan L
Published: May 2014

Studies have evaluated enquiry-based learning (EBL) and problem-based learning in terms of student learning (Connelly and Seneque, 1999; Yeung et al, 2003; Williams, 2004), but the aim of this study was to listen to student midwives' experiences of EBL and evaluate their satisfaction with EBL as a teaching and learning strategy.

The study took a qualitative phenomenological research approach. Analysis of the data identified five themes: students' satisfaction with EBL; impact on clinical learning; students' motivation; issues around group work; and the role of the facilitator. These themes are discussed in detail in this article with relation to available published literature.

Overall, the students enjoyed and valued EBL as a learning strategy. A number of issues were identified and this article makes various recommendations to inform future developments in midwifery education.
Outcomes for older and younger mothers
Authors: Clift-Matthews Victoria
Published: May 2014

This month BJM takes a more detailed look at the issues surrounding maternal age. It is encouraging to note that the number of teenage pregnancies has fallen by 13.3% since 1998 (ONS, 2010) but what will happen to the previous government's recent Teenage pregnancy strategy: Beyond 2010 (DSCF, DH, 2010) is anyone's guess at present with a new coalition taking its first steps in government. Lucy Russel offers her view on page 374.
Providing long-term support to women
Authors: Clift-Matthews Victoria
Published: May 2014

Providing support to women is an important and necessary aspect of the midwife's role. Being a midwife is, at times, a bit like being a counsellor. To understand the woman's position, what her history is and what her influences are that inform her ideas and decisions, requires the midwife to listen attentively and to imagine what it must be like to be that woman. At the same time, the midwife must retain her professional hat so that she can step back to see the wider picture that has the woman's and her baby's health and wellbeing at the forefront. She must use the knowledge she has gained through her listening skills to offer support and advice that is appropriate for that women, non-judgmental and congruent with that woman's position.
International collaboration: ERASMUS teacher exchange to Sweden
Authors: Taylor Alison M , Fry Jane
Published: May 2014

In 2009, having secured funding from the European Commission for an ERASMUS exchange programme, two midwifery lecturers from Bournemouth University visited the Karolinska Institute in Sweden. To exchange ideas and knowledge, a range of activities including lecturing students, research presentations, clinical site visits and social gatherings were undertaken. This unique opportunity to experience Swedish culture both within higher education and the health service provided valuable insights and comparisons, including varying philosophies underpinning maternity care within the two countries. The two institutes continue to maintain a strong relationship, where exchange of teaching and learning strategies and research collaboration bring fresh insights and new ways of working. Thus, a more profound knowledge and understanding of midwifery practice and education is realized, which can help influence practice within the UK and provide cross-cultural perspectives to our own pre‑ and post-registration midwifery students.
Getting your first job: the interview
Authors: Lee Karen , Whitmore Jane
Published: May 2014

In the second article of this series, the focus will be on preparation and attendance at interview, especially for that all-important first job. Quotes from senior clinicians on what they specifically look for in candidates are provided throughout, along with some examples of frequently asked interview questions.
Researching breastfeeding awareness in primary schools
Authors: Angell Catherine , Alexander Jo , Hunt Jane
Published: May 2014

Despite a wide range of interventions, the effective promotion of breastfeeding continues to be challenging, particularly among women from communities where infants are usually formula milk fed. It has been suggested that infant feeding education in primary schools might enable positive breastfeeding attitudes to be adopted that could influence choices in adulthood. However, little is known about children's awareness or receptiveness to this subject, and there is a lack of evidence on which to base potential educational interventions. Although breastfeeding research in primary schools may perhaps appear unnecessary or premature, a case for study in this field can be demonstrated.
Valuing the supervision of midwives in higher education
Authors: Yearley Carole , Rogers Cathy
Published: May 2014

Supervision of midwives provides a framework to support every practising midwife in the UK ( Local Supervising Authority Midwifery Officers' National Forum, 2009 ). This article discusses the importance and uniqueness of supervision of midwives in higher education institutions (HEIs), which are responsible for the provision of pre- and post-registration midwifery education programmes and which employ midwifery lecturers to deliver them. It was identified that midwifery lecturers working in HEIs should have their own strategy for supervision of midwives. The rationale for, and the development and implementation of, a local strategy for supervision of midwives in an HEI is presented, along with some examples to illustrate how the key goals identified in the strategy are being achieved.
Women's experience of control in labour and childbirth
Authors: O’Hare Joanne , Fallon Anne
Published: May 2014

This qualitative study used a phenomenological approach to interpret the lived experience of control in labour and childbirth. Semistructured interviews were carried out with nine primigravid women who gave birth in a maternity hospital in Ireland. The interviews were transcribed verbatim, and the data were analysed using frameworks influenced by Smith et al (2009) and van Manen (1990) . The themes that emerged were then categorized into what Smith et al (2009) referred to as superordinate themes. The participants’ experiences of control in childbirth were both positive and negative and the findings concurred with the literature to suggest that control is indeed important in the experience of childbirth. The study highlights the need for greater midwifery input into antenatal care in an attempt to prepare women for childbirth. This preparation should not be limited to antenatal education—it also involves the provision of emotional and psychological support. It is the role of the midwife to prepare women for the normal physiological process of childbirth, but also, to prepare them for the unpredictable nature of such an event.
Comparing birth plan preferences among Irish and Nigerian women
Authors: Sheridan Carmel P , Yekinni I , Oyeye G , Ogunleye K , Oluyede G , O’Sullivan K , Higgins John R
Published: May 2014

The demographics of the obstetric population in Ireland are increasingly changing due to immigration patterns. As the obstetric population becomes more ethnically diverse, the challenge for health professionals is to provide more appropriate, culturally-specific care. This observational study compared birth plan preferences among Irish and Nigerian pregnant women. Included in this study were 113 Nigerian women and 519 Irish women attending the Unified Maternity Services in Cork. A questionnaire was used to assess patients' attitudes toward varying aspects of obstetric care. Differences between the two study populations were seen across all aspects of care. Among other differences, Nigerian women booked at a later gestation compared to their Irish counterparts (33.8 weeks vs. 20.8 weeks respectively, P < 0.001), preferred to have a vaginal delivery (90.7% vs. 64.2%) and an analgesia-free birth (39.6% vs. 5.8%). This study demonstrates a need to recognize the cultural variations in preferences for pregnancy and childbirth in order to provide culturally-specific care.
Postpartum morbidity and help-seeking behaviours in Iran
Authors: Rouhi Maryam , Mohammed-alizadeh C Sakineh , Usefi Homa , Rouhi Narges
Published: May 2014

Health problems arising in pregnancy, delivery or the postpartum period are often resolved within 6 weeks after delivery. However, many health problems persist and can have an effect on activities of daily living. Some mothers may not initiate consultation, making it difficult for health providers to treat subsequent problems. The aim of this study was to assess mothers' experiences of postpartum maternal morbidity, the prevalence of depression and fatigue 6 weeks after delivery and postpartum help-seeking behaviours. Method: In this study 1330 mothers who visited public health centres in Tabriz, Iran, were interviewed about their health problems experienced within 6 weeks after delivery and their help-seeking behaviours. The Edinburgh Postnatal Depression Scale and Fatigue Identification Form were also used to assess depression and fatigue respectively. The Chi square test was used to assess associations between some variables. Results: The majority of the women (89%) reported experience of one or more health problems in their postnatal period. The problems included backache (53%), headache (50%), fatigue (44%) and constipation (27%) among other problems. Conclusion: With a majority of women not seeking help, the timing and content of antenatal care visits, and postpartum care should be reexamined and include more information about postpartum problems.
Provider strategies for contraceptive counselling among Swedish midwives
Authors: Wätterbjörk Inger , Häggström-Nordin Elisabet , Hägglund Doris
Published: May 2014

Previous studies have shown that in contraceptive counselling the provider sets the agenda. The aim of this study was to describe how a group of Swedish nurse-midwives think and act in their role as contraceptive counsellors. Semi-structured questions were put to a convenience sample of 16 nurse-midwives. Data were analysed using qualitative content analysis. Five categories were identified: exploring the woman's situation; providing information about contraceptive methods; performing medical evaluation; guiding the decision-making process; and following up on the counselling. Results showed that the providers had developed their own strategies and suggest the use of interventions which combine counselling methods to provide information, with a theory for decision-making, to help in giving advice. This study could contribute to personal reflection on contraceptive counselling in practice, both for experienced counsellors and those new to the task.
Perspectives on risk and obesity: Towards a ‘tolerable risk’ approach?
Authors: McGlone Anne , Davies Sarah
Published: May 2014

NHS trusts are required to demonstrate the actions they are taking to reduce the risks for obese pregnant women. To this end, health professionals often use the body mass index to identify women at risk. While the aim of risk management is to increase safety, taking an ‘absolute risk’ approach of considering risk in terms of what can go wrong is arguably narrow and does not take into consideration individual factors. This article considers an alternative approach to risk management in maternity services—‘tolerable risk’ management in which midwives can help to successfully address the issue of maternal obesity through a partnership approach based on women's individual needs.
Feminism as a theoretical perspective for research in midwifery
Authors: Yuill Onje
Published: May 2014

Over the last few decades feminism has played a pivotal role in improving women's wellbeing, health and position in society, and yet the term ‘feminist’ is often misconceived as a picture of ‘man-hating’ women refusing any assistance from men. This results in a loss of appreciation of the true nature of feminism. Historically the midwifery profession has been oppressed since the biomedical domination of childbirth. The ‘yummy mummy’ culture that the media unrealistically promotes leads to further devaluation of motherhood. Midwives are in an ideal position to use feminism as a theoretical perspective to perform research which is truly women-centred, extrapolating their true needs and beliefs.
High-risk pregnancy: Effects on postpartum depression and anxiety
Authors: Zadeh Marzieh Akbar , Khajehei Marjan , Sharif Farkhondeh , Hadzic Maja
Published: May 2014

In order to examine the prevalence and risk factors of postpartum depression and anxiety subsequent to high-risk pregnancies, 400 postpartum women aged 16–43 years were recruited into two study groups: a high-risk pregnancy group (i.e. with medical problems in the mother or fetus), and a normal term pregnancy group. Symptoms of depression were measured using the Beck Depression Inventory (BDI). The Spielberger Standard Test was used to assess symptoms of anxiety. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 11.5. Results showed that the prevalence of moderate-to-severe symptoms of depression and anxiety was higher among women who had a high-risk pregnancy; however, anxiety was more prevalent than depression in both groups. The high-risk pregnancy group suffered more problematic pregnancies with more frequent nausea, vomiting, dysuria and headache compared to the normal term pregnancy group. Physical health of mothers was shown to affect the health of newborns. Weight problems, ICU hospitalization and meconium aspiration rates were higher in babies born by mothers with high-risk pregnancy. The high-risk pregnancy was shown to be an important risk factor for postpartum psychological problems in mothers and newborns' health.
Underpinning safety: Communication habits and situation awareness
Authors: Abbott Stephen , Rogers Mary , Freeth Deela
Published: May 2014

Health care services that show evidence of a safety culture demonstrate effective communication and good situation awareness. This article reports observational research looking at these characteristics in two delivery units, undertaken as part of a study of safety culture. Contrasting team styles evident in daily routines (calm and cohesive in one, more fragmented in the other) were associated with contrasting levels of team situation awareness, which affected the handling of unexpected or urgent events. However, the association between safety and quality in the unit was less simple, suggesting that different styles of team work may be suited to routine and urgent care.