bluuebunny/crossref_metadata_2025 huggingface dataset:
Debriefing following traumatic childbirth
Authors: Phillips Sharon
Published: May 2014

Despite the negative results of recent randomized controlled trials, psychological debriefing remains the most widely used structured intervention following traumatic events. However, its use in association with a normal life experience, such as childbirth, may be a cause for concern. This paper presents a brief history of psychological debriefing, followed by an evaluation of the evidence base for its use in a midwifery context. The usefulness of other types of evidence in informing clinical practice is also considered.
Midwife alone: NICE guidelines
Authors: Rogers Jane
Published: May 2014

This article describes my involvement on two working parties set up to formulate national guidelines (under the auspices of the NICE). These were Electronic Fetal Monitoring in Labour (RCOG Clinical Effectiveness Support Unit, 2001a) and Induction of Labour (RCOG Clinical Effectiveness Support Unit, 2001b). My role in the development of the guidelines has been portrayed and I have identified challenges raised and lessons learnt from the process. These include the need to play the political game while adhering to values that are important to midwifery; also the importance of representing a wide spectrum of (midwifery) views in as fair and articulate manner as possible. The article concludes with suggestions for how midwives can contribute positively to future guideline development and, in so doing, strengthen the midwifery perspective.
When normal birth is in the minority
Authors: Page Lesley
Published: May 2014

In 2001 only 44% of women in the UK had a normal birth, that is, birth without a caesarean section, or regional anaesthesia, assisted delivery or episiotomy ( www.birthchoiceuk.com ). Recent data from the Department of Health (BirthChoice UK, 2003) indicate that the caesarean section rate has risen yet again, from 21.5% for the year 2000–2001 to 22.3% for the year 2001–2002. There has been a slight fall in the instrumental birth rate from 11.1% to 10.9% in the same period. This means that the caesarean section rate has virtually doubled since 1989 when it was 11.3% with an instrumental rate of 9.7%. So the figure for women having a normal birth will be even lower now. Normal birth is clearly in the minority.
Factors affecting staffing ratios
Authors: Ball Jean , Bennett Beverley , Washbrook Marie , Webster Frances
Published: May 2014

There was clear evidence that the ratio of hospital births:work-time-equivalent midwife is affected by the intrapartum case-mix related to clinical policies and uptake an epidural analgesia and by the volume of cross-border flow of clients between different units. Both of these factors were variable between different units. In many units the data showed that 40–50% of all cases had entirely normal labour and delivery while in others the figure was less than 25%. This raises issues about the potential for midwife-led care within main hospitals and the difficulty for midwifery managers in influencing clinical practice. Cross-border workload can be very high for some units and questions are raised about the costs of this ‘extra’ workload.
Antenatal perineal massage: Part 2
Authors: Gomme Clare , Sheridan Mary , Bewley Susan
Published: May 2014

Antenatal perineal massage was introduced as a new service for women and the aim of the audit was to evaluate the effect of the service on subsequent perineal trauma sustained at delivery. Data was collected from the maternity notes and a convenience survey of postnatal women. The midwives’ views were obtained through questionnaires and focus group discussions. Although the number of eligible women receiving information on perineal massage was well below the audit target, a 6% reduction in perineal trauma was noted in women who had a vaginal delivery. Compliance with the massage instructions varied, but women were generally positive about perineal massage and would repeat it in a subsequent pregnancy. The maternity unit will continue to offer antenatal perineal massage as a service for women.
Deep vein thrombosis: are postnatal women aware?
Authors: Reynolds Shelley I
Published: May 2014

Thromboembolism is the leading direct cause of maternal deaths (Confidential Enquiry into Maternal Deaths, CEMD, 2001). Although there has been a reduction in the number of deaths from thromboembolic disease (TED), women seem to have little knowledge about the disease and the importance of recognising the symptoms and seeking medical aid. Midwives are in a prime position to inform women regarding this issue. This article explores the lack of client understanding of TED through a small personal audit of a community midwife's routine postnatal visits.
Advanced maternal age: a literature review
Authors: Byrom Anna
Published: May 2014

This literature review analyses and evaluates the impact of advanced maternal age on women's health with recommendations on how to address the issue within the wider public health arena. It includes an in depth synthesis of the issues surrounding advanced maternal age, incorporating the physical, psychological and sociological impacts on women's health.
Webwatch
Authors: Carr Natasha
Published: May 2014

This month's Webwatch reviews the health section, of the BBC website. Although the site is not specifically for midwives, the sphere of midwifery practice is growing and it is increasingly necessary to be knowledgeable about public health, sexual health and reproductive and women's health issues.
Caesarean sections NICE guidelines
Authors: Page Lesley
Published: May 2014

It is fitting that a topic of such fundamental importance as caesarean sections should have been a topic of discussion at a meeting of the All Party Parliamentary Group on Maternity on December 2003. At this meeting representatives of the Royal College of Midwives (Clare Capito), the Royal College of Obstetricians and Gynaecologists (Professor James Walker), and the National Childbirth Trust (Mary Newburn) commented on the final draft of the National Institute of Clinical Excellence (NICE) Caesarean Section Guidelines (2003). The presentations were followed by a discussion that included the audience.
Midwifery on the net: new communication technology
Authors: Brooks Fiona , Rospopa Christine , Scott Peter
Published: May 2014

In the modernized NHS, if midwives are to have an influential voice over the development of care they need to be able to actively engage with the policy and decision-making processes. Such engagement will largely be dependent on the establishment of effective communication routes between midwives. It is far from clear exactly how broad-based communication is to be achieved, particularly given high workloads and an increasingly mobile and part-time midwifery workforce. This article reports on a 2-year study, funded by the Department of Health, based in an NHS Trust, that enabled midwives to use computer-mediated communication to create a forum for the collective discussion of midwifery practice. Through their use of the system, midwives successfully discussed and implemented changes in the delivery and organization of care. Overall, the system demonstrated how new communication technologies can function to empower midwives, and to advance women-centred, midwifery-led practice.
A consultant midwife's community clinic
Authors: Dunkley-Bent Jacqueline
Published: May 2014

Midwives have a unique role within public health and are described as public health practitioners (Royal College of Midwives, RCM, 2000). Evidence or acknowledgement of the midwife's role in public health is not always apparent. In this article, a consultant midwife with a special interest in public health presents the findings of a community clinic. The focus of care is health promotion, with emerging public health themes including domestic violence, rape and sexual assault, traumatic childbirth, mental ill health and maternal request for caesarean section. The findings highlight the popularity and increasing uptake of the service provided and present an opportunity for health promotion research.
Birth centres unsafe for primigravidae
Authors: Walsh Denis
Published: May 2014

Headings like the one above tend to grab attention, but it is not a sound basis for informed opinion. The story appeared on a midwifery e-mail network and was related to a study published in the British Journal of Obstetrics & Gynaecology (Gottvall et al, 2004). A birth-centre midwife was reporting that the study's findings was likely to influence local consideration of whether to allow primigravid women to book at her birth centre.
Essentials of newborn skin care
Authors: Hopkins John
Published: May 2014

Effective care of newborn skin is based on a thorough understanding of both the physiology and specific environment of infant skin. The essentials of newborn skin care are effective cleansing, effective moisturizing and the maintenance of an effective barrier against external irritants. An evidence-based clinical practice guideline published by the Association of Women's Health, Obstetric and Neonatal Nurses in the USA confirms that modern baby care products for cleansing, moisturizing and barrier protection, which meet the guidelines for being pH neutral and having a good safety profile, are safe and effective for neonatal skin care.
Clinical Governance: quality at centre of services
Authors: Currie Lynne , Morrell Clare , Scrivener Ross
Published: May 2014

This article is aimed anyone who has an interest in quality and the implementation of clinical governance. The article summarizes the key themes of clinical governance which form the basis for the new reporting framework for NHS trusts and strategic health authorities in England. The key themes are: placing the patient's or client's experience at the heart of health care; making information work for you; quality improvement in action; supporting staff in the workplace; and the building blocks of clinical governance.
A return to Wales after 20 years
Authors: Magill-Cuerden Julia
Published: May 2014

This year's Royal College of Midwives (RCM) Annual Conference, Mapping New Horizons: Politics and Change, was special. Midwives were given a wonderful welcome, in true welsh style, with warmth, song and humour.
Time limits for civil litigation: a case study
Authors: Dimond Bridgit
Published: May 2014

In page 365 the law relating to time limits is explained. In this article, examples are given of cases where claimants have been faced, in order to obtain compensation, with a defence from the defendant that they are outside the limits.
Withholding and letting die
Authors: Dimond Bridgit
Published: May 2014

In the case involving Tony Bland, the spectator who was crushed in the Hillsborough stadium disaster, the House of Lords recognised that there was a distinction between killing and letting die (Airedale, 1993). To let nature take its course when the prognosis is appaling for the patient and there is no longer a duty to keep a person alive at all costs, is not contrary to the law. On the contrary to take action to end a person's life may be murder or manslaughter.
Abortion and the girl under 16 years old
Authors: Dimond Bridgit
Published: May 2014

On the previous page we consider a recent challenge to the termination of pregnancy outside the 24 gestation time limit in the case of a fetus who would be born seriously handicapped. In this article we consider the legal situation of a teenager who consents to a termination without her parents being informed.
Limits on second stage pushing and time
Authors: Chalk Amanda
Published: May 2014

The second stage of labour has provided debates concerning when maternal pushing efforts should begin and how long they should last for in order to safeguard maternal and fetal wellbeing. Spontaneous maternal pushing may begin before or following full cervical dilatation. Either way, midwives need to fully comprehend the boundary between the first and second stages of labour and respond to maternal cues for spontaneous pushing. Fixed time limits for the duration of the second stage of labour are frequently being discussed and have even been described as unnecessary. Providing maternal and fetal wellbeing is maintained, and until more conclusive evidence is available, midwives are encouraged to pay attention to the rate of progress of the second stage of labour and act on signs of maternal pushing rather than being preoccupied with time limits for the second stage of labour. This second article of a three-part series explores the issues of limits on pushing and time in the second stage of labour and critically analyses the evidence available.
Expanding the workforce through return to practice
Authors: Payne Sheena , Green Sarah
Published: May 2014

In February 1999 the government acknowledged a national shortage of qualified midwives in the NHS. Return to midwifery practice courses have been seen as one answer to the problem. The courses need to reflect a cohesiveness between education, clinical practice and midwifery supervision. Simultaneously returnees need to be supported whilst being reoriented to the reality of midwifery practice. In order to evaluate the effectiveness of the return to midwifery practice courses, transparent audit mechanisms need to be in place. This article debates the reasons as to why midwives continue not to practice and the procedures that are in place to facilitate their return.
Reflexivity: Not just a qualitative methodological research tool
Authors: Kingdon Carol
Published: May 2014

Reflexivity is the process associated with researchers' self-awareness – of how they impact and transform the research they undertake. It is widely accepted as a methodological consideration among researchers undertaking qualitative enquiry in midwifery. This article uses sociological literature to introduce notions of reflexivity that emphasize its importance as a theoretical concept and a methodological tool. The ‘doing’ of reflexivity is discussed using examples from published studies of maternity care. The author’s own unpublished research, investigating primigravid women's views of vaginal and caesarean birth, is also used to illustrate the relevance of reflexivity to quantitative and qualitative data collection from a social constructionist theoretical perspective. This article demonstrates that reflexive accounts of the research process should not just be confined to qualitative methodology papers, research diaries or thesis chapters, but are relevant to all research
Twin pregnancies: evaluating risk through fetal monitoring
Authors: Blincoe Alana Juman
Published: May 2014

Multiple pregnancies can come with a number of risk factors for mother and baby. The risks are present at almost every stage of the pregnancy through to the birth. Twin pregnancies have a higher incidence of pre-term birth, while perinatal mortality is also higher than it is for singletons (Barret and Ritchie, 2002). There is also a greater risk of cerebral palsy and various birth defects. In turn, the mother has a greater risk of pre-eclampsia, anaemia, liver problems and gestational diabetes. It is therefore paramount that twin pregnancies are managed and monitored well through the antepartum and intrapartum stages to ensure a positive outcome for all.
Midwifery-led care: Establishing a postnatal perineal clinic
Authors: Dugdale Annette F , Hill Simon R
Published: May 2014

This article discusses perineal anatomy, physiology and the management of women who have sustained perineal trauma and advocates a proactive approach by midwives in the management of this debilitating problem. It looks at perineal anatomy and physiology, causes, risk factors and mechanism of injury. Current treatments are also discussed. The article also follows the establishment in 1999 of a designated postpartum, midwife-led perineal clinic. Women are empowered to connect with this service to reduce morbidity. They can also be ‘signposted’ to the relevant personnel if it is deemed necessary. Finally, the article highlights one case of perineal trauma and how it was successfully treated through a midwife-led approach.
Telemedicine: Supporting normality in midwife-led community units
Authors: Warriner Sian , Martinez Andrea
Published: May 2014

Nearly 7500 babies are born at The Oxford Radcliffe Hospitals Trust each year. While most are born in the Oxford and Banbury hospitals a significant number of women have their antenatal care and birth in one of three community midwife-led units, which provide a service for women living in the more rural areas of the county. A telemonitoring project, aimed at enabling women living in the more rural areas of the county (around the community units) to access day assessment facilities normally only available in the district units, was established. Qualitative research used questionnaires to explore women's opinions about the service they received for example, appointment times, convenience, reason for attendance, reassurance felt and confidence in the practitioner. In addition midwives were surveyed about the impact on their role and effects on practice.
Challenges of caring for homeless pregnant women – 2
Authors: Wood Tracey , Watts Kim
Published: May 2014

This second paper will examine how the role of the midwife is changing in response to the new public health policies of today. It will examine the problems faced by pregnant homless women and how well these women are served by social policies and initiatives. The paper will explore the following; nurse prescribing, the extended midwives role, consultant midwives, Sure Start Initiatives and how these may continue to evolve. The conclusion of this paper will discuss the potential benefits for homeless pregnant women with the introduction of the children's centres.
Psychological trauma symptoms of operative birth
Authors: Gamble Jenny , Creedy Debra
Published: May 2014

This is the first in a series of articles on operative birth and psychological issues. This paper looks at negative childbirth experiences and how they can result in the development of trauma symptoms and post-traumatic stress disorder (PTSD). Psychological trauma symptoms following childbirth are debilitating, and may affect a woman's ability to care for her baby. This study aimed to examine the relationship between type of birth and symptoms of psychological trauma at 4–6 weeks postpartum. 400 Australian women in the last trimester of pregnancy were recruited from three public antenatal clinics. Participants were interviewed about the birth within 72 hours postpartum and telephone interviews conducted at 4–6 weeks postpartum to assess symptoms of psychological trauma. Results showed that women who had an emergency caesarean delivery or operative vaginal delivery were more likely to meet the diagnostic criteria for PTSD than women who had an elective caesarean section or spontaneous vaginal birth.
Views on cultural barriers to caring for South Asian women
Authors: Reynolds Frances , Shams Manfusa
Published: May 2014

The study examined whether UK midwives perceived any difficulties in providing effective prenatal care to women from South Asian ethnic backgrounds; explored whether perceptions were associated with their length of midwifery experience and degree of contact with patients from South Asian cultural backgrounds; and collated suggestions for improving the cultural appropriateness of prenatal care. Questionnaires were returned by 30 qualified and student midwives. Respondents reported a number of communication difficulties during the prenatal care of women from South Asian backgrounds, and perceived certain cultural barriers as having at least a moderately important limiting influence on prenatal care. Midwives with higher proportions of South Asian mothers in their caseload were significantly more positive about their communications during prenatal care, and saw cultural barriers as less detrimental. Many respondents recommended closer liaison with the South Asian community to find out about pregnant women's needs, and thought it helpful to have more midwives from South Asian backgrounds in their profession.
Webwatch
Authors: Carr Natasha
Published: May 2014

Maternity rights and benefits have evolved in recent years and with the changes a variety of government, union and charity-funded websites have also developed. Midwives are often asked for advice on practical issues and the following websites contain useful information on the very specific rights that cover parents during and after pregnancy.
Birth settings and pain control trends among women in Finland
Authors: Mander Rosemary , Melender Hanna-Leena
Published: May 2014

This paper aims to identify similarities and differences between the Finnish and UK systems of maternity care. Issues relating to maternity care policy emerge as crucial. Topics for comparison were identified during visits to Finnish hospital and community settings. These topics formed the basis of a selective review of the literature. Qualitative research by the co-author served to inform the comparison. The authors found that Finnish women are clear in their expectations of labour pain and the role of professional personnel. Because of these expectations the women adopt one of three coping styles. There is found to be a strong link between pain coping style and choice of place of birth. There may, however, be some dissonance between health care providers' and women's thinking about the place of birth. Midwives' positions are variable, but their thinking may not correspond with the woman's. It becomes clear that midwives' non-acceptance of women's knowledge base has serious implications. The conclusion is drawn that midwives should seek to understand women's thought processes.
Improving support for women with incontinence
Authors: Bishop Mary
Published: May 2014

Thousands of women in the UK and across Europe are suffering in silence – victims of stress urinary incontinence (SUI), an embarrassing and debilitating gynaecological condition that has been dubbed as one of health care's last taboos (Voelker, 1998).
Body mass wars: Effective use of resources or discrimination?
Authors: Daniel Lincia
Published: May 2014

Lincia Daniel considers the issue of in-vitro fertilization provision limitations for overweight women as suggested by the British Fertility Society.
Student midwives' views of the objective structured clinical examination
Authors: Rennie Anne Marie , Main Martyn
Published: May 2014

Educational researchers have established beyond doubt that assessment greatly influences learning. However, the assessment of practical skills is complex and presents difficulties. Research in other disciplines has shown that the objective structured clinical examination (OSCE) is an effective evaluation tool to assess practical skills. The creation of a clinical skills laboratory within the educational setting, that simulates clinical reality, can enable experiential learning to occur.

Most OSCE research so far has been focused on medical and nursing students, not midwifery students. This work focuses on student midwives’ views of the OSCE in order that future OSCE processes could be advanced.

Three main themes to emerge from the data were: practicalities of running the OSCE, preparation for the OSCE assessment and the impact of assessors, volunteers and simulation on OSCE performance, all of which impacted on levels of anxiety for the student midwives.
Perinatal depression: its absence among Black Caribbean women
Authors: Edge Dawn
Published: May 2014

Anecdotal evidence from clinical practice suggests that Black Caribbean women rarely consult with symptoms of perinatal depression. Reasons for this are unclear. Unlike White British or South Asian women, there has been little perinatal research within this ethnic group.

In-depth qualitative interviews with a purposive sample of Black Caribbean women were undertaken in order to gain insight into the factors which might account for this phenomenon. The sample was drawn from a larger mixed-method, comparative study of prevalence and risk factors for perinatal depression among both Black Caribbean and White British women in the northwest of England (Edge et al, 2004) Interviews were audiotaped, transcribed and analysed thematically using QSR NUD*IST4 to facilitate data management.

Findings suggest that women's beliefs about mental illness underpinned by personal and socio-cultural attitudes to help seeking might act as barriers to accessing primary care mental health services. Additionally, service provision, antenatal education and the attitudes of some health professionals might prevent women from this ethnic group receiving care and treatment for perinatal depression.

The confluence of structural, socio-cultural, and personal barriers might account for the apparent absence of Black Caribbean women from those receiving treatment for perinatal depression.
Why do women experience mood disorders following childbirth?
Authors: Jones Ian
Published: May 2014

Mood disorders are common in pregnancy and the postpartum period and there is little doubt of the clinical and public health importance of affective illness occurring at this time. However, over recent years the scientific concept of postnatal depression has been challenged by studies suggesting no increased risk of depression at this time and little difference in the clinical presentation, response to treatment or prognosis of depression presenting in the postpartum and non-postpartum period. In the case of bipolar disorder (manic depression), however, there is compelling evidence that the postpartum is a period of very high risk and evidence is emerging to suggest that, for at least a proportion of women with major depression, there is a specific relationship to a childbirth related trigger. The author will consider some of the lines of evidence pointing to a specific relationship between childbirth and mood disorders and argue that this link is an important clue that can inform understanding, not only of postpartum mood disorders, but of affective disorders in general.
Redefining the second stage of labour could help to promote normal birth
Authors: Long Louise
Published: May 2014

The following article considers the possibility of redefining the second stage of labour to place the emphasis on descent rather than dilatation. The idea for this was triggered when the author attending the Jean Sutton's Optimal Fetal Positioning study day. The article suggests that the new definition for 2nd stage would be ‘From when the presenting part has passed through the cervix and is therefore below the ischial spines, to the baby being born’. It discusses the current problems seen in labour – that of a mother pushing too early and the delaying tactics used by midwives – and how the new definition would help to overcome these issues> It also incorporates the two other stages often seen in labour; ‘transition’ stage and the ‘rest and be thankful stage’, offering an order in which these stages could work with the new definition.
What happens after a difficult birth? Postnatal debriefing services
Authors: Ayers Susan , Claypool Jennifer , Eagle Andrew
Published: May 2014

There is increasing pressure to improve maternity services and provide postnatal services for women who have a difficult birth experience. However, there is little information about services currently offered. This survey aimed to establish the type and availability of postnatal services in the UK for women who have a difficult or traumatic birth. A telephone survey was carried out of a quarter of UK hospitals randomly chosen from the Department of Health listing. Seventy-one hospitals took part (76% of eligible hospitals). Results showed that 94% of hospitals provide postnatal services for women who have difficult births. Most of these (78%) are debriefing services that were implemented in response to need; only 5% were reportedly started on the basis of research evidence. Results are discussed in relation to the relative lack of awareness that such services exist and the controversy over the use of debriefing after trauma.
Antenatal investigations: Where is the evidence of benefit?
Authors: Walsh Denis
Published: May 2014

I will always remember from my student midwife training a wise old professor of obstetrics asking us: What is the point of an antenatal investigation if its gives you information about the fetus being at risk but there is no effective treatment. Doesn't that just increase anxiety for everyone and lead to further testing?
Bullying and horizontal violence: Cultural or individual phenomena?
Authors: Curtis Penny , Ball Linda , Kirkham Mavis
Published: May 2014

A large minority of respondents to the Why do Midwives Leave (WML) study (Ball, Curtis and Kirkham, 2002) reported that they had experienced bullying or horizontal violence, either from their managers or from their clinical colleagues. Certain factors, including clinical grade, level of experience, health status and familiarity with the practise environment, appeared to foster vulnerability, leaving individuals liable to be subjected to the inappropriate behaviours of others. Some managers were unwilling to label such behaviour as bullying and there were examples when inappropriate behaviour was condoned, for fear of upsetting the perpetrators who played a key clinical role. Heads of midwifery were aware of the problem of bullying in the workplace, recognising this as a cultural rather than an individualistic issue. Although progress towards confronting bullying cultures was being made in some locations, much remains to be done.
Alleviating postnatal perineal trauma: To cool or not to cool?
Authors: Steen Mary , Briggs Michelle , King David
Published: May 2014

This article discusses the evidence reported from quasi randomised trials and randomised controlled trials on the efficacy and acceptability of localised cooling methods in alleviating perineal trauma. Two types of cooling methods were identified: iced sitz baths and cooling devices. The review suggests that cooling may lower the levels of reported perineal pain after childbirth and reduce the inflammatory response associated with perineal trauma. However, women's preferences as well as the efficacy of the cooling method should be taken into consideration. Women's natural reluctance to sit in iced sitz baths suggests that this cooling method is unpleasant and may explain why there has been a decline in this method being used in clinical practice over the last two decades. The use of localised cooling devices appear to be a more acceptable method for women.
Infant nutrition: Building health from the womb to weaning
Authors: Blincoe Alana Juman
Published: May 2014

Nutrition plays a critical role in infant growth and development. It begins directly with the fetus through to adolescence. A well balanced diet is essential for mothers-to-be to ensure their unborn child is receiving the adequate nutrients that is needed to produce a healthy pregnancy and thus a healthy newborn. Once the child is born, maternal diet is still key as mother's breast feeding need to make sure they are able to provide their child with all the nutrients they need at such a crucial stage in the growth. Once the child is at weaning stage the mother needs to be made aware of the changing nutritional needs of her growing child.
Research ethics committee approval: The good, the bad and the ugly
Authors: Cooper Tracie
Published: May 2014

Ethics committees have a joint role; they protect the rights of participants and ensure that ethically sound research is facilitated. Researchers are usually committed and passionate about their project and want to secure ethical approval. Both want the project to have ethical credibility and overall they have the same aims. When the history of ethics is examined the principles of why ethics committees are required can be unequivocally justified.
The ‘stages’ model of labour: Deconstructing the myth
Authors: Winter Clare , Cameron Joan
Published: May 2014

The current practice of dividing labour into stages is based on assumptions about the process of labour that conflict with current understandings of physiology. The ‘stages’ model is associated with arbitrary time limits placed on each stage of labour and is associated with an increase in the use of intervention. The requirement that midwifery practice is based on current best evidence conflicts with the adherence to the ‘stages’ model of labour. This article proposes an approach to labour that views it as a physiological process rather than an event. This approach would enable knowledge and understanding of physiology to inform decision making in labour. The ‘process’ approach to labour has the potential to enable care to be individualized. To accept this approach to labour, midwives need to become skilled in coping with uncertainty.
Lone mothers: Midwives have the ability to make their starts easier
Authors: Bainbridge Jane
Published: May 2014

Jane Bainbridge examines the phenomenon of the single mother, looks at the common prejudices surrounding lone parenting and how midwives can help to give these mothers a good start.
Midwives must not allow publicity to push them into defensive practice
Authors: Symon Andrew
Published: May 2014

Risk avoidance among practitioners is a natural consequence of increasing litigation in health services. Andrew Symon urges midwives not to allow the fear of legal action to shape their practice.
How can we make our children happy?
Authors: Daniel Lincia
Published: May 2014

Britain's children are the unhappiest of the world's wealthiest nations and many are born disadvantaged according to a UNICEF report. Mothers and babies are also being denied basic breastfeeding care.
Developing a specialist midwife practitioner in Russia
Authors: Walton Irene , Essay Rosemarie , Morgan Jane
Published: May 2014

In Russia poor maternal and perinatal mortality and morbidity rates are coupled with a declining birth rate (World Health Organization, 2005). In order to improve outcomes for women and their babies there was an identified need to improve the knowledge and skills of midwives. Funding was secured for a collaborative educational project that aimed to educate specialist midwives in order to develop a woman-centred, innovative and evidence based approach to care.

Outcomes were identified to include role specification, skills for the specialist midwife and strategies for teaching and learning. A curriculum was developed and learning outcomes identified and the programme was delivered using a variety of teaching methods. The midwives chose a clinical topic and identified key issues for change. Twenty-five midwives from eight institutions took part. The programme was successfully evaluated and further developments were identified from the project.
Screening eggs for abnormalities: hope for childless couples?
Authors: Bainbridge Jane
Published: May 2014

Not everyone is lucky enough to conceive as soon as they want to and IVF with its high cost and shockingly low success rates deter many couples, but is there hope at last with a new technique being developed?
Homeopathic remedies for self-administration during childbirth
Authors: Calvert Jan , Steen Mary
Published: May 2014

This is part one in a series of two articles which describes a study that assessed the usage and impact of providing a self-administered kit of homeopathic remedies during the end of pregnancy, childbirth and following birth. The kit contained ten specially chosen remedies that could be used for common conditions associated with pregnancy, birth and after birth. The homeopathic kit was designed to be easy to use and be self-administered by the woman and her birth partner. The study was undertaken in the home and hospital setting. An antenatal home visit was carried out to explain the use of the homeopathic remedies kit. Women were given a semi-structured questionnaire to complete and were asked questions relating to their knowledge and use of homeopathy and to specifically record the reasons why and when they decided to take a remedy, which remedy they chose and their perceived response to the remedy. Nineteen women living in South Leeds, West Yorkshire took part in the study during a six month period (September 2005 to February 2006). Written evidence demonstrated that all women who participated perceived some positive benefits from using the kit of homeopathic remedies. In addition it was also evident that this had a positive impact on their birth partner's involvement. The findings will form the foundations for undertaking further research in this field.
Protecting neonates' delicate skin
Authors: Hale Rachel
Published: May 2014

It is essential that neonatal skin maintains its integrity and pH balance in order for it to carry out its duty of creating a protective barrier to ward off infections, and also to protect its functions of thermoregulation, fat storage, immunosurveillance and prevention of excessive fluid loss. Some have argued that if the skin is immediately exposed to chemicals such as creams and bubble baths it could disrupt these processes. As a result of this some believe that neonates should be washed with water only for the first month of life, particularly those babies who have been born prematurely. Both schools of thought do agree however that any cleansing products that are used on neonatal skin should be very mild and pH neutral. There is little conclusive research in this area so it would be beneficial if a large scale study were to be carried out to help set guidelines for a uniform approach to neonatal skin care.
Delivering choice: where to birth?
Authors: Kightley Robb
Published: May 2014

Delivering the choices recommended once again by the Department of Health in ‘Making it Better: For Mother and Baby’ seems just as challenging as when these were recommended in ‘Changing Childbirth’. Altering the culture of hospital birth in the UK means influencing a population that is continually exposed to media aimed at persuading women to change. Meanwhile midwives take on wider and wider roles trying to be both ‘with woman’ at home, in birth centres, in tertiary obstetric units etc. while practice may face further constraints due to the ‘uninsurable’ risk posed by birth.
Delayed cord clamping or immediate cord clamping?: A literature review
Authors: Cook Elizabeth L
Published: May 2014

An extensive literature review was undertaken to assess the most advantageous time to clamp and cut the umbilical cord following uncomplicated pregnancy and vaginal birth. This is primarily considered in respect of neonatal hematological parameters, neonatal pulmonary function, maternal blood loss, and overall neonatal wellbeing in early infancy. Additional influencing aspects also evaluated include gestational age, management of the immediate postpartum period, complicating factors and the precedence of historical practices. Based on a summation of all findings the author concludes and advocates that slightly delayed cord clamping between 30 seconds and five minutes after birth is superior to immediate cord clamping done at delivery.
Vaginal bleeding in the first trimester
Authors: Calleja-Agius J
Published: May 2014

Causes of vaginal bleeding in early pregnancy include: miscarriage, ectopic pregnancy, gestational trophoblastic disease and lesions in the lower genital tract. Miscarriage is the most common pregnancy disorder and can be classified as threatened, complete, incomplete or early embryonic/fetal demise. Ectopic pregnancy should be suspected in any pregnant woman presenting with lower abdominal pain and/or vaginal bleeding in the first trimester. Patients with gestational trophoblastic disease need to be followed up due to the potential risk of choriocarcinoma. Cervical polyps, cervical ectropion, and carcinoma, can give rise to vaginal bleeding, but one should conclude that these are the sole causes only after exclusion of all the other causes. All units should provide a dedicated outpatient early pregnancy assessment service so that women receive efficient care of high quality. In view of the psychological sequelae associated with pregnancy loss, a system must be in place for informing all relevant primary care professionals.
Teenagers' experiences of postnatal care and breastfeeding
Authors: Hunter Louise
Published: May 2014

This audit explores young women's views and experiences of in-patient and community postnatal care in Oxford, UK. Twenty-nine teenage mothers responded to a postal questionnaire received between one and four months postpartum. Their responses indicate a requirement for more proactive help and support with basic babycare tasks, and are discussed in relation to the small amount of research into this area. Of the respondents 80% indicated an intention to breastfeed, but many either did not start or gave up very quickly. Strategies to support young mothers to breastfeed suggested by other research are explored. Implications for future research and support initiatives are discussed.
Protecting children: key principles
Authors: Griffith Richard
Published: May 2014

It is some twenty years since allegations of child abuse in Cleveland led to a judicial inquiry that influenced the philosophy of the Children Act 1989 (Cleveland Report, 1988). The Act was further influenced by the United Nations Convention on the Rights of the Child (United Nations, 1989) that requires governments to have regard for all children in their legislative and policy decisions and this includes a right to be protected from abuse.
‘Not in labour’: impact of sending women home in the latent phase
Authors: Barnett C , Hundley V , Cheyne H , Kane F
Published: May 2014

Women who were sent home from hospital in the latent phase of labour were asked to keep a diary to reflect on their experiences. Twenty-one women consented to complete the diary but only six returned it. These six women were approached to participate in a one-to-one interview at home to further explore the effects of being discharged home. Five women agreed to be interviewed. Interviews were tape-recorded and transcribed verbatim. The data were analyzed using latent content analysis. Five themes were identified: influence of others, reassurance, coping/pain, sleep deprivation and undervaluing of the latent phase. Women were strongly influenced regarding when to go into hospital by the anxiety of family and partners. Most women sought reassurance but being sent home made them feel unsupported and this may have increased their anxiety. Further research is needed into how best to support women planning a hospital delivery who in the latent phase of labour at home.
Guide to the Mental Capacity Act 2005: decision making capacity
Authors: Griffith Richard
Published: May 2014

The Mental Capacity Act 2005 changed the way decisions about care and treatment are made for people who lack decision making capacity. To benefit from the protection of the Act midwives must show that they have complied with its requirements. It is essential therefore that midwives apply the Act accurately when deciding if a woman has decision making capacity and whether care and treatment is in her best interests. This is the first of a short series of articles on the Mental Capacity Act 2005
An exploration of the undetected or concealed pregnancy
Authors: Ali Elizabeth A , Paddick Stella-Maria
Published: May 2014

This article explores the literature on the phenomenon of the ‘concealed’ or ‘undetected’ pregnancy. It proposes a useful working definition and categorization predominantly based on the work of Conlon (2006). Women's unawareness of pregnancy up to giving birth is explored. Evidence from Confidential Enquiries highlights the risks to both mother and child associated with concealment. By raising awareness among care providers and suggesting remedial action such as making maternity services more accessible it may be possible to reduce the consequences of this problem. Included in this article are four case studies which illustrate the phenomenon. Details have been altered to protect confidentiality. Other accounts where tragedy has resulted are not included, as these might be more easily identifiable.
Midwifery and nursing leadership in the ever-changing NHS
Authors: Warriner Sian
Published: May 2014

This case study reviews the historical context for reform in nursing and midwifery leadership and reflects on the main drivers and barriers to change. Traditionally, health services have been seen as being primarily bureaucratic with clear characteristics designed to produce standardization above all else. However, over the last few years the NHS has, as an organization, been the subject of a radical and sustained reform agenda aimed at changing its culture. Centrally to this cultural change has been the recognition and acknowledgment that effective leadership is a key ingredient to modernizing today's health service. The concept of leadership within the health service is emphasised throughout the NHS reform agenda, which identified the importance of self-aware leaders, motivated to produce real improvements in clinical practice and to establish direction and purpose, to inspire and motivate their teams. However, a significant barrier to change may be the organization's ability to engage with a different type of leadership based on clinical competence.
Coping with diabetes through pregnancy
Authors: Richmond Jennefer
Published: May 2014

Many pregnant women with diabetes present at booking with poor glycaemic control, despite the fact that this increases the risk of miscarriages, congenital abnormalities, stillbirths, macrosomic babies and early deliveries (Janz et al, 1995; Evers et al, 2004). Generally glycaemic control is improved during the pregnancy, but this is often not sustained following childbirth (Gold et al, 1998). This prospective study used a phenomenological approach to explore how identity was linked to the improvement, and deterioration, of blood glucose control in women with type 1 diabetes. Eleven women agreed to take part (ages ranged from 25 to 42 years). Diagnosis of diabetes ranged from 5 to 26 years. Interviews were conducted during the first and third trimesters of pregnancy and approximately 6 to 12 months after childbirth. Women's accounts show that pregnancy for women with diabetes is extremely hard work. The accounts also reveal the dilemmas they faced on a daily basis and the juggling acts they had to perform to achieve ‘good’ diabetic control (3.5–7.0mmols/l in pregnancy). The ways in which salient identities, in particular, that of being a mother influenced how women cared for their diabetes are highlighted. HbA1cs reduced during pregnancy and rose after childbirth in most cases. The findings have significantly impacted on practice.
Women's experiences of following advice to stay at home in early labour
Authors: Nolan Mary , Smith Julie
Published: May 2014

The aim was to explore women's experiences of staying at home following advice from an obstetric triage unit. Semi-structured interviews were undertaken with eight women who contacted a triage unit in early labour and were advised to remain at home; interviews were analysed using thematic analysis. Four themes were identified: reassurance (the need to have labour validated by health professionals); uncertainty about early labour; pressure from women's families to go to hospital; and seeking permission to come in. The overall theme reflected women's sense that advice to stay at home was a professional rather than a woman-centred response to early labour. Advice from midwives to stay at home in early labour may be insufficient to reassure women who lack trust in their own ability to interpret what is happening in labour, and who depend on health professionals.

Until women's own faith in their ability to labour and give birth can be restored, women may feel obliged to stay at home in early labour, rather than feeling comfortable to do so.