bluuebunny/crossref_metadata_2025 huggingface dataset:
Part 1: What is law?
Authors: Dimond Bridgit
Published: May 2014

It is against the law is a powerful statement and anyone making it should be able to declare the source of the law to which the reference is being made. If the statement is accurate then either an Act of Parliament (known as a statute or legislation) or a decided case would be cited.
Multi-professional education programmes in midwifery
Authors: Houston Sandra M
Published: May 2014

Multi-professional educational programmes are relatively new in relation to pre-registration midwifery programmes. Increasingly, however, educationalists are being asked to consider the feasibility of creating pre-registration programmes that will be utilized by a variety of health-care professionals. This has engendered considerable debate among educationalists. It is likely that this educational approach will provide students with increased learning opportunities; however, the challenges may be insurmountable. Issues such as ensuring that the learning outcomes of all professional groups are achieved are the key to success in any multi-professional programme.
The use of maternity statistics at a local level
Authors: Kenney Natalie , Macfarlane Alison , Dobson Pam
Published: May 2014

Midwives go to considerable efforts to record information about the women and babies for whom they care. Many may be unclear about the extent to which this information and the statistics derived from them can be used. In the first of two articles we describe the need for accurate and complete maternity information and the use which can be made of this information at a local level.
Debate about the current system
Authors: Symon Andrew
Published: May 2014

The current fault-based system for deciding claims about clinical negligence has its critics. This article discusses the central requirement to establish fault, and the concurrent need to demonstrate a causal connection between fault and damage. The role and applicability of the Bolam test is also examined.
Multidisciplinary care — continuing the debate
Authors: Bates Carol
Published: May 2014

A recent editorial by Walsh (1999) has prompted a flurry of letters from midwifery researchers and others expressing a range of views on Walsh's suggestion that teamwork and multidisciplinary research are euphemisms for an obstetric-led agenda. Midwives involved in the ORACLE Trial have understandably written to defend their corner but they ignore Walsh's key criticism that the trial is obstetric in origin focusing instead upon the need for multidisciplinary research (Kenyon, 1999). Two correspondents consider Walsh's concerns to be valid and worthy of further exploration (Stewart, 1999; Bick, 1999). Other issues are raised — the difficulties surrounding research funding (obstetricians fare better at this than midwives) and the fact that some midwifery researchers tend to publish in medical rather than midwifery journals. Another letter strongly supports the ORACLE Trial and stresses the importance of such trials for women (Lavender, 1999).
Part 10: Health and safety laws
Authors: Dimond Bridgit
Published: May 2014

Laws on health and safety come from two sources: Acts of Parliament and Regulations made under them, and the common law, i.e. case law or judge-made law. The principle Act of Parliament is the Health and Safety at Work Act 1974, which has been followed by more detailed regulations, some as a result of European Community Directives.
Can elective labour induction be woman-centred?
Authors: Homer Caroline SE , Davis Gregory K
Published: May 2014

Some women request elective induction of labour (IOL) at term (or before) for pragmatic, social and emotional reasons. The risks of such a procedure are largely unknown with only two small randomized controlled trials (Cole, 1975; Ohel et al, 1996) and a number of reviews on which to base clinical decision making. Currently, women who request IOL at term are either refused, dissuaded or spurious reasons are invented to enable the procedure to occur. Last year we proposed a study to investigate elective IOL at term. This proposal caused much distress among the midwives in the unit and compelled us to examine our woman-centered philosophy. This paper outlines the proposed study and briefly describes the debate that occurred during the planning phase. Some issues pertaining to IOL and the provision of woman-centred care are also discussed.
Midwives: proud to be MAD
Authors: Henderson Christine
Published: May 2014

It will be interesting to see what happens with the care for Cherie Blair during the pregnancy. Will she accept what the NHS has to offer — the services of midwives with only consultant input if necessary?
The challenges of the new millennium
Authors: Hunt Sheila C
Published: May 2014

Midwifery has come a long way since the early days of this century and the first Registration of Midwives Act in 1902. A three month training has been replaced by a three year degree and diploma courses run in higher education institutions. Labour can be pain free — women can be supported through the whole of their child bearing experience by the same knowledgeable, well educated, professional midwife. The condition of her fetus can be monitored throughout her pregnancy by the most sophisticated machinery.
The therapeutic relationship in midwifery
Authors: Siddiqui Jeanne
Published: May 2014

As the ‘science’ of midwifery profresses within higher education, it is important that midwife teachers, students and practitioners maintain and value the fundamental concept of midwifery care that is expressed in human interaction. The relationship that develops between the woman and the midwife is at the core of human caring and may provide the basis of the professional body of knowledge that encapsulates midwifery. In 1992, Slevin and Buckenham wrote about the concerns they had that nursing would lose sight of the central focus of caring, i.e. the therapeutic relationship. Midwife educators should share these concerns and ensure that the elements of caring are at the centre of the midwifery curriculum.
Initiatives continue to promote breastfeeding
Authors: Allen Rose
Published: May 2014

Infants' specific nutritional needs are met by human milk. As this is the optimum and preferred means of infant feeding it seems reasonable to expect all infants to be breastfed. The 1980s saw an array of published material relating to breastfeeding. In 1985, 65% of women in the UK chose to commence breastfeeding (Martin and White, 1998). However, most women ceased to use this method of infant feeding within 14days of delivery. Indeed it was identified that only 26% of women continued to totally breastfeed their infants at four months. It is recommended that all infants should be completely breastfed until four months of age, unless it is completely impossible. Therefore, the 26% breastfeeding rate warranted specific attention. A number of issues were highlighted which may have contributed to the decline of breastfeeding rates in the UK.
Reasons for students' views about healthy pregnancy
Authors: Parker Tina , Stanisstreet Martin , Edwards Grace , Boyes Edward
Published: May 2014

The aim of this study was to determine the thinking that underlies adolescents' ideas about the relationship between maternal nutrition and the health of the fetus, and about when a woman should begin to ‘take care’ with her diet. The study design involved a quantitative survey using a combined precoded and free response questionnaire, the content of which was derived from the results of a previous questionnaire study. The subjects comprised 219 school students from the Northwest of England in British National Curriculum Year 10 (age 14/15) and from mixed-ability classes in four non-religious, mixed-gender, community comprehensive schools. The results show that school students are unaware of the reasons why certain dietary items should be treated with caution during pregnancy, and have misconceptions about the risks they present. They are also unaware of the importance of the early stages of pregnancy in this context, because they feel that pregnancy does not start until it is confirmed. The study concluded that there is a continuing need for education about the relationship between a healthy diet and pregnancy outcome, and about the significance of preconception care. Midwives and other health professionals may have a role in such education, and should be aware of the reasons that underpin certain misconceptions, so that they can be corrected.
Dashed hopes for midwives
Authors: Henderson Christine
Published: May 2014

More pay for newly qualified staff, an expensive recruitment campaign, plans to scrap the grading system and introduce three levels of practitioner, changes in nursing education. These are the Governments answer to the recruitment and retention problems in the NHS. They will not address the recruitment or retention problems in midwifery.
A review of puerperal psychosis
Authors: Gaskell Catherine
Published: May 2014

It is now well established that two out of every thousand women delivered are admitted to a psychiatric hospital suffering from puerperal psychosis. It is remarkable that this incidence has remained broadly constant for over a century in different countries (Kendell et al, 1987; Paffenberger, 1964; Brockington et al, 1982). Yet, despite advances in reducing maternal and infant mortality and improving safety and pain relief in labour, the incidence of women's ‘psychosis’ post-birth has remained static. The number of women who are becoming severely mentally ill post-birth is the same now as in Emily Pankhurst's era.
Midwives designing and delivering the future
Authors: Murphy-Black Tricia
Published: May 2014

Glasgow, which in 1999 is the UK City of Architecture and Design, welcomes the Royal College of Midwives for its annual conference. Delegates from all over the UK, some old hands at the conference scene, some first timers will be assembling in Glasgow for four packed, stimulating and exhausting days from 20–23April. The Professional Day ‘Midwives delivering the new NHS’ concludes the conference.
The FemePad, a breakthrough in perineal pain relief
Authors: Steen Mary
Published: May 2014

Many women suffer from perineal pain following chilbirth injury, and this often has numerous negative consequences for them (Steen and Cooper, 1998). The majority of women in the UK will be advised to take regular baths and paracetamol (Sleep, 1990) to ease this pain. Some women will be offered icepacks, which are produced by either freezing a normal saline sachet, a water-filled finger from a latex glove, or even better, a condom!
Pathology and physiology of neonatal jaundice
Authors: Coe Lynne
Published: May 2014

Neonatal jaundice is a normal, physiological event that is being treated on a belief of pathology. Treatment at present is based on historical fears, and not on the evidence available. This has implications for all involved: midwives, paediatricians, mothers and babies. Midwives must increase their knowledge of this condition and develop their skills in recognizing those infants at risk of pathological jaundice. The risk of trauma associated with kernicterus must be brought back into perspective in order to care for the infant in the most appropriate manner. This article attempts to examine the current treatment and encourage further discussion on what is fundamentally a normal, transitional function of the neonate.
The role of the lecturer/practitioner in midwifery
Authors: Jackson Karen B
Published: May 2014

This article explores the literature concerning the role of the lecturer/practitioner in midwifery. Incorporating the varying definitions of a lecturer/practitioner, the theory-practice gap, clinical credibility, reflection and discussing whether such a role can address some of the problems experienced in midwifery education. Miller (1985) states that: ‘there is a major barrier between nursing as it ought to be and nursing as it is’, with educationalists expounding the former and practitioners the latter (Rafferty, 1992). By implication the statements could equally apply to midwifery. Indeed, the problems associated with nurse education, i.e. applying theory to practice and educational support in the clinical area are also common in midwifery education. Is it possible that a lecturer/practitioner role could help to alleviate some of these common problems? The author found sparse literature pertaining to the role of lecturer/practitioner in midwifery, and therefore by acknowledging that nursing and midwifery are separate but parallel professions, the author believes that utilizing nursing research is both legitimate and valid in this instance.
Midwives: making a difference
Authors: Henderson Christine
Published: May 2014

Consider the following: ‘In a trust in England there are clinical guidelines in place last revised a few years ago. Practice has moved on and is different to the guidelines. There are WHO guidelines that support what the practice is and the Baby Friendly Initiative, supported by the trust, is at odds with the existing written guidelines. The midwives want to update them but are prevented from doing so because the consultant doesn’t see the need. The midwives are powerless to take the matter further.’ The power to change is out of the hands of midwives. Sound familiar?
Nobody actually tells you: a study of infant feeding
Authors: Hoddinott Pat , Pill Roisin
Published: May 2014

This article examines antenatal expectations and postnatal experiences of first-time mothers to provide an insight into postnatal discontent and why so many women change their feeding behaviour in the first few weeks after birth. Qualitative semistructured interviews were conducted early in pregnancy and 6–10weeks after birth. Twenty-one white, low income women expecting their first baby were interviewed, mostly at home, and often with their partner or relative. Most women felt inadequately prepared for motherhood. Women who felt well prepared and coped best postnatally were those with high levels of exposure to newborn babies and those with constant support from someone with recent mothering experience. A breakdown in women's confidence postnatally seems to be the key motivator for women changing their method of feeding Apprenticeship-style learning of parenting skills improves women's confidence, wellbeing and ability to cope as a new parent. The study concluded that the current approach to preparing and supporting women in childbirth is heavily weighted toward providing women with theoretical knowledge rather than apprenticeship-style learning and support. Changing this balance could impact on many areas of maternal, family and child health as well as infant feeding.
Antenatal class charges are a harebrained proposal
Authors: Beland Paul
Published: May 2014

On the 13 November 1999, Alan Milburn, Secretary of State for Health, described his vision for the NHS during the British Broadcasting Corporation (BBC)'s Any Questions. He said:
Midwives, now is the time to speak up
Authors: Ryan Christine , Rogers Cathy
Published: May 2014

Midwives everywhere must respond to the new consultation document Modernising Regulation. The New Nursing and Midwifery Council. It outlines the Government's proposals for the new regulatory frameworks for nursing, midwifery and health visiting. Greater public protection is central to these proposals, which is to be achieved through greater patient and public representation and faster more transparent procedures.
Clinical governance using a business excellence model
Authors: Jackson Sue
Published: May 2014

This article explores the suitability of the EFQM excellence model (a model that originated in business) for delivering clinical governance within maternity services. It also explains some of the key aspects that emerged from the initial stages of implementing the model within a particular maternity unit. The potential for the model to stimulate continuous improvement for the benefit of all customers of maternity care was soon recognized.
Knowledge about attitudes can help change behaviour
Authors: Hollins Caroline
Published: May 2014

This paper addresses the issue of social attitudes. The purpose is to facilitate understanding of attitude structures and the application of this knowledge to midwifery practice. Attitudes have been defined and their development within individuals described. The above information has been applied to midwifery practice emphasizing the issue of respect for a client's attitudes and opinions which may differ considerably from our own. Attitude change has been addressed in relation to helping women change behaviours which promote obstetric damage. An explanation has been given to assist midwives’ understanding of why women continue with damaging behaviour.
A practical guide to preventing and treating nappy rash
Authors: Price Sally
Published: May 2014

Most midwives, particularly those working in the community, will have encountered a baby with nappy rash. This common skin condition may cause concern to new parents and discomfort to babies, yet can be easily prevented. A wide variety of effective treatments are also available. This article will explore the advice midwives can give to parents to assist them to make an informed choice in the prevention and treatment of nappy rash.
Causes, prevention and treatment of toxoplasmosis
Authors: Turner Alfred
Published: May 2014

Toxoplasmosis is a common infection caused by a parasite. 30% of people carry the infection by the age of 30, and for every 10 years of life, the chance of infection increases by 10% (Lumsden and Hickey, 2000).
Midwives and mothers: Telling the truth
Authors: Robinson Jean
Published: May 2014

However often I tell myself Im worth it, I still feel guilty about spending money on lipstick or perfume, but even at my poorest I have never had a qualm about buying books. Thank heavens I married a fellow bookaholic (though the shelves are overflowing and the floor space shrinks around us). My latest two indulgences have been so worthwhile I cant wait to share them.
An historical overview of physical activity and childbirth
Authors: Rankin Jean , Hillan Edith M , Mutrie Nanette
Published: May 2014

This paper explores the association between childbirth and physical activity and social class. Throughout history, active hard-working women tended to have easier labours and smaller babies than sedentary women, while painful and dangerous labours were associated with women from higher social classes. The philosophy of the 17th and 18th centuries encouraged pregnant women to exercise. Recommendations and contraindications for physical activity were offered within the lifestyle restrictions of this era. This was in contrast to the 19th century which was dominated by patronizing attitudes to women and pregnancy. During this period it was socially acceptable for pregnant women to be indolent and inactive. Antenatal exercise programmes were developed and established in Britain during the first 60years of the 20th century. Programmes included physical and psychological preparation of women for childbirth and this remains an important component in modern-day midwifery practice.
It was one moment in time…
Authors: Gedes Ann
Published: May 2014

After much planning and media hype the dawn of a new Millennium is now behind us. In the build up to the new century much time was spent ensuring that our houses were in order. At a personal level we were advised to ensure we had enough cash under the bed and sufficient food in the cupboard to survive while bugs in the supply chain took their toll. At a professional level the medical and computer equipment in the service needed checking for date awareness. It was also a good opportunity to clear out the corner store cupboards.
Measuring fetal scalp blood lactate during labour
Authors: Savvidou Makrina D , Spencer John AD
Published: May 2014

Fetal blood lactate can easily and safely be measured with the new microvolume lactate meter. The system requires only 5µl of blood and gives the result in 60 seconds. As opposed to pH meters, the lactometer is considerably cheaper and does not require trained staff or regular attention from a technician. Trials have shown the levels of lactate and pH in fetal scalp blood to be comparable in predicting low Apgar scores at delivery as well as the need for neonatal intensive care unit admission. Lactate concentration in umbilical artery blood has also been shown to have the same predictive properties as pH in relation to perinatal morbidity and mortality. Owing to its simplicity of performance, lactate analysis with the new test strip method is an attractive complement of intrapartum fetal monitoring.
Richer women, worse care?
Authors: Robinson Jean
Published: May 2014

Now heres a mystery. Why should women who pay for private antenatal care but give birth on the NHS, halve their chance of normal onset of labour and halve their chance of getting a full-term baby?
The initiation of labour: physiological mechanisms
Authors: Harrison Julie M
Published: May 2014

The exact mechanism, which triggers the onset of labour is not fully understood, however, research involving animal models and humans has shown that it is the fetus which initiates a train of physiological interactions which initiate labour. However, sometimes pregnancy is prolonged and induction of labour required. This article examines the physiology of the onset of labour and highlights how this has led to development of methods utilized in the induction of labour. Knowledge of physiology is important as the midwife not only provides information and care for women regarding the onset of spontaneous labour, but also when induction of labour is required.
The Highland experience: immersion in water in labour
Authors: Jessiman Wendy C , Bryers Helen
Published: May 2014

In September 1997, the most northerly labouring and birthing pool in Scotland was installed at Raigmore Maternity Unit. The decision to install the pool was made in response to local demand, and this raised a number of professional issues, the most important of which concerned the use of the pool in labour suite and the demand for water birth. An audit of the first two years of the use of the pool indicates variable use, influenced perhaps by conventional baths and obstetricians who do not support water birth. Eighty seven women used the pool in labour and two women gave birth to their babies in the pool. Of these, twenty women had their labours induced. The most common reason for women leaving the pool was to obtain further analgesia. Eighty two per cent of women and 79 per cent of midwives rated the pool very highly.
Home births: manslaughter, misconduct and negligence
Authors: Dimond Bridgit
Published: May 2014

An analysis of a case in France where a midwife was prosecuted and suspended from practice following a stillbirth and a home delivery. Could this happen in the UK?
Early warning on negligence and failures in the NHS
Authors: Dimond Bridgit
Published: May 2014

The Government has announced its intention to set up a national system for adverse incident reporting in the NHS. This article discusses the reasons for the scheme and potential problems.
Part 19: Withholding medical treatment
Authors: Dimond Bridgit
Published: May 2014

Occasionally the midwife might be in a situation where the baby fails to thrive and significant decisions have to be made as to whether high technological interventions have to be made to keep the baby alive. Must action always be taken to ensure that life continues? In what circumstances could a baby be allowed to die?
Pelvic floor exercises: A comparative study
Authors: Jones Maxine
Published: May 2014

The aim of this study was to assess the prevalence of stress incontinence 3months after childbirth and to evaluate the effect and benefit of taught pelvic floor exercises in the prevention of stress incontinence following childbirth. The study compares women who attended antenatal parentcraft classes who were instructed on a programme of pelvic floor exercises with women who had declined the invitation to attend. Data were analysed to compare the groups and to identify independent factors for stress incontinence. The results of the analysis found a significant association between stress incontinence, mode of delivery and birth weight. There was also a highly significant association with reduced incidence of stress incontinence and daily pelvic floor exercises. Women who attended antenatal parentcraft classes and received instruction on a programme of pelvic floor exercises had benefited in the prevention of stress incontinence. This was found to be highly significant when the exercises were practised daily. There was, however, a poor uptake of the continence service designed to support and assess women with stress incontinence and this is an area that needs to be addressed.
Improving maternity care for pregnant diabetics
Authors: Mitchell Mary
Published: May 2014

The last decade has seen a dramatic improvement in the care offered to women with diabetes in pregnancy. Some studies have demonstrated that pregnancy outcomes equal to the normal pregnant population can be achieved with intensive support and management regimes (Garner, 1995; Diabetes Control and Complications Trial (DCCT), 1996). However, many controversies still exist in the management of pregnancy for the insulin-dependent diabetic. There is also evidence that the care many pregnant diabetics receive is substandard, leading to poor pregnancy outcomes (Jardine-Brown et al, 1996). Although a woman who is pregnant and has diabetes clearly needs considerable medical attention, the midwife's role is vital to help the woman and her family retain a semblance of normality during pregnancy and birth.
Baby Skincare Wipes pass No More Tears
Authors: Jones Kathleen
Published: May 2014

The mildness of baby wipes is often questioned by health professionals, causing their suitability for use on babies to be reviewed. Consequently, this article offers a review of the Johnsons No More Tears® claim and its relevance, now it has been applied to Johnsons Baby Skincare wipes. The additional skincare benefits of the Johnsons Baby Skincare Wipes are also reviewed.
Informed consent is a primary requisite of quality care
Authors: Cooper Tracey Jane
Published: May 2014

Pregnant women are expected to make various choices about their care. In order to make these decisions, women need information on which to base their choices and thus give their consent. For this consent to be informed, the client must be competent and able to make a decision and have the necessary information to do this. Ensuring that this information is given in a non-judgmental and unbiased way is part of the midwife's role. There are many barriers to informed consent and these need to be identified by the midwife and the issues addressed if the sharing of information is to be successful.
Essential fatty acids for maternal and fetal nutrition
Authors: Turner Alfred
Published: May 2014

Long chain polyunsaturated fatty acids (LC-PUFA) play an important role in fetal and infant development. They are supplied by the mother to the fetus during pregnancy. This supply can be continued after the child is born through breast-feeding.
‘Misconceptions’ in midwifery and motherhood
Authors: Warwick Cathy
Published: May 2014

I quite like this time of year. The roads that have been abnormally quiet are filling up as children return to school. There is an autumn nip in the air but the days are still sunny. Lots of people, including myself, have been on holiday and are back at work feeling refreshed. I have a feeling of optimism as during the first week I am back at work I gradually piece together what has been going on in the world of maternity services. Then I pick up the Saturday morning paper and read an edited extract from a new book by the feminist author Naomi Wolf Misconceptions: Truth, Lies and The Unexpected On The Journey To Motherhood.
Midwives' views on redefining midwifery 1: health promotion
Authors: Lavender Tina , Bennett Natalie , Blundell Jackie , Malpass Lyn
Published: May 2014

To explore midwives' views of the recommendations outlined in the Making a Difference document, a regional survey was conducted in seven hospitals in the north west of England. Specifically designed, semi-structured questionnaires were administered to all practising clinical midwives from the study hospitals (n=735). Four hundred and sixty eight questionnaires were returned giving a response rate of 66.4%. In particular the study aimed to highlight any midwifery anxieties, identify training needs and explore midwives' perspective of the effect of the expanding role on service provision. The structured data were analysed descriptively. The open responses were analysed using qualitative methods. This, the first of four papers, focuses on the midwives views of their role in health promotion. The main findings suggested that midwives are generally receptive towards the potential changes to their role, however some reservations were reported.
The clinical application of evidence-based practice
Authors: Hindle Helen
Published: May 2014

This article demonstrates the difficulties faced by clinical midwives when trying to use evidence-based practice. An unusual case of group B Streptococcus in breast milk highlights how midwives can work through the evidence-based practice process. Clinical midwives can sometimes feel that following this process is not feasible especially in an area where there is little research evidence. Midwives must accept their own limitations, but working within a group can have a positive impact on evidence-based practice within the clinical area. Strategies can be developed to enable the identification of issues that need to be addressed and together with the evidence-based process effect change.
Post-traumatic stress disorder: avoidance behaviour
Authors: Robinson Jean
Published: May 2014

The symptoms so coolly described in textbooks seem very different when you see their effects in real life. ‘Avoidance’ is one of the classic symptoms of post-traumatic stress disorder (PTSD). As well as suffering nightmares, flashbacks, personality changes and depression, suffers will try to avoid contacts or situations which cause them to relive their traumatic experience. We have learned this can include locations, sights, sounds, odours, uniforms and people with similar names or appearance to those involved.
Drugged babies are still becoming addicted adults
Authors: Robinson Jean
Published: May 2014

We finally wrote to Tony Blair last summer. After all, we had tried everyone else — chief medical officers of health, royal colleges, every obstetrician we could nobble. As the Blairs had recently had a baby, they just might be interested.
Who should gain informed consent for post mortems?
Authors: Jones Shirley
Published: May 2014

I recently spent part of a weekend reading The Royal Liverpool Children's Inquiry: summary and recommendations (The Alder Hey Report). I was reluctant to read all the appalling details but as ethics and health-care law are my specialist areas, I felt compelled to proceed, if only because I knew it would not be long before my opinions would be sought, even in passing conversation.
The cot death scandal: A case of collective amnesia
Authors: Robinson Jean
Published: May 2014

I have a huge admiration for retired American peadiatrician William Silverman, who wrote one of my favourite books. It is a superb analysis of the retrolental fibroplasia epidemic which blinded many children who were born prematurely and explains how the connection with excess oxygen levels was discovered (Silverman, 1980). He concluded that because all those children had, in fact, been blinded by doctors, there was a conspiracy of collective amnesia in the whole medical profession. They didn't want to talk about it, or even think about it, so the patterns of thought and behaviour which had led to that mistake were still there, and similar disasters were likely to be repeated.
One week in Devon: The forecast is bad
Authors: Lewis Paul
Published: May 2014

In writing this pre-conference review, my thoughts and what I want to put down on paper have, like the Torquay tides, fluctuated in and out according to the climate of the moment; or in my case, as the pressing issues of the day have impinged upon my hopes and expectations.
Part 29: Midwives and medicines
Authors: Dimond Bridgit
Published: May 2014

In the last article we considered the general law relating to medicines. In this one we consider the specific laws applicable to midwives. In addition to the legislation under the Medicines Act 1968 and the Misuse of Drugs Act 1971, the registered midwife is subject to midwives rules which are legally binding. The midwife would also be expected to comply with the Midwives' Code of Practice (UKCC, 1998). This is complementary to the practice rules but, unlike the practice rules, it does not have the force of law. The midwife is also expected to comply with the UKCC code of professional conduct and other guidance from the UKCC.
Does prenatal screening provoke anticipatory grief?
Authors: Robinson Janet
Published: May 2014

Prenatal screening has been defined as a means of detecting and preventing the birth of ‘less than perfect’ babies. Midwifery literature reflects an increasing awareness of the psychological costs of screening to the mother and concern is now emerging about possible adverse affects on the fetus. A recent report stressed the importance of the fetal stage of life to the psychological and emotional state of the adult. By relating the two concepts of anticipatory grief and attachment/detachment theory, the author sets out a possible hypothesis to develop this argument. Definitions and brief descriptions of anticipatory grief are included and related to prenatal screening. The questions raised include the risk of damaged relationships between the mother and fetus and possible long-term emotional effects for the infant. The work of Bowlby (1993; 1980; 1969) and Klaus and Kennell (1982) into attachment and detachment theory is mentioned in this respect. Although the author is aware of the difficulties, the article concludes with a plea for further empirical research into the psychological effects of prenatal screening on the emotional wellbeing of the child.
Midwives must prepare for the electronic patient record
Authors: Dimond Bridgit
Published: May 2014

This article considers the implications of the government's announcement that by March 2005 every person will have their own electronic health record
The introduction of a special needs advisor
Authors: Brown Barbara
Published: May 2014

The change in the health service over recent years has also resulted in changes to the maternity services. In 2001, government policy making is increasingly being influenced by the views of consumers. However, despite these changes, an area which could still benefit from reform is that of women with special needs. The Disability Discrimination Act 1995 (Department of Education and Employment, 1995) makes it unlawful to offer a lower standard of service to women with disabilities. Therefore it is in the interest of the maternity services to look at ways to provide equal care to these women and their families. This article covers how a special needs advisor could be introduced into a maternity service, follows through the problems this change may cause and suggests ways to overcome these problems.
Female genital mutilation: a midwifes experience
Authors: Parkin Julie
Published: May 2014

This article is based upon the reflections that were made by the author after providing care for the first time, to an infibulated woman and the general issues raised by the knowledge gained. Female genital mutilation, circumcision and infibulation are the terms used for a range of procedures which involve the partial or total removal of the female external genitalia and/or injury to the female genitals, for cultural or other non-therapeutic uses. The learning outcomes of the reflection, issues of professional accountability and advocacy are discussed.

The reasons why female genital mutilation continues to be practised are examined, including women's role in society and the physical and psychological effects of infibulation upon them. The author analyses the legal, ethical and cultural issues that surround female genital mutilation and examines the changes that may be necessary to prevent its occurrence. The midwife's role with regard to sexuality and the care of the infibulated woman are also discussed.
Electronic fetal monitoring equipment
Authors: Price Sally
Published: May 2014

This article reviews a range of electronic fetal monitors, produced by three manufacturers — Hewlett Packard, Huntleigh Diagnostics and Nicolet Vascular Inc. It aims to familiarise midwives with the functions of the monitoring devices available, and considers some possible advantages and disadvantages of the use of different types of electronic fetal monitors.
Midwifery diagnosis of labour onset
Authors: Burvill Susan
Published: May 2014

The premise of this study was that midwifery diagnostic cues have been subsumed by the biomedical approach. The purpose of this qualitative study was to find out how midwives diagnose labour onset and create a model of that knowledge. Two approaches for data collection were used: A preliminary midwife focus group and a series of in-depth interviews with an expert midwife. The focus group generated themes and concepts leading to a three part conceptual framework: physiological, sociophilosophical and psychological. The main findings were that midwives use a variety of emotional, psychological and physical cues to diagnose labour onset. The overall ‘tendency’ for labour onset is described as ‘increasing inward focus’, reflected in cues such as movements, breathing, conversation and emotional states. The recognition and use of these cues is influenced by the political and social context in which a midwife works. The final model demonstrates how midwives can work with women outside the biomedical paradigm. It is hoped that this research will contribute to a midwifery discourse surrounding labour onset care.
Are expectant teenage mothers adequately informed?
Authors: MacLeod Annie , Weaver Sue
Published: May 2014

This study evaluates the psychological impact of antenatal services on pregnant teenagers in Hull and the surrounding areas. Participants were recruited from the two main maternity units in the area. The study was designed particularly to examine the role of the midwife in empowering and facilitating autonomy in these expectant mothers. The perceptions, views and knowledge of a sample of 99 expectant teenagers regarding their antenatal consultations and parentcraft classes were recorded as part of structured interviews undertaken at 20 and 37weeks gestation. Participants completed a structured interview at 20 and 37weeks gestation. The results highlight problems surrounding the amount of time given during antenatal consultations and the teenagers understanding of the information given. The results are discussed in relation to other research regarding information provision, and question the adequacy of information given by health professionals to this population.
Addicted to intervention: can obstetricians change?
Authors: Robinson Jean
Published: May 2014

I find it peculiarly satisfying when I come across a paper which provides some proof of what I ‘knew’ — or thought I did. I cherish it as another strand to weave into the argument to convince the doubters.
Step 41: Legal aspects of research 1
Authors: Dimond Bridgit
Published: May 2014

The next Steps articles look at the midwife and research. This article examines the incorporation of research findings into professional practice. The midwife is likely to become involved in research in three ways.
Exploring inconsistent breastfeeding advice: 1
Authors: Simmons Valerie
Published: May 2014

There is now no doubt that breastfeeding provides health benefits for both infant and mother. Although 68% of all mothers in the UK initiate breastfeeding, only 44% are still breastfeeding at 6weeks (Foster et al, 1997). This large proportion of mothers who discontinue breastfeeding before the infant is 6-weeks old do so at a time when the input from health professionals (midwives and health visitors) is at its greatest. It is recognised that professional support when needed is an important element in successful breastfeeding, but conflicting or inconsistent professional advice and practice appear to remain persistent disadvantages. This series of three articles describes a qualitative study which involved interviewing midwives, health visitors and a group of breastfeeding mothers within a single NHS Trust in the north of England. Framework content analysis was used to analyse the interview data in order to explore the basis and effects of inconsistent breastfeeding advice.
Screening for sickle cell disorders: part 2
Authors: Hall Fay Julie
Published: May 2014

This second article in the series on screening for sickle cell disorders (SCDs) looks at midwife educational needs, and whether they are equipped to deal with clients with SCDs. Their awareness and understanding of SCD may be influenced by misconception and ignorance surrounding ethnic minority needs. The need for equity of care, including the importance of trained genetic counsellors is also addressed. The lack of such specialised services outside of larger inner cities is proof of inequality of service for the population in need outside these areas. The summary of findings concludes that midwives’ overall knowledge of SCD is poor and this ultimately affects their understanding of screening protocols, and the issues surrounding ethnicity.
Epidurals: a concern for public health?
Authors: Stafford Sharon
Published: May 2014

This article considers the increasing use of epidurals for pain relief in labour from a public health perspective. The effectiveness, appropriateness, incidence and potential short- and long-term side-effects are discussed. The implications for midwives providing appropriate information to women regarding the potential side-effects are also considered.
Routine HIV and HBV antibody screening
Authors: Miller Riva , Hynes Liz , Howard Neil , Sayer Jenny
Published: May 2014

Following the directive from the Department of Health (1999) that action should be taken to reduce mother-to-baby transmission of HIV infection, Norfolk Health Authority instigated a series of workshops. The purpose was to prepare midwives for the task of integrating HIV and Hepatitis B (HBV) testing alongside other screening tests in a ‘low’ HIV prevalence area. This paper describes the challenges and methods used to help midwives acquire the necessary information and to identify and enhance their existing skills. An immediate uptake in excess of the required minimum 50% was achieved and after 12months uptake was 89%, approaching the target set for 31 December 2002 of 90%.
Stress in pregnancy: effects on the child
Authors: Robinson Jean
Published: May 2014

Thou shalt not smoke, drink alcohol, eat unpasteurised cheese… Now, there is a new commandment. Thou shalt not become anxious. Thank heavens that one wasn’t around when I was pregnant. It would have sent me spiralling down in a vortex of anxiety. It reminds me of those irritating notices you see in lifts: ‘If trapped in the lift DO NOT PANIC.’ It had never occurred to me to panic until they put the idea into my head.
A survey of maternity care in practice in Japan
Authors: Hiruta Yumi
Published: May 2014

The present survey was carried out to examine maternity care on the basis of Care in Normal Birth: A Practical Guide by the World Health Organization (1996). The present study surveyed 76 hospitals and 25 midwife clinics in Osaka, Japan. Comparison of the two groups showed that midwife clinics primarily considered the right to women’s informed choice and offered consistent support from the same nurse-midwives during labour and delivery. In hospitals, maternity care was basically aimed at protecting mothers and babies from infection. Many inappropriate practices were still carried out in hospitals, such as the use of enemas in the first stage, pubic shaving, prophylactic insertion of an intravenous cannula and the lithotomy position. These results suggested that the collaboration of hospitals and midwife clinics is imperative for the practice of safety and empathic care in childbirth.
Developing a midwifery skills framework
Authors: Darra Susanne , Hunter Billie , McIvor Marian , Webber Fran , Morse Nan
Published: May 2014

This paper describes the work of the Welsh Association of Midwifery Lecturers in their aim to develop a framework of ‘composite skills’ descriptors to teach and assess practical midwifery skills. Following the UKCC Fitness for Practice report (1999) the All Wales Initiative was set up and the Association was formed from this. Their first aim was to devise a framework tool that would combine theory with practice, as part of the Fitness for Practice aim of midwifery competence. It was developed specifically to enhance the learning opportunities for students, while proving useful in everyday practice. Potentially, the tool will be applicable to the development of the grading of practice for degree programmes.
An audit of third degree perineal tears
Authors: Austin Julia
Published: May 2014

Significant morbidity is associated with third degree perineal tears, and 50% of women develop symptoms following primary repair (Kamm, 1994). In the short-term these include pain, infection and interference with breastfeeding and caring for the infant. In the long-term there can be problems with faecal incontinence, sexual dysfunction and psychological problems. An audit of third degree tears was carried out to investigate if optimal care delivery was procured. Audit findings revealed shortfalls in appropriate analgesia during repair, inadequate record-keeping and lack of specialist follow-up.
Maternity care for asylum seekers
Authors: Bentham Katie
Published: May 2014

The focus of maternity care should be about identifying individual need for the woman and her family, not only relating to physical wellbeing, but also in respect of emotional and social need. This concept may prove difficult and challenging to some caregivers when trying to meet these needs of women from other countries who are seeking political asylum and find themselves separated from their families and maternity care that is familiar to them. This article, in presenting some of the issues relating to care for asylum seekers, attempts to highlight how midwifery practice should be underpinned by tolerance, dignity and equal rights to all women.
Casting the net: using the internet for survey research
Authors: Stewart Sarah
Published: May 2014

This article will discuss the internet as a relatively new medium for research, and in particular how it can be used for survey research. The internet can be used as an effective tool for collecting information as well as providing material for research. This article will explore its advantages, such as reduction of costs, although one must consider the expense of developing and maintaining a website. Large populations can be reached, and response times are thought to be faster than postal surveys. Its disadvantages will also be discussed, such as sample bias, and how that affects research results. Other issues that will be explored include software compatibility, questionnaire layout and graphics. Practical information will be given on how to design a survey, using the principles for web-based questionnaire design developed by internet scholars. Finally, the article will address some of the ethical questions that researchers are faced with, such as how to gain consent and protect the participants' anonymity.