bluuebunny/crossref_metadata_2025 huggingface dataset:
NICE guideline: antenatal care under the microscope
Authors: Sidebotham Mary
Published: May 2014

In this article the author looks at how midwives can plan the care they give women in the antenatal period to be consistent with the principles outlined within the recently published NICE antenatal care guideline. Midwives are encouraged to think about services with vision and focus on the enabling aspects of the guidance in their interpretation and approach to implementation.
Breastfeeding and Type 1 diabetes mellitus
Authors: Jackson Wendy
Published: May 2014

This article provides practical and theoretical information for midwives and other healthcare professionals who work with parents with Type 1 diabetes mellitus – in particular to support breastfeeding mothers. Evidence suggests that the choice to breastfeed or not has far-reaching consequences for the health of not only the mother who has Type 1 diabetes, but also the child born to a mother or father who has the disease. Mayer et al (1998) proposed that breastfeeding offers protection from developing the disease for children who are genetically predisposed to developing Type 1 diabetes. Protection from an external causative factor, the development of antibodies to bovine serum albumin, is also considered. Breastfeeding has a significant impact on the mother's diabetes. Mothers and midwives need to be aware of how breastfeeding effects day-to-day management of the disease. Midwives are in an ideal position to provide parents with positive, specific, and practical advice about breastfeeding.
Using oral history in midwifery research
Authors: Reid Lindsay
Published: May 2014

The use of oral history as a way of researching the past has considerable potential. Written sources can be one-sided and lacking in detail. Oral sources add colour, life and unsuspected aspects to a story, while simultaneously contributing the exciting possibility of challenging an accepted view of the past. In this article, the author describes how she went about using oral history to illuminate the history of Scottish midwives in the 20th century. The article presents a brief overview of the background to today's use of oral history, examines issues of recruiting interviewees, discusses the appropriateness of single and multiple interviews, and other practical and ethical aspects of interviewing.
The new NHS Foundation Trusts
Authors: Dimond Bridgit
Published: May 2014

This month sees the establishment of NHS Foundation Trusts www.doh.gov.uk/nhsfoundationtrusts ). The Health and Social Care (Community Health and Standards) (HSC(CHS) Act) Act 2003 defines an NHS Foundation Trust as: ‘A public benefit corporation which is authorised to provide goods and services for the purposes of the health service in England.’
Caesarean section: perceived demand
Authors: McCourt Chris , Bick Debra , Weaver Jane
Published: May 2014

The British media has devoted much time and space during recent weeks to the pros and cons of delivery by caesarean section (CS), in particular, planned CS. The debate appears at times to have been one-sided, with more coverage given to the presumed benefits and safety of primary elective CS, with the NICE CS Guideline (National Collaborating Centre for Women's and Children's Health, 2004), which recommends careful consideration of maternal request, attracting particular criticism because choice is perceived to be restricted. So what are we to make of the issue of choice and demand for CS?
Screening programme for Down's syndrome
Authors: Simms Mabel
Published: May 2014

This article examines the experiences of 10 women who declined amniocentesis following receipt of a high-risk screening result for Down's syndrome. In all cases, information was given before carrying out the screening test. However, upon receipt of the screening result, the women realised that they lacked understanding of the implications of the test. The discussion that took place subsequently with the clinical specialist greatly enhanced their understanding and the offer of amniocentesis was declined, based on an informed choice. However, when a genetically normal baby is born, parents still need confirmation of this normality.
Do managers exacerbate complaints?
Authors: Robinson Jean
Published: May 2014

Another phone call: ‘It's Clare'. She immediately launches into the latest episode in the long running saga of her complaint. Unfortunately there are three Clares (or maybe it is Tracys or Carolines) battling away at the moment. I hastily try to fit the voice with the right story in the first few sentences. Is this the one with the post-epidural walking problems, the one injured by a ventouse delivery (yes, we do know it is supposed to be safer for the mother than forceps), or the one who was so desperate for help with breastfeeding while in the postnatal ward of one London teaching hospital, that she actually telephoned another London teaching hospital and pretended she was one of their Mums? (Thank you, St. Mary's, you turned up trumps, and we and the mother are grateful). Fortunately, I soon manage to slot the voice and the story together without interrupting the flow.
Pregnancy loss — the Islamic perspective
Authors: Arshad Mohammed , Horsfall Alex , Yasin Rubina
Published: May 2014

Supporting parents who are bereaved following pregnancy loss is challenging for all staff. When religions and cultures are different to our own, a lack of knowledge and understanding of specific spiritual needs may leave professionals feeling even more helpless, and families dissatisfied. The purpose of this article is to help provide an awareness and information for health professionals when supporting bereaved Muslim families. Islamic requirements may appear complex to non-Muslims, however an understanding of specific rituals will assist both professionals and families alike in providing client-centred care.
Implementing informed choice on infant feeding
Authors: Adamson Jan
Published: May 2014

The proportion of mothers in the UK who choose to breastfeed their babies is actually increasing, albeit at a frustratingly sluggish rate. The most recent figures suggest that 69% of babies were breastfed in 2000 (DoH, 2002). This is an increase on the 66% figure recorded in 1995 but, despite the valiant efforts of midwives up and down the land, initiatives to encourage breastfeeding are still falling some way short of the government's target of a 2% increase per year.
Niger food crisis hits pregnant women
Authors: Bainbridge Jane
Published: May 2014

Niger's food crisis is hitting pregnant women and lactating mothers particularly hard as the country is crippled by drought, locust invasions and accelerating desertification. Considered one of the most at-risk groups, mothers in Niger are at even greater than usual risk of maternal and infant mortality, because of the lack of food.
Admissions and delivery outcomes at a midwife-led unit: 1995-2005
Authors: Andres Marjorie , Rankin Jean
Published: May 2014

The midwife-led unit (MLU), which sits alongside the consultant-led unit (CLU) in Ayrshire Central Hospital, was opened in 1995. Since then 10000 women have been admitted to MLU accounting for 41% of the total number of women admitted to ACH in spontaneous labour. Over the ten years there has been an increase in the admissions to the MLU, which has mainly been due to the relaxation of the admission criteria and on going developments for this option of care. Around 90% of all admissions to the MLU achieve a spontaneous vaginal birth with 5% resulting in LUSC and 6% in an instrumental delivery. Obstetric involvement averages 4.4% and paediatric involvement ranges between 7 and 10 % of all deliveries within the MLU.
The 2015 challenge: Making pregnancy and birth safer across the world
Authors: Maclean Gaynor D
Published: May 2014

This article considers some of the achievements and challenges surrounding global efforts to reduce the high toll of maternal and neonatal deaths and disease. Since its inception in 1987, the Safe Motherhood Initiative has underpinned endeavours to make childbirth safer for women, particularly the poorest and most vulnerable. Reflecting on pertinent historical issues, considering examples of current achievements and speculating on the future, the paper provides insights into the challenges of midwifery practice worldwide.
West not the best for maternity care
Authors: Walsh Denis
Published: May 2014

If you get an opportunity to read anything by Beverley Chalmers a doctor and researcher, specialising in reproductive health issues, take it. No better place to start than her recent commentary in the British Journal of Obstetrics and Gynaecology (Chalmers, 2004) where she addresses the topic of globalisation and maternity services with insight and wisdom. It seems that activists for childbirth who have worked with the World Health Organisation (WHO) have an urgent message to convey. Marsden Wagner, author of Pursuing the Birth Machine is another example. It may be their international perspective that makes them such convincing critics of the developed world's maternity care agenda.
Re-designed community postnatal care trial
Authors: MacArthur Christine , Winter Heather , Bick Debra , Henderson Christine , Knowles Helena
Published: May 2014

A randomised controlled trial of re-designed community postnatal care showed that intervention care improved women's psychological health relative to standard care. This paper provides a detailed description of the re-designed care package such that its replication and evaluation in other settings could be achieved. The intervention care was midwife-led, with no routine GP care required, and it was given over an extended period. Visits during this period were made according to women's assessed needs and in consultation with them. The postnatal discharge check was performed by the midwife at 10–12 weeks. In addition to the roles of the health personnel, the timing and content of care is fully described, as well as an outline of training and support that was given. The documentation used by the midwives in the care delivery is also made available.
Midwifery in Scotland 3: intranatal practices
Authors: Reid Lindsay
Published: May 2014

This article, the third in the series exploring midwifery in Scotland from 1916-1983, with the help of examples from oral history testimonies, examines some aspects of midwives' practice in the care of mothers in labour. It explores the extent to which midwives were able to fulfil their role as autonomous practitioners as specified in the 1915 Midwives (Scotland) Act. This includes discussion on: who delivered the babies; the shift during the time-period from an estimated 95% home births to 99.5% hospital births, along with increasing medicalisation of childbirth. This took the normality out of many births and had a negative impact on midwifery. The subsequent change in midwife/mother relationships and the requirement for midwives to follow hospital policy and protocol will also be discussed.
How do maternity services provide individualized care?
Authors: Magill-Cuerden Julia
Published: May 2014

Just before leaving her post, speaking at a conference, the former chief nursing officer, Sarah Mullaly challenged the audience to consider what they meant by ‘individualized care’. This has since bothered me. How do we make care individualized with protocols, policies and NICE guidelines that frame the way a midwife works and provides care for women? Does the system of care provide the opportunity for care to be tailored to the individual?
Transcutaneous electrical nerve stimulation during birth
Authors: Rodriguez Maria Anguita
Published: May 2014

The amount of pain a woman experiences is influenced by many individual, physical, emotional and environmental factors. Some of these factors can be anticipated and controlled. It is important that, before the birth, a woman is aware of relaxation techniques and of all the forms of pain relief which are available before and during the birth. The midwife has an important role to play in informing the woman of the options available and devising a birth plan to suit the woman's needs. This article focuses on transcutaneous electrical nerve stimulation (TENS), where electrodes placed on the woman's back send out electrical signals, blocking pain and stimulating the production of endorphins. There are no known harmful side effects and studies have shown that it greatly reduces the need for pharmacological analgesia. Women should be made aware of all methods of pain relief available so they can make an infomed choice on what they believe will suit them.
Employment rights for pregnant women and NHS employees
Authors: Dimond Bridgit
Published: May 2014

This article explores the rights of the pregnant and breastfeeding woman in the workplace. It should be read in conjunction with the article on page 558 of this journal which looks at the reality of the employment situation. The two main statutes recognizing the rights of the pregnant employee are the Employment Rights Act 1996 (as amended by the Employment Act 2002), the Sex Discrimination Act 1975 and the Management of Health and Safety at Work Regulations 1999.
Can hands-on perineal repair courses affect clinical practice?
Authors: Andrews Vasanth , Thankar Ranee , Sultan Abdul H , Kettle Chris
Published: May 2014

To determine whether attending a hands-on training workshop in repair of episiotomy and second degree tears changed clinical practice by increasing participants' ability to accurately classify obstetric anal sphincter injuries (OASIS) and manage perineal trauma according to best practice. Participating midwives and doctors completed a questionnaire prior to and 8 weeks after the one-day workshop. Between October 2002 and May 2004, 208 people attended the courses and 147 (71%) returned a repeat questionnaire. One hundred and thirty three (64%) were dissatisfied with their training prior to performing their first unsupervised perineal repair. Following the workshop there was an increase in participants ability to classify obstetric anal sphincter injuries accurately. There was a change in practice relating to performing a rectal examination before and after repairing perineal trauma – 56/203 (28%) vs 125/141 (89%) – P<0.001. Significantly more participants changed to evidence-based care by converting to the continuous technique of perineal repair.
Cord blood donation, testing and banking: A guide for midwives
Authors: Armitage Sue , Sheldon Joanna , Pushpanathan Prasharnie , Ellis Jonathon , Contreras Marcela
Published: May 2014

Banking of cord blood has developed to supplement bone marrow stem cell transplantation. Placental umbilical cord blood can be used as an alternative to bone marrow or peripheral blood cells to treat life-threatening disorders of children and adults. Cord blood is collected at no risk to the donor, is less likely than adult bone marrow donations to carry viral infections, brings to the recipient a lower incidence and severity of acute and chronic graft-versus-host-disease. Before cord blood is donated the mother's medical history is checked and samples are rigorously tested. Informed consent is crucial throughout.
Why do midwives leave? (Not) being the kind of midwife you want to be
Authors: Curtis Penny , Ball Lynda , Kirkham Mavis
Published: May 2014

This article, the first in a series of six, presents findings from the Why do Midwives Leave? study which explored leavers’ reasons for ceasing to practise. For many midwives, making the decision to leave had been a protracted and difficult process. Although there were five main reasons given for leaving, the largest single group of leavers comprised those midwives who had grown dissatisfied with the way they were required to practise within the contemporary NHS. Concern was evident in relation to the standard of care they felt able to provide and the relationships that they were able to establish with their clients. Organisational issues were also highlighted, including low staffing levels and unsupportive midwifery management.
Postnatal care in the home setting: Essential support after birth
Authors: Magill-Cuerden Julia
Published: May 2014

Postnatal care of the mother and baby has long been an established part of the midwifery service in the United Kingdom (UK) and is considered a woman's right. In many other parts of the world where this service is not available, the UK system is envied for the benefits it offers to post-parturient women. As is the case with many areas of midwifery, this aspect of care has not been evaluated well and there is little evidence to demonstrate the benefits to women of midwives giving postnatal care. In fact, postnatal care is often labelled the ‘Cinderella service’ denoting its lack of value in the opinion of those who make decisions about maternity services.
An ideal birth environment? The right facilities and support for women
Authors: Page Lesley
Published: May 2014

Is there an ‘ideal’ birth environment? To what extent is a more homely environment associated with lower rates of intervention such as caesarean section, operative assisted birth, episiotomy, use of analgesia including epidural and a more positive experience of birth? What do women want from the birth environment?
Electronic fetal monitoring and infection control
Authors: Cutlan Claire
Published: May 2014

The use of intrapartum electronic fetal monitoring is recommended for women with high-risk pregnancies. Electronic fetal monitoring has evolved since the early 17th century, now providing sophisticated technology. In terms of continuous monitoring, this can be performed using an external transducer or an internal fetal scalp electrode and the method of choice is based on both clinical need and the woman's preference. There has been anecdotal evidence of concerns regarding cross infection with the use of the fetal scalp electrode, therefore a new product is being launched to minimize this risk.
Childhood immunization: The vital role of the midwife
Authors: Biggs Emma
Published: May 2014

In the present climate of change within the health-care system and with the emphasis on improving health and eradicating disease, the controversial issue of immunization has once again come under public scrutiny. The purpose of this article is to present the subject of immunization from an Irish perspective, in a clear and concise manner and to highlight relevant issues pertaining to the safety of immunization in light of recent public outcry and media coverage.
The Birth Place Choices Project: Phase one
Authors: Barber Toni , Rogers Jane , Marsh Sarah
Published: May 2014

The Birth Place Choices (BPC) Project was carried out between May 2003 and May 2005 as a collaboration between Southampton University Hospitals NHS Trust and Portsmouth Hospitals NHS Trust. The BPC Project had three aims:

1. To identify factors that influence women's decisions about where to give birth

2. To determine whether the introduction of specially designed information and educational initiatives increase women's knowledge of choices for place of birth

3. To determine whether implementation of these initiatives was associated with an increase in the number of women choosing to give birth outside main consultant-led maternity units.

Phase one of the BPC Project, described here, addressed the first aim. This is the first of three articles describing the work of the BPC Project.

Following a literature review and an analysis of locally collected routine statistics relating to birthplace, a cross-sectional survey of local women and focus groups involving local women and midwives were carried out. The findings revealed that, compared to other health professionals, midwives had the greatest influence on maternity service users with regard to their birth place choices, yet were perhaps not using their influence effectively to ensure local women were aware of all their birthplace options, including midwifery-led units and home birth.
Information giving or receiving: Helping women make informed choices
Authors: Magill-Cuerden Julia
Published: May 2014

Simply accepting the current mantra that women should have choices in their birthing is fraught with difficulties. There are complex issues concerning choices that women may make about birthing their baby that are both individual and social with influences of health and obstetric concerns. Just offering choice overlooks the important issues of information and knowledge. More important than making choices is women's understandings of issues that affect them in their personal decision-making. Women, even before pregnancy and for the duration of the childbirth event, have ‘need to know’ and ‘need to understand’ options available to them with the likely anticipated outcomes. These should be based upon best available evidence for decisions for a particular course of action or non-action.
Stories as evidence: the premature urge to push
Authors: Perez-Botella Mercedes , Downe Soo
Published: May 2014

This is the second article in this series to examine issues around pushing in labour using story telling as a catalyst for exploring the nature of, and influences on, normal childbirth. In the stories told in this article, two women experience the urge to push before official diagnosis of full dilatation of the cervical os. The formal evidence base in this area is reviewed and in the absence of strong evidence, the practices observed are critically analysed. As part of the process of reflection on action, the feelings and responses of the author as practitioner in the story are reported and critically considered. The article is intended to highlight the potentially dramatic impact that story telling could have in the shaping of maternity services when constructively used as a tool to inform practice especially, but not only, in the absence of a formal evidence base.
Maternal anxiety: its effect on the fetus and the child
Authors: Glover Vivette , O'Connor Thomas
Published: May 2014

There is good evidence that symptoms of anxiety and depression are more common during pregnancy than in the postnatal period. In addition, pregnancy is a period during which stresses between partners and domestic violence may be elevated. Recent research suggests that the stresses and strains that women experience in pregnancy can have long-term adverse effects on the fetus and the child. Stress/anxiety during pregnancy can double the risk of a range of emotional, behavioural and cognitive problems. There is a wide variation in outcome among exposed children; current research seeks to clarify the interaction between prenatal stress/anxiety, genetic vulnerabilities and postnatal risk exposures and protective factors. Although such research is important, it is clear that there are immediate practical applications of the findings so far. There needs to be appropriate prenatal screening and intervention. It should be possible to significantly reduce the incidence of child neurodevelopmental disorder.
Simplifying antenatal screening: What midwives need to know
Authors: Chapple Jean
Published: May 2014

The last decade of the 20th century brought an avalanche of new antenatal tests that can be offered to women. While providing them with choices, they also brought confusion and anxiety for both parents and professionals. It is vital that parents and professionals understand that screening is not diagnostic. Equally, midwives need to be aware that women approach screening with a different mindset to professionals: they may not realise that the professional viewpoint is that screening is a test to pick up any structural abnormality.
Childbirth delivery options in the UK in 2001-2: Midwife care and governance
Authors: Smith LF , Smith Calli
Published: May 2014

This paper reports on a study conducted in 2001 and 2002 to establish the range of labour related procedures that UK midwives undertake and the supporting training and governance mechanisms. Two postal questionnaires were sent to maternity services managers at UK maternity units, requesting information on the number and type of midwifery procedures undertaken and the clinical governance and training activities in place. The study concluded that despite government policy promoting greater parental choice there is a wide variation in the range of labour related tasks that midwives undertake in the UK. If more midwife led units are to be established as a way of promoting parental choice, then adequate governance and training mechanisms must be in place to enhance continuity of care and reduce transfers.
Risk factors for the development of postnatal anal incontinence
Authors: Birch Linda , Doyle PM , Ellis Roger , Hogard Elaine
Published: May 2014

Faecal Incontinence is the involuntary loss of faeces. This can affect up to 4% of primiparous women long term after delivery. Anal Incontinence generally refers to involuntary loss of faeces and/or gas (Brubaker, 2001) and is more common, affecting up to 26% of primiparous women long term after delivery (Zetterstrom et al, 1999a). Research into pre-existing, demographic, behavioural and obstetric factors, which increase the risk of developing anal incontinence, remains inadequate in several areas. Data from different studies is often conflicting due to inconsistency in definitions, study design and population variables. This paper reviews the evidence associated with several obstetric and non-obstetric risk factors, for the development of postnatal anal incontinence.
Institutional racism and discrimination: Are they endemic in the NHS?
Authors: Symon Andrew
Published: May 2014

The matter of racism within the NHS has been aired many times over the years. The problem has been particularly prominent in the area of mental health, with a recent legal enquiry into the death of a black psychiatric patient talking of the ‘abscess’ of ‘institutional racism’, which was ‘a blot on the good name of the NHS’ (Gould, 2004).
Developments in maternity services should be driven by evidence
Authors: Gould Debby
Published: May 2014

Many developments within our maternity services are driven by emotion and instinct rather than by the facts argues Debby Gould, who believes that the government must stand firm and steer a new course.
Teenage mothers' experiences of maternity services: a qualitative study
Authors: Arthur Angela , Unwin Sally , Mitchell Theresa
Published: May 2014

There is a plethora of literature examining the social, economical and psychological effects of teenage pregnancy, but there is a paucity of evidence that explores teenagers' perceptions of their local services before, during and after their pregnancy.

Teenage Pregnancy Liaison Midwives collected data from interviews with teenage mothers between April 2005 and May 2006. These data were subsequently analysed by the midwives between May and October 2006 using a framework proposed by Diekelmann (1990).

Eight participants were recruited from statutory and voluntary organizations across a county in south-west England.

Accessing clinic venues and opening times were highlighted as major problems. The first six months of a pregnant teenager's confinement appears to be the most unstable, where breakdown in family relationships, housing issues and fear attribute to poor utilization of services. It is useful to identify which agencies teenagers feel are most supportive and how prepared they feel for pregnancy, labour and parenthood.
Monitoring fetal and maternal wellbeing
Authors: Hale Rachel
Published: May 2014

The use of fetal heart monitoring (FHM) to diagnose the wellbeing of the fetus has been practiced for centuries. It plays an important role in the care of the fetus and mother during labour and birth. There have been many technological advances in FHM to aid midwives in monitoring the fetal heart. The use of the Pinard stethoscope or hand held Doppler for intermittent auscultation is recommended for low risk mothers-to-be. For higher-risk pregnancies, electronic fetal monitoring (EFM) offers continuous surveillance. However, since the introduction of EFM in the 1970s, its widespread use is causing much debate in the obstetric field, particularly because it is sometimes routinely used to observe low-risk cases. There is a call from regulatory bodies for a balanced use of EFM. Regular EFM training for midwives will help them to interpret EFM data. According to some studies, EFM reassures expectant mothers and their technical advances are offering mothers more accurate information and freedom of movement during labour.
Birth trauma: talking with women and the value of conversation analysis
Authors: Kitzinger Celia , Kitzinger Sheila
Published: May 2014

The skills of talking with women who have had unhappy birth experiences rarely find a place in midwifery education. Nor is it apparent from the literature just what these skills are, or how they can be implemented in the moment-by-moment unfolding of an interaction. Yet this is a vital part of any relationship that offers continuous support to women through the transition to motherhood. We have recorded more than 400 calls to the Birth Crisis help-line, and used conversation analysis to explore the skills deployed in these interactions. We show some examples from the calls and describe how we use our analyses as a basis for workshops with midwives and other caregivers.
Do mammograms cause more harm than good?
Authors: Daniel Lincia
Published: May 2014

It is recommended in the USA that women over the age of 40 have a mammogram every year but this has been criticized for raising false alarms, as well as giving some women a false sense of security.
Record keeping: midwives and the law
Authors: Griffith Richard
Published: May 2014

The recently reported case of Richards v Swansea NHS Trust [2007] once again highlights how important keeping accurate records are to successfully demonstrating that the duty of care owed by midwives to their patients has been properly discharged.
From nurse to student midwife: do they have the advantage?
Authors: Spence Nicola
Published: May 2014

I have been a senior staff nurse in cardiothoracic medicine for seven years. Just over a year ago I accepted a place on the 18-month midwifery course to train to do a job I had always wanted to do, accept that careers advice led me to train as a nurse first. It did not occur to me that the transition from nurse to student midwife could be so difficult.
Celebrating International Day of the Midwife
Authors: Lavender Tina , Clift-Matthews Victoria
Published: May 2014

To celebrate the International Day of the Midwife a high profile event took place bringing together all the Professors of Midwifery in the UK, as well as esteemed guests and delegates from England, Scotland, Wales and the Isle of Mann. The conference was unique in that it combined educational elements with a celebration of midwifery and fundraising activities. All proceeds of the day were given to the White Ribbon Alliance in Tanzania.
Infant nutrition and the benefits of breastfeeding
Authors: Hale Rachel
Published: May 2014

Babies who are smaller than average at birth are more likely to face health problems during their adult life. A major influence on the size of the baby is maternal nutrition. Maternal energy requirements are not greatly increased, but other nutrients have been shown to influence fetal wellbeing: these include folate and riboflavin. Maternal diet is still important once the child is born, as mothers who breastfeed need to make sure they are able to provide their child with all the nutrients they need at this crucial growth stage. Mothers who choose not to breastfeed need to be supported through their decision and taught the importance of good sterilization techniques and how to make up bottles properly.
Registration requirements for midwives in Australia: a delphi study
Authors: Pincombe Jan , McKellar Lois , Grech Carol , Grinter Elizabeth , Beresford Gerardine
Published: May 2014

Midwifery education in Australia has embraced competency-based learning models where assessment of clinical competency is fundamental to educational programmes. Both clinical and theoretical components of the programme need to be fulfilled and passed in order to register as a midwife. Concerns have been raised regarding competency-based approaches to midwifery education which may not incorporate national competency standards and, in particular, minimum clinical requirements for registration. It is the purpose of this paper to present the findings from a delphi study which aimed to gain consensus from experts regarding the appropriateness of using minimum requirements of birth and follow-through experiences for registration purposes in Australia. The delphi is stage two of a research project. Stage one involved a systematic review of literature to establish the evidence for measuring competency in midwifery practice using minimal requirements of stated clinical experience for registration purposes. The findings from this review concluded that no specific evidence exists for measuring competency in midwifery practice using minimum requirements of stated clinical experience for registration purposes. The results of the delphi indicate that there is consensus that prescriptive criteria should be incorporated to measure competence in midwifery students for registration purposes. Nevertheless, a number of significant issues were raised with regards to achieving minimum requirements in practice.
Say goodbye to big babies: thanks to modern medical procedures
Authors: Ainsworth Steve
Published: May 2014

The most obese nation is the USA and 10% of babies are born weighing over 4kg. Although world records exist of babies being born at around the 10kg mark, this is unlikely to be repeated.
A new direction for breast cancer research
Authors: Bainbridge Jane
Published: May 2014

A cure for cancer is the Holy Grail for the medical profession and breast cancer is the most common form of cancer diagnosed and much feared by women of all ages, especially those with a family history.
How can we improve choice provision for childbearing women?
Authors: Martin Caroline J Hollins
Published: May 2014

Obedience research has shown that under situational pressures and within hierarchical relationships, people have a propensity towards submission to authority (Milgram, 1974). Once they have done so, their actions are no longer guided by their own values but by the desire to fulfill authority's wishes (Meeus and Raaijmakers, 1995). When an authority figure gives direction, this may clash with a midwife's knowledge of a woman's preferred choice. Hollins Martin and Bull (2005) showed the success that a senior midwife had at socially influencing decisions of more junior midwives, even when the outcome contravened their established views of best practice. Hollins Martin and Bull (2006) showed that choice provision for childbearing women was difficult to provide because of the imposition of hospital protocols, the hierarchy and fears of challenging senior people. Acknowledging these identified constraints this paper poses eight plausible solutions to facilitate midwives with providing the choice that is advocated in social policy documents (Department of Health, 1993; DH, 2003; DH, 2004).
Pregnancy late in life might be possible but is it safe?
Authors: Bainbridge Jane
Published: May 2014

Older women having children is on the rise with the help of fertility treatment. In ten years the number of women giving birth in their forties went up by seventy per cent, but what are the medical implications?
‘A tale of two cities’: auditing midwifery practice and perineal trauma
Authors: Mutema Eric Kinoti
Published: May 2014

A lot of interest has been expressed on reduction of morbidity from perineal trauma sustained after childbirth with emphasis on doctors' training. It is of great concern however that similar effort has not been directed toward midwifery colleagues who perform most of the deliveries.

This audit was carried out in two district general hospitals (A and B) and aimed to assess the adherence to standards of management of perineal trauma sustained following vaginal delivery. Questionnaires were distributed at random to qualified midwives attending their routine shifts in the respective labour wards. The midwives were asked to complete and return the form during their shift.

Only 35% (A) and 30.4% (B) of midwives had had formal training on repair of perineal tears. Less than 65% could correctly identify a first degree perineal tear and the percentages were much less on the more severe tears. Eighteen per cent in A and less than 30% in B performed rectal examinations as recommended. More than 90% of the midwives felt inadequately prepared to assess and/or repair perineal tears in both units and all of the midwives were keen to attend study days on perineal trauma. There was a general lack of knowledge on the agreed classification of perineal trauma, and most midwives involved in the assessment and/or repair of perineal trauma felt inadequately trained in this area. Up to a third of the midwives who participated do not perform rectal examinations on assessment or after repairing the perineal tear, which falls short of Royal College of Obstetrics and Gynaecology (RCOG) standards. It is imperative that the training needs of midwives on this aspect of midwifery care are addressed. It is particularly important because midwives conduct more than half of all deliveries in the UK.
TENS machines and their use in managing labour pain
Authors: Juman Blincoe Alana
Published: May 2014

Transcutaneous electrical nerve stimulation (TENS) machines have been used in medical practice since the 1970s, initially to combat chronic lower back pain. With a rise in interest of non-pharmacological methods of pain management during labour, the TENS machine has become increasingly used to manage labour pain. TENS machines are small and portable. They work by transmitting a controlled level of electrical stimulation into the skin via electrodes, which enables the blocking of painful impulses at the dorsal horn of the spinal column. It also stimulates the body to produce natural endorphins and enkephalins. With these attributes a TENS machine is a method of pain relief whereby there are no adverse side-effects to mother and/or child. It is non-invasive, can be used in the home and controlled by the woman. There is however little scientific evidence to support TENS machines as a stand alone form of pain control throughout labour. So far it is seen as better suited to being used in the very early stages of labour and then combined with either pharmacological methods or entonox.
Reducing maternal mortality: a key goal in India
Authors: Daniel Lincia
Published: May 2014

India has the highest maternal mortality rate but an estimated 99% of all maternal deaths take place in the developing world among the poorest and most vulnerable women, who cannot claim their human rights.
Nina's story: as good as it gets?
Authors: Stephens Liz
Published: May 2014

Nina had one of the most beautiful and positive births I have ever been privileged to be a part of; yet I only felt the need to reflect and write about it following discharging her at six weeks. I had told people about her positive birth experience, and used it as a positive birth story to share with women anxious about impending birth, but the complete normality of it somehow made it seem not worth writing about.
The language of suggestion
Authors: Maier Belinda
Published: May 2014

I am interested in the ways midwives talk to women in pregnancy and labour to encourage a drug free birth. I am concerned that if midwives do not start to articulate such an important aspect of our work then it will be another lost part of who we are, what we do and will become something ‘other’ such as hypnobirthing or ‘hypnosis in pregnancy’.
Babies born at home denied US citizenship
Authors: Daniel Lincia
Published: May 2014

Passport applications in the USA are being rejected because the state department is refusing to accept birth certificates issued by midwives as proof of citizenship, which is affecting the Latino-American community.
Obstetric Ultrasound: Artistry in Practice
Authors: Pateman Kate
Published: May 2014

This book is divided into 22 easily readable chapters focusing on the ultrasound findings associated with common congenital abnormalities and major obstetric conditions, such as pre-eclampsia, that midwives are likely to encounter in their everyday practice. By explaining the reasoning behind ordering an ultrasound investigation and the interpretation of the findings in this book, midwives should be better equipped to support parents through routine (first trimester and anomaly scan) and additional clinically indicated scans for fetal wellbeing.
A window of opportunity
Authors: Stephens Liz
Published: May 2014

Over the last few years I have been in the role of consultant midwife, moving into the independent sector and after a while back into the NHS. This has led me to reflect on the NHS, midwifery and childbirth in the early 21st century and to ask myself why we are still not getting it right for so much of the time. The NHS is a massive bureaucracy, it is the largest employer in the UK, carries out millions of procedures each year and is largely focused on ill health, science and technology. Childbirth is the mystery of new life, a physiological rite of passage, the start of a new family and, as such, is a beginning not an end in itself. How then do these fit together?
What happened to our money?
Authors: Buddhaa Lavanya , Sanjeevib Ajanta , Navaneethamc Neena
Published: May 2014

The NHS Plan introduced the government's intention to link the allocation of funds to hospitals to the activity they undertook through a system of payment by results. Therefore the finance departments in the hospitals claim the payments from the primary care trusts based on the information recorded on the KMR1 forms. A prospective audit was undertaken in our maternity unit around the completion of these KMR1 forms. We compared the health care resource group cost of the coding from the information on the forms, and what it would have been, had the missing information been included and thereby calculated the financial loss incurred.
Third degree tears: the three-stage negligence test
Authors: Symon Andrew
Published: May 2014

Faecal incontinence is one of the most distressing, and perhaps one of the most feared, instances of postnatal morbidity and is said to be reported by three to ten per cent of mothers (RCOG, 2004). A recent court case in England heard how one mother, who gave birth to her first child in 2000, tried to obtain compensation for what she believed was clinical negligence leading to long-term faecal incontinence (Starkey v Rotherham NHS Trust [2007]). The claim centred on the examination of her perineum immediately after the birth and the failure to note trauma to the external anal sphincter. While this claim concerned an obstetrician, a similar situation involving a midwife is quite feasible.
The midwifery curriculum: introducing obstetric emergency simulation
Authors: Norris Gail
Published: May 2014

Employing high fidelity simulations of obstetric emergencies for student midwives has great teaching and learning potential. Simulations can provide student midwives with a learning experience that facilitates knowledge application to midwifery practice. This article describes student midwives evaluation of a simulated obstetric emergency study day. Twenty-seven undergraduate student midwives participated in this pilot study. The main findings of this study revealed that students valued the opportunity to apply the theory they had learned into practice within a safe environment. The opportunity to work as a team was also appreciated by the students. Simulations can be incorporated into the midwifery curriculum as a teaching strategy to develop the decision making, communication and team working skills used when dealing with an obstetric emergency.
Breastfeeding challenges
Authors: Daniel Lincia
Published: May 2014

Changing attitudes to breastfeeding requires not only the support of friends, colleagues and the government but also that of businesses by way of providing suitable facilities at work and on the high street.
Birthwrite: the experience of flow and physiological birth
Authors: Walsh Denis
Published: May 2014

From a researcher's perspective, one of the trickiest aspects of normal childbirth is how to theorize or understand ideas of growth and empowerment attributed to it. This is particularly challenging when, by implication, one appears to be suggesting that caesarean or managed birth is unable to realize these attributes. Many women end up with managed or caesarean birth for very good reasons and it would be quite judgmental to imply that their growth into motherhood is somehow compromised because of it.
Cord prolapse audit: recognition, management and outcome
Authors: Rogers Cathy , Schiavone Nada
Published: May 2014

Cord prolapse is a rare obstetric emergency associated with increased risks of perinatal mortality. Given the rarity of this complication and associated perinatal mortality and morbidity, multi-disciplinary skills and drills are promoted as a means to ensure that all staff are appropriately skilled in the management of this condition. The aim of the audit was to investigate in one large obstetric unit standards of practice in relation to the management of cord prolapse. All women who presented with a cord prolapse over a 30-month period were identified and a retrospective audit of their records was performed to evaluate compliance against agreed standards of care. The results showed that in line with previous studies prematurity and breech presentation were major risk factors. The mean time between diagnosis and delivery was 16.2 minutes. Manoeuvres to relieve pressure on the umbilical cord were largely poorly documented, as was communication with the woman and their partners. The results demonstrate the need to strengthen training programmes to include these aspects of care.
Celebrity older mothers: does the media give women a false impression?
Authors: Wood Michelle
Published: May 2014

I am married, in my late thirties and increasingly conscious of a somewhat biological pressure of whether to start a family. It seems society is weaving into our cultural fabric that age is no longer a barrier to having a baby. We only have to look at the increasing media attention given to older celebrity pregnancies like Madonna who had her second child at 41, Marcia Cross who gave birth to twins at 44 and Jane Seymour who had twins at 45, to see how overly publicised this is. These celebrities, however, are reflecting a significant trend towards older motherhood as more and more women are delaying having children.
Behind closed doors
Authors: Acton Kate
Published: May 2014

A London Trust recently undertook an audit into the use of admission CTG for low risk women in labour. The purpose: to determine adherence to the NICE Guidelines on Intrapartum Care (2007). The result of this audit showed that in the sample group 70% of low risk women had been placed on the monitor on admission to labour ward.
Breastfeeding: the Breast Buddy campaign
Authors: Entwistle Francesca
Published: May 2014

The Department of Health recommends exclusive breastfeeding for the first six months of an infant's life, with continued breastfeeding alongside solid foods after that. But while many groups in society recognize its importance only 25% of UK babies receive any breastmilk at six months of age. Research shows that young women between the ages of 16 and 25 years in low socio-economic groups are least likely to initiate and continue to breastfeed. This article highlights government initiatives such as the Breast Buddy campaign which are specifically designed to encourage these young women to breastfeed.
Ultrasound and the safety myth
Authors: Beech Beverley A Lawrence
Published: May 2014

When Ian Donald first developed the use of ultrasound in pregnancy he warned that: