bluuebunny/crossref_metadata_2025 huggingface dataset:
Teaching breast-feeding skills: Is it time for a new approach?
Authors: Woods Anne , Bramwell Ros , Dykes Fiona
Published: May 2014

Despite recognition as the healthiest method of infant feeding, the prevalence of breast-feeding in the UK remains disappointing. Of those women who start to breast-feed, the time in hospital and the first week following the birth are the most likely time to stop. A lack of role models leaves many women dependant upon the skills of health-care professionals to teach the techniques required for successful breast-feeding. However, short hospital stays, fragmented care, and inconsistent advice remain issues to be resolved. A systematic review has shown that improvements in outcomes can be made when additional support mechanisms are provided. It highlighted the need for research into those which may prove effective. It has already been shown that ensuring women leave hospital able to position and attach their infant can result in a significant reduction in cessation of breast-feeding. Therefore, if a structured approach to teaching the skills required for correct positioning and attachment could be developed, an increase in breast-feeding outcomes may be achieved. To this end, a positioning and attachment checklist was developed and is currently being subjected to a controlled trial.
Midwifery in the land down under: rural education issues
Authors: Glover Pauline , James Heather , Byrne Jen
Published: May 2014

Midwifery education has been taught at Flinders University Adelaide for the past 9 years. During this time there have been a number of rural nurses who have undertaken this study by distance (or flexible) learning. One has only to look at the South Australian Health Commission (now Department of Human Services) document South Australian Midwifery Training Requirements 1997–2001 to realise that there is a shortfall of midwives in South Australia. For whatever reason it is not possible for all students to study full-time in the city and therefore flexible delivery of midwifery education for rural students is crucial. This paper discusses the midwifery programs offered at Flinders University and describes theory, clinical and assessment issues. The cost of study, the clinical environment and support for learning are issues that are explored.
Visiting women after a termination
Authors: Young Nicki , Bennett Ruth
Published: May 2014

This paper describes a small qualitative study exploring the practice of community midwives when making postnatal visits to women who have undergone termination of pregnancy for fetal abnormality. Twelve community midwives from two separate NHS trusts were interviewed. It was established that many women did not receive postnatal care as a matter of course after termination for fetal abnormality. The respondents reported the need to address psychological reactions and emotional distress. They attended to physical needs but considered emotional needs to be the greater. Support for the midwives themselves was another important theme of the data. Provision of care for this group of women is clearly needed and trusts should provide education and support for midwives to enable them to supply an effective service.
Intelligent activity
Authors: Gould Debby
Published: May 2014

It is interesting how when you look at a problem from the other angle it suddenly becomes clearer. You almost need to understand what something is not, in order to understand what it is. Often there is no good or bad in a perspective, merely differences. For instance, it is often easier to define what constitutes normal labour by outlining what is abnormal. Indeed obstetricians are very good at defining what they believe to be abnormal while midwifery is struggling to determine what is normal. One of the reasons for this could be that normal is a vast and variable continuum, being individually and socially interpreted, while abnormal lies within the pathological paradigm which can easily be broken down into smaller parts to be ‘fixed’ or acted upon.
Midwives’ views on redefining midwifery 4: general views
Authors: Lavender Tina , Bennett Natalie , Blundell Jackie , Malpass Lyn
Published: May 2014

This is the fourth and final paper in a series of papers presenting key findings from a regional survey that was undertaken to explore midwives’ views of the recommendations outlined in the Making a Difference (Department of Health, 1999) document. The background and methodology of the study have been outlined in the first paper. This paper will present the findings from the midwives’ open responses. In particular, issues related to perceived barriers will be discussed. Although midwives expressed a strong urge to meet the needs of their local communities they believed that organisational restraints were preventing them from fulfilling this role. Ways of breaking down these barriers will be discussed.
Midwives’ knowledge of Down’s Syndrome screening
Authors: Samwiil Lisa
Published: May 2014

The aim of this survey was to assess midwives’ knowledge of Down’s Syndrome screening and their confidence in counselling women about the screening test. A questionnaire was sent to 280 clinical midwives working in a large trust in the north of England in July 1999. The overall response rate was 58% (162/279). Poor knowledge was found in 41 % of responders. Only 39% (42/144) of midwives reported they were confident in counselling women about the screening test. These results indicate that for a significant proportion of midwives inadequate knowledge of Down’s Syndrome screening and low confidence in counselling women about the tests are perceived problems in their work.
Cord snapping at waterbirth delivery
Authors: Cro Suzanne , Preston Julia
Published: May 2014

The lack of evidence on the merits and risks of waterbirth make it essential that midwives should continually audit their practice in order to contribute to the knowledge and expertise in this area. This paper discusses one rare risk — rupture of the umbilical cord at waterbirth — which, if it goes unrecognised, can have serious consequences for the neonate.
Fetal scalp electrode use in practice
Authors: Murray Lorraine
Published: May 2014

Evaluating midwifery practice is fundamental to developing clinical decision-making. This descriptive study investigates midwifery practice regarding use and non-use of the fetal scalp electrode, in association with continuous electronic monitoring of the fetal heart pattern, during labour. A case study and postal survey were conducted in 1997 and 1998. The results show that wide variations in practice exist in hospitals providing intrapartum care in England and Wales. Clear explicit guidelines for the practice of fetal surveillance should be available, clinical audit undertaken and regular or repetitive scalp electrode usage reviewed.
Treatment of heartburn and constipation during pregnancy
Authors: Jones Kathleen
Published: May 2014

Heartburn and constipation are frequently classified as minor disorders of pregnancy. The symptoms suffered by pregnant women with one or both of these complaints can be extremely distressing. Midwives can be a vital source of information and support to the woman in enabling her to understand the conditions and to access treatment. Heartburn is a common complaint, with an estimated two in three women suffering at some time during her pregnancy, whereas constipation affects about one in five pregnant women. Both conditions are more common in the last trimester and the postnatal period. This product focus examines the aetiology of these conditions and suggests effective treatment.
Conscientious objection 2: professional responsibilities
Authors: Raynor Maureen , Marshall Jayne
Published: May 2014

Recognising that there exists a significant number of health-care professionals who have ethical, moral, religious or other personal objections to abortion, this second paper in a series of two articles, aims to address the interface between the professional and legal implications of conscientious objection for midwives.
Further issues concerning the indemnity insurance debate
Authors: Rogers Cathy
Published: May 2014

Some interesting issues were raised in Cathy Warwick's August editorial (Warwick, 2002) on the Nursing and Midwifery Council's (NMC) invitation for responses to their proposal to include, within the Code of Professional Conduct, a clause requiring that all practising professionals ‘have indemnity cover against claims for negligence’.
Midwives without children
Authors: Rowan Cathy
Published: May 2014

This qualitative study using a phenomenological approach was undertaken to explore the feelings and experiences of midwives who did not have children, in relation to their work with mothers and babies. Fifteen midwives were interviewed from differing trusts. Participation was voluntary following invitation. Semistructured interviews were undertaken and major themes that arose from these were identified. Nearly all of the midwives interviewed in the study had been asked if they had their own children, and most did not mind, seeing this as a way of making conversation. Some felt the question could be intrusive and imply that the midwife might lack insight or understanding. Many midwives responded to the question with humour and there was usually no further discussion on the subject. Midwives felt that personal experience of childbirth would not make them better midwives and that sometimes those without children could be more objective in giving care and offering choice. This paper discussed the themes from the interviews with reference to relevant literature.
Changes in the law and the NHS over the past 10 years
Authors: Dimond Bridgit
Published: May 2014

This abstract looks at changes in the law and in the organizational structure of the NHS and considers their impact on midwifery practice.
Webwatch
Authors: Hassall Jenny
Published: May 2014

In the latest Confidential Enquiry into Maternal Deaths in the UK for 1997–1999, indirect deaths from medical conditions exacerbated by pregnancy (6.4 per 100000 maternities) have for the first time outnumbered direct deaths (5 per 100000 maternities). While this has been largely attributed to improved care in the management of traditional key complications in obstetrics, it could also reflect the increasing importance of medical disorders in modern obstetric practice.
Antenatal perineal massage: Part 1
Authors: Gomme Clare , Sheridan Mary , Bewley Susan
Published: May 2014

Randomized controlled trials have provided evidence that antenatal perineal massage is effective in reducing perineal trauma. The provision of information on antenatal perineal massage was introduced as a new service for women and a series of training sessions were held to teach perineal massage to midwives working in antenatal clinics. This article includes a literature review on perineal massage and an evaluation of the massage training. Midwives' views on perineal massage and the training they received were obtained through questionnaires and focus group discussions. The response to perineal massage was varied, with some midwives actively promoting the service while others had no interest in the project and did not give information on antenatal perineal massage to their women. Although just under half of all eligible women received information on perineal massage, an audit of perineal trauma rates found a 6% reduction in perineal trauma since the introduction of the new service.
Breastfeeding and contraception
Authors: Too Sooi-Ken
Published: May 2014

Postpartum ovulation varies individually. It can occur as early as 28 days following delivery. Women who breastfeed are likely to suppress ovulation for a longer time. The onset of the first postpartum menses is a sign of impending fertility. It is therefore advisable for breastfeeding women to commence contraceptive protection regardless of the breastfeeding and amenorrhoea status. The chosen method should not affect the quantity and quality of the breast milk or infant health. During contraceptive counselling accurate, up-to-date, evidence-based information should be given about the methods including the failure rates, health benefits and health risks so that the couple can make an informed choice about their preferred method of contraception. This article aims to discuss the current issues surrounding contraceptive choices for the breastfeeding women.
Higher level practice — have you a view?
Authors: Warwick Cathy
Published: May 2014

The Nursing and Midwifery Council (NMC) was required under the Nursing and Midwifery Order 2001 (HMSO, 2002) to consult on the make up of the new Register. The report on this consultation was submitted to Council on 16 January 2003. One of the issues that respondents were asked about was whether or not the Register should allow higher levels of practice to be shown. The NMC was advised that this proposal was strongly supported in the consultation and has agreed in principle that higher levels of practice should be shown in the new Register.
Questions and answers on the law
Authors: Dimond Bridgit
Published: May 2014

Legal issues appear to be a growing concern of midwives and this article discusses some of the concern raised by midwives at a recent seminar. They include staffing resources and instructions not to use agency staff, the delegation and supervision of students, privacy and the Human Rights Act, the right of a husband with an unconscious pregnant wife and the right of a wife to keep from the husband the fact that the baby is HIV positive.
Guided reflection as a tool for CPD
Authors: Yearley Carole
Published: May 2014

Local Supervising Authorities, the NMC and formerly the ENB identified the role of the supervisor of midwives (SoM) in staff support, enabling midwives to evaluate their practice and identify areas for development. This tenet is integral to the continuing professional development (CPD) quality programme strategy (Department of Health (DoH), 1999a). At local levels, it has been demonstrated that guided reflection, set within the context of a framework of Statutory Supervision of Midwives, strengthens professional learning and can be used constructively, demonstrating CPD to be one flexible method for meeting PREP standards; a statutory requirement (UKCC, 2001a). Additionally it has the potential to operate as a cost-effective resource. This article argues that SoMs through their statutory function are ideally placed to lead the development and implementation of group guided reflection in practice, as a tool for CPD and quality assurance. The transfer, implementation and evaluation of an established, successful model for guided reflection, facilitated through midwifery supervision, from a small birth unit to two larger services within the same trust are presented.
Maternity notes — a jaundiced account
Authors: Walsh Denis
Published: May 2014

Handing me a set of notes the shift leader said, ‘Have a look at this. This is one of your team midwives and here is what she recorded for the night shift on the delivery suite’. She added, ‘And the woman she was looking after was in normal labour’. I glanced through 10 pages of A4 notes — a tad excessive I thought. On closer inspection, eight of those pages were comments on an essentially normal cardiotocograph (CTG) — describing the character of the trace at 30 minute intervals in some detail. What crossed my mind apart from the sadness that the midwife seemed so intimidated by a risk management ethos, was what else had happened during this labour and birth? I could tell from the notes that her cervix had dilated and the baby had descended, that her contractions were moderate with a frequency of 3:10, that she had used entonox and been given 100 mg of pethidine, that her blood pressure stayed around 125/75 mmHg and her pulse 74 beats per minute. A female infant was born at 5.30 am in good condition…
Talking with women after birth
Authors: Baxter Jackie , McCrae Alison , Dorey-Irani Ann
Published: May 2014

This article describes the introduction of a new service which intended to contribute to the new public health agenda by furthering the support already provided by midwives for women following birth. The role of the liaison midwife was established to provide a debriefing service for women and also to coordinate complaints. An initial review found that 80% of all women had been contacted by the liaison midwife. There was a marked difference between the take-up of a discussion if the contact was made on the ward and where women were contacted by phone or letter. Forty four percent considered the service to be very necessary. The new woman-centred service has enabled midwives to see the world through the eyes of the women to whom they provide care. Both the need to provide information and to include women and their partners in the care process has been highlighted.
How midwives' attitudes can affect the research process
Authors: Poat Angela , McElligott Mary , Fleming Valerie
Published: May 2014

The decision-making power base in maternity care has altered in the last century with recent government documents suggesting that it be more women-centred. Those midwives who do not use evidenced-based practice and who teach, support and demonstrate ritualistic practices without reference to the substantial research available, are limiting women's choice(s) in maternity care. In a trial (Fleming et al, 2001), investigating whether routine suturing of perineal lacerations is required, the researchers concluded that midwives appeared to have attempted to influence the outcome because of their own deep-held beliefs about suturing. The rationale for this behaviour is not always easy to understand and it is examined here to determine what concepts are influencing these practices. First, is this behaviour a way of raising the midwife's profile as an expert or are midwives in fact feeling less the expert of normal childbirth as their role is eroded by other disciplines? Second, are midwives trying to regain autonomy by controlling women as a response to the control of this speciality by the medical and nursing professions? Finally, could it be that midwives' lack of support for women in making informed choice(s) is an ethical misunderstanding that they have between beneficence and autonomy? Unfortunately, whatever the rationale, the practice observed suggests that some midwives appear to be demonstrating the paternalistic attitudes previously associated with the medical profession.
Development of a preceptorship programme
Authors: Hobbs Julie , Green Sarah
Published: May 2014

‘Reality shock’ appears to be a common phenomenon among newly qualified midwives. In response to this problem, a working relationship was formed between the University of the West of England and North Bristol Health Trust and a new preceptorship programme was initiated. This article details the development of the programme using a structured support system aimed at facilitating adaptation to qualified status and role. Conscious reflection upon experience is employed as the underpinning philosophy of the programme. The authors considered a preliminary evaluation of the initiative. Although it is apparent that some minor modifications to the programme are required, the working partnership appears to have had a positive effect upon the newly qualified midwives' perceptions of support and development.
The pseudo-choice game
Authors: Robinson Jean
Published: May 2014

My grannie used to say, ‘What you've never had, you don't miss’. With eight children to feed and a husband often out of work, it was a comforting philosophy, and I remember her as resilient and cheerful. But even as a small child I was not convinced.
Step 55: National Service Frameworks
Authors: Dimond Bridgit
Published: May 2014

The White Paper on the NHS (Department of Health (DoH), 1997) set out a package of measures to raise standards within the NHS and these were further elaborated in The NHS Plan (DoH, 2000). Included in this programme of action was the introduction of National Service Frameworks (NSFs).
Midwifery care and the lesbian client
Authors: Jackson Karen
Published: May 2014

The traditional model of ‘the family’ is rapidly changing. Married parents living with their biological offspring (RCM, 2000) is no longer the only accepted norm. Single parenting, reproductive technologies and parenting outside of marriage are all becoming more common in contemporary society. Increasing numbers of lesbian women are choosing to become mothers. With such a shift in the historical concept of the family, midwives are having to readjust their attitudes and practices. This article focuses on the issues concerning lesbians receiving maternity care. These include: defining lesbianism, an historical perspective, discrimination and invisibility of lesbians in health care, stereotyping, exploding myths and what midwives can do.
Home birth proves more of a challenge than a choice
Authors: Thomas Tessa
Published: May 2014

Jenny was in no doubt as to how, where, and with whom she wanted her fourth baby. But when she rang the hospital to book again with the dedicated home birth midwives, she was told they could no longer take bookings. She was, in common with many local women, angry and perplexed.
Proposed standards for LSAs — have your say
Authors: Rogers Cathy , Yearley Carole
Published: May 2014

The Nursing and Midwifery Council (NMC) has invited responses to their consultation document on the Proposed Standards for Local Supervising Authorities (LSAs) and LSA Responsible Midwifery Officers (LSAMOs). The second consultation document contains revisions and additions which warrant careful consideration by midwives and other stakeholders of the maternity services before responding.
Webwatch
Authors: Hassall Jenny
Published: May 2014

Within the demanding current climate that many midwives find themselves working in, it is understandable that many are feeling disillusioned with the quality of care they are able to provide. This month's Webwatch reviews the website for the Association of Radical Midwives, a group of midwives, student midwives and others in the UK committed to improving the maternity care provided by the NHS. The site being reviewed can be found at:

www.radmid.demon.co.uk/
Sacroiliac dysfunction: a proactive approach
Authors: Reynolds Kate E
Published: May 2014

Sacroiliac dysfunction is the most common cause of low back pain in pregnancy. This article outlines the causes, diagnosis and treatment of the condition. In addition, it is argued that midwives should play an active role in raising women's awareness of the condition, thus preventing its onset orreducing its most debilitating effects. The author focuses on the mental health and social issues which surround sacroiliac dysfunction and which affect women's experience of pregnancy and the puerperium. The article encourages midwives to adopt a proactive approach, which embraces preventive measures, and places this medical condition in the social and family context of the client.
Step 56: NHS Direct and walk-in centres
Authors: Dimond Bridgit
Published: May 2014

The White Paper on the NHS (Department of Health (DoH), 1997) proposed the establishment of a 24-hour nurse-led helpline providing confidential healthcare advice and information.
Taking Action: towards evidence-based practice
Authors: Baxter Jackie
Published: May 2014

The report Taking Action Moving Towards Evidence Based Practice (Foundation of Nursing Studies (FoNS), 2001) was conducted by Dr Ann Mulhall and Dr Andree le May and traced the progression of evidence-based practice (EBP) over the previous 10 years. It investigated the impact of a programme of critical appraisal training and research utilization skills provided to nurses and midwives in nine NHS Trusts across the UK.
A duty of candour: will it really make amends?
Authors: Robinson Jean
Published: May 2014

The junior doctor lied. He made a false entry in the medical record of the woman he had seen to conceal his obvious negligence, and then made a false statement during the investigation which followed her serious complaint. The distress and indignation of the client was understandable. It is her word against his. After obtaining all the details and listening to the account of the woman, who had professional qualifications herself and had no reason to lie, we have no doubt which one we believe.
Asking pregnant women about domestic abuse
Authors: Keeling June , Birch Linda
Published: May 2014

The aim of the research was to explore the prevalence and nature of domestic abuse experienced by women attending an early pregnancy unit and the correlation between demographic variables such as age and employment status. Participants were given the opportunity to identify if they agreed with these questions being asked in the clinic. 26% of women had experienced severe emotional or physical intimate partner abuse, whilst 9% had experienced physical abuse within the last year. There was a significant association between the age of the woman and the prevalence of domestic abuse. The majority of women feel that it is appropriate for health professionals to ask about experiences of domestic abuse when attending an Early Pregnancy Clinic.
Care of the newborn: proposed new guidelines
Authors: Trotter Sharon
Published: May 2014

This article questions the potential harm associated with early overuse of skincare manufactured products. There is an undeniable need for standardized guidelines that can be introduced nationally, which will inform and educate. Although predominantly involving skincare and cord care, it is important to remember that anything placed on, in or around the neonate has the capacity to harm. With this in mind, and with no available evidence to support their use, it is no longer appropriate for hospitals to supply free, products that are clearly not relevant to the care of the neonate. These new guidelines will not only simplify and supersede previous advice, but also encompass the role of health promotion. This role, which is central to every midwife, cannot be underestimated. If, as a result of the new guidelines, less babies go on to develop skin conditions, then the savings in treatment alone could be considerable. Not withstanding the emotional and psychological effects of such conditions, this, in the cost-effective climate of today's NHS, must be seen as evidence-based practice at its most effective.
The effect of perineal trauma on women's health
Authors: Layton Sylvia
Published: May 2014

This study aims to evaluate midwifery practice in relation to the long-term health of women. The objectives are two-fold. It asks if there is an association between not suturing some perineal tears and the incidence of urinary incontinence and dyspareunia after childbirth. It also seeks to establish whether women are given midwifery advice regarding pelvic floor exercises. The study rationale is that midwives may be unaware of the extent of problems because of the short duration of maternity care. The results of this study fail to show an increase in the incidence of urinary incontinence or dyspareunia by leaving some perineal tears unsutured. The results suggest that the condition of urinary incontinence can be prevented or improved by performing pelvic floor exercises. Incontinence is under-reported and awareness of the extent of the problem is essential.
Domestic hazard analysis of infant feeding utensils
Authors: Mainstone Adrian
Published: May 2014

The attention given to teaching new mothers correct routines for sterilizing infant feeding utensils has diminished over recent years. However, research has shown that an infant is vulnerable to infection from members of the family and that its feeding utensils can act as transfer sites for pathogenic microorganisms. Specialized products and equipment are available to carry out these procedures easily and efficiently and motivational education should be afforded to each new mother. Consideration should be given to incorporating the teaching of home hygiene, with specific emphasis on the safe management of infant feeding utensils based on the hazard analysis process, as an integral part of every parentcraft programme.
Supporting midwives’ role should be top of the agenda
Authors: Cohen Harry
Published: May 2014

Attending the Royal College of Midwives (RCM) conference this May in Cardiff, I stood before the statue of Aneurin Bevan, the founder of the NHS. He called it a ‘cradle to the grave’ health service. I am a ‘cradle to the grave’ socialist, but my preference is for the cradle.
Third and fourth stages of labour: sitting position
Authors: Jahanfar Shayester , Amini Laila , Jamshidi Rohangiz
Published: May 2014

The mother's position for the second stage of labour can significantly influence its management. The sitting position may shorten the duration of the third stage and facilitate the expulsion of the placenta. The aim of this study was to determine the effect of the sitting position on the length of the third stage of labour and the amount of bleeding during the third and fourth stages of labour. This was a clinical trial with a comparison group. One hundred women with normal delivery were divided into 2 groups: those who delivered in the sitting position, and those who delivered in the lithotomy position. The result suggests that the second stage of labour and placenta expulsion time was shorter in the experimental group as compared with the controls. The volume of bleeding during the third stage was significantly more in the sitting position, although the findings do not suggest any significant increase in the amount of fourth stage bleeding. It was concluded that sitting position can facilitate the expulsion of placenta but it enhances the amount of third stage bleeding.
Webwatch
Authors: Hassall Jenny
Published: May 2014

In the current climate of midwifery, student midwives find themselves facing numerous challenges, ranging from financial hardship, work/life balance difficulties and frustrations with organization and delivery of programmes.
Maternity experiences of asylum seekers in England
Authors: McLeish Jenny
Published: May 2014

Asylum seeking women are a marginalized and vulnerable group who may have complex emotional and mental health needs, including grief for the children, families and friends they have lost or left behind, and the chronic uncertainty of the asylum process. This article describes the findings of a qualitative study of the maternity experiences of thirty-three asylum seekers, based on semi-structured interviews carried out in seven English cities. The women who took part in the study described problems in: accessing the maternity services; in obtaining information about the services and about pregnancy itself; in obtaining interpreting support for antenatal classes; postnatal care; and in securing the right to make choices about their own care. Half of the women encountered explicit hostility and racism from within the maternity services. The majority described feelings and behaviour consistent with postnatal depression, and most were very isolated and had significant unmet needs for social support.
A survey of newborn blood spot screening practices
Authors: Cavanagh Christine , Coppinger Catherine , Franck Linda
Published: May 2014

A comprehensive understanding of current midwifery practices for newborn screening blood spot sampling is lacking. This is an impediment to identifying best practices, training needs, writing of professional guidelines, and highlighting issues that need further investigation. A two-part study surveyed 125 and 101 midwives, respectively, identifying common practices and variability in how the blood spot sampling procedure was conducted. The majority of midwives surveyed reported their traditional practice was to pre-warm the babies' feet although the evidence shows this is not helpful. A wide variety of lancet devices are used, and further research is required to determine the most cost effective device. Practice varies with 60% of midwives not discarding the first spot of blood collected as instructed on the reverse of the blood spot card.
Emphasizing parental choice on newborn screening
Authors: Parsons Evelyn P , Moore Cindy , Israel Janet , Hood Kerenza , Clarke Angus J , Bradley Don M
Published: May 2014

This study assessed the implications of changing the protocol for newborn screening for Duchenne muscular dystrophy (DMD) to make choice more explicit. In the intervention group, if screening was requested, a separate card was used. Mothers from both intervention and control groups completed a questionnaire providing data on satisfaction, awareness the test was optional, choice and worry. Overall the intervention did improve satisfaction and awareness that the test was optional with no increase in levels of worry. However, some mothers felt they had been given a choice about screening, but were not aware that the test was optional. There is evidence that even with a rigorous service delivery protocol situations do arise where a decision to screen may not be ‘consented’. This raises important questions about the feasibility of obtaining consent for other newborn screening tests and subsequent storage of DNA.
The health benefits of breastfeeding for mothers
Authors: Blincoe Alana Juman
Published: May 2014

Over the past thirty years much research and medical study has seen breastfeeding reconfirmed as the best option for the health of infants, so much so that it has influenced public health policies. As a result, research on the beneficial effects of breastfeeding on the health of mothers is somewhat limited. But information, which supports the view that there are significant positive health benefits for the breastfeeding mother, is growing. Most significant is information on breastfeeding's links to limiting the risks of various cancers, osteoporosis and diabetes. It is also found to be beneficial for uterine involution, weight loss, natural contraception and reducing stress. Yet, it is still the case in the UK that women are not opting to breastfeed in large enough numbers, or are breastfeeding for a very short time. Mothers need to be encouraged to breastfeed for their own health benefits as well as those of their child's. When making infant feeding decisions, women need to be well-informed about all aspects.
Pregnancy in women with eating disorders: a review
Authors: Martos-Ordonez Carmen
Published: May 2014

The majority of eating disorders occur in women of adolescent and childbearing age. Eating disorders such as anorexia and bulimia nervosa are associated with adverse consequences during and after pregnancy, including higher rates of miscarriage, low birth weight, obstetric complications, postpartum depression and breastfeeding problems. Women with eating disorders are reluctant to disclose their condition or symptoms to health care professionals. Therefore, midwives need to improve their understanding of the predisposing factors associated with eating disorders, and of any indicators of the presence of these conditions during the antenatal or postnatal period. Increased knowledge in this area will help midwives to properly assess a woman's condition in order to promote a healthy pregnancy and neonatal outcome.
Uterine fibroids: Potential complications and impact on pregnancy
Authors: Henshaw Anne-Marie
Published: May 2014

Uterine fibroids (also called leiomyomas or myomas) are the most common benign tumour identified in women of childbearing age, with a reported incidence of between 20%–30%. This article examines the etiology, classification, pathophysiology and morbidity associated with fibroids and, informed by research findings, considers the potential complications in pregnancy and birth attributable to fibroids. The link between fibroids, and bleeding and spontaneous miscarriage in early pregnancy will be considered as well as complications which may occur in later pregnancy and birth. These complications include pelvic pain, abdominal pain, an increased risk of placental abruption, pre-term labour, breech presentation, dysfunctional and/or prolonged labour, caesarean section, post partum haemorrhage and retained placenta. The impact of size, location and number of fibroids in relation to complications will be discussed.
Are we facing a complaints and litigation crisis in the health service?
Authors: Symon Andrew
Published: May 2014

Complaints and litigation are undoubtedly significant features of contemporary health care. In a democratic system there is a need to hold people to account for what they do, and midwives should not be in the position of denying this avenue when the circumstances are appropriate. There is perhaps a tendency to believe that the incidence of complaints and legal actions are is rising inexorably, but this is not so. My own research from the 1990s (Symon 2001) questioned this belief with regard to litigation, and there has been little evidence since to suggest that the incidence of legal claims has increased significantly. Nevertheless, the fear of litigation, whether based on a rational appraisal of its likelihood or not, has consequences (Symon, 2000;, Clark, 2002). A great deal of attention was devoted to considering the litigation ‘crisis’ (better understood as a compensation crisis) in the 1990s (Travers, 2004).
Birth before arrival at delivery suite: Associations and consequences
Authors: Loughney Andrew , Collis Rhona , Dastgir Saleem
Published: May 2014

The objective of this cohort study was to identify factors associated with birth before arrival (BBA) at the delivery suite in women planning a hospital birth. The secondary objective was to determine the initial consequences of this event for women and their babies. The study involved 124 women experiencing a BBA in a five year period, together with one general cohort and one parity matched cohort of women who gave birth on delivery suite as planned. We found that BBA was associated with multiparity and a previous short second stage of labour. Labour culminating in BBA was attended by less pain, less frequent contractions and later spontaneous rupture of the membranes than other labours. Maternal consequences included prolonged third stage, haemorrhage and blood transfusion. Neonatal consequences were limited to a failure to maintain body temperature. In conclusion, BBA is likely to remain common in modern obstetric practice but its consequences may be reduced by the promotion of skin-to-skin contact after birth and by training ambulance crews in third stage management techniques.
Women's experience of infant feeding following birth by caesarean section
Authors: Baxter Jackie
Published: May 2014

This paper explores the infant feeding experiences of a group of women who gave birth by caesarean section. A quantitative survey was posted to 422 women between five and eighteen weeks after the caesarean section. Following one reminder a 68% response rate was achieved. In addition a review of the women's case notes was undertaken to determine infant feeding rates and progress as documented by midwives. Eighty five per cent of all the women in the sample which included responders and non-responders to the questionnaire in the case note review commenced breastfeeding and 65% of the respondents were still breastfeeding when they completed the questionnaire. Overall the most common reasons given by women for stopping breastfeeding were the perception of insufficient milk and inconvenience. Other reasons reported by the women for giving up at an early stage were difficulty with attachment, pain and lack of support at outset. This paper identifies the need for help and support with breast and bottle feeding on the postnatal ward which may be even more important for women who have caesarean sections. This work highlights how crucial the role of the health professional is to successful breastfeeding.
The birth centre model: as good as it gets?
Authors: Acton Kate
Published: May 2014

I have been privileged over the past year to have been Lead Midwife for a beautiful, brand new, co-located birth centre in south-west London. We have facilitated over 600 births, provided hydrotherapy in 65% of these labours and 23% of these women gave birth in the water.
Changing families means changing parental responsibility
Authors: Griffith Richard
Published: May 2014

The changing demographic of the family in the UK has required parliament to modernise the law relating to parental responsibility for children. Co-habiting families, lone parent families and second families are all much more common now although families where the parents are married are still the majority (Office of National Statistics, 2005).
Care during the latent phase of labour: supporting normal birth
Authors: Baxter Jackie
Published: May 2014

Many women experience symptoms commonly associated with the onset of labour when in fact they are not in established labour. If these women are not already at home then they are sent home and this can be confusing for them. How the care of women is managed during the latent phase of labour is of vital importance and has implications for the whole labour experience.
Over-the-counter culture:complementary therapy for pregnancy
Authors: Warriner Sian
Published: May 2014

Over the last decade the use of alternative forms of medicine and health related treatments has increased and the sale of non-prescription medicines, vitamins, minerals, homeopathic remedies and herbal supplements has grow exponentially. However, knowledge of the potential side effects of these preparations by expectant mothers is limited. This is of particular concern in pregnancy, considering the potential effects on fetal development and drug interactions. We know very little about the factors related to the use of over-the-counter and complementary therapies (CAM) in pregnancy or the knowledge or attitudes pregnant women have towards them. Complex societal factors unrelated to evidence of efficacy appear to influence the increasing use of complementary and alternative therapies. This article reviews the information and evidence available about the use of over-the-counter and complementary therapies (CAM) in pregnancy and childbirth.
Narratives from the Blackburn West caseholding team: setting up
Authors: Byrom Sheena , Downe Soo
Published: May 2014

For maternity services in Blackburn, Lancashire, the Changing Childbirth (Department of Health, 1993) document was a long awaited publication. Prior to 1993 there had been radical change in local maternity service provision facilitated by inspirational leadership and enthusiastic midwives. Small, under-utilized and expensive GP led maternity homes were closed with an aim to provide one equitable service by blending the philosophies and expertise of low and high risk caregivers. From that time the service has continually striven to improve the continuity of care for women through the development of midwifery led care and team midwifery. In early 2004 a midwifery group practice was established in Blackburn. The development was made possible through an effective partnership between a hospital Trust, a Primary Care Trust, a Sure Start local programme and a Higher Education Institution. This paper tracks the setting up of this midwifery group practice. Future papers will address the ongoing management of the project, impacts and outcomes associated with it, and the arguments used to mainstream, sustain and develop it.
Perineal tears and episiotomy: how do wounds heal?
Authors: Steen Mary
Published: May 2014

The care of perineal wounds is an important aspect of postnatal care. The aim of this article is to focus specifically on the healing aspect of perineal wounds. A description of tissue trauma, different types of wounds and classification of perineal wounds are given. This is then followed by a very detailed account of how wounds heal. Factors that can prevent healing are also highlighted as is the need to provide adequate pain relief that will have no adverse effect on healing.
More supportive midwives mean no more epidurals
Authors: Walsh Denis , Barclay Philip
Published: May 2014

If you read all the research on what lowers epidural rates you could be forgiven for concluding the obvious: if you want to reduce epidural rates, birth where there is no epidural service, because the studies of home birth and birth centres show these women have far fewer epidurals than a comparative group who birth in consultant units (Walsh, 2007). Of course they have some, because a small number are transferred to hospital for complications of labour.
Fetal monitoring and the use of doppler
Authors: Hale Rachel
Published: May 2014

Electronic fetal heart monitoring provides accurate information of fetal wellbeing during the antenatal and intrapartum periods, but the monitoring equipment is usually large and therefore confined to hospital premises. During labour the use of a traditional fetal heart monitor (CTG machine) can often limit the mother's choice of birthing position. The rise in the use of hand-held doppler devices has enabled midwives to monitor fetal heart rates in the community setting and even underwater during a waterbirth delivery. Many expectant mothers, especially those who have experienced a previous difficult pregnancy, experience anxiety between obstetric appointments. Hand-held doppler devices are now available for hire or purchase for the mother to use herself.
Birth and Power—‘A Savage Enquiry’ revisited
Authors: Jones Shirley R
Published: May 2014

Having followed Wendy Savage's initial case, which started in 1985, I was pleased to have the opportunity to read this follow-up. Not only does it update those of us aware of the original situation, but there is additional material that is of interest. I would advise any reader who is not familiar with A Savage Enquiry, published in 1986, to start by reading the reproduction of it that forms the back section of this book. In this way, references to that case that are made in the new book will make immediate sense.
Developing services for local women
Authors: Isaacs Pat , Kamara Ros , Biswas Marti , Ali Shamima , Emmanuel Madelina
Published: May 2014

Midwives have been charged with delivering the vision for maternity care set out in the National Service Framework and Maternity Matters, this can be achieved if a collaborative approach to the planning and delivery of care is used. This article shows how this was achieved with the managers, midwives and local advocates.
Midwives and confidentiality
Authors: Griffith Richard
Published: May 2014

A report by the Safeguarding Children Board in Birmingham recently found that a 15-year-old girl killed herself some three weeks after telling a health professional that she had been raped. The health professional agreed to keep the conversation confidential and did not refer the allegation on to the police or social services (Doherty, 2007). The case highlights that while the duty of confidence owed by midwives is a fundamental part of their relationship with the patient it is not absolute and that information can be disclosed to others where appropriate.
Workplace Bullying in the NHS
Authors: Hurrell Sharon
Published: May 2014

The issue of bullying has promoted many debates in recent years following spates of reported violent episodes, suicides and even reaching media, government and worldwide attention following a series of incidences in a reality television show. Indeed it seems that bullying does not stop once one reaches adulthood—there is no escape, however old you are, what you do as a profession and it seems even if you are being filmed in the name of ‘light entertainment’.
Understanding grounded theory
Authors: Roberts Taniya
Published: May 2014

Grounded theory is a research methodology whereby the researcher has an area of research interest and is led by the research data to describe and explain with a ‘theory’ what is happening in a social interaction or setting. Data collection and data analysis are performed in tandem and is referred to as ‘constant comparative analysis.’ It can follow either the quantitative or qualitative approach to research design but is most often used in the latter because of the flexibility this offers. Increasingly it is being used in midwifery research. It is a research methodology that can provide a framework for midwifery researchers to produce interesting and innovative research.