bluuebunny/crossref_metadata_2025 huggingface dataset:
Norplant's demise: abortion rate rise?
Authors: Gbolade Babatunde A
Published: May 2014

On 30 April 1999, Hoechst Marion Roussel, UK distributors of Norplant, stunned UK family planning and reproductive health care consumers and providers. The company announced discontinuation of the contraceptive in the UK by the end of October 1999 (Eaton, 1999). The company sought to allay concerns by stressing that its decision was commercial and that its confidence in the safety and effectiveness of the contraceptive remained unchanged. One of the reasons cited for deciding to discontinue the implant was the relentless negative publicity and ‘trial by media’ had resulted in the reduction of the uptake of new prescriptions to an unacceptably low level. The company is also planning to merge with another and envisages that contraception will not be a core activity for the new merged company.
The midwife advice service at Reading Remand Centre
Authors: Oliver Lesley
Published: May 2014

This article describes a midwifery advice service provided for the visitors of inmates at Reading Young Offenders Institute and Remand Centre. The need for this service was identified following a Healthy Options Day at the prison in December 1995, and the observations of one of the health-care officers working with both the inmates and the visitors. The aims of the scheme were: to provide antenatal education, advice and support to the women visiting their partners in the remand centre; to provide general health education to both women and their partners, e.g. smoking, diet and avoiding infection; and to liaise with other health professions/organizations to facilitate ongoing health care. Evaluation of the scheme has been difficult. However, the feedback from the visitors, inmates and staff has been very positive and the results show that the aims are being met.
Court authorised caesarean
Authors: Wray Emma
Published: May 2014

The issue of women who will not consent to medical or surgical treatment during pregnancy poses difficult medical, ethical and legal problems. Midwives in particular need to be aware of the legal issues so they can offer support and advice to women who are faced with the threat of court interventions. Recent cases have focused attention on the unusual situations in which a woman might refuse medical interventions in pregnancy, particularly around the time of delivery. The background to these cases will be outlined in brief, followed by a summary of the current legal position. While such cases are rare, the ethical and moral dilemmas that arise are considerable. The law, however, is now clear, and it is important that health carers are aware of the current legal position in order to be able to offer advice and support.
Oral history and research part 2: current practice
Authors: Hunter Billie
Published: May 2014

This is the second of two articles investigating the use of oral history research in midwifery. This article explores the relevance of oral history research findings for contemporary and future practice. PreNHS community midwives provided one-to-one, midwifery-led care, which resembles the practice recommended by current government policy. Concerns have been raised as to the sustainability of such practices. This article uses the themes proposed by Sandall (1997) to analyse the practice of preNHS midwives, and suggests that occupational autonomy is of particular significance in maintaining job satisfaction and morale.
Manual handling and the immobile mother
Authors: Mander Rosemary
Published: May 2014

What do you do when a woman says to you: ‘I want to sit more upright, but my legs are numb and they won’t work?'. If you're like me, you think of all your midwifery colleagues with ‘bad backs’. Because most of us have encountered these problems during our nursing experience, we tend to accept low back pain as a fact of life. The situation, however, is changing. This article examines the evidence to determine the extent to which low back pain informs midwifery practice.
Consent, compulsion and the child
Authors: Dimond Bridgit
Published: May 2014

In a recent case a judge made a declaration that a 15-year-old girl should be compelled to have a heart transplant against her will. In this article the law relating to consent is discussed in relation to underaged pregnant girls.
Cranial ultrasound scanning
Authors: Reeve E Rosemarie
Published: May 2014

This article discusses cranial ultrasound scanning in the neonate as an ‘expanded role’ for experienced neonatal nurses/midwives. It discusses the rationale for this new development in neonatal nursing and highlights the benefits to the premature infant. A comprehensive explanation of the procedure is given and the author draws on the experience of one neonatal unit to describe how a team of experienced nurses have been prepared to safely perform this procedure, previously undertaken by junior doctors. Insight is given into the nature and content of the training needed and into the safety aspects involved. Most importantly, the author emphasizes that expanding the role of neonatal nurses to embrace ultrasound scanning has enhanced clinical decision making through improving the quality of scans produced, and therefore has ensured greater continuity of care for the baby.
Adoption: how to support the relinquishing mother
Authors: Woodger Janet
Published: May 2014

Last year, the Home Secretary suggested that more teenage mothers should be encouraged to give up their babies for adoption. This article considers the impact that unresolved grief has had on the lives of many women who have relinquished their babies in the past. Mothers involved in ‘open adoptions’ do not appear to suffer as many adverse effects and further research in this area would be useful. Meanwhile, the midwife needs to identify and develop the skills needed when caring for a mother planning to relinquish her baby. These include adopting a non-judgmental approach, being an effective listener, offering choices about every aspect of care and recognizing that interventions known to help bereaved mothers may also prove beneficial to the relinquishing mother. It is more difficult to provide long-term support, but the midwife should be able to put the relinquishing mother in touch with the charitable agencies who can offer appropriate help.
Who will be there to do vaginal breeches now?
Authors: Robinson Jean
Published: May 2014

Pressure on women to have a caesarean for a breech baby is going to increase after the recent publication of an international randomized trial (Hannah et al, 2000) and its already bad enough. What I find so surprising is that many of the women who call us asking if they can still get a home birth or a vaginal delivery have never been offered external cephalic version (ECV). Of the 2000 women in the trial, only a fifth had had an attempt at version.
Cauls: Precious membranes believed to bring good fortune
Authors: Rushen Joyce
Published: May 2014

It is amazing sometimes the strange objects that are considered to bring good luck and are rated as treasured amulets. One which is surrounded by all manner of ancient superstitions is the caul.
Part 24: Statutory compensation
Authors: Dimond Bridgit
Published: May 2014

In general if a person alleges that they have suffered harm and wish to receive compensation, then they have to prove that the harm resulted from a person's negligence or breach of statutory duty. In other words, this country has a system of fault liability as opposed to the no-fault liability schemes in New Zealand, Sweden and Finland, for example.
Helping pregnant women to stop smoking
Authors: Buckley E Rosemary
Published: May 2014

Smoking during and after pregnancy is associated with well recognized problems. Research has established the efficacy of giving simple advice and literature to smokers. As their main professional carers, midwives have an important role in advising pregnant smokers of the risks and encouraging them to quit. At Nottingham City Hospital, interactive software SmokeScreen was developed, based on Prochaska's (1983) stages of change model. It produces questions which, depending on the replies, generate further questions with prompts on advice, literature and support. A post natal questionnaire is used to ask all women about smoking with prompts for advice about the risks of exposing babies to smoke and the importance of smoke-free zones. Audits showed that the majority of pregnant smokers receive advice at booking and after delivery. There was a mean 10.1% fall in the amount of women smoking between booking and delivery. We believe SmokeScreen facilitates evidence based advice-giving, which helps women to quit smoking and as a result reduces morbidity in mothers and babies.
SIDS — midwives can make a difference
Authors: Mueller Pam
Published: May 2014

Seven babies die every week of Sudden Infant Death Syndrome (SIDS) in England and Wales. This comprises the largest single category of deaths in infants between one month and one year of age, despite the success of the Back To Sleep campaign introduced in 1991 and which resulted in the dramatic reduction of SIDS over the following year.
Enhancing communication skills with the ENB R56 course
Authors: Tomlin Maggie
Published: May 2014

Successive government reports (Department of Health, 1993a; CESDI, 1997; Audit Commission, 1997) and research evidence (Jacoby, 1988; Kirkham, 1989; Martin, 1990; McIntyre, 1982; Methven, 1989) highlight the importance of good communication for women's satisfaction with and sense of control in childbirth. Developments in woman-centred midwifery practice and the drive to provide postnatal debriefing services provide new impetus for midwives to look at this issue. This article offers a review of the midwifery literature identifying some common areas on which midwives can focus their development. Anecdotal evidence related to the use of language in midwifery is supported by the findings of the author's own small study. Further support for arguments related to issues of power and control are taken from feminist critiques of language and communication. This article concludes by identifying innovative strategies that have been developed locally, including the creation of the ENB R56 course, to integrate psychological theory of human interaction and midwifery theory with the real world of practice, in order to promote evidence-based practice in communicating with childbearing women.
Giving birth in competing cultures
Authors: Robinson Jean
Published: May 2014

You are offered a tour of the labour ward. But what if your family believes that recently delivered women are polluted, and as a pregnant woman you should avoid contact with them? One Gujerati woman did the tour with other women in her antenatal class, but dared not tell her mother-in-law. However, when her baby was born underweight, she feared it was a punishment for her deviance.
The national sentinel caesarean section audit
Authors: Callwood Allison , Thomas Jane
Published: May 2014

Caesarean section rates have increased from 9% in 1980 to 15.5% in 1994-5 (NHS Maternity Statistics, 1997), the last year for which national data is available. There is no correct rate for caesarean section, but there is concern that the rate is rising. A consensus statement from the World Health Organization suggests there is no increase in health benefits associated with caesarean section rates above 10-15%, although this is not based on any empirical evidence.
Part 19: Review of medical devices
Authors: Dimond Bridgit
Published: May 2014

The Medical Devices Agency (MDA) was established to promote the safe and effective use of devices. In particular, its role is to ensure that whenever a medical device is used, it is:
Down's syndrome: A breast-feeding challenge
Authors: Davies Cathy
Published: May 2014

On 27 April 1995 I gave birth, at home, to our third child, Sam. He had no sucking or rooting reflex and had low muscle tone. At 4weeks old, he was diagnosed as having Down's Syndrome and duodenal stenosis, requiring urgent surgery. What follows is a description of Down's Syndrome and its implications; how I taught Sam to breast-feed and my personal story of the weeks and months after his birth.
Ectopic pregnancy: Treatment and implications
Authors: Chandler Julia
Published: May 2014

Ectopic pregnancy is a relatively common condition, affecting approximately 1 in 100 pregnancies, although in most cases the ectopic pregnancy dies and is absorbed before a period is missed. It occurs when the fertilized egg implants outside the womb in the ovary, the abdomen, the cervix, at the join between the tube and the womb (the cornua) or, most commonly, in the fallopian tube. As the pregnancy progresses, it causes abdominal pain and bleeding, which can lead to maternal cardiovascular collapse and death.
Managing shoulder dystocia: We need clearer guidelines
Authors: Rhodes Amanda , Kenyon Sarah , Sidebotham Mary
Published: May 2014

The obstetric emergency shoulder dystocia is a relatively rare event which is generally unpredictable but is associated with a high level of fetal mortality and morbidity and has the potential to lead to litigation. To minimize these problems, it is essential that health professionals are adequately trained in the management of shoulder dystocia. This article presents the results of a survey of training activities and an analysis of practice guidelines in relation to shoulder dystocia. The findings suggest a need for a more formalized, structured and monitored approach to training.
Stronger leadership is needed before we can own change
Authors: Gould Debby
Published: May 2014

Vision 2000 is the Royal College of Midwives (RCM) latest strategy document (2000). The report describes the outcomes following the RCMs consultation period with key stakeholders, including users and the colleges membership. It portrays the RCMs vision for the future development of our maternity services.
Physiological changes of the puerperium
Authors: Harrison Julie M
Published: May 2014

Remarkable changes take place during the puerperium, which enable the womans body to revert to the non-pregnant state. This article focuses on the physiology of the puerperium and illustrates how antenatal care and management strategies used in labour influence the recovery of the woman. Knowledge of physiology is essential if the midwife is to fulfil her unique role in continuing to monitor progress, recognise abnormalities and offer appropriate support and advice at this time.
Aromatherapy classes help promote natural childbirth
Authors: Einion Alyson B
Published: May 2014

Women are demanding more choice and control in their childbirth experience, and often look to complementary therapies for alternatives or adjuncts to standard obstetric care. The essential oils used in aromatherapy are now widely available, often in products such as bath oils, cosmetics and massage oils. As many of these aim to promote relaxation, they are a popular choice for pregnant women anticipating labour.
Pain relief: A practical guide to obstetric TENS machines
Authors: Price Sally
Published: May 2014

Most midwives working in today's maternity services will be familiar with transcutaneous electrical nerve stimulation (TENS) as a form of pain management in labour. Many maternity units provide this facility, but it is also likely that women may hire a TENS machine to use before they are admitted to hospital or for a home birth. Midwives may encounter a range of TENS machines, each with their own distinctive features. This article will examine some of the TENS machines currently available for hire and discuss the implications for practice.
Part 25: Criminal injury compensation
Authors: Dimond Bridgit
Published: May 2014

A scheme to compensate those who have suffered personal injuries as the result of criminal action has been in existence since 1964. A new scheme for compensation following injuries or death as a result of a crime was established on 1 April 1996 under the Criminal Injuries Compensation Act 1995 based on a statutory scale of awards known as the ‘tariff’. Claims are processed by the Criminal Injury Compensation Authority (CICA) and claims officers and adjudicators on a panel determine whether a claim can be met.
Gestational diabetes: A controversial concept
Authors: Mitchell Mary
Published: May 2014

The diagnosis and management of gestational diabetes is fraught with controversies. Screening tests employed for the detection of gestational diabetes are not standardised. Many different practices exist in the UK causing confusion for practitioners and perhaps the institution of inappropriate treatment. There are differing opinions with regards to the complications for the mother and baby associated with gestational diabetes. The appropriate management of gestational diabetes is also uncertain as the treatment with diet and insulin therapy is controversial. These issues are explored in this article with the aim of encouraging midwives to take a more critical approach to analysing the routine care offered to pregnant women.
Part 34: community health councils
Authors: Dimond Bridgit
Published: May 2014

Community health councils (CHC) were set up in the reorganisation of the NHS in 1974. They were funded by the NHS which covered the costs of a secretary, office and administration. Their tasks were identified in Schedule 7 to that Act and subsequently by regulations in 1996 (NHS Executive, 1996a).
The legal implications before and after Bristol
Authors: Dimond Bridgit
Published: May 2014

This article examines the principle recommendations and implications of the recent report of the Bristol Royal Infirmary Inquiry, set up to review the management of care of children receiving cardiac services at the Bristol Royal Infirmary, and analyses their significance in relation to midwifery.
Hepatitis B and HIV antenatal screening 2: user survey
Authors: Bruce Maggie , Peacock Janet , Iversen Angela , Wolfe Charles
Published: May 2014

This survey was undertaken to ascertain pregnant women's knowledge of hepatitis B and HIV infection before the introduction of universal antenatal screening for these infections. Information was also obtained on women's awareness of the antenatal tests currently offered, whether they felt they had sufficient information to give informed consent to hepatitis B and HIV testing and whether they would have accepted the latter if it had been offered to them. Of 120 pregnant women who were asked to take part, 100 (83%) agreed to fill in the questionnaire. It was found that women knew less about hepatitis B than HIV. While 37% of women felt that they had sufficient information to give informed consent for hepatitis B screening, 66% would have accepted hepatitis B testing if it had been offered. In contrast 69% felt that they had sufficient information to give informed consent for HIV screening, but only 48% would have accepted HIV testing. Only 7% of women were fully aware of the current tests offered; while 44% were aware that testing for syphilis was routine, 22% incorrectly believed that toxoplasmosis screening was included in the routine tests. The results of this survey influenced the subsequent hepatitis B and HIV antenatal screening programme.
Suitable suture material for perineal repair
Authors: Harris Tracey
Published: May 2014

This article focuses on a relatively new suture material, Vicryl* rapide which is advocated by health care professionals as the ideal suture material for perineal repair. Thousands of women sustain some form of perineal trauma following childbirth, many experiencing long-term problems of pain and dyspareunia and while there is a large amount of literature regarding perineal trauma there is little evidence of randomised trials that can reliably inform and improve practice. What the majority of literature concludes is that the extent of morbidity women experience following this procedure depends greatly upon the materials used for the repair, the skill of the operator and the method employed.
Randomised trials: changing the culture of maternity care
Authors: West Jane , Tuffnell Derek , Jankowicz Dawn , McCandlish Rona
Published: May 2014

Over the past 6 years, clinical staff and women using the maternity services in the Bradford NHS Trust have been involved in a quiet revolution. We have been creating a care culture which aims to be not only evidence-based, but also one in which we can all contribute information about the effects and effectiveness of care. An important component of this has been incorporating recruitment to and participation in randomised, controlled trials into routine practice. In this article we describe the background of and contributions to this work; some of the challenges we have faced; our initiatives to support excellence in clinical research; and our plans to develop opportunities for care providers and those who access care to participate in high-quality clinical randomised controlled trials.
Varied clinical management and caesarean section rate
Authors: Paranjothy Shantini , Thomas Jane
Published: May 2014

In England and Wales, one in five pregnant women now have caesarean births (Thomas and Paranjothy, 2001). The National Sentinel Caesarean Section Audit (NSCSA) has been completed and findings were published in a report in October 2001. This was a vast study with data on demographic and clinical characteristics of over a 150000 women who gave birth in all maternity units in England, Wales and Northern Ireland. In addition detailed information was collected on all caesarean sections (CSs) that were carried out during the study period. The role of local facilitators was critical to the success of this extensive project and credit is due to all midwives and staff on delivery suites who were involved with data collection.
The law regarding embryo and stem cell research
Authors: Dimond Bridgit
Published: May 2014

In December 2000 Parliament approved a statutory instrument which made lawful the use of embryonic stem cells for research. This article looks at the background to the decision and the arguments for and against.
Connection and disconnection: Experiences of integration
Authors: Shallow Helen
Published: May 2014

The proposed changes recommended by the report Changing Childbirth (Department of Health, 1993) heralded a new era for midwifery as it moved towards utilizing midwifery skills in a more holistic and less fragmented way in order to promote continuity of care. Seven years on from the report, midwives are unhappy. The proposed changes have led to midwives becoming overworked, stressed, undermined and feeling devalued. The majority of women are still cared for at the birth by an unknown midwife, and care continues to be fragmented. This is the second part of a four-part series, drawn from a qualitative study examining midwives' experiences of becoming integrated within teams. The author looks at why grounded theory was used to analyse the data. Issues of bias and being an insider are discussed, as they are factors crucial to the integrity of the work. It then examines the first major theme, ‘Connection and Disconnection’. Some women experienced an increase in the contact with women and connected with them for the first time, while others experienced a reduction in the contact with women they knew. Ultimately, all midwives experienced disconnection, as they were unable to deliver the continuity of care that the new model was set up to provide.
A guide to providing care for survivors of child sex abuse
Authors: Aldcroft Dionne
Published: May 2014

The actual prevalence of women who were sexually abused in childhood is estimated as being 1 in 5, with some studies suggesting 1 in 3. Pregnancy can trigger memories of forgotten childhood sexual abuse which makes a survivor feel that they have lost control of their bodies. They may use coping mechanisms such as repudiation of the fetus, leading to possible harm of the fetus. Suicidal thoughts are also evident, reflecting their low self-esteem. Survivors need to be empowered so that they can take back control of their bodies. The midwife is in an ideal position to empower women who have been sexually abused, because of her close, privileged relationship. This article discusses aspects of care and how the midwife can promote positive experiences of pregnancy and childbirth for women who have been sexually abused in childhood.
Counting the cost of pressure damage in the maternity unit
Authors: Newton Heather , Carson Liz
Published: May 2014

This article describes a review of midwifery practice in response to an increase in the incidence of pressure damage within the authors' NHS Trust. Five women developed pressure damage over a 6-month period. The review highlighted that existing systems in place for preventing skin breakdown were ineffective. Traditional practices focused on protecting the sheets rather than the women's skin. Following a product evaluation, outcomes clearly demonstrated the need to change existing practices in order to reduce the risk of women developing pressure damage during labour.
Part 28: Medicines and prescribing
Authors: Dimond Bridgit
Published: May 2014

This article sets out the legal provisions relating to medicines and will be followed by an article looking at the legal position of midwives. The 1968 Medicines Act provided a statutory framework for the supply and control of medicines.
Food for thought: international perspectives on violence
Authors: Warwick Cathy
Published: May 2014

For one reason or another I attend various conferences, discussion groups, working parties and committees. You might imagine that there is a lot of repetition. In fact boredom is very rare. I nearly always hear something new, and often get a different perspective on something of which I am already aware.
Checking up on the doctors: Is GMC registration enough?
Authors: Robinson Jean
Published: May 2014

We learned the hard way. AIMS reported a ‘doctor’ to the GMC and found they had never heard of him. Ever since then, we automatically check registration when we get a serious complaint. We have had a steady trickle of cases where we have found that women had been in the hands of doctors who were not registered with the GMC at the time. This means, of course, that the women were unprotected. The only power a professional body has over those who commit misdeeds is to remove them from the register. They cannot be removed from a register they are not on, although they might be prosecuted for taking money from the NHS they were not entitled to – if they can be found. Overseas doctors often return to their own country when a complaint is made, and trusts find their departure uncommonly convenient.
Clinical governance and CESDI: part 2
Authors: Henderson Nicola
Published: May 2014

In the second of a two-part article the author describes the findings of the survey conducted in hospital maternity units in the South and West Executive NHS Region in England. The units were asked about their current risk management activity and implementation of the recommendations of the Confidential Enquiry into Stillbirths and Death in Infancy (CESDI). The results indicate that CESDI is recognised and its' more specific recommendations are adopted into clinical practice. However the link with risk management could be developed further. In addition, CESDI coordinators could provide additional education input to aid dissemination of CESDI findings.
Partner involvement in smoking cessation
Authors: Holmes Carla
Published: May 2014

This paper reports the findings from a study which investigated the influence a partner's smoking status can have on the ability of a woman to stop smoking during pregnancy. The prevalence of smoking during pregnancy and the potential for partner involvement in smoking cessation in Leeds is also investigated. The findings indicate that women whose smoking partner stops smoking for the pregnancy are more likely to give up themselves, compared to women whose partners continue to smoke (adjusted odds ratio 6.3, 95% confidence interval (CI) 1.2–34.6; P=0.034). The study revealed the prevalence of smoking during pregnancy to be 20% (95% CI, 12–28%; P<0.05). However, 65% (95% CI 56–74%; P<0.05) of the partners who smoke were unable to attend antenatal clinics where smoking cessation intervention takes place.

The high prevalence of smoking during pregnancy reveals the continued need to seek more innovative approaches to the promotion of smoking cessation in pregnancy. Partner involvement could potentially be of paramount importance for the success of such intervention during pregnancy and long-term smoking cessation. Before effective intervention can be designed to target the partners, the presence of partners at antenatal clinics requires investigation, in particular their levels of attendance and the reasons for any absence.
Midwifery and perinatal mental health care provision
Authors: Bloom Jane
Published: May 2014

This article identifies issues relevant to perinatal mental health. It refers to the National Service Framework for Mental Health (Department of Health, 1999a) and outlines how some of the key priorities and standards to be achieved can be influenced by midwives. It considers how midwives might make a difference to influence the standard of care in the development, provision, and integration of perinatal mental health services, particularly in terms of increased access to psychological therapies. It also acknowledges some of the difficulties midwives currently face when trying to identify clients who may be motivated to make use of a ‘talking treatment’. There is a realistic appraisal of what midwives might achieve and a recognition that they cannot expect to carry the burden of responsibility for women's mental health. The article also suggests that some midwives will want to focus on the psychodynamics involved in difficult relationships, taking into account the delicate boundaries that overlap their professional responsibility, their client's wishes, and the availability of psychological therapies.
A new clinical negligence scheme for the NHS
Authors: Dimond Bridgit
Published: May 2014

The Department of Health has set up a committee to investigate a new clinical negligence scheme for the NHS. This article considers the suggestion of no fault liability structured settlements, fixed tariffs and greater use of medication.
Community midwives' role perceptions
Authors: Baston Helen , Green Josephine
Published: May 2014

The aim of this study was to identify, describe and provide theoretical analysis of community midwives perceptions of their role in the context of the recommendations of Changing Childbirth. Ten community midwives, from both rural and inner city areas in the UK, were interviewed. The data generated three substantive categories: choice, continuity and relationships with colleagues. The midwives in the study enjoyed providing continuity of care for women but felt that continuity of antenatal and postnatal care was more important, both for themselves and the women, than having a known midwife in labour. Despite feeling adequately skilled and in favour of providing intrapartum care for more of their women, they did not feel that it was a realistic option, for a variety of reasons. This study raises important issues about community-based maternity care which merit further investigation and highlight the need for midwives to develop a shared philosophy of care with their colleagues.
Fear of labour and birth
Authors: Walsh Denis
Published: May 2014

It is an illuminating to listen to daily news bulletins about childbirth and note their source. It became apparent that the British Medical Journal and the Lancet were the principal sources of newsworthy stories and inevitably, because of the type of research published in these journals, studies of morbidity predominate. This focus encourages a public attitude that childbirth is risky and fraught with complications.
Resource Reviews
Authors: Brown Alison
Published: May 2014

This ground-breaking book examines spiritual care in midwifery practice, a significant achievement given the paucity of evidence available directly related to midwifery. Clearly midwifery research on this subject is now required, and the author provides some suggestions for how this might proceed. This book provides a wake-up call for midwives to look t ways in which they can be responsive to the spiritual needs of women.
Step 40: NHS Plan 2: central control
Authors: Dimond Bridgit
Published: May 2014

In the February edition (Dimond, 2002) of this journal, details of the patient representation aspects of the NHS Plan (Department of Health (DoH), 2000) and how they were being implemented in law were published. In this article we consider chapter 6 of the NHS Plan which recommends significant changes to the controls within the NHS.
Celebrations!
Authors: Henderson Christine
Published: May 2014

During Christmas and New Year celebrations I was reminded of the well-known phrase from the film Forest Gump. ‘Life is just like a box of chocolates. You never know what you’re gonna git until...’ This is only half true because most of the time there is a guide included identifying what you will get when biting into the chocolate. However, if you are familiar with the chocolates, like the Celebrations® by Mars, then you know exactly what you will get. I suppose this could also be true of the maternity services.
Exploring the value of midwifery continuity of carer
Authors: Warren Chris
Published: May 2014

Ten years ago, Changing Childbirth (Expert Maternity Group, 1993), the Government's policy on maternity care heralded the start of woman-centred care. It stressed the importance of continuity, choice and control. There have been many pilot studies but the majority of women have even less continuity of care now and there are very few continuity of carer schemes. Midwives like it, women like it, it is safe and cost-effective, so why has continuity of carer not become universal practice? This article explores these issues.
Changing Childbirth: 10 years on
Authors: Cumberlege Baroness Julia
Published: May 2014

Ten years ago, as a new Minister, I was delighted to be allocated Maternity Services as part of my responsibilities. I had only arrived in Whitehall a few weeks when a report from the Health Select Committee landed on my desk accompanied by the Government's response which I was invited to sign. The response was courteous and in the politest terms thanked the committee and told them to get lost.
Ten years of midwifery supervision
Authors: Jones Kathleen , Edwards Debbie
Published: May 2014

The supervisor of midwives contributes and plays an important part in risk management strategies whilst promoting women-centred care. The overall purpose of supervision is ultimately to support and promote good midwifery practice and to protect the public. This article looks at the role of the supervisor.
Providing information on Klinefelter syndrome
Authors: Hall Sue , Kirwan Donna , McIntosh Karen , Marteau Theresa , Limbert Caroline , Reid Margaret , Bobrow Martin , Cameron Alan , Walkinshaw Stephen , Soothill Peter
Published: May 2014

The aim of this study was to compare the information that midwives, obstetricians and geneticists report they would give parents following the prenatal diagnosis of Klinefelter syndrome. Fifty midwives, 135 obstetricians and 66 geneticists completed a brief questionnaire assessing the information they reported providing to parents following the prenatal diagnosis of Klinefelter syndrome. Geneticists reported providing more information about Klinefelter syndrome than midwives and obstetricians, particularly positive information about the condition. The information parents receive after the prenatal diagnosis of Klinefelter syndrome may vary according to the specialty of the health professionals consulted. This variation may reflect differences in the information these groups have about the condition. It remains to be determined whether such variation leads to different decisions about whether or not to continue with the pregnancy and subsequent parental adjustment.
Asking about domestic violence
Authors: Wright Lee
Published: May 2014

This article attempts to look at some of the midwifery issues surrounding domestic violence. It discusses the prevalence of domestic violence and some of the signs that women may be involved in an abusive relationship. The Government's policy towards domestic violence has changed. Documents such as the NHS plan have outlined how midwives must become active in tackling domestic violence. In the future the midwives' role will be one focussing on public health rather than pregnancy alone. Midwives have still to ask women about domestic violence as part of their everyday practice. The author hopes to explore some of the reasons why midwives are reluctant to ask women about domestic violence and some of the practical questions surrounding domestic violence, such as what do midwives actually say to women? A local model devised by the midwives at the Royal Devon and Exeter hospital is used as an example of the ideal guidelines and approaches for asking women about domestic violence. In conclusion, midwives have to become involved in tackling domestic violence in the future.
Risk aversion and the culture of fear
Authors: Hewson Barbara
Published: May 2014

Jean's Robinson's account of professional fear as a barrier to consent (Vol 11(12): 719) reflects a wider trend in modern society. In trying to make sense of this troubling phenomenon, it may help to consider it from a broader sociological perspective. The reason why professionals working in maternity care may be unsympathetic to the exercise of choice and autonomy by pregnant women is that, as a society, we are excessively preoccupied with ‘playing it safe’, even though we are far healthier and safer than previous generations.
Pre-eclampsia: pathophysiology and its management
Authors: Morley Anne
Published: May 2014

Pre-eclampsia has a significant impact on the mortality and morbidity of pregnant women and their neonates. It is a multisystem condition in which systemic damage occurs before symptoms become apparent. This article describes the pathophysiology, investigations and management of pre-eclampsia, especially before 34 weeks gestation, when the decision between expectant management and delivery is often difficult. The implications of the Magpie trial for the management of pre-eclampsia are also discussed.
Enhancing patient safety and reporting near misses
Authors: Madden Isobelle , Milligan Frank
Published: May 2014

Patient safety incidents are acknowledged as a significant cause of unnecessary and preventable harm in modern healthcare. This article outlines the nature and extent of the problem and applies the concepts of patient safety incidents and near miss events to maternity care. It is argued that as in other parts of healthcare, significant improvements in the quality of maternity care can be achieved through an enhanced focus on patient safety.
Whose baby? Complaints about neonatal care
Authors: Robinson Jean
Published: May 2014

At what point does an increase in complaints become more than a blip and turn into a trend? We have been asking that question about special care baby units for a couple of years now. It is not just the number of comments and complaints from parents which we discuss, but their quality and kind. This is no blip. We have the impression that paediatrics in general, including neonatal paediatrics, has become more authoritarian. It is geographically patchy – but increasingly obvious. The doctors concerned seem unaware of how damaging their behaviour is both to the family and the reputation of their specialty.
Donor anonymity removed
Authors: SIDEBOTHAM MARY
Published: May 2014

There has been much professional and media interest in the subject of infertility treatment within the last 12 months with the introduction of the recent NICE guidelines, and a promise of a Government review of the Human Fertilization and Embryology Act.
The state of maternity care: a curate's egg?
Authors: Robinson Jean
Published: May 2014

The other day we were asked by a European visitor to give a quick summary of the current state of maternity care in the UK. We could not give an immediate answer – not because we do not have a view, but because the picture is so complex it is not easy to summarise in a few sentences. There are clearly discernible pieces of the jigsaw, but they just do not fit together. It looks like a jumble of pieces from entirely different boxes.
Breast cancer during pregnancy
Authors: Grosser Lisa
Published: May 2014

The majority of breast cancer occurs in women over the age of 50 (Cancer Research UK, 2003), therefore, women diagnosed under this age can often feel isolated and marginalized and may have different issues and needs. A diagnosis in women during pregnancy is uncommon and these women may potentially experience a greater sense of isolation as a result. The treatment management these women receive will vary according to the trimester in which they are diagnosed. A further issue once treatment has finished can also be the possibility of future pregnancy.
Clarifying cord and maternal blood sampling
Authors: Shreeve Karen
Published: May 2014

Routine Kleihauer and direct Coombs testing are performed postnatally on maternal and cord blood samples. These tests are the recommended standard for RhD-negative women post-delivery and they inform decisions in the care and management of both mother and baby. Errors and omissions by clinicians in blood sampling, labelling and completion of the request form will result in unnecessary delays for the mother and her baby and may have serious implications for their care. In the hospitals referred to in this article, the request form used for the investigations is a standard haematology form. It has to be amended by hand to accommodate all relevant details. This article describes the implementation of a new, specific request form designed by the author with the aim of facilitating the procedure for midwives and reducing the risk of errors and omissions.
Time limit on civil action for compensation
Authors: Dimond Bridgit
Published: May 2014

Department of Health advice recommends that records relating to maternity and childbirth can be destroyed after 25 years (HSC, 1999). This length of time may be adequate to take into account the extended time allowed for children and young persons to bring legal actions, but it may not be sufficient for other situations. This article considers the legal rules relating to the time within which actions for compensation for clinical negligence must be started.
Correspondence
Authors: Walker Lyne , Gomez Elizabeth
Published: May 2014

Having read two different articles (Hopkins, 2004; Trotter, 2004) regarding skin care of the newborn, both advocating different skincare practices, we felt the need to respond.
Parental rights, withdrawal or withholding treatment
Authors: Dimond Bridgit
Published: May 2014

The Glass case attracted considerable media attention and a recent decision of the European Court of Human Rights has great significance for parental rights. The facts are given in Box 1.
Blood sample labelling errors
Authors: Green Jan
Published: May 2014

The recent publication of the Serious Hazards of Transfusion (SHOT, 2003) report highlighted that 75% of reported incidents were related to an incorrect blood component being transfused. This reflects a 25% increase in the number of reports from the previous 12 months. Approximately 30% of these incidents were due to mislabelling of samples.
Evidence into practice for midwifery-led care: Part 4
Authors: Spiby Helen , Munro Jane
Published: May 2014

This is the final article describing the introduction of evidence-based midwifery practice supporting a scheme of midwifery-led care in one consultant unit. It will include experiences of the process by those responsible for the initiative. Factors that appeared to contribute to the success of the initiative and challenges for this and other similar projects are discussed, together with aspects of the work not included in the earlier articles. These include issues of context, the value of a team approach, resourcing and the involvement of key groups such as service users and midwifery educationalists.
Memories are made of this: the midwife effect
Authors: Robinson Jean
Published: May 2014

I remember clearly the face of the midwife who sat bottle-feeding my baby, though it is many years ago, and I was ill at the time. She had dark hair, and a warm, kindly face, and I was glad she was older, and somehow more motherly than the crisp, competent younger women who bustled around. As I struggled to escape from the haze which surrounded me, I could see she cradled her arm around the baby gently. I knew she could be trusted, and I was grateful.
New staff grading system: at sixes and sevens
Authors: Edwards Anne
Published: May 2014

At the RCM conference recently members were encouraged to vote for the prompt and full funding of Agenda For Change so that the Government would not jeopardise the implementation of the new pay deal by delaying it.
Correspondence
Authors: Lewis Paul , Maynell Care
Published: May 2014

While I found the article on ‘pushing in the second stage of labour’ (vol 12(8): 502) was well written and informative, I was very concerned that the pictures illustrating the supported dorsal position (Figure 1) and the McRobert's position (Figures 2 and 3) are not only misleading but dangerous and counter productive.
Maternity hospitals and suspensions
Authors: Flint Caroline
Published: May 2014

Sometimes I think to myself that I am living in a world of madness. Two things this month have me screaming inside. The first one is the category of Care Home that our Birth Centre has been placed in, and the second one is the case of the midwife who has been suspended for delivering a baby.
Stress and the midwife
Authors: Dimond Bridgit
Published: May 2014

In 1994 the High Court held that an employer owed a duty to take reasonable care of the health and safety of the employee and this duty included mental health (Walker vs Northumberland County Council, 1994). Eighteen months ago we considered the law relating to stress and bullying in the context of staffing shortages in midwifery. Subsequently one of the cases discussed in the article, which was heard by the Court of Appeal (Hatton vs Sutherland; Barber vs Somerset County Council; Jones vs Sandwell Metropolitan Borough Council; Baker vs Baker Refractories Ltd, 2002), went to the House of Lords and this article considers the implications of its decision.
Supporting antenatal screening coordinators
Authors: Harcombe Joanna
Published: May 2014

The profile of antenatal screening has risen recently due to the implementation of a new antenatal screening structure at the National Screening Committee, and the introduction of new antenatal screening programmes. This activity has focused attention on the role of the Antenatal Screening Coordinator (ASC). This role, previously confined to regional centres, is now high on the agenda at many maternity units across England. Regional Coordination of Antenatal Screening Services commenced in 2001 and there now exists a team of nine coordinators across England. This article focuses on activity within the Northern and Yorkshire region, where a small survey was conducted to inform the training plans of the ASC. Providing impartial, up-to-date information to women of what screening is available and supporting the subsequent decision-making process was cited as top priority for this group. Resource and time restraints were seen as the main barrier to the role. Appointment of a dedicated ASC would improve this situation, but this is difficult in the face of competing demands for midwifery time. Appropriate education and training could support the above, therefore a training plan has been designed and implemented that reflects the unique needs of the ANC.
Could I kill my baby? Unjustified infanticide fears
Authors: Robinson Jean
Published: May 2014

When Sian Busby had her first baby, she knew there was a history of infanticide in the family – a guilty secret, never openly discussed, but whispered by adults (Busby, 2004).