bluuebunny/crossref_metadata_2025 huggingface dataset:
A clinical guide to umbilical cord clamping
Authors: Selkirk Lisa , Blumberg Raoul , Broadhurst Ed , Penrice Juliet , Klaber Robert
Published: May 2014

Cord clamping is a routine procedure but there are potential complications that midwives should be aware of. This article provides a reminder of the physiology behind the need for cord clamping and a brief history of cord clamping methods that have been used across the world. It includes a case study to illustrate a potential consequence of inadequate clamping and offers midwives a clinical guide that considers cord assessment after clamping; what midwives should look for in caring for the cord; advice to new parents about cord care; and possible problems with the cord.
Recognizing liver disease in jaundiced infants
Authors: McClean Patricia
Published: May 2014

Serious liver disease in infancy often presents as jaundice in an otherwise healthy baby. Recognition of these babies is made more difficult by the occurrence of physiological jaundice of the newborn. It is important for midwives to be aware that in most infants, including those who are breast fed, physiological jaundice has cleared by 14 days of age. Therefore any infant who remains jaundiced beyond 14 days should have a special split bilirubin blood test. If the conjugated bilirubin is greater than 20% of the total bilirubin, the infant should be referred immediately to a paediatrician for investigation and treatment of liver disease. Early management significantly improves the long term prognosis and avoids unnecessary complications
Selecting students for midwifery education: is PBL the answer?
Authors: Meddings Fiona , Porter Jan
Published: May 2014

Midwifery programmes attract a large number of applications with an ever increasing demand for the small number of places available. Higher Education Institutions (HEI) are concerned with attracting students who have the right attributes for a career in midwifery and who are likely to succeed on the programme. Potential students however are concerned with making the right choice of HEI where they will be comfortable spending three years working towards attaining a degree in midwifery.

The University of Bradford has sought an innovative approach to the selection of students. The programme is predominantly taught through problem based learning, which enables the development of a range of skills that will benefit them in professional practice. Personal attributes required for this process can be identified at an early stage therefore a system has been introduced whereby prospective students are selected purely through the utilization of the problem based learning process.
Information for new parents
Authors: Daniel Lincia
Published: May 2014

Are young people and those expecting for the first time really informed about having a baby? Is it possible to think beyond labour and be prepared for the reality of looking after a newborn?
Assessment of the neonate: involving the mother
Authors: Blake Diane
Published: May 2014

This article discusses initiatives that will enable women and their partners to assert their influence in determining the wellbeing of their newborn infant. Midwives must ensure they support women to have control and responsibility in assessment of their newborn baby. Facilitating women and their partners in this process may reduce the risk of missed neonatal malformations. In this regard, following initial physical assessments within local practice, neonatal defects were reported. Midwives are often consumed with pressures of transferring women from delivery suite to postnatal wards, which lead to careless and hurried examinations of the neonate. Therefore encouraging parents to assess their baby's physical health will ensure an accurate account of the neonates' wellbeing. Government initiatives have supported midwives in advocating family involvement empowering women to intercede in assessing their baby's health and wellbeing. Midwives must offer women a direct approach to caring for their baby promoting ownership for the parents and maintaining high standards of neonatal care.
Understanding phenomenology: the lived experience
Authors: Mapp Taniya
Published: May 2014

This article details the use of Phenomenology as a research method which is to fully describe a person's lived experience of an event or experience. It stresses that only those that have experienced phenomena can communicate them to the outside world. It therefore provides an understanding of an experience from those who have lived it. The two schools of phenomenology which are described are utilized in both midwifery and nursing research. These are Husserlian and Heideggerian (Hermeneutics) phenomenology. The main focus in this article, however, is on the Husserlian approach, its background, data collection, data analysis methods and its application to midwifery research.
Equipment for birth
Authors: Hale Rachel
Published: May 2014

Waterbirth has been practised safely and to enormous benefit in the UK for decades (Miller, 2006). In 2006 the RCM/RCOG reported that 64% of UK hospitals had a birth pool installed, though usage varied from only 15-60% (RCM, 2000). This article will look at the benefits of water during labour and birth, and discuss the types of pool that are available for hire and purchase. There will also be a short discussion of birth balls and TENS machines for use in both the hospital and home setting.
Pinnard obsolete?
Authors: Ali Elizabeth
Published: May 2014

I feel Diane Blake doth protest too much, in her article condemning the pinnard stethoscope to the museum (Blake, 2008). The new Intrapartum Guidelines do not require confirmation of the fetal heart (FH) with pinnard either for intermittent or prior to commencing continuous recording, though obviously the convenience and comfort of the woman is the driving force behind this. The latest antenatal guidelines, as did the old, do not recommend any instrument for auscultation, as it is not deemed a required screen. More appropriate is the enquiry of the mother that she is feeling plenty of fetal movements. So, indeed, according to these authorities, the pinnard is out of date. However, I feel that what is heard with the hand-held ultrasound device (poppler or sonicaid) warrants a more detailed explanation than supplied by the article, to enable an understanding as to why skills in use of the pinnard should be taught and maintained by midwives.
Seeing and holding a stillborn baby
Authors: Schott Judith , Henley Alix
Published: May 2014

Rädestat and Christoffersen make some excellent points in the article, ‘Helping a woman meet her stillborn baby while it is soft and warm', and there is much there with which we agree. Sands (the Stillbirth and neonatal death charity) receives an enormous amount of anecdotal evidence from parents who appreciated seeing and holding their stillborn babies and being supported in doing so.
Clinical care in labour: do you have the faith?
Authors: Acton Kate
Published: May 2014

I read with interest Denis Walsh's excellent article ‘Research evidence and clinical expertise’ (Walsh, 2008) last month. I have been mentoring a selection of fantastic student midwives recently which has led me to think also about how we make decisions as midwives. Some of the students are in their first year, wondering how on earth they will ever learn everything they need to know. Others are in their final year, worried about being on their own and making the right decisions for women in labour come September. ‘How do you do it?’ they ask. ‘How did you know that the baby was just around the corner when the second stage seemed to be taking so long?'
Problem-based learning in a Canadian midwifery programme
Authors: Lobb Derek K , Butler Richard
Published: May 2014

A subgroup of a class of Canadian second year midwifery students in the Ontario Midwifery Education Programme took consecutive basic science courses with the same instructor, the first in a problem based learning (PBL) format and the second in lecture format. The students reported that the PBL format was “better” not only for their education but also for their enjoyment. Students that scored in the top half of their class in the PBL format stayed in the top half of their class in the lecture based course. Some students that were below the median in the PBL format were able to score better and move into the top half in the lecture course.
Good clinical reputation—bad day at work
Authors: Symon Andrew
Published: May 2014

When mother and baby are transferred from midwifery care with an apparently good outcome, there may be a temptation to conclude that all is well, and all will be well. However, situations can change; a legal case against a GP heard recently in the English High Court (Sumbulu v Sarker) illustrates this very well.
Developing a role for a diabetes specialist midwife
Authors: Irwin Jo-anne
Published: May 2014

Diabetes is the most common, pre-existing medical disorder in pregnancy in the UK (NICE, 2008), and continues to have associated risks for the mother, fetus and neonate (CEMACH, 2007). Worldwide diabetes is becoming more prevalent (Macfarlane, 2006) and type 2 diabetes in the childbearing population is on the increase. The role in which the midwife should take in such pregnancies has come under question as not all units have diabetes specialist midwives (Miller, 2005). This review will seek to discuss the dilemma for midwives delivering care to pregnant women who have diabetes.
Birth centres in the East Midlands: views and experiences of midwives
Authors: Thorgen Anneli , Crang-Svalenius Elizabeth
Published: May 2014

In order to investigate midwives' views and experiences of working at birth centres a qualitative interview study was performed at three birth centres in the UK. Nine midwives were recruited for personal interviews via snowball sampling. Qualitative content analysis was undertaken with the identification of categories and themes. Autonomy of practice emerged as the main category with five subcategories: midwifery aspects, professional development, flexibility and work demand, independence and interprofessional relationships. The main outcome of this study was the autonomy the midwives felt by practising and promoting normal midwifery care. Many midwives also expressed a feeling of increased confidence and professional development by working in a birth centre. Experiences of flexibility and work–life balance were generally positive. Continuity of care was much appreciated. Negative aspects were mainly associated with high work pressure, staff shortages and at times a demanding work environment. The different localizations of the birth centres had both advantages and disadvantages.
Fathers' involvement in antenatal screening: midwives' views
Authors: Reed Kate
Published: May 2014

Research on fathers' roles in antenatal screening has grown in recent years. Such research has emphasized the increasing importance of men's roles as supporters of pregnant partners undergoing screening, and as potential fathers interested in the wellbeing of their baby. Despite this increasing attention to men's roles in screening, existing research has tended to concentrate on seeking the views of those whose partners are undergoing screening. The views of professionals involved in screening are seldom explored. Drawing on a small scale empirical study with midwives in a northern city in the UK this article seeks to develop an understanding of men's participation in screening from a professional perspective. The article will highlight a number of interesting issues on this subject from attendance at screening to issues of paternity. The article concludes by emphasizing the importance of midwives' contributions, making suggestions for further research in this area.
Fathers' perspectives on breastfeeding: ideas for intervention
Authors: Sherriff Nigel , Hall Valerie , Pickin Martina
Published: May 2014

This article presents the findings of a small-scale qualitative study with fathers which was part of a larger social marketing project focusing on increasing rates of exclusive breastfeeding in Brighton and Hove. In-depth semi-structured interviews were used to explore fathers' experiences during the pregnancy, birth and up to the first year. Findings revealed a number of potential areas which may be of use to midwives, health visitors, and other health professionals to increase the initiation and continuance of breastfeeding. In addressing these possibilities, we also discuss a number of practical ways forward and suggest areas for future research.
Child protection – safeguarding children
Authors: Griffith Richard
Published: May 2014

In this final article considering how the law protects children from abuse, Richard Griffith discusses the investigation of abuse and the role of the law in this process. To fulfil their role in protecting children midwives must have a working knowledge of this process and the orders that support them.
Embodiment: a crucial concept for midwives
Authors: Walsh Denis
Published: May 2014

Two midwifery publications in recent months have addressed the concept of ‘embodiment’ and both highlight the centrality of this sociological concept for midwives. Whether we articulate it or not, all of us are applying in clinical practice our particular understanding of this word. I want to argue here that although we may have a preferential ‘take’ on the concept, it is best if it can be flexible and adaptable.
Maternity care pathways and the law
Authors: Griffith Richard
Published: May 2014

Care pathways are used by midwives to ensure the quality of maternity care delivered to mothers is consistent and efficient. The pathways seek to address one of the key challenges facing maternity services today; making the best use of limited resources, while providing high quality, timely, evidence-based care.
How can supervisors of midwives influence the outcome of labour?
Authors: Phipps Jan
Published: May 2014

As a team of supervisors of midwives (SOM) we are proactive in ‘promoting childbirth as a normal, physiological event’ (NMC, 2006). We have signed up to decreasing the caesarean section rate in our trust, in particular, the high number of repeat caesarean sections that are carried out. As a way forward we held a meeting with our obstetric colleagues to arrange the initiation of a vaginal birth after caesarean section (VBAC) clinic.
Women in labour: feel the pain or feel a failure?
Authors: Clift-Matthews Victoria
Published: May 2014

Last month comments reported in the press about pain in labour from one of our board members, Denis Walsh, created a furore among women across the country. It seems a number of women were incensed at what they read about childbirth pain having a function and the suggestion that epidurals these days are given too freely. Indeed, I had dinner with my mother and sister the day of the story and it wasn't long into our dinner before one of them brought up the ‘outrageous’ comments of this ‘typical man’.
A national survey of the use of TENS in labour
Authors: McMunn Valerie , Bedwell Carol , Neilson James , Jones Anthony , Dowswell Therese , Lavender Tina
Published: May 2014

Transcutaneous electrical nerve stimulation (TENS) is a non-invasive method of pain relief, regularly used by women in labour. The National Institute for Health and Clinical Excellence (NICE) intrapartum care guidelines do not recommend its use on grounds of ineffectiveness to reduce pain. However, the recent Cochrane review challenges this guidance, as previous studies have limited capability to exclude an effect, and there is evidence that some women choose TENS as their preferred method of pain relief. We aimed to explore whether the NICE guidelines have impacted on health professionals' support for the use of TENS, and to determine support for a possible clinical trial of TENS. We therefore conducted a national survey of all maternity units in England; responses were received from 139 (76%) of the units. The findings demonstrate overwhelming support for TENS use. Furthermore, the survey identified a willingness among midwives to conduct a multi-centre trial of TENS versus usual care. We conclude that the combination of a dearth of robust evidence together with midwives' beliefs that TENS should be an available pain relieving option, confirms the need for a randomized controlled trial.
Coming late to motherhood: a workshop for professionals
Authors: Baxter Jackie
Published: May 2014

Midwives and obstetricians at University College London Hospitals NHS Foundation Trust (UCLH) provide care for a significant number of women who are of a higher maternal age. A bid was successful and funding obtained for a workshop. The grant was a University College London (UCL) Futures Grant awarded for a workshop series on older women in the Institute for Women's Health. This workshop aimed at increasing knowledge and awareness in this under-researched area of care. The multidisciplinary team met together. Users also attended as both participants and within the audience. Experts from various disciplines in the area presented the many issues faced by pregnant women who are 35 years old and more.
Improving health-care services in rural areas of Nigeria
Authors: Daniel Lincia
Published: May 2014

In Nigeria 2000 midwives are taking up positions in rural areas as part of a recruitment drive for 10 000 new midwives across the whole country to improve access to services such as antenatal care.
Demise of the Albany is a blow to the midwifery profession
Authors: Harrington Rebecca
Published: May 2014

The cancellation of the Albany Midwifery Practice's contract with King's Hospital NHS Foundation Trust marks the end of a pioneering way of providing midwifery care. Since its conception in 1997 it has been regarded by many as the ‘gold standard’ and has been inspiring midwives across the country. The decision has been met with an overwhelming response, with women who have been cared for by the Albany midwives mobilizing to try and save the practice and asking King's to justify their decision.
Support and information about Down's syndrome
Authors: Gammons Sue , Sooben Roja D , Heslam Sheila
Published: May 2014

UK policies emphasize the importance of providing balanced and accurate information on Down's syndrome to pregnant women and supporting them to make informed choices about screening, diagnostic tests and, ultimately, whether or not to continue their pregnancy. This article presents key findings of a study that investigated the experiences of new parents of babies with Down's syndrome and the views of midwives and antenatal screening co-ordinators (ASCs) on what information and support is provided during pregnancy and at birth. While midwives/ASCs believe they provide information and support, the experience of parents indicates variability in how effectively these professionals deliver information to mothers and support them in making informed choices. This study reinforces the need for further training on what it is like to live with Down's syndrome in today's world for health professionals working in maternity services.
One-To-One with…
Authors: Lavender Rebecca
Published: May 2014

Can you give me a brief summary of your midwifery career to date?
When will we change practice and stop directing pushing in labour?
Authors: Cooke Alison
Published: May 2014

There have been many papers written about the issue of pushing in the second stage of labour, and yet anecdotally some midwives are still restricted by labour ward policies of timed second stages, active pushing once fully dilated and subsequent interventions when time runs out.

Research is fraught with frustration on occasion; some studies stop early because of preliminary findings indicating obvious benefits, while others, although offering beneficial findings, are often ignored and traditional practices continue. This article considers the research supporting spontaneous pushing in labour; it asks why change is so difficult and then considers what could be done to encourage a change in practice.

The article finds that women should be allowed to push spontaneously. A change in clinical practice is recommended. It considers whether further research is necessary, or whether a change in the definitions used for the stages of labour would allow midwives to let women dictate when to push.
Clinical mentors' influence on student midwives' clinical practice
Authors: Armstrong Nicola
Published: May 2014

The aim of this study was to find out whether final-year student midwives were influenced by traditional (non evidence-based) practices of their clinical mentors.

Questionnaires were used to collect data from 145 students from five different universities spread across the North of England. Despite students having perceived that the higher education institution (HEI) advocated evidence-based practices (EBP), the majority of students felt that what was taught in the HEI, did not always correspond to what happened in the workplace. Most agreed that within the clinical setting there were some practices that were based on tradition and agreed that some of these practices were good because they appeared to work. While the majority of students indicated a preference towards using EBP, the findings suggested that, where there was an embedded use of traditional practice within the workplace, the students were more likely to adopt these traditional practices of their mentors. While statistically most perceived they would challenge their mentors if they did not employ EBP, their comments overall conflicted with these findings, as many felt that by challenging their mentors they might jeopardise their clinical assessments and career prospects.
Preconception care for women with diabetes: the midwife's role
Authors: Hughes Clare , Spence Dale , Holmes Valerie A , McCorry Noleen K
Published: May 2014

Diabetes mellitus is a chronic illness which affects a significant number of childbearing women. Despite the potential for adverse consequences for both maternal and fetal wellbeing, few women with diabetes plan their pregnancies to ensure that they enter pregnancy in optimal health. Furthermore, while adverse pregnancy outcomes are well documented for women with type I diabetes, it is now apparent that an increasing number of women with type II diabetes are becoming pregnant with similar adverse associated risk. There is an increasing recognition that significant adverse pregnancy outcomes are determined before a woman initiates pregnancy care, many of which could be minimized with the introduction of preconception care. As formalized preconception care clinics remain scant across the UK, there is an urgent need to increase the opportunities for the provision of preconception care and advice to women with diabetes. Midwives are ideally placed to provide preconception advice to women and could provide the missing link in terms of preconception advice for women with diabetes.
Improving practice: women's views of a maternity triage service
Authors: Molloy Cathy , Mitchell Theresa
Published: May 2014

A new triage service was initiated in an acute trust in southwest England to assess women who presented with a problem in their pregnancy but who did not necessarily require admission to delivery suite.

Questionnaires were used to obtain the views of women using triage and to identify areas which they thought were good practice and also identify those areas that required improvement. Data were analysed using the SNAP survey software which enabled basic features within the data to be described.

Most women were happy with the amount of time they waited in triage which appears to negate the need for appointments. Women were satisfied with the amount of time they spent with the midwife and obstetrician and reported being treated with dignity and respect, although there were some problems relating to the triage environment.
Revisiting a social model for antenatal and postnatal care
Authors: Walsh Denis
Published: May 2014

It was nearly a decade ago that Mary Newburn and I wrote two papers on the application of a social model to the different phases of maternity care (Walsh and Newburn, 2002a; 2002b). Since then, the National Institute for Health and Clinical Excellence (NICE) has published national guidelines in all three areas of antenatal, intra-partum and postnatal care. With the advent of new approaches to delivering antenatal and postnatal care, it is timely to revisit both these areas to assess how much current mainstream provision reflects a social model.
The complexities of supporting teenagers in pregancy
Authors: Thompson Sue
Published: May 2014

This article describes the multifactorial issues that are involved when providing appropriate care to teenagers who become pregnant. The teenage pregnancy clinic was set up over 10 years ago in Liverpool by an innovative midwife, Lorna Wood, with the support of a consultant obstetrician. The pregnant teenager's journey begins at the booking in visit, continuing throughout antenatal care and ends at the postnatal visit, approximately 6 weeks after the birth.

The article highlights the importance of the careful, accurate assessment of each individual in order to provide an optimum, flexible plan of care for both mother and baby.

The success of the clinic can be measured in many ways, not least the very low rate of non-attendance. The outcomes are good and the rate of repeat pregnancies is low, (less than 3% each year). This is in part owing to the provision of contraception at the postnatal visit and continuity of care throughout by the two midwives involved.
Promoting normal birth: Appropriate use of intrapartum cardiotocography
Authors: Thompson Heather
Published: May 2014

Evidence has demonstrated that electronic fetal monitoring during labour increases the likelihood of intervention without having a positive effect on neonatal outcomes including cerebral palsy, infant mortality or other measures of wellbeing ( Alfirevic et al. 2006 ). Many midwives believe cardiotocography (CTG) leads to unnecessary interventions, yet continue to use this technology instead of practising intermittent auscultation. This article explores the reasons behind the reliance on CTGs and suggests ways in which practice may be improved.
Suturing of labial trauma: An audit of current practice
Authors: Jenkins Ellie
Published: May 2014

There is minimal research to support the practice of non-suturing or suturing of labial trauma associated with childbirth. A local audit of 63 women was conducted to look at midwives’ and obstetricians’ management of postpartum labial trauma. Results showed that labial trauma is recorded as tears or grazes, and 52.4% of labial trauma was sutured and 47.6% was left unsutured. Tears are sutured more often than grazes. The preferred suture material is Vicryl Rapide Gauge 4.0. The majority of cases were sutured with a continuous ‘oversew’ technique (33.4%). Labial trauma occurs daily in a unit of approximately 6000+ deliveries a year so the lack of research is a concern if treatment is being delivered with little knowledge of efficacy or long-term outcomes.
Why do some women prefer birth by caesarean? An internet survey
Authors: Hull Pauline McDonagh , Bedwell Carol , Lavender Tina
Published: May 2014

Caesarean section at maternal request remains a contentious issue, fuelled by reports of associated morbidity. To explore the motivations behind women’s expression of preference for a planned caesarean birth, an internet survey was conducted using semi-structured questionnaires available via a UK-based international website, www.electivecesarean.com, over a 9-month period. A convenience sample of 359 pregnant women who stated that their preferred delivery method was ‘elective caesarean section through my own choice’ was included. Data were analyzed descriptively and thematically. Women from 16 countries were included. Two main themes were identified: 1) anti-vaginal birth; and 2) physical and psychological validation. Women who were anti-vaginal birth had a fear of morbidity (maternal and neonatal) and of the birth experience. They viewed vaginal birth as unpredictable and saw planned caesarean birth as a safer alternative. Some women justified their decision of birth mode by referring to either a physical or psychological issue that related to a previous birth or an existing medical complication. Respondents had similar views regardless of country of residence. We concluded that women have multiple reasons for wanting a caesarean birth. These reasons are usually considered, and motivated by a genuine desire to avoid the potential problems of vaginal birth. Individualized birth consultations should include discussion of the risks and benefits of vaginal and caesarean birth as they relate to individual women.
Diary of a mature student: Is it too late to become a supervisor of midwives?
Authors: Barker Karen
Published: May 2014

This article follows the progress of a mature and experienced midwife undertaking the Preparation for Supervisors of Midwives course (PSOM). It provides an outline of the course content and challenges and identifies what qualities are needed for success. If you are contemplating undertaking the course or indeed have never even considered it then this is for you. It might reap personal and professional rewards.
Newborn deaths in China cut by half due to more hospital births
Authors: Bainbridge Jane
Published: May 2014

A study of 1.5 million births in China has shown that babies born in hospitals were between two and three times less likely to die in their first month than those born at home.
Universal risk assessments to guide use of thromboprophylaxis
Authors: Bennett-Day Sarah
Published: May 2014

The recent development of universal risk assessments aimed at reducing incidence of venous thromboembolism (VTE) in pregnancy and puerperium has been driven by a national campaign aimed at reducing VTE in the general population. However, limited high-grade evidence exists to determine unique risk factors associated with VTE and pregnancy and the benefit of thromboprophylaxis treatment regimens. Current suggested risk factors are based on low-grade evidence, and these risk factors may be relatively common in pregnant women. Therefore, a low threshold for intervention means that a significant number of women may be offered thromboprophylaxis. In recent years healthcare policy has been strategically linked to commissioners paying healthcare providers for each patient seen via Payment by Results (PbR) schemes ( Department Health (DH), 2011 ). One such payment framework, Commissioning for Quality and Innovation (CQUIN) ( DH, 2010 ) aims to provide higher quality care by linking a proportion of income to achievement of quality improvement goals; in this instance, the mandatory collection of VTE risk assessment data. Such schemes are powerful policy levers. In the important drive to reduce VTE, practitioners have a duty to question whether routine risk assessments for all pregnant women based on universal government payment campaigns will enhance practice or be detrimental and lead to increased intervention. Numerous unintended consequences potentially exist including physical and emotional harm, disempowerment of women, and threats to current perceptions of ‘normality’. In this sense it is necessary to ensure that any new intervention is balanced with regard to any potential negative impact on women's access to care options and informed choice.
Use of the lithotomy position for low-risk women in Perth, Australia
Authors: Bayes Sara , White Christine
Published: May 2014

In the first half of 2010, it was noted that an increasing number of low-risk women who gave birth spontaneously at term in one Western Australian maternity unit did so in the lithotomy position, which is known to carry a number of associated risks for women. A snapshot review of case notes was undertaken to try and determine the causes, consequences and decision-making surrounding this intervention. The review revealed that in 39% of cases (n = 12), no evident need to move the woman into lithotomy was documented. In 20% (n = 6) of cases, being moved into the lithotomy position was associated with the woman sustaining a perineal tear involving the anal sphincter. Discussion with the woman about moving into lithotomy was not recorded in any case. Anecdotally, it seems that some midwives may move women into the lithotomy position in a well-meaning attempt to optimize their chances of achieving a normal birth within the time limits available to them. Further investigation is needed to determine midwives’ views, practices and rationale for the use of lithotomy in low-risk women.
Short-term international midwifery consultancy: Discussing the need
Authors: D. Maclean Gaynor
Published: May 2014

This article is the first in a series of three articles concerning short-term international midwifery consultancy. It is presented against the background of global efforts to achieve the Millennium Development Goals (MDGs) with a specific focus on the reduction of maternal and perinatal mortality and morbidity. The article addresses the first two of six critical questions that can legitimately be considered by a midwife contemplating this kind of work. Consultancy in this context is first defined and discussed and then differing approaches are presented. The current need for midwifery consultants is considered and the framework within which the midwife is required to work is explored and examined in some detail.
What is in the bag? Birth essentials for the independent midwife
Authors: Hughes Kim
Published: May 2014

Midwives attending home births carry essential obstetric equipment to monitor the wellbeing of mother and baby and to deal with problems that may occur unexpectedly at birth.

This article looks at the obstetric equipment needed and used by midwives in the community, from the perspective of a midwife based in an independent practice in Yorkshire.
The risky business of supervision, 2: Gaining skills and knowledge
Authors: Richards Julie
Published: May 2014

The role of supervisors of midwives (SoM) with regards to risk management is set out in Rule 15 of the Midwives Rules and Standards ( Nursing and Midwifery Council, 2004 ) to ensure that incidents which cause serious concern relating to maternity care or midwifery practice are notified to the local supervising authority midwifery officer (LSA MO). Case study research was undertaken to explore the interface of SoMs in the notification of critical incidents and provided a detailed and balanced account of the phenomenon of statutory supervision and their role in notification of serious untoward incidents. This article will provide greater insight into the experiences of supervisors of midwives and the way they gain the skills and knowledge required for the role.
The impact of exhaustion on Step 6 of the Baby Friendly Initiative
Authors: Jones Eleanor
Published: May 2014

Maternal tiredness can be a significant factor in the choices women make about exclusively breastfeeding. Using a variety of viewpoints known as a patchwork text, elements of maternal exhaustion have been explored to better understand how this phenomenon in the early postpartum period can affect the continuation of breastfeeding. The first patch is a personal reflection following an experience of supporting a woman to breastfeed. The second patch explores media and society and the possible impact on women's perceptions of motherhood. The third patch portrays the woman's feelings through expressive writing, and the final patch synthesizes the themes identified in Patches 1, 2 and 3 and concludes that maternal tiredness can have significant impact on breastfeeding outcomes.
Acquiring cultural competency in caring for black African women
Authors: Esegbona-Adeigbe Sarah
Published: May 2014

The recent findings of the Centre for Maternal and Child Enquiries (CMACE) (2011) report ‘Savings Mothers’ Lives’ has highlighted the high mortality rates among women of black African ethnicity, particularly those who have newly arrived in the UK. Failure to engage with maternity services was found to be a common trend with this group of women, and this may be linked to cultural differences in expectations of healthcare services. Of the 28 black African mothers who died from direct or indirect causes related to pregnancy between 2006 and 2008, only 9 were UK citizens; significantly, the remaining 19 women were recently arrived immigrants, refugees or asylum seekers ( CMACE, 2011 ). In recent years, a greater emphasis has been placed on health professionals recognizing and appreciating diversity in order to acquire cultural competency. Cultural knowledge is the most important construct of cultural competence for health professionals, being crucial for the accurate appreciation of a patient’s worldview ( Okrentowich, 2007 ). This review explores issues around immigrant black African women’s health in the UK during pregnancy and stresses the benefits for midwives to acquire a level of knowledge and awareness of black African culture to enable the provision of culturally‐appropriate maternity care.
Cheri's top tips for new students
Authors: Price Cheri
Published: May 2014

Cheri Price, newly qualified midwife, discusses how to support pregnant women new to the UK
Secure transfer of postnatal information: The STOW project
Authors: Morris-Thompson Trish , Easton Suzanne , Read Jessica , Marks-Maran Di
Published: May 2014

In London, it is estimated that about 10% of women deliver in one NHS trust but receive postnatal care in another area. Transfer of postnatal information about women and babies is done via fax. A more reliable method of communication was needed. A pilot project, the Secure Transfer of Women (STOW), was undertaken in four NHS trusts in north London to test the transfer of postnatal information via email, using NHSmail between the maternity units. Communication with other NHS trusts would continue via fax. Training and IT support was provided in the pilot NHS trusts.

An evaluative study undertaken showed that members of staff liked the system. They felt that email transfer improved the service for mothers and babies. Maternity units also received fewer calls from mothers to say that they had not yet had their postnatal visit. Postnatal transfer of information via email is now being rolled out across London.
Problem-solving and communication skills in clinical practice: A reflection
Authors: Younger Mimi
Published: May 2014

As part of pre-registration midwifery education, the Nursing and Midwifery Council stipulates that students need to progressively develop essential key skills including problem-solving and communication. It is insufficient for these skills to be understood on a purely academic level; they need to be applied in clinical practice. This reflective account illustrates how progression and attainment of these skills and the application thereof is an achievable standard. Additionally it demonstrates the requirement for students to build on these skills so that they learn to effect positive outcomes in challenging situations which occur frequently in the midwifery profession.
The use of donor milk to support women's choices
Authors: Howard Helen
Published: May 2014

This article considers the need to support women's choices, by referring to a Case Study in which a woman required donor breast milk. Diagnosed with breast cancer whilst pregnant, the lady still wanted her baby to receive breast milk until she was able to breastfeed herself, once the chemotherapy medication was out of her system. As Infant Feeding Coordinator, I wanted to explore all the options available to support her choice.
Caesarean section at maternal request: An update
Authors: Thompson Heather
Published: May 2014

The argument for and against caesarean section performed at a woman's request in the absence of a medical indication has always been a source of extensive debate in the media and the medical professions. The National Institute for Health and Clinical Excellence (NICE) has published an updated version of its guidance on caesarean section which includes suggestions on how to respond to a woman's request for caesarean section, including offering operative delivery to those who want it. This article aims to explore recent research findings, in conjunction with the new guidance, and assess the impact these may have on current practice.
The Maternity Services Improvement Programme for London
Authors: Thompson Trish Morris , Richardson Margaret , Wallace Meryl , Marks-Maran Di
Published: May 2014

In January 2008 the Healthcare Commission published a review of maternity services in England. In the review, 19 of the then 27 provider maternity units across London were identified as ‘least well performing.’ NHS London established a Maternity Services Improvement Board (MSIB) who created a work programme to make improvements to maternity services across London. This article identifies the work undertaken by the MSIB and the results of an evaluation audit that was undertaken to measure the extent to which the deliverables identified by the MSIB were achieved. The results of the evaluation show that 16 out of the 19 maternity units had fully implemented their action plans during the lifespan of the MSIB (March 2010). The remaining trusts had actions that could not be implemented in an 18-month period, e.g. re-building a maternity unit and building midwife-led birth centres. With the work of the MSIB now at an end, this article also identifies the handover to local trusts and commissioners of the continuing work to improve maternity services in London and how NHS London will sustain the improvements to maternity services.
LOFIR: Introducing a framework for building midwifery-type questions
Authors: Edwins Jennifer
Published: May 2014

Midwifery is an evidence-based profession. Evidence is drawn from a wide range of disciplines and midwife researchers are increasingly generating a distinct body of knowledge to support high quality care for women and their babies. Every enquiry must begin with a good question. This is the first step in the evidence-based practice cycle but existing question-building tools have largely emerged from the paradigm of evidence-based medicine. The questions student midwives want to develop often relate to women's experiences, rather than a comparison of treatment options. A framework to support the development of midwifery-type questions has not previously been differentiated. The LOFIR (theoretical location, focus, intervention, result) tool offers an alternative framework to facilitate the development of effective midwifery-type questions.
Maternal reflection on labour pain management and influencing factors
Authors: Rachmawati Imami Nur
Published: May 2014

Childbirth is a critical time in a woman's life, during which most women experience high-intensity pain. This study used an interpretive phenomenology approach (hermeneutic phenomenology) to describe the phenomenon of labour pain management in Indonesia from the mother's perspective. Interviews were conducted using semi-structured questions with field notes with seven women who had recently experienced childbirth. They were also observed during childbirth. Each interview was transcribed and analyzed using the Van Manen method. The results revealed six interrelated themes: the negative experience of labour pain; prior knowledge to alleviate pain; anxiety but pain must be faced; desire to handle labour pain; desire to be accompanied; and awareness of the mother's needs. The findings showed that women handle labour pain in their own ways because of a lack of information about the childbirth process and a belief that pain should be expected. The findings suggest that the maternity service in Indonesia is not sufficiently oriented to the mother. Healthcare providers need to provide a caring relationship and environment to meet the mother's needs.
Systematic reviews: the good, the not so good and the good again
Authors: McGowan Linda
Published: May 2014

Systematic reviews provide a rigorous approach to combining research findings across several studies. They follow a structured protocol and are specifically designed to control for the various types of bias that can threaten the review process. Systematic reviews provide a more scientific approach to a review of existing research where included studies are also rated for quality of included studies. They are a useful resource for student essays and dissertations as a way of gaining knowledge about a topic area because they strive to cover as much of the relevant published and unpublished literature as possible. For busy practitioners they offer a useful way of keeping up to date with the evidence-base. Systematic reviews are considered to be at the top of the evidence hierarchy, as such they provide midwives and student midwives with a sound basis on which to base their practice.
Retained vaginal swabs: review of an adverse event in obstetrics through closed claims analysis
Authors: Healy Patricia
Published: May 2014

Background:

An integrated approach to clinical risk management and litigation claims management in the health service is essential to drive and support safe patient care. This approach identifies adverse events and enables learning from those events.

Objective:

To explore the issue of retained vaginal swabs in the maternity services and to identify common themes and areas for improvement.

Methods:

Closed claims analysis using retrospective review of legal case records held by the State Claims Agency in Ireland for the period 2004–2011.

Subjects:

Litigation cases handled by the State Claims Agency regarding alleged vaginal retention of a surgical swab following childbirth.

Results:

Review of the 16 closed cases revealed 3 major areas of concern; staff clinical performance, workload issues and documentation.

Conclusion:

Cases of retained vaginal swabs were few in number. However, they represent a significant problem in that they are very difficult to defend in clinical negligence litigation, as they reflect the failure of clinicians to comply with practice standards around a clinical procedure. Maternity service providers must put measures in place to manage this preventable clinical risk.
Research midwives: Importance and practicalities
Authors: Rowland Lois , Jones Charlotte
Published: May 2014

High quality research is imperative to provide women with up-to-date evidence-based practice. Midwives can be integral in a multidisciplinary research team as they are in a unique and privileged position to understand the needs of pregnant women and already possess many of skills that are required for research. The role of a research midwife can be very varied and include designing studies, recruiting and gaining consent, collecting and analysing data, and disseminating results. The research midwife role provides many opportunities to improve current skills and learn many new ones. The experience gained may lead to a rewarding career in research or enhance clinical practice.
Asking women to complete health and maternal histories for maternity records: A qualitative study
Authors: Aitchison Patricia E , Entwistle Vikki A , Teijlingen Edwin van , Whitford Heather M , Davidson Tracey , Humphrey Tracy , Tucker Janet S
Published: May 2014

Midwives usually document women's health and maternal histories during booking appointments. This qualitative study of use of the Scottish Woman Held Maternity Record (SWHMR) found some midwifery teams were asking women to document their own histories before these appointments. Pregnant women and midwives from these teams thought this could save midwives time, improve the accuracy of records and lead to more individually appropriate discussions. However, some women were disappointed that midwives had not fully discussed what they had written. Some midwives from teams that had not asked women to document their own histories were sceptical about the likely accuracy and usefulness of women's entries. If the potential advantages of asking women to document their own histories are to be safely realised, support must be available for women with limited English or reading and writing skills, and midwives must have time to review and discuss what women write.