bluuebunny/crossref_metadata_2025 huggingface dataset:
Spinal lesions causing cord compression: a practice-related evaluation of care
Authors: Warren Diana
Published: May 2014

This paper will analyse the management and symptom control of spinal tumours within health and social care delivery, and how this may benefit a patient’s experience. As long-term disease occurs across the whole spectrum of health; physical, economical, social wellbeing and mental health will be analysed with view to assess the impact they have on physical symptoms. The author will look at self-care and management of symptom control and how this is cost-effective while promoting self-efficacy. The new role of the community modern matron will be examined into accessing services for support and self-help.
Place of death: a question of equity of care
Authors: Chapman Simon
Published: May 2014

It is important that people approaching the end of life are able to decide where they want to die. It has been found there is a considerable divergence over place of death for people with neurodegenerative diseases and the rest of the population. Those with neurodegenerative diseases should not be treated differently.
Sexual dysfunction in multiple sclerosis: part 1
Authors: Ward-Abel Nicki , Hall Joy
Published: May 2014

Multiple sclerosis (MS)-related sexual dysfunction affects a significant amount of those diagnosed. Its effects can impact on an individual’s self-esteem as well as their intimate relationships; it can significantly reduce quality of life. There are a variety of ways sexual function is affected by MS including erectile dysfunction, reduced libido, impaired genital sensation and difficulty with orgasm. Despite these devastating symptoms, many health and social care professionals ignore or avoid issues associated with sexuality, body image and sexual function, thus they are poorly managed. If the practitioner is to become more familiar with this area of practice and be in the best position to educate and enable the individual to manage this part of their illness, it is essential they are well informed. This article is the first of two which aims to demystify sexual dysfunction as experienced by those with MS. It will discuss the pathophysiology of sexual function as a normal process and then examine what happens to those with MS. It will also revisit sexuality and body image to establish how this is affected. The authors will suggest methods that enable the practitioner to feel more confident, at ease and skilful in assisting individuals self-manage their sexual difficulties.
Effective headache management in the aneurysmal subarachnoid haemorrhage patient
Authors: Mahon Paul , Smith Breffni , Browne Jayne , Hawkshaw Susan , McEvoy Linda , Greene Karen , Rowan Ciara , Markey Fiona , Trehy Sharon
Published: May 2014

Subarachnoid haemorrhage (SAH) is described throughout the literature as a devastating neurological disorder associated with significant mortality and morbidity rates, arising not just from the haemorrhage itself, but also as a result of the catastrophic multisystem sequelae that can accompany the condition. Rupture of an intracranial aneurysm accounts for up to 85% of instances of SAH, occurring in approximately 6–7 people per 100 000 in most populations and costing an estimated £510 million annually in the UK alone ( Rivero-Arias et al. 2010 ). Treatment of aneurysmal SAH (aSAH) includes prevention of re-bleeding, evacuation of space-occupying haematomas, management of hydrocephalus and prevention of secondary cerebral insult. Headache has been highlighted as the predominant, most characteristic and often only symptom of aSAH, its severity having a variety of physiological and psychological effects on the patient. This paper summarizes the findings of a literature review conducted as part of a research study to examine existing practices in the assessment and management of headache in patients with aSAH in an Irish Neurosciences Centre. The review demonstrates that, despite a wealth of published literature on the diagnosis and management of aSAH, evaluation and management of its main symptom, headache, remains suboptimal and under-researched. The lack of available literature demonstrates that such enquiry is both timely and necessary.
Anti-NMDA receptor antibody encephalitis: a new challenge in the diagnosis of psychosis
Authors: Marsland Laura , Bray Joy
Published: May 2014

Anti-NMDA receptor antibody encephalitis is a relatively newly described disease of the central nervous system that commonly presents with acute psychosis and behavioural difficulties, both of which offer significant challenges to its effective management. For this reason, treatment of patients with the disease is preferably shared between the disciplines of neurology and psychiatry. It is important that medical, nursing and multidisciplinary staff working in both specialties are able to recognise and manage both its characteristic neurological symptoms and its psychiatric manifestations.
Improving quality of life for men using intermittent self-catheterisation
Authors: Woodward Sue
Published: May 2014

Clean intermittent self-catheterisation (CISC) is often a treatment option for men with urinary incontinence, particularly those with neurogenic bladder dysfunction. In appropriate patients it has been shown to promote continence, maintain safe bladder function and improve quality of life. CISC can promote privacy and dignity for men with urinary incontinence due to impaired bladder emptying. Patient choice regarding product selection is important. There are a range of different products available on prescription for patients, and many have been designed specifically with men in mind. Nurses need to keep up to date with new product availability in order to offer choice to men performing CISC. The LoFric Origo is a new catheter that has recently been added to the UK NHS Drug Tariff.
Parkinson's disease: making the diagnosis and monitoring progression
Authors: Magennis Brian , Corry Margarita
Published: May 2014

As research advances knowledge of illnesses, nurses need to keep abreast of developments. Although advances in knowledge of the pathology of Parkinson's have been limited, there has been some advance in understanding the involvement of the pre-motor areas of the brain and the final pathways to cellular death. This paper, the first of a three-part series, explores current approaches to diagnosing Parkinson's and advances in knowledge of the pathological changes that take place and the signs and symptoms of the condition. In part two of the series, ten common causes of sudden deterioration in Parkinson's will be explored, along with approaches to management. Part three will discuss medical advances in the management of Parkinson's and how these affect the role of the nurse.
Early pregnancy loss: men have feelings too
Authors: Murphy Fiona A , Hunt Sheila C
Published: May 2014

Early pregnancy loss occurs in one in four pregnancies. The role of men, as they share the feelings and try to support their partners, has received little attention. Utilizing a phenomenological approach, the aim of this study was to describe the experience of early miscarriage from a male perspective. It suggests that at least for these men, miscarriage is a difficult and painful situation. In addition to coping with their own feelings, which may not be acknowledged, they have to cope with the feelings and grief of their partner. Effective intervention should be based on an awareness of the effect that early miscarriage has on both partners. Midwives and other practitioners can make a difference to a couple's experience by increasing their understanding of their needs.
Appraising a randomized-controlled trial to enable informed choice
Authors: Oliver S , Crowe S , Needham G
Published: May 2014

This article asks whether routine amniotomy is good for childbearing women and their babies, and what can we learn from a randomized controlled trial. It discusses questions which can help readers judge whether a study is valid for assessing the effects of care, interprets the results and decides whether the findings are relevant to them.
Feast or famine? Oral intake during labour: current evidence and practice
Authors: Berry Harriette
Published: May 2014

To feed or fast women in uncomplicated labour continues to be the subject of heated professional debate. This article examines the basis for maternity unit policies which enforce fasting of parturients and presents current policies and practices of English maternity units as elicited by a recent survey. Seventy out of eighty (87.5%) maternity units throughout England responded to a postal survey conducted to elicit information regarding oral intake policies during labour, to observe if units utilize selection criteria for oral intake and whether units differ in this regard. Of all units, 52.9% do not have restrictive oral intake policies, which is a greater percentage than observed in previous years. Of the units utilizing selection criteria, there is a wide variation in policies between units. Chi-square analysis demonstrated there was no significant difference between the units in terms of oral fluid policies; however, differences exist between consultant units and other units with regard to oral food policies. Midwifery managers are not involved in policy division in 33.3% of units with restrictive policies.
Smoking cessation in pregnancy: a multiple contact approach
Authors: Gleeson Carole , Memon Iqbal , Milner Margaret , Baines Sanchia
Published: May 2014

This article introduces a research project currently in progress to assess the effectiveness of multiple contact support as an intervention measure in smoking cessation among pregnant women. Little work has been done to confirm or dispute this method as an effective means of supporting pregnant women although the literature recognizes that it may well be appropriate. The study, involving 200 women, reflects the work of Prochaska et al (1994) in their stages of change approach and aims to bring about a positive change in smoking status which will be maintained after delivery of the infant.
RCOG recommends routine antenatal anti-D
Authors: Madden Vicki
Published: May 2014

The long awaited green top guidelines which recommend routine antenatal prophylactic use of anti-D immunoglobulin (Ig) in Rh negative women have recently been published by the Royal College of Obstetricians and Gynaecologists (RCOG) (1999).
Listening to mothers: improving evidence-based practice
Authors: Richens Yana
Published: May 2014

Recently I met a woman and her granddaughter while taking my daughter to school. We walked together and during our conversation the grandmother asked me whether I worked and what I did. Like many other midwives I was reluctant to tell her, but I did and then prepared myself for her obstetric history.
Part 11: Midwifery registration
Authors: Dimond Bridgit
Published: May 2014

In previous steps articles the accountability of the midwife in civil, criminal and disciplinary proceedings has been discussed. In this article the registration provisions and professional misconduct proceedings will be considered.
When delivery is torture — postnatal PTSD
Authors: Robinson Jean
Published: May 2014

The cases that worry us most are those where the mother has postnatal post traumatic stress disorder (PTSD). Often when she calls us, months or years after the birth, she does not know that is what she has, because it has not been diagnosed. Her GP and health visitor see her as a case of postnatal depression and she has been on anti-depressants, with or without tranquilizers, for a long time with little benefit.
Building the evidence base for midwifery in New Mexico
Authors: Albers Leah
Published: May 2014

The emphasis on evidence-based practice is uneven around the US, although its importance is acknowledged by many in maternity care.
HIV modes of spread: a global and national perspective
Authors: Bott Jane
Published: May 2014

Midwives need to be updated on HIV issues as new information becomes available. This article will begin by introducing the virus, with reference to a simple explanation of the viral structure. This is followed by a brief overview of the course of HIV infection ranging from the initial infection through to the final stage which ends in death. The main modes of HIV transmission will be identified before presenting and discussing recent estimates of the spread of HIV from both a global and a national perspective. Finally relevant practice issues, with a particular focus on the midwife's role will be discussed.
Information for local, national and international populations
Authors: Kenney Natalie , Macfarlane Alison , Lancucki Lesz , Chapple Jean , Davidson Leslie
Published: May 2014

In the previous article, we discussed the need for midwives to record accurately and and completely information about the women for whom they care, and described the uses which can be made of this at local level (Kenney et al, 1999). in this article we examine the use made of maternity data by health authorities and the Department of Health and show how data can also be used to monitor international trends in maternity care.
There are three kinds of midwife…
Authors: Robinson Jean
Published: May 2014

Keeping up with the journals can be quite a chore. Often its just pages and pages of stodge. Some I can quickly skim or even ignore. The most wearisome is the research I know I have to plough through because it is important, but it is dull stuff.
Labour and delivery in the birthing pool
Authors: Forde Clover , Creighton Sarah , Batty Antonia , Hawdon Jane , Summers-Ma Sharon
Published: May 2014

The objective of this study was to determine basic data on maternal and neonatal well-being and infection risk in a group of low-risk women using a water pool for delivery. A prospective non-randomized method was followed. Delivery details and complications were recorded, and post-delivery patient satisfaction questionnaires were completed. Forty-nine women delivered in the pool. There was no clinically significant neonatal infection, however, there were some positive maternal and neonatal swabs. Although two babies required basic resuscitation and some babies had transient abnormalities of postnatal observations, there was no evidence of serious neonatal morbidity. The data analysed in this study did not suggest any increased risk of bacterial infection to the mother or baby after delivery underwater. The neonatal observations suggest that neonatal morbidity is rare after waterbirth in a carefully selected group of mothers and with close attention to fetal and neonatal well-being. We recommend that protocols for selection of women suitable for waterbirth and for neonatal observation are maintained to reduce the risks to both mothers and babies. The results remain to be tested in a randomized case control study to compare water and ‘dry-land’ birth.
A tale of two conferences?
Authors: Henderson Christine
Published: May 2014

From Harrogate: I make no excuses for reporting on the Royal College of Nursing Congress held as usual in Harrogate. There are about 4500 in the RCN Midwifery Society, a membership that is growing. Representatives of the society were very much in evidence among the 10000 attending. The betrayal of experienced nurses by the Government provoked responses of bitterness and anger at the recent pay award, but delegates voted reluctantly to accept the recommendations, making clear that it was at least a starting point for further debate.
Lessons fom the Lawrence Inquiry
Authors: Schott Judith
Published: May 2014

Mr and Mrs Lawrence have faced every parents nightmare, the death of a child. Like all parents they need to know what happened and why. Their persistence and tenacity may not have achieved everything they wanted, but have resulted in the publication of the report of the Stephen Lawrence Inquiry (1999).
The reliability of newborn length measurement
Authors: Wilshin Jean , Geary Michael , Persaud Marcia , Hindmarsh Peter
Published: May 2014

It is important to measure birth length accurately and precisely, as it is a reflection of the pattern of fetal growth and it acts as a baseline assessment towards monitoring the pattern of fetal growth in the infant and childhood periods. Fetal and infant growth patterns have been associated with the development of chronic disease in adults. Anthropometric assessment of newborn length will therefore have implications both in the short term and in the long term and it is necessary that it is performed accurately and precisely. This paper examines different methods of assessing newborn length. It particularly focuses on the accuracy of the current routine method of measuring birthlength in our department (tape measure), which is compared to a more objective method (stadiometer) in 200 babies delivered consecutively in a study of fetal growth. The routine method significantly over-estimated newborn length. The implications of these findings are discussed.
Part 4: the duty of care
Authors: Dimond Bridgit
Published: May 2014

When an action for compensation is brought in a civil court, following an allegation of negligence, the claimant has to show that there was a breach of the duty of care, which caused harm that was reasonably foreseeable. These elements are sometimes referred to simply as: duty, breach, causation and harm. The claimant may be the mother in respect of harm which she has suffered or the parent of a child who has suffered harm or died. What is meant by the duty of care?
Evidence and experience
Authors: Downe Soo
Published: May 2014

What do we do with research evidence which we don't like? The question came to me following a debate which I was involved in recently with a group of midwives. The issue was routine electronic fetal monitoring. I forget the details, but the conversation went something like this. I was contending that the use of an initial 20 minute electronic fetal heart trace has not yet been fully evaluated, and that there may be some place for examining its effectiveness in clinical practice.
Part 6: Causation
Authors: Dimond Bridgit
Published: May 2014

Not only must a claimant establish that there has been a breach of the duty of care owed to him or her, the claimant must also show that the harm which has been suffered has resulted from this breach of duty. This third element in the law of negligence is known as causation. The harm must not only be caused by the breach of duty as a matter of fact, but it must also be a reasonably foreseeable kind of harm.
Maternity care on the skids?
Authors: Robinson Jean
Published: May 2014

I hate to be all doom and gloom. I'd love to fill this column with happy stories. When I admired the photograph of the jolly baby on her desk, the young librarian told me how wonderful the midwives had been at his birth in an Oxford hospital, and what a terrific job they had done, especially as she had a long labour and a large baby. His birth had been a triumph for her, and the afterglow was clearly noticeable over a year later, as she talked about the pure joy of being a mother.
Childbearing women, violence and abuse in the workplace
Authors: Steen Mary , Allen Rose
Published: May 2014

In 1792 it was legal for a husband to beat his wife with a stick so long as it was no thicker than the thumb and it was only a hundred years ago that men were denied the legal right to beat their wives (Womans Aid, 1992). The supposedly safe environment of ones own home was, in fact, unsafe for many women and this continues today. Women most at risk tend to be aged 16-29 and have children (British Medical Association, 1998).
Complaining about CESDI
Authors: Robinson Jean
Published: May 2014

We are grateful — really we are. We look forward to the annual CESDI reports, even though they have shrunk since the Royal Colleges took over. We particularly value the work of all those who toil away on regional panels, collecting death certificates and case notes and going through the dismal task of assessing how many of those precious lives might have been saved. Valuable lessons have been learned — for example the need for training of doctors and midwives in interpreting CTGs (though if anyone with experience in maternity care needed CESDI to tell them that, I'll eat my hat — the posh one I bought for my niece's wedding, veil and all).
HIV testing and the midwife
Authors: Bott Jane
Published: May 2014

On 13 August 1999 the Department of Health (DOH) issued a press release on targets to cut numbers of babies born with HIV by 80% by 2002 (DOH, 1999) which received widespread coverage on national television. Many women and midwives will no doubt have seen the news broadcasts of the announcement by Tessa Jowell, Minister for Public Health. These targets have been recommended by the Expert Group, set up in April 1999 and chaired by the Deputy Chief Medical Officer Dr Jeremy Metters. Key aspects of the press release, are as follows:
A new strategy for nursing (and midwifery too!)
Authors: Hunt Sheila C
Published: May 2014

In July 1999 the Government launched an important document which sets out the future of nursing, midwifery and health visiting in the new NHS. Not surprisingly media coverage of this focussed on the salaries of the new super nurses with some strange comments that suggested midwives would, in future, work under the direction of health visitors.
Reflections on the use of pyschotherapy in midwifery
Authors: Gosden Diane , Saul Ann
Published: May 2014

This article questions the appropriateness of a psychological developmental paradigm being applied in maternity care. It draws attention to the appearance of this paradigm in midwifery and childbirth literature, and to the advocacy within this paradigm of psychotherapeutic interventions for birthing women. Several authors have suggested that psychotherapeutic skills may become a component of midwifery practice. We see this as both a response to consumer demands for humane and personalized care, and part of the development of an international professionalized midwifery. However, we are concerned that potentially disempowering effects can arise if there is a shift in the midwife's role from that of empathetic listener to a more interventionist psychological role. This article debates the normalizing potential of a psychological developmental paradigm for pregnancy and childbirth.
Transcutaneous electrical nerve stimulation
Authors: Walsh Denis
Published: May 2014

Transcutaneous electrical nerve stimulation (TENS) was developed in the 1960s and utilizes the gate-control theory of pain relief. It ‘closes the gate’ to pain impulses, in the case of labour, at the synapse in the spinal cord of afferent uterine nerve impulses. It does this by the generation of a barrage of below-pain-threshold impulses by a small current generator which mediates its effects via leads attached to two sets of conduction pads attached to the woman's back. The unit thus consists of a pulse generator and amplifier, together with a hand held ‘boost’ button that generates continuous impulses when engaged. The strength and frequency of impulse discharge is controlled by the woman and therefore it enhances her control. Additionally, it has the ability to stimulate natural endorphin release.
Breast self examination and the role of the midwife
Authors: Beckford-Ball Jason
Published: May 2014

The new government document Making a Difference. Strategy for Nurses, Midwifery and Health Visiting (Department of Health, 1999) highlights the wider role of midwives, not just in ensuring the physical wellbeing of the mother and baby during childbirth but also making a significant contribution to the health of the community as a whole.
Ultrasound: The slippery slope
Authors: Robinson Jean
Published: May 2014

If only the women in Finland and Philadelphia knew. They had happily consented to research on their unborn babies — still at the embryo stage, before they were even fetuses (Leiva et al, 1999; Makikallio et al, 1999). It was non-therapeutic research — it could not possibly benefit the babies, but the women must have been assured it was safe. After all, in each case it was approved by the local ethics committee.
The midwifes role in the new primary-care led NHS
Authors: Houston Sandra M
Published: May 2014

This article addresses some of the issues that have arisen following recent government reports which place midwives in a pivotal public health-role. It outlines the proposals which have been put in place to meet the six key principles designed to modernize the NHS.
Part 14: Confidentiality
Authors: Dimond Bridgit
Published: May 2014

Midwives have a duty to respect the confidentiality of information they receive from the women they care for. This duty derives from several sources — the contract of employment; the Professional code of practice, duty of care at common law (Furniss v Fitchett, 1958) and as part of the trust relationship with clients. In addition, some legislation imposes specific duties in relation to confidentiality (Department of Health, 1996). The Department of Health has also encouraged NHS trusts to raise standards of confidentiality by the appointment of Caldicott Guardians (NHS Executive, 1999).
Letters
Authors: Welch Ross
Published: May 2014

Madam, I feel that a recent article Termination of pregnancy: Why are live births occuring? (Drazek, (1999) M Br J Midwifery 7 (12) 742–4) should not go unanswered.
The stages of post-natal depression
Authors: Beckford-Ball Jason
Published: May 2014

Post-natal depression does not attract as much attention as it might because childbirth is supposed to be a happy event, but figures show that up to 70% (Wilkie, 2000) of women may experience 'baby blues' following the birth of their child and more women may go on to experience more serious mental health problems. These disorders can interfere with the mother's attachment to the baby, prevent family integration and in some cases present danger to the safety of the mother, the baby and other children (Lowdermilk et al, 1999).
Mental incapacity and maternity services
Authors: Dimond Bridgit
Published: May 2014

At present relatives of adults who are mentally incapable do not have the power in law to make decisions on their behalf. An extensive consultation exercise by the Law Commission resulted in major proposals for a new statutory framework. Subsequently following further consultation, the Government has published its proposals. These include a revamped Court of Protection, continuing powers of attorney, and a general authority to act reasonably in the best interests of mentally incapacitated adults. Draft legislation will be placed before Parliament.
Caesarean section: the trendy delivery choice?
Authors: Hilian Edith M
Published: May 2014

Last week the health minister in Scotland indicated that she wants to curb the number of caesarean sections being performed in Scotland because the method is becoming too ‘trendy’. Recently, Victoria Beckham and Madonna both had caesarean deliveries, as did Patsy Kensit. It is said that Cherie Blair is also planning a caesarean birth. With so many celebrity mothers delivering by section, there seems to be concern that more women will elect to have this type of delivery because they see it as fashionable. No doubt, a further concern for the health minister was that the Audit Commission Report First Class Delivery (1997) identified that each 1% increase in the caesarean section rate costs the NHS in the UK over £5million per year.
Sterilization, the law and the midwife
Authors: Dimond Bridgit
Published: May 2014

In recent years there have been many successful cases where compensation has been paid for either a sterilization operation performed negligently, or for a failure to warn couples that the sterilization could fail resulting in pregnancy. The House of Lords has recently ruled that, while compensation is payable to the woman for the pain and suffering of the pregnancy and birth, compensation was not payable to cover the cost of bringing up a healthy child. Compensation may be payable for the cost of bringing up a disabled child.
Made-to-measure midwives
Authors: Kirkman Sandy , Bale Barbara
Published: May 2014

Since the concept of domino care in the 1970s and the pioneering work of Caroline Flint in the 1980s, midwives have sought to deliver maternity care in a number of ways and patterns. Briefly, these include team midwifery, domino scheme, caseload managed care, shared care and midwifery-led care.
Maternity rights for the employee
Authors: Dimond Bridgit
Published: May 2014

New provisions for maternity leave and pay and giving parents and those those caring for dependents rights to time off work are coming into force. This article sets out the law and the changes which are being made.
Deafness — disability or linguistic minority?
Authors: Bramwell Ros , Harrington Frank , Harris Jennifer
Published: May 2014

Although deaf women are usually seen as disabled, there is a movement among British Sign Language Users (BSL) to be seen instead as a linguistic minority. The deaf community itself is divided on this issue, and it is seen by some commentators on disability issues as inappropriate at a time when the meaning of the term ‘disability’ is itself being redefined positively. Access to services including sign language translation may depend on how these ‘labels’ are interpreted and used. Midwives should be sensitive to the woman's own, potentially ambiguous, view of herself as either having a disability or being a member of particular cultural and linguistic group.
For tomorrows babies: learning from SIDS today
Authors: Sherratt Samantha
Published: May 2014

Midwives may think that what happens after a cot death does not routinely fall within their remit. Yet midwives at the Foundation for the Study of Infant Deaths (FSID) conference last month heard that they can have a key role to play. They hold valuable information about babies and their families that may help identify factors which have contributed to a sudden and unexpected death, and can help further our knowledge about ways to reduce the risk.
Health-care equity: how to recognize clinical signs in skin
Authors: Schott Judith , Henley Alix
Published: May 2014

The ability to recognize clinical signs in differently coloured skins is an essential part of providing care in a multiethnic society. Most textbooks base their descriptions of skin signs on the assumption that skin is white and do not include information on how to assess people with differently coloureds skin. This perpetuates an unaware, colour-blind approach to care which is discriminatory and potentially dangerous. This paper describes how to recognize clinical signs such as cyanosis, pallor, inflammation, jaundice, rashes and bruising in differently coloured skin.
Is there a legal right to a home confinement?
Authors: Dimond Bridgit
Published: May 2014

This paper explores the legal basis for a woman to insist upon a home confinement. It shows that there is no legal power to compel a woman to go into hospital for the birth. Precedents show the courts do not support an absolute right to obtain health care. Support for home confinements is a cultural issue. Changing Childbirth does not seem to have secured a great increase in support for a woman's choice.
How to cope with insomnia during pregnancy
Authors: Turner Alfred
Published: May 2014

Insomnia is the perception or complaint of inadequate or poor quality sleep. It can be characterised by any of the following: difficulty falling asleep, waking up frequently during the night, waking up too early in the morning, or experiencing sleep that is not refreshing. It is common for women to experience bouts of insomnia during pregnancy. These may be caused by foetal movements, muscle cramping, increased urinary frequency, and shortness of breath as well as other discomforts associated with pregnancy (Wold and Hammond, 1999).
Training midwives in inner-city Karachi, Pakistan
Authors: Gibson Hannah
Published: May 2014

This article recounts the author's experiences as a midwife in Pakistan where she has worked since 1998. The Lady Dufferin Hospital is situated in a slum area of Karachi, — 90% of the women come from very poor families. Most of their care is subsidised or free. Pakistan has a deplorable maternal mortality rate. Approximately 30000 women die each year from pregnancy and childbirth related causes, (UNICEF, 1997). While midwifery training exists, it appears that few midwives work outside hospitals. A shocking 80% of women deliver with untrained attendants, either relatives or Dais — untrained birth attendants (Tinker, 1998).

The author's job has been to improve the standards of midwifery care, by upgrading the clinical skills of the midwives. The experience has been very positive, with most of the midwives trained now at the stage where they can practise independently.
Endometriosis: the 'disease of theories'
Authors: Chandler Julia
Published: May 2014

Endometriosis is a chronic and often progressive condition that affects women during their reproductive years. In the condition, the endometrial cells that normally grow inside the womb are found outside it in the ovaries, fallopian tubes, the lining of the pelvic cavity and the outer surface of the womb, or in the bowel near the womb. Endometriosis can also occur in the vagina or around old scar tissue.
Letters
Authors: Jakeman Niki
Published: May 2014

Wendy Fowler raises some important and interesting issues in her article (Focusing upstream to analyse perinatal mortality rates Br J Midwifery 2000 8(7): 415–20). However, it is disappointing to read that she feels the work of the confidential enquiry into stillbirths and deaths in infancy (CESDI) is of such questionable value.
Obstetric Cholestasis: Symptoms, causes and treatments
Authors: Turner Alfred
Published: May 2014

Obstetric Cholestasis (OC) is a rare liver disease that only occurs in pregnancy. Often the only symptom is itching, particularly on the arms, legs, hands and feet. The itching generally appears during the last 3months of pregnancy and is completely resolved within a week or two of delivery. Although OC does not cause any long-term health problems for mothers, if undiagnosed, it can lead to fetal distress, premature delivery, excessive bleeding after delivery or still birth (British Liver Trust Information Service, 1995).
Can a life ever not be worth living?
Authors: Walsh Ann
Published: May 2014

The conjoined twins Mary and Jodie's (named by a High Court Judge in order to protect their identity) parents came to Britain in the hope that the twins could be successfully separated following birth. The lack of sophisticated medical services in their own remote European community necessitated their journey. However, the parents’ hopes were dashed when medical investigations revealed that Jodie was dependent on Mary for heart and lung function. Based on their own social concerns and moral thinking, which is underpinned by their religious beliefs, Mary and Jodie's parents have requested that nature should be allowed to take its course.
Part 20: Advice and instruction
Authors: Dimond Bridgit
Published: May 2014

The duty of care, which was discussed in an earlier steps article (Dimond, 1999), also includes the duty to take care when giving advice and instructions to others. A considerable part of the midwives time is taken up in communicating: talking to women and their children; colleagues within the community and primary care setting and the social services; voluntary organizations; and many other people.
End of year review and some predictions for 2001
Authors: Dimond Bridgit
Published: May 2014

This paper looks at the key developments in 2000 including the establishment of National Institute of Clinical Excellence (NICE), the work of the Commission for Health Improvement (CHI) and the NHS Plan. Changes in prescribing, the completion of the Genome Project, The Human Rights Act, 1998 coming into force and changes in employment rights are also discussed as are the major challenges for 2001.
Practice recommendations for the induction of labour
Authors: McGeown Pat
Published: May 2014

The West Midlands Perinatal Institute has been set up to proactively address the highest perinatal mortality rates in England and Wales. One strategy employed by the Institute to facilitate and inform appropriate professionals of recent evidence and advances in practice, is the introduction of multiprofessional perinatal forums on topics related to modern perinatal care. These forums provide an oppportunity for the region's professionals to discuss and reflect on their practice in a non-threatening environment. This is the first article in a series of reviews of the West Midlands perinatal forums.
Look, listen, act and make a difference
Authors: Sidebotham Mary
Published: May 2014

The eighth annual Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) report should be compulsory reading for all midwives because there within the tables, the facts and figures and the analysis and commentary is a clear message. Midwives can make a difference. CESDI was established to reduce the numbers of fetal and infant losses. Within this report there is clear evidence that improvements have been made in intrapartum related deaths which account for 0.62 deaths per 1000 lives births compared to 0.95 in 1994.
Part 35: Health Service Commissioner
Authors: Dimond Bridgit
Published: May 2014

In the last Step by Step we considered the role of the Community Health Councils, one of whose functions has been to support an individual complainant. The last point of appeal in the complaints system has been the Health Service Commissioner (HSC) otherwise known as the Ombudsman.
Step 36: hospitals and nursing homes
Authors: Dimond Bridgit
Published: May 2014

Of those registered in 2000 as practising midwives, by far the vast majority are employed and working within the NHS: 27772 were shown as working in NHS hospitals and/or the community, 121 were practising in private institutions, 2099 were employed by a midwifery bank and 504 were employed by an agency, some of whom may work in the private sector. Only 63 were shown as self-employed in private practice.
A questionable legacy: Hospital birth in Nepal
Authors: Carla Beatrice
Published: May 2014

Improving perinatal and maternal mortality rates in developing countries tends to be viewed as being entirely dependent on the introduction of Western health-care systems. No-one would wish to deny the tremendous benefits such efforts can bring, but in the past too little attention has been paid to the potentially harmful effects that may also be produced. This article describes the author's experience of working in the delivery suite of a government-run hospital in Nepal. It highlights the impact of procedures — all of which are now discredited in the West — on women's and babies' experiences of birth and in many cases, on their postnatal health. The impact this has had on the author herself has led her to set up a small project to share some of our current knowledge and experience of a more holistic approach to child-bearing with colleagues in Nepal.
Successful home birth groups need support not closure
Authors: Thomas Tessa
Published: May 2014

Home birth has always been the Cinderella of the maternity services. Undermined by the mass medicalization of childbirth in the 1970s and under-resourced by local health authorities thereafter, it struggled to reassert itself in the 1980s and 1990s. Where it did manage to get taken seriously and work successfully, it was largely thanks to the personal commitment of individual managers and midwives who worked hard to push it back on the agenda.
Female circumcision and episiotomy: both mutilation?
Authors: Cameron Joan , Rawlings-Anderson Karen
Published: May 2014

Many women worldwide undergo some form of female circumcision. The practice of female circumcision is more common in communities with high poverty levels and is usually undertaken by unqualified practitioners. The practice is deemed harmful by many health professionals because of the health problems associated with it. Episiotomy is a surgical procedure which is common in western cultures. It is strongly linked to an increased use of technology. The practice has been promoted by the medical and midwifery professions because it is perceived to be beneficial for the woman and her baby. However, a growing body of evidence suggests that the routine use of episiotomy is unlikely to confer any advantage on the woman and overuse of the procedure leads to short- and long-term morbidity. In this article, the two procedures are critiqued from a rational, scientific standpoint and the reasons for the enduring popularity of both procedures are explored.
How to raise awareness of pressure sore prevention
Authors: Morison Barbara , Baker Christine
Published: May 2014

In the past, tissue viability and pressure sore awareness have not been considered applicable to midwifery practice (Department of Health, 1991). However, in the past two years, maternity units have reported a small incidence of pressure sore damage (Malone, 2000; Newton and Butcher, 2000). This article describes a multiprofessional risk-management investigation of this problem and the subsequent actions that were taken. The implications of clinical governance, professional practice, record-keeping, documentation and education are discussed. The improvements inquality of care need to be monitored and audited to ensure that they are maintained.
How to advise women about painful intercourse after birth
Authors: Turner Alfred
Published: May 2014

Sometimes when a woman resumes intercourse with her partner after she has given birth, she will experience a condition called dyspareunia; that is pain with entry into her vagina. Many women will experience pain during intercourse at some point during their lives, and there are many possible causes for this pain: vaginal dryness; infections, such as Candida, Trichomonas, herpes, and Bartholin's cysts; muscle spasm; and scars from vaginal surgery or childbirth can all cause dyspareunia.
Prenatal screening: a retrospective study
Authors: Robinson Janet
Published: May 2014

This study used a phenomenological framework to explore the experiences of women who had given birth to a normal baby after screening high-risk for Down's syndrome in the quadruple test. It explored women's feelings and experiences during the screening process and examined the extent to which receiving potentially bad news influenced their recollections of their pregnancy. Women who had screened ‘high-risk’ to the quadruple test and given birth in a local trust hospital were contacted by their midwife for recruitment to the study. Ten interviews were conducted in the women's own homes. The data was analysed and four categories emerged: the testing process; effects on the pregnancy; interpersonal skills of the professionals and present relationships/ future decisions. Results showed that women tended to view the test as ‘routine’ without fully considering the implications. Their experience had a negative effect on their perceptions of the pregnancy and anxiety levels were increased. Recommendations were made to improve the procedure and the need was highlighted for further research into possible psychological effects on the unborn child.
Part 31: Woolf reforms of justice 2
Authors: Dimond Bridgit
Published: May 2014

There are two kinds of witnesses heard in court: witnesses of fact and expert witnesses. Witnesses of fact describe the actual facts of the situation and what they did and saw. The opinions of witnesses of fact are not usually relevant. In contrast, expert witnesses give evidence of their opinion in relation to the standards of care which should have been followed by the defendants or its employees. Expert evidence would also be required to advise on whether the harm suffered by the claimant was caused by a failure to follow the reasonable standard of care (i.e. causation) and also to give an opinion on the amount of compensation which should be awarded. These experts would be respected members of the relevant profession, e.g. doctors, nurses, midwives, radiographers and possibly a head of a department or training college. Lawyers would look to the leading organisations of individual professional groups to obtain recommended names.
Consent for emergency caesareans
Authors: Robinson Jean
Published: May 2014

There was I, happily ploughing through a pile of articles on the time it takes to do an emergency section, when I came across a paragraph that set my consumer antennae all a quiver.
Vulval preparation in labour: use of lotions or tap water
Authors: McCormick Carol
Published: May 2014

Evidence-based practice is all well and good when there is sound evidence to guide the decision-making process. But how do midwives challenge current practice or introduce changes without such evidence?

This article describes, in the light of little or no evidence at the time of change, Nottingham City Hospital NHS Trust Maternity Unit's experience of challenging the ritual of perineal swabbing with Savlon (chlorhexidine gluconate 0.15% and cetremide 0.15%) along with the routine use of sterile vaginal examination packs during labour and delivery. This innovation was triggered by one midwife questioning current practice, and then using local expertise to help facilitate and inform the process of changing practice.
Licensed to treat infant colic?
Authors: Jones Kath
Published: May 2014

Infant colic is a particularly distressing condition for both infants and their parents. Many new parents are anxious and the added stress of an unhappy and crying baby compounds their anxiety. This article will discuss the physiology of colic and the use of appropriate treatments. Simethicone is a clinically proven treatment and its advantages, backed by the relevant research, will be demonstrated.

In recent years there has been a tendency to confuse colic with lactose intolerance, often resulting in inappropriate advice and treatment. The difference will be addressed in this article.
Caesarean section in Scotland
Authors: Page Lesley
Published: May 2014

The overall rate of caesarean section (CS) in Scotland has risen from 5% in 1970 to 19.7% in 1999. So now 1 in 5 Scottish women have their babies through a CS. An Expert Advisory Group on Caesarean Section in Scotland (EAGoCS) was set up to review caesarean birth in Scotland because of concern with the constant rise in the rate. The report of the EAGoCS to the Chief Medical Officer (2001) is of relevance to all those concerned with the rise in the caesarean section rate wherever they may live. Scotland, like England, has one of the highest CS rates in the world, with the exception of Latin America. The cause of such a trend is always complex. In general a high CS rate is associated with the gross national product, in other words with national affluence.
Part 33: Supervisors of midwives 2
Authors: Dimond Bridgit
Published: May 2014

In the last step by step article we considered the statutory provisions for the supervision of midwives and the establishment and role of the Local Supervising Authority (LSA). The Midwives code of practice expands upon the role of the supervisor of midwives in paragraphs 30 to 34. The UKCC recommends that the LSA function should be undertaken by a practising midwife, who is professionally experienced in the supervision of midwives. This person should be deployed at LSA level as the designated responsible officer and the relationship between such a midwife and the local director of nursing and/or midwifery is of particular importance.
How to get sued: an update
Authors: Robinson Jean
Published: May 2014

We sat in the Chief Executive's office. He was supported by a senior consultant, another doctor and a hospital administrator. It had taken the complainant 2 years to get to this point — 2 years of prevarication and multi-layered dishonesty. She and I had already gone through original copies of her medical records. One crucial section stood out, pristine new among the thumbed and used surrounding pages. (Did they think someone who sat for 6 years on Professional Conduct Committee at the GMC wouldn't notice?) At the end of the 2 hour meeting I pointed out that the cost of the salaries of the people in the room and the time spent on this case over the years was a monstrous waste of NHS resources, and if they had investigated properly and told the truth in the beginning, they would have saved a lot of money.