bluuebunny/crossref_metadata_2025 huggingface dataset:
Glioblastoma multiforme in adults and the role of the advanced nurse practitioner
Authors: Al-Maqbali Mohammed Abdullah
Published: May 2014

Treatment of people with glioblastoma multiforme requires a multidisciplinary team approach, in which the advanced nurse practitioner has a vital role. The prognosis for these patients is poor and the impact of the diagnosis on patients and caregivers can be devastating. A comprehensive care plan can guide the patient through the disease process and mitigate the impact on them and their family. A holistic approach considering physical, psychosocial and economic factors can be useful in delivering effective care. The aim of this paper is to explore a systematic approach to physical and psychosocial assessment through a description of the diagnosis, treatment and symptom management of glioblastoma multiforme. The paper also discusses the role of the advanced nurse practitioner in meeting patients' and caregivers' complex needs.
Choice of a scan: how much info do women receive before ultrasound
Authors: Proud Jean , Murphy-Black Tricia
Published: May 2014

In order to discover the amount of information given to women so that they can make a choice as to whether to have a scan or not, a questionnaire was sent to 100 maternity units. Ninety-four units responded; out of these a subsample of 45 were sent a further, more detailed questionnaire. Analysis of the results revealed that 48% of the initial sample units gave information to women of the scan's potential to detect anomalies; of these only 26% gave the information before the first scan. Eighty-three per cent of the midwives asked knew that anomalies can be detected at any scan.

The value of scanning as a screening procedure was only discussed with women in 10 units in this sample, 83% of the midwives seemingly confused about its use in this respect. It was found therefore that the minority of units in this sample gave comprehensive, unbiased, information to aid women in their choice of whether or not to undergo ultrasound in pregnancy.
Screening for Down's syndrome: what the women think
Authors: Fairgrieve S
Published: May 2014

An audit of womens views was undertaken in an attempt to improve the Downs sydrome screening programme. The findings highlight the key contribution of midwives and indicate womens need for more explanation and information about the test.

The audit cycle was completed by a repeat questionnaire to assess the impact of recommendations introduced following the preliminary audit. This showed significant improvements in the levels of satisfaction with the screening programme.
Reflective journals as a teaching/learning strategy: a literature review
Authors: Stuart Chit Chai
Published: May 2014

The concept of learning through reflection on practice is poorly understood. Consequently, attempts to foster learning through this strategy have met with varying degrees of success. Facilitators of this educational strategy need to have a clear understandingof the conceot and processes of reflection.
Is continuity of carer a top priority for all women?
Authors: Fellowes Deborah , Horsley Anji , Rochefort Julie
Published: May 2014

This project aimed to measure local progress toward selected Changing Childbirth indicators using a client questionnaire. From responses given, it appears that knowing a named carer throughout pregnancy and childbirth is not the top priority for all women. For respondents, it was more important to have good quality care from all health professionals. In conclusion, the Changing Childbirth indicators should not be audited in the same way as objective standards. It is important to consider women's own interpretation of whether services were satisfactory, in addition to ascertaining what these services were.
Uptake an acceptability of antenatal HIV testing
Authors: Boyd Fiona M , Simpson Wendy M , Johnstone Frank D , Goldberg David J , Hart Graham J
Published: May 2014

As part of a trial on the uptake of antenatal HIV testing, this study investigated the effect of the midwife on women's uptake of testing. Ten midwives who had been involved in offering HIV testing to 2727 women antenatally completed a questionnaire examining their knowledge and attitudes towards HIV. The midwife with the most positive attitude towards HIV testing was the one who achieved highest uptake and caused women least anxiety. Midwives' knowledge was not associated with uptake of HIV testing. If high uptake of testing is the goal, then midwives must have a positive approach towards HIV testing. Recommendations for midwife training are represented.
The portfolio as an assessment tool in midwifery education
Authors: Howarth Amanda J
Published: May 2014

This article examines the use of portfolios as clinical assessment tools within midwifery education. The main aim of the portfolio is to maximize learning experiences and to provide the student with a continuing record of personal and professional development and achievement (Gerrish, 1993). The article discusses the benefits of using portfolios in midwifery education, such as providing learning that is both personal and pertinent to each individual. The advantages of a continuous learning record in which the student identifies their own learning needs are discussed. Much research into the use of portfolios in education has been carried out and has provided valuable information but some aspects of portfolio use, namely the practical and ethical issues, remain inadequately researched (Gerrish, 1993; Pansini-Murrell, 1994).
Midwives, informed choice and power: part 1
Authors: Levy Valerie
Published: May 2014

Qualitative data were gathered in a study on how midwives facilitate and women make informed choices in pregnancy. Issues of power permeated the data. This series of three articles interprets and discusses these issues in relation to Lukes' (1974) conceptualization of power, and more recent theories regarding empowerment. This first article discusses how Lukes' first dimension of power was seen to operate within the data.
The silent infection: chlamydia and pregnancy
Authors: Stevens Georgina
Published: May 2014

Chlamydia, dubbed the silent infection, is the most common sexually transmitted disease (STD) in the UK and Europe (Macmillan, 1999). It is the lack of obvious symptoms associated with chlamydial infection that makes the disease so common; people often do not realize that they have become infected and pass of the disease to their sexual partners or their unborn baby. This makes control of the infection extremely difficult, although the associated long-term health risks associated with infection by this bacterium mean detection and treatment should be a priority.
Healthy infant skin: focus on nappy rash and sensitive skin
Authors: Turner Alfred
Published: May 2014

Nappy rash causes discomfort to many infants and concern for their parents. This paper looks at the causes and symptoms of nappy rash and explores ways in which the frequency and severity of the condition can be reduced. Keeping a baby clean and dry is very important. Recent clinical studies have shown that the Sensitive range of products pioneered by Pampers can help to reduce nappy rash. Pampers Sensitive Nappies have been clinically proven to prevent nappy rash. Pampers Sensitive Wipes have been shown to be suitable even for neonates and infants with atopic dermatitis.
Reflections on emotional disturbances after childbirth
Authors: Marmion Sharon
Published: May 2014

The aim of this article is to foster awareness among health-care professionals and provide information on various emotional disturbances which can be experienced following childbirth. Such psychological disturbances and unresolved emotional problems can have long term implications, not only for the woman herself, but for her whole family (Holden, 1991). Health-care professionals have a role in promoting psychological wellbeing. To do this they must possess adequate knowledge and understanding of this topic. This article outlines the incidences, risk factors, signs and symptoms, identification, treatments and outcomes of the three categories of emotional disturbances which can be experienced following childbirth, namely ‘baby blues’, postnatal depression and puerperal psychosis. It is important to acknowledge that the adaptation to motherhood is stressful and it is normal to experience some problems during this period. A social model of care recognizes the benefits of increased support at this time, such as support groups led by health-care professionals and mothers. A medical model of care involves treatment with various pharmacological drugs. The potential effects discussed highlight the importance of vigilant monitoring of women in the postnatal period.
Writing a review of the literature: a practical guide
Authors: Burden Barbara
Published: May 2014

Producing a detailed review of the literature on a given topic often poses difficulties for the prospective writer. The sources of evidence are often easily collected but it is possible to quickly be overwhelmed by the sheer number of pieces, as they silently over run the kitchen table. By developing a methodical approach to the documentation and evaluation of the sources, and the implementation of a thematical approach to their review, it is possible to commence the review from the very first article or source collected.
Step 46: Duty of confidentiality
Authors: Dimond Bridgit
Published: May 2014

The Data Protection Act 1998 was considered in an earlier Steps article (Dimond, 2000). Unlike the earlier legislation in the 1984 Act, the 1998 Act applied to computerised and manually-held records. There were concerns that so tightly were disclosure rules set under the 1998 Act, that such collections of data as the National Cancer Register could actually be illegal. In the light of this, the Government sought to regulate the situation. Powers were given to the Secretary of State (SoS) under Section 60 of the Health and Social Care Act 2001 to make regulations on disclosure of patient information.
Midwifery in north east Brazil
Authors: Tucker Christine , Cook Dorothy
Published: May 2014

This article is based on the establishment of a 3–year partnership project between the University of Rio Grande do Norte, Brazil, and the University of the West of England, Bristol, UK. The project aims to strengthen the nurse/midwife specialisation programmes in north east Brazil, which has high maternal and perinatal infant mortalities. A further objective is to normalise and humanise the birth process. Change, which will take time and money, will be monitored by a research project which has been developed concurrently.
A midwife's private practice in Israel
Authors: Slome Judy
Published: May 2014

Sixteen years of a private Israeli nurse-midwife’s practice in Israel were analysed in four groups: 1985–1994, 1994–1997, and 1997–2001 and home births. All 1000 consecutive births were summarised. While maintaining essentially the same management, the caesarean section rate dropped from 5.1% to 0.7% among the 812 hospital births. The episiotomy rate decreased from 11% to 1%. There was one neonatal death among the hospital births accounting for a perinatal mortality rate of 1.0/1000. The improvement in outcomes coincides with a gradual increase in experience as well as an increase in autonomy to practice with a midwifery model of care when two home-like hospital birthing rooms were established in 1994. In addition to the hospital births, 188 home births were analysed separately, showing similar outcomes to the 1997–2001 hospital outcomes. This study adds compelling evidence to the hypothesis that it is safer for women with normal pregnancies to be cared for by care providers with a midwifery philosophy of care rather than providers with an obstetric philosophy of care.
MMR and giving advice — the legal issues
Authors: Dimond Bridgit
Published: May 2014

This article explores the background to the controversy over giving the triple measles, mumps and rubella (MMR) vaccine to children and the legal liability of the midwife in giving advice.
Africa Midwives Research Network
Authors: Lugina Helen , Mlay Rose , Smith Helen , Lavender Tina
Published: May 2014

Evidence-based practice is pivotal to improving maternity care. In the developing world there exist multiple barriers that inhibit midwives from developing their research skills and implementing findings into practice. This article describes an initiative carried out by African midwives to overcome some of these barriers. An ongoing programme is discussed which highlights the achievements made by committed midwives who are striving to improve the health of women.
Checking not listening: how midwives cope
Authors: Kirkham Mavis , Stapleton Helen , Thomas Gwenan , Curtis Penny
Published: May 2014

The material in this series of papers is derived from a Department of Health funded evaluation of the MIDIRS Informed Choice leaflets (Kirkham and Stapleton, 2001). Many women in this study expressed their disappointment when midwives behaved like doctors in placing more emphasis on clinical tasks rather than on the facilitative and listening skills required to support informed decision-making. Some women perceived midwives as oppressed and conformist with few opportunities for acting as autonomous and empowered professional women. Women were very aware that midwives were busy people with many demands on their time and this inhibited them from asking questions and voicing their concerns. Pregnant women use a wide variety of information-seeking strategies. The range and sophistication of these behaviours went mostly unrecognised by midwives, some of whom mistook them as evidence of women’s avoidance of decision-making responsibility. Midwives who stood by women when they made unconventional choices were referred to as ‘gold mines’ and were greatly treasured and respected.
The new Code of Professional Conduct
Authors: Dimond Bridgit
Published: May 2014

This article welcomes the new Code of Professional Conduct of the Nursing and Midwifery Council and looks critically at its clauses and significance.
Step 44: Research 4 — the LREC
Authors: Dimond Bridgit
Published: May 2014

Any midwife who intends to undertake a research project must ensure that she obtains details of the requirements of her local research ethics committee (LREC). In planning the timetable for her research, the midwife must build into it the time that will be required for the LREC to scrutinise the research project and suggest necessary amendments to the research proposal.
Letters
Authors: Raynor Wendy E
Published: May 2014

A response to the article ‘The public health role of the midwife’
Separation from the baby — a cause of PTSD?
Authors: Robinson Jean
Published: May 2014

The first proper book I read as a child at school left a deep impression perhaps because I realised that it opened a magic gate to other worlds. I was fortunate that the first book my teacher gave me was a Victorian classic by George MacDonald — The Princess and the Goblins. The little princess finds a secret staircase leading up to one of the turrets in the castle and meets a wonderful old lady who gives her a ring. If ever she is in trouble, she is to follow its magic thread which will lead her back to safety. Lo and behold when she and her boy protector, Curdie, are trapped in a tunnel pursued by the dreaded goblins, she feels her ring and finds an invisible thread attached which leads them back to safety and the loving fairy godmother. At 8 years old, I did not know the value of the lesson I was learning.
Stereotyping as a professional defence mechanism
Authors: Kirkham Mavis , Stapleton Helen , Curtis Penny , Thomas Gwenan
Published: May 2014

The material in this series of papers is derived from a Department of Health funded evaluation of the MIDIRS Informed Choice leaflets (Kirkham and Stapleton, 2001). In this paper we discuss the use of stereotyping as a defence mechanism which appeared to assist midwives in coping with the pressures of contemporary professional life. Midwives sometimes misjudged women's ability and willingness to participate in their maternity care and, as a consequence, women were negatively labelled, for example, as demanding and/or as uncooperative. Midwives often formulated their opinions about their clients on the basis of circumstances over which childbearing women exercised little control: housing tenure, age and/or social class. Even when such judgments were shown to be erroneous, they generally endured throughout the maternity episode and sometimes reappeared in a subsequent pregnancy. The corrosive effects of stereotyping are examined, particularly in relationship to choice and decision-making. The article concludes with a brief mention of the short-term benefits of stereotyping as a coping mechanism in the face of limited resources.
Views of Heads of Midwifery on electronic patient records
Authors: Hart Angie , Henwood Flis , Jones Andrea
Published: May 2014

Midwives know from experience that the history of the introduction of maternity computer systems is not entirely a positive one. The idea that such systems will invariably make their working lives easier and will benefit client care is not an idea to which they naively subscribe. The authors’ recent survey of the Heads of Midwifery (HoMs) suggests that HoMs are more optimistic about the benefits to be gained by the introduction of electronic patient records (EPRs) than some of the evidence from their past experiences with maternity computer systems might suggest. The survey results also lend support to the hypothesis that involvement of system users in the procurement of information systems will make such systems more acceptable to them. Finally midwives should mobilize their considerable experience as clinicians and as managers with regard to the introduction of maternity computer systems, both to be rightly cautious of the claims made by EPR advocates and suppliers, and to influence procurement decisions within NHS Trusts.
Exploring theories of grief: personal reflection
Authors: Fahey-McCarthy Elizabeth
Published: May 2014

The following article explores theories of grief, paying particular attention to Bowlby's attachment theory (Bowlby, 1981). The article relates to the author's personal experience of the impact of the stillbirth of her daughter. It examines the bereavement experience using the established traditional understandings of grieving, i.e. that the bereaved need to sever the ‘bonds’ with the deceased in order to avoid pathological outcomes. It then compares these with the theory of grief proposed by writers of the late 20th century who propose that, in order for healthy grieving to occur, bereaved persons should not sever such bonds but instead integrate the deceased within their lives. This article is a reflective account which implicitly demonstrates the importance of reflection in developing understanding, and outlines the relationship between reflection and learning for personal and professional growth.
Postnatal depression: why women lie
Authors: Robinson Jean
Published: May 2014

There seems to be an awful lot of ‘so-what’ research. I plough dutifully through the journals – worthy, decent stuff, but of no practical use. Then I chance on a jewel, and the brain wakes up. Something that has a ring of truth about it. Something you knew was there, waiting to be discovered, but which lay hidden because people were not asking the right questions.
Step 59: the new NHS University
Authors: Dimond Bridgit
Published: May 2014

The NHS Plan was published in July 2000 (Department of Health, DoH, 2000) and had the aim of increasing investment into the NHS and at the same time meeting the significant challenges of the NHS. One of these challenges was to ensure that those working within the NHS were competent to provide the necessary services. It was envisaged that health professions would increase in their flexibility, training and working practices and demarcations would be removed. In addition, there would be a major expansion of the healthcare workforce. This demanded a huge human resource strategy.
Power: how it is used and sometimes abused
Authors: Axten Su
Published: May 2014

Power is both emotive and complex. Whoever you are and wherever you work, you will have experienced it. From birth, power will have had some impact on your life, sometimes to your benefit, other times to your detriment. As I have progressed through the NHS I have become increasingly aware of the abuse of power. Moreover, those that do abuse power appear to be unaware of their behaviour. The following article explores why an individual may abuse power, why as a group we may permit it and how it influences our professional care.
Antenatal guidelines: quality not quantity
Authors: Sidebotham Mary
Published: May 2014

Are the NICE antenatal guidelines a new set of rules dictating our practice and creating cuts in services, or do they present us with an opportunity to reform and modernize antenatal care? I take the latter view. This is an opportunity to structure a service based on a woman's needs and deliver a schedule of care that is relevant and based on sound evidence. However, some individuals will see restriction rather than opportunity.
Clinical governance and caesarean section
Authors: Torrance Elaine , Dockery Karen
Published: May 2014

This article demonstrates how clinical governance supported a change in the practice of routine elective caesarean section (CS) being performed at 38 weeks of pregnancy. Clinical incident reporting highlighted the issue that some babies delivered by elective CS were being admitted to the neonatal unit with respiratory problems. On searching the literature it was found that there was evidence to support the decision that elective CS should be performed at 39 weeks to reduce neonatal respiratory morbidity. An evidence-based guideline was developed and through a process of clinical audit the gestation for performing the elective CS is now in line with evidence-based care.
Women's experiences of fetal abnormality
Authors: Pelly Deborah
Published: May 2014

Women who are told that their unborn baby has an abnormality experience shock and grief. The decisions that they then make may affect the rest of their lives. The importance of effective and compassionate care around the time of the diagnosis of a severe fetal abnormality cannot be emphasized too strongly. Sixteen women's views on the care that they had received, in a fetal medicine unit, were investigated by tape-recording semi-structured interviews. The main themes were identified and are presented in the form of a discussion. All the women reported that they had been confronted with unexpected information. The findings for some of the women were inconclusive and this contributed to difficulties in the decision-making process if a termination was considered. All expressed the need for greater information. Almost all expressed a loss of confidence in their ability to have a normal pregnancy in the future.
Group B Streptococcus: testing and treatment
Authors: Read Sue
Published: May 2014

The group B Streptococcus bacteria is now the leading cause of neonatal infection which can have devastating consequences for the newborn and their families. This article provides information for midwives and their clients on the nature of the organism and the risks it poses to the wellbeing of the infant. A universal screening programme has been shown to be ineffective in reducing mortality and morbidity rates. Antibiotic therapy in the antenatal period, prescribed on the basis of a positive vaginal culture, is inappropriate and may be putting women at unnecessary risk of anaphylaxis. Indiscriminate use of such therapy may also be instrumental in the development of antibiotic resistant strains of the organism, which has implications for the wider public health. The midwife has an important role to play in providing sound information to the women in their care, in order to allay undue anxiety and facilitate informed choice.
The Dutch maternity care: Best Practice Mission 2002
Authors: Lavender Tina , Baker Lisa
Published: May 2014

Set against a background of recent UK governmental investments into maternity care, the opportunity to seek and share innovative and effective maternity care practices was announced in a competition held by the BJM and Cow & Gate in the October 2002 edition of the journal. The competition required midwives to state how many baby girls were born in the Netherlands in 2001. The correct answer was 98 797. There were five winners, Jackie Hatch (Hull Maternity Hospital), Natalie Bennett (Aintree Centre for Women's Health, Liverpool), Veronica Holland (Wexham Park Hospital, Slough), Julia Ramsey (Coventry Hospital) and Teresa Manders (St Helier Hospital), each of which were accompanied by a midwifery colleague of their choice. The competition prize was a 2–day trip to Amsterdam, combining work and leisure on the 2–3 December 2002. The first day was planned to allow the guests the opportunity to enjoy Amsterdam and for the group to network with each other. The second day comprised a full programme which sought to provide an overview of midwifery training, independent midwifery and facilities, hospital practices and inter-professional relationships.
Towards Harrogate: a European spa city
Authors: Magill-Cuerden Julia
Published: May 2014

This year's annual Royal College of Midwives (RCM) conference entitled: Promoting The Business of Midwifery will be held in Harrogate from 13-16 May. It is perhaps worthwhile to reflect on some of the results of last year's conference motions and some of the events that have influenced the lives of midwives over the past year. These may be in the minds of midwives at this year's conference.
Webwatch
Authors: Hassall Jenny
Published: May 2014

The exact number of disabled parents in the UK is not known. Estimates range, according to how they are calculated, from 1.2 to 4 million parents, and numbers are thought to be increasing (Social Services Inspectorate, 2000). This month's Webwatch seeks to identify the resources available to midwives caring for women with a disability. The site I have chosen to review is:
Who's choosing caesarean section?
Authors: Kingdon Carol , Lavender Tina , Gyte Gill , Cattrell Ruth , Singleton Vicky , Nielson James
Published: May 2014

In November 2002 the University of Toronto hosted a conference entitled, Choosing delivery by caesarean: Has it's time come?. The Birthing Circle, a Canadian consumer advocacy group, protested outside the conference venue highlighting how contentious issues surrounding caesarean section (CS) and informed choice have now become. So what are the risks of planned CS compared with planned vaginal birth (VB) and what is the legitimacy of a woman's right to choose the way she gives birth in modern maternity care systems?
An inspector calls: a CHI visit
Authors: Dimond Bridgit
Published: May 2014

This article considers the legal powers of the Commission for Health Improvement and the results of its inspection of a midwifery unit in Kent. It looks at the significance of its findings for midwifery services generally.
Biofeedback and visualization to control nausea and vomiting
Authors: Slome Cohain Judy
Published: May 2014

There is some evidence that nausea and vomiting of pregnancy may share a common etiology with all forms of nausea and vomiting. While the etiology and treatment of nausea and vomiting in pregnancy has not been well studied, nausea and vomiting associated with motion sickness in pilots has been extensively researched. Biofeedback has been used comprehensively and successfully to treat nausea and vomiting in airforce pilots, 28% of whom suffer from motion sickness. Biofeedback, uses an electrode on the palm to detect microscopic amounts of sweating, the earliest sign of the onset of nausea and vomiting. With exercises and training, a person can learn to prevent the onset of nausea and vomiting. Since biofeedback does not involve drug intake, this may be an excellent treatment protocol for nausea and vomiting of pregnancy and hyperemesis.
Natural birthing lessons from Nepal
Authors: Carla Beatrice
Published: May 2014

The legacy of an outdated medical model approach to intrapartum care is still apparent in most of the developing world. Rather than trying to avoid the issue of the Western responsibility for this situation, we might do well to consider what we could learn from the history of medical and cultural colonialism. With an awareness of these issues, the author set up the Nepal Midwives Initiative in 2000. This article describes her efforts to reintroduce the option of natural active birth to urban maternity care centres.
Not ‘just’ a student midwife during clinical placements
Authors: Kennard Claire
Published: May 2014

‘Make your student do that, that's what she's there for!’. These words have stayed with me ever since my first labour ward placement. As a first year student midwife, I remember being told I could not go for a break on a quiet night shift because the healthcare assistant had just gone, and I was to clean the room that had just been vacated by a woman who had gone to the postnatal ward. I remember cleaning the room, thinking: ‘This isn't what I came into this to do.’ I wanted to have a break and discuss with my mentor what we had just been doing.
Partograms are not needed in birth centres
Authors: Osbourne Astrid , Lavender Tina
Published: May 2014

Partograms are universally used in the active management of maternity labour care throughout the Western world. Not using a partogram is a challenging process for midwives who want to provide greater choices for women in childbirth. However, the reliance on time framing in labour is a real constraint.
Promoting midwifery-led care within an obstetric-led unit
Authors: Walton Cathy , Yiannousiz Katie , Gatsby Helen
Published: May 2014

In 2002–2003 an attempt was made to establish ‘normal birth’ rooms within the main delivery suite/labour ward of an inner city teaching hospital, with the aim of providing a less clinical environment for low-risk women to give birth in. The innovation formed part of an initiative to increase the normal birth rate at a hospital with a high caesarean section rate. The process of change, including the promotion of midwifery-led care within the unit was explored as part of a postgraduate research project. An action research approach was used to enable midwives to identify their needs for skills development appropriate to promoting normal birth and to facilitate the exploration of problems encountered. The project formed part of a process of change that has enabled a change in the culture of the unit, increasing the profile and value attached to normal birth and decreasing the caesarean section rate.
Health promotion: a practice framework for midwives
Authors: Piper Stewart
Published: May 2014

A re-orientation of health policy over the last decade (e.g. DH, 1992, DH, 1999a; DH, 1999b; DH, 2000) has formally put health promotion and;public health on the midwives' agenda. For midwives to address this contemporary challenge effectively, a framework is required that can be used to guide, map and contextualize health promotion intervention. This article offers one such framework for consideration and seeks to articulate the nature and function of four models of health promotion and how they can be used in practice, and the relative positions of power held by practitioner and client. In translating these models into practice. The intention is to help move the debate beyond any narrow or traditional view of health promotion as simple information or advice giving, and highlight the need for a repertoire of approaches and a framework for intervention in the modern arena of midwifery.
Midwives' coping methods for managing birth uncertainties
Authors: Green Belinda
Published: May 2014

This article reports some of the findings from a larger study exploring the influence of uncertainty on the decision-making of midwives and doctors, and its potential as a contributory factor to the rising caesarean section rate. The specific focus of this paper is on the coping mechanisms used by midwives when dealing with uncertainty in childbirth and their attitude towards caesarean section. The findings indicate that midwives have ambivalent attitudes towards caesarean sections and rely on a range of strategies to cope with clinical uncertainty, such as the disclosure and non-disclosure of uncertainty with women, humour and adherence to clinical guidelines. However, the study did find that some midwives had poor coping responses to clinical uncertainty and spoke of considering other career options. The implications for practice suggest that the current emphasis on being certain and on specific time frames for women in labour threaten to obviate traditional midwifery skills.
Conflicting evidence: the importance of accurate record keeping
Authors: Jones Shirley R
Published: May 2014

Shirley R Jones suggests that cases of conflicting evidence could be dramatically reduced if midwives made accurate, more detailed records of birthing events.
Waiting with Gabriel: a story of cherishing a baby's brief life
Authors: McNeily Patricia
Published: May 2014

Poignant and moving, Waiting with Gabriel recounts one family's story of love, loss and grief. Both gripping and heartbreaking, this book shares with the reader the emotions that surround Gabriel's birth, his short life and the almost tangible stillness immediately after his death.
Blood spot testing: Comparing techniques and automated devices
Authors: Glenesk Ann , Shepherd Ashley , Niven Catherine , Mackenzie Joan
Published: May 2014

The use of automated devices for blood spot sampling will ensure safety and benefits for babies and midwives (UKNSPC, 2005). The devices available differ in the technique of incision. The majority, which are less expensive utilise a guillotine incision and the other less common devices utilise an arched shaped incision. The results of a randomised controlled trial comparing two devices with the different techniques of incision suggest that devices with an arched shaped incision provide better quality blood samples, require fewer heel pricks to obtain a quality sample and the devices are cost neutral when all aspects of the blood spot sample are taken into account.
Diagnostic medical ultrasound in obstetrics: An overview
Authors: Dixon Anne-Marie
Published: May 2014

The use of ultrasound in obstetric practice is well established and it is widely accepted as a safe and clinically accurate medical ‘test’. In presenting an overview of the routine medical applications of ultrasound in obstetric practice the aim of this paper is to increase the midwife's awareness and understanding of the clinical role of antenatal ultrasound; in so doing it is hoped that this will enable them to support pregnant women from a more informed perspective and help prevent unnecessary referrals. This has potential to spare women unnecessary anxiety from tests performed inappropriately or when the purpose, scope or results of tests are misunderstood.
Working together? Indices of division within the midwifery workforce
Authors: Curtis Penny , Ball Linda , Kirkham Mavis
Published: May 2014

Findings from the Why do Midwives Leave? (WML) study evidenced divisions between midwives and their managers. In the Talking to Managers (TTM) study (Curtis, Ball and Kirkham 2003), these horizontal divisions were also acknowledged by managers. However, other ‘fault-lines’ are also visible within midwifery. Distinctions between midwives were made on the basis of academic credentials: for promotion, formal educational achievements were felt to be valued over clinical skills and experience, leading to perceptions of a ‘two-tier’ system. Managers also distinguished between midwives on the basis of practice philosophy; midwifery idealists, who were seen as ill-fitted to the stresses of ‘real’ midwifery work, were contrasted with midwifery realists, who knew how they ‘actually had to work in practise’. Though divisions between midwives may function as defence mechanisms for some, they can leave other midwives isolated and vulnerable to the inappropriate behaviour of others in the workplace.
Caring for neonatal skin and common infant skin problems
Authors: Blincoe Alana Juman
Published: May 2014

The skin is the largest organ of the human body, and has the important duty of creating a protective barrier for the neonate, to fight off infections and defend its programmed functions, such as thermoregulation, fat storage, immunosurveillance and the prevention of excessive fluid loss. There is unfortunately little research available defining the best method of ensuring that infant skin is kept at its healthiest, but two schools of thought have developed over the past five years. One argues for a water-only policy in the first month of life, while the other states that cleansing products can be used if kept to a minimum both in frequency and amount. Both however do agree that cleansers used on babies skin should be both mild and pH neutral. Despite such informal guidelines however, skin disturbances are still fairly widespread, particularly nappy rash and cradle cap. Even though it is taken as a given that such occurrences are commonplace in newborns, it is not necessarily the case. More research in this area is definitely needed in order to establish set guidelines for a uniform approach to infant skin care.
Flexible working patterns: Balancing service needs or fuelling discontent?
Authors: Curtis Penny , Ball Linda , Kirkham Mavis
Published: May 2014

Concern for the organization of working hours was widespread among respondents to the Why do Midwives Leave study (Ball, Curtis and Kirkham, 2002). This was especially important to midwives who gave ‘family commitments’ as their main reason for leaving. Managers in the Talking to Manager study (Curtis, Ball and Kirkham 2003) reported the availability of a variety of flexible, ‘family friendly’ working patterns. However, they felt constrained to restrict their availability in order ‘to balance the needs of the service’ and to enable an adequate skill mix to be maintained. Managers were also concerned that family friendly working was exacerbating discontent within midwifery and fuelling divisions between midwives, for family friendly working hours may leave ‘unfriendly’ gaps in the staff roster that others have to fill.
Postpartum tightening operations on two delivery wards in Sudan
Authors: Berggren V , Elsiddig Yagoub A , Mahmoud Satti A , Abdel Khalifa M , Abdel Aziz F , Bergstrom S
Published: May 2014

This paper describes a study to explore the prevalence of postpartum tightening operations of the vulva and reinfibulation (RI) in Sudan. Participatory observations with digital vaginal examinations before and after delivery were carried out on a sample of 100 women in two hospital settings. In 61% of the women tightening vulval operations had been carried out after delivery. Of the women who had not been submitted to female genital mutilation (FGM) with suturing before delivery, 35% had such an operation after delivery. Two out of 20 women without any primary FGM had undergone a tightening operation following delivery. In the two study settings observed, the prevalence of postpartum tightening operations was 61% and included women without previous FGM. The tradition of tightening operations of the vulva after delivery is an important issue for further research concerning the implicit sociocultural determinants and their possible relation to the tradition of primary forms of FGM.
Birth, employment and child care: Searching for the invisible tax break
Authors: de Ferrer Gina
Published: May 2014

Despite the fact that birth and parenthood are wonderful things, what follows is often a minefield of expense and complex organization. Gina de Ferrer examines society's contrary attitudes towards children.
Paternal experiences of pregnancy and labour
Authors: Rosich-Medina Anais , Shetty Ashalatha
Published: May 2014

To evaluate first time fathers' experiences during pregnancy and to compare labour experiences between three different modes of delivery. Fathers whose partners delivered at Aberdeen Maternity Hospital were given a questionnaire postnatally before their partners' discharge from hospital. Fathers rated their experiences of pregnancy and labour on a visual analogue scale. 142 fathers completed the questionnaire. Fathers became progressively more connected to the pregnancy feeling most connected to it during the scans and when feeling fetal movements. Throughout labour fathers in emergency deliveries felt more anxious, helpless and frustrated compared to fathers in spontaneous vaginal deliveries (SVD) and elective/semi-elective caesarean sections (CS). Fathers in emergency deliveries felt labour did not match their expectations more so than those fathers in SVDs. Health professionals should be sensitive to fathers' needs during their transition towards fatherhood and their role during labour should be assessed regularly.
Rising caesarean section rates: the power of mass suggestion
Authors: Gould Debby
Published: May 2014

We can be certain of one thing and that is that we can never make childbirth totally safe. ‘Mother Nature’ will always carry an element of uncertainty that we cannot and perhaps should not try to tame. Every time we attempt risk aversion rather than risk management we find more and more defensive practices creeping in to ‘protect’ and ameliorate from harm. However the cumulative effect is not more protection but ultimately more harm. Chaos theory states that something you do in one area, however small, will always have a knock-on effect in another area and the whole picture is changed.
Ultrasound scanning in pregnancy
Authors: Manning Sara , Shah Sheetle , O'Brien Pat
Published: May 2014

Ultrasound in pregnancy has been in use for more than 50 years, proving to be safe and efficient. However, significant advances in the resolution and technical capabilities of ultrasound machines have diversified its uses. In the care of the healthy pregnant woman, ultrasound now has a clear and defined role, helping to date the pregnancy and screen for structural anomalies. More recently its role has expanded to look at fetal wellbeing and growth as well as looking for maternal conditions such as pre-eclampsia. Such is the scope of modern imaging that high risk obstetrics is now significantly influenced by ultrasound findings. While helping with decision making in antenatal care, this modality also offers parents a window to their baby and reassurance that the pregnancy is progressing as it should. In this article we hope to provide a simple guide to commonly used terms, uses and further roles for ultrasound imaging in pregnancy.
Children of male smokers more likely to inherit genetic mutations
Authors: Daniel Lincia
Published: May 2014

A direct link between smoking and irreversible changes in DNA sequence of sperm cells has been found, meaning that fathers can potentially damage their offspring even before they decide to have children.
Criminal liability for spreading sexually transmitted disease
Authors: Griffith Richard
Published: May 2014

Giovanni Mola was recently convicted of culpably and recklessly infecting his partner with HIV through unprotected sex. Mola refused to wear condoms after starting a relationship with the woman and did not disclose his HIV status even though he had been found to have the virus three years earlier. He was sentenced to nine years in prison (Horsnell, 2007).
Doctors, nurses and healthcare assistants are gaining more power and responsibilities, but have midwives been overlooked?
Authors: Smithye Debra
Published: May 2014

As a practicing midwife, and having also given birth in an NHS hospital, I have experienced first-hand the inadequacies of the NHS from both sides. I am appalled at the disarray of the midwifery profession, not within the midwives, but from our so-called regulatory and professional bodies.
The antenatal journey: ‘I was worried sick’
Authors: Walsh Denis
Published: May 2014

Recently I was chatting with a midwife who was researching the women's experience of antenatal care and she was constantly hearing one word—'worry'. She was getting the distinct impression that the antenatal journey was a troublesome one for most women and that you did well to negotiate without any complications. In April this year both Tolofari (2007) and Anderson (2007) discussed aspects of the problem and both had novel solutions.
Major challenges of midwifery in Africa
Authors: Pettersson Karen Odberg
Published: May 2014

Midwifery in Africa is faced with a variety of challenges. Our colleagues in many countries must regularly deal with maternal death without being offered professional psychological support. Moreover they are forced to work in non-conductive environments which reduce demand–response capacity. Adaptation of midwifery education to national context and evidence-based procedures is a complex issue that requires multi-faceted interventions. The challenges of belonging to a low status profession include financial hardships as well as disrespect from the population and the other key member of the maternal health care team. The ‘brain drain’ (exodus to western countries) and ill health/death due to HIV/AIDS leaves the continent with a huge deficit of midwives. Last but not least a major part of the community does not have access to skilled maternal health care and midwives do not have sufficient support and medical back up to take on the challenge.
Abortion law: an opportunity to inform the debate
Authors: Griffith Richard
Published: May 2014

Midwives have a rare opportunity to inform the debate on the reform of abortion law some forty years after the Abortion Act 1967 liberalized the law relating to the termination of pregnancy. Both pro choice and pro life groups are dissatisfied with the current law and have called for change. The pro life lobby is asking for a reduction in the time limit on abortion and a statutory cooling off period while pro choice lobbyists are demanding less regulation and increased choice for women by allowing health professionals, such as midwives, to terminate pregnancies.
Cardiotocography revisited
Authors: Symon Andrew
Published: May 2014

The interpretation of cardiotocograph (CTG) evidence is a crucial feature in many legal claims. A case heard in the Court of Session in Edinburgh in June (Lowe v Yorkhill) is of interest to midwives for three reasons in particular. The first concerns the ability to assess intrapartum CTG recordings; the second is the use of documentary evidence that can be used when deciding whether clinical actions were negligent or not; and the third concerns the advisability of experts criticising the actions or opinions of those in another profession.
Who appreciates student midwives?
Authors: Modasia Deena
Published: May 2014

Although many student midwives feel as though they are a spare part within the midwifery team and feel as though their contribution is not wholly appreciated, there is one person who does appreciate the care and support provided by student midwives and that is the labouring woman herself, and perhaps her birthing partner.
Remembering the midwife
Authors: Magill-Cuerden Julia
Published: May 2014

This is one woman's birth story which I have listened to and abbreviated to include here.