bluuebunny/crossref_metadata_2025 huggingface dataset:
What influences women in Athens to choose home birth?
Authors: Kontoyannis Maria , Katsetos Christos
Published: May 2014

Home birth rates in Greece have decreased in the last 25 years and make up less than 0.9% of the total births. In contrast, the caesarean section rate exceeded 50% in 2001. The home birth service is only provided on a small scale by private midwives and does not come under the auspices of the Greek National Health Service. It is argued that women should have a right to choose where to give birth, but it seems that this is not an option for most Greek women. In order to understand the reasons women in Athens give for choosing a home birth, narrative interviews were conducted. According to the findings, women in this study decided on a home birth primarily because they wanted to be in control of their birthing experience. The familiar surroundings of their home gave them a sense of reassurance and safety, which in turn enhanced their self esteem and confidence during labour. The belief that birth is a natural event the woman's body is programmed for was another reason women gave for choosing a home birth. This belief in normality of labour came in contrast to the strict medical atmosphere of hospitals'.
Politics and the sexual health of teenagers
Authors: Daniel Lincia
Published: May 2014

When US republican, vice presidential candidate Sarah Palin announced her unmarried, 17-year-old daughter is pregnant it put the spotlight on teenage pregnancy on both sides of the pond.
Duration of breastfeeding in young women: psychological influences
Authors: Bailey Jacqueline , Clark Marie , Shepherd Richard
Published: May 2014

Breastfeeding rates for young mothers are lower than for older mothers and are poorer at four months than at initiation. Therefore the aim of this study was to discover which psychosocial factors influence breastfeeding duration and which factors are different between age groups.

Fifty-seven participants aged 16–24 and 25–40 completed the following measures antenatally and postnatally: a self-esteem-scale, a parent expectations survey, a general self-efficacy scale (GSES), an attitudes to breastfeeding scale, a breastfeeding support scale and a breastfeeding self-efficacy scale (BSES).

Duration of breastfeeding varied from 0 days to 4 months. There was a significant difference in attitudes between the age groups with the older women having more positive attitudes. Multiple hierarchical regression analysis showed that the GSES scores and the BSES scores significantly predicted duration independently of age. Breastfeeding self-efficacy decreased overall after giving birth and to a greater extent in younger mothers who had significantly lower scores on postnatal breastfeeding self-efficacy, which perhaps accounts for younger mothers giving up breastfeeding sooner.
Negotiated placements: enhancing midwifery education
Authors: Common Lisa
Published: May 2014

At the University of Nottingham student midwives have the opportunity to negotiate an optional placement at the end of teaching period II to observe the delivery of midwifery care in a different organization for up to four weeks. Students take responsibility for making the arrangements with the receiving organization; setting realistic aims and objectives; and meeting all costs involved. I will be eternally grateful to the Iolanthe Midwifery Trust (www.iolanthe.org) and my university's Alumni Association which provided funding for me to undertake my placement in Zambia, Africa during the autumn of 2007.
Acute fatty liver of pregnancy: a woman's story
Authors: Nimis Marjorie
Published: May 2014

In August 2004 I got pregnant for the first time. I was what my midwife would have called a ‘healthy 26-year-old female’. I drank a unit or two of alcohol about every two weeks, occasional smoker (to accompany those drinks), weighed a healthy nine and a half stones for five foot three. The first trimester of my pregnancy was very much textbook. At my booking visit I had a scan to check the pregnancy and was more than surprised to discover I was expecting twins, since there are none on either side of the family.
Caring for women with nausea and vomiting in pregnancy: new approaches
Authors: McParlin Catherine , Graham RH , Robson SC
Published: May 2014

Nausea and vomiting in pregnancy (NVP) is a frequently occurring but often debilitating condition. The more severe form, hyperemesis gravidarum (HG) results in increased health care use and a reduced quality of life for sufferers. Management is inconsistent and results in multiple admissions and poor experience of the health care system. Women feel isolated, depressed and lonely and are often treated unsympathetically. Assessment of the severity of symptoms alongside alternative approaches which take into account the interaction between social, psychological and biological events should be considered. A combination of traditional and alternative remedies may be of benefit while ongoing information, advice, social, psychological and emotional support results in increased knowledge, reassurance and confidence which hopefully empowers and encourages women to carry out health promoting activities. This can be carried out in person or via telephone which is an economical and convenient option. Ultimately this should result in improved care and quality of life for sufferers.
Postpartum MMR immunization uptake in non-immune women
Authors: Yung Chee , Skidmore Sue , Lord Sharon
Published: May 2014

The percentage of rubella susceptible pregnant women has increased recently. Main approaches to postpartum measles, mumps and rubella (MMR) immunization are either immunization before discharge or a recommendation to attend GPs for vaccination after discharge. As there is no national surveillance of MMR uptake postpartum in non-immune women, an audit was carried out in two delivery units using different approaches. In the unit using referral to GPs, only 29% (22/76) of women could be confirmed as having received MMR immunization six months post delivery. The approach offering MMR immunization in the delivery unit postpartum showed a confirmed uptake of 60% (26/43).

Therefore the latter approach is more effective and likely to result in better uptake than referring women to their GPs. It should be used to provide immunization to vulnerable women since this would lead to a reduction in the number at risk of acquiring rubella during pregnancy.
Guide to the Mental Capacity Act 2005: determining best interests
Authors: Griffith Richard
Published: May 2014

The first part of the guide to the Mental Capacity Act 2005 considered the principles of the Act and how midwives must apply the two-stage test for assessing decision making capacity in practice.
CTG use in intrapartum care: assessing the evidence
Authors: Walsh Denis
Published: May 2014

Continuous CTG has always been a provocative area of intrapartum practice to examine because strong custom and practice routines preceded robust evidence. This article discusses the evidence base, the limitations of CTG as a diagnostic tool and the implications, as well as its effect on women and midwives.
Higher IQs for breastfed babies
Authors: Bainbridge Jane
Published: May 2014

If further proof were ever needed of the benefits of breastfeeding, a new study in the USA shows that children who were breastfed in the first few months of life have higher IQs.
An insight into Chinese maternity services
Authors: Franks Lauren
Published: May 2014

I recently had the opportunity to spend a two-week elective observational visit in China. As a 20-year-old, second-year student midwife, with little experience in travelling, this was a daunting yet exciting opportunity to broaden my perspective of life, and enhance my understanding of diversity within midwifery.
Young parents' perceptions of barriers to antenatal and postnatal care
Authors: Smith Debbie M , Roberts Ron
Published: May 2014

The teenage pregnancy strategy outlines the need for improved support to lower young parents' risk of long-term social exclusion by enabling 60% to return to employment, education or training. While current literature indicates that young parents need support during and after their pregnancy, little UK research has explored the influence of support on young parents' outcomes. This mixed-methods study provides insight into the antenatal and postnatal experiences of young parents in one London primary care trust. Four main barriers to receiving efficient antenatal and postnatal support were highlighted: a lack of male involvement; a poor and uncommunicative relationship between health professionals and young parents; the age restriction of services and a lack of knowledge about support availability. Age, gender and self-esteem were highlighted as influencing the needs and experiences of young parents and thus need to be considered when designing future antenatal and postnatal interventions.
Book Reviews
Authors: O'Brien Ediri
Published: May 2014

Saggy Boobs and other breastfeeding myths provides all the essential facts about breastfeeding in a beautifully illustrated and engaging book. The book is the result of an ‘Awards for All’ project developed through the partnership of Val Finigan, infant feeding co-ordinator at Pennine Acute Hospitals NHS Trust and the creative arts project, Lime. Through Val's work with mothers and breastfeeding groups and with the talents of embroidery artist Lou Gardiner, ‘Saggy Boobs’ tackles the common breastfeeding myths in a light-hearted but informative way.
Using a childbirth simulator in midwifery education
Authors: Murray Davis Beth , Soltani Hora , Wilkins Heather
Published: May 2014

The use of simulation is suggested to be an innovative and appropriate tool in educating health professionals. However, the evidence regarding the use of simulation, especially the childbirth manikin, within midwifery education is limited. This article describes a pilot project evaluating midwifery student and midwifery educator experiences with the use of simulation. The benefits, issues related to reality setting and theory–practice gap, as well as challenges will be discussed.
Book Reviews
Authors: Davies Louise
Published: May 2014

A book solely about examination of the newborncould be quite a dry read, however, this book istruly excellent and entices the reader to continue to explore its contents more fully. It is written predominantly by midwives, although there are other contributors including a physiologist, doctor, neonatal ICU manager and lecturer in optometry. This makes this book appealing to all health professionals who examine neonates and care for their families. This book would also appeal to those studying midwifery or neonatal care, such is its broad appeal.
Pregnancy following bariatric surgery
Authors: Richens Yana , Fiennes Alberic GTW
Published: May 2014

As the obesity epidemic continues to rise, midwives are going to be faced with new clinical challenges, one of these being the care and management of women who have undergone bariatric surgery. The incidence of such surgeries is increasing worldwide. The aim of the article is to highlight the differences between types of surgery and the midwife's role in supporting this group of women during pregnancy.
Weight management during and after pregnancy
Authors: Cullum Adrienne
Published: May 2014

Weight gain during pregnancy and weight retention after childbirth preoccupy many women. Even those who feel comfortable with their changing body shapes during pregnancy may fondly recall their slimmer, less sleep-deprived selves postnatally, not least when reading about the latest celebrity to slip back into their size zero wardrobe within weeks of giving birth. However, despite our preoccupation with weight, many women—and health professionals for that matter—may be unaware of the serious health risks associated with obesity in pregnancy.
Parents' views of 4D ultrasound scans following diagnosis of cleft condition
Authors: Cadogan Julia , Marsh Cathy , Winter Rosemarie
Published: May 2014

Ceft conditions are the most common congenital craniofacial anomalies. Feeding, hearing, speech and the alignment of teeth are often affected, particularly where a cleft of the palate is present. The aim of this qualitative study was to explore the value of 4D ultrasound scans for parents where a cleft had been identified on a routine 2D ultrasound scan. Parents completed three questionnaires: once they had decided to proceed with the 4D scan; as soon as possible after the 4D scan at about 28 weeks gestation; and postnatally at a cleft clinic. The questionnaires assessed parents' reasons for having the scan, expectations of the scan and advantages and disadvantages. The results suggest that for most of the parents their expectations were met or exceeded, they would recommend having a 4D scan to others and overall the advantages outweighed the disadvantages. The majority of parents were not disappointed.
Exploring empowerment issues with student midwives using forum theatre
Authors: Kemp Joy
Published: May 2014

Starbuck (2006) suggests that creative activity, which uses the left side of the brain, can encourage deeper learning. I have used a variety of creative teaching strategies. Games and other participatory activities can lighten the delivery of ‘heavy subject matter’ and rehearse complex processes. The spontaneous construction of 15-minute models and posters using arts and crafts materials can demonstrate to students their creative potential. However, the approach which I consider the most innovative—and risky—has been the use of forum theatre to explore the concept of empowerment in midwifery with student midwives.
Managing demand: telephone triage in acute maternity services
Authors: Cherry Alison , Friel Ruth , Dowden Barbara , Ashton Kim , Evans Rhian , Pugh Yeasmin , Evans Yvonne
Published: May 2014

A project providing triage in acute maternity settings was developed to better manage demand and ensure the right service was available at the right time and in the right place. Data collected prior to implementing the telephone triage project identified that a significant number of women accessed the labour ward as their first point of contact for advice with maternity services resulting in an unnecessarily high volume and throughput where labour ward was in effect gate-keeping other clinical areas.

The project was designed and introduced to maximize the use of the clinical expertise possessed by a group of practice development midwives. Early results suggest that demand and patient flow is better managed following the introduction of the telephone triage service.

The development of a telephone triage service within an acute maternity service is beneficial and can result in a reduction in inappropriate admissions. There are benefits at a client, clinician, service and organizational level.
Choice for women and choice for midwives—making it happen
Authors: van der Kooy Brenda
Published: May 2014

For many years now it has been acknowledged that retention of midwives is a major problem for the maternity services, which numerous initiatives have proved unsuccessful in resolving. This is now hindering policy to improve quality of care such as Maternity Matters (Department of Health, 2007).
Recovery of the pelvic floor after pregnancy and childbirth
Authors: Day Jane , Goad Katy
Published: May 2014

The pelvic floor muscles are weakened during pregnancy by the weight of the growing baby, the effects of hormones and by stretching and trauma sustained during vaginal delivery. Pelvic floor muscle training is recommended during pregnancy and after birth to re-tone the muscles, which helps recovery, prevents and treats urinary incontinence and avoids the development of future pelvic floor disorders. Despite this, not all new mothers receive reinforcement of this education after childbirth and may benefit from further care. In comparison, French women receive specialist physiotherapy treatment to re-tone the pelvic floor after childbirth as part of their national health service. New clinics in the UK are offering biofeedback and electrical stimulation treatments, pelvic floor and core body exercises and education to help new mothers understand and improve the health of their pelvic floor, address and prevent postnatal complications and maintain good core muscle support.
Antenatal anxiety in pregnant women from rural Cambodia
Authors: MacLellan Jennifer
Published: May 2014

This article is a report of a grounded theory study of pregnancy and childbirth experiences of women in rural Cambodia. Antenatal anxiety and depression have been linked to adverse outcomes of preterm delivery and low birth weight in the baby. Recent study findings from Cambodia reveal high levels of clinically significant antenatal anxiety and depression with consequent links to low birth weight in the infant.

Thirteen in-depth interviews with rural pregnant women were conducted in December 2008 over 3 days during the midwifery outreach service to the villages. The research process followed the principles of grounded theory methodology. Four core categories were identified during the interview analysis: fear of childbirth, lack of information, traditional versus allopathic practice, and access to the government midwife.

Childbirth causes fear, largely owing to a lack of knowledge about the normal physiological process and fear of death in the case of complications due to poor access to health services. Traditional and allopathic practice largely ran in parallel or in contradiction to each other but there were some examples of successful integration. Most of the interviewees wanted more contact with the government midwife. This could be an opportunity to share information in a confidential, non-threatening but informative relationship while reducing anxiety and consequences for the mother and her child. These categories can be extrapolated to the wider context highlighting complex barriers to women accessing midwifery care, while emphasizing the negative impact of anxiety on fetal wellbeing and the role of accurate information and professional support.
Care and consequences of perineal trauma
Authors: Steen Mary
Published: May 2014

This article discusses the care and consequences of perineal trauma which affects the majority of women. It is clearly evident from the literature that failure to recognize the extent of trauma, incorrect repair and inadequate pain relief can lead to negative consequences in both the short and long term. Women complain of varying degrees of perineal pain and discomfort and pain relief is an important aspect of midwifery care. It would appear that a combination of systemic and localized treatments is necessary to achieve adequate pain relief which will meet individual women's needs.
The Equality Act 2010: further protection against discrimination
Authors: Griffith Richard
Published: May 2014

Discriminating against a woman in the workplace on the grounds that she is pregnant has long been unlawful under the Sex Discrimination Act 1975, section 3A. In Drewett vs. Penfold [2009], for example, the Employment Appeals Tribunal found that a woman had been discriminated against when she was summarily dismissed from her job as a nanny and housekeeper when her employer discovered she was pregnant.
Who cares about teenage dads? Role of a young fathers' worker
Authors: Hansom Justina , Nur Norman
Published: May 2014

The Teenage Pregnancy Support Team in Newcastle believes the involvement of the prospective father is vital for maximising the wellbeing of a child. It also provides a forum for a primary health promotion approach to improving health outcomes for him. The antenatal period is an excellent opportunity to involve young fathers-to-be, whether or not they intend to remain with their current partner. In Newcastle there has been a dedicated young fathers' worker for two years. He has developed a holistic community approach to supporting the young dads and has created a social space which enables each new prospective father to have a separate discussion with him. This holistic assessment approach enables the young fathers' worker to signpost the young dads to other appropriate health and social community resources, such as educational, vocational and parenting courses.
Birth Companions: working with women in prison giving birth
Authors: Marshall Denise
Published: May 2014

The needs of women giving birth from prison were highlighted in 1995. A group of antenatal teachers and midwives in London met and decided to offer birth support to women in Holloway prison. Birth Companions has been working with pregnant women and mothers and babies in Holloway for 14 years and has expanded the birth support service to include breastfeeding and working with women post release. The aim of the project is to improve the experience of this vulnerable group of women and babies. Studies show that birth support can improve outcomes for mothers and babies and the feedback from women in Holloway is very encouraging. However, there is a need for more research into the needs and experiences of women and babies who are in prison during the perinatal period.
Do midwives give adequate information to women about instrumental birth?
Authors: Goyder Karen , Bahl Rachna , Ford Jenny , Strachan Bryony
Published: May 2014

One in four women in their first pregnancy will have an instrumental birth. Many women are traumatized by their experience of instrumental birth and feel they have been inadequately prepared. If this is the case are we, as a profession, falling short of providing women with the information they need to support them through these more challenging births?

This study investigates the format and content of information given by community midwives about instrumental birth. The midwives were asked what training they had to support them and how they adapted their education classes to encourage women from all backgrounds to attend. A questionnaire survey was completed by community midwives from a University Teaching Hospital (Foundation Trust).

The findings demonstrate that information about instrumental birth is not consistent and does not reach enough women. The study draws attention to the training needs of midwives and highlights their concerns regarding workload constraints and time pressures.
Fetal alcohol syndrome: raising awareness about alcohol in pregnancy
Authors: Fleisher Susan
Published: May 2014

I adopted my daughter Addie when she was 3 years old. At the time of my daughter's adoption, I was not aware that her birth mother's drinking would harm her for the rest of her life and it was only as she grew up that the full impact of fetal alcohol syndrome (FAS) became apparent.
Healthy eating on the NHS: leading by example
Authors: Bainbridge Jane
Published: May 2014

While obesity affects a person's health at all stages of their life, there are particular medical issues if that person is a woman and she becomes pregnant, not to mention the strain this puts on the maternity services.
The teenage pregnancy strategy: Beyond 2010
Authors: Russel Lucy
Published: May 2014

I was recently asked the question, ‘So why should we continue the teenage pregnancy strategy with a new government?’ I had to get a clear message across. My instinctive response was to say, ‘because we're finally getting the hang of it’.
Caesarean section at maternal request: a literature review
Authors: Thompson Heather
Published: May 2014

UK caesarean section rates have seen an exponential rise in recent years. Despite recommendations from the Expert Maternity Group to implement woman-centred maternity services that encourage natural birth, and despite the publication of National Institute for Health and Clinical Excellence (NICE) guidelines in 2004, rates of abdominal delivery continue to increase. Caesarean section performed at a patient's request in the absence of medical indications is the source of extensive debate in the media and the medical professions. In 2002, 7.3% of all primary caesarean sections in the UK were performed at maternal request, costing the NHS in excess of £10 million. The reasons behind such requests are varied and often are influenced by social, cultural, emotional and economic factors. This review explores factors that influence some women's preference for elective caesarean section over vaginal delivery and discusses the existing evidence.
Professional Ethics in Midwifery Practice
Authors: Mockler Joanne C
Published: May 2014

With the authors' professional backgrounds of midwifery, and one a professor of ethics, the reader can be assured the authors have the knowledge and expertise to write this book.
Caseloading: students solve their own problems using action learning
Authors: Lee Karen , Porteous Carol
Published: May 2014

Caseloading is a relatively new aspect of midwifery education and as such it is useful to share information with students at other institutions. This article discusses how students identify their own concerns related to specific NHS Trust placement sites and how they are solved using action learning. This article makes reference to several articles that have been written on the topic of caseloading.
Findings from a UK feasibility study of the CenteringPregnancy® model
Authors: Gaudion Anna , Menka Yvonne , Demilew Jill , Walton Cathy , Yiannouzis Katie , Robbins Judith , Rising Sharon Schindler , Bick Debra
Published: May 2014

CenteringPregnancy® is a model of group antenatal care which was devised and developed in the United States. A feasibility study was conducted in South East London from 2008 to 2010, to assess if the model could be introduced into NHS settings, if women would be prepared to join a group model of care and to explore the views of the women, their partners and midwives who participated. This was the first time the model had been implemented in the UK. Six antenatal groups, attended by 60 women and their partners and facilitated by 12 midwives, were established for the feasibility study with a seventh group of 8 women and their partners established later to bring the learning together and inform an operational guidance document ( Gaudion and Menka, 2011 ). Women whose pregnancies were classed as low or high risk could opt for group antenatal care at the study site after discussion with a midwife at their antenatal booking visit. Integral components of the CenteringPregnancy model are the evaluations of care which women and their partners are asked to provide in late pregnancy and at one month after the birth of their baby. The midwives who facilitate the groups are also required to complete evaluation forms and to contemporaneously reflect and enhance the care they offer, if this is appropriate. Feedback from these sources, together with an evaluation of the means of learning in the development process, was very positive and has informed the ongoing roll-out of the model at the study site. The potential to conduct randomized controlled trials in the UK to assess the clinical utility and cost-effectiveness of group antenatal care compared with individual antenatal care for women in low- and high-risk obstetric populations should now be considered.
Use of oil for baby skincare: A survey of UK maternity and neonatal units
Authors: Cooke Alison , Cork Michael J. , Danby Simon , Lavender Tina
Published: May 2014

Olive oil is commonly recommended by health professionals to new parents for use in the prevention and treatment of the term baby's dry skin, and for baby massage. There is no evidence to support this practice. The use of olive oil may be harmful to skin, affecting skin barrier function. This effect may be a contributory factor in the prevalence of childhood conditions such as atopic eczema. This paper discusses a national online audit of UK maternity hospitals (n = 67) and neonatal units (n = 33) performed between November 2010 and January 2011. Our findings confirm that oil use on babies' skin is common practice. As the direct cost to the NHS for treatment of atopic eczema is high, it is imperative that further research in this area is performed, preferably in the form of a randomized controlled trial. Health professionals will then be in a position to provide accurate information to parents with regard to oil in baby skin care regimens.
Maternal obesity in pregnancy: Women's understanding of risks
Authors: Keely Alice , Gunning Melanie , Denison Fiona
Published: May 2014

Aim: To explore obese women's perceptions of obesity as a risk factor in pregnancy and their experiences of NHS maternity care. Methods: Open-ended, semi-structured interviews were used to gain an in-depth understanding of participants’ experiences. Eight women were interviewed in their own homes in Edinburgh and the surrounding area. All had a pregnancy of beyond 34 weeks’ gestation and had a body mass index (BMI) greater than 40 kg/m2 at pregnancy booking. Findings: Participants were aware of obesity as a risk factor in pregnancy, but this awareness had developed only during the index pregnancy. Some participants felt the significant risks posed by obesity in pregnancy had not been explained adequately to them, both prior to and early in the pregnancy. This had caused significant anxiety in some cases. Conclusions: There is a need for opportunistic health promotion aimed at disseminating information about the risks of obesity in pregnancy to overweight and obese women of childbearing age. In addition, midwives need guidance in discussing this sensitive issue with women, in order to promote open communication and effective clinical care.
The genesis and consequences of stress among midwifery students
Authors: Khajehei Marjan , Ziyadlou Samaneh , Hadzic Maja , Kashefi Farzaneh
Published: May 2014

This study investigated various sources of stress among junior and senior midwifery students in Iran. It also explored the effect of stress on the students’ performance and physical and mental health. Ninety junior and senior midwifery students participated in this survey. Data were collected using self-created questionnaires and analysed using the Statistical Package for the Social Sciences (SPSS). The data showed that the most stressful activity for juniors was nursing care practice. Prenatal health care practice was identified as the second most common cause of stress in juniors. For seniors, nursing care practice and prenatal health care practice were equally stressful. The preceptor (mentor) as well as the clinical setting and staff have been identified as two major factors causing stress, somewhat more in juniors than in seniors. The most common physiological and behavioural demonstrations of stress in the students were palpitation, exacerbated asthma, fatigue, unusual behaviour and dizziness. It is evident that efforts need to be made to minimize the negative effect of stress on students by creating and establishing healthy learning environments.
Women's experience of giving birth with their husband's support in Nepal
Authors: Sapkota Sabitri , Kobayashi Toshio , Takase Miyuki
Published: May 2014

The purpose of this qualitative study was to explore women's experiences of giving birth with their husband's support in urban Nepal. The study was conducted in July 2009 at a midwife-led birthing centre in the capital of Nepal. In-depth, semi-structured interviews were conducted among twelve first-time expectant mothers who gave birth with the support of their husband. Each interview was audio-taped. The recorded data was analysed using thematic analysis. Three themes were identified: (1) feeling in control of the labour process, (2) concern for their husband and (3) emotional discomfort. Most of the time, the women, with support from their husband, felt in control of the childbirth process, but they were also periodically in discomfort. Moreover, they were concerned that their husband had to witness their labour pain. Educational and birth preparation classes for expectant couples would help to reduce women's emotional discomfort and alleviate their concern for their husband.
Transactional analysis: A method of analysing communication
Authors: Hollins Martin Caroline J.
Published: May 2014

Midwives are required to develop effective and constructive communication skills for use within the workplace. When a student is on placement, the Nursing and Midwifery Council (NMC) essential skills clusters for care, compassion and communication are the first skills students are required to demonstrate to their mentor. Communication is an idiom that both students and staff sometimes find difficult to assimilate, with communication problems identified in vague terms. Accordingly, methods of clearly defining and assessing attainment are commonly requested of midwifery lecturers. To facilitate students, midwives, managers and lecturers with an instrument to assess good communication, the technique of transactional analysis (TA) is proposed.
A mindfulness approach to antenatal preparation
Authors: Warriner Sian , Williams Mark , Bardacke Nancy , Dymond Maret
Published: May 2014

This article describes a small exploratory workshop undertaken to investigate the feasibility and acceptability of using a mindfulness-based approach to antenatal childbirth education. Good mental health and wellbeing, and not simply the absence of mental illness, have been shown to result in health, social and economic benefits for individuals, communities and populations ( Department of Health, 2011 ). Mindfulness practices are increasingly being used as a way of managing pain, reducing stress and anxiety and have the potential to help parents preparing for childbirth to reduce the risk of postpartum depression and increase ‘availability’ of attention for their baby. As mindfulness practices help participants to see more clearly the patterns of the mind, it helps both to halt the escalation of negative thinking that might compound pain or depressed mood, and deals with the tendency to be on autopilot. This small pilot workshop received a remarkably positive response and showed that the training was acceptable to couples and midwives in the UK context.
Integrating a clinical model of smoking cessation into antenatal care
Authors: Fendall Lisa , Griffith Wendy , Iliff Alison , Lee Andrew , Radford John
Published: May 2014

Smoking rates during pregnancy in Rotherham are high, and between 2007 and 2010 were on an upward trend. Previous local initiatives to address the problem, such as introducing an opt-out pathway and incentive schemes, were not proving effective. In early 2010 NHS Rotherham undertook a major service redesign of the smoking in pregnancy pathway, embedding intensive specialist smoking cessation advice into routine antenatal care. The proportion of pregnant women smokers who set a quit date increased from 33.7% in 2008/09 to 43.9% in 2010/11 (P < 0.05). The percentage of women still smoking at the time of delivery had initially been on an upward trend since 2006/07, reaching a high of 27.3% during 2009/10. This trend has now reversed, falling to 22.4% during 2010/11 and to 19.3% in the first quarter of 2011/12. Embedding stop smoking advice in routine antenatal care has enabled more women to receive a single intensive stop smoking intervention. It has succeeded in engaging women who attend their antenatal scans but have little other interaction with health services. The pathway is achieving better outcomes without requiring additional resources.
Electronic health records in maternity: the student experience
Authors: Brooke-Read Melanie , Baillie Lesley , Mann Robert , Chadwick Sandra
Published: May 2014

In 2002, the Department of Health (DH) introduced an information strategy that was intended to improve care, reduce duplication and increase patients' involvement in their own records and management of care. Student midwives are educated to appreciate that good record keeping and documentation is integral to safe, effective midwifery practice. As electronic health records (EHRs) become more widespread, this survey aimed to investigate midwifery students' experiences of electronic health records (EHR) in practice, using questionnaires and focus groups. The questionnaire results indicated the types of EHRs students had accessed and used. From the focus group, three themes emerged: benefits of EHRs for care delivery; practical issues of EHRs and accountability; incongruence between EHRs and the concept of ‘normality’ in childbirth. As student midwives increasingly encounter EHRs in their practice, education and health providers should collaborate to implement appropriate training and preparation.
Maternal obesity: risk or resolution? A literature review—part 1
Authors: Williams Helen
Published: May 2014

This article presents the first part of an extended literature review aiming to explore whether current antenatal care results in a missed health promotion opportunity to address the issue of obesity in pregnant women. This integrative literature review analysed 36 primary and secondary research studies. Both qualitative and quantitative studies were included. Five main themes emerged from the study:

Resource implications around maternal obesity The value of measurement and monitoring of gestational weight gain The value and effectiveness of antenatal interventions Women and midwives understanding of the risks of obesity The links between maternal obesity psychological, and socio-economic factors.

The first two themes will be discussed in part 1 of this review. The concluding part explores the other three themes and identifies recommendations for practice and further areas for research.
Stop the midwife shortage
Authors: Price Cheri
Published: May 2014

Cheri Price, student midwife, questions why there is still a lack of midwifery jobs for newly qualifed midwives despite the current baby boom.
Antenatal care before caesarean section in rural Turkey
Authors: Okumus Filiz , Sohbet Rabia
Published: May 2014

This cross-sectional study was conducted at the state hospital in Gaziantep, rural Turkey, to assess the quality of antenatal care in women who underwent caesarean section (CS). Data collected from 581 women admitted for CS between October and December 2005 were retrospectively analysed and found that Turkish women preferred obstetricians to midwives for their antenatal care. Obstetricians chiefly consider antenatal care as a follow-up to ultrasound, and procedures such as weight monitoring, blood pressure measurement and blood analysis, all of which help to facilitate timely diagnosis of complications, were mostly overlooked.

The belief that antenatal care is only for women with complications could be abolished through education and may help to encourage vaginal delivery. Pregnant women who receive antenatal care from obstetricians are more likely to undergo CS, thus greater collaboration between obstetricians and midwives is necessary in future to promote normal births.
Part 2: Applying the cultural web – Changing the labour ward culture
Authors: Freemantle Danielle
Published: May 2014

This is the second of two articles looking at cultural change in maternity services using Johnson's cultural web model (1992). Part one explored and explained the model in terms of the dominant cultural paradigm, and its analysis and potential for change ( Freemantle, 2013 ). This article demonstrates the application of the cultural web model to maternity services and its potential impact on women-centred care—specifically labour ward culture. A cultural web is developed and summarised before using the model to consider change and identify a desired culture that aligns with the Chief Nursing Officer's (CNO) ‘6 Cs’ vision for nursing and midwifery care ( Department of Health (DH), 2012 ), the Safer Childbirth report ( Royal College of Obstetricians and Gynaecologists (RCOG) et al, 2007 ) and Maternity Matters ( DH, 2007 ). For demonstration purposes, the change focus or problems are continued use of outdated, entrenched labour ward practices around the second stage of labour, which conflict with National Institute for Health and Care Excellence (NICE) (2007 ) best practice guidance and may well diminish or deny the opportunity for normal birth ( Williams, 2007 ). It recognises the fundamental part midwives and midwifery leadership plays in shaping and changing the culture of care, with particular reference to Supervisors of Midwives (SoM). Consequently, this model has the potential for widespread application throughout maternity services by improving efficiency, effectiveness and the environment of care.
Are ‘early’ and ‘late’ fetal heart rate decelerations extinct? A survey of British midwives and analysis of controversies, facts and fiction
Authors: Sholapurkar Shashikant L
Published: May 2014

An anonymous survey of 56 midwives from different NHS hospitals revealed a major change in the categorisation of fetal heart rate (FHR) decelerations after the National Institute for Health and Care Excellence (NICE) (2007) guidelines on intrapartum care were implemented. The survey showed that the midwives currently categorise hardly any decelerations as ‘early’ or ‘late’ (median 0%, mean < 1%), the majority being ‘variable’ (median 100%, mean > 99%). A high proportion (40–70%) of the cardiotocographs (CTG) were classed as ‘pathological’ without any intervention required. In the survey, 33 midwives who had worked for more than 5 years stated that the vast majority (50–70%) of decelerations were ‘early’ (p < 0.0001) before the NICE guidelines (2007). The paradox of near extinction of early FHR decelerations (head compression which is a very common phenomenon) is not just a theoretical matter but leads to increasing numbers of false positive pathological traces. Midwives may be increasingly disenfranchised by having to rigidly adhere to the NICE categorisation of FHR decelerations.
Midwifery students' experiences of achieving competency for beginning practice
Authors: Licqurish Sharon , Seibold Carmel , McInerney Fran
Published: May 2014

Three-year undergraduate Bachelor of Midwifery programmes were introduced into Australian universities in 2002 in response to the midwifery profession's changing political, economic and workforce needs and expectations of the midwife's role ( Glover, 1999 ; Cutts et al, 2002; Leap, 2002 ). There was an identified need to broaden the entry pathways and structure of midwifery courses to make them accessible to those who did not hold a nursing qualification or experience. Expectations of the midwife's role and scope of midwifery practice in Australia were shifting ‘from the biomedical, hospital-centric focus of pregnancy to one emphasising a “new midwifery” based on a midwife-woman partnership and evidence-based practice’ ( Seibold, 2005: 10 ) and this was reflected in the new midwifery curriculum. This paper presents findings from a grounded theory study exploring the experiences of early Australian Bachelor of Midwifery students, graduating in 2005–2008, from a university in Victoria, Australia. The study was timely, as the first graduates from these courses had entered the profession in 2004 and these students' experiences had not been explored. The findings demonstrate how these students underwent a process of ‘assimilation’ to achieve competency for beginning practice. Assimilation involved three sub-processes: ‘realisation’, ‘adaptation’ and ‘consolidation’.
Young people's attitudes towards breastfeeding: A survey of 13–15-year-old pupils in a south London school
Authors: Gale Liz , Davies Nigel
Published: May 2014

As part of a larger study investigating why mothers in a socially disadvantaged area did not breastfeed, a survey of local schoolchildren was commissioned to establish the views of future parents. examining the attitudes of both boys and girls towards infant feeding, 81 pupils (60% female, 40% male) from Years 9 and 10 (aged 13–15) completed the questionnaire. The school pupils were asked to record whether they agreed or disagreed with a range of statements about breast and bottle feeding in general, with additional comments invited. The study showed that school pupils are aware that ‘breast is best’ but that this does not necessarily reflect future feeding intentions. Feeding in public was viewed as unacceptable and there appeared to be conflict between breastfeeding as ‘physiologically natural’ and bottle feeding as ‘socially natural’. Differences in attitude towards infant feeding between boys and girls or between different ethnic groups were not apparent.
Pregnancy-related lumbopelvic pain: Prevalence, persistence, risk factors and management implications
Authors: Clark Carol J , Carr Eloise CJ , Way Sue
Published: May 2014

Symphysis pubis dysfunction (SPD)/Pregnancy-related lumbopelvic pain (PLPP) is a common condition with a prevalence range of 14–85% ( Larsen et al, 1999 ; Orlikowski et al, 2006 ). In the literature, a number of terms and definitions have been employed by professionals from different countries to describe this condition. Women report a wide range of symptoms and there is a requirement for a careful assessment. The goal of this paper has been to raise awareness of the pain and activity limitations reported by some women during pregnancy and postpartum. The clinical presentation and women's experiences are described. The risk factors predisposing women to SPD/PLPP both during pregnancy and postpartum are presented. There is a requirement to meet the expectations of women with SPD/PLPP. Women need to be assessed, be able to tell their story, have the condition explained, and be involved in the management of their symptoms and activity limitations. Midwives play a key role in assessing for SPD/PLPP, so this paper proposes a five-step plan to guide midwives and doctors in the management of this condition.
Using wheat bran fibre to improve bowel habits during pregnancy - a call to action
Authors: Jefferson Angie , Croton Jo
Published: May 2014

Constipation and haemorrhoids are two of the most common problems experienced by pregnant women. Clinical guidelines agree that increased fibre (particularly wheat bran) and fluid intakes are advisable to promote bowel health ( Jewell and Young, 2001 ; National Institute for Health and Care Excellence (NICE), 2010 ) but no specific guidance is given as to how much fibre or fluid should be consumed. This lack of direction leaves midwives relying on a common sense approach to supporting women in improving their dietary intake. However, do midwives have sufficient nutritional knowledge to empower women with appropriate, healthy, high-fibre choices? A literature search was carried out to identify papers addressing the role of fibre and fluid during pregnancy. Overall, fibre consumption reported by pregnant women fell woefully short of recommended intake. Studies suggest that most pregnant women in the UK would benefit from an increase in fibre intake of at least 10 grams a day in order to help prevent constipation and haemorrhoids. This article provides practical advice to help boost fibre intake in order to improve the quality of life of pregnant women.
Family history taking at the booking clinic – Results from a pilot audit in the West Midlands
Authors: Cooley Candy , Bishop Michelle
Published: May 2014

Taking a medical family history is a key role for the midwife during the antenatal period. This audit was developed following a National Patient Safety Agency (NPSA) alert on medium-chain acyl-coA dehydrogenase deficiency (MCADD) where it was noted that, anecdotally, midwives were often unsure of the relevance of the family history information. The findings show wide variation in the genetic family history information collected and the follow-up documented when a genetic condition has been identified.
Percutaneous endoscopic gastrostomy: psychological effects
Authors: Rickman Jenny
Published: May 2014

Percutaneous endoscopic gastrostomy (PEG) tube insertion is increasingly being used for patients with dysphagia. The length of time needed for feeds and the change in lifestyle affects both patients and their carers.
Complaints about nurses: the unlearnt lessons
Authors: Tingle John H
Published: May 2014

The latest annual reports from the Health Service Commissioner (HSC), or Ombudsman (HSC, 1998a,b), have highlighted, yet again, the problems of poor communication, record keeping and complaint handling within the NHS. A record number of complaints about the NHS were filed, 20% more than in 1996. The HSC upheld 12 out of 27 grievances in relation to complaints about care and treatment by nurses and midwives, and 6 out of 11 grievances in relation to communication. For example: