bluuebunny/crossref_metadata_2025 huggingface dataset:
Telemedicine for stroke: a systematic review
Authors: Roots Angela , Bhalla Ajay , Birns Jonathan
Published: May 2014

Inequalities in stroke patient care have been demonstrated in different locations and at different times. To overcome the inequity of access to specialist stroke care, telemedicine systems have been developed to provide remote specialist assessment of patients with real-time clinical evaluation for hyperacute care and rehabilitation. An electronic database search was performed of MEDLINE, EMBASE and the Cochrane Library and extensive manual searching of articles was conducted to identify studies investigating the use of telemedicine in managing acute stroke and post-stroke rehabilitation. There were 20 observational and 2 randomized, controlled acute studies involving 15872 patients and 2 observational and 4 randomized controlled rehabilitation studies involving 112 patients that met the inclusion criteria. Telemedicine for stroke, in both acute and rehabilitation settings, was demonstrated to be safe, effective, feasible and acceptable and was shown to reduce geographical differences and increase diagnostic accuracy and uptake of thrombolytic treatment.
The psychological impact of the unpredictability of multiple sclerosis: a qualitative literature meta-synthesis
Authors: Wilkinson Hannah Rose , Nair Roshan das
Published: May 2014

Background:

Multiple sclerosis (MS) is a neurological condition characterised by an unpredictable nature. This characteristic is reported to be the largest challenge for individuals with the condition. Chronic illness literature highlights the psychological impact of unpredictability, but there is a paucity of research examining this concept in MS.

Objectives:

This systematic review aimed to explore the psychological impact of unpredictability in MS.

Methods:

A meta-synthesis was conducted. A total of 6 studies with 59 participants were reviewed and critically appraised. Themes relating to the psychological impact of unpredictability were extracted and synthesised.

Results:

A preliminary model of the unpredictability of MS was developed highlighting the different psychological impacts of diagnosis, remission and relapse.

Conclusions:

The psychological impact of unpredictability alters through diagnosis, remission and relapse. Further research is required to explore the experience of unpredictability in MS.
Childbirth on television
Authors: Clement Sarah
Published: May 2014

In Britain, and much of the developed world, most births take place in hospital, usually with only the birthing woman, her partner and healthcare professionals present. It is therefore rare for women to witness childbirth before they themselves give birth. Women do, however, witness birth indirectly, through the eye of a television camera.
Stress in student midwives: an occupational perspective
Authors: Cavanagh Stephen J , Snape John
Published: May 2014

This article reviews key aspects of occupational stress in health professions with special reference to midwives. Findings from the general literature on this subject have been consistent for many years, and reference will be made to key articles which best illustrate the possible cause and impact of stress on professional health staff. There is, however, a dearth of literature looking at stress in midwives (Carlisle et al, 1994). This article reports studies which have made specific reference to occupational stress as a result of practice, education or other professional issues. This study examined, from a qualitative perspective, sources of stress encountered by student midwives during their training, and educational and practical sources of stress. A total of 199 students from 12 midwifery centres participated in the study; 127 from pre-registration and 74 from pre-registration (shortened) courses. Students were asked to describe incidents during their practice that they felt were stressful, and were asked to consider whether the stress resulting was: ‘a little’, ‘much’ or ‘very much’. The most common stressor was the concern about finding employment following qualification. There were a number of professional issues raised by respondents, who felt that they were disenchanted with the profession because of their perception of poor practice, long hours, poor job prospects and low wages. Several expressed their intent to leave midwifery. A major finding was that the ‘everyday’ experiences of the education setting (for example cancelled classes and poor resources) can have an impact upon students. Practitioners and educationalists are urged to consider the impact of the learning environment and appropriate preparation when educating students.
Caseload holding with a difference
Authors: Walsh Denis , McLean Moira , Benjamin Yvonne
Published: May 2014

Midwives involved in practice development, research and teaching linked to the Women's Hospital, Leicester Royal Infirmary NHS Trust are sharing a small caseload of women as a model of clinical practice. This article explains the rationale behind the initiative, some operational details and explores the personal reflections of the participants.
Reflections on postnatal depression
Authors: Bott Jane
Published: May 2014

Midwives are being encouraged to utilize reflective practice in order to develop professionally (Chesney, 1996). Indeed, with the implementation of PREP (post-registration education and practice) (UKCC, 1995), every practitioner is required to demonstrate professional updating, and reflective writing is one way of achieving this. This article consists of a ‘reflection’ on the experience of caring for a postnatally depressed mother. Gibbs' (1988) reflective cycle has been utilized to assist the reflective process. In addition, background factors have been integrated by adapting the reflective cycle to include cue questions from a model of structured reflection develpoed by Bulman (1994), who draws form the work of Johns (1992) and Carper (1978). To ensure confidentiality, a fictitious name has been used when referring to the mother.
The impact of team midwifery on GPs
Authors: Pankhurst Francesca L , Hart Angie
Published: May 2014

Many GPs in the UK have faced changes in midwifery service provision following the publication of Changing Childbirth (Department of Health, 1993). However, there is little documented evidence of how new midwifery schemes have affected the work of GPs. This study investigated: GPs' satisfaction with the current maternity and midwifery services; their views of the effects of team midwifery on GPs, midwives and women and whether it improved the maternity service; and assessed their training needs in relation to team midwifery. All GPs received a survey. Ten GPs associated with the team midwifery scheme were also interviewed. A total of 87 (50%) surveys were returned. Most GPs who responded were satisfied with current maternity and midwifery service provision. Most surgeries (66%) mainly provided shared care, the preferred mode of care delivery for 74% of respondents. Similar aspects for praise and criticism of either midwifery scheme were raised with communication figuring prominently at both extremes. Views of team midwifery ranged from support of the philosophy behind the scheme to anxieties about the GPs' role in maternity care. Fewer respondents thought team midwifery was better for GPs (48%), than for midwives (59%) or women (60%). Those without direct experience of team midwifery were more likely to think that GPs needed training in response to the implementation of team midwifery.
Fetal perspectives on labour
Authors: Harrison Julie M
Published: May 2014

The influence of the midwife is vital in enhancing the physiological processes of labour. This article focuses on fetal physiology and gives insights into how the fetus experiences labour. Awareness is raised of possible adverse factors, which if introduced into the care could detract from maternal and fetal health. The role of the midwife in protecting fetal wellbeing is emphasized.
Midwife consultants: a welcome step
Authors: Warwick Cathy
Published: May 2014

The strategy document Making a Difference (Department of Health (DoH), 1999) confirmed that nurse, midwife and health visitor consultant posts would be established in the NHS. Detailed guidance has now been issued (DoH, 1999b) as to the process employers wishing to establish and appoint to such consultant posts must follow.
Experience of childbirth from the fathers perspective
Authors: Bartels Rosemarie
Published: May 2014

A literature review was conducted on the experiences of childbirth from the father's perspective. Studies have shown that the presence of fathers during labour and delivery is valued. Hennenborn and Cogan (1975) noted that the father's presence reduced the pain suffered by the woman and Kennell (1987) indicated that increased involvement of the father at the birth fosters the development of future family bonds. However, studies also indicate that labour and delivery can be stressful event for expectant fathers, and that midwives do not recognize or meet many of their needs. Midwives have an important role in making the labour and birth experience a positive one for both mothers and fathers.
Every picture tells a story: Life and birth experiences
Authors: Chesney Margaret
Published: May 2014

May I introduce you to Noshaba and Pervez; this picture was taken following the birth of their son Harris on September 12, 1996. Sharing their life and birth experience has served to increase my awareness of cultural issues surrounding childbirth, I hope by telling their story we can share the learning
Electronic fetal monitoring equipment update
Authors: Hinds Marian
Published: May 2014

Electronic fetal monitoring has been with us for the last 30 years. In that time there has been a plethora of literature written on the subject, much of it questioning the value of its use particularly in low risk women. Despite the continuing debate, monitoring remains an extremely common intervention during labour.
Act now to save the midwife!
Authors: Page Lesley
Published: May 2014

Midwifery and nursing are facing the most acute shortages in staffing ever. It is estimated that there are currently 13000 vacancies in the UK. The Royal College of Midwives estimated that there were about 1000 midwife vacancies in the UK in 1998. This is a significant problem given that there are only 32803 practising midwives (out of 93776 registered), and especially because a recent survey indicated that significant numbers of heads of midwifery felt that the funded midwifery establishment for their trust was not adequate anyway. The shortage is most acute in the Thames Regions (Royal College of Midwives, 1998).
Family planning: a consideration of the issues
Authors: Kelly Mary E
Published: May 2014

The midwife's role encompasses the provision of sound family planning information and advice. Midwives need to have an understanding of the complex nature of family planning to ensure they help women make informed choices. This article examines the subject from a historical perspective initially, and then reviews the pertinent issues that influence choice.
Parents in tears after cot death stories
Authors: Sherratt Samantha
Published: May 2014

Bereaved families have been severely distressed by recent media stories suggesting that many babies, registered as victims of cot death, have actually been harmed by their parents. These stories hit the morning news on 7January, following an article by Professor Sir Roy Meadow (1999), in which he stated that some babies are being miscategorized as dying of cot death. He reported on 42 babies which had, he concluded, been murdered, many having obvious signs of abuse, including broken limbs.
Baby snatching social workers?
Authors: Robinson Jean
Published: May 2014

Whatever the outcome for the Bramleys, who ran away with the two children they hoped to adopt, they have achieved something useful. They have aroused the interest of the press and the public in the power of social workers and the quality of their decisions. Not before time. From the debates on radio and television, it became obvious that there is a huge amount of hidden criticism from many who feel they were the victims of arbitrary and unjust decisions by social workers.
Improving relationships through clinical supervision: Part 1
Authors: Deery Ruth
Published: May 2014

This paper, the first of two parts, focuses on the way in which the midwife/client relationship has evolved and how this has affected the way in which midwives relate to each other and the women they attend. Midwives are urged to examine this aspect of their role in light of recent policy initiatives, which have, to some extent, created a competitive, ever-changing, and sometimes,threatening environment in which they work. For some midwives this has made the way they practice more daunting and challenging, and some have stated that they do not find the support they require within the current model of statutory supervision (Association of Radical Midwives, 1995). The second part of the paper addresses the therapeutic relationship that exists between midwives and clients and encourages supervisors of midwives and midwifery managers to consider an alternative way in which they themselves and a constantly changing health care organization could offer support to midwives. The concept of clinical supervision is therefore introduced and offered as one possible alternative to the current model of statutory midwifery supervision.
Review of the 1999 RCM Conference, Glasgow
Authors: Henderson Christine , Eglington Gill
Published: May 2014

A service of dedication opened the 117th Annual Meeting and Conference of the Royal College of Midwives in Glasgow. Soloists Susan Rose sang Words of Praise and Linda Donaldson sang the midwives' hymn, Vita Donum Dei (Life is the gift of God). A Celtic blessing concluded the service and a warm welcome to Glasgow. The Glasgow midwives did a brilliant job in a conference centre that seemed to engulf the 300+ midwives attending. The enormity of the centre seemed to reduce the normal camaraderie between delegates and others in attendance. There was certainly not the same buzz about the conference as in previous years. A ‘first timer’ from South Yorkshire was disappointed that the buzz she expected did not happen, although another midwife from the West Midlands did.
Women's reactions to their experience of maternity care
Authors: Proctor Sue
Published: May 2014

The importance of involving and using consumer perceptions of services is widely recognized in maternity services. This has been endorsed across the NHS in the recent White Papers for health care. It is unclear, however, which factors are sources of positive or negative responses in much of health care, including maternity services. This study focused on women's responses to maternity care, and sought to gain insight into the aspects of their experience that generated positive or negative reactions. Antenatal (n=158) and postnatal (n=155) women were selected from booking lists of the delivery registers of two large maternity units in northern England. A postal questionnaire, developed through numerous focus group discussions, and which included optional open questions was sent to each woman. Over 70% (n=223) of women who returned the questionnaire completed the optional questions, and wrote at length about aspects of the service that ‘impressed’ or ‘bothered’ them. Within these 223 responses, there were 403 references to different aspects of the service. Overall, 59.1% (n=238) of the points made were positive, but this proportion varied according to antenatal (56.7%), labour (72.6%) or postnatal care (48.1%). Some consistencies were identified throughout the service, but there were specific issues raised during different phases of the service. Data reflecting women's views that are based on issues that matter to them, rather than just those that are measurable, offer much in terms of increasing our understanding of their experience. While challenging, such data also help to focus and inform service development to become more woman and baby focused.
Female genital mutilation: A global perspective
Authors: Rawlings-Anderson Karen , Cameron Joan
Published: May 2014

More than 130 million girls and women worldwide have undergone some form of female genital mutilation (FGM). In this article, the prevalence of FGM and the different types are outlined. Research related to the subject is reviewed along with the evidence of complications related to the practice. The meaning of the practice to the communities where it occurs and the perceived health-care needs of women are summarized and the implications for future research discussed
Labour interventions associated with normal birth
Authors: Downe Soo , McCormick Carol , Lawrence Beech Beverly
Published: May 2014

A prospective cross-sectional prevalence survey of five consultant units in one region was carried out to establish the percentage of births which were termed ‘normal’ or ‘spontaneous’ but which in fact involved one or more of a specific set of interventions. Of the 1486 possible births in the survey, 1464 forms were completed (98.5%). Of the 956 births recorded as being normal or spontaneous, 596 fulfilled the definition of obstetric delivery (62.3%, confidence interval (CI) 59–65%). The rate for multiparous women was 60% (393/650, CI 56–64%) and for primiparous women 66.3% (203/306, CI 61–71%). Approximately one third of all women recorded as having a spontaneous or normal birth had experienced induction or acceleration of labour. Future work should examine the situation across the UK and internationally, along with the potential personal and economic consequences of the current culture of birth in hospital consultant units.
Guidelines on the teaching of pelvic floor exercises
Authors: Mason Linda
Published: May 2014

While many women suffer from stress incontinence during pregnancy or following delivery, a recent study showed that the instruction women received in pelvic floor exercise varied enormously. Some women received no information at all. In order to determine current policy and practice in pelvic floor instruction, enquiries were made of the UKCC and the Chartered Society of Physiotherapists. Neither body produced routine guidelines for their members on this subject. This may stem from the lack of conclusive research evidence regarding the efficacy of pelvic floor exercise at this time, which means that professional bodies are unable to provide clear directives to their members. This article argues for the need to establish the relationship between antenatal and postpartum exercises and stress incontinence, and in light of any conclusions drawn, for professional bodies to provide clear guidelines to their members so that women receive standardised treatment and care, if deemed necessary.
The Bristol Inquiry Report: support for midwives
Authors: Dimond Bridgit
Published: May 2014

The Report of the Bristol Inquiry recommends that staff in the NHS should be valued. This paper considers the legal rights of the midwife.
Asthma in pregnancy: How should it be treated?
Authors: Turner Alfred
Published: May 2014

Bronchial asthma is an acute respiratory illness. It is thought to be linked to an overactive immune system (Brewer, 1999). In asthma the bronchi are irritable and have a tendency to become swollen, narrowing the airways and causing breathing difficulties.
Alder Hey and the retention and storage of body parts
Authors: Dimond Bridgit
Published: May 2014

This article looks at the situation which led to the Alder Hey Inquiry into the removal, retention of body parts and considers the action taken by the Department of Health and the guidelines for improved practice.
Now nappies are designed for developmental stages
Authors: Turner Alfred
Published: May 2014

The baby's nappy has been subject to a remarkable number of improvements since the first disposables appeared on the market. This article looks at the history of innovations in nappy technology: from the first use of super absorbent polymers; through to the large scale use of refastenable tape and the incorporation of petrolatum based ointment transfer systems; to the introduction of the first breathable nappies by Huggies. It also looks at the new child-centred nappy design concept pioneered by Huggies — a range of nappies designed to cater for the different demands of a baby at each developmental stage.
What is usual? Normality in maternity care
Authors: Taylor Deborah J
Published: May 2014

Midwives have always been seen as the ‘guardians of normality’ (Rosser and Anderson, 1998) yet increasingly the limits for normality are changing. This paper explores the concepts of ‘normality’ and ‘usualness’ in the context of the midwifery role. The issues surrounding normality have been well researched yet their application to what is ‘usual’ in practice is harder to define. The skills and knowledge demanded by our consumers and colleagues have demonstrated the ability to adapt and be flexible across a variety of traditional definitions. There are many midwives pioneering ‘normal but not the usual’ within specific practice issues. What is ‘normal and usual’ for midwifery conduct is unclear and this article lists matters that demonstrate these in terms of the service provided. These areas of care are often ‘normal but not the usual’ yet they are the essence of what is termed midwifery care.
Ruth Maureen Davies
Authors: Phillips Robyn
Published: May 2014

Ruth Davies was a founder member of the editorial board of the British Journal of Midwifery (BJM), reflecting her lifelong enthusiasm for promoting education and the passion she had for sharing research-based knowledge.
Anaemia and pregnancy: avoiding complications
Authors: Turner Alfred
Published: May 2014

Anaemia, which affects at least one out of every five pregnant women, is the most common medical disorder of pregnancy (Lowdermilk, 1999). It occurs when haemoglobin levels fall below normal, and thus the capacity of blood to carry oxygen around the body is impaired. Iron deficiency causes 90% of anaemia cases during pregnancy (Lowdermilk, 1999), the remaining 10% being a variety of acquired and hereditary anaemias. Causes include folic acid deficiency, sickle cell haemoglobinopathy, and thalassaemia.
The issues surrounding diabetes and pregnancy
Authors: Turner Alfred
Published: May 2014

Over 1.4 million people in the UK have diabetes (Diabetes UK, 2001). Diabetes used to be seriously problematic during pregnancy, but with improved monitoring and control, childbearing for young diabetic women can be as safe as for non-diabetic women (Kitzinger, 1997). Some women who are not normally diabetic experience a condition called gestational diabetes during their pregnancy. These women too, require intensive monitoring and control of their condition in order to minimise the risk of complications occurring.
Midwives in the middle: balance and vulnerability
Authors: Stapleton Helen , Kirkham Mavis , Thomas Gwenan , Curtis Penny
Published: May 2014

The material in this series of articles is derived from a Department of Health funded evaluation of the MIDIRS Informed Choice leaflets (Kirkham and Stapleton, 2001). This article, the last in the series, outlines some of the strategies midwives adopted in order to juggle a variety of competing needs. Many midwives expended considerable energy attempting to mediate between the preferences expressed by their clients and the demands of medical and managerial power-holders. In order to avoid ‘trouble’ most midwives identified strongly with the two latter groups. Such allegiances had a divisive effect on relationships that could be reflected in ‘horizontal violence’ towards those who did not conform. Midwives who supported women in making decisions that went against the flow of medically defined customs and practices found themselves in a vulnerable position and many were subjected to increased surveillance over their clinical practice. This article concludes by examining the cultural changes needed to move beyond the current rhetoric of informed choice, to embracing a model of care which privileges the position of the childbearing woman.
Evaluating women's experiences for a MSLC
Authors: Messent Peter
Published: May 2014

This paper describes the main results of a survey of women's experiences of maternity care (n=850) in two trusts initiated by a local Maternity Services Liaison Committee (MSLC). Overall women who responded were very positive about the quality of maternity services at each trust. There were perceived shortfalls in relation to antenatal clinic waiting times, pain relief during labour and especially postnatal ward care. On the postnatal wards, across both trusts, approximately 59% of respondents felt the midwives were too busy to spend enough time with them. This compared with 25% on the labour wards. The figures suggest the postnatal wards are understaffed by midwives. Balancing resources between labour and the postnatal wards remains challenging. This study also identified process issues MSLCs may wish to consider before embarking on evaluations of women's views of maternity services. MSLCs must be encouraged to ask trusts to provide systematic written evidence detailing exactly how their departments have responded to previous survey results and audit cycles, before embarking on fresh evaluations.
Electronic patient records: the view from maternity
Authors: Jones Andrea , Henwood Flis , Hart Angie
Published: May 2014

The Government has made the development and implementation of electronic patient records (EPRs) central to its strategy for a new, modernised NHS. EPRs are intended to improve the organization and communication of clinical information, reduce duplication, and lead to increased patient involvement in the management of both their health record and their care. The results from this survey of maternity units in England and Wales have enabled the authors to make a preliminary assessment of how far the maternity services are prepared for such developments and how likely they are to accept them. The first of three articles, will report on how current record-keeping practices in maternity, and the legacy of existing maternity information systems are all likely to present considerable challenges for the policy and implementation of EPRs.
Stillbirth: is seeing the baby harmful?
Authors: Robinson Jean
Published: May 2014

Failure to see and hold your dead baby could have adverse effects on mourning. That is what we believed. This is apparently what bereaved parents are being told. Now along comes a piece of research which finds the reverse: mothers who see their dead babies could be more badly affected than those who do not (Hughes et al, 2002). What is more, mothers who also hold the baby could be in an even worse state. And emotional development of the next child they have could be damaged.
Webwatch
Authors: Bass Janice
Published: May 2014

One of the aims of this page is to draw attention to new websites, especially those that offer the potential to fill a much needed gap, and provide something different. I was therefore really excited to find a newly developed website that offered both, and certainly provided an alternative approach to the current proliferation of rather mediocre websites. This month’s review will concentrate solely upon.
The supervisory needs of midwifery lecturers
Authors: Rogers Cathy
Published: May 2014

This paper reports on the results of an audit of midwife lecturers’ experiences and needs from supervision in one education institution and the development of a strategy to meet the needs identified. This work was inspired by the retirement of the head of department who was the named supervisor for this group and the results of the report by Stapleton et al (1998), who identified that the supervision of midwives employed in education was variable. All of the midwifery lecturers in this study wanted to be able to choose their supervisor and have a choice of supervisors from clinical practice and education. The two most important support needs identified were in maintaining practice competencies and opportunities to discuss practice issues. The need to strengthen the profile and contribution of supervision in the development of pre-registration and postregistration midwifery education was also identified.
Benefits of breastfeeding and breast pumps
Authors: Jones Kathleen
Published: May 2014

This product feature describes the advantages of breastfeeding for both mother and baby. There are various factors related to the cessation of breastfeeding including mothers returning to work. Expressing breastmilk using hand-held mechanical or battery-operated breast pumps enables mothers to continue to feed their baby breastmilk and give them the best start in life.
Modern matron or traditional battle-axe?
Authors: Stephens Liz
Published: May 2014

Recently I find myself challenged by the concept of the 'modern matron'. This post we are told is the result of public demand, following consultation regarding The National Plan (Department of Health, 1999). Some important midwifery posts are being advertised as ‘modern matron’, and I wonder what this says about the way we value key roles within our organisation? What is it that the public think this matron can do?
The ever widening gap — symphysis pubis dysfunction
Authors: Wellock Vanda
Published: May 2014

Symphysis pubis dysfunction (SPD) appears to be on the increase. The majority of doctors and midwives have no knowledge of this condition and therefore may cause more damage to the women in their care. The condition is debilitating, painful and can have many psychological difficulties associated with it. Midwives must be educated about methods to prevent further morbidity and help these women to feel that there is support available to them. This article reviews the condition and its aetiology, considers the methods used to diagnose SPD and attempts to ascertain the incidence. The incidence varies considerably, a fact which prompted the author to review her own working area. This revealed an alarming number of women with the problem and this has fuelled further interest. The signs, symptoms and management of this condition are difficult to formulate until more research and the education of midwives and doctors has taken place, but will provide a better informed workforce to help alleviate a very stressful and painful condition in pregnant and newly delivered women.
Women’s worry in the antenatal period
Authors: Homer Caroline , Farrell Tanya , Davis Gregory , Brown Mark
Published: May 2014

Considerable attention is paid to the treatment and clinical outcomes of ‘at-risk’ pregnancies but the level of worry experienced by these women has not been addressed. A multidisciplinary team, known as the Risk Associated Pregnancy (RAP) team, cared for 159 women with risk-associated pregnancies. Their level of worry was compared with that of 699 women with normal pregnancies (NPs): 360 receiving continuity of midwifery care and 339 receiving standard care. Underlying level of anxiety was similar among groups. Women managed by the RAP team reported a lower level of worry than women in either of the NP groups.
Conscientious objection 1: legal and ethical issues
Authors: Marshall Jayne , Raynor Maureen
Published: May 2014

With continuing advances in diagnostic testing during the antenatal period, midwives are increasingly being exposed to women who may consider termination of their pregnancy for fetal abnormality. This can challenge the midwife’s personal beliefs and professional responsibilities, and could affect the staffing of maternity units. This first article in a series of two examines the legal and ethical issues surrounding termination of pregnancy and conscientious objection; a second article will address professional and supervisory issues.
Towards a social model of childbirth: part one
Authors: Walsh Denis , Newburn Mary
Published: May 2014

Though critiques of the biomedical model of childbirth have served to highlight the shortcoming of present-day maternity services, writing on an alternative social model is less developed. Specifically, contrasting beliefs within each model and how that is applied requires more reflection. These two articles suggests how the social model of birth may be understood, both as beliefs and values and as an applied midwifery model. Part one examines contrasting emphases between a medical and social model in relation to their beliefs and values around childbirth, the roles of woman users, obstetricians and midwives.
Removing baby at birth breached human rights
Authors: Robinson Jean
Published: May 2014

The funny thing is, as a volunteer you end up doing things that you would not dream of doing as a paid job, no matter how high the salary. You grab some sandwiches and a bottle of water at the station and just make the train, sitting for hours in front of a book you ought to be reading but can't even see. Then you take a taxi to the hospital to sit with a mother who has just had a caesarean, looking wan and devastated. There is no cot. Social workers came in and took her baby within hours of the birth, despite the consultant's warning about her high blood pressure. When the father arrives, he is equally distraught. Working with mothers after a stillbirth is not easy — especially when they believe the death was avoidable. But it was easier than my vigil that day. The absence of the baby was palpable, and filled every corner of the room.
Looking at midwifery over the last 100 years
Authors: Warriner Sian
Published: May 2014

The centenary of the 1902 Midwives Act this year has given midwives the opportunity to reflect on their profession. The Act was part of a wave of social legislation that typified the late 1880s and early 1990s when reformers had grown increasingly concerned about the conditions under which large sections of the population lived and the social consequences of poverty and ill-health. The Act constituted a radical break from midwifery's past, it provided the legal power to reform the practice of midwifery, which at this time was described by the Institute as unorganised and typically practised by working-class lay midwives. For almost two decades after the passage of the Act, the majority of registered practising midwives continued to be working class women with no formal training. However, as described by Elizabeth Roberts (1984):

‘…many of these midwives could be close as friends with the woman they attended and that when faced with a long and anxious labour nothing could replace the steady nerves and comforting hand of an experienced midwife.’
Improving the caesarean experience
Authors: Robinson Jean
Published: May 2014

One of the ideas we throw around at AIMS committee meetings is setting up a Consumer Award for professionals in health care. Even obstetricians would be eligible. Of course we'd never have Nobel Prize money, but if we could raise the funds, we would like at least to provide a decent dinner for the winners. We could hardly expect them to share our pot-luck committee meals where we bring home-made food and babies crawl around the floor. But we'd love to do something, because so often we see enormous benefit from work which does not get due credit when the glittering prizes are awarded.
Benchmarking practice: monitoring the fetal heart
Authors: Birch Linda
Published: May 2014

Benchmarking is an effective tool to explore quality of care. The philosophy provides a structured framework to guide professionals in the identification and sharing of best practice. This article provides an illustration of how the benchmarking philosophy has been applied to the subject of fetal monitoring. This enabled factors contributing to quality of care and best practice to be identified and compared at regional level. Unlike a traditional audit, the benchmarking tool not only highlights where practice is at present and towards were it is moving, but it identifies what needs to happen for it to get there. In this case, the benchmark highlighted that many improvements to quality of care can be made by the introduction of relatively simple, inexpensive measures; primarily, raising staff awareness and improving communication.
Protecting, promoting and supporting breastfeeding
Authors: Dykes Fiona
Published: May 2014

In this article the metaphor of the journey is used to explore changes in relation to the protection, promotion and support of breastfeeding in the UK over the past 10 years. Research with women that helps to illuminate the way, the direction provided by government, and the removal of obstacles by the UNICEF UK Baby Friendly Initiative (BFI) are highlighted. The ways in which peer support programmes are smoothing the way for women, breastfeeding organizations are building bridges, and education for health professionals is filling the gaps, are all referred to.
New midwifery vision for the 21st century
Authors: Savage Wendy
Published: May 2014

Twenty seven years ago the Association of Radical Midwives (ARM) published their Vision, the same year that WHO published Birth is not an Illness, both concerned about increasing use of technology and loss of midwifery skills. In 1986, the third edition of the Vision envisaged a 10-year plan, stressing the importance of the role of the midwife in working with women and the importance of the relationship between them. Midwives' skills should be fully used ensuring continuity of care and choice for all women, with most care in the community. Care should cause no harm to mother or baby. They envisaged that in 10 years 60% midwives would be working in the community in groups of 2–5, based in a variety of settings. The midwife would be the portal of entry for pregnant women into care, and would care for the majority of healthy pregnant women.
CORRESPONDENCE
Authors: Plummer Anni
Published: May 2014

October midwifery conference
Creating a better birth environment
Authors: Page Lesley
Published: May 2014

For a moment imagine what it feels like to be starting out on one of the most momentous times of your life. You are about to give birth, labour has started, you are anxious and in pain, wondering if you will be embarrassed by a lack of control of body functions or emotions.
Managing clinical risk in maternity units
Authors: Cooper Sarah , Jolliffe Sue
Published: May 2014

Clinical risk management is key to improving care to women and their families during pregnancy and childbirth, and to reducing the high cost of claims in maternity. A new assessment process designed specifically for maternity has been implemented by The National Health Service Litigation Authority (NHSLA) from April 2003. This article explains why maternity units are going to have the opportunity to be independently assessed.
Professional fear: a barrier to consent
Authors: Robinson Jean
Published: May 2014

Consent issues seem to be dominating our postbag at present, which is ironic when you consider all the emphasis on choice in maternity care, now officially carrying the seal of approval from Whitehall. Whenever we see an increase in any type of complaint, the Chair (Beverley Beech) and I get together and try to identify reasons and underlying factors. We go through the files and mull over the telephone calls.
Webwatch
Authors: McDonnell Cheryl
Published: May 2014

During 2003 The Nursing and Midwifery Council and DoH have undertaken a number of consultation exercises that are significant to the practice of midwives. Many of the proposed changes could have profound implications for those midwives who choose to practice independently of the NHS and debatably offer women an opportunity for greater choice and continuity in their birth experience. The Independent Midwives Association (IMA) represents the largest body of midwives working independently within Britain and it is their website, or at least the part open to public access, that is the focus of this months review:

www.ima-acceptance.org.uk
Current priorities for antenatal care
Authors: McGeown Pat , Hodgkiss Sharon , Folarin Cynthia , Gardosi Jason
Published: May 2014

The first decade of the 21st century is bringing increased responsibilities for all in health care, and in particular for midwives as the principal providers of maternity services in the NHS. An increased awareness of problems challenge traditional roles and methods of thinking, and make education, training and governance increasingly important. These place ever more demands on the providers of maternity care.
Making sense of information technology
Authors: Reynolds Shelley
Published: May 2014

Everyday life has embraced technology in ways that seemed unimaginable in the past. The advent of mobile phones, personal computers and use of the internet has revolutionized the way we live. The philosophy of this present government is to harness the information and communication technology revolution and use it to benefit patients in all arenas of care, including primary and secondary care settings. Community midwifery in an East Midlands Trust is behind in development to meet targets set out in the Government White Paper Information for Health (Department of Health (DoH), 1998). This article discusses government initiatives. It examines the education required to underpin technological advance and the difficulties experienced implementing change. It suggests ways in which the using the NHS Plan (DoH, 2000) could put ideas into practice to enhance midwifery care in this Trust. It has a vision for the future.
BabyG.R.O.E. — an independent voice for informed choice
Authors: Oak Susan , Cochrane Lynoa
Published: May 2014

BabyG.R.O.E. is an environmentally friendly information directory aimed at pregnant women to help them make informed choices about the products and services they use to raise their babies.
Outcomes after pethidine or diamorphine administration
Authors: Torrance Elaine , Thomas Joanne , Grindey Julie
Published: May 2014

Despite the common use of pethidine (PTD) and diamorphine (DMP) in providing pain control during labour, there is little evidence of their effectiveness. In addition, some studies have suggested that PTD is associated with a poor neonatal and maternal outcome. Conversely, DMP has not been reported to have any major adverse neonatal or maternal outcomes. The objective was to compare the effects of intramuscular PTD with DMP on neonatal outcome, maternal vomiting and further administration of pharmacological pain relief during labour. The study involved retrospective case note analysis of 268 women in their first pregnancy giving birth between February 1999 and May 2000: 134 receiving PTD and 134 receiving DMP as the first pharmacological pain relief in labour for a singleton vaginal delivery following an uncomplicated spontaneous labour at term. The following information was collected: neonatal Apgar score at 1 minute; neonatal resuscitation; time to first infant feed; actual and intended method of feeding; maternal vomiting; and further administration of analgesia. There were no significant differences in the two groups in respect of Apgar score of less than 7, neonatal resuscitation and time to initiate first feed. However, those women receiving PTD were significantly less likely to vomit or to require further analgesia than those receiving DMP.
Flexible working: new regulations
Authors: Dimond Bridgit
Published: May 2014

This article looks at the newly introduced right for employees who satisfy the specified conditions to apply for a variation in their terms of contract and the procedure which must be followed by the employer implementing the flexible working regulations.
Learn, grow and lead
Authors: Tucker Christina
Published: May 2014

Leadership style is often a reflection of the leader's inner values and beliefs. When leaders trust themselves, they trust others.
Domestic violence and the midwife: can you report it?
Authors: Dimond Bridgit
Published: May 2014

This article looks at the evidence relating to the incidence of domestic violence. It discusses whether the victims are entitled to a duty of confidentiality in respect of the violence, considers their rights under Article 8 of the European Convention of Human Rights, and concludes that midwives would be lawfully justified in reporting reasonable belief that violence is occurring. It also considers the Home Office consultation paper on domestic violence.
The medication vs breastfeeding dilemma
Authors: Jones Wendy , Brown David
Published: May 2014

The benefits of breastfeeding are well documented. As the proportion of women who initiate and sustain breastfeeding increases, the importance of the safety of drugs passing to babies through their mother's breast milk will increase. All health professionals need to be aware of the importance of considering whether a mother is breastfeeding before recommending medication. Texts with sufficient detail to enable quantitative data to be evaluated on the risk:benefit ratio for individual mother:baby pairs are not currently readily available. The authors conducted research amongst cohorts of 1000 GPs, community pharmacists and mothers in a matched area by postal questionnaire, on the experiences of, and attitudes towards, medication during lactation. This article gives an outline of some of the research results, and examines the expressed needs of the three survey populations.
Step 57: the NHS legislative changes
Authors: Dimond Bridgit
Published: May 2014

The NHS was set up in July 1948 on the basis of the legal provisions of the NHS Act 1946. Subsequently the main provisions of this Act were re-enacted in the NHS Act 1977. Section 1(1) of the 1977 Act places duties on the Secretary of State to continue the promotion in England and Wales of a comprehensive health service designed to secure improvement in:

▪ The physical and mental health of the people in those countries, and in the ▪ Prevention, diagnosis and treatment of illness and provide and secure the effective provision of services in accordance with this Act.
Webwatch
Authors: Hassall Jenny
Published: May 2014

Michel Odent's work has had an immeasurable impact on our understanding of the both physiological and psychological perspectives of childbirth. Two discrete websites were found which disseminate his work. The site I have chosen to review is:

www.birthpsychology.com
Trust me, I am a midwife
Authors: Gould Debby
Published: May 2014

The issue of ‘trust’ is fundamental to midwifery practice. Midwives, as guardians of normality, talk a lot about ‘trusting’ the birthing process and encouraging women to ‘trust’ in their own body's ability to give birth.
Introduction of maternity care assistants
Authors: Lindsay Pat
Published: May 2014

The national shortage of midwives, coupled with midwifery role expansion, has produced strain within the maternity services in many areas. Healthcare assistants have been employed for some years in most Trusts, but there have been limitations to their role and deployment in Maternity care. This article outlines the introduction of a new pilot training programme for support workers: maternity care assistants. The course is part of the Trust City & Guilds NVQ Level 2 training provision, with the taught content having a maternity focus. The support workers spend time in all areas of the hospital during the training year and thus achieve the knowledge and skills to support women, midwives and nurses in all parts of the maternity service.
Making government ideas reality
Authors: Magill-Cuerden Julia
Published: May 2014

The Department of Health (DH) has offered a view of the public's expectations for healthcare in the 21st century (DH, 2004). Though the messages are similar to those advocated for midwifery over the last decade, the ideas are endorsed for the total health service. Midwives should be able to implement these ideas but the reality in clinical practice is very different. There is a conflict between policy and practice.
New NMC register unveiled
Authors: Dimond Bridgit
Published: May 2014

A new register of the Nursing and Midwifery Council (NMC) came into existence on 1 August 2004, with new statutory procedures for entering qualification details and other details onto the register. The former 13 parts to the register have been replaced by three: nurses, midwives and specialist community public health nurses (RSCPHN).