bluuebunny/crossref_metadata_2025 huggingface dataset:
Vitamin K update: survey of paediatricians in the UK
Authors: Ansell Pat , Roman Eve , T Fear Nicola , Simpson Jill , Day Nick , Eden Tim
Published: May 2014

Prophylactic policies for the prevention of vitamin K deficiency bleeding have attracted controversy since 1992, following the report of an association between vitamin K given to neonates by the intramuscular, but not oral, route and childhood leukaemia. There is now good evidence that vitamin K is not associated with leukaemia or any other cancers in children, yet in the UK there remains wide variation in policies. Here the authors report the pattern and frequency of policy changes between 1977 and 2002 in 20 large maternity units in England. The continuing lack of consensus amongst policy makers and practitioners needs urgent reconsideration.
Staff shortages: whose problem?
Authors: Warwick Catherine
Published: May 2014

Christine Henderson's editorial in the January edition of the BJM (vol 12(1): 4) referred to the fact that ‘the power of the media cannot be overestimated’. With that fact in mind I would imagine a considerable number of midwives switched on to watch ‘Tonight with Trevor McDonald’ on the 16th February wondering what it might contribute to all of our efforts to deliver high quality maternity services.
Psychological barriers to labour
Authors: Walsh Denis
Published: May 2014

One of the wonderful things about The Labour Progress Handbook (Simkin and Ancheta, 2000) is the inclusion of psychological reasons to explain the slowing of labour. The authors' approach is holistic and their solutions are based on empathic, caring responses, supporting physiology and, only as a last resort (at the very bottom of the list), medical interventions like artificial rupture of membranes and syntocinon. Their emphasis on the psychological and emotional when gauging how labour is going increasingly resonates with qualitative research revealing the ‘emotional work’ of labour support. Speaker after speaker at the inspiring 2nd Normal Birth Conference in the Lake District in early June told stories with this focus.
Cancer in the pregnant woman
Authors: Paterson Gaye
Published: May 2014

Cancer in pregnant women is rare, affecting an estimated one in 1000 pregnancies. The clinical decision-making process is complex, and although a range of standard cancer treatment modalities exists, only chemotherapy has received significant attention in the literature regarding the implications for pregnant women. As many more women are being offered chemotherapy than in the past, long-term studies are needed to evaluate its effects on the mother, the foetus, and the newborn. While published studies also provide valuable insight into women's attitudes and into concerns regarding pregnancy after cancer treatment, further research is undoubtedly required. Midwives and oncology nurses need to be proactive in supporting women and their families, and in collaborating with multidisciplinary colleagues to develop an appropriate and adequate evidence base for practice.
Creating change: Developing a midwifery action research project
Authors: Choucri Lesley
Published: May 2014

The current modernization agenda means that midwives must embrace the challenge of developing their practice to ensure that their care is focused on women's needs. A group of midwives with practice development lead roles are working in a collaborative way through an action research project to achieve change and development of the service. This article discusses the action research methodology and describes the processes these midwives have worked through to begin to create change.
Sure Start Midwife: Giving a voice to the voiceless
Authors: Ukoko Felicity
Published: May 2014

Making a difference (Department of Health, 1999) called for an enhanced midwifery role in maximizing women's health and in contributing to public health targets. The Sure Start programme is now working in areas of deprivation right across the country. It is now recognized that improving maternity services is a vital step in tackling health inequalities. This is why some Sure Start programmes employ midwives to provide midwifery care in innovative ways for disadvantaged or isolated mothers. A Sure Start midwife with a special interest in refugees and asylum seekers presents the findings of an on-site antenatal service for pregnant asylum seekers living in emergency accommodation and awaiting dispersal. This article, in presenting some of the issues relating to the care of pregnant asylum seekers urges midwives to increase their knowledge and understanding of the health needs and cultural issues that affect this group of women in order to deliver appropriate care.
The booking visit: A difficult encounter for lesbian clients?
Authors: Porter Janet
Published: May 2014

The objective of this study was to explore the experience of the maternity booking visit and blood sampling for lesbian clients.The design of the project was based on a review of relevant literature together with personal reflection on the care offered to one lesbian client. Among the findings the author notes that at the booking visit, midwives often make presumptions that the client is heterosexual. This can make it difficult for lesbian clients to discuss their needs. When midwives are aware of clients' sexuality, personal beliefs and attitudes may affect the care offered. The author makes a number of key conclusions and recommendations for practice which include: midwives must be aware of the diversity of the pregnant population; avoid making presumptions about sexuality; midwives prejudices need to be set aside; and appropriate care should be offered to all women.
Cleansing and caring for the skin of neonates
Authors: Blincoe Alana Juman
Published: May 2014

It is essential that neonatal skin maintains its integrity and pH balance, in order for it to carry out its pre-programmed duty of creating a protective barrier to ward off infections and to protect its functions of thermoregulation, fat storage, immuno surveillance and prevention of excessive fluid loss. Some argue that if the skin is immediately exposed to chemicals it could disrupt these processes. As a result some believe that infants should be washed with water only for the first month of life, particularly those infants who are born prematurely. While others have found that reducing the frequency of baths, but still using cleansing products can also have a positive effect on neonatal skin. Both schools of thought do however, agree that cleansing products used on neonatal skin should be very mild and pH neutral. As there is not very much conclusive research in this area, it is essential that midwives keep themselves up-to-date with the latest evidence-based research
Supporting teenage mothers with breastfeeding guardians
Authors: Lavender Tina , Thompson Susan , Wood Lorna
Published: May 2014

Despite the potential benefits of breastfeeding, only a minority of teenagers choose to breastfeed in the UK. In some areas, local audit has demonstrated that just 1 in 5 teenagers initiate breastfeeding prior to leaving hospital. In an attempt to increase these rates, and with the support of a Department of Health project grant, the authors implemented a system whereby a named midwife was employed to support teenagers to breastfeed. This paper will describe the model of support employed, the project evaluation and subsequent implementation of a system which was deemed successful and was valued by the teenagers.
Perinatal bereavement support: a quantitative study
Authors: Chan Moon Fai , Day Mary Christine , Chan Suk Hing
Published: May 2014

This article aims to explore Hong Kong-based midwives' attitudes towards perinatal bereavement care and identify their required support and bereavement care training needs. It is based on a study of 93 certified midwives working in an obstetrics and gynaecology unit in one of Hong Kong Island's largest public hospitals. Data were collected through a structured self-administrated questionnaire. The study measured: midwives' attitudes towards perinatal bereavement support; required support and bereavement care training needs. The main findings were that the majority of this study's sample held a positive attitude towards bereavement care and there was a significant difference in attitudes towards perinatal bereavement support in terms of demographics, practical experiences and training factors.
Evidence Based Midwifery Network: Third national conference
Authors: Spiby Helen , McFadden Alison , Crawshaw Sarah , Townend Susan
Published: May 2014

The Evidence Based Midwifery Network (EBMN) held its third conference in Leicester on 25 March 2006. Attended by approximately 70 midwives from posts in clinical practice, midwifery education and research, delegates travelled from the UK, Sweden, Holland, Denmark and Ireland for this event. The conference theme Celebrating Change: Evidence led innovations in midwifery practice was pursued in two plenary sessions complemented by a programme of concurrent sessions.
Newborn skincare and the modern nappy
Authors: Hale Rachel
Published: May 2014

Effective care of newborn skin is based on a thorough understanding of both the physiology and specific environment of infant skin. The essentials of newborn skin care are effective cleansing, effective moisturizing and the maintenance of an effective barrier against external irritants (Kuller et al, 2001). The baby's nappy has been subject to a remarkable number of improvements since the first disposables appeared on the market; 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.
Showing respect for women: another skill for midwives
Authors: Magill-Cuerden Julia
Published: May 2014

Maternity care has, since ‘Changing Childbirth’, espoused three principle concepts for women's care. These are the three Cs: continuity, choice and control. Within each ideal is another concept that is less well articulated. This concept is ‘respect’. The term is used frequently nowadays by the government, particularly in relation to anti-social behaviour orders, abuse or violence.
Mad, bad or different? Midwives and normal birth in obstetric led units
Authors: Russell Kim E
Published: May 2014

In the UK most births take place in obstetric led units (ONS, 2004). The main purpose of this small study was to describe midwives' experiences of supporting normal birth in two different obstetric led units. Six semi-structured interviews were undertaken with midwives currently working on labour ward. The main findings were that labour ward midwives used a range of strategies to support clinical autonomy and facilitate normal birth. Some midwives who used traditional or non-scientific approaches in their practice were seen as different, being described as ‘mad’ or ‘bolshie’ by fellow midwives and doctors. The ability to support normal birth skills in obstetric units is problematic and appears to be governed by midwives’ faith in normal birth, the birthing environment and personal level of empowerment.
Pregnancy loss and death of a baby: the new Sands Guidelines 2007
Authors: Schott Judith , Henley Alix
Published: May 2014

The third edition of the Sands (Stillbirth and Neonatal Death Charity) Guidelines will be published in June 2007. This article discusses some of the issues that are covered. These are: The current debate about whether parents should see and hold their baby following a stillbirth or late miscarriage and the principle of choice. The increased risk of perinatal mortality in some minority ethnic groups and the need to provide culturally sensitive care and professional interpreters. The importance of recognizing and meeting the needs of bereaved fathers. The Human Tissue Authority Codes of Practice and asking for consent for post mortem examination. The experience of women having a mid-trimester miscarriage and whether they should be cared for in a gynaecology ward or a labour ward.
Spirituality in pregnancy: a diversity of experiences and needs
Authors: Carver Nicole , Ward Bernadette
Published: May 2014

This paper presents findings from Australian research into women's perceptions of their spiritual needs during pregnancy. Most women participating in the study described a spiritual dimension to their pregnancy which they chose to express, either through formal religion or through other forms of spiritual awareness and practices. Although spirituality was important to the participants, they did not expect health professionals to assist them to meet their spiritual needs. However, they expressed a need for health professionals to respect their spiritual beliefs. Midwives need to be aware of the diversity of spiritual belief in the community and practice midwifery in a manner that enables women to express their spiritual beliefs if that is their wish.
Midwifery supervision and home birth against conventional advice
Authors: Carr Natasha Jayne
Published: May 2014

Statutory supervision of midwives has evolved and developed as a means to support midwives in their practice and it protects the public by promoting best practice, preventing poor practices and promoting normality in childbirth. As midwifery practice becomes increasingly women focused, it presents midwives with more challenges, one being how to deal with a women requesting a home birth against advice. With the support of statutory supervision a midwife should be able to facilitate women-centred care and empower women to choose and make informed choices regarding home birth, a respected reality even if choices made may in theory not be the safest option. This article explores the role of the supervisor and midwife in facilitating home births against advice by considering the legal and ethical perspectives, record keeping, accountability, responsibility, reflection and the need for modern supervision to be proactive.
Clinical simulation: a new approach to midwifery education
Authors: Dow Angela
Published: May 2014

A review of the literature demonstrated that the theory–practice gap caused by a shift from the traditional apprenticeship-style education to higher education institutions (HEIs) ten years' ago might have impacted on the students' fitness to practice at the point of registration. However a new approach to midwifery education, clinical simulation, could transform teaching and learning strategy for undergraduate student midwives.

Clinical simulation is based on the concept of experiential learning and can enhance skill acquisition by providing a safe and controlled, student-focused learning environment in a setting that is comparable to reality. While this may offer students the opportunity to apply their learning more easily when they return to the clinical area, further research into the effectiveness of clinical simulation in preparing students for the reality of clinical practice and, in particular, the transfer of simulated skills to the workplace, is suggested.
Timing of umbilical cord clamping: midwives' views and practice
Authors: Airey Rebecca , Farrar Diane , Duley Lelia
Published: May 2014

Early clamping of the umbilical cord is widely practised. Delaying clamping increases placental transfusion. Although this is associated with benefits when compared with early clamping, such as a reduction in anaemia in infancy, the overall impact on mother and baby remains unclear. To assess the feasibility of conducting a randomized trial we surveyed practice in a UK maternity unit with a policy of active management. Sixty-three delivery suite midwives were invited to complete a questionnaire. Fifty-two (83%) responded of whom 47 (90%) gave oxytocin with the anterior shoulder and 48 (92%) clamped the cord within one minute. Care was observed for 100 births; all received oxytocin and controlled cord traction. Cord clamping was within ten seconds for 32 births and within thirty seconds for 85. There is variation in timing of cord clamping. A trial comparing the effects of delayed, rather than early, cord clamping appears feasible.
Postnatal depression and unhappiness
Authors: Kightley Robb
Published: May 2014

A recent RCM survey has reported postnatal depression rates of over one quarter of women in the postnatal period and recent Confidential Enquiries have highlighted the importance of psycho-social needs.
Recording labour: a national survey of partogram use
Authors: Lavender Tina , Tsekiri Ediri , Baker Lisa
Published: May 2014

There is little consensus regarding the use of partograms and labour charts in the western world. As a consequence there are variations in practices within and between units. Prior to implementation of the National Institute for Clinical Excellence (NICE) Intrapartum Care Guidelines we conducted a survey of all Heads of Midwifery exploring the current status of labour documentation across England. This enabled a baseline of current practice to be established and offers insight into disparities. The results indicated general support for the partogram, although some units chose not to use it for certain women. There was some consistency in recorded quantifiable details, although most charts lacked any psychological data. A minority of units had pre-printed alert or action lines although often the associated guidelines were similar. Few units provided evidence to support their particular guidelines. Awareness of national variations in partogram use highlighted useful variations in partogram designs which may assist midwives in their own practice. Units should re-evaluate their own charts in line with the recommendations of the National Intrapartum Care Guidelines.
Understanding perineal pain: womens descriptions
Authors: Steen Mary
Published: May 2014

Women perceive, describe and react to pain differently; it cannot be easily quantified. Pain is a private and personal experience to the individual. It is therefore impossible for another person to know exactly what someone else's pain feels like. When measuring pain there is a need to assess both the intensity and the quality of the pain to gain an insight into a person's experience of pain. During a PhD Study, which involved the investigation of the effectiveness of localised cooling treatments to alleviate perineal pain, women were asked to describe the pain as well as the intensity (Steen and Marchant, 2007). The quality of pain was measured by asking the woman to describe the pain in her own words. These words were analyzed as pain descriptors under the themes of sensory, affective, evaluative and miscellaneous as described by the McGill Pain Scale. In addition, intensity, discomfort, physical symptoms, metaphors used and links to the expectations of the woman were considered (Melzack and Wall, 1996). This article will give an overview of the pain syndrome, discuss measurement of pain methods and the use of word descriptors to assess the quality of pain. The assessment of perineal pain and women's descriptions will be further explored. This insight will give an understanding of the pain experience of women who have perineal trauma following childbirth and this may lead to further research and the development of a specific evaluating tool.
Obedience and conformity in clinical practice
Authors: Martin Caroline J Hollins , Bull Peter
Published: May 2014

This study analyzes the psychological processes involved when a midwife accepts directions from a senior person. A representative sample of 20 midwives were recruited from 7 maternity units in North Yorkshire. An inductive thematic analysis was used to interpret interview data. Results showed that midwives respond to social influence from senior people using two processes: obedience and/or conformity.

Thirteen (65%) excerpts informed that participants' interpreted direction from the senior person as instructions they were expected to follow (obedience) and seven (35%) showed that others voluntarily changed their viewpoint to agree with the one offered by the senior person (conformity). Participants' behaviour has been explained in terms of ‘legitimacy', ‘perceived obligation to the organization' and ‘social identification'. These pressures create conflict between the midwives' knowledge of how they would prefer to behave and concern to please authority or fit into the social group. Consequently, it may be difficult for midwives to support safe requests from women that conflict with what a senior person
Birth, Countdown to Optimal
Authors: Hunter Louise
Published: May 2014

This book, written by a ‘busy, work-from-home mother’, offers women a ten-step countdown which they are invited to follow in order to achieve an ‘optimal’, or entirely physiological, birth. The central message of the book is that in order for women to tap into their inner resources and enable their bodies to birth effectively, they should aim to labour alone and undisturbed, without conventional or complementary pain relief—even breathing exercises are frowned upon. Readers are promised that if they succeed their new baby will be completely alert and able to breastfeed, and they themselves will easily resume daily activities within minutes of giving birth, cleaning up their own mess and generally picking up where they left off.
Exploring the perceptions of midwifery staff about safety culture
Authors: Currie Lynne , Richens Yana
Published: May 2014

This study aimed to describe midwifery staffs' perceptions about safety culture and make recommendations for a positive safety culture that could benefit clients, staff and the organization. This work is part of a wider study exploring the perceptions of both nurses and midwives about safety culture.

Data were collected through the use of focus groups and were analyzed using a thematic approach.

The study was set in a large obstetric hospital with a diverse client population within an urban acute NHS trust in England.

A voluntary sample of 5 senior midwifery managers, 6 community midwives, 17 midwifery students and 5 midwifery support staff participated in the study.

Seven main themes were identified from the data: error reporting and under-reporting; client expectations of the service; feedback and learning; decision-making and staffing; communication; prioritization of safety; and staff safety.

Key considerations and implications for practice were that: organizations must ensure that all staff are given the authority to complete incident reports; systematic feedback geared towards effective learning is cascaded to all levels of staff; targeted education and training on effective communication strategies and core skills for safety are offered to midwifery managers; foresight training is provided to all front-line clinical staff to make them more ‘risk aware’ and ‘error wise’; and patient safety is accorded the highest priority at trust board level.
Book Reviews
Authors: Mead Marianne
Published: May 2014

This book is published at a time when the rising rates of caesarean sections across the world are becoming major public health issues. This is a very detailed and thoughtful book that should be read by all midwives and obstetricians and that could also be a real eye opener for women who are pregnant, contemplating pregnancy or who have undergone a previous caesarean section.
Emotional processing in childbirth: a predictor of postnatal depression?
Authors: Wilkins Carol , Baker Roger , Bick Debra , Thomas Peter
Published: May 2014

Childbirth is an emotionally challenging experience, resulting for some women in depression. A predictive tool to assist the identification of women at risk of developing depression would prove invaluable to practitioners in facilitating strategies to manage psychological distress. Usually emotions are managed in such a way that they do not interfere with everyday life. This management can be measured using the emotional processing scale (EPS), a validated self-report questionnaire. Using the EPS, together with other measurement tools, a study is currently taking place that follows a cohort of 960 women from early pregnancy to six weeks postpartum to investigate the relationship between emotional processing and perinatal depression with emotional processing as a possible risk factor. The study also explores the predictive quality of impaired processing as an indicator of depression. Although research is still ongoing the implications of the emergent findings should prove to be significant for the future care of women and their families.
Use of complementary and alternative medicine in obstetrics
Authors: Rüdiger Wiebelitz Karl , Weyert Goecke Tamme , Brach Janina , Beer André-Michael
Published: May 2014

Midwives are increasingly using methods of complementary and alternative medicine (CAM) during pregnancy, delivery and postpartum. These include phytotherapy, hydrotherapy, homeopathy and acupuncture. Frequency of application, demand for these methods, status of qualification of midwives and future development have not been examined in Germany so far. In 2007 a survey was carried out in seven midwifery schools in Germany. A total of 309 midwives and midwifery students were questioned by means of a structured questionnaire. Of the respondents 63.1% estimated CAM to be applied frequently (>25%) by midwives. The available training was considered to be inadequate by 88.4% of midwives. More than 90% of the respondents have not been taught CAM by doctors. Quality assurance requires the establishment and evaluation of these CAM methods within the scientific framework of universities and midwifery schools.
Contemporary childbirth practices in Nepal: improving outcomes
Authors: Regmi Kiran , Madison Jeanne
Published: May 2014

Nepal has one of the highest infant and maternal mortality rates in the world, second only to parts of Africa. Using in-depth interviews, fifteen postpartum mothers and eight mothers-in-law were interviewed to examine current cultural, social and contextual birthing process in Nepal. Analysis of this qualitative data through a grounded theory approach identified the dichotomy between ‘traditional birthing’ and modern medical obstetric care. This dichotomy limits technical, social and cultural collaborative birthing practices between the many traditional birthing attendants and medical staff. The emerging themes suggest other approaches for childbirth care; bringing harmony to traditional as well as modern clinical approaches. The outcomes of this study hope to enfranchise women with safer and more acceptable birthing experiences and outcomes not only in Nepal but also in other developing countries.
Book Reviews
Authors: Symon Andrew
Published: May 2014

Written by Helen Churchill, a Principal Lecturer in Sociology, and the obstetrician Wendy Savage, a veteran campaigner for normal birth, this slim volume is subtitled A Handbook for Women who want a Natural Birth, and is a companion piece to the authors' other handbook, Vaginal Birth after Caesarean. It is targeted principally at pregnant women who face the prospect of a caesarean, and is intended to give them information on which to base decisions about their care. As such, its style is open and easy-to-read. Numbered references are given so the text is not interrupted. There are a few line drawings to illustrate fetal and maternal positions.
Labour pain and epidurals: tampering with the pain–pleasure paradox
Authors: Walsh Denis
Published: May 2014

It is important to reflect on experience and learn from it, especially when it has been unpleasant, and have a plan if something similar happens in the future. The seven days following Sunday 12 July, 2009, when I gave an interview to the Observer, have provided plenty of scope for reflection.
Pregnancy and Childbirth A Cochrane Pocketbook
Authors: Hughes Kim
Published: May 2014

This book is a useful resource for anyone interested in the provision of safe and effective care of the mother and newborn. It is an up to date and authoritative work containing abstracts of over 400 Cochrane systematic reviews. Effective and ineffective therapies are highlighted and, in addition, areas for further research suggested.
Book Reviews
Authors: Bharj Kuldip
Published: May 2014

This important resource sets out to explore effects of sexual abuse on childbirth and mothering and makes valuable reading for midwives. The information generated adds to the growing body of knowledge to the topic of sexual abuse, a topic which has suffered from scarcity of the published material owing to the ‘tabooed’, albeit prevalent, nature of the subject.
Informing choices: outcomes for women at a stand-alone birth centre
Authors: Rogers Cathy , Pickersgill Judy , Palmer Joe , Broadbent Mark
Published: May 2014

The objective was to determine outcomes for women booked at a stand-alone birth centre (SABC) between March 2000 and April 2008.

The design used was a descriptive prospective cohort study of all women who booked to give birth at a SABC from 2000 to 2008. All women who intended to deliver at the birth centre during the study period were approached.

The main outcome measures were antenatal, intrapartum and postpartum transfer rates and reasons for consultant-led care, mode of delivery and perinatal outcome.

Information was available for 5099 women who intended to deliver. Of this group, 29.9% of women were transferred in the antenatal period, 13.96% were transferred in labour and 5.09% transferred in the postnatal period. During the study period 3573 women were admitted to the Edgware Birth Centre (EBC) in labour and 2861 (80.07%) delivered at the EBC. The overall intrapartum transfer rate was 20%. Transfer rate was eight times higher in the primigravida cohort (35.9% vs 4.61%). Approximately 6% of women were transferred in the postnatal period and 3% of neonates were transferred. Information on modes of delivery was available for 3476 women for women who were admitted to the EBC in labour. Of this group 89.35% had a spontaneous vertex delivery, 5.60% had an emergency caesarean section and 5.03% had an instrumental delivery. The perinatal mortality rate for women admitted to the EBC in labour was 1.1 per 1000 total births.

The study concludes that approximately half of all women deemed at low risk of obstetric/medical complications require transfer to consultant obstetric services at some stage during their maternity episode. Intrapartum transfer rate for primagravid women is significantly higher than for multigravid. Overall 95% of women who were admitted to the EBC achieved a vaginal birth.
Book Reviews
Authors: Symon Andrew
Published: May 2014

Evidence Based Midwifery – Applications in Context
Maternal-infant bonding: a concept analysis
Authors: Altaweli Roa , Roberts Julia
Published: May 2014

Bonding is a complex phenomenon that occurs during a significant phase for the mother and her infant. However, the definition and use of the term bonding, frequently misleads because of the inclination to refine and oversimplify the attachment phenomenon. The objective of this concept analysis is, therefore, to clarify the meaning of this concept with specific reference to maternal-infant bonding. Adopting Walker and Avant's (2005) adaptation of Wilson's (1963) concept analysis procedure, bonding, as a concept, is analysed to arrive at a clearer and more accurate meaning. This analysis presents definitions and defining characteristics of bonding. Antecedents and consequences of maternal-infant bonding are also explored, while model, contrary and borderline cases are presented to further enhance clarity and thereby inform operational definitions. Implications for nursing and midwifery practice are discussed.
Lower back pain during pregnancy: advice and exercises for women
Authors: Richens Yana , Smith Karen , Wright Shelia Leddington
Published: May 2014

Lower back pain during pregnancy can be severely debilitating for some women, and midwives can provide help and support for this group of women by providing advice, reassurance and onward referral where needed.
Cardiotocography and ST analysis (STAN): a retrospective review
Authors: Jomeen Julie , Cross Deborah , Cairns Janet
Published: May 2014

Fetal heart monitoring via cardiotocograph (CTG) has become integral to modern maternity care. The development of more sophisticated analytical techniques for fetal heart rate analysis has resulted in fetal monitoring systems that can add automated fetal electrocardiographic ST segment analysis (STAN) to the customary CTG information, providing continuous diagnostic information about the ability of the fetus to respond to the stress of labour. One such method, the STAN fetal monitoring system has demonstrated clear clinical utility, however, unidentified adverse outcomes for women monitored by STAN have been shown to be a result of poor CTG interpretation, delay in taking action and non-adherence to guidelines, as well as poor signal quality. This article presents some of the findings of a 3-year retrospective review of STAN cases following its introduction into a UK maternity unit. Findings corroborate other study results which have highlighted that CTG interpretation is often poor, although a key issue in this review was a failure by practitioners to actually classify the CTG. Review findings, however, suggest that this might be more often a record keeping problem than an issue of clinical competence. Interesting findings around epidural use require further investigation. The findings of this review have clear implications for training and practice not only in units where STAN is used but more broadly.
Implementation and evaluation of a nutritional screening tool
Authors: Langstroth Caroline , Wright Claire , Parkington Tracey
Published: May 2014

The aim of this study was to implement and evaluate the use of a nutritional screening tool for pregnant women. The nutritional screening tool was piloted by seven midwives on between four and ten pregnant women to assess the tool's ease of use. On completion of the pilot the midwives completed a questionnaire about the use of the nutritional screening tool. The midwives were randomly selected and worked for an East Lancashire hospital.

The main study evaluated the diets of pregnant women. A random sample of 55 pregnant women was screened using the nutritional screening tool and their diets assessed using a validated food frequency questionnaire. The participants were recruited at the antenatal clinic. Dietary analysis was performed on the food frequency questionnaire data using Qbuilider.

The response from the pilot of the nutritional screening tool by the midwives was positive. The midwives rated the tool easy to use with a clear and simple format. The nutritional screening tool was not statistically validated but the tool had 100% sensitivity and 66% specificity.
Achieving ‘baby friendly’ standards in pre-registration education
Authors: Long Louise
Published: May 2014

The Florence Nightingale School of Nursing and Midwifery at King's College, London is delighted to have achieved re-accreditation for both of its pre-registration midwifery education courses (BSc 18 months; BSc 3 year). It originally gained accreditation in June 2007. Since then there has been a lot of interest in gaining the award and universities all over the UK are seeking to follow suit.

This article will explain what the ‘Baby Friendly’ Initiative (BFI) Educational Standards are; how they fit with the Nursing and Midwifery Council (NMC) essential skills clusters; detail how we placed these standards into our curriculum; the assessment process and what it has meant for our newly-qualified midwives.
Midwifery taster course for prospective midwifery students
Authors: McIntyre Helen R
Published: May 2014

The midwifery taster course was first run in 2006 following numerous requests from local students to the acute trusts for work experience and concern about attrition from the 3-year pre-registration midwifery programme. A focus group with a local comprehensive school inspired the creation of a 5.5-day course incorporating theoretical academic and clinical exposure. The latter includes acute and community settings. This article details the course outline and qualitative findings from evaluations relating to the students' experiences. Students commented on the role and scope of midwifery practice, professionalism and team work, comparisons between acute and community midwifery and the student–mentor relationship. Of the four students from this cohort who applied to the 3- year programme, all are successfully continuing their studies.
Understanding ‘late bookers’ and their social circumstances
Authors: Callaghan Melissa , Buller Ana Maria , Murray Susan F
Published: May 2014

Little is known about the social context behind women's experiences concerning booking and antenatal care. In this study, women's narratives revealed that reasons for booking late are varied and sometimes complex. Personal non-acceptance of pregnancy, demanding social circumstances and supply-side circumstances such as administrative delays and inefficient communications are contributing factors. Some women booking late found that, once booked, little effort was made to actively retain contact. Other women reported lack of continuity of carer, language and communication issues as well as judgmental attitudes. Overall trust of the service was influenced by hospital reputation, previous experiences and staff behaviours. Disappointment was resolved by seeking care elsewhere in the subsequent pregnancy. It was concluded that maternity services should use late booking as a signal for tailored attention. Services need to be flexible and engaging and alternative communication strategies such as text messaging and use of email employed to inform women about timely booking.
Developing a care pathway for obese women in pregnancy and beyond
Authors: Baker Janet
Published: May 2014

NHS West Midlands, together with the 17 primary care trusts in the West Midlands, identified childhood obesity as a priority in its Investing for Health Strategy ( NHS West Midlands, 2007 ) because of the high proportion of children who were classified as obese in the region. The Maternity and Early Years Service was developed to help prevent childhood obesity in the future by improving the health, eating habits and physical activity of pregnant women. A care pathway and training programme were developed based on a literature review ( Cowbrough and Hindle, 2008 ) and potential user views ( Edmunds et al. 2008 ). The intervention recruited women in the West Midlands who were already obese and worked with them to identify small behaviour change goals around eating and activity through their pregnancy and the first few months after delivery. Six areas (urban and rural) tested the referral pathway, recruitment to the service, training of staff and collection of key performance indicators. The mean weight gain at 38 weeks was 7.27 kg (n = 75, standard deviation (SD) 5.66) compared to a common weight gain for all women of 10–12.5 kg during pregnancy ( NHS Choices, 2009 ). Additional benefits identified from the qualitative research commissioned by the author on behalf of NHS West Midlands as part of the overall project management, included: postnatal weight loss; increased physical activity; reduced unhealthy food; increased fruit and vegetable intake; cooking from scratch; and less use of jar foods for weaning. The pilot sites proved the care pathway could be implemented and it was possible to control weight gain during pregnancy for obese women with additional extra benefits.
Jacqueline Dunkley-Bent
Authors: Lavender Rebecca
Published: May 2014

Professor and Director of Midwifery and Nursing, Imperial College Healthcare Trust
Patient satisfaction with provision of information on labour analgesia
Authors: Kamarzaman Zaiti , Clark Felicity , Haque Shamimul , Ghani Afshan
Published: May 2014

Background:

Patient satisfaction assessment is a tool in analysing standards of care. This survey is conducted to audit the standards of labour analgesia care of mothers in Mid-Staffordshire NHS Foundation Trust. The purpose of the audit is to assess women's awareness and overall experience of labour analgesia during labour.

Method:

A standardized questionnaire survey was performed to ascertain labour analgesia knowledge and satisfaction achieved with analgesia during labour. A further study with the community midwifery team responsible for the antenatal care of mothers was conducted through a semi-structured interview to ascertain labour analgesia information discussed with their patients.

Results:

The study recruited 333 patients. More than 90% of the patients were satisfied with the labour analgesia information and the usage of analgesia in labour. Community midwives were quoted as the main source of information.

Conclusion:

Almost all the participants were satisfied with the labour analgesia information and analgesia received during labour within the Mid-Staffordshire NHS Foundation Trust.
Swine flu and pregnant women: Advice, prevention and management
Authors: Ponnampalan Sathana , Khalil Asma , O'Brien Pat
Published: May 2014

Since mid-December 2010, there has been an increase in the number of reported cases of severe H1N1A, or ‘swine flu’. Maternity units across the UK have also seen a rapid rise in the number of hospital and intensive care unit admissions due to H1N1A infection among pregnant women. Hospitalization, critical illness and mortality rates in pregnant women with H1N1A infection are significantly higher than those of non-pregnant women of the same age. For this reason, key public health messages, including respiratory and hand hygiene, should be emphasized. Midwives and doctors should also promote influenza vaccine uptake among all pregnant women who have not previously been vaccinated against H1N1A. All those who care for pregnant women should also seek vaccination themselves.
Wound management in obese women following caesarean section
Authors: Nobbs Stefania , Crozier Kenda
Published: May 2014

The number of obese, childbearing women is growing and causing great concerns in midwifery. Delivery via caesarean section entails the risk of developing a wound infection, or wound dehiscence. While it is essential to ensure that the care provided to women and their babies is safe, effective, individualized and based on up-to-date evidence, this may not always be the case and midwives may lack experience and appropriate training in managing these wounds. In this article, the current evidence on the impact of obesity on wound care management will be considered, along with the advice midwives should give to women after a caesarean section. The physiology of wound healing will be considered as well as the need to assess the caesarean section incision correctly by examining its appearance. Factors that affect wound healing in the obese woman and how these impact on the wound care management and advice offered by midwives will be discussed. Recommendations for midwifery practice are made throughout and include suggestions on raising awareness among staff on the impact that obesity has on wound care management and advice through training.
Joint initiative to reduce deaths in childbirth in developing countries
Authors: Bainbridge Jane
Published: May 2014

Grants of between $250 000 and $2 million will be made available to innovative people with unconventional and unique ideas for helping to improve healthcare in the developing world.
The impact of maternity crisis resource management training
Authors: Régo Patricia , Lyon Pauline , Watson Marcus
Published: May 2014

The Maternity Crisis Resource Management (MaCRM) programme for midwives and doctors was developed in response to the critical need to address unacceptable levels of preventable adverse events in maternity care, a high proportion of which result from poor communication between medical and midwifery staff. Quantitative and qualitative methods were used in this study to explore the outcomes for programme participants in terms of their satisfaction and importantly, the application of their learnings in the complex clinical environment of the birth suite. MaCRM graduates have pre-empted some serious complications, and dealt effectively with complications over which they had no control. An important outcome of this study is the reinforcement of the urgent need for all who have clinical contact with obstetric patients to receive regular compulsory up-skilling in the management of maternity emergencies.
A service user's involvement with the supervision of midwifery system
Authors: Amesu Carla
Published: May 2014

The Local Supervising Authority Midwifery Officers (LSA MO) Forum UK has identified as a key priority the need to increase user involvement in the work of Local Supervising Authorities (LSA) and LSA MOs. This can help to promote better communication between service user and supervisors of midwives, which can ultimately improve maternity services. In this article, a service user explains how she became involved with supervision of midwifery through working with her LSA on service user audits and recruitment for the Preparation for Supervisors of Midwives course.
Obesity in pregnancy leads to low iron levels in neonates
Authors: Bainbridge Jane
Published: May 2014

A US study has shown that babies born to obese mothers with elevated hepcidin levels tended to have lower iron status at birth.
Correct timing of folic acid supplementation during pregnancy
Authors: Derbyshire Emma
Published: May 2014

It is generally acknowledged that folic acid should be taken in pregnancy to prevent birth defects such as neural tube defects (NTDs). However, most women take folic acid as a supplement in the later stages of pregnancy, once they have received guidance from health practitioners. Unfortunately, this is typically after the critical period of neural tube closure, which occurs within the first 28 days after conception. Further public health campaigns are needed to strengthen women's understanding of ‘why’ folic acid is needed before conception and in the early stages of pregnancy. Equally, new ways to communicate this important information at appropriate time periods are also required.
Reflecting on the place of birth…and death
Authors: Spranzi Francesca
Published: May 2014

This reflection is intended to offer an alternative debate about place of birth. it explores similarities in the arguments regarding place of birth and place of death in the UK, drawing attention to common aspects of these two unique events, both of which now tend to occur in hospital, rather than at home. as made explicit by the Department of Health, everyone has the right to choose where to give birth and where to die. This article touches on the complexity of the right to informed choice to suggest that other more fundamental rights are involved: a safe and positive birthing experience and a ‘good death’.
How far can a complex system with increased interventions be pushed?
Authors: McIntosh Bryan , Bewley Susan
Published: May 2014

Postnatal care is an area for serious concern, with readmission of women and infants following discharge having increased significantly over the past decade. A reduction in average postnatal stays together with care delivered by many members of a fragmented multidisciplinary team disallowing full timely assessments of health needs, are reasons cited for this. There is a disjuncture between process, policy and health outcomes in maternity and neonatal outcomes. While there is evidence indicating what needs to be done to reduce mortality and morbidity and improve outcomes, more is required in relation to how this is done; central to this is innovation. Currently, the NHS does not have sufficient useful data on the extent to which frontline workers are delivering needed interventions, or their short and long-term impacts. Unscheduled maternity and neonatal admissions are supposedly a key indicator of the quality of maternity care. An understanding of why these incidents occur could generate significant cost reductions at a time of severe austerity and enhance the quality of care and safety for women and their infants.