bluuebunny/crossref_metadata_2025 huggingface dataset:
Midwifery Standards review in New Zealand: a personal view
Authors: Stewart Sarah M
Published: May 2014

Every pregnant woman in New Zealand is entitled to a lead maternity carer (LMC), who can either be an obstetric GP or midwife. The LMC provides care for the woman throughout pregnancy, birth and the postnatal period. In order to ensure an uniformity of midwifery care that is consistently of a high standard, the New Zealand College of Midwives (NZCOM) has facilitated the establishment of midwifery standards review committees (MRSCs) throughout New Zealand. MSRCs offer an LMC midwife the opportunity to review her practice according to the 10 standards of midwifery practice, devised by the NZCOM. The aim of the review is to encourage the midwife in areas of excellence and to point out any areas that need development. This article describes the MRSC in Gisborne, New Zealand, the process of review, and how I felt empowered as a midwife during the process of review.
The pros and cons of movement monitors
Authors: Sherratt Samantha
Published: May 2014

Movement monitors (also known as breathing or apnoea monitors) are increasingly available in the high street. Promoted as giving ‘reassurance’ and ‘peace of mind’, they have obvious appeal for parents anxious to prevent their babies dying of sudden infant death syndrome (SIDS). However, there is no evidence that monitors prevent SIDS. This article looks at the types of monitors available and the theory that originally linked them to SIDS prevention, a theory that has since collapsed, although its legacy remains. It also reviews the double dilemma faced by midwives — how should they advise parents on the pros and cons of monitor use, and how can they continue to promote the Reduce the Risk advice if parents think, thanks to monitors, that SIDS is no longer a problem.
The development of an eclampsia box and fire drill
Authors: Draycott Tim , Broad Gabby , Chidley Kay
Published: May 2014

Deficiencies in the care of mothers and babies have been identified by both recent confidential enquiries into maternal mortality and deaths in infancy, and improved, multidisciplinary training has been identified as a priority. Although excellent courses do exist, they are expensive and cannot accommodate all of the midwives, doctors and ancillary staff in the UK who require training. This article presents a simple, multidisciplinary training initiative — an eclampsia 'fire drill’ — that has been used at a local level to improve confidence, team working skills and local facilities. This is a development that could be used by departments across the UK to improve their own practice and local facilities. We do not suggest that all departments uniformly adopt our box or our drill but units could develop their own using local protocols.
Daring to be different: future resolutions
Authors: Lewis Paul
Published: May 2014

As the new millennium begins to gather pace, midwives along with nurses and health visitors are being challenged to make a difference (Department of Health, 1999). Indeed, the new millennium and every new year that comes and goes prompts us to re-evaluate our lives. Resolutions on how we will make things different and improve on the old are as perennial as the season itself and in most cases, just as inconsistent. Still, looking back at a midwifery career of some 20years I am minded to ask myself what hopes I have for the future. What new-year resolutions would I make, what would I want to change, and how would I try to make things better.
Part six: Limits on pushing and time in the second stage
Authors: Walsh Denis
Published: May 2014

Traditional approaches to pushing and time limits in the second stage of labour are based on a narrow, one-dimensional understanding of its physiology. Paradoxically, good quantitative and qualitative evidence that exposes these limitations has existed for some time but changes in practice have been slow to catch up. Some of the most robust and woman-centred recommendations for practice described so far in this series can be generated from the evidence, making the continuation of some conventional practices difficult to justify.
Part seven: Does social support affect pain in labour?
Authors: Mander Rosemary
Published: May 2014

Social support is widely recommended as the remedy for a range of health-related problems. This article examines the literature on the effects of social support on pain in labour. The evidence is found to be of uncertain relevance to midwifery care.
Part 23: Property and the law
Authors: Dimond Bridgit
Published: May 2014

The loss or damage of the property of patients and their relatives can be a constant problem in health care, diverting attention from the care of the mothers and their babies, and causing distress and complaints.
Her masters voice? Amniotomy in Dublin
Authors: Robinson Jean
Published: May 2014

The title looked so promising: 'Maternal attitudes to amniotomy and labour duration: a survey in early pregnancy' (Impey, 1999) — an under-researched area, where good qualitative data is badly needed. And this study came from the national Maternity Hospital in Dublin, where 80% of nulliparae have membranes ruptured at 2cm dilatation or less (Wingfield and Boylan, 1997), so there would be no shortage of research subjects, though untreated controls might be harder to find.
Spiritual midwifery care: old practice for a new millennium
Authors: Hall Jennifer
Published: May 2014

Please don’t skip this page, even if the title has put you off. Not for egotistical reasons, you understand. I would just like as many as possible to read it so that we may begin a long-awaited debate at the start of this new age. Discussions with colleagues about spirituality has already produced a variety of reactions. The cynical sly smile was one, indicating they believe in my insanity at even daring to mention it! Others have been embarrassed and showed a polite interest, accompanied by a glazed look in the eyes! Others have been genuinely enthusiastic and supportive and have provided a backbone to my evolving thoughts. I am grateful to those in publishing who have caught the vision I have presented and have been willing to put the ideas into print (Hall, 2000). This is a risky thing to do in an age where spiritual issues have become the taboo subject for discussion. But now I think is the time for change.
Neonatal nurse practitioners in midwifery care
Authors: Redshaw Margaret , Harvey Merryl
Published: May 2014

A large-scale evaluative study of the role and education of neonatal nurse practitioners (NNPs) was carried out by a team of researchers. A key element of the evaluative study was an investigation of the views and experiences of other professionals working alongside this new group. Midwifery managers or senior midwives in all the trusts in the United Kingdom in which NNPs were employed were sent questionnaires and most (82%) responded. Other data were obtained from qualified NNPs and senior clinicians working in neonatal care in the same trusts. The quantitative and qualitative study data show that NNPs are actively involved in care of the newborn in the delivery suite, particularly in relation to resuscitation, care on the postnatal wards where they carry out examinations, and being on call duty for baby problems. A positive contribution to teaching midwives on a wide range of topics was also reported. The developing responsibilities of NNPs and their input in these areas have been largely welcomed by senior midwives and the NNPs appear to be valued colleagues in the area of maternity care.
Part 15: Access to health records
Authors: Dimond Bridgit
Published: May 2014

There is both a statutory right and also a right at common law for a person to access their health records, but neither right is absolute.
The challenges of midwifery practice for critical thinking
Authors: Mong-Chue Cheng
Published: May 2014

Midwives are now working in a complex and rapidly changing society. This paper states some of the challenges midwives are facing: appraisal of evidence and translating it to practice, explaining their actions and their judgement and advancing their practice. Consequently, the growing need for midwives to think critically has gathered momentum in the last decade. Critical thinking can be a source of energy that midwives may use to meet these challenges. This paper illustrates how the four dimensions of critical thinking: logical dimension, framework dimension, pragmatic and attitudinal dimension can help midwives to think more accurately and more defensibly.
Research incentives: a thank you or a bribe?
Authors: Lavender Tina
Published: May 2014

Midwives in Liverpool are questioning whether recruitment gifts are ethical, necessary or even welcomed. Most units conduct at least one research study to answer an important question. Being at the forefront of care, midwives have become increasingly involved in the day-to-day running of many research projects, one of their major roles being the recruitment of suitable participants.
How to cope with heartburn during pregnancy
Authors: Lloyd Nicola
Published: May 2014

Heartburn (pyrosis) is a burning sensation that occurs behind the sternum and may extend to the neck, throat and face. It is the primary symptom of gastroesophageal reflux, the movement of stomach contents into the oesophagus.
Challenges facing midwifery in the new millennium
Authors: Elliot Maggie
Published: May 2014

Midwives from all four countries of the UK are preparing to travel to Jersey for the first Royal College of Midwives Conference of the new millennium. Undoubtedly, in the tradition of all Royal College of Midwives conferences, they will debate, network and hopefully have some fun. There are several issues currently facing the midwifery profession, some new and others probably have been debated long and hard since midwifery became a legal profession!
Celebrating midwifery
Authors: Page Lesley
Published: May 2014

Recently I have spent some time practising in the Queen Charlotte's Hospital delivery suite as part of a personal professional development programme.
Evidence-based care series: an introduction
Authors: Walsh Denis
Published: May 2014

Evidence-based care is here to stay. It may reappear under a different name just as evidence-based care replaced research-based care during the 1990s but the central idea will endure. This is because it asks very basic questions, in the maternity care context, about the care women receive at the hands of professionals: Is the care effective? Do benefits outweigh costs? Is it acceptable to women?
Midwives of the 21st century: turning the tide in Jersey
Authors: Lewis Paul
Published: May 2014

This year, the Royal College of Midwives held its annual general conference on the island of Jersey. A choice location, it enticed midwives from all corners of the British Isles and offered them a hospitality that was both warm and welcoming. This was the first AGM of the new millennium and with a radical departure from its usual conference proceedings, midwives had the opportunity to discuss and debate issues key to our profession and the future of the maternity services.
Why more research is needed into fetal pain and distress
Authors: Sparshott Margaret
Published: May 2014

The Animal (Scientific Procedures) Act of 1986 requires protection from pain for preborn vertebrate animals such as rats, guinea pigs and hedghogs — in fact the Act says 'any living vertebrate other than man.' Why are preborn humans excluded from this protection?
How do we create midwives who can make a difference?
Authors: Hillan Edith M
Published: May 2014

Policy documents such as Working Together (Department of Health (DoH), 1999) and Towards a New Way of Working (SODoH, 1999) place an obligation on employers to support continuing education for all professionals and to enable individuals to access learning opportunities.
CESDI report recommends the way practice can be improved
Authors: Sidebotham Mary
Published: May 2014

The Seventh Annual CESDI Report (2000), should be essential reading for all those professionals directly and indirectly involved in the care of pregnant women and babies. While there is encouraging evidence within the changing local practice chapter that recommendations are being put firmly into practice in some regions, there are still areas of concern highlighted in this report where major improvements could be made.
Part three: Assessing womens progress in labour
Authors: Walsh Denis
Published: May 2014

The monitoring of progress in labour is still driven by a preoccupation with time and definitions that pathologise labour if it deviates from strict time parameters. This may have a place where obstetric services are vast distances from primary care settings and where women's health is severely compromised prior to labour. However, for the vast majority of women in the UK, time limits on the first stage of labour reflect practitioners’ predisposition to distrust normal labour physiology.
British Columbia here we come
Authors: Page Lesley
Published: May 2014

Many of our life transitions are just like the transition phase at the end of labour. Six days ago, I arrived in my new home in Canada. Before that, I went through the feelings that many women experience just before they give birth. A fear and reluctance of moving on and letting previous roles go and entering a new life. Now I am in my ‘new world’ and I am starting to feel excited and ready to move on to my new challenges and responsibilities.
The incidence of blood transfusion in obstetrics
Authors: Stones Richard , Enderby Beth , Ghosh Swati , Rigby Claire , Johanson Richard
Published: May 2014

The transfusion experience for a 1-year period (1998) at a large district general maternity unit was reviewed retrospectively. There were 5266 deliveries and 128 women received a blood transfusion (2.4%). The commonest reason for transfusion was retained placenta and/or membranes (49%) with low postnatal haemoglobin (29.6%) and uterine atony (11.7%) being the next most frequent indications. The highest rate of transfusion (10%) was seen in women delivered by forceps and the lowest (1.3%) with normal deliveries. This rate is higher than those reported in the literature. A prospective review is indicated, in parallel with the development and distribution of good practice guidelines.
Under the microscope: the 8th Annual CESDI Report
Authors: Sidebotham Mary
Published: May 2014

Midwives should all know what CESDI is, and what it sets out to achieve. The overall aim to ‘To improve understanding of how the risks of death in late fetal life and infancy from 20 weeks of pregnancy to 1 year might be reduced’ remains as valid today as when it was first stated in 1992. There should be systems in place to ensure that the recommendations made, are taken up nationwide to fulfil that aim.
Continuity and case load midwifery
Authors: Walsh Denis
Published: May 2014

Recently another research paper found improved clinical outcomes in a case load scheme, among them a higher normal birth rate and fewer epidurals (Benjamin et al, 2001). The paper adds to the increasing evidence of efficacy from labour continuity schemes. It is therefore a cruel irony that the scheme was stopped just 4weeks before the publication and, after 6years in operation. Not only that — all continuity schemes attached to this particular unit are to be discontinued because of staff shortages within the hospital service. Managers deemed the situation unsafe for women on the delivery suite and hospital wards and felt they had no alternative but to pull back into the hospital integrated midwives running the continuity schemes.
Midwives' views on redefining midwifery 2: public health
Authors: Bennett Natalie , Blundell Jackie , Malpass Lyn , Lavender Tina
Published: May 2014

This is the second of four papers focusing on the expanding role of midwives. The first paper published last month, explored midwives' views of their role in health promotion. This paper focuses on midwives' views of their contribution to the public health strategy. The main findings suggest that, generally, midwives recognise and support a public health role. Over half of the midwives surveyed said they had a role in child protection; promoting effective parenting skills, informing young people about healthy lifestyle choices, providing well-women clinics, targeting vulnerable groups and promoting sexual health. Many midwives acknowledged the need for multiprofessional collaborations. Training was an important and consistent issue.
And finally… how do we put all the evidence into practice?
Authors: Walsh Denis
Published: May 2014

The evidence-based practice agenda will remain a theoretical objective unless attention is focused on how best to influence clinicians to change practice. Studies in this area already tell us that addressing the specific barriers to change in practice environments are crucial to success. Qualitative research methods have a key role in enabling us to change practice behaviours by revealing underlying power relationships that imbue practice. Midwifery needs to break free from an obstetric-led evidence agenda if it is to salvage physiological birth from evidence-driven clinical protocols claiming to reduce risk.
We should make peace with baby milk representatives
Authors: Richens Yana
Published: May 2014

Midwives are currently discussing and hotly debating what does and what does not constitute evidence-based practice. However, it is not only what is and isn't evidence-based practice that is being discussed. The question of what it should be called by midwives is also being discussed, with some midwives preferring to use the term evidence-informed midwifery practice (Wickham, 1999). Who knows, we may soon witness the advent of evidence-based neonatal practice.
Objective assessment is needed to ensure competence
Authors: Govaerts Marjan JB , Schuwirth Lambert WT , Pin Annerien , Clement Mieke EJ , van der Vleuten Cees PM
Published: May 2014

Over the last decade assessment practices of professional competence evaluation have rapidly changed, partly as a result of growing dissatisfaction with previous forms of student assessment. New strategies for the assessment of competence show an increasing emphasis on performance-based assessment (also known as ‘authentic’ assessment). Changes have been prompted by the awareness of the enormous influence of assessment on student learning. This paper will describe the development and the use of a performance-based test at Kerkrade Midwifery School in the Netherlands. The objective structured clinical examinations (OSCE) based midwifery competence test (MCT) was designed to assess competence in risk assessment and management in midwifery care during the final stages of the educational programme. First experiences with the MCT suggest that the test is a powerful tool in the guidance of student learning. Our experiences also suggest that, although several aspects of the test need further attention, the MCT is a useful and acceptable tool for evaluating competence of student-midwives.
Breast-feeding: Continuing professional development
Authors: Jack Catherine M , Wilson Jean E , Winder Val , Day Janet , Blenkinship Linda
Published: May 2014

Despite the numerous potential benefits to mother and infant, there has been little increase in the rates of initiation and duration of breast-feeding in the last decade. Continuing professional education for midwives, health visitors and nurses is an important factor in improving this situation. This paper discusses a collaborative educational breast-feeding initiative. This was designed to promote reflective and evidence-based practice with emphasis placed on the central importance of effective interpersonal skills in interactions with breast-feeding mothers.
Who is setting standards for maternity care?
Authors: Dimond Bridgit
Published: May 2014

This article looks at the standard setting in midwifery practice and considers the role of the Bolam test and the likely impact on NICE, NSF, Audit Commission and CNST on standard setting.
Who would choose to have a caesarean?
Authors: Kitzinger Sheila
Published: May 2014

It is time to deconstruct the concept of choice. 'Choice' comes from the language of advertising. It is used to promote products. Remember the advertisement 'You've come a long way baby! Smoke Virginia Slim?'. The message is: 'You are free to poison yourself with nicotine, to give yourself and those around you lung cancer'.
Screening for HIV during pregnancy
Authors: Roth Carolyn
Published: May 2014

Disquiet about the Department of Health policy on antenatal HIV testing has been expressed by midwives (Davies, 2000) and anecdotal reports suggest that there are aspects of testing that midwives find problematic. Concern has been expressed that the test might produce false positive results, particularly where prevalence of HIV is low (Davies, 2000). Another more general concern focuses on ensuring informed choice for women to a ‘recommended’ test, for which the Department of Health has set targets for rates of uptake (UK Health Department, 1999). Given midwives' critical role in the provision of antenatal HIV testing, it is important to reflect on the issues at stake both for women and their caregivers.
Dame Karlene Davis
Authors: Davis Dame Karlene
Published: May 2014

The British Journal of Midwifery would like to extend their warmest wishes and congratulations to Karlene Davis, the general secretary of the Royal College of Midwives (RCM), who was appointed Dame Commander of the British Empire in the Queen's Birthday honours list. The appointment, for services to midwifery and the NHS, was published by the Prime Minister's office on 16 June.
www.BirthChoiceUK.com: helping women choose
Authors: Dodwell Miranda , Armes Ruth
Published: May 2014

BirthChoiceUK.com is a recently launched website aimed primarily at pregnant women to help them choose where to give birth. In our work as childbirth educators we are aware that the majority of women have very little information to assist them in making a choice for maternity care and place of birth. They are generally unaware that they even have a choice, or that the place they choose will profoundly affect the birth experience they have. A minority of women do arrange care directly. This is most often the case for women who have decided early on to have a home birth or a Domino (DOMiciliary IN and Out) birth, or are booking with independent midwives.
Not so NICE clinical guidelines
Authors: Thornton Tim
Published: May 2014

The National Institute for Clinical Excellence (NICE) recently issued two clinical guidelines of relevance to midwives, The Use of Electronic Fetal Monitoring (EFM) (National Institute for Clinical Excellence, 2001a) and Induction of Labour (National Institute for Clinical Excellence, 2001b). I confess my heart sank when I received them. This was not because the guidelines are wrong, or because I strongly disagree with any of the recommendations. Nor is it because the choice of the acronym ‘NICE’, for this most centralising current government initiative, in what is already the world's most centralised health service, has always irritated me. It is just that there seem to be so many guidelines these days.
Doctor Foster went to Gloucester
Authors: Newburn Mary
Published: May 2014

Over the summer the maternity services suddenly began receiving the kind of attention last experienced in the early 1990s when the Health Select Committee published their report and the Government responded with Changing Childbirth (Department of Health, 1993). On 18 July, the Department of Health Children's Taskforce team held an ‘open space’ event to begin to define the scope of the National Service Framework for Children that will include maternity care, and Sheila Adam, Chair of the Maternity and Neonatal Workforce Group, addressed a meeting of the All-Party Parliamentary Group on Maternity (APPG) at Westminster. The same week, the Dr Foster website was launched providing comparative birth statistics for most UK maternity units, accompanied by a Good Birth Guide supplement in the Sunday Times (15 July) and a Channel 4 television programme.
The NICE guidelines on electronic fetal monitoring
Authors: Spiby Helen
Published: May 2014

This eagerly awaited guideline was issued by the National Institute for Clinical Excellence (NICE) in May (NICE, 2001). All members of the Royal College of Midwives were circulated with the document in June, thus achieving a high level of access for one of the professions most interested in and affected by it. It is interesting then that midwifery response to this document appears fairly quiet, when midwives can surely welcome its publication.
Part 32: Supervisors of midwives 1
Authors: Dimond Bridgit
Published: May 2014

Midwives are unique among health professionals in having a system of supervision prescribed by statute. The current arrangements for midwifery supervision are set out in the Nurses, Midwives and Health Visitors Act 1997. New provisions for statutory regulation are due to come into force in April 2002 when the Nursing and Midwifery Council formally takes up its duties, but changes to the legislation for supervision of midwives have not yet been proposed.
Practice makes perfect: maternal emergency training
Authors: Cro Suzanne , King Ben , Paine Patti
Published: May 2014

Deficiencies in the care of mothers have been identified by the report Why Mothers Die and improved multidisciplinary training has been identified as a priority. In response to this statement an initiative has been set up at Gloucestershire Royal NHS Trust to teach midwives and trainee doctors how to manage maternal emergencies. The 1-day course has been called ‘Maternal Emergencies and Resuscitation Course’.

The course teaches the theory and practice of the assessment and immediate management of life threatening situations. It aims to enable practitioners to maintain their skills and to be confident of their practice in situations that they are likely to meet infrequently. Clinical governance demands that we take responsibility for the quality of the service we provide. By organising and arranging a good training course we can hope to improve the clinical effectiveness, confidence and team building skills of the staff who work within the unit.
Baby powder: exploring the myths and realities
Authors: Hopkins John
Published: May 2014

Baby powders have been used safely for over 100years by both adults and infants. Talcum powder plays a useful role in infant skin care owing to its lubricant properties which help to prevent chafing of delicate skin by clothing . By absorbing excess moisture in the skin folds, powders reduce the likelihood of skin rashes caused by bacterial and fungal infections. The safety of talc was recently reviewed by US government agencies and it was concluded that pure grade talc was safe. Cosmetic grades of talc, as used in the UK, are extremely pure, complying with a strict specification; they do not contain asbestos or any other hazardous ingredients.
Uterine displacement and prolapse
Authors: Turner Alfred
Published: May 2014

Structural disorders of the uterus and vagina can be a delayed result of childbearing. Uterine displacement represents a variation in the normal placement of the uterus. The most common form is posterior displacement (retroversion). Variations include retroflexion and anteflexion.
Measles, mumps and rubella (MMR) vaccine
Authors: Bedford Helen E , Elliman David AC
Published: May 2014

In the UK, although few immunisations are given to neonates, midwives are asked by some pregnant women and new mothers for their advice about childhood immunisations (Health Promotion England, 2001). Over the last 3–4 years there has been a lot of publicity around the combined measles, mumps and rubella (MMR) vaccine, much of it adverse and misleading, and so it is likely that mothers will seek views on this vaccine, in particular, from their midwife.
100 years of statutory supervision of midwives
Authors: Kirby Joy
Published: May 2014

The year 2002 sees us celebrating 100 years of statutory supervision of midwives. Throughout the 100 years, the roles, functions and education of the supervisor of midwives (SOMs) have been shaped and defined by changes in social policy, professional development and practice. This is an opportunity to look back at some of the historical landmarks which have influenced and strengthened supervision of midwives over the last 100 years.
Accessing midwifery supervision
Authors: Hughes Angela , Richards Julie
Published: May 2014

A qualitative research study was conducted to ascertain if a study day on the role of the supervisor, would encourage midwives to actively access supervision on a more regular basis. An audit was conducted prior to the study day, and a second audit 6 months after attendance. The aim was to assess if the acquired knowledge would empower midwives to increase their access to supervision. The sample involved 219 Shropshire midwives and the first audit return rate was 100%, return rate for the second audit was 60%. The data analysis was undertaken by the trust clinical audit department, which enabled independent analysis. The findings indicate that as a result of attending the study day, midwives are now accessing supervision on a more regular basis, rather than just for the annual review. There was also a definite increase in the number of midwives who consider supervision to be effective, and 77% of midwives felt the study day had developed their midwifery practice.
Physical assessment of the newborn: a holistic approach
Authors: Lumsden Hilary
Published: May 2014

The role of the midwife encompasses holistic care of the mother and baby in the antenatal, intranatal and postnatal periods. Midwives carry out the initial examination of the newborn infant at birth to rule out any obvious abnormalities. The baby is usually examined again at the time of discharge. Traditionally this role has been performed by the paediatric or obstetric senior house officer. When babies are born at home, the general practitioner should examine the baby at least once during the postnatal period. With the implementation of the Scope of Professional Practice (UKCC, 1992) midwives are now in a position to undertake all the examinations of neonates in their care. This would further enable midwives to provide seamless care to the family unit.
Webwatch
Authors: Bass Janice
Published: May 2014

This month finds me exhausted and rushing around in ever decreasing circles, rather like Lewis Carroll's white rabbit with pink eyes. Thanks goodness that like Alice I chose to follow the white rabbit and go blindly down that large rabbit hole called web searches. Luckily I found myself in a web-based wonderland called: www.birthchoiceuk.com
Nepal revisited: initiating change
Authors: Carla Beatrice
Published: May 2014

With few exceptions, normal hospital intrapartum care in developing countries is characterised by the continued use of procedures which, although first introduced by the developed world, have since been understood to be unhelpful and even potentially harmful. This knowledge is not easily accessible in many developing countries, yet the women there deserve the same basic human rights that we expect to be granted here: to be afforded respect and dignity, to be listened to, not to have physical or emotional harm done to one. Many of the procedures still in use militate against these rights. Following a brief period of working in the delivery unit of a hospital in Nepal, an account of which appeared in the February 2001 issue of this journal (Carla, 2001), the author set up a small initiative to share research evidence with Nepali colleagues. This article relates the author’s experiences of working in two separate delivery units in Nepal during September—December2000, and asks how we in the developed world may best respond to the plight of our sisters in developing countries who have not yet found their own voice.
The Nursing and Midwifery Council
Authors: Dimond Bridgit
Published: May 2014

This article looks at the role and function of the Nursing and Midwifery Council which came into being in April 2002 having existed in shadow form for almost a year.
The development of a birthing bed mattress
Authors: Pritchard Verna
Published: May 2014

Pressure ulcers (PUs) develop as a result of immobility. While PU incidence is largely associated with the elderly, or those with neurological impairment, there has been an increasing awareness that women in labour are equally at risk of PU development. In particular, those women who have had an epidural are often required to spend long periods of time immobile and with reduced or absent sensation. It has been suggested that sensory loss is a more important risk factor in PU development than paralysis. However, in many establishments the provision of mattresses for this client group would appear to be inadequate, with the women being nursed on marble-covered NHS mattresses. This product focus describes how the need for pressure reducing mattresses that could also manage the other requirements of a birthing mattress, led to the development of the Medical Support Systems Ltd maternity mattress.
Resource reviews
Authors: Price Sally
Published: May 2014

The Royal College of Midwives (RCM) has recently produced a toolkit, comprising of seven step-by-step guides to the implementation of the principles of Vision 2000 (RCM, 2000). This publication is to be welcomed since any vision, no matter how innovative, will eventually be meaningless unless it becomes a practical reality.
A guide to infant nutrition and specialist feeds
Authors: Belton Dr Neville
Published: May 2014

Breast milk is undoubtedly the ideal food for babies. Infant formula however, plays an important role when not breastfeeding. This product focus looks at the range of different formulas currently available for healthy, term infants and for infants with special feeding needs. It also includes recent developments in infant nutrition and their impact on current formulations.
Not waving but drowning: mothers in distress
Authors: Bloom Jane
Published: May 2014

Research indicates that when mothers become depressed or disturbed the majority do not seek help from any source and only 25% of them consult a professional (McIntosh, 1993). When psychological problems are identified, there is widespread confusion about appropriate referral to the variety of psychological therapies available. Current demand for psychological services outstrips supply, with a shortage of trained practitioners and long waiting lists for both clinical psychology and psychotherapy. Added to this, there are fears that staff offer therapies for which they do not have adequate training or supervision (Department of Health, 1996). There is also a general lack of information available nationally and locally about the psychological needs and treatment of women during the reproductive years, with a resulting lack of benchmarks against which services could be audited. This paper draws attention to the unidentified and unmet psychoanalytical psychotherapy treatment needs of women during the reproductive years, and further NHS developments that would support midwives professionally to appropriately keep the mother in midwifery care while also continuing to improve perinatal mental health care.
Midwives and Patient Group Directions: supplying medicine
Authors: McCormick Catherine
Published: May 2014

This aim of this article is to respond to a number of questions raised by midwives regarding the introduction of Patient Group Directions. It will reiterate the current position for midwives with respect to the supply and administration of medicines and is designed to clarify the position related to the continued use of ‘standing orders’.
Step 42: Legal aspects of research 2
Authors: Dimond Bridgit
Published: May 2014

The last steps article looked at the midwife’s obligation to keep up-to-date with research and ensure that it is incorporated into her practice when appropriate. This article looks at the legal implications of the midwife caring for women who are being used as subjects in a research project.
Role of midwives in depression screening
Authors: Tully Lucy , Garcia Jo , Davidson Leslie , Marchant Sally
Published: May 2014

Many women experience antenatal and postnatal depression which can be distressing, debilitating and associated with long-term difficulties. However, there is a lack of evidence about the effectiveness of universal screening for depression during and after pregnancy, and the practices of midwives in relation to depression screening. This study aimed to describe the current policies and practices in maternity units in England and Wales and to investigate the role of midwives in identifying depression and making referrals. Questionnaires were sent to all maternity units in England and Wales with a response rate of 87%. The survey showed that 94% of units asked women about previous or current psychological problems in the booking session, 25% undertook some formal screening to identify depression antenatally and 57% undertook screening for depression postnatally. Midwives were responsible for antenatal screening in 27% of units, but only 16% of units provided training for midwives to undertake screening. This study shows that maternity units are involved in screening for antenatal and postnatal depression, but training, referral and support systems appear inadequate.
Returning from Vienna and Bournemouth
Authors: Magill-Cuerden Julia
Published: May 2014

Now the two conferences are over, it is time to reflect upon the messages from both the 26th Triennial Congress of the International Confederation of Midwives, from 14–18 April in Vienna, and the Royal College of Midwives Annual Conference in Bournemouth from 30 April to 3 May.
Subliminal medicalisation
Authors: Gould Debby
Published: May 2014

This year at the annual RCM conference in Bournemouth there was great debate about what constitutes normality, the reasons for the increasing medicalisation of birth and the rising caesarean section (CS) rate. What is shocking in many maternity units across the country is the very few number of women who give birth following a totally physiological first, second and third stage of labour. Women are requesting elective CS. So what are we doing to women in labour that is making them so frightened they would prefer major surgery?
Letters
Authors: Hall Fay Julie
Published: May 2014

This letter is in response to the Birthwrite article, Continuity and case load midwifery (Walsh, 2001) in the November 2001 issue.
Towards a social model of childbirth: part two
Authors: Walsh Denis , Newburn Mary
Published: May 2014

Modern childbirth has been appropriated by the biomedical model, such that clinical parameters, not social process, dominate its every phase. An exploration of a social model will assist in reconnecting and integrating childbirth phases with its traditionally strong sociocultural base. This requires a shift in values and an orientation to wellbeing, rather than pathology.
The changing medicolegal climate for midwives
Authors: Symon Andrew
Published: May 2014

The last 10 years have seen a dramatic shift in the medicolegal climate. Midwives are not unique in their experience of medicolegal issues, nor are they necessarily immune from those issues that primarily affect others. There is certainly a perception that some of the changes witnessed are societal in origin — an increased willingness to sue when things go wrong is probably the most frequently cited example. It can also be argued that the political regulatory mood has changed significantly, and that this is the product of a governmental centralizing tendency. Statutory controls inevitably colour the medicolegal environment. Some of these ‘top-down’ changes can of course be attributed to a response to perceived societal pressure for change.
Midwifery in Scotland: diversity in adversity
Authors: Murphy-Black Tricia
Published: May 2014

Scottish midwifery and maternity services shared much with the UK since 1993: appreciation of the expectations and needs of mothers and families; smaller families, older mothers; women with complex medical problems; rising caesarean sections; treatments for infertility; the (re)introduction of single registered midwives, the move to higher education and from hospital to community based care; the closure of small maternity units; increased duties following the reduction of junior doctors' hours; and consultant midwives.
Physiotherapy for back and pelvic pain
Authors: Lennard Fiona
Published: May 2014

This article presents the findings of a questionnaire which was sent to 200 women who received physiotherapy in the treatment of antenatal back and pelvic pain as part of an audit to discover the success rate of physiotherapy treatment at reducing antenatal back and pelvic pain. It was found that outcome varied depending on the pain type as classified by Ostgaard (1996). Physiotherapy has been found to be an effective treatment, however, some women will experience a reoccurrence of back pain postnatally. Physiotherapy is effective in the treatment of antenatal back and pelvic pain with 75–80% of women reporting an improvement in their symptoms following physiotherapy. The majority of women require only one treatment. Some women will have a reoccurrence of their pain postnatally.
Drug error in maternity care: a multiprofessional issue
Authors: Birch Linda , Culshaw Ann
Published: May 2014

Errors of drug administration, prescription and omission are a hidden phenomenon in maternity units. Clinical risk management reporting is often ineffective at detecting and monitoring such mistakes. The procedural and human errors that lie behind such incidents are rarely recognized and often compound one another. Substantial deficits in the clinical care of women following caesarean section were discovered. This audit focuses specifically on thromboembolic prophylaxis and post-operative analgesia. However, the findings highlight issues, which can be extrapolated to the problems of drug errors in general. This may be attributable to a combination of factors, including poor communication, bureaucracy around spheres of responsibility, inadequate local policies and an apparent disregard for the importance of accurate prescription and administration of medication. The audit also highlights profound inaccuracies in midwifery knowledge.
External cephalic version — a new midwifery role
Authors: Taylor Paula , Robson Stephen
Published: May 2014

The RCOG (2001) recommend external cephalic version (ECV) for breech presentation at term. When practised at term ECV has been shown to be safe and effective avoiding the associated risks of a vaginal breech delivery for the fetus and caesarean section for the mother. However, despite evidence of benefit, the provision of ECV varies due to lack of appropriately trained medical staff available to perform this procedure safely and effectively. This article describes the introduction of a midwife-led ECV service at the Royal Victoria Infirmary Newcastle and includes the preparation and rationale for expanding the midwife's role, the training undertaken and results of independent clinical practice. The authors report a midwife success rate of 43%, which is comparable to that of an experienced obstetrician.
Two interventions for postnatal support
Authors: Reid Margaret , Glazener Cathryn , Connery Lindsey , Mackenzie Jill , Ismail Debbie , Prigg Anne , Taylor Gillian
Published: May 2014

This study reports detailed findings from the two interventions from a randomized, controlled trial of postnatal support, these being an invitation for a support group, and a reading pack designed for women postnatally. Women who attended once were likely to return and topics at the groups were primarily women-centred; they were also more likely to be middle class. Non-attenders reported finding the group location and/or timing inconvenient and some reported social diffidence about turning up. Women reported reading the ‘pack’ a number of times and had clear views about the sections that they found most help, many liking the women-centred topics. Support initiatives are helpful to some women; more could be done in future to tailor the initiatives to women especially those who may find ‘joining in’ difficult.
Why mothers die: perinatal mental health
Authors: Sullivan Amanda , Raynor Maureen , Oates Margaret
Published: May 2014

Suicide is now the leading cause of maternal death and midwives have a large part to play in addressing this problem. There are exciting opportunities for midwives to work in new ways: as key stakeholders in multiagency collaborations. Public health and psychiatric issues have never been more relevant. In Nottingham, this teamwork approach to perinatal mental health has created a direction for future service(s). Educational needs, aimed at these objectives, have also been clearly identified. An antenatal screening tool for mental illness has also been devised. In this, the first of a series of two articles, the local response to service needs is described. The second article will explore some of the issues in more depth (Raynor et al, 2003).
Ensuring we are ‘in it together’
Authors: Gould Debby
Published: May 2014

Last week I was privileged to visit Wales and witness for myself the advances being made in midwifery there. I attended the Heads of Midwifery Advisory Group Conference held in Cardiff aptly named In it Together. This is precisely the ethos that we need to emulate both as individual practitioners, working with women and collectively as a profession. In Wales they have developed a ‘normal labour pathway’ that is both inspiring and tantalizingly simple.
Study into the effectiveness of MOTHERMATES (TM)
Authors: Benbow Maureen , Vardy-White Claire
Published: May 2014

It is estimated that 70% of women in the UK initiate breastfeeding with their first-born baby, yet 25% of mothers discontinue when their infants are less than 6 weeks old, citing nipple pain as the primary reason (DoH, 1995). The aim of this study was to compare the use of MOTHERMATES™, a hydrogel dressing manufactured by Tyco Healthcare Group LP, Massachusetts, USA, as an intervention for nipple pain and excoriation, with traditional treatments such as education and breastmilk expression. It was hypothesized that the dressings may reduce nipple pain and excoriation, thus promoting breast comfort in breastfeeding women. The study results support the use of the MOTHERMATES™ hydrogel dressings for managing nipple soreness and promoting breast comfort in breastfeeding women.
Home birth experience 1: decision and expectation
Authors: Andrews Alison
Published: May 2014

Eight women's experiences of home birth were explored using tape recorded semi-structured interviews. The main themes were identified and presented in the form of dialogue and quotes. This article explores the available literature, describes the methodology and reports the results from the first two themes of the study. The decision to have a home birth was based on previous birth experience, the desire for a familiar environment and concerns over childcare. Expectations centred on maintaining normality, a calm atmosphere and having more control.
Sure Start: Public health success or expensive failure?
Authors: Edwards Grace
Published: May 2014

Early findings of the national evaluation of the £3billion Sure Start programme have found no overall improvement in the target areas. The first published findings of the national evaluation have suggested that there is no difference in the development, language and behaviour outcomes of children in Sure Start areas compared to children in areas with no Sure Start initiatives. This depressing finding was published in the Guardian last month. But the report goes on to say that there have been real successes in some areas and it is too early in the evaluation to give a comprehensive picture of the overall success of the scheme (Ward, 2005).