bluuebunny/crossref_metadata_2025 huggingface dataset:
CMACE: improving the health of mothers, babies and children
Authors: Miller Alison
Published: May 2014

This article introduces the Centre for Maternal and Child enquiries (CMACE) which is continuing the work previously carried out by the Confidential Enquiry into Maternal and Child Health (CEMACH). Details of the CMACE work programme are given, including independently-funded projects and those funded by the National Patient Safety Agency.
Merits of safe and trustworthy supervision of midwives
Authors: Kuypers Barbara
Published: May 2014

It was with some disappointment and consternation that the article ‘The price of greatness is responsibility’ (Gould, 2009) was received by the Local Supervising Authority (LSA) Midwifery Officers Forum UK. The article opens and discusses the need to motivate and inspire, coach and influence the new leadership models in the NHS. The underlying assumption being that greater performance, and hence improved quality of care, is best delivered by an inspired self-motivated team (Gill, 2006). The article continues and suggests that the function of supervision, rather than a supportive mechanism, is in fact a de-motivating factor and alludes to the history of supervision as disempowering to the profession.
Our duty of care is to mothers and babies around the world
Authors: Stephens Liz
Published: May 2014

A recent trip to Ethiopia has led me to reflect on how fortunate we are in western countries and yet how irresponsible we can be. Fortunate in that we are able to reflect on and investigate every incidence of maternal mortality, learning the lessons and making changes to ensure such incidents are unlikely to recur. Irresponsible in that we fail to understand how the way that we do things has repercussions around the world, especially in developing countries where the belief is that mortality rates in the UK are low because we have got it right. We also underpin this belief in the ways in which we offer aid, showing that we believe we know the right way to do things.
Preceptorship for newly-qualified midwives: time for a change?
Authors: Davies Sarah , Mason Jean
Published: May 2014

According to the Nursing and Midwifery Council (NMC), the purpose of preceptorship is to provide support and guidance enabling new registrants to make the transition from student to accountable practitioner. To facilitate this, the NMC recommends that new registrants should have protected learning time in their first year of qualified practice, as well as access to a preceptor with whom regular meetings are held (NMC, 2006).
Psychosocial challenges of testing positive for HIV during pregnancy
Authors: Kelly Carmel , Alderdice Fiona , Lohan Maria
Published: May 2014

Since the introduction of routine antenatal HIV testing midwives are increasingly involved in the screening, diagnosis and reproductive counselling and care of HIV-positive women and their partners. Within the context of care there is a risk that preventing onward transmission to the baby is prioritised over meeting the needs of the woman as a woman in her own right. This article explores the psychosocial challenges faced by women who test HIV-positive during a pregnancy by reviewing the literature on antenatal testing procedures, the impact of an HIV diagnosis and effect on the experience of motherhood, disclosure to partners and the social and cultural significance of an HIV diagnosis during pregnancy.
Needlestick injuries: the practitioner as the claimant
Authors: Symon Andrew
Published: May 2014

There is a current tension in society regarding health and safety issues. Criticisms of safety notices (‘Warning – contents may be hot’, etc) reflect the view that contemporary society has become overconcerned with removing every aspect of risk from our lives. There is a corresponding view that such approaches are less to do with ensuring individual or group safety and more to do with protecting institutions from possible litigation. Nevertheless, we should not forget that the Health and Safety at Work Acts originated in the laudable aim of minimizing the risk of death or severe injury among the workforce.
More midwives employed but it's never enough
Authors: Clift-Matthews Victoria
Published: May 2014

The problems many couples experience when trying to conceive have been highlighted with the advent and growing popularity of IVF in recent years. Such is the coverage one could be forgiven for thinking that conception is a challenge. Midwives no doubt come across more and more couples who have conceived in this manner. Perhaps it is partly thanks to IVF that fertility statistics are showing that the birth rate is increasing. It was only last year that the Office for National Statistics announced that our fertility rate is at its highest in 34 years (ONS, 2008) with a 3% increase in live births in England and Wales. This increase was apparent in all age groups apart from the under-20s and the highest percentage was in the over-40s. Over the last ten years the numbers of births in this age group has nearly doubled.
Understanding ethnography
Authors: Roberts Taniya
Published: May 2014

Ethnography is considered to be the oldest of the qualitative research methodologies. The research methodology of ethnography is becoming increasingly popular in the field of health-care research to study behaviour and social interactions, and specifically in midwifery, to explore the culture of childbirth. Ethnography is a research methodology that can enable researchers to make sense of peoples actions by observing them in the context of their environment, such as a labour ward. This then allows for an understanding of midwives' behaviour within their cultural arena. This demonstrates the essence of ethnography. There are two types of observation used in this research methodology: participant and non-participant observation. The researcher is the major research tool for data collection and collects the data in ‘field notes’. If the researcher does not understand what has been observed, further data collection is conducted by semi-structured interviews with representatives from the group observed. Data collection methods can also incorporate photography and the use of film. Ethnographers are also open to visual analysis of any artefact or document witnessed within the environment under study, for example, a noticeboard in the clinical area.
Factors surrounding tools used in smoking and pregnancy research
Authors: King David , Edwards Grace
Published: May 2014

It has been recommended to use biomarkers in an antenatal setting when focusing on smoking and pregnancy research (Delpisheh et al, 2007). This is primarily due to biomarkers being considered more objective than using questionnaires to measure levels of smoking in pregnant women. However, when a study was designed using a biomarker to compare the levels of smoking reported by pregnant women at the booking appointment, numerous confounding issues became apparent. This article aims to introduce midwives to common biomarkers frequently used in smoking and pregnancy research and to discuss confounding issues that can affect a biomarker's performance using cotinine as a prime example. The confounding factors are discussed under the themes of population, metabolism, specimen, tobacco and behaviour.
Advertising condoms: raising awareness or promoting promiscuity?
Authors: Bainbridge Jane
Published: May 2014

Saying ‘No’ used to be the recommended form of contraception but the government has recognized the failure of this policy and is now advertising condoms, the morning-after pill and even abortion services.
Fat is a family issue
Authors: Clift-Matthews Victoria
Published: May 2014

According to a poll of 5000 men, the average father-to-be gains a stone during his partner's pregnancy, mainly as a result of larger meals and greater snacking on unhealthy food such as pizza and crisps (BBC, 2009). Part of the reason for this increase in weight was that couples tended to go out for more meals to make the most of the time they had together before the baby came. However, only a third of fathers joined their partner in trying to lose weight on a post-pregnancy diet. A father's attitude to nutrition can influence their partner's habits, which in turn will impact on their baby's health, so fathers should be included in any nutrition advice that a health professional gives. Although women may be sensitive about weight gain during this time it is a vital window of opportunity for delivering an important message to the whole family.
Student midwives' views on story sharing: the BUMP study
Authors: Leamon Jen , Wilkins Carol , Brown Sarah , Rawnson Stella
Published: May 2014

Reflective practice has been an integral part of preregistration preparation for several decades. To date the focus of this development has been associated with enhancement of cognitive skills. This article reports on the qualitative exploration of story sharing which formed part of a larger action research study undertaken by the Bournemouth University Midwifery Programme (BUMP) group. Analysis of the data revealed four themes: selecting, preparing and timetabling the sharing of stories; sharing experiences; listening and being listened to; and issues related to the tutors and the structuring of the learning. Students reported that learning via the preparation and sharing of their stories supported their development as midwives by enhancing their intrapersonal communication skills, creativity and problem solving.
Impact of obesity on female fertility and fertility treatment
Authors: Malik Shazia
Published: May 2014

The prevalence of obesity in women of reproductive age, and in the infertile population, continues to increase with recent recognition that abdominal obesity is associated with greater metabolic disturbances and reduced conception, even in ovulating women. Obesity contributes to anovulation and menstrual irregularities, reduced conception rates and a reduced response to fertility treatment. It also increases miscarriage, congenital anomalies and contributes to maternal and peri-natal complications. Obese women undergoing fertility treatment should therefore be advised of the increased risks they are undertaking. Obesity independent of polycystic ovary syndrome (PCOS) is associated with anovulation, and minimal weight loss alone is an effective therapy for induction of ovulation in both obese women and obese PCOS women. Studies also show the effects of reduced fertility in overweight men. Consequently, lifestyle programmes encouraging weight loss, along with medical or surgical treatment of obesity, should be considered to be an ovulation induction treatment and due consideration for a potential pregnancy in an obese woman given, prior to other fertility treatments.
Medicines and the law – patient group directions
Authors: Griffith Richard
Published: May 2014

Midwives will be aware that as a general rule prescription only medicines should be supplied and administered in accordance with the directions of an appropriate practitioner set out in a valid prescription (Medicines Act 1968, section 58). This strict regime protects the public from the harmful effects of medicines but can result in a delay in treatment and the need to visit an appropriate practitioner before the medicine can be supplied or administered. To overcome this inflexible process, while still ensuring the safety of patients, the Prescription Only Medicines (Human Use) Order 1997 allows medicines that would normally require a prescription to be supplied and/or administered through the use of patient group directions (PGDs).
Restrictions on the supply and administration of medicines
Authors: Griffith Richard
Published: May 2014

As well as taking advantage of patient group directions to supply and administer medicines to mothers without the need for prescription, midwives are also able to supply and administer medicines under a range of exemptions to the requirements of the Medicines Act 1968.
Immersion in water: use of a pool by women in labour
Authors: Jessiman Wendy C
Published: May 2014

Since 1997 women in a consultant-led unit in Inverness have had access to a purpose-designed pool for labour and birth. The number of women using the pool over the last 11 years has steadily increased and midwives have gained more experience and confidence in the use of the pool for labour and birth. This article describes the ongoing evaluation of the pool from September 1997 to December 2008 and identifies how the experience in Inverness varies from other units in the UK.
Clinical skills: issues affecting the left-handed midwife
Authors: Chapman Vicky
Published: May 2014

Left-handed people have the advantage in certain sports, are found concentrated in particular careers and are apparently more likely to be creative and artistic. Unfortunately, they are also more likely to suffer from poor memory, are genetically predisposed to schizophrenia, have a greater tendency towards accidents and probably find the placement of the pen on a chain in the post office frustrating.

Issues affecting left-handed midwives have yet to be cohesively addressed. This article identifies some of the practical skills left-handed midwives may find awkward or near impossible. For midwifery students the problems of learning new skills with their right hand poses the greatest difficulties. Mentors and tutors need to identify and even place left-handed students with other left-handers for learning left-hand specific techniques such as perineal repair. In addition, mentors need to teach flexibly and allow left-handers to use their left hand if preferred, even if it means they need to stand on the opposite side of the woman, such as when palpating, performing a vaginal examination or delivering a baby.
A student midwife's experiences in the 21st century
Authors: McTavish Lisa
Published: May 2014

This is an exract from An Essential Guide for Student Midwives Preparing for Professional Practice (2008). Edited by Sue Jacob and Tina Lavender, published by Quay Books.
Making the profession stronger by delivering expectations
Authors: Gould Debby
Published: May 2014

The report Midwifery 2020 Delivering Expectations (2010) finally moves midwifery away from the current pervasive ideology of ‘managing’ rather than ‘delivering’ women's expectations. Hopefully the nuance of the wording will not be lost on midwives and others who need to implement the recommendations to translate this ambitious vision into reality. The report boldly states that midwives need to create ‘life-enhancing’ experiences for women and their families, around the time of pregnancy and birth, as well as ensuring women and babies are safe, and women emerge emotionally satisfied with their experiences. Within these three overlapping paradigms the opportunity for midwives to make a significant contribution to addressing health inequalities is promoted.
‘Baby brain’: forgetfulness is not a biological consequence of pregnancy
Authors: Bainbridge Jane
Published: May 2014

Recent research has shown that, contrary to popular belief, pregnant women have similar cognitive abilites to their non pregnant counterparts and any memory loss is simply down to focusing on the new baby.
Tay Sachs disease carrier testing in the UK Jewish population
Authors: Alberg Corinna , Levene Sara , Burton Hilary
Published: May 2014

Midwives have a key role in identifying women at risk of having a child with a serious genetic condition. Tay Sachs disease (TSD) is a degenerative neurological condition that causes death in early childhood. The mutations causing TSD, although rare, are ten times more common among Ashkenazi Jews. The birth of an affected child is avoidable through carrier testing of the parents and then prenatal testing of the fetus, if it is at risk. Screening for TSD carrier status has been approved by the National Screening Committee since 1999 and is available through NHS laboratories. Midwives, particularly those who work in areas with a significant Jewish population, need to be aware of the make up of their communities, be informed of the condition, who is at risk, what carrier testing services are available and how they can be accessed. Our survey suggests this is not currently the case.
Termination of the Albany Practice contract: unanswered questions
Authors: Davies Sarah , Edwards Nadine
Published: May 2014

As Yiannouzis (2010) comments in the previous issue of the British Journal of Midwifery, King's College Hospital management's decision to terminate its contract with the Albany Midwifery Practice (AMP) has caused significant concern among midwives. More importantly the decision, which was taken with no public consultation, has caused a huge amount of distress to the families served by the AMP. Shortly afterwards, a support group ‘Albany Mums’ was set up on Facebook and has attracted 690 supporters. The Albany Action Group (supported by members of Royal College of Midwives (RCM), Association for Improvements in Maternity Services (AIMS), National Childbirth Trust (NCT), Association of Radical Midwives (ARM), Independent Midwives UK (IMUK) organized a rally in London which attracted 2000 people voicing their support and a desire for the caseload model of care to be rolled out across the UK. A petition with 4000 signatures has been handed in to the Department of Health.
Giving advice and information on risks
Authors: Griffith Richard
Published: May 2014

In law a midwife must obtain a valid consent from a woman before any touching can occur (F v West Berkshire HA [1990]). To be valid, that consent must be full, given voluntarily and the woman giving consent must be reasonably informed about the treatment and its risks (Chatterton v Gerson [1981]).
Involving supervisors of midwives in student education
Authors: Bacon Lisa
Published: May 2014

As the complexities and challenges of practice and expectations of the midwifery role requirements increase then so will the support that midwives require from supervisors of midwives as part of their professional relationship.

It is well documented in the literature that the role of mentor can bring with it a particular series of challenges, one of the most difficult of these being when a midwife is faced with the situation of having to fail a student in practice. The Nursing and Midwifery Council clearly states that robust processes should be in place to ensure that where there are issues of concern with regard to a student's practice, these should be dealt with swiftly. Early and continued involvement of supervisors of midwives can make a significant contribution to these processes and the form these contributions can take merits further discussion. It is suggested that positive role modelling of supervisors of midwives will benefit students by helping them develop a positive concept of accountability. As leaders of the profession it is argued that supervisors of midwives must create opportunities to engage strategically in the development and delivery of midwifery education.
Midwives should perform the routine examination of the newborn
Authors: Baker Karen
Published: May 2014

Research indicates that midwives are equally effective as senior house officers, if not more so, in performing the routine examination of the newborn. When midwives performed this examination their level of job satisfaction was increased and the mother's satisfaction with the examination was also increased. However, studies have also highlighted that midwives are concerned that they might be pressurized into taking on new roles as well as being worried that they may have no control over their workload. Furthermore, it has also been shown that the majority of maternity units do not have enough staff to cope with the rising birth rate and that midwives already have to deal with an increasing workload, resulting in them struggling to provide a safe, quality service to women and babies without taking on new roles.

By delegating some of a midwife's workload to another category of skilled worker may enable midwives to re-evaluate their existing role, and take on new roles that support the midwifery philosophy of care. This philosophy of care views pregnancy, childbirth and the postnatal period as a continuum, with the woman and baby being the primary focus of the midwives' practice, stresses the importance of the midwife working in partnership with the woman and her family. Such a philosophy enables the woman to make informed decisions about her care. The pregnancy continuum is also viewed as a normal life event, which is supported by midwives.

If research indicates that midwives are better at performing the examination of the newborn, then why is it that more maternity units do not have midwives who are able to carry out this skill, since midwives in the UK have been able to undertake this examination for more than 10 years? In addition, in units which do have midwives who can perform the examination, why are these midwives not using their skills?
Reflection on nutrition in pregnancy and the advice given to women
Authors: Thompson Heather
Published: May 2014

Diet varies throughout the world, depending greatly on the level of industrialization of a country and the foods available. Malnutrition is very common in lesser economically developed regions, although is still an issue in some lower income households in the UK. Usually, lack of food is not the problem in developed countries; it is the quality and type of diet that causes concern about the variety of nutrients being consumed. A ‘western’ diet, based on red and processed meat and increased fat from dairy products, has been associated with an increased risk of growth restriction to the fetus (Knudsen et al, 2008)
Lactational mastitis: recognition and breastfeeding support
Authors: Noonan Maria
Published: May 2014

Mastitis is an inflammatory condition of the breast which may be infective or non-infective. The incidence of lactational mastitis may reach 33% but is usually less than 10% (World Health Organization, 2000). A number of predisposing causes have been identified. A case study has been included and the discussion may assist the midwife in recognizing and supporting the woman with lactational mastitis.
NHS Litigation Authority report on claims involving stillbirths
Authors: Symon Andrew
Published: May 2014

The NHS Litigation Authority (NHSLA) maintains a database of legal claims involving NHS organizations in England. Over the years this has built up into a substantial resource of information about contemporary clinical negligence litigation, and in 2008 the NHSLA decided to analyse selected claims so that lessons can be learnt. Clinical practitioners will be familiar with the routine collection of maternity data, and the analysis of near misses and poor outcomes. The intention is always to see what lessons can be learned so that repetition of poor outcomes is made less likely.
Hope for women in Afghanistan as new midwives are trained
Authors: Bainbridge Jane
Published: May 2014

Under the rule of the Taliban women are forbidden treatment by male doctors and women cannot train to be physicians but new midwives may help to reduce maternal mortality.
Perceptions of birth in a stand-alone centre compared to other options
Authors: Rogers Cathy , Harman Joan , Selo-Ojeme Dan
Published: May 2014

Promoting choice is central to current NHS policy. In seeking to better understand the choices women make, this study aimed to identify if women would choose to give birth in a stand-alone birth centre, and the factors influencing this choice. A survey approach was adopted, and 121 responses were obtained (a response rate of 53%). The majority (n = 76, 62.8%) of responders would choose to have their baby in a stand-alone birth centre. The provision of a homely environment, opportunities for a natural birth, use of water in labour and accessibility were the main reasons given for choosing to give birth at a specific stand-alone birth centre. Compared to second or subsequent births, women expecting their first baby were six times more likely to give ‘can use water in labour and birth’ as a reason and this was significant (P = 0.001). Among women who would not choose to deliver in a stand-alone birth centre, the main reasons were preference to give birth in a co-located unit and concerns over safety. There was no significant difference about concerns for transfer between primagravid women and multigravid women. Nevertheless, in contrast to previous studies, 87% of women perceived that birth in a stand-alone birth centre provided a safe alternative to a hospital birth or home birth. Women also stated that they would access a stand-alone birth centre for pregnancy testing, antenatal education and antenatal and postnatal care.
Adapting the CenteringPregnancy® model for a UK feasibility study
Authors: Gaudion Anna , Bick Debra , Menka Yvonne , Demilew Jill , Walton Cathy , Yiannouzis Katie , Robbins Judith , Rising Sharon Schindler
Published: May 2014

CenteringPregnancy® is an innovative model of group antenatal care devised and developed in the United States. The model differs from traditional care in that women participate in a social, supportive group process, which develops their knowledge and confidence, and increases their personal and maternal self-efficacy. Following initial studies in the US, the CenteringPregnancy model has been adapted and implemented in a number of studies internationally, with a growing body of evidence of positive results in terms of clinical outcomes, satisfaction with antenatal care, perceived knowledge of issues around pregnancy, birth and parenthood. The background to the development and implementation of the first feasibility study to be conducted in the UK is described. This includes adaptations necessary to comply with national guidance and policy recommendations for NHS maternity care, and midwifery rules and regulations. There is a need for further larger studies to assess if similar positive outcomes could be replicated in the UK maternity settings.
Women’s experiences of using heroin substitute medication in pregnancy
Authors: Varty Kate , Alwyn Tina
Published: May 2014

Background and aims: There has been little research into women’s experience of being on heroin substitute medication. This study, set in a large South Wales city, aimed to explore pregnant women’s experiences of taking methadone or buprenorphine. Method: A qualitative research design was used, using semi‐structured interviews. The transcripts were analysed to extract themes of importance to the women. Results: Six women taking substitute medication for the treatment of heroin dependence were interviewed. The women raised issues of importance to them, and some common themes were identified relating to their feelings and to their clinical and psychological care during the pregnancy: denial; guilt; shame and embarrassment; concerns about parenting; and treatment by and attitudes of professionals. Conclusions: Women want to do the best for their babies, but feel embarrassed and ashamed at their substance use, which can inhibit engagement with services. Women would prefer increased support and monitoring from drug services. The impact of methadone on nausea and vomiting needs to be addressed on an individual basis. Tailored, seamless and non‐judgmental multi‐agency care needs to be available to improve engagement and outcomes in this high‐risk population.
Clinical Practice Facilitator: A new role to support mentors and students
Authors: Wood Gaynor , Harben‐Obasuyi Julie , Richardson Margaret
Published: May 2014

This article illuminates the role of the midwifery Clinical Practice Facilitator (CPF) which is currently unique to London trusts and universities. Since its implementation it has quickly established its worth in both clinical and educational settings. There are many challenges and much scope for innovation. The aim of this article is to illustrate why the role was created, how the role has been developed and to provide some clarity for this diverse role. This article is a reflection of some of the experiences and achievements during the first year of its implementation. The authors have included a ‘day in the life of …’ to provide readers with further insight into the role of the CPF.
Urine elimination in pregnancy: Indications for catheterization
Authors: Doyle Patrick Mark , Birch Linda
Published: May 2014

Most women will maintain normal urinary function throughout their pregnancy and postnatal period, with only minor or transient alterations to their ability to produce, store and eliminate urine. However, for some, changes to urinary function are more profound. This article provides a brief summary of the relevant physiology of urine production and elimination and outlines the impact that pregnancy and delivery can have on this. The authors then present an overview of urinary catheterization, summarizing indications, risks and methods during the antenatal, intrapartum and postnatal periods.
Statutory supervision: Achieving the balance
Authors: Phipps Jan
Published: May 2014

Constant changes in society and medical technology has resulted in more women presenting with complex needs in pregnancy. These women may have actual or perceived health risks either during pregnancy or the delivery period for both themselves and their unborn babies.Traditionally, a particular management plan aimed at reducing the perceived risk would be advised and followed. A small but growing number of women are looking for higher levels of midwifery care and support than traditionally provided by NHS midwives in isolation. It is the role of the supervisor of midwives (SoM) not only to provide support for the woman in her choices, but also to the midwives providing the care while minimising any identified risks ( Osbourne, 2007) .
Clinical assessment of women with cardiovascular abnormalities
Authors: Roberts Rachel , Ketchell Alison
Published: May 2014

For a small number of women the physiological changes of pregnancy, especially those concerning the cardiovascular system, can influence both maternal and fetal mortality and morbidity. Common cardiac problems that may be detected and/or influenced by pregnancy include cardiac arrhythmias, ischaemic heart disease, dilated cardiomyopathy and mitral valve stenosis. Undiagnosed mitral valve stenosis, a result of rheumatic heart disease, affects 0.3 per 1000 cases in the UK, and as the migration of people between countries increases, so too does the occurrence of such cardiovascular abnormalities. Appropriate and effective ‘track and trigger’ systems for early detection and diagnosis of cardiac abnormalities, combined with the appropriate referral to fully equipped specialist centres involving input from cardiology, obstetric, midwifery, anaesthetic, haematology and neonatology services, is imperative. The early involvement of experienced multidisciplinary team specialists for support, care and management can minimize the serious consequences of inadequately controlled heart conditions. Pre-conception counselling (where indicated) can enable and empower a woman to make informed decisions about whether or not to continue with the pregnancy due to the risks of maternal and/or fetal mortality and morbidity.
The silent killer: exploring amniotic fuid embolism
Authors: Price Cheri Angharad
Published: May 2014

This article discusses amniotic fluid embolism—a rare and widely misdiagnosed disease, using a case study to direct the practicalities of treating and caring for a woman who has had amniotic fluid embolism. It examines the poorly understood aetiology and pathophysiology of the disease, along with the varying spectrum, risk factors, systemic response, diagnosis and treatment of the disease. It uses recent confidential enquiry into maternal and child health (CEMACH) reports to illustrate the trends in mortality and morbidity related to this disease, considering the outcomes and prognosis for women and babies who have had amniotic fluid embolism. It also considers the importance and need for inclusion of amniotic fluid embolism within midwifery education programmes and continuing professional development to reduce the high mortality and morbidity rates associated with this disease.
Setting up a triage telephone line for women in early labour
Authors: Weavers Annette , Nash Kate
Published: May 2014

This article aims to provide an overview of a collaborative service improvement project that was undertaken by midwives at the Royal Berkshire NHS Foundation Trust to improve services for women in early labour. The labour triage line was set up to increase the consistency of information and advice provided to women in early labour and to enable women to feel confident in using coping strategies to help them remain at home during early labour. It was hoped that this would reduce the number of women attending the labour ward for early labour assessment and increase both Women's and midwives' satisfaction with the service provided. A review of early labour services was initially undertaken to inform the project. This revealed that most women in early labour telephoned and were assessed on the labour ward with only a small proportion receiving advice about coping strategies. A survey of postnatal women found that the provision of calm, friendly advice over the telephone was reassuring, with more than half of the women surveyed stating that their experience of early labour could be improved through good telephone advice from a midwife. Following this, the telephone labour triage line was implemented and evaluated following a 6-month pilot. Feedback from women suggested a high degree of satisfaction with the service and a significant improvement in midwives discussing coping strategies with women in early labour. Other findings included an increase in the use of the midwifery-led unit and normal birth rate for low-risk first-time mothers. The triage line has now been extended to 24 hours and will move to the new midwifery-led unit that is being built this year where the outcomes will continue to be monitored.
Screening for antenatal psychological distress
Authors: King Lydia , Pestell Sarah , Farrar Steph , North Nigel , Brunt Caroline
Published: May 2014

Effective psychological screening within the perinatal period has been an increasing priority for maternity services. The screening questions recommended by the National Institute of Health and Clinical Excellence (NICE) guidance for antenatal care (2008) screen only for depression and do not give an indication of severity. This service development looked at staff confidence in psychological assessment after the provision of training. It also used the Hospital Anxiety and Depression Scale (HADS) ( Zigmond and Snaith, 1983 ) as a screening measure for anxiety and depression during the booking interview with a community midwife. It was found that training significantly increased staff confidence in their ability to identify and manage psychological distress. HADS is not validated in perinatal populations; trends suggest prevalence of antenatal anxiety in this sample is equal to that of antenatal depression. The questions sometimes referred to as the ‘Whooley questions’ ( Whooley et al, 1997 ) are identical to the Patient Health Questionnaire (PHQ-2) and will be referred to as such throughout this article. Comparison between the HADS and the PHQ-2 indicated that the latter is less sensitive to anxiety, especially when a woman scores in the borderline ranges.
Midwife documentation of a shoulder dystocia delivery
Authors: Stohl Hindi , Chen Judy , Jaque Jenny
Published: May 2014

Introduction:

The objective of this study is to describe and analyse certified nurse midwife delivery notes after a simulated shoulder dystocia using a standardised case presentation and simulation technique.

Methods:

Seven experienced midwives from a single academic institution in california, US, underwent a standardised simulated shoulder dystocia delivery. Delivery notes were collected and analysed according to pre-specified criteria to assess for accuracy and comprehensiveness.

Results:

Fifteen documentation elements were examined. The median score was 11 out of 15, with 71% of participants recording 10 or more of the key components. The time of delivery, the presence of the paediatrics team for delivery, and the correct order of the manoeuvres performed were recorded by all midwives. The least commonly recorded items were the identification of the anterior shoulder, presence/absence of an epidural, and the name of the on-call supervising obstetrician

Conclusion:

Narrative shoulder dystocia documentation by experienced midwives contains many components of standard birth documentation but lacks certain critical elements.
The bottom line on nappy rash
Authors: Morris Heather
Published: May 2014

Nappy rash is a general definition used to describe a range of inflammatory reactions of the skin in the nappy area, often it is a mild condition that affects most babies at some time. There appear to be key times when infants become more prone to nappy rash. This article describes these trigger points from a parents prospective and provides skin care advice to help manage and treat the condition.
Simulation-based learning: a case study, part 3
Authors: Dow Angela
Published: May 2014

The purpose of this study, presented in this series of three articles, was to explore the concept of clinical simulation in the setting where it was applied, that is, the clinical environment. A case study approach, consisting of a purposive sample of midwifery lecturers, midwife mentors and student midwives was adopted and data were collected by qualitatively driven methods which included interviews and focus groups. Categorical aggregation of interview and focus group data provided the basis for developing the thematic analysis.

In part 1 and part 2 of this series, data were presented relating to the role of clinical simulation in preparation for, and application to, clinical practice. This third article explores the influence of simulation on learning in the workplace, where it was found that simulation-based learning (SBL) had a positive impact, and that it perhaps offered an interface between the university and practice placement. There was also evidence to suggest that simulation facilitated the mentors’ teaching role.
Post-partum MMR immunisation rates in rubella-susceptible antenatal women
Authors: Matthews Linda , Gray Selena , Gray Debra , Lawrence Lynne M
Published: May 2014

Rubella, an insignificant viral disease of childhood, can have devastating effects on the fetus if infection is acquired during pregnancy. An immunisation programme was established in the UK in the 1970s, with the monitoring of pregnant women for rubella susceptibility and post-partum immunisation for those found to be susceptible. This policy has recently been reviewed by the National Screening Committee. This study examined records of 115 rubella-susceptible pregnant women (defined as rubella IgG titre < 10IU/ml) identified in a South Wales Health Board area in 2010. Of these, 101/115 (88%) were offered post-partum immunisation and 77/101 (76%) of those accepted the offer. In total, 38/115 (33%) left maternity services care without receiving post-partum immunisation. The study also showed that 32/53 (60%) of those reported as susceptible had received two doses of an appropriate vaccine; this has implications for the proposed changes to screening where two doses would be presumed to be protective.
One-to-one midwifery care in Singapore – the first 100 births
Authors: Fox Deborah , Lina Chu , Ting Kelly Er Li , Raes Ana , Ihdinaa Rooslee Siti , Siew Keing Pua , Yap Seng Chong
Published: May 2014

The Enhanced Midwifery Maternity Care (EMMa Care) programme at the National University Hospital in Singapore was implemented in 2011 to provide women with primary obstetric care in collaboration with one-to-one midwifery support. The continuity of care women are able to access from both an obstetrician and a midwife provides a unique opportunity for women and babies to benefit from both obstetric expertise and holistic midwifery care. This article describes the development of the programme, and the outcomes of the births of the first 100 women who booked. Sixty women were primiparous and 40 were multiparous. Birth outcome data demonstrated a caesarean rate of 20% and seven out of nine vaginal birth after caesarean (VBAC) attempts were successful (77.77% success rate). Of the women birthing vaginally, 81.33% did so without any pharmacological pain management; 58 women used water immersion in labour and 36 birthed their babies in water. There were no third or fourth degree perineal tears, no postpartum haemorrhages and the episiotomy rate was 4%. Apgar scores were above 7 at 5 minutes in all but one baby; five babies required phototherapy for hyperbilirubinemia and eight babies (including one set of twins) were admitted to the neonatal intensive care unit (NICU) for hypoglycaemia and/or prematurity. EMMa Care is associated with good maternal and neonatal outcomes. Caesarean section rates were lower than overall rates in the same hospital setting and use of pharmacological pain management was minimal.
Stigma associated with postnatal depression: A literature review
Authors: McLoughlin Jennifer
Published: May 2014

This literature review aims to explore women's experiences of postnatal depression (PND). It is well recognised that psychiatric diagnoses are potentially stigmatising in the general population ( Rüsch et al, 2005 ; Time to Change, 2008 ). This is also highlighted in National Institute for Health and Care Excellence (NICE) guidelines pertaining to women's perinatal mental health (2007). The motivation for this literature review is to bridge the gap between the recommendations from NICE that health-care professionals be aware of the potential for stigma and shame associated with perinatal mental health problems ( NICE, 2007 ) and the perspective of the midwife in practice. From a review of the literature, it is hoped that some insight might be offered as to what stigma and shame about PND ‘look like’, and how and why they might arise.
Women's use of complementary and alternative medicine in pregnancy: a journey to normal birth
Authors: Mitchell Mary
Published: May 2014

This article presents some findings of a research study that explored Women's motivations and experiences of using complementary and alternative medicine (CAM) in pregnancy and childbirth. a narrative approach was chosen, as through story telling it is possible to come to an understanding of how CAM contributed to Women's experiences of pregnancy and childbirth. Participant's CAM use was motivated by their desire to achieve a normal birth, one without unnecessary medical intervention and one which was an emotionally fulfilling experience.
Supporting smoking cessation in pregnancy
Authors: Edwins Jenny
Published: May 2014

A large study by Bickerstaff et al (2012) has once again confirmed the association between smoking in pregnancy and poor outcomes for both women and their babies. they identify that ‘quitting smoking prior to conception is most desirable; however, there is also likely to be benefit in stopping smoking prior to the second trimester, and women should be encouraged and supported to do so.’

This review article aims to signpost a number of currently available resources to update midwives’ understanding of the complexities of smoking cessation. the main focus will be on the role of the midwife in promoting strategies that improve the likelihood of pregnant women stopping smoking and remaining smoke free. it is assumed that the reader is already aware of the adverse consequences of smoking in pregnancy and motherhood, for both women and their children.
Understanding the research methodology of interpretative phenomenological analysis
Authors: Roberts Taniya
Published: May 2014

This article will explore the emergence of interpretative phenomenological analysis (IPA) as an approach for midwifery research. a brief history of the research methodology of phenomenology is given to aid understanding of how this relatively new approach of IPA has developed. the background to IPA research is examined, its methodological processes discussed, and research examples with specific applications to midwifery practice are provided.
Postpartum rupture of a splenic artery aneurysm: A case report and review of the literature
Authors: Mirza Omar , Ahluwalia Anjali , Galloway Simon
Published: May 2014

Splenic artery aneurysm is the most common visceral artery aneurysm ( Lang et al, 2002 ). There is a strong association with the formation of splenic artery aneurysms in pregnancy and multiparity. They remain largely asymptomatic unless they rupture—a potentially catastrophic event. This article presents an unfortunate case of a fatal ruptured splenic artery aneurysm in the postpartum period, where the initial diagnosis was thought to be a pulmonary embolus. The various anatomical and physiological changes that occur during pregnancy can make the diagnosis, evaluation and treatment of a pregnant or postpartum woman difficult. Considering other less prevalent pathologies and relying less on protocol-driven care where no definite diagnosis has been made is vital in ensuring timely management. A ruptured splenic artery aneurysm, although infrequent, is an important differential diagnosis to consider when faced with an acutely unwell pregnant or postpartum patient. Early recognition, prompt diagnosis and urgent surgical intervention are essential to avoid fatal outcome.
Does transitional care improve neonatal and maternal health outcomes? A systematic review
Authors: Miah Rukeya
Published: May 2014

Current evidence has shown that transitional care benefits the health outcomes of moderately compromised infants and mothers in terms of de-medicalisation of care, improving mother and infant attachments, parenting skills for dependant infants and the potential for shorter length of hospitalisation. Transitional care units exist in a variety of forms in neonatal services, ranging from nurse-led to midwife-led units. This review establishes whether transitional care units improve maternal and neonatal health outcomes. Objective: To review and synthesise published research on ‘Does transitional care improve neonatal and maternal health outcomes?’ Methods: Systematic reviews of published literature from nine electronic databases were undertaken and a total of ten studies were reviewed that met the reviews inclusion criteria. Findings: Five studies were rated as moderate strength, four studies were rated as very high quality and one study was rated as poor quality. Three overarching primary outcomes were identified. Within each outcome, a series of seven secondary outcome measures were reported. These included very positive benefits on one end of the scale and no benefits at the other end. The outcome measures report inconsistently across studies of the values of transitional care units for infants, ‘shorter length of stay’, ‘transitional model of care’ and the ‘reduced risks of infection’. Family centred care, mother as main carer, and increased bonding and attachments featured strongly across studies and thus supported the benefits of transitional care units in improving neonatal and maternal health outcomes. Conclusion: This review highlighted the values of transitional care in increasing the ‘mother–infant’ model of care. More studies are required for the evidence base for strategies to reduce the length of hospitalisation for moderately vulnerable infants. It was discovered that there are substantial variables in transitional care unit practices in the UK, as well as a need for well-conducted studies.