bluuebunny/crossref_metadata_2025 huggingface dataset:
Midwives conducting the neonatal examination: part 1
Authors: Mitchell Mary
Published: May 2014

The neurobehavioural physiological assessment of the newborn for midwives course began to prepare midwives to conduct the neonatal examination in 1996. This is the first study to report midwives’ experiences of undertaking this practice. Adopting a grounded theory approach 19 midwives were interviewed to gain insight into their experiences and identify the factors that both promote and constrain the midwife in undertaking the neonatal examination. Part one of a series of two articles, will explore the background to the development of midwives undertaking the neonatal examination. Details of the research study are given and the findings that relate to the context in which midwives have incorporated this new role into their practice. Part two will present the remaining findings from the research study with the implications for practice.
Down's syndrome: breaking bad news
Authors: Reynolds Shelley
Published: May 2014

Giving adverse screening results to women is an important and often emotionally complex part of a midwife's role. Midwives are continuously involved in the explanation, counselling, implementation and the giving of serum screening test results for Down's syndrome. Very little literature is available on the feelings and attitudes of midwives when giving these results. Consequential to practice is that not everybody is good at giving ‘bad news’ and an attempt to standardise this practice could be made by giving such news differently.
Safeguarding the welfare of children: part two
Authors: Chapman Therese
Published: May 2014

This is the second part of a series of articles that explores current national policy relating to the protection of children and specifically examines the implications of its application to midwifery practice. Part one (Chapman, 2002) examined the contraindications arising from the social constructs of motherhood, childhood and abuse and described how intrinsic tensions, coupled with a lack of any objective tools are likely to give rise to conflict in the midwife-mother relationship. This second part explores how the governmental Framework for the Assessment of Children in Need and their Families (Department of Health, 2000) could be adapted for utilization by midwives, to assist them in making objective social assessments and identifying the needs of individual women and their families, supporting a welfare-based approach to the provision of care and services. Midwives will then be in a position to work in partnership with women, and to articulate explicitly and advocate more effectively for vulnerable women and children who may be at risk of harm in the future.
Aims and associations of reducing teenage pregnancy
Authors: Allen Elizabeth J
Published: May 2014

Described as transitional years, the teenage years are ones of mental and physical development, experimenting and taking risks. The riskiest of all teenage behaviour is that of sexual activity. Teenage pregnancy rates are continuing to rise in the UK whereas rates in other countries are falling. This article shall discuss the issues of teenage pregnancies and the goal of reducing the rates set by the Government in the Our Healthier Nation document (Department of Health, 1998). It is important that midwives develop acknowledgement, appreciation and understanding of the factors that affect the rates of teenage pregnancy and use this to enhance their roles in caring for the pregnant teenager and in turn, improve health care outcomes.
Why mothers die: a public health concern
Authors: Raynor Maureen , Sullivan Amanda , Oates Margaret
Published: May 2014

For the first time ever, suicide is the leading cause of maternal deaths in the UK (CEMD, 2001). This haunting reality illuminates the need for antenatal screening to detect women at risk of mental health-related problems. This second article in a series of two articles proposes that the timely intervention of antenatal screening for postnatal depression and serious mental illness is an important public health issue. The early detection of emotional difficulties is the key to helping and supporting vulnerable groups of women and their families, and preventing mortality.
Inconsistent advice and practice: part 3
Authors: Simmons Valerie
Published: May 2014

This is the final in a series of three articles. The first two articles presented a primary research study which explored if, and why, inconsistent breastfeeding advice and practice existed amongst a group of midwives and health visitors. Findings demonstrated that this arose because of an inadequate and inappropriate knowledge base amongst some professionals, as well as the use of ineffective communication. This article discusses the challenge of providing effective communication and support to breastfeeding mothers. In doing so, it suggests some strategies that can support the health professional to deliver more consistent and effective care.
Are midwives less kind if you speak Urdu?
Authors: Robinson Jean
Published: May 2014

It is odd how some pieces of research result in change, and others get the occasional mention, are dutifully quoted in the list of references, but seem to have little noticeable effect. People seem to mentally tick them off: ‘Well, that's that one done and dusted’. I still recall the sadness and shame I felt when I read a study of midwives’ attitudes to Asian women 10 years ago (Bowler, 1993). Surely once people realised what was happening, things would change? Yet stories of insensitive behaviour – and worse – continued to arrive.
Expecting twins and more: support and information
Authors: Wood Lorna , Young Donna , Young Duncan
Published: May 2014

This article discusses the antenatal education programme offered to women who attend a multiple pregnancy clinic (MPC) within a regional Hospital in the North West of England. The Liverpool Twins & More Club (LT&MC) was established in 1995 as a support group for women and families with a multiple pregnancy. Members of the LT&MC carried out a small survey, using specially-designed semi-structured questionnaires, in 2001. The survey aimed to identify what information the LT&MC members had found helpful throughout their pregnancy so that this could be shared with others in future classes. The survey was also an attempt to reassure newly pregnant women that the anxieties and experiences they have are shared by others and are a normal response to a multiple pregnancy. The main themes identified were: initial reaction, reaction of others, physical changes, antenatal information, sibling support, preparation for birth, coping with discharge, infant feeding, twin/triplet identity, bonding,amily/professional support and sleeping. The responses informs the content of the evening class and forms the basis of an information booklet, which is now given to all women attending the MPC.
The new midwifery rules
Authors: Dimond Bridgit
Published: May 2014

New Midwives Rules (NMC, 2004), came into force on 1 August 2004. The new Rules were drawn up under the Nursing and Midwifery Order 2001 (SI 2002/253) and in particular Articles 42 and 43 on the Rules as to midwifery practice and the local supervision of midwives. At the same time the NMC has replaced the Midwives code of practice with standards and guidance on the Rules.
New fitness to practice rules
Authors: Dimond Bridgit
Published: May 2014

Since its establishment, the Nursing and Midwifery Council (NMC) has been using the procedures and committees on professional conduct hearings established under the United Kingdom Central Council for Nursing, Midwifery and Health Visiting. Following a consultation on replacing the procedures relating to hearings for professional misconduct, new fitness to practice procedures were introduced on 1 August 2004.
Midwifery practice and sexual abuse
Authors: Barlow Joanne , Birch Linda
Published: May 2014

Women may have been subjected to unwanted sexual experiences. This can have a lasting emotional and psychological impact. The intimacy associated with pregnancy and childbirth may provoke particular fear and anxiety in these cases. This may be further exacerbated by midwifery and obstetric practice. Ultimately, previous personal experiences combined with those encountered when accessing maternity care may have the potential to influence the utilization of all health care in the future. Having awareness and understanding of past sexual abuse can enable healthcare professionals to adopt a sensitive approach and prevent unknowingly re-traumatizing the woman. This article outlines some simple strategies that health professionals may consider to reduce the trauma associated with intimate procedures for all women.
Enhancing clients' rights and quality of care
Authors: Lavender Tina , Briscoe Lesley , Downe Soo , Kingdon Carol
Published: May 2014

Midwives from Tanzania, Zambia, Zimbabwe, and Mozambique first conceived the African Midwives Research Network (AMRN) in Tanzania in 1992 (Lugina et al, 2002). The network provides a pathway for best evidence and information to be shared internationally, helping to create strategies and solutions for future practice. The aim of the network is to reduce maternal mortality and morbidity rates and improve the quality of care for women globally.
The cost-effectiveness of breastfeeding peer support
Authors: Battersby Susan , Aziz Muna , Bennett Kay , Sabin Karen
Published: May 2014

Although many breastfeeding peer support projects have been initiated, evaluating their cost-effectiveness is difficult as a result of a paucity of data and relevant literature. However, from a review of the limited data it can be shown that breastfeeding peer support programmes can, by increasing the number of babies who are breastfed, make significant savings to the NHS. Other areas that could offer long-term savings to the NHS, but have not been fully analysed, include potential reductions in pre-menopausal cancers in mothers who have breastfed, childhood obesity, urinary tract infections and necrotizing enterocolitis. Consideration of the value-added benefits that peer support workers offer to the mothers and the community highlights the special value of breastfeeding peer support programmes.
Long-term nicotine replacement therapy
Authors: Hegaard Hanne K , Kjrgaard Hanne , Mller Lars F , Wachmann Henrik , Ottesen Bent
Published: May 2014

The aim of this study is to describe the effectiveness and safety of nicotine replacement therapy (NRT) in 75 pregnant smokers. The cessation rate was 28% after 1 month, and 13% 1 year after delivery. The side-effects of NRT were transitory. Complications to pregnancy were similar in the NRT group and a comparable group. Nicotine replacement products used included either 2mg nicotine gum, or a 15mg nicotine patch (16 hours/day), or both. The individual therapy was decided on the level of nicotine dependence, as measured by the Fagerström score. The concentration of cotinine in saliva and carbon monoxide in expired air was lower when the women used NRT than when they smoked. For women using either nicotine patch or patch plus gum, the mean saliva concentration of cotinine was significantly reduced (p<0.001). For women using only gum, the reduction was borderline significant (p=0.06).
Complementary and alternative medicines
Authors: Dimond Bridgit
Published: May 2014

There is clear evidence of the growth in popularity of complementary and alternative medicines (CAM) over recent years. This increase in popularity has however been linked with concerns over their safety and the need for regulation.
Childbirth: how safe is safe enough?
Authors: Devane Declan , Begley Cecily
Published: May 2014

Concerns have been expressed by women and professionals alike as a result of negative media and research reports on the effectiveness and safety of alternative models of childbirth for women (The Observer 28 September 2003; Gottvall et al, 2004). But what is ‘safety'? The concept of safety in maternity care is ambiguous and appears to be ‘person', politically and socio-economically dependent. Some may, for example, regard a composite measure of ‘birth asphyxia’ as the most important indicator of safety. Others regard emotional wellbeing, mode of delivery and control as the most important indicators of safety.
HIV infection and pregnancy
Authors: Reynolds Kate
Published: May 2014

Human immunodeficiency virus (HIV) is predominantly a sexually transmitted infection, which is increasingly manifested in heterosexually acquired statistics in the UK. As the rate of HIV disease rises in women, the incidence of vertical transmission (mother-to-child) is likely to escalate. This article outlines factors affecting the efficiency of vertical transmission and preventive measures in clinical midwifery practice. Specialist advice will ensure the most appropriate care and support for the HIV-positive patient.
Midwives’ role in preparing women for birth
Authors: Eames Carol
Published: May 2014

The art and the joy of midwifery lies in the skills of the midwife who recognises the individuality of each woman, believes in her and works with her towards the same goal: her ‘best possible birth'. How best can midwives help prepare women for birth? Do antenatal classes provide women with the information and knowledge they need to help them feel in control of their labour? This article discusses the potential of antenatal classes in reducing fear, creating confidence, and promoting understanding and freedom of choice for women. When these processes are transferred to the labour ward, the woman feels more in control. She may find it easier to ask questions and state her wishes, thereby increasing her potential for an improved physical and emotional labour outcome.
Webwatch
Authors: Carr Natasha
Published: May 2014

There is no escaping that labour is painful for most women. A midwife is in a prime position to be able to offer help, advice, and support women to enable and assist them in coping and experiencing labour in a way that is right and positive for them. This month's webwatch reviews some of the many websites available that are related to coping strategies and pain relief.
Worrying truth behind home birth figures
Authors: Stephenson Liz
Published: May 2014

The recently published National Service Framework (NSF) (DH, 2004) places strong emphasis on normality and midwifery-led care. It comes more then ten years since the publication of Changing Childbirth (DH, 1993) with its emphasis on normality. Home birth is both normality and midwifery-led care at its best and is almost always physiological birth. Yet nationally the home birth rate runs at around 2% according to www.birthchoiceuk.com (2004). Why then are we not raising the rate of home births when it is estimated that when women are given true choice the rate would be around 8-10%?
It is time for our leaders to emerge
Authors: Gould Debby
Published: May 2014

Bertrand Russell, the philosopher and author, once said: ‘The whole problem with the world is that fools and fanatics are always certain of themselves, and wiser people so full of doubt’. Russell's words echo some of the dilemmas midwives face today as they try to promote normality in a potentially hostile environment.
Routine enquiry into domestic abuse – the All-Wales clinical pathway
Authors: Hardacre Suzanne
Published: May 2014

The Department of Health has announced plans to introduce antenatal routine enquiry into domestic abuse throughout the UK. In order to demonstrate its commitment to this issue in Wales, a care pathway has been developed for use by all midwives and health visitors. National service frameworks underpin national service frameworks and so provide a structure that will assist the midwife and health visitor in carrying out routine enquiry. The pathway is a legal record of care provision and has been compiled multi agency guidance and expertise. It will afford midwives an evidence-based structured approach to highlighting disclosures of abuse and the level of risk faced by women.
Teaching and assessing: Reflection upon planning, delivery and evaluation
Authors: Minter Amanda
Published: May 2014

Exploration of actions, thoughts and feelings of an event may better benefit the reflector when organized through the use of a reflective model. What follows is a reflective account of a teaching and assessing session. It focuses on the theory and activity of the ‘hands off’ technique of breastfeeding as described by Jamieson (1990) and hand expression of breast milk. This was the practical element to the teaching and assessing module (towards BSc Midwifery Practice), and was the author’s first attempt at processing her reflections in such a way. Stuart's (2000) model of reflection (Figure 1) was developed for midwife practitioners as carers. By modifying the emphasis of the model slightly from caring to teaching, it made sense to the experience of teaching and learning, enabling the author to move productively through the phases of reflection.
Starting as we mean to go on: Supporting newly qualified practitioners
Authors: Powell Alison
Published: May 2014

Supporting newly qualified practitioners is crucial to the future of the midwifery profession. Alison Powell looks at how supervisors can provide midwives with the best start and continued support.
Supervision of midwifery: a vehicle for introducing reflective practice
Authors: Ralston Rossana
Published: May 2014

This article describes the use of reflection to enhance midwives confidence and competence in clinical practice. The importance of reflective practice in midwifery is well documented and it has been demonstrated that guided reflection, set within the context of a framework of statutory supervision of midwives, strengthens professional learning by demonstrating continuing professional development. The author believes that supervisors of midwives are ideally placed to lead the development and implementation of guided reflection in practice as a tool to enable midwives evaluate their practice and identify areas for development. This paper focuses on supervision of midwifery as a vehicle for introducing Reflective Practice.
Malaysian midwives' views on postnatal depression
Authors: Keng Soon Lean
Published: May 2014

Postnatal depression (PND) although, not psychotic in nature has an insidious onset, and is a serious disorder that progresses imperceptibly. It may then affect the quality of life of mothers and threatens the psychological and healthy functions of the mother, infant and of the entire family. The aim of this descriptive study was to explore the views held by midwives at the Hospital Universiti Sains Malaysia (HUSM) about postnatal depression (PND). Fifty-seven midwives from the Maternity Units at HUSM were surveyed and their knowledge and perception of PND analyzed. More than 50% of midwives confused PND with postnatal ‘blues’ or women not adjusting to life after giving birth. More than 17% of midwives said that PND health education and awareness programmes were important for midwives. The results of this study suggest areas of concern, in particularly, those that relate to the lack of knowledge of PND among the midwives in the HUSM and in Malaysia. Midwives are purportedly able to detect abnormal conditions in mothers as advocated by the Malaysian Midwives Act (1966), fulfilling the role designated by the midwifery profession. Including PND content in midwifery training could help midwives to be more able to identify mothers at risk of, or experiencing this condition.
Enquiry-based learning links psychology theory to practice
Authors: Fisher Margaret , Moore Sue
Published: May 2014

Problem-based learning (PBL) or enquiry-based learning (EBL) was recently introduced into the midwifery curriculum at the University of Plymouth in an attempt to help students to apply psychological theory to practice. An evaluation study was conducted to ascertain its effectiveness. Through questionnaires and focus groups involving students and lecturers it became clear that PBL/EBL had many advantages. Particularly positive outcomes included enhanced links between theory and practice and development of graduate skills. This paper provides a background to the PBL/EBL concept, discusses the study and explores some of the factors which may contribute to the development of a graduate practitioner who is fit for purpose.
Lactational amenorrhoea method as a contraceptive
Authors: Jackson Karen B
Published: May 2014

Lactational Amenorrhoea Method or LAM, is a highly effective form of natural family planning. If used correctly, it is over 98% effective (Szarewski and Guillebaud 2000), which rates very favourably when compared to other forms of contraception. Yet midwives appear to be reluctant to include this choice of contraception when discussing this issue postnatally with breastfeeding women. This article will look at the evidence to support the efficacy of LAM, the criteria women need to follow (the Bellgio consensus statement) to comply with LAM, some common fears and misconceptions surrounding LAM and the professional responsibilities of the midwife in relation to postnatal contraception advice.
DNA testing and the Human Tissue Act
Authors: Dimond Bridgit
Published: May 2014

On page 310 of this journal the provisions of the Human Tissue Act 2004 are set out. Included in the Act are provisions relating to DNA testing, which for the first time neatly consolidate and set out the laws relating to the use of DNA.
Webwatch
Authors: Carr Natasha
Published: May 2014

One of the roles of the midwife is to care for and monitor the progress of the mother in the postnatal period. She should offer all necessary advice to the mother on infant care to enable her to ensure the optimum progress of the newborn ininfant (NMC, 2004). Whether a mother should choose a disposable nappy or more environmentally friendly cloth nappies is becoming an increasingly important issue.
Parental perceptions and adaptation to parenthood
Authors: Glazener Cathryn MA
Published: May 2014

The establishment of a good relationship between the parents and their new baby is one of the crucial factors in enhancing the outcome of postnatal care. The objective of this study was to assess the value and meaning of a descriptive list of baby adjectives, as a tool in the measurement of this relationship, for use in research aimed at improving postnatal outcomes. The list was used in a prospective longitudinal questionnaire survey of postnatal care. The adjectives allowed parents to express negative as well as positive feelings about their child. A score derived from the adjectives was explored using multiple regression to identify significant associations with other factors. The net adjective score proved a responsive and time-sensitive method for tracking changes in parental perceptions of their baby over time. Mothers' scores became more positive within the first two months with little change thereafter, and were more positive than fathers at 12–18 months. Mothers' scores were related to maternal anxiety and depression, and aspects of baby behaviour such as sleeping and crying problems, colic and teething; but not to obstetric factors such as method of delivery. Fathers' scores were affected by their partners' adaptation to motherhood and the baby's behaviour. The net adjective score is a useful and simple method of accessing parental perceptions of their babies. It could be used as an outcome measure in trials of interventions to improve postnatal outcomes.
Breastfeeding peer support: Health service programmes in Scotland
Authors: Britten Jane , Hoddinott Pat , McInnes Rhona
Published: May 2014

The objective of this multiple case study was to identify and describe health service breastfeeding peer support programmes operational in urban and rural areas in Scotland between 1995 and 2002. The programmes aimed to increase breastfeeding rates in areas of low initiation. Supporters all had breastfeeding experience and training was provided in eight of the nine programmes. Two models of peer support were identified: individual support at home by trained supporters paired wth pregnant or breastfeeding women and group support between currently breastfeeding mothers, trained or untrained. Supporters’ roles were wide ranging and some became breastfeeding ‘experts’. Professionals were generally supportive of the programmes.
Umbilical artery doppler: A screening tool for fetal wellbeing
Authors: Blincowe Jill
Published: May 2014

This paper describes the effectiveness of Umbilical Artery Doppler (UAD) as part of screening for fetal well being, especially where severe placental insufficiency or intra-uterine growth restriction is suspected. The paper also argues for UAD as a routine part of health surveillance in low risk pregnancies. UAD aids detection of cases where the fetus may be at risk and it is particularly valuable in monitoring high risk pregnancies. Studies have shown that growth restricted fetuses with abnormal UAD readings can be monitored regularly until the optimum delivery point is reached. A telemonitoring project at the Day Assessment Unit allows UAD findings to be transmitted by phone to a consultant led unit.
Care of pregnant women with heart disease: A multidisciplinary approach
Authors: Abdin Sabah
Published: May 2014

Owing to recent advances in paediatric cardiology and surgery almost 90% of children born with congenital heart disease will now survive to adulthood. Approximately half of these patients are female.

In midwifery we are seeing a new population of pregnant women who have complex heart disease. Many of these young women will have had some form of intervention or surgery previously to treat their heart disease and some are left with significant residual haemodynamic problems. However, these women can have a safe pregnancy with good outcomes for both mother and baby if they are given access to specialist care and a multidisciplinary team approach is taken to their management.
Maternal deaths continue to occur regularly across the globe
Authors: Bainbridge Jane
Published: May 2014

Jane Bainbridge reports on the international failure to reduce maternal mortality rates substantially, and explores the reasons why through a review of statistics and studies.
Lingering pregnancy fat puts women in danger
Authors: Bainbridge Jane
Published: May 2014

The link between obesity and adverse pregnancy outcomes is strengthened. Women who gain weight or fail to lose their baby weight between pregnancies raise their risk of complications in the next pregnancy.
Cot death: the benefits and dangers of health promotion
Authors: Webb Geoffery P
Published: May 2014

We are bombarded with advice about diet, lifestyle and health; much of it is based upon tenuous evidence and put forward in the mass media by people with no credible medical or scientific expertise. Health promotion that is not supported by convincing evidence of holistic benefit can be dangerous. If dietary and lifestyle changes have the potential to promote health then they must also have the potential to do harm.
An evaluation of time spent by midwives on supervisory activities
Authors: Mead Marianne , Kirby Joy
Published: May 2014

It has recently been suggested that supervisors of midwives spend one day a fortnight on supervisory activities, but this assumption did not rest on empirical evidence. A survey of all supervisors in England, facilitated by the LSA Midwifery Officers (England), was therefore undertaken to calculate the amount of time supervisors estimate they spend on supervision and identify potential variations across the country. Supervisors estimated that they spend a day a week on supervision, but the study also identified major differences in the perception of the role: most supervisors identified specific times spent on supervisory tasks while a minority was more likely to identify supervision as an intrinsic part of their midwifery activities. This phenomenon was not affected by length of qualification or number of hours worked, but was more common in H grade midwives and in some LSA regions. Further research would be useful to identify potential differences in the style and characteristics of these different groups of supervisors.
A useful introduction to wound healing in the field of midwifery
Authors: Jeanes Annette
Published: May 2014

This paperback book offers a useful introduction to wound healing in the field of midwifery. It gives a comprehensive background of the immune system, wound healing and the role of nutrition in healing. There are chapters on perineal and caesarean wounds, complimentary therapies, sepsis and infection control.
Empowering midwife mentors with adequate training and support
Authors: Finnerty Gina , Graham Lesley , Magnusson Carin , Pope Rosemary
Published: May 2014

In this article, the authors illuminate some of the hidden aspects of the mentor role, which often go unnoticed in challenging clinical settings. Four key areas have been selected for the purpose of stimulating thought and debate on current mentorship issues: preparedness for the mentor role; management of students’ clinical learning and skills development; processes of practice assessment and support for the mentoring role. The findings demonstrate the need for increased funding to enhance the clinical curriculum. This includes formal protection of time for mentors to provide quality learning experiences. Investment in the mentor/student dyad is essential as successful mentoring can literally be a ‘gift’ to student midwives.
Yummy Mummies: Hijacking motherhood and undermining women?
Authors: Daniel Lincia
Published: May 2014

In a society obsessed with celebrity the media has turned its attention to motherhood or the Yummy Mummy. Freelance writer Lincia Daniel examines the pressures now placed on women by this focus on impossible glamour and makes a plea for valuing parenthood and the family in a real context.
Can midwives maintain their enthusiasm in the current climate?
Authors: Rowbotham Mandy , Hunt Sarah
Published: May 2014

We are birth addicts. There, we’ve said it; admitted it, purged ourselves of what would appear to be an asset – as seen by some midwives – or an affliction, if other peers are to be believed. But there it is. We are eager, enthusiastic and at times, obsessive, but so passionate is our desire to see, be at and help women birth their babies, that it begins to colour our working and personal lives. Partners have to be very understanding as we creep out at 2am for a home assessment of a first time mum beginning to puff, and children are more than used to seeing mum pick up her diary and work bag, so much so that one of our three-year olds will regularly enquire: “Are you going to measure a baby, mum?”
The mother-midwife partnership: A critical analysis of intrapartum care
Authors: Kerrigan Angela
Published: May 2014

Midwifery practice requires knowledge of current research and an awareness of the need for critical analysis of personal practice. Reflective and reflexive thinking are essential to midwifery practice and are advocated as ways of developing professional knowledge and improving skills. This article examines a particular intrapartum case, examining the midwifery care provided to Maria, highlighting the factors that can influence maternal positioning, choice of pain relief and labour management and the numerous decisions made by both the mother and the midwife during labour, and the impact these decisions can have on birth outcome. Through the analysis of this case, it is evident that there are many ways in which personal midwifery practice could be altered through reflective thinking and have a positive impact on the experience of women in the future.
The abuse of female human rights is not a cultural issue
Authors: Rendell Baroness Ruth
Published: May 2014

In the 1970s, when families first began coming to the UK from the Horn of Africa, obstetricians and midwives examining pregnant women, discovered what they thought were congenital malformations of the genitalia. Of course they were not. What these health professionals were looking at were the results of purposeful disfigurement. Reading of this was what first alerted me to female genital mutilation (FGM) or ‘female circumcision’ as it is still referred to by those unwilling to face its ugly and painful facts.
Second degree tears: to suture or not? A randomized controlled trial
Authors: Langley Vanessa , Thoburn Alison , Shaw Steve , Barton Andy
Published: May 2014

This article describes a randomized controlled trial to assess the relative rates of healing, pain, return to normal urinary and sexual function, subjective perception of healing and quality of life between women who had been sutured following second degree perineal tears and those who had not. The trial was conducted in the maternity department of South Devon Healthcare NHS Trust. The study population consisted of two hundred previously consented women delivering at the department who had sustained a suitable tear with no restriction on parity. The women were randomly allocated to the suturing or non-suturing groups. Outcomes were measured at 5, 10 and 28 days, 6 weeks, 6 months and 1 year. Long-term healing between sutured and non-sutured groups was comparable. Non-suturing results in a slower rate of healing but only at first. Pain relief is more often required by sutured women. There is no significant difference in postpartum incontinence or resumption of sexual activity. An apparent imbalance in severity between the groups is thought to be the result of midwives having a clearer view of the tear in preparing for and undertaking suturing. This has important implications for the examination of the perineum.
An African experience
Authors: Graham Ruth
Published: May 2014

I travelled to Uganda with no expectations at all, except to learn a great deal. My community mentor advised me: ‘Africa will profoundly change you; you will not come back the same person as you leave.’
Examining the newborn: why don't midwives use their skills?
Authors: Steele Dianne
Published: May 2014

A survey by Hayes and colleagues (2003), highlighted that most examinations of the newborn are conducted by paediatricians. This survey identified that two per cent of midwives are trained to examine the newborn, however, a third of this group carry out no examinations at all. This is a qualitative study to establish why some midwives may not continue to practice their skills following successful completion of the neuro-behavioural, physiological assessment of the newborn course (N96). A sample of midwives who completed the N96 course between 1998 and 2004 at the University of Greenwich was selected for this study. A number of midwives interviewed acknowledged a decline and loss of skills, while others identified difficulties in the execution of skills on completing the course. The findings suggest midwives feel they have little control of their workload, lack of recognition of role and lack support from their midwifery manager. These factors may influence the demise of the midwife's opportunity to conduct the examination of the newborn. Midwifery managers may want to consider how midwives can practice their newly acquired skills on completion of the course.
Detection and initial assessment of mental disorder: the midwife's role
Authors: Elliott Sandra , Ross-Davie Mary , Sarkar Anindita , Green Lucinda
Published: May 2014

Two studies were undertaken to evaluate a programme to encourage midwives to detect and refer women with mental health problems. In the first study, 187 midwives completed questionnaires before and one month after a study day. There was a significant improvement in answers to knowledge questions and in self-reported confidence and attitudes. In the second study, the handheld maternity notes carried by pregnant patients were examined after discharge. Significantly more records showed mental health problems entered and more had explanatory information added beside the diagnosis.
Medicalization of bladder care
Authors: Walsh Denis
Published: May 2014

Recently I was told the following tale by a midwife. She was caring for a labouring woman with an epidural and was relieved for her break by another midwife. When she returned, she noted that the midwife had catheterized the woman because she had not voided her bladder for the previous six hours. My colleague glanced at the residual volume and saw it was 150mls. She believed the intervention was unnecessary because the woman had not had a palpable bladder. She knew this because, when she came on duty the woman had recently had the epidural sited and her bladder was full. the woman was unable to void so the midwife had passed a catheter and got back 550mls. In the ensuing hours, the women had drunk little and only about 250mls of fluid had been infused.
Obesity and underweight among first trimester pregnant women
Authors: Abayomi Julie , Watkinson Helen , Topping Joanne , Hackett Allan
Published: May 2014

Pregnant women with a body mass index (BMI) greater than 30 or less than 18.5 kg/m2 have greater risk of maternal and/or fetal mortality. The aim of this study was to determine the prevalence of obesity and underweight among women booking at a Liverpool hospital and to estimate dietetic resources needed. A report was compiled consisting of height, weight, age and parity for 7,981 women booking between July 2004 and June 2005. BMI was calculated and women were categorized: underweight (BMI < 18.5); normal weight (BMI 18.5–24.9); overweight (BMI 25.0–29.9) and obese (BMI > 30). There was a high prevalence of overweight and obesity, 26.7% and 17.2%respectively and 267 women (3.8%) were underweight. A positive relationship with obesity and both age and parity was observed (p < 0.001). An increase in dietetic provision would help to improve diet and optimize weight gain and may also prevent complications, reducing maternal and infant death risk.
Lessons to learn from an emerging maternity service
Authors: Magill-Cuerden Julia
Published: May 2014

In contrast to the history of the maternity services in the UK, Canada is setting up midwifery services state by state. An opportunity to attend an annual conference of the Canadian Association of Midwives in Ottawa is not to be missed. We can learn so much from the Canadian midwives from their current struggles to develop maternity services for women. The issues in midwifery are of course similar, promoting discussions such as: continuity of care/r; competence to practice; safety standards; transferring women into hospital; home from hospital; home birth; reducing caesarean section rates; developing practices; working with women; leadership issues and developing change.
Home births and birth outcomes: midwifery in pre-war Guernsey
Authors: Head Rosemary , Ellison George
Published: May 2014

This study aimed to explore the characteristics of births attended by a community midwife in the predominantly rural setting of Guernsey in the inter-war years. Sociodemographic determinants of home births and birth outcomes were examined among 1808 home births attended by the same midwife from 1923–1937 and a representative 10% sample of 1137 births over the same period. The results showed that neonatal mortality was similar in home and institutional births even though home births were associated with lower paternal social class. Births attended by the community midwife were therefore unusual because they were more likely to be in the more affluent urban parishes. However, among these births paternal occupation was not associated with any birth outcomes. Instead, birth outcomes were primarily determined by pre-existing or concurrent clinical factors. This indicates that home births in this rural setting did not appear to be at increased risk of undesirable outcomes.
How much do we know about stillbirth?
Authors: Daniel Lincia
Published: May 2014

Older women are three times more likely to have a stillbirth than women in their twenties. Given the rise in the number of women having babies in their 40s, research in this area is now a matter of urgency.
Examining a newborn baby: are midwives using their skills?
Authors: McDonald Sharon
Published: May 2014

Midwives across the UK have been undertaking the discharge examination of newborn babies for more than ten years. The perception is that many have the examination of the newborn qualification but do not use it. An audit was undertaken of 100 midwives, neonatal nurses and health visitors known to have the appropriate qualification in one area of the UK.

The aims of the audit were to ascertain if midwives in this one area were in fact discharging newborn babies and to gain a better picture of local needs to improve the quality of local training. The audit sought to determine how many of the midwives, neonatal nurses and health visitors were discharging newborn babies, the number of babies they had discharged in one given month. What prevented them from using their skills and how best the training could be moved forward in the light of the changes in hospital based paediatrician working hours and GP service provision.
Disclosing patient information
Authors: Griffith Richard
Published: May 2014

Midwives base their care and treatment on a thorough examination of the expectant mother. This includes a personal history where personal details are disclosed on the basis that the midwife will keep the personal information private and undertake not to disclose it without permission.
Student midwives and accountability: are mentors good role models?
Authors: Fowler Deirdre
Published: May 2014

Successive Department of Health (DH) reports have emphasized midwifery accountability as paramount in delivering high quality care within the maternity services. Effective role modelling and observation of a positive concept of accountability during midwifery training is crucial in achieving this outcome. A negative concept of accountability may lead to defensive practice and an over reliance on protocols at the expense of supporting normality. Midwifery mentors have varied opinions of professional accountability depending on personal experience and consequently influence their student protégés accordingly. Mentors who act as positive role models of accountability encourage student midwives to reflect and develop analytical skills as well as professional values. It could be argued that whether student midwives adopt a negative or positive notion of accountability is directly correlated to observation and experience of mentors in practice.
Electronic fetal heart rate monitoring: help or hindrance?
Authors: Pateman Katie , Khalil Asma , O'Brien Patrick
Published: May 2014

Cerebral Palsy is a non-progressive disease of the developing fetal brain thought to arise from hypoxic or infective insults in the antepartum and intrapartum periods. Electronic fetal monitoring in the form of the cardiotocography (CTG) was designed to assess fetal wellbeing and reduce the incidence of cerebral palsy: it has not. The widespread use of CTG in low risk women has increased the rate of intervention in the form of instrumental delivery and caesarean section. Severe abnormalities of the CTG require action either by fetal blood sampling or expedition of delivery; yet some of these babies with ‘pathological’ CTGs will have no evidence of fetal hypoxia (i.e. a normal cord pH). In addition, some pathological traces are not recognized or acted upon appropriately. This article discusses the case for and against electronic fetal monitoring in pregnant women.
Newborn vitamin K prophylaxis: developments and dilemmas
Authors: Harvey Belinda
Published: May 2014

Newborn vitamin K prophylaxis against vitamin K deficiency bleeding is routinely recommended in the UK. Different regimes and recommendations are considered in the light of recent reports. There is no clear consensus regarding the best route, frequency of oral administration, or efficacy of preparations. The formulation of the only vitamin K preparation available is not vegetarian in origin. The possibility of an increase in the small number of parents who withhold consent to newborn prophylaxis is considered alongside other issues which may influence women's choice. Midwives and doctors may face considerable difficulties and dilemmas in obtaining informed consent, particularly in the case of vegetarian women because there is currently no vegetarian alternative to offer. A campaign is in progress towards finding a solution to this dilemma.
Doctor invisible
Authors: Daniel Lincia
Published: May 2014

Modern technology has made obtaining products and services fast and accessible via the internet, but could women be putting their health at risk by purchasing contraceptives at the click of a button?
Reproductive disruptions: gender, technology and biopolitics in the new millennium
Authors: Jones Shirley
Published: May 2014

This edited book has a social anthropological approach to what the editor and chapter authors call ‘reproductive disruption’ (i.e. the ‘norm’ not being followed for whatever reason). Within this title they include infertility, pregnancy loss, childbirth and beyond. There are eight chapters, in two parts, and an introduction that defines women's health and is divided into 12 themes, called ‘messages'. The underlying national approach is American (US) and, therefore, practices are not necessarily comparative with the UK. In fact, the underlying research is from Chicago; it is ethnographic, using participant observation, interviews and visits to medical facilities. However, what has been used in this book is mainly what has been published in two magazines: Fit Pregnancy and Mothering, plus one issue of Awake (a Jehovah's Witness pamphlet), the New York Times and a textbook on medical malpractice law. Formal interviews were undertaken with doctors and midwives and, additionally, informal interviews were undertaken with men, women and nurses. Despite the overall US perspective, pages 51–54 in Chapter 1 contain some international comparisons between developed and developing countries.
Investigation into 27 baby deaths in Turkey
Authors: Daniel Lincia
Published: May 2014

Turkey already has a high infant mortality rate but in a 14-day period there have been 27 baby deaths at one hospital in Ankara, although it claims not to be at fault despite sub-standard conditions for newborns.
Safeguarding children from significant harm
Authors: Griffith Richard
Published: May 2014

An estimated 300 million children worldwide are subjected to violence, exploitation and abuse. In Europe the United Nations Children's Fund (2003) reported that two children die from abuse and neglect every week in Germany and the UK, and three a week in France. In the UK, figures show some 32 000 children on child protection registers (Creighton, 2006). The registers are a list of the names of children thought to be at risk of abuse and who require agencies to work together to ensure their safety and protection.
Mindfulness approaches to childbirth and parenting
Authors: Hughes Annie , Williams Mark , Bardacke Nancy , Duncan Larissa G , Dimidjian Sona , Goodman Sherryl H
Published: May 2014

Mindfulness meditation is increasingly being used as a way of managing pain, reducing stress and anxiety and, in the form of mindfulness-based cognitive therapy (MBCT), as a way of reducing the risk of recurrence in depression (NICE, 2004). This article considers its potential for parents preparing for childbirth focusing on three areas: managing pain during pregnancy and labour; reducing risk of perinatal depression; and increasing ‘availability’ of attention for the infant. The encouraging evidence to date suggests the possibility that mindfulness has an important contribution to make, both for reducing vulnerability in high-risk groups and as a universal intervention.
Statutory supervision of midwives: adding value to the profession
Authors: Cathy Warwick
Published: May 2014

Every midwife is aware of the existence of statutory supervision of midwives, particularly when the standard of care they have provided is called into question. But do they all use supervision positively and do midwives value it as a means of supporting their efforts to practice to a high standard? Supervision of midwives exists as part of a system of professional regulation designed to protect the public but women might not understand its role in ensuring they receive high-quality maternity care. The entire health system is challenged to pay equal attention to quality and financial balance but are senior health service executives aware of the contribution that supervision can make to quality care and good governance?