bluuebunny/crossref_metadata_2025 huggingface dataset:
Continuity of carer what can we learn from a Cochrane review?
Authors: Oliver S , Needham G
Published: May 2014

Reviews can be a handy source of information for decisions about maternity services. Checking how reliable and relevant a review is (critically appraising it) is essential. This article shows how critical appraisal of a review in The Cochrane Library may relate to Maternity Services Liaison Committee discussions.
Assessment of needs model in midwifery practice
Authors: Crichton Margaret A
Published: May 2014

This model was designed for a use in midwifery, as most models were adaptations of nursing models. Its aims and objectives are to provide individualized care for every pregnant woman in the district used. The model has been trialed and evaluated poitively. It is now used in both its original and adapted versions in two trusts within this region. It is definitive, but offers scope for adaptation to meet differing demographic needs.
The British Journal of Midwifery's 1997 RCM Conference review
Authors: McCormick Catherine
Published: May 2014

This year's Royal College of Midwives (RCM) annual conference held in Harrogate attracted a record number of delegates. Seven hundred midwives joined their new President, new Chairman of Council and new General Secretary for what will go down in history as one of the most stimulating and challenging conferences ever.
Recollections of staff: versions of the truth
Authors: Symon Andrew
Published: May 2014

Staff recollections, as with those of patients, vary in their accuracy, and may be affected by the passage of time. Detailed contemporaneous case records will often do much to help staff to recall events; however, the presence of such records is no guarantee that memories will be jogged. The case notes may on occasion provide the only reliable evidence of the relevant time.
Using the evidence: putting the research into practice
Authors: Hicks Nicholas R , Mant Jonathan
Published: May 2014

A case study of the use corticosteroids in the management of preterm delivery in Oxfordshire is used to illustrate the principles of how research can be put into practice. Where there is a gap between research findings and clinical practice, as was the case for corticosteroids in preterm labour in the early 1990s, the first step is to diagnose the reason for the gap. If the cause is clinical uncertainty, then appropriate strategies to close the gap are predominantly educational ones aimed at improving awareness of the evidence. If there is clinical agreement that the treatment is indicated, then an understanding of and an abiiity to influence the structural and organizational factors that are acting as barriers is required.
Newborn examination: whose responsibility?
Authors: Michaelides Stephanie
Published: May 2014

The implementation of the Winterton report followed by Changing Childbirth have changed the maternity services with the speedy adoption of teams and caseload midwifery. However, it sometimes seems that midwives are clinging to routines and familiar knowledge bases. With increased demands being made on midwives, it may be that some practices have simply been lifted from the hospital setting and applied to the community.
The midwife consultant and the law
Authors: Dimond Bridgit
Published: May 2014

It is highly probable (though this is not a statement based on research), that most midwives if offered a higher salary would accept the offer. If that is the main reason behind the Prime Minister's recent statement about the introduction of consultant nurses and it applies to midwives, then there could be a high take up. The purpose of this article is to consider the legal implications of the role of the consultant midwife.
The risks of alcohol consumption during pregnancy
Authors: Allen Rose
Published: May 2014

Pacanowski (1997) states that the evidence of the effects of alcohol on pregnancy outcome is inconclusive. However, a vast amount of data has been collected in the last 10 years, all of which provides evidence of the harmful effects alcohol has on the fetus (Elhassani, 1996). Advice such as: ‘a glass of red wine is beneficial’ and: ‘a tot of whisky is acceptable’ only adds to the controversies regarding alcohol consumption. The Government has given a clear message to motorists through their health education campaigns. Slogans like: ‘don’t drink and drive' have been replaced more recently by: ‘don’t drink and die!' These health education campaigns are giving a clear message to the general public. However, because of the lack of conclusive evidence, midwives are left with numerous messages to convey to women.
Evidence and experience
Authors: Downe Soo
Published: May 2014

What do you do when a woman you are accompanying in labour seems to be making little progress? I suppose the answer to this question must depend on the stage of her labour, and how you are measuring it. There has been plenty written about the necessity of ensuring that a woman is in the active phase of labour before using a partogram, so that she doesnt appear to be plodding endlessly along at some soul destroying pace when in fact she isnt really in established labour.
Midwives, informed choice and power: part 2
Authors: Levy Valerie
Published: May 2014

Qualitative data were gathered in a study of how midwives facilitate and women make informed choices in pregnancy. Issues of power permeated the data. This series of three articles will interpret and discuss these issues in relation to Lukes' (1974) conceptualization of power, and more recent theories regarding empowerment. This second article examines Lukes' second dimension of power, wherein the dominant group controls the agenda of what may and may not be discussed, and what decisions may therefore be made, in relation to data from the informed choice study.
Hypertension and complications in pregnancy
Authors: Stevens Georgina
Published: May 2014

Hypertensive disorders are a common cause of maternal mortality in pregnancy (15.5%), coming second after thrombosis and thromboembolism (27.1%) (Department of Health, 1996). As 80% of the deaths from hypertensive disorders are associated with some degree of substandard care, the ability to recognize hypertension and understand the dangers associated with it in pregnancy is of paramount importance.
A one-to-one with Alan Milburn
Authors: Page Lesley
Published: May 2014

Announcements about the appointment of the new Secretary of State for Health, Alan Milburn, have been accompanied by messages of determination to make a real difference to the NHS. If only I could have a one-to-one with him.
Rising caesarean section rate: A public health issue
Authors: Warwick Cathy
Published: May 2014

The Rising Caesarean Rate: A Public Health Issue was held on 23 November in London. It was planned in response to the 1998/99 English National Board Survey — Midwifery Practice that found that 25% of maternity services had a caesarean rate of over 30% and was organized by the National Childbirth Trust (NCT), the Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG).
Part 11: Trespass to the person
Authors: Dimond Bridgit
Published: May 2014

One of the most important civil actions which are included in the bundle of civil wrongs known as ‘torts’, is that of ‘trespass to the person’. Any person who alleges that his or her person has been touched without his or her consent or other lawful justification could sue for trespass to the person. Unlike an action for negligence, an action for trespass is actionable without proof of harm being suffered. A doctor might decide that a person needed to have a blood transfusion and thereby save their life — if the transfusion was given without the consent of the mentally competent woman then she could sue for trespass to the person even if she would have died without the transfusion. The fact that the woman benefited from the treatment is not a valid defence for the doctor (Malette v Schumann, 1990).
Termination of pregnancy: Why are live births occurring?
Authors: Drazek Marian
Published: May 2014

Sue was a midwife with two years experience who had recently commenced in a new post and was working on labour ward as part of her induction programme. While on duty in the second week there she was asked to care for a woman (Gravida 2 Para1) undergoing a termination of pregnancy at 23 weeks gestation for a fetal abnormality. At her previous hospital, Sue had not experienced this as no late terminations were carried out there and referrals were always made to the nearest specialist centre.
A Canadian perspective on Jennifer Sleep's contribution
Authors: Kaufman Karyn
Published: May 2014

I remember the surprise and pleasure of discovering that the first author of the 1984 West Berkshire perineal management trial was a midwife. In 1984 it was a rare event for a midwife to do a large randomized controlled trial and have it published in British Medical Journal! The appearance of Jennifer Sleep's publication was a notable event. It was a special pleasure to me because midwifery was not recognized anywhere in Canada, yet interest was growing in having midwives become part of Canadian health care. Witnessing midwives in other countries publishing research aimed at improving the care given to women was very motivating to those of us working to establish midwifery.
Tell the truth and sack the lawyer
Authors: Robinson Jean
Published: May 2014

We ended up suing them because in the end we felt it was the only way we could make them take any notice. The mother who wrote that letter to AIMS has now been offered a substantial settlement. Does AIMS push people towards litigation? Not a bit of it.
Alternatives to litigation1: procedural change
Authors: Symon Andrew
Published: May 2014

Several possible alternatives to the current method of deciding medical negligence claims have ben suggested. Greater openness concerning access to clinical records has been achieved. Assisting defendants with financial arrangements has also been addressed in England and Scotland. Mediation offers a less adversarial approach, but remains to be fully evaluated.
Fetal pulse oximetry: a new standard of obstetrical care?
Authors: Swedlow David B , de Bord Denise L , Cunningham Christine
Published: May 2014

Pulse oximeters are in vivo non-invasive devices that provide accurate, continuous, and real-time measurement of arterial blood oxygen saturation. All oximeters take advantage of the fact that the major light absorbers in blood are oxyhaemoglobin (haemoglobin molecules carrying oxygen) and deoxyhaemoglobin (haemoglobin without oxygen). These two molecules absorb red and infrared light very differently. Oxyhaemoglobin weakly absorbs red light, and strongly absorbs infrared light; thus haemoglobin-carrying oxygen appears to be bright red and dark infrared. The opposite is true for deoxyhaemoglobin. By shining both red and infrared light into blood and measuring the relative absorption at each colour, one can accurately determine the fraction of haemoglobin that is carrying oxygen. This value is known as oxygen saturation.
Attacks on nursing and midwifery education
Authors: Chaffer Denise
Published: May 2014

The recent media attacks on nursing education have emerged in the face of the increasing nursing shortages. The suggestion being that nursing has become too academic and those who exit the current courses are either too bright to be caring or unable to undertake basic nursing skills.
Relief of heartburn and constipation during pregnancy
Authors: Jones Kathleen
Published: May 2014

Heartburn and constipation are typically listed among the minor disorders of pregnancy, however, for those women suffering from one or both of these conditions they can be both distressing and disabling. The midwife will be a vital source of information to the woman, both in terms of her understanding of the condition and her access to treatment. Heartburn is a common complaint, with an estimated two in three women suffering at some time during their pregnancy. Constipation also affects about one in five pregnant women and is more common in the last trimester and the postnatal period. This article will discuss the aetiology of these conditions and suggest effective treatments.
The less-loved child: the price of oxytocin
Authors: Robinson Jean
Published: May 2014

The bad fairy you didnt invite to the christening turns up anyway and says your beautiful daughter will prick her finger with a needle and disaster will follow. But even fairies keep up with the times. They no longer have to wait until the princess grows up and finds the spinning wheel in the turret tower. They dont even have to wait for the christening. They make sure mother is pricked before birth -- with an intravenous tube carrying a generous supply of oxytocin.
A new step in umbilical cord care management
Authors: Roberts Carolyn
Published: May 2014

The umbilicus is recognized as the first site of Staphylococcus aureus colonization and this generally occurs by 48 hours after birth. The sites of heaviest colonization are the umbilicus, nose, groin and perineum (Corner et al, 1960). As the umbilicus is the only ‘open’ area of the baby's body, care must be taken to prevent introducing infection. Colonization may be followed by infection of the cord, skin and eyes (Stark and Harrisson, 1992) and cross infection of other neonates and mothers might also occur (Forfar and MacCabe, 1958).
The demand of caesareans: fact or fiction?
Authors: Robinson Jean
Published: May 2014

Oh those poor obstetricians. You cant help feeling sorry for them. They are apparently being beseiged by pregnant women who are demanding caesarean sections simply because they prefer abdominal surgery to vaginal birth. It simply isnt fair to blame doctors for the high section rate. Women are supposed to be given a choice nowadays, so what is a poor, helpless obstetrician to do?
One woman's birth experiences in the Netherlands
Authors: Ireland Jillian
Published: May 2014

There has been frequent reference to midwifery in the Netherlands over the past few years both in the popular press (Appleton, 1987; NZPA, 1987) and in midwifery journals (Beck, 1991,Bakker et al, 1996). There have been articles written about the organization of maternity care (Van Teijlingen, 1992; Van Teijlingen and Bryar, 1996), the experiences of midwives and student midwives visiting from the UK (Ellis, 1996), and questions asked about the applicability of such a system to the UK (Oppenheimer, 1993; Mander, 1995). This article gives an overview of the roles of midwife, obstetric nurse and maternity home care assistant (‘kraamverzorgende’) and then relates three birth experiences from the point of view of the consumer. This mother has a special story to tell because she has experienced three types of maternity care during the birth of her three sons. Her first son was delivered by caesarean section in hospital attended by an obstetrician and an obstetric nurse; she delivered her second attended by a midwife in hospital and her third at home with the same midwife. The names of the individuals in this real account have been changed. All the details of the pregnancies and maternity care received are from the mother's account only.
A model for developing skills of reflection
Authors: Stuart Chit Chai
Published: May 2014

There are many models of reflection to guide midwives in developing the skills of reflection. The model proposed here utilises the four stages of Kolb's (1984) experiential learning cycle and relates the skills of reflection to each of these stages. The skills of reflection can then be inferred as abilities to 'engage' in an experience, processing that experience through critical analysis, developing ideas and concepts through synthesis and evaluation and implementing new strategies of care as a result of that learning. Central to the process of learning through reflection is the activity of journal keeping, both as a database and for self-understanding. Through this systematic process of reflection, instances of practice can be collected over time enabling the development of a database of practice knowledge. Midwives can then begin to understand the real reasons underlying and influencing their practice and begin to obtain answers to whether they are truly ‘with woman’.
Continuity of carer during pregnancy for diabetic women
Authors: Finlay Audrey , Heddle Maureen , Hundley Vanora , Mowat Lesley , Lang Gordon , Pearson Donald
Published: May 2014

The aim of this study was to identify the level of continuity of carer that women with type 1 diabetes received during pregnancy and the level of community midwifery involvement. The audit compares the maternity care of all women with type 1 diabetes having a singleton pregnancy during a 5-year period in Grampian with a matched comparison group. The findings suggest that the diabetic group received as good, if not better, continuity of carer and that the care was more hospital centred. Diabetic women had less involvement from their community midwife or GP. Evidence shows that local community care is important to women, helping to provide greater social support. Further exploration of women's views of specialised maternity care is required to determine whether women want the community midwife to be more involved in their care and if so how this can be achieved.
Changing the focus for the third stage of labour
Authors: Harris Tina
Published: May 2014

This paper suggests that midwives re-evaluate management strategies for the third stage of labour and reflect upon the widely-held belief that intervention at this time is an improvement on the normal physiological processes and is without risk. Midwives are challenged to embrace a normal rather than a risk focus in light of support from WHO, who suggest ‘definite conclusions about the value of active management of the third stage in healthy low-risk populations cannot yet be drawn’ (WHO, 1999). If midwives are to face this challenge they need to be proactive in normalising the third stage, developing expertise in expectant management and revisiting skills in detecting those women deviating from normal in whom an active third stage may be appropriate.
Will the consultant midwife change the balance of power?
Authors: O'Loughlin Christine
Published: May 2014

The role of consultant midwife has been introduced at a time of extensive change within the NHS. These changes could affect the complex balance of power within the professions of midwifery and obstetrics. The power positions of the two professions appear to be levelling, but at the same time midwifery has been made more hierarchical by the implementation of the post of consultant midwife. The role of the consultant midwife has the potential to impact on the relationships within the maternity services, e.g. between midwifery colleagues, obstetric colleagues, educationalists and managers. The implementation of the post could influence genuine equity between the professions as opposed to the current multiprofessional teams who work under an obstetric-led agenda.
Teams and the marginalization of midwifery knowledge
Authors: Shallow Helen
Published: May 2014

This paper is the third in a four-part series drawn from the findings of a masters degree dissertation which looked at midwives' experiences of becoming integrated within teams in a district general hospital in the north of England. This discussion will centre on midwifery knowledge and how it would appear that despite the rhetoric, midwifery knowledge continues to be marginalized. Regardless of the proposed moves towards more care in the community, the prevailing authoritative knowledge around birth remains confined to the techno-medical model, which confines midwives to a practice that is not the art and science of midwifery.
Competence and confidence: Working in a climate of fear
Authors: Shallow Helen
Published: May 2014

The concluding part of this four-part series examines midwives' views of their competence and confidence and surmises that for many, caring for women during birth in hospital settings engenders fear and anxiety and pressure to view all births as abnormal. The discussion will outline my interpretation of the study's findings taking into account the notion of expertise combined with recommendations for a way forward.
Rhesus negative women and the implications for pregnancy
Authors: Turner Alfred
Published: May 2014

As well as being categorized by the ABO system, human blood may be classed as either rhesus positive or rhesus negative. A rhesus negative woman may experience specific complications during pregnancy related to her blood type. The term ‘rhesus negative’ is generally used to describe the absence of rhesus D antigens in the blood (rather than the much rarer rhesus C or E antigens). Rhesus positive refers to blood where rhesus D antigens are present.
Breast-feeding in Norway: Where did they go right?
Authors: Gerard Abigail
Published: May 2014

It is well recognized that breast-feeding declined in most European countries during the 1960s. How some countries, such as Norway subsequently increased the breast-feeding rates is less known. This comparative paper between Scotland and Norway, analyses the historical, social and cultural factors that influence the prevalence of breast-feeding. It is argued that the choice of feeding method is based on the dominant cultural norms which exist in each society. In comparison to Scotland, there is a strong cultural norm to breast-feed in Norway. This is partly because of a more relaxed attitude towards the naked human body, a healthier lifestyle in general and that the practical barriers that deter women from breast-feeding have been removed. In addition, strategies to reverse the effects of commercial promotion of formula milk, and inconsistent advice by health professionals were implemented at an early stage of the declining trends.
All is not well with maternity services
Authors: Page Lesley
Published: May 2014

The late Audrey Wise MP was moved to call for an investigation of the maternity services when she became aware that 'all was not well' from the accounts of her own family and constituents. The report that resulted, known as the Winterton Report (House of Commons, 1992), and the Expert Maternity Committee report Changing Childbirth (Department of Health, 1993) that followed, made fundamental recommendations for change.
Hepatitis B and HIV antenatal screening 1: midwives survey
Authors: Bruce Maggie , Peacock Janet , Iversen Angela
Published: May 2014

The survey detailed in this article was undertaken to ascertain community midwives' knowledge of hepatitis B, HIV, and antenatal screening for these infections. Information on the process by which current antenatal tests were undertaken and the attitudes of midwives towards these tests was also collected. All community midwives employed by three trusts in one health authority were asked to take part (response rate = 89%). The survey found that the community midwives knew less about hepatitis B than HIV. Knowledge gaps and concerns about the programme were identified. Only 66% of midwives usually or always discussed current tests with pregnant women after the pregnant women had received written information (and had the opportunity to discuss the tests with their partners), and before booking bloods were taken. Only 22 (31%) of the community midwives had no reservations about current antenatal tests. The information gained was used to inform the planning process for local universal antenatal hepatitis B and HIV screening.
Guidelines for intrapartum midwifery-led care
Authors: Rogers Jane
Published: May 2014

This article describes the collaborative process which led to the production of guidelines for midwifery-led intrapartum care in Southampton. The guidelines were formulated specifically for women deemed to be at low risk of developing problems in childbirth. Although the principles of flexible, women-centred care and midwifery accountability receive explicit support in national strategies and initiatives, locally the project was set against the background of medical dominance. With the aim of promoting ownership, a collaborative and facilitative approach was taken, and users of the service were included. Over a period of almost a year, use of a structured method led to the formulation of 12 guidelines and standards. Debates involving users and professionals were held to negotiate agreement on contentious issues. Audit of individual guidelines (including views of service users) is currently being undertaken to assess the success of the innovation.
Professional indemnity and the midwife
Authors: Dimond Bridgit
Published: May 2014

This article looks at the requirement of the NMC that all registered professionals have a professional duty at all times, the need for insurance cover for activities not covered by vicarious liability and the NMC, and consultation on whether every registered practitioner should be required to take out professional indemnity cover.
One-to-one midwifery practice part 3: meaning for midwives
Authors: Stevens Trudy , McCourt Christine
Published: May 2014

This paper focuses on midwives’ experiences of working with a case load and what it meant to them, both professionally and as individuals. Four themes emerged that summed up the midwives’ experiences of working with a case load. These were role and time, holistic practice, relationships with women, and ‘orientation’ in relation to their sense of autonomy and responsibility. Midwives found case load practice rewarding in terms of control of their time, in their relationships with the women they looked after, and the personal and professional development they achieved. As a result, they felt like ‘real midwives’ in a way they had not done before.
A bereavement counselling service for parents: part 1
Authors: Herkes Barbara
Published: May 2014

As infant mortality rates fall and life expectancy increases, parents who experience pregnancy loss, stillbirth or neonatal death may have little or no experience in the rituals that involve death or mourning. As traditional support systems available for bereaved parents diminish, parents may now look towards health-care professionals for guidance and emotional support following the death of their baby. The grief process following miscarriage, stillbirth and neonatal death involves prospective rather than retrospective grieving. It also involves the difficulty of recognising a life and often simultaneously mourning a death. Parental grief is often secret and unrecognised by both relatives and health-care professionals. It is also often prolonged and may pass unrecognised for a lifetime. Not all bereaved parents will need or accept professional counselling. However, bereaved parents should be given the choice whether or not to take up the offer of counselling.
The stormy seas of change
Authors: Page Lesley
Published: May 2014

I have returned back home again after a year in Canada, and am about to start a new position, with the opportunity and challenge that creates. I have been trying to work out how midwifery in the UK has changed, and where we are now. The classic work of the change process is to decide where you want to be, how you want to get there, and how you will do it. Life tends to be so complicated, and change so fast, that in order to use these principles I find it helps to simplify changing policy, ideas and evidence.
Scapegoats
Authors: Robinson Jean
Published: May 2014

I reckon you could write a history of obstetrics and maternity care simply by looking at the dominant themes in the AIMS complaints files for the last 40years. In the 1960s it was all keeping infants away from the nasty germs their parents harboured: babies were whisked away from mothers at birth and kept in the nursery every night, and husbands were allowed in only for a precious hour at strict visiting times. In the 1970s it was the agony of oxytocin inductions. From the 1980s onwards it was perineal problems from episiotomies and ruined sex lives. In the 1990s there was the rise of painful prostaglandins pessaries and ruptured uteri.
Breastfeeding and fertility regulation
Authors: Too Sooi-Ken
Published: May 2014

Breastfeeding plays an important part in the human reproductive process as it lengthens the duration of lactational infertility. This paper focuses on the criteria and effectiveness of the lactational amenorrhoea method as a postpartum contraceptive method.
Problems with the placenta
Authors: Robinson Jean
Published: May 2014

If the phone rings while I’m stirring the gravy my husband wouldn’t dream of answering it. Ever since a woman launched into a detailed account of her labour and ended with a request for a recipe to cook her placenta (assuming because the poor man is married to me he would know all the answers), he avoids the telephone. It’s a pity the children weren’t home — they would have happily discussed seasoning and a few herbs with the caller. Actually, I didn’t have a recipe either, and had to consult Sheila Kitzinger, who came up trumps. Paté, anyone?
Folic acid and public health
Authors: Anderson Andrea
Published: May 2014

Folic acid is a vitamin that is known to reduce the incidence of neural tube defects (NTDs), if taken preconceptionally. Folic acid has been part of a public health campaign since 1992, but despite this, the incidence of NTDs has not decreased. The article explores three health education models that health professionals can use to achieve compliance when focusing on preconception and antenatal care: the medical model, the behaviour change model and the political radical societal change model. Health education models require that any health-care professionals involved in promoting healthy living and lifestyle should have an understanding of the inequalities in health that exist in communities.
Consent and the case of Miss B
Authors: Dimond Bridgit
Published: May 2014

This paper considers the case where Miss B applied to court for a declaration that a ventilator on which she was dependent could be switched off, and the application of the principles set down by the court on consent to treatment to midwifery practice.
Ventouse for operative vaginal delivery
Authors: Price Sally
Published: May 2014

This article explores the use of ventouse for operative vaginal delivery, including the evidence base and the role of the midwife. It also describes two hand-operated vacuum delivery systems, produced by Menox™ and Kiwi™.
The inverse care law in antenatal midwifery care
Authors: Kirkham Mavis , Stapleton Helen , Curtis Penny , Thomas Gwenan
Published: May 2014

The material in this series of papers is derived from a Department of Health funded evaluation of the MIDIRS Informed Choice leaflets (Kirkham and Stapleton, 2001). The ‘inverse care law’ was first described over 30 years ago (Hart, 1971) and this paper reveals how little has changed in respect to the pregnancy and related health needs of the poorest and most marginalised women. Inequalities in the delivery of maternity care are examined and examples of midwifery practices which support, rather than challenge, service-related inequity are described. The assumed correlation, made by many midwives in this study, between a woman's social class and her knowledge base was not supported by data from the randomised, controlled trial. The stereotyped assumptions midwives made, however, had a direct and negative impact on the care of materially deprived women. The pressures upon midwives' time and the organisational constraints on their practice hindered the development of trusting relationships with those women most in need of strong midwifery support.
The thinking practitioner
Authors: Gould Debby
Published: May 2014

As we welcome the New Year it is traditional in our culture to consider the future and make resolutions for lifestyle improvements, or simply to outwardly affirm inner aspirations. That started me thinking. What is thinking?
Counselling in perinatal loss
Authors: Redman Carolyn
Published: May 2014

Clinical investigations and quantitative research have contributed much to our understanding of perinatal loss over the past 20 years. The provision of a caring empathic environment to enable the family to cope with the reality of the situation is now part of standard nursing and social support in most countries of the developing world. A strategy for supporting parents through end-of-life decisions should include a continuum of bereavement support. Experience suggests that counselling could help parents prepare to say goodbye to their baby. It is acknowledged that parents need help at this distressing time, but research suggests that there is little guidance available to staff on how to cope with these events. A recognized training programme enables the midwife to move from using basic communication skills to using counselling skills that allow further exploration of the issues.
Correspondence
Authors: Ethiopia Su Axten
Published: May 2014

The woman was a para 3, no history to suggest the need for extravigilance. A medical student was caring for her and when he said that I might see a delivery today, I was both expectant and apprehensive.
The Health Protection Agency
Authors: Dimond Bridgit
Published: May 2014

Many must have wondered how the UK would have coped had the SARS virus hit the country. The answer would have been completely in the hands of the Health Protection Agency (HPA). This organization was created on 1 April 2003 to provide a coordinated approach to health protection and reduce the impact of infectious diseases, poisons, chemicals, biological and radiation hazards. It was set up in light of the report Getting Ahead of the Curve, which recognised the need to bring together in one organization the skills and expertise in a number of organizations to work in a more coordinated way, to reduce the burden and consequences of health protection threats or disease, with the aim of providing a more comprehensive and effective response to threats to public health. The HPA brings together the:
Home birth, staffing and acute service
Authors: Walsh Denis
Published: May 2014

The recent sacking of a community midwife for attending a home birth against Trust policy raises important issues. Most of the debate has been around the conflict of interest that ensues between thestatutory requirement to attend a birth if the midwife is called, and employee compliance with the employer's policies. The Trust has probably regretted formalising such a policy as this withdrawal of home birth provision denies women the homebirth choice. It cuts across all rhetoric we have heard and endorsed at least since Changing Childbirth about the centrality of choice in maternity care provision. It places the midwife in an impossible position. In addition, I seem to remember that advocacy on behalf of clients is also a professional responsibility. I do not recall the former UKCC, or the NMC since, producing guidance to clarify such dilemmas.
Teenage pregnancy: medical encounters
Authors: Bailey Nicola , Brown Geraldine , Letherby Gayle , Wilson Corinne , Di Marco Heather
Published: May 2014

This article draws on completed qualitative research with pregnant teenagers, young mothers and the professionals (including midwives and health visitors) who support them. The aim of the project was to consider health and wellbeing in pregnancy, birth and postnatally for women who become pregnant under the age of twenty years. The research was commissioned and funded by Coventry and Walsall Primary Care Trusts. Here we draw on a selection of our data and following a brief discussion of relevant background material and our method we consider experience of antenatal and parentcraft classes, birth experience and experience on the maternity ward. We conclude by suggesting that young women in this situation do have specific needs and are subject to specific risks. Overwhelmingly our data suggests that the greatest risk to young pregnant women or mothers is their lack of access to appropriate services. By access we mean not only the physical presence of young women but their unproductive encounters within these services when they are accessed.
Managing pre-eclampsia 2: charting patient records
Authors: Jankowicz Dawn , Tufnell Derek
Published: May 2014

The audit of the regional guidelines for pre-eclampsia by the Yorkshire Obstetric Critical Care Group (YOCCG) regional link midwifery network in Yorkshire highlighted the need for a better mechanism for recording care in these high risk cases. Midwives have undertaken the development and implementation of the chart as they are the main recorders of care in these cases and are well placed to guide other members of the multidisciplinary team in the use of the new chart. The new chart was developed in consultation with all the units it has been introduced to. The initial response has been extremely favourable with all clinicians appreciating the one stop documentation tool for these cases and the lack of duplication required. The most important gain has been the freeing up of time to spend with the woman and her family during this period of time whilst the condition is so acute.
Improving consultation with disadvantaged service users
Authors: Lockey Rachael , Hart Angie
Published: May 2014

This article looks at two major policy drives: (1) consulting and involving service users in health care research, planning and provision and (2) addressing inequalities in health, in relation to the actual practice of consulting 'disadvantaged' service users in research. Drawing on the findings of a research project previously undertaken by the authors we look at the researchers’ experience of consulting 'disadvantaged' service users. Whilst 'disadvantaged' service users may be the most hard to involve, because of practical and or social barriers as well as the extra time and expertise needed by researchers, these services users must be involved in order to inform research, policy and service delivery.
Guidelines, procedures, protocols and the law
Authors: Dimond Bridgit
Published: May 2014

The legal significance of NICE guidelines, procedures, protocolsand other guidance produced by NHS Trusts, professional associations and other organizations is explored.
Multidisciplinary forums: not all voices are equal
Authors: Walsh Denis
Published: May 2014

Recently, I was asked to be a keynote speaker at a multidisciplinary forum examining different models of maternity care.
A welcome to Wales/Creoso i Cymru
Authors: Magill-Cuerden Julia
Published: May 2014

I have received excellent hospitality in Wales and remember my first visit to Cardiff in the sunshine of a hot summer day.
Changing Childbirth and beyond
Authors: Dimond Bridgit
Published: May 2014

Changing Childbirth identified three key principles that should underlie effective woman-centred maternity services: the woman must be the focus of maternity care; maternity services readily and easily accessible to all; effective and efficient services.
Immunization special: changes to the childhood immunisation programme
Authors: Moreton Judith
Published: May 2014

The recent changes to the routine childhood immunization programme in England, announced by the Department of Health on 9th August 2004, have been reported widely – but not always accurately – by the national media, causing confusion for many parents and parents-to-be.
Choice: fact or fiction?
Authors: Robinson Jean
Published: May 2014

Gloomy evenings and nothing but rubbish on the telly. Him indoors is glued to the rugby, of course – what else would any decent Yorkshireman be doing – but there's a limit to the time I can spend admiring all those chunky, mud-spattered male legs. Reader, I married him, and one ex rugby-player should be quite enough for any woman. Nowadays if I want something else meaty, solid and satisfying I like a good book. – and they don’t come any better than my latest treat. What's more I settled down with a packet of chocolate Brazil nuts from the local Oxfam shop on the side (try them, they’re terrific – not too sweet, and really high quality dark chocolate).
Book Review
Authors: McCourt Chris
Published: May 2014

Dangerous Motherhood – Insanity and childbirth in Victorian Britain is a scholarly and thorough book, which is also a pleasure to read. The author effectively explores a range of historical sources – including asylum casenotes, diaries, letters and medical texts – in order to build a complex and engaging picture of how Victorian society viewed motherhood and mental health.
Breastfeeding awareness message is getting through
Authors: Blincoe Alana Juman
Published: May 2014

We are all familiar with the encouraging slogans borne out of National Breastfeeding Awareness Week (NBAW) since it began in 1993 – ‘Give it a go’, ‘Give your baby the best’. Even the culture of text messaging has been used in ad campaigns to entice young mothers – particularly teens – to breastfeed. But the fact remains that the UK has one of the lowest rates of breastfeeding in Europe. Almost a third of women in England and Wales never try to breastfeed compared to 2% in Sweden. (Department of Health (DH), 2004). It is hardly surprising given the history of hospital practices and social attitudes. NBAW has been trying to change negative, even hostile attitudes towards an activity which has been, and to some extent still is, viewed by the public (including mothers) as embarrassing, confining and likely to be painful and problematic.
Do we need new legislation to cover embryology?
Authors: Dimond Bridgit
Published: May 2014

Inevitably, science moves faster than the law, and there is always a catching up process by the latter. Nowhere is this phenomenon seen more clearly than in the scientific developments and the law relating to fertilization and embryology.
EOC discrimination in pregnancy report
Authors: Dimond Bridgit
Published: May 2014

The Equal Opportunity Commission (EOC, 2005) has been conducting an investigation into pregnancy discrimination in the workplace. Findings from its latest report (EOC, 2005) and its interim report (EOC, 2004) are disquieting and disappointing.
The impact of pregnancy on peak flow values in women with asthma
Authors: Anderson Beckmann Claudia
Published: May 2014

Asthma is the most common respiratory complication of pregnancy and affects approximately four per cent of all pregnant women. The purpose of this study was to establish normative data regarding how peak flow values change during gestation in pregnant women with asthma. Eighteen pregnant women with asthma were recruited and completed daily logs throughout their pregnancies. The findings suggest there is a difference in peak flow values in different trimesters. Specifically peak flow values were highest in the second trimester with significant differences between the second and third trimesters. While the sample size is small it does provide longitudinal data that suggest changes in asthma as the pregnancy progresses. This study represents a logical next step in identifying the impact of pregnancy on asthma.
Early parenthood among young people of minority ethnic origin in England
Authors: Higginbottom Gina , Owen JM , Mathers N , Marsh P , Kirkham M
Published: May 2014

In 1999, a framework for government policy on teenage pregnancy was created with a major report from the Social Exclusion Unit. Young mothers from minority ethnic backgrounds were considered to be at particular risk of exclusion, although there was little detailed research on their experiences. Findings on social support for young parents in general are emerging but remain limited; published work which directly addresses young minority parents’ experiences, and views is very scarce. This paper describes a qualitative study to explore the teenage parenting experiences of ethnic minority young parents in England. The views of service providers and grandmothers were also elicited. Data were collected using focus groups interviews, in-depth semi-structured interviews and a telephone survey. The National Centre for Social Research ‘Framework’ approach for analysis was used.
The myth of safety in hospital births
Authors: Cohain Judy
Published: May 2014

Volume 14(2) of BJM published the myth that the rise in the up to 1-year-old infant mortality rate in war torn Iraq, found by a “survey carried out by the UN Development Program”, is shockingly high “because women can't reach hospital” to have their babies. The article continues that “maternal mortality rates are high” and “one reason suggested is that mothers are unable to reach hospitals at night.”
Measuring up to the challenges of fetal blood sampling
Authors: Roberts Philippa
Published: May 2014

A high proportion of litigation claims against the NHS arise from decisions taken in obstetrics. Fetal blood sampling (FBS) is undertaken to establish fetal pH levels in cases where delivery by caesarean is contemplated because of an abnormal fetal heart-rate pattern and other indications of distress. Rapid falls in pH can be indicative of distress accompanied by a high risk of hypoxia. Accuracy in both sampling and analytical procedures is crucial, since the diagnostic outcome of FBS can provide the basis for decisions taken during the course of labour and may subsequently provide the necessary legal evidence that those decisions were correct.
Ethiopia and Egypt are identified as the worst perpetrators of FGM
Authors: Daniel Lincia
Published: May 2014

Lincia Daniel takes a look at the news on midwifery, reproductive and child health worldwide and offers an overview of initiatives to address current issues across the globe.
FGM: Custom and tradition or an abuse of human rights?
Authors: Hughes Breedagh
Published: May 2014

The World Health Organisation is of the view that, “Female genital mutilation is a deeply rooted, traditional practice. However it is a form of violence against women that has serious physical and psychological consequences which adversely affect health” (WHO, 1999). The feminist writer, Germaine Greer, quoted by the House of Commons All Party Parliamentary Group on Population, Development and Reproductive Health, (THS, 2002), provided a somewhat different perspective however, when she compared female genital mutilation (FGM) to cosmetic surgery carried out on American women and questioned our right to sit in judgement on other cultures.
Women in their sixties are too old to become mothers
Authors: Bedwell Carol , Lavender Tina
Published: May 2014

Birth after the menopause has happened only infrequently to date, but with women leaving it later and later to start families it is likely to gain in popularity. The ‘have it all’ generation will no doubt expect this ability to have children at whatever age to be their right, but it would be a mistake for women to believe that they can manage their fertility in this manner. Some argue that as men can have children into their 70s why can't women? However, it is nature and not our views of equality that determine this differential. Women's bodies are designed to have children between ages when they are at their most fit and able to cope physically. Fertility declines and the menopause happens for a reason and women should accept that they cannot control nature. Women having children naturally in their 40s are at risk of increased health problems such as diabetes and high blood pressure and these risks must increase further for older women, many of whom may have already developed such conditions.
The challenge of interdisciplinary collaboration: midwifery needs a model
Authors: Walsh Denis
Published: May 2014

I find it challenging to be involved in interdisciplinary collaboration between obstetrics and midwifery because of too many past experiences of dysfunctional dynamics. However, I acknowledge that there is evidence that poor models of collaboration contribute to poor clinical outcomes. Confidential maternal and perinatal reports have constantly highlighted inadequacies over the years and intrapartum transfers from out-of-hospital settings to consultant units have been similarly affected (Davis-Floyd, 2001).