bluuebunny/crossref_metadata_2025 huggingface dataset:
Protecting neonatal skin: cream or water?
Authors: Juman Blincoe Alana
Published: May 2014

The fact that there are no national guidelines regarding the routine skin care of newborns, both term and preterm, can prove difficult for the health carer, and calls for there to be more rigorous, research based studies in this area. But there are many tried and tested methods that have developed protocols aimed at keeping an infant's skin as healthy as possible. Not only does it require a good skin care routine but the products used on an infant's skin need to be assessed also. One of the major areas of concern for an infant's skin health is nappy rash. There are many choices of nappy available on the market today, and there have been many research studies into the most appropriate product to use, to ensure an infant's skin is kept as dry as possible. Although there is evidence that disposable nappies fare better than cloth ones, there is no hard evidence that cellulose core based nappies are better than cellulose core with absorbent gelling material nappies.
Bladder filling: an effective technique for managing cord prolapse
Authors: Houghton Gillian
Published: May 2014

Bladder filling was first proposed as a method of managing cord prolapse in the first stage of labour by Vago in 1970. A 16G Foley catheter and standard giving set are used to rapidly fill the bladder with saline so that the bladder is distended above the pubis, 500mls usually being enough.
Management and morale: Challenges in contemporary maternity care
Authors: Curtis Penny , Ball Lynda , Kirkham Mavis
Published: May 2014

This paper, the second in a series of six, brings together the findings from the Why do Midwives Leave? study and a subsequent study, Why do midwives leave: talking to managers (TTM). The TTM study was commissioned to explore managers’ perceptions of issues affecting satisfaction with practise and their perspectives on recruitment and retention. Many managers were concerned that they had limited power to effect real change in the practise environment. There was an overwhelming consensus among managers that staff shortages and inappropriate midwifery establishments underlay many of the problems that they faced. Although often committed, personally and professionally to the ideal of woman centred care, staff constraints limited the viability of this as they struggled to ensure a safe level of staffing on wards on a day to day basis.
Consortium aims to raise standard of health care in Malawi
Authors: Daniel Lincia
Published: May 2014

Lincia Daniel takes a look at the news on midwifery worldwide and offers an overview of initiatives to draw attention to current issues and promote maternal and infant health across the globe.
Shadow work in midwifery: Unseen and unrecognised emotional labour
Authors: John Veronica , Parsons Evelyn
Published: May 2014

Ethnographic observation and in depth interviews were used to explore the interactions between ten women and their midwives on a delivery suite in a low risk obstetric unit in Wales. There was evidence that for midwives a dichotomy of emotions existed, some of which were ‘natural’ and others ‘professional’, as biological feelings were controlled using emotion management techniques. This shadow labour forms part of the unseen work undertaken by midwives. Although mothers valued the feelings of safety provided because midwives maintained a normal environment, they often failed to recognise it as work. This unseen component in the work of midwives, together with inadequate support mechanisms, could go some way to explaining recent retention and recruitment problems within the profession.
Engaging with the concept of unique normality in childbirth
Authors: Downe Sue
Published: May 2014

Modern midwifery in most countries of the world claims to offer expertise in, and guardianship of, ‘normal’ childbirth. While there has been international concern about the rising rates of caesarean section, rates of reported spontaneous vaginal birth do not seem to have fallen proportionally. However, closer examination of intrapartum practices indicates that many women experiencing so-called ‘normal’ birth in centralised hospital settings in fact experience a wide range of technical or pharmacological interventions. This raises questions about the nature of normal childbirth. This paper examines three different concepts of normal birth, and proposes a way of seeing birth that engages with the concept of ‘unique normality’.
What a difference a pool makes: Making choice a reality
Authors: Baxter Liz
Published: May 2014

In recent years it became increasingly apparent that women accessing services at Corbar Birth Centre in the High Peak wanted the choice of using water for labour and birth. The Birth Centre responded by undertaking a large project, which resulted in practice development and the introduction of a permanent birthing pool. Clinical audit was implemented to evaluate the new service and assess the perceived risks and benefits of immersion in water during labour and birth on specific outcomes. This article describes how the project evolved and aims to share the findings from the March 2001 to April 2004 audits comparing ‘pool users’ with ‘pool births’ and reflects on the experience of the midwives.
Female genital mutilation: A growing challenge for midwives in the UK
Authors: Bikoo Maligaye , Davies Melissa , Richens Yana , Creighton Sarah
Published: May 2014

Women with a past history of FGM are increasingly presenting to obstetric units in the UK for care and delivery. The aim of the study described in this paper was to determine the need for antenatal defibulation and subsequent obstetric outcome of women with a history of FGM presenting to a London obstetric unit. A prospective cohort study was carried out of all pregnant women with a history of FGM referred for antenatal assessment. Twenty-six women completed the study. All had undergone FGM and 67% required defibulation prior to delivery; 79% of women sustained either an episiotomy or tear. A significant number of women (38%) declined antenatal defibulation, preferring to wait until the onset of labour. This has implications for midwives and obstetricians who are not at present trained in the management of women with previous FGM presenting in labour. Although caesarean section and instrumental delivery rates were comparable to the hospital averages, all women – whether defibulated or not – had extremely high levels of perineal trauma. Further work is necessary to identify ways to minimize this.
Postnatal care: Is it based on ritual or a purpose? A reflective account
Authors: Wray Julie
Published: May 2014

Postnatal care has for too long been the Cinderella of the childbirth continuum and marginalized within maternity care services. Most women in the UK are hospitalized after giving birth and spend time on a postnatal ward. Women tend to view this aspect of their childbirth journey as the least satisfying, and in-depth analysis as to the reasons for this perspective is limited. This article presents a thought-provoking debate on postnatal hospital care and is underpinned by data that have emerged from observing postnatal wards as part of a larger research study. Two main points are pursued: reflections on carrying out ‘fieldwork’ and the notion that postnatal care is becoming deficient in purpose. Questions are raised as to the intention of hospitalization after birth, given the culture and context of a busy ward. Many factors impinge upon the woman's experience of the postnatal ward: the availability of midwives, the status/value of postnatal work and having enough time to spend with women on a busy ward. However, the essence of midwifery and intention of postnatal care must not be lost. Evidence to support postnatal care by midwives needs to be visible.
WHO Health Promoting Hospitals: maternity services in Scotland
Authors: Barnett Carol
Published: May 2014

In 2004 Tayside Acute Hospitals in Scotland joined the World Health Organization (WHO), Health Promoting Hospital (HPH) initiative and the maternity service in Tayside was designated a ‘hub’ unit (Health Scotland, 2005). Health promotion is an integral part of the maternity service and is incorporated into the routine delivery of care to pregnant women, but the delivery of this care can depend on the knowledge and skills of the midwife. To measure the health promoting activity of the maternity service the WHO five standards for HPH self-assessment audit tool was used. The experience of using this audit tool and the advantages of participating in the Health Promoting Hospital networks will be discussed.
Physiological third stage of labour: support it or lose it
Authors: Fry Jane
Published: May 2014

The third stage of labour marks the final stage of the transition from woman to mother. For most women or parents this is a particularly precious moment as they meet their baby for the first time. Yet the medical paradigm views this final juncture as the most dangerous stage of labour. While there may be an essence of truth in this approach, in the Western world it could be considered as a historical legacy from childbirth dating back to the 19th century when postpartum haemorrhage was a devastating cause of maternal mortality and morbidity. Medicalization of childbirth was seen to be an attractive innovation without risk at this time. It is questioned whether this legacy has relevance in contemporary maternity care where women's improved nutrition and social conditions have reduced morbidity and mortality from postpartum haemorrhage. This article discusses the current evidence on physiological verses active management of the third stage of labour. However it focuses primarily on how to support women during a physiological third stage of labour and proposes a study designed to further explore the essence of this support.
Ontological perspectives of breastfeeding
Authors: Spencer Rachael
Published: May 2014

Globally, breastfeeding initiation and duration has fallen over the past century. Research confirms that exclusive breastfeeding for six months, as espoused by the World Health Organization is rare in both industrialized and developing countries. Furthermore, breastfeeding rates in the UK and Ireland are among the lowest in Western Europe and indeed worldwide despite breastfeeding being acknowledged internationally as the best food for babies. This article briefly reviews some of the ontological perspectives of breastfeeding and argues that breastfeeding is an embodied human experience, which needs to be researched as such in order to deepen understanding of women's breastfeeding decisions.
Effects of Ramadan fasting on pregnancy
Authors: Cross-Sudworth Fiona
Published: May 2014

Pregnant women fasting in Ramadan is sometimes an emotive and controversial subject for Muslims. It would appear that most health care professionals advise against fasting during pregnancy. There is research on the subject however much is not new, some appears to be methodologically flawed and much appears to be restricted to the issue of the effect of fasting on birth weight. There are large gaps in knowledge and more current research is needed. However in the light of available research, Ramadan fasting has no long term effects on normal healthy mothers or their full term offspring.
Managing shoulder dystocia: ‘on your back’ or ‘all fours’?
Authors: Walsh Denis
Published: May 2014

I was encouraged to read in the International Journal of Gynaecology and Obstetrics recently a short report on the most intuitive and physiological approach to shoulder dystocia—adoption of the ‘all fours’ position (Kovavisarach, 2006). It is encouraging because the regular appearance in traditional obstetric journals of papers on more physiological birth practices will slowly correct the bias to medically-led labour practices.
Racism and discrimination in maternity services
Authors: Cross-Sudworth Fiona
Published: May 2014

In spite of a legal and professional framework designed to stamp out racism, racism is still an ongoing challenge to the NHS. It can be in services not offered, services badly given or in services provided that are inappropriate for the client group. Midwives and their managers need to actively and openly tackle racism if they see racism or practices that discriminate, whether that is to the client group or within the workforce. Midwives need to be better educated in cultural practices and religion. It is important however to also examine personal attitudes and possible prejudices and tackle these. To stop racism a real ‘heart and minds’ campaign is required, not just lip service and a policing of words.
Helping women: the use of Heron's framework in midwifery practice
Authors: Tennant Julie A , Butler Margaret S
Published: May 2014

Communication and relationships are central to contemporary agendas such as ‘partnerships’ and have been aligned to the defining features of a ‘good’ midwife. This article discusses the use of Heron’s (2001) Six Category Intervention Analysis as a framework for the midwife to use in a helping relationship with women. The framework is described and examples of its use in midwifery practice are outlined and current research is explored. Emerging issues such as the context of practice, emotional competence and self-awareness are debated in relation to the use of interventions in practice. Implications for practice consider the need for support for midwives and students to develop both the necessary skills and to reflect upon ‘self’. The need for research within a midwifery context is proposed.
Symphysis pubis dysfunction: women's experiences of care
Authors: Wellock Vanda K , A Crichton Margaret
Published: May 2014

This paper explores the interaction between health care professionals and pregnant and newly delivered women, who have symphysis pubis dysfunction (SPD). The aim of this research was to identify women's experiences of the care offered by health care professionals when they were diagnosed with SPD. Recent media coverage has suggested it is poor.

A qualitative, phenomenological approach using semi-structured interviews was used so that women's experiences with health care professionals could be told.

The study was carried out in a large maternity hospital in the north-west of England. Twenty-eight women were interviewed at diagnosis of condition, 36 weeks gestation and 6 weeks postpartum.

Three themes and four sub-themes were identified in the study relating to women's interactions with their carers. Midwives, doctors and physiotherapists were the main carers highlighted. There were positive and negative comments in all cases. The sub-themes of pain, negative labelling, dismissive staff and feelings of dissatisfaction were expressed by most women.

Women with SPD found that pain and the inability to perform the normal activities of daily living had a profound effect on them. Some women found that professionals lacked knowledge about how to manage their condition.
Habitual patterns of physical activity during pregnancy and postnatally
Authors: Derbyshire E , Davies GJ , Costarelli V , Dettmar PW
Published: May 2014

Few British studies appear to follow expectant mothers through the gestative period and study patterns of activity during all three trimesters of pregnancy and after birth. This study set out to investigate patterns of physical activity throughout pregnancy and after birth in women living in London. Using the International Physical Activity Questionnaire, physical activity levels were assessed at weeks 13, 25, 35 of pregnancy and 6 weeks postpartum. Ninety-four primiparous pregnant women were recruited at the study start and 70, 58, 59 and 54 completed the first, second, third trimester and postpartum study stages respectively. Women undertook most vigorous activity in the first trimester of pregnancy (29.8mins per day). Up to 5 kcal per kg per day of energy was expended through participation in home activities after birth. This study demonstrates that domains of activity change as pregnancy progresses and that household activity plays a key role in contributing to energy expenditure, particularly after birth.
Why are student midwives afraid to question practice?
Authors: Henderson Ruth
Published: May 2014

As student midwives we are encouraged by our lecturers to maximize our learning in the clinical environment by asking questions and discussing practice issues with our mentors. We also learn that it is vital to question our own actions through the reflective process, if we are to develop and improve our practice to provide evidence-based, woman-centred care. Despite my strong belief in these principles I was dismayed to acknowledge, through reflecting on an experience from practice, that I do not question poor practice but remain passive. Through discussion with my peers I understand that I am not alone in being reluctant to question practice; this has led me to consider why this is so and the effect of the employment crisis on the behaviour of students and the future of midwifery.
Student caseloading: embedding the concept within education
Authors: Rawnson Stella , Fry Jane , Lewis Paul
Published: May 2014

This final article in a series of three papers examines how the initiative of student midwife caseloading at Bournemouth University (BU) forms a central strand of our undergraduate pre-registration midwifery curriculum. It offers a model for other midwifery education providers to consider and possibly replicate. Following the initial success of our student caseloading scheme, steps were taken to embed it at the strategic and operational levels within our wider educational provision. It now forms an essential and integral part of the theoretical and practice elements of the pre-registration midwifery programme, underpinning the philosophy of approach, facilitation of learning and assessment of competence throughout the curriculum. This strand has been an evolutionary process that has developed from a purely practice-based initiative to a comprehensive educational component throughout all three years of midwifery education. Its development can be traced from the beginning of student caseloading in 1997 to BU's current and contemporary educational provision.
Health inequalities: opportunity for interprofessional learning
Authors: Williams Jacqui , Thorpe Lucy
Published: May 2014

Second-year student midwives attended a two-day interprofessional learning set based in a deprived area of an inner city. Through a case study model they considered how well the interprofessional team was meeting the clients' needs. The groups of students offered solutions to these complex cases. Through immersion within the locality and involving service users students were better able to appreciate the challenges of addressing inequalities of health.
Student midwives' views of self-assessment
Authors: Wilkins Carol , Leamon Jen , Rawnson Stella , Brown Sarah
Published: May 2014

Student self-assessment is a valuable skill which can enhance effective learning and facilitate continuing professional development. This article reports on a qualitative exploration of self-assessment, which formed part of a larger action research project into a pre-registration midwifery programme. Analysis of the data identified four key themes: understanding; preparation; value; and ability. Underpinning these themes was the students' desire for greater clarity of understanding of the self-assessment process, together with a desire for more preparation for the process through the provision of a supportive tutorial framework. This should include opportunities to discuss, develop and practice assessment criteria and receive relevant feedback on self-evaluations. The findings provide a rationale for recommending the development of a structured approach and identified pathway following the progress of self-assessment skills in all units, aimed at facilitating a more comprehensive engagement with the self-assessment process by both students and tutors and enhancing understanding of its value to future learning.
How authoritative texts reinforce the medical model of birth
Authors: Murray Davis Beth
Published: May 2014

This study describes the experiences of midwifery clients in Ontario, Canada during the process of consultation or referral with another health professional. Thematic analysis of semi-structured interviews and document analysis highlighted the role of language and texts in shaping women's childbirth experiences. Examples of how language from two differing models of care impacted women's experiences of childbirth are examined.
A support programme for mothers with perinatal loss in South Africa
Authors: Modiba Lebitsi
Published: May 2014

Although the general topic of death is receiving increasing attention from the medical community, little is known about the impact that pregnancy loss has on the lives experiencing it. The purpose of this study is to develop a support programme for mothers with pregnancy loss. This research is a qualitative research design that is exploratory, descriptive and contextual in nature. The support programme was formulated from the information gathered from phases I; II; and III. The support programme was validated and recommendations were made by experts. Phase I phenomenological interviews were conducted with ten mothers on how they experienced pregnancy loss and care. Phase II the focused semi-structured individual interviews were conducted with seven medical doctors and ten midwives on their experience. Phase I and II were not in this study but phase I was published in Health SA research journal: June 2007. Phase II submitted for accreditation in the same journal.
Student midwife caseloading - a new approach to midwifery education
Authors: Lewis Paul , Fry Jane , Rawnson Stella
Published: May 2014

Student midwife caseloading was pioneered by Bournemouth University (BU) in 1996. Following a successful pilot study and further refinements of the process, it was introduced as a core element of our undergraduate pre-registration midwifery programmes in 1999. This is the first of a series of three articles in which the ideas, initiative and success of establishing this groundbreaking project are considered. The founding of the concept, the process and practicalities of setting up the scheme and the lessons learnt are documented and discussed in this primary article. The importance of effective planning, positive collaboration and effective communication have underpinned and facilitated this seminal change from traditional student placements. The second and third articles will explore how student caseloading works in practice and is sustained to form a fundamental educational strand throughout the BU pre-registration midwifery curriculum; enhancing accountability and autonomy of our students and future practitioners of midwifery.
Student caseloading: preparing and supporting students
Authors: Fry Jane , Rawnson Stella , Lewis Paul
Published: May 2014

In this second of a series of three papers that describe and explore student caseloading at Bournemouth University (BU), we consider the practicalities of the scheme and the organization and management of student caseloading in practice. The theoretical and practice preparation are defined and the process of communication, maintaining links and tri-partite collaboration between key parties are made explicit. A supportive framework underpins the founding principles of developing knowledge, competence in practice, clinical supervision and professional accountability. Students learn what it means to carry a caseload, and are confronted with the practicalities, responsibility and realities of continuity of carer alongside their other personal and academic commitments. This innovative approach has produced student midwives who are grounded in the principles of women-centred care, whose relationships with women are enhanced and who are better able to meet and address the pressures of practice. The third and final article will discuss how this educational strategy has become embedded as a key strand within Bournemouth University's pre-registration midwifery undergraduate curriculum.
Birth planning for midwives and mothers
Authors: Hollins Martin Caroline J
Published: May 2014

If women are to be empowered to make choices for childbirth, it is important that midwives explore and discuss their wishes and feelings about the delivery options available. Providing practical and sensible information should facilitate women with constructing a more accurate picture from which realistic hopes, fears and expectations can be formulated about impending labour. To facilitate midwives with this process, a flexible framework for a birth plan has been proposed. This easy to complete template can be used to assist childbearing women with assimilating their ambitions and desires regarding labour. Birth planning is important, since studies that compare women's expectations of childbirth with actual experience present contrasting accounts, with disappointment, guilt and failure compared with delight, pride and success. Since experiences differ it is recommended that midwives audit birth satisfaction against women's birth plans. Results would inform auditors of whether there is satisfaction with a woman's birth experience and the quality of care that she perceived she received. Women's articulated wishes about birth would facilitate understanding of why satisfaction/dissatisfaction occurs.
Exploring maternity care for asylum seekers and refugees
Authors: Briscoe Lesley , Lavender Tina
Published: May 2014

The aim of this study was to explore and synthesize the experience of maternity care by female asylum seekers and refugees. The approach was a longitudinal exploratory multiple case study that used a series of interviews, photographs taken by the women, field notes and observational methods to contextualize data obtained during 2002 and 2003. Data was collected in the women's home and a hospital trust. Four women agreed to participate, three women were asylum seekers and one woman was a refugee.

Three key themes were generated: the perception of ‘self’ understanding in practice, and the influence of social policy. The women perceived ‘self’ as a response to social interaction. At times, ‘taken for granted’ communication in practice created a barrier to understanding for the women. Social policy related to seeking asylum, dispersement, housing and health directly affecting the lives and subsequent maternity experiences of the women.

The theory of symbolic interactionism and transformational educational theory was applied to the findings, highlighting that self-awareness is of paramount importance in care delivery. The strength and resilience of migrating women is acknowledged and should be used as a starting point to develop partnerships in care and to build the woman's self-esteem during their maternity experiences.
Postnatal clinics: women's and midwives' experiences
Authors: Lewis Louise
Published: May 2014

Until recently not much has changed in the organization of postnatal home visits. They have been performed by community midwives in the UK for centuries, largely unchanged and with little clinical evaluation of their effectiveness. The introduction of midwifery postnatal clinics is one of the most radical changes to occur in postnatal maternity services. The clinics have been introduced to improve the organization of postnatal care in the community by increasing the efficiency of the service and offering women more choice, however, they have been introduced without evidence of their success. This article presents some key findings of a study that explored how community midwives and women felt during the postnatal period about the implementation of postnatal clinics. The key themes emerged to reveal that postnatal clinics offered more choice, increased time efficiency and played an important role in increasing satisfaction for both women and midwives.
After a stillbirth – offering choices, creating memories
Authors: Schott Judith , Henley Alix
Published: May 2014

The death of a baby around the time of birth is a major catastrophe for parents. Their grief is likely to be profound and long lasting. Many parents welcome the opportunity to create memories of their dead baby and treasure the brief time during which they were able to see or hold him or her. NICE guidance consists of four documents which make different statements about parents seeing and holding their baby. Lack of consistency about an important aspect of practical care and the potential for choice to be removed, is unhelpful to parents and to the professionals caring for them. Informed choice must remain the overriding principle of care.
Recognizing and responding to acute illness: using early warning scores
Authors: Hancock Angela , Hulse Coral
Published: May 2014

The reports on the Confidential Enquiries into Maternal and Child Health (CEMACH) (Lewis, 2004; 2007) have recommended using early warning scores (EWS) in conjunction with vital signs monitoring, similar to those commonly used in the general adult inpatient population. This is a challenging process for midwives, obstetricians and critical care staff. Collaborative planning, working and multi-disciplinary training at Mid Cheshire Hospitals NHS Foundation Trust (MCHFT) led to the successful implementation of EWS alongside a structured and graded response algorithm. All obstetric inpatients at MCHFT now have a standardized approach to vital signs monitoring using EWS.
Ethnicity and domestic abuse: issues for midwives
Authors: Cross-Sudworth Fiona
Published: May 2014

Domestic abuse affects many people in all cultures and across all socio-economic groups, although women make up the majority of the victims. While there is inconclusive evidence that ethnic minorities have an increased rate of abuse, it is believed that those who are vulnerable are more at risk. Stress from poverty or social disadvantage can trigger domestic abuse with immigrant populations having additional risk factors. Furthermore those who face discrimination may find it harder to access help. Pregnancy, while sometimes a trigger for abuse, is also an opportunity for disclosure. Nevertheless for appropriate information and support to be given, midwives need training with good communication and cultural awareness in order to follow up disclosure of domestic abuse. Locally agreed care pathways, appropriate referral to support agencies and a multidisciplinary team approach are also needed. In spite of this there is little research or even information on ethnicity and abuse and there is a pressing need for further knowledge.
A tongue-tie clinic and service
Authors: Ridgers Irene , McCombe Katherine , McCombe Andrew
Published: May 2014

There is substantial evidence that the presence of a tongue-tie can interfere with, and adversely affect, breastfeeding. Division of a tongue-tie in this situation produces significant improvements. A new clinic was set up to provide this service locally and in parallel with a breastfeeding clinic. Two hundred and twenty tongue ties were divided, from a cohort of 7982 live births, over a 16 month period. The procedure was performed easily without any anaesthetic. Feeding problems were fully resolved in 168 (67%), improved in 47 (21%) and unchanged in only 5 (2%) cases. Most of the mothers (and fathers) involved in this study reported significant satisfaction with the service both in terms of improvement in feeding difficulties and ease of access. In addition, no problems or complications were encountered. This new clinic provides rapid and easy access to a simple and effective procedure for this relatively common problem.
Nothing ventured, nothing gained: a journey into phenomenology (part 1)
Authors: Snow Sarah
Published: May 2014

The application of phenomenology within midwifery research is intellectually challenging and theoretically complex, yet ultimately rewarding.

In this first article of two the attempt to think phenomenologically set against the background of a Master's research methodology and study findings is explored. A discussion of the origins and unique challenges presented by phenomenology is offered. The article aims to encourage debate about the potential offered by phenomenology towards a better understanding of women's experiences.
Non-physicians performing caesarean sections: a review
Authors: McNamara Mariah , Ahn Roy , Burke Thomas F
Published: May 2014

The crisis in human resources for global health is negatively impacting maternal health. In particular, access to emergency obstetric care is vital to prevent maternal deaths. In response to a severe shortage of physicians, various non-physician clinicians (NPCs), including midwives, perform caesarean sections in under-resourced environments. We reviewed the literature on the practice of any cadre of NPCs performing caesarean sections. The very limited literature on this topic finds that caesarean sections performed by NPCs and physicians appear to result in similar clinical outcomes. NPCs perform caesarean sections successfully and are more likely to stay in district hospitals than physicians. NPCs, including midwives, equipped with caesarean section skills may represent an extraordinary opportunity for solving a critical and unmet gap in the global maternal health crisis.
Student midwives' views of caseloading: the BUMP study
Authors: Rawnson Stella , Brown Sarah , Wilkins Carol , Leamon Jen
Published: May 2014

In 2007 the Nursing and Midwifery Council recommended that across the UK all pre-registration, undergraduate student midwives should, as part of their education, have the opportunity to experience continuity of care through caseloading practice. This article reports on a qualitative exploration of student midwives' views of caseloading a known group of women, which formed part of a larger action research project through Bournemouth University's pre-registration, undergraduate midwifery programme. Analysis of the caseloading data revealed four themes: preparation to undertake a caseload; knowing your mentor; tri-partite meetings; and relevance of caseloading to their learning in becoming midwives. Caseloading was identified by the students as being a highly valuable learning experience. Attitudes of the midwife mentor and link tutor were seen as important and impacted on student confidence in preparing for, and learning from, their caseloading experience. Findings of this study highlight the importance of developing a shared understanding and commitment to agreed support mechanisms, which sustains and enriches the experience of the student through their caseloading.
Factors influencing antenatal depression, anxiety and stress
Authors: Reid Helen , Power Michael , Cheshire Katherine
Published: May 2014

The purpose of this study was to investigate the prevalence and factors influencing antenatal depression, anxiety and stress symptomatology. The study used a cross-sectional survey design in a sample of 302 antenatal women across the trimesters of pregnancy. The questionnaire collected demographic and pregnancy data, included two measures of emotional distress; the Edinburgh Depression Scale (EDS) and Depression Anxiety Stress Scale (DASS-21), a measure of social support; the Significant Others Scale (SOS), and an adapted measure of distress from life events; the List of Threatening Experiences (LTE). Seventeen per cent were identified as suffering from depression symptomatology, 25% as having symptoms of anxiety and 25% as having symptoms of stress. Analysis revealed that a lack of support from a partner, mother, and an ‘other’ (typically a sibling or friend) were significant predictors of symptomatology. There were different predictive factors for antenatal women with children and primiparous women. Information was also obtained about antenatal women's preferences for health-care support with emotional distress. The need to widen the focus from postnatal depression to perinatal mental health was demonstrated. Interventions with an interpersonal focus may prove particularly effective as lack of social support appears to be a significant predictor of antenatal emotional distress.
Bully for you: harassment and bullying in the workplace
Authors: Hollins Martin Caroline J , Martin Colin
Published: May 2014

Bullying and harassment is a significant predicament that midwives face on a regular basis. Bullying and harassment may be characterized by unpleasant, threatening, malevolent or offensive behaviour. It involves abuse or misuse of power intended to undermine, humiliate, denigrate or harm the recipient. Deliberate bullying and/or harassment can have a major impact upon physical and mental health, as well as function within role. There are consequences for the persecutor, victim and institution in terms of health, cost and reputation. The objective of this paper is to provide managers with solutions to diminish levels of bullying and harassment within maternity units. To this effect, a bullying and harassment protocol has been written to guide managers to use appropriate strategies to diminish the intensity of bullying and harassment within their unit. To audit success, a Bullying and Harassment Scale (BAHS)has been devised to measure effectiveness of interventions targeted at reducing the problem.
Infant feeding in emergencies
Authors: Cook Vivienne
Published: May 2014

This article addresses the range of issues that arise when an area is struck by disasters of natural and human origin, and considers how infant feeding practices are affected in a compromised environment. Strategies to enable mothers to continue to feed infants safely are considered, along with the role of emergency workers, health-care providers and the media in influencing how women choose to feed their infants in disaster zones.

The article focuses on promoting safe infant feeding practices by highlighting the risks posed by unsanitary conditions, and the benefits of supporting, promoting and protecting breastfeeding, particularly in compromised environments.
The importance of effective support during childbirth
Authors: Baker Karen
Published: May 2014

Effective support during childbirth reduces the need for intervention during childbirth and therefore increases women's chances of experiencing normal births. Two theoretical explanations have been suggested for these positive effects: one is that effective support during childbirth aids the passage of the fetus through the pelvic and soft tissues; the other is that it decreases the stress response to childbirth. This article reviews the literature surrounding effective support in childbirth.
Influence of deprivation on young parents' pregnancy decisions
Authors: Smith Debbie
Published: May 2014

Young pregnancy remains high on the UK public health agenda. This article reviews current literature and considers the role of midwives in helping to reduce adverse outcomes in young pregnancy. Reviewing work from the author's PhD work, attention will be directed to how midwives can intervene and help improve young parents' pregnancy experiences.
Maternal and fetal heart rate confusion during labour
Authors: Bhogal Karnie , Reinhard Joscha
Published: May 2014

Continuous electronic fetal heart rate monitoring is commonly used by clinicians during labour and delivery to assess fetal wellbeing. The Doppler ultrasound cardiotocograph (CTG) detects the fetal heart rate (FHR) and the uterine activity (toco) simultaneously and displays it in the form of graph. There have been reports of the FHR being substituted by the maternal heart rate (MHR) with this method of monitoring. FHR/MHR confusion left undetected can lead to adverse outcomes.

This article gives an overview of the pattern of the MHR during labour in continuous maternal and fetal heart rate monitoring using an abdominal maternal and fetal electrocardiograph monitor (abfECG) in contrast with more traditional Doppler methods.

The exploration of the pattern of the MHR during labour and delivery demonstrates how an incorrect assessment of fetal wellbeing could be made if the monitor was used in isolation and the MHR was being reported rather than the FHR.

This article also explores how midwives can minimize the risk of such incidents occurring.
Labour rhythms vs labour progress: one final update
Authors: Walsh Denis
Published: May 2014

This year there have been two publications that contribute significantly to the perennial debate on ‘labour rhythms’ versus ‘labour progress’ approaches. For over 10 years, I have argued in this column, and elsewhere, for a move away from a labour progress focus which has swamped labour care with an imperative to measure length and understand it as linear.
Evaluation of care after stillbirth in Sweden based on mothers' gratitude
Authors: Rådestad Ingela , Westerberg Anna , Ekholm Ann , Davidsson-Bremborg Anna , Erlandsson Kerstin
Published: May 2014

Caring routines in many countries for parents following the death of a baby have shifted over the last 40 years, from initial recommendations that parents should not see their baby, to the opposite in present day. This study aims to describe mothers' gratitude for the actions taken by health professionals in connection with the birth of their child. The study also examines whether the aspects of care for which they were grateful differed between mothers whose children died before and after 1990. Data was collected from 799 women via a questionnaire posted on the homepage of the Swedish National Infant Foundation. Women who gave birth to a stillborn child after 1990 expressed gratefulness more often than women who gave birth to a stillborn child before 1990, for several reasons including the help received in creating memories of their baby. The mothers were thankful for being supported in their motherhood, and that the staff encouraged them to see, hold and be with their baby.
A reflection on the emotional potential of qualitative interviewing
Authors: Mitchell Mary
Published: May 2014

Interviews are the most common data collection tool in qualitative research ( Silverman, 2001 ). The researcher is considered a vital part of the research process, and an emphasis is placed on the relational and collaborative process of gaining understanding ( Finlay and Gough, 2003 ). During the interview process the relationship that may develop between participants and researchers often facilitates the disclosure of emotions. In this reflection, the often-neglected emotional potential of qualitative interviewing for both researcher and participant will be explored. Using Gibbs' model of reflection (1988), this article aims to help readers achieve a new level of understanding and awareness about the profound effect that asking people to share their stories may have. Researchers who engage with qualitative interviewing need to anticipate that participants may experience emotional distress, consider how they will deal with displays of emotions, and explore the significance of these emotions in learning from those being interviewed. For midwifery researchers, the challenges in maintaining the boundaries between the role of the midwife and the role of researcher is also highlighted. The emotional impact on the researcher is less well acknowledged in the literature and the aim of this article is to share these reflections to encourage new researchers to think about these issues.
Women's perceptions of stressful life events in relation to pre-term birth
Authors: Wood Lorna , Quenby Siobhan
Published: May 2014

This is the second of two articles exploring the views and emotions of women in a subsequent pregnancy with a history of pre-term birth or pregnancy loss. The first article outlined the preliminary literature review that informed this study. In the literature review it was found that: women who had experienced pre-term birth or pregnancy loss were anxious throughout a subsequent pregnancy; that pregnancy milestones were important to get past; that grief resurfaces during a subsequent pregnancy; and that the psychological effects of a past experience could alter women's locus of control and ability to deal with the next pregnancy. In light of these findings, a qualitative study was undertaken—the Stress, Immunity and Pre-term birth (SIP) study. Data collected from the List of Threatening Experiences Questionnaire (LTE-Q) from a larger quantitative prospective observational study (n = 200) was used to explore stressful life events. ‘Think-aloud’ methods were explored because of the structured format of data collection and 26% of women's responses (n=52) were analysed thematically using ‘framework analysis’. Themes are described in relation to ‘damage’—that is, damage to self, damage to the child and damage to relationships as a result of experiences of pre-term birth or pregnancy loss.
Decision making and supervision for third-year student midwives
Authors: Kitson-Reynolds Ellen , Rogers Jackie
Published: May 2014

Developing autonomous practice for third-year student midwives provides educators and supervisors of midwives with the opportunity to devise innovative learning and teaching strategies. A Decision Making Week activity was devised concerning decision-making tools, theory and their application to clinical experiences, risk management and clinical governance. Students undertook record-keeping audits to critique decision making. This was linked to an existing drop-in supervisor of midwives (SOM) surgery. It is anticipated that students will present key findings to their clinical colleagues as a means of sharing knowledge and developing good practice. By using audit tools as a means for reflection and education, it is hoped that midwives can gain credibility for their decision-making processes and the documentation of the decision-making audit trail. By doing so, it may encourage greater involvement and partnership-working between midwives and clients in planning care.
Chinese women's perception of effectiveness of antenatal education
Authors: Holroyd Eleanor , Twinn Sheila , Yim Ip Wan
Published: May 2014

The aim of this Hong Kong-based study was to evaluate Chinese women's perspectives on the educational effectiveness of hospital-based antenatal education programmes in the preparation for pregnancy, labour and the early postpartum period. A multiple case study design was used including a programme satisfaction questionnaire (PSQ), an antenatal knowledge questionnaire (CANKQ), and telephone interviews repeated during pregnancy and postnatally with the women attending each programme. Antenatal knowledge was seen to improve at both hospitals as a result of the programme. The interpersonal skills of the midwives, the presentation skills of the educators and the perceived accessibility of the health professionals to ask questions to were considered important to the Chinese women. In addition, the importance of providing education about Chinese medicine in pregnancy and postnatal care (e.g. the need for rest and recovery, and restrictions on their activities) was emphasized. The need for a comprehensive curriculum covering all stages of the childbirth process from pre-pregnancy to parenting was highlighted. The importance of regular evaluation to ensure antenatal education programmes continue to meet Chinese women's needs and expectations is suggested. From this study, recommendations are made to develop a framework which incorporates a methodology for health education planning that focuses on the effectiveness of health services from the perspective of Chinese
Fear of childbirth: Understanding the causes, impact and treatment
Authors: Otley Henrietta
Published: May 2014

This article is based on a review of the literature related to fear of childbirth, and pragmatically considers issues for midwifery practice. Research shows that around one in ten women in the developed world is affected by severe and disabling fear of childbirth during pregnancy ( Saisto and Halmesmaki, 2003 ). An important finding in the research is the significant link between fear of childbirth and caesarean section (for which the UK currently has very high rates). Fear is also associated with a negative birth experience. While personality and social factors are shown to raise the risk of severe fear of childbirth, midwives need to recognize that loss of control, misinformation and previous traumatic experiences have a serious detrimental effect on Women's perceived capacity to give birth vaginally.