bluuebunny/crossref_metadata_2025 huggingface dataset:
Caesarean birth: the kindest cut?
Authors: Page Lesley
Published: May 2014

Given their daily contact with the problems of birth and surgical specialization, it is easy to see why 31% of obstetricians might choose to have an elective caesarean section (Al Mufti et al, 1997). In fact, the figure might be expected to be higher. Such a population is likely to develop a degree of fear of birth. But why would any average woman, without this biased view of birth, ask for an elective caesarean section when there is no medical indication? Graham et al (1998) found in their observational study of 186 women undergoing caesarean section that 7% thought it was a preferable option. There was no explanation given for this preference. Jackson and Irvine (1998) reported that of the 570 women in their study who had a caesarean section, 18.2% were elective and 38% of these elective caesareans were performed because of maternal request.
An evaluation of team midwifery
Authors: Hart Angie , Pankhurst Francesca L , Sommerville Fiona
Published: May 2014

This article describes an evaluation of a pilot scheme of team midwifery which was implemented in response to a local drive to improve care within a budget and the recommendations set out in Changing Childbirth (Department of Health, 1993). the main focus of the paper is on women's perspectives of the pilot scheme and the traditional midwifery system regarding continuity of care and satisfaction with the service. The findings of the evaluation revealed ambivalence toward continuity of intrapartum care and equivalence in most satisfaction ratings between the two systems. The future of team midwifery at this trust remains uncertain within this context of differing priorities and prteferences of women for continuity of care and service provision in addition to limited financial resources.
Informed choice in maternity services
Authors: Churchill Helen , Benbow Angie
Published: May 2014

The aim of this study was to investigate informed choice in relation to care-giver and location of care, within maternity services in Powys. The study utilized a survey design, eliciting both quantitative and qualitative data from respondents. The aims of the research were to evaluate women's perceptions of the quantity and quality of information received, to highlight examples of good practice and to identify potential areas of concern. The results demonstrated high levels of satisfaction with the amount of information on antenatal and birth care received by women taking part in the study, midwives being identified as playing a key role in informing women in all antenatal and birth settings. Further, the findings suggest that midwives in midwife-led antenatal clinics and midwife/GP maternity units are more successful in imparting information and enabling women to have a sense of participation in the decision-making process. Type of delivery is also identified as a key factor in women's perceptions of participation in informed decision-making with anticipated intervention in birth being a possible indicator of low levels of satisfaction. Thus it may be that organizational, structural or experiential factors affect women's perceptions of having an active role in the decision-making process more than the health care personnel involved. The discussion relates the findings of this study to wider debates on informed choice in maternity services, issues of continuity of carer and effects of cross-boundary services. Areas for further research are identified.
Building a stronger case for home births
Authors: Warwick Cathy
Published: May 2014

There was a rather daunting pile of documents waiting to be read when I returned from holiday. Two of them have received my close attention: The NHS Plan and the UKCCs Position Statement Supporting Women Who Wish to Have a Home Birth (2000).
Labour debriefing is crucial for good psychological care
Authors: Axe Sally
Published: May 2014

High expectation surrounds pregnancy and birth, not only for physical safety but also for emotional fulfilment. Each labour is a unique event and many differ considerably from the experience the woman expected. It is a commonly held belief that the pain and distress of labour is quickly forgotten once a woman holds her healthy baby in her arms. For some women, however, this is not the case. Questions and emotions not dealt with at the time can surface later to cause problems which could affect the woman's physical health, increase the likelihood of postnatal depression and interfere with good parent-infant relationships. This article aims to examine the role of labour debriefing by midwives in the provision of good psychological care.
Aromatherapy in childbirth: An effective approach to care
Authors: Burns Ethel E , Blamey Caroline , Lloyd Andrew J
Published: May 2014

This article discusses findings from a large evaluative study on the use of aromatherapy in childbirth (Burns et al, 1999). The sample involved 8058 mothers and took place on the delivery suite of a busy teaching unit. A primary objective was to examine whether aromatherapy could facilitate maternal coping mechanisms during labour by improving mothers’ sense of wellbeing, reducing anxiety and fear and influencing the perception of pain. Mothers consistently rated the administration of aromatherapy positively. Aromatherapy was found to be an inexpensive choice for mothers. Only 100 mothers reported minor side-effects associated with essential oil administration. This study provides a valuable insight into the potential for the use of a aromatherapy in midwifery practice.
The use of audit to explain the rise in caesarean section
Authors: Chaffer Denise , Royle Livia
Published: May 2014

An audit was undertaken in a maternity unit in 1996. The caesarean section in the unit studied in 1996 was 21.7% compared to a UK national rate at that time of 13%. The unit staff believed the main reason for these figures was the influence of maternal request. The aims of the study were to: identify factors influencing the CS rate, assess physiological and psychological implications to both the mother and baby, make recommendations to reduce the rate both safely and effectively, and identify resource implications. Recommendations made include the need to introduce multi-professional evidence-based guidelines on the management of fetal distress, trial of labour with history of previous CS and the use of external cephalic version in the cases of the uncomplicated breech presentation. The need to ensure that women electing to have a CS are fully informed of the risks related to CS was also highlighted.
Some cultural perspectives of birth
Authors: Kitzinger Sheila
Published: May 2014

In traditional cultures, birth is a social and religious event choreographed by women and takes place in a domestic territory. In contrast, in northern cultures, birth has become a medical event conducted in an alien institution, and is largely managed by men. Women may feel violated by an experience in which they are disempowered.
Do we provide information to women in the best way?
Authors: Lavender Tina , Moffat Helen , Rixon Sue
Published: May 2014

Various methods of supplying women with information are used in maternity units to assist midwives in making childbirth decisions. However, maternal views on the suitability of information provided during maternity care are inconclusive. A longitudinal study was carried out to discover how women feel about the information that is currently provided regarding pregnancy, labour and parenthood. In particular, the study aimed to explore the timing, amount, content and format of information. These issues had been previously highlighted in three focus groups conducted at the hospital. A descriptive longitudinal panel study was employed using semi-structured questionnaires. A group of 80 women from a purposive sample were questioned at five different stages, i.e. first, second and third trimester, and twice during the postnatal period. The structured data were analysed descriptively and the open responses were analysed using qualitative methods. The findings suggest that women did not receive information which met their individual requirements. Information was not always given at an appropriate time and was often unrealistic. The study highlights aspects of information provision which can be improved. Such improvements may enhance the childbirth experience for women.
New mothers knowledge of sudden infant death syndrome
Authors: Roberts Helen , Upton Dominic
Published: May 2014

Guidelines for the prevention of Sudden Infant Death Syndrome for parents were altered in 1996 with five preventative factors outlined. In this cross-sectional survey 206 new mothers were interviewed post natally to assess knowledge of these factors and actual infant practices. The findings indicated that although knowledge of the preventative factors was generally high, a quarter of mothers were not adopting the recommended sleep position for infants and a third continued to smoke. The level of advice provided by health care professionals, with the exception of community midwives, was perceived to be low and there were instances of inappropriate professional practice that may have perpetuated incorrect sleeping position. Overall, it was concluded that health care professionals need to continue to promote the awareness of the preventative factors associated with SIDS amongst parents and ensure that their own practices reflect these.
Breast-feeding: midwives meeting mothers in the middle
Authors: Stein Julie , Dykes Fiona , Bramwell Ros
Published: May 2014

This paper describes a qualitative study in which midwives’ perceptions of high and low quality interactions between midwives and breast-feeding mothers were elicited. Questionnaires using a critical incident technique were distributed to all the midwives in a maternity service in the North of England. Structured analysis of 16 responses (40%) led to the development of four major themes: communication, support by health professionals, inaccuracy/inconsistency of advice and breast-feeding policy. The case for further education of midwives to improve their self-awareness and communication skills is presented along with recommendations related to resource allocation and policy development.
Cultural learning: midwifery in Scotland and Germany
Authors: Fleming Valerie , Milde Jessica
Published: May 2014

This article describes the education for practice of midwives in Scotland and Germany with a particular focus on the strengths of each country's approach. Recent developments in midwifery practice in the two countries are highlighted, analysing their similarities and differences. The next section reflects upon each midwifery education system in a similar manner. Although the focus is firmly on the strengths of each system, some criticism is offered in the final section which discusses how midwives in each country can gain from the experience of the other.
The implications of rest and sleep following childbirth
Authors: Larkin Valerie , Butler Margaret
Published: May 2014

The importance of sleep has been underestimated in nursing theory and practice (Southwell, 1995). Equally, its recognition as a priority in midwifery care has received only token lip service within the midwifery literature and profession. Although it is frequently identified as a need, there is little discussion as to the impact of insufficient rest and sleep or the role of the midwife in facilitating this need. The apparent mismatch between the reported occurrence of lack of rest and sleep and its relatively low priority in midwifery care, suggests there is a need to highlight and explore sleep and rest in the postnatal period. This article aims to explore the physiological significance of rest and sleep upon women during the postnatal period. This analysis will then be related to the emotional, cognitive and physical demands following childbirth, which may contribute to insufficient rest and sleep. Finally, the role of the midwife and care provisions will be discussed and recommendations made for practice.
Part four: Fetal monitoring should be controlled
Authors: Walsh Denis
Published: May 2014

The continued widespread use of electronic fetal monitoring in normal labour is illustrative of technology becoming our master, not our servant. It is one of the clearest examples of iatrogenesis as false positive rates continue to result in unnecessary caesarean sections. The opportunity now presents itself to remove monitors from women in normal labour as clinical governance advocates evidence-based practice in maternity care. For many midwives, whether it achieves this will be an acid test. Will clinical governance herald a new dawn in the sensitive application of proven treatments (and the banishment of the ineffective), or will it become just another control mechanism where selective interventions are endorsed or rejected but those that challenge entrenched practices and vested interests are quietly ignored?
Cholestasis in pregnancy: A challenging disorder
Authors: Coombes Janet
Published: May 2014

Intrahepatic cholestasis of pregnancy (ICP) is a poorly recognized and under-diagnosed maternal condition associated with an increased incidence of fetal mortality and morbidity. This article reviews the current understanding of the epidemiology and pathogenesis of the condition, and explores the effects on both mother and fetus. The article concludes with a brief review of possible explanations of the pathophysiology. An understanding of the clinical and laboratory features of this disease will facilitate early diagnosis, which is imperative if the high stillbirth rate in ICP is to be reduced.
Termination for fetal defects: The effect on midwifery staff
Authors: Askey Karen , Moss Linda
Published: May 2014

This study looks at the experiences of staff caring for women who have a late termination of pregnancy for fetal abnormality. Grounded theory was used to look at how staff coped with the experiences and the impact on the individual, their professional role and the organization. A total of 23 staff from a wide cross section of the professions within the directorate of obstetrics and gynaecology took part. The analysis showed a process of caring that evolved over time and was dependent on the emotional reaction of the individuals and families to the news of the fetal abnormality. The authors describe the process in a staged model called ‘the experience of the evolution of caring’. This was seen as a reflective and dynamic model. Three main stages are identified in the model through several main categories such as support, boundaries and limitations, and detachment. These formed the basis for the experience of caring. A core category identified was that of ‘doing the right thing’.
Clinical outcomes of one-to-one midwifery practice
Authors: Page Lesley , Beake Sarah , Vall Andy , McCourt Christine , Hewison Jenny
Published: May 2014

One-to-one midwifery was established in 1993 to put into practice the principles of Changing Childbirth. This second cohort study was undertaken to assess differences between one-to-one and standard care and to assess whether or not differences had persisted since an early study. A random sample of all women receiving standard care (postal districts W4 and W6) and of all women receiving one-to-one care (postal districts W3 and W12) who were expecting to give birth in the same NHS Trust between 15May 1997 and 14May 1998 were invited to enter the study of women's responses to care, the notes of all women were audited. Clinical endpoints were specified in advance, these were: caesarean and assisted delivery rates, epidural rates in those not having elective caesarean section, rates of intact perineum in those not having elective caesarean section, and labour duration. Satisfaction with care was recorded through the postal questionnaires. These endpoints were analysed using linear and logistic regression adjusting for prespecified confounders. There was a lower rate of all clinical interventions associated with one-to-one care and rates of satisfaction were higher. Differences were increased from the first cohort study.
What does it take to be a consultant midwife?
Authors: Osbourne Astrid
Published: May 2014

Intellectualising the power dynamics of midwifery and the interaction with our aligned professions has done little to clarify the position of the consultant midwife. However, one thing is clear, midwives are the only group of health professionals who are concerned with a physiological process. As such, we are set apart from our colleagues in nursing and medicine. This is evident in the different job descriptions in the first wave of nurse and consultant posts.
Genital mutilation: Human rights and cultural imperialism
Authors: Cameron Joan , Rawlings-Anderson Karen
Published: May 2014

Female genital mutilation is widely practised in many cultures. It may be viewed as a rite of passage for girls or women, or it may be regarded as mutilation and a threat to health. This article considers the ethical issues surrounding the practice. The standpoints of cultural relativism and universal human rights are used to explore the debate surrounding the practice and to determine the response of health-care workers and society in general to the practice.
HIV testing in antenatal care: a cross-sectional study
Authors: Low Nicola , Lambe Cheryl , Welch Jan , Kennedy Jane , Stallard Andrew , Clements Vanessa , White Julia
Published: May 2014

Midwives' attitudes and practices regarding antenatal HIV testing, including integration of testing into routine antenatal care, were analysed using a self-administered structured questionnaire. This was completed by hospital and community-based midwives in an area of high HIV prevalence. In total, 162 responses were received. Most midwives (71%) agreed that HIV testing is an integral part of antenatal care but 61% also believed that only individuals with a counselling qualification should offer tests. Fifty seven per cent had attended a recent course about the management of HIV infection in pregnancy. Midwives who had attended a course were more likely to agree with integrated testing (odds ratio 5.2, 95% confidence interval 2.0–13.5). Midwives qualified between 5 and 9years ago were less likely than more recently qualified or more experienced midwives to offer tests, and this was not explained by differences in access to educational courses. Midwives' attitudes towards antenatal HIV testing are generally favourable. Despite an observed increase in uptake rates, many midwives continue to believe that only qualified counsellors should offer tests. All midwives should receive ongoing education that emphasizes the changing management of HIV infection in pregnancy and encourages testing.
A personal experience of midwifery in Denmark
Authors: Godsman Kim
Published: May 2014

Having secured a scholarship to explore midwifery in Denmark, the author visited Copenhagen in February 1999. She undertook a study period to explore midwifery care at a midwifery led unit in Hvidovre Hospital. Care provision was effective, in particular with regard to the promotion of breast-feeding. The breast-feeding initiation rate was over 99%, with only three women during 1999 under the care of the birth clinic choosing to artificially feed their babies. The author was able to compare the cultural attitudes to breasts and infant feeding. The Danish midwives worked hard to maintain normality of the birth process. The abandonment of institutional routines, effective team work and the holistic involvement of the father throughout the childbirth experience had all contributed to the units' success.
Stillbirth: care and long-term psychological effects
Authors: Rdestad Ingela
Published: May 2014

The article summarises the findings from a nationwide follow-up of women who gave birth to a dead child (n=314) or who delivered a live child (n=322). Three years after the delivery, stillbirth gave a slightly higher prevalence of anxiety-related symptoms, as compared with a live birth, but also a higher level of social satisfaction. Care during the hours before and after delivery decided the risk of long-term anxiety. It can be diminished by a short time between a diagnosis of death in utero and initiation of the delivery, allowing the mother to meet and say farewell to her child as long as she wishes and the collection of tokens of remembrance (hand- or footprint, lock of hair, photograph) of the dead child. The study also shows that dead and alive children were treated with equal respect, that mothers typically want to know the cause of their child's death, and that a stillbirth increases the satisfaction with the relation to the child's father, as compared with live birth. Suggestions for refined care during stillbirth are given.
Involving men in antenatal education
Authors: Lee John , Schmied Virginia
Published: May 2014

Although antenatal sessions have changed over the last 20years, there is still dissatisfaction among new parents about the level of preparation for their new role. In particular, research indicates that fathers feel ill-prepared. This paper reports the introduction in one Australian hospital of men-only discussion groups which are facilitated by a father. In each case the facilitator was a health professional, although this may not be a necessary qualification. Each group sets its own agenda, and so a range of issues may be discussed. These include ‘fathering’ — the adjustment to being a father, and different parenting styles; and ‘birth’ — the man's role in the childbirth process.
The information needs of first-time pregnant mothers
Authors: Singh Debbie , Newburn Mary , Smith Nina , Wiggins Meg
Published: May 2014

Changing Childbirth (Department of Health, 1993a) emphasised the importance of providing accessible information during pregnancy. Five years after Changing Childbirth became government policy, a self-complete questionnaire was sent to a randomly selected sample of women to assess how well their maternity information needs were being met. This article focuses on the information needs of first-time mothers during pregnancy. Findings suggest that demand for information is increasing. Over two thirds of the 702 first-time mothers surveyed said that they wanted to know ‘a great deal’ about pregnancy and birth and all had some unmet information needs. Young mothers, ethnic minorities, and women from lower socioeconomic groups showed the greatest desire for more information. All maternity services should have an information and support strategy. As part of this midwives should review how well they are meeting women's individual information needs and should take action to improve women's access to reliable information and opportunities to talk over issues during pregnancy.
Screening for sickle cell disorders: part 1
Authors: Hall Fay Julie
Published: May 2014

The purpose of this article is to explore the issues surrounding sickle cell disorders (SCDs) and how they affect antenatal and neonatal screening. The literature reviewed examined several aspects which influenced care including, whether current midwifery services are meeting client need, and if the screening policies in place are adequate in today’s multicultural climate. In part one, the findings of the author suggest that SCDs are generally very poorly understood by midwives working outside large city areas. Inexposure to a multicultural setting, and misconceptions on race and ethnicity, are some of the areas identified that result in lack of awareness and possible racial bias within the maternity arena.
Accessing a debriefing service following birth
Authors: Inglis Sue
Published: May 2014

There is growing acceptance among health professionals involved with women during childbirth that the effects of a woman’s birth experience can be associated with subsequent psychological morbidity (Czarnocka and Slade, 2000 ). This article describes a mixed methods study that investigated the effectiveness of a debriefing service set up for women to discuss their experiences of labour. The main themes that emerged from the data included communication and the need for appropriate relevant information. Women also raised the importance of being able to contextualise their experiences and gain reassurance that they would be able to influence any future contact with maternity services.
A pragmatic tool for the measurement of perineal tears
Authors: Metcalfe Alison , Tohill Susan , Williams Amanda , Haldon Valerie , Brown Lynn , Henry Lavinia
Published: May 2014

Perineal trauma following childbirth affects around 70% of women (Greenshields and Hulme, 1993). The two main sources of trauma are due equally to either episiotomy (surgical incision of the perineum) or to a spontaneously occurring tear. Perineal tears vary in size and are graded from first degree (the most minor) to fourth degree (most severe). First, third and fourth degree tears are all clearly defined by the anatomical structures involved and clearly describe the extent of the trauma incurred. However, second-degree tears can vary widely in size and are often given the subjective descriptions of small, medium and large. Approximately 25–35% of all childbearing women sustain a second-degree perineal tear during childbirth but research and audit of the most appropriate aftercare for the wound has been restricted by the inability to provide a more objective measurement of second-degree tears. The Birmingham Perineal Research Evaluation Group has developed a tool to provide an objective measurement of second-degree tears. This paper describes the development of the tool and its validation that showed substantial levels of agreement between two midwives measuring the depth and length of perineal tears (n=130). The assessment tool does not cause any distress to the woman and is quick and easy to use, which should assist its use and uptake by clinically-based midwives. The use of this tool will provide the first objective method of assessing second-degree perineal tears that can be used in clinical practice to assist education, research and audit.
A midwife's role in prenatal screening
Authors: Deacon Elinore
Published: May 2014

As technology in the field of investigative medicine is advancing rapidly, a growing number of expectant parents are choosing to undertake prenatal screening. However, as much of the literature surrounding this subject highlights, the processes, implications, limitations and results of this testing are still poorly understood by the majority of expectant parents. As informed choice and consent are of such importance in health care today, the distinct lack of knowledge in this area suggests that there is a further need for pre-test information and counselling, particularly as serum screening tests are performed on an opt-in basis. The role of the midwife has now been expanded to include genetic counselling. Therefore midwives must be fully informed about all areas of serum screening in order to impart this information to the women in their care. It is also essential for all women to understand the limitations of screening tests.
Violence in the workplace and towards the midwife
Authors: Dimond Bridgit
Published: May 2014

This article considers the growing violence on NHS staff, the legal duties on employer and employee in the field of health and safety and the implications of the zero tolerance policy and website for midwives.
Child protection and the midwife
Authors: Dimond Bridgit
Published: May 2014

This article discusses the Green Paper Every child Matters, which was published following the Laming Inquiry and considers the role of the midwife in child protection.
Knowledge and experience of domestic violence
Authors: Morgan Jane E
Published: May 2014

This study was funded by the Home Office Crime Reduction Programme Violence Against Women. The study used a survey approach in order to obtain information on the amount of knowledge staff in an Obstetric and Gynaecology Directorate had regarding domestic violence. Doctors, Midwives and Nurses in the Unit were asked to complete a questionnaire which focused on their knowledge of the subject in relation to women's health, the impact domestic violence has on gynaecological conditions and the impact on childbirth. The Unit has a strategy in place for women to disclose domestic violence and staff were asked how often women used it. Staff were also asked to disclose their own experience of domestic violence. From the results of the questionnaire, staff identified a limited knowledge of domestic violence and women's health, the strategy in the Unit was not successful and prevalence of domestic abuse amongst the staff to be 21.77%, similar to the national statistic of 23%.
Emotional intelligence
Authors: Gould Debby
Published: May 2014

Quality education and training is undoubtedly imperative to being able to deliver good maternity care. While midwifery and medical academic education is under the auspice of Universities, the clinical component resides firmly in the service. Achieving good quality education in clinical practice relies precariously on many factors, not least staffing levels, experience and attitudes of mentors, working culture and environment and good links between the academic institutions and the clinical practice areas. However one of the hardest things to determine is what constitutes ‘good practice’. Herein lies the dilemma for many, as good practice is determined by personal, professional and organizational core values in which care is delivered and also increasingly influenced by outside agencies such as Clinical Negligence Schemes for Trusts, Clinical Governance and the Confidential Enquiries.
Birthrate Plus programme: a basis for staffing standards?
Authors: Ball Jean , Bennett Beverley , Washbrook Marie , Webster Frances
Published: May 2014

Since the start of 2001, 101 maternity units have entered the Birthrate Plus programme and of these 64 have completed their studies, with many more in progress. Although not designed or funded as a comparative study of midwifery workload and staffing needs, a coordinated analysis of the data gives a unique insight into demand for and patterns of midwifery care in England at the present time and has produced ratios of births:work-time-equivalent midwives which could form a basis for standards of care.
Edgware Birth Centre: a waterbirth experience
Authors: McCloghry Kim
Published: May 2014

Waterbirth is an increasingly popular choice for women. There are approximately 300 waterbirths at the Edgware Birth Centre each year. Trusts need to have robust evidence-based guidelines in place and there is now a great deal of evidence about this way of birth. Waterbirth dopplers are essential equipment to enable fetal monitoring which is comfortable for the mother and convenient for the midwife. A torch and mirror are also useful tools for the midwife and mother as they encourage the essential hands-off technique required for this type of birth. Workshops are useful ways to inform parents about the advantages and disadvantages of waterbirth. Midwives need to be trained in this technique and workshops and reflection are useful ways to support and inform midwives.
Webwatch
Authors: McDonnell Cheryl
Published: May 2014

The wide availability of contraception in Britain can mask the fact that pregnancy for many women is an unanticipated and sometimes unwelcome event. Those who believe, or find, themselves to be unexpectedly pregnant may look to internet sources for further guidance. Two sites that women may use under such circumstances are the Family Planning Association (FPA) and the British Pregnancy Advisory Service (BPAS):

www.fpa.org.uk

www.bpas.org
The USA approach to maternity care
Authors: Walder Jane
Published: May 2014

This article provides an account of maternity services in a university hospital in the USA, covering pregnancy, labour and delivery and follow-up care. Obstetricians are the main care providers, although midwifery care is also available. Obstetric nurses give labour and postnatal support. Although this is not an account of the differences between the UK and the described USA system, the most obvious differences are highlighted, these being the variety of practice and the numbers of personnel involved at the delivery. Resources available to both staff and users of the service are substantial, and if midwives are contemplating gaining experience overseas the author highly recommends working within the USA health system.
Spoilt for choice: consuming maternity care
Authors: Davis Deborah
Published: May 2014

Medical care throughout the 19th and 20th centuries was characterized by a paternalistic approach to care. From the mid-20th century we began to see a shift in the way health was conceptualized and approached. Individuals demanded more control over their experiences, encouraging individual choice and responsibility. The emergence of the discourses of individual choice and responsibility has had a significant impact on midwifery practice. This article focuses on some of the consequences of these discourses, suggesting that it has submerged some other important professional imperatives such as promoting normal birth. It is suggested that midwives will need to take a more active approach. This article explores this issue within the context of midwifery practice in New Zealand. While some points of history and details of the maternity system or practice may be specific to New Zealand, the discourses explored and implications for practice are relevant to many other Western countries and their midwives.
SARS: pregnant women's fears and perceptions
Authors: Ng Judy , Sham Alice , Tang Pey Leng , Fung Sylvia
Published: May 2014

This study explored the perceptions of pregnant women on Severe Acute Respiratory Syndrome (SARS) and the effects of perceptions during the SARS epidemic in Hong Kong during March 2003. A survey was conducted at the maternity clinic of a regional hospital. 980 pregnant Chinese women completed self-administered questionnaires on their knowledge of SARS, their awareness of personal hygiene and their perception of any additional strain on their daily life. We concluded that, the SARS crisis brought drastic changes to the lives of most people in Hong Kong. Midwives played a pivotal role in providing care, health education and counselling to help pregnant women in during and after the crisis.
Fetal monitoring advances
Authors: Mainstone Adrian
Published: May 2014

Fetal monitoring plays an important role in the care of the fetus and mother during labour and birth. Monitoring methods and technology have developed considerably during recorded medical history and have accelerated in recent years. Technology may have increased our diagnostic capabilities but there is the argument that it should not replace routine auscultation by a skilled clinician. This article seeks to trace the history of fetal monitoring and to highlight the results of just a few of the many studies available on the efficacy and use of modern equipment.
Developments in perinatal mental health assessments
Authors: Gibbon Kim
Published: May 2014

There is substantial evidence that perinatal mood disorders are present at significant rates in the population. Despite this there are no systematic evidence-based processes in place to ensure women who suffer receive appropriate care. There is also significant evidence that early detection is critical to outcome. Arrowe Park Hospital has devised and implemented protocols to address these issues which are consistent with the National Service Framework (NSF) for Mental Health. Two standardised self-rating questionnaires are used by midwives with women in their care. Mid-range scores trigger monitoring through re-test, high scores require referral into a multi-agency approved modified mental health care pathway. Preliminary audits suggest the methodology is effective.
Postnatal care: what new mothers say
Authors: Ockleford Elizabeth M , Berryman Julia C , Hsu Ron
Published: May 2014

In this article, multiparous and primiparous women of White and Indian ethnicity were interviewed about their postnatal experiences. Low staff levels on hospital wards was apparent to new mothers, some of whom left hospital earlier than planned because of this perceived lack of support and care. There is an apparent mismatch between expectation and the service that can be provided. Provision of care by family and community midwife fills the needs of mothers after a short period of surveillance and practical advice received in hospital. Anxiety was expressed about going home. Comments on all issues revealed no particular difficulties according to ethnic or religious background or experience of motherhood.
Lesbian users of maternity services: appropriate care
Authors: Lee Elaine
Published: May 2014

Lesbians constitute a significant proportion of users of maternity services. However, their existence is poorly acknowledged and, therefore, their needs may not be adequately assessed. Treating all women in the same way denies the existence of problems and stresses specific to this client group. Provision of women-centred care which recognizes the imperative to remove assumptions regarding sexuality may provide the key to better understanding. It may also result in maternity services within which lesbian mothers feel safe enough to express their individuality. Failure by midwives to provide this safe environment is a failure to be ‘with woman'. The author proposes a constructive rethinking of institutional heterosexist factors which render lesbian mothers largely invisible and unacknowledged.
Health promotion: partners’ perceptions of breastfeeding
Authors: Okon Miranda
Published: May 2014

Breastfeeding is recognized as the most appropriate method of infant feeding (UNICEF, 1999a), yet past research suggests that it declines during the early postpartum period (Foster et al, 1995). More importantly, recent studies have suggested that partners may influence breastfeeding decisions (Jackson, 2000) so their roles significantly reinforce more recent findings (Hamlyn et al, 2002). This small qualitative study explores partners' perceptions of breastfeeding, the extent of influence on breastfeeding decisions, and how health promotion can contribute to the uptake of breastfeeding. In this article, an open-ended, in-depth guide was used during the interviewing of eight male participants. The findings were analysed using thematic analysis. The findings indicate that partners have significant influence on a mother's infant-feeding decisions by their use of language, and that partners are greatly influenced by their perceptions of gender.
Transcutaneous electrical nerve stimulus (TENS)
Authors: Mainstone Adrian
Published: May 2014

Avoiding pain is a basic human operating procedure, yet pain enables us to recognise injury or disease and so take appropriate action. The transmission of pain is modulated at the base of the spinal cord by a ‘gate’ that may be closed or opened in order to prevent or allow signals to pass to the brain. Operating on this principle, transcutaneous electrical nerve stimulation (TENS) is an effective way of managing both short-term acute pain and long-term chronic pain without the disadvantages of pain-relieving drugs. These units can be hired or purchased depending upon the function a unit is to fulfil.
Feelings and fears during obstetric emergencies – 1
Authors: Mapp Taniya , Hudson Kaylyn
Published: May 2014

This study addresses the balance by providing an illuminating picture of women's experiences of these traumatic events during childbirth. This qualitative study followed a phenomenological approach to highlight women's experiences of obstetric emergencies. Selection criteria was specifically aimed at women who had experienced one or more of the following types of emergencies during childbirth – cord prolapse, placental abruption, shoulder dystocia, uterine scar rupture, severe pre-eclampsia and major postpartum haemorrhage. Ten women were interviewed. They described their ‘lived experiences’ of the emergencies. Significant themes included issues around communication both verbal and non-verbal and the need to make sense of what had happened to them. The interviews provide a valuable insight into obstetric emergencies highlighting areas for improvement and also the positive aspects to care that women received during these events.
Feelings and fears post obstetric emergencies – 2
Authors: Mapp Taniya
Published: May 2014

We have previously described women's experiences of obstetric emergencies. This second paper describes the postnatal consequences. Training for managing specific obstetric emergencies is available to healthcare professionals. However this training is not always informed of how women have perceived their experience. This study provides a picture of women's experiences of these traumatic events during chidbirth. This qualitative study followed a phenomenological methodology. Selection criteria was specifically aimed at women who had experienced one or more of the following types of emergencies during childbirth – cord prolapse, placental abruption, shoulder dystocia, uterine scar rupture, severe pre-eclampsia and major postpartum haemorrhage. Ten women were interviewed – they described their lived experiences of the emergencies. The study has raises issues for the improvement in care in an emergency setting and has implications for ‘debriefing’ in the postnatal period.
Webwatch
Authors: Hassall Jenny
Published: May 2014

While the Internet provides a wealth of useful resources for midwives finding relevant information can be time consuming and at times, quite frustrating. The National Library for Health provides an excellent gateway to a range of invaluable material to support clinical practice.
Exploring women's views on information provided during pregnancy
Authors: Soltani Hora , Dickinson Fiona M
Published: May 2014

The aim of this research was to explore women's views on information provided during pregnancy and assess whether it met the needs of women from varying backgrounds. Information was gathered via a cross-sectional survey using a questionnaire. The research focussed on hospital and home births within Southern Derbyshire Acute Hospitals NHS Trust (now called Derby Hospitals NHS Foundation Trust) in Derby, UK.The questionnaire was distributed to 700 women over a three month period. There was a 47% response rate and respondents were generally representative of the local population. The research found that women obtained most of their information from health professionals, family and friends, but 28% also obtained information from the internet. They preferred information to be given in either a one-to-one discussion or written format. Although over 90% read and understood most or all of the information provided, the sub-group analysis revealed that more than half of the women in the non-professional group did not understand all of the information. Women's individual information needs vary considerably and this should be taken into account in the planning and provision of maternity information.
Evaluation of a midwifery support service for pregnant teenagers
Authors: Mead Marianne , Brooks Fiona , Windle Karen , Kukielka Michelle , Boyd Danielle
Published: May 2014

In the context of the report on Teenage Pregnancy from the Social Exclusion Unit, two maternity units supported by their local county council, each established a support midwife post to provide increased support to pregnant teenagers and reduce social exclusion. One midwife was employed as supernumerary and provided support to the young women in addition to the care provided by midwives and other health care professionals. The other midwife was allocated a caseload of young women and provided full midwifery care. A retrospective study using the midwives' records, indepth interviews of key respondents and focus groups of the young women suggested some differences in the two models: the supernumerary midwife was able to make contact and involve a greater number of other professionals who could be influential in reducing social exclusion, but was not able to provide continuity of midwifery care. On the other hand, the case load midwife offered this continuity of care. The responses of the young women suggest that the use of resources specifically aimed at providing a service adapted to their needs had positive social, educational and health benefits. The role undertaken by these two midwives can be very challenging and isolating.
`I can't sit down' – easing genital tract trauma
Authors: Steen Mary
Published: May 2014

This article discusses the high prevalence of genital tract trauma and its many negative consequences for women, such as being unable to sit down comfortably. It highlights how suture technique and suture material can significantly contribute to the severity of perineal pain and discomfort and the importance of asking women about their ‘pain experience’. Treatments to alleviate the pain and discomfort are then reviewed. In conclusion, it would appear that a combination of systemic and localised treatments is necessary to achieve adequate pain relief which will meet individual women's needs.
Postnatal caesarean care: evaluating the skill mix
Authors: Baxter Jackie , Macfarlane Alison
Published: May 2014

The government, in its plan for reforms in the NHS, recognizes the importance of nurses and midwives undertaking new roles and breaking down old demarcations (Department of Health, 2000). In response to feedback from women and in order to provide safe and effective care for women who experience birth by caesarean section at a central London teaching hospital it was decided registered general nurses (RGNs) and nursery nurses (NNs) were recruited to provide support for midwives in caring for women postnatally. The nurses would support the women with their specific nursing needs while they recovered from surgery and nursery nurses would help women care for their babies. The aim was to free up more time for midwives to spend giving specific midwifery care. A postal questionnaire was sent to women who gave birth by caesarean before and after the nurses and nursery nurses were recruited. The introduction of these new roles appears to have improved care for women who experienced birth by caesarean section.
The health visitor's role and postnatal depression: an overview
Authors: Rothman Ruth
Published: May 2014

Health visitors have been working with women with postnatal depression for over a decade. Although this aspect of their role is not always seen as a priority, for many it has broadened so that some health visitors now have a real skill in this area. This article highlights the valuable role that health visitors have in the whole field of perinatal mental health and how this role could develop if it became a priority. It emphasises the reasons why this area is so important and the difference a proactive health-visiting service could make to families, as well as the importance of collaborative working. This article is based on my specialist work with families in this area for the last five years.
Support for infant feeding: mothers' perceptions
Authors: Cairney Patricia A , Alder Elizabeth M , Barbour Rosaline S
Published: May 2014

This study was designed to elicit how first-time mothers felt about the amount and type of support they received from health professionals about infant feeding.

The study took place in Eastern Scotland. Two hundred and ninety-seven women, of 23 years and over, expecting their first baby and experiencing a pregnancy free of complications, were included in this report.

Six statements about perceived behaviour and the attitudes of different health professionals were scored on a Likert scale. In this sample new mothers perceived midwives as giving less support than doctors or health visitors, and they were seen as more likely to favour breastfeeding women. Additionally, women who were giving some or exclusive formula feeds were more likely at one month to perceive midwives in this way.