bluuebunny/crossref_metadata_2025 huggingface dataset:
Why are some babies mucousy after birth?
Authors: Ingram Jenny , Johnson Debbie , Greenwood Rosemary
Published: May 2014

An exploratory investigation collected information about the factors during labour and around birth associated with the production of excess mucus in 160 breastfed babies (80 mucousy and 80 non-mucousy controls). Multiple logistic regression showed that the significant factors associated with ‘being mucousy’ were induction (odds ratio (OR) 2.55) vs spontaneous labour, a long membrane rupture to delivery interval (OR 16.19 for >24hours to delivery vs <6hours), heavier birthweight (OR 3.43 per kg heavier), a delay to the first breastfeed (OR 18.37 for >12hour delay vs <2hours) and skin-to-skin contact that was shorter than 30minutes (OR 6.02) vs >30minutes.
Silence and time in antenatal care
Authors: Stapleton Helen , Kirkham Mavis , Curtis Penny , Thomas Gwenan
Published: May 2014

The material in this series of papers is derived from a Department of Health funded evaluation of the MIDIRS Informed Choice leaflets (Kirkham and Stapleton, 2001). This paper analyses some of the behaviours and responses observed during interactions between midwives and childbearing women during antenatal consultations. In the majority of consultations observed there was little continuity of carer and women were mostly silent unless directly questioned by the midwife. Silence tended to be interpreted by midwives as both compliance with the suggestions they made, and as an absence of need for further information. Very few midwives demonstrated awareness of the powerful non-verbal cues they communicated to women. These cues signalled a clear preference for women to assume a silent, passive role and to agree with the midwife’s time-pressured agenda. Status and power differences between women and their midwives were largely maintained and only rarely did women report feeling a sense of equity in their interactions. Midwives across all study sites spoke positively, and often at length, about the concept of informed choice, yet they mostly behaved in ways which ensured women’s informed compliance with the local medical agenda.
Psychological support for perinatal trauma and loss
Authors: Read Sue , Stewart Chris , Cartwright Pat , Meigh Sue
Published: May 2014

This article explores the issues associated with perinatal loss identified from a professional and psychological support perspective within North Staffordshire. Bereavement is examined, and the impact of perinatal loss from a range of professional perspectives is explored. Examples of proactive responses (incorporating training and education, counselling, support and the development of specialist support) are offered as examples of collaborative ventures to address the psychological support needs of families for ongoing encouragement. The importance of collaborative working and sharing good professional practice is recognized as being crucial to this process.
Webwatch
Authors: Carr Natasha
Published: May 2014

This month's webwatch reviews the Nursing and Midwifery Council's (NMC) website: http://www.nmc-uk.org
What have the midwives ever done for us?
Authors: Ward Ivan , Singh Kalu
Published: May 2014

We have been reading the newspaper and magazine articles, and watching the occasional television programme about the shortage of midwives for some years. We wondered what ordinary citizens, ordinary humans, should think about this, and how they should act.
Sweet and sour – the National Service Framework
Authors: Robinson Jean
Published: May 2014

More on the National Service Framework (NSF) this month (Department for Education and Skills/Department of Health 2004). I'd like to see mothers pulling out cards from their handbags with selected extracts when the going gets tough. (A yellow card, I think – like the referee's warning.)
Current issues in Midwifery: Not just another conference
Authors: Lavender Tina
Published: May 2014

It is a very exciting time for midwifery, with the publication of the National Service Framework for Children; the launch of the Royal College of Midwives’ Campaign for Normal Birth (fomerly known as the Virtual Institute for Birth); and the growing feeling among many midwives that the direction of maternity care is back on track. Midwives’ passion for normality is, at last, high on professional agendas and the many facets of midwives’ roles, e.g. high dependency, mental health, public health and community engagement, are being acknowledged.
Learning lessons from ‘Why Mothers Die’
Authors: Modder Jo
Published: May 2014

The ‘Why Mothers Die’ Report (2000 – 2002) from the Confidential Enquiry into Maternal and Child Health (CEMACH) (RCOG, 2004), was launched on 12 November 2004 at the Royal College of Obstetricians and Gynaecologists (RCOG). This is the latest report by the Confidential Enquiry into Maternal Deaths (CEMD), the first having been published in 1957 when the risk of a mother dying was 1 in 1500.
Evidence-based approaches to neonatal screening
Authors: Shepherd Ashley , Glenesk Ann , Niven Catherine
Published: May 2014

Since the introduction of the Guthrie test in the 1970s, millions of babies have been screened for inborn errors of metabolism. Technological advances in the automated devices used to puncture the heel ensures that they are ‘safe’ in so far as the depth of incision is controlled, eliminating damage to the calcaneus bone. However, the choice of automated or manual device used by midwives is arbitrary and not supported by research findings. The procedure used by midwives today is similar to that issued when the Guthrie test was first introduced despite research findings which contradict parts of the procedure. There is also evidence that the number of insufficient samples have been on the increase since 1998. This, coupled with the need for more blood since the introduction of cystic fibrosis screening in Scotland, points to the need for evidenced-based practice being applied to the newborn bloodspot screening test.
Commission for Health Audit and Inspection
Authors: Dimond Bridgit
Published: May 2014

The Commission for Health Improvement was set up in 2000 to act as an inspector and watchdog of standards within the NHS. Its powers and functions were set out in the Health Act 1999 and subsequent statutory regulations. From April 2004, as a consequence of the Health and Social Care (Community Health and Standards) Act 2003, it is to be replaced by a successor body, the Commission for Health Audit and Inspection, which has been preparing in shadow from under the chairmanship of Sir Ian Kennedy. The equivalent body for social services is the Commission for Social Care Inspection (CSCI).
Correspondence
Authors: Warwick Catherine
Published: May 2014

I read Caroline Flint's column in the March edition of the journal with interest (Vol 12(3): 141) and would like to express a different point of view about NICE Guideline Antenatal Care.
Webwatch
Authors: Carr Natasha
Published: May 2014

It is estimated that about one in seven people have problems conceiving. In midwifery we often see the success stories, but we must also be mindful of the process that some couples will have been through to get to the point of being pregnant. The Human fertilisation and Embryology Authority (HFEA) was initially set up by the Human Fertilisation and Embryology Act 1990. It is concerned with regulating and monitoring IVF, donor insemination, the storage of eggs, sperm and embryos and human embryo research that occurs in the UK, including a Code of Practice.
Understanding birth and Sphincter Law
Authors: Gaskin Ina May
Published: May 2014

Have you ever found it difficult to explain to a physician or to a pregnant woman why some women give birth with ease, whereas others seem to require extraordinary measures in order to give birth? For over half a century, authors of obstetrical textbooks have explained this difference by invoking the so-called ‘Law of the 3 Ps’, the Ps being the passage (the woman), the passenger (the baby) and the powers (the quality and frequency of uterine contractions). This mechanical explanation has not changed at all over the last 75 years, although the rate of medical interventions in childbirh has increased drastically in most industrialized countries during that same period.
Legal liability of the midwifery delegator
Authors: Dimond Bridgit
Published: May 2014

In this month's Legal Forum (page 42) there is a discussion of the lawfulness of delegating midwifery activities. In this article we consider delegation and liability.
Learning from the Bristol Pregnancy and Domestic Violence Programme
Authors: Baird Kathleen , Salmon Debra , Price Sally
Published: May 2014

This paper reports on an evaluation of the Bristol Pregnancy and Domestic Violence Programme, introduced to support the launch of routine antenatal enquiry for domestic violence. In particular, it focuses on data from a national survey of Higher Education Institutions (HEIs) (n=23) and interviews with educationalists (n=10) that assessed the potential impact on education of the introduction of routine antenatal enquiry. Findings suggest that a more systematic approach to domestic violence teaching is needed, focusing on the development of skill acquisition in ‘asking the question’. While HEIs were enthusiastic about their role, professionally developed competencies for pre-registration students are also required to sustain routine enquiry in the longer term. Similarly, existing staff require access to validated programmes within trusts, in association with child protection training to enable existing practitioners to role-model good practice. Where possible, education should be delivered inter-professionally to enable practitioners to establish their role alongside other professionals and agencies, particularly the voluntary sector.
Cutting smoking rates in pregnant women
Authors: Viccars Anne
Published: May 2014

National No Smoking Day on 9 March 2005 highlighted the battle the UK still faces in tackling smoking. The health implications are particularly significant for midwives and for women in their care. The effects of cigarette smoking on adults and their children, specifically on the developing fetus, are well documented. Coverage in the national press suggest that we are on a roller coaster with some trying to protect against environmental or passive cigarette smoke and others trying to take a more moderate view and raising issues of freedom of choice.
Are we surrogate mothers, form fillers or practitioners?
Authors: Donovan Pat
Published: May 2014

Everyone knows that there is a chronic shortage of midwives. In some areas there are problems with recruitment and in others there are problems with retention. Midwives are also under continual pressure to provide a service expanding out of proportion. Antenatally, more is required from the midwife in offering informed choice so women are aware of all they are entitled to as well as what is locally available. Giving advice on screening results and on lifestyle changes, exploring mental health and social circumstances all impact on maternal mortality (Confidential Enquiry into Maternal and Child Health (CEMACH), 2004) are an essential role of the midwife in the 21st century. It is therefore necessary to explore a more effective ‘use’ of the midwife.
Avoiding professional misconduct
Authors: Robinson Jean
Published: May 2014

We are just waiting for the next case, where the defendant may be claiming ‘But I was just following the recommendations in the last Confidential Enquiry into Maternal Deaths’. Let's see what the Professional Conduct Committee makes of that one. If the accused midwife also says ‘and, as the enquiry suggested, I discussed the case with my supervisor, who backed my decision’, AIMS will report the supervisor too. And if the NMC fails to act, we have every intention of going higher.
Designer babies: sense and suitability
Authors: Dimond Bridgit
Published: May 2014

The House of Lords held on 28 April 2005 that it was lawful for the Human Fertilisation and Embryology Authority HFEA to give a license for tissue typing an embryo, thereby enabling a woman to have an embryo implanted whose tissue would be compatible with that of an existing sick child. The facts of the case are set out in Box 1.
Newborn screening: a study of midwives' educational needs
Authors: Israel Janet A , Parsons Evelyn P , Williams Gail , Bradley Don
Published: May 2014

This study aimed to evaluate the educational needs of midwives about newborn screening and medical genetics and make recommendations about appropriate educational interventions. A questionnaire was completed by a group of midwives in Wales (n=607) detailing their educational needs. Three focus groups (n = 24), provided qualitative data on midwives educational needs and potential educational interventions. There was a strong indication that midwives needed more education both in terms of the diseases screened for in the newborn period and medical genetics. If midwives practice is to keep abreast of the changes in society and the advances in science, consideration must be given to more comprehensive post-registration education. A structured framework incorporating self and directed learning and the development of the newborn screening co-ordinators remit is one approach to ensuring midwives are ‘competent, capable and caring’. Such an approach would also help ensure that the recommendations of the Human Genetics Commission (March 2003) are upheld. New technologies need to be used in such a way that mothers and families receive good advice and guidance.
Anti-shock suit to control postpartum haemorrhage could save lives
Authors: Bainbridge Jane
Published: May 2014

Freelance health writer Jane Bainbridge takes a look at news on midwifery worldwide and offers an overview of initiatives to promote maternal, infant and reproductive health across the globe.
A relevant overview of perinatal mood and anxiety disorders
Authors: Church Sarah
Published: May 2014

This book presents an overview of mood and anxiety disorders that can occur during the postpartum period. It is a synthesis of the research and clinical experience of two known authors within the field of postpartum mental health. Although it is an American text, it does provide midwives working outside the US with a useful resource. While the organization and delivery of care is specific to the US, the discussion is well supported by international literature, which may reflect the authors’ intention to appeal to an international audience.
The role of TBAs in midwifery care: The Ugandan experience
Authors: Tuguminize Lydia
Published: May 2014

According to The Millennium Goals, 2005 was considered a breakthrough year, especially in the areas of maternal and infant morbidity and mortality (Uganda National NGO Forum,). In Uganda the figure of 506 maternal deaths/100,000 live births has remained high in spite of a huge amount of money and effort expended on reproductive health programmes. According to information from M.O.H, most direct causes of maternal mortality in Uganda include bleeding, infection abortion and lack of antenatal and postnatal health care. A cross-sectional observational study was carried out in Kitimbwa, Kayunga District, Uganda. The objectives were to evaluate the knowledge and skills of traditional birth attendants (TBAs) in their role as auxiliary midwives.
Caesarean delivery at maternal request: Why we should promote normal birth
Authors: Lavender Tina , Kingdon Carol
Published: May 2014

An article published recently in a national newspaper sparked furious debate on the question of choice for women in the manner of birth. Tina Lavender and Carol Kingdon examine the arguments on both sides and offer their own view on the article and the issues raised.
Birth centre closures: Avoiding long term costs for short term savings?
Authors: Robotham Mandy , Hunt Sarah
Published: May 2014

Stroud Birth Centre is once again threatened with closure despite increased birth rates, breastfeeding rates above the national average and a knack for balancing the books that their controlling trust could usefully strive to emulate.
NICE draft intrapartum guideline: Join the consultation and have your say
Authors: Walsh Denis
Published: May 2014

Over the summer the NICE draft intrapartum guideline is out for consultation and registered stakeholders have until the end of August to feedback. The timeframe is short (they have been available on the NICE website www.nice.org.uk since the 22 June) and the scope of the guideline huge, as it also includes place of birth.
Appropriate delegation of midwifery duties: Widespread confusion persists
Authors: Jones Shirley
Published: May 2014

Delegation of midwifery duties is a cause of some disagreement among midwives. Accountability is key argues Shirley Jones, reminding midwives that competence and proficiency must be ensured.
Malaria and HIV: A deadly combination for African mothers and infants
Authors: Daniel Lincia
Published: May 2014

Lincia Daniel reports on the combined scourge of malaria and HIV/AIDS in Africa and offers an overview of initiatives to address current midwifery and infant health issues across the globe.
Management of the nuchal cord: a summary of the evidence
Authors: Melvin Cathie , Downe Soo
Published: May 2014

A systematic review of management practices, caregivers' views and women's experiences was undertaken to determine the outcomes associated with nuchal cord management practices after the birth of the baby's head and before the delivery of the shoulders for vaginally born, term, healthy neonates.

Three hundred and sixty-one initial hits arose from the search strategy. After abstract and full text review, three of these were found to fit the inclusion criteria. They were tabulated thematically. The findings were that midwives' stated beliefs appear to endorse a hands-off policy, although there is some evidence that midwives tend to cut or reduce nuchal cords in practice. There are almost no data on women's experiences of manoeuvres associated with locating and severing a nuchal cord. There is a notable absence of evidence that could be used to support recommendations for cord clamping practices with regard to management of the nuchal cord.
Midwifery education in Australia: requirements for assessment
Authors: Pincombe Jan , McKellar Lois , Grech Carol , Fedoruk Maria , Bria Karina , Grinter Elizabeth , Beresford Geraldine
Published: May 2014

Over several decades, national competency standards have been developed in Australia to define competence for midwives. Furthermore, national standards for the accreditation of the three year, Bachelor of Midwifery programme have been developed. Each standard has associated evaluative criteria such as minimum clinical requirements to determine if the standard has been met. Concerns have been raised regarding competency based approaches to midwifery education which may not incorporate national competency standards and, in particular, minimum clinical requirements for registration. Philosophically there has been a move by many of the registering bodies in Australia from competency based standards to a more prescriptive approach. For example, midwifery graduates seeking to register as a midwife are now required to demonstrate substantial birthing experience as a pre-requisite for registration. However, the current number of births required for registration purposes is unsupported by evidence and appears to be based on custom and tradition. It is essential that any midwifery practice requirements are based on evidence based research in order for the profession to be guided by evidence based outcomes. It is the purpose of this paper to present a systematic review of the evidence for incorporating minimum clinical requirements as an appropriate assessment criterion for registration.
Sickle cell anaemia in pregnancy and the neonates: ethical issues
Authors: Zack-Williams Dorothy
Published: May 2014

Modern Britain is a pluralistic, multi-racial society and nowhere does this diversity manifest itself more patently than in NHS hospitals where people from diverse racial, ethnic and religious backgrounds are treated or work. Yet in many ways health professionals are not fully equipped to deal with the specificity of inherited blood disorders, which are often associated with Black and Racial (ethnic) Minority/Black and Minority Ethnic (BRM/BME). Often conditions such as sickle cell anaemia and thalassaemia are treated as ‘clinical exotica’ because they are uncommon in the White/European population. However with the advent of universal screening we are now seeing unusual haemoglobin occurring in the White population because of inter-marriage and the subsequent gene mixing. In this article attention is drawn to some ethical issues for midwives working with pregnant women suffering from sickle cell anaemia and sickle cell disease. The article begins by discussing what constitutes sickle cell anaemia, sickle cell disease and sickle cell trait. It moves on to look at the incidence of sickle cell conditions in Britain and addresses some of the ethical issues that will confront midwives working with these women in pregnancy, labour and with neonates.
What is evidence-based practice and why do we need to use it?
Authors: Roughley Gwen
Published: May 2014

Midwifery can at times be viewed as ritualistic with certain procedures and interventions now established within midwifery-led care and ‘normal’ childbirth. Performed without thought or analysis these rituals may be founded on obsolete data, preferences, opinions, customs and habit rather than good, quality research results and as such cannot be classed as evidence-based practice.
Incapacity to consent
Authors: Symon Andrew
Published: May 2014

The law regarding consent is well established, and most midwives will be entirely familiar with it. O'Boyle (2006) notes that there is a plethora of guidance supporting practitioners when considering this topic. Midwives mainly deal with women who are mentally competent and the question of over-ruling a woman's stated wishes rarely arises, at least not explicitly. However, there are those who claim that both ‘informed choice’ and ‘informed consent’ are myths in contemporary maternity care (Robertson, 2003). There is an argument which claims that the ‘obstetric police’ are determined to over-rule the expressly stated wishes in favour of ‘fetal rights’ (Meredith, 2005), although most of the supporting evidence for this derives from the USA and not the UK.
Do women understand the reasons given for their caesarian sections?
Authors: Baxter Jackie
Published: May 2014

This paper intends to highlight two important additional findings from a study set up to evaluate a change of practice in postnatal care. The study found significant differences in levels of satisfaction with their postnatal ward care between women who both gave birth by caesarean section (cs) before and after the introduction of nursing staff during 2003. Women cared for after this change were found to be significantly more satisfied than women prior to the recruitment of the nursing staff. The full study is presented elsewhere (Baxter and Macfarlane, 2005) As well as serving as a mechanism for evaluating new roles this study has also provided a welcome opportunity of finding out more about the experiences of a group of women who gave birth by caesarean section in a central London teaching hospital.
Tackling maternal obesity: suggestions for midwives
Authors: Richens Yana
Published: May 2014

Maternal obesity is the largest future challenge facing maternity services. Currently there is no national guideline on how midwives should care for this group of women. Those involved with the care of women must start to address this issue. This article highlights some of the complications and risks to mothers and babies and provides suggestions for care based on the current evidence.
Bring back the scales
Authors: Richens Yana
Published: May 2014

One of the biggest threats to the health and wellbeing of mothers and their babies today is the rising epidemic of obesity. As I recently suggested, midwives have been aware of, and have attempted to deal with the problems associated with obesity during pregnancy for several years.(Richens, 2008). However this has been done on an ad hoc basis as there are no current guidelines or advice for midwives or obstetricians on caring for women who are obese, despite the fact that they are at increased risk of:
Re-engaging with accountability
Authors: Gould Debby
Published: May 2014

Last month the Nursing and Midwifery Council (NMC) published an analysis of Local Supervisory Authority UK reports (NMC, 2008). The supportive use of Midwifery Supervision in raising midwifery standards and improving safety of care for women and babies is acknowledged. However ten recurrent themes of concern are identified which span many years and the whole of the UK. The NMC suggest this may indicate that there are as yet unaddressed fundamental issues affecting midwifery and maternity services which transcend individual organizations. The ten themes are:
Case studies in childbirth journals: stories of unusual birth
Authors: Walsh Denis
Published: May 2014

If you are someone who regularly looks at obstetric journals, you will have noticed the regular slot that is set aside for unusual pathology in the form of a case study. This type of entry is shared by many of the major obstetric journals and I wonder if it serves a purpose beyond curiosity and quirkiness. At one level, it suggests that childbirth can go wrong in all sorts of ways and of course it reinforces the idea that childbirth is risky. Sara Wickham (2005), among others, has written about theoretical risks that influence practice, for example, water embolism in water birth. Theoretical risks are, by definition, theoretical—nobody has heard of it ever happening—yet they probably make individuals wary of a new practice. Recently, a midwife enquired whether it was really safe for a woman who had ruptured membranes to enter a birthing pool because local policy excluded it and she did not know why.
Supervised practice programmes: help or hindrance?
Authors: Capito Clare
Published: May 2014

The statutory supervision of midwives has been in place since the 1902 Midwives' Act and was viewed as a means of regulating midwives by ensuring that they were appropriately educated. Over the years the supervision of midwives has developed and evolved to being more supportive of midwives by ensuring that they are promoting best practice and that poor practice is dealt with by means of remedial action. This remedial action has developed into the provision of a programme of supervised practice. In 2007 the Nursing and Midwifery Council published the Standards for the supervised practice of midwives with the purpose of ensuring that there was clarity and consistency with the use of supervised practice to address poor practice.

As an experienced supervisor of midwives, who has provided a number of supervised practice programmes, the author has written this article to share her knowledge and experience in this field. This article should prove to be of interest not only to supervisors of midwives but to midwifery managers who have to resource supervised practice programmes as well as to midwives so that the process is demystified and understood.

The author believes that when a programme of supervised practice is appropriately run, it can be a positive learning experience for all those involved.
A guide to omega-3 DHA intake during pregnancy and breastfeeding
Authors: Parker-Littler Catharine , Klein Kathy
Published: May 2014

It is well established that good nutrition plays an essential physiological role in a woman's and baby's health during pregnancy and the postpartum period.

Midwives have a strategic opportunity to influence and support healthy eating habits and dietary intake but need accurate and evidence-based information including any new knowledge to inform their clinical practice.

In recent years systematic reviews of scientific literature and consensus recommendations from international and national experts have emphasized the important benefits of Omega-3 long-chain polyunsaturated fatty acids (LC-PUFA) especially docosahexaenoic acid (DHA) on fetal development and maternal health.

This article includes a review of recent literature relating to adequate DHA intake for preconception, pregnancy and breastfeeding. The literature is reviewed with the purpose of providing midwives with a scientific basis from which they will be confident to share their knowledge.

Also included is a guide designed to help midwives establish a cohesive practice regarding the communication of Omega-3 DHA information and intake recommendations, including common food sources.
Folic acid supplements risky in late pregnancy
Authors: Bainbridge Jane
Published: May 2014

Although folic acid supplements are recommended in early pregancy, an Australian study has found that they may not be safe to take beyond 16 weeks gestation as there is a risk that the baby may develop asthma.
Improving the quality of maternity service provision
Authors: Airey Rebecca , Farrar Diane , Wilkinson Kath , Walker Julie , Tuffnell Derek
Published: May 2014

Government iniatives have emphasized the need for development of patient-led services. There is a commitment within these initiatives for service user involvement in the development of high quality, safe and accessible care which meets the needs of the local population and that the implementation of this initiative should be within existing funding. The achieving sustainable quality in maternity (ASQUAM) model aims to identify areas for service improvement and involve users in non-threatening, multidisciplinary group discussions and decision making, through a process of democratic prioritization. This article discusses the implementation of the ASQUAM model in Bradford, past implimentation success, recently identified areas for improvement and future development. Overall the ASQUAM model is viewed as positive by service users, the general public and health professionals.
Midwifery research internships: the future?
Authors: Docherty Ann , Louise Leon Rebecca , Kennedy Rosemary
Published: May 2014

Research in education has been part of the government's agenda for a number of years, highlighted in the Strategic Plan 2006–2011 (Higher Education Funding Centre for England, 2005), Innovation nation (Department for Innovation, Universities and Skills, 2008) and the High quality care for all: NHS next stage review (Darzi, 2008). This commitment by the government to promote innovation and high value services can only be achieved through research which enables the expansion of knowledge and understanding. The provision of research intern opportunities to undergraduates is one way to help maintain and improve the UK's reputation as second to only the USA in quality of research (Higher Education Funding Centre for England, 2005). This standing can only be enhanced by such initiatives that aim to increase knowledge exchange between the research base and service sector. Three students had the privilege to take part in such internships.
Fatty foods in pregnancy linked to fatter babies
Authors: Daniel Lincia
Published: May 2014

Women who eat a diet of high glycaemic foods in the later stages of pregnancy are having babies with higher birth weights and putting their babies at greater risk of childhood obesity.
Book Reviews
Authors: Creighton Sarah
Published: May 2014

Paediatric and adolescent gynaecology is increasingly recognized as a sub-speciality within gynaecology. It is becoming clearer that those caring for children and adolescent girls need specials skills. This book is a concise handbook covering both common and rare gynaecological issues in children.
Migration is our challenge and our success
Authors: Warwick Cathy
Published: May 2014

The machinations of MPs' expenses, the daily speculation as to the fitness of government and the outcomes of local and European elections may not be uppermost in the minds of midwives doing their best on a day to day basis to improve services to women. It is unlikely however to have escaped their notice that the British National Party (BNP) has just won two seats in the European Parliament.
Questioning mentorship
Authors: Baikie Kyle
Published: May 2014

As a third-year midwifery student, I feel the importance of clinical placement has increased with each year of my training. During the first year I worried about achieving my goals within my Clinical Competencies and Continuous Assessment booklet (CAP book) and witnessing a birth. In the third year, however, the CAP book is at the back of my mind, and experience and responsibility are my priorities.
Supporting the message: ‘alcohol and pregnancy don't mix’
Authors: Barnett Carol , Forbes Jane
Published: May 2014

Women are faced with conflicting advice on how much alcohol is safe in pregnancy so in November 2008, Alcohol Focus Scotland ran a campaign to deliver their message that ‘alcohol and pregnancy don't mix’.
Diagnosing the latent phase of labour: use of the partogram
Authors: McDonald Ginny
Published: May 2014

Clinically the latent phase of labour is poorly understood and can be hard to define. The concept of the latent phase has significance in understanding normal childbirth because labour is considerably longer when a latent phase is included. This in itself can be detrimental to a woman's opportunity to birth naturally without intervention.

This article explores the literature available surrounding the phenomena of the latent phase of labour, how it is diagnosed and how it is measured in the form of a partogram. Discussion finds that there is no reliable evidence to support the use of arbitrary time limits that are placed on women during labour. Exploration is made surrounding the misdiagnosis of labour, the inappropriate use of the partogram and also the consequences of getting it wrong.
Dame Christine Beasley (DBE)
Authors: Lavender Rebecca
Published: May 2014

Can you give me a brief summary of your career to date?

After training as a nurse at the Royal London Hospital and working as a staff nurse and junior sister, I left nursing for 10 years to focus on my children. I returned to nursing as a district nurse. I have held a range of senior nursing and managerial posts, which included chief nurse and general management posts in hospital and community services. I have worked at regional and national level in developing policy and implementing large scale change across England.
Going to university: hints and tips for new midwifery students
Authors: Lee Karen , Busby Alison
Published: May 2014

This article is aimed at new undergraduate students of midwifery. Healthcare programmes are a mix of theory and practice and therefore have unique challenges. Hints and tips are provided here on living away from home managing finances, practice and study.
Spurious fetal movement after late fetal death
Authors: Burden Christy , Male Sophie , Fox Robert
Published: May 2014

One in 200 babies are born dead in the UK (Confidential Enquiry into Maternal and Child Health (CEMACH), 2009). There were 4 037 stillbirths in 2007, an average of more than 10 per day. This compares with the much lower rate of 1 in 10 000 for sudden infant death (CEMACH, 2009)
Medication-taking behaviour during pregnancy: is it appropriate?
Authors: Twigg Michael , Desborough James , Wright David
Published: May 2014

The medication-taking behaviour of pregnant women during the first two trimesters of pregnancy was assessed to ascertain whether they were appropriately using over-the-counter (OTC) preparations during pregnancy. 578 (55.7%) women completed and returned a questionnaire, of which 248 (42.9%) reported using one or more medications to treat one of the six common ailments listed in the questionnaire. The majority of medicines purchased were for heartburn and indigestion and which are considered safe to use during pregnancy. However, there were seven (1.9 %) reports of women using oral decongestants which are deemed inappropriate. This study suggests that most women are using available information to make appropriate decisions about OTC medicine use during pregnancy. However, warnings pertaining to the use of oral decongestants may need to be more prominent or woman may need better education on how to interept them
Induced lactation in the nulliparous adoptive mother
Authors: Denton Yvonne
Published: May 2014

For some adoptive mothers and their babies, breastfeeding provides both physical and emotional benefits. Recent research has highlighted the difficulties that adopted babies have with attachment and bonding, and researchers advocate breastfeeding as a way of improving the mother and baby's relationship. In addition, it has been suggested that breastfeeding an adopted baby may help to relieve the disappointment of not being able to become pregnant and build confidence in becoming a mother. Therefore, the aim of this paper is to discuss the needs of the nulliparous adoptive mother who wants to breastfeed and to create an action plan in supporting such a woman to ensure maximum potential in achieving her goal.
Australian researchers claim home birth increases risk of babies dying
Authors: Bainbridge Jane
Published: May 2014

New research highlighting risk has supported the Australian Federal Government's decision not to provide indemnity insurance and Medicare funding to midwives attending home births, leading to angry midwives.
Improvement of maternity services will require further investment
Authors: Stephens Liz
Published: May 2014

It seems a long time ago now, but over the Christmas period I managed to do a rare but welcome week in clinical practice. The first of my days I worked a long day, when I arrived the labour ward was busy. Our labour ward coordinators are very kind to me, and usually give me low-risk women to look after. This particular morning I was allocated a very nice woman having her second baby. As she was in early labour and all the midwives were looking after women, most of whom had more complex needs, I was happy to admit a second woman when she arrived. This woman was expecting her first baby and was in early labour.
One size fits too few: complex needs of women
Authors: Clift-Matthews Victoria
Published: May 2014

How many of you try on a pair of trousers or a dress where the label says it is your size but you can't quite seem to fit into it—either the waist is too big or it is made for someone with small breasts when your shape is somewhat more buxom? One size definitely does not fit all. Similar can be said sometimes for the services we receive. Good customer service where queries or complaints are responded to quickly, where nothing is too much trouble, and your name is remembered is always appreciated.
Deprivation of liberty safeguards
Authors: Griffith Richard
Published: May 2014

Midwives will occasionally have to care for women who lack decision making capacity because of a mental health problem or severe learning disability. To protect such women from harm it may be necessary to deprive them of their liberty by subjecting them to a great deal of control and supervision and prevent them from leaving the maternity unit. For example, in Norfolk and Norwich Healthcare NHS Trust v W [1997] a woman with a history of mental health problems arrived at hospital ready to deliver her baby but in a state of arrested labour and denying that she was pregnant. She would not consent to the caesarean that was urgently needed. Treatment was authorized because W lacked the capacity to make the decision.
Indonesia improves quality of care in childbirth to reduce maternal death
Authors: Bainbridge Jane
Published: May 2014

Indonesia has one of the highest maternal mortality rates in Asia, but as well as needing better medical facilities, another problem is that rural families often seek the help of shaman.
Sexual Offences Act 2003: key concepts
Authors: Griffith Richard
Published: May 2014

Most sexual offences evolved in the 19th century and resulted in some of the crassest anomalies in the law from times when values and opinions used to prevail which have long since been abandoned. Reform has been slow and done in a piecemeal, unstructured fashion.
ONE-TO-ONE WITH…
Authors: Lavender Rebecca
Published: May 2014

I qualified as a doctor in 1972 and worked in Sri Lanka the UK and Singapore. I returned to the UK in 1997 where I have remained. For 6 years I was treasurer of the International Federation of Obstetrics and Gynaecology and Secretary General for 3 years before serving as Vice President for Education at the RCOG. I became President in 2007.
Bonding begins before birth
Authors: Clift-Matthews Victoria
Published: May 2014

Bonding is a term used frequently to encapsulate elements of attachment and affection observed and desired by the mother for her child. Forming a bond can be a complicated and emotive issue, one that brings much joy where a bond is recognized and much anxiety and even self-blame for the mother when a bond is felt to be lacking. There is much written about bonding in journals, magazines and baby books, enough for any mother to feel inadequate if she doesn't perceive an instant bond with her new baby, but there are many different ways to bond and circumstances which can impede the initial bonding process.
The young parents' group: supporting vulnerable parents
Authors: McKenzie Karen , Wade Rebecca , Davidson Linda
Published: May 2014

This article reports on one of the initiatives developed by the first Sure Start midwife in Scotland: a young parents group which provides antenatal and postnatal support to vulnerable young parents. The structure and content of the group is outlined and is related to the existing evidence base. The feedback received from the participants suggests that they find the group beneficial and that, in particular it provides valuable validation of them in the parental role. No formal evaluation of the group has taken place to date and it is important this is carried out.
ONE-TO-ONE WITH…
Authors: Lavender Rebecca
Published: May 2014

Can you give me a brief summary of your career to date?

I began my midwifery career as a general nurse before qualifying as a midwife in 1983. I spent many happy years working as a midwife across a variety of clinical settings at the Birmingham Women's Hospital. While working in a number of senior posts, I had three children, developed an interest in infant nutrition and gained an MSc in Advanced Midwifery. In 1999, I was appointed as the National Infant Feeding Adviser to the Department of Health in London and had a steep learning curve getting to grips with national policy and civil servants. I joined NICE in 2006 and I have worked in the centre for clinical practice for 3 years, playing a major role in developing clinical guidelines for the NHS.
‘Maternity tourism’ in Hong Kong straining healthcare system
Authors: Bainbridge Jane
Published: May 2014

Chinese women are keen to give birth in Hong Kong to avoid the penalties of having more than one child in China, but this means that maternity services are struggling to cope.
Control of fertility severely disrupted in areas experiencing violent conflict
Authors: Bainbridge Jane
Published: May 2014

The delivery of basic reproductive health services, prenatal and maternal care, family planning and terminations have been found to be significantly disrupted in war-torn regions.
A call to arms: The efficient use of the maternity workforce
Authors: McIntosh Bryan , Cookson Graham , Sandall Jane
Published: May 2014

NHS maternity services in England must increase productivity if the NHS is to make efficiency savings by 2014. At the same time, it is expected to maintain or improve patient outcomes such as safety and quality. Given staff costs are 60% of the budget; it is likely that either the number or composition of the workforce will need to be changed to meet these targets. In this article, the authors argue that very little is known about the impact of altering the skill mix on either productivity or patient outcomes. Furthermore, it is unclear whether output and outcomes are themselves trade-offs between increased workload, increased number of deliveries and the increased complexity of demand.
Antenatal interventions that support obese pregnant women
Authors: Powell Jenny , Hughes Clare
Published: May 2014

Maternal obesity is recognised as one of the main challenges facing maternity care today, yet there appears to be an aversion by health professionals to place non-diabetic, obese, pregnant women on a monitored, calorie-appropriate nutritional regime. This article explores current evidence in relation to the use of interventions during pregnancy and whether they can impact on maternal and neonatal outcomes. Overall evidence from the research would suggest that a more successful antenatal strategy appears to be to encourage a change in overall dietary composition to promote a more health-conscious diet rather than reducing food intake or avoiding specific dietary components. Interventions that incorporate exercise regimes are also discussed. The midwife's role in relation to supporting women with obesity during pregnancy is examined and the possible benefits of utilising motivational interviewing techniques when caring for these women is identified.
Samoan women's attitudes towards antenatal and midwifery care
Authors: Tanuvasa Ausaga Faasalele , Cumming Jacqueline , Churchward Marianna , Neale Jenny , Tavila Aliitasi
Published: May 2014

Late antenatal care attendance could be linked to Pacific women having higher rates of perinatal mortality, premature delivery and birth complications ( Perinatal and Maternal Mortality Review Committee (PMMRC), 2010 ). Aim: To explore, in depth, the attitudes of Samoan women towards antenatal and midwifery care. Methods: A qualitative study, where individual face-to-face audio-recorded interviews were conducted in either English or Samoan with 40 Samoan women and 10 key informants from professional organisations and midwifery practice. Results: Most women in this study did not have complications with their pregnancies and attended their first antenatal appointment in their first trimester of pregnancy. Fewer women attended antenatal care later in their pregnancies (15th week of pregnancy or after), but this group did not experience pregnancy complications either. The Samoan women viewed pregnancy as wellness and very few of them had planned their pregnancy. Although most participants did not relate to the content of mainstream antenatal classes because they were not culturally appropriate, they were satisfied with their midwifery care. Conclusions: While it is generally assumed that early attendance at antenatal care services is related to good pregnancy outcomes, this research tends to suggest that this is not always the case. Most of the Samoan women in the study had not planned their pregnancy and pregnancy was not considered to be an ‘illness’. Because they felt well during pregnancy, these women did not see the need to attend antenatal classes and did not necessarily register with antenatal services early in their pregnancy. Regardless of when they first accessed antenatal care services, most of the women had healthy pregnancies and were happy with the service provided by their midwives.
Progress in prenatal genetic diagnosis: Using cell-free fetal DNA in maternal blood
Authors: Oxenford Kerry , Karunaratna Madhavi , Hill Melissa , Taffinder Sally , Chitty Professor Lyn
Published: May 2014

Non-invasive prenatal testing (Nipt) using cell-free fetal DNA (cffDNA) is an exciting area of development in prenatal diagnosis. CffDNA is found in maternal plasma from 4–5 weeks' gestation, enabling fetal genetic testing from a maternal blood sample, and thus avoiding the miscarriage risk associated with current invasive tests. Nipt is already established in the UK for predicting the rhesus D (RHD) type of the fetus in sensitised RhD-women and fetal sex determination for women who are carriers of sex-linked conditions. applications of Nipt likely to be available in the near future include testing for single gene disorders and chromosomal abnormalities, such as Down's syndrome, as well as routine fetal RHD typing for all RhD negative women. Midwives will play a key role in providing information to women and ensuring new tests are implemented effectively into practice. this article will provide an overview of the current developments in Nipt and discuss some of the ethical and social implications.