bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the value of smoking cessation advice
Authors: Jones Diane
Published: May 2014

Midwives need to critically analyse how they can effect smoking rates in the UK. The National Institute for Clinical Excellence (NICE) (2002) estimate that approximately 4 million smokers a year attempt to quit, but only 3–6% succeed. This quantitative study explores the attitudes of midwives and pregnant women towards smoking cessation advice, to understand why it is not a routine part of antenatal care, and to influence a decline in smoking among pregnant women. Questionnaires were given to 86 midwives, 33 were returned (response rate 38%) and 94 given to pregnant smokers attending antenatal clinic over a 1 month period. Forty were returned (response rate 42%). The data were analysed using SPSS specific statistical tests. Only 45% of midwives offered smoking cessation advice routinely, although 82% felt it should be a part of the antenatal care (82%). Lack of time (66%) and training (54%) were the major reasons for this. Smoking cessation advice was not a priority for discussion among the midwives compared to topics such as antenatal screening or place of delivery. Women were aware of the dangers of smoking in pregnancy, but those who wanted to quit need more support from their midwives (83%). They ranked smoking cessation as a high priority for discussion at the antenatal visit. The midwives did not feel able to offer smoking cessation advice. The main reason being a of lack of time in the antenatal clinic.
Fasting in Islam — implications for midwifery practice
Authors: Zaidi Fawzia
Published: May 2014

In Islam fasting is one of the five Pillars of faith and is observed during the month of Ramadan. Muslims observe the obligatory fast as an act of self-discipline, self-restraint and obedience to God. Pregnant Muslim women often fast during Ramadan. There is no mention of exemption in the Qu'ran for this group but some religious scholars would consider their exemption. Current evidence on clinical outcomes during the fast of Ramadan is inconclusive. However, in the event of maternal and fetal compromise, medical concerns should be clearly explained so that informed decisions can be made. Support and understanding by health-care professionals would ensure high quality maternity care.
Further issues in deciding staffing needs
Authors: Ball Jean , Bennett Beverley , Washbrook Marie , Webster Frances
Published: May 2014

Undertaking the Birthrate Plus (BR+) Programme in so many units indicated other areas of information needed for staffing decisions. This has produced a basis for calculating extra allowances of time for day-to-day supervision of midwifery and this is added to the example of how the different ratios per hospital, home/caseload based births:whole time equivalent (w.t.e.) midwives can be used for strategic planning. A ratio for cross-border cases per w.t.e. midwife is also indicated but needs further validation. There is an urgent need for the profession to debate the issue of staffing standards for midwife-led units and a way forward is suggested. The results of the BR+ Programme to date have provided a basis for staffing standards in midwifery and continuing data if funding allows will provide further validation and understanding.
Self help for constipation and haemorrhoids in pregnancy
Authors: Tiran Denise
Published: May 2014

Constipation and haemorrhoids are considered to be ‘minor’ disorders of pregnancy, but in reality they can cause some women severe physical and psychological distress, as well as potential long-term postpartum morbidity. This article considers how complementary therapies can provide a range of additional self-care options for women suffering these problems.
Managing pre-eclampsia 1: establishing guidelines
Authors: Jankowicz Dawn , Tufnell Derek
Published: May 2014

The introduction of guidelines for the management of severe pre-eclampsia in the Yorkshire region has led to the development of a Regional Midwifery Network. The appointment of a central co-ordinating audit midwife has facilitated this development. The network has primarily provided the structure required to audit a large series of cases of severe pre-eclampsia and eclampsia, providing knowledge about the use of the guidelines within the region and enabling improvements in care and outcome to be made. Secondary effects for the midwives have been increased clinical confidence in caring for pre-eclamptic or eclamptic women, educational resources, the evolution of a focused high-risk midwifery forum and improved multidisciplinary working in what has previously been a highly medicalised area of care.
Non-English speaking women are at risk
Authors: Richens Yana
Published: May 2014

This editorial focuses on a topic of great concern and aims to promote discussion and debate.
Testing a tool to assess perineal trauma
Authors: M Ullman Rosina , Yiannouzis Katie , C Gomme Clare
Published: May 2014

There is a need for an objective method of assessing perineal trauma. This would improve documentation and help clinicians decide whether or not a perineal tear should be sutured. This article describes the evaluation of a perineal assessment tool involving a convenience sample of 52 double assessments of postnatal perineal trauma. Comments made during and after the assessment showed midwives generally found the tool easy to understand and use. However, whilst inter-rater reliability in terms of concordance for each of the 6 components of the assessment tool was good (ranging from 68% to 96%), Cohen's Kappa for each set of scores was showed only low or fair levels of agreement (values for Kappa ranged from 0.081 to 0.559). One of the main reasons for these low scores was the limited range of trauma used to test the assessment tool. Further work is planned to carry out standardized reliability testing of the tool using a wider range of trauma.
Maintaining infant skin health and hygiene
Authors: Mainstone Adrian
Published: May 2014

Maintaining the health of a newborn's skin is an essential part of infant care and the choice of nappies and hygienic nappy-care plays an important role in achieving this. The critical care points where compromise can occur are identified as the time the infant spends in a wet nappy, leading to mechanical, chemical and microbial trauma, the cleansing routine of the skin at nappy change time, the steps taken to preserve the skin's own defence mechanisms, and control of infection through avoiding contamination of clothes, bedding and carers by soil and urine. There are factors common to infant care in both home and hospital although it is recognised there are added risks when many infants are cared for together.
A survey of soap and skin care product provision for well term neonates
Authors: Walker Lynne , Downe Soo , Gomez Liz
Published: May 2014

In the absence of definitive evidence relating to the use of soaps, detergents and emollients on the skin of the term neonate, we undertook a postal survey in the north west of England to establish the use and distribution of these products. Three surveys (antepartum, intrapartum and postpartum) were sent to all 29 maternity units. Seventy questionnaires were returned (80%). A total of six different bathing and cleansing products and ten products for dry skin were stocked within maternity units for use on neonates. Five were listed as being distributed to women. Seventeen products were recommended by midwives for the treatment of dry skin. Some respondents indicated that they did not always know what was distributed to postnatal women. Four of the units submitted guidelines. One of these was comprehensive. We conclude that, in this particular region, a range of products were used and recommended. In the absence of any definitive evidence in this area, it is important that formal research is undertaken into the potential benefits or harm of these products.
Stemming the rising caesarean section rate
Authors: O’Brien Patrick
Published: May 2014

I am facing a dilemma, and it's not for the first time. I'm sitting in my clinic opposite a woman – not a patient: she's perfectly healthy – who wants an elective caesarean section. There's no medical indication; this is a ‘maternal request’. She's a barrister, so is clearly far brighter than I am. She's also very well informed, having searched the net and read not merely random uninformed opinions, but NICE guidelines, Cochrane reviews and Lancet leaders. This woman is not ‘too posh to push’. She does not have a morbid fear of labour. But she has weighed up all the pros and cons and is certain that an elective CS is the right choice for her.
Wanting a caesarean section: the decision process
Authors: Weaver Jane J , Statham Helen
Published: May 2014

This article is the final part of a three-part study on operative birth and psychological issues. This part examines the findings from a three-year study into choice and decision-making in caesarean section (CS). Forty-four postnatal women were interviewed because they had reported making a decision about CS during pregnancy. The ideas, factors and events that influenced the women's thoughts and decisions were explored. Most of the women who had wanted CS discussed concerns about their own safety or the well-being of the baby. Sometimes these were grounded in previous obstetric problems, but sometimes they evolved during pregnancy. Although these concerns appeared to play a major part in the woman's decision they were sometimes not expressed to professionals. When they were expressed they were not always recognised or considered legitimate. Many women perceived CS to be safer than vaginal birth.
Birth centres offer the best
Authors: Newburn Mary , Muirhead Lorna
Published: May 2014

Before Christmas last year, we reported there ‘may be no room at the Inn’ for real life ‘Mary and Joseph’ expectant couples across the UK, because of the closure of birth centres. But this wasn't just a problem for the festive period; it's an issue that's continuing into 2006, as many mothers up and down the country find that their local birth centre has shut down, either temporarily or permanently.
Caseload midwifery: How teamwork makes family life possible
Authors: Fleming Anita
Published: May 2014

Is it possible to have a life and caseload midwifery? As a midwife practising in this way, I am constantly asked this question. It is certainly evident from remarks that have been made to me that the assumption is that there cannot be a work/life balance whilst working in a one to one midwifery group practice. In fact, one colleague remarked that she would not work in this way because her family life was too important to her. And mine isn't? So, when asked to give an opinion on the subject, I saw this column as an opportunity to set the record straight, and to try and demonstrate how this model of working can enhance family life.
Ten common pitfalls to avoid when conducting quantitative research
Authors: Hart Anna
Published: May 2014

Quantitative research requires a significant amount of time, effort and planning and all research has strengths and weaknesses that should be recognized and stated. The results should be interpreted by the researcher in the context of what is already known. This paper describes the problems commonly associated with quantitative research, including the formation of clear objectives, use of appropriate tools, loss or error in data. The key to good research is planning and anticipating problems.
Birth as rape: There must be an end to `just in case' obstetrics
Authors: Kitzinger Sheila
Published: May 2014

Women who suffer traumatic births often use the same language as victims of rape. Sheila Kitzinger discusses post-traumatic stress disorder resulting from birth and describes the effect on these women.
Increasing out-of-hospital births: what needs to change?
Authors: Barber Toni , Rogers Jane , Marsh Sarah
Published: May 2014

This is the third of three articles describing the work of the Birth Place Choices (BPC) Project, a Department of Health funded project carried out between May 2003 and May 2005 as a collaboration between Southampton University Hospitals NHS Trust and Portsmouth Hospitals NHS Trust.

The BPC Project had three aims:

1. To identify factors which influence women's decisions about where to give birth.

2. To determine whether the introduction of specially designed information and educational initiatives increase women's knowledge of choices for place of birth.

3. To determine whether implementation of these initiatives was associated with an increase in the number of women choosing to give birth outside main consultant-led maternity units.

This article describes the evaluation process carried out during phase two of the BPC Project, as well as the key successes of the BPC Project and the barriers which limited its effectiveness.
Cervical cancer in pregnancy: an assault on family and fertility
Authors: Roberts Karen , Rezai Nakissa , Edmondson Richard J
Published: May 2014

This case study offers an instructive example of how one gynaecological oncology and midwifery team provided comprehensive care to a 26-year-old woman diagnosed with cervical cancer at 27 weeks gestation into her second pregnancy. The paper highlights the lack of prospective randomized trials and clinical guidelines in this area and argues that each case is unique. The wishes of the woman and her family are of paramount importance when decision making about the potential impact of cancer treatment on their unborn baby. As this case study demonstrates many issues complicate both the cancer and the obstetric management in this situation. Following treatment for cervical cancer and the safe delivery of a baby life will never be the same again for the woman with cervical cancer. She must confront the reality of her disease, care for a premature infant, accept the impact upon her future fertility and live with the risk of future disease recurrence. This paper also explores the role of the nurse consultant in gynaecological oncology and the key nursing and midwifery issues during treatment, delivery and beyond.
Modern parents' perspectives on breastfeeding: a small study
Authors: Bailey Jacqueline
Published: May 2014

The aims of this study were to explore the meanings attributed to decisions and experiences surrounding breastfeeding and weaning by both parents. The study used semi-structured interviews to elicit the participants' stories. Six women and five men were interviewed in 2004. Transcripts were made of the recorded interviews and these were analysed using the techniques of IPA. Master themes and sub-themes were extracted and it was discovered that the parents were in agreement on many issues. Male and female parents today often work together as a team, but there is a sense among both that the woman should be discreet when breastfeeding. Women therefore need support to be able to feed their infants however, whenever and wherever they wish.
Self-administered homeopathy part two: a follow-up study
Authors: Steen Mary , Calvert Jan
Published: May 2014

Self-administered homeopathic remedies may be acceptable and effective for women and their partners during pregnancy, birth and after birth. They may also reduce the use of pharmacological pain relief methods and promote less intervention during childbirth. However, there has been very little research in this area to date.

This second paper discusses a follow-up study that used a semi-structured interview technique to explore further the experiences of women and their partners following the use of a specifically chosen homeopathic kit that included ten remedies for self-administration. Interviews were undertaken in the homes of 18 women who reside in the South Leeds area, West Yorkshire during a six month period (September 2005 to February 2006). Four themes were generated from the data, namely how remedies were used, empowerment, emotional needs, fathers and birth partners. The final core theme was a positive birth experience. The interviews demonstrated that women and several birth partners experienced positive emotional, psychological and physical benefits from using the kit of homeopathic remedies. Self-administered homeopathy has the potential to promote a women-led approach to childbirth and an active supportive role for the birth partner. The findings will form the foundations to undertake further research in this field.
Erythrovirus B19 as a potential cause of fetal hydrops: assessing awareness
Authors: Elbaz Wesam F , Coyle Peter , Hunter Alison , Farragher Sami
Published: May 2014

Erythrovirus (previously parvovirus) B19 was discovered accidentally in 1975 while screening for hepatitis B surface antigen (Chan et al, 1998). It is a small ssDNA virus that targets erythroid progenitor cells. Infection with B19 virus during pregnancy may cause serious complications in the fetus such as fetal hydrops and intrauterine fetal death. Early diagnosis and treatment is essential in the management of these complications. We conducted a survey study to assess the awareness of both front and second-line obstetric staff(GPs, midwives, senior house officers, specialist registrars and consultants) of B19 as a potential and treatable cause of hydrops fetalis. Overall there was poor awareness particularly among the front-line carers compared to the second-line carers regarding the diagnosis and management of B19 infection in pregnancy. A total of 94% of the responders agreed there was a need for educational updates on the role of B19 infection during pregnancy.
Supervision: the changing world of midwifery
Authors: Osbourne Astrid
Published: May 2014

This paper examines the changes that have taken place during the time that the role of supervisor of midwives has been active. It examines how this role has evolved in the changing world of maternity health care. Case studies are used to illustrate the challenges that supervisors of midwives and practice midwives encounter.
Negligence and the standard of midwifery practice
Authors: Griffith Richard
Published: May 2014

While the Nursing and Midwifery Council regulates the conduct and competence of a midwife through what is now referred to simply as the Code (Nursing and Midwifery Council (NMC), 2008) it is left to the common law to regulate the standard of care through the law of negligence.
Maternal satisfaction regarding anaesthetic services during childbirth
Authors: L Halls Katie
Published: May 2014

Maternal satisfaction regarding the experience of childbirth is influenced by a unique combination of factors. This study presents an overview of obstetric anaesthesia in a District General Hospital, in order to determine the relative contribution of analgesia towards satisfaction. 199 mothers were asked to evaluate their chosen methods of pain relief and responses were analyzed in reference to features of their respective deliveries. Results showed that 94% of women requested analgesia, of which 13% reported subsequent dissatisfaction. Almost two-thirds of dissatisfied mothers were primipara. Ten per cent of women attributed their dissatisfaction to unacceptable side effects and 60% described inadequate administration of their pain relief. Overall only 30% of dissatisfied women were concerned with the actual efficacy of their analgesia, suggesting that maternal satisfaction does not simply equate to sufficient pain relief. Mothers wish to receive their preferred mode of analgesia, within an appropriate period following their request, under the assurance that inadequate pain relief will be recognized and resolved.
Confidence in newly qualified midwives
Authors: Donovan Pat
Published: May 2014

This article focuses on the level of confidence in students exiting from three pre-registration programmes leading to a midwifery qualification. Confidence was explored using a tool covering 24 basic skills. This was given to students from 18-month, 3-year and 4-year courses on the last day of their course. A total of 45 responded. Results were analyzed using descriptive statistics. Generally all scores were similar from 18-month and 4-year students but this may have occurred because of curriculum similarities. Three-year students showed a wider variation of confidence levels in all skills. Multiple factors play a part in developing confidence, including the quality of the learning experience, the educational programme and personality. These need further exploration.
Abortion rates on the rise in Arab countries
Authors: Bainbridge Jane
Published: May 2014

Islamic law dictates that abortion is only permissible if the pregnancy is the result of rape or it puts the mother's life at risk, yet abortion is increasing and many are being performed by midwives.
Ethics on-the-run
Authors: Kinnane Joanne
Published: May 2014

Midwives are involved in a very dynamic profession. As they face their everyday tasks they encounter many different situations and a variety of people which results in a vast number of interactions. This narrative research project sought to identify some of the ‘ordinary’ encounters and interactions that midwives working in a hospital environment experience in their daily work and explore them from an ethical perspective. It found that many ethical decisions have to be made ‘on-the-run’, with no time to contemplate or decide what the best course of action might be. As ethics is embedded within every encounter a midwife has, it is essential that all midwives have an awareness and understanding of their own value systems, professional ethical codes and ethical principles that can act as guides when they have to make choices in these situations, which are frequently challenging.
Encouraging positive reactions to pregnancy in first-time mothers
Authors: Nakamura Yauka
Published: May 2014

The purpose of this study was to explore the differences in maternal psychosocial adaptation between pregnant women who received nursing intervention that focused on their comfortable experiences and those who didn't. A longitudinal and semi-experimental comparative research design with convenience sampling was used. The Japanese version of the prenatal self-evaluation questionnaire was administered to 13 pregnant women who received nursing intervention and 11 pregnant women who didn't at each trimester of pregnancy. Intervention group had significantly better total score and preparation for labour in the third trimester than in the first and second trimester. Acceptance of pregnancy showed significantly better scores in the third trimester than first trimester in the intervention group. The findings of this are important as they provide a nursing intervention which has the potential to promote positive birthing experiences for Japanese women.
Methadone-treated mothers: pregnancy and breastfeeding
Authors: Jambert-Gray Rosemary , Lucas Kevin , Hall Valerie
Published: May 2014

Care and advice given to mothers engaged in treatment for illicit drug use during pregnancy and early motherhood will be influenced by both the midwives' personal views about drug users and their knowledge and understanding of issues involved. Opiates remain the main drug of choice for pregnant drug users; over the past ten years in the UK there has been a 67% increase of neonatal abstinence syndrome (NAS). As 60–90% of opiate-exposed infants show symptoms of NAS, this article considers methadone treatment in pregnancy and advises that mothers should not reduce their usual therapeutic dose of methadone. Breastfeeding is advised as an optimal solution for not only ameliorating NAS symptoms but also for keeping mother and baby together which leads to better bonding and a shorter hospital stay. This article recommends that midwives receive ongoing opportunities to gain knowledge and understanding of the management of methadone-treated women as part of clinical supervision in working jointly with specialist drug workers.
Sporting achievements after pregnancy and childbirth
Authors: Daniel Lincia
Published: May 2014

Kim Clijsters took two years off from playing tennis after childbirth before returning to win the US Open and proving that women can still compete with the best after pregnancy and motherhood.
The midwife as prescriber
Authors: Griffith Richard
Published: May 2014

The alternatives to prescription that allow midwives to supply and administer certain medicines to mothers and babies in their care have been outlined in previous articles. The midwives exemptions under the Medicines Act 1968 and the use of patient group directions allow midwives to use a wide range of medicines without prescription. Given the wide scope of these alternatives is there any benefit to midwives becoming non-medical prescribers?
Energizing enquiry based learning through technology advances
Authors: Kitson-Reynolds Ellen
Published: May 2014

The innovative use of virtual learning tools to support first year student midwives is key in current education. Blended learning considers both face to face student teacher contact as well as accessing e-learning activities to enhance student learning. The process of EBL encourages students to gain a deeper understanding of the theory linked to clinical experiences along with the use of learning resources within both academic and clinical environments. By doing so it aims to enhance and embed knowledge. This article outlines the processes of two such innovations: a ‘WIKI’ and an interactive filmed scenario based activity. An evaluation of these learning technologies to compliment an existing enquiry based learning approach to midwifery education is provided. Future developments of learning technologies can only enhance the student experience with the ultimate aim of ensuring fitness for practice.
Female genital mutilation in a globalized age
Authors: Lavender Rebecca
Published: May 2014

Female Genital Mutilation (FGM), despite being illegal in the UK, remains a major public health issue. This article reports the findings of a semi-structured survey, exploring current FGM services, conducted at a multi-disciplinary event. Seventy-eight respondents from the health sector, voluntary agencies, education sector and police force completed the survey. Data were analyzed descriptively. Findings suggest that training, information and practical issues need addressing. Furthermore, the routine recording of FGM data needs consideration. The FGM National Clinical group has used these findings to target areas where they can offer support.
Thoughts on the obesity epidemic
Authors: Johnson Nicola
Published: May 2014

Obesity was a term not so familiar some 20 years ago. However, it is now a serious problem in the UK with an alarming projection of 9 in 10 people being overweight or obese by 2050, should the current trend continue (Department of Health, 2009).
Women's advice to mothers-to-be: ‘Clearly voice your needs’
Authors: von Feilitzen Christina , Rådestad Ingela , Hildingsson Ingegerd , Häggström-Nordin Elisabet
Published: May 2014

The objectives were to investigate what advice women who have given birth would give to parents-to-be using an open question analysed by content analysis. This was a population-based study including women giving birth in Sweden. Data were collected by means of anonymous postal questionnaires and information was provided by 322 women. The advice was predominantly directed towards mothers-to-be. Six categories were identified: preparation, optimize preparation before birth; support, strengthen confidence in your own capacity; confidence, encouragement to rely on the staff and destiny; control, understand the situation; live in the present, do not worry in advance; parenthood, cooperation with partner is important. A theme for all advice was formulated as ‘stand up for yourself’. Key conclusions and implications for practice were that through their advice, the women wanted to strengthen mothers-to-be to clearly voice their needs during labour. Health professionals can improve how they support women during pregnancy and birth so that women's ability to express their needs is strengthened.
Doulas: supportive, calm birth partners or obstructive to clinicians?
Authors: Bainbridge Jane
Published: May 2014

Women need a supportive partner during labour, be it the baby's father, family member or friend and some women choose a doula, but what is the scope of the doula's role and are they afforable for many women?
Teenage mothers in Perth, Australia have second babies too quickly
Authors: Bainbridge Jane
Published: May 2014

Poor contraceptive use among teenage mothers in Perth leads to second pregnancies within 2 years of having their first baby, even among those using condoms and oral contraceptives.
Are some pregnant women in denial about their alcohol consumption?
Authors: Daniel Lincia
Published: May 2014

Advertising campaigns might not be effective in warning women against excessive alcohol consumption in pregnancy but perhaps a new test that reveals the cold hard facts of their drinking could make a difference?
An evaluation of clinical decision making study days
Authors: Dunkley-Bent Jacqueline , Jones Diane
Published: May 2014

This study evaluated the impact of a clinical decision making study day on midwives experiences of decision making in clinical practice. More than half the midwives employed by a maternity unit in London attended the study day that involved exploring the process of clinical decision making, influences and barriers to making clinical decisions and how to use a model of decision making when making clinical decisions in practice. Midwives attended the study day once in groups of no less than eight and no more than 13. The evaluation process involved the distribution of pre and post study day questionnaires and a 3-month follow-up questionnaire that aimed to explore the influence of the study day on clinical decision making. The results of the evaluation showed that midwives used the model of decision making in clinical practice to improve the decisions they made. Incidentally, at this time, critical incidents relating to decision making measured by the submission of critical incident reporting were reduced.
Holy Innocents – Grieving for the death of a baby
Authors: Cameron Joan
Published: May 2014

This book has been written for parents who have experienced the loss of a baby and the professionals who care for them. The text is written in a conversational style that makes it easy to read. It covers the development of the baby in utero, the loss of a baby, and the way in which different religions approach birth and death. The author draws on her own extensive clinical experience to llustrate her arguments and these make powerful reading. In particular, the accounts of parental responses to the loss of a baby are poignant. Many parents would recognize their own reactions to the loss of their baby in her descriptions. Reading and reflecting on her stories, health professionals might arrive at a better understanding of the impact of their behaviours on parents whose baby has died.
Ask a midwife
Authors: Kettle Christine
Published: May 2014

All your pregnancy and birth questions answered with wisdom, insight and expertise
Weight management for midwives
Authors: Clift-Matthews Victoria
Published: May 2014

The rising prevalence of obesity has been perceived by midwives for some time now owing to the increasing numbers of overweight and very overweight women presenting for maternity care. Guidance on the best way to manage care for these women has been desperately needed. At long last the National Institute for Health and Clinical Excellence has published its guidance on weight management in pregnancy and it gives a clear message that pregnancy is not a time to be eating for two after all. However, it does not recommend that pregnant women try to lose weight because this may put the health of their unborn child at risk. (To read the full guidance see: http://guidance.nice.org.uk/PH27 .)
Social networking: confidentiality and professional issues
Authors: Lee Karen , Bacon Lisa
Published: May 2014

Use of social networking sites has grown rapidly in recent years but students and health professionals should think carefully about their employer before posting about their day at work and about their personal life. In this article issues of confidentiality and professional behaviour are explored, including the possible consequences of posting to a potential readership of 400 million people.
Diagnosis of preterm labour: introducing the fetal fibronectin test
Authors: Ponting Jennie , Tomlin Maggie
Published: May 2014

This article reports on an innovation within a maternity unit to introduce a fetal fibronectin, point of care test, which will aid the clinician in correctly diagnosing preterm labour. In turn, this will assist in developing an individual plan of care for each woman with suspected preterm labour, rather than treating each case with the same interventions regardless of subsequent outcomes.

Fetal fibronectin (FFN) is a complex adhesive glycoprotein which can be detected in the cervico-vaginal secretions of women during pregnancy. Its concentration varies throughout pregnancy. Detectable before 24 weeks of pregnancy the concentration then dips below the minimum detectable level up to 34 weeks of pregnancy, unless the woman is in preterm labour.

The FFN test was successfully introduced into clinical practice. It demonstrates that, when used appropriately on women with symptomatic suspected preterm labour, FFN testing can aid in accurate diagnosis and avoid unnecessary, costly interventions.
Breastfeeding: Is my baby getting enough milk?
Authors: Noonan Maria
Published: May 2014

Perceived insufficient milk is one of the most common reasons cited for supplementing or discontinuing breastfeeding. However, only a small minority of women experience a true insufficient milk supply. In this article, an overview of the signs of sufficient milk intake will be provided, particularly weight gain and nappy output. Normal newborn and breastfeeding behaviour such as frequency of feeds, growth spurts and sleeping patterns will also be explained. This may assist clinicians to support breastfeeding mothers to recognize the signs that breastfeeding is going well and when intervention is required.
The risky business of supervision, 1: Interfacing with safety mechanisms
Authors: Richards Julie
Published: May 2014

Supervision of midwives is a statutory responsibility providing a mechanism for support and guidance to every midwife practising in the UK (Nursing and Midwifery Council (NMC, 2008a). The role of supervisors with regards to risk management is set out in Rule 15 of the Midwives Rules and Standards ( NMC, 2004 ) to ensure that incidents which cause serious concern relating to maternity care or midwifery practice are notified to the Local Supervising Authority Midwifery Officer (LSA MO). Case study research was undertaken to explore the interface of supervisors of midwives in the notification of critical incidents and provided a detailed and balanced account of the phenomenon of statutory supervision and the role of the LSA MO in notification of serious untoward incidents.
The Birthplace Study: Turning the tide of childbirth
Authors: Rogers Cathy , Yearley Carole , Littlehales Carol
Published: May 2014

The publication of the Birthplace Study should herald a major shift in the provision and organization of maternity services, in particular the expansion of births outside obstetric units or at home. The media portrayal of the findings were disappointing as the focus was very much on the homebirth findings in relation to first-time mothers and did not promote the unequivocal evidence that delivery in a midwifery-led unit is safe. The adverse outcomes for low-risk women who choose to give birth in an obstetric unit were glossed over as if of limited significance. Based on the findings of the study, maternity service commissioners and providers need to develop a strategy to ensure low-risk women are given informed choice with respect to place of birth and that recourses are available to support this. This study provides us with a really good opportunity to turn the tide of childbirth.
‘Telling stories, hearing stories’: The value to midwifery students, Part 2
Authors: Weston Rosalind
Published: May 2014

This article reports on the findings of a narrative inquiry that aimed to explore the value that students place on birth storytelling, and the significant stories that they tell and hear during their midwifery programme. This is the second of two articles and focuses on whether storytelling is valued by students in developing their learning. Purposive sampling of two cohorts of final year midwifery students from one university in the south east of England in 2007 elicited five participants. Two focus groups enabled data collection and seven themes emerged from the data analysis: validating experiences; stories used as reflection; listening to other students' stories; retold stories; lecturers' humorous stories; not wanting to be judged by mentors when recounting stories; and opportunities for story-sharing. Storytelling appears to assist students to integrate and enhance their experiential learning, particularly on returning from practice placements into the classroom. The findings suggest storytelling is valued by students and does facilitate learning. This study can have implications for students, mentors, midwifery lecturers, others in higher education and for curriculum development.
Evaluating enquiry-based learning in a new pre-registration programme
Authors: Hamilton Cathy , Yearley Carole , Boyle Sally
Published: May 2014

In accordance with the need to provide contemporary midwifery education which meets the Nursing and Midwifery Council (NMC) (2009) standards, the pre-registration midwifery education programme at the University of Hertfordshire underwent a major curriculum development in 2008, which afforded the opportunity to review the existing learning and teaching strategies. The curriculum development team were keen to develop an education programme which would enable student midwives to develop the necessary skills associated with adult learning and encourage individual responsibility for life-long learning ( NMC, 2010 ) in the belief that such skills would help prepare student midwives to be better equipped to cope with both the demands of the programme and the challenges of contemporary midwifery practice. The learning and teaching strategy of enquiry-based learning (EBL) was introduced as a key feature throughout the 3-year midwifery programme. This article presents an evaluation of the introduction of EBL for a group of first-year students as they progressed through the first year of their midwifery training. It reports on some of the emerging themes from the students' perspectives from their experience of EBL and on the resulting changes which occurred in response to the findings from a series of facilitated student focus group meetings.
Identifying pregnancies at risk of MCADD: Advice for midwives
Authors: Instone Joanna , Cooley Candy , Newton Rob , Bishop Michelle
Published: May 2014

A National Patient Safety Agency (NPSA) Rapid Response Report entitled ‘Keeping newborn babies with a family history of MCADD alive in the first hours and days of life’ was issued in October 2011 to reduce neonatal death associated with medium-chain acyl-CoA dehydrogenase deficiency (MCADD). This document contained four actions that must be met by obstetric, paediatric and midwifery NHS services by 26 April 2012. This article has been written to assist midwives to meet the actions, in particular the action concerning taking a family history. Identification of ‘at risk’ pregnancies is facilitated by the taking of an accurate family history from the pregnant woman. Here we provide practical tips on how to elicit relevant family history information. When an ‘at risk’ pregnancy is identified, the appropriate neonatal care plan, including a feeding regimen and close observation, should be instigated. This article also describes the symptoms and management of neonates with MCADD.
Ethnicity as a risk factor for postpartum depression
Authors: Rouhi Maryam , Usefi Homa , Hasan Masumeh , Vizheh Maryam
Published: May 2014

Studies on postpartum depression (PPD) in Iran have focused on prevalence and risk factors. There is little information available on the ethnic risk factors of PPD. We aimed to evaluate prevalence and some ethnic risk factors of PPD among women in West Azerbaijan, Mahabad, Iran. Twelve hundred mothers (600 Kurdish women, 600 Azeri women) who visited Mahabd public health centres for immunisation of their eight week old infants were interviewed about symptoms of depression. Most of the participants (89%) completed the questionnaire independently, while 11% required assistance by midwives because they were illiterate. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess depression. In the study, 36.3% of women had high depression scores (i.e. a score ≥13 indicated a higher risk of PPD). The mean depression score among Kurdish women was 14.77, and Azeri women 12.99. The common risk factors for higher scores were: younger mothers, unplanned pregnancy, poor economic status, mothers who did not work outside the home, having an infant with health problems, and poor paediatric care. Women from different ethnic backgrounds appeared to have different levels of emotional wellbeing, with Kurdish women experiencing higher levels of depressive symptoms. It appears that timing, as well as the quality of postpartum care, should be reexamined to address individual ethnic needs.
UK Infant Feeding survey: Good news for breastfeeding
Authors: Dodds Rosie
Published: May 2014

The UK-wide Infant Feeding survey (IFS) is conducted every 5 years to examine trends and monitor the extent to which policies and practice are reaching mothers. Both breastfeeding initiation and duration have increased over the last 5 years, although this varies geographically and across socioeconomic and age groups. In line with previous surveys, women reported common reasons for early cessation: babies who would not attach to the breast or were always hungry, painful breasts or nipples, and insufficient milk. The perpetuation of these experiences seems to indicate a continuing lack of familiarity with breastfeeding, and insufficient accurate information and skilled support in the first few days. Data is included on formula milks used, the take up of the healthy start scheme, when babies started on solid foods, breastfeeding in public places and returning to work.
The multidisciplinary management of type 2 and gestational diabetes in pregnancy
Authors: Abayomi Julie , Wood Lorna , Spelman Sue , Morrison Gillian , Purewal Tejpal
Published: May 2014

The UK is experiencing a dramatic increase in the prevalence of type 2 diabetes mellitus (T2D). Consequently, there is a corresponding increase in diabetes in pregnancy, with 87.5% of pregnancies in the UK complicated by diabetes due to gestational diabetes mellitus (GDM), and 27% of those with pre-existing diabetes having T2D (National Centre for Health and Clinical Excellence (NICE), 2008a ). Although the risks to mother and baby are similar to type 1 diabetes (T1D), the approach and management often differ. Women with GDM and T2D are more likely to be older, multiparous and live in deprived areas. Certain ethnic groups are more prone to GDM and T2D, and there is a strong association between being overweight or obese and diabetes. Women who develop GDM in pregnancy also have an increased risk of T2D in later life ( Diabetes UK, 2011a ). Some surveys, such as the Confidential Enquiry into Maternal and Child Health ( CEMACH, 2007a ) have shown that women with T2D often receive suboptimum care prior to conception and in early pregnancy. This paper presents an overview of the multidisciplinary management of T2D and GDM in pregnancy and identifies areas where care may be lacking for these women.
Collaborative working within community maternity services – is this the chink in the armour?
Authors: Shaw Brona , Hamilton Shona , McCullough Dr Melissa
Published: May 2014

Contemporary maternity care in Northern Ireland will be driven by the aims of Midwifery 2020 ( Department of Health (DH), 2010 ), High Quality Woman’ s Health Care ( Royal College of Obstetricians and Gynaecologists (RCOG), 2011 ), Maternity Strategy for Northern Ireland2012–2018 ( Department of Health, Social Services and Public Safety (DHSSPSNI), 2011 ) and Transforming Your Care ( DHSSPSNI, 2011 ). These reports all have at their core the idea of’ promoting normality’ within a maternity service that will be community based and led by midwives. With this shift, general practitioners (GPs) will be expected to play a significant role within the teams that care for pregnant women. Effective collaboration between professional groups is an essential element in good quality and safe care. It is necessary if the planned transfer of services is to succeed. This study explores if midwives, GPs and those planning maternity services believed that systems were in place for effective collaborative working in the community. The service evaluation used mixed methods to collect data, including five in-depth interviews, questionnaires and a professional forum, with the results demonstrating that few community practices have implemented systems for sharing information between community midwives and GPs. The study found that collaborative working is not a characteristic within community maternity services. It revealed four recurrent themes that hinder effective collaboration: organisation, inter-professional relationships, communication, and quality and safety.
Parturition and arthritis: A midwifery approach
Authors: Nolte Anna GW , Hastings-Tolsma Marie , Harper Teresa C
Published: May 2014

Arthritis is an inflammation of one or more joints producing pain, swelling and potentially permanent disability. While the cause can be infectious, autoimmune or traumatic, arthritis often has an unclear aetiology and presents challenges for management during pregnancy. A common problem that can occur in many different forms, arthritis is often referred to as a rheumatic disease and may improve, remain unchanged or exacerbate during pregnancy. Management and treatment that could be effective in treating arthritis may need to be evaluated and managed differently during pregnancy due to fetal safety concerns.
Midwifery staffing: Variation and mismatch in demand and capacity
Authors: Yelland Andrew , Winter Cathy , Draycott Tim , Fox Robert
Published: May 2014

Pressure on maternity services arising out of variation in number of births has always existed. Of singular importance during peak demand is the capability of maternity units to maintain safe outcomes. Additional to variation in birth numbers, heightened patient expectations, social issues and increased prevalence of medical comorbidities have increased functional demand on maternity units, at a time of more restricted health expenditure. Intuitively, it seems logical to suppose that gaps in provision experienced in practice could have an accumulative effect on patient satisfaction, clinical outcomes, and perhaps even midwives' health and morale. This review presents data on variation in birth rates over seven decades, across the seasons, during the week and throughout the day. Recent functional demands on maternity services are reviewed alongside changes in staffing that influence capacity. The need for further research into possible links between demand, staffing and outcomes is explained.
Promoting normality in the management of the perineum during the second stage of labour
Authors: Moore Emma , Moorhead Carolyn
Published: May 2014

The management of the perineum during birth has multiple long-term effects on women and their families. The midwife has a key role to play and often the techniques they employ vary significantly, as does their justification of these practices. This article seeks to examine current evidence to explore what is known to contribute to lower perineal trauma rates and what practices should be avoided to protect childbearing women. The conclusions drawn show that the updating of practice and antenatal education may be required so that woman are given the information they need to make an informed choice as to what they want for their own body, child and experience.