bluuebunny/crossref_metadata_2025 huggingface dataset:
Students' perceptions of the OSCE: a valid assessment tool?
Authors: Jay Annabel
Published: May 2014

This paper presents the results of a qualitative study into student midwives' perception of the Objective Structured Clinical Examination (OSCE). The study was conducted at the University of Hertfordshire in the summer of 2005 as part of the author's Masters Degree in teaching and learning. Ten volunteers from a sample cohort of 23 students were surveyed through the medium of semi-structured interviews.

The findings show that OSCE is generally perceived by student midwives to be an acceptable, valid and fair means of assessing clinical skills in simulation. However, several aspects were highlighted for criticism, in particular the artificiality of the situation, poor equipment and unsatisfactory administration, all of which contributed to student anxiety. Many suggestions for improvement were offered, such as allowing interaction with assessors during workstations and having flexible time limits to complete each station.

On balance, the author concludes that the student perception of OSCE is encouraging enough to justify its continued use.
You cope by breaking down in private: fathers and PTSD following childbirth
Authors: White Gillian
Published: May 2014

Literature on birth trauma has focused on women's experiences and the evidence of post-traumatic stress disorder (PTSD) following childbirth. For some fathers witnessing a traumatic birth involving their partner and/or baby, symptoms of post-traumatic stress disorder may also be apparent. In this New Zealand study descriptive phenomenology was used to explore the phenomenon of post-traumatic stress following childbirth as twenty-one fathers narrated their experiences of witnessing a traumatic birth. Four themes encapsulated their experiences: it's not a spectator sport; it's about being included; it's sexual scarring; it's toughing it out. These results demonstrate that some men are left with a negative emotional experience that has serious consequences for their relationships and families. Midwives should be aware that many men have ambiguous expectations about being at the birth. If fathers are witness to a traumatic birth, as they perceive it, they need resolution.
Midwives' management of episiotomy at a district general hospital
Authors: Thomas Elizabeth , Cameron Helen
Published: May 2014

Episiotomy used to be a popular procedure in obstetrics and was performed almost routinely to facilitate labour. Evidence now suggests that a episiotomy cut should only be performed if there is clinical need. Subsequently, episiotomy rates have dropped and midwives are less exposured to the procedure. This audit investigates midwives' training, clinical experience, technique, and confidence with regard to episiotomies. Over a 5-week period, questionnaires were completed by 66 midwives working at Sunderland Royal Hospital (SRH). It found that a large majority had received episiotomy training but fewer had been trained in episiotomy repair before registering with the Nursing and Midwifery Council (NMC). The description of the procedure varied, with the angle for an episiotomy cut suggested between 29° and 80° from the midline of the perineum. There is a reported lack of clinical experience, especially amongst junior midwives, and self-confidence varies considerably; with those who have been qualified the longest, claiming to be more confident in these procedures.
Private practice – why?
Authors: O'Brien Patrick
Published: May 2014

OK, so let's get the thorny issue of money out of the way first. I'll be honest: when I became a consultant in 1999, probably the main reason I first went into private practice was the financial reward. And there's no doubt it pays well; of the 80 or so hours I work a week, I spend around 20 in private practice, yet it contributes two-thirds of my income (and please note that I am contracted to the NHS for 44 hours a week, so don't even think of suggesting that my private work eats into my NHS practice).
Reproductive autonomy and prisoners' human rights
Authors: Symon Andrew
Published: May 2014

The notion of prisoners' rights is often a divisive one. The desire to punish those who transgress the law, and the aspiration of encouraging rehabilitation, sometimes seem incompatible. However, determining exactly which rights are forfeited upon conviction is not always clear. While few will be surprised to hear that some female prisoners are pregnant, the circumstances in which a prisoner and his/her partner attempt to start a pregnancy, including recourse to human rights legislation, may raise some eyebrows. This article examines one case involving a male prisoner and his desire to father a child with his wife.
Birth Crisis
Authors: Noble Amy
Published: May 2014

Sheila Kitzinger is described on the cover of her recent book, Birth Crisis as ‘the high priestess of the birth movement’. Being an anthropologist she offers an alternative and very valuable perspective on pregnancy, childbirth and maternity care. The content of this book is typical of her strong feminist values and her belief in natural childbirth and the perfect competence of women's bodies. Themes of control and choice run through the issues discussed.
Maternity unit design study part 4: midwives' perceptions of staff facilities
Authors: Symon Andrew , Paul Jeanette , Butchart Maggie , Carr Val , Dugard Pat
Published: May 2014

Staff wellbeing is a recognized feature of workplace effectiveness. This final results paper presents data on staff attitudes from a multi-site study in England examining maternity unit design. Two hundred and twenty-seven midwives completed questionnaires relating to their workplace; follow-up focus groups provided further insights. Adequate and clean facilities for rest, uniform changing and washing appear not to be available in many units. While most midwives felt that the clinical area was spacious enough, those working in midwife-led units (MLUs) were more likely to say that ward layout facilitated observation of mothers and babies (p<.001) and promoted positive staff interaction (p<.001). Midwives in obstetric-led units (OLUs) were more likely to indicate that ward layout made maintaining cleanliness more difficult (p=.01). Poor air quality and oppressive lighting were the most commonly cited environmental sources of potential health problems. Midwives' workstations were frequently cramped with inadequate space for computer and other electronic equipment. At times this was felt to compromise confidentiality.
‘Coming ready or not!’ Preparing parents for parenthood
Authors: McKellar Lois , Pincombe Jan , Henderson Ann
Published: May 2014

The transition to parenthood is a major life event and may be one of the most acute changes experienced during a person's life. Nevertheless, many parents find themselves unprepared for their parenting role. It has been found that a positive experience throughout the period of transition to parenthood contributes to the parent's confidence and ability to master new roles, highlighting the need to develop innovative strategies which support parents through the transitional period. This article introduces one such strategy, a postnatal planner entitled ‘Coming ready or not!’ developed from an action research study designed to develop, implement, and evaluate strategies to improve postnatal education for parents. Using the antenatal period to address postnatal concerns must be considered.
The Kingscord model: a public cord blood collection service
Authors: Duffy Terie , Querol Sergio , Dennes William , Tarrio Maria , Mason Kate , Busby Helen , Okeke Winsome , Goldman John , Madrigal J Alejandro , Mufti Ghulam , Pagliuca Antonio , Yiannouzis Katie
Published: May 2014

To evaluate the impact of offering cord blood (CB) collection as a public service within the Anthony Nolan CB Bank, a research study was conducted at King's College Hospital to assess the attitudes of health professionals, explore the perspectives, knowledge and experiences of donors and to analyze quality and risk of the collection methods. A midwife developed the required services for the CB collection programme, to be evaluated after an eight-month period. Initially a series of questionnaires given to midwives showed a high level of enthusiasm for the project, though they expressed concerns regarding staffing levels as a potential problem. Mothers interviewed felt their participation was worthwhile. During this time 72 mothers gave their consent, of whom 50 had CB collected from their baby's placenta, and 27 were interviewed. Collected CB units were transferred to the Anthony Nolan Cell Therapy Centre at Nottingham Trent University for quality assessment and storage. The major quality issues detected were clotting and bacterial contamination. Different parameters were analyzed to assess risk. No differences were found between ex-utero collection, in-utero collection, and those not collected. The development of a public CB collection service is highly feasible and safe and could be adopted for larger NHS maternity hospitals. Special attention must be given to training and funding of additional personnel to maintain quality assurance and support staff.
Antenatal services for ethnic minority women in South Tyneside
Authors: Mastrocola Emma L , James Nwabineli Nwachukwu
Published: May 2014

Black and Minority Ethnic (BME) women are identified as being a disadvantaged group, often prevented from accessing adequate antenatal care due to various barriers.

This audit aimed to assess provision of antenatal services for BME women at South Tyneside District Hospital (STDH) and identify potential areas of change, to improve quality and accessibility of care.

The audit retrospectively reviewed 60 sets of case notes of BME women booked between January and June 2007. Results showed that only 23.5% of women who needed an interpreter received one. All English-speaking women were given written information about antenatal care but documentation was absent regarding whether or not non English-speaking women had received information in their native languages. 82.4% of women had booked their pregnancies by 12 weeks gestation.

It concluded that an adequate service is provided for BME women at STDH, although amendments could be made, with regards to the provision of interpreters and documentation of individual needs.
Obesity, risk and the challenges ahead for midwives
Authors: Irwin Jo-Anne
Published: May 2014

Assessing and managing risk is, and has always been, a central part of midwifery practice. Worldwide obesity is becoming an epidemic and its increasing prevalence during pregnancy gives one of the biggest threats today to the wellbeing of mothers and babies. For the midwife there are many challenges in identifying and managing risk for the pregnant woman with obesity and currently there are no national guidelines on which to base policies enabling provision of current and future care management.
Joint hypermobility syndrome and symphysis pubis dysfunction
Authors: Clark Carol
Published: May 2014

Joint hypermobility syndrome is a multisystem connective tissue disorder presenting as signs and symptoms associated with tissue laxity. Pain enhancement and chronic pain are frequent features. There is anecdotal evidence that some women report the onset of life-long symptoms during their first pregnancy. This review explores the prevalence of symphysis pubis dysfunction in those with joint hypermobility syndrome, mechanical features associated with pelvic instability and the clinical implications. Midwives play a key role both during and after pregnancy in recognizing and understanding the impact associated with symphysis pubis dysfunction. Further consideration needs to be given to those with joint hypermobility syndrome who are predisposed to soft tissue changes, joint instability and pain.
Women's worries about childbirth: making safe choices
Authors: Maier Belinda
Published: May 2014

The aim of this research was to provide a qualitative account of a number of women's everyday worries about childbirth. This was facilitated by asking women about their worries and identifying their social and personal contexts.

The central findings of this Australian study were that women worry about their own health and their baby's; normality and the effects of their pregnant and potential birthing behaviours. In addition the study showed that pain is linked with vulnerability and that women feel they are not valued for their individual selves.

This study has implications for professionals offering health services for pregnant women. It challenges health providers to reconsider assumptions about what it is women worry about and what measures should be taken.

Understanding the complex ways that women worry about childbirth within social and personal contexts can improve knowledge and practice, and the experience of pregnancy and childbirth for women.
Caring for parents following the death of a twin: A student's experience
Authors: Attia Linda , Nolan Ann
Published: May 2014

Reflection encourages midwives to challenge their thoughts, feelings and beliefs, and, as a result, creates a questioning approach to existing knowledge. While reflection is part of best practice and improving care, when reflection involves dealing with birth and death at the same time, the challenge can be immense.

This article is a reflective account of a student midwife's experience of caring for bereaved parents. It highlights the caring relationship that was built up between them. The student reflects on the bittersweet experience of a young couple's attempt to deal with the complexity of emotion experienced at the time of the birth and death of their twin daughter. As the account unfolds, the unique role of the midwife in facilitating parents' grieving at the time of childbirth can be clearly seen. The importance of parents spending time with their baby is highlighted. Discussion also focuses on the significance of creating mementos in the grieving process.
Do women’s ideas of ‘normal’ birth match those held by professionals?
Authors: Edwards Alison , Conduit Jacky
Published: May 2014

Aim: To explore the definitions of normal birth held by women who have not given birth, what influences that perspective, and compare it with those of health professionals. Background: Available evidence provides conflicting definitions of normal childbirth. The majority of available evidence encapsulates the views of the health professionals themselves or women who have experienced childbirth. Little evidence exists that reflects the views of women yet to experience childbirth. Method: Six participants were identified via purposive sampling to undertake a small exploratory qualitative study utilizing semi-structured interviews and thematic analysis. Ethical approval was obtained. Results: The definition of normal birth is individual and complex. The absence of complications and use of interventions influenced this definition, which in part agrees with health professionals’ current definitions. Birth was perceived as a scary prospect; a view largely constructed from negative stories from friends and family. Conclusions: The findings suggest that working within the confines of a definition of ‘normal’ childbirth is far from straightforward. It highlights a need to encourage women to view birth more positively. Expanding this research further would explore these issues in more detail, providing more conclusive evidence to support practice.
Placental biomarkers can help the clinical management of pre-eclampsia
Authors: Lewis Jayne
Published: May 2014

A recent symposium held in June 2011, ‘Placental Biomarkers and the Clinical Management of Pre-Eclampsia’ reviewed the current incidence, challenges and outcomes associated with pre-eclampsia. Attracting over 250 delegates from all sectors of the perinatal professions, the sessions also looked at the potential role of new placental biomarkers to definitively ‘rule in’ and ‘rule out’ placental dysfunction in pregnant women with suspected pre-eclampsia before 35 weeks of pregnancy, particularly with reference to their impact on improved management of patients, outcomes, resources and costs.
Recording practice: Lessons for students, mentors and teachers
Authors: Jessiman Wendy C. , Matheson Shirley , Murray Irene
Published: May 2014

All midwifery students must provide evidence of attending 40 women in labour and birth. The shortened midwifery programme at the University of Stirling's Highland Campus in Inverness, which completed in 2010, required this care to be logged by the student on a specifically designed intrapartum template which was signed by the student's mentor. This article presents an audit of the completed intrapartum templates of the care recorded for low- and high-risk women. A review of both individual and collective student experience identified that students may have no experience in specific areas such as non-directed pushing and physiological third stage. In this audit student midwives cared for many more high-risk women than low-risk women in labour. Therefore, midwife educators, students and mentors should examine in detail the experience of all students to highlight any apparent deficits in their skills in order to ensure they are prepared for contemporary midwifery practice.
India's National Rural Health Mission to further promote breastfeeding
Authors: Bainbridge Jane
Published: May 2014

A report from WHO and UNICEF suggests that the lives of 1.5 million infants in South Asia could be saved with proper breastfeeding and appropriate additional feeding after 6 months
To screen or not to screen: Group B streptococcus and prenatal infections
Authors: Steer P J
Published: May 2014

Currently in the UK, it is usual practice for maternity services to screen for infection with syphilis, HIV, hepatitis B and rubella. As their incidence in the UK population is currently rising, continued screening is recommended. Group B streptococcus is the major cause of neonatal death from infection in the UK, and routine antenatal screening is now carried out in the USA, Australia, Germany, Italy and Spain, with prophylaxis using intravenous penicillin in labour (which can prevent up to 95% of cases) being offered to the 30% of mothers who are carriers. The USA has seen an 80% drop in cases. Despite this evidence, the National Institute for Health and Clinical Excellence (NICE) does not currently recommend screening in the UK and, as a result, many mothers and even professionals are unaware of the condition. Group B Strep Support campaigns to raise awareness among mothers and professionals about this preventable condition and for screening to be offered in the UK. Other prenatal infections such as cytomegalovirus, varicella and herpes affect far fewer babies, so screening is not currently recommended.
Providing effective maternity care for women affected by fibromyalgia
Authors: King Denyse
Published: May 2014

Fibromyalgia is a condition for which information is not readily accessible in midwifery or obstetric text books. This ‘invisible disability’ can have detrimental implications for all aspects of maternity care. From the physiology and psychology of fibromyalgia during the antenatal through to the postnatal period, this article highlights key issues that can have a hidden but significant impact on the maternity experience of women with fibromyalgia. The author explores these issues and suggests ways in which midwives can improve the quality of the care given to women affected with this condition.
Winning the battle: A review of postnatal depression
Authors: Miles Sarah
Published: May 2014

Mental health problems are distressing at any time of life, but they may have greater impact during pregnancy and the postnatal period. Early detection and effective treatment are essential in managing postnatal mental health problems, from baby blues to psychosis. Midwives need a comprehensive knowledge and understanding of the psychological changes that occur for women in pregnancy and postnatally, so that they can provide thorough holistic care. Many midwives feel inadequately prepared in the domain of maternal mental health and therefore training and education are essential to improve this lack in service. Furthermore, a clinically useful predictive tool needs to be developed in order that midwives can test and implement antenatal interventions in women at risk during the perinatal period. Most women find depression screening acceptable, although the stigma associated with depression can be a barrier to seeking treatment. Barriers to treatment include not wanting to disclose symptoms, stigma and lack of knowledge that symptoms are serious enough to warrant help and support. The midwife must therefore always be alert to signs and symptoms and know how to proceed when they are present.
Supervision and non-NHS midwives: Understanding a range of practices
Authors: Kurutac Judith
Published: May 2014

Supervision of midwifery is a statutory responsibility and most midwives are able to gain access to and support from their supervisor relatively easily. However, for midwives working outside the NHS it can be problematic to get appropriate supervision from a midwife who understands their role and subsequent needs. While the debate over the framework of statutory midwifery supervision continues into the future, supervisors and midwives need to uphold the principles of individualized safe midwifery care for women and to respect the lessons to be learnt by all practising midwives, including those practising outside the NHS.
Short-term international midwifery consultancy: Preparing and promising
Authors: Maclean Gaynor D.
Published: May 2014

This is the second of three papers concerning short-term international midwifery consultancy, and considers preparation for and decisionmaking about commitment to assignments. The article addresses a further two of the six critical questions that need to be considered by a midwife contemplating this kind of work. The reality of consultancy work in a cross-cultural situation is discussed and the very real issues associated with the lags, gaps and shocks involved in global practice are explored. Drawing from the evidence, portraits of the ‘ideal’ and ‘nightmare’ consultant are outlined, although it is acknowledged that neither portrait is likely to exist in totality. Since the consultant can offend in attitude as well as action, ‘sins of being’ and ‘sins of doing’ are identified and some strategies of preparation aimed at avoiding these offences are proposed. The article includes practical issues associated with terms of reference and contracting.
One hundred days as a direct entry student midwife: A personal account
Authors: Clarke Esther
Published: May 2014

This article discusses a personal experience of being a direct entry student midwife, with no previous practical experience of working within a maternity hospital or with labouring women. The author discusses some of the issues and feelings experienced during placement learning, shadowing midwives and weekly rotations around the hospital units.
Funding and support needed to help women and children in East Africa
Authors: Bainbridge Jane
Published: May 2014

With more than 10 million people in need of food and clean water in East Africa, members of the Partnership for Maternal, Newborn and Child Health are responding to the crisis.
The Birthplace in England Study: Methods, findings and evaluation
Authors: Walton Cathy
Published: May 2014

This article presents a summary of the method and findings of the Birthplace in England National Prospective Cohort Study recently published in the British Medical Journal. The study is a major research project into place of birth funded by the National Institute for Health Research Service Delivery and Organization Programme and the Department of Health Policy Research Programme. This article summarizes the methods and major findings of this national study comparing perinatal outcomes, maternal outcomes and interventions by planned place of birth at the start of care in labour for women with low-risk pregnancies. Data were collected from NHS trusts providing home birth services, freestanding midwifery-led units, alongside midwifery-led units and a stratified sample of obstetric units. A total of 64 538 eligible women with a term, singleton pregnancy were included. Women who had a planned elective caesarean, caesarean section before the onset of labour, an unplanned home birth or no antenatal care were excluded. A composite primary outcome measure was used to compare perinatal mortality and morbidity between the four settings of birth. Analysis was by planned place of birth at the start of care in labour. The overall incidence of a primary outcome event was 4.3 per 1000 births. The odds of the primary outcome were higher for nulliparous women for planned home births: adjusted odds 1.75 (1.07–2.86 95% confidence interval) but not for either midwifery unit setting. For multiparous women there were no significant differences in the incidence of the primary outcome by planned place of birth. Interventions in labour were lower in all non-obstetric unit settings. Transfers from non-obstetric unit settings were substantially higher for nulliparous women.
The implications of mandatory professional development in Australia
Authors: Thomas Sara
Published: May 2014

In July 2010, a major shift occurred in Australia's nursing and midwifery community, with the nationalizing of education and registration. With this shift came mandatory continuing professional development (CPD), coming into line with current practices in the UK. This has raised issues relating to finance, motivation and the potential dichotomy of interests relating to employee and employer. CPD has many benefits for both parties, but due to financial and organizational pressures it may prove difficult to please both sides. It is vital that a way forward is found that enables nurses and midwives to update their skills, in ever-changing areas of practice, whilst also satisfying the needs of the organization. Practitioners need to become more adept at identifying and utilizing educational opportunities in all their forms.
Earthquake study in Chile shows risk for birth outcomes of stress exposure
Authors: Bainbridge Jane
Published: May 2014

Women living close to the epicenter of the earthquake during their second and third trimesters of pregnancy had shorter pregnancies and were at an increased risk of delivering prematurely
Maternal obesity: Risk or resolution? A literature review—part 2
Authors: Williams Helen
Published: May 2014

This is the second of two articles discussing the findings of an extended literature review undertaken to explore whether midwives are missing a health promotion opportunity within the care of obese pregnant women. This integrative review analysed 36 primary and secondary research papers to elicit emerging themes. The impact of maternal obesity on service provision and the value of measuring and monitoring gestational weight gain were discussed in part 1 of this article ( Williams, 2012 ). Part 2 explores the value of antenatal interventions and some of the underlying issues around obesity, which may contribute towards the challenges of addressing this important public health issue. The concluding section will identify areas for practice development and further research.
Factors influencing multiparous women to choose a home birth—an exploratory study
Authors: Ashley Sarah , Weaver Jane
Published: May 2014

This is the second article in a two-part series exploring the factors that influence multiparous women to chose to birth at home after a previous hospital birth. The first article examined existing research in the area ( Ashely and Weaver, 2012 ). This paper will discuss a phenomenological study using tape-recorded semi-structured interviews with eight multiparous women who chose a home birth after a previous hospital birth. The transcribed data were analysed using a modified version of Colaizzi's (1978) seven-step phenomenological method.

The factors that influenced women could be separated into four themes: the midwives' role, the experience of home birth, the consideration of risk associated with home, and issues regarding the control of birth. The decision to home birth is highly individualised and complex, with an extensive array of influencing factors, which include both positive and negative previous birth experiences, as well as life experience and the influence of others.
Confusion between maternal and fetal heart rate during the second stage of labour
Authors: Equy Véronique , Buisson Séverine , Heinen Mélanie , Schaal Jean-Patrick , Hoffmann Pascale , Sergent Fabrice
Published: May 2014

To determine risk factors for confusion between maternal heart rate (MHR) and fetal heart rate (FHR) while pushing in the second stage of labour, a prospective historical cohort including 300 singleton birth at term was conducted at Grenoble University maternity clinic.

Confusion between MHRandFHR occurred in 65% of cases. The median percentage of confusion was 34.5% of the pushing tracings. Three elements were significantly correlated to confusion: epidural analgesia, which lowers the percentage of confusion, maternal tachycardia and obesity, which both enhance the confusion percentage. No consequences of confusion with regards to the neonatal state could be established. The instrumental delivery rate was significantly lower when the percentage of confusion increased.

FHR monitoring using external captors during pushing appears to be of limited help to assess the fetal wellbeing as the percentage of confusion with MHR remains high.
Immersion injury: Presenting a case report as a cautionary tale
Authors: Ahmad Z , Wright E , Cadier M
Published: May 2014

The authors present a case of an immersion injury caused by a health professional while performing a routine postnatal screening test in the community. The article highlights the dangers associated with uncontrolled limb immersion in neonates as a technique to induce vasodilatation.
Transitioning from a student to a midwife: A first-hand account
Authors: Evans Sarah , Choucri Lesley
Published: May 2014

In this personal account, a newly qualified midwife uses aspects of her educational, professional and personal development to critically discuss how progress in all of these areas have been vital in helping her make the transition from a student to a registered midwife. The discussion demonstrates how the combination of problem-based learning (PBL) in university which helps develop team building and problem-solving skills, together with excellent mentorship on clinical placements, fully equipped this student to successfully make the transition into an autonomous practitioner.
Babies delivered by caesarean section at greater risk of developing asthma
Authors: Bainbridge Jane
Published: May 2014

Research from the Norwegian Mother and Child Cohort Study shows that, by three years of age, children born by caesarean section had a slightly elevated risk of asthma.
Attitudes of employees working in public places toward breastfeeding
Authors: Marsden Amy , Abayomi Julie
Published: May 2014

Background: The benefits of breastfeeding are well documented but the UK has one of the lowest breastfeeding rates in Europe. Perceptions of social disapproval of breastfeeding in public is one of the main reasons ( Acker, 2009 ; Dyson et al, 2010 ) why women may choose to bottle feed instead of breastfeeding, or why they may cease breastfeeding early. To better understand the social attitudes toward breastfeeding in public that women may face, the aim of this study is to explore these attitudes and opinions among employees working in public places.

Methods: Nine semi-structured interviews were carried out with employees from public places with and without baby-friendly facilities or a breastfeeding policy. Interviews were audiotaped and transcribed verbatim. Transcripts were analyzed qualitatively by sorting and coding data into common themes.

Findings: Breastfeeding is viewed as good and natural; however, public breastfeeding still makes some people feel uncomfortable, particularly younger and childless people. Most employees were supportive of women breastfeeding on their premises and their opinions seem unrelated to the facilities offered. Most employees thought breastfeeding facilities should be more widely available but that women should be able to choose whether to use these facilities or not. Breastfeeding education may help to normalize breastfeeding in society and make women feel more comfortable about breastfeeding in public.

Conclusions: Most people view public breastfeeding positively; however, there is still a perception that breastfeeding women may feel uncomfortable breastfeeding in public, and private facilities may help to alleviate their anxieties.
Taking the pulse of the London maternity units
Authors: Lingen-Stallard Andrew , Read Jessica , Helleur Angela
Published: May 2014

Capacity, closure and diverts has been an issue for the maternity services in the capital. London is unique in that there are 26 provider units accepting maternity admissions with an additional number of stand-alone and attached midwifery units. In the past, escalation, closure and monitoring relied on each maternity unit self-reporting to the local supervisory authority (LSA) in London. Any formal closure (suspension) of service and diverts of women with in the maternity services also entailed informing the London Ambulance Service (LAS) of any temporary closure so that pregnant women or any obstetric emergencies could be directed or taken elsewhere by the ambulance service. The development of the pan-London closure and divert policy between the LSA, strategic heath authority (SHA), LAS and London maternity provider units provided a unique opportunity to develop a coordinated strategic planning and monitoring tool, which enabled monitoring of escalation and unit closure. This monitoring tool developed as a traffic light system and embedded in the closure policy, enabled maternity unit capacity and service status to be an effectively monitored with an independent information system hosted by the LAS which informs the LSA, and importantly ensures that women are able to access care from the nearest open maternity service in a timely fashion during times of high capacity.
Supervisors of midwives as human rights defenders
Authors: Jessiman Wendy C , Stuttaford Maria
Published: May 2014

A ‘human rights defender’ is a term used to describe people who, individually or with others, act to promote or protect human rights ( United Nations General Assembly, 1999 ). The right to health is a human right. Although predating the Declaration of Human Rights and the right to health, the statutory framework of supervision can easily be aligned to the right to health. Supervisors of Midwives (SoMs) are specifically appointed to protect women and babies, ensure maternity services respond to the needs of women, and ensure that midwives provide a high standard of care. Therefore, in the area of childbirth SoMs perform a role similar to that of a human rights defender.
Puerperal sepsis: a case study
Authors: Dawson Grace , Robson S. Elizabeth
Published: May 2014

Every pregnancy is a unique experience for a woman; an experience which may be complicated at any stage. The following case study reflects on the care given to a woman re-admitted to hospital during the postnatal period with puerperal sepsis. This condition has a long history in midwifery and obstetrics and has recently re-emerged as a major cause of maternal death. Midwives must be vigilant in order to reduce the risks posed by puerperal sepsis. Potential avenues of research must be explored to offer women the best evidence-based care. The recent development of national guidelines is necessary to inform practice.
Simulation-based learning: a case study, part 2
Authors: Dow Angela
Published: May 2014

For several years, simulation-based learning (SBL) has been applied in academic settings in the acquisition of professional knowledge and skills ( Cioffi et al, 2005 ). In midwifery education, clinical simulation promotes learning by providing an opportunity for students to experience a realistic learning experience in a simulated, safe environment within the theoretical setting without harming the mother or baby. However the effectiveness of clinical simulation in preparing student midwives for the reality of clinical practice and the application of simulated skills to the workplace is uncertain.

This second of three articles presents the findings from a case study, which explored the application of clinical simulation to clinical practice. Findings indicate that it was mainly the practical skills developed from simulation which were transferred and applied in practice. There was also evidence to suggest that context-dependent memory played a role in effective recall of the sequencing of practical skills in an environment similar to the university.
Understanding a physiological third stage of labour: A personal reflection
Authors: Jennings Rosie
Published: May 2014

This article is a personal reflection of a student midwife after witnessing a physiological third stage of labour at a home birth. Reflection in nursing and midwifery is a well established tool in developing both critical and analytical skills and is a required Nursing and Midwifery council (NMC) competency for both midwifery practitioners and students. The reflection aims to explore and critically discuss the midwifery care needs of a woman during a physiological third stage of labour, in particular the use of gentle cord traction with reference to the relevant literature, using Johns model of structured reflection ( John and Graham,1996 ).
A guide to maternity costs—why smaller units have higher costs
Authors: Jones Rod
Published: May 2014

In a time of international health care austerity, the costs of running a maternity unit are under increasing scrutiny. Economy of scale is shown to be central in understanding why smaller units cost more to run than larger ones. Awareness of the role of economy of scale in maternity costs can be traced back to the 1930s. In England, the Department of Health (DH) has insisted for many years that economy of scale is not a key factor in the tariff of services by which hospitals are paid for various activities. However, economy of scale can be clearly seen in maternity costs in England and elsewhere and this has led to a situation where smaller units have been subject to unjustified cost pressures while larger units have reaped undeserved profits. The situation has been partly obscured by exceedingly poor costing of maternity services, a situation which the DH appeared to leave untouched. Midwives are urged to become involved in the costing process at their hospital and to lobby the DH to address this unsatisfactory situation.
When maternity doesn't matter: Dispersing pregnant women seeking asylum
Authors: Feldman Rayah
Published: May 2014

Asylum seekers receiving housing and subsistence support from the Home Office are routinely dispersed to areas outside London. Pregnant women seeking asylum have often been dispersed very late in their pregnancies, and in some cases very soon after delivery ( Reynolds and White, 2010 ; Beecher Bryant, 2011 ). A study carried out by Maternity Action and the Refugee Council ( Feldman, 2013 ) investigated the experiences of women who had been dispersed during pregnancy and of midwives involved in the care of such women. It found that dispersal policies and procedures failed to take account of the vulnerabilities and special needs of this group of women, despite recognition by the National Institute for Health and Care Excellence (NICE) that they required additional support ( NICE, 2010a ). Women found the experience of dispersal and its impact distressing. Dispersal interrupted established maternity care and left women without social and family support, and many gave birth alone. Midwives' efforts to create rapport and trust and to establish multiagency and specialist support were undermined. The study advocated radical changes in Home Office dispersal policy for pregnant women. This article is based on the findings and report of the larger study ( Feldman, 20 13).
Acute surgical wound care 2: the wound healing process
Authors: Moore Peter , Foster Lorraine
Published: May 2014

The first article in this series on acute surgical wound care traced the history of surgical wound care from primitive dressings and techniques of closure used in the past to the present-day approaches. It also outlined the classification of acute surgical wounds (Vol 7(18): 11016). This second article describes the four stages of wound healing in acute surgical wounds, using clinical slides to illustrate the wound healing process. General factors, such as age, nutrition and medication, and local factors, including a moist environment, blood supply and wound infection, will be discussed to demonstrate their importance in promoting optimum wound healing.
Transcultural mental health nursing 1: benefits and limitations
Authors: Narayanasamy Aru
Published: May 2014

Mental health nurses often have to respond to the needs of clients from a diverse cultural background and ethnicity. The cultural needs of mental health clients can be met by transcultural nursing. In this article, the first of two parts, transcultural nursing is explained in terms of its assumptions, benefits and limitations and the emerging literature in this area of mental healthcare practice is highlighted. The second article will review the terms ‘race’, ‘culture’ and ‘ethnicity’ to illustrate their centrality in transcultural care. Following this, some aspects of mental health problems are presented in the context of cultural variation. Finally, the ACCESS model (Narayanasamy, 1998) (Assessment, Communication, Cultural negotiations and compromise, Establishing respect, Sensitivity and Safety) is suggested for use in transcultural care in mental health nursing.
Immediate management of acute severe asthma in adults
Authors: Cruickshank Jeremy P , Lumley Kay
Published: May 2014

Asthma is a disease with an increasingly high incidence in the UK, tragically accounting for almost 2000 UK deaths per year (Jones and Morris, 1997). Acute severe asthma is potentially life-threatening, necessitating immediate assessment and management. This article covers the main types of asthma, the pathophysiology of asthma, and the principles and rationale for the immediate management of adults admitted to the accident and emergency department suffering from an acute severe asthma attack. The authors have used the British Thoracic Society (BTS, 1997) guidelines on the management of asthma as the basis for their advice.
Intuition in nursing relationships: the result of ‘skills’ or ‘qualities’?
Authors: Turnbull Jacquie
Published: May 2014

Maintaining the scientific orientation of health and nursing care systems has resulted in a lack of focus on nurses' intuitive knowledge base. Consequently, confusion exists as to whether intuition in nursing is the result of acquired skills, or is dependent upon the inherent qualities of the individual. In deconstructing the apparently intuitive process of building rapport, neuro-linguistic programming (NLP) can offer insight, suggesting that rapport building depends on learnt skills that have moved into unconscious competence. The examination of nurses' intuitive knowledge, in order to identify underlying skills, needs to be just as rigorous as the acquisition of scientific knowledge. Examining intuitive knowledge can be achieved within a framework of reflective practice to counter the inherent dangers of an increasingly scientific approach operating within a caring profession.
Barriers to physical activity in people at risk of coronary heart disease
Authors: Brown Jenny
Published: May 2014

Scotland has a high risk of coronary heart disease (CHD) and a literature search identified the risk factors and the importance that physical activity plays in reducing the risk. The search also revealed that patients at risk of CHD find it difficult to increase their exercise levels. In an attempt to understand this, barriers to exercise were explored from a psychological perspective. The study uses the Multidimensional Health Locus of Control Scale (MHLCS) (Wallston and Wallston, 1978) in conjunction with a specifically designed exercise questionnaire. The results show that differences in exercise levels exist between different age groups and between males and females. Differences in MHLCS scores and in barriers to exercise are also shown between the different age groups and sexes, as well as between those working and those not working. The main barriers to exercises were time, ill health, preference to do other things, money, having nobody to go with and lack of confidence.
Universal precautions: improving the knowledge of trained nurses
Authors: Roberts Carol
Published: May 2014

Universal precautions relate to the management of blood-borne viruses such as human immunodeficiency virus (HIV) and hepatitis B and C. Advice on the transmission of blood-borne viruses and the precautionary measures used to reduce or eliminate cross-infection have been addressed by national and professional bodies. There is a significant amount of research which assesses trained nurses’ knowledge of universal precautions and includes understanding of the transmission routes of blood-borne viruses and the measures required to prevent cross-infection. However, the majority of the literature indicates an incomplete knowledge among trained nurses of the principles and application of universal precautions. The ability of the trained nurse to fulfil his/her role as health educator, teacher and therefore effective infection control practitioner is questioned by the literature. This article discusses the role of education in improving the knowledge of trained nurses and considers the implementation of in-service training and preregistration education.
Speaking of sex: the need to dispel myths and overcome fears
Authors: Evans David T
Published: May 2014

Myths and fears are intimately associated with issues of sex, sexuality and sexual health. Many myths and fears, present in both the education and clinical settings, prevent health carers from maximizing the potential for wholeness and wellness, for both themselves and their clients. In order for nurses, midwives and health visitors to take their role in therapeutic communication around the sex issues seriously, these myths must be dispelled and the fears overcome. Many of the hindrances to communication are shrouded in other people's taboos and morals, and hidden within the languages of clinical terminology and silence. This leads numerous clinicians and educators to an incommensurate fear of dealing with the sexual issues of life. This article argues that this is an example of institutionalized erotophobia (fear of sex), which results in a barrier to genuine, therapeutic, communication. For the sake of brevity, ‘sex’ will refer to sex, sexuality and sexual health. Likewise, unless a clear distinction is being made, ‘nurse’ will include midwives and health visitors.
3m Tegasorb Thin: A hydrocolloid dressing for chronic wounds
Authors: Williams Clare
Published: May 2014

Hydrocolloid dressings remain as popular today as when they were first developed in the early 1960s (Williams, 1994). The reason for this is that they provide a convenient and cost-effective treatment option for those who deal with the management of chronic wounds such as pressure sores and leg ulcers. This article examines Tegasorb Thin from 3M and shows how it can create the optimal moist wound healing environment.