bluuebunny/crossref_metadata_2025 huggingface dataset:
HIV and women: health and childbearing issues
Authors: Bott Jane
Published: May 2014

Women with known HIV infection who may have deferred child-bearing because of their serostatus are now reconsidering their reproductive options, because of the promise of new therapies which both improve their own health and reduce the risk of vertical transmission (Beckerman, 1998). In addition, it is hoped that more women will be diagnosed during pregnancy as HIV testing is now to be offered and recommended to all women along with other routine blood tests during pregnancy (Department of Health, 1999). By developing their professional knowledge and understanding, midwives will be more prepared to enable HIV-infected women to make informed decisions about their lives, either preconceptually or during pregnancy. This article aims to provide up-to-date factual information regarding HIV-related women's health and childbearing issues.
The duty of quality and midwifery services
Authors: Dimond Bridgit
Published: May 2014

This article looks at the statutory provisions which underpin the new institutions established to secure quality in the NHS. It looks at the duty of quality which is at the heart of the concept of clinical governance. It describes the functions of the National Institute of Clinical Excellence and the powers and role of the Commission for Health Improvement. The functionof the Supervisor of Midwives is considered in relation to the duty of quality and the need for clarification set out.
Part 13: Giving information
Authors: Dimond Bridgit
Published: May 2014

In the last article the civil action of trespass to the person was explained. Unless a patient has given consent or there is other legal justification, any direct contact with that person could constitute a trespass to that person. Harm does not have to be proved. In order for the consent to be valid, sufficient information must be given to the person so that it is clear to what they are giving consent. If the patient has given a valid consent to treatment, an action for trespass to the person will fail, however, the patient may have a right to action for failure to fulfil the duty of care to inform (Chatterton v Gerson, 1981). In this article we consider that part of the duty of care which relates to the giving of information to the patient.
Contagion and confusion: Puerperal fevers story retold
Authors: Robinson Jean
Published: May 2014

A healthy young woman gives birth to a beautiful baby. A couple of days later she suddenly starts shivering intensely. Her pulse races and she develops a high fever. Then she gets abdominal pain so agonizing she cannot bear the lightest touch on her skin. When the pain stops her family heaves a sigh of relief — she has turned the corner. But the doctor knows it is the sign of impending death. A classic case of childbed fever.
Part 21: Congenital disabilities Act 1976
Authors: Dimond Bridgit
Published: May 2014

The thalidomide tragedy when babies were born with severe disabilities as a result of their mothers taking thalidomide during the pregnancy raised the legal question of whether an unborn child could claim compensation because of injuries it suffered prenatally. The law does not accept that an unborn child is a legal personality, so it was a major issue as to whether it would be entitled to receive compensation for prenatal negligence which caused harm. The result was the passing of the Congenital Disabilities (Civil Liability) Act. The Act enables a child who is born alive to sue any person (except the mother, apart from the one situation — see below) who has caused him to be born disabled as a result of an act of negligence.
Coping with morning sickness and hyperemesis gravidarum
Authors: Turner Alfred
Published: May 2014

Morning sickness is regarded as a normal characteristic of early pregnancy. It usually begins 4-6weeks after the last menstrual period and peaks at 8-12weeks before gradually lessening (Long and Russell, 1993). Although these experiences may be distressing, they generally pose no risk to the mother or the foetus.
Psychodynamic understanding: Its use and abuse in midwifery
Authors: Raphael-Leff Joan
Published: May 2014

Psychodynamic understanding of the complexities of human emotion can enhance the service provided by maternity-care professionals. However, this does not qualify them to make interpretations to the client about the intricacies of her psychological state. Psychotherapeutic intervention is the domain of trained counsellors and psychotherapists. What midwives, obstetricians, health visitors and paediatricians can offer is an ongoing relationship based on trust. This grants them intimate knowledge of the client which, coupled with their own empathic sensitivity to the client's communications, enables them to recognize difficulties. Expertise lies in differentiating between ordinary emotional turbulence, which inevitably accompanies child-bearing and rearing, and experiences of unbearable distress or massive denial requiring referral for psychotherapeutic help.
The case of Jodie and Mary: Separating conjoined twins
Authors: Dimond Bridgit
Published: May 2014

This article considers the legal issues which arose in the Court of Appeal decision that an operation should proceed to separate conjoined twins.
Can a woman refuse life-saving treatment?
Authors: Dimond Bridgit
Published: May 2014

Practical concerns held by midwives about the consequences of the right of the mentally competent woman to refuse life saving interventions are considered.
How to manage urinary tract infections in pregnancy
Authors: Turner Alfred
Published: May 2014

Pregnant women have a greater risk of experiencing urinary tract infections because of the pressure and the engorgement of blood vessels in the pelvic area (Kitzinger, 1997). Swift diagnosis and treatment are important in order to minimize the risk to both mother and baby. The risk of infection spreading to the kidneys is increased during pregnancy, as the flow of urine from the kidneys to the bladder becomes sluggish (Lumsden and Hickey, 2000). Urinary tract infections are experienced by 2–4% of postpartum women (Lowdermilk et al, 1999).
HIV screening issues for midwives
Authors: Bott Jane
Published: May 2014

The Department of Health (DoH, 1999a) has issued guidelines which state that all women are to be offered and recommended an HIV test along with other tests during their antenatal care. This article will consider the implications of offering and recommending HIV screening as part of routine care along with other antenatal blood tests at the booking visit. Although the HIV test is now becoming routine, various issues surrounding testing reflect the special nature of this test. This article will examine the ethical principles of beneficence, non-maleficence, autonomy, informed consent and confidentiality in relation to offering and recommending the test to women during pregnancy. An understanding of these ethical principles, which will be applied to the midwife's role in relation to offering and recommending HIV screening during pregnancy, will enable midwives to practice in line with 'Changing Childbirth' (DOH, 1993) recommendations. The cornerstone of good practice involves providing women with relevant and accurate information in order that they can make an informed choice.
Smoking in pregnancy in Nottingham - 11 years on
Authors: Northeast Sarah , Fraser Diane , Watts Kim , White John
Published: May 2014

The aim of this study was to assess whether the smoking habits of women during pregnancy had changed since the baseline survey conducted in 1986 in Nottingham (Madeley et al, 1989). The study design involved a quantitative survey of all pregnant women attending the two hospital antenatal clinics in Nottingham over a six week period in 1997. A total of 1716 self-completion questionnaires were returned, representing a response rate of 80%. It was found that although the percentage of women smoking in pregnancy had fallen from 31% in 1986 to 24% in 1997, there were still similar factors associated with prevalence of smoking in pregnancy. For example, the largest proportion of smokers by age group was in the 14–20 age range but this had increased from 47% in 1986 to 56% in 1997. The study concluded that although there had been an increase in the percentage of women receiving advice about smoking and pregnancy from midwives and nurses, there are some worsening trends in the prevalence of smoking in pregnancy, particularly in the teenage population. It is therefore recommended that smoking intervention strategies are specifically targeted towards young, disadvantaged women and those with no live-in partner and those in their household.
Health promotion for the HIV positive mother
Authors: Lydall Rosemary
Published: May 2014

As the numbers of HIV positive women are now shown to be rising, midwives need to be aware that they are going to be coming across mothers who have HIV and they need to be suitably prepared and informed. The Government has already demonstrated that they are keen to limit the spread of HIV infection and has called on many groups and agencies to play their part in this. Midwives are on the front line when it comes to health promotion, with this already being an integral aspect of our role. Due to this, midwives must become educated on the many facets of HIV which will give them the strength to empower HIV positive women, allowing them to take responsibility for their own health.
The events of early pregnancy
Authors: Harrison Julie M
Published: May 2014

Development of the embryo involves a complex series of events, which are influenced by both genetic and environmental factors. Aspects of developmental biology are discussed and how the midwife can use this knowledge to promote the wellbeing of the woman and her developing embryo. The importance of folic acid in the prevention of neural tube defects is emphasized.
The role of reflective practice in managing critical incidents
Authors: Laing Katharine G
Published: May 2014

The critical incident reviewed in this article demonstrates the value of reflective practice and the importance of effective communication and counselling skills between midwives and clients. This is a key issue to effective and sensitive care, especially when events are not straightforward or when bereavement has occurred. The first stage of the reflective process is an awareness of uncomfortable feelings and thoughts, leading to an awareness that the knowledge applied to the situation was inadequate to address the issue and support the couple involved. However, the knowledge, skills and insights gained through the review of this incident may be applied to all the aspects of midwifery care, thus improving practice.
Fetal Doppler: the panacea for fetal heart monitoring
Authors: Meddings Fiona
Published: May 2014

One of the midwife's responsibilities during the antenatal period is to detect the fetal heart rate. This is one of the most important indicators as to the wellbeing of the developng fetus. The activities of a midwife defined by The European Union Midwives Directive states that each midwife should:
HIV screening during pregnancy: gender issues
Authors: Bott Jane
Published: May 2014

Midwives have a key role in promoting health and providing health education to women and their families. The HIV epidemic is presenting midwives with fresh challenges in relation to reducing the rate of heterosexual transmission of HIV and reducing the number of babies born with HIV as a result of vertical transmission. During the booking interview midwives are now required to offer and recommend HIV screening to all pregnant women (Department of Health, 1999). This entails providing women with relevant information regarding HIV screening, and advising them in relation to safer sex (Antenatal HIV Testing Working Party, 1998). This article will critically discuss gender and social issues in relation to offering and recommending HIV screening to women during pregnancy.
Midwife consultant posts: a necessary intervention
Authors: Meakin Stephen
Published: May 2014

In 1999 the ENB Midwifery Audit revealed information gathered from 178 maternity services for the year 1998-99. Overall, a rather depressing picture emerged with normal deliveries undertaken by midwives down to as low as 52% in some units, and caesarean section often as high as 27%. Meanwhile, consultant obstetricians are demanding an increase in their numbers by 600 to cover maternity units effectively, which, at a starting salary of £50000 per annum, equates to a total of £30million per year.
Part 17: Record keeping
Authors: Dimond Bridgit
Published: May 2014

It is a statutory duty for midwives to keep records. Rule 42 of the Midwives’ Rules (UKCC,1998) states:
Feme pad: out of the ice age and into the new millennium
Authors: Steen Mary
Published: May 2014

In the UK there are approximately, 750000 live births per annum and there is evidence to suggest that 69% of women will sustain perineal injury during childbirth (Kettle and Johanson, 1997). Pain associated with the injury is frequently underestimated and many women suffer unnecessarily, often in silence (Kitzinger and Walters, 1993).
Some new and important clues to the causes of colic
Authors: Buckley Mary
Published: May 2014

Colic or persistent unexplained crying in infants is a disorder commonly encountered by health professionals. Although colic is not detrimental to an infant's health it can place stress on the family. Researchers have investigated a wide variety of therapies including formulae change, pharmacotherapy, and infant positioning manoeuvres but study results have been conflicting.
Midwives must seize the moment
Authors: Henderson Christine
Published: May 2014

I will do all I can to support you in all your endeavours and to listen to you and work with you, so said Sarah Mullally, Chief Nursing Officer for England. She was addressing midwives at the English National Boards recent midwifery conference.
Part 18: Handling complaints
Authors: Dimond Bridgit
Published: May 2014

Complaints present an extremely useful management feedback enabling swift ameliorative action to be taken. Speedy and effective handling of complaints may also prevent litigation. NHS trusts and health authorities have a statutory duty under the Hospital Complaints Act 1985 to ensure that there is an effective complaints system in place.
Whose baby? The politics of fetal surgery
Authors: Robinson Jean
Published: May 2014

Just once in a while I come across a book as rich and satisfying as dark Valrhona chocolate (yes, I know it's expensive but my excuse is that just one square gives me my ‘fix’, so I end up eating fewer calories). Sorry I can’t share that treat with all our BJM readers, but I can give you a taste of a gourmet sociological study The making of the unborn patient (Casper, 1998).
Focusing upstream to analyse perinatal mortality rates
Authors: Fowler Wendy
Published: May 2014

The Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) has been investigating stillbirths and infant deaths for almost ten years. It seeks clinical and individual causes, through examination of clinical evidence, post mortem studies (Persad et al, 1996) and the effects of certain at risk behaviours on biological processes (CESDI, 1996; 1997; 1998; 1999). However, epidemiological evidence suggests that perinatal and infant mortality are more closely linked to structural factors, poverty, deprivation and poor environments. Against these, clinical medicine has little impact, yet CESDI frequently blames clinical practice, including midwifery services. Our Healthier Nation (Department of Health, 1999) recommends a move away from secondary measures and towards public health and primary care. Epidemiology not laboratory medicine supports these approaches, identifying models of susceptibility that can underpin the development of more effective and primary care orientated midwifery services. This article considers the epidemiology of perinatal mortality and how it supports the public health model of primary care rather than the ‘futile’ efforts of CESDI.
The magic ingredient of quality care
Authors: Warwick Cathy
Published: May 2014

Recently there seems to have been more going on than ever. The air is buzzing with new ideas and new challenges. I feel a need for reflection. I also find myself amidst all the excitement of change wondering why, on some occasions, it seems to be so difficult to get the basics right. What is the magic ingredient that makes one woman's experience of the maternity services so positive and when absent, negative?
Different ways to measure satisfaction
Authors: Duff Lesley A. , Lamping Donna L.
Published: May 2014

Qualitative and quantitative methods can be used to evaluate women's views of maternity care in order to provide patient-based evidence about what constitutes a quality service. Qualitative methods provide rich data about the views, experiences and preferences of individual patients. However, as numeric estimates are often required to detect change or improvement and to make other comparisons, quantitative methods provide an alternative and complementary strategy in quality assessment. This paper outlines the relative advantages and disadvantages of qualitative and quantitative methods of evaluating women's satisfaction with maternity care, comprehensively reviews quantitative measures which can be used, and provides guidelines to help decide the most appropriate method to use.
Midwives need training in the lost art of breech birth
Authors: Robinson Jean
Published: May 2014

I remember only too well a case I sat on as a member of the General Medical Council's professional conduct committee. A baby, conceived after infertility treatment, had died.
Baby friendly care reduces child abandonment rates
Authors: Robinson Jean
Published: May 2014

My blood ran cold. What an odd expression — yet that's exactly how it felt. I was sitting in a comfortable library, surrounded by current issues of medical journals. I knew I had to re-read the article in front of me but somehow I could not bear to do so. I walked to the photocopier, made a copy and put it in my bag to take home, so I could get through the rest of the pile. It was useless. I could not concentrate on anything else.
Implications of the Disability Discrimination Act 1995
Authors: Dimond Bridgit
Published: May 2014

The implementation of the Disability Discrimination Act 1995 is slowly taking place and by 2004 will be fully in force. In this article, its provisions are described and the impact on midiwfery practice considered.
UKCC does not support the right to give birth at home
Authors: Robinson Jean
Published: May 2014

The AIMS hotline is already dealing with the fallout from the UKCC's pusillanimous position statement issued in June. Supporting Women Who Wish to Have a Home Birth, they called it — an ominous title. The statement does not give women support: it's the kiss of death. Most of the women who ask us for help are not merely ‘wishing’ for a home birth, like wishing for a new sofa. They intend to give birth at home — and they are entitled to do so. Most have already experienced a hospital birth, and they know only too well what they are rejecting.
Folic acid supplementation: Is it a safe option?
Authors: Mason John , McNabb Mary
Published: May 2014

Technological advances in molecular biology and recent scientific findings on the effects of folic acid have raised a number of questions about the safety of British governmental strategies that rely on folic acid supplementation and fortification as a pharmacological solution to neural tube defects (NTD). As the recent recommendations of the Committee on Medical Aspects of Food and Nutrition Policy (COMA) is currently under consultation, midwifery practitioners need to examine recent research findings to decide on the safety of the proposed change in government policy (DOH 2000).
The mask of pregenancy: Causes and treatment of chloasma
Authors: Turner Alfred
Published: May 2014

Hormonal changes during pregnancy can cause changes to the skin. These changes may take various forms. Women may experience red, itchy palms; blue and blotchy legs and feet; skin tags — which are benign growths often exacerbated by tight clothing; heat rash; reduction in apocrine perspiration which diminishes body odour; and skin hyperpigmentation, or darkening of the skin (Evennett, 1998).
What are the causes of postnatal agoraphobia?
Authors: Robinson Jean
Published: May 2014

They usually call us when they are expecting their next baby and they are having problems getting to the hospital for antenatal care. The story is usually the same: there was a normal first birth. In contrast to the much more common cases of post traumatic stress disorder we see there was no birth trauma. But since they had the first baby, they have been unable to go out and now a second child is on the way.
Individual trusts are impeding home births, not the UKCC
Authors: Beland Paul
Published: May 2014

Since the UKCC released it's position statement ‘supporting women who wish to have a home birth’, some confusion has arisen as to whether or not midwives have an obligation to attend women insisting on giving birth at home. Or, to put it another way, do women — at least low-risk women — have a right to expect an NHS midwife to attend them if they so insist?
Consumer criticisms of CESDI
Authors: Robinson Jean
Published: May 2014

First the good news—and it is good. Intrapartum death rales are down. It has always seemed particularly tragic thal babies who were alive at the onset of labour somehow died during that short journey. In 1993 there were 529 such deaths. In 1998 there were only 398. We will never know how much of this improvement we owe to the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI), which identi-fied poor quality monitoring in labour as a major avoidable factor. The many staff around the country who share the work deserve credit, and as consumer repre-sentatives we should record our grati-tude. Any criticisms should not detract from their notable achievements.
The tree of life: a midwife's experience in the Philippines
Authors: Rose Zenana-Renee
Published: May 2014

The purpose of this article is to describe the experience of a student on an international transcultural nursing programme that took place in the developing world. The programme was of 7weeks duration and was a total immersion into the bio/psycho/socio/cultural constructs of the host country. The area of concentration was childbearing women and their children; usually a very neglected segment of society. Students worked with indigenous nursing students, nurses, midwives and ancillary personnel both in the community and the hospital. They practiced their profession in hospitals equipped with few amenities and technological devices. They worked with perinatal clients whose experiences in labour and delivery vastly contrasted with the women in the developed world. This article describes the author's experience in a very poignant and compelling manner; an event that has had profound effects in both her life and professional practice.
Audit shows rising caesarean section rate
Authors: Paranjothy Shantini , Thomas Jane
Published: May 2014

Concerns about the rise in the number of caesarean sections (CS) and possible variation in rates between maternity units have been a matter of public debate. There has been a global increase in CS rates over the last 30years, the timing and rate of increase has differed between countries and international comparisons have been hindered by a lack of national comparative data (Notzon et al, 1987). However, few developed countries now have rates within the 10–15% range recommended by the 1985 World Health Organisation (WHO) consensus statement.
Providing continuity of care in high-risk patients
Authors: Yeadon Dianne , Adams Angela , Baldwin Joanne , Hema Karumpuzha Ramakrishnan , Leighton Nicola , Jones Peter , Johanson Richard
Published: May 2014

Further to an audit in 1990, this project aimed to improve the specialised training of midwives at North Staffordshire Hospital to facilitate the achievement of targets set within the guidelines for management of severe preeclampsia. Fifteen midwives received ‘high-risk care’ training. After completion of training, the quality of care given to patients was examined by reviewing patient notes. Despite numerous staffing changes, 85% were looked after by a ‘high dependency’ trained midwife. Appropriate monitoring and fluid management improved significantly. The proportion cared for by five or more decision makers remained high, although there were no significant differences between the three audits. Input from a specialist team was sought in 28% of cases, significantly less than in 1994, however 85% were seen by a consultant obstetrician. It is evident that the training improved the quality of care and monitoring, with minimal adverse incidents. In addition, the majority of patients were looked after at some point by a midwife with enhanced skills and a greater knowledge of high dependency care.
Long-term health after childbirth
Authors: Carter Jacky , Johanson Richard , Heycock Elizabeth , Sultan Abdul , Walklate Karen , Jones Peter
Published: May 2014

Maternal bowel and/or urinary dysfunction and child development were compared in a 5-year follow-up after normal delivery and assisted vaginal delivery. Maternal adverse symptoms were relatively common, with no statistically significant differences between the two groups except in the greater use of laxatives by the second group. There were no significant differences in child development or in the incidence of visual problems. Important maternal symptoms may persist 5years after vaginal delivery. Children delivered normally or with instruments appear to develop in a comparative manner: later visual problems may not relate to the method of delivery.
Part 26: Termination of pregnancy
Authors: Dimond Bridgit
Published: May 2014

The law does not recognize the fetus as having a legal personality, which means that action cannot be taken in the name of the unborn child, until such time, if ever, it is born. This does not mean, however, that the unborn child is not protected in law. The Offences Against the Persons Act 1861 Sections 58 and 59 and the Infant Life Preservation Act 1929 create criminal offences in relation to the attempt to secure the miscarriage of an unborn child. However, if the legal provisions of the Abortion Act 1967, as amended by the Human Fertilization and Embryology Act 1990, are followed, then this is a complete defence against any alleged infringement of the 1861 and 1929 Acts. This article sets out the legal provisions for a lawful abortion.
The effects of epilepsy on pregnancy and childbirth
Authors: Turner Alfred
Published: May 2014

Epilepsy is a brain disorder that causes recurrent seizures. Around one in every hundred young women suffer from epilepsy (Lumsden and Hickey 2000). It is the most common neurological disorder accompanying pregnancy (Cartlidge 1995).
Part 27: Registering births and deaths
Authors: Dimond Bridgit
Published: May 2014

There is a duty on the doctor or midwife attending a woman in childbirth to notify the prescribed medical officer of the birth or stillbirth within 36hours. This applies whether the birth is at home or in an institution.
An election pregnant with new meanings
Authors: Symon Andrew
Published: May 2014

A general election may be just around the corner. What role will midwives and the NHS have in the election campaign? While the NHS was generally considered to be part of the post-war consensus, with backing from both Conservative and Labour governments, financial constraints and the introduction of market philosophies in the 1970s and 1980s generated significant political divisions.
Better life-saving skills are needed for safer childbirth
Authors: Johanson Richard , Hinshaw Kim
Published: May 2014

Although childbirth in the UK has never been safer, both the Confidential Enquiries into Maternal Deaths and Stillbirths in Infancy continue to show considerable areas of substandard care. Specific recommendations for improvements include the provision of guidelines and checking on implementation with audit. There is a great emphasis on improving communication skills and team working. If we are to learn from our mistakes, there is an urgent need for every unit to implement recommendations relating to enhanced skills training. In this respect health and childbirth professionals need to consider the options becoming available which include new computer-based and video learning materials. Specific courses in pratical skills training are recommended if care in this area is to be enhanced.
Margaret Rose Allen
Authors: Hinds Marion
Published: May 2014

Margaret Rose Allen, British Journal of Midwifery's special features editor, died on 23 March 2001. She had been diagnosed as having breast cancer in 2000. Here, two colleagues pay tribute to her.
Making sense of litigation and clinical governance
Authors: Henderson Nicola
Published: May 2014

In the first part of a two-part article, the author examines the background for a research article about the Confidential Enquiry into Sudden Death in Infancy (CESDI), its recommendations and the implications for practice with particular reference to clinical governance and risk management. This part provides an overview of clinical governance, with particular reference to risk management. With 60% of the bill for negligence claims occur in this area, there is also an examination of litigation.
Delivering a framework for maternity care
Authors: Newburn Mary
Published: May 2014

As the general election approaches the National Childbirth Trust (NCT) has drawn up priorities for mothers, babies and the maternity services. Our manifesto will be widely distributed throughout England. In February, the Government announced plans for a National Service Framework (NSF) for Children in the next parliament. This would apply in England, and similar initiatives might be in train for the other UK countries. Northern Ireland, Scotland and Wales are ahead of England in developing a breast-feeding strategy. In January, Scotland led the way with a Framework for Maternity Services (Scottish Executive, 2001a).
Updating regulations with the nursing and midwifery council
Authors: Rogers Cathy , Ryan Chris
Published: May 2014

The Department of Health (DoH) has finally published the draft nursing and midwifery order 2001, having taken cognisance of responses received to the initial consultation document (DoH, 2001). Comments are now invited on the draft legislation, which is to be laid before Parliament as a Statutory Instrument under section 62(9) of the Health Act 1999 for approval by resolution of each House of Parliament.
Should midwives be teaching aquanatal exercise?
Authors: Dinwoodie Kate , Moran Victoria Hall , Bramwell Ros
Published: May 2014

Water-based exercise has been shown to be a ‘safe’ form of activity for women during pregnancy. This study investigates the level of involvement midwives have or would like to have in the provision of aquanatal classes. Postal questionnaires were used to investigate midwives' training for, and experience of running aquanatal exercise classes at four hospital sits in North West England. Of the 506 questionnaires distributed, 174 were returned. In answer to the question ‘who should run aquanatal classes?’, 94 midwives (54%) agreed that midwives were the ideal personnel to carry out aquanatal classes. However, only 41 midwives were involved in running aquanatal sessions and of those, just 25 had received any training. Of these, 15 felt that their training had been inadequate. It is recommended that a core group of exercise, midwifery and physiotherapy professionals should be responsible for agreeing a standard programme of education on aquanatal exercise for health professionals.
We must stop the distorted vision of birth in the media
Authors: Robotham Mandy
Published: May 2014

Childbirth does seem to be popular of late. Rarely have we seen so many newspaper pages dedicated to it. It seems to be open season on the maternity services and often, by consequence, midwives. Perhaps I'm being a little paranoid, but there seemed little let up in a spate of largely anecdotal, but nonetheless damaging, pieces.
A holiday in Devon: The RCM congress
Authors: Magill-Cuerden Julia
Published: May 2014

The RCM annual conference and exhibition at Torquay from Tuesday 30 April to Friday 4 May exhibited a welcome solidarity among midwives, rather like a group of people on holiday being amicable and friendly. It seemed that we were content with our lives and with few troubles, which is in contrast to the reality of our work. Lewis' (2001) concerns were perhaps not heeded by the debates portrayed by the 600 or so midwives attending.
Part 30: Woolf reforms of justice
Authors: Dimond Bridgit
Published: May 2014

Any civilised society must have a just and robust system for the administration of justice. An awareness of major deficiencies in civil procedure in the UK led to the appointment of Lord Woolf to examine the deficiencies and make recommendations for reform in his report Access to Justice.
HIV and infertility: ethical considerations
Authors: Parkin Julie C
Published: May 2014

There has been a rise in the heterosexual spread of HIV-1 infection in recent years (Berer and Ray, 1993). As a consequence, a rise in the number of women of childbearing age and their male counterparts infected with HIV can be expected. Therefore, it is probable that there may be more couples affected by HIV-1, who also experience fertility problems. This article examines attitudes towards infertility, the ethics of being a ‘perfect’ parent, and the rights and desires of HIV-1 positive couples to have a child. The discrimination against, and lack of provision for, these couples is analysed, and the treatment and equity of services available to them discussed. The financial implications of infertility treatment, the ethical problems faced when deciding whom to treat, and the role of the midwife within infertility services are also debated.
Infection control standards and the midwife
Authors: Dimond Bridgit
Published: May 2014

This article explores the unacceptably high number of cases of both cross infection and hospital-acquired infections in the UK, and details the Government's plans to improve and maintain standards of infection control within the NHS. It also details the laws in place which enable prosecution of any organization that fails to maintain reasonable hygiene standards and which enable any patient suffering harm as a result of infection to make a claim for compensation. Throughout the article, the role of the midwife in ensuring that standards of hygiene are met, and her participation in quality assurance mechanisms in the maternity unit, are highlighted.
Passive smoking: empowering mothers to protect babies
Authors: Robinson Jean
Published: May 2014

A few years ago I was interviewed by a young American woman doctor. I asked her what had aroused her interest in birth research. She said that after qualifying, she worked in a poor area in the South. She was unenthusiastic when the GP in charge suggested she should look at their maternity care, which was very low tech. ‘It was the effect on these women of giving birth which astonished me. These were women who had nothing — no education, no respect, no self esteem, no money. After having the baby they were somehow more powerful — they could cope, they could do things, they had confidence. In the community they could be amazing. I just had to understand what was happening, and what we were doing to women in childbirth.’
Accidental damage and midwifery
Authors: Murphy-Black Tricia
Published: May 2014

Last week I had a car accident. Four cars had been stopped by a car trying to manoeuvre a difficult turn during rush hour. When I rounded the bend, within the speed limit and braked sharply, I was not able to stop my car quickly enough. I hit the back of the car in front of me. The damage was minimal, no-one was hurt, details were exchanged and both cars drove off. I accepted the outcome — car in for repair and loss of a no-claims bonus — with resignation. It was a well known accident spot as it is almost impossible to turn into the oncoming rush hour traffic. It happens all the time and it is no big deal. Friends and colleagues were sympathetic and understanding.
Childbirth and primary health care in Nigeria
Authors: Adikibi Anne
Published: May 2014

Like many developing countries, Nigeria is unable to provide adequate maternal and child health care to its people because of inadequate and inequitable distribution of health resources. This paper explores the issues of traditional birth attendants in primary health care in Nigeria. This work is part of a larger study which investigated the role of traditional birth attendants in primary health care in the Rivers State, Nigeria: (Adikibi, 1988). The author has continued to follow up these traditional birth attendants in this area to monitor their progress within their community.
Litigation in the NHS: recommendations for change
Authors: Dimond Bridgit
Published: May 2014

In a recent report of the National Audit Office (National Audit Office, 2001), it was stated that the NHS must make provision for outstanding claims of £2.6billion together with an estimated liability of a further £1.3billion where negligent episodes are likely to have occurred, but where claims have not yet been received. The report noted that the number and value of claims continues to rise and they are taking on average about 5years to settle. Somewhat startlingly, it was found that nearly half the claims settled in 1999–2000 cost more in legal and other costs than the settlement itself. For settlements up to £50000 the costs of reaching the settlement are greater than the damages awarded in over 65% of the cases. Recommendations are made for the NHS Litigation Authority and the Legal Services Commission to work together to speed up the completion of cases; the Department of Health, the Lord Chancellor's Department and the Legal Services Commission to resolve the smaller and medium sized claims with a wider range of non-financial remedies and for the Department of Health to give clear guidance to NHS trusts on what information should be given to patients who have suffered adverse incidents. This article analyses the situation and makes recommendations for change.
Varicose veins during pregnancy
Authors: Turner Alfred
Published: May 2014

In pregnancy a woman's circulatory system experiences a number of changes. Her network of veins expands to cope with her increased blood supply. Blue lines may be noticeable on her breasts or abdomen, particularly if she is slim or pale skinned. This is perfectly normal. Some women, however, may experience discomfort from varicose veins, a condition caused by a hereditary weakness in the valves in the long veins of the legs that help blood to flow upwards, back towards the heart against the pull of gravity.
Fetal distress and blood lactate monitoring
Authors: Mason Ruth , Paterson-Brown Sara
Published: May 2014

Monitoring the fetal heart rate during labour is associated with increased operative delivery for presumed fetal distress. The addition of fetal scalp blood sampling to determine fetal pH reduces this effect but does not remove it. The pH of blood is influenced by elevated levels of both carbon dioxide (associated with respiratory acidosis secondary to cord compression) and lactic acid (indicating metabolic acidosis secondary to tissue hypoxia). Fetuses experiencing hypoxia switch to anaerobic metabolism thereby raising their blood levels of lactic acid. It is these fetuses which are in most danger of hypoxic-ischaemic damage. A method of measuring lactic acid directly could be superior to pH alone in terms of supplementing fetal heart rate monitoring. This is now possible with a new device called Lactate Pro and studies are under way investigating this simple bedside test.
Demand and supply in maternity care
Authors: Robinson Jean
Published: May 2014

Women wanting home births who are thought to have any risk factors are now openly being told by some midwifery managers, ‘Get a private midwife.’ I have had three such calls recently. Can anyone imagine a women who asked for an expensive unnecessary caesarean section being told, ‘You can’t have it on the NHS, go private'? Of course not. On the contrary such a request is welcomed by many obstetricians because it helps them to claim that the reason their section rates are sky high is that women are ‘demanding’ them and they have to comply. Choice is apparently all right provided women choose what the management approves. Meanwhile women without the funds to pay a private midwife, or without one in their area, are in limbo. They fear they will have no alternative but to give birth alone.
New horizons on intrapartum electronic fetal monitoring
Authors: Richens Yana
Published: May 2014

The ability of new fetal monitoring techniques to reduce complications and intervention rates was the focus of the recent 6th Internal Symposium on Intrapartum Surveillance (ISIS). The current state of fetal pulse oximetry and new electronic fetal monitoring (EFM) techniques formed a large part of the 2-day, biannual meeting held this July in Birmingham.
Evidence-based midwifery in action: an introduction
Authors: Spiby Helen , Munro Jane , Spiby Helen
Published: May 2014

Over the past 3 years, meetings have been held for midwives involved in work related to evidence-based practice to discuss ideas, network and to consider areas for future shared working. What has emerged from these meetings is that the midwifery effort in this area is fragmented and under-reported.
Evidence into practice for midwifery-led care
Authors: Spiby Helen , Munro Jane
Published: May 2014

A system of Midwifery-Led Care introduced for women receiving maternity care in one NHS Consultant Unit meant that new guidelines were required to support care provided by midwives. This paper describes the process of developing and implementing Evidence-Based Guidelines to support Midwifery-Led Care on the labour ward. The identification of topic areas, literature used in the development of the practice recommendations and the activities held during both development and after the formal launch of the guidelines will be described.
Anytime, anyplace,anywhere?
Authors: Tucker Christina
Published: May 2014

Yes, you've got it, the Martini slogan. I have been mulling this phrase over in my head whilst in a managers meeting recently, exploring yet another debate on the Link Lecturer. It seems to me that this role has always been problematic, but particularly so since NHS education has been incorporated into higher education. Although many of us would have to admit that even before incorporation the role was for some ambiguous and open to many and varied interpretations.
Infant nutritional needs: an overview
Authors: Turner Alfred
Published: May 2014

Proper nutrition is important for an infant's growth and development. For 4-6months all of an infant's nutritional needs can be satisfied through breast or formula milk, but as a child grows it develops a need for a more diverse diet. The nutritional needs of an infant are discussed further.
Fathercraft: a changing role
Authors: Symon Andrew
Published: May 2014

Fatherhood has rarely been as prominent as it is now. The coverage of high profile fathers ranges from the political (the prime minister) to the sporting (for example, David Beckham and Dennis Wise). The public display of these men's involvement with their young children has helped to alter the traditional perception of ‘father-as-provider’ and ‘mother-as-nurturer’. In contrast to the image of the distant Victorian authority figure, fathers are now seen as being capable of caring openly for their children.
Celebrating a century of supervision
Authors: Drown Julia
Published: May 2014

As Chair of the All Party Parliamentary Group on Maternity (APPGM), I share in the celebration of 100years of the statutory supervision of midwives. In that time, midwives have made a difference to millions of lives by giving them a better start. We've also seen big changes and big technological advances, but we need to ensure that these developments are helping and not hindering good birth experiences. The move towards a medical model needs to be resisted. There is overwhelming evidence supporting midwives being the lead in care.
Learning from our international contacts
Authors: Lavender Tina
Published: May 2014

Recently, I was fortunate enough to be invited to the 21st Conference on Priorities in Perinatal Care in Eastern Cape, South Africa. Delegates were midwives, obstetricians and paediatricians from all regions of South Africa and included clinicians, researchers and educators. The size of the meeting was limited to 150 to encourage close networking among delegates. The conference aim was to identify and solve problems that are priorities in perinatal care in Southern Africa. The conclusions reached will be sent to key provincial and national members of the Health Department.
Antenatal screening: turning research into practice
Authors: Soltani Hora , Hampshaw Susan , Thornton-Jones Helen
Published: May 2014

One of the major challenges in evidence-based health care is the wide gap between research and practice. The aim of this study was to review local screening programmes systematically to assess the extent to which the services were informed by available best evidence. The information on local screening practices was collected, using a structured questionnaire and follow-up telephone interviews with local key informants. Best evidence for practice was identified by collating findings of systematic reviews and guidance from authoritative sources. Twenty-three antenatal screening programmes were identified. ‘Decision sheets’ for all the programmes were developed to facilitate the decision-making process and summarise areas of variation locally and with respect to best practice. Currently, authoritative guidance exists for 22 programmes and is followed locally for the most part. On occasions, the authoritative sources gave different guidance which resulted in variations in practice locally. In two programmes we considered that variations in local practice needed to be addressed (Down’s Syndrome and neural tube defect). This approach was much valued by both health professionals and lay representatives. Using the decision sheets, the Maternity Strategy Group formed a view on how to align services for Down’s Syndrome screening. This article suggests a generic approach to narrow the research-practice gap. Further evaluation of the decision sheets is required
Resource reviews
Authors: Downe Soo , Abbott Laura
Published: May 2014

The most shocking fact about Naomi Wolf’s book is that it is necessary at all. Much of what she has described as the USA way of birth in the 1990s was revealed by Suzanne Arms 20 years previously, and by other authors since. However it is vital that it is said again, and by women of influence, and crucially by a feminist.
From Vienna to Bournemouth
Authors: Magill-Cuerden Julia
Published: May 2014

April is conference month for midwives. This will enable midwives to be engaged, uplifted and renew their faith in the midwifery profession. It is a time to reflect on the purpose of midwifery and to recognise the roles that midwives play in the lives of women.
Small really is beautiful
Authors: Walsh Denis
Published: May 2014

In the context of normal birth, can anyone please tell me any reasons why centralising place of birth is a good thing? I can only think of a multitude of reasons why ‘small is beautiful’ for this event.