bluuebunny/crossref_metadata_2025 huggingface dataset:
Midwives' views on redefining midwifery 3: continuity of care
Authors: Lavender Tina , Bennett Natalie , Blundell Jackie , Malpass Lyn
Published: May 2014

This is the third of four papers examining the opinions of midwives on their expanding role. The first paper explored midwives' views of their role in health promotion, while the second focused on midwives' views of their contribution to public health strategy. This paper studies midwives' views of potential changes in practice, which may result in increased continuity of care. The main findings suggest that midwives believe that improved continuity of care can be achieved by extending the duration of contact they have with women. They also suggest that preconception input and additional postnatal visiting may have a positive impact on health outcomes.
Celebrating history and embracing change
Authors: Charlton Doug
Published: May 2014

Happy New Year to you all and congratulations for getting through yet another difficult year of targets and challenges. I sometimes wonder when they will end or at least slow down. But let's not be down in the mouth. Through all the doom and gloom of the winter, I want to spread a little excitement into this New Year. As you probably already know this year is the centenary year of the introduction of the Midwives Act 1902. The profession is 100 years old. Yes I know, I hear some of you saying, that's how you feel after a long shift, but stop just for a moment and think of the difference you, as an individual and our profession as a whole has made to the health and development of this great nation.
Webwatch
Authors: Bass Janice
Published: May 2014

This is the first in a new series of articles providing a review of websites relevant to midwives. The speed of change and the explosion of information technology means that midwives need to access reliable evidence to inform practice, yet need to be more selective about the information they access and use. Each month a website will be reviewed and rated according to certain specifications including accessibility, navigation, design, content, special features, and an overall rating out of 10.
New research into infant colic
Authors: Kanabar Dipak , Clayton Paul , Randhawa Manjit
Published: May 2014

New research using Colief Infant Drops, and published in the October 2001 issue of the Journal of Human Nutrition and Dietetics (Kanabar et al, 2001), has confirmed transient lactose intolerance as one of the principal causes of infant colic.
Supporting women after obstetric complications
Authors: Briscoe Lesley , Lavender Tina , Alfirevic Zarko
Published: May 2014

Postnatal support has been discussed in the literature over several decades. However support for women following an obstetric complication has received less attention. A descriptive study was carried out to discover how these women feel about the support that was currently provided in the postnatal period and aimed to discover whether additional support is required after a complicated pregnancy. A group of 49 women were questioned using a specifically designed semistructured questionnaire. The findings suggest that, in general, this group of women felt well supported and highlighted factors that women valued in their individual support frameworks. Although it is known that emotional support given to women in labour is important, this study indicates that this may also be true of the postnatal period. This study recognises that to provide an equitable maternity service, midwives must be aware of the implications for those women who are unsupported and may need the listening abilities provided by effective maternity care.
Midwifery cannibalism
Authors: Gould Debby
Published: May 2014

As we celebrate 100 years of the Midwives Act 1902, which protected the term ‘midwife’ in statute and reinforced midwives’ right to autonomous midwifery practice, it is important to consider how current trends in maternity services are affecting our midwifery profession. My intention is to stimulate debate and I suspect that ‘midwifery cannibalism’ may seem a somewhat emotive metaphor. Yet ‘cannibalism’, or eating your own kind is exactly what I suggest the midwifery profession is indulging in today. Cannibalism, even in societies where it is not normal, emerges as a survival strategy in extreme conditions. Midwives are their own worst enemies.
Webwatch
Authors: Bass Janice
Published: May 2014

This month is National Breast feeding Awareness week from the 12-18 May. Therefore this edition of Webwatch includes a review of the newly launched www.smanutrition.co.uk
Pals in pregnancy: a luxury or a lifeline?
Authors: Fogarty Bernadette , Kingswell Sue
Published: May 2014

This article examines the evolution and evaluation of, the Coventry-based, peer social support service, ‘Pals in Pregnancy’. The service is aimed at vulnerable pregnant women and delivered by paid, trained peers. During the study period 100 clients were referred by community midwives. Thirty one clients completed the service and 20 clients were still receiving support at the time of evaluation. Pals made over 400 personal contacts, providing, on average, 22 hours of social support to each client who completed the service. The Pals in Pregnancy model has demonstrated itself to be a useful vehicle for reaching some of society's most vulnerable pregnant women, providing practical support that directly enhances their lives. The service is most acceptable to women who have lived in an area for 2 years or less. Most clients prefer their Pal as a source of information and the service is especially valued by women in, or fleeing a violent relationship
Child abuse and domestic violence
Authors: Miller Stephanie
Published: May 2014

Two major theories of child abuse are discussed and examined and possible causes of child abuse are identified. Research carried out by recognised specialists in the field of child abuse is discussed, while demonstrating the correlation between child abuse and domestic violence. The need for greater awareness into the possible causes of continuances of child abuse are identified with implications for all health-care professionals.
Sharing reflections in midwifery practice
Authors: Hansom Justina , Butler Margaret
Published: May 2014

Reflection has been recognized as being beneficial in helping midwives to evaluate practice. A reflective practice group has been in operation since 1997 in a large regional maternity unit in the north east of England and is open to all midwives in both hospital and community settings. Continued evaluation of the group has identified common themes throughout the life of the group which include, communication issues, lack of support and practice dilemmas. While positive comments have been received on the value of the group to individual midwives, ongoing evaluation has also highlighted the need to encourage greater attendance of the group with the creation of small groups attached to specific clinical areas.
Funding folly causes lost opportunity
Authors: Gould Debbie
Published: May 2014

Today's midwife needs a balance of in-depth knowledge of her area of practice and the clinical skills necessary to provide optimum care for a woman, her baby, and her family during pregnancy and childbirth. If a midwife is going to practice truly woman-centred care, she must be competent in health assessment and able to exercise her ‘discretion and judgment’, referring directly to other professionals as appropriate (Standing and Nursing and Midwifery Advisory Committee, SNMAC, 1998; RCM, 2000).
An unborn baby's smile. At what price?
Authors: Robinson Jean
Published: May 2014

There it was on the front page – a large colour photograph of a 34-week unborn baby, apparently smiling ‘in the comfort of its mother's womb’ (Daily Telegraph, 2003). Irresistible. I bet every mother was looking at it and going ‘Aaah’. Me too. What a splendid advertisement for the private health clinic where the picture was taken, and for the doctor who has pioneered this scanner ‘which can be used as early as the seventh week of pregnancy’. Isn't technology wonderful?
Sonicaid FetalCare: fetal heart rate analysis
Authors: Pardey James
Published: May 2014

Advances in technology over the past 30 years enable us to assess fetal health using safe and non-invasive ultrasound techniques. One such technique is fetal heart rate monitoring, and in pregnancies where there is fetal compromise the fetal heart rate contains crucial information with regard to the optimum timing of delivery. The features of the fetal heart rate are well understood, but numerous studies have shown that expert assessment of traces is prone to inconsistency. In addition, when junior or inexperienced staff review traces important features may not be noticed, with the danger that critical decisions are delayed. Computer analysis of the fetal heart rate using Sonicaid FetalCare or the care analysis built into Sonicaid fetal monitors is therefore a welcome and much-needed way of standardizing interpretation to the highest standards. Such analysis captures an enormous amount of clinical experience and in effect brings it to the bedside.
NHS Modernization Agency: Step 58
Authors: Dimond Bridgit
Published: May 2014

The NHS Plan ( www.nhs.uk/nhsplan/contentspdf.htm ) was published in July 2000 and had the aim of increasing investment into the NHS and at the same time meeting the significant challenges of the NHS, which were seen as:
The importance of postnatal care
Authors: Bick Debra
Published: May 2014

The 10th anniversary of this journal is also cause to celebrate a decade of interest in a previously ignored aspect of maternity care: the postnatal period.
Antenatal education changes and future developments
Authors: Schott Judith
Published: May 2014

Parent education has long been considered to be an integral part of the service offered to expectant parents. This article discusses the changes in antenatal education that have taken place over the last 10 years, what has not changed and what still remains to be done to meet the needs of expectant parents.
Local Supervision Authority: a sense of direction
Authors:   LSA Midwifery Officers
Published: May 2014

Local Supervising Authority (LSA) Midwifery Officers can celebrate the achievements of statutory supervision of midwives and LSA Midwifery Officers over the past 10 years.
We should go with the rhythm of labour
Authors: Walsh Denis
Published: May 2014

‘I faked labour for a couple of hours in the hope that I could avoid intervention’. I was really disturbed by this statement made in the course of chatting to a woman about her labour. To feel driven to such behaviours is a serious indictment of current maternity care. One thing this woman was absolutely clear on was that the professionals were very focused on labour progress as a marker of a ‘good’ labour. Faking it could be counter-productive because eventually a vaginal examination will catch her out.
Truly with women: natural birthing centre
Authors: Wood Tracey
Published: May 2014

At Crowborough Birthing Centre (CBC) we rely on neither cardiotocograph monitors nor epidurals for labour. This gives us time to be truly ‘with woman’. Instead, we fully use our observation to monitor the ‘normal’, and our skills as midwives to reduce the use of drugs. In doing so we have facilitated an environment, both spiritual and loving, where birth is a memorable experience for all the right reasons, for all concerned.
Female obstetricians' birth choices
Authors: Robinson Jean
Published: May 2014

Do you remember the kerfuffle there was in 1997 when a survey was published of the views of London obstetricians on elective caesarean sections for themselves or their partners (Al-Mufti, 1997)? Nearly a third (31%) of the women said they would choose an elective section if they had an uncomplicated single cephalic presentation. Only 8% of the men would want an elective section for their partners. The reason most of the women wanted a section was to avoid damage to the pelvic floor.
Midwives conducting the neonatal examination: part 2
Authors: Mitchell Mary
Published: May 2014

This second article on neonatal examination explores the experiences of midwives conducting the neonatal examination under the themes that relate to the midwives' actual conduct of the examination: including feedback from the mothers and professional issues surrounding responsibility and competence. Midwives felt they carried out the neonatal examination in a way that maximized their opportunity to achieve its aim. They compared themselves favourably to doctors believing they enhanced the quality of the examination. Most midwives felt they were conducting sufficient neonatal examinations to maintain competence. All midwives rejected the notion of formalized systems to check competence, accepting the responsibility for the development and maintenance of competencies as stipulated by the NMC (2002).
Step 51: Race discrimination
Authors: Dimond Bridgit
Published: May 2014

The Race Relations Act 1976 (modelled on the Sex Discrimination Act 1975) made it a statutory offence to discriminate against a person on the grounds on race. Racial grounds are defined widely as meaning colour, race, nationality, or ethnic or national origin (S.3). Ethnic is wider than race and covers a group with a long-term shared history with a cultural tradition, social customs and manners. Discrimination could take three forms: direct, indirect and victimization.
Two become one, the birth of CEMACH
Authors: Sidebotham Mary
Published: May 2014

It has been a very long and difficult pregnancy but finally after 3 years of doubt, mistrust, apprehension and angst we can welcome the birth of the newly created Confidential Enquiry Into Maternal And Child Health (CEMACH). CEMACH was officially launched under the parentage of NICE on 1 April 2003, and after the years of consultation and waiting, we will now be watching carefully as expectations of this new organization are high.
The PEER project: a model of peer review
Authors: Cheyne Helen , Niven Catherine , McGinley Mary
Published: May 2014

PEER (Peer, Education, Evaluation, Review) is a model of peer review which involved midwives meeting regularly as a group with each midwife presenting a case study to the group. Case review followed set rules covering confidentiality, positive feedback and critical evaluation. The aim of this project was to evaluate the implementation of the PEER model of peer review for midwives. Three centres participated, selected to represent a range of midwifery practice. There were two groups of five midwives from each centre, 30 midwives in all. The research tools included; semi-structured interviews, an adjective checklist diary, semi-structured group interviews and a postal questionnaire. Midwives were overwhelmingly positive about the experience of participating in PEER. They had appreciated the opportunity to reflect on their practice and learn from other's experiences. Many indicated it had increased awareness of accountability and the importance of record keeping. PEER provides a model of peer review, which is acceptable to, and supported by midwives, providing a positive impetus for changing and sustaining practice.
What are they eating?
Authors: Robinson Jean
Published: May 2014

Am I the only one who worries about the diet of pregnant women nowadays? There seems to be a wider and wider gap between those who have the money, the time, the know-how to nurture the child even before conception with a carefully selected range of wholesome organic food, and those who have sub-optimal nutrition for a variety of reasons. I see adolescent girls on sporadic slimming diets. Inadequate calcium intakes even when bones are still growing. Sudden switches to unplanned vegetarian food, which can deplete iron levels until the body adjusts to obtaining non-haem iron from other sources (if enough of them are eaten). There are the depressed mums who get by on a cup of tea and a ciggy — the women's refuge was full of them when I was working there. And always the hard-up mums who feed the children but have too little money or energy left over for themselves.
Postnatal breast and perineal pain
Authors: Steen Mary
Published: May 2014

Painful breasts and perineum are a very common phenomenon in the early postnatal period. Both types will cause acute pain and may cause considerable distress and discomfort for many mothers. Assessing pain before offering advice on how best to alleviate the pain is an important issue. Midwives will, therefore, need to routinely assess the intensity and quality of the pain by asking mothers to self-report. It is generally accepted that acute pain is managed inadequately by the use of systemic analgesics alone. Localized pain relief, however, can assist to alleviate acute pain and hot and cold therapy throughout the centuries has been used effectively to achieve this. This product focus describes the benefits of two cooling devices (Mom's Breast Soother® and the femé Pad®) manufactured by Florri-Femé Pharmaceuticals Ltd, that will assist newly delivered mothers to achieve breast and perineal pain relief.
Clinical teaching privileges and practice
Authors: Pincombe Jan
Published: May 2014

This article describes an academic's experience of gaining midwifery clinical teaching privileges at a major maternity hospital in South Australia, in the midwives' clinic (located in the antenatal clinic), delivery suite, postnatal ward and neonatal unit. The themes that became apparent from the case study analysis were: communication and continuity of carer, synergy with the birthing environment, duty of care and legal responsibilities, sensitivity to cultural needs, power of management systems, increased documentation and awareness of neonates' needs and the power of technology. The article concludes that several ways are available for academics to gain midwifery clinical teaching privileges.
Do women understand prenatal screening for fetal abnormality?
Authors: Ockleford Elizabeth , Berryman Julia , Hsu Ron
Published: May 2014

Screening for fetal abnormality is routine in many parts of the world. This qualitative study found an alarming level of misunderstanding surrounding the purpose of ultrasound scans and serum testing. Findings show that some women did not understand that they were free to choose whether or not to have tests. Some who did understand the optional nature of the tests were making decisions based on poor understanding of what the tests were for or the nature of the results they would yield. The issue of consent is discussed the light of these findings. This research has highlighted an important area of concern and it is clear that further work is needed to ensure that a better level of understanding is attained by those undergoing prenatal screening.
Give mothers real choice say MPs
Authors: Robinson Jean
Published: May 2014

Glory Hallelujah! The MPs on the Health Committee believed our evidence and their latest report Choice in Maternity Services endorses everything that the consumers asked for (House of Commons, 2003): ‘Rather than seeing home birth as a potential drain on sacred resources, home births should be seen as a gateway to promoting normal birth and a spur towards midwife recruitment and retention.’
Better Births Initiative in South Africa
Authors: Smith Helen J
Published: May 2014

Reliable evidence of the effects of all types of healthcare interventions exists; the challenge is to help health professionals access, understand and use this information to make more informed decisions about care. Many different interventions to change health professional behaviour have been tried and evaluated, usually in high-income settings, and the results are variable. There are specific physical and human resource constraints that mean strategies to change health professional behaviour designed and tested in North America or Europe might not be applicable or effective in an African setting. This article discusses the challenges of implementing a low cost, interactive educational programme to encourage labour ward staff in a resource-poor setting to change their practice according to evidence-based standards.
Developing a home for midwives
Authors: Page Lesley
Published: May 2014

For many years I was unconvinced of the value of birth centres and home-from-home units in hospitals. I was concerned about the term home-from-home because in fact there is no place like home, and felt (and still believe) that the woman's own home is best for women with healthy pregnancies who feel safe there.
Midwives: advocates or arbitrators?
Authors: Warriner Sian
Published: May 2014

The Government's Health Committee Maternity Sub-group report Choices in Maternity Services (DoH, 2003), published in July this year, once again reflects the difficulties many women face when accessing maternity services across the country. Julia Drown MP, Chair of the Maternity Services Sub-committee, said: ‘This report reflects our disappointment that extensive reforms to Government policy on maternity services made 10 years ago, have not resulted in a greater degree of choice and control for women and their families.’
Critical incident analysis of water immersion
Authors: Campbell Gillian
Published: May 2014

The process of reflection allows the possibility of exploring previous experiences, feelings, thoughts and attitudes (Parker et al, 1995). Reflection is a fundamental part of critical incident analysis. This study reflects on a woman's experience of using water immersion during the first stage of labour, and is arranged using Gibbs’ reflective cycle. This dynamic cycle involves a description of the incident, feelings and thoughts experienced, evaluation and analysis of the incident, conclusions and action plan (Gibbs, 1988). There is not enough evidence to evaluate the use of immersion in water during labour (Nikodem, 2002). However, the uncomplicated pregnant woman who wishes to labour in water should be encouraged accordingly. Water immersion during the first stage of labour presents an opportunity for midwives to demonstrate the tenets of women-centred care, such as informed maternal choice, control, continuity of care and effective communication.
The risks and benefits of neonatal screening
Authors: Ladhani Shamez
Published: May 2014

The benefits of neonatal screening to detect asymptomatic disease and prevent severe complications are supported by four decades of positive experience with phenylketonuria and congenital hypothyroidism. Success has led to proposals for screening of dozens of other genetic and infectious conditions. Molecular genetics has added a new dimension to neonatal screening by improving screening tests, detecting carriers, allowing anticipation of disease complications and providing parents with the opportunity to decide and prepare for future pregnancies. On the other hand, previous experience has shown that screening can be costly and cause adverse psychological effects, such as anxiety, stress, guilt, social stigma, reduced self-esteem, and social, insurance and employment discrimination. Ethical concerns, too, need to be addressed regarding the detection of carriers and screening for late-onset diseases in the neonatal period. However, neonatal screening will continue to expand as governments and the public move towards disease prevention. Careful periodic reviewing of new screening tests should ensure that screening programmes do more good than harm.
Book Review
Authors: Abbott Laura
Published: May 2014

Jennifer Worth has written this novel based on her own experiences as a midwife working in London's East End in the 1950s. Working with an order of nuns practicing since the 1870s, she brings the poverty stricken conditions alive. The dedication of the midwives is quite humbling and the honesty of Ms Worth's writing is emotionally moving. The novel is an important piece of work detailing midwiferyhistory which would otherwise be lost to one incredible woman's memory. There is a beautiful description of the authors first breech birth at home, a 26-week old baby born prematurely who survived withkangaroo care at home, and a woman having her 25th baby in as many years.
Attitudes to female genital mutilation
Authors: Momoh Comfort
Published: May 2014

Immigrants from Africa, Somalia in particular, bring with them traditional sociocultual and religious values and beliefs that continue to present challenges for midwives in the UK. British-born daughters of immigrants remain at risk of female genital mutilation (FGM) and it is imperative that those attending circumcised women in the UK understand the complex nature of attitudes to the practice and are aware of the legal issues (Prohibition of Female Circumcision Act 1985; Female Genital Mutilation Act 2003). The author of this article travelled to Somaliland to discover, first-hand, what sustains practice of FGM and what is being done there to raise awareness of the dangers of FGM. The findings are reflected in recent legislation summarised in the text.
Service framework calls for cultural shift
Authors: Richens Yana , Thomas Merly
Published: May 2014

The National Service Framework (NSF) for Children, Young People and Maternity Services was officially launched on 15 September 2004, and is receiving a positive welcome with endorsements by the Royal College of Midwives (RCM) (RCM, 2004) and the Royal College of Obstetricians and Gynaecologists (RCOG) (RCOG, 2004).
Female genital mutilation: cause for concern in the UK
Authors: Siwha Joyce , Baron Maurina
Published: May 2014

Many midwives would have heard about the recent case of the doctor in the North East London strategic Health Authority, struck off the General Medical Council register for serious professional misconduct for offering to carry out Female Genital Mutilation (FGM) for £50 at a time. He was videotaped agreeing to circumcise an eight-year old girl and circumcise and stitch two older girls (Forward, 2004). This case generated much political debate, which challenged the knowledge, concepts and attitudes about FGM.
Advances in ventouse extraction
Authors: Mainstone Adrian
Published: May 2014

Obstetric history records the development of instruments and apparatus invented to assist operative delivery. This article traces the path from the invention of forceps to the latest ‘ventouse’ or vacuum extractors designed to improve the safety and well being of both mother and infant during delivery.
Pregnant women and substance misuse: an audit
Authors: Prentice Sheena , Watts Kim
Published: May 2014

This article presents the findings of an audit completed between April 2002 and March 2003 in Nottingham City and the surrounding boroughs. The audit was undertaken as a result of a change in service provision due to the introduction of a specialist midwifery role working with pregnant drug using women. This article will explain the background to the introduction of the post and the subsequent impact this has had on maternal and neonatal outcomes of pregnant drug-using women and their infants.
National Institute for Clinical Excellence
Authors: Dimond Bridgit
Published: May 2014

The National Institute for Clinical Excellence (NICE) was established on 1 April 1999 to promote clinical and cost-effectiveness (NICE, 1999). It is an independent organization for providing guidance on treatments and care for those using the NHS in England and Wales. It can be accessed on its website (www.nice.org.uk).
Managerial implications of expanding practice
Authors: Andrews Shirley
Published: May 2014

A combination of practitioner, consumer and government pressure has resulted in a radical reappraisal of the role of the midwife over the last decade, expanding their sphere of practice into new responsibilities. This article will examine the effect this has had on managing midwifery services. It will start with background material by outlining the core role of the midwife, the position of midwifery management within trusts and the causes and origins of the expansion of midwives’ sphere of practice. This will be followed with an assessment of the managerial implications, problems and advantages of the changes in the role of the midwife.
Leaving midwifery: bullying by stealth
Authors: Gould Debby
Published: May 2014

Why do midwives and doctors leave the NHS ? Studies have demonstrated similar reasons for both professional groups leaving the NHS, including perceived lack of support and not being able to practice in the way that they would want to (Kirkham, 2002; Health Policy and Economics Research Unit, 2004). Both midwives and doctors are united under a system which does not really respect individualism but rather wants people to conform to the organizational norms and established authority.
The independent midwife
Authors: Page Lesley
Published: May 2014

Ten years ago Changing Childbirth (1993) described the need for midwives to work closely with women, practising autonomously and being part of the local community. Continuity of carer was seen as being fundamental to the close supportive relationship that enables the midwife to practise sensitively and effectively. Changing Childbirth described the need for services that treat individual women with respect and dignity long before NHS policy as a whole called for responsive accessible services that are focussed on the ‘patient'. Last year the House of Commons (2003) affirmed the importance of the policy laid down by Changing Childbirth, and talked about disappointment that the principles had not been established for all women, and that maternity services still experienced some severe problems.
Toenails and selenium: preventing pre-eclampsia
Authors: Robinson Jean
Published: May 2014

I escape to the cool, ordered, world of the medical library. There, tragedies are neatly summarised, set in reassuring print, somehow remote from the distressing events women share over the telephone. My good intentions of keeping up-to-date with the reading are always coming unstuck, but I find I need that time to take a broader look and get my brain in gear.
Low birth weight: exploring an enigma of failure
Authors: Ball Linda
Published: May 2014

Low birth weight (LBW) (≤=2500g) is universally recognized as a significant health problem, yet there remains a paucity of published evidence concerning how to intervene successfully in a preventative capacity. This article comprises an overview of a ‘review of reviews’ (Ball and Kirkham, 2002), in which high-quality systematic reviews and background literature on preventative intervention were identified. By default, the findings of published research provide a key to the enigma of LBW, and the phenomenon is more readily understood when considered in the context of basic inequalities in health, which are generational in nature and deeply entrenched among families who live in poverty and deprivation. What is needed therefore is a completely radical model of care, which operates outside the traditional boundaries of medical practice. Many excellent initiatives are today embraced into practice (e.g. Sure Start), and their methods and achievements should be placed in the public arena as a matter of priority.
Medical device training in maternity care: Part 1
Authors: Crozier Kenda , Sinclair Marlene
Published: May 2014

This article explores the role of the midwife in relation to the competent use of birth technologies (equipment and devices used to support midwifery care). It is argued that it is extremely important for midwives to consider the important role that birth technologies now play in their professional practice and to ensure that they are competent in using the various devices commonly found in our maternity care settings. The clinical environment in which the majority of midwives practice is saturated with new and sophisticated pieces of birth technology including sonicaids,electronic fetal monitors, blood glucose monitors, electronic infusion pumps and syringe drivers. The competent use of birth technologies relies upon the midwife having a clear understanding of the principles of device operation, limitations of the device, safety features, potential for harm and skill in risk assessment and management. However, training for midwives and nurses in the use of equipment is generally informal and often relies upon the passage of information from one colleague to another (cascade learning) with no formal assessment of competence. A checklist from the Medical Devices Agency provides some questions that midwives can ask themselves when using medical equipment.
Birth, common sense and evidence
Authors: Magill-Cuerden Julia
Published: May 2014

The term common sense appears to have disappeared from the vocabulary and has been superseded by evidence-based practice. Is common sense of equal importance to evidence-based practice in a midwife's repertoire of skills when caring for pregnant women?
Pushing in the second stage of labour: Part 1
Authors: Chalk Amanda
Published: May 2014

The second stage of labour has traditionally been managed by the midwife, directing women how and when to push. This usually involves women being instructed to use the Valsalva manoeuvre within prescribed time limits in supine or lithotomy positions. The rationale is that the duration of second stage of labour is reduced and therefore the risks of adverse effects to mother and fetus minimised. However, there is accumulating evidence that directed pushing within arbitrary time limits in supine positions is disadvantageous to the woman and fetus and is actually unjustified. Spontaneous pushing, which allows the woman to follow her own instincts and push in the second stage of labour, does not put the women or the fetus at risk of adverse effects. On the contrary, it offers clear benefits to both. Furthermore, the woman should be allowed to adopt positions that are most comfortable for her, yet encourage fetal rotation and descent through the maternal pelvis. The positions adopted can be variable, as long as labour is progressing, although upright positions are advocated during the second stage of labour compared to supine positions, which are not recommended.
Termination of pregnancy
Authors: Dimond Bridgit
Published: May 2014

In a previous article (vol 9(2): 108), the statutory provisions of the Abortion Act 1967 as amended by the Human Fertilisation and Embryology Act 1990 were considered. In this article we consider some challenges which have recently been made to the provisions of the Act and its interpretation.
Home birth experience 2: births/postnatal reflections
Authors: Andrews Alison
Published: May 2014

This second article explores the home birth experience and the time after the birth. The women perceived their home births as being positive, this increased their confidence and led to feelings of mastery over the labour and birth. They valued the support of the midwives although their overall manner was more important than knowing them. It was recognised that partners felt able to take a more active role, while other children found it easier to adapt to their new sibling. The time after the birth was seen as a more celebratory and family event. Overall birth at home was seen as a fulfilling and empowering experience.
Turner syndrome: screening and symptoms
Authors: Shepherd Jayne
Published: May 2014

Turner syndrome is a chromosomal condition that affects approximately 1 out of every 2500 female live births worldwide. Abnormalities vary from major heart defects to minor cosmetic issues. Some women with Turner syndrome may have only a few features, while others may have many. Almost all women with Turner syndrome have short stature and loss of ovarian function, but the severity of these probelms varies considerably between individuals. Other features of Turner syndrome vary among affected females and can include webbing of the neck, puffiness or swelling (lymphoedema) of the hands and feet, skeletal abnormalities, heart defects, and kidney problems. This article endeavours to raise midwives' awareness about Turner Syndrome.
Webwatch
Authors: Hassall Jenny
Published: May 2014

The site chosen for this webwatch developed from a search focusing on complications in pregnancy. This elicited the online manual Managing Complications in Pregnancy and Childbirth. Initially this was located via the World Health Organization (WHO) site, but further investigations revealed the Reproline site, which not only gives full access to the manual but also provides a wealth of other invaluable midwifery resources.
An essential guide to post-education registration and practice (PREP) rules
Authors: Smith Nancy
Published: May 2014

Recruitment and retention are two of the biggest challenges facing midwifery managers today. To ensure that midwives maintain their registration, employers must also be mindful of regulatory requirements. One of the most important regulatory issues to be aware of is post-education registration and practice, otherwise known as PREP.
Tanzania targets maternal mortality rate
Authors: Mlay Rose
Published: May 2014

The Tanzania Demographic Health Survey (DHS, 1996) reported a maternal mortality rate (MMR) of 529 per 100000 live births and only 40% of the women receiving skilled attendance during childbirth. Ten years later (2005), the DHS revealed an increase of MMR to 578 per 100,000 live births and still only 46% of the women receiving skilled attendance during childbirth. WHO, UNICEF and UNFPA maintain that skilled birth attendance is crucial in reducing the MMR.
Providing the best of birth worlds?
Authors: Daniel Lincia
Published: May 2014

As I contemplate the nightmare that is moving house, I have found myself drawn to property shows in search of inspiration and ideas for making our new home warm, welcoming and worth the agony. From ‘House Doctor’ to ‘Selling Houses’, these programmes testify to the positive psychological impact of clean, well-designed interiors.
Improving postnatal care for every woman
Authors: Ladyman Stephen
Published: May 2014

The government recognises and values the vital work that midwives undertake for pregnant women and their families from the first antenatal visit through to the early weeks after the birth of their baby. But how can midwives and government work together to further improve postnatal care for women?
Using action research to facilitate skin-to-skin contact
Authors: Price Mary , Johnson Martin
Published: May 2014

Breastfeeding has health benefits for mothers and babies. A year-long action research project was undertaken in a hospital maternity unit. The aim was to improve knowledge of breastfeeding and implement a change in practice, that of uninterrupted skin-to-skin contact between mother and baby at birth. Focus groups with midwives guided the changes. Data were collected by field notes, focus groups and semi-structured interviews and analysed using critical reflection. Empowerment of women and midwives was essential to the implementation of the change in practice. Memory aids for midwives facilitated the implementation of the new practice, until it was internalized. The practice of skin-to-skin contact increased from almost nil, to over 80%. Before successful change in practice can occur, practitioners need to be convinced of its value, involved in the change process and helped to incorporate it into practice. This process can take time, but it is more likely to ensure that the new practice is a lasting one.
Webwatch
Authors: Hassall Jenny
Published: May 2014

Effective parent education is one way that midwives can have a major impact on women's experiences of childbirth. This month's webwatch looks at three sites that all share a common theme of encouraging women and their care providers to respect and facilitate the normal, natural physiological process of birth through education and advocacy. Each site offers a different perspective and offers an excellent range of materials for midwives providing parent education.
Postnatal care: what matters to midwives
Authors: Cattrell Ruth , Lavender Tina , Wallymahmed Akhtar , Kingdon Carol , Riley Julie
Published: May 2014

There has been little change in the provision of postnatal care over the last decade. Yet anecdotal evidence suggests that midwives are increasingly concerned about the service they are providing. This study aimed to explore midwives perceptions of the current provision of postnatal care in the North West of England. A stratified random sample of 26 midwives working in a hospital or community setting attended five focus group interviews. Qualitative analysis was undertaken using an open coding mechanism to identify emergent themes. The main themes generated were priorities in postnatal care, societal influences and job satisfaction.This paper will use the views of midwives to debate the way forward in postnatal care.
Anti-D: helping women make informed choices
Authors: Wickham Sara
Published: May 2014

Anti-D is a blood product which is offered to all rhesus negative women who have given birth to a rhesus positive baby in an attempt to prevent isoimmunisation, which may cause rhesus haemolytic disease in future rhesus positive babies. This article outlines the process by which anti-D works, and explores the screening tests which are used in this area and the risks and benefits of anti-D for women. Implications for midwifery practice include the need for midwives to understand the risks, benefits and contraindications of this product, and to be aware of related issues in order to enable women to make informed choices.
Mental capacity and midwifery practice
Authors: Dimond Bridgit
Published: May 2014

On page 234 of this journal we consider the principles and provisions set out in the Mental Capacity Bill 2005. In this article we consider how these principles and provisions would apply, when enacted to situations arising in a midwifery department.
Books Reviews
Authors: Molloy Catherine
Published: May 2014

Perineal Care: an international issue provides invaluable information on caring for women who have suffered a perineal tear while giving birth. Each chapter is written by authors who are internationally recognized as experts in their field, covering a range of topics from perineal tear prevention to assessment, suturing and care of tears. A well-observed foreward by the NCT's Gillian Fletcher very accurately describes the problems of perineal trauma and the repercussions for women postnatally.
Webwatch
Authors: Hassall Jenny
Published: May 2014

Despite a multitude of initiatives, breastfeeding rates in the UK remain disappointingly low. Just one in five babies are still receiving breast milk at six months, despite recommendations that babies need nothing other than breastfeeding for the first six months of life. This month's webwatch looks at sites that offer good sources of support and information on breastfeeding.
Why women choose to have a repeat caesarean section
Authors: York Sarah , Briscoe Lesley , Walkinshaw Stephen , Lavender Tina
Published: May 2014

Rising caesarean section rates may be partly attributed to women choosing to have a repeat caesarean section. This study explores factors influencing women who chose to have an elective caesarean section following a previous emergency caesarean section. The views of women who had experienced one previous emergency caesarean section were explored during the antenatal phase of a subsequent pregnancy. In-depth, semi-structured interviews involved a purposive sample of 10 women. Analysis used an interpretative approach that searched for recurrent themes and categories. Verification of interpretation was obtained from the women. The study found that women were concerned about safety, and feared vaginal birth as the unknown. Control over childbirth was important to them and the decision on mode of birth happened either shortly after their first birth or early during their current pregnancy. The women relied on discussions with relatives, friends or women who had similar experience rather than on detailed information from health care professionals. The women would have welcomed more and consistent information, which may have altered their decision.
Developing nutrition within the midwifery curriculum
Authors: Elias Sandra , Stewart Sarah
Published: May 2014

Nutrition is important during pregnancy. It is imperative, therefore, that health care professionals responsible for the care of pregnant women have nutrition knowledge specifically related to pregnancy. In New Zealand, midwives provide the majority of maternity services, including primary health care, counselling and education. Reports show that practising midwives have inadequate nutrition knowledge or lack confidence to provide nutrition information to women. Midwifery education in New Zealand aims to prepare students for independent midwifery practice but presently there is a gap in the midwifery curricula regarding nutrition. The School of Midwifery at the Otago Polytechnic in Dunedin, New Zealand, however, has incorporated nutrition into the undergraduate midwifery curriculum. Due to the importance of nutrition in pregnancy it is essential that practical and evidence-based nutrition education is incorporated into all midwifery curricula. This will enable midwives to achieve competence in providing sound nutrition advice to women during pregnancy.
Exploring interpersonal tensions and opportunities
Authors: Bloom Jane
Published: May 2014

Midwives are required to form relationships with their clients that are therapeutic and supportive, based on trust, respect and the appropriate use of power (NMC, 2002). This article points to the interpersonal tensions and opportunities students face in their relationships and explores management of the boundaries between therapy and education when emotions are stirred up in clinicians in response to their work. The education group has enormous potential, providing a stage for exploring the tensions and opportunities that women face. Problem-based learning can be used in midwifery education to examine these issues.
Caught in the web: e-health and midwifery practice
Authors: Stewart Sarah
Published: May 2014

This article explores the concept of e-health, which is the process of providing health care by electronic means, in particular via the internet. A major force behind e-health is the increase in demand for health information and resources from consumers. Internet technology can provide practical clinical support for midwives and facilitate easy access to evidence-based information, increasing consumer empowerment and involvement in decision-making. However, there are concerns that e-health will interfere with relationships between consumers and health professionals. E-health is here to stay and the challenge for midwives is that they do not ignore it, but rather work to exploit its potential for both maternity consumers and the midwifery profession.
Co-ordinated assistance for newborn screening
Authors: Augustine Glenda
Published: May 2014

Health for All Children (Hall and Elliman, 2004) recommends that a comprehensive examination of all newborns is performed within the first 24 hours, or at least within the first 72 hours of life, with a second similar examination being performed at 6–8 weeks of age. The examination includes checks for congenital cataracts, developmental dysplasia of the hips and cryptorchidism.
Exploring women's views on patterns of antenatal care
Authors: Soltani Hora , Dickinson Fiona M
Published: May 2014

The aim of this study was to explore women's perceptions of the pattern of antenatal care in everyday practice. A cross sectional survey, using a piloted questionnaire, was employed to collect a combination of quantitative and qualitative data. The questionnaire was distributed to 700 women, over a three months period, within Southern Derbyshire Acute Hospitals NHS Trust (now called: Derby Hospitals NHS Foundation Trust). There was a 47% response rate and the respondents were generally representative of the local population. For 58% of women, their first health professional contact in pregnancy was with a GP, whereas more than half of women would have preferred to see a midwife. The average gestation at booking was 11 weeks and this was perceived by most women to be about right. On average, women had 11 routine antenatal visits, mostly in the community. This was in line with the wishes of the great majority of respondents. 87% of women reported being allocated a named midwife, and 54% indicated a preference for continuity of care. Generally women were satisfied with their antenatal care, although a number of areas were identified where women's preferences differed from that which they routinely receive, including first contact with health professionals.