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How a woman experiences birth is influenced by how she is treated, and who has power and control in the birthing environment. Focus on 'delivery' of an infant disregards the transformative event for the woman, with poorer physical and psychological outcomes. New evidence is needed to understand how to prevent trauma and improve maternal wellbeing. This paper presents a feminist methodology to view the lived experience of caesarean birth. Feminist birthing theories integrated with a phenomenological perspective provide insight for those working in maternity care and create a novel framework for researchers considering the position of women in a medicalised healthcare system. Feminist phenomenology with a theoretical feminist overlay refreshes the methodological framework for a new understanding of how this perinatal event impacts women. [ABSTRACT FROM AUTHOR]

Background/Aims: Extensive research focuses on the advantages and disadvantages of various positions throughout active second stage labour, but there is limited focus on midwives' practice. This study aimed to explore midwives' practice of maternal positions throughout the active phase of second stage labour. Methods: An integrative review of three databases was carried out for research papers published between 2015 and 2022. Thematic analysis was used for data analysis and synthesis. Results: Five eligible research papers were included. There were four key findings: maternal positions practised by midwives, midwives as the prime decision maker, midwives' personal convenience and comfort, and barriers to practising maternal positions. Conclusions: Midwives were seen as prime decision makers, who hindered informed decision making on maternal positions during active second stage labour. Inadequate knowledge, skills and confidence were barriers to practice and attributed to midwives adopting positions that were convenient and comfortable for themselves. Strategies are needed to enhance practice through review and evaluation of current clinical settings, regular updates to evidence-based practice and refreshing essential midwifery skills. [ABSTRACT FROM AUTHOR]

Background/Aims: Ideological perceptions of normal, physiological birth can be potentially dangerous. Clinicians highlighted to the Health and Social Care Committee how social media affects this, believing that the 'pressure' of social media contributing to 'a big expectation of normality' among expectant parents. This review's aims were to explore the available literature to support this statement and provide a contemporary insight that incorporates the consequences of the COVID-19 pandemic. Methods: This review was a qualitative meta-synthesis of literature identified in April 2022 using seven subject specific electronic databases: CINAHL Plus, MEDLINE, AMED, APA PsychInfo, APA PyschArt, MIDIRS and The British Nursing Database. Five qualitative primary research papers were critiqued and summarised. Results: The first theme was focused on how social media reshapes and marginalises narratives of birth; the dominant narrative of medicalised birth is reinforced, but the curated narrative around physiological birth can also be problematic. The second theme encompassed how social media alters women's autonomy and agency in decision making about birth by affecting information sharing and their sense of connection. Conclusions: Social media can contribute to an ideological perception of normal birth, creating additional pressures on women. However, a medicalised portrayal of birth, which women conform to, dominates these spaces. Social media both supports, and threatens, women's ability to make informed decisions about childbirth. [ABSTRACT FROM AUTHOR]

Birth satisfaction relates to women's perceptions of their childbirth experience, with importance placed on the midwife to improve standards of the intranatal care provided. With evaluating intranatal care in mind, this paper aims to educate midwives about one particular method of measuring women's experiences of labour, which involves using the valid and reliable Birth Satisfaction Scale-Revised (BSS-R). The BSS-R is a 10-item self-report valid and reliable measure, which is recommended by the International Consortium for Health Outcomes Measurement (ICHOM) as the 'method of choice' for evaluating women's 'birth experience'. Since the ICHOM began recommending the BSS-R as part of its pregnancy and childbirth standard set, the scale (at time of print) has been used in 39 countries and 134 sites around the world. [ABSTRACT FROM AUTHOR]

It may often be assumed that, historically, women's awareness of the possibility of maternal or 'childbed' death made them fearful of childbirth. This paper considers, in historical terms, the perceptions of the childbearing woman in relation to maternal death, especially when approaching labour. It addresses and counters the view that has been advanced suggesting that the possibility of maternal death was not significant to the childbearing woman in the early modern period. To address the neglect of this topic in the literature on Scotland, the argument will be supported by documentary evidence from Scottish sources. This evidence shows that childbearing women responded to these anxieties by making appropriate preparations for labour, birth and the postnatal period. [ABSTRACT FROM AUTHOR]

The aim of this article is to relate basic findings from research papers to identify the effects that valsalva manoeuvre ('purple pushing') has upon maternal and fetal wellbeing. Analysis of 16 papers revealed four main consequences from purple pushing. These include: an increase in fetal distress; maternal distress; and perineal trauma, when compared with spontaneous pushing. Valsalva manoeuvre also makes little difference to length of second stage. Key conclusions from this literature review are that women should be encouraged to push instinctively, which often embraces natural vocalization. Restrictions of time should not be imposed when mother and fetus are well. Awaiting instinctive behaviour reduces the incidence of urinary system, pelvic floor and perineal trauma. These findings should facilitate midwives to critically understand research that underpins the Royal College of Midwives (2007) second stage of labour guidelines. [ABSTRACT FROM AUTHOR]

The first two papers in this series described the early development, and ongoing evolution of a caseholding team in the north-west of England (Byrom and Downe, 2007; Fleming and Downe, 2007). We described the outcomes of the scheme and suggested that nine key factors may underpin the success of the project, namely: continuity of carer; visibility in the community; multi-agency involvement; inter-disciplinary collaboration; leadership; strategic partnership; ability to be innovative and flexible; involvement of local community and individuals; and shared group philosophy. Based on principles of service user involvement it was agreed that the ongoing monitoring of the project would include an invitation to all those using the service to write their birth story to summarize their experiences with the scheme. This paper presents a selection of these stories as a reflection on the processes and outcomes of the scheme. The stories indicate that the benefits of the scheme are evident for both the women using the service, and the midwives providing it. They also illustrate many of the nine core factors for success identified in our previous paper. Specifically, the scheme offers the opportunity for women at high clinical and socio-demographic risk to experience positive childbirth experiences. It also offers the opportunity for midwives to exercise their skills in normalizing birth in complex situations. [ABSTRACT FROM AUTHOR]

At the moment in Wales there is a gradual sense of optimism and a renewed passion for the art of midwifery. This can, in part, be attributed to a sense of ownership and the clear direction provided by the publication of a midwifery briefing paper (Welsh Assembly Government, WAG, 2002). The impetus for developing the midwifery briefing paper was provided when the Nursing Division of the Welsh Assembly Government published the Strategy for Nursing, Midwifery and Health Visiting Realising the Potential (WAG, 2000). [ABSTRACT FROM AUTHOR]

Caesarean section by maternal request (CSMR) is the provision of a caesarean section when requested by the mother, with no medical indication. This paper aims to provide a narrative overview of CSMR to inform clinicians about the pertinent issues. It will examine current provision of CSMR in the UK and contextualise it among prevailing social and societal factors. It will explore in detail the reasons why women may choose caesarean section, and provide arguments for and against the provision of CSMR on the NHS. [ABSTRACT FROM AUTHOR]

Background: Vaginal birth after caesarean (VBAC) is a safe option for most women. In the UK, just over 50% of women with a previous caesarean section opt for a VBAC and repeat caesarean is one of the four main causes of the rising caesarean rate. It is therefore important to review the literature in order to explore the factors which influence women's decision-making, which may increase normal birth rates. Method: A literature search was conducted using Ovid Online and EBSCOhost database platforms. Primary, qualitative, peer reviewed, English language research papers were assessed according to inclusion/ exclusion criteria. Results: Nine primary research studies were found. The findings were synthesised into five themes: personal beliefs about birth, previous birth experience, the need for control, health professionals and practical considerations. Discussion: The influence of women's beliefs about birth, as well as the attitudes of health professionals were identified as the main factors that influence women's decision-making with regards to VBAC. It is important for practitioners to reflect on their own way of communicating with women about VBAC to increase perceived supportiveness and women's autonomy. Further research is required to better understand the psychosocial aspects of decision-making. Conclusion: Knowledge of the identified themes will give health professionals an insight into the inner 'lived' experience of women making decisions regarding VBAC, increasing their awareness of their potential influence on a woman's final decision when planning her birth. The factors found may also be able to be applied to other areas of women's decision-making in maternity care. [ABSTRACT FROM AUTHOR]

Despite the widespread recognition of the benefits of minimal interventions within birth, the number of women having a 'normal birth' is less than half and dissatisfaction is often reported (Department of Health, 2005; Birth Choice UK, 2013). This paper presents how an elective placement in a freestanding birth centre shaped the author's attitude to midwifery. The placement specifically enabled the author to consider what makes birth go well (rather than focusing just on what makes it go 'wrong') and encouraged her to examine the role she might play in contemporary maternity services. This experience was powerful in identifying avenues for personal and professional development, and has enabled the author to clarify her objectives as a midwife and what is needed to achieve them. [ABSTRACT FROM AUTHOR]

This article provides an overview of the literature regarding choice and how this impacts on the potential success of 'Maternity Matters', with particular focus on place of birth. The findings neither favour nor discourage the introduction of the latest government paper, but indicate the complexity of implementing choice. Choice is not straightforward and women are placed within a whirlpool of influences from professionals, the institution and from those around them. There are a number of success stories and these should be used as examples of good practice but many trusts and individuals will need to think quickly and carefully about how they will implement Maternity Matters, not least because of the tight deadline set. [ABSTRACT FROM AUTHOR]

Self-administered homeopathic remedies may be acceptable and effective for women and their partners during pregnancy, birth and after birth. They may also reduce the use of pharmacological pain relief methods and promote less intervention during childbirth. However, there has been very little research in this area to date. This second paper discusses a follow-up study that used a semi-structured interview technique to explore further the experiences of women and their partners following the use of a specifically chosen homeopathic kit that included ten remedies for self-administration. Interviews were undertaken in the homes of 18 women who reside in the South Leeds area, West Yorkshire during a six month period (September 2005 to February 2006). Four themes were generated from the data, namely how remedies were used, empowerment, emotional needs, fathers and birth partners. The final core theme was a positive birth experience. The interviews demonstrated that women and several birth partners experienced positive emotional, psychological and physical benefits from using the kit of homeopathic remedies. ISelf-administered homeopathy has the potential to promote a women-led approach to childbirth and an active supportive role for the birth partner. The findings will form the foundations to undertake further research in this field. [ABSTRACT FROM AUTHOR]

Women who have had a caesarean birth face a decision about how to deliver their baby in a subsequent pregnancy. This paper describes a qualitative study exploring the decision making experience of such women. Eleven pregnant women who had had a caesarean section in their previous pregnancy took part in semi-structured interviews one to three days after they had made a choice about mode of delivery. A thematic analysis of the transcripts revealed that most women felt they had made a choice about delivery method, though the extent of involvement in the decision differed. Making choices about delivery after a previous caesarean birth was influenced by a number of people and other factors and it involved assessment of information from previous experiences and trusted others. Medical information about risk/benefit was considered alongside beliefs about birth and moral concerns about the ñcorrect' choices to make. [ABSTRACT FROM AUTHOR]

The paper outlines the current global situation in respect of making childbirth safer through the promotion of skilled care during this critical life event. The implications of the fifth Millennium Development Goal (MDG5) are discussed and a hypothesis offered that has been derived from an analysis and synthesis of a vast quantity of literature. Examples of policy and practice from numerous countries are shared and the possible implications for midwifery practice in the UK contemplated. [ABSTRACT FROM AUTHOR]

Increasing numbers of pregnant women are turning to homeopathy and other complementary therapies to help with pregnancy and childbirth. In response to this, a programme was put together to provide safe education and treatment by a multidisciplinary team of professionals. Working collaboratively, a multidisciplinary group of midwives and staff from two departments within a large NHS Trust have set up this innovative new service. This paper describes a pilot scheme to introduce homeopathy and other complementary therapies into mainstream care provision. Pregnant women can attend the new clinic for their routine follow up antenatal checks and at the same time experience a parent education session initially including homeopathy, stress management and relaxation, and also nutrition for mother and baby. [ABSTRACT FROM AUTHOR]

Modern midwifery in most countries of the world claims to offer expertise in, and guardianship of, 'normal' childbirth. While there has been international concern about the rising rates of caesarean section, rates of reported spontaneous vaginal birth do not seem to have fallen proportionally. However, closer examination of intrapartum practices indicates that many women experiencing so-called 'normal' birth in centralised hospital settings in fact experience a wide range of technical or pharmacological interventions. This raises questions about the nature of normal childbirth. This paper examines three different concepts of normal birth, and proposes a way of seeing birth that engages with the concept of 'unique normality'. [ABSTRACT FROM AUTHOR]

Faecal Incontinence is the involuntary loss of faeces. This can affect up to 4% of primiparous women long term after delivery. Anal Incontinence generally refers to involuntary loss of faeces and/or gas (Brubaker, 2001) and is more common, affecting up to 26% of primiparous women long term after delivery (Zetterstrom et al, 1999a). Research into pre-existing, demographic, behavioural and obstetric factors, which increase the risk of developing anal incontinence, remains inadequate in several areas. Data from different studies is often conflicting due to inconsistency in definitions, study design and population variables. This paper reviews the evidence associated with several obstetric and non-obstetric risk factors, for the development of postnatal anal incontinence. [ABSTRACT FROM AUTHOR]

This article considers some of the achievements and challenges surrounding global efforts to reduce the high toll of maternal and neonatal deaths and disease. Since its inception in 1987, the Safe Motherhood Initiative has underpinned endeavours to make childbirth safer for women, particularly the poorest and most vulnerable. Reflecting on pertinent historical issues, considering examples of current achievements and speculating on the future, the paper provides insights into the challenges of midwifery practice worldwide. [ABSTRACT FROM AUTHOR]

This article reports some of the findings from a larger study exploring the influence of uncertainty on the decision-making of midwives and doctors, and its potential as a contributory factor to the rising caesarean section rate. The specific focus of this paper is on the coping mechanisms used by midwives when dealing with uncertainty in childbirth and their attitude towards caesarean section. The findings indicate that midwives have ambivalent attitudes towards caesarean sections and rely on a range of strategies to cope with clinical uncertainty, such as the disclosure and nondisclosure of uncertainty with women, humour and adherence to clinical guidelines. However, the study did find that some midwives had poor coping responses to clinical uncertainty and spoke of considering other career options. The implications for practice suggest that the current emphasis on being certain and on specific time frames for women in labour threaten to obviate traditional midwifery skills. [ABSTRACT FROM AUTHOR]

This is the first in a series of articles on operative birth and psychological issues. This paper looks at negative childbirth experiences and how they can result in the development of trauma symptoms and post-traumatic stress disorder (PTSD). Psychological trauma symptoms following childbirth are debilitating, and may affect a woman's ability to care for her baby. This study aimed to examine the relationship between type of birth and symptoms of psychological trauma at 4–6 weeks postpartum. 400 Australian women in the last trimester of pregnancy were recruited from three public antenatal clinics. Participants were interviewed about the birth within 72 hours postpartum and telephone interviews conducted at 4–6 weeks postpartum to assess symptoms of psychological trauma. Results showed that women who had an emergency caesarean delivery or operative vaginal delivery were more likely to meet the diagnostic criteria for PTSD than women who had an elective caesarean section or spontaneous vaginal birth. [ABSTRACT FROM AUTHOR]

We have previously described women's experiences of obstetric emergencies. This second paper describes the postnatal consequences. Training for managing specific obstetric emergencies is available to healthcare professionals. However this training is not always informed of how women have perceived their experience. This study provides a picture of women's experiences of these traumatic events during chidbirth. This qualitative study followed a phenomenoiogical methodology. Selection criteria was specifically aimed at women who had experienced one or more of the following types of emergencies during childbirth - cord prolapse, placental abruption, shoulder dystocia, uterine scar rupture, severe pre-eclampsia and major postpartum haemorrhage. Ten women were interviewed - they described their lived experiences of the emergencies. The study has raises issues for the improvement in care in an emergency setting and has implications for 'debriefing' in the postnatal period. [ABSTRACT FROM AUTHOR]

This paper presents the findings from a research study to investigate if there was an association between uptake of newborn screening for Duchenne muscular dystrophy (DMD) and social distribution. Postcode data was obtained over a three month period for all new births in Wales. Sample of 1636 new births that were offered screening, of these 567 refused and 1069 accepted screening. Postcodes were linked to social distribution using the Welsh Index of Multiple Deprivation. Statistical analysis was carried out using SPSS. There was evidence of a weak association between uptake and social distribution but further investigation is required. [ABSTRACT FROM AUTHOR]

A study on the association between the day on which a woman gives birth and obstetric outcomes made headlines in 2015. As some of the media coverage could cause anxiety, the authors have offered here to explain what the paper did and did not say. [ABSTRACT FROM AUTHOR]