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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]

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]

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]

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]

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]

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]

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]

Constant electronic fetal monitoring has become a ubiquitous part of birth management in most high-income countries, both reflecting and creating the social context. This article uses a post-structuralist feminist critique to show that the use of the cardiotocograph in birth reinforces and reflects the logic of the separate sovereign self. This creates a rupture in the intrinsic relationality of the mother–fetus and the mother–midwife on a philosophical and physiological level. The cardiotocograph in labour privileges the medical model, constrains women through wires and the imperative to 'keep the trace', takes everyone's attention and gives midwives tasks other than caring for the woman. It externalises the fetus and gives it selfhood separate from the mother, to the extent that it can seem like the machine is keeping the baby alive. This undermines women's and midwives' subjective knowledge, relegating women to organic containers. A reimagining of birth that centres relationality would start by acknowledging the nature of the self as semi-permeable and the being/doing, both/and nature of the mother–placenta–fetus in pregnancy and birth. Intermittent auscultation of the fetal heart in labour is better able to centre the mother–placenta–fetus relation and the midwife–mother relation. [ABSTRACT FROM AUTHOR]

Background/Aims: Nitrous oxide is a potent greenhouse gas widely used in childbirth in the form of Entonox. In this study, its use was investigated because of its negative climate effect. The study aimed to identify and investigate midwives' use of Entonox in the labour ward of a tertiary Scottish hospital. Methods: This qualitative service evaluation was conducted using semi-structured interviews with 10 midwives and an environmental sustainability manager. Thematic analysis using combined deductive and inductive approaches were used to analyse the data. Results: Deductive analysis revealed all six work systems factors from the system engineering initiative for patient safety framework to be pertinent to Entonox use in the labour ward, with specific influences and perceived outcomes of Entonox use found through inductive analysis. Conclusions: A reduction in Entonox use would be difficult, but changes have been recommended to raise awareness among healthcare staff of Entonox risks and create a more environmentally sustainable work system. [ABSTRACT FROM AUTHOR]

Maternal and infant mortality rates are reassuringly low in developed countries. Despite this, birth is increasingly seen as risky by women, health professionals and society in general. In wider society, women are subjected to a litany of risks regarding birth, including sensationalising negative incidents by the media. Within maternity care, both structural and operational factors contribute to heightened risk perceptions. Women are processed through a system where risk-management strategies can take precedence over individualised care as health professionals attempt to protect themselves from implication in adverse outcomes and litigation. This results in increasingly interventionist care, depriving women of psychosocial safety in the birth process. Midwifery, as a profession promoting trust in normal birth, is threatened by this dominant medical model of maternity care and interventionist birth practices. Midwives need to act to reclaim their role in promoting normal birth, while balancing considerations of risk with the principle of woman-centred care. [ABSTRACT FROM AUTHOR]

Little is known regarding third stage management approaches and the incidence of and treatment of postpartum haemorrhage in women giving birth solely in midwife-led units. This systematic literature review identified nine studies of varying quality that investigated active versus expectant management of the third stage of labour and any related blood loss in women, who had a normal physiological birth and gave birth or intended to give birth in a midwife-led unit. The results identified a need for further research studies into this area of practice, as birth settings are becoming increasingly more important. This is because of research studies that have reported many beneficial outcomes for healthy women at low risk of obstetric complications, who plan to give birth in midwife-led units. [ABSTRACT FROM AUTHOR]

The emergence of viral diseases, such as COVID-19, represents a global public health threat, particularly the high-impact animal viruses that have switched hosts and are able to be transmitted within human populations. Pandemics threaten the general population; however, there are special groups, such as pregnant women and their babies, which may be at a higher risk of, or more severely affected by infection. Pregnancy is considered a unique immunological condition; therefore, current challenges include decisions on preventing and treating infections during pregnancy and the possible implications for the fetus and newborn infant. This integrative review, the first of a two-part series, analyses selected literature on COVID-19 within maternal and newborn care, drawing on key themes relating to the impact on the pregnant woman. The themes discussed are: the nature of the immune system in pregnant and newly birthed mothers, maternal risk, mode and timing of birth, care during pregnancy and childbirth, and the transition to parenthood including the implications for practice for maternal mental wellbeing. [ABSTRACT FROM AUTHOR]

Objective: This service evaluation aimed to collect data on clinical handover on labour ward and compare them with the local guideline. Design and methods: This service evaluation was structured in four stages, each using a different design and research methods. Setting: The study was undertaken between September 2013 and August 2014 in a maternity unit in a large NHS teaching hospital in London, UK. Findings and conclusion: Communication breakdown is widely considered to be a significant factor contributing to poor patient outcomes, with handover being a major risk point. The discrepancy between the local guideline and current clinical practice reinforces the belief that urgent action is needed to improve clinical handover on labour ward. The results of this service evaluation suggest that a drastic overhaul of the communication model during handover should be considered, ie from handover to takeover, and that the mnemonic SBAR may not be fit-for-purpose in maternity care and should be replaced with a different format that reflects the chronological flow of clinical events. [ABSTRACT FROM AUTHOR]

Women make choices throughout pregnancy and childbirth and interactions with healthcare providers are integral to the journey. Healthcare providers have the potential to advise, influence and support women in their choices as to where to give birth. The aim of this study was to examine Northern Ireland healthcare providers' attitudes and experiences of women choosing place of birth, independent of risk profile. A qualitative study design was used to undertake key informant interviews with healthcare providers who were involved in caring for women antenatally, intrapartum and postnatally. Seven midwives and five obstetricians were interviewed. These interviews were transcribed, coded and presented in themes. Emerging themes included: informed decision-making among pregnant women; understanding and judgement of risk; autonomy and choice; culture of control and fear; and human rights. Interviewees highlighted barriers to women being able to access their chosen place of birth because of legal concerns, cultural perception of birth, and lack of senior managerial support for those providing clinical care to women who are considered at risk of complications during pregnancy or birth. Proposed solutions include developing a human rights-based approach which is about health and not isolated pathologies and focuses on empowering women, and not merely avoiding maternal morbidity or mortality. [ABSTRACT FROM AUTHOR]

The Ehlers-Danlos Syndromes (EDS) are an underdiagnosed group of conditions with implications and risks associated with childbearing. Those with EDS suggest that health professionals lack of awareness in this area, and consequently describe delays in access to appropriate healthcare services. This article draws on the existing international evidence available to present evidence-based care considerations for childbearing women with hypermobile Ehlers-Danlos Syndrome (hEDS) throughout the antenatal, intrapartum and postnatal periods. Care considerations are also offered in relation to the care of the newborn infant. The management of hEDS in childbearing women and babies can be complex. Findings point to the need for a multidisciplinary approach to formulating individualised care plans in partnership with women. In understanding the evidence in relation to this issue, midwives will be better able to practice evidence-based and woman-centred care. [ABSTRACT FROM AUTHOR]

Background: Women with diet-controlled gestational diabetes have been excluded from birthing in one midwife-led birth centre due to an assumed risk of complications. Aims: This study aimed to examine the rates of adverse outcomes for women diagnosed with gestational diabetes who have controlled their hypoglycaemia through dietary change, but who may be excluded from birthing in a midwife-led centre owing to risk of complications, to identify whether outcomes are the same for these women as for other low-risk women giving birth in one local maternity unit. Methods: Retrospective analysis was conducted of data on low-risk women giving birth at a maternity unit in the South East of England to compare the birth outcomes of women with or without gestational diabetes. Data were analysed in Microsoft Excel and presented as descriptive statistics. Findings: In 2014, a total of 164 out of 4032 women who gave birth at the maternity unit had gestational diabetes. Among these, 89 were controlled through diet alone. Data for 4 months in 2015 were also examined for 57 women with gestational diabetes. Conclusions: The mode of delivery and outcomes for the women in this cohort who remained normoglycaemic have been found to be in line with the general outcomes for all women at this hospital during the study period. The women diagnosed with gestational diabetes but well controlled on diet had similar outcomes to low-risk women giving birth at the maternity unit. The small sample size means further work is needed to confirm the findings, but indicates that the option of using the birth centre may be considered a reasonable alternative for these women. [ABSTRACT FROM AUTHOR]

Background: Uninformed adoption of simulation technology such as high-fidelity simulators may result in ineffective learning and teaching. However, in the literature little is known about specific developmental approaches to prepare midwifery educators for using this pedagogy. Aims: The overall aim of this research was to describe the experiences of midwifery educators following a 2-day high-fidelity workshop and the impact on their perceived preparedness to teach using a high-fidelity simulator. Methods: Qualitative data were gathered from one semi-structured focus group 2 weeks following the workshop. Thematic analysis identified emergent themes pertaining to the research objectives. Findings: Four main themes emerged from the data: fears regarding complex technology, time for scenario-building, opportunity for team-building, and enhancement of the curriculum. Conclusions: Initial face-to-face high-fidelity workshops are recommended to achieve successful integration of high-fidelity simulators into midwifery education, with supportive materials to promote continued accessibility and learning. Support from technical staff is essential. [ABSTRACT FROM AUTHOR]

A systematic review of the literature was undertaken to explore fathers' opinions and views on antenatal education and its effectiveness in preparing them for their role as birth partners and for parenthood. The findings are categorised under four key themes: outnumbered, excluded, anxious and uncertain, and preparedness. While research suggests that most fathers want to support their partners and be involved in the pregnancy, labour and birth of their baby, they are less likely to attend antenatal classes than women. While fathers who attend antenatal education classes value them, their experiences are not always as positive or helpful in preparing them for their role as birth partners or in parenthood. It was highlighted that men are more likely to feel unprepared when complications at birth arise. A common finding was that men would welcome the opportunity to focus on their individual needs. [ABSTRACT FROM AUTHOR]

The importance of good clinical communication to women during pregnancy and birth is clear. Poor communication in labour is associated with general dissatisfaction, more complaints and a range of perinatal mental health problems including post-traumatic stress disorder (PTSD) and postnatal depression. To communicate effectively, maternity staff need information about which women are vulnerable and require extra support. To address this, a pink sticker communication system to alert midwifery and obstetric staff to potential psychological difficulties experienced by some women was implemented and evaluated. Evaluation showed this system was viewed positively by women and midwifery staff. Audit of referrals to the perinatal psychology service during this period suggests no woman with a pink sticker developed birth trauma as a direct result of perceived poor care. In addition, the proportion of referrals to perinatal psychology for birth trauma significantly reduced during this period. [ABSTRACT FROM AUTHOR]

New models of maternity service provision are currently emerging across the NHS. One to One (North West) Limited was the first Any Qualified Provider (AQP) of midwifery care throughout the maternity continuum, with midwives providing community-based care for women across the risk spectrum. It was also the first non-NHS maternity organisation to gain independent insurance for intrapartum care. One to One commenced a 3-year contract with NHS Wirral in November 2011. This article discusses the care the organisation's midwives offer, and presents routinely collected clinical outcome data and women's testimonies from One to One's first full year of operation. Between 1 November 2011 and 31 October 2012, 711 women were booked, 414 of whom gave birth with One to One. The spontaneous vaginal birth rate was 76% for all births, while the home birth rate was 31%. The article highlights the successes, challenges and opportunities a reconfigured NHS offers for those receiving and providing midwifery care. [ABSTRACT FROM AUTHOR]

Objective: To gain insight into how continuity of care can increase student midwives' understanding of midwifery, with emphasis on the promotion of normal pregnancy, childbirth and postnatal period. Design/setting: A pilot project at Sør-Trøndelag University College. Six student midwives provided continuity of care to 58 women throughout their pregnancy, childbirth and postnatal period. The students, under the supervision of a clinical midwife, worked in pairs during the antenatal care, in groups during antenatal classes and individually during childbirth and the home visit. A group interview with the six student midwives, based on a focus group technique, was conducted at the end of the project. Qualitative data were analysed through systematic text condensation. Findings: The findings include three main themes: relational continuity, personal development and health-promoting perspective. By offering relational continuity, the students experienced interdependent trust and partnership. This resulted in personal development based on mastering skills and relational learning. The students became aware of the importance of individual care, holistic care and empowerment and understood midwifery through a health-promoting perspective. Conclusions: To achieve high quality midwifery skills, student midwiveswould benefit from experiencing relational continuity in their practical studies. This continuity promotes interdependent trust and partnership with the women in their care. Follow up through continuity of caregives the students more meaningful practice and results in personal development for the students and health promotion in midwifery. [ABSTRACT FROM AUTHOR]

This article is a report of a grounded theory study of pregnancy and childbirth experiences of women in rural Cambodia. Antenatal anxiety and depression have been linked to adverse outcomes of preterm delivery and low birth weight in the baby. Recent study findings from Cambodia reveal high levels of clinically significant antenatal anxiety and depression with consequent links to low birth weight in the infant. Thirteen in-depth interviews with rural pregnant women were conducted in December 2008 over 3 days during the midwifery outreach service to the villages. The research process followed the principles of grounded theory methodology. Four core categories were identified during the interview analysis: fear of childbirth, lack of information, traditional versus allopathic practice, and access to the government midwife. Childbirth causes fear, largely owing to a lack of knowledge about the normal physiological process and fear of death in the case of complications due to poor access to health services. Traditional and allopathic practice largely ran in parallel or in contradiction to each other but there were some examples of successful integration. Most of the interviewees wanted more contact with the government midwife. This could be an opportunity to share information in a confidential, non-threatening but informative relationship while reducing anxiety and consequences for the mother and her child. These categories can be extrapolated to the wider context highlighting complex barriers to women accessing midwifery care, while emphasizing the negative impact of anxiety on fetal wellbeing and the role of accurate information and professional support. [ABSTRACT FROM AUTHOR]

Research indicates that midwives are equally effective as senior house officers, if not more so, in performing the routine examination of the newborn. When midwives performed this examination their level of job satisfaction was increased and the mother's satisfaction with the examination was also increased. However, studies have also highlighted that midwives are concerned that they might be pressurized into taking on new roles as well as being worried that they may have no control over their workload. Furthermore, it has also been shown that the majority of maternity units do not have enough staff to cope with the rising birth rate and that midwives already have to deal with an increasing workload, resulting in them struggling to provide a safe, quality service to women and babies without taking on new roles. By delegating some of a midwife's workload to another category of skilled worker may enable midwives to re-evaluate their existing role, and take on new roles that support the midwifery philosophy of care. This philosophy of care views pregnancy, childbirth and the postnatal period as a continuum, with the woman and baby being the primary focus of the midwives' practice, stresses the importance of the midwife working in partnership with the woman and her family. Such a philosophy enables the woman to make informed decisions about her care. The pregnancy continuum is also viewed as a normal life event, which is supported by midwives. If research indicates that midwives are better at performing the examination of the newborn, then why is it that more maternity units do not have midwives who are able to carry out this skill, since midwives in the UK have been able to undertake this examination for more than 10 years? In addition, in units which do have midwives who can perform the examination, why are these midwives not using their skills? [ABSTRACT FROM AUTHOR]

Presents three web sites which 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. Web site of the Lamaze Institute for Normal Birth; Web site of the National Childbirth Trust; Web site for Birth International.

Postnatal care has for too long been the Cinderella of the childbirth continuum and marginalized within maternity care services. Most women in the UK are hospitalized after giving birth and spend time on a postnatal ward. Women tend to view this aspect of their childbirth journey as the least satisfying, and in-depth analysis as to the reasons for this perspective is limited. This article presents a thought-provoking debate on postnatal hospital care and is underpinned by data that have emerged from observing postnatal wards as part of a larger research study. Two main points are pursued: reflections on carrying out 'fieldwork' and the notion that postnatal care is becoming deficient in purpose. Questions are raised as to the intention of hospitalization after birth, given the culture and context of a busy ward. Many factors impinge upon the woman's experience of the postnatal ward: the availability of midwives, the status/value of postnatal work and having enough time to spend with women on a busy ward. However, the essence of midwifery and intention of postnatal care must not be lost. Evidence to support postnatal care by midwives needs to be visible. [ABSTRACT FROM AUTHOR]

Eight women's experiences of home birth were explored using tape recorded semi-structured interviews. The main themes were identified and presented in the form of dialogue and quotes. This article explores the available literature, describes the methodology and reports the results from the first two themes of the study. The decision to have a home birth was based on previous birth experience, the desire for a familiar environment and concerns over childcare. Expectations centered on maintaining normality, a calm atmosphere and having more control. [ABSTRACT FROM AUTHOR]

The author reflects on a parenthood case in which a child was born to a transgender woman in Great Britain who has secured a Gender Recognition Certificate (GRC) before becoming pregnant and its possible impact/s to the midwifery profession. Topics include the provision of the 2008 Human Fertilisation and Embryology Act stating that the person who gave birth to a child is the mother and whether one should stop claiming that a 'midwife' is 'with woman.'

BJM is not alone in celebrating its 25th birthday this year. Midwife Jonathan Cliffe describes returning to the hospital in which he was born in 1993 [ABSTRACT FROM AUTHOR]

The author emphasizes the need to respect the human rights of women to ensure that their dignity is protected while receiving maternity care during childbirth. She relates the vulnerability of women during pregnancy and childbirth. An overview of the results of a national survey in Great Britain which examined the experiences of women in childbirth in the context of respectful care and choice in maternity services is provided.

A letter to the editor is presented urging solidarity among midwives to safeguard their profession against professional climbers who deride midwives' capabilities.

The article discusses the appropriateness of midwifery duties in Great Britain. The education of student midwives always needs delegation, however it does not equate to substitution. Under the rules and standards of the Nursing and Midwifery Council, a midwife cannot arrange for anyone to act as a substitute, other than another practicing midwife or a registered medical practitioner. Only midwives and registered medical practitioners are permitted to attend a woman in childbirth.

Discusses the problem in health care and in midwifery where the need to get information from clients is essential for safe care has reduced the time for real contact with the client. Escalation of the quantity of information required; Observation that the questions have become more sensitive for the client; Need for management to be reminded of the need for real contact.