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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: There are considerable tensions for healthcare staff between their employee allegiance and contracts, patient safety, and their responsibilities to codes of conduct within professional registration, and the NHS Constitution. Aims: The research aim was to identify how power and hierarchy influence staff safety in maternity services and this was achieved by reviewing research papers concerned with personal narratives of staff experiences and perspectives of employment in their profession. Methods: This systematic narrative review was based on the approach of a narrative synthesis, with papers coded using Nvivo software. Findings: Power and hierarchy influence staff safety in maternity services by creating challenges to staff safety, which appear to essentially derive from poor communication. The workplace adversity described by participants seems to be linked with 1) psychological vulnerability 1.1) anxiety about the job, and 1.2) dysfunctional relationships, alongside 2) working conditions 2.1) poor organisational and structural conditions 2.2) institutional normalisation of dysfunctional relationships and 2.3) interpersonal elements feeding into an obstructive culture. Conclusion: The negative influences of the cultural concepts of power and hierarchy on staff safety are significant within maternity services. Disconfirmation findings, those which stood out as different from the rest, evidenced the possibilities that healthy, psychologically safe working conditions could offer for healthcare staff in improving their prevailing culture. [ABSTRACT FROM AUTHOR]

Background: This is the second of a two-part series exploring father's inclusion in the perinatal years. The first paper was published in volume 29, issue 4 of the British Journal of Midwifery. This paper explores the results of the study and discussion in relation to previous literature and to professional practice. Positive father involvement during the perinatal period has important implications for families. However, previous research suggests that fathers experience marginalisation, while staff report a lack of training and time for engaging fathers. Aims: This study explored fathers' and perinatal professionals' experiences of fathers' involvement during the perinatal period, and ideas for paternal support. Method: A Delphi method was employed. Thematic analysis from focus groups informed an online survey which was completed by 24 fathers and 22 professionals. A third-round survey finalised group consensus. Results: Both groups agreed on the importance of fathers. Participants suggested improvement ideas, such as supporting fathers with psychological change. Groups disagreed on some ideas, such as fathers receiving a session alone to discuss concerns. Discussion: The findings support the inclusion of fathers in perinatal services and a focus on the whole family system. Limitations of this study include low participant diversity and possible selection bias. Implications for further research are discussed. [ABSTRACT FROM AUTHOR]

This is an educational paper which aims to inform midwives of tools available to help them make appropriate provisional diagnosis of perinatal depression. A second aim of the paper is to increase midwives' awareness of the relatively newer diagnosis of antenatal depression (AND). Of additional clinical importance, midwives need to recognise that postnatal depression (PND) may be a continuation of AND. To date, screening for AND has received relatively little attention compared with PND, with the evidence-base supporting that the impact can be as severe. It is important for midwives to know that screening for AND can be undertaken using valid and reliable psychometric self-report depression screening questionnaires which have known validity characteristics and threshold cut-off scores. There are several of these tools available to help midwives make the decision about whether or not to refer the women to the mental health team. Current practice in the UK involves the midwife asking an initial short two-item 'Whooley Question' screen which, if indicates depression, can be followed up by the women completing a self-report depression screening questionnaire. To highlight their availability, a selection of valid and reliable psychometric self-report depression screening questionnaires are discussed herein, with it being important for midwives to develop a toolkit that can be given to women at clinics, in pamphlets, online or embedded into mobile applications. [ABSTRACT FROM AUTHOR]

Background The author conducted a review on how power and hierarchy affect staff safety in maternity services, using a narrative synthesis of staff voices from relevant literature. The review was coded using NVivo software. This article aims to evaluate NVivo as a tool for thematic narrative synthesis. Methods Selected papers were coded inductively using NVivo software, a subjective idealist approach to knowledge where iteration is achieved at the coding and synthesis stages of the process. Results NVivo proved to be a versatile tool; the imported files could be word or pdf, the import tab made it possible to upload images and audio files and information could be transferred from OneNote, Outlook and bibliographic software such as Endnote and RefWorks. NVivo software provided numerous options to explore data within different tabs. Users could create relationships between files and there were opportunities to display the findings in word clouds, hierarchies and clusters. Conclusions NVivo was a user-friendly tool for a novice user, facilitating coding for thematic narrative synthesis. A discussion of the review findings were explored in a previous article. [ABSTRACT FROM AUTHOR]

Background: Following birth, some women report negative and traumatic feelings. There is relatively little research on women's perceptions of these emotions. It is important to understand why some women experience distress following labour. The work presented in this paper focuses on one aspect of a wider mixed methods research study. Aims: To explore reasons why some women may leave the birth experience with emotional distress. Method: A descriptive qualitative approach was used. A total of 16 semi-structured, qualitative interviews were undertaken. These were with women following birth, some of whom had attended a local birth reflections service. Thematic analysis was performed using typewritten transcripts. Findings: Three key themes were identified which illuminated the topic of women's subjective distress: 'giving birth as traumatic/horrific', 'lasting emotions linked to the birth process' and 'the impact of the health professional on women's experiences of giving birth'. As well as identifying how women are feeling following birth, this study has also highlighted how midwives can affect women's birth experience. It seems that trauma relating to the birth event may be mediated by professional behaviours and how supportive they are. Conclusion: Lack of support by care professionals was a key factor associated with a negative birth experience. Maternity services and education providers need to ensure optimal training for all healthcare professionals who provide care to women during labour and birth. [ABSTRACT FROM AUTHOR]

This paper critically evaluates and reflects upon an aspect of change (introduction of new electronic records) that occurred in contemporary practice, from a supervisor of midwives' (SoM) viewpoint. The statutory framework of supervision is contextualised (Nursing and Midwifery Council (NMC), 2011a; 2012), followed by a brief discussion as to why records are important. To facilitate critical analysis of the implementation of a new electronic records system, an adaptation of John Kotter's (1996) eight-step process to change by Kotter and Rathgeber (2006) (Figure 1) is utilised. Throughout the paper the SoM's role, in relation to implementing, supporting and evaluating a change in practice, are debated (including actual actions or suggestions of how to facilitate change). Utilising Leamon's Fusion Framework for reflection (2012) (Figure 2), the change to practice is considered and recommendations for future practice shared (Stewart, 2002). Finally, the paper offers a conclusion summarising the key points debated. [ABSTRACT FROM AUTHOR]

Public health is now clearly defined in policy and statute as an integral part of the midwife's role and this work continues to develop as health challenges emerge and diversify. To clarify the knowledge and skills required by contemporary midwives, this article provides an overview of health promotion and public health concepts and discusses how these are embedded in midwifery policy. The approaches and processes midwives should adopt are considered and an analysis of public health learning in midwifery education highlights areas that need to be addressed. This paper concludes with recommendations for midwifery preregistration education to develop the underpinning public health knowledge and skills that midwives require for optimum practice. [ABSTRACT FROM AUTHOR]

The objective of this review of recent literature was to assess the evidence on the efficacy of skills based interprofessional education (IPE) for post-qualifying health care professionals involved in maternity care in the UK. A systematic literature review of relevant UK based papers was conducted using an a-priori search strategy. Agreement in final inclusion was reached by consensus across the team. The findings were scored and described narratively and thematically. Of 225 studies identified, seventeen fitted the inclusion criteria. The papers included in this review varied in design, quality and focus. This is reflected in the scoring and coding system adopted. After scoring, four papers were considered to be of a higher order, and are described in more detail. It is evident from the review of the literature that evaluations of IPE programmes are often positive but it is not clear to what extent the interprofessional nature of the programme affects the outcomes. [ABSTRACT FROM AUTHOR]

The design of buildings, particularly interior design, Is acknowledged to have an effect on those who live and work there. Within the context of health care, a number of studies have attempted to identify what works best and least well. The outcomes measured include clinical outcomes, and patient and staff wellbeing. However to date there has been limited research examining the role of design in maternity units. This paper provides the background to a three-year multi-method/multi. site study examining the impact of maternity unit design on satisfaction levels, and of staff perceptions of work performance. Results are given in three accompanying papers. This article provides details of the participants: women who had recently given birth (n=559), and staff (n=227) working within the units. Methods included questionnaire survey, focus group, individual interview and on-site design evaluation. [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]

This two-part paper proposes a model of evidence-based decision-making for midwifery. In part 1, the nature of the woman-midwife partnership, decision-making theories, and the meaning of evidence are explored with reference to the literature. The impact of risk culture on decision-making and the role of guidelines are discussed. The case is made for a new fit-for-purpose model of decision-making on which to base personalised care in increasingly complex maternity care systems. To do this, the argument is made for a radical, broader definition of evidence that includes information from the woman, the midwife, research findings and other resources. These are set within an environmental context. Part 2 will introduce and explain the new model for evidence-based decision-making in midwifery. [ABSTRACT FROM AUTHOR]

Background: Choice in childbirth, which also involves choice of place to give birth, is a fundamental right of all women. Despite the availability of health-care options for maternity services, most women living in Switzerland continue to give birth in hospital. This paper explores factors influencing the decision of Swiss women to give birth at home. Study design: A descriptive qualitative study was used. Semi-structured interviews were conducted with six pregnant women living in Switzerland who were planning a homebirth. Data were analysed using thematic analysis. Findings: Previous hospital experience, expectations of homebirth, women's attitudes to birth, and personal and societal influences were reasons women gave for choosing a homebirth. Homebirth offered women more autonomy, less medical intervention, and a more relaxing environment than traditional hospital settings. Conclusion: Women in Switzerland who choose homebirth are motivated by the same factors as women elsewhere. The findings from this study suggest a need for personalised maternity care which supports women in their childbirth choices. [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]

This paper will provide a critical narrative review of public health interventions in pregnancy and the role of the midwife in public health. The historical and political context of public health and midwifery will be examined to give a background to the current midwifery public health agenda. The article will identify specific public health interventions used in pregnancy by midwives and assess how midwives perceive their role in implementing them. Midwives are important public health practitioners, who alongside other agencies can make a long-term, positive contribution to the life course of women and their families. [ABSTRACT FROM AUTHOR]

The first 1 to 2 hours following delivery of the placenta is defined as the fourth stage of labour and it could be argued that blood loss during this stage is often overlooked by practitioners. In this article, it is suggested that midwives should be considering how much blood a woman loses in the fourth stage of labour as this could enhance our future understanding of third stage management. This paper presents a critical analysis of the evidence surrounding the fourth stage of labour and suggests an altered perspective about expectant, physiological or conservative management. Further research is needed to improve our understanding around the significance of the type of management adopted in the third stage of labour and the impacts of this on blood loss in the fourth stage. [ABSTRACT FROM AUTHOR]

This paper presents and discusses a collaborative midwifery curriculum development involving service users and academic staff, focusing on maternal perinatal mental health. An overview of contemporary drivers for service user involvement in midwifery care, practice and education and the significance of maternal perinatal mental health are highlighted to set the context for the educational development. The potential advantages and challenges of service user involvement in the pre-registration midwifery curriculum are outlined. The authors' response to these challenges, through the process of initiating, implementing and evaluating a blended learning package is discussed. At the heart of this blended learning activity is the facilitated narratives of two service users, interspersed with student-focused reflective and analytical activity to develop an appreciation of a wide range of evidence, including practice experiences, theory and literature. This partnership approach to developing teaching materials for the pre-registration curriculum is advanced as a means to ensure the service user voice becomes central to the pre-registration midwifery curriculum. INSET: Box 1. Alison and Claire's expericences. [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]

For maternity services in Blackburn, Lancashire, the Changing Childbirth (Department of Health, 1993) document was a long awaited publication. Prior to 1993 there had been radical change in local maternity service provision facilitated by inspirational leadership and enthusiastic midwives. Small, under-utilized and expensive GP led maternity homes were closed with an aim to provide one equitable service by blending the philosophies and expertise of low and high risk caregivers. From that time the service has continually striven to improve the continuity of care for women through the development of midwifery led care and team midwifery. In early 2004 a midwifery group practice was established in Blackburn. The development was made possible through an effective partnership between a hospital Trust, a Primary Care Trust, a Sure Start local programme and a Higher Education Institution. This paper tracks the setting up of this midwifery group practice. Future papers will address the ongoing management of the project, impacts and outcomes associated with it, and the arguments used to mainstream, sustain and develop it. [ABSTRACT FROM AUTHOR]

Women with sickle cell disease (SCD) constitute a high-risk pregnancy group. SCD is an autosomal recessive inherited blood disorder. The most common and severe form of SCD is sickle cell anaemia (SCA). Knowledge of SCD and its effects on pregnancy is essential for midwives who work in areas which have a high prevalence for sickle cell disorders (>1.5 pregnancies per 10 000 births). This ensures that appropriate woman-centred care is provided. The midwife has an important role in working in partnership with the multidisciplinary team to co-ordinate individualised care and surveillance in pregnancy. This paper provides an overview of care required for women with SCD in pregnancy and the midwife's role in facilitating a positive and safe experience. [ABSTRACT FROM AUTHOR]

The UK is experiencing a dramatic increase in the prevalence of type 2 diabetes mellitus (T2D). Consequently, there is a corresponding increase in diabetes in pregnancy, with 87.5% of pregnancies in the UK complicated by diabetes due to gestational diabetes mellitus (GDM), and 27% of those with pre-existing diabetes having T2D (National Centre for Health and Clinical Excellence (NICE), 2008a). Although the risks to mother and baby are similar to type 1 diabetes (T1D), the approach and management often differ. Women with GDM and T2D are more likely to be older, multiparous and live in deprived areas. Certain ethnic groups are more prone to GDM and T2D, and there is a strong association between being overweight or obese and diabetes. Women who develop GDM in pregnancy also have an increased risk of T2D in later life (Diabetes UK, 2011a). Some surveys, such as the Confidential Enquiry into Maternal and Child Health (CEMACH, 2007a) have shown that women with T2D often receive suboptimum care prior to conception and in early pregnancy. This paper presents an overview of the multidisciplinary management of T2D and GDM in pregnancy and identifies areas where care may be lacking for these women. [ABSTRACT FROM AUTHOR]

Chronic fatigue syndrome (CFS) is a severe, systemic, acquired illness which presents with overpowering tiredness that cannot be relieved by rest and is deteriorated through physical and mental activity. Due to the window of prevalence (20-40 years), some women diagnosed with CFS become pregnant. Given that CFS targets women in their reproductive years, responsibility is placed upon midwives to educate, support and provide families with advice. To equip midwives with knowledge about CFS, the objectives of this paper are to provide an overview of: how CFS impacts on reproductive health; the effects of pregnancy on CFS symptoms; CFS-related pregnancy complications; intrapartum management of women with CFS, and postpartum recovery of women with CFS. To date, only a handful of studies have explored the relationships between CFS and childbearing, and associated complications. A greater understandings of CSF interactions with physical, psychological and social reproductive processes are required. [ABSTRACT FROM AUTHOR]

Olive oil is commonly recommended by health professionals to new parents for use in the prevention and treatment of the term baby's dry skin, and for baby massage. There is no evidence to support this practice. The use of olive oil may be harmful to skin, affecting skin barrier function. This effect may be a contributory factor in the prevalence of childhood conditions such as atopic eczema. This paper discusses a national online audit of UK maternity hospitals (n = 67) and neonatal units (n = 33) performed between November 2010 and January 2011. Our findings confirm that oil use on babies' skin is common practice. As the direct cost to the NHS for treatment of atopic eczema is high, it is imperative that further research in this area is performed, preferably in the form of a randomized controlled trial. Health professionals will then be in a position to provide accurate information to parents with regard to oil in baby skin care regimens. [ABSTRACT FROM AUTHOR]

Design and use of space are critical features of contemporary healthcare facilities, but there is often pressure on available space. The drive to minimize the 'Institutional' feel of maternity units has led to the move to make them more 'homely'. This first of three results papers presents findings from a three-year nine- site study in England examining maternity unit design and its impact on women giving birth there. Data from a questionnaire survey of 559 mothers and 227 ward-based staff are augmented by analysis of follow-up focus groups. For mothers perceptions of spaciousness were strongly associated with overall satisfaction with surroundings and facilities (p<.01), as well as with care received (p<.01). Mothers' perceived ability to move themselves or room furniture around during labour varied across units and was not associated with overall room size. Among midwives the belief that they provided good quality care was moderately correlated with positive responses concerning ward layout (p<.01) and a comfortable working environment (p<.01). [ABSTRACT FROM AUTHOR]

Routine screening for domestic abuse in pregnancy is recommended and midwives are in an ideal position for this role. However due to an apparent reluctance to enquire about domestic abuse it often remains a hidden problem with detrimental consequences for women and their unborn children. The aim of this systematic review was to identify the most commonly reported factors that prevent healthcare professionals from routinely screening women for domestic abuse. Six electronic databases were searched for all articles published in the English language up to January 2006. Data, including all the reported reasons for not screening for domestic abuse, were extracted from all the studies which met the inclusion criteria. A simple 'vote-counting' analysis was performed with graphical representation and calculation of weighted means. Thirteen papers met the inclusion criteria. The perceived barriers to screening appeared similar across a range of specialities and clinical settings. The most commonly cited factors were: lack of time, lack of training, and inadequate resources. Domestic abuse remains a serious public health issue and is frequently exacerbated by pregnancy. Our results suggest that raising awareness of the issue should help midwives understand the need to prioritise screening and find the time required to do so. Encouragingly it also suggests that improving basic education and increasing access to simple resources, such as leaflets giving details of where to get support, may provide practitioners with the confidence required to ask women about domestic abuse. [ABSTRACT FROM AUTHOR]

The paper examines the philosophy and practice of appreciative inquiry (Al) as an alternative and creative approach to problem solving. Examples of the method are drawn from around the globe and some case studies utilizing Al in the context of maternal and neonatal health care are outlined. It is proposed that Al offers an innovative and inspiring way of realizing the best in skilled care and contributing to an enabling environment in which to provide that care. Al emphasizes the unique value not only of the lives of those requiring care but also of that of the caregiver. It offers a way to improve quality through discovering the strengths of individuals, organizations and communities, It is defined by the dreams and destined by the design of those at the heart of the situation where every team member is valued and the seemingly impossible becomes achievable. [ABSTRACT FROM AUTHOR]

Choice has been an enduring theme of maternity policy since the advent of Changing Childbirth (1993). Maternity Matters outlines four national choice guarantees, which aim to give women choice about how to access maternity care, the type of antenatal care they receive, choice of place of birth and choice of postnatal care. This paper presents some key findings of a study which sought to explore and advance the understanding of maternity care choice through actual women's experiences. Ten women took part in conversational in-depth interviews at four time points, 12-16 weeks and 32-34 weeks pregnant and 14 days and 6 months postnatal in order to explore their choices for care, the rationale for those choices and their experiences and feelings at that point in in time. The key themes that emerged revealed that choice is not an equitable concept for women, it is constrained by inequalities but also by the health care professionals that women are in contact with, the social discourses that surround pregnancy and birth and obstetric complications. Models of care which offer choice need to be designed to take into consideration the dangers of offering choices that may not be fulfilled and the importance of choice in the postnatal environment. Above all choice needs to be presented in an honest and realistic manner. [ABSTRACT FROM AUTHOR]

Obedience research has shown that under situational pressures and within hierarchical relationships, people have a propensity towards submission to authority (Milgram, 1974). Once they have done so, their actions are no longer guided by their own values but by the desire to fulfill authority's wishes (Meeus and Raaijmakers, 1995). When an authority figure gives direction, this may clash with a midwife's knowledge of a woman's preferred choice. Hollins Martin and Bull (2005) showed the success that a senior midwife had at socially influencing decisions of more junior midwives, even when the outcome contravened their established views of best practice. Hollins Martin and Bull (2006) showed that choice provision for childbearing women was difficult to provide because of the imposition of hospital protocols, the hierarchy and fears of challenging senior people. Acknowledging these identified constraints this paper poses eight plausible solutions to facilitate midwives with providing the choice that is advocated in social policy documents (Department of Health, 1993; DH, 2003; DH, 2004). [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]

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]

It is already known that for many women hospital postnatal care is the least satisfying and valued part of their maternity care provision (Audit Commission, 1997). Furthermore, it continues to be reported that research in the area of postnatal care has been neglected leading to an insufficient body of knowledge and evidence to support postnatal care (MacArthur et al 1991; Bick et al 2001; Wray 2002). There are major issues in relation to the content and organisation of postnatal care, yet there has been limited revision to service delivery, which is struggling to cope when faced with a shortage of midwives. This local study sought to involve service users, notably newly delivered mothers and an established users group in a participatory manner to explore mothers' experiences of postnatal care. A number of important factors emerged that provide further insights into what matters to women after birth. Postnatal care at home was highly regarded and valued by mothers in this study, but concerns continued to be raised about postnatal hospital care. Fundamental components of service delivery in hospital such as cleanliness and hygiene, visiting arrangements, noise, rest and support for infant feeding and baby care were key findings. This paper presents an overview of the study, discussing aspects of the hospital stay and reflections on the study. [ABSTRACT FROM AUTHOR]

This paper, the second in a series of six, brings together the findings from the Why do Midwives Leave? study and a subsequent study, Why do midwives leave: talking to managers (TTM). The TTM study was commissioned to explore managers' perceptions of issues affecting satisfaction with practise and their perspectives on recruitment and retention. Many managers were concerned that they had limited power to effect real change in the practise environment. There was an overwhelming consensus among managers that staff shortages and inappropriate midwifery establishments underlay many of the underlay many of the problems that they faced. Although often committed, personally and professionally to the ideal of woman centred care, staff constraints limited the viability of this as they struggled to ensure a safe level of staffing on wards on a day to day basis. [ABSTRACT FROM AUTHOR]

Reflexivity is the process associated with researchers' self-awareness - of how they impact and transform the research they undertake. It is widely accepted as a methodological consideration among researchers undertaking qualitative enquiry in midwifery. This article uses sociological literature to introduce notions of reflexivity that emphasize its importance as a theoretical concept and a methodological tool. The ‘doing’ of reflexivity is discussed using examples from published studies of maternity care. The author's own unpublished research, investigating primigrevid women's views of vaginal and caesarean birth, is also used to illustrate the relevance of reflexivity to quantitative and qualitative data collection from a social constructionist theoretical perspective. This article demonstrates that reflexive accounts of the research process should not just be confined to qualitative methodology papers, research diaries or thesis chapters, but are relevant to all research. [ABSTRACT FROM AUTHOR]

This paper alms to identify similarities and differences between the Finnish and UK systems of maternity care, issues relating to maternity care policy emerge as crucial. Topics for comparison were identified during visits to Finnish hospital and community settings. These topics formed the basis of a selective review of the literature. Qualitative research by the co-author served to Inform the comparison. The authors found that Finnish women are clear in their expectations of labour pain and the role of professional personnel. Because of these expectations the women adopt one of three coping styles. There is found to be a strong link between pain coping style and choice of place of birth. There may, however, be some dissonance between health care providers' and women's thinking about the place of birth. Midwives' positions are variable, but their thinking may not correspond with the woman's. It becomes clear that midwives' nonacceptance of women's knowledge base has serious implications. The conclusion is drawn that midwives should seek to understand women's thought processes. [ABSTRACT FROM AUTHOR]

A randomised controlled trial of re-designed community postnatal care showed that intervention care improved women's psychological health relative to standard care. This paper provides a detailed description of the re-designed care package such that its replication and evaluation in other settings could be achieved. The intervention care was midwife-led, with no routine GP care required, and it was given over an extended period. Visits during this period were made according to women's assessed needs and in consultation with them. The postnatal discharge check was performed by the midwife at 10–12 weeks. In addition to the roles of the health personnel, the timing and content of care is fully described, as well as an outline of training and support that was given. The documentation used by the midwives in the care delivery is also made available. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This paper examines the changes that have taken place during the time that the role of supervisor of midwives has been active. It examines how this role has evolved in the changing world of maternity health care. Case studies are used to illustrate the challenges that supervisors of midwives and practice midwives encounter. [ABSTRACT FROM AUTHOR]

The author discusses the launched of a series of papers on ending preventable stillbirths which was released by the general medical journal "The Lancet" in January 2016. Topics mentioned include the launch of the East Baby Counts project in Great Britain which focuses on reducing neonatal deaths, the decrease of stillbirth rates in England and the recommendation of Homer et al. to include bereavement training in midwifery education.

Complaints about the NHS in general and midwifery in particular have been steadily rising over recent years. The Office of the Parliamentary and Health Service Ombudsman (PHSO) is the final rung on the complaints ladder once the NHS complaints procedure has been exhausted. It is a good idea to try to settle complaints at the earliest possible stage and to avoid escalation to this level. This paper identifies a change in culture and how the effects of complaints can be resolved as early as possible by all staff acknowledging their corporate responsibility coupled with good proactive management. Four common roots of complaints are identified, the role of the PHSO described and a conclusion drawn that complaints are everybody's business. [ABSTRACT FROM AUTHOR]

The author offers information on publications that contribute to the debate on birth labour rhythms and labour progress. He agrees that the knowledge of midwifery has suffered due to the lesser number of research regarding the alternatives for partograms and vaginal examinations in the assessment of labour rhythms. He examines a journal paper by Zhang et al on birth labour. Also investigated are the history of labour, the active phase of labour and the book "Childbirth, Midwifery and Concepts of Time," by Chris McCourt.