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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]

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

Background/Aims Asylum-seeking women face higher rates of maternal and neonatal mortality as a result of multiple barriers to accessing maternity care. Midwives are currently experiencing short staffing and high rates of burnout. Complex cases can add additional workload and stress. There is an evidence gap concerning midwives' experiences of caring for asylum-seeking women in the UK. This study's aim was to examine the existing literature on this topic and consider the findings against the current realities of working within the NHS maternity system. Methods Literature was screened using the Critical Appraisal Skills Programme qualitative article checklist and the preferred reporting items for systematic reviews and meta-analyses flow diagram. Eight studies were included and analysed for thematic similarities. Results The results of the systematic review were categorised into three themes: racism and resentment, structural difficulties and systematic problems. Conclusions Midwives lacked the time to appropriately care for asylum-seeking women. A lack of time and resources may negatively impact midwives' attitudes towards asylum-seeking women. [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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

Background: There has been a shift in maternity care over the past decade. The changes encountered by postnatal ward staff and the impact of these changes on women postnatally requires exploration. This study aimed to ascertain midwives' and healthcare assistants' perspectives of the changes in postnatal care and challenges to providing care in the current context. Methods: This was a qualitative study involving two focus groups of 15 midwives and healthcare assistants from an Irish urban maternity hospital. The participants' responses were analysed thematically. Results: Changes in women's clinical characteristics, including increased comorbidities and caesarean section rates, were highlighted as creating additional care needs. Furthermore, additional midwifery tasks and clinical protocols as well as shorter hospital stays leave little time for high-quality, woman-centred care. Participants highlighted a negative impact on maternal health from limited follow-up midwifery care in the community. Conclusions: With additional midwifery duties and a reduction in time to complete them, additional community midwifery care is key to providing high-quality follow-on care after postnatal discharge from hospital. [ABSTRACT FROM AUTHOR]

In this article, professionalisation, the midwifery profession and professional autonomy are explored from a sociological perspective to answer whether it is possible for a midwife to achieve professional autonomy within the contemporary UK system. Within part 1, obstetric influences and frictions, government policy and guidelines, risk, litigation and increasing managerialisation were considered, highlighting the complexities of professional midwifery and the challenges it faces. In part 2, choice, service pressures, evidence-based care, consumerism, leadership and reflexive practice are considered in the context of professional autonomy and the intention of retaining women's choice as the core belief of the profession. A conceptual framework has been devised to enable this, utilising the concept 'New Professional Midwifery'. [ABSTRACT FROM AUTHOR]

Background: A healthy urinary system is vital to every woman's life, and the relationship between childbirth and bladder dysfunction has been well documented in the medical literature. Aims: To explore women's bladder care experiences during the antepartum, intrapartum, and postpartum periods. Methods: An exploratory, descriptive research study with nine in-depth semi-structured interviews. Findings: Thematic analysis showed three themes: 'muddling through to earn "a badge of honour"', 'caring for a baby, but who cares for me?' and 'do you speak bladder language?' with an overarching theme of 'lack of bladder care'. Women's experiences reflected a lack of understanding, information, and promotion regarding bladder care, aggravated by the use of ambiguous language when professionals communicated with women about bladder health. Conclusions: Bladder care was very limited for women during the antepartum, intrapartum and postpartum period although reports of urinary incontinence were frequent. Bladder care could therefore be characterised as 'lack of bladder care'. Clinicians should become more proactive in delivering information and promoting bladder health during these periods but that attention needs to be paid to communication methods. [ABSTRACT FROM AUTHOR]

The article considers the factors that contribute to the development of responsive intrapartum interpersonal skills and supportive personalised care during labour. They include emotional intelligence, the concepts of containment and reciprocity, and attentiveness. It also explains why effective interpersonal skills are integral to midwifery practice.

How effective is the continuity of carer model? India Wentworth finds out by asking midwives to share their experiences [ABSTRACT FROM AUTHOR]

Background: The NHS Litigation Authority's ‘sign up to safety’ campaign aims to prevent undiagnosed breech birth and possible poor birth outcomes. An audit was completed following the introduction of hand-held scanning ultrasound examination. Aims: The hand-held ultrasound was used by midwives for all women in labour and before induction of labour to confirm presentation. Methods: A criterion-based retrospective audit, conducted over 6 months in 2016, with a sample of 2737 women. Findings: The audit demonstrated that 22 breech presentations were detected when using the hand-held ultrasound before induction of labour or in labour. The audit standard of 100% of women receiving an ultrasound scan was not met, and potential reasons are explored. Conclusions: The results support the use of hand-held ultrasound, as it did detect breech presentation before induction of labour or spontaneous labour and birth. Further work includes the audit of the reasons that hand-held ultrasound scanning was not used, to ensure that a targeted action plan can be created. Future research into midwifery values, cultural attitudes and the effectiveness of abdominal palpation is also needed, to develop the knowledge base on which scanning can be framed. [ABSTRACT FROM AUTHOR]

Background: Nearly two decades after the introduction of the consultant midwife post in the UK, little is understood about where they are and the roles they fulfil within their organisations. Aim: A study was undertaken to determine the overall number of consultant midwives, explore the range of clinical specialities and map their location and coverage across the UK, Channel Islands and Isle of Man. Methods: A survey and intelligence gathering exercise took place with an online survey being sent to key networks including Heads of Midwifery and consultant midwives in 2016/17. Findings: A total of 84 consultant midwives were identified as being employed by around one third of the NHS Trusts and Health Boards. A number of issues were highlighted, including potential retirements and the gradual incorporation of managerial roles in the job description of consultant midwives. Conclusion: Given the national imperatives for high quality maternity care, there needs to be a focus on succession planning and growth of the role of consultant midwives across all organisations. [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]

Vulnerable migrant women are at an increased risk of developing postnatal depression, compared with the general population. Although some symptoms are the same as in other pregnant women, there are specific reasons why vulnerable migrant women may present differently, or may not recognise symptoms themselves. Factors associated with migration may affect a woman's mental health, particularly considering forced migration, where a woman may have faced violence or trauma, both in her home country and on the journey to the UK. Vulnerable migrant women engage less with maternity care than the average woman for reasons including a lack of knowledge of the UK healthcare system, fear of being charged for care, or fear that contact with clinicians will negatively affect their immigration status. This article explores the issues surrounding vulnerable migrant women that increase their risk of developing postnatal depression and presents reasons why this may go unrecognised by health professionals such as midwives. [ABSTRACT FROM AUTHOR]

Background Maternal sepsis is the leading cause of direct maternal death in the UK. Cost-effective training for staff is essential in providing safe, high-quality maternity care. Aims This project aimed to examine the impact of a maternal sepsis training package, provided during the period 1 April – 30 September 2013 (quarters 2–3), on maternity staff ’s compliance with the Trust’s maternal sepsis guideline, as documented in maternity notes. Methods An audit was undertaken of the staff compliance rates for the Trust’s maternal sepsis guideline (on which the training package is based) recorded in maternal notes during the period 1 January – 31 December 2013 (quarters 1–4). Data were analysed to investigate significance. Findings There was no statistically significant increase in compliance with the guideline from quarter 1 through to quarter 4. Conclusions Despite its limitations, this audit suggests the training has not had a significant impact on practice. When an initiative starts to deliver results that are not providing value for money, reassessing services in the interest of quality care must be the priority. [ABSTRACT FROM AUTHOR]

This article highlights principles for the safe administration of blood transfusion in maternity care. The aim is to increase awareness of the context for blood transfusion in midwifery, the components most frequently used and the process for safe blood transfusion, including clinical observations. There are serious hazards associated with this procedure so there should be a clear indication for transfusion. Midwives must not engage in the administration of blood unless they have received appropriate training, have been assessed as clinically competent and meet the requirements for periodic review or assessment in administering blood transfusion. [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]

Making a difference (Department of Health, 1999) called for an enhanced midwifery role in maximizing women's health and in contributing to public health targets. The Sure Start programme is now working in areas of deprivation right across the country. It is now recognized that improving maternity services is a vital step in tackling health inequalities. This is why some Sure Start programmes employ midwives to provide midwifery care in innovative ways for disadvantaged or isolated mothers. A Sure Start midwife with a special interest in refugees and asylum seekers presents the findings of an on-site antenatal service for pregnant asylum seekers living in emergency accommodation and awaiting dispersal. This article, in presenting some of the issues relating to the care of pregnant asylum seekers urges midwives to increase their knowledge and understanding of the health needs and cultural issues that affect this group of women in order to deliver appropriate care. [ABSTRACT FROM AUTHOR]

Stress and burnout are endemic in the NHS and the midwifery profession, having a negative impact on the health and wellbeing of individual midwives and on retention and recruitment for the profession as a whole. Stress can also have a negative impact on the care of women as midwives seek to manage their stress levels by employing strategies such as task orientation. As part of a larger project to engage staff in personal and workplace wellbeing, the Oxford University Hospitals NHS Foundation Trust maternity services provided staff with the opportunity to learn the practice of mindfulness meditation. An 8-week course was made available with the intention of supporting staff to manage stress and anxiety, increase resilience and self-compassion, and improve the culture of the organisation as a whole. Evaluations carried out immediately post-course and after 4-6 months indicated a positive impact in both personal and organisational domains. [ABSTRACT FROM AUTHOR]

Objective: To explore community midwives' (CMs') experiences with respect to deployment policies and processes developed and used in Pakistan. Methods: A qualitative, descriptive, exploratory design was used; 11 CMs' perspectives were gained through two focus groups. Results: The findings are summarised under a key theme, 'Surviving as community midwives', and four related categories: (1) lack of identity and recognition; (2) state of helplessness; (3) depletion of competence and confidence; (4) unavailability of resources and financial support. Conclusion: The study findings highlight the need for revising the deployment policies, especially those related to the preparation of CMs for working independently in communities; introducing the CMs and their roles within the communities; establishing independent work stations (birthing centres); and streamlining the remuneration processes. The findings recommend greater preparation of district and regional-level government officials by policy makers for the implementation of the new CMs' deployment plan. [ABSTRACT FROM AUTHOR]

Enquiry-based learning (EBL) is an approach to education that generally involves students working in groups, forming their own questions and solving scenarios formulated from an initial 'trigger' presented by tutors. EBL entails specific demands but is believed to effectively apply theory to practice and enhance deep learning. In 2012, the midwifery programme at the University of Worcester was reapproved to run as an EBL curriculum. The research summarised here is an evaluation of students' perceptions and experiences of the first year of the new curriculum. A mixed-methods design was employed, using questionnaires and interviews. The students were most likely to perceive the benefits of EBL as increasing critical thinking (73%), problem-solving (68%), and leadership skills (66%). Concerns were voiced about the teaching of anatomy and physiology, and consistency of approach among tutors. All the students stated that their perceptions of EBL and its outcomes became increasingly positive over time. This evaluation suggests that EBL has potential to enhance the key skills of students who will be required to practise within increasingly complex maternity services. Further research is needed to explore the views of mentors as key stakeholders in midwifery education. [ABSTRACT FROM AUTHOR]

The objectives of this mixed-methods study were: a) to investigate midwives' approaches to early pushing urge (EPU); and b) to explore midwives' perspectives and experiences of helping women cope with EPU. A quantitative observational methodology was adopted to investigate midwives' approaches to EPU in 60 cases. A qualitative phenomenological approach was carried out in order to gain more in-depth understanding of midwives' views and experiences of EPU management strategies. It was found that midwives mainly adopt two approaches in the case of EPU: letting the woman do what she feels, and a stop-pushing technique. The findings are presented as four main domains: a) midwives' approaches to EPU; b) drivers guiding midwives' approaches to EPU; c) influencing factors in helping women cope with EPU; d) variation of midwives' approaches to EPU over time. [ABSTRACT FROM AUTHOR]

Guidelines from the National Institute for Health and Care Excellence (NICE, 2010) recommend the use of routine carbon monoxide (CO) monitoring in all pregnant women. However, there is no research describing pregnant women's experiences of being offered the CO test at booking. Method: This was part of a phenomenological study conducted to examine midwives' experience of using CO monitoring for smoking cessation in pregnancy. Individual semi-structured interviews were carried out and recorded with 10 midwives who use CO monitoring at booking. They were asked about women's reactions to the test. Data were analysed using Colaizzi's (1978) approach and bracketing. Results: Midwives reported that women were generally happy to accept the test. However, pregnant women appeared to be uninformed about it. Other reactions described include curiosity, shock, relief, guilt and surprise at the results. Conclusion: Overall, women's reactions were positive but an increased public awareness of the test would smooth its implementation. [ABSTRACT FROM AUTHOR]

This article explores supervision of midwives through a person-centred care (PCC) lens. Using PCC models and concepts, I consider if the current framework of supervision supports midwives in a way that reflects principles of PCC. This article is a personal reflection submitted in 2014 as part of the first year of a 3-year MSc in Advanced Clinical Skills currently being undertaken at Edinburgh University. [ABSTRACT FROM AUTHOR]

The Birthplace Study should have provided the catalyst to change the planned place of birth for nearly half of the women in England. However 4 years on, only 10% of women give birth in a midwife-led setting. Using the evidence from national studies, new initiatives focusing on improving informed choice and the knowledge and confidence of midwives were implemented in one large maternity unit. The strategies have, in part, been successful, with approximately 30% of local women planning to give birth in a midwifery-led setting. This work has demonstrated the challenging task of changing current perceptions around the safety of planned birth outside an obstetric unit demanding strong leadership supported by an effective marketing campaign. The publication of the recent National Institute for Health and Care Excellence Intrapartum Guidelines should provide further impetus in transforming the culture around childbirth. [ABSTRACT FROM AUTHOR]

A Cochrane systematic review has shown midwifery-led continuity models of care provide explicit benefits for mothers and babies compared with other models of maternity care, with a comparable level of safety. This study explored the local impact of the review, alongside other midwifery-led care evidence and guidelines. Electronic surveys were undertaken exploring women’s and health professionals’ awareness of models of maternity care evidence, including midwifery-led care and homebirth, and how they use evidence to guide their choices and practice. A low awareness of much of the available evidence was shown among the women and the professionals. There is a need for better dissemination of information to professionals as they are women’s preferred source of information about the options available for place of birth and midwifery-led care. [ABSTRACT FROM AUTHOR]

An anonymous survey of 56 midwives from different NHS hospitals revealed a major change in the categorisation of fetal heart rate (FHR) decelerations after the National Institute for Health and Care Excellence (NICE) (2007) guidelines on intrapartum care were implemented. The survey showed that the midwives currently categorise hardly any decelerations as 'early' or 'late' (median 0%, mean < 1%), the majority being 'variable' (median 100%, mean > 99%). A high proportion (40-70%) of the cardiotocographs (CTG) were classed as 'pathological' without any intervention required. In the survey, 33 midwives who had worked for more than 5 years stated that the vast majority (50-70%) of decelerations were 'early' (p < 0.0001) before the NICE guidelines (2007). The paradox of near extinction of early FHR decelerations (head compression which is a very common phenomenon) is not just a theoretical matter but leads to increasing numbers of false positive pathological traces. Midwives may be increasingly disenfranchised by having to rigidly adhere to the NICE categorisation of FHR decelerations. [ABSTRACT FROM AUTHOR]

The aim of this literature review is to investigate whether women of low-risk status should be denied oral fluids and food intake during labour. Objective: To improve outcome of mothers and neonates by looking at appropriate studies to discern whether withholding oral fluids and food during labour decreases the risk of maternal morbidity from Mendelson's syndrome (1946). The review also aims to determine the benefits and harm of oral fluid or food for women in labour compared with women free to eat and drink. Method: Randomised controlled clinical trials. Data collection methods: Quarterly searches of the Cochrane Database of Systematic Reviews and weekly searches of MEDLINE. Findings: This review discovered that there is no clear statement of findings restricting oral fluids and foods in labour, and that the validity of this practice needs to be questioned and further research carried out. Conclusion: When undertaking this literature review, the author found limited studies looking at eating and drinking in labour. The issue of whether women should eat and drink in labour is controversial. This diet restriction is a precaution for women who are at high risk of requiring a caesarean section (general anaesthesia); however, for pregnant women who are low risk, the research indicated there was little risk and midwives should review policies within their own Trusts. [ABSTRACT FROM AUTHOR]

Midwives collect considerable amounts of data as part of their routine practice. They also have access to extensive information about patients and, more generally, about effective interventions. An investigation of data related to smoking in pregnancy was undertaken in one UK NHS Trust. The brief was to identify what data were collected, how these data were transmitted to appropriate staff and how these data were used to inform practice. In addition, evidence on smoking in pregnancy in the research literature was reviewed and examples of best practice in other Trusts sought. A wide range of issues inhibiting optimal use of data were identified and recommendations for changes made. As well as changes in approaches to data use and collection, this led to changes in clinical practice. Specifically, this research supported moving from ascertaining maternal smoking behaviour via asking questions to undertaking carbon monoxide tests as routine antenatal practice. INSETS: Figure 1. High impact issues identified;Figure 2. Recommendations for change. [ABSTRACT FROM AUTHOR]

Transforming interprofessional groups through education resources (TIGER) has released the 'parenting and disability' materials as open education resources to be used by a range of practitioners in the care of parents who live with a disability. They are particularly relevant to the maternity services. The materials can be used by midwives independently or with other health professionals in a virtual learning environment. This case study highlights the benefits of the TIGER repository for midwives continuing education. INSETS: Advantages of developing an open education resource;Sample of the students¿ comments about the parenting and ...;Feedback in relation to design of the TIGER Repository;Could you be a TIGER Champion? [ABSTRACT FROM AUTHOR]

Health care services that show evidence of a safety culture demonstrate effective communication and good situation awareness. This article reports observational research looking at these characteristics in two delivery units, undertaken as part of a study of safety culture. Contrasting team styles evident in daily routines (calm and cohesive in one, more fragmented in the other) were associated with contrasting levels of team situation awareness, which affected the handling of unexpected or urgent events. However, the association between safety and quality in the unit was less simple, suggesting that different styles of team work may be suited to routine and urgent care. [ABSTRACT FROM AUTHOR]

Perinatal psychiatric illnesses are a leading cause of maternal morbidity and mortality but difficulties still exist with the correct identification and management of these disorders. This study surveyed health professionals involved in the care of women with maternal mental health disorders and identified where improvements are required. Midwives, obstetricians and health visitors were asked for their views on the identification, treatment and management of a range of perinatal mental health disorders. The results showed that participants lacked the required knowledge/ skills to identify and manage these disorders effectively and most had not received any specific pre-qualification or postgraduate training in perinatal mental health. Most requested additional support, including specialist advice, training and guidelines and agreed that all women with perinatal mental health disorders should have the support of specialized perinatal psychiatric services. Systems are needed to develop and maintain practitioners' knowledge and skills and to ensure improved access to specialist advice and support when required. [ABSTRACT FROM AUTHOR]

The crisis in human resources for global health is negatively impacting maternal health. In particular, access to emergency obstetric care is vital to prevent maternal deaths. In response to a severe shortage of physicians, various non-physician clinicians (NPCs), including midwives, perform caesarean sections in under-resourced environments. We reviewed the literature on the practice of any cadre of NPCs performing caesarean sections. The very limited literature on this topic finds that caesarean sections performed by NPCs and physicians appear to result in similar clinical outcomes. NPCs perform caesarean sections successfully and are more likely to stay in district hospitals than physicians. NPCs, including midwives, equipped with caesarean section skills may represent an extraordinary opportunity for solving a critical and unmet gap in the global maternal health crisis. [ABSTRACT FROM AUTHOR]

A Delivery Suite Assessment Unit (DSAU) has been established at a large Northern teaching hospital. This was as a recommendation of ASQUAM (achieving sustainable quality in maternity) to reduce antenatal admissions to delivery suite and provide a more appropriate environment for women attending for antenatal or labour assessment. The DSAU has also provided an effective teaching environment where skills such as effective telephone triage, diagnosis of labour and care of women with pre-labour spontaneous rupture of membranes (SROM) have been developed by junior staff. The first twelve months' audit results indicate that the establishment of the DSAU has been successful in reducing antenatal admissions to delivery suite by increasing the transfers of clients home, rather than to the antenatal wards. This may reflect the confidence of the highly skilled midwives working in this environment and the confidence women feel about their ability to obtain prompt and accurate advice over the telephone. [ABSTRACT FROM AUTHOR]

Communication and relationships are central to contemporary agendas such as `partnerships' and have been aligned to the defining features of a ‘good’ midwife. This article discusses the use of Heron's (2001) Six Category Intervention Analysis as a framework for the midwife to use in a helping relationship with women. The framework is described and examples of its use in midwifery practice are outlined and current research is explored. Emerging issues such as the context of practice, emotional competence and self-awareness are debated in relation to the use of interventions in practice. Implications for practice consider the need for support for midwives and students to develop both the necessary skills and to reflect upon ‘self’. The need for research within a midwifery context is proposed. [ABSTRACT FROM AUTHOR]