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Background: Women of non-white British ethnicity have a higher maternal mortality risk for reasons not yet fully understood, and report significant concerns about stereotypes, racism and overall dissatisfaction in care. This study aimed to examine what midwives perceive to be contributing factors to ethnic disparity in maternity care. Methods: A systematic search of the literature was conducted to find contemporaneous, relevant studies which were appraised for inclusion and quality. Four qualitative studies were included. Results: Midwives spoke about practical, cultural and logistical concerns that contribute to health inequalities; none mentioned racism. Three themes emerged: relationship barriers, logistical barriers and a sense of us vs them. Three areas of us vs them were explored: 'incongruent expectations', 'structural racism, stereotypes and implicit bias' and 'culture vs professional accountability'. Conclusions: Further research into the impact of implicit bias is needed to adequately address health inequalities for non-white British women. A national strategy could be used to set expectations for women accessing UK maternity services early in pregnancy. Midwives need to be empowered and supported to thoroughly document women's choices so that their professional responsibilities are met. [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]

Performing female genital mutilation (FGM) is prohibited within the UK by the FGM Act of 2003. A mandatory reporting duty for FGM requires regulated health and social care professionals and teachers in England and Wales to report known cases of FGM in under 18-year-olds to the police. An application to the court for an FGM protection order (FGMPO) can be made to keep individual women and girls safe from FGM. This paper reveals the significant disconnect between the number of FGMPO applications and known recorded cases of FGM. The introduction of FGMPOs requires critical exploration as there is insufficient evidence to show that FGMPOs are effective in protecting women and girls from FGM. It is therefore unclear what impact, if any, FGMPOs are having upon the protection of women and girls at risk of FGM. The barriers to the implementation of FGMPOs and possible solutions are discussed. [ABSTRACT FROM AUTHOR]

Black and black British women have an increased risk of stillbirth in the UK. The stillbirth rate for the UK in 2017 has reduced to 3.74 per 1 000 total births. However, mortality rates remain high for black or black British women, despite stillbirth rates for these groups reducing over the period 2015–2017 from 8.17–7.46 per 1 000 births (Draper et al, 2019). These facts raise the question of why these trends continue and what steps can be taken to address this issue. This paper explores the possible reasons why black and black British women continue to be at increased risk for stillbirths. Recommendations will be made on reducing the risk of stillbirth and the importance of tailoring health services for black and black British women. For the purpose of this paper, the term 'black women' will be used for black and black British women. [ABSTRACT FROM AUTHOR]

Background: Many women in prison are mothers and an increasing number are pregnant. These women face the harsh reality of potentially being separated from their babies or children, which can have detrimental effects on both the mother and the child. Aims: To review the literature surrounding the impact of mothers and children staying together in a prison environment. Method: The review focused on papers from the past 9 years and included mothers whose children resided with them in prison, and mothers who had been separated from their babies after giving birth in prison. Three articles were identified: two qualitative studies based on interviews with imprisoned mothers, and one quantitative study into re-offending rates of women who had been released from a prison nursery programme. Findings: Keeping their babies and mother together in a prison environment resulted in a positive outcome, particularly for the mothers. However, when thinking about the welfare of the child, there need to be sufficient opportunities to allow for their physical, social and emotional development. The common themes that emerged during this literature review were: low re-offending rates, motherhood producing motivation for change, and the effect of staying together on maternal and child wellbeing. Conclusions: This review highlighted the need for further studies, especially focusing on prisons in the UK. [ABSTRACT FROM AUTHOR]

Statutory supervision has been a feature of midwifery practice in the UK since 1902. As part of statutory supervision, all midwives meet with their named supervisor of midwives to review their practice over the previous year and to confirm their competence to practise in the coming year. This is referred to as the Annual Supervisory Review (ASR). In 2014, with the aim of protecting the public, a new Future Proofing Model of supervision was developed by Welsh Local Supervisory Authority Midwifery Officers and launched in Wales (but not in other parts of the UK) in August of that year (Ness and Richards, 2014). The new model is being evaluated on an ongoing basis. This paper reports on findings from the evaluations undertaken between summer 2014 and summer 2015. The data were drawn from a survey, an audit by lay reviewers, a focus group discussion and routinely collected evaluation forms. The paper draws on findings from these four sets of data to conclude with a recommendation for the inclusion of group supervision as part of the Nursing and Midwifery Council revalidation process. [ABSTRACT FROM AUTHOR]

Statutory supervision has been a feature of midwifery practice in the UK since 1902. As part of statutory supervision, all midwives meet with their named Supervisor of Midwives (SoM) to review their practice over the previous year and to confirm their competence to practise in the coming year. A new Future Proofing Model of Supervision in Wales was launched in August 2014 (Ness and Richards, 2014), and the annual one-to-one supervisory meetings were replaced with group supervision meetings, based on an action learning approach (Machin and Pearson, 2014). With the impending withdrawal of statutory supervision of midwifery in the UK, this paper explores the wider issue of clinical supervision and group supervision; part 2 (to follow in a future issue) will present the findings from several sets of data exploring the value of group supervision in midwifery in Wales. [ABSTRACT FROM AUTHOR]

The history and professionalisation of midwifery has travelled through turbulent times to arrive at an opportunity for transformation in the contemporary UK maternity system. This professionalisation, the midwifery profession and professional autonomy are explored in this article from a sociological perspective, to answer the question of whether a midwife can achieve professional autonomy within the UK system. This is a two-part article. Part one has a strong focus on the historical context of midwifery, government policy and guidelines, risk, litigation and increasing managerialisation to frame the discussion in part two. The second part provides a discussion of autonomy, choice, managerialisation and reflexive practice, to create a conceptual framework utilising the concept New Professional Midwifery. This is to centralise a core belief in midwifery autonomy and women's choice facilitation. This paper is part one of two. [ABSTRACT FROM AUTHOR]

Aims This study aimed to assess the scope of newborn infant physical examination (NIPE) education in programmes of pre-registration midwifery education. Methods An online questionnaire was sent to all lead midwives for education in the UK. Findings are reported in two parts: part A (the current paper) examines the education provision for the inclusion of NIPE in the midwifery curriculum. Part B (a subsequent paper) explores NIPE education as a post-registration module. Findings Of 58 education institutions, 40 (68.9%) completed the questionnaire. A quarter (25.0%) stated that NIPE training is included in their pre-registration midwifery programmes; 37.5% reported plans to implement it within the next 2–5 years and 30.0% had no plans to do so. Benefits for practice partners, commissioners, students and service users were identified. Challenges were noted, particularly in relation to resources and student support in practice. Conclusion Although barriers doubtless exist, the success of the few institutions that have incorporated NIPE into their curricula is evidence that this is not only possible, but has proven benefits. [ABSTRACT FROM AUTHOR]

Background: Poor perinatal mental health, in particular depression, affects at least 10% of new mothers in the UK. Current best practice recommends the use of talking therapies or medication; however, many women choose not to use medication or are deterred from accessing NHS services. Those who can access NHS treatment often face a long waiting list to see a clinician or therapist. Untreated perinatal depression has an impact on the health and wellbeing of women and babies, so it is essential to consider alternative psychosocial interventions delivered by non-clinicians. Aims: This review aims to explore the effects of psychosocial interventions on maternal perception of perinatal depression. Methods: A systematic review was conducted on seven quantitative studies examining the effect of psychosocial interventions in reducing maternal symptoms of depression. Interventions focused either on physical activity or peer support, measuring depression scores with a validated screening tool. Findings: The seven reviewed studies considered either physical activity or peer support-based interventions. There is some evidence that antenatal group peer support may benefit women in the antenatal period and that postnatal peer telephone support may be helpful for primiparous women. Conclusions: Further large-scale research is required to ascertain the effectiveness of a range of interventions in improving maternal perception of perinatal depression. [ABSTRACT FROM AUTHOR]

Abstract: In the UK there continues to be an ongoing debate about home birth. Limited research is available to determine what influences multiparous women who chose home birth after a previous hospital birth. This paper is the first of a two-part series exploring these influences. This paper will explore the existing literature around the topic and evaluate the key themes. Six databases were searched for relevant literature, and 20 relevant papers were identified. The majority of available research did not differentiate between primiparous and multiparous women, and the predominant focus was on the perception of risks associated with home birth. Persistent themes in the literature were related to control of the birth, negativity about a previous birth, risks and safety, home birth as a lifestyle choice and the influence of midwives. The second paper will report the findings of a phenomenological study in which eight multiparous women were interviewed about the factors that influenced their decision to home birth after a previous hospital birth. [ABSTRACT FROM AUTHOR]

Higher education institutions and the NHS both face a number of major challenges. This paper provides an overview of some of the key contemporary publications that will have an impact on the UK university system in the coming months, and attempts to clarify their potential and real effect on the future of midwifery education and the ongoing development of midwifery curriculum. There is a very real risk that recent government proposals for future higher education funding in conjunction with their major reconfiguration of the NHS will both fragment and destabilise existing university education systems. Money is tight, and will become tighter, making the task of meeting the demands of midwifery stakeholders, while not compromising on the quality of the midwifery student experience, even harder for educators. Women and their partners deserve a safe transition to parenthood and a positive and life-enhancing experience of UK maternity services-in the coming months midwifery curricula will be judged on their ability to facilitate this. [ABSTRACT FROM AUTHOR]

In 2002, the Department of Health (DH) introduced an information strategy that was intended to improve care, reduce duplication and increase patients' involvement in their own records and management of care. Student midwives are educated to appreciate that good record keeping and documentation is integral to safe, effective midwifery practice. As electronic health records (EHRs) become more widespread, this survey aimed to investigate midwifery students' experiences of electronic health records (EHR) in practice, using questionnaires and focus groups. The questionnaire results indicated the types of EHRs students had accessed and used. From the focus group, three themes emerged: benefits of EHRs for care delivery; practical issues of EHRs and accountability; incongruence between EHRs and the concept of 'normality' in childbirth. As student midwives increasingly encounter EHRs in their practice, education and health providers should collaborate to implement appropriate training and preparation. [ABSTRACT FROM AUTHOR]

Background: Prenatal measurement can highlight early attachment issues in mothers and prenatal attachment could be a predictor of postnatal attachment. It is necessary to better understand prenatal attachment trends in both genders to identify and intervene quicker when attachment issues are present. Aims: This paper explores the changes in parent-fetal attachment throughout pregnancy, examining attachment score changes and differing gender trends. Methods: Of the participants, 101 parents (59 female, 42 male) completed the respective Maternal/Paternal Antenatal Attachment Scale (Condon, 1993) at two administrations during pregnancy. Findings: Paired t-tests revealed a significant increase in female scores (p<0.0001) and a non-significant increase in male scores (p=0.102) from first to second administration. Conclusion: Female attachment increased in strength as pregnancy progressed, while male attachment remained relatively stable throughout. Further research is needed to examine gender differences across trimesters, the impact of interventions designed to improve attachment and attachment in more diverse populations. [ABSTRACT FROM AUTHOR]

Background/Aims: Under-representation of pregnant women, their partners and parents from minority ethnic backgrounds has been reported in research involving the perinatal period. This study's aim was to explore the experiences of parents from minority ethnic groups who participated in research during the perinatal period, focusing on barriers and facilitators to participation. Methods: In-depth qualitative interviews were conducted via Microsoft Teams by all three researchers with a purposive sample of 16 parents. Data were analysed using thematic analysis. Results: Seven overarching themes were identified: motivating factors; unique contributions; language, understanding and access; cultural values, beliefs and practices; lack of time and other commitments; facilitators for participation; and experience of the current study. Conclusions: Understanding motivation for participation is essential to developing recruitment strategies that promote involvement of parents from minority ethnic backgrounds. A clear understanding of research goals and perceived benefits, and maximising access to studies, is likely to result in improved recruitment. Implications for practice: Ways to encourage research participation from parents in minority ethnic groups include using a range of advertising techniques and venues, offering a choice of time and place for activities and alternative methods of data collection, and disseminating information on available studies in early 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]

Background Pelvic floor muscle exercises positively impact on urinary stress incontinence and quality of life for women. Aim To try and understand more about pelvic floor exercises. Methods A search was performed on Cochrane, CINAHL and Discover More. Delimiting the search provided 28 papers, which then informed this literature review. Differing methodology and small sample size of individual studies, variation in trainer and the design of pelvic floor muscle exercises education limited the evidence base. Findings Many barriers existed and women were found to be disinterested with pelvic floor exercises or unaware of the reasons for performing them. Those who were young, in their first pregnancy and from deprived areas were less likely to perform pelvic floor muscle exercises, as they had no access to information or believed they were not necessary. Midwives lacked confidence in their knowledge and suggested that other health professionals could perform promotion better. Conclusions It is important to investigate how midwives can influence education about pelvic floor muscle exercises and women's perceptions. New and creative methods of health promotion are needed to engage women with pelvic floor muscle exercises more effectively. [ABSTRACT FROM AUTHOR]

Constipation and haemorrhoids are two of the most common problems experienced by pregnant women. Clinical guidelines agree that increased fibre (particularly wheat bran) and fluid intakes are advisable to promote bowel health (Jewell and Young, 2001; National Institute for Health and Care Excellence (NICE), 2010) but no specific guidance is given as to how much fibre or fluid should be consumed. This lack of direction leaves midwives relying on a common sense approach to supporting women in improving their dietary intake. However, do midwives have sufficient nutritional knowledge to empower women with appropriate, healthy, high-fibre choices? A literature search was carried out to identify papers addressing the role of fibre and fluid during pregnancy. Overall, fibre consumption reported by pregnant women fell woefully short of recommended intake. Studies suggest that most pregnant women in the UK would benefit from an increase in fibre intake of at least 10 grams a day in order to help prevent constipation and haemorrhoids. This article provides practical advice to help boost fibre intake in order to improve the quality of life of pregnant women. [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]

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]

Public Health England and the Department of Health (2015) have documented that parents are requesting consistent professional advice throughout pregnancy and the early weeks following birth, as their care is transferred from midwives to health visitors. In addition, commissioners are increasingly seeking to integrate services to provide joined-up care and improve health outcomes for parents and families. This paper discusses the benefits, to both parents and health professionals, of collaborative working, together with the challenges faced by midwives and health visitors in the current climate. It explores the benefits of collaborative learning between the two disciplines in the higher education setting, with an example of a successful collaboration at the University of Central Lancashire. [ABSTRACT FROM AUTHOR]

Midwives do not routinely receive training in how to manage parent care when Down syndrome (DS) is identified in pregnancy or after birth. Many parents report dissatisfaction with the response of health professionals during this time. In response to this, the UK Down's Syndrome Association has developed the Tell it Right, Start it Right training. This paper reports on an evaluation of the training using the Kirkpatrick model (Kirkpatrick and Kirkpatrick, 2006). A repeated measures online survey was delivered before training, immediately afte training and 2 months after training. Midwives constituted the majority of participants. The evaluation found that knowledge of DS, confidence in communicating with parents and confidence in delivering a diagnosis of DS significantly increased after attending. Some evidence of applying knowledge in the workplace was identified; however, such training must become embedded in mandatory professional education if widespread improvements in parent experience are to be achieved. [ABSTRACT FROM AUTHOR]

Background: Newborn screening for congenital heart disease (CHD) forms part of the newborn physical examination (NPE) in the UK. However, research has shown that up to 50% of cases of CHD can be missed by this examination. The purpose of this literature review is to investigate the significance of hearing an asymptomatic heart murmur at the NPE in relation to the presence of CHD. Methodology: A critical literature review was conducted to answer the research question. The findings were discussed using a narrative synthesis approach. Findings: There was considerable heterogeneity of results. The prevalence of murmur in newborns ranged between 0.6%–10.7%. Between 13%–67% of those newborns had some form of CHD, although many had clinically insignificant lesions. Between 2%–9% of newborns with murmurs had a form of critical CHD (CCHD). The ability to discern whether a heart murmur relates to pathology or not improves with experience. No single optimal timing for the NPE was identified. Pulse oximetry was shown to increase sensitivity of screening for CCHD. Conclusion: There is a significant increase in the prevalence of CHD when a newborn has a heart murmur, hence referral for diagnostic echocardiography is required when a heart murmur is identified. Pulse oximetry is an important adjunct to newborn screening for CCHD. Some newborns affected by CCHD will not present with murmur at the NPE. Therefore, those caring for newborns during the early days must know the signs and symptoms of CHD so that appropriate medical assistance can be sought. [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]

Meeting the needs of young parents and their children more effectively will improve their life and long term health. This paper examines the Family Nurse Partnership as a public health initiative in supporting young women and improving the outcomes of themselves and their child(ren). It explores evidence of effectiveness, cost benefit and resource implications and discusses the role of the midwife within the context of public health initiatives and specifically to the delivery of the Family Nurse Partnership. [ABSTRACT FROM AUTHOR]

Background: Female genital mutilation affects an estimated 200 million women and girls worldwide. This article examines a midwife-led service that integrates health advocates and counsellors into a model of holistic woman-centred care and was the blueprint for new national clinics opened in 2019. Methods: This retrospective case note review examined referral patterns, clinical findings and interventions over 11 years at a UK specialist clinic for non-pregnant women with female genital mutilation. Results: More than 2000 consultations were conducted. Two thirds of women had type 3 mutilation. Most were Somali (73.4%) with 18 other ethnic backgrounds represented. Women presented with dysuria, dyspareunia/apareunia, dysmenorrhea, recurrent infections, post-traumatic stress disorder, nightmares, flashbacks and psychosexual issues. Interventions included deinfibulation under local anaesthetic (many as same day walk-in cases), clinical reports for asylum applications and trauma counselling. One in 10 attendees were healthcare professionals/carers. Nearly 5% were refugees/asylum seekers. There were 12 safeguarding referrals, three cases of mandatory reporting duty and two protection orders. Intersectional violence was frequently reported among women of West African origin. Conclusions: Significant numbers of non-pregnant women require specialist help. Innovative means to publicise clinics and routine enquiry during gynaecological consultations and GP registration, could ensure earlier signposting to services. Deinfibulation can be safely performed by an expert midwife in a community or outpatient setting. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the sleeping position of infants attending an outpatient clinic, considering the influences of the back to sleep (BTS) campaign. A paper survey was given to 678 parents who presented their infant (under 1 year of age) to the paediatric chiropractic clinic for care asking their infant’s sleep position. Of the total survey sample, 50% of parents selected the supine position as the preferred position they placed the baby to sleep, 19% of parents preferred to place their babies prone, 34% on the babies side and 2% selected other. Some mothers selected more than one preferred sleeping position. The initial decline of mothers using non-supine positioning, seen shortly after the implementation of the BTS campaign, is no longer evident. Recent research implies approximately half of infants are now placed in a non-compliant sleeping position. If an infant’s most preferred sleeping position is not that of current guidelines, manual therapy such as chiropractic care should be sought to help infants sleep supine with comfort. [ABSTRACT FROM AUTHOR]

This article reviews the UK literature about the extent to which midwives are prepared for their role in child protection in order to identify the evidence and to make recommendations for further research. Findings from the studies reviewed revealed a number of themes related to child protection in midwifery including: midwives perspectives, educational perspectives, multi-agency working and organisational perspectives. The review revealed that there is a dearth of empirical studies in this area with no studies found related to vulnerable groups such as those with mental health problems, learning disabilities, women with problems of substance abuse and teenagers. [ABSTRACT FROM AUTHOR]

It is acknowledged that women who use substances in a problematic way are more likely to have co-existing mental health problems (Grella, 1996; Kelly et al, 2001; Neale, 2004; Teesson et al, 2012). Likewise, there is evidence that women are more likely to experience certain mental health problems such as depression (Melville et al, 2010). Given that both substance misuse and mental illness have an increased incidence during the childbearing years (Kelly et al, 2001), there is a paucity of research in the area of pregnant women who have comorbid mental health and substance use problems. This paper explores the ways in which this group of women can be engaged and assessed in practice. [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]

As midwives embrace a society where more and more women are making active decisions regarding their pregnancy and labour, many decide to deviate from the recommended pathways surrounding their care. This paper examines a case study featuring Sarah, a fictional, para one woman who wants a vaginal birth after caesarean section (VBAC) at home, and whose fetus is presenting in the breech position at her 36 week antenatal appointment. Professional, legal and ethical aspects pertinent to the scenario are discussed, along with the role of the midwife. [ABSTRACT FROM AUTHOR]

This is the second of two articles discussing the findings of an extended literature review undertaken to explore whether midwives are missing a health promotion opportunity within the care of obese pregnant women. This integrative review analysed 36 primary and secondary research papers to elicit emerging themes. The impact of maternal obesity on service provision and the value of measuring and monitoring gestational weight gain were discussed in part 1 of this article (Williams, 2012). Part 2 explores the value of antenatal interventions and some of the underlying issues around obesity, which may contribute towards the challenges of addressing this important public health issue. The concluding section will identify areas for practice development and further research. [ABSTRACT FROM AUTHOR]

It is recommended that a physical examination of the newborn (PEN) is carried out within 72 hours following birth (National Institute of Health and Clinical Excellence (NICE), 2006). Historically, these examinations have been carried out by junior paediatricians or general practitioners (GPs). However, it is now increasingly likely that PEN will be done by midwives and advanced neonatal nurse practitioners (ANNPs) instead. This move has been made to embrace the government ethos for the NHS where midwives and nurses take on extended roles, traditionally carried out by doctors (Department of Health (DH), 2007; DH, 2009). There is variation in how maternity services are providing PEN nationally. Locally, we became increasingly aware that there are factors that need to be considered to ensure optimal service provision. This paper describes the models of care that are used by midwives carrying out PEN locally, and highlights the catalysts for change to provide a flexible women-centred, efficient and cost-effective service. [ABSTRACT FROM AUTHOR]

In September 2008, an enquiry-based learning (EBL) approach was implemented for the first time into the University of Hertfordshire's (UH) pre-registration midwifery programme. An evaluation of this approach was therefore required. This study explored the lecturers' experiences of using EBL within the first year of its implementation. A qualitative methodological approach using a phenomenological design were used and two of the main themes that emerged are presented in this paper: 'facilitation of EBL' and 'EBL and the midwifery curriculum.' Conclusions drawn from this study found that overall, EBL is a useful approach within the midwifery curriculum but it should be supported by key lectures that address foundational knowledge in midwifery. The method of facilitation is a key factor in the effectiveness of this approach and staff reflection is deemed to be an important aspect in supporting facilitators to develop in their role. Recommendations are made for the future development of this approach. [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]

This paper looks at the utilisation of tandem mass spectrometry (MS/MS) in newborn bloodspot screening. MS/MS has the ability to analyse a single blood sample for a relatively large number of neonatal disorders, including inborn errors of metabolism. It has therefore the capability to transform the face of newborn screening. In the UK medium chain acyl-coenzyme A dehydrogenase deficiency (MCADD) has been highlighted as a suitable candidate for screening using MS/MS but debates are still taking place about the disease process and the psychosocial implications of screening. Midwives are central to newborn screening and therefore any expansion of bloodspot screening would have implications for their practice in terms of information giving, parental consent and education. To ensure the continued success of newborn bloodspot screening it is important that midwives practice in accordance with professional standards, are aware of current developments and engage in debates prior to new service delivery implementation. The Department of Health and the National Screening Committee have undertaken a two year pilot study (2004-2006) looking at newborn screening for MCADD and their report, due out 2006/2007, has the potential to contribute constructively to current debates. [ABSTRACT FROM AUTHOR]

This paper reports on a study conducted in 2001 and 2002 to establish the range of labour related procedures that UK midwives undertake and the supporting training and governance mechanisms. Two postal questionnaires were sent to maternity services managers at UK maternity units, requesting information on the number and type of midwifery procedures undertaken and the clinical governance and training activities in place. The study concluded that despite government policy promoting greater parental choice there is a wide variation in the range of labour related tasks that midwives undertake in the UK. If more midwife led units are to be established as a way of promoting parental choice, then adequate governance and training mechanisms must be in place to enhance continuity of care and reduce transfers. [ABSTRACT FROM AUTHOR]

Despite the potential benefits of breastfeeding, only a minority of teenagers choose to breastfeed in the UK. in some areas, local audit has demonstrated that just 1 in 5 teenagers initiate breastfeeding prior to leaving hospital. in an attempt to increase these rates, and with the support of a Department of Health project grant, the authors implemented a system whereby a named midwife was employed to support teenagers to breastfeed. This paper will describe the model of support employed, the project evaluation and subsequent implementation of a system which was deemed successful and was valued by the teenagers. [ABSTRACT FROM AUTHOR]

Discusses British government initiatives set forth in the White Paper 'Information for Health.' Aims of the paper; Application in primary and secondary care settings; Education required to promote technological advance and the difficulties experience implementing change; Ways of enhancing midwifery care.

Midwives understand the benefits of breastfeeding, both for the infant and mother. However, the biochemical and physiological reasons for the superiority of breast milk are less widely known. This is, in part, because of the extraordinary complexity of breast milk's composition. Its key components include nucleotides, which benefit gut and immune development, human milk oligosaccharides, which promote an optimal gut biome, lipids in the milk fat globule membrane, which promote gut health and brain development, immunoglobulins, which modulate the infant's immune system, and an optimum protein content, which is high in the first 2 weeks after birth but decreases thereafter. A greater awareness and understanding of the mechanisms behind the benefits of breastfeeding could help midwives to have informed discussions with parents and potentially contribute to improving the UK's breastfeeding rates. Growing understanding of breast milk's unique composition may also help infant formula manufacturers drive innovation and improve the formulation of their products. [ABSTRACT FROM AUTHOR]

The incidence of obstetric anal sphincter injury in the UK is rising. This condition leads to significant morbidity in otherwise healthy women. Significant long-term complications of obstetric anal sphincter injury include anal incontinence, ano-vaginal or recto-vaginal fistula and psychological distress. Current management of third and fourth degree perineal tears post-vaginal birth is primary repair. This article discusses the role of a defunctioning colostomy in women with severe perineal tears in the immediate postnatal period. A defunctioning colostomy is a surgical procedure to open a section of colon (large bowel) onto the abdominal wall; a stoma bag is then worn over this to collect faeces. The rectum and anal canal are not used (defunctioned), while the stoma is in place and the perineum is healing. This article describes the purpose and operative steps of colostomy formation and reviews current published evidence of outcomes in those with colostomy formation for obstetric anal sphincter injury. It also addresses the difference in clinical approach between obstetricians and colorectal surgeons in relation to the management of severe obstetric anal sphincter injury and highlight the need for multidisciplinary input. [ABSTRACT FROM AUTHOR]

Women with a past history of FGM are increasingly presenting to obstetric units in the UK for care and delivery. The aim of the study described in this paper was to determine the need for antenatal defibulation and subsequent obstetric outcome of women with a history of FGM presenting to a London obstetric unit. A prospective cohort study was carried out of all pregnant women with a history of FGM referred for antenatal assessment. Twenty-six women completed the study. All had undergone FGM and 67% required defibulation prior to delivery; 79% of women sustained either an episiotomy or tear. A significant number of women (38%) declined antenatal defibulation, preferring to wait until the onset of labour. This has implications for midwives and obstetricians who are not at present trained in the management of women with previous FGM presenting in labour. Although caesarean section and instrumental delivery rates were comparable to the hospital averages, all women — whether defibulated or not — had extremely high levels of perineal trauma. Further work is necessary to identify ways to minimize this. [ABSTRACT FROM AUTHOR]

George F Winter explores existing issues in the provision of midwifery care for women in prison, in relation to the United Nations' declaration regarding standards of care for prisoners [ABSTRACT FROM AUTHOR]

As part of the revalidation process, midwives are required to undertake 35 hours of continuing professional development (CPD), of which 20 must be ‘participatory’. Participatory learning includes any learning activity that involves interaction with other people, providing the opportunity to learn with and from each other. Participation can take place face-to-face such as attendance at a study day or conference; or virtually, such as an online discussion group using a social media platform. As oposed to a didactic methods, a participatory approach to ongoing professional development is more likely to lead to positive changes in practice and thus better levels of care. This article will look at the theory of CPD and compare CPD activities of midwives and teachers to consider how ‘teacher research’ might be adopted by midwives, with the potential for service improvement and better quality of care as a consequence. [ABSTRACT FROM AUTHOR]

The UK and Brazil both have sizable populations with significant demands on antenatal and maternity care. However, access to different healthcare professionals and knowledge regarding the importance of maternal nutrition vary widely between the two countries. This article compares the different approaches used in maternal nutrition between the UK and Brazil, seeking to share best practice and improve antenatal care. [ABSTRACT FROM AUTHOR]

Background/Aims For refugee women, pregnancy and early motherhood can exacerbate poor underlying health, poverty, and deprivation. Despite the wealth of research exploring the experiences of pregnant refugee women, maternity care providers remain unprepared for their unique needs. The aim of this study was to ask what refugee women require from maternity care, reduce adverse risks, and improve maternity care experiences Methods Secondary analysis of focus group data from refugee women as part of the 'What women want' White Ribbon Alliance campaign. Results Three key themes emerged: feeling safe in the maternity system and in their communities; fair and equal access and treatment in maternity care and the asylum system: building a future in the UK. Conclusions Midwives need additional training and education to understand the wider issues of the negative discourse around migration and being an asylum seeker and use this knowledge in practice when caring for women to help them feel safe. [ABSTRACT FROM AUTHOR]

Workload pressures within midwifery have magnified because of the global pandemic, causing anxiety and stress for healthcare professionals across all settings. The prediction of the retirement time bomb, combined with midwives leaving the profession as a result of burnout, is having a considerable impact on maternity service provision. There is additional recognition of stress factors caused by the changing landscape within maternity services, one of which has been identified as the national implementation of the continuity of care model. The support framework for midwives and student midwives and the continuous improvement process that the advocating for education and quality improvement model is designed to achieve is needed now more than ever in what have become known as unprecedented times. The author is passionate regarding support for student midwives and prior to lockdown, commenced a postgraduate course in coaching and mentoring. The rationale for undertaking this qualification was to enhance professional midwifery advocate skills further. This proved to be beneficial to the development of the professional midwifery advocate services. [ABSTRACT FROM AUTHOR]

Background: Evidence acknowledges inequalities to progression and achievement for black, Asian and minority ethnic students within higher education, as well as barriers for promotion of black, Asian and minority ethnic staff within the NHS. In the UK, legislation and regulatory guidance requires students studying undergraduate midwifery to undertake their programme across both these institutions. Aims: To understand the experiences of black, Asian and minority ethnic students studying undergraduate midwifery at a UK university. Methods: This qualitative study used semi-structured interviews with five student midwives who identified as black, Asian or minority ethnic from a university, conducted by a peer researcher. Thematic analysis was used to analyse anonymised transcript data. Results: Three key themes were identified: 'invisibility', 'emerging visibility' and 'managing visibility'. Participants experienced a monocultural focus in the curriculum and in practice and were exposed to racist behaviours, causing them to modify behaviours. Conclusions: A need for diverse teaching materials and cultural inclusivity across institutions was identified to help combat outdated systemic Eurocentric practices and support the implementation of recently published midwifery standards. [ABSTRACT FROM AUTHOR]

Peggy Mulongo and Sue McAndrew respond to a review of the law surrounding protection orders, published in the July issue of the British Journal of Midwifery, and call for a national commissioner [ABSTRACT FROM AUTHOR]