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

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

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

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

The 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]

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

This article provides an overview of the use of digitally enabled programmes to support perinatal mental healthcare in the NHS in Scotland, focusing on the Perinatal Wellbeing Programme from SilverCloud®. This follow up to a previous article published in the British Journal of Midwifery considers the experiences of using this programme in a Scottish context, examining feedback from users of the intervention. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

Background/Aims Antenatal care is important for screening, monitoring and management of pregnancy risks. This study analysed determinants of antenatal care in Indonesia among women aged 18-24 years and older than 30 years, who are at greater risk of pregnancy and birth complications. Methods This cross-sectional study used secondary data from 4338 women in the 2017 Indonesian demographic health survey. Chi-square tests and binary logistic regression were used to explore the effects of individual, partner and social factors on antenatal care. Results Antenatal care attendance was associated with a younger age at first birth (adjusted odds ratio: 1.49; P<0.001), health insurance (adjusted odds ratio: 1.54; P=0.004) and the middle wealth quintile (adjusted odds ratio: 1.78; P=0.002). Conclusions Collaboration is needed to increase awareness of complications and the importance of antenatal care. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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: Multidisciplinary team collaboration has been identified as a key factor in optimising intrapartum care. The way future doctors feel about their undergraduate placements with midwives is worth considering, given that this might influence their behaviour in the long term. This study aimed to investigate the experience of medical students working with midwives on NHS labour wards. Methods: Qualitative thematic analysis was done on transcripts of in-depth interviews with 10 medical students from across England. These students had clinical experiences with midwives or were seeking to work with midwives, and had experiences of training during or after 2010. Results: Midwives were described as 'gatekeepers', with the power either to open or close the labour room door to medical students. Participants described mixed feelings about midwives; some reportedly provided pivotal learning experiences, particularly regarding physiological labour and birth. Others were perceived as unsupportive. The dynamic with midwives was often linked to wider multidisciplinary team culture. Conclusions: Despite national calls to improve multidisciplinary team relations and undergraduate experiences, this sample of medical students shows that some still perceive tension with midwives. This may affect future obstetricians' exposure to physiological birth at an impressionable time and also influence their multidisciplinary team behaviour. Research into midwives' perspective is needed, given that collaboration is a key factor in providing safer, more personalised care. [ABSTRACT FROM AUTHOR]

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

Background: Around 70% of women who give birth vaginally experience perineal injury during childbirth, which may happen spontaneously or as a result of the incision made to facilitate childbirth. There are very few studies on the perceptions of episiotomy recipients about these services. Therefore, investigating these women's perception is crucial for providing appropriate care. Methods: This qualitative study examined 20 women from hospitals and health centres who had undergone episiotomy using in-depth semi-structured interviews. Data were analysed using conventional content analysis and the accuracy and rigour of the data were assessed using the Lincoln and Guba criteria. Results: The 'change in perception and behaviour' theme encompassed one category of negative experiences and views about episiotomy and a second category covering positive views. Conclusions: Women's perceptions of episiotomy contained both positive and negative views. Since healthcare systems should support mothers' physical and mental health, it is recommended that health policymakers devise plans to boost factors that lead to positive views and eliminate those contributing to negative experiences and views. [ABSTRACT FROM AUTHOR]

This article discusses the evidence reported from quasi randomised trials and randomised controlled trials on the efficacy and acceptability of localised cooling methods in alleviating perineal trauma. Two types of cooling methods were identified: iced sitz baths and cooling devices. The review suggests that cooling may lower the levels of reported perineal pain after childbirth and reduce the inflammatory response associated with perineal trauma. However, women's preferences as well as the efficacy of the cooling method should be taken into consideration. Women's natural reluctance to sit in iced sitz baths suggests that this cooling method is unpleasant and may explain why there has been a decline in this method being used in clinical practice over the last two decades. The use of localised cooling devices appear to be a more acceptable method for women. [ABSTRACT FROM AUTHOR]

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

Background: Satisfaction with childbirth is associated with a number of factors prior to and during birth, including perceived control during labour, and has implications for postnatal psychological health. Methods: A total of 38 pregnant women recruited prior to 20-weeks gestation completed questionnaires regarding perceptions of control during, and satisfaction with, childbirth, mental health and maternal attachment at two-months postpartum. Birth details and breastfeeding difficulties were obtained from hospital records. Results: Satisfaction with childbirth was associated with perceived control and a physiological birth, and perceived control was associated with a physiological birth and midwife-led continuity of care. At two-months postpartum, satisfaction with childbirth was associated with fewer depressive symptoms, while perceived control was associated with fewer anxiety symptoms. Discussion: It is important for healthcare providers to implement practices that support birthing satisfaction, such as provision of midwife-led continuity of care. Healthcare provision should also provide psychological support to mothers whose birthing experience was unsatisfactory and tailor additional support during early breastfeeding for these women. [ABSTRACT FROM AUTHOR]

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

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

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]

Background: Women's sexual function can be dramatically affected during and after pregnancy. Aims: To explore Australian women's personal experience of changes in their sexual function during pregnancy and childbirth. Methods: This was an online qualitative survey in which women across Australia who had given birth in the previous 12 months were invited to take part. A total of 273 responses were included. Findings: The five main themes that emerged were: mental health changes; obstetric violence (including lack of support from caregivers, violation of privacy, instrumental delivery and episiotomy); relationship issues (including lack of support from partner, lack of intimacy and domestic violence); physical changes (including birth trauma and negative body image); and role conflict (including role incompatibility, breastfeeding and lack of sleep). Mental health changes were reported to have both positive and negative impacts on women's sexual function. Conclusions: Women experience many changes in their sexual function during and after pregnancy. Health professionals should take an integrated approach to improve women's sexual function and overall wellness. [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]

Post traumatic stress disorder-post childbirth (PTSD-PC) is a powerful pathophysiological reaction that occurs in response to experiencing a traumatic birth and affects between 1–6% of women. Regardless of its trigger, PTSD-PC causes significant impairment to women’s social interactions, ability to work, and daily life. A key symptom of PTSD-PC is re-experiencing the birth in the form of nightmares, flashbacks, continual replay, intrusive thoughts, and images. When these symptoms persist beyond 1 month, a diagnosis of PTSD-PC should be considered. In awareness that there are additional mental health problems that a childbearing woman could encounter, the authors have elected to focus on two of the more commonly experienced diagnoses; specifically PTSD and postnatal depression (PND). It is important for midwives to be able to differentiate between PTSD-PC and PND, because diagnoses and treatments differ. Generally, PND is treated with antidepressants and cognitive behavioural therapy (CBT), while PTSD is treated with eye movement desensitisation and reprocessing (EMDR) therapy or emotional freedom technique (EFT). There is potential for a women to develop a dual diagnosis, with partner and family also affected. Clarity surrounding the differences between PND and PTSD are key to accessing appropriate diagnosis, referral, and treatment. [ABSTRACT FROM AUTHOR]

Background An interprofessional education initiative was developed and piloted in 2014 at Queen’s University Belfast, within the School of Nursing and Midwifery and the School of Medicine. Aims The aim of the collaboration was to introduce concepts of normal labour and birth to fourth-year medical students, led by final-year midwifery students. Methods A variety of birthing resources were available to the midwifery students to promote interactivity with the medical students, including birthing balls and birth manikins. Artistic licence in relation to planning the activities was encouraged. Significant emphasis was placed on the importance of relationship-building with women in labour, and the concept of being ‘with woman’ was core to all elements of teaching. Midwifery students undertook acting roles such as the labouring woman, partner or midwife role and acted out mini scenarios such as contacting for advice about early labour, positions for labour or positions for birth. Medical students were encouraged to participate in the role play, and the interactive workshop culminated with a hands-on simulation of childbirth. Findings Evaluation of the workshops has been extremely positive. The midwifery students reported a perceived benefit of teamwork in preparing for the workshop and also a perceived increased level of confidence. Conclusion Both schools have recognised the benefits of this form of inter-professional education and have subsequently made a commitment to embed it within their respective curricula. [ABSTRACT FROM AUTHOR]

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

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

The article presents abstracts on medical topics which include postpartum depression, fear of childbirth, and hypertension in pregnancy.

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