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Background Despite the steady increase in the number of women giving birth via caesarean section in the UK, little is understood about how shared decision making is implemented in obstetrics or what this means for women that have given birth via caesarean. The aim of this review is to assess narratives of women's experiences of caesarean birth as an informed choice and their involvement in this process. Methods A number of databases were searched, including MEDLINE via EBSCO, EMBASE via OVID, MIDIRS via OVID, Scopus, Wiley Online Library, Google Scholar and Ethos, as well as the reference sections of the included studies. Primary studies published between 1990–2020 were included and quality was assessed using the critical appraisal skills programme tool. Findings were analysed using a thematic synthesis framework to elicit higher order interpretations. Results A total of 11 studies were included in the final review. Quality assessment indicated the studies were generally of good quality, with the main limitations being in methodology quality indicators. Thematic synthesis identified eight subthemes within three main themes: ‘patient-doctor relationships’, ‘decision making as an emotional journey’ and ‘caesarean not really an informed “choice”’. The role of healthcare providers in promoting women's agency via patient-centred care was a prominent theme in women's narratives. Conclusions Women's decision making in consent to undergo caesarean births is a complex, emotionally driven process that can have a significant long-term psychological impact.

Background Professional guidelines recommend midwives and obstetricians actively involve women in making decisions about their care. To date, breech research has focused mainly on assessing the effectiveness of different management options. Aim This research explores women's experience of breech presentation and their perception of choice and support in making decisions with regards to breech management. Methods This study uses a phenomenological research design. Semi-structured interviews took place in hospital or women's homes. A total of six postnatal women who were diagnosed with breech presentation after 36 weeks' gestation took part in the study. Data was analysed using Colaizzi's method. Findings A total of 84 significant statements were clustered into four main emerging themes. These include women's feelings, their healthcare expectations, their preferences and their values. Results Breech discussions mostly occurred between obstetricians and women. These primarily focused on external cephalic version, Elective Lower Segment Caesarean Section and Breech Vaginal Birth. These options did not always become choices available to women.

Lockdown and international travel restrictions are once again being eased in many countries, including the UK. However, travellers need to be aware that COVID-19 remains a worldwide risk. Practice nurses have a role to play in supporting UK travellers to make an informed choice about travelling abroad during this ongoing pandemic.

Offering sensitive and compassionate clinical and bereavement care following perinatal death is the innate focus of the caring healthcare professional and facilitating informed choice around the subject of lactation following loss is an integral part of this. However, evidence suggests that there may be a deficiency in the provision of lactation advice and support following loss. Contributory factors may include a lack of awareness of lactation options following bereavement amongst midwives, as well as an absence of clarity around where the responsibility for offering lactation support and advice lies. This paper presents the literature surrounding the support of women's decision-making for lactation following perinatal death, explicating the physiology of lactation in the antenatal and postnatal periods, and exploring the challenges and opportunities for the midwife when supporting grieving mothers to decide the best option for them and their family.

Background Midwifery standards promote autonomous decision-making and informed choice, resulting in maternal home birth choices which may contravene guidelines. There is a paucity of evidence exploring midwives' experiences of managing these choices. Aims To explore the lived experiences of midwives facilitating home birth outside of guidelines. Methods A qualitative design using an interpretive hermeneutic cycle to analyse semi-structured interviews. Findings Participants reported confidence in supporting maternal choices, identifying barriers including other birth supporters. Perceived levels of risk, previous experience and safety concerns impacted on confidence. Peer, unit and professional midwifery advocate (PMA) support were identified as being beneficial to midwives. Recommendations Expansion of birth choices clinics; implementation of dedicated home birth teams; guideline review for midwife led birthing units; expansion of the PMA role; implementation of a structured debriefing service and further research looking at women's choices, and the impact of the loss of midwifery supervision.

Abstract: A variety of bleaching materials and techniques are available across the dental market, and these are being used by the profession as a conservative approach to improving the appearance of discoloured teeth. The array of materials available and misunderstandings around the legality of their use has complicated the practitioner's approach to making an informed choice regarding dental bleaching. This article aims to provide an overview of the common causes of dental discoloration and presents a simple approach to diagnosing potential causes of discoloured teeth. CPD/Clinical Relevance: A sound and systematic approach to understanding and diagnosing causes of dental discoloration are fundamental in ensuring the correct management approach and treatment outcome. This is key to ensuring that patients are not over-treated and receive appropriate, safe and effective treatment.

Background In 2012, there was a concern about the incidence of postpartum haemorrhage (PPH) and the prevalence of physiological third stage management at a midwife-led birthing unit. Aims To determine whether midwives considered risk factors for PPH and provided informed choice when planning third stage management, and whether there was any relationship between third stage management and PPH. Methods A cohort of 57 women who experienced a PPH >500mL was identified, and their records audited. Findings were shared with the midwifery team, who generated solutions. These were implemented in 2013/14 and a re-audit was conducted in 2015. Findings The re-audit showed that the incidence of PPH >1000mL had decreased. As a result of improvements in risk assessment and informed consent surrounding third stage management, no women were inappropriately managed physiologically during the third stage. Using an agreed pathway and PPH boxes was associated with an improvement in the quality and speed of treatment. Conclusions The audit cycle was used effectively to review practice. It identified deficiencies and helped the midwifery team to generate solutions, which resulted in improved outcomes for women.

Menopause occurs around the age of 51 on average and for some women, but not all, it is accompanied by troublesome symptoms such as hot flushes, night sweats and vaginal dryness. Symptoms can vary in intensity and duration. Women with symptoms that they find bothersome may seek medical advice. Hormone replacement therapy is the most effective treatment for menopausal symptoms; however, not all women want or need it. Many clinicians are uncertain about the evidence around hormone replacement therapy. This article aims to provide an overview of the risks and benefits of treatment, and highlights the importance of providing individualised advice. Hormone replacement therapy for the menopause can be a confusing topic. Kathy Abernethy provides practice nurses with the information they need to help women make an informed choice about the right treatment for them

Prostate cancer incidence is increasing. There were more than 41 000 cases in 2011. Is this because prostate cancer is becoming endemic or because prostate-specific antigen (PSA) testing is becoming endemic? More men are now requesting the test as media coverage gathers pace and practice nurses on the front-line of primary care are getting more requests from asymptomatic men who believe that their lives will be saved if they get checked out. This article aims to discuss some of the signs, symptoms and risk factors of prostate cancer and the evidence for and against PSA testing, as well as discussing some of the consequences of biopsy and treatment, and guidelines to help practice nurses counsel men to make an informed choice.

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

Immediately following birth, the newborn remains attached to the mother via the placenta and umbilical cord. During this period, the blood transferred from the placenta to newborn is known as placental transfusion. Placental transfusion can contribute between one-quarter and one-third of the total blood volume of the newborn (80–85 ml/kg) and delayed cord clamping (DCC), can reduce the hypovolemic damage, long term difficulties and even disability associated with early cord clamping (ECC). DCC also increases iron stores in infancy ( Andersson et al, 2011 ); higher iron levels have been found to correlate with improved neurological and cognitive development (Szajewska, 2010). Through integrating DCC into routine third stage management, both mother and newborn can benefit from improved outcomes. With such compelling evidence, why do hospital protocols and guidelines not reflect the latest evidence? And why are women not being given the opportunity for informed choice on such an important issue?.

Promoting and supporting breastfeeding is an integral part of the role of the midwife. These aspects of the role, however, can cause dilemmas and conflict for midwives. Conflicts arise from how midwives acquire their knowledge of breastfeeding, which if used inappropriately can disempower breastfeeding women. Promotion of breastfeeding can cause dissonance between providing informed choice and what midwives see as coercion. The issue of time can greatly undermine midwives support for breastfeeding mothers and the dichotomies between evidence-based practice and experiential/personal experiences can result in inappropriate care being provided for breastfeeding mothers. Midwives can overcome some of the conflicts within their role by gaining more knowledge of breastfeeding, learning the art of good communication and by reflecting personal experiences.

The management of the perineum during birth has multiple long-term effects on women and their families. The midwife has a key role to play and often the techniques they employ vary significantly, as does their justification of these practices. This article seeks to examine current evidence to explore what is known to contribute to lower perineal trauma rates and what practices should be avoided to protect childbearing women. The conclusions drawn show that the updating of practice and antenatal education may be required so that woman are given the information they need to make an informed choice as to what they want for their own body, child and experience.

The publication of the Birthplace Study should herald a major shift in the provision and organization of maternity services, in particular the expansion of births outside obstetric units or at home. The media portrayal of the findings were disappointing as the focus was very much on the homebirth findings in relation to first-time mothers and did not promote the unequivocal evidence that delivery in a midwifery-led unit is safe. The adverse outcomes for low-risk women who choose to give birth in an obstetric unit were glossed over as if of limited significance. Based on the findings of the study, maternity service commissioners and providers need to develop a strategy to ensure low-risk women are given informed choice with respect to place of birth and that recourses are available to support this. This study provides us with a really good opportunity to turn the tide of childbirth.

Dr Helen Warren, investigates whether horse owners really understand what and why they are feeding supplements to their horses and, how to make an informed choice

For health professionals to make an informed choice and tailor each bed bath to the individual needs of the patient, they must firstly understand the different bed bath options available, their impact on skin integrity, and any associated risks they may pose to the patient in terms of cross-infection. Only with this knowledge can health professionals determine the appropriate form and frequency of the bed bath. Specialist wipes offer significant improvements in skin care and a reduced risk of cross-infection, compared with the traditional soap and water bed bath. Use of these wipes also improves the efficiency of the process, which links to the Productive Ward Initiative and results in clinical staff (i.e. nursing staff, healthcare assistants) having more time available to undertake additional patient care activities. This product focus highlights the benefits of moving to a wipe-based bed bath method, and the significant efficiency savings that can be realized as a result.

A range of products and accessories are available to assist patients to overcome a number of stoma problems and enhance their self-care. Used in conjunction with good appliance selection, they help to maintain peristomal skin integrity and promote pouch reliability. For many patients they make the difference between gaining independence in their stoma care, and living with continuing problems. Anna Boyles examines the incidence of problematic stomas, why accessories are used and who should recommend them. A range of problems are examined and the choices available on the market and their appropriate use are discussed.

The death of a baby around the time of birth is a major catastrophe for parents. Their grief is likely to be profound and long lasting. Many parents welcome the opportunity to create memories of their dead baby and treasure the brief time during which they were able to see or hold him or her. NICE guidance consists of four documents which make different statements about parents seeing and holding their baby. Lack of consistency about an important aspect of practical care and the potential for choice to be removed, is unhelpful to parents and to the professionals caring for them. Informed choice must remain the overriding principle of care.

Policy decisions to expand newborn screening and support informed choice prompted a review of information for parents and resources to support health professionals. The UK Newborn Screening Programme Centre conducted a needs assessment to identify training needs. We took into account existing reports of training needs as well as conducting our own survey of Midwifery Schools and screening laboratories. Prior evaluations, and our own survey, suggested the need for national resources on newborn bloodspot screening, rather than an additional national training programme. Based on these findings we developed resources that could be used within current training initiatives. These resources are now available to midwifery trainers for use alongside or in place of existing resources, as well as to individual midwives as part of a ‘self-learn’ package.

Some people with disabilities require advice, assisitive equipment or adaptations to their homes in order to be able to wash their bodies. A wide range of bathing and showering aids and specialist baths and showers is available to help with this personal care activity and it is important for occupational therapists to know what equipment is available so they can help service users to make an informed choice. This article explores some of the bathing and showering equipment currently available. It emphasizes the importance of empowering individuals to make the right choice for themselves. The key to providing a good service is to ensure that advice provided follows an appropriate assessment that takes into account individual needs.

Antenatal screening is a crucial component of antenatal care, with midwives playing a key role in offering screening and providing information which can enable women to make an informed choice. The authors carried out a systematic review to examine whether women from ethnic minority groups experience reduced access to antenatal screening, either through not being offered screening or because they are less likely to take up screening when offered. In the studies reviewed it was often not possible to distinguish between the offer of testing and whether women took up the offer. However, this review provides evidence that women from some ethnic groups are less likely to receive screening for certain conditions and that these women may also be less likely to be offered screening. These findings are discussed and the implications for midwifery practice considered.

The proportion of mothers in the UK who choose to breastfeed their babies is actually increasing, albeit at a frustratingly sluggish rate. The most recent figures suggest that 69% of babies were breastfed in 2000 (DoH, 2002). This is an increase on the 66% figure recorded in 1995 but, despite the valiant efforts of midwives up and down the land, initiatives to encourage breastfeeding are still falling some way short of the government's target of a 2% increase per year.

This article examines the experiences of 10 women who declined amniocentesis following receipt of a high-risk screening result for Down's syndrome. In all cases, information was given before carrying out the screening test. However, upon receipt of the screening result, the women realised that they lacked understanding of the implications of the test. The discussion that took place subsequently with the clinical specialist greatly enhanced their understanding and the offer of amniocentesis was declined, based on an informed choice. However, when a genetically normal baby is born, parents still need confirmation of this normality.

Postpartum ovulation varies individually. It can occur as early as 28 days following delivery. Women who breastfeed are likely to suppress ovulation for a longer time. The onset of the first postpartum menses is a sign of impending fertility. It is therefore advisable for breastfeeding women to commence contraceptive protection regardless of the breastfeeding and amenorrhoea status. The chosen method should not affect the quantity and quality of the breast milk or infant health. During contraceptive counselling accurate, up-to-date, evidence-based information should be given about the methods including the failure rates, health benefits and health risks so that the couple can make an informed choice about their preferred method of contraception. This article aims to discuss the current issues surrounding contraceptive choices for the breastfeeding women.

The present survey was carried out to examine maternity care on the basis of Care in Normal Birth: A Practical Guide by the World Health Organization (1996). The present study surveyed 76 hospitals and 25 midwife clinics in Osaka, Japan. Comparison of the two groups showed that midwife clinics primarily considered the right to women’s informed choice and offered consistent support from the same nurse-midwives during labour and delivery. In hospitals, maternity care was basically aimed at protecting mothers and babies from infection. Many inappropriate practices were still carried out in hospitals, such as the use of enemas in the first stage, pubic shaving, prophylactic insertion of an intravenous cannula and the lithotomy position. These results suggested that the collaboration of hospitals and midwife clinics is imperative for the practice of safety and empathic care in childbirth.

Orthodontic treatment carries with it the risks of tissue damage, treatment failure and an increased predisposition to dental disorders. The dentist must be aware of these risks in order to help the patient make a fully informed choice whether to proceed with orthodontic treatment. This paper outlines the potential hazards and suggests how they may be avoided or minimized.

The material in this series of articles is derived from a Department of Health funded evaluation of the MIDIRS Informed Choice leaflets (Kirkham and Stapleton, 2001). This article, the last in the series, outlines some of the strategies midwives adopted in order to juggle a variety of competing needs. Many midwives expended considerable energy attempting to mediate between the preferences expressed by their clients and the demands of medical and managerial power-holders. In order to avoid ‘trouble’ most midwives identified strongly with the two latter groups. Such allegiances had a divisive effect on relationships that could be reflected in ‘horizontal violence’ towards those who did not conform. Midwives who supported women in making decisions that went against the flow of medically defined customs and practices found themselves in a vulnerable position and many were subjected to increased surveillance over their clinical practice. This article concludes by examining the cultural changes needed to move beyond the current rhetoric of informed choice, to embracing a model of care which privileges the position of the childbearing woman.

The material in this series of papers is derived from a Department of Health funded evaluation of the MIDIRS Informed Choice leaflets (Kirkham and Stapleton, 2001). In this paper we discuss the use of stereotyping as a defence mechanism which appeared to assist midwives in coping with the pressures of contemporary professional life. Midwives sometimes misjudged women's ability and willingness to participate in their maternity care and, as a consequence, women were negatively labelled, for example, as demanding and/or as uncooperative. Midwives often formulated their opinions about their clients on the basis of circumstances over which childbearing women exercised little control: housing tenure, age and/or social class. Even when such judgments were shown to be erroneous, they generally endured throughout the maternity episode and sometimes reappeared in a subsequent pregnancy. The corrosive effects of stereotyping are examined, particularly in relationship to choice and decision-making. The article concludes with a brief mention of the short-term benefits of stereotyping as a coping mechanism in the face of limited resources.

As technology in the field of investigative medicine is advancing rapidly, a growing number of expectant parents are choosing to undertake prenatal screening. However, as much of the literature surrounding this subject highlights, the processes, implications, limitations and results of this testing are still poorly understood by the majority of expectant parents. As informed choice and consent are of such importance in health care today, the distinct lack of knowledge in this area suggests that there is a further need for pre-test information and counselling, particularly as serum screening tests are performed on an opt-in basis. The role of the midwife has now been expanded to include genetic counselling. Therefore midwives must be fully informed about all areas of serum screening in order to impart this information to the women in their care. It is also essential for all women to understand the limitations of screening tests.

The material in this series of papers is derived from a Department of Health funded evaluation of the MIDIRS Informed Choice leaflets (Kirkham and Stapleton, 2001). Many women in this study expressed their disappointment when midwives behaved like doctors in placing more emphasis on clinical tasks rather than on the facilitative and listening skills required to support informed decision-making. Some women perceived midwives as oppressed and conformist with few opportunities for acting as autonomous and empowered professional women. Women were very aware that midwives were busy people with many demands on their time and this inhibited them from asking questions and voicing their concerns. Pregnant women use a wide variety of information-seeking strategies. The range and sophistication of these behaviours went mostly unrecognised by midwives, some of whom mistook them as evidence of women’s avoidance of decision-making responsibility. Midwives who stood by women when they made unconventional choices were referred to as ‘gold mines’ and were greatly treasured and respected.

The material in this series of papers is derived from a Department of Health funded evaluation of the MIDIRS Informed Choice leaflets (Kirkham and Stapleton, 2001). This paper analyses some of the behaviours and responses observed during interactions between midwives and childbearing women during antenatal consultations. In the majority of consultations observed there was little continuity of carer and women were mostly silent unless directly questioned by the midwife. Silence tended to be interpreted by midwives as both compliance with the suggestions they made, and as an absence of need for further information. Very few midwives demonstrated awareness of the powerful non-verbal cues they communicated to women. These cues signalled a clear preference for women to assume a silent, passive role and to agree with the midwife’s time-pressured agenda. Status and power differences between women and their midwives were largely maintained and only rarely did women report feeling a sense of equity in their interactions. Midwives across all study sites spoke positively, and often at length, about the concept of informed choice, yet they mostly behaved in ways which ensured women’s informed compliance with the local medical agenda.

The material in this series of papers is derived from a Department of Health funded evaluation of the MIDIRS Informed Choice leaflets (Kirkham and Stapleton, 2001). The focus of these papers is on the role of the midwife in disseminating information to, and facilitating informed decision-making with, women in her care. Although health professionals generally expressed positive sentiments out the MIDIRS leaflets and their potential to assist women in making informed choices, competing demands within the clinical environment limited their effective use. This paper illustrates behavioural and organisational impediments, such as midwives’ conversational styles and pressures on their time, which reduced the opportunities for pregnant women to access the evidenced-based information they needed to participate more effectively in decision-making processes.The material in this series of papers is derived from a Department of Health funded evaluation of the MIDIRS Informed Choice leaflets (Kirkham and Stapleton, 2001). The focus of these papers is on the role of the midwife in disseminating information to, and facilitating informed decision-making with, women in her care. Although health professionals generally expressed positive sentiments out the MIDIRS leaflets and their potential to assist women in making informed choices, competing demands within the clinical environment limited their effective use. This paper illustrates behavioural and organisational impediments, such as midwives’ conversational styles and pressures on their time, which reduced the opportunities for pregnant women to access the evidenced-based information they needed to participate more effectively in decision-making processes.

The wide range of pressure-relieving or reducing cushions and armchairs can make selection a challenge. This article outlines the main considerations that should determine the practitioner's choice.

Since the implementation of universal precautions, the use of disposable gloves has become part of everyday clinical practice. Guidance has been published to advise healthcare workers of the risks of latex allergies associated with the wearing of powdered latex gloves. The literature supports the use of gloves when contact with blood or body fluids is likely. However, an audit of glove usage indicated that practitioners were wearing gloves inappropriately, i.e. to wash patients (20%). The results of this study also demonstrated that a small percentage of staff (20%) were wearing vinyl gloves to deal with blood spillages and for venepuncture (13%) and cannulation (10%). A glove policy and a flow chart to assist staff in the selection of gloves were introduced. An educational programme for all hospital staff was commenced. These measures can assist healthcare workers in making an informed choice regarding glove usage.

There are many factors which influence how an HIV positive mother will feed her infant. In order to offer informed choice, midwives should be aware of the many issues regarding HIV transmission before discussing them in an unbiased way. Only then will women be enabled to make proper informed choices regarding their care. Government policy advocates artificial feeding for HIV positive women based on Dunn et al's (1992) conclusions, yet new research reveals conflicting findings. It appears that transmission of HIV through breast milk is dependant on the pattern of breastfeeding. Further research is necessary to substantiate these findings.

Critical incident analysis is a method of reflective practice that enables a particular topic to be studied in great detail. Under the headings and guidance of Gibbs’ reflective cycle (Gibbs, 1988), the management of the third stage of labour has been carefully analysed, criticised and discussed. Active management of third stage has become almost routine practice in many maternity units, with professionals justifying their actions by acknowledging the potential risk of postpartum haemorrhage. It is interesting to discover that women can perhaps tolerate a greater blood loss than previously thought and it must be accepted that the entire birthing process involves normal physiological events that have evolved for a good reason. While it is imperative that safety of mother and baby remain the priority, woman-centered care and informed choice should form the basis of all midwifery practice.

The aim of this study was to investigate informed choice in relation to care-giver and location of care, within maternity services in Powys. The study utilized a survey design, eliciting both quantitative and qualitative data from respondents. The aims of the research were to evaluate women's perceptions of the quantity and quality of information received, to highlight examples of good practice and to identify potential areas of concern. The results demonstrated high levels of satisfaction with the amount of information on antenatal and birth care received by women taking part in the study, midwives being identified as playing a key role in informing women in all antenatal and birth settings. Further, the findings suggest that midwives in midwife-led antenatal clinics and midwife/GP maternity units are more successful in imparting information and enabling women to have a sense of participation in the decision-making process. Type of delivery is also identified as a key factor in women's perceptions of participation in informed decision-making with anticipated intervention in birth being a possible indicator of low levels of satisfaction. Thus it may be that organizational, structural or experiential factors affect women's perceptions of having an active role in the decision-making process more than the health care personnel involved. The discussion relates the findings of this study to wider debates on informed choice in maternity services, issues of continuity of carer and effects of cross-boundary services. Areas for further research are identified.

Qualitative data were gathered in a study of how midwives facilitate and women make informed choices in pregnancy. Issues of power permeated the data. This series of three articles will interpret and discuss these issues in relation to Lukes' (1974) conceptualization of power, and theories regarding empowerment. This final article discusses Lukes' third dimension of power, and relates data from the study to more recent ideas about empowerment.

Qualitative data were gathered in a study of how midwives facilitate and women make informed choices in pregnancy. Issues of power permeated the data. This series of three articles will interpret and discuss these issues in relation to Lukes' (1974) conceptualization of power, and more recent theories regarding empowerment. This second article examines Lukes' second dimension of power, wherein the dominant group controls the agenda of what may and may not be discussed, and what decisions may therefore be made, in relation to data from the informed choice study.

Qualitative data were gathered in a study on how midwives facilitate and women make informed choices in pregnancy. Issues of power permeated the data. This series of three articles interprets and discusses these issues in relation to Lukes' (1974) conceptualization of power, and more recent theories regarding empowerment. This first article discusses how Lukes' first dimension of power was seen to operate within the data.

Changing Childbirth emphasizes the notion of women having an ‘Informed choice’ through being aware of all the options open to them, knowledge of both the medicalized and demedicalized approaches to childbirth should open up the possibility for this choice. This research suggests that the ‘Informed choice’, as it 15 currently received, may not necessarily lead to any changes in childbirth experience due to certain fundamental cultural needs of women in our society.

A quality assurance model for midwifery was used in Glasgow to develop a midwife-managed care programme for healthy women. The programme goals were to provide continuity of carer, individualized care planning and informed choice, and service specifications were written for each goal. While continuity proved difficult to maintain, the remaining specifications were achieved for most women.

There is a wide range of powered wheelchairs, scooters and buggies designed for use outdoors. For many disabled and elderly people these are an ideal way of getting around and maintaining independence. The choice of vehicles can, however, be bewildering, and too frequently they are purchased without full consideration of the user's requirements. This article outlines the range of vehicles available and the features that should be taken into consideration in making an informed choice.

Informed choice is one of the new buzz phrases — everybody seems to agree that it's ‘a good thing’. But it asks a lot of midwives; to find the time, and to keep sufficiently up-to-date in all areas of practice. The Informed Choice Initiative will help midwives as they help women to exercise informed choice.

The paucity of research on coitus interruptus is part of the reason why many health professionals who give contraception advice do not even recognise it as a method of contraception. This article examines the available evidence from a historical and sociological perspective and invites readers to draw their own conclusions based on informed choice.

Disquiet about the Department of Health policy on antenatal HIV testing has been expressed by midwives (Davies, 2000) and anecdotal reports suggest that there are aspects of testing that midwives find problematic. Concern has been expressed that the test might produce false positive results, particularly where prevalence of HIV is low (Davies, 2000). Another more general concern focuses on ensuring informed choice for women to a ‘recommended’ test, for which the Department of Health has set targets for rates of uptake (UK Health Department, 1999). Given midwives' critical role in the provision of antenatal HIV testing, it is important to reflect on the issues at stake both for women and their caregivers.

Most midwives, particularly those working in the community, will have encountered a baby with nappy rash. This common skin condition may cause concern to new parents and discomfort to babies, yet can be easily prevented. A wide variety of effective treatments are also available. This article will explore the advice midwives can give to parents to assist them to make an informed choice in the prevention and treatment of nappy rash.

British Journal of Midwifery • January 2015 • Vol 23, No 1 On 3rd December 2014, the much awaited updated National Institute for Health and Care Excellence guidelines on intrapartum care were published (NICE, 2014). The guidelines focus on the care of healthy pregnant women in labour who have had a straightforward pregnancy. New recommendations have been added in a number of areas, including choice of place of birth, care during the latent first stage of labour, transfer of care, fetal assessment and monitoring during labour (particularly cardiotocog‐ raphy compared with intermittent auscultation) and management of the third stage of labour. Some of the key priorities regarding choice of place of birth include advising ‘low‐risk multiparous women that planning to give birth at home or in a midwifery‐led unit is particularly suitable for them because the rate of interven‐ tions is lower and the outcome for the baby is no different compared with an obstetric unit.’ The advice for nulliparous women is slightly different regarding homebirth as the guidelines state there is a ‘small increase in the risk of an adverse outcome for the baby’. Much of the advice on place of birth comes from the 2011 Birthplace Study (Birthplace in England Collaborative Group, 2011), which found that for low‐ risk women giving birth is generally very safe. It also endorsed a woman’s right to chose where she has her baby. Women must know that they have a choice in their care and be able to access and understand the evidence‐ base in order to make an informed decision. However, as Cathy Rogers et al (page 42) point out, changing current perceptions around the safety of giving birth in midwifery‐led settings is challenging. This is apparent as 4 years after the Birthplace Study was published, only 10% of women give birth in a midwife‐led setting. The authors set about changing this and their paper discusses new initiatives focusing on improving informed choice and the knowl‐ edge and confidence of midwives in one large maternity unit. The strategies have been successful with approximately 30% of local women planning to give birth in a midwifery‐led setting. This is great news and something that could be implemented in other Trusts. The authors do acknowledge that these initiatives need to be supported by a national strategy for a cultural shift in birthplace to take place. On page 22 Soltani et al explored the local impact of a Cochrane review that demonstrated that midwifery‐led continuity models of care provide explicit benefits for mothers and babies compared with other models of maternity care alongside other midwifery‐led care evidence and guidelines. Again, neither the women nor the health professionals had much of an awareness of the supporting evidence. How are women expected to make informed decisions if those caring for them are unaware of all the options and evidence available to them? BJM

The January edition of the British Journal of Midwifery contained an article and a review of the Informed Choice leaflets produced by MIDIRS and the NHS Centre for Reviews and Dissemination. The five leaflets in the series entitled, Alcohol in pregnancy, Ultrasound in early pregnancy, Support during labour, Fetal monitoring and Positions in labour, are based on systematic reviews of the literature. Each title has a short version for women and a longer version for professionals. The official launch was made on January 18 1996 by Baroness Cumberlege, and there will be further additions to the series in June.

This reflection is intended to offer an alternative debate about place of birth. it explores similarities in the arguments regarding place of birth and place of death in the UK, drawing attention to common aspects of these two unique events, both of which now tend to occur in hospital, rather than at home. as made explicit by the Department of Health, everyone has the right to choose where to give birth and where to die. This article touches on the complexity of the right to informed choice to suggest that other more fundamental rights are involved: a safe and positive birthing experience and a ‘good death’.