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This is a reflective analysis on the lived experience of a medical mission in a third world country, where young women are abused and trafficked for sex. Practices of Scripture study, Lectio Divina, and contemplative prayer enabled me to deal with the spiritual darkness we encountered. Opening a dialogue with community members to view males and females in a different manner and battling alongside the local mission and ministers against sex trafficking, are not easy tasks. The perseverance found in the Bible gives us hope to be witnesses and healers in our broken world, and a small part in change that can take root with prayer.

Obesity is an issue seen more and more in the media, and is a leading cause of death and health complications worldwide (World Health Organization (WHO) 2014). Antenatally, women are classified as obese or overweight at booking and their midwifery care is altered accordingly, which may lead to further stress. A lot is known about the apparent dangers of obesity but not much is known about the malnourishment of obese pregnant women and the potential harm their diet could be doing to the fetus. The focus needs to be shifted from the dangers of obesity on to the importance of nutrition for both mother and fetus and the role midwives could play in this issue.

The quality of daily food intake is the most important and most ignored factor determining pregnancy outcomes. In the absence of chromosomal issues, the health of the fetus is determined by the woman's diet, exercise and lifestyle choices. The placenta is continuously remodeled with old villi being constantly replaced by new ones as the placenta migrates upward, giving women the ability to improve fetal nutrition during pregnancy. Prenatal care including intensive hours spent improving diet has the potential to optimize pregnancy outcomes.

This article exposes the need for support for midwives, to ensure that they are equipped to meet the needs of deaf parents to be. It uncovers research which demonstrates the urgent need for an increase in awareness, education and resources; and the reasons that deaf people have higher rates of teenage pregnancy and sexually transmitted infections than the general population. With stories from midwives at a loss as to how to communicate with deaf mothers in labour, and stories from deaf women who can't understand their health professionals, nor read the literature that has been given to them--this is thought provoking reading.

Experienced health professionals are sharing their skills with midwives and nurses in Ethiopia to improve the education their counterparts receive and help reduce the risks expectant mothers face. In Ethiopia, there are 676 deaths per 100,000 live births compared with an average of 290 per 100,000 in other developing countries and only 6 per cent of women have medical support during labour. International development organisation, Voluntary Service Overseas (VSO) is working with the Ethiopian Government to help them address this workforce shortage by placing experienced volunteer midwives in hospitals, universities and midwifery education institutions. There are many challenges, but volunteers can play a vital role in improving the country's maternal healthcare by teaching midwifery tutors and students and supporting permanent staff.

Objective: this exploratory work examined and assessed the experiences of participants (n=90) using an interactive drama workshop to facilitate the planning and understanding of multiagency working around domestic violence during pregnancy., Design: a descriptive research design was utilised to collect data from field observations, participant reflective feedback sheets and semi-structured telephone interviews., Participants: participants invited to the workshop originated from a wide range of backgrounds including health and social care, criminal justice and the third sector. All participants were invited to complete the reflective feedback evaluation form. To enhance the comprehensiveness of the enquiry, semi-structured interviews were also conducted with 10 of the participants., Findings: shared themes emerging from the data analysis included improved awareness of the consequences of domestic violence; greater understanding of multiple professional roles including the policy context and enhanced skill development. However, participants questioned the extent to which this approach impacted upon longer term practice and policy development., Key Conclusions: by centring attention on the emic perspective of women themselves, the drama approach developed professional's awareness, relationships, understanding and skills. Nevertheless, drama can be an expensive education tool. It is therefore essential that further research explores the longer term impacts on practice and outcomes for women that include cost-benefit analysis., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

A number of ear, nose and throat symptoms are often associated with pregnancy, which although transient (most will disappear after birth), can have a significant impact on the woman's quality of life. It is essential therefore that midwives are aware of how such symptoms might present during pregnancy, in order to appropriately inform women and safely manage those symptoms. Tinnitus, the most common ear symptom experienced by women during pregnancy, for some will be a distressing experience and for others may indicate more serious conditions such as pre eclampsia, requiring careful monitoring and confident management.

Sarah Proechel, Midwife International clinical director, reflects on the state of violence in the world today including its presence in birth and explores its roots as deeply embedded in the human experiences of shame and vulnerability. She offers the role of the midwife as an opportunity to transform violence at the source, holding the space for a more peaceful world to be born.

There is evidence to suggest that pregnancy may trigger or exacerbate domestic violence. Domestic violence is recognised to be a significant contributory factor to maternal and fetal morbidity and mortality. The midwife is ideally placed to recognise domestic abuse and offer care, support and information. This article describes and discusses the multi-complex issues surrounding domestic abuse, highlights possible indicators, how to ask questions, the importance of documenting evidence and explores ways that midwives can be responsive to the needs of abused women and their children.

Objective: to investigate how midwives are currently communicating with women about smoking during pregnancy with a view to involving them in a smoking cessation intervention in antenatal clinics., Design: a qualitative study using individual, in-depth interviews for data collection., Setting and Participants: 24 nurses providing antenatal care to pregnant smokers attending public sector clinics in five major cities in South Africa., Findings: three archetypes of midwives, characterised by different styles of communication and approaches to smoking cessation, emerged from the analysis of the interview data. These were described as the 'Angry Scolders', the 'Benign Carers' and the 'Enthusiastic Friends'. The first type conformed to the traditional, authoritarian style of communication, where the midwife assumed a dominant, expert role. When women failed to comply with their advice, these midwives typically became angry and confrontational. The second type of midwife used a paternalistic communication style and emphasised the role of education in changing behaviour. However, these midwives had little confidence that they could influence women to quit. The third type embraced a patient-centred approach, consciously encouraging more interaction with their patients and attempting to understand change from their point of view. These midwives were optimistic of women's capacity to change and more satisfied with their current health education efforts than the first two types. The Benign Carers and Enthusiastic Friends were more open to participation in the potential intervention than the Angry Scolders., Key Conclusions: the prevailing traditional, authoritarian style of communication is inappropriate for smoking cessation education and counselling as it provokes resistance and avoidance on the part of pregnant smokers. The paternalistic approach appears to be largely ineffectual, whereas the patient-centred approach elicits the most positive response from pregnant women and enhances the possibility of a trusting and cooperative relationship with the midwife. Midwives using this style are more open to fulfilling their role in smoking cessation., Implications for Practice: smoking cessation interventions need to attend to not only what midwives say to pregnant women about smoking, but also how they communicate about the issue. The use of a patient-centred approach, such as brief motivational interviewing, is recommended as a means of improving counselling outcomes among pregnant smokers., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Objective: to explore the experiences and concerns of health professionals who care for childbearing women who are obese., Background: obesity is increasing nationally and internationally and has been described as an epidemic. A number of studies have highlighted the risks associated with obesity during childbirth, yet few studies have investigated the experiences and concerns of midwives and other health professionals in providing care to these women., Design: a descriptive qualitative study using focus groups and face-to-face interviews to collect data. Interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis., Setting: three maternity units in New South Wales, Australia., Participants: participants included 34 midwives and three other health professionals., Findings: three major themes emerged from the data analysis: 'a creeping normality', 'feeling in the dark' and 'the runaway train'. The findings highlight a number of tensions or contradictions experienced by health professionals when caring for childbearing women who are obese. These include, on the one hand, an increasing acceptance of obesity ('a creeping normality'), and on the other, the continuing stigma associated with obesity; the challenges of how to communicate effectively with pregnant women about their weight and the lack of resources, equipment and facilities ('feeling in the dark') to adequately care for obese childbearing women. Participants expressed concerns about how quickly the obesity epidemic appears to have impacted on maternity services ('the runaway train') and how services to meet the needs of these women are limited or generally not available., Conclusion and Implications for Practice: it was clear in this study that participants felt that they were 'not waving but drowning'. There was concern over the fact that the issue of obesity had moved faster than the health response to it. There were also concerns about how to communicate with obese women without altering the relationship. Continuity of care, training and skills development for health professionals, and expansion of limited services and facilities for these women are urgently needed., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Most women with depression around the time of childbearing are not treated adequately, or at all. Clinical practice guidelines focus primarily on provision of information rather than on interaction factors. In this study, we explored clinician interactional style characteristics contributing to patient response to perinatal depression referral and treatment. Stratified purposeful sampling resulted in 23 participants selected by pregnancy, socioeconomic, and depression status. Participants completed semistructured interviews exploring their experiences with and preferences for clinician interactional style characteristics in the context of obstetrics-setting referral and delivery of depression treatment. Thematic analysis revealed a central theme related to interactional cues that influence women's reactions to clinical encounters, summarized by the question, "Can this person help me?" Women evaluated this question in four domains: feeling heard, developing trust in the clinician, perceiving technical competence in the clinician, and feeling that the intervention focus is effectively chosen and communicated. Our results imply that, in addition to informational factors, the way in which clinicians interact with patients about depression might strongly influence patient responses.

The recently published Centre for Maternal and Child Enquiries (CMACE) report, Maternal Obesity in the UK: Findings from a National Project, has provided new information on how often we are caring for women who have a body mass index (BMI) of 35 or more, who these women are, the complications and consequences associated with obesity during pregnancy and the preparedness of maternity services to meet these women's needs. Focusing on booking, this article highlights some of the study's key recommendations and discusses the implications for midwives. Accurate calculation of BMI, discussion of dietary advice including supplementation, risk assessment and referral on are all considerations for this consultation.

Objectives: to compare and contrast how midwives working in either hospital- or community-based settings address domestic violence by evaluating their views on: prevalence of domestic violence; their role in addressing domestic violence; the acceptability of routine enquiry; and barriers encountered in asking clients questions about violence and abuse in pregnancy., Design: a postal survey questionnaire., Setting: Northern Ireland., Study Population: 983 hospital and community midwives., Findings: overall, 488 midwives returned a completed questionnaire; a 57% response rate. Comparisons were made using descriptive, inferential statistics and cross-tabulation. Although there were significant differences between hospital- and community-based midwives in relation to domestic violence, both groups of midwives tended to underestimate its prevalence., Key Conclusions: the findings suggest that midwives per se identify and respond to a fraction of the cases of domestic abuse in pregnancy, due to lack of confidence, education and training. This reinforces the need for both hospital and community midwives to gain further confidence and an understanding of the many psychosocial factors that surround domestic violence., Implications for Practice: healthy settings theory can be used effectively to identify good practice with women who experience domestic violence. Effective investment for health care requires the gaps between hospital- and community-based practice to be bridged, and for work to be integrated.

This qualitative study explored the experiences of seven couples where the female partner experienced depressive symptoms during pregnancy. Female and male partners were interviewed together and data was collected and analyzed according to Colaizzi's ( 1978 ) phenomenological research design. The interviews yielded the following themes: (a) Challenges and stressors associated with depressive symptoms during pregnancy, (b) Pregnancy's effect on mood states, (c) Relationship dynamics that influence moods, (d) Pregnancy and the influence of mood on relationship dynamics, and (e) Reliance on external sources of support. The findings extend current research and provide insight into possibilities of how to enhance assessment and intervention for women who are depressed during pregnancy by including a relational component. Findings, clinical implications, and future research are discussed.

Objective: to conduct a qualitative study of perceptions of experiences of childbirth from Somali health workers in the UK., Design & Setting: in depth narrative interviews at community centres and places of work in London., Participants: eight Somali women aged between 23 and 57 years. The interviewees worked within the health sector in the UK and/or as nurses or gynaecologists in Somalia. Six of the women had also given birth in the UK., Key Findings: mismanagement of care of female circumcision provided during pregnancy and labour leads to problems at birth for many Somali women. The importance of Somalia's oral culture is not recognised when addressing communication barriers and continuity of care is lacking but important. Somali women also felt that midwives held stereotyped and negative attitudes towards them. Existing pressures as a consequence of migration were compounded by these experiences of childbirth in the UK., Key Conclusions: issues concerning female circumcision, verbal communication, cultural aspects of care and pressures that were a consequence of migration play a part in the experience of childbirth in the UK for Somali women., Implications for Practice: midwives need to possess the necessary clinical knowledge and skills to deal with women who have been circumcised and the issue needs to be raised early in the pregnancy. Attention needs to be paid to ensure continuity of care, maximising verbal communications and challenging stereotypical views of Somali women.

Aim: This paper seeks to help midwives more fully understand smoking in pregnancy, particularly from a midwifery partnership perspective., Method: Using the midwifery philosophy of partnership as a framework for reviewing literature on smoking in pregnancy, we explored the literature on nicotine metabolism and addiction in general, and the changes that occur in pregnancy. Quit smoking interventions commonly used were examined to see if knowledge about addiction and the physiological adaptations of pregnancy are incorporated into anti-smoking efforts aimed at pregnant women., Results: Quitting is harder for the pregnant woman because the physiological adaptations of pregnancy increase the clearance of nicotine thus lowering nicotine levels and increasing the desire to smoke. Women who continue to smoke generally have fewer external sources of pleasure and satisfaction in their lives, which, when combined with the physiological and emotional challenges of pregnancy, means that they are less likely to quit smoking and remain abstinent. These factors do not appear to be taken into account for pregnant smokers. The concept of partnership between women and midwives during anti-smoking interactions is lacking., Conclusion: Midwives are in a position to support women and their families in all health related issues, including smoking cessation. We recommend that midwives ask permission before making enquires about sensitive issues such as smoking. When discussing smoking with pregnant women, midwives work within the philosophy of midwifery, with the emphasis on building trust and maintaining relationships. Great sensitivity is required and as much as possible the conversation should be a dialogue, not a monologue.

Health care practice with addicted mothers requires health professionals to both desire and acquire knowledge, skills, and attitudes geared toward developing relationships that foster trust. In this article, nursing and social work theories are used to offer an integrated and interdisciplinary framework for building relationships with addicted mothers in health care settings. Embracing and utilizing caring/relational concepts serve as an impetus to the development of effective relationships with this vulnerable population.

This article was written to help nurses better understand the family strengths framework and encourage them to incorporate family strengths into the nursing care they give. In times of stress or crisis for families, nurses can use the conceptual framework of family strengths as a mechanism to promote strong, healthy relationships. The family strengths perspective identifies and builds on positive attributes in family functioning. Family strengths qualities are (a) commitment, (b) appreciation and affection, (c) positive communication, (d) time together, (e) a sense of spiritual well-being, and (f) the ability to cope with stress and crisis. With the family strengths approach, nurses help families define their visions and hopes for the future instead of looking at what factors contribute to family problems. Family strengths assessment can be used in nursing practice, nursing education, and everyday life.

Instrumental inputs, the units of energy that are passed from nurse to client in therapeutic encounters, stimulate the client to develop new competencies. This article develops the concept, part of the Interpersonal Theory of Nursing, and discusses its use in 2 clinical trials of an advanced practice psychiatric-mental health intervention with high-risk mothers with significant depressive symptoms. Systematic documentation of instrumental inputs in the strategic interactions between advanced practice psychiatric-mental health nurses and clients has provided cumulative empirical examples that are presented. The concept has great utility for clinical practice and research and continuing development and testing of the Interpersonal Theory of Nursing.

This phenomenological study explored the experiences of a small group of South Australian midwives engaged in client data collection within a unique midwifery triage model. Gadamerian hermeneutic principles guided data collection through unstructured interviews with the midwives and the identification of key themes. Findings included a philosophy of dialogue, the dynamics of dialogue, protection and advocacy issues and individual practices and concerns.

Objective: to describe how midwives experience the care of women who are at high obstetric risk or who have an obstetric complication during pregnancy, childbirth and early parenthood., Design: a qualitative approach using a phenomenological method., Participants: 10 Swedish midwives, recognised as highly skilled clinicians with at least five years of clinical experience in the studied context, from four different hospitals., Findings: the essence of midwifery when caring for women at high obstetric risk or with a manifested complication was defined as 'a struggle for the natural process'. Women's transition, physically as well as emotionally, during pregnancy, childbirth and early parenthood, was described as a genuinely natural process. The midwives' struggle consisted of encouraging and preserving this process within each woman. It was based on embodied knowledge and included a balancing between the medical and natural perspectives. Prerequisites, and therefore part of the struggle for the natural process, were sensitivity to the spontaneous, mutual interaction with the woman and enduring presence. KEY CONCLUSIONS AND IMPLICATION FOR PRACTICE: the midwives' responsibility is to promote the natural process during pregnancy, childbirth and puerperium within every woman at high obstetric risk or with obstetric complications. The findings could serve as a basis for reflection on the professional role of midwives, and on the organisation of modern maternity care., (Copyright 2001 Harcourt Publishers Ltd.)