Showing papers in "The British Journal of Midwifery in 2003"

Protecting, promoting and supporting breastfeeding

Abstract: In this article the metaphor of the journey is used to explore changes in relation to the protection, promotion and support of breastfeeding in the UK over the past 10 years. Research with women that helps to illuminate the way, the direction provided by government, and the removal of obstacles by the UNICEF UK Baby Friendly Initiative (BFI) are highlighted. The ways in which peer support programmes are smoothing the way for women, breastfeeding organizations are building bridges, and education for health professionals is filling the gaps, are all referred to.

The medication vs breastfeeding dilemma

Abstract: The benefits of breastfeeding are well documented. As the proportion of women who initiate and sustain breastfeeding increases, the importance of the safety of drugs passing to babies through their mother's breast milk will increase. All health professionals need to be aware of the importance of considering whether a mother is breastfeeding before recommending medication. Texts with sufficient detail to enable quantitative data to be evaluated on the risk:benefit ratio for individual mother:baby pairs are not currently readily available. The authors conducted research amongst cohorts of 1000 GPs, community pharmacists and mothers in a matched area by postal questionnaire, on the experiences of, and attitudes towards, medication during lactation. This article gives an outline of some of the research results, and examines the expressed needs of the three survey populations.

Casting the net: using the internet for survey research

Abstract: This article will discuss the internet as a relatively new medium for research, and in particular how it can be used for survey research. The internet can be used as an effective tool for collecting information as well as providing material for research. This article will explore its advantages, such as reduction of costs, although one must consider the expense of developing and maintaining a website. Large populations can be reached, and response times are thought to be faster than postal surveys. Its disadvantages will also be discussed, such as sample bias, and how that affects research results. Other issues that will be explored include software compatibility, questionnaire layout and graphics. Practical information will be given on how to design a survey, using the principles for web-based questionnaire design developed by internet scholars. Finally, the article will address some of the ethical questions that researchers are faced with, such as how to gain consent and protect the participants' anonymity.

Spoilt for choice: consuming maternity care

Abstract: Medical care throughout the 19th and 20th centuries was characterized by a paternalistic approach to care. From the mid-20th century we began to see a shift in the way health was conceptualized and approached. Individuals demanded more control over their experiences, encouraging individual choice and responsibility. The emergence of the discourses of individual choice and responsibility has had a significant impact on midwifery practice. This article focuses on some of the consequences of these discourses, suggesting that it has submerged some other important professional imperatives such as promoting normal birth. It is suggested that midwives will need to take a more active approach. This article explores this issue within the context of midwifery practice in New Zealand. While some points of history and details of the maternity system or practice may be specific to New Zealand, the discourses explored and implications for practice are relevant to many other Western countries and their midwives.

Breastfeeding and contraception

Abstract: 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.

Birthrate Plus programme: a basis for staffing standards?

Abstract: Since the start of 2001, 101 maternity units have entered the Birthrate Plus programme and of these 64 have completed their studies, with many more in progress. Although not designed or funded as a comparative study of midwifery workload and staffing needs, a coordinated analysis of the data gives a unique insight into demand for and patterns of midwifery care in England at the present time and has produced ratios of births:work-time-equivalent midwives which could form a basis for standards of care.

Development of a preceptorship programme

Abstract: ‘Reality shock’ appears to be a common phenomenon among newly qualified midwives. In response to this problem, a working relationship was formed between the University of the West of England and North Bristol Health Trust and a new preceptorship programme was initiated. This article details the development of the programme using a structured support system aimed at facilitating adaptation to qualified status and role. Conscious reflection upon experience is employed as the underpinning philosophy of the programme. The authors considered a preliminary evaluation of the initiative. Although it is apparent that some minor modifications to the programme are required, the working partnership appears to have had a positive effect upon the newly qualified midwives' perceptions of support and development.

Factors affecting staffing ratios

Abstract: There was clear evidence that the ratio of hospital births:work-time-equivalent midwife is affected by the intrapartum case-mix related to clinical policies and uptake an epidural analgesia and by the volume of cross-border flow of clients between different units. Both of these factors were variable between different units. In many units the data showed that 40–50% of all cases had entirely normal labour and delivery while in others the figure was less than 25%. This raises issues about the potential for midwife-led care within main hospitals and the difficulty for midwifery managers in influencing clinical practice. Cross-border workload can be very high for some units and questions are raised about the costs of this ‘extra’ workload.

Women's experiences of fetal abnormality

Abstract: Women who are told that their unborn baby has an abnormality experience shock and grief. The decisions that they then make may affect the rest of their lives. The importance of effective and compassionate care around the time of the diagnosis of a severe fetal abnormality cannot be emphasized too strongly. Sixteen women's views on the care that they had received, in a fetal medicine unit, were investigated by tape-recording semi-structured interviews. The main themes were identified and are presented in the form of a discussion. All the women reported that they had been confronted with unexpected information. The findings for some of the women were inconclusive and this contributed to difficulties in the decision-making process if a termination was considered. All expressed the need for greater information. Almost all expressed a loss of confidence in their ability to have a normal pregnancy in the future.

How midwives' attitudes can affect the research process

Abstract: The decision-making power base in maternity care has altered in the last century with recent government documents suggesting that it be more women-centred. Those midwives who do not use evidenced-based practice and who teach, support and demonstrate ritualistic practices without reference to the substantial research available, are limiting women's choice(s) in maternity care. In a trial (Fleming et al, 2001), investigating whether routine suturing of perineal lacerations is required, the researchers concluded that midwives appeared to have attempted to influence the outcome because of their own deep-held beliefs about suturing. The rationale for this behaviour is not always easy to understand and it is examined here to determine what concepts are influencing these practices. First, is this behaviour a way of raising the midwife's profile as an expert or are midwives in fact feeling less the expert of normal childbirth as their role is eroded by other disciplines? Second, are midwives trying to regain auto...

Addressing inequalities in health: breast benefits project

Abstract: It is well known that people from low socioeconomic backgrounds are less likely to breastfeed than others, thus potentially increasing health inequalities. Breast Benefits is a project working in secondary schools, reaching a target audience of young men and women aged 13–15 years living in areas of relative socioeconomic deprivation. This article gives a detailed description of the research process undertaken in order to develop a user-friendly education pack for use with young people aged 13–15 years. The project team included young people, educationalists, researchers, midwives and community workers. The findings from the pilot sessions show that young people were responsive to classroom sessions about breasts and breastfeeding, finding them interesting and informative. A key outcome of this work is an educational pack designed to assist teachers to stimulate cultural change by tackling the subject of both breasts and breastfeeding with young people. This research suggests that the devised teaching ses...

Midwives conducting the neonatal examination: part 1

Abstract: The neurobehavioural physiological assessment of the newborn for midwives course began to prepare midwives to conduct the neonatal examination in 1996 This is the first study to report midwives’ experiences of undertaking this practice Adopting a grounded theory approach 19 midwives were interviewed to gain insight into their experiences and identify the factors that both promote and constrain the midwife in undertaking the neonatal examination Part one of a series of two articles, will explore the background to the development of midwives undertaking the neonatal examination Details of the research study are given and the findings that relate to the context in which midwives have incorporated this new role into their practice Part two will present the remaining findings from the research study with the implications for practice

Knowledge and experience of domestic violence

Abstract: This study was funded by the Home Office Crime Reduction Programme Violence Against Women. The study used a survey approach in order to obtain information on the amount of knowledge staff in an Obstetric and Gynaecology Directorate had regarding domestic violence. Doctors, Midwives and Nurses in the Unit were asked to complete a questionnaire which focused on their knowledge of the subject in relation to women's health, the impact domestic violence has on gynaecological conditions and the impact on childbirth. The Unit has a strategy in place for women to disclose domestic violence and staff were asked how often women used it. Staff were also asked to disclose their own experience of domestic violence. From the results of the questionnaire, staff identified a limited knowledge of domestic violence and women's health, the strategy in the Unit was not successful and prevalence of domestic abuse amongst the staff to be 21.77%, similar to the national statistic of 23%.

Maternity care for asylum seekers

Abstract: The focus of maternity care should be about identifying individual need for the woman and her family, not only relating to physical wellbeing, but also in respect of emotional and social need. This concept may prove difficult and challenging to some caregivers when trying to meet these needs of women from other countries who are seeking political asylum and find themselves separated from their families and maternity care that is familiar to them. This article, in presenting some of the issues relating to care for asylum seekers, attempts to highlight how midwifery practice should be underpinned by tolerance, dignity and equal rights to all women.

Do women understand prenatal screening for fetal abnormality

Abstract: Screening for fetal abnormality is routine in many parts of the world. This qualitative study found an alarming level of misunderstanding surrounding the purpose of ultrasound scans and serum testing. Findings show that some women did not understand that they were free to choose whether or not to have tests. Some who did understand the optional nature of the tests were making decisions based on poor understanding of what the tests were for or the nature of the results they would yield. The issue of consent is discussed the light of these findings. This research has highlighted an important area of concern and it is clear that further work is needed to ensure that a better level of understanding is attained by those undergoing prenatal screening.

Why mothers die: perinatal mental health

Abstract: Suicide is now the leading cause of maternal death and midwives have a large part to play in addressing this problem. There are exciting opportunities for midwives to work in new ways: as key stakeholders in multiagency collaborations. Public health and psychiatric issues have never been more relevant. In Nottingham, this teamwork approach to perinatal mental health has created a direction for future service(s). Educational needs, aimed at these objectives, have also been clearly identified. An antenatal screening tool for mental illness has also been devised. In this, the first of a series of two articles, the local response to service needs is described. The second article will explore some of the issues in more depth (Raynor et al, 2003).

When normal birth is in the minority

Abstract: In 2001 only 44% of women in the UK had a normal birth, that is, birth without a caesarean section, or regional anaesthesia, assisted delivery or episiotomy (www.birthchoiceuk.com). Recent data from the Department of Health (BirthChoice UK, 2003) indicate that the caesarean section rate has risen yet again, from 21.5% for the year 2000–2001 to 22.3% for the year 2001–2002. There has been a slight fall in the instrumental birth rate from 11.1% to 10.9% in the same period. This means that the caesarean section rate has virtually doubled since 1989 when it was 11.3% with an instrumental rate of 9.7%. So the figure for women having a normal birth will be even lower now. Normal birth is clearly in the minority.

Creating a better birth environment

Abstract: For a moment imagine what it feels like to be starting out on one of the most momentous times of your life. You are about to give birth, labour has started, you are anxious and in pain, wondering if you will be embarrassed by a lack of control of body functions or emotions.

Asking about domestic violence

Abstract: This article attempts to look at some of the midwifery issues surrounding domestic violence. It discusses the prevalence of domestic violence and some of the signs that women may be involved in an abusive relationship. The Government's policy towards domestic violence has changed. Documents such as the NHS plan have outlined how midwives must become active in tackling domestic violence. In the future the midwives' role will be one focussing on public health rather than pregnancy alone. Midwives have still to ask women about domestic violence as part of their everyday practice. The author hopes to explore some of the reasons why midwives are reluctant to ask women about domestic violence and some of the practical questions surrounding domestic violence, such as what do midwives actually say to women? A local model devised by the midwives at the Royal Devon and Exeter hospital is used as an example of the ideal guidelines and approaches for asking women about domestic violence. In conclusion, midwives have ...

Why mothers die: a public health concern

Abstract: For the first time ever, suicide is the leading cause of maternal deaths in the UK (CEMD, 2001). This haunting reality illuminates the need for antenatal screening to detect women at risk of mental health-related problems. This second article in a series of two articles proposes that the timely intervention of antenatal screening for postnatal depression and serious mental illness is an important public health issue. The early detection of emotional difficulties is the key to helping and supporting vulnerable groups of women and their families, and preventing mortality.

Inconsistent advice and practice: part 3

Abstract: This is the final in a series of three articles. The first two articles presented a primary research study which explored if, and why, inconsistent breastfeeding advice and practice existed amongst a group of midwives and health visitors. Findings demonstrated that this arose because of an inadequate and inappropriate knowledge base amongst some professionals, as well as the use of ineffective communication. This article discusses the challenge of providing effective communication and support to breastfeeding mothers. In doing so, it suggests some strategies that can support the health professional to deliver more consistent and effective care.

Symphysis pubis dysfunction: improving the service

Abstract: Collaborative working to generate guidelines is a recommendation from the document Making a Difference (DoH, 1999). A protocol development group was set up to address problems in the existing care pathway, which had been identified by the Oxfordshire Symphysis Pubis Dysfunction (SPD) support group. The aims of the protocol development group were to make sure that all women who experience SPD have appropriate and timely diagnosis and treatment. The objectives were to develop a protocol which bridges professional roles and service/agency boundaries, and to raise awareness of the issue and protocol with professionals and women who use the service. The SPD protocol development group consisted of all those who might be affected by a clinical guideline, as advised by the National Institute of Clinical Excellence (NICE, 2000) and included the users of the service (DoH, 2000). A strategy of change in practice was designed. The experience of a collaborative project resulted in positive benefits for both the servic...

Physiotherapy for back and pelvic pain

Abstract: This article presents the findings of a questionnaire which was sent to 200 women who received physiotherapy in the treatment of antenatal back and pelvic pain as part of an audit to discover the success rate of physiotherapy treatment at reducing antenatal back and pelvic pain. It was found that outcome varied depending on the pain type as classified by Ostgaard (1996). Physiotherapy has been found to be an effective treatment, however, some women will experience a reoccurrence of back pain postnatally. Physiotherapy is effective in the treatment of antenatal back and pelvic pain with 75–80% of women reporting an improvement in their symptoms following physiotherapy. The majority of women require only one treatment. Some women will have a reoccurrence of their pain postnatally.

Talking with women after birth

Abstract: This article describes the introduction of a new service which intended to contribute to the new public health agenda by furthering the support already provided by midwives for women following birth. The role of the liaison midwife was established to provide a debriefing service for women and also to coordinate complaints. An initial review found that 80% of all women had been contacted by the liaison midwife. There was a marked difference between the take-up of a discussion if the contact was made on the ward and where women were contacted by phone or letter. Forty four percent considered the service to be very necessary. The new woman-centred service has enabled midwives to see the world through the eyes of the women to whom they provide care. Both the need to provide information and to include women and their partners in the care process has been highlighted.

Risk management is not objective

Abstract: Risk management affects profoundly maternity services in the UK, and some large units now have a full-time risk manager post, commonly a midwife. The official line on the advent of risk management is its dovetailing with clinical governance, ensuring quality in care and the avoidance or diminution of risk in clinical care and the working environment. Commonly, complaints management will form part of its strategy.

The PEER project: a model of peer review

Abstract: PEER (Peer, Education, Evaluation, Review) is a model of peer review which involved midwives meeting regularly as a group with each midwife presenting a case study to the group. Case review followed set rules covering confidentiality, positive feedback and critical evaluation. The aim of this project was to evaluate the implementation of the PEER model of peer review for midwives. Three centres participated, selected to represent a range of midwifery practice. There were two groups of five midwives from each centre, 30 midwives in all. The research tools included; semi-structured interviews, an adjective checklist diary, semi-structured group interviews and a postal questionnaire. Midwives were overwhelmingly positive about the experience of participating in PEER. They had appreciated the opportunity to reflect on their practice and learn from other's experiences. Many indicated it had increased awareness of accountability and the importance of record keeping. PEER provides a model of peer review, which i...

Talking about the birth with a midwife

Abstract: Evidence suggests that some women are psychologically traumatized by their birth experience and that talking to an appropriate professional may be therapeutic. This study explores the provision for talking about the birth as a postnatal routine and its perceived benefits. A postal questionnaire was sent to a cohort sample of 100 women who had given birth 8–10weeks earlier. The women who talked about the birth regarded it positively. The discussion generally took place within the first 3days with the community midwife. Most women felt that this was right although some would have liked to talk to the midwife present at the birth. The main findings suggested that women found talking about the birth useful. Perhaps more significant is that all the women who did not talk about the birth expressed the wish to do so.

Sharing reflections in midwifery practice

Abstract: Reflection has been recognized as being beneficial in helping midwives to evaluate practice. A reflective practice group has been in operation since 1997 in a large regional maternity unit in the north east of England and is open to all midwives in both hospital and community settings. Continued evaluation of the group has identified common themes throughout the life of the group which include, communication issues, lack of support and practice dilemmas. While positive comments have been received on the value of the group to individual midwives, ongoing evaluation has also highlighted the need to encourage greater attendance of the group with the creation of small groups attached to specific clinical areas.

Safeguarding the welfare of children: part two

Abstract: This is the second part of a series of articles that explores current national policy relating to the protection of children and specifically examines the implications of its application to midwifery practice. Part one (Chapman, 2002) examined the contraindications arising from the social constructs of motherhood, childhood and abuse and described how intrinsic tensions, coupled with a lack of any objective tools are likely to give rise to conflict in the midwife-mother relationship. This second part explores how the governmental Framework for the Assessment of Children in Need and their Families (Department of Health, 2000) could be adapted for utilization by midwives, to assist them in making objective social assessments and identifying the needs of individual women and their families, supporting a welfare-based approach to the provision of care and services. Midwives will then be in a position to work in partnership with women, and to articulate explicitly and advocate more effectively for vulnerable w...

Further issues in deciding staffing needs

Abstract: Undertaking the Birthrate Plus (BR+) Programme in so many units indicated other areas of information needed for staffing decisions. This has produced a basis for calculating extra allowances of time for day-to-day supervision of midwifery and this is added to the example of how the different ratios per hospital, home/caseload based births:whole time equivalent (w.t.e.) midwives can be used for strategic planning. A ratio for cross-border cases per w.t.e. midwife is also indicated but needs further validation. There is an urgent need for the profession to debate the issue of staffing standards for midwife-led units and a way forward is suggested. The results of the BR+ Programme to date have provided a basis for staffing standards in midwifery and continuing data if funding allows will provide further validation and understanding.