Sample extract inside s
Midwifery Digest
June 2015, volume 25, number 2
research & education midwifery pregnancy labour & birth postnatal infant nutrition neonatal & infancy worldwide maternity services news & reviews
www.midirs.org
Want to stay in touch with what matters in midwifery? Join the thousands of midwives and midwifery students who read our high-quality, evidence-based journal to keep up to date and get inspiration and support in practice.
MIDIRS Midwifery Digest
• Academic journal (4 issues per year). • In-depth exploration of maternity topics. Coverage of the antenatal to • postpartum period. £11.50 per quarter (students) £15.75 per quarter (practitioners)
• Focus and debate on worldwide research. • Point of reference for undertaking further studies. Original articles and updates on UK and • overseas research. Add on access to MIDIRS Reference Database for just £5 per quarter (see back inside cover for details).
des414-dig
UK prices quoted
To subscribe visit: www.midirs.org/dig10
Contents Housekeeping............................................................................................................................ 137 Contents.................................................................................................................................... 138 Editorial..................................................................................................................................... 140
141 Hot Topic Midwifery – the key to quality care............................................................................................ 141 Mary Renfrew
147 Research & Education Midwives’ concerns about a shift of focus to computers in maternity settings: technology invading birth.......................................................................................................... 147 Alison Craswell, Lorna Moxham, Marc Broadbent Why midwives should be feminists ............................................................................................ 154 Denis Walsh, Monica Christianson, Mary Stewart Group B Strep: where we are and where we’re heading ............................................................. 161 Courtney Trowman, Philip Steer, Jane Plumb Water birth safety and suggestions for new guidelines ............................................................... 165 Keith Brainin, Adam Tobias The relationship between emotional intelligence, previous caring experience and mindfulness in student nurses and midwives: a cross sectional analysis ..................................... 171 Austyn Snowden, Rosie Stenhouse, Jenny Young et al – Reviewed by Tania McIntosh
175 Midwifery Midwifery-led care for a low-risk cohort — a clinical outcomes overview: over a three year period in a multicultural setting ......................................................................................... 175 Kathryn Gutteridge Caseloading midwifery — an ever evolving model of care?........................................................ 186 Katie Wainwright, Maureen Collins Preventing maternal deaths and overcoming challenges related to disability in pregnant women........................................................................................................................ 190 Ganesh Acharya Good on paper: the gap between programme theory and real-world context in Pakistan’s Community Midwife programme.............................................................................. 192 Zubia Mumtaz, Adrienne Levay, Afshan Bhatti et al
193 Pregnancy The internet: a reliable source for pregnancy and birth planning? A qualitative study................ 193 Catherine Lynch, Gergana Nikolova A longitudinal study of unplanned pregnancy in a maternity hospital setting ............................ 200 Aoife McKeating, David A Crosby, Martha Collins et al Prevalence of substance abuse in pregnancy among Danish women........................................... 205 Nete LK Rausgaard, Ing O Ibsen, Jan S Jørgensen et al The impact of maternal obesity, age, pre-eclampsia and insulin dependent diabetes on severe maternal morbidity by mode of delivery — a register-based cohort study........................ 206 Nanneli Pallasmaa, Ulla Ekblad, Mika Gissler et al — Reviewed by Ailsa McGiveron Less-tight versus tight control of hypertension in pregnancy...................................................... 208 Laura A Magee, Peter von Dadelszen, Evelyne Rey et al A prospective cohort study of depression in pregnancy, prevalence and risk factors in a multi-ethnic population.............................................................................................................. 209 Nilam Shakeel, Malin Eberhard-Gran, Line Sletner et al Effects of advanced paternal age on reproduction and outcomes in offspring ............................ 210 Hussein A Abbas, Rym El Rafei, Lama Charafeddine et al
211 Labour & Birth Implementation of delayed cord clamping in the active management of the third stage of labour ................................................................................................................................... 211 Alexandra Buder 138
MIDIRS Midwifery Digest 25:2 2015
The importance of person-centred care in reducing birth trauma............................................... 218 Elaine Connell Maternal vitamin D status, prolonged labor, cesarean delivery and instrumental delivery in an era with a low cesarean rate.................................................................................................. 223 Alison D Gernand, Mark A Klebanoff, Hyagriv N Simhan et al Pregnancy outcomes of induced labor in women with previous cesarean section: a systematic review and meta-analysis .......................................................................................................... 224 Angela C Rossi, Federico Prefumo
225 Postnatal ‘Pregnancy is socially acceptable, but being fat is not’: considering psychosocial aspects of obesity in pregnancy.................................................................................................................. 225 Ailsa McGiveron Misunderstood as mothers: women’s stories of being hospitalized for illness in the postpartum period..................................................................................................................... 231 Tamara Power, Debra Jackson, Bernie Carter et al — Reviewed by Rowena Doughty Managing posttraumatic stress disorder and major depression in women veterans during the perinatal period ................................................................................................................... 233 Geetha Shivakumar, Elizabeth H Anderson, Alina M Surís Heightened Maternal Separation Anxiety in the postpartum: the role of socioeconomic disadvantage...................................................................................................... 234 Amanda R Cooklin, Nina Lucas, Lyndall Strazdins et al
235 Infant Nutrition Vitamin A concentration in human milk and its relationship with liver reserve formation and compliance with the recommended daily intake of vitamin A in pre-term and term infants in exclusive breastfeeding............................................................................................... 235 Gisele Souza, Manoela Dolinsky, Andréa Matos et al Transgender men and lactation: what nurses need to know ....................................................... 242 Emily Wolfe-Roubatis, Diane L Spatz Coparenting breastfeeding support and exclusive breastfeeding: a randomized controlled trial........................................................................................................................... 243 Jennifer Abbass-Dick, Susan B Stern, LaRon E Nelson et al The association of breastfeeding initiation with sensitivity, cognitive stimulation, and efficacy among young mothers: a propensity score matching approach ..................................... 244 Renee C Edwards, Matthew J Thullen, Linda G Henson et al
245 Neonatal & Infancy Evaluation of Period of PURPLE Crying, an abusive head trauma prevention program............. 245 Laura Schwab Reese, Erin O Heiden, Kimberly Q Kim et al Should we tell parents when we’ve made an error?.................................................................... 252 Sigall K Bell, Keith J Mann, Robert Truog et al Prevention and management of pain and stress in the neonate................................................... 253 Denise Harrison, Mariana Bueno, Jessica Reszel Evaluation of the introduction of a postnatal ward liaison neonatal nurse ................................ 254 A O’Sullivan, B Boyd, Marian O’Shaughnessy et al
255 Worldwide Maternity Services To what extent do cultural normalities influence women’s experience during pregnancy and childbirth?........................................................................................................................... 255 Indigo Lowe Perceptions of female teenagers regarding contraceptive use and termination of pregnancy....... 261 OA Oyedele, SCD Wright, TMM Maja Severe maternal morbidity associated with maternal birthplace in three high-immigration settings........................................................................................................... 266 Marcelo L Urquia, Richard H Glazier, Laust Mortensen et al — Reviewed by Kerry Evans
269 News & Reviews Did you miss it?......................................................................................................................... 269 Author index ............................................................................................................................. 271 Subject index ............................................................................................................................. 271 MIDIRS Midwifery Digest 25:2 2015
139
From the Editor We should always find time for celebration in midwifery and the recent International Day of the Midwife, 5th May, is an excellent example of this. Midwives from all over the globe come together for one assigned day in the year to not only celebrate achievements in midwifery, but just as importantly, to renew our beliefs as midwives and to remind us what being a midwife means to each and every one of us. To share these beliefs, Michelle Anderson produced a short video made up of midwives from around the world demonstrating what midwifery means to them #ItsAllAbout (http://www.midirs.org/itsallabout/). The response to this has been amazing, highlighting the passion, pride and motivation midwives have for their vocation in supporting women throughout pregnancy and beyond. In these difficult financial and policy driven times it is uplifting to be caught in this wave of enthusiasm. A further celebration being marked this month is the anniversary of the publication of the Lancet Series on Midwifery. In the Hot Topic Professor Mary Renfrew highlights this great achievement. Mary gives a short introduction continuing with a discussion as to why the series was needed, its achievements and impact. In addition, although a global study, consideration has been given to its meaning within a UK context. The sheer volume of work involved compiling the series has been phenomenal bringing together the universal meaning of midwifery and maternity care. One can easily assume that maternity care in one part of the world may be vastly different to another; however, the series turns this on its head. At the core of all midwifery and pregnancy care are the same basic principles and needs of women. This is clearly articulated and reinforces the basic needs of care, compassion, respect, communication and knowledge to enable women to safely achieve a healthy pregnancy and birth. A human rights-based approach was at the forefront of the series focusing on the needs of childbearing women, children and families. The series is not yet complete and two further papers are due to be published shortly centred around human rights and research. Further exciting studies that are in their early stages of development include a global piece of work from the World Health Organization (WHO) which will be a critical analysis of midwifery and set an agenda for future research. Another major review to commence in the UK will look at the current care and options for women and will be reported on by the end of this year. Leading this report is Baroness Julia Cumberlege, a name many of you will be very familiar with as she also led the previous major review of maternity care in the 1990s which resulted in the important Changing childbirth report for the Department of Health (DH 1993). It is envisaged that the current report will make evidence-based recommendations for models of maternity care which are safe and efficient, meeting the needs of women, families and midwives. In addition, how the NHS can support midwives and allied professionals in providing care for women that is responsive and appropriate to women’s needs and choices. The papers included in this edition of the Digest also reflect the passion and thought around how we support women through this exciting and sometimes daunting time of 140
their lives. Walsh et al (p154) explore midwifery through a feminist viewpoint, giving the reader much to ponder on. Kathryn Gutteridge’s (p175) report on the clinical trial results of midwifery-led care greatly contributes to the growing body of evidence in its support. In contrast, Wainwright & Collins (p186) discuss the impact on midwives of working with a caseload, this leads to interesting debate on how we can best provide care for women without compromising the health and well-being of the midwife. The birth setting is further explored in an interesting paper looking at person-centred care by Elaine Connell (p218). These papers illustrate how midwives are all working together, sharing a common goal, which fits well with the Lancet series and the forthcoming reviews in providing the highest possible care for all. Behind the scenes work is constantly being undertaken to ensure that all midwives are fit for purpose at the point of registration and during their careers. This was discussed in the last edition when looking at the role of the Lead Midwife for Education (LME) (Marshall 2015). In this paper Jayne Marshall refers to the Nursing and Midwifery Council’s The Code (NMC 2008) when discussing accountability as LME. This document had been revised (NMC 2015) but could not appear in print as not publicly released until 31st March. This illustrates that midwifery and indeed nursing care is continually evolving, ensuring practice is safeguarded for the public and the professional. Finally, this editorial would not be complete without paying tribute to Sheila Kitzinger who died peacefully on 11th April, 2015. Sheila was an anthropologist, feminist and an advocate for women, particularly during pregnancy and childbirth. The title of her autobiography encapsulates her beliefs A passion for birth. Sheila was also a founding member of MIDIRS who gave great support with her knowledge and beliefs. So her life should also be celebrated and we should remember the passion and strength of her work.
References Department of Health (1993). Changing childbirth. Part I: report of the Expert Maternity Group. London: HMSO. Marshall JE. The power of the lead midwife for education (LME): the role, function and challenges. MIDIRS Midwifery Digest 25(1):11-14. Nursing and Midwifery Council (2008). The Code: standards of conduct, performance and ethics for nurses and midwives. London: NMC. Nursing and Midwifery Council (2015). The Code: professional standards of practice and behaviour for nurses and midwives. London: NMC.
Cathy Ashwin, principal editor. © MIDIRS 2015. MIDIRS Midwifery Digest 25:2 2015
Hot Topic
Midwifery — the key to quality care Mary Renfrew
ORIGINAL The Lancet Series on Midwifery is the most critical, wide-reaching, and high-profile examination of midwifery to date. In this paper, I will examine why the series was needed, what it has achieved so far, and why it is having such an impact. I will also consider briefly what it might mean in a UK context. Published in June 2014, The Lancet Series on Midwifery consists of four papers — two others are still to follow — with a set of commentaries and an editorial (Homer et al 2014, Renfrew et al 2014, ten Hoope Bender et al 2014, Van Lerberghe et al 2014). Almost immediately after publication it became clear that the series was being received very positively, both within the international midwifery community, and more widely across maternal and newborn care, sexual and reproductive health, public health, and human rights communities. The findings and recommendations have been debated widely, and are now supported by all relevant global agencies. The work of the series was supported by the Bill & Melinda Gates Foundation, and by the Norwegian aid agency for development cooperation, NORAD. A public campaign to support the findings of the series, Midwives4all, is being led by the Swedish Foreign Ministry (http://midwives4all.org).
The core challenge that the series aimed to address was the lack of high-quality care for childbearing women, babies and families. This manifests in different ways in different settings, for example: • In low-income countries: —— Preventable mortality of women and babies, and stillbirths, remain at unacceptable levels. • In all countries: —— Acute and chronic morbidity is suffered by many women and children after birth. —— Inequalities in the provision of good quality care mean that those already most vulnerable are likely to receive the worst care, with an impact on mortality as well as health and well-being. —— Some important outcomes — mental health and longer-term complications, for example — are seldom measured. —— Over-medicalisation of health systems results in escalating rates of unnecessary interventions with harmful sequelae and unsustainable use of resources. —— Attention is often focussed on specific technical solutions — hospital birth, for example, or risk screening, or the MIDIRS Midwifery Digest 25:2 2015
availability of emergency services — rather than the whole picture of the skilled and compassionate care needed by all women and all babies before, during and after birth. —— A lack of respectful care is commonly reported, whether manifesting as a lack of communication, conducting interventions without agreement or information, a lack of privacy, or physical or emotional abuse. —— The rights of women and children to life and to health are severely compromised as a result. The international community was seeking solutions to these challenges, and specifically there was a need to identify approaches to inform global policy developments such as the Save the Children programme (2005), the Universal Health Coverage, post-2015 agenda (Vega 2012), Every woman, every child (WHO 2012). Many organisations and individuals working in maternal and newborn health care had direct experience of the important contribution of midwifery, but as midwifery is implemented inconsistently in many countries, many others did not, and some were unconvinced that midwifery could add value to existing services. Internationally, care for childbearing women and infants is provided by a very diverse workforce 141
Hot Topic
including traditional birth attendants, community health workers, nurses, and doctors as well as midwives. There are important barriers to the implementation of high-quality midwifery such as low status and lack of effective professional regulation, and professional territorialism. Even in countries where midwives are educated to international standards, their scope of practice is often limited or they find themselves practising in situations where over-medicalised care is the norm and midwifery is undervalued. There was a dearth of evidence on midwives and their impact in low-income settings, where much of the research effort has focussed on less-skilled workforce groups. These factors combined meant that the evidence was hard to interpret. There was a clear and urgent need to examine the evidence for the contribution that midwifery could make to high-quality care for women, infants and families. This was the context in which The Lancet Series on Midwifery was planned. It meant that a radical new approach was needed, both to understand the challenges and to analyse existing evidence. Around 35 authors from very diverse backgrounds and from more than 20 countries across five continents worked on the series for three years, with the involvement of global agencies and more than a dozen critical readers. We drew on this experience as well as a very diverse evidence base that included systematic reviews of interventions, meta-syntheses of studies of women’s views, case studies, modelling, and health system analysis.
A new approach to the evidence Our work started with a conversation with all the authors to define the scope and methods of the papers. This included debating and agreeing a set of core principles that would enable a new approach to the evidence. At the heart of the series is a human rights-based approach to the needs of all women, babies and families (UN 1948, Office of the United Nations High Commissioner for Human Rights 1966, UN Women 1979, Office of the United Nations High Commissioner for Human Rights 1989). The focus of the series is therefore clearly on the needs of childbearing women, babies and families, across the continuum of care. That might sound simple and obvious, but many studies examine individual interventions, or the needs of the health system, or care at birth, as their focus. Our approach resulted in two new developments. The first of these was a definition of midwifery from the perspective of what women and babies need. This is not a definition of a midwife — the International Confederation of Midwives (ICM) has already developed that — but instead it is a definition of the skilled and compassionate care that all women and all babies need in pregnancy, during labour and birth, and after
MIDIRS Midwifery Digest 25:2 2015
birth, regardless of where or who they are. Midwifery as defined in this series could in principle be provided by whoever is caring for women and children — we were also concerned with contexts in which there are no midwives, so it was essential to consider the care that should be provided even if that was by a diverse workforce. Our analyses of the evidence on workforce, however, went on to demonstrate that educated, trained, licensed and regulated midwives integrated into the health system and working in partnership with other professionals are the best and most cost-effective way to provide this care. Midwifery is defined in The Lancet Series on Midwifery as: ‘Skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum throughout pre-pregnancy, pregnancy, birth, postpartum and the early weeks of life. Core characteristics include optimising normal biological, psychological, social and cultural processes of reproduction and early life, timely prevention and management of complications, consultation with and referral to other services, respecting women’s individual circumstances and views, and working in partnership with women to strengthen women’s own capabilities to care for themselves and their families’ (Renfrew et al 2014).
The second new development was a framework to describe the quality care needed by women and infants in all settings. This framework for quality maternal and newborn care (QMNC) was built by re-examining very diverse sources of evidence through a new lens. As with the definition, our focus was on the needs of the woman, infant and family, rather than the needs of the system or of the practitioners. Our analyses separated out what is done — usually called practices, interventions, or tasks — from how it is done and who does it. This allowed us to identify the impact of the organisation of care and continuity, for example, separately from specific interventions, and from the provision of respectful care — while recognising that women and infants needed all these elements to be in place. Rather than focus on a low-risk/high-risk dichotomy, we focussed both on the needs of all women and babies and also on the needs of those with complications, recognising that whatever the complications experienced, high-quality midwifery care is still needed. In this way, we were able to identify the impact of preventive and supportive care for all as well as the management of complications, again recognising that to meet the needs of women and babies, systems need to be in place both to prevent and to treat problems; and that if preventive care is in place, fewer women and infants are likely to experience complications. The QMNC framework allowed us to analyse the broad impact of the complex processes that are inherent in high-quality midwifery. Using the framework as a basis, our re-analyses of 461
143
Hot Topic
Cochrane reviews of interventions found that over 50 outcomes can be improved by midwifery. These include reductions in mortality for women and infants, reduced stillbirth, and improvements in a wide range of short- and long-term clinical and psychosocial outcomes. Costs and resource use were also better. Reducing the use of unnecessary and harmful interventions was clearly an important factor; we found that over 60% of effective practices demonstrated the importance of optimising normal biological, psychological, social, and cultural processes and of strengthening women’s own capabilities. This included practices such as avoiding immobility in labour, routine episiotomies, and separation of mother and baby, for example. Importantly, outcomes were also improved by provision of care in regard to wider public health factors such as nutrition, and family planning; care for women with problems of domestic violence, mental health, substance misuse; and the positive offering of information, education, support, and respectful, compassionate care in pregnancy, during labour and birth, and after birth. The QMNC framework then offered us a stable context for modelling of different scenarios, examining the impact of midwifery implemented to different degrees in low- and middle-income settings. These calculations found that over 80% of maternal and newborn mortality, and stillbirths, could be reduced by the implementation of midwifery (Homer et al 2014). Our health system analyses in countries where midwifery was part of a successful strategy to reduce maternal mortality showed the essential need for integration of midwifery into a health system, working as part of multidisciplinary teams (ten Hoope Bender et al 2014, Van Lerberghe et al 2014).
What does The Lancet Series on Midwifery tell us? Midwifery makes a difference. The scale of its impact is striking; midwifery can make an important contribution to tackling all of the challenges we set out to examine. Midwifery has an impact on women, and babies, and families. Implementing high-quality midwifery could reduce mortality and morbidity, and have a positive impact on many other longer-term factors through improving physical and mental health, increasing breastfeeding rates, improving mother-baby interaction, and reducing costs. Midwifery matters to women, babies, families and communities in all countries. It matters to health systems, in terms of the quality and cost of care provided. Midwifery care — and specifically, care by educated, trained, licensed and regulated midwives — is essential. This is an important message for decision makers to hear in many countries where midwifery is not implemented effectively, or is weakened by a lack of policy support or by substantive barriers.
focus on the skilled and compassionate care that makes the difference. In others, even midwives educated to international standards find their practice limited by a lack of professional status, poor remuneration, over-medicalised systems, or professional territoriality. This is no longer acceptable. The costs to women, babies, families, communities, and society are too high. The evidence in the series also calls into question the risk-focussed and task-focussed analysis of maternal and newborn care. The new analyses demonstrate that how care is given — kind, respectful care, promoting women’s own strengths and capabilities, optimising normal processes, avoiding unnecessary interventions — is as important as what care is given. A focus on minimum levels of care and on treating complications is not enough. Women and babies need midwives who work in and with interdisciplinary teams, fully integrated into the health system.
What has been its impact so far? The series has not happened in a vacuum. Other developments in reproductive, maternal and newborn health are also having an impact, and together an energy and momentum is developing around midwifery globally. In particular, there is a strong synergy with Saving newborn lives (Save the Children 2005) and The state of the world’s midwifery 2014 (United Nations Population Fund 2014), and in regard to low-income settings. Since the series was published, it has been debated and disseminated globally and at country level all over the world. Sessions led by the WHO, UNFPA, ICM, and series authors have taken place in global forums and national meetings in countries that have so far included Australia, Brazil, Canada, Croatia, Greece, Laos, the Netherlands, Hong Kong, Iceland, Malaysia, Tanzania, the UK and the USA. The papers are being very widely read — the Altimetrics scores which reflect the interest in the papers have consistently shown that they are all in the top 5% of papers of the same age. The QMNC framework is starting to be used by individuals and agencies in many countries to analyse the provision of maternal and newborn services, and to plan future provision — we have yet to see the full extent of this work, or its impact. The Swedish government’s global campaign, Midwives4all was launched in Geneva with the full support of the Director General of the WHO, the Director of UNFPA, and seven country ambassadors. It is now rolling out across Swedish embassies in seven low-income countries, and a major digital campaign will be launched in the summer of 2015 to draw attention to the importance of midwifery among the public, professionals, and decision makers.
Yet midwifery is not widely available. In some countries there are no midwives and there is little
144
MIDIRS Midwifery Digest 25:2 2015
Hot Topic
© Greatbass.com, Fotolia.com
What are the lessons for the UK? The Lancet Series on Midwifery has relevance for midwifery in all countries, and the series’ authors hope that it will help to inform debate and developments both globally and within individual countries. The worldwide recognition that midwifery has a positive impact on reducing mortality, including stillbirth, as well as morbidity, puts midwifery into the first line of key interventions that should be available for all women and babies. This includes the UK, where the midwifery profession is strong, established, and mature, and where midwifery has for many years already focussed on the needs of women, babies and families. Even in a UK setting, barriers to the full scope of midwifery care for all women, babies and families exist, and this series can inform debate about tackling those barriers. The new analyses and their findings, and using the QMNC framework, have potential to strengthen existing strategic directions and challenge existing policy and practice. The distinctions made between what is needed, how that is provided and who provides it is a language and an understanding that can be used to frame midwifery, its impact and its characteristics for students, colleagues, policy makers, and the public. The framework can be used to develop standards, education curricula, and monitoring systems. It can help to avoid a dichotomy between care for ‘low-risk’ and ‘high-risk’ women, as the focus is on skilled and compassionate care for all. It can demonstrate that even when the technical approaches have been put in place, much more is needed to ensure that they are used in a way that optimises normal processes of pregnancy, birth, postpartum and the early weeks of life and avoids over-medicalised approaches. The focus is clearly on the needs
MIDIRS Midwifery Digest 25:2 2015
of women and babies and their interdependent relationship — at the same time, rather than seeing those as separable. The focus on the continuum of care can help to draw attention away from labour and birth to a wider perspective on the preventive, supportive and nurturing care that is needed in pregnancy and after birth as well as in labour. Importantly, the evidence in the series demonstrates the key contribution of optimising normal processes and strengthening women’s capabilities and clarifies that a focus on risk management and technical interventions is not enough. At the same time, it demonstrates that care should take place in the context of effective interdisciplinary working and with interventions and technical solutions being available when needed. As one example, the framework may offer a way to analyse, discuss, and learn from the tragic events in Morecombe Bay NHS Foundation Trust (Kirkup 2015). Going forward, the QMNC framework may also offer a context for discussions on the changes taking place to midwifery supervision in the UK (Nursing & Midwifery Council 2015) to ensure that the needs of women, babies and families are at the heart of supervision, as well as of care and services. The evidence shows that the impact of midwifery reaches well beyond pregnancy, birth and postpartum. A growing body of evidence demonstrates the importance of the first 1000 critical days of a child’s life on their brain development and how the emotional world into which they are born impacts on their future health and well-being (WAVE Trust 2014, All Party Parliamentary Group for Conception to Age 2: The First 1001 Days 2015). At the same time, midwifery’s positive impact on longer-term and psychosocial outcomes as well as short-term clinical outcomes demonstrates that midwifery has an 145
Hot Topic
essential role in care for women who are vulnerable through anxiety and depression, poverty, domestic violence, mental illness, or substance use, for example, all of which can impact on the physiological and behavioural functioning of the baby. Midwifery has an essential contribution to make to these discussions, and to strategic planning for promoting the long-term health and development of children.
Conclusion Midwifery is key to quality care for all women, all babies, and all families. The evidence and new analyses presented in The Lancet Series on Midwifery can inform strategic developments both globally and nationally. The information presented can help to avoid polarised positions and narrow discourses, keep our perspectives and ambitions broad, and strengthen the position of midwifery in national strategy for women, children and families. As the series concludes, a system-level shift is needed: ‘from fragmented maternal and newborn care focussed on identification and treatment of pathology for the minority, to skilled, compassionate care for all. Midwifery is pivotal to this approach’ (Renfrew et al 2014). Professor Mary Renfrew, Director, Mother and Infant Research Unit, University of Dundee; Director, Scottish Improvement Science Collaborating Centre; Principal Investigator, The Lancet Series on Midwifery.
Resources The Lancet Series on Midwifery (you need to register on The Lancet site, but it’s all freely available after that at: http://www.thelancet.com/series/midwifery).
uploads/system/uploads/attachment_data/file/408480/47487_MBI_ Accessible_v0.1.pdf [Accessed 9 April 2015]. Nursing & Midwifery Council (2015). Nursing and midwifery regulator calls for supervision to be removed from its legislation. London: NMC. http://www.nmc.org.uk/news/news-and-updates/ nursing-and-midwifery-regulator-calls-for-supervision-to-beremoved-from-its-legislation/ [Accessed 9 April 2015]. Office of the United Nations High Commissioner for Human Rights (1966). International Covenant on Economic, Social and Cultural Rights. Geneva: OHCHR. http://www.ohchr.org/EN/ ProfessionalInterest/Pages/CESCR.aspx [Accessed 9 April 2015]. Office of the United Nations High Commissioner for Human Rights (1989). Convention on the Rights of the Child. Geneva: OHCHR. http://www.ohchr.org/en/professionalinterest/pages/crc. aspx [Accessed 9 April 2015]. Renfrew MJ, McFadden A, Bastos MH et al (2014). Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. The Lancet 383(9948):1129-45. Save the Children (2005). Saving newborn lives final report, 2000-2005. Washington: Save the Children Saving Newborn Lives programme. ten Hoope-Bender P, de Bernis L, Campbell J et al (2014). Improvement of maternal and newborn health through midwifery. The Lancet 384(9949):1226-35. United Nations (1948). The Universal Declaration of Human Rights. New York: UN. http://www.un.org/en/documents/udhr/ [Accessed 9 April 2015]. United Nations Population Fund (2014). The state of the world’s midwifery 2014. A universal pathway: a woman’s right to health. UNFPA: New York. http://unfpa.org/public/home/publications/ pid/17601 [Accessed 9 April 2015]. United Nations Women (1979). Convention on the Elimination of All Forms of Discrimination against Women (CEDAW). New York: UN Women. http://www.un.org/womenwatch/daw/cedaw/cedaw. htm [Accessed 9 April 2015].
http://midwiferyaction.org,
Van Lerberghe W, Matthews Z, Achadi E et al (2014). Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality. The Lancet 384(9949):1215-25.
Twitter @midwiferyaction, #lancetmidwifery
Vega J (2012). Universal health coverage: the post-2015 development agenda. The Lancet 381(9862):179-80.
Midwifery Action website and Twitter:
Midwives4all website and Twitter: http://midwives4all.org, Twitter @midwives4all, #midwives4all
Midwifery Action films on You Tube: https://www.youtube.com/user/midwiferyaction
References All Party Parliamentary Group for Conception to Age 2: The First 1001 Days (2015). Building Great Britons. Conception to age 2: First 1001 Days All Party Parliamentary Group. Croydon: Wave Trust. http://wavetrust.org/sites/default/files/reports/ Building_Great_Britons_Report-APPG_Conception_to_Age_2Wednesday_25th_February_2015.pdf [Accessed 9 April 2015].
Wave Trust (2014). Social justice begins with babies. The first annual report of Scotland’s coalition supporting Putting the Baby IN the Bath Water. Croydon: Wave Trust. http://wavetrust.org/sites/ default/files/reports/BinB%20Coaltion%201st%20Annual%20 Report%20web%20version%202014.pdf [Accessed 9 April 2015]. World Health Organization (2012). Every woman, every child: from commitments to action. The first report of the independent Expert Review Group (iERG) on information and accountability for women’s and children’s health. Geneva: WHO.
Renfrew M. MIDIRS Midwifery Digest, vol 25, no 2, June 2015, pp 141–146. Original article. © MIDIRS 2015.
Homer CSE, Friberg IK, Augusto Bastos Dias M et al (2014). The projected effect of scaling up midwifery. The Lancet 383(9948):1146-57. Kirkup B (2015). The report of the Morecambe Bay Investigation. London: The Stationery Office. https://www.gov.uk/government/
146
MIDIRS Midwifery Digest 25:2 2015
Research & Education
Why midwives should be feminists Denis Walsh, Monica Christianson, Mary Stewart
© in the skies, Fotolia.com
ORIGINAL
Gender inequality and oppression is a pervasive feature of human cultures and societies across the world and this is reflected in women’s reproductive health with unacceptably high maternal mortality rates in low-income countries and excessive rates of intervention in childbirth in high-income countries. Midwifery, a profession whose raison d’etre is to be ‘with women’ with an explicit focus on maximising their reproductive health, has been slow to engage with a gendered analysis of these effects. There has also been a reluctance to utilise a feminist lens in addressing midwifery policy, practice and research. In this paper, we argue for change so that feminist values and gender equality become central to all midwifery endeavours.
Introduction Nearly 4000 midwives from all over the world attended the International Confederation of Midwives 30th Triennial Congress in Prague, 2014 and were exposed to an incredibly varied programme centred on midwifery and childbirth. Yet within the printed programme, the phrase ‘gender equality’ was hardly mentioned and the word ‘feminism’ never. This irony was made all the more striking by a massive electronic advertisement thrown onto one of the walls of the Congress centre of a topless woman covering her breasts in a provocative pose. The image was part of a loop of advertisements that confronted every delegate as they approached the building. Many midwives, women and men, would have found this offensive in any context, let alone at an international conference of midwifery. Yet this explicit objectification of women on the outer wall and in broader society was not critiqued in the formal programme for the conference inside. There was an absence of a language 154
and vocabulary to frame any presentation or debate through a gender or feminist lens. In this paper, we develop an argument that calls for a comprehensive recasting of childbirth and midwifery issues through a feminist lens and language. This is imperative, we will argue, if the layers of oppression, injustice and the factors that undermine women’s agency in both low-income and high-income countries are to be exposed and challenged at their source. This is not to diminish in any way the multiple initiatives happening all over the world at a macro and micro level to improve childbearing women’s lives, but to make the link to institutionalised gender inequality beyond childbirth at virtually every level of society and across cultures. By raising a ‘feminist consciousness’ (Green 1979) in this way, to borrow a phrase from second wave feminism, we believe the profession of midwifery will be more effective in challenging and overturning injustices in childbirth wherever and whenever they occur. MIDIRS Midwifery Digest 25:2 2015
Midwifery
Midwifery-led care for a low-risk cohort — a clinical outcomes overview: over a three year period in a multicultural setting Kathryn Gutteridge ORIGINAL Challenging maternity culture, reconfiguring services and developing a midwifery-led facility of excellence are explored in this article, using opportunities whereby a failing service is radically reconstructed with two midwifery-led birth centres at the heart of the change model. The development of Serenity Birth Centre in 2010, and shortly after in 2011 Halcyon Birth Centre, has reaped benefits for women, their babies and midwives. Many midwifery-led units have been developed and are giving women choices that are real and beneficial; this article demonstrates how clinical outcomes can support high-quality midwifery care. The collection and interpretation of data is essential to the future of midwifery-led care and this article shows how powerful those changes can be.
Introduction
Situated in the west of Birmingham and close to the city centre, this Trust provides care for 10,500 women with 6500 women giving birth within the unit every year. This means that over 4000 women choose to give birth in neighbouring units which are deemed nearer in location and easier to access. The population we serve is socially complex and falls into the lowest social quintile with a history of poverty, deprivation and gang culture requiring frequent input into safeguarding of both children and adults. Women using our services include a large asylum seeking, refugee and migrant population, adding to the indigenous, largely non-white and non-English speaking female group.
• Twenty-two per cent of residents were born outside the UK, compared with 14% in England as a whole and 11% in the West Midlands region. • Since 2001 the population has increased by almost 100,000 (10.2%). This is an average rate of 0.9% per year. • The population increase over the last decade is associated with more births, fewer deaths and international migration. • A greater number of younger age groups, while England, as a whole, has a greater proportion of older people. • Forty-five point seven per cent of Birmingham residents are under 30, compared with 36.8% for England (Birmingham City Council 2011). The current childbearing population for this Trust is within the poorest quintile in Birmingham which demonstrates high levels of poverty, unemployment, housing problems and standards of health and well-being that are lower than that of comparable women in other areas. Nutrition advice and smoking cessation are commenced early in pregnancy with many women prescribed vitamins and supplements as a standard.
Key demographic facts • Around 42% of residents from an ethnic group other than white. • Forty-six point one per cent of Birmingham residents said they were Christian, 21.8% Muslim and 19.3% had no religion.
Families are more likely to live in accommodation considered to be of a poorer standard and often live in multi-family arrangements, making them more susceptible to ill health. Women are more likely to have three or more children that will be non-English or British in origin.
Offering midwifery care to women on a low-risk pathway is commonplace in the United Kingdom (UK) with many midwifery units and birth centres embedded within traditional maternity services. Sandwell and West Birmingham Hospitals (SWBH) NHS Trust invested resources into this model of care in 2010 as part of a larger change model strategy. The co-located Serenity Birth Centre opened in May 2010 and the freestanding Halcyon Birth Centre later in November 2011.
MIDIRS Midwifery Digest 25:2 2015
175
Pregnancy
The internet: a reliable source for pregnancy and birth planning? A qualitative study Catherine Lynch, Gergana Nikolova
ORIGINAL Aims and objectives: The study aims to explore why and how pregnant women use the internet as a health information source, what overall effect it has on their decision making and how this is affecting their interaction with their health care professional. Background: As the internet has become primarily a source of information among mothers-to-be, health care professionals require greater understanding of the impact of such technology to provide adequate support and advice to new mothers. Selection criteria: Pregnant women, from the time of their first meeting with their midwife until birth, were approached for the study. Supplementary criteria included: age 18 and above, living within Frimley Heath Foundation Trust, and fluency in the English language. Data collection and analysis: This was a primary research study with data collected through an online survey. As the purpose of the study was to collect data on an impact that cannot be directly observed, an online questionnaire was utilised to collect both qualitative and quantitative data. The data was analysed and presented thematically. Results: In accordance with the UK government policy to promote registration of clinical studies and public access to research findings affecting health and social care, the research is registered on the public database. Authors’ conclusion: The use of the internet as a source of pregnancy-related information has become increasingly popular and influential among childbearing women. As health professionals, midwives have a responsibility to acknowledge the fact that women access the internet for support and pregnancy-related information. For the wider profession, midwifery leaders need to set the direction of travel for their profession in engaging with social media and provide guidance on directing pregnant women towards sources of information which are both evidence-based and valid.
Introduction
Background and rationale for the study
Pregnant women increasingly are turning to the internet for information during pregnancy (DH 2009, Lagan et al 2010, Kim et al 2011, Kraschnewski et al 2014). The worldwide social network exposes women to different unregulated sources of information and predicting the impact of potentially unreliable materials on maternal choices appears to be impossible. This paper addresses the extent and the degree of influence which online sources have on pregnant women’s decision making practices. Potentially an understanding of why women turn to the internet could help in developing strategies and protocols to support both users and providers of maternity services.
Miller (2005) argued that although authoritative knowledge varies across geographical locations and indeed over time, it always forms ‘acceptable’ practices and constructs ‘expectations’. Historically, authoritative knowledge of childbirth was passed from mother to daughter; however it appears that the internet has now become a significant source of information. Although the provision of pregnancy information on the internet can be seen to complement traditional sources, very little is known about the actual or potential impact of online sources of information on mothers’ decisions (Lowe et al 2009, Cohen & Raymond 2011).
MIDIRS Midwifery Digest 25:2 2015
193
Labour & Birth
Implementation of delayed cord clamping in the active management of the third stage of labour Alexandra Buder ORIGINAL Introduction During pregnancy the fetus is dependent upon the placenta for its existence; at birth, major circulatory and respiratory changes and adaptations occur. The baby’s lungs now take over the important role of oxygenation due to a progressive fall in pulmonary vascular resistance accompanied by an immediate rise in systemic vascular resistance, which subsequently increases pulmonary blood flow and oxygen uptake in the lungs. As a result, the baby’s circulatory system changes from a low-pressure system to a high-pressure and self-sustaining system (Coad & Dunstall 2005, Cook 2007). Amongst other changes, umbilical cord clamping contributes to the adaptations that take place in the baby’s circulation and respiration and finalises the baby’s transition from intrauterine to extrauterine life. Following birth, the umbilical cord continues to deliver blood from the placenta to the baby if not clamped immediately. This so called ‘placental transfusion’ is a natural process and is usually complete within two to five minutes in term babies but may take longer in preterm babies. If this process is not disturbed by early cord clamping (ECC), the infant gains on average an additional 80–100 ml of blood, which increases the blood volume by approximately 30% (Cook 2007, Duley & Batey 2013). Studies have shown that up to 60% of fetal red blood cells, containing iron, oxygen and stemcell rich blood, can be found in the fetal-placental circulation (Mercer & Erickson-Owens 2006, Hutton & Hassan 2007). Overall, delayed cord clamping (DCC) is not only thought to increase birth weight (up to 2% of the newborn’s birth weight) but also contributes to increased iron levels (40–50 mg/kg). Consequently, DCC reduces the risk of anaemia and may benefit the central nervous system and cognitive development (Eichenbaum-Pikser & Zasloff 2009, van Rheenen 2011). At present, the timing of umbilical cord clamping remains a controversial issue, varies significantly between birth settings, and is mainly based on the personal preferences of midwives and obstetricians. The exact definition of the terms ‘early’ and ‘delayed’ MIDIRS Midwifery Digest 25:2 2015
cord clamping remain unclear (Abalos 2009). Therefore, the timing of cord clamping cannot be clearly specified.
Background From a historical perspective, the change from the previously commonly used practice of DCC, to the nowadays mainly practised ECC, may be related to the increased popularity of the use of analgesics during labour and the possible impairment to the baby’s respiratory effort, resulting in the immediate need for resuscitation. Additionally, managing the third stage of labour actively became routine clinical practice in the 1960s, and aimed to reduce the incidence of postpartum haemorrhage (PPH) (Duley & Batey 2013). Active management comprises an injection of synthetic oxytocin, ECC, and controlled cord traction (CCT) (Duley & Batey 2013, McDonald et al 2013). ECC became the new parameter for the timing of umbilical cord clamping in order to protect the baby from blood over-transfusion resulting from strong uterine contractions initiated by the injection of synthetic oxytocin (Cook 2007, Duley & Batey 2013). Recently, the European Resuscitation Council, Department of Making Pregnancy Safer, World Health Organization (WHO), the International Federation of Gynecology and Obstetrics, the International Confederation of Midwives, and the Royal College of Obstetricians and Gynaecologists changed their guidelines in favour of DCC between one and three minutes (ICM/FIGO 2006, Department of Making Pregnancy Safer & World Health... 211
Postnatal
‘Pregnancy is socially acceptable, but being fat is not’: considering psychosocial aspects of obesity in pregnancy Ailsa McGiveron ORIGINAL Historically, the relationship between weight gain and pregnancy focused upon inadequate maternal weight gain (Siega-Riz et al 2004). The consequences of inadequate weight gain for fetal growth were traditionally thought to be such that pregnant women were advised to ‘eat for two’ and avoid slimming. However, more recently, the impact of excessive weight gain and obesity in pregnancy has shifted the focus. Obesity is a serious public health concern. Not only does it burden our society with increased health care costs, pose risks for disease, disability and death, it also presents many social, emotional and aesthetic concerns. The abundance of energy dense foods, motorised transport and sedentary lifestyles are causing the people of Britain to become heavier simply by living in the Britain of today. Modern living ensures that every generation is heavier than the last — a trend known as ‘passive obesity’ (Foresight 2012). population has significant implications for women of childbearing age and has been described as the biggest challenge for maternity services today (Centre for Maternal and Child Enquiries(CMACE) 2010).
© JPC-PROD, Fotolia.com
The costs to the National Health Service (NHS) for overweight and obesity-related conditions are projected to reach £50 billion per year by 2050 (Foresight 2012). The increase in obesity in the UK
MIDIRS Midwifery Digest 25:2 2015
225
Infant Nutrition
Vitamin A concentration in human milk and its relationship with liver reserve formation and compliance with the recommended daily intake of vitamin A in pre-term and term infants in exclusive breastfeeding Gisele Souza, Manoela Dolinsky, Andréa Matos, Cristiane Chagas, Andréa Ramalho
REPRINT Purpose: To evaluate vitamin A concentration in mature breast milk of nursing mothers aiming to meet the daily needs and the formation of liver reserve in pre-term (PT) and term infants (T) in comparison with the recommended intake for this nutrient in this group. Methods: We analyzed the retinol concentration in the milk of 120 nursing mothers (40 of PT infants and 80 of T infants) by collecting 10 mL of mature breast milk, held by a hand spray of one of the breasts 2 h after the last feeding in the morning. The cutoff points adopted for identification of vitamin A deficiency (VAD) and the liver reserve were <1.05 and >2.3 µmol/L, respectively. Results: The concentrations of retinol in the human milk of T infants were superior to concentrations in the milk of PT infants (1.87 + 0.81 > 1.38 + 0.67 µmol/L, p < 0.0001). They were higher in T compared to PT (352.64 + 152.72 > 217.65 + 105.65 µg, p < 0.0001), but both were below the recommendation. VAD was 20.0 % (T) and 27.5 % (PT). Only 40.0 % (T) and 22.5 % (PT) of the mothers had retinol concentrations in milk above 2.3 mmol/L. Conclusion: The milk of the nursing mothers studied did not have enough retinol to meet the daily needs and to form liver reserve in both groups, especially in PT newborns. This finding reinforces the idea that supplementation with massive doses of vitamin A in the immediate postpartum period can be used as a protective device of the infant against VAD. Keywords: Vitamin A, human milk, pre-term, term, liver reserve
Introduction Vitamin A has many functions in the human body as in its growth and development, antioxidant and immune function, which highlights the importance of this vitamin in maternal and infant health.1,2 Vitamin A liver reserves are formed during pregnancy, but they are more markedly formed during the last trimester when there is intense transplacental passage. Therefore, it is expected that the pre-term birth will reflect negatively on this vitamin nutritional status, causing low concentrations of serum retinol and of retinol binding protein (RBP), in addition to poor liver reserve.3 In parallel, vitamin A nutritional needs
MIDIRS Midwifery Digest 25:2 2015
in a pre-term infant are higher than at any other time in life. This is due to the intense catabolism during the first weeks after birth with the short supply of retinol in the liver at birth, the low concentrations of plasma retinol and the low concentrations of RBPs, in comparison with term infants.4 The low liver reserve of vitamin A can be increased during lactation as this vitamin is transferred from mother to child approximately 60 times more during the first 6 months compared with the accumulation by the fetus during the 9 months of gestation,5 configuring, in this way, the time of the greatest vitamin A nutritional demand.6
235
Neonatal & Infancy
Evaluation of Period of PURPLE Crying, an abusive head trauma prevention program Laura Schwab Reese, Erin O Heiden, Kimberly Q Kim, Jingzhen Yang
REPRINT The Period of PURPLE Crying program is used to educate parents and caregivers about normal infant crying and the dangers of infant shaking. We evaluated nurse-led, hospital-based implementation of the program using a nonexperimental, posttest-only design. New mothers rated the program as useful, and the program was effective in teaching mothers about normal infant crying, the dangers of infant shaking, and soothing and coping techniques. The findings support the feasibility and need for broad dissemination of the program.
Keywords: Shaken baby syndrome, abusive head trauma, birthing mother, evaluation, prevention Pediatric abusive head trauma (AHT), a form of inflicted brain injury resulting from violent shaking or blunt impact, is a leading cause of death in children younger than age one year with mortality rates ranging from 15% to 38% (Stewart et al 2011, Ward, Bennett & King 2004). The estimated annual incidence of AHT for infants younger than age one is between 29 and 39 per 100,000 infants, although the actual number of AHT cases is likely underreported. Pediatric AHT and AHT prevention have received increased attention, in part due to substantially higher rates during the recent economic recession in the United States (Berger et al 2011). Although recent studies indicate the rates of AHT are no longer increasing, AHT remains a pressing public health issue (Niederkrotenthaler, Xu, Parks & Sugerman 2013).
Abusive head trauma The Centers for Disease Control and Prevention (CDC) defined AHT as injury due to inflicted blunt impact and/or violent shaking that results in injury to the skull and/or brain (Parks, Annest, Hill & Karch 2012). Abusive head trauma is one of the most deadly forms of child abuse (Scribano, Makoroff, Feldman & Berger 2013). It often results in damage to the brain, retinal hemorrhages, and fractures (Shanahan, Zolotor, Parrish, Barr & Runyan 2013). Compared with infants who experience other forms of brain injury, infants who experience AHT are 5 times more likely to die and 8 times more likely to have long stays in the hospital following injury (Niederkrotenthaler et al 2013). There is very limited recent information available about the long-term
MIDIRS Midwifery Digest 25:2 2015
consequences of AHT, but early research suggests infants who experience AHT are more likely to have life-long disability including neurologic, cognitive, visual, and developmental impairment compared with infants who experience other forms of head trauma (Ewing-Cobbs et al 1998). By the time they reach school age, children who experienced AHT often exhibit significant weaknesses in intelligence quotient (IQ), working memory, mental organization, and inhibition (Stipanicic, Nolin, Fortin & Gobeil 2008). Nearly all infants who survive AHT will require some form of ongoing care for the rest of their lives (King, MacKay, Sirnick & Canadian Shaken Baby Study Group 2003).
Period of PURPLE Crying To prevent AHT, several parent-education programs have been developed and implemented among infant caregivers (Barr, Barr et al 2009, Barr, Rivara et al 2009, Dias et al 2005, Goulet et al 2009, Stewart et al 2011). The Period of PURPLE Crying is one parent education program that educates parents and caregivers about normal infant crying and the dangers of shaking an infant. The education program is based on a developmental framework that suggests that infants go through a unique developmental phase beginning at age 2 weeks through age 3 to 4 months. During this phase, infants may cry for hours despite efforts to soothe them. The crying may come and go without any discernable external or internal stimuli and last for more than 5 hours per day (Barr 2013). The infants may look like they are in pain, even when they are not. 245
Worldwide Maternity Services
To what extent do cultural normalities influence women’s experience during pregnancy and childbirth? Indigo Lowe
ORIGINAL Editor’s note: The author of this paper, Indigo Lowe, became interested in the different cultural practices of women whilst undertaking a placement abroad in preparation for applying to become a midwife in the UK. This gave her considerable insight into how women from different countries view pregnancy and childbirth and for midwives, the potential difficulties of understanding the cultural norms when caring for these women in a UK setting.
Migration is becoming more common as families move to other countries either by choice to seek employment, or for reasons of safety, bringing with them their traditional cultures associated with pregnancy and childbirth. This paper will explore some of the cultural traditions that are considered the norm in countries other than the United Kingdom (UK), in particular those of Thailand, China and Africa, with the aim of exploring whether these cultural norms influence women throughout their childbirth continuum, either in a positive or negative way. Furthermore, it aims to create a greater understanding of what other cultures consider normal in pregnancy and childbirth, and help midwives support women by encouraging greater understanding of, and sensitivity towards, their needs. During this study it was apparent that women can be greatly influenced by their cultures in a variety of ways, and that there are some practices which could be introduced into midwifery in the UK. For example, many women in the UK are still labouring and giving birth on their backs, whereas in Africa the preferred position is either upright or squatting, allowing greater movement of the coccyx to widen the birthing canal. However, there has been evidence of this practice being adopted in the UK through the promotion of normal childbirth.
Introduction Although childbirth is something that occurs universally, the experience differs greatly from culture to culture. There are different approaches to how a child is born and the postnatal care provided depends on where you are in the world and how pregnancy is perceived. The term ‘cultural normalities’, in this paper, refers to the influences on women from elements within their own cultures. For example, within specific countries or religions there may be particular protocols, rituals, rules and regulations concerning pregnancy. In certain cultures the women’s parents have the final word on maternity care, in others the partners can be the main decision makers. For it to be of significant cultural impact, it needs to have a strong influence upon the outcome of the birth or the maternity care. Last summer, whilst visiting a private hospital in Chiang Mai, Thailand for a hospital placement, I
MIDIRS Midwifery Digest 25:2 2015
shadowed some of the midwives on the obstetrics and gynaecology ward. During my time there I was able to witness a natural birth and five caesarean sections (CS). A surprising element of this experience was that when women were given the option, they chose to have a caesarean birth. My mentor on the ward told me that in the hospital, 90% of the births were elective CS which shocked and intrigued me. There were both parallels and significant differences which I considered — given my knowledge of maternity care in the UK. This ignited an interest in gaining a greater understanding of how other countries differ from the UK in their approach to childbirth and pregnancy, and if any of these practices could benefit women in the UK. In 2013 the Care Quality Commission conducted a survey of 25,488 women over the age of 16 who had experienced a live birth in a hospital, a birth centre, a maternity unit or at home (CQC 2013).
255
News & Reviews
Did you miss it? Birth place decisions Kirstie Coxon has produced an excellent booklet aimed at supporting women and partners in planning where to give birth. It includes information on where a woman can give birth, the suitability of the settings and where help can be sought. The booklet has been written in an easily understood format with graphic images showing the risks and benefits of making decisions around place of birth. Mary Newburn, former ambassador for the NCT, said: ‘It is a great achievement to have the document published so soon after the NICE IPC guideline and the graphics look fantastic — so clear and accessible. Together with the cartoon drawings and the detailed but very clear text, the whole package is great.’
Birth place decisions Information for women and partners on planning where to give birth
Where can I give birth? What birth settings might be suitable for me?
Where can I find out more?
Who can I ask for help?
What if I change my mind about where to give birth?
What’s available near me?
Further details of the ‘Birthplace in England’ booklet can be found at: http://www.nhs.uk/Conditions/ pregnancy-and-baby/Documents/Birth_place_ decision_support_Generic_2_.pdf
New National Maternity Survey shows women are seeking pregnancy care earlier Findings of the 2014 National Maternity Survey, launched on 26th February, show that, compared with earlier surveys in 2006 and 2010, women are realising MIDIRS Midwifery Digest 25:2 2015
they are pregnant and seeing a health professional earlier, with 96% seeking care by 12 weeks. Other results show that postnatal hospital stays are continuing to get shorter and the number of postnatal visits declining. Overall satisfaction with care remains high although, as in earlier surveys, satisfaction with postnatal care is lower than that for antenatal care or care in labour and delivery. Read more about the survey at: https://www.npeu.ox.ac.uk/maternitysurveys, or download the full report at: https://www. npeu.ox.ac.uk/downloads/files/reports/Safely%20 delivered%20NMS%202014.pdf
Wellbeing Foundation Africa (WBFA) gain prestigious consultative status on the Economic and Social Affairs Council (ECOSOC) of the United Nations, calls for every woman to be able to access a midwife, as part of Sustainable Development Goals (SDGs) Access to a midwife for every pregnant woman should be specifically indicated within the SDGs relating to maternal health, according to a leading pan-African maternal, newborn and child health charity that received United Nations’ ECOSOC status in April. This is a pivotal year for the WBFA to be granted consultative status, as ECOSOC is the UN’s central platform for reflection, debate, and innovative thinking on sustainable development. With the finalisation of the SDGs later this year, WBFA will be placing reproductive, maternal, newborn, child and adolescent health (RMNCAH) in Nigeria and across the African continent, at the heart of the discussions. The founder-President of WBFA, Her Excellency Mrs Toyin Saraki, is the Global Goodwill Ambassador for the International Confederation of Midwives (ICM), and will be seeking to raise awareness of the impact that midwives have in reducing maternal, newborn and child mortality. As the Lancet Series on Midwifery found, a 25% increase in access to midwives could lead to a 50% reduction in maternal mortality. Therefore, WBFA will be calling for the SDGs to recognise the important role of midwifery and ensure every childbearing woman is able to access 269
News & Reviews
a midwife as part of the targets for maternal health. WBFA will be especially calling for Indicator number 28 (under Goal 3) to specifically mention measurable access to midwives, while the tentative Complementary National Indicator number 3.1 should mention access to midwives in high-burden countries. More information is available at: http://tinyurl. com/pwo8f33 or contact: Denesha Brar, Aequitas Consulting, Tel: 0207 759 1142.
NHS Number for Babies update from the Health and Social Care Information Centre England
doctors usually only diagnose the disease at the age of 12 to 18 months. The patient will then quickly receive stem cell therapy, but by then the brain and skeleton will usually already have been irreparably damaged. Reference: Aldenhoven M, Wynn RF, Orchard PJ et al (2015). Long-term outcome of Hurler syndrome patients after hematopoietic cell transplantation: an international multicenter study. Blood 125(13):2164-
The Roar behind the silence by Sheena Byrom and Soo Downe (eds)
Jacque Gerrard, Director RCM England/Midwifery Directorate has announced that the way the NHS Number is issued for newborn babies has finally changed. Midwives in England will be aware that for the past few years a service called NHS Numbers for Babies (NN4B) has been used to allocate NHS Numbers at birth. NN4B means that babies have an NHS number from birth, for life, making the process of building a true life-long electronic health record possible. In addition, it fulfils statutory and screening requirements to notify others of the birth outside the maternity department. The RCM has been very involved with this important change in the process and is delighted that it has finally happened. Please note, for Live service issues, please contact the National Service Desk on 0845 366 0066 or email: ssd.nationalservicedesk@hscic.gov.uk.
Neonatal screening also for Hurler’s syndrome Research conducted by Dr Jaap Jan Boelens of the University Medical Center Utrecht has led the Dutch Health Council to recommend that neonatal screening of newborns should include testing for Hurler’s syndrome. This is a rare inherited metabolic disease which causes damage to both the brain and skeleton. If detected early the baby can be given stem cell treatment from around two months of age which will prevent irreparable damage. The study was based on over 200 cases studied by researchers at Wilhelmina Chidren’s Hospital (part of the UMC Utrecht) led by Boelens.
Repair through stem cell therapy Hurler’s syndrome or mucopolysaccharidosis is an inherited metabolic disease that irreparably damages organs in children, resulting in death around the age of five or six. The cause of the condition is a missing enzyme, which can be ‘repaired’ through stem cell therapy. This involves giving patients bone marrow from a donor, which produces healthy blood cells. White blood cells from the donor produce the missing enzyme and release it into the patient. At present,
270
This book, edited by two renowned midwives, is unique in the fact that it brings together different perspectives of midwifery by assembling the different threads that make up the world of maternity care. The overriding message that is conveyed is that kindness, compassion and respect are essential components in caring for women, families and indeed ourselves as professionals. Contributors to the book draw together a wide range of experiences and knowledge from around the world to inspire and educate the reader, enabling them to utilise their skills in being sensitive and compassionate to the needs of women. Midwives’ working lives are often very complex dealing with policy, procedure and governance integrated within the high-quality care women deserve and expect. The uses of the words in the title are very powerful and through reading the book will evoke different meanings at different times for every reader. It gives rise to consideration and debate on when we should be silent and when the time demands a ‘Roar’! The book has been cleverly compiled with a mix of stories, perspectives and evidence which captivates the interest. It will appeal to a wide audience and I would recommend all those involved in maternity care to read including student midwives both present and future.
MIDIRS Midwifery Digest 25:2 2015
Unique Access the world’s largest midwifery-specific database Enjoy personal access to MIDIRS Reference Database for £5 per quarter with a subscription to MIDIRS Midwifery Digest. time by sourcing all your midwifery research from one place (so no more searching of libraries, the • Save internet or multiple databases). • Access to over 220,000 article references and abstracts to assist you in your research, practice and studies. • The luxury of browsing over 500 topic-focused pre-prepared literature searches. • Approximately 1,000 new records added to the database each month. • Over 400 international information sources covered.
Email: enquiries@midirs.org or call: +44 (0)117 370 6799
des414-dig
Visit: www.midirs.org/database9 for details
Brunel House, 11 The Promenade, Clifton Down, Bristol BS8 3NG Customer services: 0800 581009 (freephone) tel: 0117 370 6799 (+44 117 370 6799 overseas) email: digest@midirs.org www.midirs.org
ISSN 0961-5555
@MIDIRS