MIDIRS Midwifery Digest sample March 2017 by CarolineBrewer

Midwifery Digest

March 2017, volume 27, number 1

research & education midwifery pregnancy labour & birth postnatal infant nutrition neonatal & infancy worldwide maternity services news & reviews

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Contents Housekeeping ............................................................................................................................... 1 Contents ....................................................................................................................................... 2 Editorial ....................................................................................................................................... 4

Hot Topic Women changing maternity services. A look at service user involvement in the UK ...................... 5 Mary Newburn

11 Research & Education Satisfaction for treatment of hyperemesis gravidarum in day case settings compared to hospital admissions ..................................................................................................................... 11 Caitlin Dean, Johnathon Marsden The development of an online resource on ‘professionalism’ for student midwives and student nurses ............................................................................................................................. 20 Fern Todhunter, Gerri Nevin, Simon Riley et al ‘The greatest feeling you get, knowing you have made a big difference’: survey findings on the motivation and experiences of trained volunteer doulas in England ................................. 22 Helen Spiby, Jenny Mcleish, Josephine Green et al

23 Midwifery Constructions of risk and the maternal body: implications for midwifery practice ...................... 23 Kate Austin Planning birth in and admission to a midwife-led unit: development of a GAIN evidence-based guideline ............................................................................................................. 26 Maria Healy, Patricia Gillen Generosity of spirit sustains caseloading Lead Maternity Carer midwives in New Zealand ........ 32 Marion Hunter, Susan Crowther, Judith McAra-Couper et al

33 Pregnancy Congenital cytomegalovirus infection, knowledge and attitudes among maternal health professionals and pregnant women ............................................................................................. 33 Sharon Wood The impact of antenatal yoga on the intrapartum period: a literature review .............................. 36 Tamara Joly Complex social factors affecting pregnancy and childbirth in teenagers: a case study ................. 43 Josie Reynolds, Laura Abbott Evaluation of a retrospective diary for peri-conceptual and mid-pregnancy drinking in Scotland: a cross-sectional study ................................................................................................. 49 Andrew Symon, Jean Rankin, Geraldine Butcher et al — Reviewed by Karen Gallagher Exercise in pregnancy: an association with placental weight? ..................................................... 51 Gunvor Hilde, Anne Eskild, Katrine Mari Owe et al Natural childbirth ideology is endangering women and babies .................................................. 52 Hans Peter Dietz, Lynda Exton

53 Labour & Birth Water for labour and birth: getting back to the art of doing nothing .......................................... 53 Megan Cooper, Jane Warland, Helen McCutcheon Does a low-risk setting in the intrapartum period increase VBAC success rate? A literature review ..................................................................................................................... 59 Kate Waterman ‘That was intense!’ Spirituality during childbirth: a mixed-method comparative study of mothers’ and fathers’ experiences in a public hospital ............................................................ 68 Marie-Noëlle Bélanger-Lévesque, Marc Dumas, Simon Blouin et al

69 Postnatal ‘Halfway towards recovery’: rehabilitating the relational self in narratives of postnatal depression .... 69 Meredith Stone, Renata Kokanovic Factors influencing engagement in postnatal weight management and weight and wellbeing outcomes .................................................................................................................... 80 Amanda Avery, Sarah Hillier, Carolyn Pallister et al 2

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Pain care management and the potential link to reduce the risk of postnatal depression in women ................................................................................................................................... 86 Akanksha Subramanian Do changes in subjective sleep and biological rhythms predict worsening in postpartum depressive symptoms? A prospective study across the perinatal period ....................................... 92 Elizabeth M Krawczak, Luciano Minuzzi, Maria Paz Hidalgo et al

93 Infant Nutrition Bristol’s milk bank revisited — five years on ............................................................................... 93 Val Dickens Passions run high at Unicef UK Baby Friendly Initiative annual conference 2016 ....................... 94 Julie Clayton Determinants of exclusive breast feeding in sub-Saharan Africa: a multilevel approach .............. 97 Siddika Songül Yalçin, Anselm S Berde, Suzan Yalçin — Reviewed by Catharine Hart The emotional and practical experiences of formula-feeding mothers ......................................... 99 Victoria Fallon, Sophia Komninou, Kate M Bennett et al Infant feeding in Newfoundland and Labrador, Canada: perceptions and experiences of maternal grandmothers ........................................................................................................ 100 Felicie Young, Laurie Twells, Rhonda Joy et al Trying to live with pumping: expressing milk for preterm or small for gestational age infants ..........101 Riikka Ikonen, Eija Paavilainen, Marja Kaunonen Improving breastfeeding support by understanding women’s perspectives and emotional experiences of breastfeeding ..................................................................................................... 102 Alicia D Debevec, Tracy A Evanson ABM Clinical Protocol #26: persistent pain with breastfeeding ................................................ 102 Pamela Berens, Anne Eglash, Michele Malloy et al Feasibility and acceptability of two complementary and alternative therapies for perceived insufficient milk in mothers of late preterm and early term infants ............................ 103 Jill R Demirci, Susan Bare, Susan M Cohen et al

105 Neonatal & Infancy Neonatal resuscitation for midwives ......................................................................................... 105 Libby Baraz, Jessica Case-Stevens A child development case study ................................................................................................ 110 Michaela Mercuri Midwives’ reflections and coping strategies around neonatal death .......................................... 115 Carol Glasgow

119 Worldwide Maternity Services Historical influences on utilising upright positions for birth in Africa ....................................... 119 Eunice Nyasiri Atsali, Grace Edwards Banning traditional birth attendants from conducting deliveries: experiences and effects of the ban in a rural district of Kazungula in Zambia .................................................... 124 Chilala Cheelo, Selestine Nzala, Joseph M Zulu ‘Opening the door’: a qualitative interpretive study of women’s experiences of being asked about intimate partner violence and receiving an intervention during perinatal home visits in rural and urban settings in the USA .................................................................... 125 Loraine J Bacchus, Linda Bullock, Phyllis Sharps et al Cash transfers, maternal depression and emotional well-being: quasi-experimental evidence from India’s Janani Suraksha Yojana programme ...................................................... 126 Timothy Powell-Jackson, Shreya K Pereira, Varun Dutt et al Training of midwives in advanced obstetrics in Liberia ............................................................. 127 Obed Dolo, Alice Clack, Hannah Gibson et al Providing rural and remote rural midwifery care: an ‘expensive hobby’ .................................... 128 Susan Crowther

129 News & Reviews Did you miss it? ........................................................................................................................ 129 Author and Subject index ......................................................................................................... 135 MIDIRS Midwifery Digest 27:1 2017

From the Editor Welcome to the spring edition of MIDIRS Midwifery Digest and, hopefully, the heralding of a new season. Here in the UK, I particularly look forward to the longer daylight hours, making travelling to and from work much easier than in the dark, especially after a long night shift. It also feels as if midwifery and maternity care is emerging from a dark place into the light again, with optimism for the future. The advent of new reviews last year such as the Better Births report (NHS England 2016a) leading to the Maternity Transformation Programme (NHS England 2016b) aim to make the recommendations a reality that will improve the care and experience for women and their families during pregnancy, birth and beyond. Scotland has also recently published their review of maternal and neonatal services in which it is envisaged all women will be given person-centred care suited to their needs and enable children to get the best start in life (The Scottish Government 2017). Midwives and maternity services have been under considerable scrutiny during the last year, with midwives sometimes singled out as being insensitive to women’s needs and choices, along with the debate around denying women choice of pain relief during labour and the argument that ‘normality’ is being pushed beyond the boundaries. However, these upsetting reports should not be taken out of context. Midwives do support women to have a positive experience of birth and support them in the choices they make, but do not take all the credit (or otherwise) in how maternity services are changing to give such care. This pathway is discussed within the Hot Topic written by Mary Newburn (p5), who has many years of experience in encouraging the voices of women to be heard. One avenue is through the Maternity Services Liaison Committees (MSLC) (soon to be rebranded as Maternity Voices Partnerships (MVPs)) — groups that meet to design services which meet the needs of the women and families using them. MVPs are forums comprising service users, providers and maternity service commissioners local to their particular area. Other papers within this edition demonstrate the excellent research and work within midwifery that is continually contributing to the wealth of knowledge that enhances maternity services. Midwives and nurses are often referred to as a ‘professional friend’ and professionalism must be instilled into all students from the first day of training. Todhunter et al (p20) have developed a useful online resource to aid student’s understanding of professionalism in, and out, of the workplace. This resource should be made available to all students on entering the profession to gain an understanding of the need to maintain professional standards. If you can truly be a ‘professional friend’ then women and their families will be assured that they are receiving the highest standard of care at all times, based upon the six Cs: care, compassion, competence, communication, courage and commitment. 4

Caring for the neonate at birth is a crucial part of a midwife’s role and all midwives should be equipped to carry out neonatal resuscitation. Baraz & Case-Stevens (p105) have written an excellent paper with regard to the aspects of neonatal resuscitation for midwives and is illustrated with the newborn life support flowchart. This information is relevant to midwives throughout the world, not just those in the UK. On balance I feel that our profession has been through a great deal of upheaval and uncertainty in the past year but have now arrived at a turning point, and the culmination of hard work and dogged determination will serve as a strong base on which to build the maternity services of the future. We can begin the implementation of the review recommendations and make the childbirth experience a positive and rewarding one — not only for women but also for midwives. Midwives should not become complacent or disheartened, but feel proud and rewarded for all the good work we do in our daily lives. Each day, remind yourself of one positive change you have brought about that has made the day better for someone and take pride in it.

References NHS England (2016a). Better births. Improving outcomes of maternity services in England. A Five Year Forward view for maternity care. London: NHS England. https://www.england.nhs. uk/wp-content/uploads/2016/02/national-maternity-review-report. pdf [Accessed 23 January 2017]. NHS England (2016b). Maternity Transformation Programme. London: NHS England. https://www.england.nhs.uk/ourwork/ futurenhs/mat-transformation/ [Accessed 23 January 2017]. The Scottish Government (2017). The best start: a five-year forward plan for maternity and neonatal care in Scotland - executive summary report. Edinburgh: Scottish Government. http://www.gov. scot/Publications/2017/01/3303 [Accessed 23 January 2017].

Cathy Ashwin, Principal Editor. © MIDIRS 2017.

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Hot Topic extract

Women changing maternity services. A look at service user involvement in the UK Mary Newburn ORIGINAL In September 2016 I travelled to Sydney, Australia, to present on service user involvement in maternity services at the 11th Normal Labour and Birth Conference. This article is based on the presentation, providing further background on how I got involved as a service user advocate.

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I have been active in maternity services since the 1970s following the births of my first two children and two very different experiences of labour and birth. The first birth, after persistent occipitoposterior position during many frightening hours of very painful labour, was traumatic. However, it was also a rewarding and life-changing experience that I have replayed in my head for almost 40 years. Thankfully, the trauma has now faded but at the time, during the dead of night and all alone, I thought that I was going to die in that white box of a room. Aged just 18, I had a lot to cope with. My mother was living almost 300 miles away; I was isolated and vulnerable.

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The hospital was old and antiquated, soon to be closed down. Ultrasound was beginning to emerge for scanning in pregnancy, but was not a routine part of antenatal care, and epidurals were not yet available for pain relief. I did however have ARM, an oxytocin drip and electronic fetal monitoring with abdominal straps that restricted movement and in combination made contractions horribly painful. I was given a deep, badly sutured, episiotomy causing lots of pain for months to follow. One-to-one midwifery care in labour was not considered important but large amounts of opioids were administered, a style of management that has been well-documented (Donnison 1988, Davis-Floyd 2001, DeVries et al 2001). I was fortunate when there was a 12 hour shift change, for the second time. Having been lying on a high labour ward bed for 16 hours, the new midwife inspired and ‘delivered’ me from the misery and horror of it all. I remember to this day her saying, ‘Come on, we can do this!’. This midwife was the first professional to connect with me as an equal human being since I had been admitted, treating me with real kindness and giving encouragement. When pregnant with number two, I attended some NCT (formally known as the National Childbirth Trust) antenatal sessions that were transformative. I planned for a home birth, though this was not something my NCT teacher viewed particularly positively. She was a nurse by background and most of her experience was of hospital births. As a second-timer with an array of practical labour preparation skills to draw on, the second labour and birth was truly empowering — despite being back in the same obstetric unit for reasons beyond my control. Instead of lying stranded on my back while my belly heaved over me, I was upright and leaning forwards. My partner massaged my lower back with the heel of his hand and soothed it in between contractions with a cool compress. A few months later, I began to train as an NCT antenatal teacher myself. I found the theories about labour and birth and emerging evidence about maternity care fascinating. Essential reading for NCT student teachers included books by Grantly Dick-Read and Sheila Kitzinger, whose work I already knew, plus The cultural warping of childbirth by Doris Haire (Haire 1972) and Marjorie Tew’s critical statistics on Safer childbirth (Tew 1985, Tew 1998). In his review of Tew’s work, GP Gavin Young commented: ‘The shift to hospital birth has been one of the great sociological changes in the industrialized world in the past 50 years. Yet this change took place with almost no evidence to support it. It ought to be a source of shame to those who promoted the shift through the 1950s, 60s and 70s that controlled trials were not considered necessary. Only a few brave voices cried in the wilderness, Archie Cochrane notably and Marjorie Tew.’ (http://wisewomanwayofbirth.com/ marjorie-tew-author-of-safer-childbirth/) Alongside my training as an antenatal teacher, I joined a handful of other women to set up and run 6

a new NCT branch and, with an older, dynamic breastfeeding counsellor, we started talking to the Community Health Council about how to improve breastfeeding support in our local services. From the late 1970s onwards, I was able to weave together my personal experiences, my conversations with my radical, feminist mother and my NCT education with local activism. We formed a local association under the umbrella of a national charity, we drew other women in, and we started talking to those with the power to influence services. Now, decades on, with my own children becoming fathers, I am still motivated. Also, in the UK, there is a rich history of childbirth activism and voluntary sector influence on policy and services. In Sydney, I set out to share some of that. In particular, approaches that have worked to achieve change in maternity care, plus some of the notable recent developments in the voluntary sector and grassroots activism brought about by new social media opportunities.

Grassroots networking, national influencing As an organisation, NCT has succeeded in having huge geographical penetration, covering virtually all postcodes in the UK with branch activities and involvement opportunities for pregnant women and new parents. It has also had considerable influence through the UK media, and in national policy arenas through its research, policy, press and parliamentary work. In addition, it has had (at some times more than others), a well-developed middle layer of ‘experienced’ parent representatives or service user advocates. Women, and occasionally men, who keep on keeping on. Who don’t move on when their own children start school but stick with volunteering and leadership in maternity services.

Persistent maternity activists During his presentation, Eugene Declercq described the many midwives, academics, and some doctors, attending the Normal Labour and Birth Conference as ‘persistent maternity activists’. I really like that phrase as it is such a positive affirmation for those who make a difference through long-term engagement and the determination to shift things forward. As well as committed professionals, there are many people working from a service user perspective who have been persistent over many years. Women of the community who have been around maternity services for some time, whose children are no longer babies, are sometimes criticised for being out of touch. Nonetheless, as I argued in Sydney, there are many roles for more experienced advocates. My role is a political one, though on some occasions I make this less overt than others. My blog, ‘A midwife for Kate: the silence that demands a roar!’ (Newburn 2015) highlighted that midwives at the 2015 royal birth were unrecognised and called for them to be named like the doctors. This attracted over 42,000 views, and the midwives were named in the press a day or two after publication. MIDIRS Midwifery Digest 27:1 2017

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As well as being connected to contemporary services and aspirations through the births of grandchildren, I regularly network with leaders and members of Maternity Service Liaison Committees (MSLCs). I have developed MSLC resources and support activities, and run training (Newburn & Fletcher 2015). Other relevant activities include lobbying for updated guidance for the NHS on local multidisciplinary forums with service user involvement at the centre (Newburn 2016), planning maternity conferences (see https://www.nct. org.uk/professional/past-events), and working as a co-investigator in major research projects, including the Birthplace in England cohort study (Birthplace in England Collaborative Group 2011). Other birth activists engage in multiple ways too; many are doulas, peer supporters or trained educational facilitators with many having local community support roles. Occasionally I hear of local people working on an MSLC who have become a bit stale, who have a single interest, limited commitment to accessibility and diversity, or who prevent other, potentially more dynamic people, from moving into key roles (Newburn et al 2017, Wilcock in press 2017). On the other hand, I hear far more about people who develop as the years go by and who have more to contribute to public service (Daellenbach & Pilley Edwards 2010). With more experience people tend to have greater knowledge. This might be a better understanding of how the NHS works and the history of services — and barriers to innovation — in their area. Experience tends to correlate with increased skills, including social media skills, facilitation skills, critical appraisal of research and/or development of personal assertiveness (Newburn & Fletcher 2015). Women who work as doulas, antenatal teachers, Positive Birth Movement facilitators or breastfeeding counsellors sometimes come into a system-influencing role to help change the infrastructure, as they gradually recognise that they can do only so much through working with parents one-to-one or in small groups, and the two roles support and inform each

other (Calvert 2016). Service users also move into new volunteering or paid roles over time, including mentoring other service users with less experience. So, new blood is always needed; all kinds of voices should be heard and engaged; and I’m a vocal advocate for valuing experienced activists. A longer period of involvement leads to a larger network of influential people. Experienced service users (or service user representatives) have the potential to influence local, regional and national policy, even international debates. They can contribute to the design and reporting of research, and the development of practice within services (NCT’s work on Creating a Better Birth Environment, for example, referenced in the Department of Health’s Health Building Note (DH 2013), helped to make access to birthing pools and en suite lavatories and showers a standard part of expected facilities in units). One strategy that has proved successful has been developing relationships with people in positions of authority; listening and challenging; being sure to put across observations and concerns and not just be passively swept along. NCT set up the Maternity Care Working Party in 1999 and organised conferences with the Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) on The rising caesarean rate: a public health issue and The rising caesarean rate: from audit to action. The charity enabled the establishment of the All Party Parliamentary Group on Maternity (APPGM) in 2000, providing the secretariat and inviting and briefing politicians. A consensus statement on normal labour and birth, Making normal birth a reality, was developed collaboratively with multiple stakeholders and launched at an APPGM meeting (Maternity Care Working Party 2007). This focus on mode of labour and birth was prioritised in the context of a rapid increase in caesarean rates, with no decrease in instrumental births. There is some evidence that the decline in normal birth rates halted during the time our campaigning was most active.

Change in caeserean and normal delivery rates in England 1990-2015 70

Prepaired by BirthChoiceUK using HES data from the helath and Social care Information Centre

Percentage of deliveries

60 50 40 30 20 Normal delivery rate

Normal delivery rate (new method) Caeserean rate

0 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 19 19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20

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At its best, NCT has offered constructively critical friendship to midwives, obstetricians and NHS maternity services, using a combination of sources to make the case for change, including intelligence from community conversations, walking the patch (Dunkley-Bent & Jones 2008), local surveys, high quality evidence such as Cochrane reviews and NICE guidance, and personal experiences. Maternity Service Liaison Committees NCT has been a proponent of Maternity Service Liaison Committees (MSLCs) as a valuable mechanism for inter-professional team working and a forum enabling service users and their advocates to influence maternity services locally (Newburn et al 2017). In the UK, MSLCs, whose terms of reference state they should usually be chaired by a service user or ‘lay person’, have been functioning for over 30 years. In my conference slides I quoted Michelle Quashie of Bromley MSLC, who said: ‘Wow! 30 committee members attended our MSLC meeting tonight, including obstetricians, paediatricians and 7 service users. Such a privilege bringing so many people together to make a difference to maternity services. What a turnout!’ (Personal communication, May 2015).

experiences. But then, when she honed her knowledge of formal evidence, having heard the message that the only authoritative knowledge was from formal research, she was discounted as ‘not being the right kind of user’ because she was now out of the ordinary. The rhetoric suggests that this kind of attitude is changing. NHS England (2013) has a website dedicated to involvement and engagement entitled ‘Transforming participation in health and care: the NHS belongs to us all’. This would be encouraging were it not the case that the NHS increasingly uses language in unfamiliar and unwelcome ways. For ‘Sustainability and transformation plans’ read costsaving; for ‘Success regime’ read top-down solution; and for ‘Local maternity system’ read actually not very local at all. Murphy-Lawless’s overview of Globalisation, midwifery and maternity services would suggest that these reforms are influenced more by corporate capitalism than health needs or social community values: ‘The work the state has done in the past, which we as ordinary citizens have welcomed in relation to health, education and welfare has altered as a result (of globalisation), as has the way the state speaks of its responsibilities.’ (2010:15)

Michelle, who blogs at ‘Strong since birth’ (http:// bit.ly/2jpdrLu), also organised a ‘Women’s Voices’ conference in October 2016 using social media to get her message across to potential delegates and to a broader audience (http://bit.ly/2iTmUbv).

If economic growth and national competitiveness in international markets are to predominate, how will these imperatives limit the liberal push towards increased citizenship and health rights?

Other impressive examples of dynamic MSLCs that have come to national prominence include Sheffield, where Rachel Gardner, MSLC leader, carries out regular investigations, creates infographics and has also founded a new charity, Forging Families. In Hampshire, Mindy Noble has had a paid role as the Chair for a number of years and she manages communications between commissioners, providers and local women using social media. In Reading, Wokingham and West Berkshire Maternity Forum (MSLC), chair Lisa Ramsey has pioneered involving a large team of active volunteers with clear role descriptions, and has created an annual report as a YouTube video (http://bit.ly/2i99jxX). There is also a National Forum of MSLC service user representatives convened by Catherine Williams, who has recently coordinated a position statement on the new Maternity Voices Partnerships (Newburn 2016), working with Laura James, Helen Gray and Sandra Guise.

‘You have the right to be involved, directly or through representatives, in the planning of healthcare services commissioned by NHS bodies, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services.’ (NHS Constitution 2015, emphasis added)

MSLCs are not a panacea. Where there is no support from commissioners or clinical managers and inadequate funding they struggle or are doomed (Newburn et al 2017). Nadine Edwards has shown (2014:168) that women wanting to have some influence via an MSLC can be persistently discounted. She quotes a telling interview from her research in which a woman says she was told ‘anecdotes are not helpful, the research says bla..’ when she talked about her own 8

The NHS Constitution states:

This suggests that rights have improved, and that the role of experienced service users, or advocates, is also formally recognised. In other areas of health care the term ‘patient leader’ is being used to denote a person with direct or indirect personal experience of a condition, who has skills to work strategically: ‘Patient Leaders are patients, service users and carers, who work with others at strategic level to influence change in health and healthcare.’ (Centre for Patient Leadership 2013). In a similar vein, the new Maternity Voices Partnership guidance speaks of co-design and coproduction values and practices (Newburn 2016), yet the sticking point will almost certainly be over an adequate level of funding. Global politics are changing. Social media is being used by both the President of the United States as well as by individuals, interest groups, pressure groups and political parties. In my talk in Sydney, I highlighted MIDIRS Midwifery Digest 27:1 2017

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the work of ‘traditional’ charities like NCT and AIMS. We have published hard copy journals and information documents, and have subscribing members. We have websites and use social media but are less fleet of foot than newer, younger initiatives, who can form and function virtually at relatively low cost. Look at the following examples, organised by the date of their founding. BirthChoiceUK, established in 2001, was an early adapter in this regard. Set up and run by just two individuals, it has now sold the ‘consumer-facing’ part of the business to Which? (www.which.co.uk). Similar clinical and organisational comparison web-based professional services are now being provided by the RCOG and the RCM, and BirthChoiceUK has closed, its good idea adopted, its influencing work done. By contrast, Best Beginnings, established in 2003, is a large, well-connected charity which raises and spends substantial sums. Its focus on improving public health (breastfeeding, mental health, stillbirth) and addressing social disadvantage (pregnancy for young and vulnerable women) makes it a clear ‘good cause’. It is modern in the sense of developing professionally designed, interactive, information Apps with strong visual appeal for use primarily on mobile phones. The founder and chief executive, Alison Baum, was made an OBE in the New Year’s honours. Birthrights is another new maternity organisation in the UK, registering as a charity in 2013. It started very small, with a clear focus on the law relating to maternity and human rights. It has achieved huge respect and influence through online information, conference speaking and training for health care professionals. In 2013, the Positive Birth Movement was founded by one individual, Milli Hill. Her model is a simple, clear, inclusive and low cost, yet sustainable one, which is dependent on social media for its global success. There are over 34,000 likes on Facebook and thousands of groups internationally. Postive Birth is: ‘a grass roots movement, spreading positivity about childbirth via a global network of free Positive Birth groups, linked up by social media … (aiming for) shared expertise, power and positivity…to challenge the culture of fear that surrounds birth (and) empower women to approach birth differently.’ (www.positivebirthmovement.org). Interestingly, while some of the group facilitators are professionals such as midwives or childbirth educators, or trained doulas, others are ‘women who are simply passionate about birth as a positive experience’. Finally, in this whistle-stop tour of new kids on the voluntary sector block, comes #MatExp, founded in 2014 and run largely on social media at low cost. Gill Philips, a community development professional, and Florence Wilcock, obstetrician, work with volunteers to offer a website, a Facebook forum for sharing, and a strong Twitter presence. #MatExp aims to MIDIRS Midwifery Digest 27:1 2017

encourage service users and professionals to join in conversations together. The Whose Shoes engagement tool, which looks like a traditional board game, is closely linked with #MatExp. It was developed by Gill, who is: ‘a champion of involving “experts by experience” and using innovative co-production approaches’ (www. nutshellcoms.co.uk). In 2016, a #MatExp project, Nobody’s Patient, funded by NHS England, held multidisciplinary workshops to test out new resources designed to explore the needs and experiences of: • women who are critically ill during pregnancy • parents of babies born prematurely or unwell at term • parents of babies who die before, during, or after birth (including late miscarriage) (http:// matexp.org.uk/). There are many dozens or hundreds of smaller maternity, bereavement, trauma, mental health, disability, mothering, fatherhood and early parenthood organisations. So this is far from a comprehensive round up, but it is interesting to think about the way community associations are changing, the kinds of aims of some of the newer voluntary groups and how they function. Now, to draw all of this together. Why do women who have used maternity services get involved? They do so to try to shape the way services develop. For me and many others, personal experience drives a desire to see more caring, responsive and less harmful maternity options — readily available and fully accessible. The feminist and human rights argument is that women should be able to determine the philosophy of the maternity care provided for their gender group. Maternity is fundamental to our existence. Our physical, emotional and social survival and well-being as a species rely upon it, which is another reason to be inspired and fascinated by procreation and birth, and the ways that care is delivered. Edwards (2014), a birth companion and AIMS activist, regards herself and others as ‘thwarted midwives’, women who have a calling to midwifery but who cannot bear to work within the confines of the factory-like hospital system. Equally, she is positively drawn into the camaraderie of joint working with inspired and committed midwives and activists with a shared set of goals; so an ‘outsider’ from the maternity care system who is an ‘insider’ with her like-minded group and held close by them in an association of shared interest. This will resonate for many. I have talked about MSLCs, an institution about which UK maternity services can be proud. So 9

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far as I am aware this multidisciplinary maternity committee is unique to the UK. Nobody attending the Sydney conference suggested otherwise. Activists in some other European countries, such as The Netherlands, would like to develop similar codesign systems for parent and public involvement. Rachel Verweij, a service user rep working with the Department of Midwifery Science at the University of Amsterdam, wrote after visiting the UK for the ‘Women’s Voices’ conference ‘I am really amazed at how many (great) initiatives you have in the UK!’ (https://marynewburn1.com/2016/10/14/service-usersinfluence-in-maternity-services-sydney-normal-labourand-birth-conference-october-2016/) Now, like never before, low cost opportunities to connect, communicate and influence are opening out thanks to social media, and the ideal of a woman’s right to autonomy is upheld under the law (Prochaska 2015), though it remains to be seen in what ways, and to what extent, new opportunities and rights will be able to withstand the impact of macro-economic and political influence. Mary Newburn, Patient and Public Involvement Lead for Maternity Theme, CLAHRC South London, King’s College London.

References Birthplace in England Collaborative Group (2011). Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ :343.

Donnison J (1988). Midwives and medical me: a history of the struggle for the control of childbirth. London: Historical Publications Ltd. Dunkley-Bent J, Jones H (2008). Maternity Services Liaison Committee (MSLC) ‘walks the patch’ to reflect the views of users. Midwives [Online Oct/Nov]. http://rcm.redactive.co.uk/ midwives/in-depth-papers/maternity-services-liaison-committeemslc-walks-the-patch-to-reflect-the-views-of-users/ [Accessed 10 December 2016]. Edwards N (2014). On not becoming a midwife: the role of the birth activist. In: Mander R, Fleming V eds. Becoming a midwife. 2nd ed. Abingdon: Routledge: 161-71. Haire D (1972). The cultural warping of childbirth. ICEA News. Spring: 11(1):5-35. Murphy-Lawless J (2010). Globalization, midwifery and maternity services: struggles in meaning and practice in states under pressure. In: Davies L, Daellenbach R, Kensington M eds. Sustainability, midwifery and birth. Abingdon: Routledge: 11-22. Maternity Care Working Party (2007). Making normal birth a reality. Consensus statement from the Maternity Care Working Party: our shared views about the need to recognise, facilitate and audit normal birth. London: NCT/RCM/RCOG. Newburn M (2015). ‘A midwife for Kate: the silence that demands a roar’, Birth Talk, 2 May. https://marynewburn1.com/2015/05/02/ a-midwife-for-kate-the-silence-that-demands-a-roar/ [Accessed 16 February 2016]. Newburn M (2016). Maternity Voices Partnership - the new MSLC. The Practising Midwife 19(10):8-12. Newburn M, Easter A, Fletcher G et al (2017). Maternity partnership working - mapping MSLCs in England. The Practising Midwife 20(1):26.

Calvert H (2016). Why your MSLC matters. http://matexp.org.uk/ matexp-and-me/why-your-mslc-matters/ [Accessed 10 January 2017].

Newburn M, Fletcher G (2015). Running your Maternity Services Liaison Committee: a practical guide from good practice to troubleshooting. London: NCT. http://bit.ly/2j6r13L [Accessed 7 January 2017.]

Centre for Patient Leadership (2013). Bring it on: 40 ways to support patient leadership. http://www.inhealthassociates.co.uk/wpcontent/uploads/2015/09/Bring-it-on-40-ways-to-support-PatientLeadership-FINAL-V-APRIL-2013.pdf [Accessed 8 January 2017].

NHS England (2013). Transforming participation in health and care. ‘The NHS belongs to us all.’ https://www.england.nhs.uk/ wp-content/uploads/2013/09/trans-part-hc-guid1.pdf [Accessed 7 January 2017].

Daellenbach REA, Pilley Edwards N (2010). How can birth activism contribute to sustaining change for better birthing for women, families and societies in the new millennium? In: Davies L, Daellenbach R, Kensington M eds. Sustainability, midwifery and birth. Abingdon: Routledge: 218-32.

Prochaska E (2015). UK Supreme Court upholds women’s autonomy in childbirth: Montgomery v Lanarkshire Health Board. [Online] 12th March. Birthrights. http://www.birthrights.org. uk/2015/03/uk-supreme-court-upholds-womens-autonomy-inchildbirth-montgomery-v-lanarkshire-health-board/ [Accessed 10 January 2017].

Davis-Floyd R (2001). The technocratic, humanistic and holistic paradigms of childbirth. International Journal of Gynecology and Obstetrics 75(Suppl 1):S5-S23.

Tew M (1985). Place of birth and perinatal mortality. Journal of the Royal College of General Practitioners 35:390-4. Tew M (1998). Safer childbirth? A critical history of maternity care. 3rd ed. London: Free Association Books.

Department of Health (2013). Children, young people and maternity services. Health Building Note 09-02: maternity care facilities. London: DH. https://www.gov.uk/government/uploads/ system/uploads/attachment_data/file/147876/HBN_09-02_Final.pdf [Accessed 8 January 2017].

Wilcock F (2017). Maternity Voices Partnerships blog [In press].

Department of Health (2015). The NHS constitution: the NHS belongs to all of us. London: Department of Health.

Newburn M. MIDIRS Midwifery Digest, vol 27, no 1, March 2017, pp 5-10.

DeVries R, Benoit C, van Teijlingen E et al eds (2001). Birth by design: pregnancy, maternity care and midwifery in North America and Europe. London: Routledge.

Original article. © MIDIRS 2017.

MIDIRS Midwifery Digest 27:1 2017

Research & Education extract

Satisfaction for treatment of hyperemesis gravidarum in day case settings compared to hospital admissions Caitlin Dean, Johnathon Marsden ORIGINAL Background Hyperemesis Gravidarum (HG) is a severe and potentially life threatening complication of pregnancy characterised by extreme levels of intractable nausea and vomiting leading to dehydration, malnutrition and a host of other complications (Dean & Gadsby 2013). Although rare, affecting only 1–1.5% of pregnant women, it can have a profound effect on the sufferer’s health and well-being (Gadsby & Barnie-Adshead 2011, Einarson et al 2013). Clinical manifestations of HG include weight loss of 5% or more of pre-pregnancy weight, ketosis and/or a urine output of <500ml in 24 hours. Electrolyte imbalance can occur and, if left untreated, further complications can follow.

patient

intravenous treatment

frustration isolation study

HG affects approximately 10,500 women per year, based on the 2014 live birth rate of 695,233 and accounts for in excess of 25,000 hospital admissions (Gadsby & Barnie-Adshead 2011). A further 30% of women suffer severe nausea and vomiting of pregnancy (NVP) with high levels of morbidity but without accessing secondary care services (Gadsby & Barnie-Adshead 2011). It is estimated that around 1000 wanted pregnancies per year are lost to termination due to the condition (Pregnancy Sickness Support (PSS) 2013). In the financial year 2003/04 the cost to the National Health Service (NHS) was calculated to be in the region of £36,481,745 (Gadsby & Barnie-Adshead 2011).

distress trimester internet

sickness social survey research media support traumatisation psychodynamic dehydration thyrotoxicosis stigmatisation Facebook health care debilitating hypokalemia public depression hypermesis gravidarum community maternity pregnancy innovation Severe vomiting misconceptions nausea MIDIRS Midwifery Digest 27:1 2017

Midwifery extract

Constructions of risk and the maternal body: implications for midwifery practice Kate Austin ORIGINAL Introduction Risk, as a concept, is prevalent in discussions surrounding childbirth and maternity care (Chadwick & Foster 2014). Risk and its construction also feature as key concerns in sociological theory and research, emerging in Gidden’s (1991) and Beck’s (1992) theories of reflexive late modern ‘risk societies’ which mark periods of hazardous social uncertainty (Tulloch & Lupton 2003). More recent theoretical approaches focus on the everyday lived experience of risk (Lupton 1999); yet both treat risk as socially constructed and thus socially meaningful (Tulloch & Lupton 2003).

This paper will examine sociological concepts of risk as applied to the maternal body to reveal the consequential implications for midwifery in everyday practice. The authoritative medical discourse model will be used to briefly examine the ways in which the maternal body has been constructed as ‘risky’. Following Chadwick & Foster, attention will also be drawn to the ‘lived experience’ in the maternity episode (2014), exploring risk as an embodied subjectivity (Lupton 1999). Potential solutions will be suggested to overcome the implications of these issues in an attempt to move away from the ‘cataclysmic pessimism’ of risk management in maternity care (Tulloch & Lupton 2003, Scamell 2011), bringing the holistic focus back to the individual woman as an agent of her own embodied birth experience.

MIDIRS Midwifery Digest 27:1 2017

Pregnancy extract

Congenital cytomegalovirus infection, knowledge and attitudes among maternal health professionals and pregnant women Sharon Wood ORIGINAL Introduction Congenital cytomegalovirus infection (CMV) is a leading cause of birth defects (Dollard et al 2007, Kenneson & Cannon 2007), yet anecdotal evidence suggests that the general public has a low awareness of the virus and health care professionals are unlikely to counsel pregnant women about the risks of infection. Taking simple hygiene measures during pregnancy could reduce instances of cytomegalovirus infection and lead to a reduction in birth defects, miscarriages and stillbirths. This paper will present the results of two studies designed to assess knowledge of and attitudes towards CMV among maternal health professionals and pregnant women. The results demonstrate the need to increase knowledge about CMV infection among the general public and identify midwives as being well placed and willing to provide information on risk reduction to pregnant women. We therefore recommend that information on risk reduction should be routinely made available to pregnant women in the UK and that midwives should be trained in how to deliver this information. Background

MIDIRS Midwifery Digest 27:1 2017

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Cytomegalovirus is a common virus that belongs to the herpes virus family (NHS Choices 2014). It can be passed between people through contact with bodily fluids such as saliva and urine. In most cases, CMV does not cause symptoms in adults and children, although some people may experience mild flu-like symptoms. Many people come into contact with CMV during childhood and it is thought that up to 50â&#x20AC;&#x201C;80% of adults in UK have been infected.

Labour & Birth extract

Water for labour and birth: getting back to the art of doing nothing Megan Cooper, Jane Warland, Helen McCutcheon ORIGINAL Introduction Despite the documented anecdotal benefits and an increasing global uptake by facilities and practitioners, the practice of water immersion (WI) for labour and birth continues to be challenged on a number of fronts. The combination of a pregnant woman with a bath of water remains problematic for many, with consistent challenges raised about the associated risk and therefore safety of the practice. Whilst there is a recognised paucity of rigorous research surrounding WI there is evidence to suggest that water provides more than just physical benefits to women. However, practitioner fear remains a barrier to the adoption of WI in maternity care units around the globe as does the riskaverse views that suggest that water is just too risky. Despite this, there is emerging evidence to suggest that many practitioners view WI as just another mode of birth and therefore, no riskier than birth on land. This paper considers these issues in the context of contemporary maternity care and discusses WI as a way of restoring womenâ&#x20AC;&#x2122;s choice and the midwifery philosophy of birth as a normal physiological event.

Art is something that takes on various meanings dependent upon context. However, by definition, art is something that requires skill and knowledge with the addition of creative flair and attention to detail (Merriam-Webster 2016). Whilst midwifery may not always be a tangible entity that can be easily defined, there are elements of being a midwife that could be denoted as artful or even, artistic.

MIDIRS Midwifery Digest 27:1 2017

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The arts of midwifery: observation, intuition, patience, communication, listening

Postnatal extract

‘Halfway towards recovery’: rehabilitating the relational self in narratives of postnatal depression Meredith Stone, Renata Kokanovic ORIGINAL REPRINT This article explores expositions of subjectivity in accounts of postnatal depression (PND). It examines the public narratives of 19 Australian women contributing to a health information website (healthtalkaustralia.org), collected across two Australian qualitative research studies conducted between 2011 and 2014. For the first part of the paper we analysed narrative data using a combination of phenomenological and psychoanalytic techniques. We found that postnatal distress was described in embodied, relational terms and that women depicted their distress as a pre-verbal intrusion into ‘known’ selves. We interpreted this intrusion as a doubly relational phenomenon — informed at once by a woman’s encounter with her infant and her ‘body memory’ of earlier relational experiences. For the second part we examined how and why women classified this relational distress as PND. We drew on illness narrative literature and recent work on narrative identity to explore why women would want to ‘narrate PND’ — an apparently antithetical act in an environment where there is a duty to be a good (healthy) mother. We highlight the dual purpose of the public PND narration — as a means of re-establishing a socially sanctioned known self and as a relational act prompted by the heightened relationality of early maternity. Our focus on the salutary aspects of narrating PND, and its links to relational maternal subjectivities, offers a novel contribution to the current literature and a timely analysis of a largely uninterrogated sociocultural phenomenon.

MIDIRS Midwifery Digest 27:1 2017

Keywords: Australia, narrative interviews, postnatal depression, qualitative study, subjectivity, relational self, phenomenology, psychoanalysis. 69

Infant Nutrition extract

Bristol’s milk bank revisited — five years on Val Dickens ORIGINAL How time flies! It seems no time at all since I wrote about the opening of Bristol’s milk bank in Southmead Hospital — but in fact it was five years ago. Since then the milk bank has gone from strength to strength through the sterling efforts of determined staff and a volunteer transport organisation — catchily called Blood Bikes! On the 21st November, the wettest day of the year, a party was held in the family room of Southmead’s maternity unit. The weather delayed the arrival of many guests but eventually there was a lovely mix of milk bank administrators, maternity unit staff, donor mothers and their babies, collection drivers, representatives from equipment providers and many others who had helped the setting up of the milk bank by a variety of fundraising efforts. Two huge cakes were provided by a sponsor and there was enough left over to keep many mothers happy in the unit and the NICU.

Milk Bank 5 year celebration at Southmead Hospital

MIDIRS Midwifery Digest 27:1 2017

Neonatal & Infancy extract

Neonatal resuscitation for midwives Libby Baraz, Jessica Case-Stevens ORIGINAL Introduction Approximately 10% of infants require some assistance to establish regular respirations at birth, while less than 1% need extensive resuscitative measures (Wyllie et al 2015). Midwives are the most likely health care professional to assess the term neonate at birth and initiate neonatal resuscitation when required. It is therefore paramount that the midwife maintains skill and competence in assessing the neonate at birth and is able to respond promptly to those severely unwell infants in need of immediate intervention. The Nursing and Midwifery Council (NMC) (2009:47) require midwives from the point of qualification who can at least ‘Initiate emergency measures in both primary and secondary care settings’ and ‘sustain emergency measures until help arrives’. This would include being confident with local policies and practices around neonatal emergency care in both the hospital and community settings.

Recent approaches to ‘resuscitation of the newborn’ have acknowledged that the terminology ‘transition to extrauterine life’ may be more appropriate in the majority of cases. This article discusses the initial assessment of the newborn at birth and explores some of the latest guidance around the subject of neonatal resuscitation for midwives.

MIDIRS Midwifery Digest 27:1 2017

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Worldwide Maternity Services extract

Historical influences on utilising upright positions for birth in Africa Eunice Nyasiri Atsali, Grace Edwards ORIGINAL Birthing positions in the second stage of labour have been researched widely in the last three decades. Upright positions in this paper refer to positions attained while the spine is vertical (Sutton 2000) and other alternative positions which may facilitate normality in birth; kneeling, standing, squatting, sitting with the back at an upright angle of more than 45 degrees, all fours and lateral positions (De Jonge & Lagro-Janssen 2004). Recent evidence suggests that upright positions are associated with fewer episiotomies, less pain, reduced instrumental deliveries and shorter duration of the second stage of labour (De Jonge et al 2004, Walsh 2011, Gupta et al 2012, Nieuwenhuijze et al 2012). Moreover, there has been evidence of better neonatal outcomes and increased maternal satisfaction when compared to supine positions. Current recommendations from the UK’s National Institute for Health and Care Excellence (NICE) (2014) endorse the practice of women utilising alternative positions in labour and discourages use of supine positions in normal childbirth. Traditionally, many African women used upright positions in childbirth such as squatting, kneeling and all fours (Lugina et al 2004, Badejoko et al 2016). This practice was intuitively used by traditional birth attendants (TBAs) and still remains the practice in home birth where TBAs attend. In some countries such as Nigeria, birth was described as the ‘day of kneeling’. Kneeling is associated with respect, therefore giving birth in this position was a sign of respect and honor (Badejoko et al 2016). Upright positions are more commonly practised at home births and during midwifery-led care, even in developed countries (Hanson 1998, Priddis et al 2011, Hodnett et al 2012). Many midwives feel that women are empowered and more in control of their birth when they are free to adopt the positions which are more comfortable for them (Hanson 1998).

During the colonial period in Africa, childbirth moved from home to hospital as this was thought to be a safer environment in which to mitigate risks (Badejoko et al 2016). Although hospital birth has been promoted as reducing maternal mortality, it also encourages medicalisation of birth, such as use of continuous monitoring, use of oxytocin to augment labour and a bed conveniently placed for women to lie on (Davis-Floyd 2003, Fahy et al 2008).

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News & Reviews extract

Did you miss it? Forthcoming study day — 28th March 2017 JFH Briefing is a free CPD-accredited study day organised by the Journal of Family Health, which reflects current thinking, guidance and issues relevant to the community health care sector. The journal has an excellent reputation and now in its 50th year, the study day offers: • fifteen CPD-accredited seminars targeted at community health professionals and safeguarding leads • around 600–800 delegates sharing their knowledge and expertise • exhibitors showcasing the latest products and services available to the family health care market. A comprehensive seminar programme featuring different streams in the health care industry will run to ensure that visitors can hear experts deliver talks on key topics that will update you on policy, best practice and developments in obesity, safeguarding, nutrition, mental health and dermatology. Venue: ILEC Conference Centre, London. Email: info@jfhc.co.uk

News from Group B Strep Support Charity — pregnant women can test for leading cause of life-threatening infection in newborn babies National charity Group B Strep Support is delighted to announce a partnership with health care company HiberGene Diagnostics to help pregnant women to test for group B streptococcus (Group B Strep or GBS) — the most common cause of life-threatening infection in newborn babies. One in four pregnant women is unknowingly carrying GBS bacteria, which causes meningitis, sepsis or pneumonia in more than 500 newborn babies a year. On average, one newborn baby a week dies from GBS infection. Testing for GBS is not routinely available through the NHS, unlike in countries such as the USA, France, Germany, Poland and many others. HiberGene Diagnostics’ test for GBS is called Strepelle and uses the international ‘gold standard’ enriched culture method for detecting GBS carriage, recognised in Public Health England’s UK Standard:

MIDIRS Midwifery Digest 27:1 2017

‘We are delighted to be working with HiberGene Diagnostics who are supporting our helplines and information services for new and expectant parents’ says Jane Plumb MBE, Chief Executive of Group B Strep Support, ‘Pregnant women are rarely offered testing in the NHS, and if they are, a “gold-standard” test like Strepelle is seldom available. With their help, and their test, we are confident that more babies will be protected from preventable group B Strep infection.’ Brendan Farrell, Chairman and CEO of HiberGene Diagnostics agrees: ‘Commercial tests like Strepelle enable women to find out whether they carry group B Strep in pregnancy so they can make informed choices about what is best for them and their baby. Identifying pregnant women likely to be carrying group B Strep and giving them IV penicillin during labour can reduce group B Strep infection in newborn babies by over 80%.’ Strepelle is an easy to use home-to-laboratory test recommended from 35 weeks’ gestation. Once the laboratory has received the completed test, the results are sent via text within three working days and, for positive results, a hard-copy of the results is also sent. Strepelle costs £39.99 and is available from selected independent pharmacies and online from www.strepelle.com. For further information, please contact: Sara Milne or Nikki Fox at the Strepelle Press office, tel: (overseas 44 20 7736 4022) 020 7736 4022 (office hours), email: saramilne@clareville.co.uk or nikkifox@ clareville.co.uk, Jane Plumb MBE, Chief Executive, Group B Strep Support, tel: (overseas 44 1444 416176) 01444 416176, email: jplumb@gbss.org.uk.

First time mums needed for pre-eclampsia study Researchers are looking at why women who suffer from a dangerous condition during pregnancy are at greater risk of stroke or heart disease in later life. First time mums are being asked to take part in a study which could potentially save lives and help doctors understand more about the long-term effects of pre-eclampsia on mums’ hearts. The leading cause of maternal deaths around the world, pre-eclampsia causes poor growth of the baby and can lead to heart problems later in life for mum and child. It is characterised by high blood pressure and a large amount of protein in the urine.

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