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OBJECTIVE: to explore the use of language by midwives reporting their experiences of baby-feeding practice. DESIGN: A qualitative approach incorporating a secondary analysis of data previously collected in a study based on grounded theory principles. Data were collected using in-depth interviews. The secondary analysis involved a content analysis method. SETTING: two maternity services in the north of England. PARTICIPANTS: 30 midwives who worked across all clinical areas. FINDINGS: these midwives' explanations of how they supported women with baby feeding suggest that they used language to direct women towards decisions that the midwives thought best, without prior exploration of the woman's understanding and beliefs of baby feeding. Women were often described as 'girls' and 'ladies' indicating the power differentials in their relationship. The midwives were aware that, at times, the language they used was contradictory to woman-centred maternity care. KEY CONCLUSIONS: language may be used to control childbearing women and direct them to decisions that the midwife wants, rather than enabling the woman to make her own decisions. The terms used by midwives to relate to women, such as 'girls' and 'ladies', may be a strategy used to improve a midwife's perception of her status in maternity care. IMPLICATIONS FOR PRACTICE: language may be used to undermine women. It is important that the language used when interacting with women is considered carefully in order to facilitate an unbiased perspective and to promote partnership. The word 'women', rather than 'girls' or 'ladies', should be used when referring to users of the maternity services. [ABSTRACT FROM AUTHOR]

OBJECTIVE: to discover the views of midwives in relation to baby feeding. DESIGN AND METHOD: qualitative using grounded theory. Data collection used in-depth interviews with 30 midwives who volunteered to participate. Field notes of the interaction between the researcher and participant were also recorded as data. The constant comparison process was used to generate codes and subsequent conceptualisations from the data. SETTING: two maternity units in the North of England, UK. FINDINGS: the core category of this study is called 'surviving' baby feeding, and the findings reported here are a significant theme that emerged. These midwives described a management strategy termed 'breaking the rules' for supporting mothers with baby feeding. The concept 'breaking the rules' represented practices that were not congruent with evidence-based, baby-feeding policy and recommendations, or with some practices that were usual in the local working environment. These midwives were aware of their actions but described how they 'hid' their behaviour from mothers and from their peers. Some of the behaviour described showed that these midwives 'broke the rules' in relation to professional requirements and the facilitation of informed decision making about feeding practices with the women in their care. However, some midwives reported examples of practice that is woman-centred, and supportive of baby feeding, but this was not acceptable to others in the working environment. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: deviant behaviour was described by these midwives in relation to informed decision making and options for mothers in baby-feeding practice. These midwives 'knowingly concealed' their deviant practices from others. These behaviours should be taken seriously as they risk being negligent in relation to UK statutory professional requirements. However, practices that depart from those that are normal in the local working environment are not always negative and detrimental to the recipients of care; they can be positive. There needs to be more research, open discussion and debate about midwifery practice that does not always 'fit in' with professional, and 'normal' expectations. In this study, the term 'baby feeding' relates to how babies' nutritional needs are met. [ABSTRACT FROM AUTHOR]

Background: Chilean midwives have been identified as essential for successfully implementing an abortion law, a practice which could potentially be understood as contradicting their central mission. Nevertheless, to date, there has been no investigation into how Chilean midwives have incorporated induced abortion care provision into their professional identity., Objective: To elucidate how Chilean midwives understand and provide abortion care and how they have (re)defined their professional identity to include induced abortion care. This article reports the findings of the second part of this aim., Methods: This study was underpinned by a constructivist grounded theory methodology informed by a reproductive justice and feminist perspective. Midwives from Chile who have cared for women undergoing abortion were invited to participate in the study. After purposive and theoretical sampling, fifteen midwives were recruited., Findings: Midwives' identity is woman-centred, with high value placed on their role protecting life. These two aspects of midwives' identity are in contradiction when providing abortion care. Midwives' identity results from and informs midwives' practice. Midwifery regulation influences both practice and identity. The model 'Navigating a maze' explains the interaction of these three elements., Conclusion: Midwives' identity response to the enactment of the Chilean abortion law is an example of how professional identity must navigate regulation and practice to make sense of its purpose. In light of this study's findings, the current tension experienced in midwives' identity should be carefully attended to prevent adverse outcomes for midwives and the Chilean population., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Policy implementation can be affected by what individuals believe to be right and wrong. When implementing abortion policies, providers' moral beliefs can be relevant in the success of the implementation process. Considering that midwives and nurses are direct providers of abortion care, exploring their experiences related to abortion policy implementation could provide helpful information to prevent policy failure., Methods: Systematic integrative review. The studies were identified through an electronic search strategy and the screening of the reference lists of all selected articles. Studies were retrieved from eight medical and social sciences databases. Thirty-one studies focused on midwives' and nurses' experiences of implementing abortion policies, irrespective of setting or age of study were included in this review. Studies included used qualitative, quantitative and mixed methods. Study quality was appraised using the Mixed Method Appraisal Tool version 2018. No study was excluded from this review based on its quality appraisal., Results: In terms of their quality, most studies included in this review were conducted appropriately. Three superordinate themes represent the main elements that challenge midwives and nurses when providing abortion care. The first superordinate theme identified that many midwives and nurses believed fetuses are sentient beings, making them worthy of compassionate treatment. The next superordinate theme was focused on preferences and expectations about abortion care. Finally, the third superordinate theme illustrates midwives' and nurses' experiences with other team members, highlights their creativity when challenged with insufficient resources and provides a glimpse of the numerous techniques used for coping with work-related stress., Conclusion: Midwives and nurses worldwide face multiple challenges when providing abortion care. Guidelines aiming to support policy implementation should consider how abortion affects healthcare providers and suggest appropriate measures to reduce these and other barriers. Midwives and nurses technical and ethical competencies for abortion provision should be strengthened., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: to explore how midwives׳ personal involvement in clinical negligence litigation affects their midwifery practice., Design: descriptive phenomenological study using semi-structured interviews., Setting: in 2006-2007 in-depth interviews were conducted in participants׳ homes or at their place of work and focused on participants׳ experience of litigation. Participants were recruited from various regions of England., Participants: 22 National Health Service (NHS) midwives who had been alleged negligent., Findings: clinical practice affected was an increase in documentation, fear of practising outside clinical guidelines and electronic fetal monitoring of women at low obstetric risk; these changes were not widespread. Changes in practice were sometimes perceived negatively and sometimes positively. Forming a good relationship with childbearing women was judged to promote effective midwifery care but litigation had affected the ability of a minority of midwives to advocate for women if this relationship had not been established. Litigation could result in loss of confidence leading to self-doubt, isolation, increased readiness to seek medical assistance and avoidance of working in the labour ward, perceived as an area with a high risk of litigation. A blame culture in the NHS was perceived by several midwives. In contrast an open non-punitive culture resulted in midwives readily reporting mistakes to risk managers. Litigation lowered midwifery morale and damaged professional reputations, particularly when reported in the newspapers. Some midwives expressed thoughts of leaving midwifery or taking time off work because of litigation but only one was actively seeking other employment, another took sick leave and one had left midwifery and returned to nursing., Key Conclusions: litigation can have a negative effect on midwives׳ clinical practice and morale and fosters a culture of blame within the NHS., Implications for Practice: education regarding appropriate documentation, use or non-use of electronic fetal monitoring and the legal status of clinical guidelines will enable midwives to respond proportionately to the threat of litigation. A culture of openness and sharing the problem when adverse events occur would help to extinguish the current blame culture in the National Health Service. Litigation must be recognised by management as capable of inducing loss of confidence and reluctance to work in the labour ward. Promoting teamwork will help support these midwives. The potential for litigation in maternity care could affect retention of the midwifery workforce., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: to explore how midwives' personal involvement in clinical negligence litigation affects their emotional and psychological well-being., Design: descriptive phenomenological study using semi-structured interviews., Setting: in-depth interviews were conducted in participants' homes or at their place of work and focused on participants' experience of litigation. Participants were recruited from various regions of England., Participants: 22 National Health Service (NHS) midwives who had been alleged negligent., Findings: unfamiliarity with the legal process when writing statements, attending case conferences and being a witness in court provoked significant stress for midwives. This was exacerbated by the prolonged nature of maternity claims. Support ranged from good to inadequate. Participants who no longer worked for the defendant Trust felt unsupported. Stress could manifest as physical and mental ill-health. Some midwives internalised the allegations of negligence believing their whole career had become worthless. Previous knowledge of the legal process ameliorated the experience. Midwives also exhibited anger and resentment when litigation concluded and some took years to heal from the experience., Key Conclusions: midwives come from a caring and relational paradigm. When interfacing with the adversarial and contentious paradigm of tort law, midwives can abreact and suffer emotional, physical and psychological harm. Support for midwives experiencing litigation must be improved., Implications for Practice: Understanding the effects of personal involvement in litigation is important in order to improve the quality of support for this group of midwives. It will also aid development of targeted education for undergraduate, post-graduate and in-service midwives. In the longer term it may help policy makers when considering reform of clinical negligence litigation and NHS employers to structure support mechanisms for staff involved., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: to describe the incidence of maternal death by age, marital status, timing and place of death in Ibadan North and Ido Local Government Areas of Oyo State, Nigeria., Design: a retrospective study using multistage sampling with stratification and clustering to select local government areas, political wards and households. We included one eligible subject by household in the sample. Data on maternal mortality were collected using the principles of the indirect sisterhood method., Setting: Ibadan city of Oyo state, Nigeria. We included eight randomly selected political wards from Ibadan North LGA (urban) and Ido LGA (rural)., Participants: 3028 participants were interviewed using the four questions of the indirect sisterhood method: How many sisters have you ever had who are ever married (or who survived until age 15)? How many are dead? How many are alive? How many died while they were pregnant, during childbirth, or within six weeks after childbirth (that is, died of maternal causes)? We also included other questions such as place and timing of death, age of women at death and number of pregnancies., Findings: 1139 deaths were reported to be related to pregnancy, childbirth or the puerperium. Almost half were aged between aged 25-34 years. More deaths occurred to women who were pregnant for the first time (33.4%, n=380) than for any other number of pregnancies, with 49.9% (n=521) dying within 24 hours after childbirth or abortion and 30.9% (n=322) dying after 24 hours but within 72 hours after childbirth or abortion. Only 71.5% (n=809) were reported to have been admitted to health-care facilities before their death, the percentage being higher in the urban LGA (72.4%, n=720) than the rural LGA (65.4%, n=89). The percentage being admitted varied from one political ward to another (from 42.9% to 80.4%), the difference being statistically significant (χ(2)=17.55, df=7, p=0.014). The majority of the deaths occurred after childbirth (63.5%, n=723). Most deaths were said to have occurred in the hospital (38.6%) or private clinic (28.2%), with 16.0% dying at home and 6.5% on the way to hospital., Key Conclusions: maternal mortality in Nigeria is still unacceptably high., Implications for Practice: ensure adequate training, recruitment and deployment of midwives and others with midwifery skills. Ensure midwives and other skilled birth attendants are backed up with functioning and well equipped health-care facilities. Provide health education and information to the public with regard to reproductive health and ensure the development and dissemination of a policy regarding attendance at birth by only health workers who have midwifery skills., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: to explore midwives' views on ideal and actual maternity care., Design: a qualitative hermeneutic phenomenological study based on the method of van Manen (1997) using individual in-depth interviews to gather data., Setting: Flanders, Belgium., Participants: 12 purposively sampled midwives, of whom nine from three different non-university hospitals and three independent midwives conducting home births., Findings: five major themes were identified: 'woman-centred care', 'cultural change', 'support', 'midwife and obstetrician as equal partners' and 'inter-collegial harmony'. In this paper 'woman-centred care', 'cultural change' and 'support' are discussed along with their subthemes. Midwives thought ideal maternity care should be woman-centred in which there were no unnecessary interventions, women were able to make an informed choice and there was continuity of care. Furthermore, ideal maternity care should be supported by midwifery education and an adequate staffing level. Also, a cultural change was wanted as actual maternity care was perceived to be highly medicalised. Barriers to achieving woman-centred care and possible strategies to overcome these were described., Conclusions: findings from this study were consistent with those of other studies on midwives' experience with obstetric-led care. Despite the medicalised care, midwives still held a woman-centred ideology. In order to be able to work according to their ideology, different barriers need to be addressed. Although midwives suggested strategies to overcome these barriers, some were considered to be very difficult to overcome., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Acceptance of a paper for publication sometimes appears to be a mountain that has to be climbed. For some it has the height of Everest but for others it is a stroll up a hill. In writing this paper I hope that readers will be able to have an easier job in writing a paper that will be accepted in this journal and that in return the editor's task will be a little easier.

Aim: to determine whether intrapartum fetal monitoring guidelines used by midwives in one region of England for women at low risk of obstetric complications were evidence-based., Objective: to assess the quality of such guidelines using an appraisal tool., Design and Setting: an appraisal of guidelines gained via a postal survey of all National Health Service Trusts supplying maternity services in one region in the north of England, conducted over a six-week period (June-July 2001)., Participants: 28 Trusts were eligible to participate; 32 guidelines were returned from 24 Trusts., Data Analysis: two reviewers from a multi-disciplinary panel appraised each guideline, producing two sets of data that were analysed independently of each other. Each was treated as a separate case (n=64 cases). Inter-reviewer agreement was summarised using descriptive categories., Findings: the highest possible overall quality score was 54, and the lowest 18. Whilst no guideline scored 54, five of the 64 cases scored 18. The mean overall quality score was 26.8. In 36 of the 64 cases, both reviewers rated guidelines as 'definitely not' recommended for practice. Guidelines were scored against specific aspects of evidence-based practice. Forty-one of the 64 cases received the lowest possible quality score (='1') for use of systematic reviews of the literature on electronic fetal monitoring. In 47 cases, guidelines were scored '1' for the quality of evidence-based clinical recommendations. The quality of information on client monitoring preferences was considered low in over half the 64 cases (n=35). There were no instances where the number of cases receiving 'highest possible quality' scores was greater than those receiving 'lowest possible quality' ratings., Conclusions and Implications for Practice: a small number of guidelines were assessed as high quality, but the majority were poorly appraised by the reviewer group in most areas. This has implications for the delivery of evidence-based midwifery care since those midwives practising according to the guidelines surveyed would not have been supported in implementing research into practice.

Objective: to explore, describe and understand the expectations during pregnancy and subsequent experiences of childbirth in primiparae., Design: a qualitative study using a phenomenological approach. Data were collected using unstructured, tape-recorded interviews in late pregnancy and at two weeks post birth., Setting: the north of England., Participants: eight pregnant women, expecting their first baby., Findings: the women all wanted to take an active part in their labour and the feeling of being 'in control' was the main finding and the 'essence' of this study. This was achieved through support from partners, the positive attitudes of the midwives caring for them during pregnancy and labour, information giving during pregnancy and labour and being able to make and be included in decision making during labour., Implications for Practice: if women are to be empowered by making choices for childbirth and feeling 'in control', then it is important for midwives to explore and discover the wishes and feelings of women in their care so that realistic expectations can be promoted and then hopefully fulfilled., (Copyright 2001 Harcourt Publishers Ltd.)

Objective: to ascertain who was providing antenatal care in the community in a defined geographical area in the north of England, and whether the care could achieve the government objectives presented in Changing Childbirth (DoH 1993)., Design: a questionnaire was used to obtain demographic information and semi-structured interviews were held with care providers in order to assess the perspective of those providing care., Participants: a purposive sample of nine community midwives and six general practitioners (GPs)., Findings: the midwife was the professional undertaking most of the antenatal care although in most instances there was a GP available on site if required. GPs saw the midwife as the main provider of care with themselves as 'back up'. Conflict over responsibility for care was an issue in some instances. Whilst changes in antenatal care provision had been, or were about to be made, only one midwife expressed a clear positive feeling towards midwife-led care. Giving women the opportunity for choice provoked an overwhelming feeling of helplessness for midwives. Midwives and GPs believed their education adequately prepared them to provide antenatal care in the community, however, GPs did not attend regular updating sessions., Implications for Practice: whilst it was recognised that midwives are taking increasing responsibility for antenatal care, GPs still believe that overall responsibility lies with them; therefore, there is a need to clarify roles. The majority of midwives expressed reservations about midwife-led care.

Objectives: 1) to provide a descriptive analysis of women's views of the antenatal care provided in the study centre; 2) to identify which aspects of antenatal care were important to women; 3) to assess whether or not women 'booked' for delivery at the study centre would welcome the formal introduction of a midwifery-led service and 4) to audit sources of satisfaction and dissatisfaction identified in the survey., Design: descriptive survey using a self-administered questionnaire, and a self-administered audit questionnaire using a modified Measure of Satisfaction., Setting: the antenatal clinic of one teaching hospital in the north of England between July 1993 and August 1993. The audit was conducted between December 1994 and February 1995., Participants: 110 women attending four 'follow up' antenatal clinics participated in the survey and 151 women participated in the audit., Findings: many women felt they were already having midwifery-led care and that it was important to them to see a doctor during pregnancy. Generally the women were satisfied with antenatal care. Factors which caused dissatisfaction were, lack of continuity of care, quality of advice, waiting time and these were the focus of the audit., Implications for Practice: local needs should be assessed before implementing changes in service. Elements of good practice should be identified to ensure that they are not compromised in a changing service. Further evaluation of the changing maternity service is needed to monitor satisfaction and dissatisfaction.