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In this article, Anita Johnson carried out an interview with Cathy Charles, a midwife and aquanatal teacher in Wiltshire, to explore the benefits of aquanatal exercise in pregnancy and the postnatal period; this is particularly pertinent at a time when there is a focus on mental wellbeing and rising obesity and caesarean section rates. Anita wanted a first-hand account from a midwife trained in water-based fitness and her experiences of delivering aquanatal classes to pregnant women. Following Anita's own experience of participating in the aquanatal class and Cathy's entertaining interview she hopes it may encourage midwives to promote this form of exercise and to pursue recognized training to deliver their own classes.

Increasing breastfeeding prevalence rates has been identified as key to improving health and well being outcomes for mothers and babies. (Dyson et al 2008, Unicef 2013; Renfrew et al 2012a; Renfrew et al 2012b). Within one maternity unit in England, in 2014, 80 per cent of women initiated breastfeeding at birth, but by day 10, only 45 per cent were breastfeeding exclusively, identifying a drop off rate of 35 per cent. As part of achieving the Unicef UK Baby Friendly standards, retrospective audit was undertaken to investigate why women were not continuing to exclusively breastfeed. Findings from the study identified that when a baby received a supplement of formula milk before 72 hours of age, the mother was less likely to be exclusively breastfeeding at 10 days. This was statistically significant (Sharp 2014). An innovation was implemented for some mothers to receive additional one-to-one feeding support in hospital and the community, as a result of which supplementation rates decreased.

Breastfeeding education must motivate a complete workforce in such a way that they are equipped with the fundamentals and extended skills to carry out their role as infant feeding gurus, throughout their career. To achieve this with any success, there is an intrinsic need to establish a total understanding of both the physiology and emotional importance which underlies the art of breastfeeding. Only when this is attained will passion and longevity for the 'art' be fully embraced and respected.

The birth of a baby is a family experience. However, in the United Kingdom birth often occurs outside the family environment, in hospital. Both home and hospital births have risks and benefits, but research shows that, for most women, it is as safe to give birth at home as it is in hospital. Women report home-birth to be satisfying with lowered risks of intervention and less likelihood of being separated from their family. It is also more cost effective for the National Health Service. Yet, whilst midwives are working hard to promote home birth as an option, it remains controversial. The aim of this paper is to raise awareness of the safety of home birth and the needs of women and midwives when a home birth is chosen. It provides an overview of care required and the role of the midwife in the ensuring care is woman-centred and personalised.

Cocaine is the second most commonly used illicit drug. Use in pregnancy and breastfeeding may have severe consequences for the baby due to its pharmacokinetic properties. Midwives need to be aware of the prolonged action of cocaine and be alert to the possibility of cocaine toxicity if a baby is excessively irritable and tachycardic. Euphoric highs are brief but breast milk and urine remain positive for long periods. Infant urine following exposure to cocaine via breast milk may remain positive for up to 60 hours. Mothers who snort cocaine should pump and dump breast milk for 24-48 hours. Passive inhalation of crack cocaine smoke may also result in infants with positive toxicology screens. Cocaine powder should never be applied to the nipples of breastfeeding mothers.

The increase in substance use which occurred in the 1980s was disproportionately large among women of reproductive age, so both the numbers of women who use drugs and the duration of drug use have increased (Hepburn 2004). While drug use occurs throughout society, the type and pattern of drug use that is associated with medical and social problems is closely associated with socio-economic deprivation. Socio-economic deprivation is in turn associated with unhealthy lifestyles and behaviours such as smoking and poor diet. Deprivation, associated lifestyles and substance use adversely affect the health of mother and baby, so the effects are cumulative. Consequently women with problem drug and/or alcohol use have potentially complex pregnancies (Hepburn 2004).

With a rise in caesarean births there is a rise in wound care management issues for midwives and the potential for surgical site infections (SSIs). The burden of SSIs include increases in maternal mortality, morbidity, length of hospital stay and cost. Sepsis is currently the leading cause of maternal mortality, with 50 per cent of the women who died from sepsis having had a caesarean birth (Centre for Maternal and Child Enquiries (CMACE) 2011). Wound management and the prevention of sepsis are therefore issues of great concern to midwives. This article considers the incidence of wound infections and presents the guidance available to help address this problem.

The Confidential Maternal and Child Enquiry (CMACE) has firmly put maternal mental health at the forefront of maternity care (CMACE 2011). Twenty nine deaths by suicide were reported and over half of these women were married or in stable cohabitation, 30 years of age or older and had a psychiatric history. Given the predictive nature of psychiatric conditions in pregnancy, midwives need to be enabled to identify women at risk, and assess and refer women appropriately. The aim of this article is to give midwives an overview and understanding of the predictability and detectability of perinatal mental illness; to explore some of the tools available; to enable midwives to assess women appropriately for referral; and to address the issue of medication in pregnancy and whilst breastfeeding.

The aim of the survey was to assess midwives' experiences and knowledge of cleft lip and/or palate (CL+/-P), confidence in supporting the families and giving feeding advice, and to identify areas for input from the cleft team. In order to do so, questionnaires were sent to maternity units across Scotland. The results were as follows: 206 questionnaires were returned (42 per cent response rate). Forty one per cent of the midwives had helped a baby with CL+/-P to be born; 23 per cent knew the incidence of CL+/-P; 33 per cent were aware of the stages in treating CL+/- P; 99 per cent were aware that feeding difficulties are a potential complication. When asked about offering support to the families, 70 per cent were not confident and 60 per cent were not confident at giving feeding advice. Regarding cleft team input, 65 per cent would like a training day, 45 per cent requested small group teaching, 50 per cent would like a website and 57 per cent would like printed literature. Our recommendations are to implement training, for midwives, along with supporting websites and literature.

Maternal physical and psychological wellbeing during the postnatal period can be significantly impaired by perineal trauma sustained during childbirth. Current literature emphasises preventative measures, yet there is a lack of a systematic, evidence based approach to postnatal perineal care. This is concerning as the eighth 'Saving mothers' lives' report (CMACE 2011) identifies genital tract sepsis for the first time as the leading cause of maternal deaths. The aim of this article is therefore to develop a systematic approach to improve postnatal perineal care with a focus on assessment and treatment of perineal pain as well as recovery of pelvic floor function.

Maternal physical and psychological wellbeing during the postnatal period can be significantly impaired by perineal trauma sustained during childbirth. Current literature emphasises preventative measures, yet there is a lack of a systematic, evidence based approach to postnatal perineal care. This is concerning as the eighth 'Saving mothers' lives' report (CMACE 2011) identifies genital tract sepsis for the first time as the leading cause of maternal deaths. The aim of this article is therefore to develop a systematic approach to improve postnatal perineal care with a focus on assessment and treatment of perineal pain as well as recovery of pelvic floor function.

There are clear contributing factors during the antenatal and intrapartum period which increase the likelihood of women experiencing postpartum bladder dysfunction. Whilst, anecdotally, stress incontinence is often talked about and accepted by many women to be part of the post childbirth experience, postpartum bladder retention is not. Understanding both the risk factors and the potential short- and long term impact of bladder dysfunction are important elements in postnatal care. This understanding should guide appropriate management and early detection in the postnatal period, considered vital in avoiding long term sequelae.

I have feared developing stretch marks since my first pregnancy. Getting to grips with my changing shape was a big challenge, but I was safe in the knowledge that post-pregnancy I could work towards losing the weight. But stretch marks are permanent, and to me-disfiguring. I researched how stretch marks can be prevented and after finding little evidence for a particular cream or lotion: I scanned forums and asked friends what worked for them. Many people claimed that by keeping skin hydrated and supple, the dreaded stretch marks can be kept at bay or at least to a minimum. So I opted for regularly massaging oil across vulnerable areas and maintaining a balanced diet, including drinking lots of water. I was lucky the first time round; time will tell if my skincare routine will work for my second pregnancy.

Newborn falls in-hospital are considered rare and mostly accidental. Few studies are available explaining such accidents. The number of cases may be under reported by parents because of the inevitable sense of guilt they experience. Although deaths have been rarely reported, such accidents may be associated with serious outcomes. An urgent assessment by both the midwifery and paediatric teams should be undertaken following the reporting of such accidents. This paper explains what is meant by newborn falls, presents some relevant literature and uses a case study involving a newborn in hospital to form the basis of a discussion. Importantly it is felt that there is a need to raise awareness of the potential of these accidents amongst health professionals. We hope this paper goes some way towards highlighting some key issues and, moreover, increases awareness of newborn falls in hospital.

It is well known that recovering from childbirth can be a real challenge for many women. New mothers are, mostly, left to self care and manage their own recovery process. In seeking to feel like their old selves again mothers in this ethnographic study took longer than the traditional six weeks and needed to manage their feelings around being cooped up after childbirth. This article highlights an aspect of self care such as getting out and about, with or without the baby--a process that is pivotal to good recuperation and a sense of wellbeing after childbirth.

Breastfeeding becomes part of a woman's identity as she enters the journey into motherhood. As women face the challenge of balancing the care of a new baby with the rest of life they come across many different ideas about the qualities of a 'good mother' from within their social networks. Throughout their journey into motherhood women weigh up information about breastfeeding in relation to this as they decide what to do. This article identifies the kinds of knowledge women draw on that reinforce their idea of themselves as 'good mothers' and the implications of this for midwifery practice.

The dramatically new UNICEF UK Baby Friendly Initiative website will launch on 9 January 2011, having been successfully piloted at the recent Baby Friendly Conference in Harrogate. One new feature will be Care Pathways, so that whether you are a parent, a health worker, or an infant feeding lead, you will be able to see and understand what good care should look like at each stage of the mother's journey. Other features of the new site will be discussion forums for health professionals to share their experiences, and video and audio-clips of mothers and health professionals sharing their stories, as well as much-improved navigation and research library.