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Background/AimsThe majority of maternal deaths occur during labour, delivery, or within the first 4 hours after birth. This can be reduced by the care that midwives provide. At Mulago Hospital, little is documented on midwives' current practice and their perception of care offered during labor and delivery. The number of maternal and neonatal deaths as a result of preventable causes such as postpartum haemorrhage, obstructed labour, ruptured uterus and sepsis remains high. The aim of this study was to document the current practice of midwives, explore midwives' perception towards practice and identify factors that influence practice during birth in Uganda, to identify possible areas for improvement.MethodsA cross-sectional study was conducted of midwives working in the three labour wards at the Mulago National referral hospital: the general ward, the private ward and the midwifery-led ward. Midwives' perceptions were explored using a semi-structured questionnaire, which asked midwives about their current practice and their perception of the care offered.FindingsCare was found to be lacking in several areas. Only one-fifth (20.0%) of midwives reported always checking temperature every 4 hours. Only 20.5% reported that women are always supported in being mobile during labour. Less than half of the midwives (44.4%) knew the recommended drugs for managing the third stage of labour. Infection prevention practices were poor. Only 54% of midwives knew how to prepare magnesium sulphate for management of severe pre-eclampsia and eclampsia. Overall, the general labour ward was found to have the most gaps in midwives' knowledge. Lack of continuing education, supplies, teamwork and clinical guidelines were reported to affect practice. Staff shortages and midwives' decisions being underlooked by obstetricians were also reported to affect practice.ConclusionsOverall, the study found that midwifery practice is suboptimal in key areas such as infection prevention, use of a partograph, and management of pre-eclampsia and eclampsia. Continuous professional development, provision of resources, and strengthening teamwork are recommended to improve maternal health outcomes at Mulago Hospital.

Background: Extant literature is limited on adoption of evidence-based harm reduction strategies in hospitals. We explored patient perceptions of incorporating harm reduction supplies and education in hospital care with patients with opioid use disorder (OUD). Methods: Qualitative descriptive study of hospitalized patients with OUD in Philadelphia, PA using semi-structured interviews conducted between April and August of 2022. Results: Three major themes emerged from 21 interviews with hospitalized patients with OUD: (1) Applicability and Acceptability of Harm Reduction Practices for Oneself; (2) Applicability and Acceptability of Harm Reduction Practices for Others; (3) Perceptions of Harm Reduction Conversations. Most participants were familiar with harm reduction but varied in their perceptions of its relevance for their lives. We noted differences in how participants viewed the applicability and acceptably of harm reduction practices that they perceived as intended to help others (e.g., naloxone) versus intended to help themselves (e.g., syringes). Most participants reported that meaningful conversations about drug use did not happen with their care team but that these conversations would have been acceptable if they were conducted in a way consistent with their individual substance use goals. Conclusions: Patients' interest and perceived acceptability of harm reduction services during hospitalization varied by individual patient factors and the perceived user of specific interventions. Given their positive potential, harm reduction practices should be incorporated in hospitals, but this must be done in a way that is acceptable to patients. Our findings reveal ways to integrate concepts from a harm reduction approach within a traditional medical model. More work is needed to understand the impact of such integration.

BACKGROUNDNurses and midwives form the backbone of health service delivery and satisfaction with care often depends on the competencies of nurses and midwives who provide the care (World Health Organization [WHO], 2002). Healthcare has become complex, challenging, and demanding across diverse sociocultural and socioeconomic changes and environments. To optimize their impact, nurses and midwives therefore need to be prepared with evidence-based competences. Nursing research therefore, is the cornerstone for evidence-based practice and for establishing the professional status of nursing and building research capacity. However, although nursing research began in the 19th century, it is limited in Africa, with little evidence generated to inform policy and practice. Although nursing and midwifery education in the region has advanced with graduate and postgraduate level education, little is known about nursing and midwifery research conducted in universities and where to find such research.OBJECTIVESThe literature review aimed at quantifying and identifying the types and gaps in nursing and midwives' research and publications in Africa.METHODSArticles published between January 1, 2007 and January 31, 2017 were retrieved from PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) with a search strategy that employed four sets of terms: (a) terms identifying published research done by nurses or midwives, or both; (b) terms identifying types of publications; (c) terms identifying filters for African countries; and (d) filters for publication dates. We also searched Google Scholar to capture nonindexed sources.RESULTS AND CONCLUSIONSThere is evidence of an increasing number of African nurses and midwives publishing research; however, much of this research may not be readily available. The promotion of nursing research and capacity building/mentorship in research for nurses and midwives is recommended to increase nurses' and midwives' skills to critically evaluate research and apply the best evidence to their practice.

BACKGROUNDIn Tanzania, cesarean section (CS) rates have been steadily increasing, yet little is known about mothers' understanding of the medical rationale for their CSs.AIMTo identify mothers' cultural understandings of the rationale for their CSs.METHODSDesign: A qualitative descriptive design was employed.Setting: A government hospital in the western region in Tanzania.Participants: A total of 117 mothers were interviewed using convenience sampling post CS.FINDINGSForty percent of the mothers were younger than 18 years, with more than 50% having had five or more live babies. Among multigravida women, 40.2% had had one or more previous CSs.The emergent themes were lack of dietary knowledge, use of local herbs, delays in coming to hospital, avoiding stressful labor pains and no ability to exercise, and no personal preferences of “push or go for an operation.”CONCLUSIONPregnant women in Tanzania need improved health education to make informed choices about childbirth and be involved all processes of antepartum care decision making to achieve optimal birth outcomes.

It has been recommended to use biomarkers in an antenatal setting when focusing on smoking and pregnancy research (Delpisheh et al, 2007). This is primarily due to biomarkers being considered more objective than using questionnaires to measure levels of smoking in pregnant women. However, when a study was designed using a biomarker to compare the levels of smoking reported by pregnant women at the booking appointment, numerous confounding issues became apparent. This article aims to introduce midwives to common biomarkers frequently used in smoking and pregnancy research and to discuss confounding issues that can affect a biomarker's performance using cotinine as a prime example. The confounding factors are discussed under the themes of population, metabolism, specimen, tobacco and behaviour.

The article presents the short story "Hindman Remembered," by Grace Toney Edwards.

There is a strong government focus on public health which is evident within the primary care trusts and a number of key national policy areas require an increasing public health focus to midwifery work. The full potential of midwives contribution’ to public health is not being realized, as there is little formal contact between midwives and public health partnerships. Midwives are ideally placed to develop their public health role, but many feel isolated and unsupported in their personal development. This paper describes the development of a network model that will support the development of midwifery and public health as part of a community-based, multidisciplinary partnership approach to the care of women and their families.

The aim of this study was to determine the thinking that underlies adolescents' ideas about the relationship between maternal nutrition and the health of the fetus, and about when a woman should begin to ‘take care’ with her diet. The study design involved a quantitative survey using a combined precoded and free response questionnaire, the content of which was derived from the results of a previous questionnaire study. The subjects comprised 219 school students from the Northwest of England in British National Curriculum Year 10 (age 14/15) and from mixed-ability classes in four non-religious, mixed-gender, community comprehensive schools. The results show that school students are unaware of the reasons why certain dietary items should be treated with caution during pregnancy, and have misconceptions about the risks they present. They are also unaware of the importance of the early stages of pregnancy in this context, because they feel that pregnancy does not start until it is confirmed. The study concluded that there is a continuing need for education about the relationship between a healthy diet and pregnancy outcome, and about the significance of preconception care. Midwives and other health professionals may have a role in such education, and should be aware of the reasons that underpin certain misconceptions, so that they can be corrected.

Over the last century the midwife's role has continually evolved. Some would say it has been enhanced but there is a danger that midwives are becoming ‘Jills of all trades and mistresses of none.’

Early findings of the national evaluation of the £3billion Sure Start programme have found no overall improvement in the target areas. The first published findings of the national evaluation have suggested that there is no difference in the development, language and behaviour outcomes of children in Sure Start areas compared to children in areas with no Sure Start initiatives. This depressing finding was published in the Guardian last month. But the report goes on to say that there have been real successes in some areas and it is too early in the evaluation to give a comprehensive picture of the overall success of the scheme (Ward, 2005).

The challenge of home birthsAttachment, bonding and lossSocialisation of women