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This article on the case of R v Noor (2024) discusses the second successful UK prosecution under the Female Genital Mutilation Act 2003, marking a significant legal precedent in addressing female genital mutilation. It underscores the critical role of midwives in detecting, reporting and caring for victims, highlighting the intersection of healthcare, law and ethics in combating this practice. By examining the case of Amina Noor, who took a child abroad for female genital mutilation, the article elucidates the legal ramifications of such acts. It stresses the importance of midwifery awareness, education and collaboration with legal entities to protect women and girls. The article advocates for continuous professional development, the use of legal tools such as female genital mutilation protection orders and a Commissioner to prevent female genital mutilation, emphasising the collective responsibility of healthcare professionals in eradicating this harmful practice and safeguarding vulnerable individuals. [ABSTRACT FROM AUTHOR]

Background/Aims: Increased rates of caesarean sections globally have potential short- and long-term impacts for mothers and babies. Research on models of care and mode of birth has reported varied results. The aim of this study was to analyse the relationship between the midwife-led model of care and mode of birth. Methods: This systematic review and meta-analysis searched PubMed, Scopus and Web of Science. Quantitative full-text open access research articles published between 2010 and 2023 in Indonesian or English were included. Research that assessed the relationship between the model and birth planning were excluded. Results: A total of 16 articles were included. Two were experimental, and the remaining 14 were observational, with a total sample of 125 201 people. The midwife-led model supported spontaneous vaginal birth (odds ratio: 1.64, P=0.01) when compared to other models. Conclusions: Implementing the midwife-led model of care may increase the likelihood of physiological birth and reduce the incidence of caesarean section, especially in low-risk pregnancies. [ABSTRACT FROM AUTHOR]

Background/Aims: Pregnancy and birth cause hormonal and bodily alterations that can have profound effects on women's sexual function and quality of life. The aim of this study was to evaluate the influence of mode of birth on postpartum sexual function and quality of life in primiparous women from health facilities in Ile-Ife, Nigeria. Methods: This study used a descriptive design to explore women's sexual function and satisfaction from those attending selected healthcare facilities. Data were collected from 120 women recruited via convenience sampling, using a structured questionnaire between January and June 2023. Data were analysed using the Statistical Product of Service Solution (version 23) software; hypotheses were tested with Pearson's Chi-squared test at P<0.05. Results: Women most commonly resumed sexual activities within 1 month of giving birth (58.3%). Greater proportions of women who had a spontaneous vaginal birth with episiotomy (26.3%), or vaginal birth without episiotomy (25.0%) reported poor postpartum quality of life than those who had a caesarean section (11.2%). Additionally, more women who had an episiotomy reported lower levels of sexual satisfaction than those who did not have an episiotomy (10.5% vs 0.0% reported lowest level of positive satisfaction; 2.6% vs 2.4% reported highest level of negative satisfaction). Sexual function and quality of life were significantly linked (P<0.001). Conclusions: Sexual function and quality of life are an important element of postpartum women's health and wellbeing. Mode of birth affected women's postpartum quality of life, with vaginal birth and episiotomy resulting in less satisfaction and lower quality of life. Implications for practice: Healthcare professionals working in maternity settings should work to prevent injury to the perineum during birth and provide education during the postpartum period to improve women's sexual function and quality of life. [ABSTRACT FROM AUTHOR]

Background: Antenatal care allows healthcare providers to assess the wellbeing of pregnant women and their fetuses, leading to positive maternal and fetal outcomes. This study assessed the available facilities for antenatal care provided by midwives, and factors that influenced the quality of care provided. Methods: This study used a mixed-method descriptive design based on the Donabedian model to explore the quality of care at 27 health facilities across the three levels of healthcare in Osun State. Qualitative data were collected from 11 purposively selected midwives using an in-depth interview guide, and a hospital checklist was used to collect quantitative data. Data were gathered over 12 weeks, then transcribed and analysed using content and thematic analysis. Results: Some facilities (9.1%) did not offer all components of antenatal care. When examining the process and structure of care, 98.6% of healthcare facilities were found to have inadequate human resources. Although the equipment at the facilities was functional, it was reportedly inadequate in 27 (84.3%) facilities. Midwives reported that a lack of education, poor working conditions, interprofessional barriers and burnout hindered the provision of quality antenatal care, while community support and regular continuing education were motivating factors. Conclusions: The quality of antenatal care was rated adequate, but there was a lack of resources, standard guidelines and retraining opportunities for midwives. Adequate manpower and resources are needed to enhance the quality of antenatal care in health facilities in Osun State. [ABSTRACT FROM AUTHOR]

Background/Aims: The Indonesian family planning programme promotes contraceptive use to control population density. Counselling is widely used to improve contraceptive use. The aim of this study was to explore women's use of contraceptives before and after counselling. Methods: This cross-sectional study collected data from 10 790 women across 10 districts/cities in East Java. The data obtained were analysed using descriptive statistical analysis and paired t-tests. Results: After counselling, use of contraceptives increased significantly (P<0.001), from 75.8% using contraceptives before counselling to 99.98% using them after counselling. Use of the contraceptive pill notably increased from 16.7% to 40.9%. Conclusions: Short-term contraceptives were most popular with women in this population. Counselling can contribute to increased use of long-term contraceptive methods. [ABSTRACT FROM AUTHOR]

Background/Aims: Midwives are vital healthcare professionals that are autonomous and passionate specialists on women, pregnancy, birthing and families. Staying up to date with contemporary issues enhances their ability to provide high-quality evidence-based care. One aspect of maternal care that is changing is the use of gender-neutral language. The aim of this review was to examine the use of gender-neutral language in maternity settings and collate the literature to expose any knowledge gaps. Methods: A narrative literature review was conducted, using primary research and literature reviews from the Cochrane Library, CINAHL and MEDLINE databases. A total of 106 articles were included. Results: Data analysis yielded four themes: etymology and the origins of language in maternity, the effects of language in maternity, attitudes, and social media and language. The literature identified the perspective of the lesbian, gay, bisexual, transgender, intersex, queer or questioning, asexual and other sexually or gender diverse population who have accessed maternity and childcare services. Not all literature was maternity specific, but provided insight into how to improve maternity services. Conclusions: It is recommended that education be provided for healthcare professionals when working with the LGBTIQA+ community. Updating paperwork and policies at a structural level will have a vast impact holistically on LGBTIQA+ maternity consumers. [ABSTRACT FROM AUTHOR]

Background/Aims: Maternal cytomegalovirus infection can result in congenital cytomegalovirus, with neonatal and childhood sequalae including sensorineural deafness, visual impairment, and neurological abnormalities. This study's aim was to explore midwives' and women's level of awareness and knowledge of cytomegalovirus infection, and its impact during pregnancy. Methods: A systematic review of the literature was carried out. Seven papers met the criteria for inclusion, and data were analysed for a total of 370 registered midwives and 1717 women. Results: Participating midwives and childbearing women experienced significant levels of inadequate knowledge of cytomegalovirus infection. Midwives exhibited restricted recognition of viral transmission, maternal and neonatal symptoms and antenatal prevention, and childbearing women documented limited awareness and understanding of cytomegalovirus infection and congenital cytomegalovirus. Conclusions: Pregnant women need to be provided with information about cytomegalovirus, including how it may affect the fetus and how to reduce the risk of exposure during pregnancy. Midwives require additional education to increase their knowledge and understanding of cytomegalovirus. [ABSTRACT FROM AUTHOR]

Background: Correct use of personal protective equipment is vital to minimise the risk of patients acquiring healthcare-associated infections. These measures are also important in preventing exposure to occupational infection. During the COVID-19 pandemic, the use of personal protective equipment was associated with anxiety, uncertainty and additional training requirements. This study investigated midwives' experiences using personal protective equipment during the pandemic. Methods: This systematic scoping review searched seven academic databases and grey literature. Data analysis was conducted using a thematic analysis framework. Results: A total of 16 studies were included. Four themes were found: 'fear and anxiety', 'personal protective equipment/resources', 'education and training needs' and 'communication'. Conclusions: Management and administration inconsistences, logistical issues and lack of training on personal protective equipment led to midwives' negative feedback. A gap has been identified in the exploration of midwives' experiences as personal protective equipment end-users during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Choice in childbirth is not a new concept, yet it has been suggested that few service-users have a genuine choice about birth. Existing research has explored midwives' experiences of caring for service users birthing outside guidelines, but nothing is known about student midwives' experiences. This study's aim was to explore student midwives' experiences of caring for women giving birth outside the guidelines. Methods: A generic qualitative approach was used, and purposive sampling recruited five student midwives from a university in east England. Data were collected using semi-structured interviews and analysed thematically. Results: The three themes were 'contradictions', focusing on the incongruity identified in the narratives, 'the actions of clinicians' illustrated by clinician behaviour witnessed by the participants and 'punishment and judgement', which outlines the treatment of service users who gave birth outside the guidelines. Conclusions: Students can be exposed to inapt clinicians' behaviours, with the failure to protect and advocate for service users leaving them feeling anxious and potentially burnt out. Midwives should act as role models, so future midwives are aware this behaviour is not conducive to person-led care. [ABSTRACT FROM AUTHOR]

Background/Aims: Midwives play a key role in the prevention and control of infection. The identification of barriers and facilitators to guideline adherence is of paramount importance to improve compliance and ultimately patient care. This review's aim was to explore barriers and facilitators to midwives' infection prevention and control guideline adherence. Methods: This integrated review used the Whittemore and Knafl method to conduct a systematic search of eight databases for research carried out between 2015 and 2021. Data were analysed using the Braun and Clarke framework and reported using PRISMA guidelines. Results: Four themes were identified: 'compliance is infrastructure and resource dependent', 'recognising and working with what you have', 'midwives' fear and anxiety' and 'culture change: a mammoth challenge'. Midwifery experience of infection prevention and control guidelines adherence is affected by factors such as resource availability, guideline availability, healthcare systems, socioeconomic factors and midwives' personal influences. Conclusions: Education for midwives is crucial to improve adherence to infection prevention and control guidance. However, education from a behaviour change standpoint has been shown to be most effective and this should be incorporated into training programmes. [ABSTRACT FROM AUTHOR]

Background/aims South Africa has a high rate of maternal and neonatal mortality. Although the global consensus is that quality midwifery care makes an essential contribution to improving maternal and neonatal outcomes, the literature still highlights that quality midwifery care in South Africa is lacking and midwives' voices are not heard. This study aimed to describe the factors affecting clinical practice in public maternity units from the perspectives of women who received care and midwives who provided it. Methods This was an exploratory and contextual qualitative study conducted in public maternity units in the Eastern Cape, South Africa, with midwives and women who received care from these midwives. Non-probability purposive sampling was used to select a suitable sample. Data were collected using semi-structured audio-recorded interviews and analysed with Creswell's spiral data analysis. Results Midwives experienced burdens related to the practice of midwifery care as a result of the shortage of suitable staff and material resources, as well as managerial issues that affected clinical performance. Women experienced negative staff attitudes that influenced the care they received. conclusions Midwifery practice in public maternity units in the Eastern Cape is affected by multifaceted factors and attention is needed to ways to improve practice. For midwifery to flourish and for women to receive high-quality care, competent midwives and an enabling working environment are needed. There is an urgent need to bring midwifery education in line with international standards, to improve quality of care, end preventable maternal and newborn mortality and stillbirths and deliver the agenda of universal health coverage. [ABSTRACT FROM AUTHOR]

Introduction: Professional quality of life is affected by various factors, such as people's perception of professional empowerment. This study aimed to investigate the role of midwives' personal perception of empowerment in their professional quality of life. Methods: This cross-sectional study was conducted with 380 midwives providing maternal and neonatal care services across five provinces of Iran. Data were collected using virtual platforms and analysed using descriptive and analytical tests including regression analysis. Results: The mean professional quality of life was high (59.7%) in most participants. Midwives' personal perception of empowerment alone predicted 17% of professional quality of life. Conclusions: Given midwives' role in maintaining and improving maternal and neonatal outcomes, it is important to devise policies and plans to enhance midwives' perception of empowerment, especially with regards to autonomous practice and management. [ABSTRACT FROM AUTHOR]

Midwives must provide woman-centred, holistic care for the diverse UK childbearing population. As the NHS moves to adopt the recommendations made in the 'Better Births' report, is there an argument to invest in protected caseload midwifery contacts for women with cystic fibrosis? Caseload midwifery refers to a continuity model where a small team of midwives provide care throughout the antenatal, intrapartum and postnatal continuum. Cystic fibrosis affects multiple organ systems and requires specialist medical management during pregnancy. Living with cystic fibrosis has many psychosocial implications and pregnancy presents additional challenges. Health and wellbeing outcomes are improved when individuals are treated holistically in the non-pregnant population; therefore, during pregnancy, birth and postnatally, caseload midwifery may provide a legitimate intervention to improve health outcomes in pregnant women with cystic fibrosis. [ABSTRACT FROM AUTHOR]

Background Occupational stress is one of the undesirable risk factors found in the midwifery profession. It can lead to job burnout, job loss and negatively affect the quality of patient care. This study aimed to estimate the prevalence of occupational stress among Iranian midwives. Methods Through searching national and international databases, a total of 11 observational studies with full texts were extracted. Observational studies in Persian or English that reported the prevalence or frequency of job stress among Iranian midwives were included in the analysis. Irrelevant studies, those conducted on midwifery students and gray literature were excluded. The metaanalysis was conducted using the random-effects model. Results 11 articles reviewed occupational stress in 1196 midwives (an average of 108 midwives per study). Analysis of the articles showed that the pooled prevalence of occupational stress was 70.82% in Iranian midwives. Meta-regression analysis showed that the prevalence of occupational stress was not related to mean age, work experience, articles' publication year or sample size. Conclusions The prevalence of occupational stress is high among Iranian midwives and it can have harmful consequences for them and their patients. Therefore, the training of stress coping strategies seems to be appropriate for this group. [ABSTRACT FROM AUTHOR]

Background/Aims: Ongoing education of midwives plays a key role in high-quality prenatal care and pregnant women's health. In Iran, online education has received growing attention because of the COVID-19 pandemic. This study aimed to compare the effects of interactive and non-interactive e-learning on midwives' knowledge and self-efficacy. Methods: This quasi-experimental study involved 76 midwives working in prenatal care in health centres who were randomly divided into two groups: interactive e-learning via computers and non-interactive e-learning via mobile applications. Knowledge and self-efficacy were measured pre- and post-intervention using an online questionnaire and differences were analysed using the chi-squared and t tests. Results: Knowledge scores in nutrition, exercise, and overall care during pregnancy increased significantly in both groups in the post-intervention phase. Self-efficacy scores increased in exercise and overall care in the interactive e-learning group. The self-efficacy scores for all four studied items improved significantly in the smartphone group. The two groups' knowledge and self-efficacy scores were not significantly different post-intervention. Conclusions: E-learning had positive effects on the knowledge and self-efficacy of midwives. The researchers suggest using these approaches alongside conventional in-service education methods. [ABSTRACT FROM AUTHOR]

Background: Due to the coronavirus infection, visitors to all hospitals were greatly restricted in the UK. In maternity hospitals, only partners of women in labour were permitted to attend the hospital. Aims: This study aimed to gain an understanding of women's experiences of visiting restrictions imposed due to COVID-19. Methods: Women who attended the hospital for outpatient appointments and who were inpatients on the antenatal or postnatal ward during a two-week period were asked to complete an anonymous survey. Findings: A total of 422 surveys were completed. The majority of women (97.6%) agreed that the hospital made adequate preparations for them to feel safe. Most women reported that the restrictions are a good thing and several advantages were identified. Women cited not having their partner with them as the main negative consequence to the restrictions. Conclusions: Although women miss having their partner for support during scans and to help after the baby is born, during the COVID-19 pandemic, the safety aspect of the restrictions and the support received from staff is considered by women when making recommendations to a maternity hospital about whether, or how, to ease restrictions on visiting. [ABSTRACT FROM AUTHOR]

Background/aims: Ultrasound scans, often performed by midwives, play a vital role in the management of pregnancy, but there is a lack of literature on midwives' experience of this task. This study aimed to systematically review the experiences of midwives when performing obstetrical ultrasounds in maternity care. Methods: Online databases, journals and cited references were searched, with no date limit. Thematic analysis was used to synthesise the findings. Results: A total of eight studies were included. The five themes identified were 1) the benefits of ultrasound in maternity care, 2) access to and performing an obstetric ultrasound, 3) the relationship between midwives and ultrasound experts, 4) ethical and legal issues and 5) education and training for midwives. Midwives' positive experiences were usually a result of access to obstetric ultrasound and adequate support from obstetricians and radiologists. Negative experiences were caused by ethical and legal complications, as well as a lack of ultrasound equipment and training. Conclusions: There is a need to support midwives in performing basic obstetric ultrasounds, through education and training, to improve maternity care. [ABSTRACT FROM AUTHOR]

Performing female genital mutilation (FGM) is prohibited within the UK by the FGM Act of 2003. A mandatory reporting duty for FGM requires regulated health and social care professionals and teachers in England and Wales to report known cases of FGM in under 18-year-olds to the police. An application to the court for an FGM protection order (FGMPO) can be made to keep individual women and girls safe from FGM. This paper reveals the significant disconnect between the number of FGMPO applications and known recorded cases of FGM. The introduction of FGMPOs requires critical exploration as there is insufficient evidence to show that FGMPOs are effective in protecting women and girls from FGM. It is therefore unclear what impact, if any, FGMPOs are having upon the protection of women and girls at risk of FGM. The barriers to the implementation of FGMPOs and possible solutions are discussed. [ABSTRACT FROM AUTHOR]

The number of women entering pregnancy with chronic hypertension is increasing, predominantly because of rising rates of obesity and pregnancy at advanced maternal age. 'Chronic hypertension' is often used interchangeably with the term 'pre-existing hypertension', but it is important to remember that a significant proportion of women are newly diagnosed in pregnancy. Chronic hypertension significantly increases the risks in pregnancy for both the mother and the fetus, and these risks are considerably higher than those associated with gestational hypertension or pre-eclampsia alone; therefore, differentiation is important. The midwife is in an ideal position to improve the care of pregnant women with chronic hypertension. This article reflects on and explores the ways in which a midwife might provide support. It outlines the critical role of the midwife in the accurate and prompt identification, assessment, referral and care of the woman with chronic hypertension in pregnancy. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality and morbidity rates remain high in sub-Saharan Africa, yet with appropriate management, these rates could be reduced significantly. Midwifery training to improve the management of women during intrapartum period is often lacking, calling for innovative training methods in midwifery clinical care. Aims: To develop and evaluate a game, aimed at the prevention and management of the main causes of maternal morbidity and mortality. Methods: In collaboration with the Lugina Africa Midwives Research Network (LAMRN), the authors developed an educational board game and field tested the final version in Kenya, Tanzania and Malawi with midwives (n=56) and student midwives (n=32). Findings: Qualitative and quantitative evaluation demonstrated that the game was well liked for its ease of use, acceptable appearance and relevance to practice. Conclusions: The board game, named 'Crisis', has potential to influence practice; however, further research is required to assess its ability to improve outcomes. [ABSTRACT FROM AUTHOR]

Background: Antenatal care refers to the assessment and care of pregnant women. In southern Zambia, the high number of maternal deaths related to pregnancy complications could be prevented by high quality antenatal care. Aims: To explore midwives' knowledge of antenatal care and assess their skill levels. Methods: A quantitative cross-sectional study was conducted between October 2016 and February 2017 with 89 midwives. A structured questionnaire was used to collect data. Descriptive statistics were used to summarise the data test associations between variables. Findings: Knowledge levels were high, but 61.8% of respondents did not have the required clinical skills when observed. Overall, 70% of respondents had received supervision in the past 6 months before data collection. Conclusions: Knowledge levels of midwives were high compared to the skills levels. Intensive, onsite, supportive mentorship and supervision is recommended to improve midwives knowledge and skills in antenatal care. [ABSTRACT FROM AUTHOR]

An increasing number of women with learning disabilities are becoming parents, and have a legal right to do so free from discrimination. By discussing the evidence, this article argues that the health and social care systems of the UK have been historically poor at supporting successful parenting for people with learning disabilities. It discusses the legislative and policy landscape in Scotland that should be changing this situation and considers the role of the midwife within this. It identifies the need for improved training and support for midwives and recognition of the time investment required to provide care for women with learning disabilities if they are avoid a loaded die against their successful parenting from the outset. [ABSTRACT FROM AUTHOR]

Vitamin D deficiency remains a significant public health issue for childbearing women in the UK. As the effect of vitamin D appears to be unclear, and supplementation outcomes for maternal and fetal health debatable, there has been widespread confusion, with midwives unclear about recommendations and women unsure about supplementation. A partnership approach allows women to understand the public health context and view vitamin uptake as beneficial for neonatal health, with women and midwives working together to break down barriers and optimise supplementation and endogenous vitamin D intakes. Many women find a balanced diet in the childbearing continuum period difficult to achieve, and midwives can only address vitamin D deficiency on an individual, case-by-case basis. Communication, and an acknowledgement that women come from a variety of cultural and social backgrounds, can be key to public health success, via a thorough exploration of women's barriers to vitamin D uptake. [ABSTRACT FROM AUTHOR]

The use of social media to disseminate and receive health messages has increased over the past ten years, and many women use social media to access pregnancy information. However, the NHS has been slow to integrate consumer facing Internet technologies into routine care services. This article describes an innovative social media project, Maternity Direct+, an Internet midwife employed by Basildon and Thurrock University Hospitals NHS Foundation Trust. The Internet midwife uses Facebook to disseminate health messages and answer non-urgent questions from pregnant women, mothers up to 28 days after birth, and women planning a pregnancy. Findings from the project evaluation demonstrated a high level of demand for a responsive, evidence-based, non-urgent information and advice service for pregnant women and new mothers, and high levels of user satisfaction. The authors conclude that social media can be integrated into routine midwifery services and used to complement existing communication channels. [ABSTRACT FROM AUTHOR]

Shoulder dystocia is a rare obstetric emergency which can be managed using the HELPERR mnemonic. Midwives should recognise the signs and understand the principles of managing shoulder dystocia. Step-by-step images to illustrate the HELPERR mnemonic can enhance knowledge and understanding of this logical sequence of actions. [ABSTRACT FROM AUTHOR]

The newborn infant physical examination (NIPE) is a screening tool and holistic assessment of the newborn, and abnormalities detected are referred as per individual Trust procedures. The extension of the role of the midwife has enabled specially trained midwives to undertake the NIPE, which had previously been the exclusive remit of medical practitioners. However, the clinical effectiveness of midwives in this role has not been measured in a robust manner. The introduction of the NIPE SMART tool should facilitate comprehensive and systematic audit of clinical effectiveness of practitioners in conducting NIPE, and standardisation of the examination and documentation. Even so, the eligibility criteria to have NIPE undertaken by a midwife varies between NHS Trusts, and calls for standardisation of such criteria have remained unanswered. [ABSTRACT FROM AUTHOR]

Advances in medicine mean there are more women with complex medical histories giving birth. This may include women with conditions such as hydrocephalus requiring a cerebrospinal fluid shunt. Midwives should understand the principles of care for such women and work with the multidisciplinary team to provide indiviulaised care throughout the pregnancy and intrapartum period. [ABSTRACT FROM AUTHOR]

Background Second-trimester miscarriage is defined as pregnancy loss after 12 and before 24 weeks’ gestation. Little is known about parents’ experiences of hospital care during a second trimester miscarriage in Ireland. Aims This study aimed to explore parents’ experiences of hospital care during a second-trimester miscarriage. Methods A focused ethnographic design was used. A series of semi-structured interviews were completed with 14 bereaved parents. The data were analysed using thematic network data analysis. Findings This paper discusses the global theme of relational and social experiences of miscarriage. Parents highlighted the need for compassionate care and expressed the importance of empathy and sensitivity from hospital staff to avoid further distress. Conclusions Compassionate care received by bereaved parents positively influenced their hospital experience, whereas a perceived lack of compassion or insensitivity had a lasting negative impact on bereaved parents. [ABSTRACT FROM AUTHOR]

Within the role of a registered midwife, the issue of maintaining confidentiality is complex. A midwife’s responsibility is outlined and governed by laws such as the Human Rights Act 1998 and the Data Protection Act 1998. The ideology of confidentiality is further reinforced by the Nursing and Midwifery Council, and should not cause the midwife undue pressure or stress; however, it often becomes a cause for concern. Midwives in Northern Ireland may carry out their role in environments that are not well suited for preserving confidentiality or sharing sensitive information. Conflict may arise for midwives in maintaining women’s confidentiality while also having a duty of care to protect the public. In today’s climate, many midwives experience a fear of litigation, so the importance and complexity of confidentiality must not be underestimated. [ABSTRACT FROM AUTHOR]

Midwives are professionally accountable for detecting deviations from the norm in pregnancy, and initiating referral to an appropriate practitioner. They must work across professional boundaries, particularly where complex conditions require the involvement of doctors, such as immune thrombocytopaenia (ITP) in pregnancy. Most pregnant women with ITP have good outcomes, with only a few requiring first-line treatment. However, close monitoring of maternal and fetal wellbeing are required and appropriate management is crucial in reducing the risk of associated complications. [ABSTRACT FROM AUTHOR]

There is currently a large-scale epidemic of Zika virus infection in the Americas. For most people, infections caused by Zika virus lead to a mild and short-lived illness, but Zika has now been confirmed as the cause of fetal microcephaly and other birth defects, and it has been linked to certain neurological disorders. This article offers some insight into Zika virus infection, management of women who are pregnant or planning a pregnancy, and the implications of Zika virus for practising midwives in the UK. [ABSTRACT FROM AUTHOR]

Many tasks in midwifery are learned and taught from a right-handed perspective, meaning they may prove difficult for people who are lefthanded. Experiences of midwives and midwifery students show that there are various barriers to learning and performing certain skills for left-handed people, and they are often forced to choose whether to persist in conforming to the 'norm' and using their right hand, or adapt elements of practice to suit left-hand dominance. [ABSTRACT FROM AUTHOR]

Globally, thalassaemia is one of the most common genetic blood disorders affecting women's ability to conceive and progress through a normal pregnancy and birth. Thalassaemia is associated with late-onset puberty, infertility due to endocrine dysfunction, growth retardation, jaundice, deformities in skeletal development and enlargement of the abdomen secondary to spleen and liver anomalies. Despite medical innovations, the management of thalassaemia remains associated with significant risk factors for women during pregnancy, birth and the postnatal period. The management of women with thalassaemia is complex, requiring a multidisciplinary approach to care as the potential for maternal and fetal complications presents risks during pregnancy and birth. Women can remain silent carriers of the disease until pregnancy induces symptomatic haematological and coagulation changes, leading to diagnosis of thalassaemia. [ABSTRACT FROM AUTHOR]

Compassionate relational care has the potential to nurture bereaved parents in a meaningful way and positively shape their grieving journey, as well as being fulfilling for midwives who offer such quality care. Enabling a quality relationship to develop with bereaved parents ensures a safe relational space is created, where parents can experience an emotional connection with their midwife when they most need it. The quality of this unique relationship created by the midwife and experienced by the parents will forever become part of their deceased baby's narrative and will continue to influence, either positively or negatively, their onward grieving journey. [ABSTRACT FROM AUTHOR]

Midwives are required to undertake a wide range of hands-on skills. Immediately upon qualification, they will be expected to use these skills safely and effectively as part of their practice. Therefore, student midwives must be supported to develop competence and confidence in such skills. Currently, many practical midwifery skills are not specifically identified in the Nursing and Midwifery Council (NMC, 2009) Standards for pre-registration midwifery education. Over time, it has become clear that some midwives were qualifying from universities in Wales and entering their new posts feeling unprepared to undertake a number of important midwifery skills, such as the administration of intramuscular vitamin K to babies. This article describes how heads of midwifery education and lead midwives for education worked together with heads of midwifery to develop and implement an All Wales Midwifery Pre-Qualifying Skills Passport, to address these shortcomings. [ABSTRACT FROM AUTHOR]

Bladder care throughout the childbearing continuum is one of the essential components of midwifery care, as health of the urinary tract affects both short-term and long-term maternal wellbeing. Throughout antenatal, intrapartum and postnatal care, midwives have the opportunity to safeguard bladder function and to promote normality. As frontline practitioners during pregnancy and childbirth, midwives are ideally placed to facilitate sensitive discussions about bladder function, considering an individualised baseline for each woman's wellbeing and recognising when deviations from the normal process occur (Strahle and Stainton, 2006). With a sound understanding of the physiology and anatomy underpinning bladder care, midwives can educate women about changes during pregnancy, providing reassurance and gold-standard care. A holistic midwifery consideration of both the physiological and psychosocial wellbeing of all women is paramount (Fritel et al, 2016), especially when considering invasive procedures such as catheterisation and the long-term sequelae associated with bladder dysfunction. [ABSTRACT FROM AUTHOR]

Public Health England and the Department of Health (2015) have documented that parents are requesting consistent professional advice throughout pregnancy and the early weeks following birth, as their care is transferred from midwives to health visitors. In addition, commissioners are increasingly seeking to integrate services to provide joined-up care and improve health outcomes for parents and families. This paper discusses the benefits, to both parents and health professionals, of collaborative working, together with the challenges faced by midwives and health visitors in the current climate. It explores the benefits of collaborative learning between the two disciplines in the higher education setting, with an example of a successful collaboration at the University of Central Lancashire. [ABSTRACT FROM AUTHOR]

The Valsalva technique for directed pushing during the second stage of labour is an intervention still used by some health care practitioners in the UK, despite evidence suggesting that this is not the best approach to intrapartum care. Current research in this area is limited, with ambiguous findings. The latest National Institute for Health and Care Excellence (NICE, 2014) guidelines recommend that until further research is forthcoming, women should be guided by their own instinctive urge to push during the second stage and directed pushing should not be used as part of routine intrapartum care. Midwives are encouraged to ensure that women are fully informed of the latest evidence, and use their professional judgement in conjunction with the woman's individual needs and preferences while undertaking care during the second stage of labour . [ABSTRACT FROM AUTHOR]

Despite it being thought of as a disease of the past, children in the UK, particularly those from high-risk groups, are at risk of rickets. The latest National Diet and Nutrition Survey estimated that 7.5% of 11/2-3-year-olds were deficient in vitamin D (Bates et al, 2014). Vitamin D deficiency presents with skeletal and non-skeletal manifestations. With the sun being the main source of vitamin D, there is a reliance on supplementation across most of the UK. This article looks at manifestations of vitamin D deficiency, the identification of at-risk groups and recommendations for supplementation. [ABSTRACT FROM AUTHOR]

Vitamin D deficiency throughout the childbearing continuum is a major public health issue, and supplementation is an arguably cost-effective and simple way of increasing maternal health and ensuring fetal wellbeing (Christesen et al, 2012). The evidence underpinning supplementation needs further exploration to accurately determine safe and appropriate levels of vitamin D to avoid toxicity and prevent harmful effects to mother and baby (World Health Organization, 2012). Despite this, maternity health professionals in the UK should advise routine vitamin D supplementation for all women in line with national guidance (National Institute for Health and Care Excellence, 2014). As key providers of public health information, midwives and health visitors hold an important role in advice and management of vitamin D deficiency and supplementation, including educating women and families around associated risks and how to increase vitamin D uptake. [ABSTRACT FROM AUTHOR]

Guidelines from the National Institute for Health and Care Excellence (NICE, 2010) recommend the use of routine carbon monoxide (CO) monitoring in all pregnant women. However, there is no research describing pregnant women's experiences of being offered the CO test at booking. Method: This was part of a phenomenological study conducted to examine midwives' experience of using CO monitoring for smoking cessation in pregnancy. Individual semi-structured interviews were carried out and recorded with 10 midwives who use CO monitoring at booking. They were asked about women's reactions to the test. Data were analysed using Colaizzi's (1978) approach and bracketing. Results: Midwives reported that women were generally happy to accept the test. However, pregnant women appeared to be uninformed about it. Other reactions described include curiosity, shock, relief, guilt and surprise at the results. Conclusion: Overall, women's reactions were positive but an increased public awareness of the test would smooth its implementation. [ABSTRACT FROM AUTHOR]

With the current caesarean section (CS) rate at 25% for England, delivering postnatal wound care is a common element of the midwife's role. Anecdotal evidence suggested CS wound care education was a need within the Trust's midwifery service. A questionnaire was used to investigate midwives' views and the need for education in relation to CS wound care. The results confirm midwives do see wound care education as a need. For the first time, information is available on the topics midwives feel should be the focus of such education and useful methods of delivering it. This information can be used to develop a wound care education package to address midwives' learning needs in this area. [ABSTRACT FROM AUTHOR]

International guidelines indicate that management of asthma during pregnancy should be multidisciplinary; however, the role of midwives has not been researched. Method: A qualitative descriptive study exploring Australian midwives’ current knowledge about asthma in pregnancy and their perceived role in antenatal asthma management was conducted, involving individual semi-structured in-depth interviews with 13 midwives in a tertiary referral hospital. Data were analysed using Morse and Field’s four-stage process. Findings: Midwives identified barriers preventing them from providing antenatal asthma management, including: lack of knowledge about asthma in pregnancy; time constraints; women’s knowledge about asthma in pregnancy; lack of a clear referral pathway; and lack of accessible asthma management equipment. Barriers were influenced by the institutional context in which the midwives worked. Conclusion: While participants identified barriers preventing them from providing recommended antenatal asthma management, they also suggested that improving their knowledge about asthma in pregnancy and developing a clear referral pathway may be beneficial. [ABSTRACT FROM AUTHOR]

In many countries, care during pregnancy, labour and the postnatal period is often provided by a practising midwife. Despite specific risks associated with pregnancy in advanced maternal age, attention has shifted away from this group of women with regard to fetal screening and testing. This study aimed to explore the experiences of mothers aged 35 years and over during pregnancy and the perinatal period, as it is unclear whether their needs are currently being met by midwives. Qualitative and quantitative data were collected via an online survey tool between May and August 2012 and the study was advertised on the social networking site Twitter. Of the 397 mothers who completed the survey, many reported receiving good midwifery care, but others felt their care needs were not met or were offered inadequate support. Continuing education for midwives and professional leadership is needed, to support practitioners in developing skills essential to care for women. [ABSTRACT FROM AUTHOR]

Workforce challenges in the NHS have lead to maternity care assistants (MCAs) playing an ever-increasing role in maternity services. However, as the role of the MCA has expanded, some reports have claimed that a number of midwives and MCAs are experiencing confusion regarding what tasks or responsibilities can be undertaken by the MCA. In some cases, this is said to be leading to role ambiguity and blurry boundaries between these two groups of staff. This article presents finding from a study into the role boundaries of the MCA. Findings illustrate that while many MCAs felt confident about the appropriate parameters of their practice, others recounted numerous instances when they had considered the boundary to be ambiguous. This article examines potential sources of this ambiguity, discusses some wider implications and offers some suggestions for more effective management of role boundaries to prevent ambiguity. [ABSTRACT FROM AUTHOR]

Workforce challenges in the NHS have lead to maternity care assistants (MCAs) playing an ever-increasing role in maternity services. However, with the development of the role of the MCA, it is important to recognize the potential for confusion regarding the tasks and responsibilities to be undertaken by the MCA. In some cases, uncertainty may lead to role ambiguity and unclear boundaries between these two groups of staff. This article presents findings from a qualitative study into the perceptions of MCAs and midwives as to the role boundaries of the MCA. Findings illustrate that while many MCAs felt confident about the appropriate parameters of their practice, others recounted some instances when they had considered the boundary to be ambiguous. This article examines potential sources of this ambiguity, discusses some wider implications and offers some suggestions for more effective management of role boundaries to prevent ambiguity. [ABSTRACT FROM AUTHOR]