Search

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 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., (Copyright 2008 Elsevier Ltd. All rights reserved.)

Background: Breastfeeding prevalence in the United Kingdom is one of the lowest in Europe. The midwife provides feeding support for new mothers but research suggests that midwives' knowledge of breastfeeding is limited., Objective: To discover the views of English midwives in relation to their breastfeeding support role., Design: Qualitative design., Settings: Two maternity hospitals in Northwest England., Participants: Thirty midwives who cared for normal, healthy babies. Midwives were selected for interview using theoretical sampling principles from a pool of midwives who volunteered. Volunteers were accessed using a poster exhibited in relevant clinical areas., Methods: Data were collected using audiotaped, in-depth interviews and were analysed using constant comparison techniques., Results: The study highlights that differing professional knowledge and beliefs about breastfeeding support created intense, mainly negative, emotions for these midwives. Irritation and despair was experienced with the greater emphasis placed on research, rather than practice knowledge in policy and recommendations for practice. Disappointment was experienced when mothers did not conform to midwives' expectations. Conflict with differing peer-based knowledge generated feelings of intimidation and annoyance for some midwives. Some midwives demonstrated that they can sustain clinical decisions whilst based in a hostile environment, but others conformed to the practice expectations of their peers. Happiness was experienced when midwives described positive relationships with mothers, rather than their professional colleagues., Conclusions: The utilisation of professional knowledge in breastfeeding practice was a highly complex issue, and generated significant negative emotional distress, for these midwives.

Over the last 20 years in the United Kingdom, midwives have implemented the routine use of intrapartum fetal monitoring regardless of the risk status of laboring women. This practice is at odds with the published research. The discrepancy between practice and best evidence merits further investigation. A qualitative study was conducted to evaluate midwives' attitudes and experiences about the use of fetal monitoring for women at low obstetric risk. Fifty-eight midwives working in two hospitals in the north of England were interviewed by using a semistructured approach. The taped interviews were transcribed and analyzed by using a general thematic approach. Issues included midwives' perceptions of low-risk status, the socialization of midwives, and the loss of woman-centered care. Midwives subscribed to the notion of woman-centered care, but because of a complexity of factors experienced in their daily working lives, they felt vulnerable when attempting to implement evidence-based fetal monitoring practices. Midwives regretted the loss of a woman-centered approach to care when technologic methods of intrapartum fetal heart rate monitoring were used indiscriminately. An appreciation of the complex factors affecting the ability of midwives to implement evidence-based practice is important when attempting to facilitate the development of appropriate fetal monitoring practices for women at low obstetric risk.

Objective: To investigate midwives' attitudes, values and beliefs on the use of intrapartum fetal monitoring., Design: Qualitative, semi-structured interviews., Subjects and Setting: Fifty-eight registered midwives in two hospitals in the North of England., Results: In this paper two main themes are discussed, these are: informed choice, and the power of the midwife. Midwives favoured the application of informed choice and shared a unanimous consensus on the definition. However, the idealistic perception of informed choice, which included contemporary notions of empowerment and autonomy for women expressing an informed choice, was not reportedly translated into practice. Midwives had to implement informed choice on intrapartum fetal monitoring within a competing set of health service agendas, i.e. medically driven protocols and a political climate of actively managed childbearing. This resulted in the manipulation of information during the midwives' interactions with women. This ultimately meant that the women often got the choice the midwives wanted them to have., Conclusions: The information that a midwife imparts may consciously or subconsciously affect the woman's uptake and understanding of information. Therefore, the midwife has a powerful role to play in balancing the benefits and risk ratios applicable to fetal heart rate monitoring. However, a deeply ingrained pre-occupation with technological methods of intrapartum fetal monitoring over many years has made it difficult for midwives to offer alternative forms of monitoring. This has placed limits on the facilitation of informed choice and autonomous decision making for women.

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.)

The objective of this study was to ascertain the changing educational needs of community nurses, midwives and health visitors in relation to the teaching, supervising and assessing of pre- and post-registration students. A questionnaire was sent to all education institutions providing community nursing experience in England (Whittaker et al. 1997), which allowed identification of three centres for in-depth study. Questionnaires were sent to practitioners (community nurses and midwives, health visitors and school nurses), their managers, and teachers of community courses in the three centres: 314 were returned. Eight semi-structured interviews were undertaken with volunteers in each of the study centres (n = 24). Extensive demands are being made on community staff to provide learning experiences for students on a wide range of courses. Practitioners reported that in order to fulfil their teaching and assessing functions they needed continuing education in matters which would assist them to provide research-based practice and education, teaching and assessing in the community and personal skills, for example assertiveness and counselling. Less than a quarter of practitioners were undertaking continuing education courses. However, opportunities for further academic study varied enormously and most practitioners had to study in their own time at their own expense.

669 boys and 753 girls born in 1962 and living at home were observed at approximately half-yearly intervals from 9 to 17 years of age. Mean ages of reaching various developmental stages were calculated for voice change and facial hair in boys, menarche and breast development in girls, and for axillary hair in both sexes. Peak height velocity and age at which it occurred were also calculated for both sexes. Means were generally in good agreement with those found about 15 years previously in the Harpenden Growth Study. Most pubertal changes in the present study showed gradients by social class; in boys, development was later in those with fathers in unskilled manual occupations, whereas in girls the greatest differences, where found, were between those with fathers in non-manual occupations and the remainder.

Consultation between the clinicians and epidemiologists responsible for the Perinatal Mortality Surveys in Scotland and in the Northern Regional Health Authority in England showed that the classification of perinatal death introduced more than 30 years ago by Sir Dugald Baird still retained its utility, but that unintentional differences in the way cases were being classified had threatened the validity of temporal or geographical comparisons. To overcome this problem an effort has now been made to define the main terms used in this classification more precisely. To preserve continuity, the main structure of the original groupings has been retained; but the opportunity has been taken to adjust certain minor groups in conformity with recent ideas, and also to modify definitions to take into account the greatly improved prognosis for babies of very low birthweight. Otherwise, it is thought that subclassification of the main groups offers a better method of exploring new hypotheses than any radical alteration of the main groups themselves.

During the decade 1960 to 1969, perinatal mortality rates in Newcastle upon Tyne fell in parallel with national trends, in association with a marked reduction of domiciliary midwifery. Analysis of the records of women booked for confinement at home or in specialist hospitals showed that the reduction of mortality occurred with unexpected uniformity in both categories, in low risk as well as high risk patients, and in all causes of mortality except congenital malformations. It could not be attributed to improvements in maternal characteristics nor to increased size of babies at birth. The most probably explanation seems to be a combination of many improvements in the quality of care, with increased awareness of risks, better selection of high-risk groups, and improved supervision and management throughout. There is no indication that single factor in obstetric management, such as more intervention during labour, had a dominant effect.

White Newcastle upon Tyne schoolchildren born in 1962 were examined at approximately half-yearly intervals from 9 to 17 years of age. During the last year of compulsory education losses to follow-up became selective with respect to socio-economic background, and the results reported here are restricted to 564 boys and 669 girls seen regularly between the ages of 10 and 15 years at least. Newcastle adolescents were slightly shorter and lighter than the London children on whom Tanner's British Standards were based. The longitudinal pattern of skinfold changes in boys was different from that observed in girls. Differences in height attained between occupational groups were well established by the age of five years, and the same was true of differences between family-size groups for children with fathers in manual occupations. It is inferred that differences in height between occupational and family-size groups resulted more from differences in leg than in trunk length. At age 15, the correlations of height attained with maternal height were 0.42 and 0.43, and with birthweight 0.25 and 0.28, for boys and girls respectively. Adjustment, by regression, of heights attained for birthweight, age at peak height velocity and maternal height diminished differences between occupational and family-size groups. After such adjustment, heights significantly lower than average were found only among subjects with fathers in unskilled manual occupations and with large families. Among subjects with fathers in manual occupations, subscapular and triceps skinfolds and arm circumference decreased significantly with increasing family size.

Data for the first 36 menstrual intervals immediately following menarche were analysed for 298 girls studied in Newcastle upon Tyne. The mean cycle length decreased from 49 . 5 days for the first cycle in 29.5 days for cycles 31-36. There was no clear seasonal pattern in cycle length. The standard deviation within subjects in the length of menstrual interval fell sharply from 23 . 3 days for cycles 1-6 to 10-7 days for cycles 7-12 and more slowly thereafter, reaching 5 . 5 days for cycles 31-36, and was not related to age at menarche. The proportion of short cycles (17 days or less) was relatively stable, but that of long cycles (57 days or more) decreased with cycle number from 27.4% for the first cycle to about 1% for cycles 31-36. The average length of menstrual flow was 5 . 5 days irrespective of age at menarche, cycle number of season. The standard deviation of menstrual flow within subjects fell from 1 . 5 days for cycles 1-6 to 0 . 8 days for cycles 25-36.

Age at menarche was recorded for 699 white Newcastle upon Tyne girls taking part in a longitudinal study of growth and development during puberty. Girls from large (5+) families started menstruation about five months later than girls from small families. This effect was observed only among girls with fathers in manual occupations. The occurrence of menarche had a peak in January and a possible secondary peak about August. Height and to some extent weight increased with the age at menarche, while arm circumference and skinfolds tended to decrease. The correlation of age at menarche with weight at given height was -0.13 and that of age at menarche with height at given weight was 0.38. The correlation of age at menarche with skinfolds and arm circumference for given weight were of the order of -0.3 and for given height of the order of -0.2. The time lapse between the age at peak height velocity (PHV) and the age at menarche decreased with increasing subscapular skinfold at PHV.