Jury of your peers?

Midwifery lecturer Sarah Davies reports on the NMC’s case against Debs Purdue

Women's birth experiences in Pakistan: the importance of the Dai

Aim: The aim of this paper is to present findings from a research study undertaken to explore women's life and birth experiences in Pakistan. Method: The design was ethnographic (Denzin, 1978) with an anthropological slant. Participant observation was undertaken in a maternity hospital in Pakistan and an over-50s luncheon club in the UK. Following two focus groups, in-depth interviews were undertaken with 16 women. Data were collected from observation, experience gained during nine field trips to Pakistan and the use of a reflective research diary. Findings/results: The main theme that emerged was the importance of the Dai (untrained traditional birth attendant) in women's accounts of their experiences. This theme included her influence on the women's birth experience and her work in the context of relatives and other health professionals. Other sub-themes not covered in this paper were boy preference, the omnipresent medical model, birth systems, the powerful symbolism of blood, purity shame and honour, and specifically from the women interviewed in the UK – coming to England and modernisation. Implications: The Dai was considered essential for the birth and currently 80% of all rural births are attended by Dai. However the medical professionals and policy-makers in Pakistan consider Dai practice to be dangerous and aim to establish systems for supervising and supporting skilled birth attendants, including the development of emergency referral services and a community midwife programme. Further research on women's experiences of birth in the home and hospital in Pakistan are necessary to inform government policy

Attacks on midwives, attacks on women’s choices

Nadine Edwards, Jo Murphy-Lawless, Mavis Kirkham and Sarah Davies ask whether recent attacks on midwives are a Human Rights issu

Association for Improvements in the Maternity Services (AIMS) critique of 'The London Project : a confidential enquiry into a series of term babies born in an unexpectedly poor condition' by the Centre for Maternal and Child Enquiries (CMACE Report)

The AIMS critique of the CMACE Report includes the following concerns: why the report was requested by King’s College Hospital the selection of cases that were sent to be reviewed the methods used to review them the validity of the conclusions that were drawn The AIMS critique concludes that the CMACE Report: Reported on the excellent reputation of Kings, but failed to include the excellent reputation of the Albany Midwifery Practice, and omitted any details about King’s community midwifery which also achieves excellent outcomes. It is possible that CMACE was not actually given access to previous reports about the Albany Midwifery Practice. Failed to consider the possibility that the 'cluster' of cases presented by King's could have been a chance event, and that the selection of data (including the time frame) may have contributed to the construction of such a 'cluster'. Failed to use the recommended term, Neonatal Encephalopathy (NE), which describes symptoms and instead uses Hypoxic Ischaemic Encephalopathy (HIE) which implies cause. Selected groups of babies with and without a problem who were cared for by the Albany Midwifery Practice and a group of babies who had a problem who were cared for by King’s community midwives, but failed to include any babies cared for by the hospital. Used Confidential Enquiry methodology designed to look for trends in large groups of cases in order to help to identify practice changes to improve outcomes. This methodology was not appropriate for the comparison of small groups of cases. Misunderstood women’s right to be supported to make their own decisions and not be pressured into having to accept care dictated by protocol and guidelines. The report contradicts itself saying that the midwives were not directive enough, yet is critical saying that “the choices the woman makes will to some extent reflect the preferences of her midwife”; it seemed that the report had clear medical views about what women should and should not be ‘directed’ to do. Assumed that the Albany Practice midwives needed further education that could be provided by them working in the hospital environment and failed to consider that King’s staff could gain from what the Albany Practice midwives could teach them, Made unsubstantiated assumptions that outcomes could be improved by adherence to hospital protocols and guidelines, and included a suggestion of a homebirth risk assessment tool. However there is no evidence that place of birth was an issue in any of the cases considered.</ul

“Am I too emotional for this job?” An exploration of student midwives’ experiences of coping with traumatic events in the labour ward.

Background Midwifery is emotionally challenging work, and learning to be a midwife brings its own particular challenges. For the student midwife, clinical placement in a hospital labour ward is especially demanding. In the context of organisational tensions and pressures the experience of supporting women through the unpredictable intensity of the labour process can be a significant source of stress for student midwives. Although increasing attention is now being paid to midwives’ traumatic experiences and wellbeing few researchers have examined the traumatic experiences of student midwives. Such research is necessary to support the women in their care as well as to protect and retain future midwives. Aim This paper develops themes from a research study by Davies and Coldridge (2015) which explored student midwives’ sense of what was traumatic for them during their undergraduate midwifery education and how they were supported with such events. It examines the psychological tensions and anxieties that students face from a psychotherapeutic perspective. Design A qualitative descriptive study using semi-structured interviews. Setting A midwifery undergraduate programme in one university in the North West of England. Participants 11 second and third year students. Analysis Interviews were analysed using interpretative phenomenological analysis. Findings The study found five themes related to what the students found traumatic. The first theme Wearing the Blues referred to their enculturation within the profession and experiences within practice environments. A second theme No Man’s Land explored students’ role in the existential space between the woman and the qualified midwives. Three further themes described the experiences of engaging with emergency or unforeseen events in practice and how they coped with them (“Get the Red Box!”, The Aftermath and Learning to Cope).This paper re-examines aspects of the themes from a psychotherapeutic perspective. Key conclusions Researchers have suggested that midwives’ empathic relationships with women may leave them particularly vulnerable to secondary traumatic stress. For student midwives in the study the close relationships they formed with women, coupled with their diminished control as learners may have amplified their personal vulnerability. The profession as a whole is seen by them as struggling to help them to safely and creatively articulate the emotional freight of the role. Implications for practice For midwifery educators, a focus on the psychological complexities in the midwifery role could assist in giving voice to and normalising the inevitable anxieties and difficulties inherent in the role. Further research could explore whether assisting students to have a psychological language with which to reflect upon this emotionally challenging work may promote safety, resilience and self-care. Key words Student midwives, traumatic stress, resilience, containment, safety, midwifery culture, hospital midwifer

Transition metal amides and imides as precursors to metal nitride and carbonitride thin films via chemical vapor deposition

Transition metal nitrides are known for their hardness and semiconducting properties. These properties have lead to their use as barrier layers, which prevent the diffusion of copper into silicon in gate electrodes. Chemical vapour deposition (CVD) and atomic layer deposition (ALD) of transition metal nitrides and carbonitrides at low temperatures (200-600 °C), using imido and amido complexes as precursors, has been reported. We have been investigating the synthesis of a range of tungsten imido and amido complexes, and zirconium cyclopentadienyl and amido compounds via transamination and metathesis reactions. We have investigated the potential of the compounds synthesised as single-source precursors to their respective metal nitrides via CVD, involving studies at low pressure (LPCVD) and using an aerosol-assisted (AACVD) technique

'Nice, normal midwifery'? A longitudinal study of the socialisation of student midwives

This qualitative, longitudinal study explores and compares the experiences of ten student midwives as they progressed through their midwifery training. Five of the students were undertaking the eighteen month course for trained nurses, while the other five were undertaking the three year course for those without a nursing qualification. A grounded theory approach was used, based on in-depth, semi-structured interviews carried out with participants at the beginning, middle and end of their midwifery course. The central finding of the study was that having started the course with a focus on birth as a normal life event, by the end of it their perspective had shifted to one which now focused more on the potential dangers of birth. They worried about `things going wrong'; such as the possibility of death or damage to mother or baby and how they would deal as newly qualified midwives with such situations. The tension between treating birth as a normal life event yet remaining at the same time alert to what is, in essence, the possibility of death, is one with which every midwife has to deal. Not surprisingly, perhaps, it caused these students considerable anxiety, particularly as they neared the end of their course. The study explores factors that impinged on their changing perceptions and levels of anxiety. These were identified from the data as the following themes: the nature of the support received by students, the relationship between theory and practice, and the characteristics of the culture within which they were learning midwifery. In the conclusion recommendations for changes in midwifery education and possible areas for future research are suggested