What is a good midwife? Insights from the literature

OBJECTIVE: to review the literature around what is considered to be a good midwife and in particular what women value in a midwife, in order to identify the gaps in the evidence for future research. DESIGN: this paper reviews the research in the area of interest over the past 30 years. The literature search focused on the concept of good midwife using synonyms and antonyms. The inclusion criteria included language (English or Italian). The examined databases were Medline, Maternity and Infant Care, Applied Social Sciences Index and Abstract and CINAHL. SETTING: studies conducted in high-income countries were taken into account. A focused review of papers which explicitly investigated what a good midwife means and a thematic analysis on what women value in a midwife were carried out. PARTICIPANTS: different standpoints have been considered (midwives, student midwives, women and their partners), focusing in particular on women viewpoint. FINDINGS: the literature review reveals information about what is considered to be a good midwife from a range of perspectives and what women value in a midwife. A good midwife should possess several attributes: theoretical knowledge, professional competencies, personal qualities, communication skills and moral/ethical values. According to the thematic analysis around what childbearing women value in a midwife, frequent key-themes emerging from the literature were: support, possibility of choice, feeling in control and having appropriate information. KEY CONCLUSIONS: the meaning of good midwife might change according to different actors involved in midwifery care and there is no agreement on the definition of what constitutes a good midwife. Furthermore, it is not clear if what women value in a good midwife corresponds to the midwives' perception of themselves as good professionals. There is a dearth of information around women's expectations and experiences specifically of a good midwife, and even less around whether this changes according to where they give birth. IMPLICATIONS FOR PRACTICE: this literature review seeks to stimulate debate and reflection among midwives and professionals involved in the childbearing event, in order to fulfil women's expectations of their midwife and increase their satisfaction with the birth experience. The identification of the gaps in the evidence provided the starting point and allowed the development of research questions and methodology for an ongoing doctoral research. On the basis of the gaps in the evidence, the doctoral research will explore and seek to explain nulliparous women's expectations and experiences of a good midwife in the context of different planned place of birth, using a Grounded Theory methodology. It is also expected that the findings of this literature review will stimulate additional research in this area to ultimately inform midwifery practice and midwifery educational programmes

Human chorionic gonadotropin isoforms in the diagnosis of ectopic pregnancy

This paper has set the scene for re-defining clinical chemistry data for the diagnosis of ectopic pregnancy. Indeed it has proved some assumptions on hCG levels to be false. Professor Iles was/is the principal investigator on these studies

Ion-Exchanged Waveguides in Glass Doped with PbS Quantum Dots

The lowest-loss (≤1 dB/cm) ion-exchanged waveguides in glass doped with PbS quantum dots are presented. Near-field mode profile and refractive index profile using the refracted near-field technique were measured for these waveguides. We demonstrate that the optical properties of this glass unchanged during the ion-exchange process

Childbearing women’s experiences of early pushing urge

AIM: To explore childbearing women’s experiences of early pushing urge (EPU). STUDY DESIGN: A qualitative phenomenological study was undertaken in an Italian maternity hospital. The sample included 8 women that experienced EPU during labor. Data were collected through semi-structured interviews. FINDINGS: The findings are presented as three main themes: (a) women’s perceptions of EPU, (b) bodily sensations versus midwives’ advice: struggling between conflicting messages, and (c) the “a posteriori” feeling of women about midwives’ guidance during EPU. The perception of EPU was characterized by sense of obstruction, bone pain, and different intensity of pushing efforts when compared with those of the expulsive phase. Women found it difficult to follow the midwife’s suggestion to stop pushing because this contradicted their bodily sensations. However, the women recognized a posteriori the importance of the midwife’s support while experiencing EPU. Women appreciated the midwives’ presence and emotional support most of all because they seemed to be more concerned with the personal relationship they formed in labor rather than the usefulness or appropriateness of their advice. CONCLUSION: Midwives should consider women’s physical perceptions to help them cope with EPU, acknowledging that women may struggle when caregivers’ suggestions are in contrast to their physical perceptions. The women’s overall positive experiences of birth suggest that EPU might be considered as a physiological event during labor, reinforcing the hypotheses of previous research. The optimal response to the EPU phenomenon remains unclear and should be studied, considering EPU at different dilatation ranges and related clinical outcomes

Midwives’ approaches to early pushing urge in labour

The objectives of this mixed-methods study were: a) to investigate midwives' approaches to early pushing urge (EPU); and b) to explore midwives' perspectives and experiences of helping women cope with EPU. A quantitative observational methodology was adopted to investigate midwives' approaches to EPU in 60 cases. A qualitative phenomenological approach was carried out in order to gain more in-depth understanding of midwives' views and experiences of EPU management strategies. It was found that midwives mainly adopt two approaches in the case of EPU: letting the woman do what she feels, and a stop-pushing technique. The findings are presented as four main domains: a) midwives' approaches to EPU; b) drivers guiding midwives' approaches to EPU; c) influencing factors in helping women cope with EPU; d) variation of midwives' approaches to EPU over time

Adding to the midwifery curriculum through internationalisation and promotion of global mobility

Despite the obvious need for student midwives to be exposed to meaningful learning experiences that consider engagement in the wider context of international health care and the associated benefits, there is a lack of information on how this is achieved within midwifery curricula both nationally and internationally. At the University of Nottingham, work has been undertaken to ensure the midwifery curriculum is internationalised and global mobility is promoted to all midwifery students. Processes and strategies have been put in place to encourage students' mobility including the Erasmus+ programme, elective placements and short-term ad hoc international opportunities. Thanks to the strategies that have been implemented, the Division of Midwifery has seen an increase in students undertaking an international placement from 5% in 2013/14 to 18% in 2015/16. Moving forward, future works will aim to develop ‘virtual mobility’ projects and evaluate the Erasmus+ programme in conjunction with European partners

Respectful handover: a good alternative when intrapartum continuity of carer cannot be guaranteed

AIM: To explore first-time mothers’ expectations and experiences of being cared for by an unknown midwife and their perceptions around continuity of carer during childbirth. DESIGN: Qualitative Straussian grounded theory methodology. SETTING: Three National Health Service Trusts in England providing maternity care that offered women the possibility of giving birth in different settings (home, freestanding midwifery unit and obstetric unit). PARTICIPANTS: Fourteen first-time mothers in good general health with a straightforward singleton pregnancy anticipating a normal birth. METHODS: Ethical approval was obtained. Data were collected through two semi-structured interviews for each participant (before and after birth). The coding process included the constant comparison between data, literature and analytical memos. FINDINGS: Childbearing women’s expectations during pregnancy and experiences during labour are reported in regard to three main themes: a) encountering an unknown midwife during labour; b) familiarity and immediate connection: ‘I felt like I’ve known her for years’; c) change of shift and respectful handover. CONCLUSION: Respectful and efficient handovers between midwives are crucial in guaranteeing a high level of care when continuity of carer cannot be guaranteed. Midwives should, therefore, pay attention to how the handover is done, how information is conveyed to colleagues taking over care and how this is communicated to the labouring woman and her companions present in the room. A handover should actively involve the mother and the birth partner(s) and be essentially respectful of their needs