Future-proofing simulation and clinical skills

Midwifery pre-registration education must adopt a range of learning and teaching approaches, including simulation and clinical skills sessions, to ensure that student midwives have the required skills and competencies to be admitted to the register. Simulation and clinical skills sessions, undertaken in the ‘safe’ environment of the classroom, enhance students' understanding, confidence and skills—particularly in managing obstetric emergencies, where in practice the needs of the woman take precedence over students' learning opportunities. The unpredictability of the clinical environment may lead to students not having the opportunity to manage an obstetric emergency until after they qualify. Setting up and facilitating simulation and clinical skills sessions is time-consuming for midwifery lecturers and not best use of their expertise, which is why specialist support in the form of laboratory/clinical skills technicians is critical to the smooth running of sessions and maintenance of costly equipment

Barriers and facilitators to smoking cessation in pregnancy and following childbirth: literature review and qualitative study

Background: Although many women stop smoking in pregnancy, others continue, causing harm to maternal and child health. Smoking behaviour is influenced by many factors, including the role of women’s significant others (SOs) and support from health-care professionals (HPs). Objectives: To enhance understanding of the barriers to, and facilitators of, smoking cessation and the feasibility and acceptability of interventions to reach and support pregnant women to stop smoking. Design: Four parts: (1) a description of interventions in the UK for smoking cessation in pregnancy; (2) three systematic reviews (syntheses) of qualitative research of women’s, SOs’ and HPs’ views of smoking in pregnancy using meta-ethnography (interpretative approach for combining findings); (3) semistructured interviews with pregnant women, SOs and HPs, guided by the social–ecological framework (conceptualises behaviour as an outcome of individuals’ interactions with environment); and (4) identification of new/improved interventions for future testing. Setting: Studies in reviews conducted in high-income countries. Qualitative research was conducted from October 2013 to December 2014 in two mixed urban/rural study sites: area A (Scotland) and area B (England). Participants: Thirty-eight studies (1100 pregnant women) in 42 papers, nine studies (150 partners) in 14 papers and eight studies described in nine papers (190 HPs) included in reviews. Forty-one interviews with pregnant women, 32 interviews with pregnant women’s SOs and 28 individual/group interviews with 48 HPs were conducted. Main outcome measures: The perceived barriers to, and facilitators of, smoking cessation in pregnancy and the identification of potential new/modified interventions. Results: Syntheses identified smoking-related perceptions and experiences for pregnant women and SOs that were fluid and context dependent with the capacity to help or hinder smoking cessation. Themes were analysed in accordance with the social–ecological framework levels. From the analysis of the interviews, the themes that were central to cessation in pregnancy at an individual level, and that reflected the findings from the reviews, were perception of risk to baby, self-efficacy, influence of close relationships and smoking as a way of coping with stress. Overall, pregnant smokers were faced with more barriers than facilitators. At an interpersonal level, partners’ emotional and practical support, willingness to change smoking behaviour and role of smoking within relationships were important. Across the review and interviews of HPs, education to enhance knowledge and confidence in delivering information about smoking in pregnancy and the centrality of the client relationship, protection of which could be a factor in downplaying risks, were important. HPs acknowledged that they could best assist by providing support and understanding, and access to effective interventions, including an opt-out referral pathway to Stop Smoking Services, routine carbon monoxide screening, behavioural support and access to pharmacotherapy. Additional themes at community, organisational and societal levels were also identified. Limitations: Limitations include a design grounded in qualitative studies, difficulties recruiting SOs, and local service configurations and recruitment processes that potentially skewed the sample. Conclusions: Perceptions and experiences of barriers to and facilitators of smoking cessation in pregnancy are fluid and context dependent. Effective interventions for smoking cessation in pregnancy should take account of the interplay between the individual, interpersonal and environmental aspects of women’s lives. Future work: Research focus: removing barriers to support, improving HPs’ capacity to offer accurate advice, and exploration of weight concerns and relapse prevention. Interventions focus: financial incentives, self-help and social network interventions

Smoking cessation and health promotion around pregnancy

A smoking cessation program targeting pregnant women and their partners was monitored during 17 years and subjected to several substudies. All women in Blekinge, who gave birth in the months of September during the period 1984 to 2000, were asked to fill out a questionnaire, anonymously, about their smoking habits before and during pregnancy. During these years a long-term educational programme concerning health factors and pregnancy was in process. All personnel the woman met during pregnancy, labour and the infant period had continuously been offered specific education in smoking cessation. The proportion of women smoking that stopped smoking during pregnancy increased from 20% in 1984 to 74% in 2000. Of the women, 84% reported having been informed about smoking cessation and 93% of them felt the information to be of good quality. Twenty-four women were interviewed 2-3 years after delivery with regard to their smoking habits during and after pregnancy. Women who still smoked at their first visit to the antenatal clinic often had an established smoking pattern. They had vague knowledge about the risks of smoking during pregnancy. All women stated that the midwife played an important role in their motivation to stop smoking but many women, however, lacked the support from other staff. In Kronoberg, 403 women, smoking at the time of conception, were asked about their smoking habits during their pregnancies. At the time of registration at the antenatal clinic, the proportion of smoking women had fallen from 403 (100%) to 308 (76%), and at the postpartum check-up, the proportion had fallen further to 225 (56%). Heavy smokers and women with smoking partners continued smoking to a greater extent, as did multiparae and women in unqualified jobs. Serum samples from 496 pregnant women were tested for cotinine. In stated non-smokers, 13 had cotinine levels suggesting substantial exposure to environmental smoke and 25 women who reported to be non-smokers had cotinine levels consistent with active smoking. Another 19 women reported to be light smokers but had values above the median of those of heavy smokers. Thus, 439 of the women (89%) had cotinine levels corresponding with their histories. Members from five groups of health care professionals, altogether 14 persons, involved in a long-term anti-smoking program in maternal and child health care were interviewed about their experiences. The interaction between the professional and the smoker was regarded as the most powerful and important factor to support smoking cessation. Continuous staff training, collaboration between different personnel groups, and program monitoring were other important factors. Pregnancy offers multiple windows of opportunity for smoking cessation intervention. The course of pregnancy and the reality of the postpartum period generate the moving goal for cessation efforts. The target of creating smoke free pregnancies, however, cannot be attained with a single, simple intervention

Tobacco cesssation - as we want it! An interview study with young people

Background Smoking among teenagers and young people is still common and about every third young smoker states that they want to quit smoking. There are no obvious evidence-based methods for tobacco cessation for young people, and therefore, the same methods are used for young people as well as adults. The aim was to study young people's views about what support they would like for quit smoking, with the intention of developing a model for tobacco cessation for young people through interviews with the target groups. Methods A qualitative study using a descriptive and exploratory design was conducted. Young smokers 16 - 29 years old (n=25) were interviewed in five focus groups in southern Sweden. Data were analyzed by content analysis. Results The results illuminate young people's suggestions to develop a model for tobacco cessation. Four main categories emerged; Existing support rejected - existing apps, support- by SMS, and self-help brochures did not appeal to young people. Agreement between friends - To sign an agreement between two friends which included a fee on relapse. A dult support - To organize the model with duo groups and give adapted support. Celebrate and competition - Lift the positive with the freedom of smoke and create the opportunity to win simple prizes to celebrate the achieved interim goals. Conclusions The young people suggested that the model for tobacco cessation would contain adult support and involves an agreement between friends and has elements of celebration and competition. The challenge will be to implement this model into environments where young people live

When do adolescents become smokers?

Objective. To follow the development of a class of pupils' tobacco habits for seven years, and to study differences in tobacco use between girls and boys. Setting. Kronoberg County in southern Sweden. Subjects. All the approximately 2000 pupils were followed from approximately age 12 to approximately age 18. Design. Yearly cross-sectional surveys from 1994 to 2000. Each year, the pupils filled in an established tobacco questionnaire. They did it anonymously in the classroom. Main outcome measures. Percentage of smokers, number of cigarettes smoked per day, and percentage of pupils using "snus", the Swedish variety of oral moist snuff. Results. From grade 6 of compulsory school to grade 12 of upper secondary school, the proportion of daily smokers rose, from 0.2% to 22% for girls and from 0.5% to 14% for boys. Among both genders, the increase occurred mainly between grades 7 and 10, and from grade 10 onwards the daily smokers were the largest group of smokers. Starting from grade 9, boys had higher total tobacco consumption than girls, as a result of their increased use of "snus", and at the end of the study 39% of the boys used tobacco compared with 34% of the girls. Conclusion. Studying young people's tobacco habits over time gives an understanding of when preventive measures should be implemented. In order for these to influence attitudes, they should be put in place well before tobacco is introduced

Obstetric and perinatal outcomes in pregnancies complicated by diabetes, and control pregnancies, in Kronoberg, Sweden

Background: Diabetes during pregnancy is an increasingly common metabolic disorder, associated with significantly increased risks for both mother and child. Aim of this study was to compare maternal and perinatal outcomes in women with pregestational (PDM) type 1 (T1DM), type 2 diabetes (T2DM), gestational diabetes mellitus (GDM) and compare these to pregnancies not complicated with diabetes. This study also evaluated a specifically organized care-model mostly involving specialist diabetes nurses. Methods: Retrospective population-based records review 2009-2012. Rates of maternal (preeclampsia, pre-term delivery, cesarean section (CS)) and fetal outcomes (large for gestational age (LGA), macrosomia, congenital malformations/intrauterine death) were assessed and potential predisposing or contributing factors as maternal age, ethnicity, obesity, weight gain, parity, HbA1c levels, insulin types and doses. Results: Among 280 pregnancies 48 were PDM, 97 GDM and 135 without diabetes. Within the group with diabetes, early-pregnancy BMI was higher (p = 0.0001), pregnancy weight gain lower (11.1 ± 6.7 kg vs 13.1 ± 7.1 kg, p = 0.005), more delivered preterm (p = 0.0001), by CS (p = 0.05), and had more LGA neonates (p = 0.06) than the group without diabetes. Among pregnancies with diabetes, GDM mothers gained less weight (9.9 kg vs 13.5 kg) (p = 0.006), and rates of CS (p = 0.03), preterm deliveries (p = 0.001) and LGA (p = 0.0001) were not increased compared to PDM; More T1DM infants were LGA, 60% vs. 27% in T2DM. In pregnancies with diabetes obesity, excessive weight gain and multiparity were associated with increased risk of LGA neonates, and mother's type of diabetes and gestational week were associated with higher rates of CS. Conclusion: Weight gain during pregnancy was lower in pregnancies with diabetes and prevalence of LGA, CS and preterm deliveries in GDM was not elevated, also for T2DM, except increased prevalence of LGA in T1DM that warrants increased clinical attention, indicating that this model of antenatal diabetes care may have contributed to improved maternal and fetal outcomes