Best Practices in Second Stage Labor Care: Maternal Bearing Down and Positioning

Despite evidence of adverse fetal and maternal outcomes from the use of sustained Valsalva bearing down efforts, current second-stage care practices are still characterized by uniform directions to “push” forcefully upon complete dilatation of the cervix while the woman is in a supine position. Directed pushing might slightly shorten the duration of second stage labor, but can also contribute to deoxygenation of the fetus; cause damage to urinary, pelvic, and perineal structures; and challenge a woman’s confidence in her body. Research on the second stage of labor care is reviewed, with a focus on recent literature on maternal bearing down efforts, the “laboring down” approach to care, second-stage duration, and maternal position. Clinicians can apply the scientific evidence regarding the detrimental effects of sustained Valsalva bearing down efforts and supine positioning by individualizing second stage labor care and supporting women’s involuntary bearing down sensations that can serve to guide her behaviors

Siting prisons, sighting communities: geographies of objection in a planning process

This paper reviews the planning process for a Scottish prison located near a former mining village. Analysing the letters of objection submitted by residents offers an opportunity to explore local views about prison and community and to relate these to the unique social and spatial history of the area. The planning process itself structured how residents were able to express themselves and defined what counted as a relevant objection. After deconstructing this process, the paper then restores and uses as a framework for analysis three geographies of objection stripped from local responses to the development proposal: the emotional, temporal, and spatial. Emotional expressions of objection added intensity and gave meaning to claims about the historical decline of the region and also conveyed a deep sense of the proposed building site as a lived space. Particular grounds of opposition—over fear of strangers, the fragility of a local orchid, and the pollution from mining—provide an opportunity to explore the complex nature of place meaning and community identity, ultimately leading to a conclusion that the meaning of place is always in flux. The paper argues that Simmel’s classic concept of the stranger, as the outsider who comes to stay, offers a useful analytic in understanding how the quality of proximal remoteness that prisons and other unwanted developments constitute participates in a constantly evolving sense of the local

How should peer-review panels behave?

Many governments wish to assess the quality of their universities. A prominent example is the UK’s new Research Excellence Framework (REF) 2014. In the REF, peer-review panels will be provided with information on publications and citations. This paper suggests a way in which panels could choose the weights to attach to these two indicators. The analysis draws in an intuitive way on the concept of Bayesian updating (where citations gradually reveal information about the initially imperfectly-observed importance of the research). Our study should not be interpreted as the argument that only mechanistic measures ought to be used in a REF

"Engaging with birth stories in pregnancy: a hermeneutic phenomenological study of women's experiences across two generations"

BACKGROUND: The birth story has been widely understood as a crucial source of knowledge about childbirth. What has not been reported is the effect that birth stories may have on primigravid women's understandings of birth. Findings are presented from a qualitative study exploring how two generations of women came to understand birth in the milieu of other's stories. The prior assumption was that birth stories must surely have a positive or negative influence on listeners, steering them towards either medical or midwifery-led models of care. METHODS: A Heideggerian hermeneutic phenomenological approach was used. Twenty UK participants were purposively selected and interviewed. Findings from the initial sample of 10 women who were pregnant in 2012 indicated that virtual media was a primary source of birth stories. This led to recruitment of a second sample of 10 women who gave birth in the 1970s-1980s, to determine whether they were more able to translate information into knowledge via stories told through personal contact and not through virtual technologies RESULTS: Findings revealed the experience of 'being-in-the-world' of birth and of stories in that world. From a Heideggerian perspective, the birth story was constructed through 'idle talk' (the taken for granted assumptions of things, which come into being through language). Both oral stories and those told through technology were described as the 'modern birth story'. The first theme 'Stories are difficult like that', examines the birth story as problematic and considers how stories shape meaning. The second 'It's a generational thing', considers how women from two generations came to understand what their experience might be. The third 'Birth in the twilight of certainty,' examines women's experience of Being in a system of birth as constructed, portrayed and sustained in the stories being shared. CONCLUSIONS: The women pregnant in 2012 framed their expectations in the language of choice, whilst the women who birthed in the 1970s-1980s framed their experience in the language of safety. For both, however, the world of birth was the same; saturated with, and only legitimised by the birth of a healthy baby. Rather than creating meaningful understanding, the 'idle talk' of birth made both cohorts fearful of leaving the relative comfort of the 'system', and of claiming an alternative birth

Reliability of ‘in-season’ fitness assessments in youth elite soccer players: a working model for practitioners and coaches.

Purpose: To assess the reliability of a battery of field tests when performed around habitual training during one micro-cycle of the ‘in-season’ period in youth elite soccer players. Methods: n=19 English Premier League academy players (mean ± SD: age, 18.3±0.2 years; stature, 1.80±0.05 m; body mass, 76.5±7.5 kg; V̇O2 max; 62.3±4.38 ml·kg-1·min-1 Sum of 8 skinfolds; 64.8±17.4 mm) performed; ‘1RM half-back squat (HBS)’, ‘vertical jump’ (VJ), ‘Yo-Yo IR2’, ’5, 10 & 20 m, sprint’, ‘the agility T-test’ and a ‘repeated sprint ability’ assessments around their habitual ‘in-season’ training and match-play on two occasions. Typical error (TE), coefficient of variation (CV), the smallest worthwhile change (SWC) was then calculated between trials. Test usefulness was then calculated by comparing the ‘SWC’ to the TE and rated as; good, OK or marginal. The smallest difference needed to be considered real (MD), was also calculated using the equation (TE×1.96×√2). Results: Most assessments demonstrated relatively high levels of reproducibility (CV; 0.3 - 4.3 %) to witness an “almost certain beneficial change” (i.e.,>MD) changes of approximately 5% (RSAbest, RSAmean, 10m & 20m sprint, ‘agility T test’ and 1RM HBS), and 11.5% (VJ, 5m sprint, and Yo-Yo IR2) are needed. Conclusions: The present training and testing ‘model’ is reliable and could be used when evaluating the fitness of highly trained youth elite soccer players during the ‘in-season’ period

Professional decision making and women offenders : containing the chaos?

This article draws on the findings from research undertaken in south-east Scotland in 2008 which sought to identify the characteristics of female offenders and to document the views of policy makers and practitioners regarding the experiences of women involved in the Scottish criminal justice system. Despite Scotland having retained a stronger 'welfare' focus than elsewhere in the UK (e.g. McAra, 2008), this is not reflected in the treatment of women who offend, with the rate of female imprisonment having almost doubled in the last ten years and community based disposals falling short of a welfare-oriented system. This article explores why the treatment that women offenders receive in the criminal justice system may be harsh and disproportionate both in relation to their offending and in relation to the treatment of men. It is argued that interventions with women need to be initiated earlier in their cycle of offending and at an earlier stage in the criminal justice process but also that the wide-ranging health, welfare, financial and behavioural needs of women who offend cannot be met solely within an increasingly risk-averse and punitive criminal justice environment

Catchment-wide interactive effects of anthropogenic structures and river levels on fish spawning migrations

Worldwide, rivers are extensively fragmented by anthropogenic structures, reducing longitudinal connectivity, inhibiting migration and leading to severe declines in many fish populations, especially for diadromous species. However, few studies have determined the effects of annual differences in hydrology on catchment penetration past barriers to spawning habitats. We investigated the upstream spawning migration of 120 (n = 61 & 59) acoustic tagged river lamprey (Lampetra fluviatilis) across two contrasting (dry and wet) years in the River Yorkshire Ouse, England. Overall, significantly more lamprey reached spawning habitat (76% vs 39%) and penetrated significantly further upstream (median [km] from release, 53.9 vs 16.8) in the wet year than the dry year. Passage at weirs was almost exclusively during elevated river levels, which directly and collectively influenced catchment-wide distribution, especially in the dry year. Indeed, higher proportions entered two upper tributaries in the wet year (9.8% vs 27.1% and 9.8% vs 30.5%), due to increased passage efficiencies at the two main river weirs (60.5–87.5% and 54.5–83.8%), and reached assumed spawning locations 66.5% and 10.9% quicker. By contrast, there was no difference in numbers of lamprey entering, or time taken to arrive at assumed spawning location, in the two lower river tributaries between years. Our study supports the landscape-scale paradigm for ecosystem restoration because of the observed catchment-level effects of hydrology and barrier distribution on fish migration. Connectivity restoration for migratory fish should be implemented at a catchment scale, with planning incorporating spatial information regarding accessibility to key habitats to reap the largest gains

A tale of two localities: Healthy Eating on a restricted income

Objective: To determine the availability and affordability of a healthy food basket and to model how those on low-incomes might manage. Design and methodology: After determining access and availability of key items from shops in two localities, called Deepdale and Ingol, a healthy food basket was developed. From this a week’s healthy menu was devised for a mother and two children, then availability of the ingredients was checked using data collected from the shops and costed. The baskets represented the cultural preferences of White British and South Asian families informed by participatory work with both these groups. We chose the income level for a family entitled to income support and child allowance. Results: Analysis of the availability of some healthy options such as brown bread, wholemeal pasta, and brown rice showed they were not widely available within shops in the two areas. The price of the ‘White British’ basket in the area of Ingol was £70.61 (lowest price). For comparable goods in the area of Deepdale, using the most expensive shopping basket, the price for the same basket was £42.47. A South Asian family shopping at a major supermarket outlet in Deepdale would pay £47.05. Using local shops they could pay between £38.59 and £44.28 by seeking out the best bargains in five shops (including some top-up items from a national supermarket). At the time of the research a mother with two children entitled to income support and child allowance would have to spend 28–32 per cent of her income in local shops and 34 per cent in a supermarket to buy a basket of healthy goods. This compared to the national average of 10–12 per cent of income being spent on food purchases. Conclusions: Prices varied enormously between the two areas. Local shops in one area offered a comparable price to shopping in the supermarkets. The Ingol area, with a large white working class population, was particularly poorly served for those on low incomes and the range of choices restricted. The percentages spent on food to meet the requirements of our healthy baskets and menus show that more than the national average – in both absolute and relative terms – would have to be spent to eat healthily. For the vulnerable and price dependent poor in Preston this will mean having to spend more on food and possibly more on travel to access basics, a healthy diet will cost more, while proportionally an unhealthy diet, as can be found in fast food outlets, may not be as expensive when other costs such as cooking are taken into account. An overall rise in food prices of 5 per cent will reduce living standards among high-income consumers by approximately 3 per cent; for low-income consumers this reduction in an already poor diet could be as high as 20 per cent. What we have demonstrated is the usefulness of local studies to highlight micro-differences in relatively small areas (Preston city) and the different experiences of groups in accessing healthy foods, and thus the need to refine interventions at a local level