Midwifery basics. Infant feeding: Managing baby related challenges

Infant feeding: is the twelfth series of ‘Midwifery basics’ targeted at practising midwives. It aims to provide information to raise awareness of the impact of the work of midwives on women’s experience and encourage midwives to seek further information through a series of activities. In this fifth article Joyce Marshall considers a range of baby related issues that pose challenges for both mothers and midwives in relation to infant feeding

Mentorship from the student perspective

Midwifery Basics: Mentorship 3 When undertaking a programme of pre-registration midwifery education, student midwives are working towards responsible and accountable practice at the point of registration. In order to facilitate this, mentors are required to support learning in a range of clinical settings and contribute to the development of the students ability to practice as a safe and competent midwife (Nursing and Midwifery Council, 2008, 2011). Experiences of mentorship can influence how a student midwife's confidence and competence develops and may shape how they will subsequently practice once qualified (Hughes and Fraser, 2011; Licqurish and Seibold, 2008). Consequently, supportive and positive mentorship is essential to enhance student learning experiences in practice and to promote their personal and professional developmen

Midwifery Basics: Assessing students

Midwifery Basics: Mentorship 4 Mentorship: is the fourteenth series of ‘Midwifery basics’ targeted at practising midwives. It aims to provide information to raise awareness of the impact of the work of midwives on student learning and ultimately on women’s experiences and encourages midwives to seek further information through a series of activities. In this the fourth article Julie Parkin and Joyce Marshall consider some of the key issues related to the responsibility of the sign off mentor in the process of assessing student midwives’ competence in clinical practice. Scenario Suzanne is practising on labour ward and is mentoring Emily, a second year student midwife. She is concerned that at the end of her first week Emily does not appear to be making the transition to being a second year student as she still requires close supervision and direction, and is struggling to communicate with women and their birth partner

The role and responsibilities of a midwifery mentor

Midwifery Basics: Mentorship 1 Mentorship of student midwives in clinical practice is an important part of the role of a qualified and experienced midwife (Steele 2009). The Nursing and Midwifery Council (2008 p9) states ‘The role of the sign-off mentor and/or practice teacher is to make judgments about whether a student has achieved the required standards of proficiency for safe and effective practice for entry to the NMC register.’ However, mentorship is much more than this and can be considered as the process of giving support for personal and professional development. This can be provided in a range of ways, such as acting as a role model, teaching, encouraging, offering feedback and formally assessing the student midwife. Less formal definitions suggest that the mentor is a guide, supporter and advisor (Casey & Clark 2012). The mentoring process, the relationship between mentor and student midwife and the institutional environment within which the mentoring occurs can present a range of rewards and challenges for both mentor and studen

Relationships between university and practice, and the role of the link lecturer

Mentorship: is the fourteenth series of ‘Midwifery basics’ targeted at practising midwives. It aims to provide information to raise awareness of the impact of the work of midwives on student learning and ultimately on women’s experience and encourage midwives to seek further information through a series of activities. In this fifth article Pat Jones and Joyce Marshall consider the relationships between university and practice, and the role of the link lecturer in supporting mentors and students. Midwives are encouraged to seek further information through a series of activities

Skills to facilitate learning in clinical practice

Midwifery Basics: Mentorship 2 Mentorship is the 14th series of 'Midwifery basics' targeted at practising midwives. The aim of these articles is to provide information to raise awareness of the impact of the work of midwives on women's experience, and encourage midwives to seek further information through a series of activities relating to the topic. In this second article Jayne Samples and Joyce Marshall consider some of the key issues that can affect student learning in clinical practice

The concept of shame and how understanding this might enhance support for breastfeeding mothers

The purpose of this paper is to explore the usefulness of the concept of shame and the literature on shame management for understanding the experiences of women who struggle to establish breastfeeding. In particular we consider what this literature might suggest with regard to good practice when supporting breastfeeding mothers, illustrating our discussion with data from two previous empirical studies. There is increasing evidence from qualitative explorations of women’s experiences of breastfeeding that, for some mothers, breastfeeding can be a psychologically uncomfortable or even distressing experience. This seems particularly likely where there are difficulties establishing successful feeding which are counter to a mother’s previous expectations and where she may then feel she is positioned by discourses of ‘good’ or ‘natural’ mothering as failing both as a mother and a woman (e.g. Williamson et al., 2012). Previous discussions of the potential for breastfeeding promotion to cause distress for women who do not breastfeed or who struggle to do so have tended to assume that the problem is guilt. In response to this a frequently made point has been the importance of recognising that apparent ‘failures’ to breastfeed are not best understood as the mother’s omission or ‘choice’ but instead as a consequence of the many barriers to breastfeeding in Western societies. Thus the possibility is created for breastfeeding advocacy to target the many ways in which breastfeeding is made difficult for women, rather than blaming mothers. However, as Taylor and Wallace (2012) point out, women’s emotional responses may be more complex than has sometimes been assumed and for many mothers who struggle with breastfeeding or turn to formula milk, shame may be as much if not more of an issue than guilt. As such the identity work which mothers engage in to make sense of not breastfeeding (e.g. Marshall, Godfrey & Renfrew, 2007) can perhaps be viewed as a form of shame avoidance. There have been several attempts to distinguish shame from guilt, and we draw on Gilbert’s (2003) work as one of the most comprehensive models which usefully highlights the differing experience of relations with others when we feel guilty or ashamed. Guilt suggests a relatively powerful position where we are able to hurt another by our actions or omissions and we may then be motivated to make reparation. However, shame can be a much more destructive emotion and therefore difficult to manage. When we are ashamed we experience ourselves as inferior or flawed before a more powerful critical ‘other’, whether this is an actual person we perceive as devaluing us or a sense of a generalised ‘other’ in front of whom we are inadequate and lesser. With shame the focus is on a sense of a damaged and unable self, rather than on specific actions. Therefore an example of shame would be a mother whose distress about feeding difficulties arises from the possibility to her that these difficulties mean she is fundamentally flawed or inadequate as a mother, and possibly exposed as such before critical others. This is a rather different emotional experience from a sense of guilt towards her baby for providing less than optimal nutrition, though the two are not mutually exclusive. We discuss some of the ways in which shame and the avoidance of shame may challenge a mother’s relationships with others, including her developing attachment with the baby and her interactions with breastfeeding supporters. Drawing on literature on shame management and some of our own research data, we suggest a number of ways in which healthcare practitioners may be able to help women to manage or repair feelings of shame. For example, Brown’s (2006) research on women’s experiences of shame in a range of contexts suggests that establishing relationships with breastfeeding women which validate both their experiences and emerging identities as mothers is important for providing a space in which it is safe to acknowledge, examine and contextualise often unspoken and taboo feelings of shame. In this way, the research on shame management supports recent proposals for breastfeeding support to adopt a more person-centred focus (e.g. Hall Moran et al., 2006). Finally, in reviewing the usefulness of a focus on shame, we reflect briefly on the irony that the most visible examples of breastfeeding in public may paradoxically be viewed as shameful acts. This underscores the difficulties that women may face within contemporary Western societies in resisting shame in relation to breastfeeding

Evaluating the ‘Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme’: A mixed method study in England

Background Caesarean section plays an important role in ensuring safety of mother and infant but rising rates are not accompanied by measurable improvements in maternal or neonatal mortality or morbidity. The ‘Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme’ was a facilitative initiative developed to promote opportunities for normal birth and reduce Caesarean section rates in England. Objective To evaluate the ‘Focus on Normal Birth and Reducing Caesarean section Rates’ programme, by assessment of: impact on Caesarean section rates, use of service improvements tools and participants’ perceptions of factors that sustain or hinder work within participating maternity units. Design A mixed methods approach included analysis of mode of birth data, web-based questionnaires and in-depth semi-structured telephone interviews. Participants Twenty Hospital Trusts in England (selected from 68 who applied) took part in the ‘Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme’ initiative. In each hospital Trust, the head of midwifery, an obstetrician, the relevant lead for organisational development, a supervisor of midwives, or a clinical midwife and a service user representative were invited to participate in the independent evaluation. Methods Collection and analysis of mode of birth data from twenty participating hospital Trusts, web-based questionnaires administered to key individuals in all twenty Trusts and in-depth semi-structured telephone interviews conducted with key individuals in a sample of six Trusts. Results There was a marginal decline of 0.5% (25.9% from 26.4%) in mean total Caesarean section rate in the period 1 January 2009 to 31 January 2010 compared to the baseline period (1 July to 31 December 2008). Reduced total Caesarean section rates were achieved in eight trusts, all with higher rates at the beginning of the initiative. Features associated with lower Caesarean section rates included a shared philosophy prioritising normal birth, clear communication across disciplines and strong leadership at a range of levels, including executive support and clinical leaders within each discipline. Conclusions It is important that the philosophy and organisational context of care are examined to identify potential barriers and facilitative factors

Challenges of mentorship

Mentorship is the fourteenth series of ‘Midwifery basics’ targeted at practising midwives. It aims to provide information to raise awareness of the impact of the work of midwives on student learning and ultimately on women’s experience and encourage midwives to seek further information through a series of activities. In this sixth article Charlotte Kenyon, Stephen Hogarth and Joyce Marshall consider some of the challenges to mentorship and possible solutions to these

Measurement of interface pressure in interference fits

When components such as bearings or gears are pressed onto a shaft, the resulting interference induces a pressure at the interface. The size of this pressure is important as many components fail because fatigue initiates from press-fit stress concentrations. The aim of the present work was to develop ultrasound as a tool for non-destructive determination of press-fit contact pressures. An interference fit interface behaves like a spring. If the pressure is high, there are few air gaps, so it is very stiff and allows transmission of an ultrasonic wave. If the pressure is low, then interface stiffness is lower and most ultrasound is reflected. A spring model was used to determine maps of contact stiffness from interference-fit ultrasonic reflection data. A calibration procedure was then used to determine the pressure. The interface contact pressure has been determined for a number of different press- and shrink-fit cases. The results show a central region of approximately uniform pressure with edge stress at the contact sides. The magnitude of the pressure in the central region agrees well with the elastic Lamé analysis. In the more severe press-fit cases, the surfaces scuffed which led to anomalies in the reflected ultrasound. These anomalies were associated with regions of surface damage at the interface. The average contact pressure in a shrink-fit and press-fit joint were similar. However, in the shrink-fit joint more uneven contact pressure was observed with regions of poor conformity. This could be because the action of pressing on a sleeve plastically smooths out long wavelength roughness, leading to a more conforming surface