Delayed cord clamping in the compromised baby

Compromised babies are routinely immediately separated from the umbilical cord in order to be resuscitated. The benefits of delayed cord clamping are numerous and apply as much, if not more, to the non-breathing baby, thus it is important to ask ‘does early cord clamping cause harm?’ The evidence suggests that early cord clamping can cause bradycardia in the baby and create the need for resuscitation. Invasive measures such as drugs and volume expanders are not required as frequently when delayed cord clamping is practised. Allowing the placenta to perform its role in the resuscitation means that oxygen supply continues, despite the failure to achieve effective respiration immediately. There appears to be no adverse psychological affects for the mother and birth partner if adequate midwifery support is provided. As midwives we must use the best available evidence to support our practice and improve outcomes

Detection of breech presentation: Abdominal palpation and hand-held scanning by midwives

Background: The NHS Litigation Authority's ‘sign up to safety’ campaign aims to prevent undiagnosed breech birth and possible poor birth outcomes. An audit was completed following the introduction of hand-held scanning ultrasound examination. Aims: The hand-held ultrasound was used by midwives for all women in labour and before induction of labour to confirm presentation. Methods: A criterion-based retrospective audit, conducted over 6 months in 2016, with a sample of 2737 women. Findings: The audit demonstrated that 22 breech presentations were detected when using the hand-held ultrasound before induction of labour or in labour. The audit standard of 100% of women receiving an ultrasound scan was not met, and potential reasons are explored. Conclusions: The results support the use of hand-held ultrasound, as it did detect breech presentation before induction of labour or spontaneous labour and birth. Further work includes the audit of the reasons that hand-held ultrasound scanning was not used, to ensure that a targeted action plan can be created. Future research into midwifery values, cultural attitudes and the effectiveness of abdominal palpation is also needed, to develop the knowledge base on which scanning can be framed

The experiences of midwives and women during intrapartum transfer from one-to-one midwife-led birth environments to obstetric-led units

Objective: To explore the transition from midwifery one-to-one support in labour within a midwife-led birth environment to an obstetricled unit from the perspectives of midwives and women. Design: Ethnographic study. Data was collected from eleven transfers to an obstetric-led unit. The transfer process was observed for four women. Semi-structured interviews were completed following the births with eleven women and eleven midwives. Nine maternity records were also analysed. Setting: An alongside midwife-led unit, freestanding midwife-led unit, women's homes in England. Findings: Territorial behaviour was the main theme experienced by midwives when transferring women to obstetric-led units. Territorial behaviour manifested itself as a feeling of 'us versus them' behaviours, 'feeling under scrutiny' and being aware of 'conflicting ideologies'. For women there were four themes that had an impact on their experiences of transfer obstetric-led units including: (1) their midwife continuing the care on the labour ward, (2) having time to adjust to their new situation, (3) all staff introducing themselves and (4) not being separated from their baby for long periods of time. Conclusion and implications for practice: Transfer from a midwife-led birth environment to an obstetric-led unit is a stressful situation for midwives and women. This paper highlights how territorial behaviours impacted negatively for midwives during transfer to an obstetric-led unit. More research is required to understand territorial behaviours within the maternity services and how more respectful compassionate working relationships can be created. Additionally, from the perspective of women this paper highlights four aspects of care that positively impacted on the experiences of women and even helped them to build resilience to cope with the change of location, situation, medical interventions and new carers when transferring to an obstetric-led unit

Exercise intervention in pregnancy: A feasibility study in Thailand

Background: Exercise during pregnancy can increase physical fitness, decrease risk of non-communicable diseases (NCDs) and control gestational weight gain (GWG) including association to enhance psychological well-being. Pregnant women generally have lower exercise behaviour than in the pre-pregnancy period. Objectives: The objectives were to determine the acceptability of a programme based on Thai Government guidance for exercise in pregnancy, and assess preliminary effects of the exercise programme. Methods: A total of 61 women between 12-16 weeks gestation were randomly allocated to the 10 week exercise intervention (n = 31) or control group (n = 30). Baseline measures were collected before intervention and preliminary effects data after completion of intervention and two weeks after expected date of delivery (EDD). Results: Analysis of Covariance (ANCOVA) showed the exercise group had lower gestational weight gain than control group after controlling for maternal age, pre-pregnancy body mass index (BMI), gestational age, and baby birth weight (p <.001). The study indicated significant increases over time in physical activity after controlling for maternal age, and pre-pregnancy BMI (p <.001). Conclusion: The study demonstrated feasibility of conducting a larger RCT with an intervention to improve exercise behaviour in pregnant women

A computer‑based simulation of childbirth using the partial Dirichlet–Neumann contact method with total Lagrangian explicit dynamics on the GPU

During physiological or ‘natural’ childbirth, the fetal head follows a distinct motion pattern—often referred to as the cardinal movements or ‘mechanisms’ of childbirth—due to the biomechanical interaction between the fetus and maternal pelvic anatomy. The research presented in this paper introduces a virtual reality-based simulation of physiological childbirth. The underpinning science is based on two numerical algorithms including the total Lagrangian explicit dynamics method to calculate soft tissue deformation and the partial Dirichlet–Neumann contact method to calculate the mechanical contact interaction between the fetal head and maternal pelvic anatomy. The paper describes the underlying mathematics and algorithms of the solution and their combination into a computer-based implementation. The experimental section covers first a number of validation experiments on simple contact mechanical problems which is followed by the main experiment of running a virtual reality childbirth. Realistic mesh models of the fetus, bony pelvis and pelvic floor muscles were subjected to the intra-uterine expulsion forces which aim to propel the virtual fetus through the virtual birth canal. Following a series of simulations, taking variations in the shape and size of the geometric models into account, we consistently observed the cardinal movements in the simulator just as they happen in physiological childbirth. The results confirm the potential of the simulator as a predictive tool for problematic childbirths subject to patient-specific adaptations

‘Crippling and unfamiliar’: Analysing the concept of perinatal anxiety; definition, recognition and implications for psychological care provision for women during pregnancy and early motherhood

Aim: To clarify how perinatal anxiety is characterised within the current evidence base and discuss how a clearer definition and understanding of this condition may contribute to improving care provision by midwives and other healthcare professionals. Background: Perinatal anxiety is common, occurs more frequently than depression and carries significant morbidity for mother and infant. The concept of perinatal anxiety is ill-defined; this can pose a barrier to understanding, identification and appropriate treatment of the condition. Design: Concept Analysis paper. Method: Rodgers’ Evolutionary Model of Concept Analysis, with review based on PRISMA principles. Findings: While somatic presentation of perinatal anxiety shares characteristics with general anxiety, anxiety is a unique condition within the context of the perinatal period. The precursors to perinatal anxiety are grounded in biopsychosocial factors and the sequelae can be significant for mother, fetus, newborn and older child. Due to the unique nature of perinatal anxiety, questions arise about presentation and diagnosis within the context of adjustment to motherhood, whether services meet women’s needs and how midwives and other health professionals contribute to this. Most current evidence explores screening tools with little examination of the lived experience of perinatal anxiety. Conclusion: Examination of the lived experience of perinatal anxiety is needed to address the gap in evidence and further understand this condition. Service provision should account for the unique nature of the perinatal period and be adapted to meet women’s psychological needs at this time, even in cases of mild or moderate distress

Examining arts-based practice in midwifery education: An integrative review

Aims: The aim of this integrative review is to synthesise the literature on creative teaching methods in midwifery education. The review question seeks to investigate the experiences of student midwives and midwifery educators of using creative methods as a learning approach. Background: The benefits of creative teaching methods are widely acknowledged but the ways in which this may impact midwifery students’ learning processes, or how this relates to their developing professional development, is not well understood. Research focused specifically on student midwives is yet to be synthesised. Design: An integrative review was undertaken using data comparison with reflexive thematic analysis to identify common themes. Methods: Eight electronic databases were searched with key terms in June 2022. English language studies from qualitative, quantitative, mixed-methods and wider literature were included. Results: Twenty-two texts were included in the synthesis. Four themes were generated from the data; 1) What is the offering - More than a lecture; exploring the educator and student exchange and environment for learning; 2) Working in parallel - examining the change in teaching dynamic and collaborative partnerships; 3) Journeying towards holism - focused on student’s integration of learning processes; and 4) Stepping into the professional - engaging with how using creativity can aid students’ growing sense of themselves as professionals. This highlights improvements in levels of confidence, professional development and emotional intelligence in midwifery students. Conclusion: Creative teaching and learning methods enable student midwives to make meaningful connections between theoretical and practice learning environments, assisting knowledge and skills acquisition

Developing a career and education framework for advanced clinical practice in midwifery

Introduction: This study outlines the nature of Advanced Clinical Practice in Midwifery (ACPiM), reporting on a stakeholder analysis as part of a national project to develop a career framework for advanced practice in midwifery on behalf of the National Health Service (NHS) in England. Methods: Between June and July 2022, 31 advanced practice midwives were recruited across England within the NHS settings. Convenience sampling was used to identify midwives working as advanced practitioners, and those pursuing this career route. Focus group and one-to-one interviews were conducted, recorded, and transcribed. These stakeholder data were then analyzed using a reflexive thematic approach. Results: ACP midwives were active across many professional settings. The findings resulted in three themes: Midwifery autonomy, Desire for progression, and Avenues of support. Midwifery autonomy highlighted a midwifery desire to utilize specialist skills and expert decision-making to provide holistic care directly to women and families. Desire for progression highlighted that, regardless of career stage, midwives aspired to advance their practice requiring a range of pathways to fulfil career satisfaction and meet local population health needs. Avenues of support discussed the barriers and facilitators to progression, highlighting the need for service vision, a multi-disciplinary approach to facilitate support for individuals, and strong midwifery leadership. Conclusions: Although the ACPiM role is desired by maternity institutions and organizations, midwives remain unclear about how to achieve this position, and employers remain unsure of how an ACPiM could transform services. If midwives are to successfully achieve ACPiM status, organizational support is needed to facilitate individuals drive for career progression, resulting in a strengthened workforce and improved patient experience

Women’s mental health during pregnancy: A participatory qualitative study

Background/objectives: British public health and academic policy and guidance promotes service user involvement in health care and research, however collaborative research remains underrepresented in literature relating to pregnant women’s mental health. The aim of this participatory research was to explore mothers’ and professionals’ perspectives on the factors that influence pregnant women’s mental health. Method: This qualitative research was undertaken in England with the involvement of three community members who had firsthand experience of mental health problems during pregnancy. All members of the team were involved in study design, recruitment, data generation and different stages of thematic analysis. Data were transcribed for individual and group discussions with 17 women who self-identified as experiencing mental health problems during pregnancy and 15 professionals who work with this group. Means of establishing trustworthiness included triangulation, researcher reflexivity, peer debriefing and comprehensive data analysis. Findings: Significant areas of commonality were identified between mothers’ and professionals’ perspectives on factors that undermine women’s mental health during pregnancy and what is needed to support women’s mental health. Analysis of data is provided with particular reference to contexts of relational, systemic and ecological conditions in women’s lives. Conclusions: Women’s mental health is predominantly undermined or supported by relational, experiential and material factors. The local context of socio-economic deprivation is a significant influence on women’s mental health and service requirements

Standards for midwife Practitioners of external cephalic version: A Delphi study

IntroductionExpansion of advanced and specialist midwifery practitioner roles across professional boundaries requires an evidence-based framework to evaluate achievement and maintenance of competency. In order to develop the role of Breech Specialist Midwife to include the autonomous performance of external cephalic version within one hospital, guidance was required on standards of training and skill development, particularly in the use of ultrasound