The effect of maternal position at birth on perineal trauma: A systematic review.

yesPerineal trauma is associated with short- and long-term maternal morbidity. Research has found that maternal position at birth can influence perineal trauma. However, there is a dearth of evidence examining specific maternal positions, including waterbirth, and how these can influence incidence and degree of perineal trauma. Such evidence is important to help reduce trauma rates and improve information for women and midwives. To address this gap in reliable evidence, a systematic review was conducted. Seven studies met the inclusion criteria. Compared to land birth, waterbirth was found to cause an increase in perineal trauma. Kneeling and all-fours positions were most protective of an intact perineum. Allowing for different variables, sitting, squatting and using a birth-stool caused the greatest incidence of trauma. The findings of this review demonstrate that further research is required around perineal guarding in alternative birth positions and how parity affects trauma rates with waterbirth, so that women may be advised appropriately. It also suggests findings that midwives can use when discussing alternative birth positions with women

Clinicians in the classroom: The consultant midwife

This is the third in a series of articles exploring expert clinicians’ participation in teaching pre-registration midwifery students in the classroom setting. This article will consider sessions facilitated by Carolyn Rooth, Consultant Midwife at Milton Keynes University Hospital NHS Foundation Trust. The role of Consultant Midwife was first introduced in the United Kingdom in 2000 (Byrom et al., 2009) with post holders attaining key senior positions within maternity services to provide professional leadership and a senior level of clinical midwifery expertise (Coster, 2006). A key element of the role of the Consultant Midwife is education, training and development (NHS Executive, 1999). Redfern et al. have suggested that whilst these advanced practitioners are practice based, they should have a key role in creating and maintaining ‘partnerships between the NHS and local universities […] to enhance education and research functions’ (2003:154)

Investigating resilience in midwifery

Royal College of Midwives funded research project exploring midwives' experience of professional resilience via a closed online discussion group

Teaching about obesity: Caring, compassion, communication and courage in midwifery education

Teaching innovation can be used to promote the 6Cs in one of the most purportedly stigmatising areas of maternity care: obesity. As rates of maternal obesity continue to rise, getting this area of care right becomes more urgent. Although a great deal has been published about the unsatisfactory and stigmatising impact that staff attitudes can have on those with obesity, there is relatively little on how this problematic area of care should be taught to the next generation of midwives. This article presents a case study of learning about obesity management at the pre-registration, undergraduate level. The case study described is an effort to move away from what is currently largely an academic debate, towards a set of tangible practice recommendations

'She can't come here!' Ethics and the case of birth centre admission policy in the UK

Using ethnographic data lifted from an investigation into midwifery talk and practice in the South of England, this paper sets out to interrogate the ethics underpinning current admission policy for Free Standing (midwifery led) Birth Centres in the UK. The aim of this interrogation is to contest the grounds upon which birth centres admissions are managed, particularly the over-reliance on abstract calculations of risk—far removed from the material lived experience of the mother wishing to access these birth centre services

V. problem presentation and advice-giving on a home birth helpline

The rate of home births in the UK is very low (around 2%) and many women who would like to give birth at home find it impossible to get midwifery cover or are advised of medical contraindications. The Home Birth Helpline offers support and expertise for women in this situation. Based on the analysis of 80 recorded calls, this article uses conversation analysis (CA) to explore how callers present their reason for calling the helpline, and what this shows about the culturally shared medicalized culture of birth. This research is an example of feminist CA in that it contributes both to the study of childbirth as a key women's health issue and to the study of helpline interaction from a conversation analytic perspectiv

Should left-handed midwives and midwifery students conform to the ‘norm’ or practise intuitively?

It has been suggested that the proportion of left-handed people, or more specifically, the greater acknowledgement of left-handedness over the past century may be due to fewer left-handed people being ‘forced’ to use their right hand to conform to the ‘norm’, rather than a greater incidence of left-handedness (McManus, 2002). There are approximately 27,000 midwives in the UK (Royal College of Midwives (RCM), 2015); however there is no official data as to the proportion of midwives who are left-handed, nor research into whether they practise with left-handed dominance. This article was inspired by hearing the experiences in practice of first year student midwives who are left-handed. It also documents the experiences of Julie, a left-handed Senior Lecturer in Midwifery who trained in the early 1980s. Questions raised by this article include whether the left-handed student midwives of today have different experiences in practice to those of 30 years ago?; should all student midwives be trained to practise with right-handed dominance or should student midwives be supported and encouraged to practise intuitively, according to their natural dominance

A national cross sectional survey of heads of midwifery services of uptake, benefits and barriers to use of obstetric early warning systems (EWS) by midwives

Objective to identify the extent to which Early Warning Systems (EWS) are used by midwives in the United Kingdom (UK), the maternity settings they are used in, physiological parameters used to ‘trigger’ referral, training provision, barriers to implementation and role in preventing maternal morbidity. Design cross-sectional survey of heads of midwifery services. An email questionnaire was sent in September 2012. Setting UK NHS secondary care organisations providing maternity care. Findings heads of midwifery from 107 (68%) of 157 NHS organisations responded, with 108 questionnaires returned as two organisations had recently merged. All organisations, apart from one which only had a free-standing midwifery unit, had introduced EWS. Nearly all respondents (99%) reported EWS were used by midwives antenatally, 76% in labour and 100% on the postnatal ward. All EWS charts included body temperature, heart rate, respiratory rate, systolic blood pressure and oxygen saturation although parameters for escalation varied widely. Barriers to use of EWS by midwives included overlap with the partogram in labour, and staff shortages and delays obtaining clinical review when referral was triggered. Two-thirds considered EWS prevented maternal morbidity although few could provide supporting evidence, for example, audit findings. Training for midwives in use of EWS was available in 83% of organisations. Conclusion most UK midwives are using EWS, with the highest use in obstetric units. The heterogeneity of EWS currently used potentially limits collation of evidence to inform appropriate system level responses. Research is needed to evaluate the role of EWS to prevent maternal morbidity during and after pregnancy in different maternity settings

Women's experiences of coping with pain during childbirth: A critical review of qualitative research

Objective To identify and analyse qualitative literature exploring women׳s experiences of coping with pain during childbirth. Design Critical review of qualitative research. Findings Ten studies were included, conducted in Australia, England, Finland, Iceland, Indonesia, Iran and Sweden. Eight of the studies employed a phenomenological perspective with the remaining two without a specific qualitative methodological perspective. Thematic analysis was used as the approach for synthesising the data in this review. Two main themes emerged as the most significant influences upon a woman׳s ability to cope with pain: (i) the importance of individualised, continuous support and (ii) an acceptance of pain during childbirth. This review found that women felt vulnerable during childbirth and valued the relationships they had with health professionals. Many of the women perceived childbirth pain as challenging, however, they described the inherent paradox for the need for pain to birth their child. This allowed them to embrace the pain subsequently enhancing their coping ability. Key conclusions Women׳s experience of coping with pain during childbirth is complex and multifaceted. Many women felt the need for effective support throughout childbirth and described the potential implications where this support failed to be provided. Feeling safe through the concept of continuous support was a key element of care to enhance the coping ability and avoid feelings of loneliness and fear. A positive outlook and acceptance of pain was acknowledged by many of the women, demonstrating the beneficial implications for coping ability. These findings were consistent despite the socio-economic, cultural and contextual differences observed within the studies suggesting that experiences of coping with pain during childbirth are universal. Implications for practice The findings suggest there is a dissonance between what women want in order to enhance their ability to cope with pain and the reality of clinical practice. This review found women would like health professionals to maintain a continuous presence throughout childbirth and support a social model of care that promotes continuity of care and an increasing acceptance of pain as part of normal childbirth. It is suggested future research regarding the role of antenatal provision for instilling such a viewpoint in preparation of birth be undertaken to inform policy makers. The need for a shift in societal norms is also suggested to disseminate expectations and positive or negative views of what the role of pain during childbirth should be to empower women to cope with childbirth and embrace this transition to motherhood as part of a normal process