EMPOWER: Empowering mothers, providing options with education and relaxation
Lecturer in Midwifery, University of Central Lancashire
Midwife, East Lancashire Hospitals Trust
Midwife, East Lancashire Hospitals Trust
Midwife, East Lancashire Hospitals Trust
Midwifery Team Leader, East Lancashire Hospitals Trust
Most women within their lifetime will experience pregnancy, birth and motherhood. Despite this almost universal experience, the process is far from uniform. Throughout the childbirth continuum, expectations and experiences of women are diverse and ever-changing (van Teijlingen et al 2017). This article explores an innovative idea, well placed within this ‘Shiny roads’ edition of The Practising Midwife. It explores the birth of the EMPOWER project within a NHS trust. EMPOWER was developed to empower mothers and provide options, education and relaxation for pregnancy, birth and the postnatal period.
Mothers in immigration detention: the most vulnerable and the hardest to reach
Lecturer in Maternal Care at the University of Leeds
Family Nurse at Lewisham and Greenwich NHS Trust(December 2016)
Phoebe Pallotti and Morag Forbes are two experienced midwives who volunteered for a charity that works for the health rights of people in immigration detention. They both have other experience of this client group and they both hold diplomas in Tropical Midwifery. Over more than three years, Phoebe and Morag have been visiting and calling on pregnant women in immigration detention, most often in the infamous detention centre, Yarl’s Wood, in Bedfordshire, where a recent Channel Four documentary was secretly filmed. The centre has a small health care facility, but there are no midwifery staff employed there, though women were often referred to the local maternity unit. This article explores the situations of the pregnant women who are detained in the UK and considers how they may better be supported.
Fathers’ views of learning infant CPR in antenatal education classes
Lecturer in Midwifery at University of Limerick(November 2016)
Infant CPR is not generally incorporated into antenatal classes for expectant women and their partners. The skills of infant CPR are normally taught where infants have cardiac and other conditions that may put them at increased risk. This article reports on the views of expectant and new fathers following infant CPR training as part of antenatal education classes. The invited comments and recommendations are part of an evaluation of expectant parents' knowledge satisfaction and use of a self-instructional infant CPR kit reported elsewhere (Barry 2015). Expectant and new fathers found that learning the skills of infant CPR and the actions to take in the event of an infant choking were very beneficial, and they recommended that training should be incorporated into the maternity services as part of parent education. Midwives have an important role to play in the facilitation of infant CPR.
SUBSTANCE MISUSE: CAN MIDWIVES REALLY MAKE A DIFFERENCE?
Student midwife at Swansea University(June 2016)
Substance misuse makes a woman vulnerable. During pregnancy, in particular, the issues surrounding substance misuse and its treatment are very emotive. Pregnancy often prompts women who substance misuse to seek help for their addiction for the first time, but for some it is part of a cycle of failure and loss: failure at rehabilitation and facing the loss of yet another child, be it through child protection issues or from the medical complications of addiction. As a midwife only engages with a woman for a relatively short period of time, can their actions have a lifelong impact on the woman and her unborn child? This article aims to examine the stigma of substance misuse and the role a midwife plays, not just as a maternity care provider but also in the continued journey of the woman and her child.
Domestic violence in pregnancy: midwives and routine questioning
Midwife at Walsall Manor Hospital
Senior lecturer in midwifery and course leader for return to midwifery practice(June 2016)
The Confidential Enquiry into Maternal and Child Health (CEMACH) (2004) set the standard for maternity care to protect women from domestic violence. Twelve women who were murdered by their partner and 43 further deaths from disclosure with no appropriate referrals prompted the routine enquiry for domestic violence to be initiated in 2000. The death rate from domestic violence had marginally decreased slightly in the latest report from The Centre for Maternal and Child Enquiries (CMACE) (2011) with 11 women murdered by their partner and 34 further deaths from disclosure with no referrals. The aim of this article is to review the current literature in order to explore evidence that questions the confidence of midwives when asking about domestic violence in pregnancy. The article aims to highlight the concerns that midwives face when confronted with a positive disclosure of domestic violence, and to provide a flow chart to aid in referral.
Introducing educational theory: vaginal examination
Jo Killingley, midwifery lecturer at Middlesex University(June 2016)
A vaginal examination (VE) is one of many core skills used in midwifery practice. Despite the controversy of whether it is necessary in all situations, in this article I take the standpoint that it is useful in providing a full clinical picture, especially at times when closer monitoring is recommended. Additionally, if the core skill is misinterpreted, the findings of the VE can distort the true clinical picture. To support the student, subjective assessment and individual learning pathways must be addressed to avoid unnecessary intervention and psychological impairment to the woman. This article explores some of the difficulties encountered with teaching and learning VE in clinical practice and offers concepts from educational theory to assist in clarifying the difficulties and offering new ways of thinking for both students and midwives.
Substance use in pregnancy
Midwife with the substance use team at East Lancashire(June 2016)
The increase in substance use which occurred in the 1980s was disproportionately large among women of reproductive age, so both the numbers of women who use drugs and the duration of drug use have increased (Hepburn 2004). While drug use occurs throughout society, the type and pattern of drug use that is associated with medical and social problems is closely associated with socio-economic deprivation. Socio-economic deprivation is in turn associated with unhealthy lifestyles and behaviours such as smoking and poor diet. Deprivation, associated lifestyles and substance use adversely affect the health of mother and baby, so the effects are cumulative. Consequently women with problem drug and/or alcohol use have potentially complex pregnancies (Hepburn 2004).
From public to private: the history of domestic abuse in Britain
Tania McIntosh, Cathy Ashwin
Midwife lecturers, University of Nottingham(June 2016)
Pregnancy has always been a time of vulnerability for women at risk of domestic abuse, but over time attitudes have changed. Today all midwives are expected to be able to ask women about domestic abuse, and to respond appropriately to any disclosure. However, it is only in the last twenty years that health professionals, including midwives, have begun to appreciate both the scale and effect of domestic abuse. This article delves into the hidden history of this most secret aspect of family relationships and explores why midwives finally began to ‘ask the question’.
Cytomegalovirus: the stealth virus
Midwife, trustee for a charity offering advice and support to those affected by congenital CMV and mummy to a shining star(May 2016)
Cytomegalovirus (CMV) is an infection, part of the herpes family of viruses which, if contracted during pregnancy, can cause devastating effects on the newborn baby. This article is written by the trustee of a volunteer-based charity, mostly run by mothers of CMV children, who are striving to raise awareness of this infection, which is more common than Down's syndrome, listeria and toxoplasmosis, and is the primary preventable cause of childhood hearing loss.
Pelvic girdle pain: updating current practice
Chair of a charity providing support and information about pelvic girdle pain(November 2015)
Traditionally, pelvic girdle pain (PGP) was viewed as a hormonal problem, untreatable during pregnancy and exacerbated by the weight of the baby. Customary advice was for rest, support belts and to await recovery following the baby's birth. However, the outcome of this management strategy resulted in many women experiencing short or long-term physical disability, as well as the psychological impact of pain and immobility. Recent research links an asymmetry of the pelvic joints to the incidence and severity of PGP and shows the cause is biomechanical and not due to pregnancy hormones. Evidence supports manual therapy as the effective way to resolve PGP quickly during pregnancy through a realignment and restoration of symmetry of movement in the pelvic joints, thereby avoiding the adverse long-term consequences of the condition.
A day in the life of a specialist pernineal care clinic
Senior midwife and labour ward coordinator at Rotherham NHS Foundation Trust(July 2015)
The specialist perineal care clinic has been running at Rotherham NHS Foundation Trust for over three years. This article tells of a quest to further improve perineal care for women in our care and demonstrates the process from conception to birth of the clinic, as well as the journey taken in order for this service to be set up and run efficiently. Prior to this clinic most women saw different people throughout their care, which was obviously confusing for them, as conflicting advice could be on offer. This clinic has provided consistency and continuity which has improved women’s experiences and, in turn, yielded improved outcomes. It has empowered the women to further play a part in their own care from antenatal methods of reducing the chance of perineal trauma to postnatal recovery after perineal breakdown and infection. Both women and staff have benefited from this service as there is always a central point of contact.
Women’s lived experiences of domestic violence during pregnancy: Part 1
Senior midwifery lecturer in the family and maternity unit at Griffith Health Institute, Griffith University, Australia(March 2015)
This paper reports on a qualitative study, which explored women's experiences of domestic violence before, during and after pregnancy. During pregnancy the women were physically attacked, including blows and kicks to the pregnant abdomen; they were punched, slapped, kicked, bitten, pushed around, held by the throat, and attempts at strangulation occurred for two of the women. The women were sexually abused, experienced enforced isolation and financial hardship. They experienced extreme psychological distress, including depression before, during and after pregnancy. Feelings of vulnerability about themselves and their unborn babies were intensified by their partners’ continuing violence and abuse. The findings from this research will support midwives to recognise the warning signs of domestic violence and abuse during pregnancy and to be able to offer an appropriate response.
Internet: a new concept of antenatal education
Senior midwife community at Frimley Health NHS Foundation Trust Wexham Park Hospital and supervisor of midwives(February 2015)
Historically antenatal education has been seen as an important part of antenatal care and a mechanism to provide women with close to realistic interpretations of childbirth and motherhood. Through the years, the main themes and emphases of parenting education have changed, sometimes to reflect the new socio-economic structure and sometimes forced by the women themselves seeking specific information and knowledge. Yet again, this time the invasion of online information and social media is about to change the perception and the philosophy of antenatal education from an informative opportunity to a powerful and effective intervention.