This website is intended for healthcare professionals.
Subscriber log in
Trial log in

Obstetric Cholestasis (OC)

Jenny Chambers, clinical trials coordinator, Imperial College London and founder of OC Support and Alice Tuson, NCT student antenatal teacher and a trustee for OC Support

 (June 2016)

Obstetric cholestasis (OC) is the most common liver condition specific to pregnancy and affects around 5,000 women in the UK every year. It's generally benign for the mother although the main presenting symptom of pruritus can sometimes be so severe that the woman scratches herself until she bleeds. However, the main concerns are for the fetus, as the condition is associated with an increased risk of fetal distress, spontaneous premature labour and stillbirth. This article aims to provide information about the condition so that as a practising midwife you can offer women sufficient support should OC be suspected or diagnosed.

Reflection on a pregnancy complicated by obstetric cholestasis

Gemma Steele, midwife

 (June 2016)

Gemma Steele, a midwife, shares her personal reflection on her first pregnancy which was complicated by obstetric cholestasis. Gemma gives insight as to how debilitating it can be suffering from this condition and highlights that a woman can be diagnosed as early as six - eight weeks gestation. For this reflection, Gemma used Gibbs' reflective cycle (Gibbs 1988) to help explore the experience and guide the reflective process (Bulman 2008).

Pregnancy nausea and vomiting - the role of the midwife

Roger Gadsby, GP and Associate Clinical Professor, Warwick University Medical School and Chairman of Trustees of a pregnancy sickness support charity

 (June 2016)

Some 75-80 per cent of pregnant women get some degree of nausea and vomiting of pregnancy (NVP) and it becomes severe in about 30 per cent of women with symptoms. Calling it 'morning sickness' is both inaccurate and damaging as it can be seen to trivialise the condition. Severe NVP can cause depression, feelings of inadequacy, loss of time at work, admission to hospital and termination of pregnancy. It is important for midwives to treat women with NVP with understanding and empathy, and for midwives to be able to assess women with NVP and refer for admission those developing hyperemesis gravidarm.

The place of Kielland's forceps in reducing caesarean section rates 

Pooja Balchandra, Fiona Marsh and Christine Landon

all doctors in the department of urogynaecology at St James’ University Hospital in Leeds

 (April 2015)

The rise in births by caesarean section (CS) is a global issue. A skilled obstetrician with a midwife knowledgeable in Kielland’s forceps (KF) is often able to achieve a successful rotational vaginal birth when safe. The KF, however, has risks - and outcomes must be audited. In this article we present the results of a literature review and retrospective audit, evaluate maternal and neonatal morbidity associated with KF in our unit and compliance with national standards. Our conclusion is that our unit complies with national standards and offers the woman an alternative to CS when it is safe to do so. Adverse outcomes with KF are not different from other modes of operative birth.

Breech birth: a series of articles from a variety of perspectives 3. Undiagnosed breech - part of midwifery practice

Jane Evans

Midwife in Dorset and runs breech birth study days

 (December 2014)

This article discusses the background to undiagnosed breech and what a midwife can do to support a woman who is giving birth to a baby in an undiagnosed breech presentation. There is no evidence to support the use of emergency caesarean section when a breech is diagnosed in labour and it is a requirement of the Nursing and Midwifery Council rules and standards that registered midwives should have been taught, pre-registration, how to assist an undiagnosed breech presenting baby to be born.

To ECV or not to ECV? The current evidence base concerning external cephalic version

Shawn Walker

Lecturer in midwifery at City University, London

 (October 2014)

External cephalic version (ECV) is the technique of attempting to turn a baby in the womb from a head-up to a head-down position. The practice is grounded on evidence that vaginal breech birth (VBB) presents greater short-term risks for babies than caesarean section (CS) (Hofmeyr et al 2011), but that labour and vaginal birth also offer benefits to both mothers and babies. Therefore, if we can turn babies to a head-down position, we can reduce the risks associated with both VBB and CS, and enable mother and baby to benefit from labour and birth.

Umbilical cord prolapse in primary midwifery care in the netherlands; a case series

Marrit Smit

Midwife researcher

Fleur Zwanenburg

Sabine van der Wolk

Both medical students

Johanna Middeldorp


All at Leiden University Medical Centre

Barbara Havenith

Obstetrician and director of an obstetric emergency training company in Boxmeer

Jos van Roosmalen

Obstetrician and professor in international safe motherhood at Leiden University Medical Centre and EMGO Institute Centre

 (June 2014)

We aimed to gain insight into umbilical cord prolapse (UCP) reported by primary care midwives in the Netherlands. Cases of UCP were reported by midwives who participated in a postgraduate training programme developed for community-based midwives. Cases were analysed using midwifery charts, ambulance report forms and discharge letters. Procedures to alleviate cord pressure, ambulance timing, mode of birth and neonatal outcomes were inventoried. Diagnosis to delivery interval (DDI) and risk factors were identified. Eight cases of UCP in primary midwifery care were reported of which six occurred at home. Risk factors such as malpresentation (breech) and/or unengaged presenting part were found in four cases, two (unengaged fetal head) were known to the midwife prior to birth. Retrograde bladder filling (2/8), manual elevation of the fetal head (7/8) and Trendelenburg position (1/8) were applied. One infant died of severe birth asphyxia; the other infants recovered and were discharged in good condition.