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Factors associated with postpartum shivering: a cross-sectional study


Ugo Indraccolo

Doctor in the Complex Operative Unit of Obstetrics and Gynaecology at Alto Tevere Hospital of Città di Castello, Umbria

Silvia Scilimati

Midwife. Silvia collected the data at the San Pietro Fatebenefratelli Hospital Rome for this study

Romolo di Iorio

Obstetrics and Gynaecology Lecturer at Sapienza University Rome

Marco Bonito

Head of the Complex Operative Unit of Obstetrics and Gynaecology at the San Pietro Fatebenefratelli Hospital, Rome

Salvatore Renato Indraccolo

Obstetrics and Gynaecology Lecturer at Sapienza University Rome

 (November 2016)


The objective of this study was to investigate the postpartum shivering phenomenon. We carried out a cross-sectional study on a sample of 597 pregnant women. Logistic regression analyses were built. Independent variables were: parity, labour induction with prostaglandin agonist, oxytocin infusion during labour, amniotomy, epidural anaesthesia, premature rupture of membranes (PROM), postpartum fever, gestational age, mode of birth. Dependent variables were: mild shivering, severe shivering (severity of shivering) and duration of shivering: less than 30 minutes; between 30 minutes and one hour; more than one hour. We found that both severity and duration of postpartum shivering phenomenon were associated with rupture of membranes (spontaneous or artificial), fever, caesarean section and oxytocin infusion. The conclusion reached was that those associations could be logically explained by already-known causes of chills. Further studies should assess those causes after birth.
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Kraamverzorgster - specialised maternity care assistant


Natalie Buschman

Midwife at St Georges Hospital NHS Foundation Trust

and winner of the Jelf Medal Award from King's College London

 (July 2016)


Postnatal care differs around the world and, in many Western countries, the debate involves optimum hospital stay after birth and the required visits afterwards, if any. Whilst UK postnatal care is at breaking point and struggling, in the Netherlands, they think they have had the answer to good postnatal care for centuries: the 'Kraamverzorgster' or specialised maternity care assistant. Providing family-centred care in the woman's home, between 24-49 hours, divided into several hours per day in the first 10 days postpartum, the kraamverzorgster is in the unique position of making a difference for mothers and babies and picking up on any pathology that may arise early on. Whilst kraamzorg seems like an obvious answer to improve postnatal care, there is a surprising lack of evidence on the benefits that kraamzorg can offer. Nevertheless the Dutch are convinced, and see kraamzorg as essential for every mother and baby.
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Tell me your story: recovering from a difficult birth


Roma Norriss

Doula, Breastfeeding Counsellor and Parenting Instructor

Binnie Dansby

International Teacher/ Healer in private practice in London, based in pre- and perinatal psychology

 (July 2016)


The authors discuss their experience of running after birth workshops as an intervention for women struggling to come to terms with a difficult birth experience. Midwives can use this approach in their practice with women in the postnatal period and also when preparing for a subsequent birth or even during a labour that follows a challenging experience. This article explores the value of supporting women to tell their story and how to do that with suggestions to build on listening skills. It also offers suggestions for self care, so that midwives can be well resourced for emotional support.
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Enhancing postnatal perineal care


Judith Stolberg was a hospital and community midwife in the UK and is now a practising midwife at a birth centre in Bavaria, Germany

 (June 2016)


Maternal physical and psychological wellbeing during the postnatal period can be significantly impaired by perineal trauma sustained during childbirth. Current literature emphasises preventative measures, yet there is a lack of a systematic, evidence based approach to postnatal perineal care. This is concerning as the eighth 'Saving mothers' lives' report (CMACE 2011) identifies genital tract sepsis for the first time as the leading cause of maternal deaths. The aim of this article is therefore to develop a systematic approach to improve postnatal perineal care with a focus on assessment and treatment of perineal pain as well as recovery of pelvic floor function. The first in this series of two articles reflects on the impact of perineal trauma on a woman's physical and emotional wellbeing and examines the role of the midwife in the assessment and treatment of perineal pain during the postnatal period.
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Pernineal wound infections: an audit


Neesha Ridley, Clinical Negligence Scheme for Trusts (CNST) lead for Lancashire teaching hospitals NHS Trust at the time of the audit and is now a midwifery lecturer at the University of Central Lancashire

 (June 2016)


An audit was completed by an NHS trust to determine the rate of perineal trauma among vaginal births and to assess the rate of perineal wound infections. The audit results confirmed a higher than average rate of perineal wound infections among women who had an instrumental birth. The trust decided to separate the contents of the delivery packs into two separate packs – one pack for birth and one pack for suturing - and developed a back-to-basics update session that was delivered to staff working within the maternity setting. A re-audit the following year confirmed that these measures had worked and the overall perineal wound infection rate reduced within the trust. The confidential enquiries report, released in 2014, has revealed that the number of women dying from genital tract sepsis has significantly decreased (MBRRACE-UK 2014). However, even though sepsis is no longer the leading cause of maternal death within the UK, midwives and other healthcare professionals should consider sepsis when caring for all women throughout pregnancy, birth and postnatally.
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A woman-led approach to improving postnatal care


Claire Fryer-Croxall,modern matron and supervisor of midwives, and Elizabeth Bailey, midwife research fellow, University Hospitals Coventry and Warwickshire NHS Trust

 (June 2016)


As a large NHS teaching trust we see 6,000 women a year who birth with us. Newly appointed as a modern matron, I noted that poor experience on our postnatal ward has always been a key issue in the complaints we receive and from the feedback that our women give to us. The ImPosE (improving postnatal experience) project was launched in December 2013. This brought together members of the multidisciplinary team who were committed to developing our postnatal ward and improving it for our women and their families. We used a quality management approach, putting ‘customer’ experience at the core, and implemented a varied package of changes as directed by feedback from service users.
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'Yummy Mummies': exploring sexuality in the antenatal and postnatal period


HaKyung Maria Kim

Midwife at Joondalup Health Campus, Western Australia

Sadie Geraghty

Co-ordinator of Master of Midwifery Practice at Edith Cowan University, Western Australia

 (June 2016)


Sexuality is often bound together with sexual function in contemporary sexual health literature; however, sexuality is a multidimensional phenomenon that has a broader historical concept and cultural meaning. In addition to a significant global decline in sexual function, women may experience decline in emotional satisfaction and physical pleasure up to 4.5 years after giving birth. Midwives have an important role in raising conversations about sexuality on a regular basis during antenatal visits, and informing couples about the decline of libido, desire and orgasm, which may lead to reduction in sexual intercourse frequency, particularly in the last trimester and puerperium.
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Peri-partum and pelvic floor dysfunction


Doreen Mcclurg, Reader at the Nursing Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, and Chair of the Pelvic, Obstetric and Gynaecological Physiotherapy Professional Network of the CSP

 (June 2016)


Pelvic floor muscles (PFM) are the layer of muscles that support the pelvic organs and span the bottom of the pelvis. Weakened PFM mean the internal organs are not fully supported and can lead to difficulties controlling the release of urine, faeces or flatus. Pregnancy and vaginal birth are a recognised cause of PFM weakness; however it has been shown that PFM exercises, if carried out correctly and routinely, can reduce the severity of symptoms. Midwives need to be pro-active in teaching PFM exercises and identifying women who may need to be referred on for more specialist treatment.
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Caesarean wound care for midwives


Margaret Murphy, lecturer in the School of Nursing and Midwifery at University College Cork

 (June 2016)


With a rise in caesarean births there is a rise in wound care management issues for midwives and the potential for surgical site infections (SSIs). The burden of SSIs include increases in maternal mortality, morbidity, length of hospital stay and cost. Sepsis is currently the leading cause of maternal mortality, with 50 per cent of the women who died from sepsis having had a caesarean birth (Centre for Maternal and Child Enquiries (CMACE) 2011). Wound management and the prevention of sepsis are therefore issues of great concern to midwives. This article considers the incidence of wound infections and presents the guidance available to help address this problem.
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The benefits of optimal cord clamping


Lisa Busellato

Midwifery student, Edith Cowan University, Perth, Western Australia

Sara Bayes

Associate professor of midwifery, Edith Cowan University, Perth, Western Australia

 (January 2016)


Optimal cord clamping is known and now widely recognised as having positive consequences for the neonate in the short- and medium term. This review of some of the key literature published over the last five years on the effects of both ECC and OCC provides an insight into the evidence on this topic. The aim of this article is to summarise the key papers on the topic of the effect of timing of cord clamping, including some of those included in the Cochrane Review as well as the majority that have been published since, to provide an up-to-date overview.
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Reflections of a birth reflections midwife


Meg Cooper

Community midwife, Chippehma, Wiltshire, and a birth reflections midwife at Royal United Hospitals Bath NHS Foundation Trust

 (October 2015)


Supporting a woman’s emotional recovery following what can sometimes be a traumatic event is becoming an important part of postnatal care. That simple question, “How was the birth?” can be the first step in allowing a woman to acknowledge and voice her innermost anxieties around the birth of her baby, and put her on the right path towards feeling better about it, if need be. The birth reflections service has been running in our area for almost six years and its purpose is twofold: firstly it provides women with a safe environment in which to talk about their labour and birth, where they can become better informed about the birth and where they can express themselves freely. Secondly, it provides first hand feedback for the maternity service about the care that’s been given, enabling us to change practice for the better.
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Perineal pain in focus: reviewing topical anaesthetic treatments 


Anna Byrom

Midwife, senior midwifery tutor at University of Central Lancashire, PhD student and editor of The Practising Midwife

 (July 2015)


Midwives have opportunities to help postnatal mothers to minimise perineal discomfort associated with perineal trauma following vaginal birth. Perineal trauma and associated pain is common and can have a negative impact on the physical, psycho-social transition to motherhood and family life. This article considers the role local anaesthetic agents have in helping women to relieve perineal pain. Key evidence is presented with associated practice considerations, and future research areas are suggested to broaden our understanding of this important aspect of postnatal care.
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A day in the life of a specialist pernineal care clinic


Cheryl Shore

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.
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Midwives benefit from good postnatal care, too


Helen Cameron

Community midwife and studying for a professional doctorate at the University of Salford

 (July 2014)


Appropriate, timely and responsive postnatal care can help women and families negotiate the major life transition that childbirth brings. However, women’s experiences of postnatal care are often negative and our increasingly biomedical approach to birth means that greater emphasis is placed on antenatal and intrapartum care at the expense of postnatal care. Good postnatal care is essential not only for women, but for midwives too, and our failure to acknowledge the significance of birth, and our contribution to that event can diminish us as people and midwives.
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A woman-led approach to improving postnatal care


Claire Fryer-Croxall

Modern matron and supervisor of midwives

Elizabeth Bailey

Midwife research fellow

both at University Hospitals Coventry and Warwickshire NHS Trust

 (July 2014)


As a large NHS teaching trust we see 6,000 women a year who birth with us. Newly appointed as a modern matron, I noted that poor experience on our postnatal ward has always been a key issue in the complaints we receive and from the feedback that our women give to us. The ImPosE (Improving Postnatal Experience) project was launched in December 2013. This brought together members of the multidisciplinary team who were committed to developing our postnatal ward and improving it for our women and their families. We used a quality management approach, putting ‘customer’ experience at the core, and implemented a varied package of changes as directed by feedback from service users.
Read more...

Peri-partum and pelvic floor dysfunction


Doreen McClurg

Reader at the Nursing, Midwifery and Allied Health Professions Research Unit at Glasgow Caledonian University and Chair of the Pelvic, Obstetric and Gynaecologyical Physiotherapy Professional Network of the CSP

 (July 2014)


Pelvic floor muscles (PFM) are the layer of muscles that support the pelvic organs and span the bottom of the pelvis. Weakened PFM mean the internal organs are not fully supported and can lead to difficulties controlling the release of urine, faeces or flatus. Pregnancy and vaginal birth are a recognised cause of PFM weakness; however it has been shown that PFM exercises, if carried out correctly and routinely, can reduce the severity of symptoms. Midwives need to be pro-active in teaching PFM exercises and identifying women who may need to be referred on for more specialist treatment.
Read more...

EXAMINATION OF THE NEWBORN: THE KEY SKILLS Part 3. The hips


Natasha Carr

Senior lecturer in midwifery and supervisor of midwives at Birmingham City University

Paula Foster

Senior lecturer in midwifery at the University of Wolverhampton

 (March 2014)


Midwives are increasingly performing the examination of the newborn. This article considers the importance of the examination of the hips in the screening process. The significance of history taking, knowledge of risk factors and the hip examination will be explored. The necessity for early detection and treatment of hip abnormalities, along with referral pathways that the National Screening Committee requires will be highlighted. The impact of late detection of developmental dysplasia of the hip (DDH) on the lives of families and children will also be considered.
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