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Living with intimate partner violence: a literature review of pregnant women’s experiences


Niamh Curran

Midwife, University Hospital Waterford

Sunita Panda

Midwife and PhD student, Trinity College Dublin

Cecily Begley

Chair of Nursing and Midwifery, Trinity College Dublin and University of Gothenburg, Sweden

2017;20(7):23-26

 (June 2017)


Pregnancy brings joy to most women’s lives. However, some women do not enjoy their pregnancy, due to physical and/or emotional health problems, or social circumstances such as being in a relationship characterised by intimate partner violence (IPV). The aim of this review is to explore women’s experiences of pregnancy and being in a relationship with IPV. The electronic databases PubMed, CINAHL, PsycINFO and Web of Science were searched in June 2015 for related qualitative studies. Twelve studies, including 157 participants, were identified and included in this review. Four themes emerged from the data: 1) Feeling trapped/fear around disclosure and uncertainty, 2) Adapting and changing, 3) Protecting the unborn and 4) Hope and faith. In order to provide support to these women, midwives need to know how to identify women living with IPV, and how to help them through information and formal social support networks.
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Lifting the fog: a smoking cessation service for pregnant women


Helen Lowrie

Smoking cessation Midwife / Supervisor of Midwives at NHS Fife

 (February 2017)


It is well established that maternal smoking can result in serious health consequences. Smoking cessation interventions for pregnant women can effectively reduce the rate of maternal smoking and consequently prevent perinatal morbidity. Although motivation is high for women in pregnancy to stop smoking, few achieve it on their own. The support available varies throughout the country; this article describes the service available in Fife, Scotland. Support is provided by two specialist midwives and is funded by the Scottish Government. It is one of the few midwife-led services available in Scotland. Home visits are the foundation of its success, enabling engagement with women in areas of deprivation. Individualised care is provided and extended to partners and other family members who are interested in stopping smoking.
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Becoming a mother in prison


Laura Abbott

Senior Lecturer in Midwifery at University of Hertfordshire

 (October 2016)


There are around 600 pregnant women incarcerated in one of the 12 prisons in England and Wales each year and approximately 100-150 babies are born while their mothers are in prison. It is understood that a significant proportion of these women have complex physical, social and psychological needs. I have carried out qualitative research studying the experience of being pregnant in prison. This article will consider the narrative of one of my research participants, Becky, and is dedicated to her.
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Female circumcision: double standards


Anne Adikibi, midwife lecturer at Salford University

 (June 2016)


Despite the general horror associated with female genital mutilation, the author has found a growing tendency for British and American women to opt for cosmetic gynaecological surgery. Female circumcision is an emotive subject condemned by all and thought to be practised by less developed countries than the United Kingdom (UK) and United States of America (USA). However, this is now a growing business among western cosmetic surgeons as these two nations become entangled in the search for 'the perfect body'. The difference lies only in the who, why, where and by whom the operations are performed in these two distinct worlds. The most frightening observation is the rate at which this business is growing in the National Health Service (NHS) and public sector.
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THINKING OUTSIDE THE BOX Who safeguards mothers


Sara Wickham

 (June 2016)


While routine screening for group B streptococcus is not recommended in the UK, women are sometimes coincidentally found to be carrying these bacteria during investigations of symptoms in pregnancy. If such women decide to decline intravenous antibiotics for themselves in labour, they can seek support from midwives in appropriate roles. But once the woman's baby is born, the situation changes somewhat, as the legal context changes and the issue of safeguarding may be raised. This article considers the issues that arise in such scenarios and raises questions about who is there to support women who experience pressure to consent to their healthy newborn baby having prophylactic intravenous antibiotics.
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The forgotten link between sexual health and pregnancy Rosie Hotchin, third year student midwife at Sheffield Hallam University


 (June 2016)

Women presenting to midwives in pregnancy have one forgotten risk factor: sexually transmitted infections (STIs). Pregnant women have had unprotected sexual intercourse at least once. Statistics highlight the increasing prevalence of STIs, with women aged under 25 being at high risk due to reasons identified by the Department of Health (DH) (2012; 2013). Focusing on chlamydia in pregnancy, the risks to the neonate are severe. There are no health campaigns about safe sex in pregnancy, so women cannot access this information. The screening and education around STIs could be dramatically improved; women should be screened for chlamydia at booking, with this repeated if they have a new partner (which is a strong possibility as 50 per cent of pregnancies are unplanned). To increase awareness of this issue, further education for midwives is essential by collaborating with sexual health services and developing a referral pathway. Antenatal education about safe sex in pregnancy can then be introduced and health campaigns developed.
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Smoking in pregnancy: where are we now? Cathy Ashwin is midwife lecturer and admissions tutor, Jayne Marshall is associate professor, director of learning beyond registration and post graduate taught courses (midwifery) and Penny Standen is professor of health psychology and learning disabilities and head of school, community health sciences, all at the University of Nottingham


 (June 2016)

The harmful effects of smoking during pregnancy have been well documented within the literature (Eastham and Gosakan 2010; British Medical Association (BMA) 2004). However, although the number of women smoking during pregnancy has fallen over the last few years, this still remains a major health concern for both women and their families. This paper aims to explore recent media campaigns and social policies focusing on smoking in pregnancy and the general population. Midwives need to be aware of current policies with regard to smoking cessation to enable high quality evidence based information and support to be provided at an optimum time in women's lives.
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FGM: Dispelling the myths; exploring the facts


Rebecca Dixon-Wright, third year student midwife at Bournemouth University

Female genital mutilation is a process that affects our practice. It is becoming more common in our ever-diversifying population and therefore education is vitally important to be able to put robust care plans in place. Understanding the psychological and physical difficulties experienced by women of childbearing age can help us to improve the care that we, as maternity healthcare professionals, can deliver. Looking at current research, this article examines some of the presumed cultural and societal beliefs behind the procedure and highlights some new evidence that change is welcomed by women and their families, and highlights the implications for midwives.

 (June 2016)



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Obesity in pregnancy Part 2: management


Dr Frankie Phillips, independent registered dietitian

 (June 2016)


Obesity is placing a huge burden on healthcare resources and the wellbeing of individuals. The first article in this two part series (October 2012) reviewed the prevalence of obesity in pregnancy and the increased risks for pregnant women to their own and their babies' health. Management of obesity during pregnancy also places a large burden on midwifery resources. A renewed focus is needed on achieving a healthy weight for pregnancy to ensure optimal outcomes and reduce risks.
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Smoking in pregnancy: where are we now? Cathy Ashwin is midwife lecturer and admissions tutor, Jayne Marshall is associate professor, director of learning beyond registration and post graduate taught courses (midwifery) and Penny Standen is professor of health psychology and learning disabilities and head of school, community health sciences, all at the University of Nottingham


 (June 2016)

The harmful effects of smoking during pregnancy have been well documented within the literature (Eastham and Gosakan 2010; British Medical Association (BMA) 2004). However, although the number of women smoking during pregnancy has fallen over the last few years, this still remains a major health concern for both women and their families. This paper aims to explore recent media campaigns and social policies focusing on smoking in pregnancy and the general population. Midwives need to be aware of current policies with regard to smoking cessation to enable high quality evidence based information and support to be provided at an optimum time in women's lives.
Read more...

The forgotten link between sexual health and pregnancy Rosie Hotchin, third year student midwife at Sheffield Hallam University


 (June 2016)

Women presenting to midwives in pregnancy have one forgotten risk factor: sexually transmitted infections (STIs). Pregnant women have had unprotected sexual intercourse at least once. Statistics highlight the increasing prevalence of STIs, with women aged under 25 being at high risk due to reasons identified by the Department of Health (DH) (2012; 2013). Focusing on chlamydia in pregnancy, the risks to the neonate are severe. There are no health campaigns about safe sex in pregnancy, so women cannot access this information. The screening and education around STIs could be dramatically improved; women should be screened for chlamydia at booking, with this repeated if they have a new partner (which is a strong possibility as 50 per cent of pregnancies are unplanned). To increase awareness of this issue, further education for midwives is essential by collaborating with sexual health services and developing a referral pathway. Antenatal education about safe sex in pregnancy can then be introduced and health campaigns developed.
Read more...

Group B streptococcus infection: risk and prevention


Jane Plumb, chief executive of a GBS charity, Ginny Clayton NHS hospital midwife and trustee of a GBS charity

 (June 2016)


Group B Streptococcus (group B Strep or GBS) is the UK's commonest cause of severe early-onset (up to six days) infection in babies. GBS is a normal body commensal, colonising the gut and vagina. GBS may pass to babies around childbirth; although most are unaffected, some develop severe infection. GBS is also a recognised cause of stillbirth and puerperal sepsis. Most GBS infection in babies is of early onset and most of these infections are highly preventable with the targeted use of intrapartum antibiotic prophylaxis. This article reviews current UK guidelines and prevention strategies.
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Maternal obesity and the importance of nutrition Lessons from a first year elective placement


Ela Yuregir, second year student midwife, Liverpool John Moores University

 (June 2016)


Obesity is an issue seen more and more in the media, and is a leading cause of death and health complications worldwide (World Health Organization (WHO) 2014). Antenatally, women are classified as obese or overweight at booking and their midwifery care is altered accordingly, which may lead to further stress. A lot is known about the apparent dangers of obesity but not much is known about the malnourishment of obese pregnant women and the potential harm their diet could be doing to the fetus. The focus needs to be shifted from the dangers of obesity on to the importance of nutrition for both mother and fetus and the role midwives could play in this issue.
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Cut it out! Smoking and pregnancy


Mandy Galloway, Medical writer and Editor of Practice Nursejournal

 (June 2016)


Smoking in pregnancy has many known risks both to the mother and her developing baby. Yet despite this knowledge, many women continue to smoke throughout pregnancy or relapse postnatally if they did manage to quit before the birth. This article highlights the importance of midwives working together with other professionals to provide smoking cessation support to women and their families. They can do this by providing information about the benefits of stopping smoking, referring to expert support and continually reassessing women's motivation to quit and progress in achieving QUIT status.
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Substance misuse: can midwives really make a difference?


Zoe Hughes

Student midwife at Swansea University

 (April 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.
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The trafficking of women and the role of the midwife


Hannah Tizard

Second year student midwife and research assistant at University of Central Lancashire

 (April 2016)


Health can be contextualised in relation to globalisation. Economic and societal influences, increasing gaps between middle income and impoverished groups, mass media, culture sexualisation, consumerism, psychological control and criminal activities, such as the drugs and sex trades, amplify challenges to maintaining the health and wellbeing of populations (Lee 2004). UK policy makers develop tools to determine care pathways, in theory allowing those working in public health roles to support individuals to better long-term health. The health needs of trafficked women and the role of the midwife require particular consideration so that this group is not further exposed and unprotected. It requires partnership with a great number of agencies within healthcare itself, but also with charities, government bodies, external organisations and the police. This article explores the health problems associated with the trafficking of women and the clinical implications in the identification and treatment of these victims for the midwife in a public health capacity.
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The impact of maternal age on midwifery care 


Rebecca Knapp

Midwife at Lancashire Teaching Hospitals NHS Foundation Trust

 (December 2015)


With a changing society, the age range at which women are choosing to become pregnant is increasing. There are different needs associated with each end of this range, with younger and older mothers facing different challenges and decisions. The midwife needs to be confident about the associated needs and potential complications for women at each end of the maternal age spectrum, in order to navigate the journey with the mother. This article aims to address the particular needs of both younger and older mothers, and highlight the midwife's unique role within this process.
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Caring for pregnant women with high BMI


Stevie Walsh

Midwifery lecturer at Robert Gordon University

Gillian Swinscoe

Community midwife at NHS Grampian

 (October 2015)


A collaborative project between a community midwife and midwifery educationalist has developed a model of compassionate woman-centred care for women with high BMI. The project aim was to test a model of care that would increase midwives’ confidence in caring for women with high BMI. It was important that any new model should not involve what would be perceived as time-consuming activities that would add significantly to the midwives’ workload. After searching the literature a five-stage brief interventions model based on motivational interviewing (MI) theory was piloted with a team of community midwives in rural Scotland. Leaflets were developed containing information and activities based on MI principles providing women with a tool to work with. The Swinscoe-Walsh model has been well received and evaluated by both midwives and women and is being considered for wider implementation by public health services for pregnant women.
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Women’s lived experiences of domestic violence during pregnancy: Part 2


Kathleen Baird

Director of midwifery and nursing education in Women's and Newborn and Children's Services at Menzies Health Institute of Queensland, Griffith University, Australia

 (October 2015)


This paper is a follow up paper to a study which explored women's experiences of domestic violence before, during and after pregnancy. Findings from this study suggested that women would like midwives to be able to recognise the signs of domestic violence and to be able to offer them an appropriate response and support. Midwives are well placed to recognise the signs of domestic violence and provide appropriate support. This paper addresses some of the challenges and dilemmas for midwives when identifying and supporting women who have experienced domestic violence and provides some key messages for midwifery practice.
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It's a WRAP! Delivering wellness for women in the UK


Karen Murray

Lead midwife for education at Queen’s University Belfast

Stephen Hamilton

Nurse education consultant and WRAP facilitator at the clinical education centre, Belfast

Shona Hamilton

Consultant midwife at Northern Health and Social Care Trust and Queen’s University Belfast

 (May 2015)


Wellness Recovery Action Planning (WRAP) was first created by Mary Ellen Copeland in 1997 and reinforced the concept of people taking individual responsibility for their health status and wellbeing. To fuel personal responsibility for one’s health status, Mary Ellen purported that it was necessary for the person to tap into their inner drive and resources with a view to owning their health. This concept has been widely accepted and disseminated within the field of mental health but has not yet been fully embraced by other professions, such as midwifery. In this piece, the authors highlight the recovery and wellness ethos inherent in the current zeitgeist of healthcare and discuss how WRAP could be utilised by midwives to facilitate the wellness of women during the antenatal period and beyond.
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ADVANCING PRACTICE Paranoid or persecuted? The stigmatisation of pregnant drug users: a literature review


Claire Hooks

Senior lecturer in midwifery and bank midwife at Anglia Ruskin University

 (January 2015)


Substance misuse is a complex issue, fraught with many challenges and inequalities for those affected; most of these are as a result not of the substances themselves, but of the underlying web of socioeconomic problems associated. Whilst the literature suggests that pregnancy may be a ‘window of opportunity’ for substance misusing women, it also suggests that there are several barriers to women engaging with health care. One of these is the fear of being judged and stigmatised by healthcare professionals. This literature review looks at research in the field of substance misuse in pregnancy, focusing on the ‘stigmatisation’ of pregnant drug users by healthcare professionals, illustrating the potential impact of this upon care.
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Cocaine use and the breastfeeding mother


Wendy Jones

Pharmacist and writer

 (January 2015)


Cocaine is the second most commonly used illicit drug. Use in pregnancy and breastfeeding may have severe consequences for the baby due to its pharmacokinetic properties. Midwives need to be aware of the prolonged action of cocaine and be alert to the possibility of cocaine toxicity if a baby is excessively irritable and tachycardic. Euphoric highs are brief but breast milk and urine remain positive for long periods. Infant urine following exposure to cocaine via breast milk may remain positive for up to 60 hours. Mothers who snort cocaine should pump and dump breast milk for 24-48 hours. Passive inhalation of crack cocaine smoke may also result in infants with positive toxicology screens. Cocaine powder should never be applied to the nipples of breastfeeding mothers.
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Substance use in pregnancy


Louise Slater

Midwife with the substance use team at East Lancashire NHS Trust

 (January 2015)


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).
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Digestive health in pregnancy


Charlotte Kenyon

Senior lecturer in midwifery and supervisor of midwives at the University of Huddersfield

 (October 2014)


Women experience the physiological changes of pregnancy in a variety of ways. Changes in pregnancy are associated with changing hormone levels. These hormonal changes have an impact on all body systems. Midwives need to have an understanding of the changes so that they can enable women to manage their digestive health effectively. The midwife needs to be vigilant in history taking to understand the woman’s experiences and to be able to offer appropriate support and advice. There are a number of conventional and alternative treatments that can help to prevent and alleviate symptoms. This article will consider the impact of pregnancy on the gastro-intestinal system and how changes can be managed.
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Magnesium: the relevance of research


Rosemary Mander

Emeritus professor of midwifery at the University of Edinburgh

 (October 2014)


The recent flurry of apparently conflicting research findings is likely to have left practitioners, if not at a loss, at least bemused about this topic. How best should the midwife advise the childbearing woman on the subject of magnesium supplementation during pregnancy? It is possible that the recent welter of words may not have been of very much help to any of those who read them. In this paper I suggest that the researchers may actually be missing the point as far as providing useful and usable data is concerned.
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Nutrition in pregnancy: keeping in mind the priorities


Michel Odent

Surgeon, obstetrician, writer and expert on primal health

 (October 2014)


Since brain development is explosive during the second half of human fetal life, the concept of ‘brain selective nutrients’ is a necessary point of departure to identify the basic nutritional needs of pregnant women. Two important brain selective nutrients are considered: iodine, essential in thyroid hormone production, and DHA, a very long chain polyunsaturated acid of the omega 3 family. Both of them are abundant in the seafood chain only. The particular case of pregnant women who do not have access to the seafood chain is considered. The focus is on the need to avoid blocking agents of the metabolic pathways of unsaturated fatty acids, particularly pure sugar, alcoholic beverages and trans fatty acids.
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