Midwifery Info

Worth the weight?

2010-11-15T07:10:00.000-08:00

Increasing numbers of British women are dieting during pregnancy, putting their children at risk of serious illness in later life, according to this article by Anita Chaudhuri. According to a study by Barker et al. for the Medical Research Council (MRC), pregnant women in Britain are dieting like never before, and the health implications are alarming. The findings indicated that four out of ten women eat a diet that is likely to deprive a child of essential nutrients.

Worried doctors opt for caesareans

2010-11-15T07:00:00.000-08:00

The Observer of 23/10/04 features an unpublished Cambridge University survey which suggests that that fear of legal action is a major factor behind the rising number of caesarean sections performed during childbirth. The high rates of caesarean sections in the UK , which are up to 28 per cent of all births in some trusts, may have less to do with women choosing an operation, and more to do with doctors' anxieties about being sued. Two-thirds of obstetricians admitted that such anxieties influenced their decision.

However, the perception that patients are becoming more litigious is a myth not born out by the statistics, according to experts. The number of legal claims against NHS trusts actually fell by 20 per cent last year.

Baby sex link to domestic status (BBC News 20/10/04)

2010-11-15T06:58:00.001-08:00

The living arrangements of parents at the time a baby is conceived may play a role in determining its sex, research suggests. A US study found parents who were married or living together before conception were slightly more likely to have a boy than those who were not. The study, by the US National Bureau of Economic Research, is based on data from 86,436 births. Details are published in Proceedings of The Royal Society.

Overall, the study found that 51.5% of babies born to couples living together at the time of conception were boys, compared to 49.9% among parents who were not.

Pregnant to be questioned on home violence (Independent 20/10/04)

2010-11-15T06:57:00.002-08:00

Pregnant women are to be routinely asked by doctors and midwives if they have been beaten up by their partners in a new drive to tackle domestic violence. The move follows evidence that women are more vulnerable to domestic violence during pregnancy. Melanie Johnson, the Public Health minister, will announce plans today for questions to be put to women during their first NHS ante-natal visits.

The initiative means that health service professionals will play a vital role in rooting out hidden domestic violence. At NHS appointments during the early stages of pregnancy, such as for foetal scans, they will inquire whether women are being abused. Sufferers will be referred to appropriate support and counselling services or the police if it emerges that they need protection or want charges to be pressed.

New Chief Nursing Officer appointed (DH 19/10/04)

2010-11-15T06:57:00.000-08:00

Health secretary John Reid has announced the appointment of Christine Beasley as England's new chief nursing officer.

For those of you who are not familiar with Christine Beasley she has held a wide range of nursing roles in hospitals and the community. Her most recent roles were as the NHS modernisation agency's Director of Partnership Development and then interim head of the agency.
On accepting the appointment Christine Beasley said that she was delighted to take up the post and was "looking forward to the challenge of ensuring all staff put hospital cleanliness and infection control at the top of the agenda".

The RCM welcomed this announcement, and said we are looking forward to working with the new chief nursing officer on a number of issues, including the extension of midwifery led care and further action to address the recruitment and retention of midwifes.

Risks of second caesarean studied (BBC News 19/10/04)

2010-11-15T06:54:00.001-08:00

A study is being carried out to help women who have given birth by caesarean decide how to give birth the next time. The DiAMOND study - Decision Aids for Mode of Next Delivery - will question 600 pregnant mothers in Bristol, Somerset and Dundee. Researchers have developed two different methods of giving women information on the risks and benefits of natural and repeat caesarean. They will be compared to women who are given standard information. The joint Bristol and Dundee University study will measure if the new methods either prompt women to take a second caesarean or opt for natural birth.

Aerosols 'harm mother and baby'

2010-11-15T06:52:00.000-08:00

A paper by Farrow et al., Farrow A, Taylor H, Northstone K, Golding J, Symptoms in mothers and infants and use of aerosols and air fresheners, has just been published in the journal Archives of Environmental Health. It is part of the ALSPAC 'Children of the 90s' study in Bristol. The work is featured on the BBC News and IC Wales web sites. Air fresheners and aerosols used in the home can cause diarrhea and earache in youngsters and depression in their mothers, according to the researchers.

Improving perinatal mental health care

2010-11-15T06:49:00.000-08:00

Nursing Standard carries a freely-available article by Thomas Currid, lecturer at London South Bank University. (2004 19:3 40-43)

Abstract:
Pregnancy and the puerperium can bring many emotional, physical and social changes to the mother, her partner and the rest of the family. While many mothers find these changes – such as the experience of pregnancy or the addition of a new member to the family – joyous, some do not share these positive feelings and often undergo emotional upheaval resulting in severe biopsychosocial distress. This period of distress does not only subject the mother and her family to increased risk of psychological crisis, mental illness and developmental disturbances, but may also, if untreated, result in the fatalistic outcomes of infanticide or suicide. In this article, the author calls for a more robust, co-ordinated and interdisciplinary approach to perinatal mental health services.

Statistical bulletin: NHS contraceptive services 2003-4

2010-11-15T06:48:00.001-08:00

In 2003-04:

- there were about 2.7 million attendances at family planning clinics, about 2% more than in 2002-03
- the number of women attending clinics was 1.20 million, about the same as in 2002-03
- the number of men attending clinics was 106 thousand, about 14% more than in 2002-03,
- the peak age for clinic attendance was 16-17; an estimated 23% of women in this age group visited a clinic during the year
- oral contraception was the primary method of 41% of clinic attenders; the male condom was the primary method of 35% of attenders
- emergency contraception was prescribed by clinics on 193,000 occasions, a decrease of 2% compared with 2002-03

A comprehensive evaluation of food fortification with folic acid for the primary prevention of neural tube defects (BMC Pregnancy and Childbirth 2004 4 20)

2010-11-15T06:47:00.000-08:00

Periconceptional use of vitamin supplements containing folic acid reduces the risk of a neural tube defect (NTD). In November 1998, food fortification with folic acid was mandated in Canada, as a public health strategy to increase the folic acid intake of all women of childbearing age. The researchers (Liu et al.) undertook a comprehensive population based study in Newfoundland to assess the benefits and possible adverse effects of this intervention.

The rates of NTDs fell by 78% (95% CI 65%-86%) after the implementation of folic acid fortification, from an average of 4.36 per 1,000 births during 1991-1997 to 0.96 per 1,000 births during 1998-2001. Based on these findings, mandatory food fortification in Canada should continue at the current levels. Public education regarding folic acid supplement use by women of childbearing age should also continue.

Marijuana use may increase the risk of ectopic (tubal) pregnancies, researchers at Vanderbilt University Medical Center (Dey et al.) reported this week. (Internet Medical Journal Monday 27th September)

2010-11-15T06:44:00.000-08:00

The researchers studied CB1, a "cannabinoid" receptor that binds the main active chemical for marijuana, delta-9-tetrahydrocannabinol (THC).

In pregnant mice that lacked the gene for the receptor, or in which the receptor was blocked, the embryo failed to go through the oviduct – the tube leading from the ovaries to the uterus. The same thing happened in normal mice when the receptor was over-stimulated.

The study, published in the current issue of the journal Nature Medicine, describes for the first time how the CB1 receptor in the mouse regulates muscle contraction to move the embryo down the oviduct.

It is not known whether drugs that block or, in the case of marijuana, over-stimulate the CB1 receptor can cause ectopic pregnancy in humans. However, "our results raise caution for women of reproductive ages regarding the chronic use of marijuana for recreation or pain alleviation," the researchers concluded.

UK boost for Iraq maternity care (BBC News 30/08/04)

2010-11-15T06:42:00.000-08:00

A team of UK doctors has helped reduce infant and maternal mortality in Iraq following a pioneering project to improve midwifery practices in the war-ravaged country. They have taught consultants and midwives how to deal with medical emergencies that can arise during childbirth without the need for expensive equipment, which they do not have.

The report states:

"Unwittingly, the British team made another impact in Iraq - by changing doctors and consultants' attitudes towards midwives. Mr Mathieson, who is also a senior lecturer in environmental health at Bristol's University of the West of England, which allowed him time off for the programme, said: "Nurses and midwives in Iraq are seen as second class citizens.

A party of Basra doctors currently on a visit to London have said what a huge difference we have made to their work. According to Andrew Mathieson, MOET trip co-ordinator, "They are mainly women and this is a misogynistic society." There were two or three midwives on each of the two courses of 18. The remainder were doctors, two-thirds of whom were women.
"We were teaching midwives the same sort of life-saving techniques as the doctors. Midwives are very experienced and this gave them the capability to support their experience. The doctors had a greater appreciation of what midwives are capable of after they had been on the course.
So we were making in-roads into changing attitudes towards midwives."

Matrons make their mark

2010-11-15T06:40:00.000-08:00

The new Matron’s Charter will set out a clear direction for senior nurses to improve hospital hygiene and infection control.

A partnership of senior nurses and facilities staff, including representatives from the Royal College of Nursing, the Royal College of Midwives, the Infection Control Nurses Association, Healthcare Facilities Management Association and the Association of Domestic Managers, will develop the charter. Designed to help promote cleanliness across the NHS, it will include recommendations on creating stronger cleaning teams, clarify the responsibilities of staff and give patients a stronger voice.

The charter – due out in October – is a key part of a new national drive to improve NHS hygiene, infection control and cleanliness standards, as outlined in Towards Cleaner Hospitals and Lower Rates of Infection. Matrons have an important role to play in leading the cultural changes that will bring improved personal hygiene, better clinical practice and a cleaner environment.

"Power of touch" report

2010-11-15T06:33:00.002-08:00

A report by Johnson's Baby (which unfortunately I cannot locate) claims that babies are being deprived of their mother's touch because of the excessive use of pushchairs and detachable car seats rather than slings which physically bring them close to their parent, a report claims today. Mild forms of sensory deprivation can come from the constant use of car seats - often used when babies are not even being driven - and pushchairs and prams, it suggests. Baby massage, however, is an increasingly

Midwife urges staffing review (Nursing Standard 08/09/04)

2010-11-15T06:33:00.000-08:00

Cathy Warwick, of King's College Hospital NHS Trust, an NMC member, has suggested that maternity units should pool their staffing resources in regional co-operatives so that all women requesting a home birth can have one, an influential midwifery expert said last week. The idea is put forward in response to the Beland case, in which a midwife was dismissed for providing a women with a home birth in defiance of his trust's policies. The NMC is expected to issue revised guidelines soon on the home birth issue.

Does cannabis increase the risk of ectopic pregnancy? (BBC News 20/09/04)

2010-11-15T06:32:00.000-08:00

Researchers at Vanderbilt University have published research that may implicate cannabis in the aetiology of ectopic pregnancy.

Sue Jacob's comments are featured:

Sue Jacob from the Royal College of Midwives said: "We need to look at the bigger picture.
"The rise in sexually transmitted infections, the rise in alcohol binging and the rise in drug taking all have an impact on sexual health. Ectopic pregnancies need to be researched further in light of these behaviours," she said.

Premature babies' disability risk (BBC News, 20/09/04)

2010-11-15T06:29:00.001-08:00

Forty per cent of very premature babies have significant learning disabilities, according to the unpublished Epicure study. The study is following the developmental progress of 1,200 babies born alive at less than 26 weeks gestation in Britain and Ireland in 1995, just over 300 of whom survived to go home. The latest results show that 40% of the surviving children had moderate to severe problems in cognitive development at the age of six, compared to 2% of a control group of their classmates.

"Candles" ethnic minority recruitment project

2010-11-15T06:28:00.000-08:00

A project in Slough to recruit more nursing and midwifery students from Asian and Caribbean backgrounds is featured in the Guardian of 18/09/04. It aims to counter negative attitudes to nursing among Indian and Pakistani communities. It is being run by Professor Elizabeth Anionwu of Thames Valley University. The project's target is to recruit 40 people from South Asian and Caribbean backgrounds on to student nurse and midwifery courses at Thames Valley University by September 2005.

Babies at risk from stress in pregnancy

2010-11-15T06:25:00.001-08:00

An intriguing link between levels of anxiety in pregnant women and the damaging effect on the brain of the unborn child will be shown this week in a new study of ambidextrous children.

Researchers have discovered that women who are very anxious in the middle of their pregnancies are significantly more likely to have a child who is ambidextrous or 'mixed handed', a condition associated with autism, dyslexia and hyperactivity. It is the first time scientists have found such a link, and they believe it may be necessary for midwives to tackle mothers' stress levels to reduce the effects on the fetus.

The findings are based on information collected by a project based at the University of Bristol which looked at the lives of more than 7,400 mothers and children. The research, by Glover et al., was published in Early Human Development 79 (2) 2004 as "Antenatal maternal anxiety is linked with atypical handedness in the child".

National Service Framework for Children

2010-11-15T06:24:00.000-08:00

On 15/09/04 the Department of Health published the National Service
Framework (NSF) for Children, Young People and Maternity Services. The
Children’s NSF is a 10-year programme intended to stimulate long-term and
sustained improvement in children’s health. Setting national standards for
health and social services for children, young people and pregnant women,
the NSF aims to ensure fair, high quality and integrated health and social
care from pregnancy, right through to adulthood.

The Children's NSF receives coverage in the Guardian, Times, and BBC News.

RCM Midwives Journal online content

2010-11-15T06:18:00.000-08:00

The online content of the RCM Midwives Journal has now migrated to the Ingenta service (www.ingenta.com) and is no longer available at www.midwives.co.uk. Issues from 5(10) 2002 can be browsed there. Access to full text is free of charge, though there is a six-month embargo on recent content, i.e. the most recent months are not available. Eventually all issues going back to 1998 will be put online.

Student Midwives' Sanctuary

This web site is a back online after an absence. I am a bit concerned about having specimen essays on the site - too much of a temptation to plagiarism, in my view. Students seem to worry a great deal about their dissertations, so a few specimens of this genre would be useful!

Erna Wright 1924-2004

The Guardian of 08/09/04 carries an obituary of Erna Wright, who in the early 1960s introduced the Lamaze method of training for childbirth into Britain.

The home birth lottery

A Guardian article (08/09/04) featuring the 'postcode lottery' in access to home birth services. The case of Paul Beland at Peterborough is discussed.

Parent trap

Negative attitudes to teenage mothers, and a YWCA campaign to change attitudes, are featured in this Guardian article (08/09/04).

Recent days have seen extensive coverage of alcohol misuse issues:

2010-11-15T06:14:00.000-08:00

A Guardian article, Binge drinkers 'risk babies with birth defects' (13/09/04) highlights the risks of FAS (fetal alcohol syndrome) incurred by young female binge drinkers, who may not realise that they are pregnant.

The BBC News site of 06/09/04 featured a Tommy's/NOP survey which shows that a large proportion of pregnant women are ignoring advice from health professionals, as 1 in 5 women smoked and 2 out of 5 drank alcohol during their pregnancy: Pregnancy not curbing bad habits. The survey also revealed extensive ignorance about diet and other lifestyle issues. Tommy's is publishing a book, 'Tommy’s guide to pre-pregnancy care’ , which is available free during September at larger Boots' branches.

Another BBC News feature on 13/09/04, Any alcohol a risk during pregnancy, highlights a presentation by Raja Mukherjee at the Foetal Alcohol Syndrome Aware UK conference. According to Dr Mukherjee, many children who develop behavioural problems as a result of exposure to alcohol in the womb are incorrectly diagnosed as having conditions such as attention deficit hyperactivity disorder. The real culprit, alcohol consumption, goes unnoticed in these milder forms, collectively called Foetal Alcohol Spectrum Disorder. He is of the view that there is no safe limit for alcohol consumption during pregnancy.

Perinatal depression among black Caribbean women

2010-11-15T06:09:00.000-08:00

Edge, D et al. Health & Social Care in the Community 12(5) 430f. 2004

I do not normally feature in this blog articles that are not available free. However, it seemed to be worth making an exception for this one.

This study showed that black Caribbean ethnicity is an important dimension in understanding the social patterning of mental illness. The findings have implications for the equitable provision of primary care services since black Caribbean women experienced depressive symptoms in pregnancy and early motherhood, but were less likely than their white British counterparts to receive treatment.

Why must we feel guilty?

An article by Lucy Cavendish in the Evening Standard of 31/08/04 about her experience of home birth. She argues strongly that it should be available to everyone.

Help for women suffering years of childbirth trauma

2010-11-15T06:08:00.000-08:00

A report in the Telegraph of 31/08/04 about the setting up of the newly-founded Birth Trauma Association. The association supports women suffering from PTSD and offers support and advice to others who find it difficult to cope with their childbirth experience.

New mums need more old hands

According to Rowan Pelling in the Independent of 29/04/04 , midwives can no longer cope with long hours, low pay and the incompetence that surrounds them.

NB this article is now available only to subscribers or on a pay-per view basis.

Second-Trimester Maternal Serum Levels of Alpha-Fetoprotein and the Subsequent Risk of Sudden Infant Death Syndrome, by Smith GCS et al. New England Journal of Medicine 351:978-986 2004

A raised maternal serum level of alpha-fetoprotein during the second trimester of pregnancy is a marker of placental dysfunction and a strong predictor of the risk of unexplained stillbirth. There is a direct association between second-trimester maternal serum alpha-fetoprotein levels and the risk of SIDS, which may be mediated in part through impaired fetal growth and preterm birth.

The research is featured in a BBC News article.

The baby business

The Independent of 02/09/04 carries an extended article by Beryl Dixon about midwifery as a career. The RCM is mentioned several times.

Test may prevent premature births

2010-11-15T06:05:00.000-08:00

Gravett and Nagalla at Oregon Health & Science University (OHSU) claim to have discovered a method for detecting intra-amniotic infections in pregnant women using state-of-the-art methods, according to the BBC News web site. They foresee that the finding may result in the development of a test for these hard-to-diagnose but common infections during pregnancy. Their research was published in JAMA.

Warning of near-term birth 'risk'

The BBC News web site highlights an article by Wang et al. published in Pediatrics, claiming that babies born just slightly prematurely have more health problems than those born at full term. They found conditions such as jaundice and hypoglycaemia were more common in babies born at 35 or 36 weeks gestation than those born at 37 weeks or more.

Brown et al. claim, in an article published in Archives of General Psychiatry, to have found that a dose of flu in the first half of pregnancy was linked to a three-fold increase in the risk of schizophrenia. However, illness in the second half of pregnancy seemed to have no effect.

These findings represent the strongest evidence thus far that prenatal exposure to influenza plays a role in schizophrenia. The researchers estimate that 14% of schizophrenia cases may be linked to exposure to the flu virus in the womb. Their work was highlighted on the BBC News web site on August 3rd.