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Promoting normality and choice by creating a home-from-home birthing room

Nicola Cooper

Midwife at Princess Elizabeth Hospital, Guernsey

Susan Way

Midwife at Bournemouth University

 (November 2016)

Promoting normality within the birth environment has been a key policy driver for a number of years. The National Institute for Health and Care Excellence (NICE) (2014) recommends that low-risk women birth either at home or in a midwife-led unit, but not all maternity services are able to easily provide these options. This reflective account explores how a small maternity unit met this challenge by changing a transitional care room into a home-from-home room. The room is designed with space, low lighting, Bradbury cushions, bean bags and a brand new birthing pool to allow one-to-one midwifery care in a relaxing environment. The feedback so far is that the women have had positive experiences and we look forward to promoting this further.

Breaking taboos about bodily fluids: how midwives can help

Emily Maclean

Student Midwife at King's College London

Let me know what you think on Twitter: @MidwifeTalk

 (July 2016)

Woman-centred maternity care involves empowering the mother at a time when she may feel physically vulnerable. Bodily fluids can create inhibitions during pregnancy, birth and the postnatal period. This article explores the background to such stigma and suggests ways midwives might address these issues to create confidence and promote normality.

Supervision: promoting birth as a normal physiological event

Louise Burns, midwife and Supervisor of Midwives

 (June 2016)

In the 100 intervening years since statutory supervision was established, the fundamental cause to promote safe practice remains intact (Nursing and Midwifery Council (NMC) 2004). However, the evolving profile of supervision increasingly recognises its role in professional clinical leadership. This embraces the concept of birth as a 'normal physiological event'. Current government policy advocates the principle of 'normal' birth. There exists a plethora of evidence to condemn the legacy of unnecessary medical intervention in the physiological process. The social recognition of the advantages of physiological childbirth is ever more acknowledged (Downe 2004; Walsh 2007). However, the paradox of medical domination still prevails. This situation augments the challenge for Supervisors of Midwives (SoMs) to provide proactive leadership and determine how to maintain the momentum towards 'normality' within this environment.

Achieving skin to skin contact in theatre for healthy newborns

Suyai Steinhauer, home birth midwife in a practice serving an Amish community in the USA

Jenny Clarke, core midwife at the Fylde Coast Birth Centre in Blackpool

 (June 2015)

The evidence base is supportive of early skin to skin contact (SSC) for optimal newborn-physiological adaptation, bonding and breastfeeding, and national guidelines encourage SSC as soon as possible, regardless of mode of birth. With an ever-rising caesarean (CS) rate, implementing SSC in theatre stands to benefit an increasing number of mothers and babies. While it may be best practice, in reality there is a lot of variation from trust to trust, and many hospitals do not facilitate it, citing numerous reasons as to why it is not possible. Midwives may feel that they should focus on normal birth, but it is our role to provide holistic care and normalise birth in all settings. This article looks at current evidence and the role of the midwife around facilitating SSC in theatre with an example from practice of how change has been implemented so that mothers and babies get the best start in life.

The power of environment

Becky Westbury

Midwife at Royal Gwent Hospital

 (June 2015)

In Ten tips for normal birth, the Royal College of Midwives (RCM) (2014) advocates the building of nests; creating an environment that helps women to feel safe and secure during birth, as this can improve women’s experiences and likelihood of normal birth. Furthermore, a private, undisturbed and dark environment, where women feel calm and safe can promote the release of oxytocin, the hormone responsible for uterine contractions and thought to promote the release of the pain relieving hormones endorphins (Uvnas Moberg 2003). When this is not achieved, women can experience fear-tension-pain syndrome, impeding labour progress and causing increased levels of pain (Dick-Read 2013). In addition, birth space has the potential to encourage the promotion of normality through providing space to mobilise, and alternative furniture to enable upright birth positions. Midwives should help women to create a birth space in which they feel safe, calm and secure, to promote normality and increase the incidence of normal birth (RCM 2014).

Hospital birth: are we giving women the facts?

Ayla Ozkan

Brierley midwife at King's College Hospital, currently working with a voluntary organisation as clinical quality advisor in Cambodia

 (April 2015)

An article published last year in the Journal of Medical Ethics compares giving birth at home to being as reckless as driving without putting a seatbelt on your child (de Crespigny and Savulescu 2014). Planning to give birth at home is often thought of as quite an ‘alternative’ decision, with just 2.4 per cent of women in England and Wales opting for this in 2011 (Office for National Statistics (ONS) 2013). The politics surrounding place of birth in contemporary maternity care are highly contentious and not at all as clear cut as one may initially presume. As a midwife working in a busy UK unit, I would liken the assumption that a low risk birth is inherently safer in a high risk unit to investing in ill-fitting metaphorical seat belts, which may give the whole family whiplash.

Being born is good for you 

Hannah Dahlen

Professor of midwifery at the University of Western Sydney

 (April 2015)

The distrust in women’s ability to give birth and the pathologising of this physiological process is a relatively recent historical phenomenon. While there is increased recognition of the importance of normal birth for women, babies and society as a whole, the focus of researchers has, to date, been on relatively short-term outcomes; in particular perinatal mortality. As scientists develop the skills and gain knowledge in the area of epigenetics and the microbiome, we are glimpsing the potential long-term and even inter-generational implications of high rates of medical intervention during labour and birth. More research is urgently needed, and helping consumers to understand the potential ramifications is also important. Midwives need to be aware of these emerging areas of research and be able to communicate with women about them.

Women’s engagement with mobile device applications in pregnancy and childbirth

Fiona Robinson

Health lifestyles midwife

Catriona Jones

Lecturer in midwifery and research associate at the University of Hull

 (January 2014)

Childbearing women are increasingly engaging with social media and technology. The use of apps for pregnancy and childbirth advice is a new approach to maternity provision, and has potential to impact upon midwifery. Apps are ideally placed to provide opportunities for women to access information; however, there are concerns about the quality of mobile app data in relation to evidence based midwifery. This discussion paper presents a general overview of the use of apps as an information resource, and provides a platform for debate about their position in midwifery care.