How do midwives facilitate women to give birth during physiological second stage of labour? A systematic review.

Both nationally and internationally, midwives' practices during the second stage of labour vary. A midwife's practice can be influenced by education and cultural practices but ultimately it should be informed by up-to-date scientific evidence. We conducted a systematic review of the literature to retrieve evidence that supports high quality intrapartum care during the second stage of labour. A systematic literature search was performed to September 2019 in collaboration with a medical information specialist. Bibliographic databases searched included: PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Maternity and Infant Care Database and The Cochrane Library, resulting in 6,382 references to be screened after duplicates were removed. Articles were then assessed for quality by two independent researchers and data extracted. 17 studies focusing on midwives' practices during physiological second stage of labour were included. Two studies surveyed midwives regarding their practice and one study utilising focus groups explored how midwives facilitate women's birthing positions, while another focus group study explored expert midwives' views of their practice of preserving an intact perineum during physiological birth. The remainder of the included studies were primarily intervention studies, highlighting aspects of midwifery practice during the second stage of labour. The empirical findings were synthesised into four main themes namely: birthing positions, non-pharmacological pain relief, pushing techniques and optimising perineal outcomes; the results were outlined and discussed. By implementing this evidence midwives may enable women during the second stage of labour to optimise physiological processes to give birth. There is, however, a dearth of evidence relating to midwives' practice, which provides a positive experience for women during the second stage of labour. Perhaps this is because not all midwives' practices during the second stage of labour are researched and documented. This systematic review provides a valuable insight of the empirical evidence relating to midwifery practice during the physiological second stage of labour, which can also inform education and future research. The majority of the authors were members of the EU COST Action IS1405: Building Intrapartum Research Through Health (BIRTH). The study protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO; Registration CRD42018088300) and is published (Verhoeven, Spence, Nyman, Otten, Healy, 2019).

How do midwives facilitate women to give birth during physiological second stage of labour? A protocol for a systematic review.

BACKGROUND: Midwives' practices during the second stage of labour vary nationally and internationally. We aim to retrieve evidence that supports high-quality intrapartum care by conducting a systematic review of the literature. METHODS: Electronic bibliographic databases including PubMed, EMBASE.com , Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Maternity and Infant Care Database (through MIDIRS), and The Cochrane Library will be searched to identify studies that meet the inclusion criteria. No language or publication date constraints will be applied. Articles that pass the two-stage screening process will then be assessed for risk of bias and have their reference lists hand searched. DISCUSSION: A midwife's practice can be influenced by education and cultural practices but ultimately it should be informed by up-to-date research evidence. By analysing and synthesising the results of the studies, this systematic review will provide valuable insight into high-quality evidence-based midwifery care, which can inform practice, education and future research. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018088300.

Does Enquiry Based Learning (EBL) impact on clinical practice? A qualitative exploration of midwifery graduates' perceptions.

OBJECTIVE: To elicit perceptions of midwifery graduates regarding the impact of Enquiry Based Learning (EBL) on their clinical practice. DESIGN: A qualitative approach utilising semi-structured interviews and content analysis. SETTING: A midwifery education provider in the Republic of Ireland. PARTICIPANTS: Purposive sampling was employed to recruit fourteen midwifery graduates, from a total of twenty eight, from two cohorts who had successfully completed a Higher Diploma in Midwifery programme. FINDINGS: Findings centred on the theme 'Effect of EBL on clinical practice', with positive perceptions of EBL reported in relation to its connexion to midwifery practice. CONCLUSIONS: Findings affirm the view that EBL augments linkage of theory to clinical practice in addition to linking clinical practice to theory. Consequently, competent practitioners are cultivated and an array of transferable skills developed, thus demonstrating the significant contribution of EBL in enriching clinical practice.

Executive functioning deficits in young adult survivors of bronchopulmonary dysplasia.

PURPOSE: To assess long-term impairments of executive functioning in adult survivors of bronchopulmonary dysplasia (BPD). METHOD: Participants were assessed on measures of executive functioning, health-related quality of life (HRQoL) and social functioning. Survivors of BPD (n = 63; 34 males; mean age 24.2 years) were compared with groups comprising preterm (without BPD) (<1500 g; n = 45) and full-term controls (n = 63). Analysis of variance was used to explore differences among groups for outcome measures. Multiple regression analyzes were performed to identify factors predictive of long-term outcomes. RESULTS: Significantly more BPD adults, compared with preterm and term controls, showed deficits in executive functioning relating to problem solving (OR: 5.1, CI: 1.4-19.3), awareness of behavior (OR: 12.7, CI: 1.5-106.4) and organization of their environment (OR: 13.0, CI: 1.6-107.1). Birth weight, HRQoL and social functioning were predictive of deficits in executive functioning. CONCLUSIONS: This study represents the largest sample of survivors into adulthood of BPD and is the first to show that deficits in executive functioning persist. Children with BPD should be assessed to identify cognitive impairments and allow early intervention aimed at ameliorating their effects. Implications for Rehabilitation Adults born preterm with very-low birth weight, and particularly those who develop BPD, are at increased risk of exhibiting defects in executive functioning. Clinicians and educators should be made aware of the impact that BPD can have on the long-term development of executive functions. Children and young adults identified as having BPD should be periodically monitored to identify the need for possible intervention.

Creating an eLearning resource to improve knowledge and understanding of pregnancy in the context of HIV infection.

Patient narratives have much to teach healthcare professionals about the experience of living with a chronic condition. While the biomedical narrative of HIV treatment is hugely encouraging, the narrative of living with HIV continues to be overshadowed by a persuasive perception of stigma. This paper presents how we sought to translate the evidence from a qualitative study of the perspectives of HIV affected pregnant women and expectant fathers on the care they received, from the pre conception to post natal period, into educational material for maternity care practice. Narrative scripts were written based on the original research interviews, with care taken to reflect the key themes from the research. We explore the way in which the qualitative findings bring to life patient and partner experiences and what it means for nurses, midwives and doctors to be prepared to care for couples affected by HIV. In so doing, we challenge the inequity between the dominance of biomedical knowledge over understanding the patient experience in the preparation of health professionals to care for HIV affected women and men who are having a baby or seeking to have a baby.

The effectiveness of weight management interventions in breastfeeding women--a systematic review and critical evaluation.

BACKGROUND: The postpartum period is a vulnerable time for excess weight retention, particularly for the increasing number of women who are overweight at the start of their pregnancy and subsequently find it difficult to lose additional weight gained during pregnancy. Although postpartum weight management interventions play an important role in breaking this potentially vicious cycle of weight gain, the effectiveness of such interventions in breastfeeding women remains unclear. Our aim was to systematically review the literature about the effectiveness of weight management interventions in breastfeeding women. METHODS: Seven electronic databases were searched for eligible papers. Intervention studies included were carried out exclusively in breastfeeding mothers, ≤2 years postpartum and with a body mass index greater than 18.5 kg/m(2) , with an outcome measure of change in weight and/or body composition. RESULTS: Six studies met the selection criteria, and were stratified according to the type of intervention and outcome measures. Despite considerable heterogeneity among studies, the dietary-based intervention studies appeared to be the most efficacious in promoting weight loss; however, few studies were tailored toward the needs of breastfeeding women. CONCLUSIONS: Weight management interventions which include an energy-restricted diet may play a key role in successful postpartum weight loss for breastfeeding mothers.

Impaired lung function and health status in adult survivors of bronchopulmonary dysplasia.

More infants with bronchopulmonary dysplasia (BPD) now survive to adulthood, but little is known regarding persisting respiratory impairment. We report respiratory symptoms, lung function and health-related quality of life (HRQoL) in adult BPD survivors compared with preterm (non-BPD) and full-term controls. Respiratory symptoms (European Community Respiratory Health Survey) and HRQoL (EuroQol (EQ)-5D) were measured in 72 adult BPD survivors (mean ± sd study age 24.1 ± 4.0 years; mean ± sd gestational age 27.1 ± 2.1 weeks; and mean ± sd birth weight 955 ± 256 g) cared for in the regional neonatal intensive care unit, Royal Maternity Hospital, Belfast, UK (between 1978 and 1993). These were compared with 57 non-BPD controls (mean ± sd study age 25.3 ± 4.0 years; mean ± sd gestational age 31.0 ± 2.5 weeks; and mean ± sd birth weight 1238 ± 222 g) and 78 full-term controls (mean ± sd study age 25.7 ± 3.8 years; mean ± sd gestational age 39.7 ± 1.4 weeks; and mean ± sd birth weight 3514 ± 456 g) cared for at the same hospital. Spirometry was performed on 56 BPD, 40 non-BPD and 55 full-term participants. BPD subjects were twice as likely to report wheeze and three times more likely to use asthma medication than controls. BPD adults had significantly lower forced expiratory volume in 1 s and forced expiratory flow at 25-75% of forced vital capacity than both the preterm non-BPD and full-term controls (all p<0.01). Mean EQ-5D was 6 points lower in BPD adults compared to full-term controls (p<0.05). BPD survivors have significant respiratory and quality of life impairment persisting into adulthood.

'Every pregnant woman needs a midwife'--the experiences of HIV affected women in maternity care.

TITLE: 'Every pregnant woman needs a midwife'-the experiences of HIV affected women in Northern Ireland. OBJECTIVE: to explore HIV positive women's experiences of pregnancy and maternity care, with a focus on their interactions with midwives. DESIGN: a prospective qualitative study. SETTING: regional HIV unit in Northern Ireland. PARTICIPANTS: 22 interviews were conducted with 10 women at different stages of their reproductive trajectories. FINDINGS: the pervasive presence of HIV related stigma threatened the women's experience of pregnancy and care. The key staff attributes that facilitated a positive experience were knowledge and experience, empathy and understanding of their unique needs and continuity of care. KEY CONCLUSIONS: pregnancy in the context of HIV, whilst offering a much needed sense of normality, also increases woman's sense of anxiety and vulnerability and therefore the need for supportive interventions that affirm normality is intensified. A maternity team approach, with a focus on providing 'balanced care' could meet all of the woman and child's medical needs, whilst also emphasising the normalcy of pregnancy.

Pregnancy planning and diabetes: a qualitative exploration of women's attitudes toward preconception care.

INTRODUCTION: Seeking preconception care is recognized as an important health behavior for women with preexisting diabetes. Yet many women with diabetes do not seek care or advice until after they are pregnant, and many enter pregnancy with suboptimal glycemic control. This study explored the attitudes about pregnancy and preconception care seeking in a group of nonpregnant women with type 1 diabetes mellitus. METHODS: In-depth semistructured interviews were completed with 14 nonpregnant women with type 1 diabetes. RESULTS: Analysis of the interview data revealed 4 main themes: 1) the emotional complexity of childbearing decisions, 2) preferences for information related to pregnancy, 3) the importance of being known by your health professional, and 4) frustrations with the medical model of care. DISCUSSION: These findings raise questions about how preconception care should be provided to women with diabetes and highlight the pivotal importance of supportive, familiar relationships between health professionals and women with diabetes in the provision of individualized care and advice. By improving the quality of relationships and communication between health care providers and patients, we will be better able to provide care and advice that is perceived as relevant to the individual, whatever her stage of family planning.

Experiences of fathering a baby admitted to neonatal intensive care: a critical gender analysis.

More fathers than ever before attend at the birth of their child and, internationally, there is a palpable pressure on maternity and neonatal services to include and engage with fathers. It is, thus, more important than ever to understand how fathers experience reproductive and neonatal health services and to understand how fathers can be successfully accommodated in these environments alongside their partners. In this paper we advance a theoretical framework for re-thinking fatherhood and health services approaches to fatherhood based on Critical Studies on Men (CSM). We illustrate the importance of this feminist informed theoretical approach to understanding the gendered experiences of fathers in a Neonatal Intensive Care Unit (NICU) setting in Northern Ireland. Using a longitudinal follow-up research design, with two data collection points, a total of 39 in-depth semi-structured interviews was conducted with 21 fathers of infants admitted to the NICU between August 2008 and December 2009. The findings demonstrate: (i) how men are forging new gendered identities around the birth of their baby but, over time, acknowledge women as the primary caregivers; (ii) how social class is a key determinant of men's ability to enact hegemonic forms of 'involved fatherhood' in the NICU, and; (iii) how men also encounter resistance from their partners and health professionals in challenging a gender order which associates women with the competent care of infants. An understanding of these gendered experiences operating at both individual and structural levels is critical to leading change for the inclusion of fathers as equal parents in healthcare settings.

Creating continuity out of the disruption of a diagnosis of HIV during pregnancy.

AIM: To understand the uniqueness of the experience of testing HIV positive from the perspective of pregnant women. BACKGROUND: As more people learn of their HIV diagnosis through routine screening processes, it is timely to reflect on the impact of receiving an unexpected positive result. DESIGN: A prospective qualitative study. METHODS: This paper draws on the case studies of four women who were participating in a larger prospective qualitative study of reproductive decision-making, pregnancy and childbirth following HIV diagnosis. Multiple interviews were conducted following diagnosis during pregnancy, and, after the birth of their babies. Thematic data analysis was undertaken. RESULTS: Drawing on Becker's theory of disruption, we document the 'sudden disjuncture' of their antenatal diagnosis and the embodied emotional struggle the women engaged in to create continuity in their lives. A diagnosis of HIV disrupted the women's biographies in terms of their health, relationships and social identity. As pregnant women, the threat of HIV was experienced most significantly in relation to their unborn child. However, their narratives also revealed how a diagnosis of HIV in the context of pregnancy, whilst traumatic, provided a focus for regaining continuity in their lives, as the baby became a metaphor for hope and orientation toward the future. CONCLUSIONS: As HIV testing becomes more 'routine', the findings of this study serve to remind health professionals that a positive diagnosis continues to constitute a major trauma to individuals and families. RELEVANCE TO CLINICAL PRACTICE: We propose that appropriately educated nursing and midwifery staff could facilitate the 'meaning making' process that is required for newly diagnosed HIV positive persons to find a subjective sense of well-being in their lives.

General and respiratory health outcomes in adult survivors of bronchopulmonary dysplasia: a systematic review.

BACKGROUND: The purpose of this systematic literature review was to examine current empirical research on general and respiratory health outcomes in adult survivors of bronchopulmonary dysplasia (BPD). METHODS: We searched seven databases up to the end of November 2010 (MEDLINE, PubMed, EMBASE, PsycINFO, Maternity and Infant Care, Cumulative Index of Nursing and Allied Health Literature, and Web of Knowledge). We independently screened and included only those studies concerning the assessment of outcome measures in adult survivors of BPD. Data on methodologic design and findings were extracted from each included study; in addition, the methodologic quality of each study was assessed using the Critical Appraisal Skills Programme checklist. RESULTS: Fourteen cohort studies met the review criteria. Of those, a total of eight studies were considered to be of high quality (score 9-12), five of moderate quality (score 5-8), and only one was of low quality (score 0-4). In all studies of adult survivors of BPD, differences were found between the index and control groups, suggesting that many adults survivors of BPD who were born preterm or with very low birth weight had more respiratory symptoms and pulmonary function abnormalities compared with their peers. Five studies concerning radiologic findings reported structural changes persisting into adulthood. Findings from three studies suggested impairment in exercise capacity, although firm conclusions were limited by the small sample size in the studies reviewed. CONCLUSIONS: Compared with adults born at term, adult survivors of BPD have more impairment in general and respiratory health, which does not seem to diminish over time.

Negotiation of risk in sexual relationships and reproductive decision-making amongst HIV sero-different couples.

The paper focuses on the ways in which medical discourses of HIV transmission risk, personal bodily meanings and reproductive decision-making are re-negotiated within the context of sero-different relationships, in which one partner is known to be HIV-positive. Eighteen in-depth interviews were conducted with 10 individuals in Northern Ireland during 2008-2009. Drawing on an embodied sociological approach, the findings show that physical pleasure, love, commitment, a desire to conceive without medical interventions and a dislike of condoms within regular ongoing relationships, shaped individuals' sense of biological risk. In addition, the subjective logic that a partner had not previously become infected through unprotected sex prior to knowledge of HIV status and the added security of an undetectable viral load significantly impacted upon women's and, especially, men's decisions to have unprotected sex in order to conceive. The findings speak to the importance of reframing public health campaigns and clinical counselling discourses on HIV risk transmission to acknowledge how couples negotiate this risk, alongside pleasure and commitment within ongoing relationships.

Experiences of fathers of babies in intensive care.

Around 2,000 sick or premature infants are admitted each year to intensive care units in Northern Ireland--8.1 per cent of the live birth population. Studies show that having a premature or 'high-risk' infant is stressful for both parents, yet most research focuses on the mothers' experiences. A literature review was undertaken in preparation for a study exploring fathers' experiences of caring for an infant admitted to a neonatal intensive care unit. It identified seven papers reporting primary research on the fathers' experiences, and others in which their views were included or assumed. Among the findings were that fathers react and cope differently from mothers, and may be burdened by having to take time off work. In addition, they may not perceive themselves as the primary caregiver to their sick infant, but rather providing a supporting role.

Does intrauterine growth restriction affect quality of life in adulthood?

OBJECTIVE: To compare health-related quality of life in 50-year-old adults who were born at term (> or =37 to 42 weeks' gestation) with intrauterine growth restriction (IUGR; birth weight <10th centile) and a group born at term without IUGR (> or =10th centile). DESIGN: Case control study. SETTING: A large regional maternity hospital in Northern Ireland. SUBJECTS: 235 adults who were born between 1954 and 1956 in the Royal Maternity Hospital, Belfast. 111 subjects born with IUGR and 124 controls with normal birth weight for gestation were compared. MAIN OUTCOME MEASURE: Health-related quality of life in adulthood was assessed using the Short Form-36 Health Survey (SF-36). RESULTS: The two groups reported similar health-related quality of life on each of the eight dimensions of the SF-36 and there were no significant differences between them. Adjusting for potential confounding variables did not alter this conclusion. CONCLUSIONS: The similarity of SF-36 scores indicated that those born with IUGR did not perceive this to adversely influence health-related quality of life at 50 years of age compared with those with normal birth weight.

Modernisation. 'What new NHS?'.

A 2001 survey of 203 doctors, nurses and midwives who had spent an average of 15 years in the NHS conducted at a teaching hospital in Belfast, showed poor understanding of the government's 'new NHS' agenda. Seventy-nine per cent were unaware that there was a new NHS. Only 44 per cent felt the principles of the new NHS were of any value in clinical practice. Only 51 per cent could name the health secretary. Much work needs to be done to bring home the importance of the government's quality agenda to clinical staff.