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This book teaches students and educators in the midwifery field how to tackle dilemmas and decision making. Combining theory and practice, and promoting critical thinking, this book provides key knowledge alongside case studies of how to approach real-life dilemmas in midwifery.Written and edited by experts in the field, this book gives midwives and student midwives the opportunity to experience a systematic approach to facing dilemmas and decision making through the use of clinical scenarios. This is done in a safe space through an annotated thinking aloud framework where students and educators can have open discussions. Student midwives and practitioners are given the opportunity to explore professional dilemmas they might not have witnessed and uncover new theories that will influence future decisions. Linked to the 2019 NMC Standards for Midwifery, this book is essential reading for all stages of the midwifery career including those supporting students, coordinating care teams and those supporting multi-cultural communities. The midwives' personal reflections explore best practice and take account of other professional perspectives, including facilitators and barriers to interdisciplinary working. Learners will be able to consider a number of factors including concepts and theories, ethics and legal accountability, to explore how they interplay in making decisions.  

Background Women approach birth using various methods of preparation drawing from conventional healthcare providers alongside informal information sources (IIS) outside the professional healthcare context. An investigation of the forms in which these informal information sources are accessed and negotiated by women, and how these disconnected and often conflicting elements influence women’s decision-making process for birth have yet to be evaluated. The level of antenatal preparedness women feel can have significant and long lasting implications on their birth experience and transition into motherhood and beyond. The aim of this study was to provide a deeper understanding of how informal information sources influence women’s preparation for birth. Methods Seven electronic databases were searched with predetermined search terms. No limitations were imposed for year of publication. English language studies using qualitative methods exploring women’s experiences of informal information sources and their impact upon women’s birth preparation were included, subject to a quality appraisal framework. Searches were initiated in February 2016 and completed by March 2016. Studies were synthesised using an interpretive meta-ethnographic approach. Results Fourteen studies were included for the final synthesis from Great Britain, Australia, Canada and the United States. Four main themes were identified: Menu Birth; Information Heaven/Hell; Spheres of Support; and Trust. It is evident that women do not enter pregnancy as empty vessels devoid of a conceptual framework, but rather have a pre-constructed embodied knowledge base upon which other information is superimposed. Allied to this, it is clear that informal information was sought to mitigate against the widespread experience of discordant information provided by maternity professionals. Conclusion Women’s access to the deluge of informal information sources in mainstream media during pregnancy have significant impact on decision making for birth. These informal sources redefine the power dynamic between women and maternal healthcare providers, simultaneously increasing levels of anxiety and challenging women’s pre-existing ideations and aspirations of personal birth processes. A lack of awareness by some professionals of women’s information seeking behaviours generates barriers to women-centred support, leaving an experience expectation mismatch unchecked. Trial registration CRD42016041491 17/06/16.

The mental health of postgraduate research students (PGRs) is a growing area of interest to Higher Education Institutions (HEIs) and researchers and has important implications for PGR wellbeing, success, and attrition. This study aimed to explore PGR experiences of mental health during the pandemic, the supervisory relationship, and seeking support. Semi-structured interviews were conducted with 20 PGRs from across the UK. Questions invited PGRs to share their experience of supervision, the impact of supervision on their mental health, and any experience of discussing mental health with their supervisor(s). The experiences of supervision varied, as did the university responses to the pandemic and levels of supervisory support. A number of PGRs felt that their supervision experiences had negatively impacted their wellbeing and reported stigma and discriminatory practices. Themes identified included discourses, supervisory knowledge, university resources, and the research culture as key factors that impacted the mental health of PGRs. Supervisors often upheld perceptions of PhD life as being isolating, with negative impacts on wellbeing to be expected, setting expectations of overworking, anxiety, and stress. The move from pandemic to post-pandemic life posed both challenges and benefits. Issues of training on mental health awareness, university processes, and accessibility of services should be considered by HEIs.

Background. Repeated infant-feeding surveys have indicated that, while there is an apparent willingness to initiate breastfeeding, rates of breastfeeding at three and six months fall well below targets. There is general agreement about the need to explore the benefits of interventions including public health programmes, clinical support and local interventions. Aim. This study set out to better understand the views of three key breastfeeding stakeholders: women, partners and midwives. Specifically, it aimed to understand to what extent, if at all, the views of the three groups differ, and how much importance the key stakeholders place on different elements of the breastfeeding experience. Method. Concept mapping is a mixed method that uses structured focus group activities where ideas are brainstormed, organised and rated. The relationships between ideas are then explored using a sophisticated multivariate statistical analysis software package. The number of focus group participants were: seven midwives, seven women and five partners. Full ethical approval was gained from Norfolk Research Ethics Committee. Analysis. Ariadne software generated mean preferences for each individual stakeholder group, and produced concept maps to demonstrate the relationship between statements. Findings. Six key themes emerged when statements from the whole group of participants were clustered: the physicality and unpredictability of breastfeeding; shared experience of breastfeeding; role of health professionals; lack of skin-to-skin contact at birth; external influences; and lack of available breastfeeding resources in the community. However, in the individual groups, different priorities emerged. Partners of breastfeeding women created a separate cluster of statements that related to their own needs. The influence of health professionals rated lower for women and their partners than for the group of midwives. Implications. The emotional impact for women of breastfeeding rated more highly than the physicality or external influences and suggests that breastfeeding motivation arises from a complex personal experience that is unique to individual women. Adapted from the source document.

The aim of this integrative review is to synthesise the literature on creative teaching methods in midwifery education. The review question seeks to investigate the experiences of student midwives and midwifery educators of using creative methods as a learning approach. The benefits of creative teaching methods are widely acknowledged but the ways in which this may impact midwifery students’ learning processes, or how this relates to their developing professional development, is not well understood. Research focused specifically on student midwives is yet to be synthesised. An integrative review was undertaken using data comparison with reflexive thematic analysis to identify common themes. Eight electronic databases were searched with key terms in June 2022. English language studies from qualitative, quantitative, mixed-methods and wider literature were included. Twenty-two texts were included in the synthesis. Four themes were generated from the data; 1) What is the offering - More than a lecture; exploring the educator and student exchange and environment for learning; 2) Working in parallel - examining the change in teaching dynamic and collaborative partnerships; 3) Journeying towards holism - focused on student’s integration of learning processes; and 4) Stepping into the professional - engaging with how using creativity can aid students’ growing sense of themselves as professionals. This highlights improvements in levels of confidence, professional development and emotional intelligence in midwifery students. Creative teaching and learning methods enable student midwives to make meaningful connections between theoretical and practice learning environments, assisting knowledge and skills acquisition.

Background: Women who develop pregnancy induced hypertension and preeclampsia face a significantly increased risk of sustained hypertension, heart attack and stroke within 14 years of the affected pregnancy. Young women participate in less physical activity than male peers, however early adoption of regular physical activity is capable of reducing blood pressure and future cardiovascular risk. Therefore understanding barriers and facilitators for young women and mothers to engage in physical activity is important. Aim: A systematic review and synthesis of relevant qualitative research, 2004 and 2014. Method: Medline, CINAHL, PsychInfo and Web of Science databases were searched using the following search terms: qualitative, cardiovascular, hypertension and physical activity. 146 studies were title and abstract dual-screened for eligibility. Studies undertaken in the USA and non-western/ non-European countries were excluded. Review results: 16 studies were selected from a potential 1682. Overall quality and rigour of the studies was sound, two of the studies were considered with caution. Findings: 615 women across five different countries participated in 176 1:1 face to face interviews and 72 focus groups. The majority of the participants were mothers under 50 years. All studies were undertaken in western socio-cultural countries; 'western' provided a culturally diverse research population across 17 different ethnic backgrounds. The synthesised findings gave rise to a new, contemporary understanding of young women's positive perceptions of physical activity, the importance of the family and social context in which they live, and their capacity to overcome multiple constraints to engage in and acknowledge the value of physical activity for both physical and mental well-being. Conclusion: The contemporary messages from this review, inclusive of detail and nuances from different ethnic perspectives, support the marketing of a positive construct of physical activity for young women and mothers. Health professionals can share these messages to motivate new and additional physical activity for early action to help with the management of blood pressure and future cardiovascular risk. doi: 10.1038/jhh.2015.90

During physiological or ‘natural’ childbirth, the fetal head follows a distinct motion pattern—often referred to as the cardinal movements or ‘mechanisms’ of childbirth—due to the biomechanical interaction between the fetus and maternal pelvic anatomy. The research presented in this paper introduces a virtual reality-based simulation of physiological childbirth. The underpinning science is based on two numerical algorithms including the total Lagrangian explicit dynamics method to calculate soft tissue deformation and the partial Dirichlet–Neumann contact method to calculate the mechanical contact interaction between the fetal head and maternal pelvic anatomy. The paper describes the underlying mathematics and algorithms of the solution and their combination into a computer-based implementation. The experimental section covers first a number of validation experiments on simple contact mechanical problems which is followed by the main experiment of running a virtual reality childbirth. Realistic mesh models of the fetus, bony pelvis and pelvic floor muscles were subjected to the intra-uterine expulsion forces which aim to propel the virtual fetus through the virtual birth canal. Following a series of simulations, taking variations in the shape and size of the geometric models into account, we consistently observed the cardinal movements in the simulator just as they happen in physiological childbirth. The results confirm the potential of the simulator as a predictive tool for problematic childbirths subject to patient-specific adaptations.

The provision of emotional and psychological support for all family members who need it is an essential element of holistic palliative care. Within East Anglia's Children's Hospice, teams of professionally trained and experienced workers offer psychosocial support to all family members at all times during the child's and family's journey. However, the effectiveness and appropriateness of current psychosocial provision is unclear, as is the requirement for any additional psychological services. The purpose of this study was to elicit perceptions about current psychological support within the hospice from a group of stakeholders (parents, hospice staff, and external professionals). Forty-five parents participated in family focus groups, telephone interviews, individual interviews in their home, or a web-based survey. Ninety-five hospice staff (including nurses, carers, play specialists, therapists, and family support practitioners) and 28 external staff (including physicians, nurses, and commissioning managers) were seen using a mixture of focus group and individual meetings. Focus groups and meetings were held at the hospice building or at an external venue. Interviews were recorded and transcribed verbatim and analyzed using thematic coding. Two main themes addressing perceptions of current psychological provision emerged: \"understanding psychological support\" and \"unmet psychological need.\" Subthemes linked to support included choice, staff roles and labels, communication, and flexibility, whereas the themes within unmet need had a stronger focus on people and problems. Understanding different user perspectives is an important first step in enhancing current psychological provision; operationalizing the findings will be challenging.

There is a general agreement that the potential of shared learning is great in terms of interprofessional working and client care. Despite the fact that interprofessional education has been a key area of professional education and practice policies for the last decade there is a dearth of evidence of its successful implementation in maternity care. Doctors and midwives are often educated in separate faculties within universities and rarely given the opportunity for shared learning activities, particularly at postgraduate level. Barriers to implementing interprofessional learning are identified within the literature and these include a difference in perception of the status each profession holds and different ways of working and learning which impedes the development of interprofessional relationships. It is argued that through interprofessional education, doctors and midwives should be enabled to develop skills of collaborative working, thus making referrals between professionals more effective. The exploration of the differences of professional cultures in a shared learning environment will enable professionals to formulate agreement on best practice in the clinical areas, based on current best evidence. Thus, interprofessional education aims to dispel the stereotypes and prejudice which often act as a barrier to effective collaborative working. The implications of interprofessional education on three main areas of practice are explored using a review of the literature: professional roles; conflict and collaboration between professions; and the sharing of knowledge and skills. Recommendations are made for the development of post-registration shared learning that address these key areas.

Background The Department of Health recently offered funding to support children's palliative care projects, one of which addressed the provision of psychology services within specific children's hospices. The aims of the project were to review best practice in the current provision of psychological support for children with palliative care needs and their families, identify methods of assessing need and evaluating outcomes, and determine how psychological services might link with and enhance the model of supportive care already provided by the hospices. Methods A mixed methods approach was adopted, involving focus groups with family members and hospice staff, individual face-to-face or telephone interviews with family members, hospice staff and external staff and a web-based survey for parents. Topics covered included the assessment of psychological need and how need is met, the provision of specialist services and any gaps in provision, and the use of assessment and outcome measures. Interviews were recorded and transcribed verbatim and analysed using thematic coding. Results Ninety-five hospice staff, 28 external staff and 74 family members participated. All staff currently provide psychological support at level 1 (NICE 2004), some provide support at levels 2–3 but there is no provision at level 4. However, there is an untapped and unrecognised resource of existing staff skills within the hospices. Validated tools are not used for assessment or evaluation and some concerns were raised about the mechanisms for families and staff to provide open and honest feedback. Particular areas of need for specialist intervention included the management of challenging behaviour and supervision for staff managing complex situations. Conclusion Provision of specialist psychology services would be of benefit to the hospices, their patients and families, and external staff. Such a role needs to be embedded in a systemic model of working and have strong links with other professional groups.