This week saw the pre-publication of ‘Core principles to reduce current variations that exist in grading of midwifery practice in the United Kingdom’ in Nurse Education in Practice. This paper is co-authored by Dr. Susan Way in the Centre for Midwifery, Maternal & Perinatal Health (CMMPH). The authors argue that these core principles could contribute to curriculum development in midwifery and other professions internationally.
Prof. Edwin van Teijlingen
- Fisher, M., Way, S., Chenery-Morris, S., Jackson, J., Bower, H. (2017) Core principles to reduce current variations that exist in grading of midwifery practice in the United Kingdom, Nurse Education in Practice (forthcoming) see: http://www.nurseeducationinpractice.com/article/S1471-5953(17)30092-6/abstract
Today we offered preliminary feedback to key stakeholders in Kathmandu as part of our research into CPD (Continuous Professional Development) for nurses in Nepal. Today’s presentation is party funded by LJMU (Liverpool John Moores University) and partly funded by BU’s Centre for Excellence in Learning (CEL). Late 2016 CEL funded the qualitative part of our research project. In this CPD project we work with representatives of the Ministry of Health , the Ministry of Education, the Nepal Nursing Association and the Nursing Council, and providers of Nursing Education (both Government-run universities and private colleges).
Today key presenter was BU Visiting Faculty Dr. Bibha Simkhada (based at LJMU). The event was opened by Associate Professor Chandra Kala Sharma, who is also the president of the Nepal Nursing Association (lighting the traditional lamp in photo right).
Our BU contributors, Dr. Catherine Angell and Prof. Edwin van Teijlingen, are both based in the Centre for Midwifery and Maternal & Perinatal Health (CMMPH). We are grateful to our collaborators in Nepal, especially Dr. Sujan Marahatta at Manmohan Memorial Institute of Health Sciences, for organising this event in our absence. The CPD research project is truly a FUSION project in the field of nursing & midwifery since it links Research in the field of Education to help improve Practice in Nepal. Further information can be found on a previous blog post, click here!
Prof. Edwin van Teijlingen
Yesterday the Scottish Government has published its national maternity review ‘The Best Start – A Five Year Forward Plan for Maternity and Neonatal Care in Scotland’. The report has been widely welcomed and gained, among others, the full support from the Royal College of Midwives (RCM). Mary Ross-Davie, RCM Director for Scotland noted: “This is a defining moment for maternity services in Scotland and will be a seismic shift for our maternity services. The plan has the potential to revolutionise maternity care, to deliver safer and better services for women, babies and their families, and to improve the health of our population.”
The Best Start recognises that maternity and neonatal services matter to the health and wellbeing of Scotland’s people. The report’s underpinning is more of a social model of childbirth as it observes that “The health, development, social, and economic consequences of childbirth and the early weeks of life are profound, and the impact, both positive and negative, is felt by individual families and communities as well as across the whole of society.”
Having lived for 25 years in Scotland I am happy to have made a small contribution to this import report.
Prof. Edwin van Teijlingen
Centre for Midwifery, Maternal & Perinatal Health
The second day of THET training showed again that gender is a critical issue in Nawalparasi, southern Nepal. We asked the ANMs about things they had changed in their own practice. Several ANMs said that they had changed the way they worked. Now they see that having a baby girl can be a significant mental health issue as it causes the women a lot of stress. Interestingly, it also caused them as health workers considerable stress The ANMs said that they had started to counsel families of girl children. They say they emphasise that it is okay to have girls.
This ties in with feedback comments from yesterday in a different group of trainees. In Sunday’s training, one ANM answered when asked about stress at work, that she finds it stressful that a room falls silent when a baby girl is born. She commented that this happens when the family is obviously hoping for a boy. She added that at the very moment a baby girl is born, the family immediately falls silent. She said that this is a great source of stress to her as a health worker.
Coincidently next door to the training venue in Nawalparasi a Hindu wedding has been taking place today. This colourful spectacle represents different roles and expectations of men and women, the bride and the groom, but also the other guests here in Nepal. Weddings everywhere are ceremonies that reflect society. Seeing the wedding from close by and listening to the ANMs over these last two days, we reflected at the end of today that these ANMs are acting bravely in raising such a culturally sensitive issue in their practice, in this largely patriarchal rural society.
Flora Douglas & Edwin van Teijlingen
Today we had our first training session of the final THET mental health in maternity care project. UK volunteer Dr. Flora Douglas spoke about key aspects of health promotion and focused particularly on notions of community-based approaches. Flora is based at the University of Aberdeen and she is also a Visiting Fellow in the Centre for Midwifery, Maternal & Perinatal Health (CMMPH). This was her first visit to Nepal. She was inspired to volunteer as she had been a MSc supervisor some years ago on a project that related to the Green Tara Nepal health promotion intervention. Bournemouth University has been working with Green Tara Trust, a Buddhist charity based in London for many years.
Yesterday Flora had visited one of the 20 birthing centres in Nawalparasi, the district where the THET training takes place. Flora was very humbled by the experiences of the community-based maternity care workers in the light of many constrains. She said: “I have seen pictures of such birthing centres and read about them in the literature, but it is not until you see them first hand that you realise how staff have to work with such limited resources.
The attendees, who are nearly ANMs (auxiliary nurse midwives) were highly enthusiastic and very keen to discuss and learn. They shared some very personal and touching stories about their practice. Flora added: “I am very struck by their understanding of the importance of the social and cultural determinants of both psychical and mental health.” Many found they had learnt something in previous THET sessions in 2016 about communication with women and counselling family members about mental health, and perhaps most importantly, listening more to women. Last, but not least, Flora commented on the dedication of the participants: “At least two of the participants told me they travelled ten hours to get here for our one-day workshop. This really shocked me, particularly having seen the quality of the roads and public transport!”
Prof. Edwin van Teijlingen
Yesterday we come down from Kathmandu, the capital of Nepal, to our THET training area in Nawalparasi. Today we are starting our sixth and last training session on the Mental health training for community-based maternity care providers. Interesting we are starting training on a Sunday as Nepal is largely a Hindu country and most workers have only a one-day weekend (which is the Saturday). This BU-led project is a collaboration between the Centre for Midwifery, Maternal & Perinatal Health (CMMPH), Tribhuvan University (Nepal’s oldest university) and Liverpool John Moores University (LJMU). The project receives funding from DFID, and is managed through THET and supported locally in Nepal by a charity Green Tara Nepal.
The landscape in the photo gives an idea of how rural this part of Nepal is. Nawalparasi is situated in the south of Nepal the India border. It is also largely very flat, not like the Nepal most people envisage namely that of the Himalayans and of Mount Everest. The flatness makes a Dutchman feel at home though.
The project depends on volunteers who work in the health sector in the UK to come out and spend their time and energy preparing and delivering the training. Our project also could not work without the logistical support from Green Tara Nepal and our academic colleagues at Tribhuvan University. The last photo shows one of the UK volunteers Dr. Flora Douglas with the translator Shiwani Manandhar on the way to the training venue.
Prof. Edwin van Teijlingen (from Nepal)
Following our health promotion dissemination meeting in Kathmandu last week, we had considerable national media coverage in Nepal. Since I wrote about of this media coverage on the BU Research Blog we have been informed about some further press coverage.
Apparently we appeared on Mountain Television, but I haven’t see the programme myself yet. On January 4th we had a very short piece in The Himalayan Times , a piece which incidentally also failed to mentioned Bournemouth University. Over the weekend we had a little write up in a magazine called New Spotlight (see photo).I have also included the original colour photo as the magazine’s copy looks unclear.
Prof. Edwin van Teijlingen
Yesterday saw the publication of the paper ‘Antenatal care trial interventions: a systematic scoping review and taxonomy development of care models’, which is the first paper this year for the Centre for Midwifery, Maternal & Perinatal Health (CMMPH) . The paper is based on a cross-UK collaboration led by Dr. Andrew Symon from the University of Dundee which is published in the Open Access journal BMC Pregnancy & Childbirth. This is the second paper from this collaboration, the first one ‘Midwifery-led antenatal care models: Mapping a systematic review to an evidence-based quality framework to identify key components & characteristics of care ‘ was published last year .
The latest BMC Pregnancy & Childbirth paper is a first step in establishing a taxonomy of antenatal care models. The article concludes that interventions can be defined and described in many ways. The intended antenatal care population group proved the simplest and most clinically relevant way of distinguishing trials which might otherwise be categorised together. Since our review excluded non-trial interventions, the taxonomy does not represent antenatal care provision worldwide. It offers a stable and reproducible approach to describing the purpose and content of models of antenatal care which have been tested in a trial. perhaps key is that the paper highlights a lack of reported detail of trial interventions and usual care processes.
Our paper provides a baseline for future work to examine and test the salient characteristics of the most effective models, and could also help decision-makers and service planners in planning implementation.
Moreover we look forward to conducting more research as part of this exciting collaboration in midwifery and maternity care.
Prof. Edwin van Teijlingen & Prof. Vanora Hundley
- Symon, A., Pringle, J., Downe, S., Hundley, V., Lee, E., Lynn, F., McFadden, A., McNeill, J., Renfrew, M., Ross-Davie, M., van Teijlingen, E., Whitford, H., Alderdice, F. (2017) Antenatal care trial interventions: a systematic scoping review and taxonomy development of care models BMC Pregnancy & Childbirth 17:8 http://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-1186-3
- Symon, A., Pringle, J., Cheyne, H., Downe, S., Hundley, V., Lee, E., Lynn, F., McFadden, A., McNeill, J., Renfrew, M., Ross-Davie, M., van Teijlingen, E., Whitford, H, Alderdice, F. (2016) Midwifery-led antenatal care models: Mapping a systematic review to an evidence-based quality framework to identify key components & characteristics of care, BMC Pregnancy & Childbirth 16: 168 http://www.biomedcentral.com/1471-2393/16/168
Yesterday’s health promotion dissemination meeting in Kathmandu has been widely reported in the national media in Nepal. Some of the national media focused largely (but not solely) on the words of the Minister of Health Mr Thapa, whilst the television news reports included the organisers and presenters at the event. The Green Tara Nepal Health Promotion Dissemination conference in Kathmandu was supported by the Centre for Midwifery, Maternal & Perinatal Health at BU and Liverpool John Moores University (LJMU) and Green Tara Trust UK (a Buddhist charity based in London). BU has been working with Green Tara Nepal for the past eight years on a number of maternal health promotion projects in rural Nepal. Overall the media in Nepal had difficulty understanding the notion of ‘health promotion’, therefore many journalists focused on health services as this was mentioned by the Minister of Health.
The event was also attended by BU Visiting Faculty Prof. Padam Simkhada (based at LJMU), CMMPH PhD student Preeti Mahato and FHSS Post-Doc. Dr. Pramod Regmi.
Prof. Edwin van Teijlingen
At the very end of December, one more academic paper on maternity care in Nepal from the Centre for Midwifery, Maternal and Neonatal Health (CMMPH). Our latest paper ‘The uptake of skilled birth attendants’ services in rural Nepal: A qualitative study’ was published today in the Journal of Asian Midwives . The paper is co-authored with colleagues from London Metropolitan University, and is the third in a series based on the PhD project of the first author Dr. Yuba Raj Baral [1-3]. The Journal of Asian Midwives is an Open Access journal hence the paper is freely available across the globe.
Prof. Edwin van Teijlingen
- Baral, YR., Lyons, K., van Teijlingen, ER., Skinner, J., (2016) The uptake of skilled birth attendants’ services in rural Nepal: A qualitative study, Journal of Asian Midwives 3(2): 7-25.
- Baral, YR, Lyons, K., Skinner, J, van Teijlingen, ER (2012) Maternal health services utilisation in Nepal: Progress in the new millennium? Health Science Journal 6(4): 618-633. www.hsj.gr/volume6/issue4/644.pdf
- Baral, Y.R, Lyons, K., Skinner, J, van Teijlingen, E. (2010) Determinants of skilled birth attendants for delivery in Nepal Kathmandu University Medical Journal 8(3): 325-332. http://www.kumj.com.np/issue/31/325-332.pdf
It is always nice to receive some good news just before Christmas. The journal BMC Pregnancy & Childbirth informed us that our paper ‘“Is it realistic?” the portrayal of pregnancy and childbirth in the media’ was in the top three most popular papers . This interdisciplinary paper crosses the boundaries between the study of maternity care & midwifery, sociology of health & illness, and that of the media. With BU’s Dr. Ann Luce as first author, it is one of the top three accessed articles of nearly 400 articles published in 2016 (as of Dec 16th).
- Luce, A., Cash, M., Hundley, V., Cheyne, H., van Teijlingen, E., Angell, C., (2016) “Is it realistic?” the portrayal of pregnancy and childbirth in the media BMC Pregnancy & Childbirth 16: 40 http://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0827-x
Congratulations to CMMPH’s Donna Wixted, Joint BU-Portsmouth Hospitals NHS Trust, doctoral student who just had a paper published in MIDIRS. The paper is titled ‘Drinking in pregnancy: poor guidelines or lack of evidence?’ The paper reports a very lively debate at the 2016 BU Festival of Learning which was a debate around the motion: “Advising pregnant women to avoid drinking alcohol during pregnancy is symptom of the Nanny State and another step towards the medicalisation of childbirth”. The debate was chaired by CMMPH’s Prof. Vanora Hundley.
The Festival of Learning event grew out of Donna’s PhD research. Donna’s PhD is jointly supervised by Dr. Greta Westwood of Portsmouth Hospitals NHS Trust & the University of Southampton and FHSS academics Dr. Liz Norton and Prof. Edwin van Teijlingen.
Wixted, D., Hundley, V., Norton, L., van Teijlingen, E., Westwood, G. (2016) Drinking in pregnancy: poor guidelines or lack of evidence? MIDIRS Midwifery Digest 26(4): 462-65.
The CMMPH was well represented at the above international conference highlighting innovations in education, practice and regulation. The conference was held this year in London and attended by HRH The Princess Royal. Presentations from CMMPH colleagues ranged from developing a common framework for assessing practice and innovative on-line education approaches, to dignity and care in pregnancy and childbirth and how evidence is utilised in practice.
Presentations (oral and poster) include:
- i) Grading Practice: A common framework to aid consistency and parity across midwifery education programmes in the UK, Fisher M and Way S
- ii) Dignity and care in pregnancy and childbirth: Educating student midwives, Hall J and Mitchell M I
- ii) The BRIEF randomised trial: do Cochrane summaries help midwifery students understand the findings of Cochrane systematic reviews? Alderdice, F and Hundley, V
- iv) UUPP study: Updating the understanding of perineal practice at the time of birth across the UK, Stride, S, Hundley, V, and Way, S.
- v) Promoting physiological birth in Malta: reflection on an educational project. Poster, Hall J and with three midwifery colleagues from Mater Dei Hospital, Malta
- vi) Not just ticking the boxes: online practice assessment in midwifery. Poster, Angell, C. Wilkins, C., Leamon, J. and Way, S.
Other research that is currently ongoing at BU, but was highlighted at the conference was the Interim report of the Human Rights & Dignity Experience of Disabled Women during Pregnancy, Childbirth and Early Parenting. Hall, J., Collins, B., Ireland, J. and Hundley, V.
The photo is of (L-R) Jenny Hall, Sara Stride, Sue Way, Carol Wilkins, Catherine Angell and Vanora Hundley.
Alongside Bournemouth University’s midwifery and other health and social care students who graduated in last Friday’s ceremony, BU honoured prominent midwife Sheena Byrom OBE with an Honorary Doctorate for her services to the profession. Sheena Byrom gave an inspiring speech at Friday’s Graduation. Sheena said, “If they can keep in their hearts the passion and the drive they had when they first came to the university, it will help them to be more resilient and keep them motivated towards what they want to do. Healthcare is a blend between love and science and both are equally important. In practice, it is key that they have the skills, but the things that makes the difference are love and compassion.”
Alongside Sheena two students from the Centre of Midwifery, Maternal & Perinatal Health(CMMPH) graduated with a PhD in Midwifery. Dr. Alison Taylor received her PhD for her qualitative research on breastfeeding. Her thesis is entitled ‘It’s a relief to talk ….’: Mothers’ experiences of breastfeeding recorded on video diaries. Dr. Rachel Arnold was awarded her PhD for her research Afghan women and the culture of care in a Kabul maternity hospital.
Congratulations to all BU undergraduates and Rachel, Alison and Sheena!
Prof. Edwin van Teijlingen
The international journal Sexual & Reproductive Healthcare (Elsevier publication) published the online first version of our latest maternity-care research paper on Nepal . This paper is part of the successfully completed PhD research project of Malin Bogren (first author). The paper uses a qualitative approach based on the framework of Complex Adaptive Systems. Malin conducted semi-structured interviews with 17 key people representing eight different organisations (actors) promoting the development of the midwifery profession in Nepal. The move of midwifery from an occupation to a profession in Nepal is a challenging process. The study indicates the importance of understanding the motivations of, and barriers perceived by, actors that can promote or obstruct the establishment of the midwifery profession. It also points to the importance of informing the wider public about the role and responsibility of an autonomous midwifery profession.
The paper adds to our previous work around midwifery in Nepal [2-3].
Prof. Edwin van Teijlingen
- Bogren, M.U., Berg, M., Edgren, L., van Teijlingen, E., Wigert, H. (forthcoming) Shaping the midwifery profession in Nepal – Uncovering actors’ connections using a Complex Adaptive Systems framework. published online: October 4, 2016
- Bogren M, van Teijlingen E., Berg M. (2013) Where midwives are not yet recognized: A feasibility study of professional midwives in Nepal, Midwifery 29(10): 1103-1109.
- Bogren, M.U., Bajracharya, K., Berg, M., Erlandsson, K., Ireland, J., Simkhada, P., van Teijlingen, E. (2013) Nepal needs midwifery, Journal of Manmohan Memorial Institute of Health Sciences (JMMIHS) 1(2): 41-44.
Our THET (Tropical Health & Education Trust) funded project which trains community health worker such as Auxiliary Nurse Midwives (ANMs) on mental health issues related to pregnancy was presented at the Royal College of Midwives (RCM) conference today by FHSS Visiting Faculty Jillian Ireland (photo). Jillian is also a community midwife at Poole Hospital NHS Foundation Trust.
Mental health is poorly covered in the training of health care providers in Nepal. This all the more worrying as it is also culturally a difficult sensitive topic to discuss. This makes it difficult for front-line health workers, especially generalists or non-mental health specialists, to start a discussion about mental health issues with pregnant women, new mothers and their wider families.
Our THET partnership includes the Department of Health, Physical & Population Education at Nepal’s oldest and largest university Tribhuvan University’s (TU), Bournemouth University and Liverpool John Moores University (LJMU). This project is funded under the Health Partnership Scheme (HPS). HPS funds to carry out training and capacity-building projects in low-income countries, such as Nepal. HPS itself is funded by the UK Department for International Development (DfID) and managed by THET (Tropical Health and Education Trust).
The partnership working has resulted in several publications on mental health and maternity care in Nepal. [1-3]
- Simkhada, B., Sharma, G., Pradhan, S., van Teijlingen, E., Ireland, J., Simkhada, P., Devkota, B. & the THET team. (2016) Needs assessment of mental health training for Auxiliary Nurse Midwives: a cross-sectional survey, Journal of Manmohan Memorial Institute of Health Sciences 2(1): 20-26. http://www.nepjol.info/index.php/JMMIHS/article/view/15793/12738
- van Teijlingen, E., Simkhada, P., Devkota, B., Fanning, P., Ireland, J., Simkhada, B., Sherchan, L., Silwal, R.C., Pradhan, S., Maharjan, S.K., Maharjan, R.K. (2015) Mental health issues in pregnant women in Nepal. Nepal Journal of Epidemiology 5(3): 499-501. http://www.nepjol.info/index.php/NJE/article/view/13607/11007
- Simkhada, P., van Teijlingen E., Winter, R.C., Fanning, C., Dhungel, A., Marahatta S.B. (2015) Why are so many Nepali women killing themselves? A review of key issues Journal of Manmohan Memorial Institute of Health Sciences 1(4): 43-49. http://www.nepjol.info/index.php/JMMIHS/article/view/12001
FHSS PhD student Preeti Mahato in the Centre for Midwifery, Maternal & Perinatal Health (CMMPH) has been awarded a funded place on the COST Action Training School BEYOND BIRTH COHORTS: from study design to data management. This training school will run from 23-15 November in Spain.
COST (European Cooperation in Science and Technology) is a unique platform where European researchers can jointly develop their ideas and initiatives across all scientific disciplines through trans-European networking of nationally funded research. Preeti pal has been awarded the sum of 500 euro to cover the cost of attending the Training School and travel and accommodation costs. Preeti’s PhD project is on maternity care provision in Nepal. Preeti’s research focuses on the quality and equity of service available at birthing centres. In Nepal, birthing centres act as first contact point for the women seeking maternity services especially the basic obstetric care. She is supervised by Dr. Catherine Angell, Prof. Edwin van Teijlingen and BU Visiting Faculty Prof. Padam Simkhada (based at Liverpool John Moores University).
Preeti has already published the first PhD paper ‘Birthing centres in Nepal: Recent developments, obstacles and opportunities’ in the Journal of Asian Midwives (JAM) , whilst another was published in the Nepal Journal of Epidemiology . Furthermore, a more general health and development paper was published this year in Health Prospect .
Prof. Edwin van Teijlingen
- Mahato, P., van Teijlingen, E., Simkhada, P., Angell, C. (2016) Birthing centres in Nepal: Recent developments, obstacles and opportunities, Journal of Asian Midwives 3(1): 17-30.
- Mahato, P.K., Regmi, P.R., van Teijlingen, E., Simkhada, P., Angell, C., Sathian, B. (2015) Birthing centre infrastructure in Nepal post 2015 earthquake. Nepal Journal of Epidemiology 5(4): 518-519. http://www.nepjol.info/index.php/NJE/article/view/14260/1157
- Regmi, P., van Teijlingen, E., Hundley, V., Simkhada, P., Sharma, S., Mahato, P. (2016) Sustainable Development Goals: relevance to maternal & child health in Nepal. Health Prospect 15(1):9-10. healthprospect.org/archives/15/1/3.pdf
Eva Hendrych Lorenzová, midwife and midwifery lecturer from the Czech Republic, visited the Centre for Midwifery, Maternal & Perinatal Health (CMMPH) this passed week. Eva was awarded a travel grant as part of the EU-funded COST Action IS1405 Short Term Scientific Mission (STSM). Eva spoke to colleagues and students at Bournemouth University as well as midwifery colleagues in Weymouth, Bournemouth, Poole and the New Forrest Birth Centre.
Over the past five year periods four different midwives from Continential Europe have been to Bournemouth University on an STSM exchange. Eva is the fourth one, and with Brexit most likely to be the last on this EU scheme! Each of these four midwives had a different aim for their STSM project. The first STSM midwifery visitor five years ago was Susanne Grylka-Baeschlin. She did a methodological piece of research which resulted in the translation of the Mother-Generated Index into German to be used in Switzerland and Germany. The STSM was part of her MSc project supervised by Prof. Mechthild Gross and supported by Dr. Kathrin Stoll, both based at the Hannover Medical School in Germany.
In 2013 Dr. Ans Luyben, a Dutch midwife working in Switzerland, came over to BU for ten days. She came to develop the survey content on organisational system design and culture as part of the international survey, taking place during the COST Action. The work focused on organisational system design and culture in regard to antenatal care, including prenatal screening.
Eva and Jillian 2016
The third STSM midwifery visitor in 2014 was Dr. Fátima León Larios from Spain. Her STSM was much more practical, Fátima was keen to find out more about how small midwifery-led maternity units were being run in England. BU’s Visiting Faculty and Poole Community Midwife Jillian Ireland took her to visit four different maternity units in the south of England. Jillian also organised Eva’s meeting with community midwives and midwives in various birthing centres in Dorset and the New Forrest in October 2016.
Prof. Edwin van Teijlingen