Tagged / CMMPH HSC

CMMPH at the 10th International Normal Birth conference

Grange-over-Sands in Lancashire was once again a beautiful setting from 15th-17th June for one of the most inspirational midwifery research conferences. Attracting a significant international attendance from eminent researchers, clinicians and user representatives from as far afield as Australia, China, Canada, Brazil and across Europe (many regular attendees), the conference is now in its 10th year. Hosted by Professor Soo Downe and her team from UCLAN, it brings together researcher across all maternity professions, to present and debate work primarily relating to physiological birth. Two members of CMMPH were presenting (and tweeting!):

Professor Vanora Hundley discussed ‘Do midwives need to be more media savvy?’, a presentation created with Professor Edwin van Teijlingen and Ann Luce, based on a previous FoL public debate at BU relating to the role media plays in creating fear in childbirth  https://research.bournemouth.ac.uk/engagement/fear-in-childbirth-are-the-media-responsible/ . She highlighted the need for midwives to be more aware of how to work with the media in order to harness the power to present positive messages, as well as understanding impact on women and health care providers. A paper on this presentation is accessible from: http://eprints.bournemouth.ac.uk/21600/

Jenny Hall with Maltese midwives and other delegates

Jenny Hall with Maltese midwives and other delegates

 

Dr Jenny Hall presented as part of a symposium with midwifery colleagues from Malta on an ongoing educational project relating to promotion of physiological birth in Malta. Malta has one of the highest Caesarean section rates in Europe and the team have been working together to develop midwives confidence in facilitating physiological birth as well as supporting them to educate women and families.

 

All delegates also received a copy of the book ‘Roar behind the silence: why kindness, compassion and respect matter in maternity care’, that includes chapters by two BU authors: Dr Jenny Hall and Consultant midwife, Katherine Gutteridge. ( see http://blogs.bournemouth.ac.uk/research/2015/02/28/stop-the-fear-and-embrace-birth/ for further information)

As usual the conference provided extensive opportunity for networking and developing links for future collaboration in a considerably relaxing environment.

A tweet storify and photographs of the whole conference are available which includes contribution from BU researchers:

https://storify.com/SagefemmeSB/normal-labour-birth-10th-research-conference

https://animoto.com/play/M21BCHDHihSqkH3LdxU0hw

 

 

Maternity, Midwifery & Baby Conference

Fusion, Research themes, Training

A recent free Maternity, Midwifery & Baby Conference held in London offered an ideal opportunity for Bournemouth University to showcase two innovative projects. The first, co-presented by Dr. Sue Way and Sian Ridden, a 2nd year midwifery student, focused on a joint chiropractic and midwifery newborn clinic which was set up with Fusion principles in mind. There are a number of aims of the clinic, of which the main is to optimise women’s opportunities to breastfeed successfully by providing chiropractic care for babies and breastfeeding support and advice to mothers. There are two further important aims, one of which, is to enhance student (undergraduate midwifery students & chiropractic students) learning opportunities and secondly, to provide networking and collaborative opportunities for students and staff in relation to research and dissemination of findings around these particular topics. When it was Sian’s turn to present, she was confident and articulate. She discussed a case study and how her knowledge was enhanced by being part of the clinic. Sian found attending the clinics provided her with a great learning experience and it was empowering that she was able to provide breastfeeding support under the guidance of the experts in the respective fields (Alison Taylor and Dr. Joyce Miller). Preliminary breastfeeding results from the clinic are promising. More details to follow in due course. Finally the seminar concluded by discussing the re-launch of the clinic in September, and to raise awareness of the re-launch, a free local conference (funded by Fusion Funding) for the community will be taking place on the 12th July 2014. For further information on the above clinic or the conference please contact Alison Taylor on ataylor@bournemouth.ac.uk or Dr. Sue Way on sway@bournemouth.ac.uk .

 

The second seminar presentation took place after lunch and it focused on a study which is currently taking place involving five 3rd year midwifery students and the feasibility of incorporating newborn infant physical examination (NIPE) competencies into the pre-registration midwifery programme.  Traditionally these competencies are usually achieved post qualification when midwives have a number of years’ experience under their belt. However BU midwifery students felt differently and Luisa Cescutti-Butler discussed how the study was initiated by Luzie who asked the question: “why couldn’t they learn all the necessary skills in the third year of their programme”? Luzie took to the podium and presented her section like a duck to water. She didn’t shy away from the difficulties from taking this extra study on, but was quite clear that the benefits for women in her care were worth the extra work.  The presentation generated quite a lot of heated discussion with some midwives in the audience quite adamant that students should not be taking on this ‘extended’ skill. However Luzie was able to stand her ground and confidently counter ague as to why students should gain these skills during the undergraduate programme. She received a resounding clap and cheers from the audience.

It takes some courage to stand up in a room full of people and present, and Sian and Luzie were brilliant.  Both students did Bournemouth University and in particular the midwifery team proud. For further information on the above study please contact Luisa Cescutti-Butler on lcbutler@bournemouth.ac.uk

 

 

 

EXON by the sea!

Training

 

After many months of negotiation I packed my weekend bag and set off to Eastbourne to provide the first of a six day programme spread over three months on newborn examination, to a select cohort of nine midwives who work for the East Sussex NHS Healthcare Trust. The nearest university (Brighton) does not provide the module and I regularly have midwives travelling up from Brighton to attend the two courses provided annually at the Lansdowne Campus.

Midwives from the midwife led unit (EMU as it is fondly referred to) at Eastbourne Hospital, the acute trust at Hastings and Crowbridge Birthing Unit all joined the module at the beginning of January 2014. Some of the midwives were undertaking the unit in work time and some during their annual leave, but all were enthusiastic and very excited to be finally learning the skills and competencies necessary to become newborn examiners. Currently no midwives in the combined trusts undertake newborn examination and all babies are either examined by junior doctors in training or general practitioners (GPs) in the community setting. For a number of years there have been concerns expressed in the literature around the quality of the newborn examination when undertaken by junior doctors and GPs mainly around training and on-going education. Traditionally doctors in NHS hospitals were taught newborn examination under the mantra ‘see one – do one – teach one’, midwives on the other hand, have had to undergo many months of extra training and are required to undertake between 40 & 60 newborn examinations before being deemed competent. These conditions became onerous for midwives as it became difficult for them to find mentors and assessors to support them in practice. Many requested extensions and in some cases took almost two years to complete. This model of learning was not sustainable in the long run for both the clinical workplace and for university processes. Therefore an opportunity arose to change how BU provided examination of the newborn (EXON) when the post registration framework was re-validated in 2012, with the main difference being in relation to the examinations.

Midwifery is a self-regulating profession; therefore it is up to individual practitioners to judge whether they are component when providing midwifery care. The philosophy of self-regulation underpinning competency guided the provision of the new EXON course in relation to the number of examinations required. Midwives have to carry out a minimum of 10 mentored newborn checks, with five examinations being directly supervised. Once 10 examinations have been carried out midwives can undertake as many self-assessed newborn checks until they feel competent. Once they have reached this point they put themselves forward for one summative assessment which is a newborn examination evaluated in practice.  Midwives have nine months to complete the module. In addition, to further support midwives in training for this role, experienced midwives around the BU patch and as far as West Wiltshire have been provided with a half day update focusing on mentoring/assessing and understanding the EXON paperwork. These midwives have now taken on the role of mentoring and assessing midwives through EXON.

Now having delivered the six day programme the midwives in Eastbourne have successfully completed the academic requirement,s with all passing their ‘enquiry-based learning’ presentations which focused on an aspect of newborn physiology/pathology. The presentations were of an extremely high standard and feedback from the unit leader recommended writing up their work for publication in the British Journal of Midwifery. Their unit evaluations were 100% positive. One of the main benefits centered on the midwives forming a cohesive group and getting to know each other better.  These midwives are leading the way at East Sussex Healthcare. Once they qualify, they in turn, can become mentors and assessors for the next cohort. Perhaps even more importantly, evidence demonstrates that when midwives undertake this expanded role, women’s satisfaction and midwifery autonomy is increased and crucially, there is continuity of care for the woman and her baby and for the midwife herself.

 

For further information on the EXON module please contact Luisa Cescutti-Butler, Senior Lecturer, Lansdowne Campus: lcbutler@bournemouth.ac.uk

 

Under-grad Midwifery Students and Examination of the Newborn – a pilot project.

BU Challenges, Fusion, Training

Five pre-registration midwifery students were successful in their application to take part in a pilot project which will equip them with the knowledge, skills and competency to undertake  examination of the newborn prior to qualification as a midwife. Midwives have always undertaken an initial examination of a baby soon after birth and the 24 hour ‘medical’ examination was traditionally undertaken by junior doctors or GP trainees. Following a change in doctor’s hours and a call for more holistic midwifery care, midwives began to take on the role of examining newborns following a period of rigorous training and education delivered through universities throughout the UK. Bournemouth University, for many years now, has been actively involved in educating midwives into this role, both locally and as far a field as Brighton and Gloucester. Currently the under-graduate midwifery curriculum does not offer this learning to its midwifery students although there is a strong push nationally for students to qualify with the skills. Two universities have already embedded the skills into their three year curriculum and BU will begin to educate and train students with the necessary skills/competencies in 2014 with a brand new midwifery curriculum. In the meanwhile we are fast tracking five motivated students. The students (Bex, Jenna, Katie, Luzie and Jeanette (not in photograph)  have to access all the post grad teaching and learning days (x5) which started last week. As well as undertaking an assessed presentation (6th day) with their qualified colleagues, they will have to undertake 30 newborn examinations under the watchful eye of their midwifery mentor who already has the qualification.  The unit leader (myself) will undertake their final assessment in practice in conjunction with their mentor. If successful the students will be awarded with 20 CPD credits for use after qualification.

Undertaking the pilot will be demanding for the students as they will still have to obtain their EU midwifery numbers, but it will not be at the expense of the pilot. Their under-grad training takes precedence.Furthermore a number of conditions were attached to the offers of a place:  the pilot cannot be used as mitigation for any referred  unit  in their 3rd year and the credits cannot be used to top up their degree should they not achieve the requisite 120 credits for completion.  All the students expressed strong commitment to obtaining the necessary skills and they have until September 2014 to complete. The pilot will pave the way for the new curriculum and will help with exposing any shortfalls in practice. I am immensely proud of the students for taking on this extra work. They have so many competing demands on their time and this will be just another. However it will provide the students with the skills to examine newborn babies when they are newly qualified midwives, which in turn will benefit women and their babies.  If anybody is interested in knowing more about the pilot please contact me on:  lcbutler@bournemouth.ac.uk

CMMPH PhD students steal the show at the GLOW maternal health conference

PG research

The second Global Women’s Health Conference, held in Birmingham on November 1st, highlighted the work that still needs to be done to reduce maternal mortality. Prof Wendy Graham from the University of Aberdeen opened the conference outlining the progress to date but reminding us that there was much still to do. Her hard hitting presentation showed the unacceptable conditions of birthing rooms in many countries. She urged the audience to remember that “we do not want universal health care of poor quality.”

Rachel Arnold

This was followed by a short film produced by BU Visiting Professor Gwyneth Lewis, which tells the story of Mrs X and why she died in childbirth.

A number of presenters highlighted hospital conditions and disrespectful staff as a disincentive for women in seeking facility birth. However, Rachel Arnold, PhD student in CMMPH,  reminded the audience that the carers were women too. She noted that it is all too easy to blame health care professionals, forgetting the challenging conditions that they have to work in. In her excellent and moving presentation Rachel presented quotes from midwives and doctors in Afghanistan that brought a number of audience members to tears.

BU Prof Vanora Hundley presented work from Pakistan evaluating a decision tool to support policy makers and programme managers who are considering the potential role of clean birth kits in their strategy for care at birth.

Sheeta;

Sheetal Sharma

While PhD student Sheetal Sharma’s poster presentation Getting women to care in Nepal: A Difference in Difference analysis of a health promotion intervention stole the day winning best poster prize.   Sheetal has a unique international supervisory team led by BU and her PhD is supported by Bournemouth University with a studentship and a Santander grant.

The event was also an opportunity to publicise next year’s international conference on Midwifery and the post-MDG agenda, which will be held at Bournemouth University.

Twenty years after the publication of Changing Childbirth, where are we now?

Twenty years after the publication of Changing Childbirth, an eminent panel of clinicians, politicians and consumer representatives assembled to review the legacy of this key Changing CHildbirthmaternity report. The session, funded by the Wellcome Trust, was held at the Royal College of Obstetricians and Gynaecologists in London – an appropriate place given the balance of power at the time of the report.  BU Professors Vanora Hundley and Edwin van Teijlingen were invited to attend as part of the selected audience at the session.

The session started with the panel reminding the audience that maternity services prior to the publication of Changing Childbirth in the early 1990s were anything but women focused. Several speakers noted that this report was the first to put women at the centre of maternity care, and many of the recommendations regarding patient-centred care across the NHS followed on from it. As the president of the Royal College of Midwives (RCM) Lesley Page commented: “It was common sense, but hugely radical.”

Changing Childbirth was the government’s response to Sir Nicholas Winterton’s ground-breaking review of the maternity services (Health Select Committee report 1992). The review was unique in seeking views from women – as Nicholas Winterton noted, his Parliamentary committee also made history by letting women who came to give evidence breastfeed during the hearing.

Baroness Julia Cumberlege reflected on how she had been determined that the Health Select Committee report would not simply be another filed document but would have an impact. Twenty years on has the report had an impact? 

The discussions covered a wide-ranging number of maternity care issues at the time of Changing Childbirth’s conception, many of which are still issues today in the UK.  We’d like to highlight two of these issues where BU has made an academic contribution.  First, the observation that we need to be cautious in making assumptions about choices that women perceive they have in childbirth. Profs van Teijlingen and Hundley’s research has demonstrated that women often cannot envisage or value potential choices if these options don’t exist in their current environment.1,2   

The second BU contribution to the debate is around the closure of small maternity units. One of the panel members compared the centralisation of maternity services to that of banks and supermarkets.  A comparative study was published in 2010 by Prof. van Teijlingen and BU Visiting Fellow Dr. Emma Pitchforth under the title ‘Rural maternity care: Can we learn from Wal-Mart?’.

Overall the panel was positive about the legacy of Changing Childbirth – that is, a more humanised maternity services. However, all present expressed disappointment at the failure of the NHS to introduce continuity of carer, something that women who gave evidence stated they valued highly. As Nicholas Winterton said: “We have made progress but we should be making further progress – It is unfinished business.”

Vanora Hundley is Professor of Midwifery

Edwin van Teijlingen is Professor of Reproductive Health Research

 References:

  1. Hundley V, Ryan M and Graham W (2001) Assessing women’s preferences for intrapartum care. Birth 28 (4): 254-263.
  2. van Teijlingen E, Hundley V, Rennie AM, Graham W, Fitzmaurice A. (2003) Maternity satisfaction studies and their limitations: “What is, must still be best”, Birth 30: 75-82.  
  3. van Teijlingen ER and Pitchforth E. (2010) Rural maternity care: Can we learn from Wal-Mart? Health & Place 16: 359-364.

 

 

 

A royal birth? Lucky Kate

PG research

With the Queen’s Jubilee, the Olympics and Andy Murray winning at SW1 Wimbledon (again) it seems Britain is still riding a wave of optimism with the birth of a male heir to the throne; the Prince of Cambridge. The baby was delivered on 22 July 2013 at St Mary’s Hospital in Paddington, west London, weighing 8lb 6oz. The document said: “Her Royal Highness, the Duchess of Cambridge was safely delivered of a son at 4.24pm today. He and the duchess will remain in the hospital overnight. A bulletin signed by the Queen’s gynaecologist Marcus Setchell, who led the medical team that delivered the baby – was taken by a royal aide from St Mary’s to the palace under police escort.

The implications are wide -reaching, in multi-cultural Britain the royal baby is unusual for London in having a mother originally from the UK and most babies delivered in the capital these days (57%) are to mothers born overseas and nearly half of all babies (48%) are born outwith marriage. With midwifery cuts and the further medicalisation of birth where the “cascade of interventions” often occurs when birth is induced.  For instance, in the USA which spends more money on healthcare than any country in the world and yet the maternal mortality rate is among the highest of any industrialised country.

And on July 19, 2013, the USA the House State-Foreign Operations Appropriations Subcommittee today approved a steep cutback in international family planning assistance for fiscal year 2014. Rejecting President’s Obama’s 2014 budget request of $635.4 million, the Subcommittee capped appropriations for international family planning and reproductive health programs at $461 million, $174 million less than the President’s request, and $137 million (23% below the current funding level).  The cuts, if approved by the full Congress, would have a devastating impact: Several million women in the developing world would lose access to contraceptives services, resulting in more unplanned pregnancies and deaths from unsafe abortions. Each pregnancy multiplies a woman’s chance of dying from complications of pregnancy or childbirth. Maternal mortality rates are particularly high for young and poor women, those who have least access to contraceptive services. It is estimated that one in three deaths related to pregnancy and childbirth could be avoided if all women had access to contraceptive services.

Not so lucky, therefore, are Kate’s counterparts in the South – Frightening statistics include that daily, approximately 800 women die from preventable causes related to pregnancy and childbirth. In our study site, Nepal every year, 4,500 Nepali women die in childbirth due to lack of medical care. In low-income countries, most maternal deaths are avoidable, as the health-care solutions to prevent or manage complications are well known. All women need is access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth.

To make every birth worldwide as joyful an event as the royal birth in London we need is: a) more and better midwifery services; and b) improved access to care for pregnant women globally.

Sheetal Sharma is a HSC PhD student and currently a visiting researcher in Barcelona, supervised by Dr. Elisa Sicuri at CRESIB on an evaluation of a health promotion programme in rural Nepal aiming to improve access to care; in which socio-economic and cultural barriers exist.

Thanks to Edwin & Elisa for their input in this piece.

References:

http://www.populationinstitute.org/newsroom/press/view/57/

http://midwifeinternational.org/how-to-become-midwife/business-of-baby/

http://www.bbc.co.uk/news/uk-23408377

http://www.unfpa.org/public/home/mothers/pid/4382

http://www.bbc.co.uk/news/uk-23403391