Congratulations to Joyce Miller, Monica Beharie and Elisabeth Simmenes based at the Anglo-European College of Chiropractic (AECC) and FHSS’s Alison Taylor and Sue Way who just had their paper ‘Parent reports of exclusive breastfeeding after attending a combined midwifery and chiropractic feeding clinic in the UK: A cross sectional service evaluation’ accepted in the journal Journal of Evidence-Based Complementary & Alternative Medicine.
Prof. Edwin van Teijlingen
FHSS PhD student Rachel Arnold has been quoted in of one world’s most famous newspapers The New York Times. Late last week on Dec. 4th The New York Times published an article under the heading ‘Reported Gains in Afghan Maternal Health Are Found to Be Implausible’ . Rachel Arnold was interviewed since her PhD study, based in CMMPH, focuses on maternity care in one of the larger hospitals in the Afghan capital Kabul. Rachel has also published an excellent paper from her research in Afghanistan in the scientific journal BJOG . Her paper analyses the culture of a Kabul maternity hospital to understand its impact on the care of perinatal women and their babies. The paper is published in Gold Open Access, hence freely available to audiences across the globe,
Prof. Edwin van Teijlingen
Centre for Midwifery, Maternal & Perinatal Health
- Nordland. R. ‘Reported Gains in Afghan Maternal Health Are Found to Be Implausible’ The New York Times Dec 4th, 2015, see: http://www.nytimes.com/2015/12/05/world/asia/afghanistan-maternal-mortality-rate.html
- Arnold R, van Teijlingen E, Ryan K, Holloway I. Understanding Afghan health care providers; a qualitative study of the culture of care in a Kabul maternity hospital. BJOG 2015: 122(2): 260–267.
Student midwives spend approximately 50% of their three year undergraduate programme in the clinical area. Going to a new placement is often a stressful time for them as they consider ‘will they fit in’, ‘will they know enough’, ‘have they the right skills’, ‘what will they be able to learn whilst there to meet their practice assessments’ and so on. Other concerns relate to being away from home, what hours they are expected to do and how they cope with ‘difficult’ mentors. If students are unfamiliar with healthcare environments it takes time for them to adjust and become used to the environment. It was these thoughts that began fermenting in my head back in 2010 and following a positive response from students whose views on a book on placements were informally sought, I pitched the idea to a commissioning editor at Wiley Blackwell. In addition wider research had revealed that no such book existed within the published midwifery arena. Finally, in 2012 a contract was agreed between myself, and Margaret Fisher, Associate Professor in Midwifery at Plymouth University to co-edit nine chapters for submission in November 2014. The book is now due for publication on the 11th December 2015.
Professor Paul Lewis wrote the forward and chapter contributions from Bournemouth University lecturers, Dr. Sue Way, Stella Rawnson and myself, prepare prospective and current students for midwifery practice and the profession, caseloading and the elective period. Jo Coggins and Henrietta Otley, both midwives practising in North Wiltshire were co-opted to write chapters on ‘Preparing for practice’ and ‘Low-risk midwifery placements’. Other chapters were written by Margaret Fisher and Faye Doris at Plymouth University.
The final published edition is small enough to fit into a uniform pocket and contains many vignettes from students currently or previously studying at Bournemouth and Plymouth University. Their stories reflect ‘real life’ clinical experience and ‘Top Tips’ provide overall advice. Three original cartoons illustrating the vagaries of placement were devised by Clare Shirley (formerly a BU student, now a newly qualified midwife) and Hugo Beaumont (4th year medical student at Plymouth University). Students and women have provided photographs. Both Margaret and I hope students far and wide will enjoy the book which aims to provide a realistic perspective on clinical placement, by offering hints and tips and encouragement along their student journey.
This month’s Café Scientific last week (Nov. 3rd) was run as a collaboration between CMMPH and the Media School. Café Scientific is a monthly event hosted at Café Boscanova for Bournemouth University.
This month’s debate was chaired by CMMPH’s Prof. Vanora Hundley (sitting in the centre of the photo taken by Naomi Kay). The debaters on either side were Dr. Ann Luce and Prof. Edwin van Teijlingen. Ann Luce is a well recognised media researcher and a Senior Lecturer in Journalism and Communication who argued against the motion “Fear in childbirth: is the media responsible?” Two opposing presentations generated a lively debate. The audience, however, was not with Ann and overwhelmingly voted in favour of the motion.
The next session of Café Scientific also has a health flavour as James Gavin will be talking on Tuesday December 1st on: Upwardly mobile: Why stair climbing helps us stay active.
Prof. Edwin van Teijlingen
Ms. Sheetal Sharma, PhD student in FHSS, published her latest paper in Midwifery (Elsevier) this week. This latest paper ‘Midwifery2030, a woman’s Pathway to health: What does it mean?’ is co-authored by a number of illustious midwifery researchers. The 2014 State of the World’s Midwifery report included a new framework for the provision of womancentred sexual, reproductive, maternal, newborn and adolescent health care, known as the Midwifery2030 Pathway. The Pathway was designed to apply in all settings (high-, middle- and low income countries, and in any type of health system). This paper describes the process of developing the Midwifery2030 Pathway and explain the meaning of its different components, with a view to assisting countries with its implementation.
Sheetal is currently in her final year of a PhD on the evaluation of the impact of a maternity care intervention in Nepal.
Prof. Edwin van Teijlingen, Dr. Catherine Angell & Prof. Vanora Hundley (all CMMPH)
Visiting Faculty Prof. Padam Simkhada (based at Liverpool John Moores University).
ten Hoope-Bender, P. Lopes, S., Nove, A., Michel-Schuldt, M., Moyo, NT, Bokosi, M., Codjia, L., Sharma, S., Homer, CSE. (2015) Midwifery2013, a woman’s Pathway to health: What does it mean? Midwifery
This week saw publication of a new CMMPH paper in BMC Health Services Research. This methodological paper ‘Assessing the performance of maternity care in Europe: a critical exploration of tools and indicators‘ is a collaboration between several European maternity-care researchers based in Spain (Ramón Escuriet, Fatima Leon-Larios), Belgium (Katrien Beeckman), Northern Ireland (Marlene Sinclair), the UK (Lucy Firth, Edwin van Teijlingen), Switzerland ( Christine Loytved, Ans Luyben) and Portugal (Joanna White). Dr. Ans Luyben is also Visiting Faculty in the Faculty of Health & Social Sciences at Bournemouth University. The underlying work was supported by the European Union through a COST Action called Childbirth Cultures, Concerns, and Consequences headed by Prof. Soo Downe at the University of Central Lancashire. COST is seen by the EU as an important tool in building and supporting the European Research Area (ERA).
This paper critically reviews published tools and indicators currently used to measure maternity care performance within Europe, focusing particularly on whether and how current approaches enable systematic appraisal of processes of minimal (or non-) intervention in support of physiological or “normal birth”.
The authors conclude: “The review identified an emphasis on technical aspects of maternity, particularly intrapartum care in Europe, rather than a consideration of the systematic or comprehensive measurement of care processes contributing to non-intervention and physiological (normal) birth. It was also found that the links between care processes and outcomes related to a normal mode of birth are not being measured.”
Professor Edwin van Teijlingen
The media are often blamed for influencing society’s attitudes and views. In this month’s Café Scientific we will debate the impact of the mass media on women’s views of childbirth. The motion is: “Fear in childbirth: is the media responsible?”
Café Scientific is being hosted at Café Boscanova in Bournemouth on November 3rd at 19.30. The debate is open to the general public. It will be chaired by Prof. Vanora Hundley, Professor of Midwifery and the two proponents on either side of the debate are Dr. Ann Luce and Prof. Edwin van Teijlingen. Ann Luce is a well recognised media researcher and a Senior Lecturer in Journalism and Communication. Edwin van Teijlingen is a medical sociologist and Professor of Reproductive Health Research.
The debate will touch upon social perceptions and beliefs about childbirth can increase women’s requests for interventions, such as caesarean section, with long-term health implications for mothers and babies. This month’s Café Scientific will explore the role of the mass media in shaping these beliefs and identify whether media portrayals are responsible for rising rates of intervention.
Join us for an interactive debate on the impact of the mass media on women’s views of childbirth. The audience will be given the opportunity to vote on the motion before and after the debate.
These academics have written a paper on the topic of debate, a copy of which can be found here!
Professor Edwin van Teijlingen (CMMPH) has been invited to present a key note speech at the Kennispoort Verloskunde conference in Utrecht, the Netherlands in January 2016. He will be speaking about ‘Dealing with risk in maternity care: the social versus medical model’. The presentation is based on a number of publications around the sociological topic of the medical/social model of childbirth. [1-3]
One of the ways sociologists analyse health and health care is in terms of a ‘medical’ versus a ‘social’ model, or in this field, a midwifery model. As pregnancy and birth are biological and physiological events which are very much embedded in a social and cultural setting, these are good examples to highlight the use and misuse of the medical and social model. Modern Western society has a slightly paradoxical view of pregnancy. On the one hand, the average woman in childbirth is not ill because pregnancy is not an illness. On the other hand, pregnant women are deemed to need a lot of health care throughout pregnancy and childbirth. Making the distinction between a medical and a social model of a social phenomenon is not exclusive to midwifery. Over the past decades researchers have pointed to the existence of a medical and social model in alcohol misuse, obesity, sex, eating disorders, infertility treatment, to name but a few phenomena.
- van Teijlingen, E. (2005) A critical analysis of the medical model as used in the study of pregnancy and childbirth, Sociological Research Online, 10 (2) Web address: http://www.socresonline.org.uk/10/2/teijlingen.html.
- MacKenzie Bryers H., van Teijlingen, E. (2010) Risk, Theory, Social & Medical Models: critical analysis of the concept of risk in maternity care, Midwifery 26(5): 488-496.
- van Teijlingen, E. (2015) Sociology of Midwifery. In: Sociology for Midwives Deery, R., Denny, E. & Letherby, G. (eds.) Cambridge: Polity Press, 22-37.
The current issue of the Nepal Journal of Epidemiology published today carries an editorial by a BU-led team of researchers and development workers. The editorial Mental health issues in pregnant women in Nepal highlights the intervention funded by THET which aims to improve the knowledge and attitude of maternity care workers in a rural district in the south of Nepal. The BU authors include Visiting Faculty: Padam Simkhada, Samridhi Pradham, Jillian Ireland and Bibha Simkhada, the other co-authors are affiliated with the charity we work with in Nepal (Ram Chandra Silwal), the Buddhist charity based in London Green Tara Trust (Padmadharini Fanning), and our Tribhuvan University based colleagues (Lokendra Sherchan, Shyam K Maharjan, and Ram K Maharjan.
This THET-funded project will involve over 15 UK short-term volunteers. It is important to bring UK volunteers, who as health professionals will bring their experience of, and training in, the provision of mental health and maternity/midwifery services including the area of mental ill health prevention and health promotion. These experienced health workers (such as midwives, family doctors, mental health nurses, health visitors, psychiatrists) from the UK are invited to volunteer for two to three weeks at a time to design and deliver training. The mixture of training staff abroad (= Education) by UK professionals (=Practice) through an intervention which is properly evaluated (=Research) is a perfect example of BU’s FUSION in action.
This project is supported by the Tropical Health & Education Trust (THET) as part of the Health Partnership Scheme, which is funded by the UK Department for International Development (DFID) and runs from this year May 1st until the autumn of 2016. The paper is freely available on line, click here!
Prof. Edwin van Teijlingen
van Teijlingen E, Simkhada P, Devkota B, Fanning P, Ireland J, Simkhada B, Sherchan L, Silwal CR, Pradhan S, Maharjan KS, Maharjan KS. Mental health issues in pregnant women in Nepal. Nepal J Epidemiol. 2015;5(3); 499-501.
The Sustainable Development Goals (SDGs) summit is being held today in New York. As part of this summit the pope will address the United Nations in NY as will Bill and Melinda Gates who run the largest private philantropic organisation in the world. The key underlying principles of the SDGs are: (a) reducing (or eradicating) poverty eradication; (b) changing unsustainable and promoting sustainable patterns of consumption and production; and (c) protecting and managing the natural resource base of economic and social development. The seventeen SDGs are outlined in Table 1.
Table 1 Sustainable Development Goals
||End poverty in all its forms everywhere
||End hunger, achieve food security and improved nutrition and promote sustainable agriculture
||Ensure healthy lives and promote well-being for all at all ages
||Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all
||Achieve gender equality and empower all women and girls
||Ensure availability and sustainable management of water and sanitation for all
||Ensure access to affordable, reliable, sustainable and modern energy for all
||Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all
||Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation
||Reduce inequality within and among countries
||Make cities and human settlements inclusive, safe, resilient and sustainable
||Ensure sustainable consumption and production patterns
||Take urgent action to combat climate change and its impacts*
||Conserve and sustainably use the oceans, seas and marine resources for sustainable development
||Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss
||Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels
||Strengthen the means of implementation and revitalize the global partnership for sustainable development
The SDGs replace the Millennium Development Goals (MDGs) formally from today onwards. Key questions to be asked by researchers (and policy makers) include: (a) how are these SDGs different from the MDGs in their effect on international development?; (b) How successful will the SDGs be?, including the question: What do we define as success?; and (c) How useful were the MDGs, in which countries and for whom? These are ‘big’ system level questions, for those of use working in the field of maternity care more specific questions to address would be around priority settting. As reducing maternal mortality was one of the eight MDGs, i.e. recognised as an individual goal or target, but in the SDGs maternal health will fall under the overarching heading of Goals 3 ‘Ensure healthy lives and promote well-being for all at all ages’. As health is only one of 17 SDGs and maternal health fits in with all other aspects of the lifespan does this mean maternal health has become less of a priority? Of course only time and plenty of good research will tell.
Prof. Edwin van Teijlingen
BU academics Ms. Lesley Milne, Prof. Vanora Hundley and Prof. Edwin van Teijlingen in collaboration with BU Visiting Faculty Prof. Padam Simkhada (Liverpool John Moores University) and Ms. Jillian Ireland (Community midwife NHS Poole) published there latest paper yesterday in BMC Pregnancy and Childbirth. The paper ‘Staff perspectives of barriers to women accessing birthing services in Nepal: a qualitative study’ originated from research conducted in small maternity hospitals in Nepal.
The project was funded in 2013 through the first ever WellBeing of Women-Royal College of Midwives International Fellowship Award. This Fellowship was the first of its kind. It was established to enable midwives to further develop research interests in midwifery, maternity services, pregnancy, childbirth and women’s health from an international perspective.
The Scholarship competition was open to RCM midwives undertaking research in the UK or abroad which would address Millennium Development Goals 4 (Reduce Child Mortality) and 5 (Improve Maternal Health). Lesley Milne in the Centre for Midwifery, Maternal & Perinatal Heealth (CMMPH) was the first and very worthy recipient of this award.
Based on the fieldwork we published our paper in BMC Pregnancy & Childbirth an Open Access journal. The paper highlights that Nepal has made significant progress with regard to reducing the maternal mortality ratio but a major challenge remains the under-utilisation of skilled birth attendants. We found other studies had explored women’s views of the barriers to facility birth; however the voices of staff who offer services have not been studied in detail. This research explored the views of staff as to the key reasons why pregnant women do not give birth in a maternity-care facility when they exist.
This study highlights a multitude of barriers, not all of the same importance or occuring at the same time in the pregnancy journey. It is clear that staff are aware of many of the barriers for women in reaching the facility to give birth, and these fit with previous literature of women’s views. However, staff had limited insight into barriers occuring within the facility itself and were more likely to suggest that this was a problem for other institutions and not theirs.
Edwin van Teijlingen, Lesley Milne & Vanora Hundley
@EvanTeijlingen / @VanoraHundley
Lesley Milne, Edwin van Teijlingen, Vanora Hundley, Padam Simkhada and Jillian Ireland, Staff perspectives of barriers to women accessing birthing services in Nepal: a qualitative study, BMC Pregnancy & Childbirth 2015, 15:142 http://www.biomedcentral.com/1471-2393/15/142
Dr. Jenny Hall and Prof. Edwin van Teijlingen are holding a lunchtime at today’s (Friday 3rd July 2015) BU Midwifery Education Conference (#MidEd15) in Business School. The one-hour session is advertised under the title ‘Believe you can write!’ Both BU academics are editors and on editorial boards of several prestigious health journals across the globe.
Over the past few years CMMPH staff have written and published several articles on academic writing and publishing. Some of these papers have been co-authored by BU Visiting Faculty, Dr. Bri jesh Sathian (Nepal), Dr. Emma Pitchforth (RAND, Cambridge), Ms. Jillian Ireland (NHS Poole) and/or Prof. Padam Simkhada (Liverpool John Moores University).
Prof. Edwin van Teijlingen & Dr. Jenny Hall
Twitter accounts: @HallMum5 / @EvanTeijlingen
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
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:
Congratulations to Professor Emeritus Paul Lewis who is listed on this year’s Queen’s Birthday Honours List. Professor Lewis has been awarded his OBE for Services to Mothers, Midwives and Maternity Services. Bournemouth University celebrated the retirement of Professor Lewis in October 2011.1 He had been leading midwifery education at Bournemouth University since 1995. The Royal College of Midwives (RCM) recognised his contribution to the midwifery profession by including his name on the Register of Honorary Fellows of the RCM.
Amongst his many contributions to the field, Prof. Lewis was a founding member of the journal The Practising Midwife. Just a few months ago Prof. Lewis co-authored a paper under the title ‘The loss of midwifery supervision: to mourn or rejoice?’ This paper was published in the March 2015 edition of The Practising Midwife. This paper ‘reflected on and discusses some of the possible consequences of the NMC’s decision to end statutory supervision of midwives in the UK.2
Prof. Edwin van Teijlingen
- van Teijlingen, E., Tully, S. and Tobias, J.H., 2011. The retirement of the UK’s first male professor of midwifery – Paul Lewis. MIDIRS Essence (Dec. issue).
- Lewis P, Freemantle D and Ireland J., 2015/ The loss of midwifery supervision: to mourn or rejoice? The Practising Midwife 18(4): 12-16.
We have just been alerted that our paper has been cited for the hundredth time in Scopus. The paper ‘Maternity satisfaction studies and their limitations: “What is, must still be best’ was published in Birth. The paper originated from the Scottish Birth Study which we were both part of in our previous academic posts at the University of Aberdeen.
This paper discusses the strengths and weaknesses of satisfaction studies in the field of maternity care, including the issues that service users tend to value the status quo (i.e. What is must be best) . The implications are that innovations, of which users have no experience, may be rejected simply because they are unknown. The paper warns that problems may arise if satisfaction surveys are used to shape service provision. We advised that satisfaction surveys should be used with caution, and part of an array of tools. While involving service users is important in designing and organizing health services, there is still the risk that using satisfaction alone could end up promoting the status quo.
Professors Vanora Hundley & Edwin van Teijlingen
van Teijlingen, E., Hundley, V., Rennie, A-M, Graham. W., Fitzmaurice, A. (2003) Maternity satisfaction studies and their limitations: “What is, must still be best”, Birth 30: 75-82.
The Royal College of Midwives (RCM) has organised a conference today to celebrate the International Day of the Midwife in Edinburgh. The conference ‘Midwives for a Better Tomorrow’ has a very international focus. Speakers include: Frances Day-Stirk, president of the International Confederation of Midwives, Mary Renfrew, who led The Lancet series on midwifery, and Frances McConville from the World Health Organization. The conference also reported on the RCM Global Midwifery Twinning Project, which was funded by THET and included three low-income countries: Nepal, Cambodia & Uganda. In attandance was BU Visiting Faculty (and Poole midwife) Ms. Jillian Ireland, who was one of the volunteers who went out to Nepal.
This year’s International Day of the Midwife conference co-incides with the centenary of the 1915 Midwives (Scotland) Act. This celebration reminds us of the importance to have government recognition and regulation for the profession of midwifery. The latter is still lacking in many low-income countries, such as Nepal. There is a large body of evidence which supports that skilled midwifery care has the potential to significantly reduce maternal and child mortality and increase wellbeing.
Prof. Edwin van Teijlingen
Today academic publisher Elsevier sent round an email with the top five most downloaded articles from the international journal Midwifery.
We were pleased to see that the fifth paper on that list is a BU paper jointly written with Dr. Helen Bryers, Consultant Midwife in Scotland.
Prof. Edwin van Teijlingen
Last night (March 16th 2015) Bournemouth University Professor Edwin van Teijlingen attended a reception and panel discussion on Midwives as agents for change organised in London by the Ambassador of Sweden Ms. Nicola Clase. Earlier this year the Swedish Ministry of Foreign Affairs launched midwives4all, which an initiative to spread the knowledge about the benefits of evidence-based midwifery, working closely with contributors to The Lancet’s series on midwifery.1
With the Millennium Development Goals (MDGs) coming to an end in 2015, it is clear that despite great improvements many countries have not reached two key targets: MDG4 to ‘reduce child mortality’ and MDG 5 to ‘improve maternal health’.2 Too many women today still die in childbirth, most of these deaths occur in low-income countries and most of these deaths are avoidable. In 2013 alone, 289 000 women died from childbirth complications. Nearly 3 million newborns die in the first month of life and 2.6 million newborns are stillborn each year.
The aim of midwives4all is to use a coordinated and innovative communication approach to highlight the need to implement universal practice of midwifery globally in order to improve maternal health and empower women. Midwives4all highlights that only 22 per cent of countries have potentially enough midwives to provide life-saving interventions to meet the needs of women and newborns, which leaves most countries with severe shortages of proper maternity care. The vast majority of women and children lose their lives due to complications and illnesses that could have been prevented. Scaling up the midwifery workforce could prevent about two-thirds of maternal and newborn deaths, saving millions of lives every year.
For some countries the first step is to ensure that midwifery is properly recognised in law. In Nepal, one of the country in which we conduct research, midwifery is not yet officially recognised as an independent profession.3 Together with the president of MIDSON and Swedish colleagues we have long argued that we urgently need to convince the Government of Nepal and other the relevant stakeholders that ‘Nepal needs midwifery’.4
Prof. Edwin van Teijlingen
- The Lancet Midwifery Series: http://www.thelancet.com/series/midwifery
- van Teijlingen, E., Hundley, V., Matthews, Z., Lewis, G., Graham, W.J., Campbell, J., ten Hoope-Bender, P., Sheppard, Z.A., Hulton, L. (2014) Millennium Development Goals: All good things must come to an end, so what next? Midwifery 30: 1-2.
- Bogren, M., van Teijlingen, E., Berg. M. (2013) Where midwives are not yet recognised: 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. www.nepjol.info/index.php/JMMIHS/article/view/9907/8082