What is a good midwife? Insights from the literature

OBJECTIVE: to review the literature around what is considered to be a good midwife and in particular what women value in a midwife, in order to identify the gaps in the evidence for future research. DESIGN: this paper reviews the research in the area of interest over the past 30 years. The literature search focused on the concept of good midwife using synonyms and antonyms. The inclusion criteria included language (English or Italian). The examined databases were Medline, Maternity and Infant Care, Applied Social Sciences Index and Abstract and CINAHL. SETTING: studies conducted in high-income countries were taken into account. A focused review of papers which explicitly investigated what a good midwife means and a thematic analysis on what women value in a midwife were carried out. PARTICIPANTS: different standpoints have been considered (midwives, student midwives, women and their partners), focusing in particular on women viewpoint. FINDINGS: the literature review reveals information about what is considered to be a good midwife from a range of perspectives and what women value in a midwife. A good midwife should possess several attributes: theoretical knowledge, professional competencies, personal qualities, communication skills and moral/ethical values. According to the thematic analysis around what childbearing women value in a midwife, frequent key-themes emerging from the literature were: support, possibility of choice, feeling in control and having appropriate information. KEY CONCLUSIONS: the meaning of good midwife might change according to different actors involved in midwifery care and there is no agreement on the definition of what constitutes a good midwife. Furthermore, it is not clear if what women value in a good midwife corresponds to the midwives' perception of themselves as good professionals. There is a dearth of information around women's expectations and experiences specifically of a good midwife, and even less around whether this changes according to where they give birth. IMPLICATIONS FOR PRACTICE: this literature review seeks to stimulate debate and reflection among midwives and professionals involved in the childbearing event, in order to fulfil women's expectations of their midwife and increase their satisfaction with the birth experience. The identification of the gaps in the evidence provided the starting point and allowed the development of research questions and methodology for an ongoing doctoral research. On the basis of the gaps in the evidence, the doctoral research will explore and seek to explain nulliparous women's expectations and experiences of a good midwife in the context of different planned place of birth, using a Grounded Theory methodology. It is also expected that the findings of this literature review will stimulate additional research in this area to ultimately inform midwifery practice and midwifery educational programmes

Adding to the midwifery curriculum through internationalisation and promotion of global mobility

Despite the obvious need for student midwives to be exposed to meaningful learning experiences that consider engagement in the wider context of international health care and the associated benefits, there is a lack of information on how this is achieved within midwifery curricula both nationally and internationally. At the University of Nottingham, work has been undertaken to ensure the midwifery curriculum is internationalised and global mobility is promoted to all midwifery students. Processes and strategies have been put in place to encourage students' mobility including the Erasmus+ programme, elective placements and short-term ad hoc international opportunities. Thanks to the strategies that have been implemented, the Division of Midwifery has seen an increase in students undertaking an international placement from 5% in 2013/14 to 18% in 2015/16. Moving forward, future works will aim to develop ‘virtual mobility’ projects and evaluate the Erasmus+ programme in conjunction with European partners

Ion-Exchanged Waveguides in Glass Doped with PbS Quantum Dots

The lowest-loss (≤1 dB/cm) ion-exchanged waveguides in glass doped with PbS quantum dots are presented. Near-field mode profile and refractive index profile using the refracted near-field technique were measured for these waveguides. We demonstrate that the optical properties of this glass unchanged during the ion-exchange process

Childbearing women’s experiences of early pushing urge

AIM: To explore childbearing women’s experiences of early pushing urge (EPU). STUDY DESIGN: A qualitative phenomenological study was undertaken in an Italian maternity hospital. The sample included 8 women that experienced EPU during labor. Data were collected through semi-structured interviews. FINDINGS: The findings are presented as three main themes: (a) women’s perceptions of EPU, (b) bodily sensations versus midwives’ advice: struggling between conflicting messages, and (c) the “a posteriori” feeling of women about midwives’ guidance during EPU. The perception of EPU was characterized by sense of obstruction, bone pain, and different intensity of pushing efforts when compared with those of the expulsive phase. Women found it difficult to follow the midwife’s suggestion to stop pushing because this contradicted their bodily sensations. However, the women recognized a posteriori the importance of the midwife’s support while experiencing EPU. Women appreciated the midwives’ presence and emotional support most of all because they seemed to be more concerned with the personal relationship they formed in labor rather than the usefulness or appropriateness of their advice. CONCLUSION: Midwives should consider women’s physical perceptions to help them cope with EPU, acknowledging that women may struggle when caregivers’ suggestions are in contrast to their physical perceptions. The women’s overall positive experiences of birth suggest that EPU might be considered as a physiological event during labor, reinforcing the hypotheses of previous research. The optimal response to the EPU phenomenon remains unclear and should be studied, considering EPU at different dilatation ranges and related clinical outcomes

Disorientation, self-awareness and ongoing learning: student midwives’ experiences of clinical placements in Italy

Objective: To explore student midwives’ perspectives, experiences and concerns regarding clinical placements in the Italian setting. Design: A qualitative phenomenological study was undertaken, with data collected through semi-structured interviews and diaries. Ethical approval was obtained. Data analysis was conducted using a thematic analysis approach. Setting: One university in Northern Italy including a midwifery undergraduate programme. Participants: Purposeful sample of 19 third-year student midwives. Findings: Four themes emerged from the data: a) becoming a midwife: disorientation, self-awareness and ongoing learning; b) mentor as key figure; c) practice and theory: a ‘chicken and egg’ situation; d) clinical placements: a window on the uniqueness of the midwifery profession. Student midwives reported a journey through different learning phases within clinical placements, from feeling disoriented while facing initial challenges in the first year of the course to having increasing awareness of their role in the second and third year of the programme. The phase of disorientation was mainly due to not being aware of the theoretical evidence behind practice, not feeling part of the team, not knowing what their role was and lack of appropriate supervision from mentors. A positive relationship with the mentor encouraged students to share perspectives and doubts, stimulating a problem solving approach. The students found it helpful when the mentor involved them in the decision making and praised them when they deserved it. A good rapport with the midwife was reported by the participants as inspiring self-confidence and cognitive enquiries; it also allowed the students to feel part of the multidisciplinary team. An overall sense of ongoing learning was still present at the end of the midwifery programme. Key conclusions and implications for practice: Continuity of mentorship and mentors’ commitment to supporting students emerged as key aspects for a positive and fruitful learning experience within practice settings. Other pivotal elements to be considered by mentors are making the students feel welcome and part of the team; orienting them on the first day of placement; allowing some time for familiarisation with the placement area and clinical policies; involving the students in the decision-making process and care planning/implementation/ evaluation. Appropriate national mandatory training should be put in place for mentors to allow a more effective learning experience in practice settings for student midwives

Midwives’ approaches to early pushing urge in labour

The objectives of this mixed-methods study were: a) to investigate midwives' approaches to early pushing urge (EPU); and b) to explore midwives' perspectives and experiences of helping women cope with EPU. A quantitative observational methodology was adopted to investigate midwives' approaches to EPU in 60 cases. A qualitative phenomenological approach was carried out in order to gain more in-depth understanding of midwives' views and experiences of EPU management strategies. It was found that midwives mainly adopt two approaches in the case of EPU: letting the woman do what she feels, and a stop-pushing technique. The findings are presented as four main domains: a) midwives' approaches to EPU; b) drivers guiding midwives' approaches to EPU; c) influencing factors in helping women cope with EPU; d) variation of midwives' approaches to EPU over time

Respectful handover: a good alternative when intrapartum continuity of carer cannot be guaranteed

AIM: To explore first-time mothers’ expectations and experiences of being cared for by an unknown midwife and their perceptions around continuity of carer during childbirth. DESIGN: Qualitative Straussian grounded theory methodology. SETTING: Three National Health Service Trusts in England providing maternity care that offered women the possibility of giving birth in different settings (home, freestanding midwifery unit and obstetric unit). PARTICIPANTS: Fourteen first-time mothers in good general health with a straightforward singleton pregnancy anticipating a normal birth. METHODS: Ethical approval was obtained. Data were collected through two semi-structured interviews for each participant (before and after birth). The coding process included the constant comparison between data, literature and analytical memos. FINDINGS: Childbearing women’s expectations during pregnancy and experiences during labour are reported in regard to three main themes: a) encountering an unknown midwife during labour; b) familiarity and immediate connection: ‘I felt like I’ve known her for years’; c) change of shift and respectful handover. CONCLUSION: Respectful and efficient handovers between midwives are crucial in guaranteeing a high level of care when continuity of carer cannot be guaranteed. Midwives should, therefore, pay attention to how the handover is done, how information is conveyed to colleagues taking over care and how this is communicated to the labouring woman and her companions present in the room. A handover should actively involve the mother and the birth partner(s) and be essentially respectful of their needs

Fermion production despite fermion number conservation

Lattice proposals for a nonperturbative formulation of the Standard Model easily lead to a global U(1) symmetry corresponding to exactly conserved fermion number. The absence of an anomaly in the fermion current would then appear to inhibit anomalous processes, such as electroweak baryogenesis in the early universe. One way to circumvent this problem is to formulate the theory such that this U(1) symmetry is explicitly broken. However we argue that in the framework of spectral flow, fermion creation and annihilation still in fact occurs, despite the exact fermion number conservation. The crucial observation is that fermions are excitations relative to the vacuum, at the surface of the Dirac sea. The exact global U(1) symmetry prohibits a state from changing its fermion number during time evolution, however nothing prevents the fermionic ground state from doing so. We illustrate our reasoning with a model in two dimensions which has axial-vector couplings, first using a sharp momentum cutoff, then using the lattice regulator with staggered fermions. The difference in fermion number between the time evolved state and the ground state is indeed in agreement with the anomaly. A study of the vacuum energy shows that the perturbative counterterm needed for restoration of gauge invariance is insufficient in a nonperturbative setting. For reference we also study a closely related model with vector couplings, the Schwinger model, and we examine the emergence of the $\theta$-vacuum structure of both theories.Comment: 31 pages, LaTeX + uuencoded figs file (=5 PS figs). UvA-ITFA 94-17, UCSD/PTH 94-0

Current Renormalisation Constants with an O(a)-improved Fermion Action

Using chiral Ward identities, we determine the renormalisation constants of bilinear quark operators for the Sheikholeslami-Wohlert action lattice at beta=6.2. The results are obtained with a high degree of accuracy. For the vector current renormalisation constant we obtain Z_V=0.817(2)(8), where the first error is statistical and the second is due to mass dependence of Z_V. This is close to the perturbative value of 0.83. For the axial current renormalisation constant we obtain Z_A = 1.045(+10 -14), significantly higher than the value obtained in perturbation theory. This is shown to reduce the difference between lattice estimates and the experimental values for the pseudoscalar meson decay constants, but a significant discrepancy remains. The ratio of pseudoscalar to scalar renormalisation constants, Z_P/Z_S, is less well determined, but seems to be slightly lower than the perturbative value.Comment: 8 pages uuencoded compressed postscript file. Article to be submitted to Phys.Rev.

Chiral Symmetry Versus the Lattice

After mentioning some of the difficulties arising in lattice gauge theory from chiral symmetry, I discuss one of the recent attempts to resolve these issues using fermionic surface states in an extra space-time dimension. This picture can be understood in terms of end states on a simple ladder molecule.Comment: Talk at the meeting "Computer simulations studies in condensed matter physics XIV" Athens, Georgia, Feb. 19-24, 2001. 14 page