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Auscultation – The Action of Listening

By Maude, R, Lawson, J, Foureur, M
on Monday, 01 Nov 2010 in New Zealand College of Midwives Journal (Reprinted with permission from the editor of Birthspirit Midwifery Journal, Issue 5, 9-17) - Volume: 43

(Reprinted with permission from the editor of Birthspirit Midwifery Journal, Issue 5, 9-17). BACKGROUND AND INTRODUCTION Intermittent auscultation (IA) of the fetal heart during labour is the recommended monitoring modality for well women with uncomplicated pregnancies. Monitoring of the fetal heart is an important component of the midwifery care of women in labour. The purpose is to monitor changes in fetal heart rate (FHR) that provide alert signals, or in other words, FHR monitoring is a screening tool for the detection of FHR abnormalities. Today, IA is recommended as the method of fetal monitoring that should be offered to women who are healthy and have had an otherwise uncomplicated pregnancy (NICE 2001; RANZCOG, 2006; NZCOM, 2005; SOGC, 2007; MIDIRS & the NHS centre for reviews & dissemination, 2003; AWHONN, 2006). This article describes the history of auscultation and the ability to listen to the fetal heart beat as a means of determining fetal well-being.

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Comment on the Wax et al., (2010), meta-analysis of home vs. hospital birth

By Crowther, S, Gilkinson, A, Hunter, M
on Monday, 01 Nov 2010 in New Zealand College of Midwives Journal - Volume: 43

Systematic reviews aim to ‘identify, evaluate and summarise the findings of all relevant individual studies’ (Centre for Reviews and Dissemination, 2008, p. v). A systematic review is often considered level one evidence as it reviews all known randomised controlled trials on the subject and synthesises the findings. When done well a systematic review can provide a reliable estimate of the effectiveness of any particular type of intervention because combining results of several similar studies can provide more evidence than one study alone. As with any research project a systematic review needs to be undertaken in a particular way so that the review question, the search strategy, the population, interventions, comparators, outcomes and study designs are clear and the review could be easily replicated. Any knowledge claims need to be clearly based on evidence found in the review, as such there is a need to minimise bias, and ensure objectivity when undertaking reviews. A recently published systematic review in the American Journal of Obstetrics & Gynecology has raised questions about homebirth. The paper in question – Maternal and newborn outcomes in planned home birth vs planned hospital births: a meta-analysis by Wax, Lucas, Lamont, Pinnette, Cartin, and Blackstone (2010) provides a systematic review and metaanalysis of homebirth. It claims that home Authors: • Susan Crowther BSc (Hons), MSc, RM Lecturer, School of Midwifery Auckland University of Technology (AUT) • Andrea Gilkison PhD candidate, M.Ed (Dist), B.A, RM Senior Lecturer, School of Midwifery AUT • Marion Hunter: MSc Senior Lecturer School of Midwifery AUT birth results in less medical intervention for the mother but is associated with a tripling of the neonatal mortality rate. We have identified several issues with this paper leading us to question the motivation of the researchers, the assumptions taken into the review and the validity of this systematic review. In this paper we critically appraise this systematic review and outline our concerns.

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Nutrition and pregnancy weight gain for optimal birth outcomes

By Paine, J
on Monday, 01 Nov 2010 in New Zealand College of Midwives Journal - Volume: 43

The importance of healthy nutrition in pregnancy and pregnancy-related weight gain is well-established, but many women may not be aware of the impact their nutritional status can have on the outcome of their pregnancy. Poorly nourished women can experience illnesses and complications of pregnancy and labour. Inadequate nutrition in pregnancy can compromise fetal growth resulting in intrauterine growth restriction and low birth weight babies. Gaining more or less than the recommended weight in pregnancy can have consequences on both mother and baby with the incidence of pregnancy complications being higher at the upper and lower extremes of weight gain. This article examines the effects of good nutrition and pregnancy weight gain on achieving optimal pregnancy outcomes, and the midwife’s responsibility in assisting her client to strive for a healthy pregnancy and successful birth outcome.

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Breastfeeding in New Zealand from colonisation until the year 1980: An historical review

By McBride-Henry, K, Clenden, J
on Monday, 01 Nov 2010 in New Zealand College of Midwives Journal - Volume: 43

Understandings of breastfeeding have changed dramatically over the past one hundred and twenty years. This historical review of breastfeeding in New Zealand highlights how women prior to 1900 embraced their embodied knowledge about breastfeeding, and that this knowledge contributed to building communities where breastfeeding was practised as an art. However, as scientific knowledge, and the associated language that depicts and describes breastfeeding, gained prominence in the early twentieth century, women’s embodied knowledge was silenced. The literature on this topic demonstrates how biomedical language about human lactation has held a privileged position over women’s knowledge since. This review highlights how midwives, nurses and other health care practitioners need to examine taken-for-granted ways of working alongside breastfeeding women, and renew the focus on woman-centred ways of knowing and associated language.

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The vaginal examination during labour: Is it of benefit or harm?

By Dixon, L, Foureur, M
on Saturday, 01 May 2010 in New Zealand College of Midwives Journal - Volume: 42

Giving birth is an important life event and care practices that occur during labour and birth can have a lasting influence on the mother and the family (Beech & Phipps, 2004). The use of regular, routine vaginal examination to assess the progress of labour is one such care practice. There are two ways of viewing the vaginal examination during labour. The first regards the vaginal examination as a physically invasive intervention which can have adverse psychological consequences (Kitzinger, 2005). The second sees vaginal examination as an essential clinical assessment tool that provides the most exact measure of labour progress (Enkin et al., 2000). This paper explores these two viewpoints in more detail and discusses the benefits versus the harms of undertaking a vaginal examination during labour. Midwives use a variety of skills and observations to assess labour progress. The vaginal examination is an important clinical assessment tool that should be used carefully when there is a need for more information to help understand labour and whether it is established and progressing, taking into account both the potential harms and benefits.

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Informed consent and midwifery practice in New Zealand: Lessons from the Health and Disability Commissioner

By Godbold, R
on Saturday, 01 May 2010 in New Zealand College of Midwives Journal - Volume: 42

Informed consent appears to be a challenging and sometimes problematic area of practice for midwives. It is not always clear, for example, what amount of information is required to be supplied to women to ensure fully informed consent. Similarly it is unclear whether midwives can provide unbiased information, and what midwives’ communication responsibilities are when other health care providers become involved in care and treatment decisions. This paper examines the Code of Health and Disability Services Consumers Rights and selected Commissioner’s opinions which consider potential breaches of the Code in relation to informed consent. Case analysis demonstrates how the principles relating to informed consent are applied in the midwifery context, and examines how the Commissioner’s opinions can offer practical guidance to midwives.

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Editorial: The place of research in the quality and safety of midwifery care

By Skinner, J
on Saturday, 01 May 2010 in New Zealand College of Midwives Journal - Volume: 42

It is an interesting time for midwives in New Zealand at the moment (isn’t it always?) as the Ministry of Health begins to develop and implement a Quality and Safety Programme for Maternity Services.

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A review of psychosocial predictors of outcome in labour and childbirth

By Howarth, A, Swain, N, Treharne, G
on Saturday, 01 May 2010 in New Zealand College of Midwives Journal - Volume: 42

In the following review we synthesise research on psychosocial factors that influence the outcome of labour and childbirth. The review covers psychological factors that have been shown to be important for the actual childbirth experience, namely pain, fear, control, anxiety, confidence and self-efficacy. The review also examines predictors of positive outcomes following birth including social support, expectations, preparation, and continuous support. This body of research informs debate on healthcare system reforms in the future and provides direction for areas of research in the intersection of midwifery practice and psychological theory.

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Being a delivery suite co-ordinator

By Fergusson, L, Smythe, L, McAra-Couper, J
on Saturday, 01 May 2010 in New Zealand College of Midwives Journal - Volume: 42

This phenomenological study was conducted to reveal five midwives’ experiences of working as coordinator/charge midwives in three tertiary hospital delivery suite settings. The findings reveal the unspoken, taken-for-granted personal experiences of the coordinators. They describe themselves as the ‘hub’ or the ‘pivot’ at their workplace. These midwives ‘know’ the unpredictability of childbirth and the challenge of managing escalating workloads. Their ability to facilitate teamwork and their resilience in the face at times of seemingly insurmountable obstacles shine through. However much managers plan staffing and bed ratios, the nature of childbirth – and therefore the intensity of the workload - is unpredictable. Recommendations from this study include consideration of strategic planning by District Health Board's (DHB’s) for when the acute clinical needs of women in a delivery suite outweigh the ratio of midwives available to provide care for women. The coordinator midwife needs to be free to utilise her clinical skills ‘on the floor’ whilst a designated resource person arranges additional staffing cover for the unit.

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Rhetorical (de)vices and the construction of a 'natural' caesarean - Erratum

By Douche, J
on Thursday, 01 Oct 2009 in New Zealand College of Midwives Journal - Volume: 41

re: Rhetorical (de)vices article, Journal 40

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