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The importance of ethical review in midwifery research

By Pickering, N, Anderson, L
on Thursday, 01 Apr 2004 in New Zealand College of Midwives Journal - Volume: 30

Many midwives have a desire to understand more about pregnancy, childbirth and the social context in which these occur. This may be partly driven by aspirations to understand more or improve their own practice and the experience for women and their families. There is also a move within health care to base practice on firm foundations of knowledge rather than on unsupported belief, theory or anecdote (Sackett, Richardson, Rosenberg & Haynes, 1998). All of these factors have meant that many health care providers, such as midwives, are involved in research. However, whenever people are part of a research study there is always the potential that harm could arise. This short article explores why ethics committees review research and some key areas of ethical concern.

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The case for rural birth

By Patterson, J
on Wednesday, 01 Oct 2003 in New Zealand College of Midwives Journal - Volume: 29

Birth in rural New Zealand has been eroded by increased medicalisation and the process of regionalisation, despite evidence supporting rural birth. If women are to continue to have the option of a local birth, then skilled and committed rural midwives need to be adequately resourced and supported.

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Guest editorial: Breastfeeding: are we making a difference?

By Stufkens, J
on Wednesday, 01 Oct 2003 in New Zealand College of Midwives Journal - Volume: 29

Initiatives to improve New Zealand breastfeeding rates.

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The relationship between pregnancy planning and breastfeeding duration

By Levine, M, Edelstein, J, Foureur, M
on Wednesday, 01 Oct 2003 in New Zealand College of Midwives Journal - Volume: 29

This exploratory study, using a convenience sample of 102 primiparous women in New Zealand, examined the relationship between pregnancy planning and duration of breastfeeding. These women, who had chosen to exclusively breastfeed their infants, responded to a two-part survey: Part I self administered on the day of discharge from hospital; Part II completed during a telephone interview at 6 weeks postpartum. Results: No relationship was found between planning of pregnancy and duration of exclusive breastfeeding. At 6 weeks postpartum, 66 (65%) were exclusively breastfeeding and 34 (35%) were not. Women who had completed 12th grade were significantly more likely to exclusively breastfeed at 6 weeks postpartum than women who had not completed high school (X2 = 5.38, p = 0.02). Conclusions: Although a relationship between planning of pregnancy and breastfeeding has been found in previous studies in the United States, it was not found in this small and potentially unrepresentative group of breastfeeding women in one New Zealand setting. One reason may have been that all the women in this study had already chosen to breastfeed. The relationship between level of education and exclusive breastfeeding at 6 weeks is not well recognised. Further research is recommended to address the issue of increased breastfeeding support for women with lower levels of education.

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Breastfeeding and breast surgery - cut and dried?

By Manhire, K
on Wednesday, 01 Oct 2003 in New Zealand College of Midwives Journal - Volume: 29

Women may have breast surgery for various reasons. The primary consideration when making the decision to have surgery may be the desire for breast augmentation or reduction. The implications of such surgery for future breastfeeding may become apparent for women and their midwives at a later date. This article discusses the implications of breast augmentation and reduction for midwifery practice.

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Breastfeeding attachment difficulties related to large nipple size: a case report and review of practice

By Hagan, A
on Wednesday, 01 Oct 2003 in New Zealand College of Midwives Journal - Volume: 29

One of the major reasons for lack of breastfeeding success is attachment difficulties. Skill development in practice is dependent on experience and knowledge. This articles considers the professional interaction between a midwife and a mother when she was experiencing breastfeeding difficulties. The difficulty was related to a baby struggling to latch on correctly when the mother had large nipples.

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Birth in a caul: a discussion on the role of amniotomy in physiological labour

By Dixon, L
on Wednesday, 01 Oct 2003 in New Zealand College of Midwives Journal - Volume: 29

In my midwifery practice I observed that membranes often remained intact when women were immersed in water during labour. I wondered what would be the optimum care for water birth in a caul. This article reviews existing information about the reasons for amniotomy and management of intact membranes at birth. Recommendations for practice are offered.

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Utilising the unborn baby's in-labour movements

By Banks, M
on Wednesday, 01 Oct 2003 in New Zealand College of Midwives Journal - Volume: 29

Aspects of midwifery practice, just as in obstetrics, can be validated in the absence of quality evidence simply because many repeat a certain action. Listening to the unborn baby’s heart rate every 15-30 minutes in labour and after every contraction when the woman is pushing is one such practice (World Health Organisation, 1996). However good the intent is to counter intervention-inducing electronic foetal monitoring (EFM), it has developed the authority of a prescribed practice – not because it has shown to be of benefit but because it is has been acknowledged as a common midwifery practice. Those who are familiar with an undisturbed labour scene acknowledge that lack of stimulation enables the primitive brain to help the woman to be ‘on another planet’. Any stimulus to the neocortex of the brain makes the labouring woman more alert, and can inhibit her labour (Odent, 1999), thus intellectual stimulation is to be avoided. While intermittent auscultation is less invasive to the woman’s ‘birthing head’ than EFM, any disturbance to the woman in labour has the potential to interrupt physiological birthing. It becomes imperative to consider other ways to assess and monitor the unborn baby and to utilise what exists in the physiological labour state.

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A breastfeeding journey revisited

By Rountree, T
on Tuesday, 01 Apr 2003 in New Zealand College of Midwives Journal - Volume: 28

Breastfeeding has been described as the most intimate form of communication a woman may have with her child (Kitzinger, 1998). It is an expression of love (Kitzinger, 1998), a precious gift (Spangler, 2000), and an act that nurtures the maternal-infant bond (Lauwers & Shinskie, 2000; Rose-Neil, 1984; Spangler, 2000). Kitzinger (1998) places emphasis on the relationship breastfeeding affords the infant, describing this first relationship as the foundation for all other relationships in life. The La Leche League considers breastfeeding as the optimal way to feed a baby. Benefits to the mother and baby are well documented and include nutritional and immune benefits to the baby, and physical and health benefits to the mother (e.g. Beasley & Trlin, 1998). Both mother and baby profit from the emotionally enriching experience (Kitzinger, 1998; Lauwers & Shinskie, 2000; Mohrbacher & Stock, 1991; Spangler, 2000). This article describes my experience of breastfeeding my first born son, Michael. He was born in 1990, in Bangkok, Thailand. Significant factors such as family, friends, hospital professionals, and the cultural influences that impacted on my breastfeeding experience, are discussed. Factors that contributed to my breastfeeding experience, and to the difficulties I encountered, are identified and explored.

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"I'm ready for you baby, why won't you come?" How long is a pregnancy and how long is too long?

By Davies, R
on Tuesday, 01 Apr 2003 in New Zealand College of Midwives Journal - Volume: 28

“When is my baby due?” “How long do they let you go?” These are two questions with which midwives are familiar. Some women focus with understandable intensity on the actual date their baby is due. My intention in this article is to review the literature in relation to two concepts, which are fundamental to an understanding of women’s experiences of “going overdue.” The tale begins by indicating the continuing confusion and controversy over how the estimated due date is calculated and the subsequent implications of this. Then I turn to the second concept, which is the significance of prolonged (overdue) pregnancy (PP), including what is, and what is not, reassuring.

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