Dr Anna Maria Brown

MIDIRS: Midwifery Digest 25(4): 419-423.

Women have to face a myriad of choices on which to make informed decisions during the childbearing continuum. Planned place of birth is of particular importance to them and their families in providing a positive birthing experience. This experience will influence future planned pregnancies and have an impact on their beliefs in the normality of labour and birth and enhance outcomes in terms of breastfeeding uptake and continuity (Sandall 2008). A challenge to ethical practice is the proposed threat to midwifery supervision, an activity that safeguards women and midwives. This paper examines the ethical implications, such as autonomy, of choosing place of birth from available choices, specifically midwifery-led care, and how these decisions can impact women’s birth experience. The discussion draws on the four principles of biomedical ethics (Beauchamp & Childress 2013) and the new Nursing and  Midwifery Council Code (NMC 2015).

British Journal of Midwifery 24(10): 702-710.

Abstract

Objectives: To examine the evidence for women who have been diagnosed with gestational diabetes mellitus (GDM) and who have controlled the condition through dietary change. These women have been excluded from birthing in a midwife-led centre due to an assumed risk of complications.

Design: Descriptive statistics for gestational diabetes of a cohort of women at one maternity unit.

Setting: A maternity unit in one local foundation trust which has recently set up a midwife-led Birth Centre.

Participants: In 2014, a total of 164 women out of 4032 delivering at the maternity unit had gestational diabetes. Among these, 89 were controlled through diet alone (for 53 of these women with GDM it was assumed that their diagnosis was based on their history of GDM in a previous pregnancy).  Data for 4 months in 2015 was also examined for 57 GDM women.

Main outcome measures: To explore if the evidence is able to recommend that, if women who are able to control GDM through dietary change, then the outcomes are the same for them as for all other low risk women giving birth in this maternity unit.

Results: The subgroup of women diagnosed with GDM but well controlled on diet had similar outcomes to the general population of women giving birth at this maternity unit.

Conclusion: The mode of delivery and outcomes for the women in this cohort who remained normoglycaemic  have been found to be in line with the general outcomes for all women at this hospital in the same year. The small sample size means that further work is needed to confirm this, but indicates that the option of using the birth centre may be considered a reasonable alternative for these women.

MIDIRS: Midwifery Digest 26(4): 455-461.

Maternity service provision in the UK includes midwife-led care for low-risk women, and the quality and safety of health care attracts political interest and a continuing level of public concern. Current challenges in the provision of maternity services are evident due to workforce and financial pressures (London School of Hygiene and Tropical Medicine, Royal College of Obstetricians & Gynaecologists 2016). Although evidence from the literature suggests that low-risk women would greatly benefit from midwife-led care, in terms of outcomes for both mother and baby (Birthplace in England Collaborative Group 2011, Delgado Nunes et al 2014, National Institute for Health & Clinical Excellence (NICE) 2014), these challenges continue to impact as to how these services can improve in the future. More recently, recommendations have been made to improve outcomes and ensure a more personalised birthing experience can be made available to every childbearing woman and her family (NHS England 2016).

MIDIRS: Midwifery Digest 27 (4): 488-495.

Background: Research has identified that regular physical exercise interventions are beneficial to mental health conditions such as depression and anxiety.

Objective: To evaluate the effectiveness of prescribed postnatal exercise on postnatal depression. Prescribed exercise was defined as any physical activity that was carried out in the postnatal period with the objective of reducing postnatal depression as determined by identified scales.

Design: A systematic review and narrative analysis of Randomised Controlled Trials (RCT’s) published between 2008 and 2016.

Data Sources: Selection criteria included full text, academic articles written in English comparing exercise retrieved using MEDLINE, CINAHL, PSYCHInfo, EMBASE and SPORTSDiscus.  Published research focusing on Postnatal or Postpartum Exercise or Physical Activity; Depression or Mood Swings was included.  The search was refined to include females from eighteen years and upwards.

Review Methods:  Forty seven articles were identified as fulfilling the inclusion criteria and full text analysis was performed by two members of the research team. Twelve articles were identified as meeting the inclusion criteria, these were distributed for scrutiny and assessment amongst the 5 members of the research team. Methodological quality was assessed using a Quality Assessment Tool for Quantitative Studies published by the Effective Public Health Practice Project (EPHPP) (1998).  Finally the articles were redistributed amongst the team for a second assessment and verification. Any discrepancy of ratings of a paper between the reviewers was resolved by a third reviewer through reassessment of the paper and further discussion.

Results: Eight studies were included in the final systematic review carried out using the EPHPP assessment tool, this identified six quality RCT’s meeting the inclusion criteria.

Midwifery 30:138-143.

British Journal of Midwifery 20 (5): 339-344

Evidence Based Midwifery 102):64-70

British Journal of Midwifery 20 (11) : 786-791

In Ethics, Law & Professional Issues (Eds: Gallagher A & Hodge S). London: Palgrave MacMillan.

Journal of Obstetrics and Gynaecology