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Examines issues raised by Changing Childbirth. Summarizes an IMS/RCM report and is based on research in maternity units at different stages in the adoption of various approaches to developing continuity of care. It is concerned with the effect on midwives′ working lives and explores issues of grading, responsibility, working hours, career progression and job satisfaction.

Within maternity hospitals midwives are expected to follow the protocol‐driven culture and orders issued by senior staff. Simultaneously, midwives are expected to follow social policy documents and the Midwives Rules and Standards that advocate choice provision for childbearing women. Quality assurors and auditors of clinical practice need to be aware that these two directives sometimes clash. Allegiance to a hierarchical system driven by protocols and orders from the top down, at the same time as providing “woman‐centred” care is often unattainable. In order for a midwife to action the woman's choice, resourceful thinking may be required. This paper aims to examine this issue.

A descriptive interview study set out to discover strategies which midwives use to resolve conflict produced from competing directives. An appraisal of 20 midwives' views were gained from semi‐structured interviews conducted in seven maternity units in the UK. Taking a post‐positivist approach, inductive thematic analysis was used to interpret the data.

Three main categories represented resourceful ways of pleasing both authority and the childbearing woman. Midwives occasionally: are economical with the truth; circumvent face‐to‐face confrontation with senior staff; and persuade women to refuse what they perceive are unnecessary and invasive interventions.

This paper offers unique insights into methods that midwives use to resolve conflicts in direction issued by management. It is important that auditors are aware that midwives sometimes struggle to support the preferences of healthy childbearing women. This reduces job satisfaction, delivery of care and consequently requires address.

The purpose of this paper is to describe what it is like to be a midwife in the professionally isolated and marginalised arena of home birth in Ireland and to explore whether the organisation of home birth services and professional discourse might be undermining the autonomy of home birth midwives.

This paper is drawn from auto-ethnographic field work, with 18 of the 21 self-employed community midwives (SECMs) offering home birth support to women in Ireland from 2006 to 2009. The data presented are derived from field notes of participant observations and from interviews digitally recorded in the field.

Home birth midwives must navigate isolated professional practice and negotiate when and how to interface with mainstream hospital services. The midwives talk of the dilemma of competing discourses about birth. Decisions to transfer to hospital in labour is fraught with concerns about the woman's and the midwife's autonomy. Hospital transfers crystallise midwives’ sense of professional vulnerability.

Maternity services organisation in Ireland commits virtually no resources to community midwifery. Home birth is almost entirely dependent upon a small number of SECMs. Although there is a “national home birth service”, it is not universally and equitably available, even to those deemed eligible. Furthermore, restrictions to the professional indemnification of home birth midwives, effectively criminalises midwives who would attend certain women. Home birth, already a marginal practice, is at real risk of becoming regulated out of existence.

This paper brings new insight into the experiences of midwives practicing at the contested boundaries of contemporary maternity services. It reveals the inappropriateness of a narrowly professional paradigm for midwifery. Disciplinary control of individuals by professions may countermand claimed “service” ideologies.

Using a health belief model (HBM), this study aims to assess the knowledge, attitudes and practices of Iranian midwives in relation to HIV/AIDS protection behavior and to determine the needs of interventional programs for promotion of the behavior among midwives of maternity care units.

This was a cross‐sectional study in five selected hospitals in Isfahan. All 58 midwifery personnel of maternity wards of these hospitals participated in the study. Tools for data collection were a checklist to assess midwives' practice and a questionnaire to assess knowledge, attitude, and the HBM of midwives about HIV/AIDS‐protection methods.

A total of 58 midwifery personnel with average working experience of 10.92±7.98 years were assessed in the study and with a high knowledge, positive attitude and moderate practice about HIV/AIDS protection methods. The midwives perceived two main barriers, which impacted on their self‐efficacy and their protection behavior. These barriers were the emergency conditions of the work and the low availability of protective equipment.

HIV/AIDS protection behavior and HBM of midwives can be promoted by overcoming management barriers such as inadequate midwifery personnel in emergency conditions and insufficient protective equipment. The behavior also needs to be promoted by educational interventions which focus on improving midwives' perceived risk of HIV/AIDS infection.

Women with little-to-no English continue to have poor birth outcomes and low service user satisfaction. When language support services are used it enhances the relationship between the midwife and the woman, improves outcomes and ensures safer practice. However, this study has shown a reluctance to use professional interpreter services by midwives. This study aims to understand the experiences of midwives using language support services.

A maximum variation purposive sampling strategy was used to recruit midwives (N = 12) to a qualitative, semi-structured interview study. Data were analysed using thematic analysis.

Four themes were generated from the data analysis with a central organising concept of “Navigating Care Without Language”. These themes were: “Continuity as Key”, “Facilitating Tools”, “Networks of Support” and “Innovative Planning”. Each of these themes had between three and four sub-themes. It was found midwives are keen to support women with language barriers. However, support can be difficult due to the unavailability of equipment and resources; lack of continuity (of interpreter and midwife); inability to plan for the acute care of women who require interpreter services; and the system not being accessible enough to women who require language support services, thus causing them to fall through the net.

Continuity of carer appears to be a protective factor due to the flexibility, relationship and continuum of support. This study will aid the development of education for undergraduate, post-graduate and practising midwives. It will also inform policymakers working to improve the service offered to women who speak little-to-no English.

Many practising midwives feel neither confident nor competent to answer the nutritional concerns of pregnant women in their care. This study was designed to develop and evaluate a nutrition open‐learning pack for practising midwives. A statistically significant increase (p < 0.001) in midwives’ nutrition knowledge scores was demonstrated following study of the nutrition open‐learning materials. Evaluation of the nutrition open‐learning materials was positive with constructive comments and suggestions being made for further development. Open learning is a time‐consuming activity that requires support from managers in terms of study time. As a strategy, open‐learning materials can be developed for whatever the topic and academic level required, which could encompass pre‐registration midwifery education, post‐graduate study and continuing professional development (CPD).

The routine use of intrapartum electronic fetal monitoring (EFM) has resulted in an increased burden of operative and vaginal instrumental deliveries for women at low obstetric risk. Such modes of delivery increase maternal mortality and morbidity risks. This study aims to explore midwives' values, attitudes and beliefs when using intrapartum fetal monitoring techniques in clinical practice.

A total of 58 registered midwives across two NHS Trusts in one region in the north of England were interviewed using a qualitative approach.

Midwives attempted to manage the psychological burden of the threat from clinical negligence by using EFM. This meant that some midwives used electronic monitoring regardless of clinical need. Midwives lack confidence in the ability of EFM to accurately detect fetal compromise but are aware that the visual monitoring record is recognised as a valuable piece of legal evidence. The midwives' perceptions of professional self‐efficacy in seeking to avoid a claim in clinical negligence contributed to defensive practice. Research limitations/implications – The study was conducted in only two hospitals in one region of England; however the Trust demographics were similar and midwifery practice within the unit reflects national maternity standards of care.

Multidisciplinary strategies may be required to overcome barriers to the effective implementation of clinical guidelines where intrapartum fetal monitoring is concerned and Trust audit departments must undertake regular audit cycles in order to ascertain practice compliance with best evidence.

The paper provides information so that midwives' knowledge regarding the limitations of EFM can be improved.

The aim of this article is to suggest that the information interaction between midwives and young women during counselling meetings about contraceptives can be approached as loci of knowledge production and discuss the consequences this has for the understanding of information practices. The overarching question is: how is knowledge produced during the interaction between the midwives and the young women and what roles do their bodies play in this interaction?

Qualitative methods inspired by ethnography were used, including conversation transcripts of ten counselling meetings, 19 interviews and participatory observations at five youth centres in the South of Sweden. The study took place over a period of nine months. The feministic conceptual framework presented by Donna Haraway concerning knowledge production was used to analyse the material.

As they meet, both midwives and young women are information sources to each other, and the information conveyed is negotiated in both words and actions. Both parties are involved in a careful negotiation to establish what information is needed and appropriate for the situation at hand, but the midwives have the final say. However, the midwives balance between exerting a generalised expertise and entering in a situated dialogue with the young women.

This study may contribute to awareness among information professionals of counselling meetings as information interactions where both words and actions are important as well as the inequality of power in that interaction.

This study contributes to library and information studies by broadening the understanding of what an information source may be and by exploring the usefulness of feminist researcher Donna Haraway's analytical tools for understanding information interactions as knowledge producing negotiations.

The purpose of this paper is to describe the development of a national standard for midwifery mentorship in Uganda, part of a wider project which aimed to develop a model of mentorship for Ugandan midwifery using the principles of action research. It aims to stimulate debate about strengthening the capacity of a health regulatory body, midwifery twinning partnerships and the use of international health volunteer placements.

Model of mentorship for Ugandan midwifery was a 20-month project implemented by the Royal College of Midwives UK and the Uganda Private Midwives Association. Following a situational analysis, the project was structured around three action reflection cycles, participatory workshops, individual twinning relationships between UK and Ugandan midwives and peer exchange visits. The capacity of the Ugandan Nurses and Midwives Council (UNMC) to develop a standard for midwifery mentorship was assessed. A capacity building programme was then designed and implemented to develop the standard for midwifery mentorship.

The capacity of UNMC was increased and the standard was developed though has yet to be validated and adopted. However, this intervention may not be replicable as a stand-alone intervention because its success was inextricably linked to the wider programme activities and support structures.

This is the first paper describing midwifery twinning to strengthen the capacity of a regulatory body to develop practice standards.

Up to 25 per cent of women will experience depression during their pregnancy. Perinatal mental health problems are a leading cause of maternal morbidity and mortality, however care provided to women is often a low priority. The purpose of this paper is to explore women’s perspective of care from GPs and midwives, when they experience symptoms of depression during pregnancy.

Women, with self-reported symptoms of depression, were invited to post comments in response to a series of on-line questions posted on two discussion forums over a nine month period. The questions were related to the care women received from GPs and midwives. Data were analysed using thematic analysis.

In total, 22 women responded to the on-line questions. A number of themes were identified from the data including women’s disclosure of symptoms to GPs and midwives; lack of knowledge of perinatal mental health among health providers; attitudes of staff and systemic issues as barriers to good care; anti-depressant therapy and care that women found helpful.

Women often face significant emotional and psychological health issues in the transition to motherhood. This small study indicates women often experience difficulties in interacting with their GP and midwife in seeking help. This research has identified some contributing factors, however more rigorous research is needed to explore these complex issues.

This paper highlights service provision in the care of women with depression in pregnancy.